A data driven partial ambiguity resolution: Two step success rate criterion, and its simulation demonstration

NASA Astrophysics Data System (ADS)

Hou, Yanqing; Verhagen, Sandra; Wu, Jie

2016-12-01

Ambiguity Resolution (AR) is a key technique in GNSS precise positioning. In case of weak models (i.e., low precision of data), however, the success rate of AR may be low, which may consequently introduce large errors to the baseline solution in cases of wrong fixing. Partial Ambiguity Resolution (PAR) is therefore proposed such that the baseline precision can be improved by fixing only a subset of ambiguities with high success rate. This contribution proposes a new PAR strategy, allowing to select the subset such that the expected precision gain is maximized among a set of pre-selected subsets, while at the same time the failure rate is controlled. These pre-selected subsets are supposed to obtain the highest success rate among those with the same subset size. The strategy is called Two-step Success Rate Criterion (TSRC) as it will first try to fix a relatively large subset with the fixed failure rate ratio test (FFRT) to decide on acceptance or rejection. In case of rejection, a smaller subset will be fixed and validated by the ratio test so as to fulfill the overall failure rate criterion. It is shown how the method can be practically used, without introducing a large additional computation effort. And more importantly, how it can improve (or at least not deteriorate) the availability in terms of baseline precision comparing to classical Success Rate Criterion (SRC) PAR strategy, based on a simulation validation. In the simulation validation, significant improvements are obtained for single-GNSS on short baselines with dual-frequency observations. For dual-constellation GNSS, the improvement for single-frequency observations on short baselines is very significant, on average 68%. For the medium- to long baselines, with dual-constellation GNSS the average improvement is around 20-30%.

A systematic review of endoprosthetic replacement for non-tumour indications around the knee joint.

PubMed

Korim, Muhammad T; Esler, Colin N A; Reddy, Venuthurla R M; Ashford, Robert U

2013-12-01

Endoprosthetic replacement (EPR) for limb salvage is an established treatment modality for orthopaedic malignancies around the knee. Increasingly, they are being used for non-tumour indications such as fractures, bone loss associated with aseptic loosening, septic loosening and ligament insufficiencies. We reviewed the evolution and biomechanics of knee EPRs. MEDLINE was searched using the PubMed interface to identify relevant studies pertaining to the use of knee EPRs in non-tumour conditions. Failures, mortality and knee scores were the main outcome measures. Subgroup analysis in the non-tumour conditions was also performed. There were nine studies with an average follow-up of 3.3years (Range 1-5years) describing 241 EPRs used in non-tumour conditions. Re-operation for any reason occurred in 17% (41/241) of cases. The most common complication was infection (15%) followed by aseptic loosening (5%) and periprosthetic fractures (5%). The mortality rate averaged 22%. Infected knee arthroplasties were less likely to have a successful outcome when salvaged with an EPR with failure rates up to 33%. Endoprosthetic replacement is a limb salvage option when other surgical options are unfeasible, especially in low demand elderly patients with limited life expectancy. They have low rates of failure in the medium term. Level 1. Copyright © 2013 Elsevier B.V. All rights reserved.

Effect of Smoking on Peripheral Blood Lymphocyte Subsets of Patients With Chronic Renal Failure.

PubMed

Düvenci Birben, Özlem; Akçay, Şule; Sezer, Siren; Şirvan, Şale; Haberal, Mehmet

2016-11-01

Smoking is known to suppress the immune system. It is also known that chronic renal failure affects the immune system. However, the number of studies investigating the effects of chronic renal failure and smoking together is limited. In our study, we examined whether smoking affects the diminished response of the immune system in patients with chronic renal failure. We compared peripheral blood lymphocyte subsets in smoking and nonsmoking patients with chronic renal failure. We also used the Fagerström Test for Nicotine Dependence to evaluate its correlation with the lymphocyte subset count in patients who are current smokers. Our study included 126 patients with chronic renal failure. According to their smoking habits, patients were divided into 2 groups: smokers and nonsmokers. The average age of patients who were smokers was 53.2 ± 1.5 years, with average age of nonsmokers being 59.2 ± 2.2 years. The average duration of smoking in smokers was 30.7 ± 2.7 packyears. We found that the percentage of cluster of differentiation 16-56 cells (natural killer cells) and lymphocyte percentage were significantly lower among smokers in our study (P < .05). We compared the lymphocyte subset panel to pack-years and found that the rate of cluster of differentiation 16-56 cells decreased as smoking duration increased. Our study revealed that smoking suppresses the immune system, as measured by lymphocyte subsets, in patients with chronic renal failure, similar to that shown in healthy smokers. According to our findings, patients with chronic renal failure, where infection is the primary reason for mortality and morbidity, must be questioned for smoking and referred to smoking cessation clinics. Because of its immunosuppressive effects, smoking behaviors must be solved preoperatively in transplant candidates.

The Relationship among Health Education Systems, Inc. Progression and Exit Examination Scores, Day or Evening Enrollment, Final Grade Point Average and NCLEX-RN® Success in Associate Degree Nursing Students

ERIC Educational Resources Information Center

Barnwell-Sanders, Pamela

2015-01-01

Graduates of associate degree (AD) nursing programs form the largest segment of first-time National Council Licensure Examination for Registered Nurses (NCLEX-RN®) test takers, yet also experience the highest rate of NCLEX-RN® failures. NCLEX-RN® failure delays entry into the profession, adding an emotional and financial toll to the unsuccessful…

Syndromic surveillance for health information system failures: a feasibility study

PubMed Central

Ong, Mei-Sing; Magrabi, Farah; Coiera, Enrico

2013-01-01

Objective To explore the applicability of a syndromic surveillance method to the early detection of health information technology (HIT) system failures. Methods A syndromic surveillance system was developed to monitor a laboratory information system at a tertiary hospital. Four indices were monitored: (1) total laboratory records being created; (2) total records with missing results; (3) average serum potassium results; and (4) total duplicated tests on a patient. The goal was to detect HIT system failures causing: data loss at the record level; data loss at the field level; erroneous data; and unintended duplication of data. Time-series models of the indices were constructed, and statistical process control charts were used to detect unexpected behaviors. The ability of the models to detect HIT system failures was evaluated using simulated failures, each lasting for 24 h, with error rates ranging from 1% to 35%. Results In detecting data loss at the record level, the model achieved a sensitivity of 0.26 when the simulated error rate was 1%, while maintaining a specificity of 0.98. Detection performance improved with increasing error rates, achieving a perfect sensitivity when the error rate was 35%. In the detection of missing results, erroneous serum potassium results and unintended repetition of tests, perfect sensitivity was attained when the error rate was as small as 5%. Decreasing the error rate to 1% resulted in a drop in sensitivity to 0.65–0.85. Conclusions Syndromic surveillance methods can potentially be applied to monitor HIT systems, to facilitate the early detection of failures. PMID:23184193

Effect of loading rate on the monotonic tensile behavior of a continuous-fiber-reinforced glass-ceramic matrix composite

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

Soerensen, B.F.; Holmes, J.W.

The stress-strain behavior of a continuous-fiber-reinforced ceramic matrix composite has been measured over a wide range of loading rates (0.01 to 500 MPa/s). It was found that the loading rate has a strong effect on almost every feature of the stress-strain curve: the proportionality stress, the composite strength and failure strain increase with increasing loading rate. The microstructural damage varies also with the loading rate; with increasing loading rate, the average matrix crack spacing increases and the average fiber pullout length decreases. Using simple models, it is suggested that these phenomena are caused partly by time-dependent matrix cracking (due tomore » stress corrosion) and partly by an increasing interfacial shear stress with loading rate.« less

Simultaneous measurement of instantaneous heart rate and chest wall plethysmography in short-term, metronome guided heart rate variability studies: suitability for assessment of autonomic dysfunction.

PubMed

Perring, S; Jones, E

2003-08-01

Instantaneous heart rate and chest wall motion were measured using a 3-lead ECG and an air pressure chest wall plethysmography system. Chest wall plethysmography traces were found to accurately represent the breathing pattern as measured by spirometry (average correlation coefficient 0.944); though no attempt was made to calibrate plethysmography voltage output to tidal volume. Simultaneous measurements of heart rate and chest wall motion were made for short periods under metronome guided breathing at 6 breaths per minute. The average peak to trough heart rate change per breath cycle (AVEMAX) and maximum correlation between heart rate and breathing cycle (HRBRCORR) were measured. Studies of 44 normal volunteers indicated clear inverse correlation of heart rate variability parameters with age (AVEMAX R = -0.502, P < 0.001) but no significant change in HRBRCORR with age (R = -0.115). Comparison of normal volunteers with diabetics with no history of symptoms associated with autonomic failure indicated significant lower heart rate variability in diabetics (P = 0.005 for AVEMAX) and significantly worse correlation between heart rate and breathing (P < 0.001 for HRBRCORR). Simultaneous measurement of heart rate and breathing offers the possibility of more sensitive diagnosis of autonomic failure in a simple bedside test and gives further insight into the nature of cardio-ventilatory coupling.

A chi-square goodness-of-fit test for non-identically distributed random variables: with application to empirical Bayes

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

Conover, W.J.; Cox, D.D.; Martz, H.F.

1997-12-01

When using parametric empirical Bayes estimation methods for estimating the binomial or Poisson parameter, the validity of the assumed beta or gamma conjugate prior distribution is an important diagnostic consideration. Chi-square goodness-of-fit tests of the beta or gamma prior hypothesis are developed for use when the binomial sample sizes or Poisson exposure times vary. Nine examples illustrate the application of the methods, using real data from such diverse applications as the loss of feedwater flow rates in nuclear power plants, the probability of failure to run on demand and the failure rates of the high pressure coolant injection systems atmore » US commercial boiling water reactors, the probability of failure to run on demand of emergency diesel generators in US commercial nuclear power plants, the rate of failure of aircraft air conditioners, baseball batting averages, the probability of testing positive for toxoplasmosis, and the probability of tumors in rats. The tests are easily applied in practice by means of corresponding Mathematica{reg_sign} computer programs which are provided.« less

Pre-configured polyhedron based protection against multi-link failures in optical mesh networks.

PubMed

Huang, Shanguo; Guo, Bingli; Li, Xin; Zhang, Jie; Zhao, Yongli; Gu, Wanyi

2014-02-10

This paper focuses on random multi-link failures protection in optical mesh networks, instead of single, the dual or sequential failures of previous studies. Spare resource efficiency and failure robustness are major concerns in link protection strategy designing and a k-regular and k-edge connected structure is proved to be one of the optimal solutions for link protection network. Based on this, a novel pre-configured polyhedron based protection structure is proposed, and it could provide protection for both simultaneous and sequential random link failures with improved spare resource efficiency. Its performance is evaluated in terms of spare resource consumption, recovery rate and average recovery path length, as well as compared with ring based and subgraph protection under probabilistic link failure scenarios. Results show the proposed novel link protection approach has better performance than previous works.

A more realistic disc herniation model incorporating compression, flexion and facet-constrained shear: a mechanical and microstructural analysis. Part II: high rate or 'surprise' loading.

PubMed

Shan, Zhi; Wade, Kelly R; Schollum, Meredith L; Robertson, Peter A; Thambyah, Ashvin; Broom, Neil D

2017-10-01

Part I of this study explored mechanisms of disc failure in a complex posture incorporating physiological amounts of flexion and shear at a loading rate considerably lower than likely to occur in a typical in vivo manual handling situation. Given the strain-rate-dependent mechanical properties of the heavily hydrated disc, loading rate will likely influence the mechanisms of disc failure. Part II investigates the mechanisms of failure in healthy discs subjected to surprise-rate compression while held in the same complex posture. 37 motion segments from 13 healthy mature ovine lumbar spines were compressed in a complex posture intended to simulate the situation arising when bending and twisting while lifting a heavy object at a displacement rate of 400 mm/min. Seven of the 37 samples reached the predetermined displacement prior to a reduction in load and were classified as early stage failures, providing insight to initial areas of disc disruption. Both groups of damaged discs were then analysed microstructurally using light microscopy. The average failure load under high rate complex loading was 6.96 kN (STD 1.48 kN), significantly lower statistically than for low rate complex loading [8.42 kN (STD 1.22 kN)]. Also, unlike simple flexion or low rate complex loading, direct radial ruptures and non-continuous mid-wall tearing in the posterior and posterolateral regions were commonly accompanied by disruption extending to the lateral and anterior disc. This study has again shown that multiple modes of damage are common when compressing a segment in a complex posture, and the load bearing ability, already less than in a neutral or flexed posture, is further compromised with high rate complex loading.

Racial differences in dietary antioxidant intake and cardiac event-free survival in patients with heart failure.

PubMed

Wu, Jia-Rong; Song, Eun Kyeung; Moser, Debra K; Lennie, Terry A

2018-04-01

Heart failure is a chronic, burdensome condition with higher re-hospitalization rates in African Americans than Whites. Higher dietary antioxidant intake is associated with lower oxidative stress and improved endothelial function. Lower dietary antioxidant intake in African Americans may play a role in the re-hospitalization disparity between African American and White patients with heart failure. The objective of this study was to examine the associations among race, dietary antioxidant intake, and cardiac event-free survival in patients with heart failure. In a secondary analysis of 247 patients with heart failure who completed a four-day food diary, intake of alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein, zeaxanthin, lycopene, vitamins C and E, zinc, and selenium were assessed. Antioxidant deficiency was defined as intake below the estimated average requirement for antioxidants with an established estimated average requirement, or lower than the sample median for antioxidants without an established estimated average requirement. Patients were followed for a median of one year to determine time to first cardiac event (hospitalization or death). Survival analysis was used for data analysis. African American patients had more dietary antioxidant deficiencies and a shorter cardiac event-free survival compared with Whites ( p = .007 and p = .028, respectively). In Cox regression, race and antioxidant deficiency were associated with cardiac event-free survival before and after adjusting for covariates. African Americans with heart failure had more dietary antioxidant deficiencies and shorter cardiac event-free survival than Whites. This suggests that encouraging African American patients with heart failure to consume an antioxidant-rich diet may be beneficial in lengthening cardiac event-free survival.

High-average-power CTH:YAG for the medical environment

NASA Astrophysics Data System (ADS)

Wright, Sidney P.; Adamkiewicz, Edward J.; Moulton, Peter F.

1992-06-01

Medical procedures such as arthroscopy have placed increasing demands on the output performance of the CTH:YAG laser at 2.1 micrometers . Intensive research has been conducted to improve the average power, pulse energies, and rep rates while reducing any failure mechanisms. The results of this work is reported along with a discussion of the important engineering parameters concerning the design of a high power medical CTH:YAG laser.

A dual-center review of compressive osseointegration for fixation of massive endoprosthetics: 2- to 9-year followup.

PubMed

Calvert, George T; Cummings, Judd E; Bowles, Austin J; Jones, Kevin B; Wurtz, L Daniel; Randall, R Lor

2014-03-01

Aseptic failure of massive endoprostheses used in the reconstruction of major skeletal defects remains a major clinical problem. Fixation using compressive osseointegration was developed as an alternative to cemented and traditional press-fit fixation in an effort to decrease aseptic failure rates. The purpose of this study was to answer the following questions: (1) What is the survivorship of this technique at minimum 2-year followup? (2) Were patient demographic variables (age, sex) or anatomic location associated with implant failure? (3) Were there any prosthesis-related variables (eg, spindle size) associated with failure? (4) Was there a discernible learning curve associated with the use of the new device as defined by a difference in failure rate early in the series versus later on? The first 50 cases using compressive osseointegration fixation from two tertiary referral centers were retrospectively studied. Rates of component removal for any reason and for aseptic failure were calculated. Demographic, surgical, and oncologic factors were analyzed using regression analysis to assess for association with implant failure. Minimum followup was 2 years with a mean of 66 months. Median age at the time of surgery was 14.5 years. A total of 15 (30%) implants were removed for any reason. Of these revisions, seven (14%) were the result of aseptic failure. Five of the seven aseptic failures occurred at less than 1 year (average, 8.3 months), and none occurred beyond 17 months. With the limited numbers available, no demographic, surgical, or prosthesis-related factors correlated with failure. Most aseptic failures of compressive osseointegration occurred early. Longer followup is needed to determine if this technique is superior to other forms of fixation.

Vagal Nerve Stimulation Evoked Heart Rate Changes and Protection from Cardiac Remodeling.

PubMed

Agarwal, Rahul; Mokelke, Eric; Ruble, Stephen B; Stolen, Craig M

2016-02-01

This study investigated whether vagal nerve stimulation (VNS) leads to improvements in ischemic heart failure via heart rate modulation. At 7 ± 1 days post left anterior descending artery (LAD) ligation, 63 rats with myocardial infarctions (MI) were implanted with ECG transmitters and VNS devices (MI + VNS, N = 44) or just ECG transmitters (MI, N = 17). VNS stimulation was active from 14 ± 1 days to 8 ± 1 weeks post MI. The average left ventricular (LV) end diastolic volumes at 8 ± 1 weeks were MI = 672.40 μl and MI + VNS = 519.35 μl, p = 0.03. The average heart weights, normalized to body weight (± std) at 14 ± 1 weeks were MI = 3.2 ± 0.6 g*kg(-1) and MI + VNS = 2.9 ± 0.3 g*kg(-1), p = 0.03. The degree of cardiac remodeling was correlated with the magnitude of acute VNS-evoked heart rate (HR) changes. Further research is required to determine if the acute heart rate response to VNS activation is useful as a heart failure biomarker or as a tool for VNS therapy characterization.

High failure rate of the laparoscopic-adjustable gastric band as a primary bariatric procedure.

PubMed

Kindel, Tammy; Martin, Emily; Hungness, Eric; Nagle, Alex

2014-01-01

Determinants of success of a bariatric procedure are many but paramount is the ability to durably produce significant and reliable weight loss. We sought to determine the primary success of the laparoscopic adjustable gastric band (LAGB) by defining failure as clinical weight loss failure with an intact band (excess weight loss [EWL]<20%) or band removal (terminal removal or conversion to a secondary bariatric procedure). A retrospective chart review was performed on patients who underwent an LAGB as a primary bariatric procedure between January 2003 and December 2007. Data collected included body mass index (BMI), weight, postoperative follow-up length, EWL, and adjustment number, as well as complications of the LAGB. Sixteen of 120 patients had the band removed. Nine were terminally removed for unmanageable symptoms, and 7 were converted to an alternative bariatric procedure. The average follow-up for the 104 patients with an intact band was 4.8 years. The average EWL for successful intact bands was 44.9±19.4%; however, an additional 35.6% of patients had an EWL<20%. Patients with an EWL<20% had a significantly higher preoperative BMI and fewer band adjustments. In total, 44% of patients had band failure because of clinical weight loss failure (31%) or eventual band removal (13%). This study finds that the LAGB failed as a primary bariatric procedure for 44% of patients because of either inadequate weight loss or adequate weight loss with unmanageable symptoms. This suggests that the LAGB should be abandoned as a primary bariatric procedure for the majority of morbidly obese patients because of its high failure rate. Copyright © 2014 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Prognostic impact of intestinal wall thickening in hospitalized patients with heart failure.

PubMed

Ikeda, Yuki; Ishii, Shunsuke; Fujita, Teppei; Iida, Yuichiro; Kaida, Toyoji; Nabeta, Takeru; Maekawa, Emi; Yanagisawa, Tomoyoshi; Koitabashi, Toshimi; Takeuchi, Ichiro; Inomata, Takayuki; Ako, Junya

2017-03-01

Intestine-cardiovascular relationship has been increasingly recognized as a key factor in patients with heart disease. We aimed to identify the relationships among intestinal wall edema, cardiac function, and adverse clinical events in hospitalized heart failure (HF) patients. Abdominal computed tomographic images of 168 hospitalized HF patients were retrospectively investigated for identification of average colon wall thickness (CWT) from the ascending to sigmoid colon. Relationships between average CWT and echocardiographic parameters, blood sampling data, and primary outcomes including readmission for deteriorated HF and all-cause mortality were evaluated. Among the echocardiographic parameters, lower left ventricular diastolic function was correlated with higher average CWT. In multivariate analysis, higher logarithmic C-reactive protein level, lower estimated glomerular filtration rate, lower peripheral blood lymphocyte count, higher E/E' ratio, and extremely higher/lower defecation frequency were independently correlated with higher average CWT. Multivariate Cox-hazard analysis demonstrated that higher average CWT was independently related to higher incidence of primary outcomes. In hospitalized HF patients, increased CWT was associated with lower cardiac performance, and predicted poorer long-term clinical outcomes. Copyright © 2016. Published by Elsevier B.V.

SU-E-T-495: Neutron Induced Electronics Failure Rate Analysis for a Single Room Proton Accelerator

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

Knutson, N; DeWees, T; Klein, E

2014-06-01

Purpose: To determine the failure rate as a function of neutron dose of the range modulator's servo motor controller system (SMCS) while shielded with Borated Polyethylene (BPE) and unshielded in a single room proton accelerator. Methods: Two experimental setups were constructed using two servo motor controllers and two motors. Each SMCS was then placed 30 cm from the end of the plugged proton accelerator applicator. The motor was then turned on and observed from outside of the vault while being irradiated to known neutron doses determined from bubble detector measurements. Anytime the motor deviated from the programmed motion a failuremore » was recorded along with the delivered dose. The experiment was repeated using 9 cm of BPE shielding surrounding the SMCS. Results: Ten SMCS failures were recorded in each experiment. The dose per monitor unit for the unshielded SMCS was 0.0211 mSv/MU and 0.0144 mSv/MU for the shielded SMCS. The mean dose to produce a failure for the unshielded SMCS was 63.5 ± 58.3 mSv versus 17.0 ±12.2 mSv for the shielded. The mean number of MUs between failures were 2297 ± 1891 MU for the unshielded SMCS and 2122 ± 1523 MU for the shielded. A Wilcoxon Signed Ranked test showed the dose between failures were significantly different (P value = 0.044) while the number of MUs between failures were not (P value = 1.000). Statistical analysis determined a SMCS neutron dose of 5.3 mSv produces a 5% chance of failure. Depending on the workload and location of the SMCS, this failure rate could impede clinical workflow. Conclusion: BPE shielding was shown to not reduce the average failure of the SMCS and relocation of the system outside of the accelerator vault was required to lower the failure rate enough to avoid impeding clinical work flow.« less

Comparison of mode of failure between primary and revision total knee arthroplasties.

PubMed

Liang, H; Bae, J K; Park, C H; Kim, K I; Bae, D K; Song, S J

2018-04-01

Cognizance of common reasons for failure in primary and revision TKA, together with their time course, facilitates prevention. However, there have been few reports specifically comparing modes of failure for primary vs. revision TKA using a single prosthesis. The goal of the study was to compare the survival rates, modes of failure, and time periods associated with each mode of failure, of primary vs. revision TKA. The survival rates, modes of failure, time period for each mode of failure, and risk factors would differ between primary and revision TKA. Data from a consecutive cohort comprising 1606 knees (1174 patients) of primary TKA patients, and 258 knees (224 patients) of revision TKA patients, in all of whom surgery involved a P.F.C ® prosthesis (Depuy, Johnson & Johnson, Warsaw, IN), was retrospectively reviewed. The mean follow-up periods of primary and revision TKAs were 9.2 and 9.8 years, respectively. The average 10- and 15-year survival rates for primary TKA were 96.7% (CI 95%,±0.7%) and 85.4% (CI 95%,±2.0%), and for revision TKA 91.4% (CI 95%,±2.5%) and 80.5% (CI 95%,±4.5%). Common modes of failure included polyethylene wear, loosening, and infection. The most common mode of failure was polyethylene wear in primary TKA, and infection in revision TKA. The mean periods (i.e., latencies) of polyethylene wear and loosening did not differ between primary and revision TKAs, but the mean period of infection was significantly longer for revision TKA (1.2 vs. 4.8 years, P=0.003). Survival rates decreased with time, particularly more than 10 years post-surgery, for both primary and revision TKAs. Continuous efforts are required to prevent and detect the various modes of failure during long-term follow-up. Greater attention is necessary to detect late infection-induced failure following revision TKA. Case-control study, Level III. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Breeding biology and nesting success of palila

USGS Publications Warehouse

Pletschet, S.M.; Kelly, J.F.

1990-01-01

We studied the breeding biology of Palila (Loxioides bailleui ) at 85 nests from 20 April to 14 September 1988. Eggs were laid over a 139-day period and incubation averaged 16.6 days. The female incubated 85.2% of daylight hours and males fed incubating females. Modal clutch size was 2 (x super(-) = 2.0) and an average of 1.4 nestlings fledged per successful nest. Nestlings were in the nest an average of 25.3 days. Both females and males fed nestlings with the rate of feeding decreasing as the nestlings grew older. Palila nesting success was 25%, reduced primarily by hatching failure and depredation of nestlings. Hatching failure, due to inviable eggs or desertion, occurred in 41% of nests with eggs (55% of nest mortality). Egg depredation was rare (5% of nest mortality). Inbreeding and low food availability are postulated as the major causes for poor hatching success.

Peritonitis outcomes in patients with HIV and end-stage renal failure on peritoneal dialysis: a prospective cohort study.

PubMed

Ndlovu, Kwazi C Z; Sibanda, Wilbert; Assounga, Alain

2017-02-03

Few studies have investigated the management of human immunodeficiency virus (HIV)-associated end-stage renal failure particularly in low-resource settings with limited access to renal replacement therapy. We aimed to evaluate the effects of HIV infection on continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis outcomes and technique failure in highly active antiretroviral therapy (HAART)-treated HIV-positive CAPD populations. We conducted a single-center prospective cohort study of consecutive incident CAPD patients recruited from two hospitals in Durban, South Africa from September 2012-February 2015. Seventy HIV-negative and 70 HIV-positive end-stage renal failure patients were followed monthly for 18 months at a central renal clinic. Primary outcomes of peritonitis and catheter failure were assessed for the first 18 months of CAPD therapy. We assessed risk factors for peritonitis and catheter failure using Cox regression survival analysis. The HIV-positive cohort had a significantly increased rate of peritonitis compared to the HIV-negative cohort (1.86 vs. 0.76 episodes/person-years, respectively; hazard ratio [HR], 2.41; 95% confidence interval [CI], 1.69-3.45, P < 0.001). When the baseline CD4 count was below 200 cells/μL, the peritonitis rate rose to 3.69 episodes/person-years (HR 4.54, 95% CI 2.35-8.76, P < 0.001), while a baseline CD4 count above 350 cells/μL was associated with a peritonitis rate of 1.60 episodes/person-years (HR 2.10, CI 1.39-3.15, P = 0.001). HIV was associated with increased hazards of peritonitis relapse (HR, 3.88; CI, 1.37-10.94; P = 0.010). Independent predictors associated with increased peritonitis risk were HIV (HR, 1.84; CI, 1.07-3.16; P = 0.027), diabetes (HR, 2.09; CI, 1.09-4.03; P = 0.027) and a baseline CD4 count < 200 cells/μL (HR, 3.28; CI, 1.42-7.61; P = 0.006). Catheter failure rates were 0.34 (HIV-positive cohort) and 0.24 (HIV-negative cohort) episodes/person-years (HR, 1.42; 95% CI, 0.73-2.73; P = 0.299). Peritonitis (HR, 14.47; CI, 2.79-75.00; P = 0.001), average hemoglobin concentrations (HR, 0.75; CI, 0.59-0.95; P = 0.016), and average serum C-reactive protein levels were independent predictors of catheter failure. HIV infection in end-stage renal disease patients managed by CAPD was associated with increased peritonitis risk; however, HIV infection did not increase the risk for CAPD catheter failure rate at 18 months.

Beyond long memory in heart rate variability: An approach based on fractionally integrated autoregressive moving average time series models with conditional heteroscedasticity

NASA Astrophysics Data System (ADS)

Leite, Argentina; Paula Rocha, Ana; Eduarda Silva, Maria

2013-06-01

Heart Rate Variability (HRV) series exhibit long memory and time-varying conditional variance. This work considers the Fractionally Integrated AutoRegressive Moving Average (ARFIMA) models with Generalized AutoRegressive Conditional Heteroscedastic (GARCH) errors. ARFIMA-GARCH models may be used to capture and remove long memory and estimate the conditional volatility in 24 h HRV recordings. The ARFIMA-GARCH approach is applied to fifteen long term HRV series available at Physionet, leading to the discrimination among normal individuals, heart failure patients, and patients with atrial fibrillation.

Crackle pitch and rate do not vary significantly during a single automated-auscultation session in patients with pneumonia, congestive heart failure, or interstitial pulmonary fibrosis.

PubMed

Vyshedskiy, Andrey; Ishikawa, Sadamu; Murphy, Raymond L H

2011-06-01

To determine the variability of crackle pitch and crackle rate during a single automated-auscultation session with a computerized 16-channel lung-sound analyzer. Forty-nine patients with pneumonia, 52 with congestive heart failure (CHF), and 18 with interstitial pulmonary fibrosis (IPF) performed breathing maneuvers in the following sequence: normal breathing, deep breathing, cough several times; deep breathing, vital-capacity maneuver, and deep breathing. From the auscultation recordings we measured the crackle pitch and crackle rate. Crackle pitch variability, expressed as a percentage of the average crackle pitch, was small in all patients and in all maneuvers: pneumonia 11%, CHF 11%, pulmonary fibrosis 7%. Crackle rate variability was also small: pneumonia 31%, CHF 32%, IPF 24%. Compared to the first deep-breathing maneuver (100%), the average crackle pitch did not significantly change following coughing (pneumonia 100%, CHF 103%, IPF 100%), the vital-capacity maneuver (pneumonia 100%, CHF 92%, IPF 104%), or during quiet breathing (pneumonia 97%, CHF 100%, IPF 104%). Similarly, the average crackle rate did not change significantly following coughing (pneumonia 105%, CHF 110%, IPF 90%) or the vital-capacity maneuver (pneumonia 102%, CHF 101%, IPF 99%). However, during normal breathing the crackle rate was significantly lower in the patients with pneumonia (74%, P < .001) and significantly higher in the patients with IPF (147%, P < .05) than it was during deep breathing. In patients with CHF the average crackle rate during normal breathing was not significantly different from that during the first deep-breathing maneuver (108%). Crackle pitch and rate were surprisingly stable in all 3 conditions. Neither crackle pitch nor crackle rate changed significantly from breath to breath or from one deep-breathing maneuver to another, even when the maneuvers were separated by cough or the vital-capacity maneuver. The observation that crackle rate is a reproducible measurement during one automated-auscultation session suggests that crackle rate can be used to follow the course of cardiopulmonary illnesses such as pneumonia, IPF, and CHF.

Treatment of odontogenic infections: An analysis of two antibiotic regimens.

PubMed

Bhagania, Manish; Youseff, Wael; Mehra, Pushkar; Figueroa, Ruben

2018-01-01

Retrospective analysis of the efficacy for two commonly used antibiotic regimens in the management of severe odontogenic infections. Evaluation of records of patients admitted to the Oral and Maxillofacial Surgery service at Boston University Medical Center from 2009 to 2014 with severe infections of odontogenic origin (SOI). Patients were divided into two groups based on the administered intravenous antibiotic: 1) Group I: Clindamycin only and 2) Group II: Penicillin and Metronidazole. Variables evaluated included demographic characteristics, ASA status, and anatomic site of infection risk, length of hospital stay, antibiotic failure, and pharmaceutical treatment cost. 78 patients (46 males and 32 females) were included in the study. There were 57 patients in group I (average age 32.6 years) and 21 in Group II (average age 32.8 years). The average white cell count at time of admission count was higher in Group I (19.3) versus Group II (17.4). Antibiotic failure rate was 3.5% in Group I and 4.7% for group 2 patients. Clindamycin alone and combination of Penicillin with Metronidazole are both effective pharmaceutical regimens for SOI. Clindamycin therapy resulted in shorter hospital stay and lower net treatment costs with a slightly higher success rate.

Sensitivity to VSR failure: K pipe break accident

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

Meichle, R.H.

1969-09-12

Reactor effects of failure of a safety rod to scram can be considered in two major respects: The reduction in total safety system strength which will affect the amount of ``prompt drop`` and subsequent flux decay rate of the average neutron flux-level; and the change in local flux distribution due to the absence of the particular rod which fails to enter the reactor. The purpose of this memorandum is to describe the physical effects involved and to indicate the approximate magnitude of both reactor-wide and localized changes in event of failure of a VSR simultaneous with a K Reactor risermore » accident.« less

Loading rate effect on mechanical properties of cervical spine ligaments.

PubMed

Trajkovski, Ana; Omerovic, Senad; Krasna, Simon; Prebil, Ivan

2014-01-01

Mechanical properties of cervical spine ligaments are of great importance for an accurate finite element model when analyzing the injury mechanism. However, there is still little experimental data in literature regarding fresh human cervical spine ligaments under physiological conditions. The focus of the present study is placed on three cervical spine ligaments that stabilize the spine and protect the spinal cord: the anterior longitudinal ligament, the posterior longitudinal ligament and the ligamentum flavum. The ligaments were tested within 24-48 hours after death, under two different loading rates. An increase trend in failure load, failure stress, stiffness and modulus was observed, but proved not to be significant for all ligament types. The loading rate had the highest impact on failure forces for all three ligaments (a 39.1% average increase was found). The observed increase trend, compared to the existing increase trends reported in literature, indicates the importance of carefully applying the existing experimental data, especially when creating scaling factors. A better understanding of the loading rate effect on ligaments properties would enable better case-specific human modelling.

Neck ligament strength is decreased following whiplash trauma

PubMed Central

Tominaga, Yasuhiro; Ndu, Anthony B; Coe, Marcus P; Valenson, Arnold J; Ivancic, Paul C; Ito, Shigeki; Rubin, Wolfgang; Panjabi, Manohar M

2006-01-01

Background Previous clinical studies have documented successful neck pain relief in whiplash patients using nerve block and radiofrequency ablation of facet joint afferents, including capsular ligament nerves. No previous study has documented injuries to the neck ligaments as determined by altered dynamic mechanical properties due to whiplash. The goal of the present study was to determine the dynamic mechanical properties of whiplash-exposed human cervical spine ligaments. Additionally, the present data were compared to previously reported control data. The ligaments included the anterior and posterior longitudinal, capsular, and interspinous and supraspinous ligaments, middle-third disc, and ligamentum flavum. Methods A total of 98 bone-ligament-bone specimens (C2–C3 to C7-T1) were prepared from six cervical spines following 3.5, 5, 6.5, and 8 g rear impacts and pre- and post-impact flexibility testing. The specimens were elongated to failure at a peak rate of 725 (SD 95) mm/s. Failure force, elongation, and energy absorbed, as well as stiffness were determined. The mechanical properties were statistically compared among ligaments, and to the control data (significance level: P < 0.05; trend: P < 0.1). The average physiological ligament elongation was determined using a mathematical model. Results For all whiplash-exposed ligaments, the average failure elongation exceeded the average physiological elongation. The highest average failure force of 204.6 N was observed in the ligamentum flavum, significantly greater than in middle-third disc and interspinous and supraspinous ligaments. The highest average failure elongation of 4.9 mm was observed in the interspinous and supraspinous ligaments, significantly greater than in the anterior longitudinal ligament, middle-third disc, and ligamentum flavum. The average energy absorbed ranged from 0.04 J by the middle-third disc to 0.44 J by the capsular ligament. The ligamentum flavum was the stiffest ligament, while the interspinous and supraspinous ligaments were most flexible. The whiplash-exposed ligaments had significantly lower (P = 0.036) failure force, 149.4 vs. 186.0 N, and a trend (P = 0.078) towards less energy absorption capacity, 308.6 vs. 397.0 J, as compared to the control data. Conclusion The present decreases in neck ligament strength due to whiplash provide support for the ligament-injury hypothesis of whiplash syndrome. PMID:17184536

Reform by the Numbers.

ERIC Educational Resources Information Center

Hanford, Terry; White, Kathleen

1991-01-01

Although numbers such as average test scores or dropout rates can capture part of a school system's success or failure, school statistics seldom tell the whole story. School board members should realize that numbers might measure compliance or process, rather than improvement. Also, improvements in numbers might reflect changes in assessment…

Adaptive Peer Sampling with Newscast

NASA Astrophysics Data System (ADS)

Tölgyesi, Norbert; Jelasity, Márk

The peer sampling service is a middleware service that provides random samples from a large decentralized network to support gossip-based applications such as multicast, data aggregation and overlay topology management. Lightweight gossip-based implementations of the peer sampling service have been shown to provide good quality random sampling while also being extremely robust to many failure scenarios, including node churn and catastrophic failure. We identify two problems with these approaches. The first problem is related to message drop failures: if a node experiences a higher-than-average message drop rate then the probability of sampling this node in the network will decrease. The second problem is that the application layer at different nodes might request random samples at very different rates which can result in very poor random sampling especially at nodes with high request rates. We propose solutions for both problems. We focus on Newscast, a robust implementation of the peer sampling service. Our solution is based on simple extensions of the protocol and an adaptive self-control mechanism for its parameters, namely—without involving failure detectors—nodes passively monitor local protocol events using them as feedback for a local control loop for self-tuning the protocol parameters. The proposed solution is evaluated by simulation experiments.

Impact of Gate 99mTc DTPA GFR, Serum Creatinine and Urea in Diagnosis of Patients with Chronic Kidney Failure

PubMed Central

Miftari, Rame; Nura, Adem; Topçiu-Shufta, Valdete; Miftari, Valon; Murseli, Arbenita; Haxhibeqiri, Valdete

2017-01-01

Aim: The aim of this study was determination of validity of 99mTcDTPA estimation of GFR for early detection of chronic kidney failure Material and methods: There were 110 patients (54 males and 56 females) with kidney disease referred for evaluation of renal function at UCC of Kosovo. All patients were included in two groups. In the first group were included 30 patients confirmed with renal failure, whereas in the second group were included 80 patients with other renal disease. In study were included only patients with ready results of creatinine, urea and glucose in the blood serum. For estimation of GFR we have used the Gate GFR DTPA method. The statistical data processing was conducted using statistical methods such as arithmetic average, the student t-test, percentage or rate, sensitivity, specificity and accuracy of the test. Results: The average age of all patients was 36 years old. The average age of female was 37 whereas of male 35. Patients with renal failure was significantly older than patients with other renal disease (p<0.005). Renal failure was found in 30 patients (27.27%). The concentration of urea and creatinine in blood serum of patients with renal failure were significantly higher than in patients with other renal disease (P< 0.00001). GFR in patients with renal failure were significantly lower than in patients with other renal disease, 51.75 ml/min (p<0.00001). Sensitivity of uremia and creatininemia for detection of renal failure were 83.33%, whereas sensitivity of 99mTcDTPA GFR was 100%. Specificity of uraemia and creatininemia were 63% whereas specificity of 99mTcDTPA GFR was 47.5%. Diagnostic accuracy of blood urea and creatinine in detecting of renal failure were 69%, whereas diagnostic accuracy of 99mTcDTPA GFR was 61.8%. Conclusion: Gate 99mTc DTPA scintigraphy in collaboration with biochemical tests are very sensitive methods for early detection of patients with chronic renal failure. PMID:28883673

An efficient scan diagnosis methodology according to scan failure mode for yield enhancement

NASA Astrophysics Data System (ADS)

Kim, Jung-Tae; Seo, Nam-Sik; Oh, Ghil-Geun; Kim, Dae-Gue; Lee, Kyu-Taek; Choi, Chi-Young; Kim, InSoo; Min, Hyoung Bok

2008-12-01

Yield has always been a driving consideration during fabrication of modern semiconductor industry. Statistically, the largest portion of wafer yield loss is defective scan failure. This paper presents efficient failure analysis methods for initial yield ramp up and ongoing product with scan diagnosis. Result of our analysis shows that more than 60% of the scan failure dies fall into the category of shift mode in the very deep submicron (VDSM) devices. However, localization of scan shift mode failure is very difficult in comparison to capture mode failure because it is caused by the malfunction of scan chain. Addressing the biggest challenge, we propose the most suitable analysis method according to scan failure mode (capture / shift) for yield enhancement. In the event of capture failure mode, this paper describes the method that integrates scan diagnosis flow and backside probing technology to obtain more accurate candidates. We also describe several unique techniques, such as bulk back-grinding solution, efficient backside probing and signal analysis method. Lastly, we introduce blocked chain analysis algorithm for efficient analysis of shift failure mode. In this paper, we contribute to enhancement of the yield as a result of the combination of two methods. We confirm the failure candidates with physical failure analysis (PFA) method. The direct feedback of the defective visualization is useful to mass-produce devices in a shorter time. The experimental data on mass products show that our method produces average reduction by 13.7% in defective SCAN & SRAM-BIST failure rates and by 18.2% in wafer yield rates.

Death of the bee hive: understanding the failure of an insect society.

PubMed

Barron, Andrew B

2015-08-01

Since 2007 honey bee colony failure rates overwinter have averaged about 30% across much of North America. In addition, cases of extremely rapid colony failure have been reported, which has been termed colony collapse disorder. Both phenomena result from an increase in the frequency and intensity of chronic diseases and environmental stressors. Colonies are often challenged by multiple stressors, which can interact: for example, pesticides can enhance disease transmission in colonies. Colonies may be particularly vulnerable to sublethal effects of pathogens and pesticides since colony functions are compromised whether a stressor kills workers, or causes them to fail at foraging. Modelling provides a way to understand the processes of colony failure by relating impacts of stressors to colony-level functions. Copyright © 2015 Elsevier Inc. All rights reserved.

Failure to Rescue Rates After Coronary Artery Bypass Grafting: An Analysis From The Society of Thoracic Surgeons Adult Cardiac Surgery Database.

PubMed

Edwards, Fred H; Ferraris, Victor A; Kurlansky, Paul A; Lobdell, Kevin W; He, Xia; O'Brien, Sean M; Furnary, Anthony P; Rankin, J Scott; Vassileva, Christina M; Fazzalari, Frank L; Magee, Mitchell J; Badhwar, Vinay; Xian, Ying; Jacobs, Jeffrey P; Wyler von Ballmoos, Moritz C; Shahian, David M

2016-08-01

Failure to rescue (FTR) is increasingly recognized as an important quality indicator in surgery. The Society of Thoracic Surgeons National Database was used to develop FTR metrics and a predictive FTR model for coronary artery bypass grafting (CABG). The study included 604,154 patients undergoing isolated CABG at 1,105 centers from January 2010 to January 2014. FTR was defined as death after four complications: stroke, renal failure, reoperation, and prolonged ventilation. FTR was determined for each complication and a composite of the four complications. A statistical model to predict FTR was developed. FTR rates were 22.3% for renal failure, 16.4% for stroke, 12.4% for reoperation, 12.1% for prolonged ventilation, and 10.5% for the composite. Mortality increased with multiple complications and with specific combinations of complications. The multivariate risk model for prediction of FTR demonstrated a C index of 0.792 and was well calibrated, with a 1.0% average difference between observed/expected (O/E) FTR rates. With centers grouped into mortality terciles, complication rates increased modestly (11.4% to 15.7%), but FTR rates more than doubled (6.8% to 13.9%) from the lowest to highest terciles. Centers in the lowest complication rate tercile had an FTR O/E of 1.14, whereas centers in the highest complication rate tercile had an FTR O/E of 0.91. CABG mortality rates vary directly with FTR, but complication rates have little relation to death. FTR rates derived from The Society of Thoracic Surgeons data can serve as national benchmarks. Predicted FTR rates may facilitate patient counseling, and FTR O/E ratios have promise as valuable quality metrics. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Estimation of lifetime distributions on 1550-nm DFB laser diodes using Monte-Carlo statistic computations

NASA Astrophysics Data System (ADS)

Deshayes, Yannick; Verdier, Frederic; Bechou, Laurent; Tregon, Bernard; Danto, Yves; Laffitte, Dominique; Goudard, Jean Luc

2004-09-01

High performance and high reliability are two of the most important goals driving the penetration of optical transmission into telecommunication systems ranging from 880 nm to 1550 nm. Lifetime prediction defined as the time at which a parameter reaches its maximum acceptable shirt still stays the main result in terms of reliability estimation for a technology. For optoelectronic emissive components, selection tests and life testing are specifically used for reliability evaluation according to Telcordia GR-468 CORE requirements. This approach is based on extrapolation of degradation laws, based on physics of failure and electrical or optical parameters, allowing both strong test time reduction and long-term reliability prediction. Unfortunately, in the case of mature technology, there is a growing complexity to calculate average lifetime and failure rates (FITs) using ageing tests in particular due to extremely low failure rates. For present laser diode technologies, time to failure tend to be 106 hours aged under typical conditions (Popt=10 mW and T=80°C). These ageing tests must be performed on more than 100 components aged during 10000 hours mixing different temperatures and drive current conditions conducting to acceleration factors above 300-400. These conditions are high-cost, time consuming and cannot give a complete distribution of times to failure. A new approach consists in use statistic computations to extrapolate lifetime distribution and failure rates in operating conditions from physical parameters of experimental degradation laws. In this paper, Distributed Feedback single mode laser diodes (DFB-LD) used for 1550 nm telecommunication network working at 2.5 Gbit/s transfer rate are studied. Electrical and optical parameters have been measured before and after ageing tests, performed at constant current, according to Telcordia GR-468 requirements. Cumulative failure rates and lifetime distributions are computed using statistic calculations and equations of drift mechanisms versus time fitted from experimental measurements.

Cliophysics: Socio-Political Reliability Theory, Polity Duration and African Political (In)stabilities

PubMed Central

Cherif, Alhaji; Barley, Kamal

2010-01-01

Quantification of historical sociological processes have recently gained attention among theoreticians in the effort of providing a solid theoretical understanding of the behaviors and regularities present in socio-political dynamics. Here we present a reliability theory of polity processes with emphases on individual political dynamics of African countries. We found that the structural properties of polity failure rates successfully capture the risk of political vulnerability and instabilities in which , , , and of the countries with monotonically increasing, unimodal, U-shaped and monotonically decreasing polity failure rates, respectively, have high level of state fragility indices. The quasi-U-shape relationship between average polity duration and regime types corroborates historical precedents and explains the stability of the autocracies and democracies. PMID:21206911

RENEW v3.2 user's manual, maintenance estimation simulation for Space Station Freedom Program

NASA Technical Reports Server (NTRS)

Bream, Bruce L.

1993-01-01

RENEW is a maintenance event estimation simulation program developed in support of the Space Station Freedom Program (SSFP). This simulation uses reliability and maintainability (R&M) and logistics data to estimate both average and time dependent maintenance demands. The simulation uses Monte Carlo techniques to generate failure and repair times as a function of the R&M and logistics parameters. The estimates are generated for a single type of orbital replacement unit (ORU). The simulation has been in use by the SSFP Work Package 4 prime contractor, Rocketdyne, since January 1991. The RENEW simulation gives closer estimates of performance since it uses a time dependent approach and depicts more factors affecting ORU failure and repair than steady state average calculations. RENEW gives both average and time dependent demand values. Graphs of failures over the mission period and yearly failure occurrences are generated. The averages demand rate for the ORU over the mission period is also calculated. While RENEW displays the results in graphs, the results are also available in a data file for further use by spreadsheets or other programs. The process of using RENEW starts with keyboard entry of the R&M and operational data. Once entered, the data may be saved in a data file for later retrieval. The parameters may be viewed and changed after entry using RENEW. The simulation program runs the number of Monte Carlo simulations requested by the operator. Plots and tables of the results can be viewed on the screen or sent to a printer. The results of the simulation are saved along with the input data. Help screens are provided with each menu and data entry screen.

Use of prostate-specific antigen (PSA) to measure semen exposure resulting from male condom failures: implications for contraceptive efficacy and the prevention of sexually transmitted disease.

PubMed

Walsh, Terri L; Frezieres, Ron G; Peacock, Karen; Nelson, Anita L; Clark, Virginia A; Bernstein, Leslie; Wraxall, Brian G D

2003-02-01

Accurate measurement of semen exposure resulting from condom failures can refine public health messages and improve predictions of condom efficacy in preventing pregnancy and HIV transmission. Eight hundred and thirty couples enrolled in a condom efficacy study were asked to collect a baseline sample of ejaculate from the inside of the first study condom they used and to collect a postcoital vaginal sample whenever a study condom broke or slipped off during intercourse. All samples were quantitatively tested for prostate-specific antigen (PSA), a substance found only in human semen, using rocket immunoelectrophoresis, and inspected microscopically for presence of sperm. Sixty-eight baseline ejaculate samples collected from the inside of the first study condom by couples who subsequently experienced a condom failure averaged 13.4 microg PSA per swab and 79% of the samples averaged one or more sperm per high power field (hpf). Seventy-nine postcoital vaginal samples obtained after a condom break averaged 5.7 microg PSA per swab and only 38% averaged one or more sperm per hpf. The PSA results indicated a 50% reduction in semen exposure compared to baseline levels (p = 0.0001). Seventeen samples obtained after a condom slip-off averaged 2.5 microg PSA per swab and none of the samples averaged one or more sperm per hpf. The PSA results indicated an 80% reduction in semen exposure compared to baseline levels (p = 0.0001). Our results suggest that even condoms that fail reduce the risk of pregnancy and the transmission of sexually transmitted disease compared to unprotected intercourse. We also used PSA results to adjust a model designed to predict consistent-use pregnancy rates from condom breakage and slippage data.

Clinical and radiological outcomes after reverse shoulder arthroplasty in patients with failed deltoid or latissimus dorsi transfers. A review of ten cases.

PubMed

Valenti, Philippe; Maqdes, Ali; Werthel, Jean-David

2017-10-01

The purpose of this study was to report clinical and radiological results of reverse shoulder arthroplasty (RSA) after failure of either a deltoid and/or a latissimus dorsi transfer. Between 2001 and 2011, ten patients (average age, 61 years) underwent primary RSA after a failed tendon transfer for irreparable postero-superior rotator cuff tear (five deltoid muscle transfers, four latissimus dorsi transfers and one both). Average follow-up was 48 months. Outcome measures included pain, range of motion and postoperative Constant-Murley score. Pain score improved significantly from a mean 8.3 to a mean 0.3. Mean shoulder elevation improved from 66 to 134°, and absolute Constant-Murley scores increased from 25.8 to 62.8 The mean improvement in external rotation was limited to 7.5°. Subjectively, six patients rated the result as much better and three rated it as better than before surgery. Failure of the tendon transfer with deterioration of the functional outcomes can be salvaged with a RSA with no impact on the expected outcome.

Substantial vertebral body osteophytes protect against severe vertebral fractures in compression

PubMed Central

Aubin, Carl-Éric; Chaumoître, Kathia; Mac-Thiong, Jean-Marc; Ménard, Anne-Laure; Petit, Yvan; Garo, Anaïs; Arnoux, Pierre-Jean

2017-01-01

Recent findings suggest that vertebral osteophytes increase the resistance of the spine to compression. However, the role of vertebral osteophytes on the biomechanical response of the spine under fast dynamic compression, up to failure, is unclear. Seventeen human spine specimens composed of three vertebrae (from T5-T7 to T11-L1) and their surrounding soft tissues were harvested from nine cadavers, aged 77 to 92 years. Specimens were imaged using quantitative computer tomography (QCT) for medical observation, classification of the intervertebral disc degeneration (Thomson grade) and measurement of the vertebral trabecular density (VTD), height and cross-sectional area. Specimens were divided into two groups (with (n = 9) or without (n = 8) substantial vertebral body osteophytes) and compressed axially at a dynamic displacement rate of 1 m/s, up to failure. Normalized force-displacement curves, videos and QCT images allowed characterizing failure parameters (force, displacement and energy at failure) and fracture patterns. Results were analyzed using chi-squared tests for sampling distributions and linear regression for correlations between VTD and failure parameters. Specimens with substantial vertebral body osteophytes present higher stiffness (2.7 times on average) and force at failure (1.8 times on average) than other segments. The presence of osteophytes significantly influences the location, pattern and type of fracture. VTD was a good predictor of the dynamic force and energy at failure for specimens without substantial osteophytes. This study also showed that vertebral body osteophytes provide a protective mechanism to the underlying vertebra against severe compression fractures. PMID:29065144

A Fault Tolerance Mechanism for On-Road Sensor Networks

PubMed Central

Feng, Lei; Guo, Shaoyong; Sun, Jialu; Yu, Peng; Li, Wenjing

2016-01-01

On-Road Sensor Networks (ORSNs) play an important role in capturing traffic flow data for predicting short-term traffic patterns, driving assistance and self-driving vehicles. However, this kind of network is prone to large-scale communication failure if a few sensors physically fail. In this paper, to ensure that the network works normally, an effective fault-tolerance mechanism for ORSNs which mainly consists of backup on-road sensor deployment, redundant cluster head deployment and an adaptive failure detection and recovery method is proposed. Firstly, based on the N − x principle and the sensors’ failure rate, this paper formulates the backup sensor deployment problem in the form of a two-objective optimization, which explains the trade-off between the cost and fault resumption. In consideration of improving the network resilience further, this paper introduces a redundant cluster head deployment model according to the coverage constraint. Then a common solving method combining integer-continuing and sequential quadratic programming is explored to determine the optimal location of these two deployment problems. Moreover, an Adaptive Detection and Resume (ADR) protocol is deigned to recover the system communication through route and cluster adjustment if there is a backup on-road sensor mismatch. The final experiments show that our proposed mechanism can achieve an average 90% recovery rate and reduce the average number of failed sensors at most by 35.7%. PMID:27918483

Effect of loading on unintentional lifting velocity declines during single sets of repetitions to failure during upper and lower extremity muscle actions.

PubMed

Izquierdo, M; González-Badillo, J J; Häkkinen, K; Ibáñez, J; Kraemer, W J; Altadill, A; Eslava, J; Gorostiaga, E M

2006-09-01

The purpose of this study was to examine the effect of different loads on repetition speed during single sets of repetitions to failure in bench press and parallel squat. Thirty-six physical active men performed 1-repetition maximum in a bench press (1 RM (BP)) and half squat position (1 RM (HS)), and performed maximal power-output continuous repetition sets randomly every 10 days until failure with a submaximal load (60 %, 65 %, 70 %, and 75 % of 1RM, respectively) during bench press and parallel squat. Average velocity of each repetition was recorded by linking a rotary encoder to the end part of the bar. The values of 1 RM (BP) and 1 RM (HS) were 91 +/- 17 and 200 +/- 20 kg, respectively. The number of repetitions performed for a given percentage of 1RM was significantly higher (p < 0.001) in half squat than in bench press performance. Average repetition velocity decreased at a greater rate in bench press than in parallel squat. The significant reductions observed in the average repetition velocity (expressed as a percentage of the average velocity achieved during the initial repetition) were observed at higher percentage of the total number of repetitions performed in parallel squat (48 - 69 %) than in bench press (34 - 40 %) actions. The major finding in this study was that, for a given muscle action (bench press or parallel squat), the pattern of reduction in the relative average velocity achieved during each repetition and the relative number of repetitions performed was the same for all percentages of 1RM tested. However, relative average velocity decreased at a greater rate in bench press than in parallel squat performance. This would indicate that in bench press the significant reductions observed in the average repetition velocity occurred when the number of repetitions was over one third (34 %) of the total number of repetitions performed, whereas in parallel squat it was nearly one half (48 %). Conceptually, this would indicate that for a given exercise (bench press or squat) and percentage of maximal dynamic strength (1RM), the pattern of velocity decrease can be predicted over a set of repetitions, so that a minimum repetition threshold to ensure maximal speed performance is determined.

Intermediate Temperature Stress Rupture of a Woven Hi-Nicalon, BN-Interphase, SiC Matric Composite in Air

NASA Technical Reports Server (NTRS)

Morscher, Gregory N.; Hurst, Janet; Brewer, David

1999-01-01

Woven Hi-Nicalon (TM) reinforced melt-infiltrated SiC matrix composites were tested under tensile stress-rupture conditions in air at intermediate temperatures. A comprehensive examination of the damage state and the fiber properties at failure was performed. Modal acoustic emission analysis was used to monitor damage during the experiment. Extensive microscopy of the composite fracture surfaces and the individual fiber fracture surfaces was used to determine the mechanisms leading to ultimate failure. The rupture properties of these composites were significantly worse than expected compared to the fiber properties under similar conditions. This was due to the oxidation of the BN interphase. Oxidation occurred through the matrix cracks that intersected the surface or edge of a tensile bar. These oxidation reactions resulted in minor degradation to fiber strength and strong bonding of the fibers to one another at regions of near fiber-to-fiber contact. It was found that two regimes for rupture exist for this material: a high stress regime where rupture occurs at a fast rate and a low stress regime where rupture occurs at a slower rate. For the high stress regime, the matrix damage state consisted of through thickness cracks. The average fracture strength of fibers that were pulled-out (the final fibers to break before ultimate failure) was controlled by the slow-crack growth rupture criterion in the literature for individual Hi-Nicalon (TM) fibers. For the low stress regime, the matrix damage state consisted of microcracks which grew during the rupture test. The average fracture strength of fibers that were pulled-out in this regime was the same as the average fracture strength of individual fibers pulled out in as-produced composites tested at room temperature.

Protection of Electrical Systems from EM Hazards - Design Guide.

DTIC Science & Technology

1981-09-01

cm) Surface flashover Voltage (KV/cm) This criterion should be met for lighting voltage stresses of either polarity applied at up to 1000 KV/v sec rate...suppressor devices can be predicted. The part failure rate models in the handbook include the effects of part electrical stress , thermal stress , operating... stress . This test series contained over one million device hours of operation at temperatures uF to 145°C. The average duration of testing ranges from

Feasibility and safety of elective transradial coronary intervention in Asian females.

PubMed

Maddury, Jyotsna; Kaushik, Manu; Madhavapeddi, Aditya; Babu, Srinivas; Kumar, Narendra; Varma, J L N; Alla, Venkata

2011-03-01

Transradial access for angioplasty and percutaneous intervention (PCI) has become more popular across the world due to lower risk of bleeding and better patient comfort. It has been shown to be effective and feasible in the Western population. However, there is a relative paucity of similar data for small-statured females, especially from Asian countries. Given the increased theoretical risk of local complications due to smaller-sized radial arteries in such females, feasibility and safety of transradial PCI (rPCI) needs to be better established in this group. We present observational data for rPCI from a 3-year period at a single tertiary care center in South Asia. Data were collected on all female patients who underwent rPCI from January 2005 to December 2007. Primary outcomes assessed were procedure failure rate and complication rate. Secondary outcomes included death, recurrence of myocardial infarction, anginal symptoms or other complaints. Outcomes were recorded post-procedurally in the hospital and after discharge for up to 6 months. A total of 93 patients were included for final data analysis. Average patient age was 57.5 ± 10.3 years, with average height of 151.7 ± 8.4 cm and average weight of 58.1 ± 12.5 kg. Seventy patients (75.3%) underwent angioplasty or percutaneous intervention (PCI) for ACS and 23 (24.7%) for chronic stable angina refractory to medical therapy. A total of 118 lesions were treated in 90 patients. Ninety-one lesions (77.1%) were classified as Type B2 and Type C according to modified American College of Cardiology/American Heart Association lesion morphology criteria. Three cases of procedure failure accounted for a failure rate of 3.23%. No specified complications were noted in any of the patients. At 6-month follow-up, no deaths were observed. Two patients developed acute myocardial infarction and 16 patients (17.7%) had recurrence of anginal symptoms. Radial artery angioplasty and stenting is feasible and safe in Asian females. Increased theoretical risk of complication due to small-sized radial arteries in this subgroup is unlikely to be true. Success rates are likely to be good even with complex coronary inventions performed with transradial access.

Characterization of the relationship between ceramic pot filter water production and turbidity in source water.

PubMed

Salvinelli, Carlo; Elmore, A Curt; Reidmeyer, Mary R; Drake, K David; Ahmad, Khaldoun I

2016-11-01

Ceramic pot filters represent a common and effective household water treatment technology in developing countries, but factors impacting water production rate are not well-known. Turbidity of source water may be principal indicator in characterizing the filter's lifetime in terms of water production capacity. A flow rate study was conducted by creating four controlled scenarios with different turbidities, and influent and effluent water samples were tested for total suspended solids and particle size distribution. A relationship between average flow rate and turbidity was identified with a negative linear trend of 50 mLh -1 /NTU. Also, a positive linear relationship was found between the initial flow rate of the filters and average flow rate calculated over the 23 day life of the experiment. Therefore, it was possible to establish a method to estimate the average flow rate given the initial flow rate and the turbidity in the influent water source, and to back calculate the maximum average turbidity that would need to be maintained in order to achieve a specific average flow rate. However, long-term investigations should be conducted to assess how these relationships change over the expected CPF lifetime. CPFs rejected fine suspended particles (below 75 μm), especially particles with diameters between 0.375 μm and 10 μm. The results confirmed that ceramic pot filters are able to effectively reduce turbidity, but pretreatment of influent water should be performed to avoid premature failure. Copyright © 2016 Elsevier Ltd. All rights reserved.

Short Stature and Access to Lung Transplantation in the United States. A Cohort Study

PubMed Central

Sell, Jessica L.; Bacchetta, Matthew; Goldfarb, Samuel B.; Park, Hanyoung; Heffernan, Priscilla V.; Robbins, Hilary A.; Shah, Lori; Raza, Kashif; D’Ovidio, Frank; Sonett, Joshua R.; Arcasoy, Selim M.

2016-01-01

Rationale: Anecdotally, short lung transplant candidates suffer from long waiting times and higher rates of death on the waiting list compared with taller candidates. Objectives: To examine the relationship between lung transplant candidate height and waiting list outcomes. Methods: We conducted a retrospective cohort study of 13,346 adults placed on the lung transplant waiting list in the United States between 2005 and 2011. Multivariable-adjusted competing risk survival models were used to examine associations between candidate height and outcomes of interest. The primary outcome was the time until lung transplantation censored at 1 year. Measurements and Main Results: The unadjusted rate of lung transplantation was 94.5 per 100 person-years among candidates of short stature (<162 cm) and 202.0 per 100 person-years among candidates of average stature (170–176.5 cm). After controlling for potential confounders, short stature was associated with a 34% (95% confidence interval [CI], 29–39%) lower rate of transplantation compared with average stature. Short stature was also associated with a 62% (95% CI, 24–96%) higher rate of death or removal because of clinical deterioration and a 42% (95% CI, 10–85%) higher rate of respiratory failure while awaiting lung transplantation. Conclusions: Short stature is associated with a lower rate of lung transplantation and higher rates of death and respiratory failure while awaiting transplantation. Efforts to ameliorate this disparity could include earlier referral and listing of shorter candidates, surgical downsizing of substantially oversized allografts for shorter candidates, and/or changes to allocation policy that account for candidate height. PMID:26554631

Heart failure and the holidays.

PubMed

Shah, Mahek; Bhalla, Vikas; Patnaik, Soumya; Maludum, Obiora; Lu, Marvin; Figueredo, Vincent M

2016-10-01

Studies suggest increased cardiac morbidity and heart failure exacerbations during winter months with a peak around the holiday season. Major sporting events and intense encounters in sports have been shown to affect cardiovascular outcomes amongst its fans. All patients admitted to Einstein Medical Center between January 1, 2003 and December 31, 2013 with a diagnosis of congestive heart failure were included in the study. They were included on the basis of the presence of an ICD-9CM code representing congestive heart failure as the primary diagnosis. Comparisons were made between the rates of heart failure admissions on the holiday, 4 days following the holiday and the rest of the month for 5 specific days: Christmas day, New Year's day, Independence day, Thanksgiving day and Super Bowl Sunday. Our study included 22,727 heart failure admissions at an average of 5.65 admissions per day. The mean patient age was 68 ± 15 years. There was a significant increase in daily heart failure admissions following Independence day (5.65 vs. 5; p = 0.027) and Christmas day (6.5 vs. 5.5; p = 0.046) when compared to the rest of the month. A history of alcohol abuse or dependence did not correlate with the reported+ rise in heart failure admissions immediately following the holidays. The mean number of daily admissions on the holidays were significantly lower for all holidays compared to the following 4 days. All holidays apart from Super Bowl Sunday demonstrated lower admission rates on the holiday compared to the rest of the month. Christmas and Independence day were associated with increased heart failure admissions immediately following the holidays. The holidays themselves saw lower admission rates. Overeating on holidays, associated emotional stressors, lesser exercise and postponing medical around holidays may be among the factors responsible for the findings.

Taking Math Students from "Blah" to "Aha": What Can We Do?

ERIC Educational Resources Information Center

Kalajdzievska, Darja

2014-01-01

In many post-secondary, introductory mathematics courses failure and withdrawal rates are reaching as high as 50% and average GPA is steadily decreasing. This is a problem that has been witnessed across the globe. With widespread reforms taking place in K-12 mathematics education, many innovative teaching strategies have been created, implemented,…

The Many Methods to Measure Testability: A Horror Story.

DTIC Science & Technology

1988-04-01

it seems overly simplistic to assign only one "magic number" as a viable design goal. Different design technologies such as digital, analog, machanical ...FAILURE RATE 1 1 BASIC TEST PROGRAM 1 1 ATLAS TEST PROGRAM 1 1 EDIF FILE 1 1 TEST STRATEGY FLOWCHART 1 1 RTOK FREQUENCY 1 1 DIAGNOSIS AVERAGE COST 1 1

Implementation of predictive data mining techniques for identifying risk factors of early AVF failure in hemodialysis patients.

PubMed

Rezapour, Mohammad; Khavanin Zadeh, Morteza; Sepehri, Mohammad Mehdi

2013-01-01

Arteriovenous fistula (AVF) is an important vascular access for hemodialysis (HD) treatment but has 20-60% rate of early failure. Detecting association between patient's parameters and early AVF failure is important for reducing its prevalence and relevant costs. Also predicting incidence of this complication in new patients is a beneficial controlling procedure. Patient safety and preservation of early AVF failure is the ultimate goal. Our research society is Hasheminejad Kidney Center (HKC) of Tehran, which is one of Iran's largest renal hospitals. We analyzed data of 193 HD patients using supervised techniques of data mining approach. There were 137 male (70.98%) and 56 female (29.02%) patients introduced into this study. The average of age for all the patients was 53.87 ± 17.47 years. Twenty eight patients had smoked and the number of diabetic patients and nondiabetics was 87 and 106, respectively. A significant relationship was found between "diabetes mellitus," "smoking," and "hypertension" with early AVF failure in this study. We have found that these mentioned risk factors have important roles in outcome of vascular surgery, versus other parameters such as "age." Then we predicted this complication in future AVF surgeries and evaluated our designed prediction methods with accuracy rates of 61.66%-75.13%.

Poster - Thur Eve - 38: Review of couch parameters using an FMEA.

PubMed

Larouche, R; Doucet, R; Rémy, E; Filion, A; Poirier, L

2012-07-01

To improve patient safety during positioning, we undertook a systematic review of the processes used by our center to obtain couch positions. We used a Failure Mode and Effects Analysis (FMEA) framework and fifteen different possible failures were identified and rated. The three major failures were 1) Loss of planned couch position and bias from the previous day's couch position, 2) DICOM origin or isocenter is different between two plans (imaging or treatment), and 3) Patient shift in opposite direction than intended. The main effect of these failures was to cause an override of couch parameters. Based on these results, we modified our processes, introduced new QA and software checks and developed new tolerance tables so as to improve system robustness and increase our success rate at catching failures before they can affect the patient. It has been a year since we made these modifications. Based on our results, we have reduced the number of overrides at our center from a maximum of 20.5% to a maximum of 6.3%, with an average at 4% of daily treatments. Our results suggest that FMEA is an effective tool in improving treatment quality that could be used in other centers. © 2012 American Association of Physicists in Medicine.

Drilling from the intercondylar area for treatment of osteochondritis dissecans of the knee joint.

PubMed

Kawasaki, Kenzo; Uchio, Yuji; Adachi, Nobuo; Iwasa, Junji; Ochi, Mitsuo

2003-09-01

We demonstrate a new method in which a drilling is made from the intercondylar space, and its efficacy in treating osteochondritis dissecans (OCD) of the knee in skeletally immature patients with relatively stable lesions with an intact articular surface, in cases where there was failure of initial non-operative management. The lesions of 16 knees of 12 patients with OCD of the femoral condyles failed to heal by conservative treatment for more than 3 months (average 5-6 months) and thereafter were arthroscopically treated with drilling from not the transarticular but the intercondylar bare area without damaging the articular surface. Eight lesions involved the medial femoral condyle, and eight involved the lateral femoral condyle. The average follow-up was 16 months. All lesions healed after drilling, and the average time of healing was 4 months by X-ray and 7 months by MRI. The average Lysholm score improved from an average of 70.4 points at preoperation to an average of 97.8 points after operation. The results of the Hughston Rating Scale were similar: 10 of the 12 patients showed excellent results and the remaining two patients good results. We advocate our new and less invasive procedure of drilling from the bare area of the intercondylar space for OCD in the knee joint of skeletally immature patients who have had failure of initial non-operative management.

Colony Failure Linked to Low Sperm Viability in Honey Bee (Apis mellifera) Queens and an Exploration of Potential Causative Factors.

PubMed

Pettis, Jeffery S; Rice, Nathan; Joselow, Katie; vanEngelsdorp, Dennis; Chaimanee, Veeranan

2016-01-01

Queen health is closely linked to colony performance in honey bees as a single queen is normally responsible for all egg laying and brood production within the colony. In the U. S. in recent years, queens have been failing at a high rate; with 50% or greater of queens replaced in colonies within 6 months when historically a queen might live one to two years. This high rate of queen failure coincides with the high mortality rates of colonies in the US, some years with >50% of colonies dying. In the current study, surveys of sperm viability in US queens were made to determine if sperm viability plays a role in queen or colony failure. Wide variation was observed in sperm viability from four sets of queens removed from colonies that beekeepers rated as in good health (n = 12; average viability = 92%), were replacing as part of normal management (n = 28; 57%), or where rated as failing (n = 18 and 19; 54% and 55%). Two additional paired set of queens showed a statistically significant difference in viability between colonies rated by the beekeeper as failing or in good health from the same apiaries. Queens removed from colonies rated in good health averaged high viability (ca. 85%) while those rated as failing or in poor health had significantly lower viability (ca. 50%). Thus low sperm viability was indicative of, or linked to, colony performance. To explore the source of low sperm viability, six commercial queen breeders were surveyed and wide variation in viability (range 60-90%) was documented between breeders. This variability could originate from the drones the queens mate with or temperature extremes that queens are exposed to during shipment. The role of shipping temperature as a possible explanation for low sperm viability was explored. We documented that during shipment queens are exposed to temperature spikes (<8 and > 40°C) and these spikes can kill 50% or more of the sperm stored in queen spermathecae in live queens. Clearly low sperm viability is linked to colony performance and laboratory and field data provide evidence that temperature extremes are a potential causative factor.

Seismic precursory patterns before a cliff collapse and critical point phenomena

USGS Publications Warehouse

Amitrano, D.; Grasso, J.-R.; Senfaute, G.

2005-01-01

We analyse the statistical pattern of seismicity before a 1-2 103 m3 chalk cliff collapse on the Normandie ocean shore, Western France. We show that a power law acceleration of seismicity rate and energy in both 40 Hz-1.5 kHz and 2 Hz-10kHz frequency range, is defined on 3 orders of magnitude, within 2 hours from the collapse time. Simultaneously, the average size of the seismic events increases toward the time to failure. These in situ results are derived from the only station located within one rupture length distance from the rock fall rupture plane. They mimic the "critical point" like behavior recovered from physical and numerical experiments before brittle failures and tertiary creep failures. Our analysis of this first seismic monitoring data of a cliff collapse suggests that the thermodynamic phase transition models for failure may apply for cliff collapse. Copyright 2005 by the American Geophysical Union.

A new method to estimate location and slip of simulated rock failure events

NASA Astrophysics Data System (ADS)

Heinze, Thomas; Galvan, Boris; Miller, Stephen Andrew

2015-05-01

At the laboratory scale, identifying and locating acoustic emissions (AEs) is a common method for short term prediction of failure in geomaterials. Above average AE typically precedes the failure process and is easily measured. At larger scales, increase in micro-seismic activity sometimes precedes large earthquakes (e.g. Tohoku, L'Aquilla, oceanic transforms), and can be used to assess seismic risk. The goal of this work is to develop a methodology and numerical algorithms for extracting a measurable quantity analogous to AE arising from the solution of equations governing rock deformation. Since there is no physical property to quantify AE derivable from the governing equations, an appropriate rock-mechanical analog needs to be found. In this work, we identify a general behavior of the AE generation process preceding rock failure. This behavior includes arbitrary localization of low magnitude events during pre-failure stage, followed by increase in number and amplitude, and finally localization around the incipient failure plane during macroscopic failure. We propose deviatoric strain rate as the numerical analog that mimics this behavior, and develop two different algorithms designed to detect rapid increases in deviatoric strain using moving averages. The numerical model solves a fully poro-elasto-plastic continuum model and is coupled to a two-phase flow model. We test our model by comparing simulation results with experimental data of drained compression and of fluid injection experiments. We find for both cases that occurrence and amplitude of our AE analog mimic the observed general behavior of the AE generation process. Our technique can be extended to modeling at the field scale, possibly providing a mechanistic basis for seismic hazard assessment from seismicity that occasionally precedes large earthquakes.

Fluid overload and kidney failure in children with severe sepsis and septic shock: A cohort study.

PubMed

Naveda Romero, Omar E; Naveda Meléndez, Andrea F

2017-04-01

In children with sepsis, fluid overload as a result of an aggressive fluid replacement or excessive fluid administration may result in kidney impairment and increased mortality. Objective. To determine the association between fluid overload and the rate of kidney failure in a group of children with severe sepsis and septic shock. This was a prospective cohort study conducted in the intensive care unit of Hospital Universitario de Pediatría “Dr. Agustín Zubillaga” (Barquisimeto, Lara State, Venezuela), between March 2013 and May 2016, in children with severe sepsis or septic shock. One hundred and forty-nine patients were included in the analysis. Sepsis predominated in 59.7% of cases; patients' average age was 6.4 ± 3.3 years old, their average weight was 17.8 ± 3.6 kg, 30.2% had fluid overload, and overall mortality was 25.5%. Kidney failure occurred in 16.1% of cases. A binary logistic regression model was used to identify fluid overload (odds ratio [OR]: 1.5; 95% confidence interval [CI]: 1.2-4.9, p = 0.028) and shock for more than 2 days (OR: 1.7; 95% CI: 1.3-6.3, p = 0.039) as independent predictors of kidney failure. In addition, a significant increase in the risk of mortality among children with kidney failure and fluid overload was observed as per the Kaplan-Meier method (p= 0.019). Fluid overload and shock for more than 2 days increase the risk for kidney failure in critically ill children with severe sepsis and septic shock.

Improved Accuracy of Automated Estimation of Cardiac Output Using Circulation Time in Patients with Heart Failure.

PubMed

Dajani, Hilmi R; Hosokawa, Kazuya; Ando, Shin-Ichi

2016-11-01

Lung-to-finger circulation time of oxygenated blood during nocturnal periodic breathing in heart failure patients measured using polysomnography correlates negatively with cardiac function but possesses limited accuracy for cardiac output (CO) estimation. CO was recalculated from lung-to-finger circulation time using a multivariable linear model with information on age and average overnight heart rate in 25 patients who underwent evaluation of heart failure. The multivariable model decreased the percentage error to 22.3% relative to invasive CO measured during cardiac catheterization. This improved automated noninvasive CO estimation using multiple variables meets a recently proposed performance criterion for clinical acceptability of noninvasive CO estimation, and compares very favorably with other available methods. Copyright © 2016 Elsevier Inc. All rights reserved.

Clavicular bone tunnel malposition leads to early failures in coracoclavicular ligament reconstructions.

PubMed

Cook, Jay B; Shaha, James S; Rowles, Douglas J; Bottoni, Craig R; Shaha, Steven H; Tokish, John M

2013-01-01

Modern techniques for the treatment of acromioclavicular (AC) joint dislocations have largely centered on free tendon graft reconstructions. Recent biomechanical studies have demonstrated that an anatomic reconstruction with 2 clavicular bone tunnels more closely matches the properties of native coracoclavicular (CC) ligaments than more traditional techniques. No study has analyzed tunnel position in regard to risk of early failure. To evaluate the effect of clavicular tunnel position in CC ligament reconstruction as a risk of early failure. Case series; Level of evidence, 4. A retrospective review was performed of a consecutive series of CC ligament reconstructions performed with 2 clavicular bone tunnels and a free tendon graft. The population was largely a young, active-duty military group of patients. Radiographs were analyzed for the maintenance of reduction and location of clavicular bone tunnels using a picture archiving and communication system. The distance from the lateral border of the clavicle to the center of each bone tunnel was divided by the total clavicular length to establish a ratio. Medical records were reviewed for operative details and functional outcome. Failure was defined as loss of intraoperative reduction. The overall failure rate was 28.6% (8/28) at an average of 7.4 weeks postoperatively. Comparison of bone tunnel position showed that medialized bone tunnels were a significant predictor for early loss of reduction for the conoid (a ratio of 0.292 vs 0.248; P = .012) and trapezoid bone tunnels (a ratio of 0.171 vs 0.128; P = .004); this correlated to an average of 7 to 9 mm more medial in the reconstructions that failed. Reconstructions performed with a conoid ratio of ≥0.30 were significantly more likely to fail (5/5, 100%) than were those performed lateral to a ratio of 0.30 (3/23, 13.0%) (P < .01). There were no failures when the conoid ratio was <0.25 (0/10, 0%). Conoid tunnel placement was also statistically significant for predicting return to duty in our active-duty population. Medial tunnel placement is a significant factor in risk for early failures when performing anatomic CC ligament reconstructions. Preoperative templating is recommended to evaluate optimal placement of the clavicular bone tunnels. Placement of the conoid tunnel at 25% of the clavicular length from the lateral border of the clavicle is associated with a lower rate of lost reduction and a higher rate of return to military duty.

Acute neurorehabilitation: does a neurosensory and coordinated interdisciplinary programme reduce tracheostomy weaning time and weaning failure?

PubMed

Berney, Loric; Wasserfallen, Jean-Blaise; Grant, Kathleen; Levivier, Marc; Simon, Christian; Faouzi, Mohamed; Paillex, Roland; Schweizer, Valérie; Diserens, Karin

2014-01-01

A new coordinated interdisciplinary unit was created in the acute section of the department of clinical neurosciences, the Acute NeuroRehabilitation (NRA) unit. The objective was to evaluate the impact of the unit and its neurosensory programme on the management of tracheostomy patients in terms of reduction in the average time taken for weaning, weaning success rate and therapeutic efficiency. This 49-month retrospective study compares 2 groups of tracheostomy patients before (n = 34) and after (n = 46) NRA intervention. The outcome measures evaluate the benefits of the NRA unit intervention (time to decannulation, weaning and complication rates) and the benefits of the coordination (time to registration in a rehabilitation centre and rate of non-compliance with standards of care). Weaning failure rate was reduced from 27.3% to 9.1%, no complications or recannulations were observed in the post-intervention group after weaning and time to decannulation following admission to our unit decreased from 19.13 to 12.75 days. The rate of non-compliance with patient standards of care was significantly reduced from 45% to 30% (Mann-Whitney p = 0.003). This interdisciplinary weaning programme helped to reduce weaning time and weaning failure, without increased complications, in the sample studied. Coordination improved the efficiency of the interdisciplinary team in the multiplicity and complexity of the different treatments.

Predicting hospitalization due to worsening heart failure using daily weight measurement: analysis of the Trans-European Network-Home-Care Management System (TEN-HMS) study.

PubMed

Zhang, Jufen; Goode, Kevin M; Cuddihy, Paul E; Cleland, John G F

2009-04-01

We sought to test the utility of weight gain algorithms to predict episodes of worsening heart failure (WHF) using home-telemonitoring data collected as part of the TEN-HMS study. Simple rule-of-thumb (RoT) algorithms (i.e. 3 lbs in 1 day and 5 lbs in 3 days) and a moving average convergence divergence (MACD) algorithm were compared. WHF was defined as hospitalization for WHF or worsening of breathlessness or leg oedema. Of 168 patients, 45 were hospitalized with WHF and 76 were hospitalized for other reasons. On average, weight gain occurred in the 14 days prior to WHF hospitalizations but not in the 14 days prior to non-WHF hospitalizations [1.9 +/- 4.7 lbs (0.9 +/- 2.1 kg) vs. -0.4 +/- 2.5 lbs (-0.2 +/- 1.1 kg), P < 0.0001]. The true alerts rate was higher for the RoT algorithms compared with the MACD (58 and 65% vs. 20%). However, the RoT algorithms had much higher false alert rates (54 and 58% vs. 9%) rendering them of little practical use for predicting WHF events. A MACD algorithm is more specific but less sensitive than RoT when trying to predict episodes of WHF based on daily weight measurements. However, many episodes of WHF do not appear to be associated with weight gain and therefore telemonitoring of weight alone may not have great value for heart failure management.

A comparison between detailed and configuration-averaged collisional-radiative codes applied to nonlocal thermal equilibrium plasmas

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

Poirier, M.; Gaufridy de Dortan, F. de

A collisional-radiative model describing nonlocal-thermodynamic-equilibrium plasmas is developed. It is based on the HULLAC (Hebrew University Lawrence Livermore Atomic Code) suite for the transitions rates, in the zero-temperature radiation field hypothesis. Two variants of the model are presented: the first one is configuration averaged, while the second one is a detailed level version. Comparisons are made between them in the case of a carbon plasma; they show that the configuration-averaged code gives correct results for an electronic temperature T{sub e}=10 eV (or higher) but fails at lower temperatures such as T{sub e}=1 eV. The validity of the configuration-averaged approximation ismore » discussed: the intuitive criterion requiring that the average configuration-energy dispersion must be less than the electron thermal energy turns out to be a necessary but far from sufficient condition. Another condition based on the resolution of a modified rate-equation system is proposed. Its efficiency is emphasized in the case of low-temperature plasmas. Finally, it is shown that near-threshold autoionization cascade processes may induce a severe failure of the configuration-average formalism.« less

Failure analysis of knee arthrodesis with the WichitaFusion Nail.

PubMed

Parcel, Ted W; Levering, Melissa; Polikandriotis, John A; Gustke, Kenneth A; Bernasek, Thomas L

2013-11-01

Arthrodesis is a salvage procedure for failed total knee arthroplasty with the intent to create a stable, pain-free limb on which to ambulate or transfer. For many patients, the alternative to arthrodesis may be an above-knee amputation. Available techniques for knee arthrodesis include compression plating, external fixators, and intramedullary fixation. The purpose of this study was to report the knee fusion rate of consecutive patients at 1 institution using an intramedullary fusion nail and to identify patient risk factors for fusion failure. Between November 1998 and November 2008, twenty-eight patients undergoing knee arthrodesis with an average follow-up of 18 months (range, 3-64 months) were retrospectively studied. Demographic information, presence of fusion, clinical function, pain level, and bone defect data were collected and analyzed. Eighty-two percent (23/28) of patients had radiographic evidence of successful fusion with an average time to fusion of 21 weeks (range, 10-58 weeks). When examining patient variables that could correlate with fusion rates, patients with an Anderson Orthopaedic Research Institute type 3 femoral or type 3 tibial defect had a statistically significant lower fusion rate. The intramedullary fusion nail is an effective device for knee arthrodesis that offers ease of insertion through the knee wound with the advantages of initial bone compression and rigid fixation. Although the use of intramedullary fusion nails leads to a high fusion rate, significant bone deficiency limits successful fusion. Copyright 2013, SLACK Incorporated.

Impact of Race on Asthma Treatment Failures in the Asthma Clinical Research Network

PubMed Central

Castro, Mario; Lehman, Erik; Chinchilli, Vernon M.; Sutherland, E. Rand; Denlinger, Loren; Lazarus, Stephen C.; Peters, Stephen P.; Israel, Elliot

2011-01-01

Rationale: Recent studies suggest that people with asthma of different racial backgrounds may respond differently to various therapies. Objectives: To use data from well-characterized participants in prior Asthma Clinical Research Network (ACRN) trials to determine whether racial differences affected asthma treatment failures. Methods: We analyzed baseline phenotypes and treatment failure rates (worsening asthma resulting in systemic corticosteroid use, hospitalization, emergency department visit, prolonged decrease in peak expiratory flow, increase in albuterol use, or safety concerns) in subjects participating in 10 ACRN trials (1993–2003). Self-declared race was reported in each trial and treatment failure rates were stratified by race. Measurements and Main Results: A total of 1,200 unique subjects (whites = 795 [66%]; African Americans = 233 [19%]; others = 172 [14%]; mean age = 32) were included in the analyses. At baseline, African Americans had fewer asthma symptoms (P < 0.001) and less average daily rescue inhaler use (P = 0.007) than whites. There were no differences in baseline FEV1 (% predicted); asthma quality of life; bronchial hyperreactivity; or exhaled nitric oxide concentrations. A total of 147 treatment failures were observed; a significantly higher proportion of African Americans (19.7%; n = 46) experienced a treatment failure compared with whites (12.7%; n = 101) (odds ratio = 1.7; 95% confidence interval, 1.2–2.5; P = 0.007). When stratified by treatment, African Americans receiving long-acting β-agonists were twice as likely as whites to experience a treatment failure (odds ratio = 2.1; 95% confidence interval, 1.3–3.6; P = 0.004), even when used with other controller therapies. Conclusions: Despite having fewer asthma symptoms and less rescue β-agonist use, African-Americans with asthma have more treatment failures compared with whites, especially when taking long-acting β-agonists. PMID:21885625

A time-efficient web-based teaching tool to improve medical knowledge and decrease ABIM failure rate in select residents.

PubMed

Drake, Sean M; Qureshi, Waqas; Morse, William; Baker-Genaw, Kimberly

2015-01-01

The American Board of Internal Medicine (ABIM) exam's pass rate is considered a quality measure of a residency program, yet few interventions have shown benefit in reducing the failure rate. We developed a web-based Directed Reading (DR) program with an aim to increase medical knowledge and reduce ABIM exam failure rate. Internal medicine residents at our academic medical center with In-Training Examination (ITE) scores ≤ 35 th percentile from 2007 to 2013 were enrolled in DR. The program matches residents to reading assignments based on their own ITE-failed educational objectives and provides direct electronic feedback from their teaching physicians. ABIM exam pass rates were analyzed across various groups between 2002 and 2013 to examine the effect of the DR program on residents with ITE scores ≤ 35 percentile pre- (2002-2006) and post-intervention (2007-2013). A time commitment survey was also given to physicians and DR residents at the end of the study. Residents who never scored ≤ 35 percentile on ITE were the most likely to pass the ABIM exam on first attempt regardless of time period. For those who ever scored ≤ 35 percentile on ITE, 91.9% of residents who participated in DR passed the ABIM exam on first attempt vs 85.2% of their counterparts pre-intervention (p < 0.001). This showed an improvement in ABIM exam pass rate for this subset of residents after introduction of the DR program. The time survey showed that faculty used an average of 40±18 min per week to participate in DR and residents required an average of 25 min to search/read about the objective and 20 min to write a response. Although residents who ever scored ≤ 35 percentile on ITE were more likely to fail ABIM exam on first attempt, those who participated in the DR program were less likely to fail than the historical control counterparts. The web-based teaching method required little time commitment by faculty.

A time-efficient web-based teaching tool to improve medical knowledge and decrease ABIM failure rate in select residents

PubMed Central

Drake, Sean M.; Qureshi, Waqas; Morse, William; Baker-Genaw, Kimberly

2015-01-01

Aim The American Board of Internal Medicine (ABIM) exam's pass rate is considered a quality measure of a residency program, yet few interventions have shown benefit in reducing the failure rate. We developed a web-based Directed Reading (DR) program with an aim to increase medical knowledge and reduce ABIM exam failure rate. Methods Internal medicine residents at our academic medical center with In-Training Examination (ITE) scores ≤35th percentile from 2007 to 2013 were enrolled in DR. The program matches residents to reading assignments based on their own ITE-failed educational objectives and provides direct electronic feedback from their teaching physicians. ABIM exam pass rates were analyzed across various groups between 2002 and 2013 to examine the effect of the DR program on residents with ITE scores ≤35 percentile pre- (2002–2006) and post-intervention (2007–2013). A time commitment survey was also given to physicians and DR residents at the end of the study. Results Residents who never scored ≤35 percentile on ITE were the most likely to pass the ABIM exam on first attempt regardless of time period. For those who ever scored ≤35 percentile on ITE, 91.9% of residents who participated in DR passed the ABIM exam on first attempt vs 85.2% of their counterparts pre-intervention (p<0.001). This showed an improvement in ABIM exam pass rate for this subset of residents after introduction of the DR program. The time survey showed that faculty used an average of 40±18 min per week to participate in DR and residents required an average of 25 min to search/read about the objective and 20 min to write a response. Conclusions Although residents who ever scored ≤35 percentile on ITE were more likely to fail ABIM exam on first attempt, those who participated in the DR program were less likely to fail than the historical control counterparts. The web-based teaching method required little time commitment by faculty. PMID:26521767

A time-efficient web-based teaching tool to improve medical knowledge and decrease ABIM failure rate in select residents.

PubMed

Drake, Sean M; Qureshi, Waqas; Morse, William; Baker-Genaw, Kimberly

2015-01-01

Aim The American Board of Internal Medicine (ABIM) exam's pass rate is considered a quality measure of a residency program, yet few interventions have shown benefit in reducing the failure rate. We developed a web-based Directed Reading (DR) program with an aim to increase medical knowledge and reduce ABIM exam failure rate. Methods Internal medicine residents at our academic medical center with In-Training Examination (ITE) scores ≤35th percentile from 2007 to 2013 were enrolled in DR. The program matches residents to reading assignments based on their own ITE-failed educational objectives and provides direct electronic feedback from their teaching physicians. ABIM exam pass rates were analyzed across various groups between 2002 and 2013 to examine the effect of the DR program on residents with ITE scores ≤35 percentile pre- (2002-2006) and post-intervention (2007-2013). A time commitment survey was also given to physicians and DR residents at the end of the study. Results Residents who never scored ≤35 percentile on ITE were the most likely to pass the ABIM exam on first attempt regardless of time period. For those who ever scored ≤35 percentile on ITE, 91.9% of residents who participated in DR passed the ABIM exam on first attempt vs 85.2% of their counterparts pre-intervention (p<0.001). This showed an improvement in ABIM exam pass rate for this subset of residents after introduction of the DR program. The time survey showed that faculty used an average of 40±18 min per week to participate in DR and residents required an average of 25 min to search/read about the objective and 20 min to write a response. Conclusions Although residents who ever scored ≤35 percentile on ITE were more likely to fail ABIM exam on first attempt, those who participated in the DR program were less likely to fail than the historical control counterparts. The web-based teaching method required little time commitment by faculty.

Statistical forecasting of repetitious dome failures during the waning eruption of Redoubt Volcano, Alaska, February-April 1990

USGS Publications Warehouse

Page, R.A.; Lahr, J.C.; Chouet, B.A.; Power, J.A.; Stephens, C.D.

1994-01-01

The waning phase of the 1989-1990 eruption of Redoubt Volcano in the Cook Inlet region of south-central Alaska comprised a quasi-regular pattern of repetitious dome growth and destruction that lasted from February 15 to late April 1990. The dome failures produced ash plumes hazardous to airline traffic. In response to this hazard, the Alaska Volcano Observatory sought to forecast these ash-producing events using two approaches. One approach built on early successes in issuing warnings before major eruptions on December 14, 1989 and January 2, 1990. These warnings were based largely on changes in seismic activity related to the occurrence of precursory swarms of long-period seismic events. The search for precursory swarms of long-period seismicity was continued through the waning phase of the eruption and led to warnings before tephra eruptions on March 23 and April 6. The observed regularity of dome failures after February 15 suggested that a statistical forecasting method based on a constant-rate failure model might also be successful. The first statistical forecast was issued on March 16 after seven events had occurred, at an average interval of 4.5 days. At this time, the interval between dome failures abruptly lengthened. Accordingly, the forecast was unsuccessful and further forecasting was suspended until the regularity of subsequent failures could be confirmed. Statistical forecasting resumed on April 12, after four dome failure episodes separated by an average of 7.8 days. One dome failure (April 15) was successfully forecast using a 70% confidence window, and a second event (April 21) was narrowly missed before the end of the activity. The cessation of dome failures after April 21 resulted in a concluding false alarm. Although forecasting success during the eruption was limited, retrospective analysis shows that early and consistent application of the statistical method using a constant-rate failure model and a 90% confidence window could have yielded five successful forecasts and two false alarms; no events would have been missed. On closer examination, the intervals between successive dome failures are not uniform but tend to increase with time. This increase attests to the continuous, slowly decreasing supply of magma to the surface vent during the waning phase of the eruption. The domes formed in a precarious position in a breach in the summit crater rim where they were susceptible to gravitational collapse. The instability of the February 15-April 21 domes relative to the earlier domes is attributed to reaming the lip of the vent by a laterally directed explosion during the major dome-destroying eruption of February 15, a process which would leave a less secure foundation for subsequent domes. ?? 1994.

Five-Year Pooled Data Analysis of the Ahmed Baerveldt Comparison Study and the Ahmed Versus Baerveldt Study.

PubMed

Christakis, Panos G; Zhang, Dongyu; Budenz, Donald L; Barton, Keith; Tsai, James C; Ahmed, Iqbal I K

2017-04-01

To determine the relative efficacy of the Ahmed-FP7 and Baerveldt BG101-350 implants. Pooled analysis of 2 multicenter, randomized clinical trials. A total of 514 patients aged 18 or older with uncontrolled glaucoma that had failed or were at high risk of failing trabeculectomy were randomized to receive an Ahmed implant (n = 267) or Baerveldt implant (n = 247). Cumulative failure rates (using an intraocular pressure [IOP] target of 6-18 mm Hg inclusive), de novo glaucoma surgery rates, mean IOP, mean glaucoma medication use, and visual acuity were compared. Baseline characteristics were similar between groups. Mean preoperative IOP of the study population was 31.5 ± 11.3 mm Hg on an average of 3.3 ± 1.1 glaucoma medications. At 5 years, mean IOP was 15.8 ± 5.2 mm Hg in the Ahmed group and 13.2 ± 4.7 mm Hg in the Baerveldt group (P < .001). Mean glaucoma medication use was 1.9 ± 1.5 in the Ahmed group and 1.5 ± 1.4 in the Baerveldt group (P = .007). The cumulative failure rate at 5 years was 49% in the Ahmed group and 37% in the Baerveldt group (P = .007). High IOP was the most common reason for failure in both groups, and de novo glaucoma surgery was required in 16% of the Ahmed group and 8% of the Baerveldt group (P = .006). Failure owing to hypotony occurred in 0.4% of the Ahmed group and 4.5% of the Baerveldt group (P = .002). Visual outcomes were similar between groups (P = .90). The Baerveldt group had a lower failure rate, lower rate of de novo glaucoma surgery, and lower mean IOP on fewer medications than the Ahmed group. Baerveldt implantation carried a higher risk of hypotony. Copyright © 2017 Elsevier Inc. All rights reserved.

Modeling the biomechanical and injury response of human liver parenchyma under tensile loading.

PubMed

Untaroiu, Costin D; Lu, Yuan-Chiao; Siripurapu, Sundeep K; Kemper, Andrew R

2015-01-01

The rapid advancement in computational power has made human finite element (FE) models one of the most efficient tools for assessing the risk of abdominal injuries in a crash event. In this study, specimen-specific FE models were employed to quantify material and failure properties of human liver parenchyma using a FE optimization approach. Uniaxial tensile tests were performed on 34 parenchyma coupon specimens prepared from two fresh human livers. Each specimen was tested to failure at one of four loading rates (0.01s(-1), 0.1s(-1), 1s(-1), and 10s(-1)) to investigate the effects of rate dependency on the biomechanical and failure response of liver parenchyma. Each test was simulated by prescribing the end displacements of specimen-specific FE models based on the corresponding test data. The parameters of a first-order Ogden material model were identified for each specimen by a FE optimization approach while simulating the pre-tear loading region. The mean material model parameters were then determined for each loading rate from the characteristic averages of the stress-strain curves, and a stochastic optimization approach was utilized to determine the standard deviations of the material model parameters. A hyperelastic material model using a tabulated formulation for rate effects showed good predictions in terms of tensile material properties of human liver parenchyma. Furthermore, the tissue tearing was numerically simulated using a cohesive zone modeling (CZM) approach. A layer of cohesive elements was added at the failure location, and the CZM parameters were identified by fitting the post-tear force-time history recorded in each test. The results show that the proposed approach is able to capture both the biomechanical and failure response, and accurately model the overall force-deflection response of liver parenchyma over a large range of tensile loadings rates. Copyright © 2014 Elsevier Ltd. All rights reserved.

Hospital Use of Observation Stays: Cross-sectional Study of the Impact on Readmission Rates.

PubMed

Venkatesh, Arjun K; Wang, Changqin; Ross, Joseph S; Altaf, Faseeha K; Suter, Lisa G; Vellanky, Smitha; Grady, Jacqueline N; Bernheim, Susannah M

2016-12-01

The Centers for Medicare and Medicaid Services publicly reports hospital risk-standardized readmission rates (RSRRs) as a measure of quality and performance; mischaracterizations may occur because observation stays are not captured by current measures. To describe variation in hospital use of observation stays, the relationship between hospitals observation stay use and RSRRs. Cross-sectional analysis of Medicare fee-for-service beneficiaries discharged after acute myocardial infarction (AMI), heart failure, or pneumonia between July 2011 and June 2012. We calculated 3 hospital-specific 30-day outcomes: (1) observation rate, the proportion of all discharges followed by an observation stay without a readmission; (2) observation proportion, the proportion of observation stays among all patients with an observation stay or readmission; and (3) RSRR. For all 3 conditions, hospitals' observation rates were <2.5% and observation proportions were <12%, although there was variation across hospitals, including 28% of hospital with no observation stay use for AMI, 31% for heart failure, and 43% for pneumonia. There were statistically significant, but minimal, correlations between hospital observation rates and RSRRs: AMI (r=-0.02), heart failure (r=-0.11), and pneumonia (r=-0.02) (P<0.001). There were modest inverse correlations between hospital observation proportion and RSRR: AMI (r=-0.34), heart failure (r=-0.26), and pneumonia (r=-0.21) (P<0.001). If observation stays were included in readmission measures, <4% of top performing hospitals would be recategorized as having average performance. Hospitals' observation stay use in the postdischarge period is low, but varies widely. Despite modest correlation between the observation proportion and RSRR, counting observation stays in readmission measures would minimally impact public reporting of performance.

Influences of granulocyte growth factor in uterine perfusion on pregnancy outcome of patients with failure of embryo implantation for unknown reason.

PubMed

He, Jun; Liu, Juan; Zhou, Hua; Chen, Chao Jun

2016-11-01

To investigate the influence of granulocyte growth factor in uterine perfusion on the pregnancy outcome of patients with failure of embryo implantation for unknown reason. Then, 68 patients with failure of embryo implantation for unknown reason were enrolled in our hospital from November 2013 to February 2015, which were divided into observation group and control group by random (34 patients in each group). Patients in observation group received basic treatment for granulocyte growth factor in uterine perfusion on the next day, while patients in control group received basic treatment with placebo. Then, endometrial preparation, adverse reaction and pregnancy outcome of patients were compared between the two groups. Comparing the endometrial preparation and average endometrial thickness of patients in control group (9.87±2.12) with those in observation group [(9.87±2.12), there is no significant difference (P<0.05). After treatment, patients in both groups performed diabetes, hypertension and other pregnancy complications without difference of statistical significance (P<0.05). The embryo implantation rate and clinical pregnancy rate of patients in observation group were significantly higher than those in control group [(82.35%) and (44.12%) vs (52.94%) and (17.65%)]. Moreover, the live birth rate of patients in observation group performed significantly higher than that in control group [(41.18%) vs (14.71%)] with significant difference (P<0.05). By taking treatment of granulocyte growth factor, patients with failure of embryo implantation can effectively improve clinical pregnancy rate and embryo implantation rate without severe complication. Therefore, treatment of granlocyte growth factor can improve the pregnancy outcome of patients.

Reliable Collection of Real-Time Patient Physiologic Data from less Reliable Networks: a "Monitor of Monitors" System (MoMs).

PubMed

Hu, Peter F; Yang, Shiming; Li, Hsiao-Chi; Stansbury, Lynn G; Yang, Fan; Hagegeorge, George; Miller, Catriona; Rock, Peter; Stein, Deborah M; Mackenzie, Colin F

2017-01-01

Research and practice based on automated electronic patient monitoring and data collection systems is significantly limited by system down time. We asked whether a triple-redundant Monitor of Monitors System (MoMs) to collect and summarize key information from system-wide data sources could achieve high fault tolerance, early diagnosis of system failure, and improve data collection rates. In our Level I trauma center, patient vital signs(VS) monitors were networked to collect real time patient physiologic data streams from 94 bed units in our various resuscitation, operating, and critical care units. To minimize the impact of server collection failure, three BedMaster® VS servers were used in parallel to collect data from all bed units. To locate and diagnose system failures, we summarized critical information from high throughput datastreams in real-time in a dashboard viewer and compared the before and post MoMs phases to evaluate data collection performance as availability time, active collection rates, and gap duration, occurrence, and categories. Single-server collection rates in the 3-month period before MoMs deployment ranged from 27.8 % to 40.5 % with combined 79.1 % collection rate. Reasons for gaps included collection server failure, software instability, individual bed setting inconsistency, and monitor servicing. In the 6-month post MoMs deployment period, average collection rates were 99.9 %. A triple redundant patient data collection system with real-time diagnostic information summarization and representation improved the reliability of massive clinical data collection to nearly 100 % in a Level I trauma center. Such data collection framework may also increase the automation level of hospital-wise information aggregation for optimal allocation of health care resources.

Effectiveness of symptom validity measures in identifying cognitive and behavioral symptom exaggeration in adult attention deficit hyperactivity disorder.

PubMed

Marshall, Paul; Schroeder, Ryan; O'Brien, Jeffrey; Fischer, Rebecca; Ries, Adam; Blesi, Brita; Barker, Jessica

2010-10-01

This study examines the effectiveness of symptom validity measures to detect suspect effort in cognitive testing and invalid completion of ADHD behavior rating scales in 268 adults referred for ADHD assessment. Patients were diagnosed with ADHD based on cognitive testing, behavior rating scales, and clinical interview. Suspect effort was diagnosed by at least two of the following: failure on embedded and free-standing SVT measures, a score > 2 SD below the ADD population average on tests, failure on an ADHD behavior rating scale validity scale, or a major discrepancy between reported and observed ADHD behaviors. A total of 22% of patients engaged in symptom exaggeration. The Word Memory test immediate recall and consistency score (both 64%), TOVA omission errors (63%) and reaction time variability (54%), CAT-A infrequency scale (58%), and b Test (47%) had good sensitivity as well as at least 90% specificity. Clearly, such measures should be used to help avoid making false positive diagnoses of ADHD.

Aleatory Uncertainty and Scale Effects in Computational Damage Models for Failure and Fragmentation

DTIC Science & Technology

2014-09-01

larger specimens, small specimens have, on average, higher strengths. Equivalently, because curves for small specimens fall below those of larger...the material strength associated with each realization parameter R in Equation (7), and strength distribution curves associated with multiple...effects in brittle media [58], which applies micromorphological dimensional analysis to obtain a universal curve which closely fits rate-dependent

Research and Teaching: Does the Classroom Matter? How the Physical Space Affects Learning in Introductory Undergraduate Science Courses

ERIC Educational Resources Information Center

Young, Kaisa E.; Young, Chadwick H.; Beyer, Adam

2017-01-01

We compare student learning and perception data from astronomy, physics, and geology courses taught in a traditional classroom with individual desks to the same classes taught in a large auditorium. In a large student sample (1,593 students), there is no clear difference between rooms in measures of failure rates or average final grades. However,…

Failure analysis of fractured dental zirconia implants.

PubMed

Gahlert, M; Burtscher, D; Grunert, I; Kniha, H; Steinhauser, E

2012-03-01

The purpose of the present study was the macroscopic and microscopic failure analysis of fractured zirconia dental implants. Thirteen fractured one-piece zirconia implants (Z-Look3) out of 170 inserted implants with an average in situ period of 36.75±5.34 months (range from 20 to 56 months, median 38 months) were prepared for macroscopic and microscopic (scanning electron microscopy [SEM]) failure analysis. These 170 implants were inserted in 79 patients. The patient histories were compared with fracture incidences to identify the reasons for the failure of the implants. Twelve of these fractured implants had a diameter of 3.25 mm and one implant had a diameter of 4 mm. All fractured implants were located in the anterior side of the maxilla and mandibula. The patient with the fracture of the 4 mm diameter implant was adversely affected by strong bruxism. By failure analysis (SEM), it could be demonstrated that in all cases, mechanical overloading caused the fracture of the implants. Inhomogeneities and internal defects of the ceramic material could be excluded, but notches and scratches due to sandblasting of the surface led to local stress concentrations that led to the mentioned mechanical overloading by bending loads. The present study identified a fracture rate of nearly 10% within a follow-up period of 36.75 months after prosthetic loading. Ninety-two per cent of the fractured implants were so-called diameter reduced implants (diameter 3.25 mm). These diameter reduced implants cannot be recommended for further clinical use. Improvement of the ceramic material and modification of the implant geometry has to be carried out to reduce the failure rate of small-sized ceramic implants. Nevertheless, due to the lack of appropriate laboratory testing, only clinical studies will demonstrate clearly whether and how far the failure rate can be reduced. © 2011 John Wiley & Sons A/S.

Similar failure rate in immediate post-operative weight bearing versus protected weight bearing following meniscal repair on peripheral, vertical meniscal tears.

PubMed

Perkins, Bryan; Gronbeck, Kyle R; Yue, Ruixian Alexander; Tompkins, Marc A

2017-08-16

Post-operative weight bearing after meniscal repair is a point of debate among physicians. This study sought to evaluate whether patients adhering to an immediate WBAT rehabilitation programme have a higher failure rate compared to those adhering to a more traditional, protected, NWB status following meniscal repair. The null hypothesis was that there would be no difference in failure between the two groups. A retrospective review of meniscal repair patients greater than 5 years from surgery was performed for patients receiving meniscal repair treatment. Patients were categorized by post-surgical weight-bearing status, either NWB or WBAT, and then analysed for failure of repair. Failure was defined as re-operation on the torn meniscus. The study controlled for variables including age at surgery, sex, height, weight, and BMI, classification of tear type, acuity of the tear, repair location (medial or lateral), repair location within the meniscus, repair technique, and concomitant procedures. Re-operations were performed in 61 of 157 patients [38.9%]. There was no difference between weight-bearing groups for failure of meniscus repair (n.s.). The tears were acute vertical tears located in the posterior horn and body. For the 61 patients with re-operation, the average time to re-operation was 2.2 years with 10 [16%] > 5 years from surgery, 17 [28%] 2-5 years from surgery, and 34 [56%] < 2 years from surgery. In isolated meniscal repair patients (n = 62), there was no difference between weight-bearing groups for rate of re-operation (n.s.). Weight bearing as tolerated after meniscal repair for peripheral, vertical tears does not result in a higher failure rate than traditional, non-weight bearing over a five-year follow-up period. The clinical relevance is that, based on these data, it may be appropriate to allow weight bearing as tolerated following meniscal repair of peripheral, vertical tears. Retrospective cohort study, Level III.

Greater occipital nerve excision for occipital neuralgia refractory to nerve decompression.

PubMed

Ducic, Ivica; Felder, John M; Khan, Neelam; Youn, Sojin

2014-02-01

Patients who undergo occipital nerve decompression for treatment of migraine headaches due to occipital neuralgia have already exhausted medical options for treatment. When surgical decompression fails, it is unknown how best to help these patients. We examine our experience performing greater occipital nerve (GON) excision for pain relief in this select, refractory group of patients. A retrospective chart review supplemented by a follow-up survey was performed on all patients under the care of the senior author who had undergone GON excision after failing occipital nerve decompression. Headache severity was measured by the migraine headache index (MHI) and disability by the migraine disability assessment. Success rate was considered the percentage of patients who experienced a 50% or greater reduction in MHI at final follow-up. Seventy-one of 108 patients responded to the follow-up survey and were included in the study. Average follow-up was 33 months. The success rate of surgery was 70.4%; 41% of patients showed a 90% or greater decrease in MHI. The MHI changed, on average, from 146 to 49, for an average reduction of 63% (P < 0.001). Migraine disability assessment scores decreased by an average of 49% (P < 0.001). Multivariate analysis revealed that a diagnosis of cervicogenic headache was associated with failure of surgery. The most common adverse effect was bothersome numbness or hypersensitivity in the denervated area, occurring in up to 31% of patients. Excision of the GON is a valid option for pain relief in patients with occipital headaches refractory to both medical treatment and surgical decompression. Potential risks include failure in patients with cervicogenic headache and hypersensitivity of the denervated area. To provide the best outcome to these patients who have failed all previous medical and surgical treatments, a multidisciplinary team approach remains critical.

TRIO: Burst Buffer Based I/O Orchestration

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

Wang, Teng; Oral, H Sarp; Pritchard, Michael

The growing computing power on leadership HPC systems is often accompanied by ever-escalating failure rates. Checkpointing is a common defensive mechanism used by scientific applications for failure recovery. However, directly writing the large and bursty checkpointing dataset to parallel filesystem can incur significant I/O contention on storage servers. Such contention in turn degrades the raw bandwidth utilization of storage servers and prolongs the average job I/O time of concurrent applications. Recently burst buffer has been proposed as an intermediate layer to absorb the bursty I/O traffic from compute nodes to storage backend. But an I/O orchestration mechanism is still desiredmore » to efficiently move checkpointing data from bursty buffers to storage backend. In this paper, we propose a burst buffer based I/O orchestration framework, named TRIO, to intercept and reshape the bursty writes for better sequential write traffic to storage severs. Meanwhile, TRIO coordinates the flushing orders among concurrent burst buffers to alleviate the contention on storage server bandwidth. Our experimental results reveal that TRIO can deliver 30.5% higher bandwidth and reduce the average job I/O time by 37% on average for data-intensive applications in various checkpointing scenarios.« less

Colony Failure Linked to Low Sperm Viability in Honey Bee (Apis mellifera) Queens and an Exploration of Potential Causative Factors

PubMed Central

Pettis, Jeffery S.; Rice, Nathan; Joselow, Katie; vanEngelsdorp, Dennis; Chaimanee, Veeranan

2016-01-01

Queen health is closely linked to colony performance in honey bees as a single queen is normally responsible for all egg laying and brood production within the colony. In the U. S. in recent years, queens have been failing at a high rate; with 50% or greater of queens replaced in colonies within 6 months when historically a queen might live one to two years. This high rate of queen failure coincides with the high mortality rates of colonies in the US, some years with >50% of colonies dying. In the current study, surveys of sperm viability in US queens were made to determine if sperm viability plays a role in queen or colony failure. Wide variation was observed in sperm viability from four sets of queens removed from colonies that beekeepers rated as in good health (n = 12; average viability = 92%), were replacing as part of normal management (n = 28; 57%), or where rated as failing (n = 18 and 19; 54% and 55%). Two additional paired set of queens showed a statistically significant difference in viability between colonies rated by the beekeeper as failing or in good health from the same apiaries. Queens removed from colonies rated in good health averaged high viability (ca. 85%) while those rated as failing or in poor health had significantly lower viability (ca. 50%). Thus low sperm viability was indicative of, or linked to, colony performance. To explore the source of low sperm viability, six commercial queen breeders were surveyed and wide variation in viability (range 60–90%) was documented between breeders. This variability could originate from the drones the queens mate with or temperature extremes that queens are exposed to during shipment. The role of shipping temperature as a possible explanation for low sperm viability was explored. We documented that during shipment queens are exposed to temperature spikes (<8 and > 40°C) and these spikes can kill 50% or more of the sperm stored in queen spermathecae in live queens. Clearly low sperm viability is linked to colony performance and laboratory and field data provide evidence that temperature extremes are a potential causative factor. PMID:26863438

The rate of transient beta frequency events predicts behavior across tasks and species

PubMed Central

Law, Robert; Tsutsui, Shawn; Moore, Christopher I; Jones, Stephanie R

2017-01-01

Beta oscillations (15-29Hz) are among the most prominent signatures of brain activity. Beta power is predictive of healthy and abnormal behaviors, including perception, attention and motor action. In non-averaged signals, beta can emerge as transient high-power 'events'. As such, functionally relevant differences in averaged power across time and trials can reflect changes in event number, power, duration, and/or frequency span. We show that functionally relevant differences in averaged beta power in primary somatosensory neocortex reflect a difference in the number of high-power beta events per trial, i.e. event rate. Further, beta events occurring close to the stimulus were more likely to impair perception. These results are consistent across detection and attention tasks in human magnetoencephalography, and in local field potentials from mice performing a detection task. These results imply that an increased propensity of beta events predicts the failure to effectively transmit information through specific neocortical representations. PMID:29106374

Do heart and respiratory rate variability improve prediction of extubation outcomes in critically ill patients?

PubMed Central

2014-01-01

Introduction Prolonged ventilation and failed extubation are associated with increased harm and cost. The added value of heart and respiratory rate variability (HRV and RRV) during spontaneous breathing trials (SBTs) to predict extubation failure remains unknown. Methods We enrolled 721 patients in a multicenter (12 sites), prospective, observational study, evaluating clinical estimates of risk of extubation failure, physiologic measures recorded during SBTs, HRV and RRV recorded before and during the last SBT prior to extubation, and extubation outcomes. We excluded 287 patients because of protocol or technical violations, or poor data quality. Measures of variability (97 HRV, 82 RRV) were calculated from electrocardiogram and capnography waveforms followed by automated cleaning and variability analysis using Continuous Individualized Multiorgan Variability Analysis (CIMVA™) software. Repeated randomized subsampling with training, validation, and testing were used to derive and compare predictive models. Results Of 434 patients with high-quality data, 51 (12%) failed extubation. Two HRV and eight RRV measures showed statistically significant association with extubation failure (P <0.0041, 5% false discovery rate). An ensemble average of five univariate logistic regression models using RRV during SBT, yielding a probability of extubation failure (called WAVE score), demonstrated optimal predictive capacity. With repeated random subsampling and testing, the model showed mean receiver operating characteristic area under the curve (ROC AUC) of 0.69, higher than heart rate (0.51), rapid shallow breathing index (RBSI; 0.61) and respiratory rate (0.63). After deriving a WAVE model based on all data, training-set performance demonstrated that the model increased its predictive power when applied to patients conventionally considered high risk: a WAVE score >0.5 in patients with RSBI >105 and perceived high risk of failure yielded a fold increase in risk of extubation failure of 3.0 (95% confidence interval (CI) 1.2 to 5.2) and 3.5 (95% CI 1.9 to 5.4), respectively. Conclusions Altered HRV and RRV (during the SBT prior to extubation) are significantly associated with extubation failure. A predictive model using RRV during the last SBT provided optimal accuracy of prediction in all patients, with improved accuracy when combined with clinical impression or RSBI. This model requires a validation cohort to evaluate accuracy and generalizability. Trial registration ClinicalTrials.gov NCT01237886. Registered 13 October 2010. PMID:24713049

Modeling of ductile fragmentation that includes void interactions

NASA Astrophysics Data System (ADS)

Meulbroek Fick, J. P.; Ramesh, K. T.; Swaminathan, P. K.

2015-12-01

The failure and fragmentation of ductile materials through the nucleation, growth, and coalescence of voids is important to the understanding of key structural materials. In this model of development effort, ductile fragmentation of an elastic-viscoplastic material is studied through a computational approach which couples these key stages of ductile failure with nucleation site distributions and wave propagation, and predicts fragment spacing within a uniaxial strain approximation. This powerful tool is used to investigate the mechanical and thermal response of OFHC copper at a strain rate of 105. Once the response of the material is understood, the fragmentation of this test material is considered. The average fragment size as well as the fragment size distribution is formulated.

Failure and Degradation Modes of PV modules in a Hot Dry Climate: Results after 4 and 12 years of field exposure

NASA Astrophysics Data System (ADS)

Mallineni, Jaya krishna

This study evaluates two photovoltaic (PV) power plants based on electrical performance measurements, diode checks, visual inspections and infrared scanning. The purpose of this study is to measure degradation rates of performance parameters (Pmax, Isc, Voc, Vmax, Imax and FF) and to identify the failure modes in a "hot-dry desert" climatic condition along with quantitative determination of safety failure rates and reliability failure rates. The data obtained from this study can be used by module manufacturers in determining the warranty limits of their modules and also by banks, investors, project developers and users in determining appropriate financing or decommissioning models. In addition, the data obtained in this study will be helpful in selecting appropriate accelerated stress tests which would replicate the field failures for the new modules and would predict the lifetime for new PV modules. The study was conducted at two, single axis tracking monocrystalline silicon (c-Si) power plants, Site 3 and Site 4c of Salt River Project (SRP). The Site 3 power plant is located in Glendale, Arizona and the Site 4c power plant is located in Mesa, Arizona both considered a "hot-dry" field condition. The Site 3 power plant has 2,352 modules (named as Model-G) which was rated at 250 kW DC output. The mean and median degradation of these 12 years old modules are 0.95%/year and 0.96%/year, respectively. The major cause of degradation found in Site 3 is due to high series resistance (potentially due to solder-bond thermo-mechanical fatigue) and the failure mode is ribbon-ribbon solder bond failure/breakage. The Site 4c power plant has 1,280 modules (named as Model-H) which provide 243 kW DC output. The mean and median degradation of these 4 years old modules are 0.96%/year and 1%/year, respectively. At Site 4c, practically, none of the module failures are observed. The average soiling loss is 6.9% in Site 3 and 5.5% in Site 4c. The difference in soiling level is attributed to the rural and urban surroundings of these two power plants.

Simulated effects of the 2003 permitted withdrawals and water-management alternatives on reservoir storage and firm yields of three surface-water supplies, Ipswich River Basin, Massachusetts

USGS Publications Warehouse

Zarriello, Phillip J.

2004-01-01

The Hydrologic Simulation ProgramFORTRAN (HSPF) model of the Ipswich River Basin previously developed by the U.S. Geological Survey was modified to evaluate the effects of the 2003 withdrawal permits and water-management alternatives on reservoir storage and yields of the Lynn, Peabody, and SalemBeverly water-supply systems. These systems obtain all or part of their water from the Ipswich River Basin. The HSPF model simulated the complex water budgets to the three supply systems, including effects of regulations that restrict withdrawals by the time of year, minimum streamflow thresholds, and the capacity of each system to pump water from the river. The 2003 permits restrict withdrawals from the Ipswich River between November 1 and May 31 to streamflows above a 1.0 cubic foot per second per square mile (ft3/s/mi2) threshold, to high flows between June 1 and October 31, and to a maximum annual volume. Yields and changes in reservoir storage over the 35-year simulation period (196195) were also evaluated for each system with a hypothetical low-capacity pump, alternative seasonal streamflow thresholds, and withdrawals that result in successive failures (depleted storage). The firm yields, the maximum yields that can be met during a severe drought, calculated for each water-supply system, under the 2003 permitted withdrawals, were 7.31 million gallons per day (Mgal/d) for the Lynn, 3.01 Mgal/d for the Peabody, and 7.98 Mgal/d for the SalemBeverly systems; these yields are 31, 49, and 21 percent less than their average 19982000 demands, respectively. The simulations with the same permit restrictions and a hypothetical low-capacity pump for each system resulted in slightly increased yields for the Lynn and SalemBeverly systems, but a slightly decreased yield for the Peabody system. Simulations to evaluate the effects of alternative streamflow thresholds on water supply indicated that firm yields were generally about twice as sensitive to decreases in the NovemberFebruary or MarchMay thresholds than to increases in these thresholds. Firm yields were also generally slightly less sensitive to changes in the NovemberFebruary than to changes in the MarchMay thresholds in the Peabody and SalemBeverly water-supply systems. Decreases in the JuneOctober streamflow threshold did not affect any of the system's firm yield. Simulations of withdrawal rates that resulted in successive near failures during the 196195 period indicated the tradeoff between increased yield and risks. The Lynn and Peabody systems were allowed to near failure up to six times. At the sixth near failure, yields of these systems increased to 10.18 and 4.43 Mgal/d, respectively; these rates increased the amount of water obtained from the Ipswich River Basin (relative to the firm-yield rate), as a percentage of average 19982000 demands, from 68 to 96 percent and from 51 to 75 percent, respectively. The SalemBeverly system was able to meet demands after the third near failure. Reservoir storage was depleted about 6 percent of the time at the withdrawal rate that caused the sixth near failure in the Lynn and Peabody system and about 3 percent of the time at the withdrawal rate that caused the third near failure in the SalemBeverly system. Supply systems are at greatest risk of failure from persistent droughts (lasting more than 1 year), but short-term droughts also present risks during the fall and winter when the supply systems are most vulnerable. Uncertainties in model performance, simplification of reservoir systems and their management, and the possibility of droughts of severity greater than simulated in this investigation underscore the fact that the firm yield calculated for each system cannot be considered a withdrawal rate that is absolutely fail-safe. Thus, the consequences of failure are an important consideration in the planning and management of these systems.

A pilot study on the functional performance and acceptability of an innovative female condom (Wondaleaf®) in Malaysia.

PubMed

Ting, Rachel Sing-Kiat; Wong, Ee-Lynn; Tnay, Jessie Koh-Sing

2018-01-01

Female condom (FC) has been available for over 30 years, but it still lacks wide acceptability. To overcome misdirection and invagination occurring in FC and to provide a wider area of protection, Wondaleaf ® (WL), a new-generation adhesive FC, was recently invented. This pioneering study sought to assess the acceptability and functional performance of WL among Malaysian women. A mixed method survey was conducted in three cities of Malaysia, recruiting sexually active heterosexual women, aged 18-50, by snowball sampling method. Participants were provided with WL and initially surveyed to rate its performance in five coital usages over 2 months. After that, the participants underwent a second survey to rate their satisfaction and acceptability toward WL. Descriptive statistics on clinical failure rates were tabulated with correlational analysis performed to identify major variables contributing to WL's functional performance and acceptability. Out of the 51 enrolled participants, 31 women completed the required surveys. WL's total clinical failure rate was 2.60% (out of 155 condom uses) with above-average ratings of functional performance. The ease of use significantly correlated with ratings of no slippage and no misdirection. The confidence in WL's safety features significantly correlated with a sense of empowerment and protection. WL has a relatively low risk of clinical failures and an overall favorable acceptability among Malaysian women. However, this study also showed that its future usage largely depends on partner acceptability. It may have the potential of complementing the existing barrier toward contraceptive use. Further studies are needed to understand the global acceptability of WL.

Plasma dia-filtration for severe sepsis.

PubMed

Eguchi, Yutaka

2010-01-01

The mortality rate in severe sepsis is 30-50%, and independent liver and renal dysfunction impacts significantly on hospital and intensive care mortality. If 4 or more organs fail, mortality is > 90%. Recently, we reported a novel plasmapheresis--plasma diafiltration (PDF)--the concept of which is plasma filtration with dialysis. PDF employs a plasma separator that has a sieving coefficient of 0.3 for albumin and which requires flowing dialysate outside the hollow fiber. For substitute liquid, 1,200 ml of fresh frozen plasma followed by 50 ml of 25% albumin solution is used for 8 h as 1 session. In a single-center study, 24 patients with septic shock were admitted to the ICU, then 37.7 +/- 30.0 h later, 7 patients received PDF. The patients' Sequential Organ Failure Assessment (SOFA) scores had increased from 14.9 +/- 3.6 on ICU admission to 17.1 +/- 3.0 before PDF procedure. PDF was performed, with an average of 7.4 +/- 4.4 sessions (range 3-15) per patient. Five patients survived after day 28, thus the 28-day mortality rate was 29%. In our multicenter study, 33 patients with severe sepsis who simultaneously suffered from liver dysfunction were enrolled and received PDF. On average, 12.0 +/- 16.4 sessions (range 2-70) per patient were performed. The 28-day mortality rate was 36.4%, while the predicted death rate was 68.0 +/- 17.7%. These findings suggest that PDF is a simple modality and may become a useful strategy for treatment of patients with septic multiple organ failure. Copyright 2010 S. Karger AG, Basel.

[Macrocephalic spermatozoa. What would be the impact on reproduction?].

PubMed

Guichaoua, M-R; Mercier, G; Geoffroy-Siraudin, C; Paulmyer-Lacroix, O; Lanteaume, A; Metzler-Guillemin, C; Perrin, J; Achard, V

2009-09-01

We want to highlight the risk of infertility and failure of Assisted Reproductive Technologies due to the presence of macrocephalic spermatozoa (MS) in the sperm at rate equalling or superior to 20% in at least one semen analysis. We did a retrospective analysis of 19 infertile patients presenting MS at average rate between 14.3 and 49.7%. For each patient, at least one semen analysis showed a MS rate equal or superior to 20%. We did an automated analysis of the spermatozoa surface for 13 patients and a detailed analysis of the MS morphology in 18 patients. Thirteen couples benefited of one or more IVF with or without ICSI. The semen analysis shows an impairment of one or more parameter of the sperm in all patients. Three morphological aspects for MS were highlighted: MS with irregular head, MS with regular head, and MS with multiple heads, with a dominance of irregular heads. The spermatozoa surface analysis shows a significant increase of the average surface and of the standard deviation (p<0.0001). The average rate of pregnancies by transfer is decreased compared to usual rates in our laboratories (13% versus 28%). We want to sensitize biologist and clinical doctors to the existence of partial forms of this syndrome, which could be related to infertility with impaired sperm parameters and low pregnancy rates after FIV or ICSI.

Module failure isolation circuit for paralleled inverters. [preventing system failure during power conditioning for spacecraft applications

NASA Technical Reports Server (NTRS)

Nagano, S. (Inventor)

1979-01-01

A module failure isolation circuit is described which senses and averages the collector current of each paralled inverter power transistor and compares the collector current of each power transistor the average collector current of all power transistors to determine when the sensed collector current of a power transistor in any one inverter falls below a predetermined ratio of the average collector current. The module associated with any transistor that fails to maintain a current level above the predetermined radio of the average collector current is then shut off. A separate circuit detects when there is no load, or a light load, to inhibit operation of the isolation circuit during no load or light load conditions.

Failed Surgical Management of Acute Proximal Fifth Metatarsal (Jones) Fractures: A Retrospective Case Series and Literature Review.

PubMed

Granata, Jaymes D; Berlet, Gregory C; Philbin, Terrence M; Jones, Grant; Kaeding, Christopher C; Peterson, Kyle S

2015-12-01

Nonunion, delayed union, and refracture after operative treatment of acute proximal fifth metatarsal fractures in athletes is uncommon. This study was a failure analysis of operatively managed acute proximal fifth metatarsal fractures in healthy athletes. We identified 149 patients who underwent operative treatment for fifth metatarsal fractures. Inclusion criteria isolated skeletally mature, athletic patients under the age of 40 with a minimum of 1-year follow-up. Patients were excluded with tuberosity fractures, fractures distal to the proximal metaphyseal-diaphyseal region of the fifth metatarsal, multiple fractures or operative procedures, fractures initially treated conservatively, and medical comorbidities/risk factors for nonunion. Fifty-five patients met the inclusion/exclusion criteria. Four (7.3%) patients required a secondary operative procedure due to refracture. The average time to refracture was 8 months. All refractures were associated with bent screws and occurred in male patients who participated in professional basketball, professional volleyball, and college football. The average time for release to progressive weight-bearing was 6 weeks. Three patients were revised to a bigger size screw and went on to union. One patient was revised to the same-sized screw and required a second revision surgery for nonunion. All failures were refractures in competitive athletes who were initially treated with small diameter solid or cannulated stainless steel screws. The failures were not associated with early postoperative weight-bearing protocol. Maximizing initial fixation stiffness may decrease the late failure rate in competitive athletes. More clinical studies are needed to better understand risk factors for failure after screw fixation in the competitive, athletic population. Prognostic, Level IV: Case series. © 2015 The Author(s).

Review and Analysis of Existing Mobile Phone Apps to Support Heart Failure Symptom Monitoring and Self-Care Management Using the Mobile Application Rating Scale (MARS).

PubMed

Masterson Creber, Ruth M; Maurer, Mathew S; Reading, Meghan; Hiraldo, Grenny; Hickey, Kathleen T; Iribarren, Sarah

2016-06-14

Heart failure is the most common cause of hospital readmissions among Medicare beneficiaries and these hospitalizations are often driven by exacerbations in common heart failure symptoms. Patient collaboration with health care providers and decision making is a core component of increasing symptom monitoring and decreasing hospital use. Mobile phone apps offer a potentially cost-effective solution for symptom monitoring and self-care management at the point of need. The purpose of this review of commercially available apps was to identify and assess the functionalities of patient-facing mobile health apps targeted toward supporting heart failure symptom monitoring and self-care management. We searched 3 Web-based mobile app stores using multiple terms and combinations (eg, "heart failure," "cardiology," "heart failure and self-management"). Apps meeting inclusion criteria were evaluated using the Mobile Application Rating Scale (MARS), IMS Institute for Healthcare Informatics functionality scores, and Heart Failure Society of America (HFSA) guidelines for nonpharmacologic management. Apps were downloaded and assessed independently by 2-4 reviewers, interclass correlations between reviewers were calculated, and consensus was met by discussion. Of 3636 potentially relevant apps searched, 34 met inclusion criteria. Most apps were excluded because they were unrelated to heart failure, not in English or Spanish, or were games. Interrater reliability between reviewers was high. AskMD app had the highest average MARS total (4.9/5). More than half of the apps (23/34, 68%) had acceptable MARS scores (>3.0). Heart Failure Health Storylines (4.6) and AskMD (4.5) had the highest scores for behavior change. Factoring MARS, functionality, and HFSA guideline scores, the highest performing apps included Heart Failure Health Storylines, Symple, ContinuousCare Health App, WebMD, and AskMD. Peer-reviewed publications were identified for only 3 of the 34 apps. This review suggests that few apps meet prespecified criteria for quality, content, or functionality, highlighting the need for further refinement and mapping to evidence-based guidelines and room for overall quality improvement in heart failure symptom monitoring and self-care related apps.

An International Survey of Industrial Applications of Formal Methods. Volume 2. Case Studies

DTIC Science & Technology

1993-09-30

impact of the product on IBM revenues. 4. Error rates were claimed to be below industrial average and errors were minimal to fix. Formal methods, as...critical applications. These include: 3 I I International Survey of Industrial Applications 41 i) "Software failures, particularly under first use, seem...project to add improved modelling capability. I U International Survey of Industrial Applications 93 I Design and Implementation These products are being

Study on electromagnetic radiation and mechanical characteristics of coal during an SHPB test

NASA Astrophysics Data System (ADS)

Chengwu, Li; Qifei, Wang; Pingyang, Lyu

2016-06-01

Dynamic loads provided by a Split Hopkinson pressure bar are applied in the impact failure experiment on coal with an impact velocity of 4.174-17.652 m s-1. The mechanical property characteristics of coal and an electromagnetic radiation signal can be detected and measured during the experiment. The variation of coal stress, strain, incident energy, dissipated energy and other mechanical parameters are analyzed by the unidimensional stress wave theory. It suggests that with an increase of the impact velocity, the mechanical parameters and electromagnetic radiation increased significantly and the dissipated energy of the coal sample has a high discrete growing trend during the failure process of coal impact. Combined with the received energy of the electromagnetic radiation signal, the relationship between these mechanical parameters and electromagnetic radiation during the failure process of coal burst could be analyzed by the grey correlation model. The results show that the descending order of the gray correlation degree between the mechanical characteristics and electromagnetic radiation energy are impact velocity, maximum stress, the average stress, incident energy, the average strain, maximum strain, the average strain rate and dissipation energy. Due to the correlation degree, the impact velocity and incident energy are relatively large, and the main factor affecting the electromagnetic radiation energy of coal is the energy magnitude. While the relationship between extreme stress and the radiation energy change trend is closed, the stress state of coal has a greater impact on electromagnetic radiation than the strain and destruction which can deepen the research of the coal-rock dynamic disaster electromagnetic monitoring technique.

Subsidence and well failure in the South Belridge Diatomite field

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

Rouffignac, E.P. de; Bondor, P.L.; Karanikas, J.M. Hara, S.K.

1995-12-31

Withdrawal of fluids from shallow, thick and low strength rock can cause substantial reservoir compaction leading to surface subsidence and well failure. This is the case for the Diatomite reservoir, where over 10 ft of subsidence have occurred in some areas. Well failure rates have averaged over 3% per year, resulting in several million dollars per year in well replacement and repair costs in the South Belridge Diatomite alone. A program has been underway to address this issue, including experimental, modeling and field monitoring work. An updated elastoplastic rock law based on laboratory data has been generated which includes notmore » only standard shear failure mechanisms but also irreversible pore collapse occurring at low effective stresses (<150 psi). This law was incorporated into a commercial finite element geomechanics simulator. Since the late 1980s, a network of level survey monuments has been used to monitor subsidence at Belridge. Model predictions of subsidence in Section 33 compare very well with field measured data, which show that water injection reduces subsidence from 7--8 inches per year to 1--2 inches per year, but does not abate well failure.« less

Reducing failures of working memory with performance feedback.

PubMed

Adam, Kirsten C S; Vogel, Edward K

2016-10-01

Fluctuations in attentional control can lead to failures of working memory (WM), in which the subject is no better than chance at reporting items from a recent display. In three experiments, we used a whole-report measure of visual WM to examine the impact of feedback on the rate of failures. In each experiment, subjects remembered an array of colored items across a blank delay, and then reported the identity of items using a whole-report procedure. In Experiment 1, we gave subjects simple feedback about the number of items they correctly identified at the end of each trial. In Experiment 2, we gave subjects additional information about the cumulative number of items correctly identified within each block. Finally, in Experiment 3, we gave subjects weighted feedback in which poor trials resulted in lost points and consistent successful performance received "streak" points. Surprisingly, simple feedback (Exp. 1) was ineffective at improving average performance or decreasing the rate of poor-performance trials. Simple cumulative feedback (Exp. 2) modestly decreased poor-performance trials (by 7 %). Weighted feedback produced the greatest benefits, decreasing the frequency of poor-performance trials by 28 % relative to baseline performance. This set of results demonstrates the usefulness of whole-report WM measures for investigating the effects of feedback on WM performance. Further, we showed that only a feedback structure that specifically discouraged lapses using negative feedback led to large reductions in WM failures.

Recommended placement torque when tightening an orthodontic mini-implant.

PubMed

Motoyoshi, Mitsuru; Hirabayashi, Masayuki; Uemura, Miwa; Shimizu, Noriyoshi

2006-02-01

To determine an adequate placement torque for obtaining a better success rate of mini-implants that are screwed into the buccal alveolar bone of the posterior region as an anchor for orthodontic treatment, implant placement torque (IPT) was measured. The subjects were 41 orthodontic patients (124 implants), with an average age of 24.9 years (SD 6.5 years), who had surgery to place titanium mini-implants. The peak value of IPT was measured using a torque screwdriver. The success rate of the mini-implant anchor for 124 implants was 85.5%. The mean IPT ranged from 7.2 to 13.5 N cm, depending on the location of the implants. There was a significant difference in the IPT between maxilla and mandible. The IPT in the mandible was, unexpectedly, significantly higher in the failure group than in the success group. Therefore, a large IPT should not be used always. According to our calculations of the risk ratio for failure, to raise the success rate of 1.6-mm diameter mini-implants, the recommended IPT is within the range from 5 to 10 N cm.

Early reading performance: a comparison of teacher-based and test-based assessments.

PubMed

Kenny, D T; Chekaluk, E

1993-04-01

An unresolved question in early screening is whether test-based or teacher-based assessments should form the basis of the classification of children at risk of educational failure. Available structured teacher rating scales are lacking in predictive validity, and teacher predictions of students likely to experience reading difficulties have yielded disappointing true positive rates, with teachers failing to identify the majority of severely disabled readers. For this study, three educational screening instruments were developed: (a) a single teacher rating, categorizing children into three levels of reading ability (advanced, average, poor); (b) a 15-item teacher questionnaire designed to measure students' cognitive and language ability, attentional and behavioral characteristics, and academic performance; and (c) a battery of language and reading tests that are predictive of, or correlate with, reading failure. The concurrent validity of each instrument was assessed in a sample of 312 Australian schoolchildren from kindergarten, Year 1, and Year 2. Students were assessed at the end of the 1989 school year after having completed 1, 2, or 3 years of schooling. The results suggest that the nature of the skills required for success in reading changes in the first 3 years of schooling. Both teachers and tests concur more closely as children progress through the elementary years and as the risk behavior (reading) becomes more accessible to direct measurement. Carefully focused teacher rating scales may be a cost-effective means of identifying children at risk of reading failure. Improved teacher rating scales should be developed and used to assist in the early screening process.

A 13000-hour test of a mercury hollow cathode

NASA Technical Reports Server (NTRS)

Rawlin, V. K.

1973-01-01

A mercury-fed hollow cathode was tested for 12,979 hours in a bell jar at SERT 2 neutralizer operating conditions. The net electron current drawn to a collector was 0.25 ampere at average collector voltages between 21.8 and 36.7 volts. The mercury flow rate was varied from 5.6 to 30.8 equivalent milliamperes to give stable operation at the desired electrode voltages and currents. Variations with time in the neutralizer discharge characteristics were observed and hypothesized to be related to changes in the cathode orifice dimensions and the availability of electron emissive material. A facility failure caused abnormal test conditions for the last 876 hours and led to the cathode heater failure which concluded the test.

Utility of an Algorithm to Increase the Accuracy of Medication History in an Obstetrical Setting.

PubMed

Corbel, Aline; Baud, David; Chaouch, Aziz; Beney, Johnny; Csajka, Chantal; Panchaud, Alice

2016-01-01

In an obstetrical setting, inaccurate medication histories at hospital admission may result in failure to identify potentially harmful treatments for patients and/or their fetus(es). This prospective study was conducted to assess average concordance rates between (1) a medication list obtained with a one-page structured medication history algorithm developed for the obstetrical setting and (2) the medication list reported in medical records and obtained by open-ended questions based on standard procedures. Both lists were converted into concordance rate using a best possible medication history approach as the reference (information obtained by patients, prescribers and community pharmacists' interviews). The algorithm-based method obtained a higher average concordance rate than the standard method, with respectively 90.2% [CI95% 85.8-94.3] versus 24.6% [CI95%15.3-34.4] concordance rates (p<0.01). Our algorithm-based method strongly enhanced the accuracy of the medication history in our obstetric population, without using substantial resources. Its implementation is an effective first step to the medication reconciliation process, which has been recognized as a very important component of patients' drug safety.

Reproductive Ecology Of The Florida Scrub-Jay (Aphelocoma Coerulescens) On John F. Kennedy Space Center/Merritt Island National Wildlife Refuge: A Long-Term Study

NASA Technical Reports Server (NTRS)

Carter, Geoffry M.; Breininger, David R.; Larson, Vicky L.; Oddy, Donna M.; Smith, Rebecca B.; Stolen, Eric D.

2005-01-01

From 1988 to 2002 we studied the breeding ecology of Florida Scrub-Jays (Aphelocoma coerulescens) on John F. Kennedy Space Center/Merritt Island National Wildlife Refuge. We examined phenology, clutch size, hatching failure rates, fledgling production, nest success, predation rates, sources egg and nestling mortality, and the effects of helpers on these measures. Nesting phenology was similar among sites. Mean clutch size at Titan was significantly larger than at HC or T4. Pairs with helpers did not produce larger clutches than pairs without helpers. Fledgling production at T4 was significantly greater than at HC and similar to Titan. Pairs with helpers at HC produced significantly more fledglings than pairs without helpers; helpers did not influence fledgling production at the other sites. Nest success at HC and Titan was low, 19% and 32% respectively. Nest success at T4 was 48% and was significantly greater than at HC. Average predation rates at all sites increased with season progression. Predation rates at all sight rose sharply by early June. The main cause of nest failure at all sites was predation, 93%.

Heroic Reliability Improvement in Manned Space Systems

NASA Technical Reports Server (NTRS)

Jones, Harry W.

2017-01-01

System reliability can be significantly improved by a strong continued effort to identify and remove all the causes of actual failures. Newly designed systems often have unexpected high failure rates which can be reduced by successive design improvements until the final operational system has an acceptable failure rate. There are many causes of failures and many ways to remove them. New systems may have poor specifications, design errors, or mistaken operations concepts. Correcting unexpected problems as they occur can produce large early gains in reliability. Improved technology in materials, components, and design approaches can increase reliability. The reliability growth is achieved by repeatedly operating the system until it fails, identifying the failure cause, and fixing the problem. The failure rate reduction that can be obtained depends on the number and the failure rates of the correctable failures. Under the strong assumption that the failure causes can be removed, the decline in overall failure rate can be predicted. If a failure occurs at the rate of lambda per unit time, the expected time before the failure occurs and can be corrected is 1/lambda, the Mean Time Before Failure (MTBF). Finding and fixing a less frequent failure with the rate of lambda/2 per unit time requires twice as long, time of 1/(2 lambda). Cutting the failure rate in half requires doubling the test and redesign time and finding and eliminating the failure causes.Reducing the failure rate significantly requires a heroic reliability improvement effort.

Experience with the artificial urinary sphincter model AS800 in 148 patients.

PubMed

Fishman, I J; Shabsigh, R; Scott, F B

1989-02-01

The latest version of the artificial urinary sphincter, AS800, was used in 148 patients with urinary incontinence of different etiologies. Followup ranged from 3 to 37 months, with an average of 20.8 months. There were 112 (76 per cent) male and 36 (24 per cent) female patients. The cuff was implanted around the bladder neck in 78 patients (53 per cent) and around the bulbar urethra in 70 (47 per cent). Socially acceptable urinary control was achieved in 90 per cent of the 139 patients with active devices in place. It was necessary to remove the sphincter in 11 patients (7.4 per cent). The reasons for removal were infection and erosion in 8 patients (5.4 per cent), infection without erosion in 2 (1.3 per cent), and erosion due to excess pressure and poor tissues in 1 (0.7 per cent). Comparison of success and failure rates associated with incontinence of different etiologies revealed that patients with incontinence after failure of a conventional antistress incontinence operation and those with incontinence after transurethral resection or radical prostactectomy had the highest success rate, and that patients with incontinence secondary to pelvic fracture or exstrophy and epispadias had the highest failure rates. The deactivation feature (the lock) of the new artificial sphincter model was beneficial for primary deactivation, urethral catheterization or cystoscopy, or for elective nocturnal decompression of the bladder neck or urethral tissues.

Systolic Strain Abnormalities to Predict Hospital Readmission in Patients With Heart Failure and Normal Ejection Fraction

PubMed Central

Borer, Steven M.; Kokkirala, Aravind; O'Sullivan, David M.; Silverman, David I.

2011-01-01

Background Despite intensive investigation, the pathogenesis of heart failure with normal ejection fraction (HFNEF) remains unclear. We hypothesized that subtle abnormalities of systolic function might play a role, and that abnormal systolic strain and strain rate would provide a marker for adverse outcomes. Methods Patients of new CHF and left ventricular ejection fraction > 50% were included. Exclusion criteria were recent myocardial infarction, severe valvular heart disease, severe left ventricular hypertrophy (septum >1.8 cm), or a technically insufficient echocardiogram. Average peak systolic strain and strain rate were measured using an off-line grey scale imaging technique. Systolic strain and strain rate for readmitted patients were compared with those who remained readmission-free. Results One hundred consecutive patients with a 1st admission for HFNEF from January 1, 2004 through December 31, 2007, inclusive, were analyzed. Fifty two patients were readmitted with a primary diagnosis of heart failure. Systolic strain and strain rates were reduced in both study groups compared to controls. However, systolic strain did not differ significantly between the two groups (-11.7% for those readmitted compared with -12.9% for those free from readmission, P = 0.198) and systolic strain rates also were similar (-1.05 s-1 versus -1.09 s-1, P = 0.545). E/e’ was significantly higher in readmitted patients compared with those who remained free from readmission (14.5 versus 11.0, P = 0.013). E/e’ (OR 1.189, 95% CI 1.026-1.378; P = 0.021) was found to be an independent predictor for HFNEF readmission. Conclusions Among patients with new onset HFNEF, SS and SR rates are reduced compared with patients free of HFNEF, but do not predict hospital readmission. Elevated E/e’ is a predictor of readmission in these patients. PMID:28352395

A pilot study on the functional performance and acceptability of an innovative female condom (Wondaleaf®) in Malaysia

PubMed Central

Wong, Ee-Lynn; Tnay, Jessie Koh-Sing

2018-01-01

Background Female condom (FC) has been available for over 30 years, but it still lacks wide acceptability. To overcome misdirection and invagination occurring in FC and to provide a wider area of protection, Wondaleaf® (WL), a new-generation adhesive FC, was recently invented. This pioneering study sought to assess the acceptability and functional performance of WL among Malaysian women. Methods A mixed method survey was conducted in three cities of Malaysia, recruiting sexually active heterosexual women, aged 18–50, by snowball sampling method. Participants were provided with WL and initially surveyed to rate its performance in five coital usages over 2 months. After that, the participants underwent a second survey to rate their satisfaction and acceptability toward WL. Descriptive statistics on clinical failure rates were tabulated with correlational analysis performed to identify major variables contributing to WL’s functional performance and acceptability. Results Out of the 51 enrolled participants, 31 women completed the required surveys. WL’s total clinical failure rate was 2.60% (out of 155 condom uses) with above-average ratings of functional performance. The ease of use significantly correlated with ratings of no slippage and no misdirection. The confidence in WL’s safety features significantly correlated with a sense of empowerment and protection. Conclusion WL has a relatively low risk of clinical failures and an overall favorable acceptability among Malaysian women. However, this study also showed that its future usage largely depends on partner acceptability. It may have the potential of complementing the existing barrier toward contraceptive use. Further studies are needed to understand the global acceptability of WL. PMID:29440937

[Application of damage control concept in severe limbs fractures combining with multiple trauma].

PubMed

Bayin, Er-gu-le; Jin, Hong-bing; Li, Ming

2015-09-01

To discuss the application and clinical effect of damage control concept in the treatment of severe limbs fractures combining with multiple trauma. From July 2009 to July 2012, 30 patients with severe limbs fractures combining with multiple trauma were treated with the damage control concept, included 20 males and 10 females with an average age of (34.03 ± 12.81) years old ranging from 20 to 60 years old; the ISS averaged (35.00 ± 12.81) points (ranged from 26 to 54 points). And the control group also contained 30 patients with severe limbs fractures combining with multiple trauma treated by the traditional operation from June 2006 to June 2009, there were 23 males and 7 females with an average age of (34.23 ± 11.04) years old ranging from 18 to 65 years old. The ISS averaged (35.56 ± 11.04) points (ranged from 26 to 51 points). The age, gender, ISS, Gustilo classification, operation time, intraoperative blood loss, blood transfusion,postoperative complications and mortality rate were observed and compared. In the damage control concept group,there were 28 cases surviving and 2 cases (6.7%) death; 6 cases of postoperative complication included 2 cases of adult respiratory distress syndrome, 1 case of multiple organ failure, 1 case of disseminated intravascular coagulation and 2 cases of wound infection. In the control group, there were 22 cases surviving and 8 cases death(26.7%); 13 cases of postoperative complication included 4 cases of adult respiratory distress syndrome,2 cases of multiple organ failure, 2 cases of disseminated intravascular coagulation and 3 cases of wound infection. There were no statistically significant differences between two groups in age, gender, ISS, Gustilo classfication and complication (P > 0.05), however there were statistically significant differences in mortality rate, operation time, blodd loss, blodd transfusion between two groups (P < 0.05). Damage control concept is used to treat severe limbs fractures combining with multiple trauma which has the rapid and effective therapy, can improve survival rate and reduce complication.

Efficacy of concurrent treatments in idiopathic pulmonary fibrosis patients with a rapid progression of respiratory failure: an analysis of a national administrative database in Japan.

PubMed

Oda, Keishi; Yatera, Kazuhiro; Fujino, Yoshihisa; Ishimoto, Hiroshi; Nakao, Hiroyuki; Hanaka, Tetsuya; Ogoshi, Takaaki; Kido, Takashi; Fushimi, Kiyohide; Matsuda, Shinya; Mukae, Hiroshi

2016-06-08

Some IPF patients show a rapid progression of respiratory failure. Most patients are treated with high-dose corticosteroids. However, no large clinical studies have investigated the prognosis or efficacy of combined treatments including high-dose corticosteroids in IPF patients with a rapid progression of respiratory failure. We enrolled IPF patients who received mechanical ventilation and high-dose corticosteroids between April 2010 and March 2013. Records were extracted from a Japanese nationwide inpatient database. We conducted a retrospective epidemiologic and prognostic analysis. Two hundred nine patients receiving an average of 12.8 days of ventilatory support were enrolled. There were 138 (66 %) fatal cases; the median survival was 21 days. The short-term (within 30 days) and long-term (within 90 days) survival rates were 44.6 and 24.6 %, respectively. The average monthly admission rate among the IPF patients with the rapid progression of respiratory failure in the winter was significantly higher than that in spring (p = 0.018). Survival did not differ to a statistically significant extent in the different geographic areas of Japan. Survivors were significantly younger (p = 0.002) with higher rates of mild dyspnea on admission (p = 0.012), they more frequently underwent bronchoscopy (p < 0.001), and received anticoagulants (p = 0.027), co-trimoxazole (p < 0.001) and macrolide (p = 0.02) more frequently than non-survivors. A multivariate logistic analysis demonstrated that two factors were significantly associated with a poor prognosis: >80 years of age (OR = 2.94, 95 % Cl 1.044-8.303; p = 0.041) and the intravenous administration of high-dose cyclophosphamide (OR = 3.17, 95 % Cl 1.101-9.148; p = 0.033). Undergoing bronchoscopy during intubation (OR = 0.25, 95 % Cl 0.079-0.798; p = 0.019) and the administration of co-trimoxazole (OR = 0.28, 95 % Cl 0.132-0.607; p = 0.001) and macrolides (OR = 0.37, 95 % Cl 0.155-0.867; p = 0.033) were significantly associated with a good prognosis. The dosage of co-trimoxazole significantly correlated with survival. Co-trimoxazole and macrolides may be a good addition to high-dose corticosteroids in the treatment of IPF patients with a rapid progression of respiratory failure.

Revision of Environmental Factors for Mil-HDBK-217B

DTIC Science & Technology

1980-09-01

and directions for application have been included. Apprpriate revision sheets to MIL-OMK-217 hee been provided as an appendix to the final report. 7...ef this study. In anticipation of insufficient data for direct statistical analysis ir, r11 categories of the study, it was determined that expert...reliability was alreadv known. The resuilting mode failure rates were too low by a factor of about 8 to 1. This methid was more accurate than Lhe average part

Relationships between day one piglet serum immunoglobulin immunocrit and subsequent growth, puberty attainment, litter size, and lactation performance.

PubMed

Vallet, J L; Miles, J R; Rempel, L A; Nonneman, D J; Lents, C A

2015-06-01

Colostrum affects gut and uterine gland development in the neonatal piglet, suggesting that subsequent growth and reproductive performance may be affected. Measuring immunoglobulin in piglet serum using the immunoglobulin immunocrit on Day 1 of age provides a simple, inexpensive indication of the amount of colostrum acquired by the piglet in the first day of life. Relationships between serum immunoglobulin immunocrit measures and subsequent growth rates, age at puberty, incidence of puberty failure, litter size, and lactation performance were examined in pigs born and subsequently farrowing between 2009 and 2013. Immunoglobulin immunocrit measures were collected on 16,762 piglets on Day 1 of age. Of these piglets, BW measurements were available from 15,324 (7,684 males and 7,640 females) piglets at a range of ages from weaning to 200 d of age, allowing an assessment of growth rates. Age at puberty was recorded from a subset of 2,857 of the females after observing them for estrous behavior from approximately 170 to 250 d of age. To examine relationships between d 1 immunocrit and puberty failure, gilts with immunocrit measures that failed to reach puberty (n = 119) were matched with littermate gilts with immunocrit measures that achieved puberty (n = 167). Similarly, number born alive was collected on a subset (n = 799) of females from first to fourth parities for which d 1 immunocrits were measured on them as neonates. Finally, d 1 immunocrit effect on adult lactational competence was assessed by measuring litter average (offspring of 440 females) and litter average piglet preweaning growth rate (offspring of 774 females) in females where d 1 immunocrits were available from them as neonates. Results indicated that low d 1 immunocrits were subsequently associated with reduced growth (P < 0.01), increased age at puberty (P < 0.01), reduced number born alive (P < 0.05), reduced litter average immunocrit (P < 0.05), and reduced litter average preweaning growth rate during lactation (P < 0.05). This suggests that management efforts to improve the amount of colostrum ingested by neonatal piglets would result in beneficial changes in production efficiency, particularly for gilts destined for the breeding herd. It also suggests that the immunoglobulin immunocrit can be useful in monitoring colostrum ingestion to maximize the beneficial effects of colostrum on subsequent performance.

40 CFR 49.10711 - Federal Implementation Plan for the Astaris-Idaho LLC Facility (formerly owned by FMC Corporation...

Code of Federal Regulations, 2012 CFR

2012-07-01

... section, consistent with any averaging period specified for averaging the results of monitoring. Fugitive... beneficial. Monitoring malfunction means any sudden, infrequent, not reasonably preventable failure of the monitoring to provide valid data. Monitoring failures that are caused in part by poor maintenance or careless...

40 CFR 49.10711 - Federal Implementation Plan for the Astaris-Idaho LLC Facility (formerly owned by FMC Corporation...

Code of Federal Regulations, 2014 CFR

2014-07-01

... section, consistent with any averaging period specified for averaging the results of monitoring. Fugitive... beneficial. Monitoring malfunction means any sudden, infrequent, not reasonably preventable failure of the monitoring to provide valid data. Monitoring failures that are caused in part by poor maintenance or careless...

Devil's Slide: An evolving feature of California's coastal landscape

NASA Astrophysics Data System (ADS)

Thomas, M.; Loague, K.

2013-12-01

Coastal landslides in the United States remain a persistent threat to human life and urban development. The focus of this study is a landslide-prone section of the central California coastline, approximately 20 km south of San Francisco, known as Devil's Slide. This investigation employs an extensive aerial image inventory, digital elevation models (DEMs), and a water balance / limit-equilibrium approach to better understand the spatial and temporal characteristics of deep-seated bedrock slides at the site. Photographic surveys of the area reveal nearly three kilometers of headscarp and a complex network of slope failures that respond to hydrologic, seismic, and anthropogenic perturbations. DEM analysis suggests that, for a 145-year period (1866 to 2010), the study area experienced an average coastal retreat rate of 0.14 m yr-1 and an average volumetric loss of 11,216 m3 yr-1. At least 38% of the landscape evolution in the steep coastal terrain has been driven by slope failure events. A loosely coupled water balance / limit-equilibrium analysis quantitatively illustrates the precarious nature of the active landslide zone at the site. The slope is shown to be unstable for a large suite of equally-likely scenarios. The analyses presented herein suggest that future work should include a rigorous characterization of pore-water pressure development, driven by comprehensive simulations of subsurface hydrologic response, to improve our understanding of slope failure initiation at the Devil's Slide site.

[Non-operative treatment for severe forms of infantile idiopathic scoliosis].

PubMed

Trobisch, P D; Samdani, A; O'Neil, C; Betz, R; Cahill, P

2012-02-01

Infantile idiopathic scoliosis (IIS) is a rare orthopaedic condition. Braces and casts are popular options in the treatment of IIS but there is a paucity of studies commenting on the outcome of non-operative treatment. The purpose of this study was to analyse failure and success after non-operative treatment for severe forms of IIS. We retrospectively reviewed the data of all children who had been treated for IIS between 2003 and 2009 at a single institution. After calculating the failure and success rates, we additionally performed a risk factor analysis for patients who failed non-operative treatment. Chi (2) and T tests were used for statistical analysis with significance set at p < 0.05. 25 children with an average age of 11 months and an Cobb angle of 46 degrees at presentation were analysed. Seven (28 %) patients were considered as having failed non-operative treatment after an average follow-up of 28 months. The pretreatment Cobb angle was identified as single significant risk factor for failure (55 versus 42) while neither age, gender, nor RVAD seem to influence the outcome. In children who were considered as successfully treated, the Cobb angle decreased from 42 to 18 degrees. Non-operative treatment for IIS is successful in 3 out of 4 patients. © Georg Thieme Verlag KG Stuttgart · New York.

Reliability Evaluation of Base-Metal-Electrode Multilayer Ceramic Capacitors for Potential Space Applications

NASA Technical Reports Server (NTRS)

Liu, David (Donhang); Sampson, Michael J.

2011-01-01

Base-metal-electrode (BME) ceramic capacitors are being investigated for possible use in high-reliability spacelevel applications. This paper focuses on how BME capacitors construction and microstructure affects their lifetime and reliability. Examination of the construction and microstructure of commercial off-the-shelf (COTS) BME capacitors reveals great variance in dielectric layer thickness, even among BME capacitors with the same rated voltage. Compared to PME (precious-metal-electrode) capacitors, BME capacitors exhibit a denser and more uniform microstructure, with an average grain size between 0.3 and 0.5 m, which is much less than that of most PME capacitors. BME capacitors can be fabricated with more internal electrode layers and thinner dielectric layers than PME capacitors because they have a fine-grained microstructure and do not shrink much during ceramic sintering. This makes it possible for BME capacitors to achieve a very high capacitance volumetric efficiency. The reliability of BME and PME capacitors was investigated using highly accelerated life testing (HALT). Most BME capacitors were found to fail with an early avalanche breakdown, followed by a regular dielectric wearout failure during the HALT test. When most of the early failures, characterized with avalanche breakdown, were removed, BME capacitors exhibited a minimum mean time-to-failure (MTTF) of more than 105 years at room temperature and rated voltage. Dielectric thickness was found to be a critical parameter for the reliability of BME capacitors. The number of stacked grains in a dielectric layer appears to play a significant role in determining BME capacitor reliability. Although dielectric layer thickness varies for a given rated voltage in BME capacitors, the number of stacked grains is relatively consistent, typically around 12 for a number of BME capacitors with a rated voltage of 25V. This may suggest that the number of grains per dielectric layer is more critical than the thickness itself for determining the rated voltage and the life expectancy of the BME capacitor. The leakage current characterization and the failure analysis results suggest that most of these early avalanche failures are due to the extrinsic minor construction defects introduced during fabrication of BME capacitors. The concentration of the extrinsic defects must be reduced if the BME capacitors are considered for high reliability applications. There are two approaches that can reduce or prevent the occurrence of early failure in BME capacitors: (1) to reduce the defect concentration with improved processing control; (2) to prevent the use of BME capacitors under harsh external stress levels so that the extrinsic defects will never be triggered for a failure. In order to do so appropriate dielectric layer thickness must be determined for a given rated voltage.

Is a high serum copper concentration a risk factor for implantation failure?

PubMed

Matsubayashi, Hidehiko; Kitaya, Kotaro; Yamaguchi, Kohei; Nishiyama, Rie; Takaya, Yukiko; Ishikawa, Tomomoto

2017-08-10

Copper-containing contraceptive devices may deposit copper ions in the endometrium, resulting in implantation failure. The deposition of copper ions in many organs has been reported in patients with untreated Wilson's disease. Since these patients sometimes exhibit subfertility and/or early pregnancy loss, copper ions were also considered to accumulate in the uterine endometrium. Wilson's disease patients treated with zinc successfully delivered babies because zinc interfered with the absorption of copper from the gastrointestinal tract. These findings led to the hypothesis that infertile patients with high serum copper concentrations may have implantation failure due to the excess accumulation of copper ions. The relationship between implantation (pregnancy) rates and serum copper concentrations has not yet been examined. The Japanese government recently stated that actual copper intake was higher among Japanese than needed. Therefore, the aim of the present study was to investigate whether serum copper concentrations are related to the implantation (pregnancy) rates of human embryos in vivo. We included 269 patients (age <40 years old) who underwent vitrifying and warming single embryo transfer with a hormone replacement cycle using good blastocysts (3BB or more with Gardner's classification). Serum hCG, copper, and zinc concentrations were measured 16 days after the first date of progesterone replacement. We compared 96 women who were pregnant without miscarriage at 10 weeks of gestation (group P) and 173 women who were not pregnant (group NP). No significant differences were observed in age or BMI between the groups. Copper concentrations were significantly higher in group NP (average 193.2 μg/dL) than in group P (average 178.1 μg/dL). According to the area under the curve (AUC) on the receiver operating characteristic curve for the prediction of clinical pregnancy rates, the Cu/Zn ratio (AUC 0.64, 95% CI 0.54-0.71) was a better predictor than copper or zinc. When we set the cut-off as 1.59/1.60 for the Cu/Zn ratio, sensitivity, specificity, the positive predictive value, and negative predictive value were 0.98, 0.29, 0.71, and 0.88, respectively. Our single-center retrospective study suggests that high serum copper concentrations (high Cu/Zn ratio) are a risk factor for implantation failure.

Sudden cardiac death rates in an Australian population: a data linkage study.

PubMed

Feng, Jia-Li; Hickling, Siobhan; Nedkoff, Lee; Knuiman, Matthew; Semsarian, Christopher; Ingles, Jodie; Briffa, Tom G

2015-11-01

The aim of the present study was to develop criteria to identify sudden cardiac death (SCD) and estimate population rates of SCD using administrative mortality and hospital morbidity records in Western Australia. Four criteria were developed using place, death within 24 h, principal and secondary diagnoses, underlying and associated cause of death, and/or occurrence of a post mortem to identify SCD. Average crude, age-standardised and age-specific rates of SCD were estimated using population person-linked administrative data. In all, 9567 probable SCDs were identified between 1997 and 2010, with one-third aged ≥ 35 years having no prior admission for cardiovascular disease. SCD was more frequent in men (62.1%). The estimated average annual crude SCD rate for the period was 34.6 per 100 000 person-years with an average annual age-standardised rate of 37.8 per 100 000 person-years. Age-specific standardised rates were 1.1 per 100 000 person-years and 70.7 per 100 000 person-years in people aged 1-34 and ≥ 35 years, respectively. Ischaemic heart disease (IHD) was recorded as the underlying cause of death in approximately 80% of patients aged ≥ 35 years, followed by valvular heart disease and heart failure. IHD was the most common cause of death in those aged 1-34 years, followed by unspecified cardiomyopathy and dysrhythmias. Administrative morbidity and mortality data can be used to estimate rates of SCD and therefore provide a suitable methodology for monitoring SCD over time. The findings highlight the magnitude of SCD and its potential for public health prevention.

Clinical Experience with the M4 Ahmed Glaucoma Drainage Implant.

PubMed

Sluch, Ilya; Gudgel, Brett; Dvorak, Justin; Anne Ahluwalia, Mary; Ding, Kai; Vold, Steve; Sarkisian, Steven

2017-01-01

To evaluate the safety and efficacy of the M4 (porous polyethylene plate) Ahmed Glaucoma Valve (AGV) drainage implant in a multicenter retrospective study. A retrospective chart review of medical records of patients who had undergone the M4 Ahmed valve was performed from January 2013 to April 2015. The primary outcome measure was surgical failure defined as: Less than a 20% reduction in baseline intraocular pressure (IOP) to last follow-up visit, final IOP less than 5 mm Hg or greater than 18 mm Hg, reoperation for glaucoma, or loss of light perception vision. All eyes not meeting the above criteria were defined as success. A total of 291 eyes met all study inclusion criteria. The average follow-up in the study was 6 months (±7.6 months) with 112 patients achieving 12-month follow-up (38.5%). 208 eyes (71.5%) met the study success criteria at final follow-up. No statistically significant spikes in postoperative IOP at 1 and 4 months were detected. The average preoperative IOP was 26.0 on an average of 2.8 medications. At 6 months, the average IOP dropped to 16.7 on 0.9 medications and stayed relatively stable at 15.8 on 1.2 medications at 12-month follow-up. The M4 valve appears to have less of a hypertensive phase compared with the other Ahmed class valves with a similar safety profile. While 71.5% success rate was achieved at final follow-up, the failure rate steadily increased over time. While the M4 production has been discontinued, the porous design of the M4 may avoid a pressure spike in the Ahmed valve class and warrants future investigation for valve design. How to cite this article: Sluch I, Gudgel B, Dvorak J, Ahluwalia MA, Ding K, Vold S, Sarkisian S. Clinical Experience with the M4 Ahmed Glaucoma Drainage Implant. J Curr Glaucoma Pract 2017;11(3):92-96.

Poor short term outcome with a metal-on-metal total hip arthroplasty.

PubMed

Levy, Yadin D; Ezzet, Kace A

2013-08-01

Metal-on-metal (MoM) bearings for total hip arthroplasty (THA) have come under scrutiny with reports of high failure rates. Clinical outcome studies with several commercially available MoM THA bearings remain unreported. We evaluated 78 consecutive MoM THAs from a single manufacturer in 68 patients. Sixty-six received cobalt-chrome (CoCr) monoblock and 12 received modular titanium acetabular cups with internal CoCr liners. Femoral components were titanium with modular necks. At average 2.1 years postoperatively, 12 THAs (15.4%) demonstrated aseptic failure (10 revisions, 2 revision recommended). All revised hips demonstrated capsular necrosis with positive histology reaction for aseptic lymphocytic vasculitis-associated lesions/adverse local tissue reactions. Prosthetic instability following revision surgery was relatively common. Female gender was a strong risk factor for failure, though smaller cups were not. Both monoblock and modular components fared poorly. Corrosion was frequently observed around the proximal and distal end of the modular femoral necks. Copyright © 2013 Elsevier Inc. All rights reserved.

Validation Study of Unnotched Charpy and Taylor-Anvil Impact Experiments using Kayenta

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

Kamojjala, Krishna; Lacy, Jeffrey; Chu, Henry S.

2015-03-01

Validation of a single computational model with multiple available strain-to-failure fracture theories is presented through experimental tests and numerical simulations of the standardized unnotched Charpy and Taylor-anvil impact tests, both run using the same material model (Kayenta). Unnotched Charpy tests are performed on rolled homogeneous armor steel. The fracture patterns using Kayenta’s various failure options that include aleatory uncertainty and scale effects are compared against the experiments. Other quantities of interest include the average value of the absorbed energy and bend angle of the specimen. Taylor-anvil impact tests are performed on Ti6Al4V titanium alloy. The impact speeds of the specimenmore » are 321 m/s and 393 m/s. The goal of the numerical work is to reproduce the damage patterns observed in the laboratory. For the numerical study, the Johnson-Cook failure model is used as the ductile fracture criterion, and aleatory uncertainty is applied to rate-dependence parameters to explore its effect on the fracture patterns.« less

Life test of the InGaAs focal plane arrays detector for space applications

NASA Astrophysics Data System (ADS)

Zhu, Xian-Liang; Zhang, Hai-Yan; Li, Xue; Huang, Zhang-Cheng; Gong, Hai-Mei

2017-08-01

The short-wavelength infrared (SWIR) InGaAs focal plane array (FPA) detector consists of infrared detector chip, readout integrated circuit (ROIC), and flip-chip bonding interconnection by Indium bump. In order to satisfy space application requirements for failure rates or Mean Time to Failure (MTTF), which can only be demonstrated with the large number of detectors manufactured, the single pixel in InGaAs FPAs was chosen as the research object in this paper. The constant-stress accelerated life tests were carried out at 70°C 80°C 90°C and100°C. The failed pixels increased gradually during more than 14000 hours at each elevated temperatures. From the random failure data the activation energy was estimated to be 0.46eV, and the average lifetime of a single pixel in InGaAs FPAs was estimated to be longer than 1E+7h at the practical operating temperature (5°C).

Failure of self-similarity for large (Mw > 81/4) earthquakes.

USGS Publications Warehouse

Hartzell, S.H.; Heaton, T.H.

1988-01-01

Compares teleseismic P-wave records for earthquakes in the magnitude range from 6.0-9.5 with synthetics for a self-similar, omega 2 source model and conclude that the energy radiated by very large earthquakes (Mw > 81/4) is not self-similar to that radiated from smaller earthquakes (Mw < 81/4). Furthermore, in the period band from 2 sec to several tens of seconds, it is concluded that large subduction earthquakes have an average spectral decay rate of omega -1.5. This spectral decay rate is consistent with a previously noted tendency of the omega 2 model to overestimate Ms for large earthquakes.-Authors

Denali, Tulip, and Option Inferior Vena Cava Filter Retrieval: A Single Center Experience.

PubMed

Ramaswamy, Raja S; Jun, Emily; van Beek, Darren; Mani, Naganathan; Salter, Amber; Kim, Seung K; Akinwande, Olaguoke

2018-04-01

To compare the technical success of filter retrieval in Denali, Tulip, and Option inferior vena cava filters. A retrospective analysis of Denali, Gunther Tulip, and Option IVC filters was conducted. Retrieval failure rates, fluoroscopy time, sedation time, use of advanced retrieval techniques, and filter-related complications that led to retrieval failure were recorded. There were 107 Denali, 43 Option, and 39 Tulip filters deployed and removed with average dwell times of 93.5, 86.0, and 131 days, respectively. Retrieval failure rates were 0.9% for Denali, 11.6% for Option, and 5.1% for Tulip filters (Denali vs. Option p = 0.018; Denali vs. Tulip p = 0.159; Tulip vs. Option p = 0.045). Median fluoroscopy time for filter retrieval was 3.2 min for the Denali filter, 6.75 min for the Option filter, and 4.95 min for the Tulip filter (Denali vs. Option p < 0.01; Denali vs. Tulip p < 0.01; Tulip vs. Option p = 0.67). Advanced retrieval techniques were used in 0.9% of Denali filters, 21.1% in Option filters, and 10.8% in Tulip filters (Denali vs. Option p < 0.01; Denali vs. Tulip p < 0.01; Tulip vs. Option p < 0.01). Filter retrieval failure rates were significantly higher for the Option filter when compared to both the Denali and Tulip filters. Retrieval of the Denali filter required significantly less amount of fluoroscopy time and use of advanced retrieval techniques when compared to both the Option and Tulip filters. The findings of this study indicate easier retrieval of the Denali and Tulip IVC filters when compared to the Option filter.

A tool for assessment of heart failure prescribing quality: A systematic review and meta-analysis.

PubMed

El Hadidi, Seif; Darweesh, Ebtissam; Byrne, Stephen; Bermingham, Margaret

2018-04-16

Heart failure (HF) guidelines aim to standardise patient care. Internationally, prescribing practice in HF may deviate from guidelines and so a standardised tool is required to assess prescribing quality. A systematic review and meta-analysis were performed to identify a quantitative tool for measuring adherence to HF guidelines and its clinical implications. Eleven electronic databases were searched to include studies reporting a comprehensive tool for measuring adherence to prescribing guidelines in HF patients aged ≥18 years. Qualitative studies or studies measuring prescription rates alone were excluded. Study quality was assessed using the Good ReseArch for Comparative Effectiveness Checklist. In total, 2455 studies were identified. Sixteen eligible full-text articles were included (n = 14 354 patients, mean age 69 ± 8 y). The Guideline Adherence Index (GAI), and its modified versions, was the most frequently cited tool (n = 13). Other tools identified were the Individualised Reconciled Evidence Recommendations, the Composite Heart Failure Performance, and the Heart Failure Scale. The meta-analysis included the GAI studies of good to high quality. The average GAI-3 was 62%. Compared to low GAI, high GAI patients had lower mortality rate (7.6% vs 33.9%) and lower rehospitalisation rates (23.5% vs 24.5%); both P ≤ .05. High GAI was associated with reduced risk of mortality (hazard ratio = 0.29, 95% confidence interval, 0.06-0.51) and rehospitalisation (hazard ratio = 0.64, 95% confidence interval, 0.41-1.00). No tool was used to improve prescribing quality. The GAI is the most frequently used tool to assess guideline adherence in HF. High GAI is associated with improved HF outcomes. Copyright © 2018 John Wiley & Sons, Ltd.

On the dynamical behaviour of low-frequency earthquake swarms prior to a dome collapse of Soufrière Hill volcano, Montserrat

NASA Astrophysics Data System (ADS)

Hammer, C.; Neuberg, J. W.

2009-03-01

A series of low-frequency earthquake swarms prior to a dome collapse on Soufrière Hills volcano, Montserrat, are investigated with the emphasis on event rate and amplitude behaviour. In a single swarm, the amplitudes of consecutive events tend to increase with time, while the rate of event occurrence accelerates initially and then decelerates toward the end of the swarm. However, when consecutive swarms are considered, the average event rates seem to follow the material failure law, and the time of the dome collapse can be successfully estimated using the inverse event rate. These patterns in amplitude and event rate are interpreted as fluctuations in magma ascent velocity, which result in both the generation of low-frequency events as well as cyclic ground deformation accompanying the swarm activity.

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

Harris, S.; Gross, R.; Goble, W

The safety integrity level (SIL) of equipment used in safety instrumented functions is determined by the average probability of failure on demand (PFDavg) computed at the time of periodic inspection and maintenance, i.e., the time of proof testing. The computation of PFDavg is generally based solely on predictions or estimates of the assumed constant failure rate of the equipment. However, PFDavg is also affected by maintenance actions (or lack thereof) taken by the end user. This paper shows how maintenance actions can affect the PFDavg of spring operated pressure relief valves (SOPRV) and how these maintenance actions may be accountedmore » for in the computation of the PFDavg metric. The method provides a means for quantifying the effects of changes in maintenance practices and shows how these changes impact plant safety.« less

Gear Fault Detection Effectiveness as Applied to Tooth Surface Pitting Fatigue Damage

NASA Technical Reports Server (NTRS)

Lewicki, David G.; Dempsey, Paula J.; Heath, Gregory F.; Shanthakumaran, Perumal

2009-01-01

A study was performed to evaluate fault detection effectiveness as applied to gear tooth pitting fatigue damage. Vibration and oil-debris monitoring (ODM) data were gathered from 24 sets of spur pinion and face gears run during a previous endurance evaluation study. Three common condition indicators (RMS, FM4, and NA4) were deduced from the time-averaged vibration data and used with the ODM to evaluate their performance for gear fault detection. The NA4 parameter showed to be a very good condition indicator for the detection of gear tooth surface pitting failures. The FM4 and RMS parameters performed average to below average in detection of gear tooth surface pitting failures. The ODM sensor was successful in detecting a significant amount of debris from all the gear tooth pitting fatigue failures. Excluding outliers, the average cumulative mass at the end of a test was 40 mg.

The compounding effects of high pollen limitation, selfing rates and inbreeding depression leave a New Zealand tree with few viable offspring

PubMed Central

Van Etten, Megan L.; Tate, Jennifer A.; Anderson, Sandra H.; Kelly, Dave; Ladley, Jenny J.; Merrett, Merilyn F.; Peterson, Paul G.; Robertson, Alastair W.

2015-01-01

Background and Aims Interactions between species are especially sensitive to environmental changes. The interaction between plants and pollinators is of particular interest given the potential current global decline in pollinators. Reduced pollinator services can be compensated for in some plant species by self-pollination. However, if inbreeding depression is high, selfed progeny could die prior to reaching adulthood, leading to cryptic recruitment failure. Methods To examine this scenario, pollinator abundance, pollen limitation, selfing rates and inbreeding depression were examined in 12 populations of varying disturbance levels in Sophora microphylla (Fabaceae), an endemic New Zealand tree species. Key Results High pollen limitation was found in all populations (average of 58 % reduction in seed production, nine populations), together with high selfing rates (61 % of offspring selfed, six populations) and high inbreeding depression (selfed offspring 86 % less fit, six populations). Pollen limitation was associated with lower visitation rates by the two endemic bird pollinators. Conclusions The results suggest that for these populations, over half of the seeds produced are genetically doomed. This reduction in the fitness of progeny due to reduced pollinator service is probably important to population dynamics of other New Zealand species. More broadly, the results suggest that measures of seed production or seedling densities may be a gross overestimate of the effective offspring production. This could lead to cryptic recruitment failure, i.e. a decline in successful reproduction despite high progeny production. Given the global extent of pollinator declines, cryptic recruitment failure may be widespread. PMID:26229065

WE-D-BRA-06: IMRT QA with ArcCHECK: The MD Anderson Experience

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

Aristophanous, M; Suh, Y; Chi, P

Purpose: The objective of this project was to report our initial IMRT QA results and experience with the SunNuclear ArcCHECK. Methods: Three thousand one-hundred and sixteen cases were treated with IMRT or VMAT at our institution between October 2013 and September 2014. All IMRT/VMAT treatment plans underwent Quality Assurance (QA) using ArcCHECK prior to therapy. For clinical evaluation, a Gamma analysis is performed following QA delivery using the SNC Patient software (Sun Nuclear Corp) at the 3%/3mm level. QA Gamma pass rates were analyzed based on categories of treatment site, technique, and type of MLCs. Our current clinical threshold formore » passing a QA (Tclin) is set at a Gamma pass rate greater than 90%. We recorded the percent of failures for each category, as well as the Gamma pass rate threshold that would Result in 95% of QAs to pass (T95). Results: Using Tclin a failure rate of 5.9% over all QAs was observed. The highest failure rate was observed for gynecological (22%) and the lowest for CNS (0.9%) treatments. T95 was 91% over all QAs and ranged from 73% (gynecological) to 96.5% (CNS) for individual treatments sites. T95 was lower for IMRT and non-HD (high definition) MLCs at 88.5% and 94.5%, respectively, compared to 92.4% and 97.1% for VMAT and HD MLC treatments, respectively. There was a statistically significant difference between the passing rates for IMRT vs. VMAT and for HD MLCs vs. non-HD MLCs (p-values << 0.01). Gynecological, IMRT, and HD MLC treatments typically include more plans with larger field sizes. Conclusion: On average, Tclin with ArcCHECK was consistent with T95, as well as the 90% action level reported in TG-119. However, significant variations between the examined categories suggest a link between field size and QA passing rates and may warrant field size-specific passing rate thresholds.« less

Medication adherence and measures of health plan quality.

PubMed

Seabury, Seth A; Lakdawalla, Darius N; Dougherty, J Samantha; Sullivan, Jeff; Goldman, Dana P

2015-06-01

Medication adherence is increasingly being considered as a measure for performance-based reimbursement contracts in healthcare systems. However, the association between health outcomes and adherence at the plan level is unknown. Retrospective analysis of medical and pharmacy claims from a large private sector claims database from 2000 to 2009. We compared plan-level measures of medication adherence and health outcomes for patients with diabetes and congestive heart failure (CHF). Plan performance was based on average rates of disease complications. Medication adherence was calculated as the percent of patients having 80% of days covered for medications treating diabetes or CHF. Both adherence and outcomes were adjusted for patient differences using multivariate regression. Plans were stratified into low, moderate, and high adherence, based on adherence in the bottom quartile, middle 2 quartiles, and top quartile, respectively. Average adherence varied significantly across plans. Plans with low adherence to diabetes medications had adjusted rates of uncontrolled diabetes admissions of 13.2 per 1000 patients, compared with 11.2 in moderate adherence plans and 8.3 in high adherence plans (P < .001). The adjusted rate of CHF-related hospitalization was 15.3% in low adherence plans, compared with 12.4% in moderate adherence plans and 12.2% in high adherence plans (P < .001). These patterns were consistent across different types of complications for both diabetes and CHF. Private health plans vary considerably in average adherence to medications treating chronic diseases. Plans with higher average adherence had lower rates of disease complications, suggesting that medication adherence measures are potentially useful tools for improving the performance of health plans.

Pilot study of an Internet patient-physician communication tool for heart failure disease management.

PubMed

Wu, Robert C; Delgado, Diego; Costigan, Jeannine; Ross, Heather; MacIver, Jane

2006-01-01

Internet disease management has the promise of improving care in patients with heart failure but evidence supporting its use is limited. We have designed a Heart Failure Internet Communication Tool (HFICT), allowing patients to enter messages for clinicians, as well as their daily symptoms, weight, blood pressure and heart rate. Clinicians review the information on the same day and provide feedback. This pilot study evaluated the feasibility and patients' acceptability of using the Internet to communicate with patients with symptomatic heart failure. Patients with symptomatic heart failure were instructed how to use the Internet communication tool. The primary outcome measure was the proportion of patients who used the system regularly by entering information on average at least once per week for at least 3 months. Secondary outcomes measures included safety and maintainability of the tool. We also conducted a content analysis of a subset of the patient and clinician messages entered into the comments field. Between 3 May 1999 and 1 November 2002, 62 patients (mean age 48.7 years) were enrolled. At 3 months 58 patients were alive and without a heart transplant. Of those, 26 patients (45%; 95% Confidence Interval, 0.33-0.58) continued using the system at 3 months. In 97% of all entries by participants weight was included; 68% of entries included blood pressure; and 71% of entries included heart rate. In 3,386 entries out of all 5,098 patient entries (66%), comments were entered. Functions that were not used included the tracking of diuretics, medications and treatment goals. The tool appeared to be safe and maintainable. Workload estimates for clinicians for entering a response to each patient's entry ranged from less than a minute to 5 minutes or longer for a detailed response. Patients sent 3,386 comments to the Heart Function Clinic. Based on the content analysis of 100 patient entries, the following major categories of communication were identified: patient information; patient symptoms; patient questions regarding their condition; patient coordinating own care; social responses. The number of comments decreased over time for both patients and clinicians. While the majority of patients discontinued use, 45% of the patients used the system and continued to use it on average for 1.5 years. An Internet tool is a feasible method of communication in a substantial proportion of patients with heart failure. Further study is required to determine whether clinical outcomes, such as quality of life or frequency of hospitalization, are improved.

Anatomy of a bottleneck: diagnosing factors limiting population growth in the Puerto Rican parrot

USGS Publications Warehouse

Beissenger, S.R.; Wunderle, J.M.; Meyers, J.M.; Saether, B.-E.; Engen, S.

2008-01-01

The relative importance of genetic, demographic, environmental, and catastrophic processes that maintain population bottlenecks has received little consideration. We evaluate the role of these factors in maintaining the Puerto Rican Parrot (Amazona vittata) in a prolonged bottleneck from 1973 through 2000 despite intensive conservation efforts. We first conduct a risk analysis, then examine evidence for the importance of specific processes maintaining the bottleneck using the multiple competing hypotheses approach, and finally integrate these results through a sensitivity analysis of a demographic model using life-stage simulation analysis (LSA) to determine the relative importance of genetic, demographic, environmental, and catastrophic processes on population growth. Annual population growth has been slow and variable (1.0 6 5.2 parrots per year, or an average k?1.05 6 0.19) from 16 parrots (1973) to a high of 40-42 birds (1997-1998). A risk analysis based on population prediction intervals (PPI) indicates great risk and large uncertainty, with a range of 22?83 birds in the 90% PPI only five years into the future. Four primary factors (reduced hatching success due to inbreeding, failure of adults to nest, nest failure due to nongenetic causes, and reduced survival of adults and juveniles) were responsible for maintaining the bottleneck. Egghatchability rates were low (70.6% per egg and 76.8% per pair), and hatchability increased after mate changes, suggesting inbreeding effects. Only an average of 34% of the population nested annually, which was well below the percentage of adults that should have reached an age of first breeding (41-56%). This chronic failure to nest appears to have been caused primarily by environmental and/or behavioral factors, and not by nest-site scarcity or a skewed sex ratio. Nest failure rates from nongenetic causes (i.e., predation, parasitism, and wet cavities) were low (29%) due to active management (protecting nests and fostering captive young into wild nests), diminishing the importance of nest failure as a limiting factor. Annual survival has been periodically reduced by catastrophes (hurricanes), which have greatly constrained population growth, but survival rates were high under non-catastrophic conditions. Although the importance of factors maintaining the Puerto Rican Parrot bottleneck varied throughout the 30-year period of study, we determined their long-term influence using LSA simulations to correlate variation in demographic rates with variation in population growth (k). The bottleneck appears to have been maintained primarily by periodic catastrophes (hurricanes) that reduced adult survival, and secondarily by environmental and/or behavioral factors that resulted in a failure of many adults to nest. The influence of inbreeding through reduced hatching success played a much less significant role, even when additional effects of inbreeding on the production and mortality of young were incorporated into the LSA. Management actions needed to speed recovery include (1) continued nest guarding to minimize the effects of nest failure due to nongenetic causes; (2) creating a second population at another location on the island --a process that was recently initiated--to reduce the chance that hurricane strikes will cause extinction; and (3) determining the causes of the low percentage of breeders in the population and ameliorating them, which would have a large impact on population growth.

FACTORS DETERMINING THE RESULTS OF THE EXAMINATION OF THE WEST AFRICAN COLLEGE OF SURGEONS IN GENERAL SURGERY.

PubMed

Ajao, O G; Ajao, O O; Ugwu, B T; Yawe, Kdt; Ezeome, E R

2014-01-01

The general surgery results of the West African College of Surgeons (WACS) post-graduate fellowship examination could not be regarded as satisfactory when compared with the results of similar post-graduate examinations in some developed countries. For example the pass rate of the West African College of Surgeons examination was usually under 40% whereas the pass rate in oral examination in a similar post-graduate examination, the American Board of Surgery was 84% in 2006, 73% in 2012. The first time pass rate in general surgery of final year general surgery residents at the American Board of Surgery qualifying and certifying examinations were 74% - 78% between 2000 and 2007. To identify the factors responsible for the high failure rate at the general surgery fellowship examinations of the West African College of Surgeons. Descriptive study .We studied and analyzed the West African College of Surgeons examination results for April 2012, October 2012, April 2013 and October 2013 with emphasis on the results, the conduct of the examination and the opinion from fellows about the examiners. Well structured questionnaires were sent to fellows who had passed all the various fellowship examinations of the West African College of Surgeons in general surgery to indicate their opinion about the examination, and the examiners. University College Hospital, Ibadan, and Jos University Teaching Hospital, Jos, Nigeria. The first part of the study dealt with an analysis of each section of the examination prospectively studied over a 2-year period. This consisted of four sets of examination results. The second part was a questionnaire-based study administered to Fellows who had passed the WACS final fellowship examination in general surgery. The questionnaire had three sections: primary, part 1 and part 2 and included basic demographics, date at attempts in each grade of the examinations and the outcome. It also included the views of the respondents on the conduct of the examination and outcome. The data were analyzed using Microsoft Excel. A total of 720 candidates with age range of 28 - 39 years and a mean of 33.2 years sat for the Part 1 Fellowship examinations in 2012 and 2013 with an average of 180 candidate per examination. At the Part 2 fellowship examination, 84 candidates with the age range of 31 - 42 year and a mean of 36.5 years sat the Part 2 Fellowship examination with an average of 21 candidates for each Part 2 examination in general surgery during the same period. The examinations held in April and October of each year. While an average of 28.8% of the candidates passed, an average of 71.2% of the candidates failed the Part 1 Fellowship examinations in 2012 and 2013. The aggregate clinical score was responsible for failure in 59.5% of the candidates. In the Part 2 Fellowship examination in general surgery during the same period, 31.5% of the candidates passed while an average of 68.5% of the candidates failed per examination. The aggregate clinical score was responsible for 53.3% of the candidates who failed the Part 2 examination. Furthermore, 60 - 69.7% of the candidates had a favourable opinion about the conduct of the examination, 54.5 - 63.6% rated the professionalism of the examiners high, even though the pass rate at the first attempts of the various grades of the examination by the respondents was about 50 percent. The clinical part of the examination is a major factor responsible for the high failure rate in the general surgery fellowship examinations of the West African College of Surgeons. In order to mitigate this, residents in training should be exposed to the clinical management of a wide range of cases in the discipline with majority of the operations performed by them under the direct supervision of their consultants.

Contraceptive Failure in the United States: Estimates from the 2006-2010 National Survey of Family Growth.

PubMed

Sundaram, Aparna; Vaughan, Barbara; Kost, Kathryn; Bankole, Akinrinola; Finer, Lawrence; Singh, Susheela; Trussell, James

2017-03-01

Contraceptive failure rates measure a woman's probability of becoming pregnant while using a contraceptive. Information about these rates enables couples to make informed contraceptive choices. Failure rates were last estimated for 2002, and social and economic changes that have occurred since then necessitate a reestimation. To estimate failure rates for the most commonly used reversible methods in the United States, data from the 2006-2010 National Survey of Family Growth were used; some 15,728 contraceptive use intervals, contributed by 6,683 women, were analyzed. Data from the Guttmacher Institute's 2008 Abortion Patient Survey were used to adjust for abortion underreporting. Kaplan-Meier methods were used to estimate the associated single-decrement probability of failure by duration of use. Failure rates were compared with those from 1995 and 2002. Long-acting reversible contraceptives (the IUD and the implant) had the lowest failure rates of all methods (1%), while condoms and withdrawal carried the highest probabilities of failure (13% and 20%, respectively). However, the failure rate for the condom had declined significantly since 1995 (from 18%), as had the failure rate for all hormonal methods combined (from 8% to 6%). The failure rate for all reversible methods combined declined from 12% in 2002 to 10% in 2006-2010. These broad-based declines in failure rates reverse a long-term pattern of minimal change. Future research should explore what lies behind these trends, as well as possibilities for further improvements. © 2017 The Authors. Perspectives on Sexual and Reproductive Health published by Wiley Periodicals, Inc., on behalf of the Guttmacher Institute.

A dislocation-based crystal plasticity framework for dynamic ductile failure of single crystals

NASA Astrophysics Data System (ADS)

Nguyen, Thao; Luscher, D. J.; Wilkerson, J. W.

2017-11-01

A framework for dislocation-based viscoplasticity and dynamic ductile failure has been developed to model high strain rate deformation and damage in single crystals. The rate-dependence of the crystal plasticity formulation is based on the physics of relativistic dislocation kinetics suited for extremely high strain rates. The damage evolution is based on the dynamics of void growth, which are governed by both micro-inertia as well as dislocation kinetics and dislocation substructure evolution. An averaging scheme is proposed in order to approximate the evolution of the dislocation substructure in both the macroscale as well as its spatial distribution at the microscale. Additionally, a concept of a single equivalent dislocation density that effectively captures the collective influence of dislocation density on all active slip systems is proposed here. Together, these concepts and approximations enable the use of semi-analytic solutions for void growth dynamics developed in (Wilkerson and Ramesh, 2014), which greatly reduce the computational overhead that would otherwise be required. The resulting homogenized framework has been implemented into a commercially available finite element package, and a validation study against a suite of direct numerical simulations was carried out.

Design test request No. 1263 K Reactor graphite key and VSR channel sleeve test

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

Kempf, F.J.

1964-12-10

The objectives of this test were: (1) Determine the coefficient of friction between two adjacent layers of K Reactor graphite at room temperature. (2) Determine the average load required to cause failure of an unirradiated K Reactor side reflector bar, when subjected to tensile loading applied through the reflector keys. (3) Determine the average load at failure and the average deflection at failure of a single VSR channel key when loaded in keyways with clearances equal to those used in original stack construction. (4) Determine the average load and deflection required to break the four K Reactor VSR keys whenmore » loaded simultaneously in both `3-layer` and `7-layer` mockups. Also determine the mode of key failure; i.e., shear, flexure or combined compression and bending. Following these key rupture tests, determine the strength and deflection characteristics of the proposed K Reactor VSR channel sleeve when loaded in a manner identical to that used to fracture the keys. (5) Determine the average load and deflection at failure of both the proposed K Reactor VSR channel sleeves and the proposed C Reactor sleeves when subjected to crushing loads. (6) Determine the extent of damage to the proposed K Reactor VSR channel sleeve when subjected to the following vertical rod loading conditions. (a) Full rod drop in a channel mockup which has been misaligned 2 1/2 inches. (b) Full rod drop in a channel which has been misaligned an amount equal to the maximum flexibility of a `universal` VSR.« less

Explanations for Success and Failure by Low and Average School Achievers.

ERIC Educational Resources Information Center

Bond, Lynne A.; Johnson, Jeannette L.

Low and average school achievers in grades 1 and 2 and grades 4 and 5 made attributions for successes and failures on school related and unrelated tasks. Students in the low achievement group were participants of the Title I program, and tested a year below their age-mates on reading and math achievement. Students were given two booklets of four…

Failure rates of mini-implants placed in the infrazygomatic region.

PubMed

Uribe, Flavio; Mehr, Rana; Mathur, Ajay; Janakiraman, Nandakumar; Allareddy, Veerasathpurush

2015-01-01

The purpose of this pilot study was to evaluate the failure rates of mini-implants placed in the infrazygomatic region and to evaluate factors that affect their stability. A retrospective cohort study of 30 consecutive patients (55 mini-implants) who had infrazygomatic mini-implants at a University Clinic were evaluated for failure rates. Patient, mini-implant, orthodontic, surgical, and mini-implant maintenance factors were evaluated by univariate logistic regression models for association to failure rates. A 21.8 % failure rate of mini-implants placed in the infazygomatic region was observed. None of the predictor variables were significantly associated with higher or lower odds for failed implants. Failure rates for infrazygomatic mini-implants were slightly higher than those reported in other maxilla-mandibular osseous locations. No predictor variables were found to be associated to the failure rates.

Relationship between respiratory failure and plasma noradrenaline levels in amyotrophic lateral sclerosis.

PubMed

Yamashita, A; Koike, Y; Takahashi, A; Hirayama, M; Murakami, N; Sobue, G

1997-08-01

We evaluated plasma noradrenaline (NA) levels at test and during head-up tilt test in 20 patients with sporadic amyotrophic lateral sclerosis (ALS). Their fasting plasma NA levels ranged from 195 to 4227 pg/ml. The average plasma NA level was 483 pg/ml in five ambulatory patients, 341 in two wheelchair-bound patients, 1264 in 11 bedridden patients, and 208 in two respirator-dependent patients whose disability grading was the worst among the four groups. Arterial carbon dioxide (PCO2) was evaluated as a measure of respiratory function. The coefficient of correlation between PCO2 and plasma NA was r = 0.654 (p < 0.01). Either respiratory failure or lower motor neuron dysfunction may relate to the elevation of plasma NA levels. In the two bedridden patients, plasma NA levels and heart rate at rest increased significantly as the disease progressed. Cardiovascular responses to head-up tilting were normal. These data suggest that the elevation of plasma NA levels may be related to progression of respiratory failure and lower motor neuron dysfunction. In conclusion, sympathetic hyperactivity in ALS is considered to be not primary, but secondary to somatic motor disabilities and respiratory failure.

A Formal Approach to the Selection by Minimum Error and Pattern Method for Sensor Data Loss Reduction in Unstable Wireless Sensor Network Communications

PubMed Central

Kim, Changhwa; Shin, DongHyun

2017-01-01

There are wireless networks in which typically communications are unsafe. Most terrestrial wireless sensor networks belong to this category of networks. Another example of an unsafe communication network is an underwater acoustic sensor network (UWASN). In UWASNs in particular, communication failures occur frequently and the failure durations can range from seconds up to a few hours, days, or even weeks. These communication failures can cause data losses significant enough to seriously damage human life or property, depending on their application areas. In this paper, we propose a framework to reduce sensor data loss during communication failures and we present a formal approach to the Selection by Minimum Error and Pattern (SMEP) method that plays the most important role for the reduction in sensor data loss under the proposed framework. The SMEP method is compared with other methods to validate its effectiveness through experiments using real-field sensor data sets. Moreover, based on our experimental results and performance comparisons, the SMEP method has been validated to be better than others in terms of the average sensor data value error rate caused by sensor data loss. PMID:28498312

A Formal Approach to the Selection by Minimum Error and Pattern Method for Sensor Data Loss Reduction in Unstable Wireless Sensor Network Communications.

PubMed

Kim, Changhwa; Shin, DongHyun

2017-05-12

There are wireless networks in which typically communications are unsafe. Most terrestrial wireless sensor networks belong to this category of networks. Another example of an unsafe communication network is an underwater acoustic sensor network (UWASN). In UWASNs in particular, communication failures occur frequently and the failure durations can range from seconds up to a few hours, days, or even weeks. These communication failures can cause data losses significant enough to seriously damage human life or property, depending on their application areas. In this paper, we propose a framework to reduce sensor data loss during communication failures and we present a formal approach to the Selection by Minimum Error and Pattern (SMEP) method that plays the most important role for the reduction in sensor data loss under the proposed framework. The SMEP method is compared with other methods to validate its effectiveness through experiments using real-field sensor data sets. Moreover, based on our experimental results and performance comparisons, the SMEP method has been validated to be better than others in terms of the average sensor data value error rate caused by sensor data loss.

Operational Failures and Interruptions in Hospital Nursing

PubMed Central

Tucker, Anita L; Spear, Steven J

2006-01-01

Objective To describe the work environment of hospital nurses with particular focus on the performance of work systems supplying information, materials, and equipment for patient care. Data Sources Primary observation, semistructured interviews, and surveys of hospital nurses. Study Design We sampled a cross-sectional group of six U.S. hospitals to examine the frequency of work system failures and their impact on nurse productivity. Data Collection We collected minute-by-minute data on the activities of 11 nurses. In addition, we conducted interviews with six of these nurses using questions related to obstacles to care. Finally, we created and administered two surveys in 48 nursing units, one for nurses and one for managers, asking about the frequency of specific work system failures. Principal Findings Nurses we observed experienced an average of 8.4 work system failures per 8-hour shift. The five most frequent types of failures, accounting for 6.4 of these obstacles, involved medications, orders, supplies, staffing, and equipment. Survey questions asking nurses how frequently they experienced these five categories of obstacles yielded similar frequencies. For an average 8-hour shift, the average task time was only 3.1 minutes, and in spite of this, nurses were interrupted mid-task an average of eight times per shift. Conclusions Our findings suggest that nurse effectiveness can be increased by creating improvement processes triggered by the occurrence of work system failures, with the goal of reducing future occurrences. Second, given that nursing work is fragmented and unpredictable, designing processes that are robust to interruption can help prevent errors. PMID:16704505

On Deviations between Observed and Theoretically Estimated Values on Additivity-Law Failures

NASA Astrophysics Data System (ADS)

Nayatani, Yoshinobu; Sobagaki, Hiroaki

The authors have reported in the previous studies that the average observed results are about a half of the corresponding predictions on the experiments with large additivity-law failures. One of the reasons of the deviations is studied and clarified by using the original observed data on additivity-law failures in the Nakano experiment. The conclusion from the observations and their analyses clarified that it was essentially difficult to have a good agreement between the average observed results and the corresponding theoretical predictions in the experiments with large additivity-law failures. This is caused by a kind of unavoidable psychological pressure existing in subjects participated in the experiments. We should be satisfied with the agreement in trend between them.

The effect of exercise training on biventricular myocardial strain in heart failure with preserved ejection fraction.

PubMed

Angadi, Siddhartha S; Jarrett, Catherine L; Sherif, Moustafa; Gaesser, Glenn A; Mookadam, Farouk

2017-08-01

High-intensity interval training (HIIT) improves peak oxygen uptake and left ventricular diastology in patients with heart failure with preserved ejection fraction (HFpEF). However, its effects on myocardial strain in HFpEF remain unknown. We explored the effects of HIIT and moderate-intensity aerobic continuous training (MI-ACT) on left and right ventricular strain parameters in patients with HFpEF. Furthermore, we explored their relationship with peak oxygen uptake (VO 2peak ). Fifteen patients with HFpEF (age = 70 ± 8.3 years) were randomized to either: (i) HIIT (4 × 4 min, 85-90% peak heart rate, interspersed with 3 min of active recovery; n = 9) or (ii) MI-ACT (30 min at 70% peak heart rate; n = 6). Patients were trained 3 days/week for 4 weeks and underwent VO 2peak testing and 2D echocardiography at baseline and after completion of the 12 sessions of supervised exercise training. Left ventricular (LV) and right ventricular (RV) average global peak systolic longitudinal strain (GLS) and peak systolic longitudinal strain rate (GSR) were quantified. Paired t-tests were used to examine within-group differences and unpaired t-tests used for between-group differences (α = 0.05). Right ventricular average global peak systolic longitudinal strain improved significantly in the HIIT group after training (pre = -18.4 ± 3.2%, post = -21.4 ± 1.7%; P = 0.02) while RV-GSR, LV-GLS, and LV-GSR did not (P > 0.2). No significant improvements were observed following MI-ACT. No significant between-group differences were observed for any strain measure. ΔLV-GLS and ΔRV-GLS were modestly correlated with ΔVO 2peak (r = -0.48 and r = -0.45; P = 0.1, respectively). In patients with HFpEF, 4 weeks of HIIT significantly improved RV-GLS. © 2017 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

Mumps in the US Army 1980-86: should recruits be immunized?

PubMed Central

Arday, D R; Kanjarpane, D D; Kelley, P W

1989-01-01

The US Army's experience with mumps hospitalizations was examined for the years 1980 through 1986. One hundred fifty-two cases among active duty Army soldiers were identified. Mumps rates declined from 3.85 per 100,000 active duty soldiers per year in 1980 to 1.28 in 1985, but an outbreak during 1986 caused rates to jump to 6.65. Attack rates were found to decline dramatically with increasing age or length of military service, with 74 per cent of cases occurring in soldiers with three years or less of service. Rates for Blacks and Whites were similar, but were higher for other minorities. Complications reported were mild. A cost-benefit analysis, assuming all recruits were to be vaccinated, estimated average annual vaccination program costs of $286,789; this figure exceeds average annual reported hospitalized mumps disease costs of $61,525 by a factor of 4.7. Mumps attack rates would have to reach at least 15.0 per 100,000 per year before savings would equal recruit vaccination costs. Failure to show that a vaccine program would be cost-saving may be due to limitations in identifying cases or to the requirement that all recruits be immunized regardless of prior immune status. It is likely that a program to immunize susceptible individuals alone would show benefit. PMID:2494895

Shear rupture of a directionally solidified eutectic gamma/gamma prime - alpha (Mo) alloy

NASA Technical Reports Server (NTRS)

Harf, F. H.

1978-01-01

Directionally solidified Mo alloys are evaluated to determine the shear rupture strength and to possibly improve it by microstructural and heat treatment variations. Bars of the alloy containing nominally 5.7% Al and 33.5% Mo by weight with balance Ni were directionally solidified at rates between 10 and 100 mm per hour in furnaces with thermal gradients at the liquid-solid interface of 250 or 100 C per cm. A limited number of longitudinal shear rupture tests were conducted at 760 C and 207 MPa in the as - solidified and in several heat treated conditions. It is shown that shear rupture failures are partly transgranular and that resistance to failure is prompted by good fiber alignment and a matrix structure consisting mainly of gamma prime. Well aligned as - solidified specimens sustained the shear stress for an average of 81 hours. A simulated coating heat treatment appeared to increase the transformation of gamma to gamma prime and raised the average shear life of aligned specimens to 111 hours. However, heat treatments at 1245 C and especially at 1190 C appeared to be detrimental by causing partial solutioning of the gamma prime, and reducing lives to 47 and 10 hours, respectively.

The effects of heart rate control in chronic heart failure with reduced ejection fraction.

PubMed

Grande, Dario; Iacoviello, Massimo; Aspromonte, Nadia

2018-07-01

Elevated heart rate has been associated with worse prognosis both in the general population and in patients with heart failure. Heart rate is finely modulated by neurohormonal signals and it reflects the balance between the sympathetic and the parasympathetic limbs of the autonomic nervous system. For this reason, elevated heart rate in heart failure has been considered an epiphenomenon of the sympathetic hyperactivation during heart failure. However, experimental and clinical evidence suggests that high heart rate could have a direct pathogenetic role. Consequently, heart rate might act as a pathophysiological mediator of heart failure as well as a marker of adverse outcome. This hypothesis has been supported by the observation that the positive effect of beta-blockade could be linked to the degree of heart rate reduction. In addition, the selective heart rate control with ivabradine has recently been demonstrated to be beneficial in patients with heart failure and left ventricular systolic dysfunction. The objective of this review is to examine the pathophysiological implications of elevated heart rate in chronic heart failure and explore the mechanisms underlying the effects of pharmacological heart rate control.

Mechanical properties of dissimilar metal joints composed of DP 980 steel and AA 7075-T6

DOE PAGES

Squires, Lile; Lim, Yong Chae; Miles, Michael; ...

2015-03-18

In this study, a solid state joining process, called friction bit joining, was used to spot weld aluminium alloy 7075-T6 to dual phase 980 steel. Lap shear failure loads for specimens without adhesive averaged ~10kN, while cross-tension specimens averaged 2·8 kN. Addition of adhesive with a thickness up to 500 μm provided a gain of ~50% to lap shear failure loads, while a much thinner layer of adhesive increased cross-tension failure loads by 20%. Microstructures of the welds were martensitic, but the hardness of the joining bit portion was greater than that of the DP 980, owing to its highermore » alloy content. Softening in the heat affected zone of a welded joint appeared to be relatively small, though it was enough to cause nugget pullout failures in some lap shear tension specimens. Finally, other failures in lap shear tension were interfacial, while all of the failures in cross-tension were interfacial.« less

THE EFFECTS OF MAINTENANCE ACTIONS ON THE PFDavg OF SPRING OPERATED PRESSURE RELIEF VALVES

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

Harris, S.; Gross, R.

2014-04-01

The safety integrity level (SIL) of equipment used in safety instrumented functions is determined by the average probability of failure on demand (PFDavg) computed at the time of periodic inspection and maintenance, i.e., the time of proof testing. The computation of PFDavg is generally based solely on predictions or estimates of the assumed constant failure rate of the equipment. However, PFDavg is also affected by maintenance actions (or lack thereof) taken by the end user. This paper shows how maintenance actions can affect the PFDavg of spring operated pressure relief valves (SOPRV) and how these maintenance actions may be accountedmore » for in the computation of the PFDavg metric. The method provides a means for quantifying the effects of changes in maintenance practices and shows how these changes impact plant safety.« less

The Effects of Maintenance Actions on the PFDavg of Spring Operated Pressure Relief Valves

DOE PAGES

Harris, S.; Gross, R.; Goble, W; ...

2015-12-01

The safety integrity level (SIL) of equipment used in safety instrumented functions is determined by the average probability of failure on demand (PFDavg) computed at the time of periodic inspection and maintenance, i.e., the time of proof testing. The computation of PFDavg is generally based solely on predictions or estimates of the assumed constant failure rate of the equipment. However, PFDavg is also affected by maintenance actions (or lack thereof) taken by the end user. This paper shows how maintenance actions can affect the PFDavg of spring operated pressure relief valves (SOPRV) and how these maintenance actions may be accountedmore » for in the computation of the PFDavg metric. The method provides a means for quantifying the effects of changes in maintenance practices and shows how these changes impact plant safety.« less

Gear Fault Detection Effectiveness as Applied to Tooth Surface Pitting Fatigue Damage

NASA Technical Reports Server (NTRS)

Lewicki, David G.; Dempsey, Paula J.; Heath, Gregory F.; Shanthakumaran, Perumal

2010-01-01

A study was performed to evaluate fault detection effectiveness as applied to gear-tooth-pitting-fatigue damage. Vibration and oil-debris monitoring (ODM) data were gathered from 24 sets of spur pinion and face gears run during a previous endurance evaluation study. Three common condition indicators (RMS, FM4, and NA4 [Ed. 's note: See Appendix A-Definitions D were deduced from the time-averaged vibration data and used with the ODM to evaluate their performance for gear fault detection. The NA4 parameter showed to be a very good condition indicator for the detection of gear tooth surface pitting failures. The FM4 and RMS parameters perfomu:d average to below average in detection of gear tooth surface pitting failures. The ODM sensor was successful in detecting a significant 8lDOunt of debris from all the gear tooth pitting fatigue failures. Excluding outliers, the average cumulative mass at the end of a test was 40 mg.

Variations in Daily Sleep Quality and Type 1 Diabetes Management in Late Adolescents

PubMed Central

Queen, Tara L.; Butner, Jonathan; Wiebe, Deborah; Berg, Cynthia A.

2016-01-01

Objective To determine how between- and within-person variability in perceived sleep quality were associated with adolescent diabetes management. Methods A total of 236 older adolescents with type 1 diabetes reported daily for 2 weeks on sleep quality, self-regulatory failures, frequency of blood glucose (BG) checks, and BG values. Average, inconsistent, and daily deviations in sleep quality were examined. Results Hierarchical linear models indicated that poorer average and worse daily perceived sleep quality (compared with one’s average) was each associated with more self-regulatory failures. Sleep quality was not associated with frequency of BG checking. Poorer average sleep quality was related to greater risk of high BG. Furthermore, inconsistent and daily deviations in sleep quality interacted to predict higher BG, with more consistent sleepers benefitting more from a night of high-quality sleep. Conclusions Good, consistent sleep quality during late adolescence may benefit diabetes management by reducing self-regulatory failures and risk of high BG. PMID:26994852

Savannah River Site generic data base development

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

Blanton, C.H.; Eide, S.A.

This report describes the results of a project to improve the generic component failure data base for the Savannah River Site (SRS). A representative list of components and failure modes for SRS risk models was generated by reviewing existing safety analyses and component failure data bases and from suggestions from SRS safety analysts. Then sources of data or failure rate estimates were identified and reviewed for applicability. A major source of information was the Nuclear Computerized Library for Assessing Reactor Reliability, or NUCLARR. This source includes an extensive collection of failure data and failure rate estimates for commercial nuclear powermore » plants. A recent Idaho National Engineering Laboratory report on failure data from the Idaho Chemical Processing Plant was also reviewed. From these and other recent sources, failure data and failure rate estimates were collected for the components and failure modes of interest. This information was aggregated to obtain a recommended generic failure rate distribution (mean and error factor) for each component failure mode.« less

Ambient temperature and biomarkers of heart failure: a repeated measures analysis.

PubMed

Wilker, Elissa H; Yeh, Gloria; Wellenius, Gregory A; Davis, Roger B; Phillips, Russell S; Mittleman, Murray A

2012-08-01

Extreme temperatures have been associated with hospitalization and death among individuals with heart failure, but few studies have explored the underlying mechanisms. We hypothesized that outdoor temperature in the Boston, Massachusetts, area (1- to 4-day moving averages) would be associated with higher levels of biomarkers of inflammation and myocyte injury in a repeated-measures study of individuals with stable heart failure. We analyzed data from a completed clinical trial that randomized 100 patients to 12 weeks of tai chi classes or to time-matched education control. B-type natriuretic peptide (BNP), C-reactive protein (CRP), and tumor necrosis factor (TNF) were measured at baseline, 6 weeks, and 12 weeks. Endothelin-1 was measured at baseline and 12 weeks. We used fixed effects models to evaluate associations with measures of temperature that were adjusted for time-varying covariates. Higher apparent temperature was associated with higher levels of BNP beginning with 2-day moving averages and reached statistical significance for 3- and 4-day moving averages. CRP results followed a similar pattern but were delayed by 1 day. A 5°C change in 3- and 4-day moving averages of apparent temperature was associated with 11.3% [95% confidence interval (CI): 1.1, 22.5; p = 0.03) and 11.4% (95% CI: 1.2, 22.5; p = 0.03) higher BNP. A 5°C change in the 4-day moving average of apparent temperature was associated with 21.6% (95% CI: 2.5, 44.2; p = 0.03) higher CRP. No clear associations with TNF or endothelin-1 were observed. Among patients undergoing treatment for heart failure, we observed positive associations between temperature and both BNP and CRP-predictors of heart failure prognosis and severity.

Survival and weak chaos.

PubMed

Nee, Sean

2018-05-01

Survival analysis in biology and reliability theory in engineering concern the dynamical functioning of bio/electro/mechanical units. Here we incorporate effects of chaotic dynamics into the classical theory. Dynamical systems theory now distinguishes strong and weak chaos. Strong chaos generates Type II survivorship curves entirely as a result of the internal operation of the system, without any age-independent, external, random forces of mortality. Weak chaos exhibits (a) intermittency and (b) Type III survivorship, defined as a decreasing per capita mortality rate: engineering explicitly defines this pattern of decreasing hazard as 'infant mortality'. Weak chaos generates two phenomena from the normal functioning of the same system. First, infant mortality- sensu engineering-without any external explanatory factors, such as manufacturing defects, which is followed by increased average longevity of survivors. Second, sudden failure of units during their normal period of operation, before the onset of age-dependent mortality arising from senescence. The relevance of these phenomena encompasses, for example: no-fault-found failure of electronic devices; high rates of human early spontaneous miscarriage/abortion; runaway pacemakers; sudden cardiac death in young adults; bipolar disorder; and epilepsy.

Survival and weak chaos

PubMed Central

2018-01-01

Survival analysis in biology and reliability theory in engineering concern the dynamical functioning of bio/electro/mechanical units. Here we incorporate effects of chaotic dynamics into the classical theory. Dynamical systems theory now distinguishes strong and weak chaos. Strong chaos generates Type II survivorship curves entirely as a result of the internal operation of the system, without any age-independent, external, random forces of mortality. Weak chaos exhibits (a) intermittency and (b) Type III survivorship, defined as a decreasing per capita mortality rate: engineering explicitly defines this pattern of decreasing hazard as ‘infant mortality’. Weak chaos generates two phenomena from the normal functioning of the same system. First, infant mortality—sensu engineering—without any external explanatory factors, such as manufacturing defects, which is followed by increased average longevity of survivors. Second, sudden failure of units during their normal period of operation, before the onset of age-dependent mortality arising from senescence. The relevance of these phenomena encompasses, for example: no-fault-found failure of electronic devices; high rates of human early spontaneous miscarriage/abortion; runaway pacemakers; sudden cardiac death in young adults; bipolar disorder; and epilepsy. PMID:29892407

Clinical Outcomes of FP-7/8 Ahmed Glaucoma Valves in the Management of Refractory Glaucoma in the Mainland Chinese Population

PubMed Central

Yang, Xuejiao; Deng, Shuifeng; Li, Zuohong; Li, Fei; Zhuo, Yehong

2015-01-01

Background To evaluate the efficacy and safety of the Ahmed glaucoma valve (AGV) and the risk factors associated with AGV implantation failure in a population of Chinese patients with refractory glaucoma. Method In total, 79 eyes with refractory glaucoma from 79 patients treated in our institution from November 2007 to November 2010 were enrolled in this retrospective study. The demographic data, preoperative and postoperative intraocular pressures (IOPs), best corrected visual acuity (BCVA), number of anti-glaucoma medications used, completed and qualified surgery success rates and postoperative complications were recorded to evaluate the outcomes of AGV implantation. Factors that were associated with implant failure were determined using Cox proportional hazard regression model analysis and multiple linear regression analysis. Principle Findings The average follow-up time was 12.7±5.8 months (mean±SD). We observed a significant reduction in the mean IOP from 39.9±12.6 mm Hg before surgery to 19.3±9.6 mm Hg at the final follow-up. The complete success rate was 59.5%, and the qualified success rate was 83.5%. The number of previous surgeries was negatively correlated with qualified success rate (P<0.05, OR=0.736, 95% CI 0.547-0.99). Patients with previous trabeculectomy were more likely to use multiple anti-glaucoma drugs to control IOP (P<0.01). The primary complication was determined to be a flat anterior chamber (AC). Conclusion AGV implantation was safe and effective for the management of refractory glaucoma. Patients with a greater number of previous surgeries were more likely to experience surgical failure, and patients with previous trabeculectomy were more likely to use multiple anti-glaucoma drugs to control postoperative IOP. PMID:25996991

Clinical Outcomes of FP-7/8 Ahmed Glaucoma Valves in the Management of Refractory Glaucoma in the Mainland Chinese Population.

PubMed

Zhu, Yingting; Wei, Yantao; Yang, Xuejiao; Deng, Shuifeng; Li, Zuohong; Li, Fei; Zhuo, Yehong

2015-01-01

To evaluate the efficacy and safety of the Ahmed glaucoma valve (AGV) and the risk factors associated with AGV implantation failure in a population of Chinese patients with refractory glaucoma. In total, 79 eyes with refractory glaucoma from 79 patients treated in our institution from November 2007 to November 2010 were enrolled in this retrospective study. The demographic data, preoperative and postoperative intraocular pressures (IOPs), best corrected visual acuity (BCVA), number of anti-glaucoma medications used, completed and qualified surgery success rates and postoperative complications were recorded to evaluate the outcomes of AGV implantation. Factors that were associated with implant failure were determined using Cox proportional hazard regression model analysis and multiple linear regression analysis. The average follow-up time was 12.7±5.8 months (mean±SD). We observed a significant reduction in the mean IOP from 39.9±12.6 mm Hg before surgery to 19.3±9.6 mm Hg at the final follow-up. The complete success rate was 59.5%, and the qualified success rate was 83.5%. The number of previous surgeries was negatively correlated with qualified success rate (P<0.05, OR=0.736, 95% CI 0.547-0.99). Patients with previous trabeculectomy were more likely to use multiple anti-glaucoma drugs to control IOP (P<0.01). The primary complication was determined to be a flat anterior chamber (AC). AGV implantation was safe and effective for the management of refractory glaucoma. Patients with a greater number of previous surgeries were more likely to experience surgical failure, and patients with previous trabeculectomy were more likely to use multiple anti-glaucoma drugs to control postoperative IOP.

Toward lean satellites reliability improvement using HORYU-IV project as case study

NASA Astrophysics Data System (ADS)

Faure, Pauline; Tanaka, Atomu; Cho, Mengu

2017-04-01

Lean satellite programs are programs in which the satellite development philosophy is driven by fast delivery and low cost. Though this concept offers the possibility to develop and fly risky missions without jeopardizing a space program, most of these satellites suffer infant mortality and fail to achieve their mission minimum success. Lean satellites with high infant mortality rate indicate that testing prior to launch is insufficient. In this study, the authors monitored failures occurring during the development of the lean satellite HORYU-IV to identify the evolution of the cumulative number of failures against cumulative testing time. Moreover, the sub-systems driving the failures depending on the different development phases were identified. The results showed that half to 2/3 of the failures are discovered during the early stage of testing. Moreover, when the mean time before failure was calculated, it appeared that for any development phase considered, a new failure appears on average every 20 h of testing. Simulations were also performed and it showed that for an initial testing time of 50 h, reliability after 1 month launch can be improved by nearly 6 times as compared to an initial testing time of 20 h. Through this work, the authors aim at providing a qualitative reference for lean satellites developers to better help them manage resources to develop lean satellites following a fast delivery and low cost philosophy while ensuring sufficient reliability to achieve mission minimum success.

An improved ant colony optimization algorithm with fault tolerance for job scheduling in grid computing systems

PubMed Central

Idris, Hajara; Junaidu, Sahalu B.; Adewumi, Aderemi O.

2017-01-01

The Grid scheduler, schedules user jobs on the best available resource in terms of resource characteristics by optimizing job execution time. Resource failure in Grid is no longer an exception but a regular occurring event as resources are increasingly being used by the scientific community to solve computationally intensive problems which typically run for days or even months. It is therefore absolutely essential that these long-running applications are able to tolerate failures and avoid re-computations from scratch after resource failure has occurred, to satisfy the user’s Quality of Service (QoS) requirement. Job Scheduling with Fault Tolerance in Grid Computing using Ant Colony Optimization is proposed to ensure that jobs are executed successfully even when resource failure has occurred. The technique employed in this paper, is the use of resource failure rate, as well as checkpoint-based roll back recovery strategy. Check-pointing aims at reducing the amount of work that is lost upon failure of the system by immediately saving the state of the system. A comparison of the proposed approach with an existing Ant Colony Optimization (ACO) algorithm is discussed. The experimental results of the implemented Fault Tolerance scheduling algorithm show that there is an improvement in the user’s QoS requirement over the existing ACO algorithm, which has no fault tolerance integrated in it. The performance evaluation of the two algorithms was measured in terms of the three main scheduling performance metrics: makespan, throughput and average turnaround time. PMID:28545075

Square-lashing technique in segmental spinal instrumentation: a biomechanical study.

PubMed

Arlet, Vincent; Draxinger, Kevin; Beckman, Lorne; Steffen, Thomas

2006-07-01

Sublaminar wires have been used for many years for segmental spinal instrumentation in scoliosis surgery. More recently, stainless steel wires have been replaced by titanium cables. However, in rigid scoliotic curves, sublaminar wires or simple cables can either brake or pull out. The square-lashing technique was devised to avoid complications such as cable breakage or lamina cutout. The purpose of the study was therefore to test biomechanically the pull out and failure mode of simple sublaminar constructs versus the square-lashing technique. Individual vertebrae were subjected to pullout testing having one of two different constructs (single loop and square lashing) using either monofilament wire or multifilament cables. Four different methods of fixation were therefore tested: single wire construct, square-lashing wiring construct, single cable construct, and square-lashing cable construct. Ultimate failure load and failure mechanism were recorded. For the single wire the construct failed 12/16 times by wire breakage with an average ultimate failure load of 793 N. For the square-lashing wire the construct failed with pedicle fracture in 14/16, one bilateral lamina fracture, and one wire breakage. Ultimate failure load average was 1,239 N For the single cable the construct failed 12/16 times due to cable breakage (average force 1,162 N). 10/12 of these breakages were where the cable looped over the rod. For the square-lashing cable all of these constructs (16/16) failed by fracture of the pedicle with an average ultimate failure load of 1,388 N. The square-lashing construct had a higher pullout strength than the single loop and almost no cutting out from the lamina. The square-lashing technique with cables may therefore represent a new advance in segmental spinal instrumentation.

A frictional population model of seismicity rate change

USGS Publications Warehouse

Gomberg, J.; Reasenberg, P.; Cocco, M.; Belardinelli, M.E.

2005-01-01

We study models of seismicity rate changes caused by the application of a static stress perturbation to a population of faults and discuss our results with respect to the model proposed by Dieterich (1994). These models assume distribution of nucleation sites (e.g., faults) obeying rate-state frictional relations that fail at constant rate under tectonic loading alone, and predicts a positive static stress step at time to will cause an immediate increased seismicity rate that decays according to Omori's law. We show one way in which the Dieterich model may be constructed from simple general idead, illustratted using numerically computed synthetic seismicity and mathematical formulation. We show that seismicity rate change predicted by these models (1) depend on the particular relationship between the clock-advanced failure and fault maturity, (2) are largest for the faults closest to failure at to, (3) depend strongly on which state evolution law faults obey, and (4) are insensitive to some types of population hetrogeneity. We also find that if individual faults fail repeatedly and populations are finite, at timescales much longer than typical aftershock durations, quiescence follows at seismicity rate increase regardless of the specific frictional relations. For the examined models the quiescence duration is comparable to the ratio of stress change to stressing rate ????/??,which occurs after a time comparable to the average recurrence interval of the individual faults in the population and repeats in the absence of any new load may pertubations; this simple model may partly explain observations of repeated clustering of earthquakes. Copyright 2005 by the American Geophysical Union.

Estimation procedures to measure and monitor failure rates of components during thermal-vacuum testing

NASA Technical Reports Server (NTRS)

Williams, R. E.; Kruger, R.

1980-01-01

Estimation procedures are described for measuring component failure rates, for comparing the failure rates of two different groups of components, and for formulating confidence intervals for testing hypotheses (based on failure rates) that the two groups perform similarly or differently. Appendix A contains an example of an analysis in which these methods are applied to investigate the characteristics of two groups of spacecraft components. The estimation procedures are adaptable to system level testing and to monitoring failure characteristics in orbit.

Effect of positive pulse charge waveforms on cycle life of nickel-zinc cells

NASA Technical Reports Server (NTRS)

Smithrick, J. J.

1980-01-01

Five amp-hour nickel-zinc cells were life cycled to evaluate four different charge methods. Three of the four waveforms investigated were 120 Hz full wave rectified sinusoidal (FWRS), 120 Hz silicon controlled rectified (SCR), and 1 kHz square wave (SW). The fourth, a constant current method, was used as a baseline of comparison. Three sealed Ni-Zn cells connected in series were cycled. Each series string was charged at an average c/20 rate, and discharged at a c/2.5 rate to a 75% rated depth. Results indicate that the relatively inexpensive 120 Hz FWRS charger appears feasible for charging 5 amp-hour nickel-zinc cells with no significant loss in average cycle life when compared to constant current charging. The 1-kHz SW charger could also be used with no significant loss in average cycle life, and suggests the possibility of utilizing the existing electric vehicle chopper controller circuitry for an on-board charger. There was an apparent difference using the 120 Hz SCR charger compared to the others, however, this difference could be due to an inadvertent severe overcharge, which occurred prior to cell failure. The remaining two positive pulse charging waveforms, FWRS and 1 kHz, did not improve the cycle life of 5 amp-hour nickel-zinc cells over that of constant current charging.

The financial cost of hamstring strain injuries in the Australian Football League.

PubMed

Hickey, Jack; Shield, Anthony J; Williams, Morgan D; Opar, David A

2014-04-01

Hamstring strain injuries (HSIs) have remained the most prevalent injury in the Australian Football League (AFL) over the past 21 regular seasons. The effect of HSIs in sports is often expressed as regular season games missed due to injury. However, the financial cost of athletes missing games due to injury has not been investigated. The aim of this report is to estimate the financial cost of games missed due to HSIs in the AFL. Data were collected using publicly available information from the AFL's injury report and the official AFL annual report for the past 10 competitive AFL seasons. Average athlete salary and injury epidemiology data were used to determine the average yearly financial cost of HSIs for AFL clubs and the average financial cost of a single HSI over this time period. Across the observed period, average yearly financial cost of HSIs per club increased by 71% compared with a 43% increase in average yearly athlete salary. Over the same time period the average financial cost of a single HSI increased by 56% from $A25,603 in 2003 to $A40,021 in 2012, despite little change in the HSI rates during the period. The observed increased financial cost of HSIs was ultimately explained by the failure of teams to decrease HSI rates, but coupled with increases in athlete salaries over the past 10 season. The information presented in this report highlights the financial cost of HSIs and other sporting injuries, raising greater awareness and the need for further funding for research into injury prevention strategies to maximise economical return for investment in athletes.

Results of Uranium Dioxide-Tungsten Irradiation Test and Post-Test Examination

NASA Technical Reports Server (NTRS)

Collins, J. F.; Debogdan, C. E.; Diianni, D. C.

1973-01-01

A uranium dioxide (UO2) fueled capsule was fabricated and irradiated in the NASA Plum Brook Reactor Facility. The capsule consisted of two bulk UO2 specimens clad with chemically vapor deposited tungsten (CVD W) 0.762 and 0.1016 cm (0.030-and 0.040-in.) thick, respectively. The second specimen with 0.1016-cm (0.040-in.) thick cladding was irradiated at temperature for 2607 hours, corresponding to an average burnup of 1.516 x 10 to the 20th power fissions/cu cm. Postirradiation examination showed distortion in the bottom end cap, failure of the weld joint, and fracture of the central vent tube. Diametral growth was 1.3 percent. No evidence of gross interaction between CVD tungsten or arc-cast tungsten cladding and the UO2 fuel was observed. Some of the fission gases passed from the fuel cavity to the gas surrounding the fuel specimen via the vent tube and possibly the end-cap weld failure. Whether the UO2 loss rates through the vent tube were within acceptable limits could not be determined in view of the end-cap weld failure.

Performance of life support breathing apparatus for under-ice diving operations.

PubMed

Lang, Michael A; Clarke, John R

2017-01-01

Single-hose scuba regulators dived in very cold water may suffer first- or second-stage malfunction, yielding complete occlusion of air flow or massive freeflow that rapidly expends a diver's air supply. This study, conducted in Antarctica, evaluated the under-ice performance of a sampling of commercially available regulators. Seventeen science divers logged a total of 305 dives in -1.86°C seawater under 6-meter-thick Antarctic fast-ice over two field seasons in 2008 and 2009. Dive profiles had an average depth of 30 msw and dive time of 29 minutes, including a mandatory three-minute safety stop at 6 msw. Sixty-nine unmodified regulator units (17 models) from 12 different manufacturers underwent standardized pre-dive regulator care and were randomly assigned to divers. Depths and times of onset of second-stage regulator freeflow were recorded. In 305 dives, there were 65 freeflows. The freeflows were not evenly distributed across the regulator brands. Regulator failure rates fell into two categories (⟨ 11% and ⟩ 26%). The regulators classified for the purpose of the test as "acceptable" (⟨ 11% failure rate: Dive-Rite Jetstream, Sherwood Maximus SRB3600, Poseidon Xstream Deep, Poseidon Jetstream, Sherwood Maximus SRB7600, Poseidon Cyklon, Mares USN22 Abyss) experienced only nine freeflows out of 146 exposures for a 6% overall freeflow incidence. Those classified as "unacceptable" (⟨ 26% failure rate) suffered 56 freeflows out of 159 exposures (35% freeflow incidence.). Contrary to expectations, the pooled incidences for the seven best performing regulators was significantly different by Chi-square test from the 10 remaining regulators (P ⟨ 0.001).

Compliance with clinical pathways for inpatient care in Chinese public hospitals.

PubMed

He, Xiao Yan; Bundorf, M Kate; Gu, Jian Jun; Zhou, Ping; Xue, Di

2015-10-06

The National Health and Family Planning Commission of China has issued more than 400 clinical pathways to improve the effectiveness and efficiency of medical care delivered by public hospitals in China. The aim of our study is to determine whether patient care is compliant with national clinical pathways in public general hospitals of Pudong New Area in Shanghai. We identified the clinical pathways established by the National Health and Family Planning Commission of China for 5 common conditions (community-acquired pneumonia, acute myocardial infarction (AMI), heart failure, cesarean section, type-2 diabetes). We randomly selected patients with each condition admitted to one of 7 public general hospitals in Pudong New Area in China in January, 2013. We identified key process indicators (KPIs) for each pathway and, based on chart review for each patient, determined whether the patient's care was compliant for each indicator. We calculated the proportion of care which was compliant with clinical pathways for each indicator, the average proportion of indicators that were met for each patient, and the proportion of patients whose care was compliant for all measures. For selected indicators, we compared compliance rates among hospitals in our study with those from other countries. Average compliance rates across the KPIs for each condition ranged from 61 % for AMI to 89 % for pneumonia. The percent of patient receiving fully compliant care ranged from 0 for AMI and heart failure to 39 % for pneumonia. Compared to the compliance rate for process indicators in the hospitals of other countries, some rates in the hospitals that we audited were higher, but some were lower. Few patients received care that complied with all the pathways for each condition. The reasons for low compliance with national clinical pathways and how to improve clinical quality in public hospitals of China need to be further explored.

Filling Open Screw Holes in the Area of Metaphyseal Comminution Does Not Affect Fatigue Life of the Synthes Variable Angle Distal Femoral Locking Plate in the AO/OTA 33-A3 Fracture Model.

PubMed

Grau, Luis; Collon, Kevin; Alhandi, Ali; Kaimrajh, David; Varon, Maria; Latta, Loren; Vilella, Fernando

2018-06-01

The aim of this study is to evaluate the biomechanical effect of filling locking variable angle (VA) screw holes at the area of metaphyseal fracture comminution in a Sawbones® (Sawbones USA, Vashon, Washington) model (AO/OTA 33A-3 fracture) using a Synthes VA locking compression plate (LCP) (Depuy Synthes, Warsaw, Indiana). Seven Sawbones® femur models had a Synthes VA-LCP placed as indicated by the manufacturers technique. A 4cm osteotomy was then created to simulate an AO/OTA 33-A3 femoral fracture pattern with metaphyseal comminution. The control group consisted of four constructs in which the open screw holes at the area of comminution were left unfilled; the experimental group consisted of three constructs in which the VA screw holes were filled with locking screws. One of the control constructs was statically loaded to failure at a rate of 5mm/min. A value equal to 75% of the ultimate load to failure was used as the loading force for fatigue testing of 250,000 cycles at 3Hz. Cycles to failure was recorded for each construct and averages were compared between groups. The average number of cycles to failure in the control and experimental groups were 37524±8187 and 43304±23835, respectively (p=0.72). No significant difference was observed with respect to cycles to failure or mechanism of failure between groups. In all constructs in both the control and experimental groups, plate failure reproducibly occurred with cracks through the variable angle holes in the area of bridged comminution. The Synthes VA-LCP in a simulated AO/OTA 33-A3 comminuted metaphyseal femoral fracture fails in a reproducible manner at the area of comminution through the "honeycomb" VA screw holes. Filling open VA screw holes at the site of comminution with locking screws does not increase fatigue life of the Synthes VA-LCP in a simulated AO/OTA 33-A3 distal femoral fracture. Further studies are necessary to determine whether use of this particular plate is contraindicated when bridging distal femoral fractures with metaphyseal comminution.

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.

Premonitory slip and tidal triggering of earthquakes

USGS Publications Warehouse

Lockner, D.A.; Beeler, N.M.

1999-01-01

We have conducted a series of laboratory simulations of earthquakes using granite cylinders containing precut bare fault surfaces at 50 MPa confining pressure. Axial shortening rates between 10-4 and 10-6 mm/s were imposed to simulate tectonic loading. Average loading rate was then modulated by the addition of a small-amplitude sine wave to simulate periodic loading due to Earth tides or other sources. The period of the modulating signal ranged from 10 to 10,000 s. For each combination of amplitude and period of the modulating signal, multiple stick-slip events were recorded to determine the degree of correlation between the timing of simulated earthquakes and the imposed periodic loading function. Over the range of parameters studied, the degree of correlation of earthquakes was most sensitive to the amplitude of the periodic loading, with weaker dependence on the period of oscillations and the average loading rate. Accelerating premonitory slip was observed in these experiments and is a controlling factor in determining the conditions under which correlated events occur. In fact, some form of delayed failure is necessary to produce the observed correlations between simulated earthquake timing and characteristics of the periodic loading function. The transition from strongly correlated to weakly correlated model earthquake populations occurred when the amplitude of the periodic loading was approximately 0.05 to 0.1 MPa shear stress (0.03 to 0.06 MPa Coulomb failure function). Lower-amplitude oscillations produced progressively lower correlation levels. Correlations between static stress increases and earthquake aftershocks are found to degrade at similar stress levels. Typical stress variations due to Earth tides are only 0.001 to 0.004 MPa, so that the lack of correlation between Earth tides and earthquakes is also consistent with our findings. A simple extrapolation of our results suggests that approximately 1% of midcrustal earthquakes should be correlated with Earth tides. Triggered seismicity has been reported resulting from the passage of surface waves excited by the Landers earthquake. These transient waves had measured amplitudes in excess of 0.1 MPa at frequencies of 0.05 to 0.2 Hz in regions of notable seismicity increase. Similar stress oscillations in our laboratory experiments produced strongly correlated stick-slip events. We suggest that seemingly inconsistent natural observations of triggered seismicity and absence of tidal triggering indicate that failure is amplitude and frequency dependent. This is the expected result if, as in our laboratory experiments, the rheology of the Earth's crust permits delayed failure.

Effectiveness and predictors of failure of noninvasive mechanical ventilation in acute respiratory failure.

PubMed

Martín-González, F; González-Robledo, J; Sánchez-Hernández, F; Moreno-García, M N; Barreda-Mellado, I

2016-01-01

To assess the effectiveness and identify predictors of failure of noninvasive ventilation. A retrospective, longitudinal descriptive study was made. Adult patients with acute respiratory failure. A total of 410 consecutive patients with noninvasive ventilation treated in an Intensive Care Unit of a tertiary university hospital from 2006 to 2011. Noninvasive ventilation. Demographic variables and clinical and laboratory test parameters at the start and two hours after the start of noninvasive ventilation. Evolution during admission to the Unit and until hospital discharge. The failure rate was 50%, with an overall mortality rate of 33%. A total of 156 patients had hypoxemic respiratory failure, 87 postextubation respiratory failure, 78 exacerbation of chronic obstructive pulmonary disease, 61 hypercapnic respiratory failure without chronic obstructive pulmonary disease, and 28 had acute pulmonary edema. The failure rates were 74%, 54%, 27%, 31% and 21%, respectively. The etiology of respiratory failure, serum bilirubin at the start, APACHEII score, radiological findings, the need for sedation to tolerate noninvasive ventilation, changes in level of consciousness, PaO2/FIO2 ratio, respiratory rate and heart rate from the start and two hours after the start of noninvasive ventilation were independently associated to failure. The effectiveness of noninvasive ventilation varies according to the etiology of respiratory failure. Its use in hypoxemic respiratory failure and postextubation respiratory failure should be assessed individually. Predictors of failure could be useful to prevent delayed intubation. Copyright © 2015 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

Need for higher fuel burnup at the Hatch Plant

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

Beckhman, J.T.

1996-03-01

Hatch is a BWR 4 and has been in operation for some time. The first unit became commercial about 1975. Obtaining higher burnups, or higher average discharge exposures, is nothing new at Hatch. Since we have started, the discharge exposure of the plant has increased. Now, of course, we are not approaching the numbers currently being discussed but, the average discharge exposure has increased from around 20,000 MWD/MTU in the early to mid-1980s to 34,000 MWD/MTU in 1994, I am talking about batch average values. There are also peak bundle and peak rod values. You will have to make themore » conversions if you think in one way or the other because I am talking in batch averages. During Hatch`s operating history we have had some problems with fuel failure. Higher burnup fuel raises a concern about how much fuel failure you are going to have. Fuel failure is, of course, an economic issue with us. Back in the early 1980s, we had a problem with crud-induced localized corrosion, known as CILC. We have gotten over that, but we had some times when it was up around 27 fuel failures a year. That is not a pleasant time to live through because it is not what you want from an economic viewpoint or any other. We have gotten that down. We have had some fuel failures recently, but they have not been related to fuel burnup or to corrosion. In fact, the number of failures has decreased from the early 1980s to the 90s even though burnup increased during that time. The fuel failures are more debris-related-type failures. In addition to increasing burnups, utilities are actively evaluating or have already incorporated power uprate and longer fuel cycles (e.g., 2-year cycles). The goal is to balance out the higher power density, longer cycles, higher burnup, and to have no leakers. Why do we as an industry want to have higher burnup fuel? That is what I want to tell you a little bit about.« less

High strain rate properties of off-axis composite laminates, part 2

NASA Technical Reports Server (NTRS)

Daniel, I. M.

1991-01-01

Unidirectional off-axis graphite/epoxy and graphite/S-glass/epoxy laminates were characterized in uniaxial tension at strain rates ranging from quasi-static to over 500 s(sup -1). Laminate ring specimens were loaded by internal pressure with the tensile stress at 22.5, 30, and 45 degrees relative to the fiber direction. Results were presented in the form of stress-strain curves to failure. Properties determined included moduli, Poisson's ratios, strength, and ultimate strain. In all three laminates of both materials the modulus and strength increase sharply with strain rate, reaching values roughly 100, 150, and 200 percent higher than corresponding static values for the 22.5(sub 8), 30(sub 8), and 45(sub 8) degree laminates, respectively. In the case of ultimate strain no definite trends could be established, but the maximum deviation from the average of any value for any strain rate was less than 18 percent.

Correlation of residual strength with acoustic emission from impact-damaged composite structures under constant biaxial load

NASA Astrophysics Data System (ADS)

Hamstad, M. A.; Whittaker, J. W.; Brosey, W. D.

1992-01-01

Small, filament-wound, Kevlar/epoxy, biaxial test specimens were subjected to various levels of impact damage. The specimens were pressurized in a proof test cycle to 58 percent of their nominal, undamaged strength and then pressurized to failure. Acoustic emission data were gathered by multiple sensors during a 10 minute hold at peak proof pressure. Post-test filtering of the data was performed to study composite behavior in the damaged region and other areas. The rate and total amount of AE produced depends on the duration of the static load and degree of damage. The concept of the event rate moment is introduced as a method of quantifying a structure's total AE behavior when under static load. Average event rate, total long duration events, and event rate moments provided various degrees of correlation between AE and residual strength.

Mechanical properties of carbon steel depending on the rate of the dose build-up of nitrogen and argon ions

NASA Astrophysics Data System (ADS)

Vorob'ev, V. L.; Bykov, P. V.; Bayankin, V. Ya.; Shushkov, A. A.; Vakhrushev, A. V.

2014-08-01

The effect of pulsed irradiation with argons and nitrogen ions on the mechanical properties, morphology, and structure of the surface layers of carbon steel St3 (0.2% C, 0.4% Mn, 0.15% Si, and Fe for balance) has been investigated depending on the rate of dose build-up at an average ion current density of 10, 20, and 40 μA/cm2. It has been established that the fatigue life and microhardness of surface layers increase in the entire studied range of dose build-up rates. This seems to be due to the hardening of the surface layers, which resulted from the generation of radiation defects and the irradiation-dynamic effect of fast ions. The sample irradiated by argon ions at the lowest of the selected dose build-up rates j av = 10 μA/cm2 withstands the largest number of cycles to failure.

Treatment Failure With Rhythm and Rate Control Strategies in Patients With Atrial Fibrillation and Congestive Heart Failure: An AF-CHF Substudy.

PubMed

Dyrda, Katia; Roy, Denis; Leduc, Hugues; Talajic, Mario; Stevenson, Lynne Warner; Guerra, Peter G; Andrade, Jason; Dubuc, Marc; Macle, Laurent; Thibault, Bernard; Rivard, Lena; Khairy, Paul

2015-12-01

Rate and rhythm control strategies for atrial fibrillation (AF) are not always effective or well tolerated in patients with congestive heart failure (CHF). We assessed reasons for treatment failure, associated characteristics, and effects on survival. A total of 1,376 patients enrolled in the AF-CHF trial were followed for 37  ±  19 months, 206 (15.0%) of whom failed initial therapy leading to crossover. Rhythm control was abandoned more frequently than rate control (21.0% vs. 9.1%, P < 0.0001). Crossovers from rhythm to rate control were driven by inefficacy, whereas worsening heart failure was the most common reason to crossover from rate to rhythm control. In multivariate analyses, failure of rhythm control was associated with female sex, higher serum creatinine, functional class III or IV symptoms, lack of digoxin, and oral anticoagulation. Factors independently associated with failure of rate control were paroxysmal (vs. persistent) AF, statin therapy, and presence of an implantable cardioverter-defibrillator. Crossovers were not associated with cardiovascular mortality (hazard ratio [HR] 1.11 from rhythm to rate control; 95% confidence interval [95% CI, 0.73-1.73]; P = 0.6069; HR 1.29 from rate to rhythm control; 95% CI, 0.73-2.25; P = 0.3793) or all-cause mortality (HR 1.16 from rhythm to rate control, 95% CI [0.79-1.72], P = 0.4444; HR 1.15 from rate to rhythm control, 95% [0.69, 1.91], P = 0.5873). Rhythm control is abandoned more frequently than rate control in patients with AF and CHF. The most common reasons for treatment failure are inefficacy for rhythm control and worsening heart failure for rate control. Changing strategies does not impact survival. © 2015 Wiley Periodicals, Inc.

Enhanced central venous catheter bundle for pediatric parenteral-dependent intestinal failure.

PubMed

Ormsby, Jennifer A; Bukoye, Bola; Lajoie, Debra; Shermont, Herminia; Martin, Lisa; Leger, Kierrah; Mahoney, Judy; Potter-Bynoe, Gail; Carpenter, Jane; Ozonoff, Al; Lee, Grace M

2018-05-16

Central line-associated bloodstream infections (CLABSIs) cause substantial morbidity and increase antimicrobial use and length of stay among hospitalized children in the United States. CLABSI occurs more frequently among high-risk pediatric patients, such as those with intestinal failure (IF) who are parenteral nutrition (PN) dependent. Following an increase in CLABSI rates, a quality improvement (QI) initiative was implemented. Using QI methodology, an enhanced central venous catheter (CVC) maintenance bundle was developed and implemented on 2 units for pediatric PN-dependent patients with IF. CLABSI rates were prospectively monitored pre- and postimplementation, and bundle element adherence was monitored. Enhanced bundle elements included chlorhexidine-impregnated patch, daily bathing, ethanol locks, 2 nurses for CVC care in a distraction-free zone, peripheral laboratory draws, bundling routine laboratory tests, and PN administration set changes every 24 hours. Adherence to enhanced bundle elements increased to >90% over 3 months. CLABSI rates averaged 1.41 per 1,000 central line days preimplementation compared with 0.40 per 1,000 device days postimplementation (P = .003), an 85% absolute reduction in CLABSI rates over 12 months. Patients with IF are at an increased risk for CLABSI. Enhanced CVC maintenance bundles that specifically target prevention practices in this population may be beneficial. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Reliability analysis of C-130 turboprop engine components using artificial neural network

NASA Astrophysics Data System (ADS)

Qattan, Nizar A.

In this study, we predict the failure rate of Lockheed C-130 Engine Turbine. More than thirty years of local operational field data were used for failure rate prediction and validation. The Weibull regression model and the Artificial Neural Network model including (feed-forward back-propagation, radial basis neural network, and multilayer perceptron neural network model); will be utilized to perform this study. For this purpose, the thesis will be divided into five major parts. First part deals with Weibull regression model to predict the turbine general failure rate, and the rate of failures that require overhaul maintenance. The second part will cover the Artificial Neural Network (ANN) model utilizing the feed-forward back-propagation algorithm as a learning rule. The MATLAB package will be used in order to build and design a code to simulate the given data, the inputs to the neural network are the independent variables, the output is the general failure rate of the turbine, and the failures which required overhaul maintenance. In the third part we predict the general failure rate of the turbine and the failures which require overhaul maintenance, using radial basis neural network model on MATLAB tool box. In the fourth part we compare the predictions of the feed-forward back-propagation model, with that of Weibull regression model, and radial basis neural network model. The results show that the failure rate predicted by the feed-forward back-propagation artificial neural network model is closer in agreement with radial basis neural network model compared with the actual field-data, than the failure rate predicted by the Weibull model. By the end of the study, we forecast the general failure rate of the Lockheed C-130 Engine Turbine, the failures which required overhaul maintenance and six categorical failures using multilayer perceptron neural network (MLP) model on DTREG commercial software. The results also give an insight into the reliability of the engine turbine under actual operating conditions, which can be used by aircraft operators for assessing system and component failures and customizing the maintenance programs recommended by the manufacturer.

Percutaneous spinal fixation simulation with virtual reality and haptics.

PubMed

Luciano, Cristian J; Banerjee, P Pat; Sorenson, Jeffery M; Foley, Kevin T; Ansari, Sameer A; Rizzi, Silvio; Germanwala, Anand V; Kranzler, Leonard; Chittiboina, Prashant; Roitberg, Ben Z

2013-01-01

In this study, we evaluated the use of a part-task simulator with 3-dimensional and haptic feedback as a training tool for percutaneous spinal needle placement. To evaluate the learning effectiveness in terms of entry point/target point accuracy of percutaneous spinal needle placement on a high-performance augmented-reality and haptic technology workstation with the ability to control the duration of computer-simulated fluoroscopic exposure, thereby simulating an actual situation. Sixty-three fellows and residents performed needle placement on the simulator. A virtual needle was percutaneously inserted into a virtual patient's thoracic spine derived from an actual patient computed tomography data set. Ten of 126 needle placement attempts by 63 participants ended in failure for a failure rate of 7.93%. From all 126 needle insertions, the average error (15.69 vs 13.91), average fluoroscopy exposure (4.6 vs 3.92), and average individual performance score (32.39 vs 30.71) improved from the first to the second attempt. Performance accuracy yielded P = .04 from a 2-sample t test in which the rejected null hypothesis assumes no improvement in performance accuracy from the first to second attempt in the test session. The experiments showed evidence (P = .04) of performance accuracy improvement from the first to the second percutaneous needle placement attempt. This result, combined with previous learning retention and/or face validity results of using the simulator for open thoracic pedicle screw placement and ventriculostomy catheter placement, supports the efficacy of augmented reality and haptics simulation as a learning tool.

Less invasive stabilization system (LISS) in the treatment of distal femoral fractures.

PubMed

Schütz, M; Müller, M; Kääb, M; Haas, N

2003-01-01

The treatment of distal femoral fractures has been associated with a high rate of complications for a long time. Although implants and surgical techniques have improved, plate osteosynthesis and intramedullary nailing have been accompanied by a high occurrence of infection, non-union and malalignment. The treatment of soft tissue envelopes using "biological" osteosynthesis and minimally invasive approaches has resulted in a decrease in complication rates and ultimately led to the concept of the less invasive stabilization system (LISS). This is an extramedullary-applied, internal fixator shaped according to the implantation site anatomy, with minimal invasiveness. The purpose of this study was to present this new surgical technique and draw attention to its advantages and importance. Although this is not a scientific paper, we hope to provide enough evidence of the LISS usefulness. The main LISS components include multiple-fixed angle screws and an insertion handle for submuscular sliding of a fixator and placement of percutaneous, self-drilling, unicortical screws for fixation of the diaphyseal fracture fragments. The LISS has been designed to preserve periosteal perfusion and to facilitate a minimally invasive application. Since the first implantation of the LISS, only a few studies have been published on its use in treatment of distal femoral fractures. The rate of infection has been low, ranging from 0 to 4%. The rate of delayed union has been between 2.4 and 6.1%, but delayed unions do not necessarily lead to secondary bone grafting or repeat osteosynthesis as the LISS has a high and lasting stability. When the LISS is used, bone grafting is rarely necessary (0 to 1.6% in primary and 0 to 5% in secondary grafting). Also implant failure differs from the failure of plate osteosynthesis because, with the use of LISS, no screw loosening or secondary malalignment occurs. Implant failures (up to 7.4%) were recorded particularly at the time of LISS introduction in surgical practice and were attributed to the technique of implantation rather than to the implant itself. Good treatment outcomes have been reported. The average knee flexion has been 103 degrees and 107 degrees. In 72.5% of the patients, flexion has been more than 90 degrees and an extension lag of > or = 10 degrees has been found in only 7.5% of all cases. The average Neer score has ranged from 73.9 to 77.2 points. In conclusion, the LISS is a useful implant for treatment of distal femoral fractures, especially when bone quality is poor. Infection, delayed union and non-union rates are low, as shown by yet unpublished data from our clinic. Primary bone grafting, which is rarely necessary with this system, is carried out only when there is a great bone loss. Implant failure, such as screw loosening or secondary malalignment, is not seen.

Contraceptive failure rates: new estimates from the 1995 National Survey of Family Growth.

PubMed

Fu, H; Darroch, J E; Haas, T; Ranjit, N

1999-01-01

Unintended pregnancy remains a major public health concern in the United States. Information on pregnancy rates among contraceptive users is needed to guide medical professionals' recommendations and individuals' choices of contraceptive methods. Data were taken from the 1995 National Survey of Family Growth (NSFG) and the 1994-1995 Abortion Patient Survey (APS). Hazards models were used to estimate method-specific contraceptive failure rates during the first six months and during the first year of contraceptive use for all U.S. women. In addition, rates were corrected to take into account the underreporting of induced abortion in the NSFG. Corrected 12-month failure rates were also estimated for subgroups of women by age, union status, poverty level, race or ethnicity, and religion. When contraceptive methods are ranked by effectiveness over the first 12 months of use (corrected for abortion underreporting), the implant and injectables have the lowest failure rates (2-3%), followed by the pill (8%), the diaphragm and the cervical cap (12%), the male condom (14%), periodic abstinence (21%), withdrawal (24%) and spermicides (26%). In general, failure rates are highest among cohabiting and other unmarried women, among those with an annual family income below 200% of the federal poverty level, among black and Hispanic women, among adolescents and among women in their 20s. For example, adolescent women who are not married but are cohabiting experience a failure rate of about 31% in the first year of contraceptive use, while the 12-month failure rate among married women aged 30 and older is only 7%. Black women have a contraceptive failure rate of about 19%, and this rate does not vary by family income; in contrast, overall 12-month rates are lower among Hispanic women (15%) and white women (10%), but vary by income, with poorer women having substantially greater failure rates than more affluent women. Levels of contraceptive failure vary widely by method, as well as by personal and background characteristics. Income's strong influence on contraceptive failure suggests that access barriers and the general disadvantage associated with poverty seriously impede effective contraceptive practice in the United States.

Arthrodesis of the knee with a long intramedullary nail following the failure of a total knee arthroplasty as the result of infection. Surgical technique.

PubMed

Bargiotas, Konstantinos; Wohlrab, David; Sewecke, Jeffrey J; Lavinge, Gregory; DeMeo, Patrick J; Sotereanos, Nicholas G

2007-03-01

Knee arthrodesis can be an effective treatment option for relieving pain and restoring some function after the failure of a total knee arthroplasty as the result of infection. The purpose of the present study was to review the outcome of a staged approach for arthrodesis of the knee with a long intramedullary nail after the failure of a total knee arthroplasty as the result of infection. We reviewed the results for twelve patients who underwent knee arthrodesis after the removal of a prosthesis because of infection. The study group included seven women and five men who had an average age of sixty-eight years at the time of the arthrodesis. All patients were managed with a staged protocol. Implant removal, débridement, and insertion of antibiotic cement spacers was followed by the administration of systemic antibiotics. Provided that clinical and laboratory data suggested eradication of the infection, arthrodesis of the affected knee with use of a long intramedullary nail was carried out. Clinical and laboratory evaluation and radiographic analysis were performed after an average duration of follow-up of 4.1 years. Solid union was achieved in ten of the twelve knees. The average time to union was 5.5 months. One patient had an above-the-knee amputation because of recurrence of infection. In another patient, nail breakage occurred three years following implantation. The average limb-length discrepancy was 5.5 cm. The mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score improved from 41 to 64 points. None of the seven patients who underwent arthrodesis with a technique involving convex-to-concave reamers had a complication, and the average time to union for these seven patients was shorter than that for the remaining five patients (4.3 compared with 7.4 months). We believe that obtaining large surfaces of bleeding contact bone during arthrodesis following staged treatment of an infection at the site of a failed total knee arthroplasty contributes to stability and enhances bone-healing. Staged arthrodesis with use of a long intramedullary nail and convex-to-concave preparation of bone ends provided a painless functional gait with low complication and reoperation rates in this challenging group of patients.

Arthrodesis of the knee with a long intramedullary nail following the failure of a total knee arthroplasty as the result of infection.

PubMed

Bargiotas, Konstantinos; Wohlrab, David; Sewecke, Jeffrey J; Lavinge, Gregory; Demeo, Patrick J; Sotereanos, Nicholas G

2006-03-01

Knee arthrodesis can be an effective treatment option for relieving pain and restoring some function after the failure of a total knee arthroplasty as the result of infection. The purpose of the present study was to review the outcome of a staged approach for arthrodesis of the knee with a long intramedullary nail after the failure of a total knee arthroplasty as the result of infection. We reviewed the results for twelve patients who underwent knee arthrodesis after the removal of a prosthesis because of infection. The study group included seven women and five men who had an average age of sixty-eight years at the time of the arthrodesis. All patients were managed with a staged protocol. Implant removal, débridement, and insertion of antibiotic cement spacers was followed by the administration of systemic antibiotics. Provided that clinical and laboratory data suggested eradication of the infection, arthrodesis of the affected knee with use of a long intramedullary nail was carried out. Clinical and laboratory evaluation and radiographic analysis were performed after an average duration of follow-up of 4.1 years. Solid union was achieved in ten of the twelve knees. The average time to union was 5.5 months. One patient had an above-the-knee amputation because of recurrence of infection. In another patient, nail breakage occurred three years following implantation. The average limb-length discrepancy was 5.5 cm. The mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score improved from 41 to 64 points. None of the seven patients who underwent arthrodesis with a technique involving convex-to-concave reamers had a complication, and the average time to union for these seven patients was shorter than that for the remaining five patients (4.3 compared with 7.4 months). We believe that obtaining large surfaces of bleeding contact bone during arthrodesis following staged treatment of an infection at the site of a failed total knee arthroplasty contributes to stability and enhances bone-healing. Staged arthrodesis with use of a long intramedullary nail and convex-to-concave preparation of bone ends provided a painless functional gait with low complication and reoperation rates in this challenging group of patients.

A dislocation-based crystal plasticity framework for dynamic ductile failure of single crystals

DOE PAGES

Nguyen, Thao; Luscher, D. J.; Wilkerson, J. W.

2017-08-02

We developed a framework for dislocation-based viscoplasticity and dynamic ductile failure to model high strain rate deformation and damage in single crystals. The rate-dependence of the crystal plasticity formulation is based on the physics of relativistic dislocation kinetics suited for extremely high strain rates. The damage evolution is based on the dynamics of void growth, which are governed by both micro-inertia as well as dislocation kinetics and dislocation substructure evolution. Furthermore, an averaging scheme is proposed in order to approximate the evolution of the dislocation substructure in both the macroscale as well as its spatial distribution at the microscale. Inmore » addition, a concept of a single equivalent dislocation density that effectively captures the collective influence of dislocation density on all active slip systems is proposed here. Together, these concepts and approximations enable the use of semi-analytic solutions for void growth dynamics developed in [J. Wilkerson and K. Ramesh. A dynamic void growth model governed by dislocation kinetics. J. Mech. Phys. Solids, 70:262–280, 2014.], which greatly reduce the computational overhead that would otherwise be required. The resulting homogenized framework has been implemented into a commercially available finite element package, and a validation study against a suite of direct numerical simulations was carried out.« less

Improved detection of congestive heart failure via probabilistic symbolic pattern recognition and heart rate variability metrics.

PubMed

Mahajan, Ruhi; Viangteeravat, Teeradache; Akbilgic, Oguz

2017-12-01

A timely diagnosis of congestive heart failure (CHF) is crucial to evade a life-threatening event. This paper presents a novel probabilistic symbol pattern recognition (PSPR) approach to detect CHF in subjects from their cardiac interbeat (R-R) intervals. PSPR discretizes each continuous R-R interval time series by mapping them onto an eight-symbol alphabet and then models the pattern transition behavior in the symbolic representation of the series. The PSPR-based analysis of the discretized series from 107 subjects (69 normal and 38 CHF subjects) yielded discernible features to distinguish normal subjects and subjects with CHF. In addition to PSPR features, we also extracted features using the time-domain heart rate variability measures such as average and standard deviation of R-R intervals. An ensemble of bagged decision trees was used to classify two groups resulting in a five-fold cross-validation accuracy, specificity, and sensitivity of 98.1%, 100%, and 94.7%, respectively. However, a 20% holdout validation yielded an accuracy, specificity, and sensitivity of 99.5%, 100%, and 98.57%, respectively. Results from this study suggest that features obtained with the combination of PSPR and long-term heart rate variability measures can be used in developing automated CHF diagnosis tools. Copyright © 2017 Elsevier B.V. All rights reserved.

Non-invasive ventilation with bubble CPAP is feasible and improves respiratory physiology in hospitalised Malawian children with acute respiratory failure

PubMed Central

Walk, J.; Dinga, P.; Banda, C.; Msiska, T.; Chitsamba, E.; Chiwayula, N.; Lufesi, N.; Mlotha-Mitole, R.; Costello, A.; Phiri, A.; Colbourn, T.; McCollum, E. D.; Lang, H. J.

2015-01-01

Background In low-income countries and those with a high prevalence of HIV, respiratory failure is a common cause of death in children. However, the role of non-invasive ventilation with bubble continuous positive airway pressure (bCPAP) in these patients is not well established. Methods A prospective observational study of bCPAP was undertaken between July and September 2012 in 77 Malawian children aged 1 week to 14 years with progressive acute respiratory failure despite oxygen and antimicrobial therapy. Results Forty-one (53%) patients survived following bCPAP treatment, and an HIV-uninfected single-organ disease subgroup demonstrated bCPAP success in 14 of 17 (82%). Compared with children aged ≥60 months, infants of 0–2 months had a 93% lower odds of bCPAP failure (odds ratio 0.07, 95% confidence interval 0.004–1.02, P = 0.05). Following commencement of bCPAP, respiratory physiology improved, the average respiratory rate decreased from 61 to 49 breaths/minute (P = 0.0006), and mean oxygen saturation increased from 92.1% to 96.1% (P = 0.02). Conclusions bCPAP was well accepted by caregivers and patients and can be feasibly implemented into a tertiary African hospital with high-risk patients and limited resources. PMID:25434361

Upper Cervical Spinal Cord Stimulation as an Alternative Treatment in Trigeminal Neuropathy.

PubMed

Velásquez, Carlos; Tambirajoo, Kantharuby; Franceschini, Paulo; Eldridge, Paul R; Farah, Jibril Osman

2018-06-01

To describe the indications and outcomes of upper cervical cord stimulation in trigeminal neuropathy. A consecutive single-center series of patients was retrospectively reviewed. It included 12 patients with trigeminal neuropathy treated with upper cervical spinal cord stimulation. Clinical features, complications, and outcomes were reviewed. All patients had a successful trial before the definitive implantation of a spinal cord stimulator at the level of the craniocervical junction. The mean follow-up period was 4.4 years (range, 0.3-21.1 years). The average coverage in the pain zone was 72% and the median baseline, trial, and postoperative numeric rating scale (NRS) was 7, 3, and 3, respectively. When compared with the baseline, the mean reduction achieved in the postoperative average numeric rating scale was 4 points, accounting for a 57.1% pain reduction. The long-term failure rate was 25%. Despite there being enough evidence to consider upper cervical spinal cord stimulation as an effective treatment for patients with neuropathic trigeminal pain, a randomized controlled trial is needed to fully assess its indications and outcomes and compare it with other therapeutic approaches. Copyright © 2018 Elsevier Inc. All rights reserved.

Behaviors of 40Cr steel treated by laser quenching on impact abrasive wear

NASA Astrophysics Data System (ADS)

Chen, Zhikai; Zhu, Qinghai; Wang, Jing; Yun, Xiao; He, Bing; Luo, Jingshuai

2018-07-01

In present work, laser quenching had been carried out to improve the impact abrasive wear resistance of 40Cr steel. The distinct microstructure between original and quenched region was demonstrated after laser quenching. Since the effect of temperature and cooling rate, the phase combinations were apparently different for quenched layer in depth. The impact abrasive wear resistance of sample was experimentally investigated and the improved level was assessed in light of the average mass loss of three repetitive tests. Worn surface was detected by means of SEM, OM and EDS, and results showed that three typical failure modes were performed during the processing of impact abrasive wear, including abrasive wear, impact effect and rolling contact fatigue. Basing on the different worn surface profile, the mainly failure mode was respectively pointed out for matrix and quenched sample, which was significantly in accordance with the result of impact abrasive wear.

Dynamic fragmentation of cellular, ice-templated alumina scaffolds

DOE PAGES

Tan, Yi Ming; Cervantes, Octavio; Nam, SeanWoo; ...

2016-01-08

Here, we examine the dynamic failure of ice-templated freeze-cast alumina scaffolds that are being considered as biomimetic hierarchical structures. Three porosities of alumina freeze-cast structures were fabricated, and a systematic variation in microstructural properties such as lamellar width and thickness was observed with changing porosity. Dynamic impact tests were performed in a light-gas gun to examine the failure properties of these materials under high strain-rate loading. Nearly complete delamination was observed following impact, along with characteristic cracking across the lamellar width. Average fragment size decreases with increasing porosity, and a theoretical model was developed to explain this behavior based onmore » microstructural changes. Using an energy balance between kinetic, strain, and surface energies within a single lamella, we are able to accurately predict the characteristic fragment size using only standard material properties of bulk alumina.« less

Midterm clinical outcomes following arthroscopic transosseous rotator cuff repair

PubMed Central

Flanagin, Brody A.; Garofalo, Raffaele; Lo, Eddie Y.; Feher, LeeAnne; Castagna, Alessandro; Qin, Huanying; Krishnan, Sumant G.

2016-01-01

Purpose: Arthroscopic transosseous (TO) rotator cuff repair has recently emerged as a new option for surgical treatment of symptomatic rotator cuff tears. Limited data is available regarding outcomes using this technique. This study evaluated midterm clinical outcomes following a novel arthroscopic TO (anchorless) rotator cuff repair technique. Materials and Methods: A consecutive series of 107 patients and 109 shoulders underwent arthroscopic TO (anchorless) rotator cuff repair for a symptomatic full-thickness tear. Pre and postoperative range of motion (ROM) was compared at an average of 11.8 months. Postoperative outcome scores were obtained at an average of 38.0 months. Statistical analysis was performed to compare pre and postoperative ROM data. Univariate analysis was performed using Student's t-test to compare the effect of other clinical characteristics on final outcome. Results: Statistically significant improvements were noted in forward flexion, external rotation and internal rotation (P < 0.0001). Average postoperative subjective shoulder value was 93.7, simple shoulder test 11.6, and American Shoulder and Elbow Surgeons (ASES) score 94.6. According to ASES scores, results for the 109 shoulders available for final follow-up were excellent in 95 (87.1%), good in 8 (7.3%), fair in 3 (2.8%), and poor in 3 (2.8%). There was no difference in ROM or outcome scores in patients who underwent a concomitant biceps procedure (tenodesis or tenotomy) compared with those who did not. Furthermore, there was no significant difference in outcome between patients who underwent either biceps tenodesis or tenotomy. Age, history of injury preceding the onset of pain, tear size, number of TO tunnels required to perform the repair, and presence of fatty infiltration did not correlate with postoperative ROM or subjective outcome measures at final follow-up. Two complications and four failures were noted. Conclusions: Arthroscopic TO rotator cuff repair technique leads to statistically significant midterm improvement in ROM and satisfactory midterm subjective outcome scores with low complication/failure rates in patients with average medium-sized rotator cuff tears with minimal fatty infiltration. Further work is required to evaluate radiographic healing rates with this technique and to compare outcomes following suture anchor repair. Level of Evidence: Level IV PMID:26980983

Comparison of Sprint Fidelis and Riata defibrillator lead failure rates.

PubMed

Fazal, Iftikhar A; Shepherd, Ewen J; Tynan, Margaret; Plummer, Christopher J; McComb, Janet M

2013-09-30

Sprint Fidelis and Riata defibrillator leads are prone to early failure. Few data exist on the comparative failure rates and mortality related to lead failure. The aims of this study were to determine the failure rate of Sprint Fidelis and Riata leads, and to compare failure rates and mortality rates in both groups. Patients implanted with Sprint Fidelis leads and Riata leads at a single centre were identified and in July 2012, records were reviewed to ascertain lead failures, deaths, and relationship to device/lead problems. 113 patients had Sprint Fidelis leads implanted between June 2005 and September 2007; Riata leads were implanted in 106 patients between January 2003 and February 2008. During 53.0 ± 22.3 months of follow-up there were 13 Sprint Fidelis lead failures (11.5%, 2.60% per year) and 25 deaths. Mean time to failure was 45.1 ± 15.5 months. In the Riata lead cohort there were 32 deaths, and 13 lead failures (11.3%, 2.71% per year) over 54.8 ± 26.3 months follow-up with a mean time to failure of 53.5 ± 24.5 months. There were no significant differences in the lead failure-free Kaplan-Meier survival curve (p=0.77), deaths overall (p=0.17), or deaths categorised as sudden/cause unknown (p=0.54). Sprint Fidelis and Riata leads have a significant but comparable failure rate at 2.60% per year and 2.71% per year of follow-up respectively. The number of deaths in both groups is similar and no deaths have been identified as being related to lead failure in either cohort. Copyright © 2012. Published by Elsevier Ireland Ltd.

Nondestructive monitoring of fatigue damage evolution in austenitic stainless steel by positron-lifetime measurements

NASA Astrophysics Data System (ADS)

Holzwarth, Uwe; Schaaff, Petra

2004-03-01

Positron-lifetime measurements have been performed on austenitic stainless steel during (i) stress- and (ii) strain-controlled fatigue experiments for different applied stress and strain amplitudes, respectively. For this purpose a generator-detector assembly with a 72Se/72As positron generator [maximum activity 25 μCi (0.9 MBq)] has been mounted on mechanical testing machines in order to measure the positron lifetime without removing the specimens from the load train. The average positron lifetime has been determined by a β+-γ coincidence. The feasibility to use the average positron lifetime for monitoring the evolution of fatigue damage and to predict early failure has been examined. In strain- and stress-controlled experiments the average positron lifetime shows a pronounced increase within the first 10% and 40% of the fatigue life, respectively. In stress-controlled experiments the average positron lifetime at failure depends significantly on the applied stress amplitude. In strain-controlled experiments significantly different positron lifetimes for different applied plastic strain amplitudes are obtained within the first 1.000 fatigue cycles, whereas differences get wiped out during further cycling until failure.

Reliability Growth in Space Life Support Systems

NASA Technical Reports Server (NTRS)

Jones, Harry W.

2014-01-01

A hardware system's failure rate often increases over time due to wear and aging, but not always. Some systems instead show reliability growth, a decreasing failure rate with time, due to effective failure analysis and remedial hardware upgrades. Reliability grows when failure causes are removed by improved design. A mathematical reliability growth model allows the reliability growth rate to be computed from the failure data. The space shuttle was extensively maintained, refurbished, and upgraded after each flight and it experienced significant reliability growth during its operational life. In contrast, the International Space Station (ISS) is much more difficult to maintain and upgrade and its failure rate has been constant over time. The ISS Carbon Dioxide Removal Assembly (CDRA) reliability has slightly decreased. Failures on ISS and with the ISS CDRA continue to be a challenge.

Free intra-osseous muscle transfer for treatment of chronic osteomyelitis.

PubMed

Lê Thua, Trung-Hau; Boeckx, Willy D; Zirak, Christophe; De Mey, Albert

2015-06-10

Chronic osteomyelitis is still a big reconstructive challenge. Even with standard care, therapeutic failures and recurrences are common. Multiple techniques of tissue transfer have increased the success rate. This study recommends free muscle transfers into the intramedullary bone cavities for treatment of chronic osteomyelitis. The review included 29 patients that were treated for chronic osteomyelitis. Osteomyelitis was located at the femur in four patients, the tibia in 22 patients, and the foot in three patients. Dead bone and scar tissue were replaced with durable free muscle flap with special attention to fill the dead space. The average age of these patients was 48.5 years old (range = 23-70 years old). The average duration of osteomyelitis was 8.2 years (range = 1-45 years). Gracilis was applied in 20 cases (69%), latissimus dorsi was used in five cases (17.2%), and rectus abdominis was performed in four cases (13.8%). There was one flap failure, one partial superficial flap necrosis, two arterial thrombosis, and one venous thrombosis. All the remaining 28 muscle flaps survived. From 1-10 years follow-up, there was one recurrence of the osteomyelitis in the distal end of the intra-medullary cavity of a femur after reconstructing using the gracilis flap. The present study demonstrated that free intramedullary muscle transfers are effective in providing a high rate of success in the treatment of chronic osteomyelitis. The secondary filling of the intramedullary cavity after extensive removal of all infected bony sequesters has proven to give a long-term arrest of chronic osteomyelitis.

The Indiana Chronic Disease Management Program's impact on medicaid claims: a longitudinal, statewide evaluation.

PubMed

Katz, Barry P; Holmes, Ann M; Stump, Timothy E; Downs, Steven M; Zillich, Alan J; Ackermann, Ronald T; Inui, Thomas S

2009-02-01

: Disease management programs have grown in popularity over the past decade as a strategy to curb escalating healthcare costs for persons with chronic diseases. : To evaluate the effect of the Indiana Chronic Disease Management Program (ICDMP) on the longitudinal changes in Medicaid claims statewide. : Phased implementation of a chronic disease management program in 3 regions of the state. Fourteen repeated cohorts of Medicaid members were drawn over a period of 3.5 years and the trends in claims were evaluated using a repeated measures model. : A total of 44,218 Medicaid members with diabetes and/or congestive heart failure in 3 geographic regions in Indiana. : Across all 3 regions and both disease classes, we found a flattening of cost trends between the pre- and post-ICDMP-initiation periods. This change in the slopes was significant for all of the models except for congestive heart failure in southern Indiana. Thus, the average per member claims paid was increasing at a faster rate before ICDMP but slowed once the program was initiated. To distinguish shorter and longer-term effects related to ICDMP, we estimated annual slopes within the pre- and post-ICDMP- time periods. A similar pattern was found in all regions: claims were increasing before ICDMP, flattened in the years around program initiation, and remained flat in the final year of follow-up. : This analysis shows that the trend in average total claims changed significantly after the implementation of ICDMP, with a decline in the rate of increase in claims paid observed for targeted Medicaid program populations across the state of Indiana.

Hypertensive emergencies remain a clinical problem and are associated with high mortality.

PubMed

Roubsanthisuk, Weranuj; Wongsurin, Unticha; Buranakitjaroen, Peera

2010-01-01

We suspect that hypertensive emergencies remain a clinical problem and data on their long-term prognosis are lacking. This study was conducted in order to determine the frequency, management, and outcome of hypertensive emergencies in this era, in which hypertension treatment is more effective than in the past. We reviewed the medical records of patients with hypertensive emergencies admitted to the medical wards of Siriraj Hospital in 2003 and collected data on their characteristic, management, investigations, and follow-ups through 31 December 2007. There were 184 patients included. Hypertension has been previously diagnosed in 89% of cases. Nearly half also had diabetes mellitus and around a quarter had chronic kidney failure. Mean +/- SD of blood pressure at presentation was 205.96 +/- 21.36/114.60 +/- 20.59 mmHg. Cardiac complications and stroke accounted for 71% and 23% of all target organ damage, respectively. Intravenous nitroglycerine and furosemide were most frequently prescribed. Additional investigations to search for the causes of hypertension were performed in only 55 cases. The average hospital stay was 9.8 days. The in-hospital mortality rate was 15%. Some 26% of patients were lost to follow-up and another 20% died later. Only 19% of patients had regular follow-ups until the end of 2007 and remained on an average of 2.4 antihypertensive drugs. Hypertensive emergencies are usually found in patients with a history of hypertension and diabetes mellitus or kidney failure. Recommended investigations usually failed to identify the cause of hypertension. The mortality rate of these patients was extremely high while their adherence to treatment was extremely poor.

Reoperations following proximal interphalangeal joint nonconstrained arthroplasties.

PubMed

Pritsch, Tamir; Rizzo, Marco

2011-09-01

To retrospectively analyze the reasons for reoperations following primary nonconstrained proximal interphalangeal (PIP) joint arthroplasty and review clinical outcomes in this group of patients with 1 or more reoperations. Between 2001 and 2009, 294 nonconstrained (203 pyrocarbon and 91 metal-plastic) PIP joint replacements were performed in our institution. A total of 76 fingers (59 patients) required reoperation (50 pyrocarbon and 26 metal-plastic). There were 40 women and 19 men with an average age of 51 years (range, 19-83 y). Primary diagnoses included osteoarthritis in 35, posttraumatic arthritis in 24, and inflammatory arthritis in 17 patients. There were 21 index, 27 middle, 18 ring, and 10 small fingers. The average number of reoperations per PIP joint was 1.6 (range, 1-4). A total of 45 joints had 1 reoperation, 19 had 2, 11 had 3, and 1 had 4. Extensor mechanism dysfunction was the most common reason for reoperation; it involved 51 of 76 fingers and was associated with Chamay or tendon-reflecting surgical approaches. Additional etiologies included component loosening in 17, collateral ligament failure in 10, and volar plate contracture in 8 cases. Inflammatory arthritis was associated with collateral ligament failure. Six fingers were eventually amputated, 9 had PIP joint arthrodeses, and 2 had resection arthroplasties. The arthrodesis and amputation rates correlated with the increased number of reoperations per finger. Clinically, most patients had no or mild pain at the most recent follow-up, and the PIP joint range-of-motion was not significantly different from preoperative values. Pain levels improved with longer follow-up. Reoperations following primary nonconstrained PIP joint arthroplasties are common. Extensor mechanism dysfunction was the most common reason for reoperation. The average reoperation rate was 1.6, and arthrodesis and amputation are associated with an increasing number of operations. Overall clinical outcomes demonstrated no significant change in range of motion, and most patients had mild or no pain. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Use of Self-Expanding Stents for the Treatment of Vertebral Artery Ostial Stenosis: a Single Center Experience

PubMed Central

Chung, Sun Young; Choi, Jin Woo; Choi, Byung Se; In, Hyun Sin; Kim, Sun Mi; Choi, Choong Gon; Kim, Sang Joon; Suh, Dae Chul

2010-01-01

Objective To evaluate our early experience using self-expanding stents to treat atherosclerotic vertebral artery ostial stenosis (VAOS), with respect to technical feasibility and clinical and imaging follow-up results. Materials and Methods A total of 20 lesions in 20 patients underwent stenting of the VAOS using a self-expanding stent (Precise RX; Cordis Neurovascular, Miami Lakes, FL). Two patients were asymptomatic. We analyzed the technical success rate, causes of technical failure, occurrence of any vascular or neurological event, and the occurrence of any neurological abnormality or in-stent restenosis (ISR) seen on follow-up. The imaging follow-up was performed with Doppler ultrasound (DUS) as a primary screening modality. Results One instance of technical failure was caused by failure of the guidewire passage. The stent diameter was 5 mm, and post-stenting balloon dilatations were necessary in all cases. Stent misplacement requiring placement of an additional stent occurred in four cases. Following a 14.8 month average clinical follow-up time, two patients showed anterior circulation ischemia, which was not attributed to the VAOS we treated. Following a 13.7 month average DUS follow-up, five patients showed a mild degree of diffuse or focal intimal thickening in the stent lumen; however, none of the stenosis showed luminal loss of more than 50% and no stent fracture was noted. Conclusion The use of self-expanding stents for treating VAOS was technically feasible and helped to improve artery patency during our limited follow-up interval. PMID:20191062

Evaluation of possible prognostic factors for the success, survival, and failure of dental implants.

PubMed

Geckili, Onur; Bilhan, Hakan; Geckili, Esma; Cilingir, Altug; Mumcu, Emre; Bural, Canan

2014-02-01

To analyze the prognostic factors that are associated with the success, survival, and failure rates of dental implants. Data including implant sizes, insertion time, implant location, and prosthetic treatment of 1656 implants have been collected, and the association of these factors with success, survival, and failure of implants was analyzed. The success rate was lower for short and maxillary implants. The failure rate of maxillary implants exceeded that of mandibular implants, and the failure rate of implants that were placed in the maxillary anterior region was significantly higher than other regions. The failure rates of implants that were placed 5 years ago or more were higher than those that were placed later. Anterior maxilla is more critical for implant loss than other sites. Implants in the anterior mandible show better success compared with other locations, and longer implants show better success rates. The learning curve of the clinician influences survival and success rates of dental implants.

Failure rate and reliability of the KOMATSU hydraulic excavator in surface limestone mine

NASA Astrophysics Data System (ADS)

Harish Kumar N., S.; Choudhary, R. P.; Murthy, Ch. S. N.

2018-04-01

The model with failure rate function of bathtub-shaped is helpful in reliability analysis of any system and particularly in reliability associated privative maintenance. The usual Weibull distribution is, however, not capable to model the complete lifecycle of the any with a bathtub-shaped failure rate function. In this paper, failure rate and reliability analysis of the KOMATSU hydraulic excavator/shovel in surface mine is presented and also to improve the reliability and decrease the failure rate of each subsystem of the shovel based on the preventive maintenance. The model of the bathtub-shaped for shovel can also be seen as a simplification of the Weibull distribution.

[Differences between German and Turkish-speaking participants in a chronic heart failure management program].

PubMed

Ernstmann, N; Karbach, U

2017-02-01

German and Turkish-speaking patients were recruited for a chronic heart failure management program. So far little is known about the special needs and characteristics of Turkish-speaking patients with chronic heart failure; therefore, the aim of this study was to examine sociodemographic and illness-related differences between German and Turkish-speaking patients with chronic heart failure. German and Turkish-speaking patients suffering from chronic heart failure and insured with the AOK Rheinland/Hamburg or the BARMER GEK health insurance companies and living in Cologne, Germany, were enrolled. Recruitment took place in hospitals, private practices and at information events. Components of the program were coordination of a guideline-oriented medical care, telemonitoring (e.g., blood pressure, electrocardiogram, and weight), a 24-h information hotline, attendance by German and Turkish-speaking nurses and a patient education program. Data were collected by standardized interviews in German or Turkish language. Data were analyzed with descriptive measures and tested for significance differences using Pearson's χ 2 -test and the t‑test. A total of 465 patients (average age 71 years, 55 % male and 33 % Turkish-speaking) were enrolled in the care program during the study period. Significant differences between German and Turkish-speaking patients were found for age, education, employment status, comorbidities, risk perception, knowledge on heart failure and fear of loss of independence. The response rate could be achieved with the help of specific measures for patient enrollment by Turkish-speaking integration nurses. The differences between German and Turkish-speaking patients should in future be taken into account in the care of people with chronic heart failure.

[A retrospective study on the incidence of chronic renal failure in the Department of Internal Medicine and Nephrology at University Hospital of Antananarivo (the capital city of Madagascar)].

PubMed

Ramilitiana, Benja; Ranivoharisoa, Eliane Mikkelsen; Dodo, Mihary; Razafimandimby, Evanirina; Randriamarotia, Willy Franck

2016-01-01

Chronic renal failure is a global public health problem. In developed countries, this disease occurs mainly in the elderly, but in Africa it rather affects active young subjects. This disease need for expensive treatments in a low income country, because of its costs. Our aim is to describe the epidemiology of new cases of chronic renal failure in Madagascar. This is a retrospective, descriptive study of 239 patients with chronic renal failure over a 3 year period, starting from 1 January 2007 to 31 December 2009, in the Department of Internal Medicine and Nephrology at University Hospital of Antananarivo. The incidence was 8.51% among patients hospitalized in the Department. The average age of patients was 45.4 years with extremes of 16 and 82 years and a sex ratio 1,46. The main antecedent was arterial hypertension (59.8%). Chronic renal failure was terminal in 75.31% of the cases (n=180). The causes of chronic renal failure were dominated by chronic glomerulonephritis (40.1%), nephroangiosclerosis (35.5%). Hemodialysis was performed in 3 patients (1.26%), no patient was scheduled for a renal transplantation. Mortality rate in the Department was 28.87%. Chronic renal failure is a debilitating disease with a dreadful prognosis which affects young patients in Madagascar. Its treatment remains inaccessible to the majority of patients. The focus must be mainly on prevention, especially on early effective management of infections, arterial hypertension and diabetes to reduce its negative impacts on the community and public health. The project on renal transplantation: living donor, effective and less expensive treatment compared to hemodialysis could also be a good solution for these Malagasy young subjects.

Mechanical loading of bovine pericardium accelerates enzymatic degradation.

PubMed

Ellsmere, J C; Khanna, R A; Lee, J M

1999-06-01

Bioprosthetic heart valves fail as the result of two simultaneous processes: structural deterioration and calcification. Leaflet deterioration and perforation have been correlated with regions of highest stress in the tissue. The failures have long been assumed to be due to simple mechanical fatigue of the collagen fibre architecture; however, we have hypothesized that local stresses-and particularly dynamic stresses-accelerate local proteolysis, leading to tissue failure. This study addresses that hypothesis. Using a novel, custom-built microtensile culture system, strips of bovine pericardium were subjected to static and dynamic loads while being exposed to solutions of microbial collagenase or trypsin (a non-specific proteolytic enzyme). The time to extend to 30% strain (defined here as time to failure) was recorded. After failure, the percentage of collagen solubilized was calculated based on the amount of hydroxyproline present in solution. All data were analyzed by analysis of variance (ANOVA). In collagenase, exposure to static load significantly decreased the time to failure (P < 0.002) due to increased mean rate of collagen solubilization. Importantly, specimens exposed to collagenase and dynamic load failed faster than those exposed to collagenase under the same average static load (P = 0.02). In trypsin, by contrast, static load never led to failure and produced only minimal degradation. Under dynamic load, however, specimens exposed to collagenase, trypsin, and even Tris/CaCl2 buffer solution, all failed. Only samples exposed to Hanks' physiological solution did not fail. Failure of the specimens exposed to trypsin and Tris/CaCl2 suggests that the non-collagenous components and the calcium-dependent proteolytic enzymes present in pericardial tissue may play roles in the pathogenesis of bioprosthetic heart valve degeneration.

Worsening Renal Function during Management for Chronic Heart Failure with Reduced Ejection Fraction: Results From the Pro-BNP Outpatient Tailored Chronic Heart Failure Therapy (PROTECT) Study.

PubMed

Ibrahim, Nasrien E; Gaggin, Hanna K; Rabideau, Dustin J; Gandhi, Parul U; Mallick, Aditi; Januzzi, James L

2017-02-01

To assess prognostic meaning of worsening renal failure (WRF) occurring during management of chronic heart failure (HF) with reduced ejection fraction. When WRF develops during titration of HF medical therapy, it commonly leads to less aggressive care. A total of 151 patients enrolled in a prospective, randomized study of standard of care (SOC) HF therapy versus SOC plus a goal N-terminal pro-B type natriuretic peptide (NT-proBNP) < 1000 pg/mL were examined. Cardiovascular (CV) event (defined as worsening HF, hospitalization for HF, significant ventricular arrhythmia, acute coronary or cerebral ischemia, or CV death) at 1 year relative to WRF (defined as any reduction in estimated glomerular filtration rate) 90 days postenrollment were tabulated. Those developing WRF by 3 months had an average 14% reduction in estimated glomerular filtration rate. There was no difference in incidence of WRF between study arms (43% in SOC, 57% in NT-proBNP, P = .29). During the first 3 months of therapy titration, incident WRF was associated with numerically fewer CV events at 1 year compared with those without WRF (mean 0.81 vs 1.16 events, P = .21). WRF was associated trend toward fewer CV events in the SOC arm (hazard ratio 0.45, 95% confidence interval 0.16-1.24, P = .12); the NT-proBNP-guided arm had numerically lower CV event rates regardless of WRF. Subjects with NT-proBNP <1000 pg/mL and WRF received higher doses of guideline directed medical therapies, lower doses of loop diuretics, and had significantly lower CV event rates (P < .001). Modest degrees of WRF are common during aggressive HF with reduced ejection fraction management, but we found no significant association with CV outcomes. HF care guided by NT-proBNP was not associated with more WRF compared with SOC, and led to benefit regardless of final renal function. Copyright © 2016 Elsevier Inc. All rights reserved.

Critical Evolution of Damage Toward System-Size Failure in Crystalline Rock

NASA Astrophysics Data System (ADS)

Renard, François; Weiss, Jérôme; Mathiesen, Joachim; Ben-Zion, Yehuda; Kandula, Neelima; Cordonnier, Benoît

2018-02-01

Rock failure under shear loading conditions controls earthquake and faulting phenomena. We study the dynamics of microscale damage precursory to shear faulting in a quartz-monzonite rock representative of crystalline rocks of the continental crust. Using a triaxial rig that is transparent to X-rays, we image the mechanical evolution of centimeter-size core samples by in situ synchrotron microtomography with a resolution of 6.5 μm. Time-lapse three-dimensional images of the samples inside the rig provide a unique data set of microstructural evolution toward faulting. Above a yield point there is a gradual weakening during which microfractures nucleate and grow until this damage span the whole sample. This leads to shear faults oriented about 30° to the main compressive stress in agreement with Anderson's theory and macroscopic failure. The microfractures can be extracted from the three-dimensional images, and their dynamics and morphology (i.e., number, volume, orientation, shape, and largest cluster) are quantified as a function of increasing stress toward failure. The experimental data show for the first time that the total volume of microfractures, the rate of damage growth, and the size of the largest microfracture all increase and diverge when approaching faulting. The average flatness of the microfractures (i.e., the ratio between the second and third eigenvalues of their covariance matrix) shows a significant decrease near failure. The precursors to faulting developing in the future faulting zone are controlled by the evolving microfracture population. Their divergent dynamics toward failure is reminiscent of a dynamical critical transition.

Application of failure mode and effect analysis in managing catheter-related blood stream infection in intensive care unit

PubMed Central

Li, Xixi; He, Mei; Wang, Haiyan

2017-01-01

Abstract In this study, failure mode and effect analysis (FMEA), a proactive tool, was applied to reduce errors associated with the process which begins with assessment of patient and ends with treatment of complications. The aim of this study is to assess whether FMEA implementation will significantly reduce the incidence of catheter-related bloodstream infections (CRBSIs) in intensive care unit. The FMEA team was constructed. A team of 15 medical staff from different departments were recruited and trained. Their main responsibility was to analyze and score all possible processes of central venous catheterization failures. Failure modes with risk priority number (RPN) ≥100 (top 10 RPN scores) were deemed as high-priority-risks, meaning that they needed immediate corrective action. After modifications were put, the resulting RPN was compared with the previous one. A centralized nursing care system was designed. A total of 25 failure modes were identified. High-priority risks were “Unqualified medical device sterilization” (RPN, 337), “leukopenia, very low immunity” (RPN, 222), and “Poor hand hygiene Basic diseases” (RPN, 160). The corrective measures that we took allowed a decrease in the RPNs, especially for the high-priority risks. The maximum reduction was approximately 80%, as observed for the failure mode “Not creating the maximal barrier for patient.” The averaged incidence of CRBSIs was reduced from 5.19% to 1.45%, with 3 months of 0 infection rate. The FMEA can effectively reduce incidence of CRBSIs, improve the security of central venous catheterization technology, decrease overall medical expenses, and improve nursing quality. PMID:29390515

VLSI (Very Large Scale Integrated Circuits) Device Reliability Models.

DTIC Science & Technology

1984-12-01

CIRCUIT COMPLEXITY FAILURE RATES FOR... A- 40 MOS SSI/MSI DEVICES IN FAILURE PER 106 HOURS TABLE 5.1.2.5-19: C1 AND C2 CIRCUIT COMPLEXITY FAILURE RATES FOR...A- 40 MOS SSI/MSI DEVICES IN FAILURE PER 106 HOURS TABLE 5.1.2.5-19: Cl AND C2 CIRCUIT COMPLEXITY FAILURE RATES FOR... A-41 LINEAR DEVICES IN...19 National Semiconductor 20 Nitron 21 Raytheon 22 Sprague 23 Synertek 24 Teledyne Crystalonics 25 TRW Semiconductor 26 Zilog The following companies

Blood pressure dynamics during exercise rehabilitation in heart failure patients.

PubMed

Hecht, Idan; Arad, Michael; Freimark, Dov; Klempfner, Robert

2017-05-01

Background Patients suffering from heart failure (HF) may demonstrate an abnormal blood pressure response to exercise (ABPRE), which may revert to a normal one following medical treatment. It is assumed that this change correlates positively with prognosis and functional aspects. The aim of this study was to characterize patients with ABPRE and assess ABPRE normalization and the correlation with clinical and functional outcomes. Methods In the study, 651 patients with HF who underwent cardiac rehabilitation (CR) were examined. Patients who presented an ABPRE during stress testing were identified and divided into those who corrected their initial ABPRE following CR and those who did not. Results Pre-rehabilitation ABPRE was present in 27% of patients, 68% of whom normalized their ABPRE following CR. Two parameters were independently predictive of failure to normalize the blood pressure response: female gender (odds ratio (OR) 3.5; 95% confidence interval (CI) 1.4-9.0) and decreased systolic function (OR 3.2; 95% CI 1.0-9.4). Patients with hypertrophic cardiomyopathy demonstrated higher rates of ABPRE normalization than patients with other causes of HF (93% vs. 62%, respectively, P = 0.03). The research population exhibited an average improvement in exercise capacity (4.7 to 6.4 metabolic equivalents (METS), P < .001), ejection fraction (35.4% to 37.7%, P < .001) and percentage of patients with New York Heart Association (NYHA) class 3-4 (50% to 43.4%, P = .123). The group who normalized their ABPRE exhibited greater improvement. Conclusions Amongst a population of patients suffering from HF, an ABPRE was normalized following CR in two thirds of patients. Female gender and a reduced systolic function independently predicted the failure to correct the ABPRE, while patients with hypertrophic cardiomyopathy demonstrated exceptionally high rates of normalization.

The microvascular anastomotic coupler for venous anastomoses in free flap breast reconstruction improves outcomes

PubMed Central

Rozen, Warren Matthew; Chowdhry, Muhammad; Patel, Nakul Gamanlal; Chow, Whitney T.H.; Griffiths, Matthew; Ramakrishnan, Venkat V.

2016-01-01

Background Venous couplers are ubiquitous around the world and are a useful tool for the reconstructive microsurgeon. A systematic review of coupler performance studies demonstrated a thrombosis rate range of 0% to 3%, whilst the average time of using the device is 5 minutes. There is sparse published data on cost analysis and the impact of operator experience on the anastomotic coupler device success. Improvements in outcomes other than time benefits have also not been shown. This study aims to address these deficiencies in the literature. Methods A retrospective clinical study was undertaken, aiming to compare equivalent groups of patients that had free flap surgery with venous micro-anastomoses with those that had sutured anastomoses. The cohort comprised all patients undergoing microsurgical breast reconstruction at the St Andrew’s Centre for Plastic Surgery & Burns from January 2009 to December 2014. Results Between January 2010 to December 2014, 1,064 patients underwent 1,206 free flap breast reconstructions. The average age of patients was 50 years. Seventy percent of patients underwent mastectomy and immediate reconstruction during this period with the remaining 30% having a delayed reconstruction. The 1,206 free flaps comprised of 83 transverse myocutaneous gracilis (TMG) flaps, and 1,123 deep inferior epigastric artery perforator (DIEP) flaps. In total the coupler was used in 319 flaps, 26% of the cohort. There was a statistically significant clinical benefit in using the anastomotic coupler for venous anastomosis. Overall, the return to theatre rate was 12.69% whilst the overall flap loss rate was 0.75%. The overall coupler failure rate was significantly less at 1.4% whilst sutured vein failure rate was 3.57% (P=0.001). Conclusions The anastomotic coupler for venous anastomosis in free flap surgery is associated with reduced operating times, reduced take-backs to theatre and cost benefits. This is the first study to demonstrate clear clinical benefits to anastomotic couplers, and suggests that these may be the gold standard for venous microanastomosis. With increasing experience with their use and technological advances, these outcomes may continue to improve. PMID:27047776

Risk Factors for Heart Failure in Patients With Chronic Kidney Disease: The CRIC (Chronic Renal Insufficiency Cohort) Study.

PubMed

He, Jiang; Shlipak, Michael; Anderson, Amanda; Roy, Jason A; Feldman, Harold I; Kallem, Radhakrishna Reddy; Kanthety, Radhika; Kusek, John W; Ojo, Akinlolu; Rahman, Mahboob; Ricardo, Ana C; Soliman, Elsayed Z; Wolf, Myles; Zhang, Xiaoming; Raj, Dominic; Hamm, Lee

2017-05-17

Heart failure is common in patients with chronic kidney disease. We studied risk factors for incident heart failure among 3557 participants in the CRIC (Chronic Renal Insufficiency Cohort) Study. Kidney function was assessed by estimated glomerular filtration rate (eGFR) using serum creatinine, cystatin C, or both, and 24-hour urine albumin excretion. During an average of 6.3 years of follow-up, 452 participants developed incident heart failure. After adjustment for age, sex, race, and clinical site, hazard ratio (95% CI) for heart failure associated with 1 SD lower creatinine-based eGFR was 1.67 (1.49, 1.89), 1 SD lower cystatin C-based-eGFR was 2.43 (2.10, 2.80), and 1 SD higher log-albuminuria was 1.65 (1.53, 1.78), all P <0.001. When all 3 kidney function measures were simultaneously included in the model, lower cystatin C-based eGFR and higher log-albuminuria remained significantly and directly associated with incidence of heart failure. After adjusting for eGFR, albuminuria, and other traditional cardiovascular risk factors, anemia (1.37, 95% CI 1.09, 1.72, P =0.006), insulin resistance (1.16, 95% CI 1.04, 1.28, P =0.006), hemoglobin A1c (1.27, 95% CI 1.14, 1.41, P <0.001), interleukin-6 (1.15, 95% CI 1.05, 1.25, P =0.002), and tumor necrosis factor-α (1.10, 95% CI 1.00, 1.21, P =0.05) were all significantly and directly associated with incidence of heart failure. Our study indicates that cystatin C-based eGFR and albuminuria are better predictors for risk of heart failure compared to creatinine-based eGFR. Furthermore, anemia, insulin resistance, inflammation, and poor glycemic control are independent risk factors for the development of heart failure among patients with chronic kidney disease. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Long-term Follow-up of Revision Osteochondral Allograft Transplantation of the Ankle.

PubMed

Gaul, Florian; Tírico, Luís E P; McCauley, Julie C; Bugbee, William D

2018-05-01

Osteochondral allograft (OCA) transplantation is a useful alternative for treatment of posttraumatic ankle arthritis in young patients but has a relatively high failure rate and further procedures are often required. The purpose of this study was to evaluate outcomes of patients who underwent revision OCA transplantation of the ankle after failed primary OCA transplantation. Twenty patients underwent revision OCA transplantation of the ankle between 1988 and 2015. Mean age was 44 years, 55% (11 of 20) were female. The mean time from primary to revision OCA was 3.0 ± 1.7 years. All patients had a minimum follow-up of 2 years. Outcomes included the American Academy of Orthopaedic Surgeons Foot and Ankle Module (AAOS-FAM) and questionnaires evaluating pain and satisfaction. Failure of the revision OCA was defined as a conversion to arthroplasty, arthrodesis, or amputation. Ten of 20 ankles required further surgery, of which 30% (6 of 20) were considered OCA revision failures (4 arthrodeses, 1 arthroplasty, and 1 amputation). The mean time to failure was 6.7 (range, 0.6-13.1) years. Survivorship of the revision OCA was 84% at 5 years and 65% at 10 years. The 14 patients with grafts remaining in situ had an average follow-up of 10.3 years; mean AAOS-FAM Core Score was 70.5 (range, 42.3-99). Of the patients who answered the follow-up questions, 4 of 7 reported moderate to severe pain, and 5 of 12 were satisfied with the results of the procedure. Although the results of revision ankle OCA transplantation are not inferior to primary OCA transplantation, the high rates of persistent pain, further surgery, and graft failure suggest that the indications for OCA as a revision procedure should be carefully evaluated, with proper patient selection. Considering the treatment alternatives, revising a failed OCA transplantation can be a useful treatment option, especially for young and active patients who wish to avoid arthrodesis or arthroplasty. Level IV, case series.

Tensile Properties and Integrity of Clean Room and Low-Modulus Disposable Nitrile Gloves: A Comparison of Two Dissimilar Glove Types

PubMed Central

Phalen, Robert N.; Wong, Weng kee

2012-01-01

Background: The selection of disposable nitrile exam gloves is complicated by (i) the availability of several types or formulations, (ii) product variability, and (iii) an inability of common quality control tests to detect small holes in the fingers. Differences in polymer formulation (e.g. filler and plasticizer/oil content) and tensile properties are expected to account for much of the observed variability in performance. Objectives: This study evaluated the tensile properties and integrity (leak failure rates) of two glove choices assumed to contain different amounts of plasticizers/oils. The primary aims were to determine if the tensile properties and integrity differed and if associations existed among these factors. Additional physical and chemical properties were evaluated. Methods: Six clean room and five low-modulus products were evaluated using the American Society for Testing and Materials Method D412 and a modified water-leak test to detect holes capable of passing a virus or chemical agent. Results: Significant differences in the leak failure rates and tensile properties existed between the two glove types (P ≤ 0.05). The clean room gloves were about three times more likely to have leak failures (chi-square; P = 0.001). No correlation was observed between leak failures and tensile properties. Solvent extract, an indication of added plasticizer/oil, was not associated with leak failures. However, gloves with a maximum modulus <4 MPa or area density (AD) <11 g cm−2 were about four times less likely to leak. Conclusions: On average, the low-modulus gloves were a better choice for protection against aqueous chemical or biological penetration. The observed variability between glove products indicated that glove selection cannot rely solely on glove type or manufacturer labeling. Measures of modulus and AD may aid in the selection process, in contrast with common measures of tensile strength and elongation at break. PMID:22201179

Tensile properties and integrity of clean room and low-modulus disposable nitrile gloves: a comparison of two dissimilar glove types.

PubMed

Phalen, Robert N; Wong, Weng Kee

2012-05-01

The selection of disposable nitrile exam gloves is complicated by (i) the availability of several types or formulations, (ii) product variability, and (iii) an inability of common quality control tests to detect small holes in the fingers. Differences in polymer formulation (e.g. filler and plasticizer/oil content) and tensile properties are expected to account for much of the observed variability in performance. This study evaluated the tensile properties and integrity (leak failure rates) of two glove choices assumed to contain different amounts of plasticizers/oils. The primary aims were to determine if the tensile properties and integrity differed and if associations existed among these factors. Additional physical and chemical properties were evaluated. Six clean room and five low-modulus products were evaluated using the American Society for Testing and Materials Method D412 and a modified water-leak test to detect holes capable of passing a virus or chemical agent. Significant differences in the leak failure rates and tensile properties existed between the two glove types (P ≤ 0.05). The clean room gloves were about three times more likely to have leak failures (chi-square; P = 0.001). No correlation was observed between leak failures and tensile properties. Solvent extract, an indication of added plasticizer/oil, was not associated with leak failures. However, gloves with a maximum modulus <4 MPa or area density (AD) <11 g cm(-2) were about four times less likely to leak. On average, the low-modulus gloves were a better choice for protection against aqueous chemical or biological penetration. The observed variability between glove products indicated that glove selection cannot rely solely on glove type or manufacturer labeling. Measures of modulus and AD may aid in the selection process, in contrast with common measures of tensile strength and elongation at break.

Markov and semi-Markov processes as a failure rate

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

Grabski, Franciszek

2016-06-08

In this paper the reliability function is defined by the stochastic failure rate process with a non negative and right continuous trajectories. Equations for the conditional reliability functions of an object, under assumption that the failure rate is a semi-Markov process with an at most countable state space are derived. A proper theorem is presented. The linear systems of equations for the appropriate Laplace transforms allow to find the reliability functions for the alternating, the Poisson and the Furry-Yule failure rate processes.

Outcomes of Ultrasound-Guided Thrombin Injection of Nongroin Arterial Pseudoaneurysms.

PubMed

Valesano, Johnathan C; Schmitz, John J; Kurup, A Nicholas; Schmit, Grant D; Moynagh, Michael R; Atwell, Thomas D; Lewis, Bradley D; Lee, Robert A; Callstrom, Matthew R

2017-08-01

To evaluate success and complication rates of percutaneous ultrasound-guided thrombin injection of nongroin pseudoaneurysms (PSAs). Retrospective review of a prospectively maintained institutional database yielded 39 cases of arterial PSAs occurring at nongroin sites that were treated with percutaneous ultrasound-guided thrombin injection between 2000 and 2016 (average patient age 69.2 y ± 14.0). Of PSAs, 74.4% (29/39) arose in the upper extremities, and 92.3% (36/39) were iatrogenic. The brachial artery was the most commonly affected vessel (51.3% [20/39]), and arterial access was the most common cause (56.4% [22/39]). Average overall PSA size was 2.4 cm (range, 0.5-7.2 cm); average amount of thrombin injected was 320 IU (range, 50-2,000 IU). Technical success was defined as absence of flow within the PSA immediately after thrombin injection. Treatment success was defined as sustained thrombosis on follow-up imaging obtained at 1-3 days after treatment. Technical and treatment success rates of thrombin injections were 100% (39/39) and 84.8% (28/33), respectively. Longer term follow-up imaging (average 71 d; range, 12-201 d) was available for 7 of the treatment successes with 100% (7/7) showing sustained thrombosis. Comparing treatment successes and failures, there was no significant difference in average PSA size (2.3 cm vs 2.0 cm, P = .51) or average amount of thrombin injected (360 IU vs 180 IU, P = .14). There were no complications. Ultrasound-guided thrombin injection is a safe, efficacious treatment option for PSAs arising in nongroin locations. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

Catheter drainage of spontaneous pneumothorax: suction or no suction, early or late removal?

PubMed Central

So, S Y; Yu, D Y

1982-01-01

Twenty-three patients with primary spontaneous pneumothorax and 30 patients with secondary spontaneous pneumothorax treated by intercostal catheter drainage with underwater seal were divided randomly into two groups, one receiving suction drainage (up to 20 cm H2O pressure) and the other no suction. The success rate was 57% for the former and 50% for the latter. The suction group spent an average of five days in hospital, whereas the non-suction group averaged four days. Suction drainage therefore did not have any advantage. To determine how soon the catheter could be removed without complication, patients were also divided randomly into two subgroups--one had the catheter removed, without previous clamping, as soon as the lung was expanded; the other had the catheters left in situ for a further three days. The success rate was 52% for the former, and 53% for the latter. But most of the failure in the early removal group was caused by re-collapse of the lung rather than persistent air leakage; hence removal of the catheter too early was not recommended. PMID:7071793

Initial experience with hysteroscopic tubal occlusion (Essure®)

PubMed Central

Depes, Daniella De Batista; Pereira, Ana Maria Gomes; Lippi, Umberto Gazi; Martins, João Alfredo; Lopes, Reginaldo Guedes Coelho

2016-01-01

ABSTRACT Objective To evaluate results of early tubal occlusions performed by hysteroscopy (Essure®). Methods This prospective study included 38 patients, 73.7% of them were white, mean age 34.5 years, they have had on average 3 pregnancies and 2.7 of deliveries. A total of 86.8% of patients previously prepared the endometrium. All procedures were carried out at outpatient unit without anesthesia. Results Insertion rate of the device was 100% at a mean time of 4 minutes and 50 seconds. Based on the analogical visual scale, average pain reported was three, and 55.3% of women did not report pain after the procedure. After 3 months, 89.5% of patients were very satisfied with the method. Simple radiographs of the pelvis showed 92.1% of topical devices, and one case of unilateral expulsion had occurred. A four years follow-up did not show failure in the method. Conclusions Tubal occlusion through hysteroscopy at outpatient unit and without anesthesia was a quickly and well-tolerated procedure. No serious complications were seen, the success rate was high, and patients were satisfied. PMID:27462885

Spacecraft Parachute Recovery System Testing from a Failure Rate Perspective

NASA Technical Reports Server (NTRS)

Stewart, Christine E.

2013-01-01

Spacecraft parachute recovery systems, especially those with a parachute cluster, require testing to identify and reduce failures. This is especially important when the spacecraft in question is human-rated. Due to the recent effort to make spaceflight affordable, the importance of determining a minimum requirement for testing has increased. The number of tests required to achieve a mature design, with a relatively constant failure rate, can be estimated from a review of previous complex spacecraft recovery systems. Examination of the Apollo parachute testing and the Shuttle Solid Rocket Booster recovery chute system operation will clarify at which point in those programs the system reached maturity. This examination will also clarify the risks inherent in not performing a sufficient number of tests prior to operation with humans on-board. When looking at complex parachute systems used in spaceflight landing systems, a pattern begins to emerge regarding the need for a minimum amount of testing required to wring out the failure modes and reduce the failure rate of the parachute system to an acceptable level for human spaceflight. Not only a sufficient number of system level testing, but also the ability to update the design as failure modes are found is required to drive the failure rate of the system down to an acceptable level. In addition, sufficient data and images are necessary to identify incipient failure modes or to identify failure causes when a system failure occurs. In order to demonstrate the need for sufficient system level testing prior to an acceptable failure rate, the Apollo Earth Landing System (ELS) test program and the Shuttle Solid Rocket Booster Recovery System failure history will be examined, as well as some experiences in the Orion Capsule Parachute Assembly System will be noted.

Economics of new oncology drug development.

PubMed

DiMasi, Joseph A; Grabowski, Henry G

2007-01-10

Review existing studies and provide new results on the development, regulatory, and market aspects of new oncology drug development. We utilized data from the US Food and Drug Administration (FDA), company surveys, and publicly available commercial business intelligence databases on new oncology drugs approved in the United States and on investigational oncology drugs to estimate average development and regulatory approval times, clinical approval success rates, first-in-class status, and global market diffusion. We found that approved new oncology drugs to have a disproportionately high share of FDA priority review ratings, of orphan drug designations at approval, and of drugs that were granted inclusion in at least one of the FDA's expedited access programs. US regulatory approval times were shorter, on average, for oncology drugs (0.5 years), but US clinical development times were longer on average (1.5 years). Clinical approval success rates were similar for oncology and other drugs, but proportionately more of the oncology failures reached expensive late-stage clinical testing before being abandoned. In relation to other drugs, new oncology drug approvals were more often first-in-class and diffused more widely across important international markets. The market success of oncology drugs has induced a substantial amount of investment in oncology drug development in the last decade or so. However, given the great need for further progress, the extent to which efforts to develop new oncology drugs will grow depends on future public-sector investment in basic research, developments in translational medicine, and regulatory reforms that advance drug-development science.

A novel handheld device for use in remote patient monitoring of heart failure patients--design and preliminary validation on healthy subjects.

PubMed

Pollonini, Luca; Rajan, Nithin O; Xu, Shuai; Madala, Sridhar; Dacso, Clifford C

2012-04-01

Remote patient monitoring (RPM) holds great promise for reducing the burden of congestive heart failure (CHF). Improved sensor technology and effective predictive algorithms can anticipate sudden decompensation events. Enhanced telemonitoring systems would promote patient independence and facilitate communication between patients and their physicians. We report the development of a novel hand-held device, called Blue Box, capable of collecting and wirelessly transmitting key cardiac parameters derived from three integrated biosensors: 2 lead electrocardiogram (ECG), photoplethysmography and bioelectrical impedance (bioimpedance). Blue Box measurements include time intervals between consecutive ECG R-waves (RR interval), time duration of the ECG complex formed by the Q, R and S waves (QRS duration), bioimpedance, heart rate and systolic time intervals. In this study, we recruited 24 healthy subjects to collect several parameters measured by Blue Box and assess their value in correlating with cardiac output measured with Echo-Doppler. Linear correlation between the heart rate measured with Blue Box and cardiac output from Echo-Doppler had a group average correlation coefficient of 0.80. We found that systolic time intervals did not improve the model significantly. However, STIs did inversely correlate with increasing workloads.

Periimplantitis Treatment: Long-Term Comparison of Laser Decontamination and Implantoplasty Surgery.

PubMed

Pommer, Bernhard; Haas, Robert; Mailath-Pokorny, Georg; Fürhauser, Rudolf; Watzek, Georg; Busenlechner, Dieter; Müller-Kern, Michael; Kloodt, Claudia

2016-10-01

Periimplantitis is the most frequent cause of late implant failure; however, little is known about the long-term success of periimplantitis treatment and the effectiveness of various therapeutic interventions. A total of 142 patients were referred to the Academy for Oral Implantology in Vienna for the treatment of recurrent periimplantitis around single-tooth implants. Of them, 72 patients (51%) were treated by laser decontamination, 47 patients (33%) by implantoplasty surgery, and 23 patients (16%) by a combination of both approaches. Overall success of periimplantitis therapy was 89% after 9 years of follow-up, and it did not differ significantly between female and male patients (P = 0.426). The number of implant failures that could not be prevented by periimplantitis treatment was 6 after laser decontamination (8%), 6 after implantoplasty surgery (13%), and 4 after a combination of both therapies (17%). Implant loss occurred after 4.9 ± 1.9 years of therapy, on average. No significant difference between the 3 treatment groups could be observed (P = 0.393). The present results suggest that success rates of periimplantitis therapy with either laser decontamination or surgical implantoplasty are high. These success rates do not appear to be associated with patient gender or treatment strategy.

A population based study of variations in operation rates for breast cancer, of comorbidity and prognosis at diagnosis: failure to operate for early breast cancer in older women.

PubMed

Bates, T; Evans, T; Lagord, C; Monypenny, I; Kearins, O; Lawrence, G

2014-10-01

Older women are less likely to have surgery for operable breast cancer. This population-based study examines operation rates by age and identifies groups which present with early or late disease. 37 000 cancer registrations for 2007 were combined with Hospital Episode Statistics comorbidity data for England. Operation rates were examined by age, ethnicity, deprivation, comorbidity, screen-detection, tumour size, grade and nodal status. Early and late presentation were correlated with Nottingham Prognostic Index (NPI) groups and tumour size. The proportion of women not having surgery increased from 7-10% at ages 35-69 to 82% from age 90. From age 70, the proportion not having surgery rose by an average of 3.1% per year of age. Women with a Charlson Comorbidity Index score of ≥1 (which increased with age), with tumours >50 mm or who were node positive, were less likely to have surgery. Although women aged 70-79 were more likely to have larger tumours, their tumours were also more likely to have an excellent or good NPI (p < 0.001). Good prognosis tumours were more likely to be screen-detected, and less likely in women aged 0-39, the deprived and certain ethnic groups (p < 0.02). From age 70 there is an increasing failure to operate for breast cancer. Younger women and certain ethnic groups presented with more advanced tumours. Older women had larger tumours which were otherwise of good prognosis, and this would not account for the failure to operate which may in part be related to comorbidity in this age group. Copyright © 2014 Elsevier Ltd. All rights reserved.

Damage Control Orthopedics Management as Vital Procedure in Elderly Patients with Femoral Neck Fractures Complicated with Chronic Renal Failure: A Retrospective Cohort Study

PubMed Central

Dong, Chenhui; Wang, Yunjiao; Wang, Ziming; Wang, Yu; Wu, Siyu; Du, Quanyin; Wang, Aimin

2016-01-01

Background Chronic renal failure (CRF) predisposes to hip fractures in elderly patients, with high subsequent mortality. Selection and timing of the surgical procedure of such patients is a serious challenge. Many clinicians believe in earlier surgery as preferable and providing better outcomes. Damage control orthopedics (DCO) aids to adjust and optimize the overall condition of patients. Methods In 32 patients with femoral neck fractures complicated with CRF, we evaluated how the timing of the surgery determines the mortality rates if the DCO approach is applied. Preoperative ASA grading, POSSUM score, P-POSSUM score and DCO were carried out. Based on the assessment, timing of the surgery was ascertained. Results Of a total of 32 patients, twenty-nine patients were accepted for either early (< 48 hours; n = 18) or delayed (3–10 days; n = 10) surgery. Hip arthroplasty (total hip arthroplasty and hemiarthroplasty) was the principal surgery option. All patients survived operation and were followed up postoperatively with the average time of 30 days. Postoperative complications tended to occur at higher rates in the early vs. delayed surgery group (7/18 vs. 5/10). During follow up, a total of 3 patients died in both groups (2/18 in the early surgery and 1/10 in the delayed surgery group), mostly from multi-organ failures and acute respiratory distress syndrome. There was no significant difference in complication rates and Harris hip score between both groups. Conclusion In patients with femoral neck fracture complicated with CRF, delaying the surgery for several days does not increase the incidence of postoperative adverse events. PMID:27149117

[Endoprosthesis failure in the ankle joint : Histopathological diagnostics and classification].

PubMed

Müller, S; Walther, M; Röser, A; Krenn, V

2017-03-01

Endoprostheses of the ankle joint show higher revision rates of 3.29 revisions per 100 component years. The aims of this study were the application and modification of the consensus classification of the synovia-like interface membrane (SLIM) for periprosthetic failure of the ankle joint, the etiological clarification of periprosthetic pseudocysts and a detailed measurement of proliferative activity (Ki67) in the region of osteolysis. Tissue samples from 159 patients were examined according to the criteria of the standardized consensus classification. Of these, 117 cases were derived from periprosthetic membranes of the ankle. The control group included 42 tissue specimens from the hip and knee joints. Particle identification and characterization were carried out using the particle algorithm. An immunohistochemical examination with Ki67 proliferation was performed in all cases of ankle pseudocysts and 19 control cases. The consensus classification of SLIM is transferrable to endoprosthetic failure of the ankle joint. Periprosthetic pseudocysts with the histopathological characteristics of the appropriate SLIM subtype were detectable in 39 cases of ankle joint endoprostheses (33.3%). The mean value of the Ki67 index was 14% and showed an increased proliferation rate in periprosthetic pseudocysts of the ankle (p-value 0.02037). In periprosthetic pseudocysts an above average higher detection rate of type 1 SLIM induced by abrasion (51.3%) with an increased Ki67 proliferation fraction (p-value 0.02037) was found, which can be interpreted as local destructive intraosseus synovialitis. This can be the reason for formation of pseudocystic osteolysis caused by high mechanical stress in ankle endoprostheses. A simplified diagnostic classification scoring system of dysfunctional endoprostheses of the ankle is proposed for collation of periprosthetic pseudocysts, ossifications and the Ki67 proliferation fraction.

Usefulness of peak exercise oxygen consumption and the heart failure survival score to predict survival in patients >65 years of age with heart failure.

PubMed

Parikh, Mona N; Lund, Lars H; Goda, Ayumi; Mancini, Donna

2009-04-01

Peak exercise oxygen consumption (Vo(2)) and the Heart Failure (HF) Survival Score (HFSS) were developed in middle-aged patient cohorts referred for heart transplantation with HF. The prognostic value of Vo(2) in patients >65 years has not been well studied. Accordingly, the prognostic value of peak Vo(2) was evaluated in these patients with HF. A retrospective analysis of 396 patients with HF >65 years with cardiopulmonary exercise testing was performed. Peak Vo(2) and components of the HFSS (presence of coronary artery disease, left ventricular ejection fraction, heart rate, mean arterial blood pressure, presence of intraventricular conduction defects, and serum sodium) were collected. Follow-up averaged 1,038 +/- 983 days. Outcome events were defined as death, implantation of a left ventricular assist device, or urgent transplantation. Patients were divided into risk strata for peak Vo(2) and HFSS based on previous cut-off points. Survival curves were derived using Kaplan-Meier analysis and compared using log-rank analysis. Survival differed markedly by Vo(2) stratum (p <0.0001), with significantly better survival rates for the low- (>14 ml/kg/min) versus medium- (10 to 14 ml/kg/min), low- versus high- (<10 ml/kg/min), and medium- versus high-risk strata (all p <0.05). Survival also differed markedly by HFSS stratum (p <0.0001), with significantly better survival rates for the low- (> or =8.10) versus medium- (7.20 to 8.09), low- versus high- (< or =7.19), and medium- versus high-risk strata (all p <0.0001). In conclusion, peak Vo(2) and the HFSS were both excellent parameters to predict survival in patients >65 years with HF.

Management and outcomes following an acute coronary event in patients with chronic heart failure 1999-2007.

PubMed

Ranasinghe, Isuru; Naoum, Chris; Aliprandi-Costa, Bernadette; Sindone, Andrew P; Steg, P Gabriel; Elliott, John; McGarity, Bruce; Lefkovits, Jeffrey; Brieger, David

2012-05-01

The outcome of patients with chronic heart failure (CHF) following an ischaemic event is poorly understood. We evaluated the management and outcomes of CHF patients presenting with an acute coronary syndrome (ACS) and explored changes in outcomes over time. A total of 5556 patients enrolled in the Australia-New Zealand population of the Global Registry of Acute Coronary Events (GRACE) between 1999 and 2007 were included. Patients with CHF (n = 609) were compared with those without CHF (n = 4947). Patients with CHF were on average 10 years older, were more likely to be female, had more co-morbidities and cardiac risk factors, and were more likely to have a prior history of angina, myocardial infarction, and revascularization by coronary artery bypass graft (CABG) when compared with those without CHF. CHF was associated with a substantial increase in in-hospital renal failure [odds ratio (OR) 1.76, 95% confidence interval (CI) 1.15-2.71], readmission post-discharge (OR 1.47, 95% CI 1.17-1.90), and 6-month mortality (OR 2.25, 95% CI 1.55-3.27). Over the 9 year study period, in-hospital and 6 month mortality in those with CHF declined by absolute rates of 7.5% and 14%, respectively. This was temporally associated with an increase in prescription of thienopyridines, beta-blockers, statins, and angiotensin II receptor blockers, increased rates of coronary angiography, and 31.8% absolute increase in referral rates for cardiac rehabilitation. Acute coronary syndrome patients with pre-existing CHF are a very high risk group and carry a disproportionate mortality burden. Encouragingly, there was a marked temporal improvement in outcomes over a 9 year period with an increase in evidence-based treatments and secondary preventative measures.

Stress transfer among en echelon and opposing thrusts and tear faults: Triggering caused by the 2003 Mw = 6.9 Zemmouri, Algeria, earthquake

USGS Publications Warehouse

Lin, J.; Stein, R.S.; Meghraoui, M.; Toda, S.; Ayadi, A.; Dorbath, C.; Belabbes, S.

2011-01-01

The essential features of stress interaction among earthquakes on en echelon thrusts and tear faults were investigated, first through idealized examples and then by study of thrust faulting in Algeria. We calculated coseismic stress changes caused by the 2003 Mw = 6.9 Zemmouri earthquake, finding that a large majority of the Zemmouri afterslip sites were brought several bars closer to Coulomb failure by the coseismic stresses, while the majority of aftershock nodal planes were brought closer to failure by an average of ~2 bars. Further, we calculated that the shallow portions of the adjacent Thenia tear fault, which sustained ~0.25 m slip, were brought >2 bars closer to failure. We calculated that the Coulomb stress increased by 1.5 bars on the deeper portions of the adjacent Boumerdes thrust, which lies just 10–20 km from the city of Algiers; both the Boumerdes and Thenia faults were illuminated by aftershocks. Over the next 6 years, the entire south dipping thrust system extending 80 km to the southwest experienced an increased rate of seismicity. The stress also increased by 0.4 bar on the east Sahel thrust fault west of the Zemmouri rupture. Algiers suffered large damaging earthquakes in A.D. 1365 and 1716 and is today home to 3 million people. If these shocks occurred on the east Sahel fault and if it has a ~2 mm/yr tectonic loading rate, then enough loading has accumulated to produce a Mw = 6.6–6.9 shock today. Thus, these potentially lethal faults need better understanding of their slip rate and earthquake history.

Ballpark Reliability Estimation Techniques

DTIC Science & Technology

1984-04-01

containing 1955 integrated cir- cuits, yielded average values of "A" and "B" of Aav a.047 and Bay -0024 Using "av and Bav as estimates of A and B in the...wave to board (csw); hand solder ( hsc ); crimp (cmp); and weld (wld). The basic failure rate model for connections is: xp b (11E xfT x fQ) 14 where...connectors in general (Ref. Table 5.1.14-1 of MIL-HDBK-217D), the "W" value of the other types of connections (i.e., hsc , csr, and ww-) differ by orders of

Reliability of Vibrating Mesh Technology.

PubMed

Gowda, Ashwin A; Cuccia, Ann D; Smaldone, Gerald C

2017-01-01

For delivery of inhaled aerosols, vibrating mesh systems are more efficient than jet nebulizers are and do not require added gas flow. We assessed the reliability of a vibrating mesh nebulizer (Aerogen Solo, Aerogen Ltd, Galway Ireland) suitable for use in mechanical ventilation. An initial observational study was performed with 6 nebulizers to determine run time and efficiency using normal saline and distilled water. Nebulizers were run until cessation of aerosol production was noted, with residual volume and run time recorded. Three controllers were used to assess the impact of the controller on nebulizer function. Following the observational study, a more detailed experimental protocol was performed using 20 nebulizers. For this analysis, 2 controllers were used, and time to cessation of aerosol production was noted. Gravimetric techniques were used to measure residual volume. Total nebulization time and residual volume were recorded. Failure was defined as premature cessation of aerosol production represented by residual volume of > 10% of the nebulizer charge. In the initial observational protocol, an unexpected sporadic failure rate was noted of 25% in 55 experimental runs. In the experimental protocol, a failure rate was noted of 30% in 40 experimental runs. Failed runs in the experimental protocol exhibited a wide range of retained volume averaging ± SD 36 ± 21.3% compared with 3.2 ± 1.5% (P = .001) in successful runs. Small but significant differences existed in nebulization time between controllers. Aerogen Solo nebulization was often randomly interrupted with a wide range of retained volumes. Copyright © 2017 by Daedalus Enterprises.

Predictors of heart failure self-care in patients who screened positive for mild cognitive impairment.

PubMed

Davis, Karen K; Himmelfarb, Cheryl R Dennison; Szanton, Sarah L; Hayat, Matthew J; Allen, Jerilyn K

2015-01-01

Heart failure (HF) is associated with cognitive impairment, which could negatively affect a patient's abilities to carry out self-care, potentially resulting in higher hospital readmission rates. Factors associated with self-care in patients experiencing mild cognitive impairment (MCI) are not known. This descriptive correlation study aimed to assess levels of HF self-care and knowledge and to determine the predictors of self-care in HF patients who screen positive for MCI. The Montreal Cognitive Assessment was used to screen for MCI. In 125 patients with MCI hospitalized with HF, self-care (Self-care of Heart Failure Index) and HF knowledge (Dutch Heart Failure Knowledge Scale) were assessed. We used multiple regression analysis to test a model of variables hypothesized to predict self-care maintenance, management, and confidence. Mean (SD) HF knowledge scores (11.24 [1.84]) were above the level considered to be adequate (defined as >10). Mean (SD) scores for self-care maintenance (63.57 [19.12]), management (68.35 [20.24]), and confidence (64.99 [16.06]) were consistent with inadequate self-care (defined as scores <70). In multivariate analysis, HF knowledge, race, greater disease severity, and social support explained 22% of the variance in self-care maintenance (P < .001); age, education level, and greater disease severity explained 19% of the variance in self-care management (P < .001); and younger age and higher social support explained 20% of the variance in self-care confidence scores (P < .001). Blacks, on average, scored significantly lower in self-care maintenance (P = .03). In this sample, patients who screened positive for MCI, on average, had adequate HF knowledge yet inadequate self-care scores. These models show the influence of modifiable and nonmodifiable predictors for patients who screened positive for MCI across the domains of self-care. Health professionals should consider screening for MCI and identifying interventions that address HF knowledge and social support. Further research is needed to explain the racial differences in self-care.

An investigation of gear mesh failure prediction techniques. M.S. Thesis - Cleveland State Univ.

NASA Technical Reports Server (NTRS)

Zakrajsek, James J.

1989-01-01

A study was performed in which several gear failure prediction methods were investigated and applied to experimental data from a gear fatigue test apparatus. The primary objective was to provide a baseline understanding of the prediction methods and to evaluate their diagnostic capabilities. The methods investigated use the signal average in both the time and frequency domain to detect gear failure. Data from eleven gear fatigue tests were recorded at periodic time intervals as the gears were run from initiation to failure. Four major failure modes, consisting of heavy wear, tooth breakage, single pits, and distributed pitting were observed among the failed gears. Results show that the prediction methods were able to detect only those gear failures which involved heavy wear or distributed pitting. None of the methods could predict fatigue cracks, which resulted in tooth breakage, or single pits. It is suspected that the fatigue cracks were not detected because of limitations in data acquisition rather than in methodology. Additionally, the frequency response between the gear shaft and the transducer was found to significantly affect the vibration signal. The specific frequencies affected were filtered out of the signal average prior to application of the methods.

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

Does the United States economy affect heart failure readmissions? A single metropolitan center analysis.

PubMed

Thompson, Keith A; Morrissey, Ryan P; Phan, Anita; Schwarz, Ernst R

2012-08-01

To determine the effects of the US economy on heart failure hospitalization rates. The recession was associated with worsening unemployment, loss of private insurance and prescription medication benefits, medication nonadherence, and ultimately increased rates of hospitalization for heart failure. We compared hospitalization rates at a large, single, academic medical center from July 1, 2006 to February 28, 2007, a time of economic stability, and July 1, 2008 to February 28, 2009, a time of economic recession in the United States. Significantly fewer patients had private medical insurance during the economic recession than during the control period (36.5% vs 46%; P = 0.04). Despite this, there were no differences in the heart failure hospitalization or readmission rates, length of hospitalization, need for admission to an intensive care unit, in-hospital mortality, or use of guideline-recommended heart failure medications between the 2 study periods. We conclude that despite significant effects on medical insurance coverage, rates of heart failure hospitalization at our institution were not significantly affected by the recession. Additional large-scale population-based research is needed to better understand the effects of fluctuations in the US economy on heart failure hospitalization rates. © 2012 Wiley Periodicals, Inc.

Surveillance of in vivo resistance of Plasmodium falciparum to antimalarial drugs from 1992 to 1999 in Malabo (Equatorial Guinea).

PubMed

Roche, Jesús; Guerra-Neira, Ana; Raso, José; Benito, Agustîn

2003-05-01

From 1992-1999, we have assessed the therapeutic efficacy of three malaria treatment regimens (chloroquine 25 mg/kg over three days, pyrimethamine/sulfadoxine 1.25/25 mg/kg in one dose, and quinine 25-30 mg/kg daily in three oral doses over a four-, five-, or seven-day period) in 1,189 children under age 10 at Malabo Regional Hospital in Equatorial Guinea. Of those children, 958 were followed up clinically and parasitologically for 14 days. With chloroquine, the failure rate varied from 55% in 1996 to 40% in 1999; the early treatment failure rate increased progressively over the years, from 6% in 1992 to 30% in 1999. With pyrimethamine/sulfadoxine, the failure rate varied from 0% in 1996 to 16% in 1995. The short quinine treatment regimens used in 1992 and 1993 (4 and 5 days, respectively) resulted in significantly higher failure rates (19% and 22%, respectively) than the 7d regimen (3-5.5%). We conclude that: a) failure rates for chloroquine are in the change period (> 25%), and urgent action is needed; b) pyrimethamine/ sulfadoxine failure rates are in the alert period (6-15%), and surveillance must be continued; and c) quinine failure rates are in the grace period (< 6%), so quinine can be recommended.

The role of thermal shock in cyclic oxidation

NASA Technical Reports Server (NTRS)

Lowell, C. E.; Deadmore, D. L.

1978-01-01

The effect of thermal shock on the spalling of oxides from the surfaces of several commercial alloys was determined. The average cooling rate was varied from approximately 240 C per second to less than 1.0 C per second during cyclic oxidation tests in air. The tests consisted of one hundred cycles of one hour at the maximum temperature (1100 or 1200 C). The alloys were HOS-875, TD-Ni, TD-NiCrAl, IN-601, IN-702, and B-1900 plus Hf. All of these alloys exhibited partial spalling within the oxide rather than total oxide loss down to bare metal. Thermal shock resulted in deformation of the metal which in turn resulted, in most cases, in changing the oxide failure mode from compressive to tensile. Tensile failures were characterized by cracking of the oxide and little loss, while compressive failures were characterized by explosive loss of platelets of oxide. This behavior was confirmed by examination of mechanically stressed oxide scales. The thermally shocked oxides spalled less than the slow cooled samples with the exception of TD-NiCrAl. This material failed in a brittle manner rather than by plastic deformation.

Status epilepticus in the elderly patients: A national data study in Thailand.

PubMed

Tiamkao, Somsak; Pranboon, Sineenard; Thepsuthammarat, Kaewjai; Sawanyawisuth, Kittisak

2017-01-15

There are limited data in terms of incidence, clinical features, and outcomes in elderly patients with status epilepticus (SE) in national level. We retrospectively explored national data in Thailand for reimbursement of all SE in elderly patients admitted in the fiscal year 2004-2012. SE in elderly patients (age>60years old) were diagnosed and searched based on ICD 10 (G41) from the national database of from the National Health and Security Office. There were 3326 SE in elderly patients. The national incidence of SE was highest at 8.78patients/100,000/year in 2012. The average age was 72.02years and most were males (1379 patients; 58.8%). At discharge, 66% of patients had improved and in-hospital mortality rate was 14.5%. Predictors of poor outcomes were older age≥80years, being female, hospital levels, chronic renal failure, central nervous system infection, respiratory failure, pneumonia, septicemia, shock, acute renal failure, and hyperkalemia. In conclusion, the number of cases of SE in elderly patients in Thailand has been increasing annually. Increasing age was associated with poor outcome in admitted elderly SE patients. Copyright © 2016 Elsevier B.V. All rights reserved.

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

Keeling, A. N.; Leong, S.; Logan, P. M.

Empyema and complicated pleural effusion represent common medical problems. Current treatment options are multiple. The purpose of this study was to access the outcome of image-guided, small-bore catheter drainage of empyema and effusion. We evaluated 93 small-bore catheters in 82 patients with pleural effusion (n = 30) or empyema (n = 52), over a 2-year period. Image guidance was with ultrasound (US; n = 56) and CT (n = 37). All patients were followed clinically, with catheter dwell times, catheter outcome, pleural fluid outcome, reinsertion rates, and need for urokinase or surgery recorded. Ninety-three small-bore chest drains (mean=10.2 Fr; range,more » 8.2-12.2 Fr) were inserted, with an average dwell time of 7.81 days for empyemas and 7.14 days for effusions (p > 0.05). Elective removal rates (73% empyema vs 86% effusions) and dislodgement rates (12% empyema vs 13% effusions) were similar for both groups. Eight percent of catheters became blocked and 17% necessitated reinsertion in empyemas, with no catheters blocked or requiring reinsertion in effusions (p < 0.05). Thirty-two patients (51%) required urokinase in the empyema group, versus 2 patients (6%) in the effusion group (p < 0.05). All treatment failures, requiring surgery, occurred in the empyema group (19%; n = 12; p < 0.05). In conclusion, noninfected pleural collections are adequately treated with small-bore catheters, however, empyemas have a failure rate of 19%. The threshold for using urokinase and larger-bore catheters should be low in empyema.« less

Empyema and effusion: outcome of image-guided small-bore catheter drainage.

PubMed

Keeling, A N; Leong, S; Logan, P M; Lee, M J

2008-01-01

Empyema and complicated pleural effusion represent common medical problems. Current treatment options are multiple. The purpose of this study was to access the outcome of image-guided, small-bore catheter drainage of empyema and effusion. We evaluated 93 small-bore catheters in 82 patients with pleural effusion (n = 30) or empyema (n = 52), over a 2-year period. Image guidance was with ultrasound (US; n = 56) and CT (n = 37). All patients were followed clinically, with catheter dwell times, catheter outcome, pleural fluid outcome, reinsertion rates, and need for urokinase or surgery recorded. Ninety-three small-bore chest drains (mean=10.2 Fr; range, 8.2-12.2 Fr) were inserted, with an average dwell time of 7.81 days for empyemas and 7.14 days for effusions (p > 0.05). Elective removal rates (73% empyema vs 86% effusions) and dislodgement rates (12% empyema vs 13% effusions) were similar for both groups. Eight percent of catheters became blocked and 17% necessitated reinsertion in empyemas, with no catheters blocked or requiring reinsertion in effusions (p < 0.05). Thirty-two patients (51%) required urokinase in the empyema group, versus 2 patients (6%) in the effusion group (p < 0.05). All treatment failures, requiring surgery, occurred in the empyema group (19%; n = 12; p < 0.05). In conclusion, noninfected pleural collections are adequately treated with small-bore catheters, however, empyemas have a failure rate of 19%. The threshold for using urokinase and larger-bore catheters should be low in empyema.

A study of Mariner 10 flight experiences and some flight piece part failure rate computations

NASA Technical Reports Server (NTRS)

Paul, F. A.

1976-01-01

The problems and failures encountered in Mariner flight are discussed and the data available through a quantitative accounting of all electronic piece parts on the spacecraft are summarized. It also shows computed failure rates for electronic piece parts. It is intended that these computed data be used in the continued updating of the failure rate base used for trade-off studies and predictions for future JPL space missions.

The impact of vaccine failure rate on epidemic dynamics in responsive networks.

PubMed

Liang, Yu-Hao; Juang, Jonq

2015-04-01

An SIS model based on the microscopic Markov-chain approximation is considered in this paper. It is assumed that the individual vaccination behavior depends on the contact awareness, local and global information of an epidemic. To better simulate the real situation, the vaccine failure rate is also taken into consideration. Our main conclusions are given in the following. First, we show that if the vaccine failure rate α is zero, then the epidemic eventually dies out regardless of what the network structure is or how large the effective spreading rate and the immunization response rates of an epidemic are. Second, we show that for any positive α, there exists a positive epidemic threshold depending on an adjusted network structure, which is only determined by the structure of the original network, the positive vaccine failure rate and the immunization response rate for contact awareness. Moreover, the epidemic threshold increases with respect to the strength of the immunization response rate for contact awareness. Finally, if the vaccine failure rate and the immunization response rate for contact awareness are positive, then there exists a critical vaccine failure rate αc > 0 so that the disease free equilibrium (DFE) is stable (resp., unstable) if α < αc (resp., α > αc). Numerical simulations to see the effectiveness of our theoretical results are also provided.

Parathyroid surgical failures with sufficient decline of intraoperative parathyroid hormone levels: unobserved multiple endocrine neoplasia as an explanation.

PubMed

Westerdahl, Johan; Bergenfelz, Anders

2006-06-01

A sufficient decline in levels of parathyroid hormone measured intraoperatively (ioPTH) precludes early and late surgical failures. A case series of consecutive patients undergoing parathyroidectomy with ioPTH measurement. A university hospital. Two hundred sixty-nine consecutive patients with sporadic primary hyperparathyroidism who underwent first-time parathyroid surgery with ioPTH measurement were followed up for as long as 10 years after surgery. Data on all patients have been collected in a prospective database. Surgical failures up to 10 years after parathyroid surgery. With an average follow-up of 3.6 years (range, 6-120 months), the overall cure rate was 96%. The ioPTH level correctly predicted long-term outcome in 248 (92%) of 269 patients. Six patients had a false-positive ioPTH finding. Five of these patients were found to have germline mutations in the gene for multiple endocrine neoplasia. The remaining patient has not undergone genetic testing. The mutations have rarely (n = 1) or never (n = 4) been described before, to our knowledge. Intraoperative measurement of PTH level has a high overall accuracy with a mean follow-up of 3.6 years. However, among the late surgical failures with false-positive ioPTH findings, overlooked mutations in the multiple endocrine neoplasia gene should be suspected, and therefore genetic analyses in these patients are of great importance.

Effects on milk yield of milking interval regularity and teat cup attachment failures with robotic milking systems.

PubMed

Bach, Alex; Busto, Isabel

2005-02-01

A database consisting of 35291 milking records from 83 cows was built over a period of 10 months with the objectives of studying the effect of teat cup attachment failures and milking interval regularity on milk production with an automated milking system (AMS). The database collected records of lactation number, days in milk (DIM), milk production, interval between milkings (for both the entire udder and individual quarters in case of a teat cup attachment failure) and average and peak milk flows for each milking. The weekly coefficient of variation (CV) of milking intervals was used as a measure of milking regularity. DIM, milking intervals, and CV of milking intervals were divided into four categories coinciding with the four quartiles of their respective distributions. The data were analysed by analysis of variance with cow as a random effect and lactation number, DIM, the occurrence of a milking failure, and the intervals between milkings or the weekly CV of milking intervals as fixed effects. The incidence of attachment failures was 7.6% of total milkings. Milk production by quarters affected by a milking failure following the failure was numerically greater owing to the longer interval between milkings. When accounting for the effect of milking intervals, milk production by affected quarters following a milking failure was 26% lower than with regular milkings. However, the decrease in milk production by quarters affected by milking failures was more severe as DIM increased. Average and peak milk flows by quarters affected by a milking failure were lower than when milkings occurred normally. However, milk production recovered its former level within seven milkings following a milking failure. Uneven frequency (weekly CV of milking intervals >27%) decreased daily milk yield, and affected multiparous more negatively than primiparous cows.

Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in South Korea, 2015: epidemiology, characteristics and public health implications.

PubMed

Kim, K H; Tandi, T E; Choi, J W; Moon, J M; Kim, M S

2017-02-01

Since the first case of Middle East respiratory syndrome coronavirus (MERS-CoV) in South Korea was reported on 20 th May 2015, there have been 186 confirmed cases, 38 deaths and 16,752 suspected cases. Previously published research on South Korea's MERS outbreak was limited to the early stages, when few data were available. Now that the outbreak has ended, albeit unofficially, a more comprehensive review is appropriate. Data were obtained through the MERS portal by the Ministry for Health and Welfare (MOHW) and Korea Centres for Disease Control and Prevention, press releases by MOHW, and reports by the MERS Policy Committee of the Korean Medical Association. Cases were analysed for general characteristics, exposure source, timeline and infection generation. Sex, age and underlying diseases were analysed for the 38 deaths. Beginning with the index case that infected 28 others, an in-depth analysis was conducted. The average age was 55 years, which was a little higher than the global average of 50 years. As in most other countries, more men than women were affected. The case fatality rate was 19.9%, which was lower than the global rate of 38.7% and the rate in Saudi Arabia (36.5%). In total, 184 patients were infected nosocomially and there were no community-acquired infections. The main underlying diseases were respiratory diseases, cancer and hypertension. The main contributors to the outbreak were late diagnosis, quarantine failure of 'super spreaders', familial care-giving and visiting, non-disclosure by patients, poor communication by the South Korean Government, inadequate hospital infection management, and 'doctor shopping'. The outbreak was entirely nosocomial, and was largely attributable to infection management and policy failures, rather than biomedical factors. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

High dose radiation with chemotherapy followed by salvage esophagectomy among patients with locally advanced esophageal squamous cell carcinoma.

PubMed

Lertbutsayanukul, Chawalit; Tharavej, Chadin; Klaikeaw, Naruemon; Prayongrat, Anussara; Lowanitchai, Chutinan; Sriuranpong, Virote

2017-05-01

Locoregional failure is a major problem associated with chemoradiation treatment for squamous cell esophageal carcinoma. The aim of this study was to assess the feasibility, efficacy, and toxicity of preoperative radiation (dose > 50 Gy) with platinum-based chemotherapy followed by esophagectomy in locally advanced squamous cell carcinoma. Data of patients with cT2-cT4 or node positive squamous cell carcinoma of the esophagus who received trimodality treatment between February 2006 and June 2015 were reviewed. Forty-four patients were treated with intensity-modulated radiation therapy, volumetric-modulated arc therapy or three-dimensional radiation therapy. The median radiation dose was 60 Gy. The average volume of the lungs receiving 10 Gy was 48.1%, 20 Gy was 24.5%, and the average mean lung dose was 14 Gy. After chemoradiation, R0 resection was achieved in 31 patients (71%). Patients who received >60 Gy had a higher pathologic complete remission rate than those in the lower dose group (59.1% vs. 36.4%). R0 resection and radiation dose >60 Gy were associated with better overall survival in Cox proportional hazards regression analysis. The median follow-up duration was 22.4 months and median survival was 25.6 months. Two-year overall, progression-free survival and locoregional control rates were 55.9%, 28.6%, and 56%, respectively. The most common grade 3-4 toxicities were esophagitis (63.6%) and neutropenia (25%). Grade 3-4 postoperative morbidities included surgical wound infection (2.3%), acute renal failure (2.3%), and anastomosis stricture (2.3%). Trimodality treatment with a high preoperative radiation dose and chemotherapy yielded a good pathologic complete response rate, and long-term survival with low toxicities. © 2017 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

Sterilization failures in Singapore: an examination of ligation techniques and failure rates.

PubMed

Cheng, M C; Wong, Y M; Rochat, R W; Ratnam, S S

1977-04-01

The University Department of Obstetrics and Gynecology, Kandang Kerbau Hospital in Singapore, initiated a study in early 1974 of failure rates for various methods of sterilization and the factors responsible for the failures. During the period January 1974 to March 1976, 51 cases of first pregnancy following ligation were discovered. Cumulative failure rates at 24 months were 0.34 per 100 women for abdominal sterilization, 1.67 for culdoscopic, 3.12 for vaginal, and 4.49 for laparoscopic procedures. Findings for 35 patients who underwent religation showed that recanalization and the establishment of a fistulous opening caused the majority of failures. Clearly, more effective methods of tubal occlusion in sterilization are needed.

Malpractice suits in chest radiology: an evaluation of the histories of 8265 radiologists.

PubMed

Baker, Stephen R; Patel, Ronak H; Yang, Lily; Lelkes, Valdis M; Castro, Alejandro

2013-11-01

The aim of this study was to present rates of claims, causes of error, percentage of cases resulting in a judgment, and average payments made by radiologists in chest-related malpractice cases in a survey of 8265 radiologists. The malpractice histories of 8265 radiologists were evaluated from the credentialing files of One-Call Medical Inc., a preferred provider organization for computed tomography/magnetic resonance imaging in workers' compensation cases. Of the 8265 radiologists, 2680 (32.4%) had at least 1 malpractice suit. Of those who were sued, the rate of claims was 55.1 per 1000 person years. The rate of thorax-related suits was 6.6 claims per 1000 radiology practice years (95% confidence interval, 6.0-7.2). There were 496 suits encompassing 48 different causes. Errors in diagnosis comprised 78.0% of the causes. Failure to diagnose lung cancer was by far the most frequent diagnostic error, representing 211 cases or 42.5%. Of the 496 cases, an outcome was known in 417. Sixty-one percent of these were settled in favor of the plaintiff, with a mean payment of $277,230 (95% confidence interval, 226,967-338,614). Errors in diagnosis, and among them failure to diagnose lung cancer, were by far the most common reasons for initiating a malpractice suit against radiologists related to the thorax and its contents.

New perspectives on the transition between discrete fracture, fragmentation, and pulverization during brittle failure of rocks

NASA Astrophysics Data System (ADS)

Griffith, W. A.; Ghaffari, H.; Barber, T. J.; Borjas, C.

2015-12-01

The motions of Earth's tectonic plates are typically measured in millimeters to tens of centimeters per year, seemingly confirming the generally-held view that tectonic processes are slow, and have been throughout Earth's history. In line with this perspective, the vast majority of laboratory rock mechanics research focused on failure in the brittle regime has been limited to experiments utilizing slow loading rates. On the other hand, many natural processes that pose significant risk for humans (e.g., earthquakes and extraterrestrial impacts), as well as risks associated with human activities (blow-outs, explosions, mining and mine failures, projectile penetration), occur at rates that are hundreds to thousands of times faster than those typically simulated in the laboratory. Little experimental data exists to confirm or calibrate theoretical models explaining the connection between these dramatic events and the pulverized rocks found in fault zones, impacts, or explosions; however the experimental data that does exist is thought-provoking: At the earth's surface, the process of brittle fracture passes through a critical transition in rocks at high strain rates (101-103s-1) between regimes of discrete fracture and distributed fragmentation, accompanied by a dramatic increase in strength. Previous experimental works on this topic have focused on key thresholds (e.g., peak stress, peak strain, average strain rate) that define this transition, but more recent work suggests that this transition is more fundamentally dependent on characteristics (e.g., shape) of the loading pulse and related microcrack dynamics, perhaps explaining why for different lithologies different thresholds more effectively define the pulverization transition. In this presentation we summarize some of our work focused on this transition, including the evolution of individual defects at the microscopic, microsecond scale and the energy budget associated with the brittle fragmentation process as a function of lithology and loading pulse characteristics.

[Heart rate control in chronic heart failure patients received cardiovascular implantable electronic device therapy: effects of optimized medication].

PubMed

Gao, Y; Liang, Y C; Yu, H B; Yan, X L; Xu, B G; Liu, R; Wang, N; Xu, G Q; Wang, Z L

2018-03-24

Objective: To investigate the heart rate control situation of chronic heart failure (CHF) patients who received cardiovascular implantable electronic device (CIED) therapy, and to assess the heart rate control efficacy by optimized medication adjustment. Methods: We performed a perspective study in heart failure with reduced left ventricular ejection fraction (HFrEF) patients who received CIED according to guideline recommendations, patients were enrolled from January 2012 to January 2017. Resting heart rate (RHR) recorded by electrocardiogram after 10 minutes' rest and medication usage within 1 month were recorded at baseline. RHR less than 70 beats per minute (bpm) was regarded as well controlled. β-receptor blockers and (or) ivabradine would be added in patients whose RHR were over 70 bpm. RHR after optimized medication adjustment was recorded during follow-up period. Results: One hundred and fifty patients were included in this study with average RHR (80.6±11.9) bpm. RHR was<70 bpm in 27.3% (41/150) patients at baseline and β-receptor blockers was underused in 80.7% patients (88/109) whose RHR was>70 bpm. The overall RHR decreased to (73.1±10.4) bpm and percent of patients with RHR<70 bpm increased to 70.0% (105/150) after up-titration of β-receptor blockers compared to baseline (χ 2 =52.958, P< 0.001). Ivabradine was added in the rest 45 patients and RHR was<70 bpm in 43 out of 45 patients after ivabradine use. The overall RHR decreased to (67.1±2.7) bpm and percent of RHR<70 bpm significantly increased to 98.7% (148/150) (χ 2 =44.504, P< 0.001 vs. up-titration of β-receptor blockers only). Conclusion: RHR in CHF patients who received CIED therapy is not ideally controlled in this patient cohort, individual up-titration ofβ-receptor blockers and ivabradine use may help to optimize RHR in these patients.

Spent fuel behavior under abnormal thermal transients during dry storage

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

Stahl, D.; Landow, M.P.; Burian, R.J.

1986-01-01

This study was performed to determine the effects of abnormally high temperatures on spent fuel behavior. Prior to testing, calculations using the CIRFI3 code were used to determine the steady-state fuel and cask component temperatures. The TRUMP code was used to determine transient heating rates under postulated abnormal events during which convection cooling of the cask surfaces was obstructed by a debris bed covering the cask. The peak rate of temperature rise during the first 6 h was calculated to be about 15/sup 0/C/h, followed by a rate of about 1/sup 0/C/h. A Turkey Point spent fuel rod segment wasmore » heated to approx. 800/sup 0/C. The segment deformed uniformly with an average strain of 17% at failure and a local strain of 60%. Pretest characterization of the spent fuel consisted of visual examination, profilometry, eddy-current examination, gamma scanning, fission gas collection, void volume measurement, fission gas analysis, hydrogen analysis of the cladding, burnup analysis, cladding metallography, and fuel ceramography. Post-test characterization showed that the failure was a pinhole cladding breach. The results of the tests showed that spent fuel temperatures in excess of 700/sup 0/C are required to produce a cladding breach in fuel rods pressurized to 500 psing (3.45 MPa) under postulated abnormal thermal transient cask conditions. The pinhole cladding breach that developed would be too small to compromise the confinement of spent fuel particles during an abnormal event or after normal cooling conditions are restored. This behavior is similar to that found in other slow ramp tests with irradiated and nonirradiated rod sections and nonirradiated whole rods under conditions that bracketed postulated abnormal heating rates. This similarity is attributed to annealing of the irradiation-strengthened Zircaloy cladding during heating. In both cases, the failure was a benign, ductile pinhole rupture.« less

Decadal-scale coastal cliff retreat in southern and central California

NASA Astrophysics Data System (ADS)

Young, Adam P.

2018-01-01

Airborne LiDAR data collected in 1998 and 2009-2010 were used to measure coastal cliff erosion and retreat between the Mexico/California border and Bodega Head, California. Cliff erosion was detected along 44% of the 595 km of shoreline evaluated, while the remaining cliffs were relatively stable. The mean cliff top retreat rate was 0.12 m/yr, while mean retreat averaged over the entire cliff face was 0.04 m/yr. The maximum cliff top and face retreat rates were 4.2 and 3.8 m/yr, respectively. Historical ( 1930s to 1998) and recent retreat rates were significantly inversely correlated for areas with large historical or recent cliff retreat, such that locations with elevated historical retreat had low levels of recent retreat and locations with elevated recent retreat were preceded by low rates of historical retreat. The strength of this inverse correlation increased with cliff change magnitudes up to r2 of 0.91 for cliff top retreat rates > 2.9 m/yr. Mean recent retreat rates were 52-83% lower than mean historical retreat rates. Although beaches can protect cliffs against wave-driven erosion, cliffs fronted by beaches retreated 49% more than cliffs without beaches. On average, unarmored cliff faces retreated 0.05 m/yr between 1998 and 2009-2010, about three times faster than artificially armored cliffs. Alongshore metrics of wave-cliff impact, precipitation, and cliff hardness were generally not well correlated with recent cliff changes. A cliff hazard metric is used to detect cliff steepening and areas prone to future cliff top failures.

Payload maintenance cost model for the space telescope

NASA Technical Reports Server (NTRS)

White, W. L.

1980-01-01

An optimum maintenance cost model for the space telescope for a fifteen year mission cycle was developed. Various documents and subsequent updates of failure rates and configurations were made. The reliability of the space telescope for one year, two and one half years, and five years were determined using the failure rates and configurations. The failure rates and configurations were also used in the maintenance simulation computer model which simulate the failure patterns for the fifteen year mission life of the space telescope. Cost algorithms associated with the maintenance options as indicated by the failure patterns were developed and integrated into the model.

Rate of change of heart size before congestive heart failure in dogs with mitral regurgitation.

PubMed

Lord, P; Hansson, K; Kvart, C; Häggström, J

2010-04-01

The objective of the study was to examine the changes in vertebral heart scale, and left atrial and ventricular dimensions before and at onset of congestive heart failure in cavalier King Charles spaniels with mitral regurgitation. Records and radiographs from 24 cavalier King Charles spaniels with mitral regurgitation were used. Vertebral heart scale (24 dogs), and left atrial dimension and left ventricular end diastolic and end systolic diameters (18 dogs) and their rate of increase were measured at intervals over years to the onset of congestive heart failure. They were plotted against time to onset of congestive heart failure. Dimensions and rates of change of all parameters were highest at onset of congestive heart failure, the difference between observed and chance outcome being highly significant using a two-tailed chi-square test (P<0.001). The left heart chambers increase in size rapidly only in the last year before the onset of congestive heart failure. Increasing left ventricular end systolic dimension is suggestive of myocardial failure before the onset of congestive heart failure. Rate of increase of heart dimensions may be a useful indicator of impending congestive heart failure.

The effect of double-row fixation on initial repair strength in rotator cuff repair: a biomechanical study.

PubMed

Meier, Steven W; Meier, Jeffrey D

2006-11-01

The purpose of this study was to compare the initial mechanical strength of 3 rotator cuff repair techniques. A total of 30 fresh-frozen cadaveric shoulders were prepared, and full-thickness supraspinatus tears were created. Specimens were randomized and placed into 3 groups: (1) transosseous suture technique (group I: TOS, n = 10, 6F/4M), (2) single-row suture anchor fixation (group II: SRSA, n = 10, 6F/4M), and (3) double-row suture anchor fixation (group III: DRSA, n = 10, 6F/4M). Each specimen underwent cyclic load testing from 5 N to 180 N at a rate of 33 mm/sec. The test was stopped when complete failure (repair site gap of 10 mm) or a total of 5,000 cycles was attained. Group I (TOS) failed at an average of 75.3 +/- 22.49 cycles, and group II (SRSA) at an average of 798.3 +/- 73.28 cycles; group III (DRSA) had no failures because all samples were stopped when 5,000 cycles had been completed. Fixation strength of the DRSA technique proved to be significantly greater than that of SRSA (P < .001), and both suture anchor groups were significantly stronger than the TOS group (P < .001). Suture anchor repairs were significantly stronger than transosseous repairs. Furthermore, double-row suture anchor fixation was significantly stronger than was single-row repair. Therefore, double-row fixation may be superior to other techniques in that it provides a substantially stronger repair that could lead to improved biologic healing. A high incidence of incomplete healing occurs in rotator cuff repair. Use of double-row fixation may help the clinician to address some deficiencies in current methods by increasing the strength of the repair, potentially leading to improved healing rates.

Micro-engineered first wall tungsten armor for high average power laser fusion energy systems

NASA Astrophysics Data System (ADS)

Sharafat, Shahram; Ghoniem, Nasr M.; Anderson, Michael; Williams, Brian; Blanchard, Jake; Snead, Lance; HAPL Team

2005-12-01

The high average power laser program is developing an inertial fusion energy demonstration power reactor with a solid first wall chamber. The first wall (FW) will be subject to high energy density radiation and high doses of high energy helium implantation. Tungsten has been identified as the candidate material for a FW armor. The fundamental concern is long term thermo-mechanical survivability of the armor against the effects of high temperature pulsed operation and exfoliation due to the retention of implanted helium. Even if a solid tungsten armor coating would survive the high temperature cyclic operation with minimal failure, the high helium implantation and retention would result in unacceptable material loss rates. Micro-engineered materials, such as castellated structures, plasma sprayed nano-porous coatings and refractory foams are suggested as a first wall armor material to address these fundamental concerns. A micro-engineered FW armor would have to be designed with specific geometric features that tolerate high cyclic heating loads and recycle most of the implanted helium without any significant failure. Micro-engineered materials are briefly reviewed. In particular, plasma-sprayed nano-porous tungsten and tungsten foams are assessed for their potential to accommodate inertial fusion specific loads. Tests show that nano-porous plasma spray coatings can be manufactured with high permeability to helium gas, while retaining relatively high thermal conductivities. Tungsten foams where shown to be able to overcome thermo-mechanical loads by cell rotation and deformation. Helium implantation tests have shown, that pulsed implantation and heating releases significant levels of implanted helium. Helium implantation and release from tungsten was modeled using an expanded kinetic rate theory, to include the effects of pulsed implantations and thermal cycles. Although, significant challenges remain micro-engineered materials are shown to constitute potential candidate FW armor materials.

Predictors of treatment failure, incipient hypothyroidism, and weight gain following radioiodine therapy for Graves' thyrotoxicosis.

PubMed

Gibb, F W; Zammitt, N N; Beckett, G J; Strachan, M W J

2013-10-01

Following radioiodine ((131)I) therapy, both late recognition of hypothyroidism and treatment failure may result in adverse outcomes. We sought to assess indicators of both incipient hypothyroidism and treatment failure following (131)I and determine factors predictive of weight gain. Retrospective study of 288 patients receiving (131)I for treatment of Graves' thyrotoxicosis. Primary outcome measures were thyroid status and weight change at 1 yr following (131)I. The treatment failure rate at 1 yr was 13.5%. Hypothyroidism developed in 80.9%, with 58.5% of patients having levels of free T4 (fT4) <6 pmol/l at diagnosis. Patients receiving thionamides before and after (131)I had significantly higher levels of treatment failure (23.3%) than those with no thionamide exposure (6.3%, p=0.003), but also had more active Graves' disease. Following (131)I, development of a detectable TSH or low-normal fT4 levels was not associated with recurrent thyrotoxicosis. Median weight gain was 5.3 kg, although patients with nadir fT4 levels <6 pmol/l gained an average 2 kg more than those with levels >6 pmol/l (p=0.05). The main predictor of weight gain was fT4 level immediately prior to treatment; those in the lowest tertile gained a median 3.1 kg whilst those in the highest tertile gained 7.4 kg (median difference 4.3 kg; 95% confidence interval: 2.5-6.2). Marked hypothyroidism following (131)I is common and often occurs early. Simple biochemical parameters may help identify incipient hypothyroidism and potentially limit excess weight gain. Treatment failure is common in patients with severe thyrotoxicosis and in such cases larger doses of (131)I may be warranted.

Effects of beta-blocker therapy on mortality in patients with heart failure. A systematic overview of randomized controlled trials.

PubMed

Doughty, R N; Rodgers, A; Sharpe, N; MacMahon, S

1997-04-01

Several randomized trials have reported that beta-blocker therapy improves left ventricular function and reduces the rate of hospitalization in patients with congestive heart failure. However, most trials were individually too small to assess reliably the effects of treatment on mortality. In these circumstances a systematic overview of all trials of beta-blocker therapy in patients with congestive heart failure may provide the most reliable guide to treatment effects. Details were sought from all completed randomized trials of oral beta-blocker therapy in patients with heart failure of any aetiology. In particular, data on mortality were sought from all randomized patients for the scheduled treatment period. The typical effect of treatment on mortality was estimated from an overview in which the results of all individual trials were combined using standard statistical methods. Twenty-four randomized trials, involving 3141 patients with stable congestive heart failure were identified. Complete data on mortality were obtained from all studies, and a total of 297 deaths were documented during an average of 13 months of follow-up. Overall, there was a 31% reduction in the odds of death among patients assigned a beta-blocker (95% confidence interval 11 to 46%, 2P = 0.0035), representing an absolute reduction in mean annual mortality from 9.7% to 7.5%. The effects on mortality of vasodilating beta-blockers (47% reduction SD 15), principally carvedilol, were non-significantly greater (2P = 0.09) than those of standard agents (18% reduction SD 15), principally metoprolol. Beta-blocker therapy is likely to reduce mortality in patients with heart failure. However, large-scale, long-term randomized trials are still required to confirm and quantify more precisely the benefit suggested by this overview.

Total elbow arthroplasty for primary osteoarthritis.

PubMed

Schoch, Bradley S; Werthel, Jean-David; Sánchez-Sotelo, Joaquín; Morrey, Bernard F; Morrey, Mark

2017-08-01

Primary osteoarthritis of the elbow is a less common indication for total elbow arthroplasty (TEA). Higher complication rates in younger, active patients may offset short-term improvements in pain and function. The purpose of this study was to determine pain relief, functional outcomes, complications, and survival of TEA in this population. Between 1984 and 2011, 20 consecutive TEAs were performed for primary elbow osteoarthritis. Two patients died before the 2-year follow-up. Mean age at surgery was 68 years (range, 51-85 years). Outcome measures included pain, motion, Mayo Elbow Performance Score, satisfaction, complications, and reoperations. Mean follow-up was 8.9 years (range, 2-20 years). Three elbows sustained mechanical failures. Complications included intraoperative fracture (n = 2), wound irrigation and débridement (n = 1), bony ankylosis (n = 1), humeral loosening (n = 1), humeral component fracture (n = 1), and mechanical failure of a radial head component (n = 1). Fifteen elbows without mechanical failure were examined clinically. Pain improved from 3.6 to 1.5 (P < .001). Range of motion remained clinically unchanged (P > .05), with preoperative flexion contractures not improving. Mayo Elbow Performance Scores were available for 13 elbows without mechanical failure, averaging 81.5 points (range, 60-100 points); these were graded as excellent (n = 5), good (n = 2), and fair (n = 6). Subjectively, all patients without mechanical failure were satisfied. TEA represents a reliable surgical option for pain relief in patients with primary osteoarthritis. However, restoration of extension is not always obtained, indicating that more aggressive soft tissue releases or bony resection should be considered. Complications occurred in a large number of elbows, but mechanical failure was low considering the nature of this population and the length of follow-up. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Application of failure mode and effect analysis in managing catheter-related blood stream infection in intensive care unit.

PubMed

Li, Xixi; He, Mei; Wang, Haiyan

2017-12-01

In this study, failure mode and effect analysis (FMEA), a proactive tool, was applied to reduce errors associated with the process which begins with assessment of patient and ends with treatment of complications. The aim of this study is to assess whether FMEA implementation will significantly reduce the incidence of catheter-related bloodstream infections (CRBSIs) in intensive care unit.The FMEA team was constructed. A team of 15 medical staff from different departments were recruited and trained. Their main responsibility was to analyze and score all possible processes of central venous catheterization failures. Failure modes with risk priority number (RPN) ≥100 (top 10 RPN scores) were deemed as high-priority-risks, meaning that they needed immediate corrective action. After modifications were put, the resulting RPN was compared with the previous one. A centralized nursing care system was designed.A total of 25 failure modes were identified. High-priority risks were "Unqualified medical device sterilization" (RPN, 337), "leukopenia, very low immunity" (RPN, 222), and "Poor hand hygiene Basic diseases" (RPN, 160). The corrective measures that we took allowed a decrease in the RPNs, especially for the high-priority risks. The maximum reduction was approximately 80%, as observed for the failure mode "Not creating the maximal barrier for patient." The averaged incidence of CRBSIs was reduced from 5.19% to 1.45%, with 3 months of 0 infection rate.The FMEA can effectively reduce incidence of CRBSIs, improve the security of central venous catheterization technology, decrease overall medical expenses, and improve nursing quality. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

Heart failure and atrial fibrillation: current concepts and controversies.

PubMed Central

Van den Berg, M. P.; Tuinenburg, A. E.; Crijns, H. J.; Van Gelder, I. C.; Gosselink, A. T.; Lie, K. I.

1997-01-01

Heart failure and atrial fibrillation are very common, particularly in the elderly. Owing to common risk factors both disorders are often present in the same patient. In addition, there is increasing evidence of a complex, reciprocal relation between heart failure and atrial fibrillation. Thus heart failure may cause atrial fibrillation, with electromechanical feedback and neurohumoral activation playing an important mediating role. In addition, atrial fibrillation may promote heart failure; in particular, when there is an uncontrolled ventricular rate, tachycardiomyopathy may develop and thereby heart failure. Eventually, a vicious circle between heart failure and atrial fibrillation may form, in which neurohumoral activation and subtle derangement of rate control are involved. Treatment should aim at unloading of the heart, adequate control of ventricular rate, and correction of neurohumoral activation. Angiotensin converting enzyme inhibitors may help to achieve these goals. Treatment should also include an attempt to restore sinus rhythm through electrical cardioversion, though appropriate timing of cardioversion is difficult. His bundle ablation may be used to achieve adequate rate control in drug refractory cases. PMID:9155607

Early Comparative Outcomes of Carbon Fiber Reinforced Polymer Plate in the Fixation of Distal Femur Fractures.

PubMed

Mitchell, Phillip M; Lee, Adam K; Collinge, Cory A; Ziran, Bruce H; Hartley, Kate G; Jahangir, A Alex

2018-05-16

To evaluate the early clinical results of distal femur fractures treated with carbon fiber reinforced - polyetheretherketone (CFR-PEEK) plates compared to stainless steel (SS) lateral locking plates. Retrospective comparative cohort study SETTING:: ACS Level I trauma center. Twenty-two patients (11 SS, 11 CFR-PEEK) with closed distal femur fractures treated by a single surgeon over a 6-year period. Nonunion, hardware failure, reoperation, time to full weight bearing, and time ` union were assessed. The CFR-PEEK cohort was on average older (71 vs. 57 years, p=0.03) and more likely to have diabetes (p=0.02). Nonunion was diagnosed in 4/11 (36%) patients in the SS group and 1/11 (9%) patients in the CFR-PEEK group (p=0.12). Hardware failure occurred in two SS patients (18%) compared to none in the CFR-PEEK group (p=0.14). Time to full weight bearing was similar between groups occurring at 9.9 weeks and 12.4 weeks in the CFR-PEEK and SS groups, respectively (p=0.23). Time to radiographic union averaged 12.4 weeks in the SS group and 18.7 weeks in the CFR-PEEK group (p=0.26). There were 4 reoperations in the SS group and one in the CFR-PEEK group (p=0.12). CFR-PEEK plates show encouraging short-term results in the treatment of distal femur fractures with a comparable nonunion, reoperation, and hardware failure rates to those treated with SS plates. This data suggests CFR-PEEK plates may be a viable alternative to SS plates in fixation of these fractures. Level III.

Cardiovascular Disease and Patterns of Change in Functional Status Over 15 Years: Findings From the Atherosclerosis Risk in Communities (ARIC) Study.

PubMed

Kucharska-Newton, Anna; Griswold, Michael; Yao, Zhihao Howard; Foraker, Randi; Rose, Kathryn; Rosamond, Wayne; Wagenknecht, Lynne; Koton, Silvia; Pompeii, Lisa; Windham, B Gwen

2017-03-01

Cardiovascular disease (CVD) is the leading cause of premature disability, yet few prospective studies have examined functional status (FS) among persons with CVD. Our aim was to examine patterns of change in FS prior to and after hospitalization for nonfatal myocardial infarction, stroke, and heart failure among members of the Atherosclerosis Risk in Communities (ARIC) study cohort. FS was assessed using a modified Rosow-Breslau questionnaire administered during routine annual telephone interviews conducted from 1993 through 2007 among 15 277 ARIC study participants. An FS score was constructed as a summary measure of responses to questions about participants' ability to perform selected tasks of daily living (eg, walking half a mile, climbing stairs). Incidence of CVD was assessed through ARIC surveillance of hospitalized events. Rate of change in FS over time prior to and following a CVD event was examined using generalized estimating equations. A decline in FS was observed on average 2 years prior to a myocardial infarction hospitalization and on average 3 years prior to a stroke or heart failure hospitalization. FS post-myocardial infarction declined relative to pre-event levels but improved to close to pre-myocardial infarction levels within 3 years. Decline in FS following incident heart failure and stroke remained over time. Observed patterns of change in FS did not differ appreciably by race or sex. This study documents that a decline in FS precedes incidence of CVD-related hospitalization by at least 2 years, providing a strong argument for routine preventative assessment of FS among older adults. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Slow, fast, and post-collapse displacements of the Mud Creek landslide in California from UAVSAR and satellite SAR analysis

NASA Astrophysics Data System (ADS)

Fielding, E. J.; Handwerger, A. L.; Burgmann, R.; Liu, Z.

2017-12-01

Landslides display a wide variety of behaviors ranging from slow steady or seasonal motion to runaway acceleration and catastrophic failure. In some cases, a single landslide moves slowly for a period of weeks to years before it rapidly accelerates into a catastrophic failure. Measurement of the spatio-temporal patterns of landslide motion in response to changes in environmental parameters such as rainfall, snowmelt, and nearby earthquakes will help us to constrain the mechanisms that control these landslide behaviors. Here, we use synthetic aperture radar interferometry (InSAR) from satellite and airborne platforms to measure the kinematics of several landslides along the coast of Central California, including the large Mud Creek landslide near Big Sur that catastrophically collapsed in May 2017 and led to the destruction of a major highway and millions of dollars in damages. We use InSAR and pixel offset data from NASA/JPL UAVSAR, JAXA ALOS1/2, and Copernicus Sentinel 1A/B to quantify the displacement time series and 3D motion. Our data show that the Mud Creek landslide has been active for at least 2.5 years and displayed persistent motion (average rate of 10 cm/yr in LOS) with seasonal variations in velocity driven by rainfall-induced changes in pore pressure. We find that each year the landslide accelerated approximately 60-90 days after the onset of seasonal precipitation, which provides constraints on the hillslope hydrology. Before its ultimate collapse, the landslide displayed a large increase in velocity due to the above average rainfall during the 2017 water year. It appears a series of major storms in January and February 2017, some fed by atmospheric rivers, triggered a sufficient increase in pore-water pressure that led to the runaway failure. We model this behavior using a rate-and-state friction model developed to capture this range of landslide behaviors. This model will allow us to explore how different landslide properties (e.g., material properties, geometry, stress changes) can control the behavior of these types of landslides. We observe additional motion of the landslide deposits after the catastrophic collapse.

Some Aspects of the Failure Mechanisms in BaTiO3-Based Multilayer Ceramic Capacitors

NASA Technical Reports Server (NTRS)

Liu, David Donhang; Sampson, Michael J.

2012-01-01

The objective of this presentation is to gain insight into possible failure mechanisms in BaTiO3-based ceramic capacitors that may be associated with the reliability degradation that accompanies a reduction in dielectric thickness, as reported by Intel Corporation in 2010. The volumetric efficiency (microF/cm3) of a multilayer ceramic capacitor (MLCC) has been shown to not increase limitlessly due to the grain size effect on the dielectric constant of ferroelectric ceramic BaTiO3 material. The reliability of an MLCC has been discussed with respect to its structure. The MLCCs with higher numbers of dielectric layers will pose more challenges for the reliability of dielectric material, which is the case for most base-metal-electrode (BME) capacitors. A number of MLCCs manufactured using both precious-metal-electrode (PME) and BME technology, with 25 V rating and various chip sizes and capacitances, were tested at accelerated stress levels. Most of these MLCCs had a failure behavior with two mixed failure modes: the well-known rapid dielectric wearout, and so-called 'early failures." The two failure modes can be distinguished when the testing data were presented and normalized at use-level using a 2-parameter Weibull plot. The early failures had a slope parameter of Beta >1, indicating that the early failures are not infant mortalities. Early failures are triggered due to external electrical overstress and become dominant as dielectric layer thickness decreases, accompanied by a dramatic reduction in reliability. This indicates that early failures are the main cause of the reliability degradation in MLCCs as dielectric layer thickness decreases. All of the early failures are characterized by an avalanche-like breakdown leakage current. The failures have been attributed to the extrinsic minor construction defects introduced during fabrication of the capacitors. A reliability model including dielectric thickness and extrinsic defect feature size is proposed in this presentation. The model can be used to explain the Intel-reported reliability degradation in MLCCs with respect to the reduction of dielectric thickness. It can also be used to estimate the reliability of a MLCC based on its construction and microstructure parameters such as dielectric thickness, average grain size, and number of dielectric layers. Measures for preventing early failures are also discussed in this document.

Monitoring nocturnal heart rate with bed sensor.

PubMed

Migliorini, M; Kortelainen, J M; Pärkkä, J; Tenhunen, M; Himanen, S L; Bianchi, A M

2014-01-01

This article is part of the Focus Theme of Methods of Information in Medicine on "Biosignal Interpretation: Advanced Methods for Studying Cardiovascular and Respiratory Systems". The aim of this study is to assess the reliability of the estimated Nocturnal Heart Rate (HR), recorded through a bed sensor, compared with the one obtained from standard electrocardiography (ECG). Twenty-eight sleep deprived patients were recorded for one night each through matrix of piezoelectric sensors, integrated into the mattress, through polysomnography (PSG) simultaneously. The two recording methods have been compared in terms of signal quality and differences in heart beat detection. On average, coverage of 92.7% of the total sleep time was obtained for the bed sensor, testifying the good quality of the recordings. The average beat-to-beat error of the inter-beat intervals was 1.06%. These results suggest a good overall signal quality, however, considering fast heart rates (HR > 100 bpm), performances were worse: in fact, the sensitivity in the heart beat detection was 28.4% while the false positive rate was 3.8% which means that a large amount of fast beats were not detected. The accuracy of the measurements made using the bed sensor has less than 10% of failure rate especially in periods with HR lower than 70 bpm. For fast heart beats the uncertainty increases. This can be explained by the change in morphology of the bed sensor signal in correspondence of a higher HR.

Partial laryngectomy as salvage surgery after radiotherapy: oncological and functional outcomes and impact on quality of life. A retrospective study of 20 cases.

PubMed

Philippe, Y; Espitalier, F; Durand, N; Ferron, C; Bardet, E; Malard, O

2014-02-01

The gold standard for the management of laryngeal squamous cell carcinoma in a previously irradiated patient is "salvage" total laryngectomy, but surgical management by partial laryngectomy can sometimes be proposed in selected patients. This study was designed to review the functional and oncological outcomes of patients treated by open partial laryngectomy for recurrent squamous cell carcinoma after failure of radiotherapy or involving previously irradiated tissues and to define prognostic criteria for the selection of patients eligible for this treatment strategy. In this retrospective study, 20 patients underwent partial laryngectomy between 2000 and 2011 for recurrence or second primary stage I or II laryngeal squamous cell carcinoma in an irradiated territory (11 vertical partial laryngectomies; 9 horizontal partial laryngectomies). The 3-year overall survival rate in patients with negative resection margins was 66%, with higher survival rates for tumours confined to the glottis, and the 2-year local control rate was 67%. Positive resection margins requiring total laryngectomy were observed in 20% of cases. The 3-year overall survival rate was 56% in these patients. Exclusive oral feeding was restored in 75% of patients after an average of 32 days. The tracheotomy tube was removed after an average of 18 days in 90% of patients. The disease-free functional larynx preservation rate was 45%. Salvage partial laryngectomy in irradiated tissues is an alternative treatment option to total laryngectomy in selected patients. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Medical management of early pregnancy failure (EPF): a retrospective analysis of a combined protocol of mifepristone and misoprostol used in clinical practice.

PubMed

Colleselli, Valeria; Schreiber, Courtney A; D'Costa, Elisabeth; Mangesius, Stephanie; Wildt, Ludwig; Seeber, Beata E

2014-06-01

To evaluate the efficacy of a combined protocol of mifepristone and misoprostol in the management of early pregnancy failure (EPF) and the average time to expulsion of tissue and rate of side effects. Retrospective chart review of all consecutive women treated with primary medical management for EPF at our institution from 2006 to 2012. 168 patients were included in the present study. The overall success rate, defined as the absence of the need for surgical intervention, was 61 % and did not differ by calendar year. There was no difference in success rate grouped by diagnosis [intrauterine embryonic/fetal demise (IUED/IUFD) vs. anembryonic gestation; p = 0.30] or gestational age (<9 or ≥9 weeks; p = 0.48). The success rate varied significantly according to the required dose of misoprostol, ≤800 or >800 μg (68 vs. 50 %, p = 0.029). Of the possible predictive factors of success, only the dose of misoprostol required was a significant independent negative predictor. Mean and median time to tissue expulsion after the first dose of misoprostol were 8.4 and 5.5 h, respectively. The incidence of side effects was low with no blood transfusions required. The success rate in this study is markedly below published data. This can possibly be attributed to retrospective study design, allowing for physician subjectivity and patients' wishes in the absence of strict study requirements. The protocol was well tolerated with a paucity of side effects. We make suggestions for enhancing success rates in the clinical setting by optimizing medication protocols, establishing precise treatment guidelines and training physicians in the accurate interpretation of treatment outcomes.

Mortality trends among Japanese dialysis patients, 1988-2013: a joinpoint regression analysis.

PubMed

Wakasugi, Minako; Kazama, Junichiro James; Narita, Ichiei

2016-09-01

Evaluation of mortality trends in dialysis patients is important for improving their prognoses. The present study aimed to examine temporal trends in deaths (all-cause, cardiovascular, noncardiovascular and the five leading causes) among Japanese dialysis patients. Mortality data were extracted from the Japanese Society of Dialysis Therapy registry. Age-standardized mortality rates were calculated by direct standardization against the 2013 dialysis population. The average annual percentage of change (APC) and the corresponding 95% confidence interval (CI) were computed for trends using joinpoint regression analysis. A total of 469 324 deaths occurred, of which 25.9% were from cardiac failure, 17.5% from infectious disease, 10.2% from cerebrovascular disorders, 8.6% from malignant tumors and 5.6% from cardiac infarction. The joinpoint trend for all-cause mortality decreased significantly, by -3.7% (95% CI -4.2 to -3.2) per year from 1988 through 2000, then decreased more gradually, by -1.4% (95% CI -1.7 to -1.2) per year during 2000-13. The improved mortality rates were mainly due to decreased deaths from cardiovascular disease, with mortality rates due to noncardiovascular disease outnumbering those of cardiovascular disease in the last decade. Among the top five causes of death, cardiac failure has shown a marked decrease in mortality rate. However, the rates due to infectious disease have remained stable during the study period [APC 0.1 (95% CI -0.2-0.3)]. Significant progress has been made, particularly with regard to the decrease in age-standardized mortality rates. The risk of cardiovascular death has decreased, while the risk of death from infection has remained unchanged for 25 years. © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

The Impact of Osseous Malalignment and Realignment Procedures in Knee Ligament Surgery: A Systematic Review of the Clinical Evidence.

PubMed

Tischer, Thomas; Paul, Jochen; Pape, Dietrich; Hirschmann, Michael T; Imhoff, Andreas B; Hinterwimmer, Stefan; Feucht, Matthias J

2017-03-01

Failure rates of knee ligament surgery may be high, and the impact of osseous alignment on surgical outcome remains controversial. Basic science studies have demonstrated that osseous malalignment can negatively affect ligament strain and that realignment procedures may improve knee joint stability. The purpose of this review was to summarize the clinical evidence concerning the impact of osseous malalignment and realignment procedures in knee ligament surgery. The hypotheses were that lower extremity malalignment would be an important contributor to knee ligament surgery failure and that realignment surgery would contribute to increased knee stability and improved outcome in select cases. Systematic review; Level of evidence, 4. According to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic electronic search of the PubMed database was performed in November 2015 to identify clinical studies investigating (A) the influence of osseous alignment on postoperative stability and/or failure rates after knee ligament surgery and (B) the impact of osseous realignment procedures in unstable knees with or without additional knee ligament surgery on postoperative knee function and stability. Methodological quality of the studies was assessed using the Oxford Centre for Evidence-Based Medicine Levels of Evidence and the Coleman Methodological Score (CMS). Of the 1466 potentially relevant articles, 28 studies fulfilled the inclusion and exclusion criteria. Average study quality was poor (CMS, 40). For part A, studies showed increased rerupture rate after anterior cruciate ligament (ACL) replacement in patients with increased tibial slope. Concerning the posterior cruciate ligament (PCL)/posterolateral corner (PLC)/lateral collateral ligament (LCL), varus malalignment was considered a significant risk factor for failure. For part B, studies showed decreased anterior tibial translation after slope-decreasing high tibial osteotomy in ACL-deficient knees. Correcting varus malalignment in PCL/PLC/LCL instability also showed increased stability and better outcomes. In cases of complex knee instability, the 3-dimensional osseous alignment of the knee should be considered (eg, mechanical weightbearing line and tibial slope). In cases of failed ACL reconstruction, the tibial slope should be considered, and slope-reducing osteotomies are often helpful in the patient revised multiple times. In cases of chronic PCL and/or PLC instability, osseous correction of the varus alignment may reduce the failure rate and is often the first step in treatment. Changes in the mechanical axis should be considered in all cases of instability accompanied by early unicompartmental osteoarthritis.

The Impact of Osseous Malalignment and Realignment Procedures in Knee Ligament Surgery: A Systematic Review of the Clinical Evidence

PubMed Central

Tischer, Thomas; Paul, Jochen; Pape, Dietrich; Hirschmann, Michael T.; Imhoff, Andreas B.; Hinterwimmer, Stefan; Feucht, Matthias J.

2017-01-01

Background: Failure rates of knee ligament surgery may be high, and the impact of osseous alignment on surgical outcome remains controversial. Basic science studies have demonstrated that osseous malalignment can negatively affect ligament strain and that realignment procedures may improve knee joint stability. Hypothesis/Purpose: The purpose of this review was to summarize the clinical evidence concerning the impact of osseous malalignment and realignment procedures in knee ligament surgery. The hypotheses were that lower extremity malalignment would be an important contributor to knee ligament surgery failure and that realignment surgery would contribute to increased knee stability and improved outcome in select cases. Study Design: Systematic review; Level of evidence, 4. Methods: According to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic electronic search of the PubMed database was performed in November 2015 to identify clinical studies investigating (A) the influence of osseous alignment on postoperative stability and/or failure rates after knee ligament surgery and (B) the impact of osseous realignment procedures in unstable knees with or without additional knee ligament surgery on postoperative knee function and stability. Methodological quality of the studies was assessed using the Oxford Centre for Evidence-Based Medicine Levels of Evidence and the Coleman Methodological Score (CMS). Results: Of the 1466 potentially relevant articles, 28 studies fulfilled the inclusion and exclusion criteria. Average study quality was poor (CMS, 40). For part A, studies showed increased rerupture rate after anterior cruciate ligament (ACL) replacement in patients with increased tibial slope. Concerning the posterior cruciate ligament (PCL)/posterolateral corner (PLC)/lateral collateral ligament (LCL), varus malalignment was considered a significant risk factor for failure. For part B, studies showed decreased anterior tibial translation after slope-decreasing high tibial osteotomy in ACL-deficient knees. Correcting varus malalignment in PCL/PLC/LCL instability also showed increased stability and better outcomes. Conclusion: In cases of complex knee instability, the 3-dimensional osseous alignment of the knee should be considered (eg, mechanical weightbearing line and tibial slope). In cases of failed ACL reconstruction, the tibial slope should be considered, and slope-reducing osteotomies are often helpful in the patient revised multiple times. In cases of chronic PCL and/or PLC instability, osseous correction of the varus alignment may reduce the failure rate and is often the first step in treatment. Changes in the mechanical axis should be considered in all cases of instability accompanied by early unicompartmental osteoarthritis. PMID:28451605

Designing for Productive Failure

ERIC Educational Resources Information Center

Kapur, Manu; Bielaczyc, Katerine

2012-01-01

In this article, we describe the design principles undergirding "productive failure" (PF; M. Kapur, 2008). We then report findings from an ongoing program of research on PF in mathematical problem solving in 3 Singapore public schools with significantly different mathematical ability profiles, ranging from average to lower ability. In…

Model analysis of the link between interest rates and crashes

NASA Astrophysics Data System (ADS)

Broga, Kristijonas M.; Viegas, Eduardo; Jensen, Henrik Jeldtoft

2016-09-01

We analyse the effect of distinct levels of interest rates on the stability of the financial network under our modelling framework. We demonstrate that banking failures are likely to emerge early on under sustained high interest rates, and at much later stage-with higher probability-under a sustained low interest rate scenario. Moreover, we demonstrate that those bank failures are of a different nature: high interest rates tend to result in significantly more bankruptcies associated to credit losses whereas lack of liquidity tends to be the primary cause of failures under lower rates.

The influence of mandibular skeletal characteristics on inferior alveolar nerve block anesthesia.

PubMed

You, Tae Min; Kim, Kee-Deog; Huh, Jisun; Woo, Eun-Jung; Park, Wonse

2015-09-01

The inferior alveolar nerve block (IANB) is the most common anesthetic techniques in dentistry; however, its success rate is low. The purpose of this study was to determine the correlation between IANB failure and mandibular skeletal characteristics. In total, 693 cases of lower third molar extraction (n = 575 patients) were examined in this study. The ratio of the condylar and coronoid distances from the mandibular foramen (condyle-coronoid ratio [CC ratio]) was calculated, and the mandibular skeleton was then classified as normal, retrognathic, or prognathic. The correlation between IANB failure and sex, treatment side, and the CC ratio was assessed. The IANB failure rates for normal, retrognathic, and prognathic mandibles were 7.3%, 14.5%, and 9.5%, respectively, and the failure rate was highest among those with a CC ratio < 0.8 (severe retrognathic mandible). The failure rate was significantly higher in the retrognathic group than in normal group (P = 0.019), and there was no statistically significant difference between the other two groups. IANB failure could be attributable, in part, to the skeletal characteristics of the mandible. In addition, the failure rate was found to be significantly higher in the retrognathic group.

The influence of mandibular skeletal characteristics on inferior alveolar nerve block anesthesia

PubMed Central

You, Tae Min; Kim, Kee-Deog; Huh, Jisun; Woo, Eun-Jung

2015-01-01

Background The inferior alveolar nerve block (IANB) is the most common anesthetic techniques in dentistry; however, its success rate is low. The purpose of this study was to determine the correlation between IANB failure and mandibular skeletal characteristics Methods In total, 693 cases of lower third molar extraction (n = 575 patients) were examined in this study. The ratio of the condylar and coronoid distances from the mandibular foramen (condyle-coronoid ratio [CC ratio]) was calculated, and the mandibular skeleton was then classified as normal, retrognathic, or prognathic. The correlation between IANB failure and sex, treatment side, and the CC ratio was assessed. Results The IANB failure rates for normal, retrognathic, and prognathic mandibles were 7.3%, 14.5%, and 9.5%, respectively, and the failure rate was highest among those with a CC ratio < 0.8 (severe retrognathic mandible). The failure rate was significantly higher in the retrognathic group than in normal group (P = 0.019), and there was no statistically significant difference between the other two groups. Conclusions IANB failure could be attributable, in part, to the skeletal characteristics of the mandible. In addition, the failure rate was found to be significantly higher in the retrognathic group. PMID:28879267

Long-Term Hearing Results After Ossiculoplasty.

PubMed

Cox, Matthew D; Trinidade, Aaron; Russell, James Shep; Dornhoffer, John L

2017-04-01

To determine if the OOPS index is predictive of long-term hearing results after ossiculoplasty. Case series with retrospective chart review. Tertiary care otology practice. Adult and pediatric patients (3-88 years of age). Ossiculoplasty with cartilage tympanoplasty, with or without mastoidectomy. Primary outcome measures included short-term hearing results (pure-tone average air-bone gap [PTA-ABG] measured between 60 days and 1 year after surgery), long-term hearing results (PTA-ABG measured ≥5 years after surgery), and the rate of successful ABG closure to ≤20 dB. Secondary measures included the need for revision surgery, delayed tympanic membrane graft failure, worsening conductive hearing loss (after an initially satisfactory hearing result), and recurrence of cholesteatoma. There was no significant difference between adults and children for short-term hearing results (average post-op PTA-ABG was 18.9 dB vs. 19.8 dB, respectively; p = 0.544), long-term hearing results (average final PTA-ABG was 19.3 dB vs. 19.4 dB, respectively; p = 0.922), or rate of ABG closure to less than 20 dB (63.1% vs. 58.0%, p = 0.282). Spearman's rank-order correlation (ρ) identified a strong positive correlation between OOPS index score and average post-operative PTA-ABG (ρ = 0.983; p < 0.001; 2-tailed), as well as average long-term PTA-ABG (ρ = 0.950, p < 0.001; 2-tailed). The OOPS index makes it possible to accurately prognosticate hearing outcomes in adult and pediatric patients undergoing ossiculoplasty in both the short term and the long term.

A quantitative model of honey bee colony population dynamics.

PubMed

Khoury, David S; Myerscough, Mary R; Barron, Andrew B

2011-04-18

Since 2006 the rate of honey bee colony failure has increased significantly. As an aid to testing hypotheses for the causes of colony failure we have developed a compartment model of honey bee colony population dynamics to explore the impact of different death rates of forager bees on colony growth and development. The model predicts a critical threshold forager death rate beneath which colonies regulate a stable population size. If death rates are sustained higher than this threshold rapid population decline is predicted and colony failure is inevitable. The model also predicts that high forager death rates draw hive bees into the foraging population at much younger ages than normal, which acts to accelerate colony failure. The model suggests that colony failure can be understood in terms of observed principles of honey bee population dynamics, and provides a theoretical framework for experimental investigation of the problem.

Some limitations of frequency as a component of risk: an expository note.

PubMed

Cox, Louis Anthony

2009-02-01

Students of risk analysis are often taught that "risk is frequency times consequence" or, more generally, that risk is determined by the frequency and severity of adverse consequences. But is it? This expository note reviews the concepts of frequency as average annual occurrence rate and as the reciprocal of mean time to failure (MTTF) or mean time between failures (MTBF) in a renewal process. It points out that if two risks (represented as two (frequency, severity) pairs for adverse consequences) have identical values for severity but different values of frequency, then it is not necessarily true that the one with the smaller value of frequency is preferable-and this is true no matter how frequency is defined. In general, there is not necessarily an increasing relation between the reciprocal of the mean time until an event occurs, its long-run average occurrences per year, and other criteria, such as the probability or expected number of times that it will happen over a specific interval of interest, such as the design life of a system. Risk depends on more than frequency and severity of consequences. It also depends on other information about the probability distribution for the time of a risk event that can become lost in simple measures of event "frequency." More flexible descriptions of risky processes, such as point process models can avoid these limitations.

The Use of a Multiplanar, Multi-Axis External Fixator to Achieve Knee Arthrodesis in a Worst Case Scenario: A Case Series

PubMed Central

Raskolnikov, Dima; Slover, James D.; Egol, Kenneth A.

2013-01-01

Background One of the most catastrophic outcomes following total knee arthroplasty (TKA) is a chronic periprosthetic infection with concomitant failure of the knee extensor mechanism. This study retrospectively reviewed the clinical records of 7 patients who were treated with a 6 axis circular external fixation frame (Taylor Spatial Frame (TSF)) for this condition. Fusion was achieved in 5 of 7 patients (71%) at an average of 8.4 months after surgery. Complications occurred in the treatment of 5 of 7 patients (71%). Infection was controlled in all cases. The TSF presents another valuable tool, which the orthopaedic surgeon should consider when treating these difficult cases. Purpose To evaluate the use of the Taylor Spatial Frame (TSF) to achieve knee arthrodesis in patients with chronically infected total knee arthroplasties (TKAs) with concomitant failure of the knee extensor mechanism. Methods We retrospectively evaluated the clinical records of 7 patients who were referred to our tertiary care orthopaedic medical center with multiple failed knee arthroplasties, chronic draining infection and complete loss of the extensor mechanism. All patients were treated with a similar protocol including, debridement and bony stabilization with an adjustable, 6 axis circular external fixation frame (TSF). Hospital charts were reviewed for sociodemographic information, surgical details, hospital course and complications. Radiographs were reviewed for healing and alignment. Follow up included clinical examination and radiographs. Results The mean age of the patients was 70.9 years (range, 59 – 83 years) at the time of application of the TSF. There were 3 men and 4 women. The average time between TKA and diagnosis of infection was 30.7 months (range, 2.6 – 67.0 months). The 7 patients had undergone an average of 3.3 prior surgical procedures (range, 2-4 procedures) on the ipsilateral extremity. Fusion was achieved in 5 of 7 patients (71%) at an average of 8.4 months after surgery (range, 6 – 10.5 months). Complications occurred in the treatment of 5 of 7 patients (71%) and included infection at the site of the pin tracks (5 patients), antibiotic- induced acute renal failure (1 patient), wound breakdown requiring flap closure (1 patient), and femur fracture secondary to a fall after placement of the antibiotic spacer but before application of the TSF (1 patient). The 2 patients in whom failure of fusion occurred returned to ambulation with an assistive device. Infection was controlled in all cases. Conclusion Fusion and complication rates in this cohort are comparable to those reported in previous studies using other techniques to achieve external fixation. The TSF is a versatile external fixator that offers another tool, which the orthopaedic surgeon should consider when treating these difficult cases. PMID:24027456

Risk factors for eye bank preparation failure of Descemet membrane endothelial keratoplasty tissue.

PubMed

Vianna, Lucas M M; Stoeger, Christopher G; Galloway, Joshua D; Terry, Mark; Cope, Leslie; Belfort, Rubens; Jun, Albert S

2015-05-01

To assess the results of a single eye bank preparing a high volume of Descemet membrane endothelial keratoplasty (DMEK) tissues using multiple technicians to provide an overview of the experience and to identify possible risk factors for DMEK preparation failure. Cross-sectional study. setting: Lions VisionGift and Wilmer Eye Institute at Johns Hopkins Hospital. All 563 corneal tissues processed by technicians at Lions VisionGift for DMEK between October 2011 and May 2014 inclusive. Tissues were divided into 2 groups: DMEK preparation success and DMEK preparation failure. We compared donor characteristics, including past medical history. The overall tissue preparation failure rate was 5.2%. Univariate analysis showed diabetes mellitus (P = .000028) and its duration (P = .023), hypertension (P = .021), and hyperlipidemia or obesity (P = .0004) were more common in the failure group. Multivariate analysis showed diabetes mellitus (P = .0001) and hyperlipidemia or obesity (P = .0142) were more common in the failure group. Elimination of tissues from donors either with diabetes or with hyperlipidemia or obesity reduced the failure rate from 5.2% to 2.2%. Trends toward lower failure rates occurring with increased technician experience also were found. Our work showed that tissues from donors with diabetes mellitus (especially with longer disease duration) and hyperlipidemia or obesity were associated with higher failure rates in DMEK preparation. Elimination of tissues from donors either with diabetes mellitus or with hyperlipidemia or obesity reduced the failure rate. In addition, our data may provide useful initial guidelines and benchmark values for eye banks seeking to establish and maintain DMEK programs. Copyright © 2015 Elsevier Inc. All rights reserved.

Left ventricular fluid kinetic energy time curves in heart failure from cardiovascular magnetic resonance 4D flow data.

PubMed

Kanski, Mikael; Arvidsson, Per M; Töger, Johannes; Borgquist, Rasmus; Heiberg, Einar; Carlsson, Marcus; Arheden, Håkan

2015-12-20

Measurement of intracardiac kinetic energy (KE) provides new insights into cardiac hemodynamics and may improve assessment and understanding of heart failure. We therefore aimed to investigate left ventricular (LV) KE time curves in patients with heart failure and in controls. Patients with heart failure (n = 29, NYHA class I-IV) and controls (n = 12) underwent cardiovascular magnetic resonance (CMR) including 4D flow. The vortex-ring boundary was computed using Lagrangian coherent structures. The LV endocardium and vortex-ring were manually delineated and KE was calculated as ½mv(2) of the blood within the whole LV and the vortex ring, respectively. The systolic average KE was higher in patients compared to controls (2.2 ± 1.4 mJ vs 1.6 ± 0.6 mJ, p = 0.048), but lower when indexing to EDV (6.3 ± 2.2 μJ/ml vs 8.0 ± 2.1 μJ/ml, p = 0.025). No difference was seen in diastolic average KE (3.2 ± 2.3 mJ vs 2.0 ± 0.8 mJ, p = 0.13) even when indexing to EDV (9.0 ± 4.4 μJ/ml vs 10.2 ± 3.3 μJ/ml, p = 0.41). In patients, a smaller fraction of diastolic average KE was observed inside the vortex ring compared to controls (72 ± 6% vs 54 ± 9%, p < 0.0001). Three distinctive KE time curves were seen in patients which were markedly different from findings in controls, and with a moderate agreement between KE time curve patterns and degree of diastolic dysfunction (Cohen's kappa = 0.49), but unrelated to NYHA classification (p = 0.12), or 6-minute walk test (p = 0.72). Patients with heart failure exhibit higher systolic average KE compared to controls, suggesting altered intracardiac blood flow. The different KE time curves seen in patients may represent a conceptually new approach for heart failure classification.

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…

Training of residents in laparoscopic tubal sterilization: Long-term failure rates

PubMed Central

Rackow, Beth W.; Rhee, Maria C.; Taylor, Hugh S.

2011-01-01

Objectives Laparoscopic tubal sterilization with bipolar coagulation is a common and effective method of contraception, and a procedure much used to teach laparoscopic surgical skills to Obstetrics and Gynaecology residents (trainees); but it has an inherent risk of failure. This study investigated the long-term failure rate of this procedure when performed by Obstetrics and Gynaecology residents on women treated in their teaching clinics. Methods From 1991 to 1994, Obstetrics and Gynaecology residents carried out 386 laparoscopic tubal sterilizations with bipolar coagulation at Yale-New Haven Hospital. Six to nine years after the procedure, the women concerned were contacted by telephone and data were collected about sterilization failure. Results Two failures of laparoscopic tubal sterilization with bipolar coagulation were identified: an ectopic pregnancy and a spontaneous abortion. For this time period, the long-term sterilization failure rate was 1.9% (0–4.4%). Conclusions The long-term sterilization failure rate for laparoscopic tubal sterilization with bipolar coagulation performed by residents is comparable to the results of prior studies. These findings can be used to properly counsel women at a teaching clinic about the risks of sterilization failure with this procedure, and attest to the adequacy of residents’ training and supervision. PMID:18465476

Dynamic injury tolerances for long bones of the female upper extremity

PubMed Central

DUMA, STEFAN M.; SCHREIBER, PHIL H.; McMASTER, JOHN D.; CRANDALL, JEFF R.; BASS, CAMERON R.; PILKEY, WALTER D.

1999-01-01

This paper presents the dynamic injury tolerances for the female humerus and forearm derived from dynamic 3-point bending tests using 22 female cadaver upper extremities. Twelve female humeri were tested at an average strain rate of 3.7±1.3%/s. The strain rates were chosen to be representative of those observed during upper extremity interaction with frontal and side airbags. The average moment to failure when mass scaled for the 5th centile female was 128±19 Nm. Using data from the in situ strain gauges during the drop tests and geometric properties obtained from pretest CT scans, an average dynamic elastic modulus for the female humerus was found to be 24.4±3.9 GPa. The injury tolerance for the forearm was determined from 10 female forearms tested at an average strain rate of 3.94±2.0%/s. Using 3 matched forearm pairs, it was determined that the forearm is 21% stronger in the supinated position (92±5 Nm) versus the pronated position (75±7 Nm). Two distinct fracture patterns were seen for the pronated and supinated groups. In the supinated position the average difference in fracture time between the radius and ulna was a negligible 0.4±0.3 ms. However, the pronated tests yielded an average difference in fracture time of 3.6±1.2 ms, with the ulna breaking before the radius in every test. This trend implies that in the pronated position, the ulna and radius are loaded independently, while in the supinated position the ulna and radius are loaded together as a combined structure. To produce a conservative injury criterion, a total of 7 female forearms were tested in the pronated position, which resulted in the forearm injury criterion of 58±12 Nm when scaled for the 5th centile female. It is anticipated that these data will provide injury reference values for the female forearm during driver air bag loading, and the female humerus during side air bag loading. PMID:10386782

Identifying Differences Between Biochemical Failure and Cure: Incidence Rates and Predictors

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

Vicini, Frank A., E-mail: fvicini@beaumont.edu; Shah, Chirag; Kestin, Larry

2011-11-15

Background: Patients treated with radiation therapy (RT) for prostate cancer were evaluated to estimate the length of time required to document biochemical cure (BC) after treatment and the variables associated with long-term treatment efficacy. Patients and Methods: 2,100 patients received RT alone for localized prostate carcinoma (external-beam RT, n = 1,504; brachytherapy alone, n = 241; or brachytherapy + pelvic radiation, n = 355). The median external-beam dose was 68.4 Gy, and the median follow-up time was 8.6 years. Biochemical failure (BF) was defined according to the Phoenix definition. Results: Biochemical failure was experienced by 685 patients (32.6%). The medianmore » times to BF for low-, intermediate-, and high-risk groups were 6.0, 5.6, and 4.5 years respectively (p < 0.001). The average annual incidence rates of BF for years 1-5, 5-10,11-15, and 16-20 in low-risk patients were 2.0%, 2.0%, 0.3%, and 0.06% (p < 0.001); for intermediate-risk patients, 4%, 3%, 0.3%, and 0% (p < 0.001); and for high-risk patients, 10.0%, 5.0%, 0.3%, and 0.3% (p < 0.001). After 5 years of treatment, 36.9% of all patients experienced BF. The percentage of total failures occurring during years 1-5, 5-10, 11-15, and 16-20 were 48.7%, 43.5%, 6.5%, and 1.3% for low-risk patients; 64.0%, 32.2%, 3.8%, and 0% for intermediate-risk patients; and 71.9%, 25.9%, 1.1%, and 1.1% for high-risk patients, respectively. Increasing time to nadir was associated with increased time to BF. On multivariate analysis, factors significantly associated with 10-year BC included prostate-specific antigen nadir and time to nadir. Conclusions: The incidence rates for BF did not plateau until later than 10 years after treatment, suggesting that extended follow-up time is required to monitor patients after treatment. Prostate-specific antigen nadir and time to nadir have the strongest association with long-term BC.« less

Comparing slow and fast rupture in laboratory experiments

NASA Astrophysics Data System (ADS)

Aben, F. M.; Brantut, N.; David, E.; Mitchell, T. M.

2017-12-01

During the brittle failure of rock, elastically stored energy is converted into a localized fracture plane and surrounding fracture damage, seismic radiation, and thermal energy. However, the partitioning of energy might vary with the rate of elastic energy release during failure. Here, we present the results of controlled (slow) and dynamic (fast) rupture experiments on dry Lanhélin granite and Westerly granite samples, performed under triaxial stress conditions at confining pressures of 50 and 100 MPa. During the tests, we measured sample shortening, axial load and local strains (with 2 pairs of strain gauges glued directly onto the sample). In addition, acoustic emissions (AEs) and changes in seismic velocities were monitored. The AE rate was used as an indicator to manually control the axial load on the sample to stabilize rupture in the quasi-static failure experiments. For the dynamic rupture experiments a constant strain rate of 10-5 s-1 was applied until sample failure. A third experiment, labeled semi-controlled rupture, involved controlled rupture up to a point where the rupture became unstable and the remaining elastic energy was released dynamically. All experiments were concluded after a macroscopic fracture had developed across the whole sample and frictional sliding commenced. Post-mortem samples were epoxied, cut and polished to reveal the macroscopic fracture and the surrounding damage zone. The samples failed with average rupture velocities varying from 5x10-6 m/s up to >> 0.1 m/s. The analyses of AE locations on the slow ruptures reveal that within Westerly granite samples - with a smaller grain size - fracture planes are disbanded in favor of other planes when a geometrical irregularity is encountered. For the coarser grained Lanhélin granite a single fracture plane is always formed, although irregularities are recognized as well. The semi-controlled experiments show that for both rock types the rupture can become unstable in response to these irregularities. In Westerly granite, slow rupture experiments tend to produce complex fracture patterns while during the dynamic rupture experiments secondary rupture planes are not formed. These findings show that grain or flaw size, flaw distribution, and rupture speed strongly influence fracture localization and propagation.

An analysis of the value of spermicides in contraception.

PubMed

1979-11-01

Development of the so-called modern methods of contraception has somewhat eclipsed interest in traditional methods. However, spermicides are still important for many couples and their use appears to be increasing. A brief history of the use of and research into spermicidal contraceptives is presented. The limitations of spermicides are: the necessity for use at the time of intercourse, and their high failure rate. Estimates of the failure rates of spermicides have ranged from .3 pregnancies per 100 woman-years of use to nearly 40, depending on the product used and the population tested. Just as their use depends on various social factors, so does their failure rate. Characteristics of the user deterine failure rates. Motivation is important in lowering failure rates as is education, the intracouple relationship, and previous experience with spermicides. Method failure is also caused by defects in the product, either in the active ingredient of the spermicide or in the base carrier. The main advantage of spermicidal contraception is its safety. Limited research is currently being conducted on spermicides. Areas for improvement in existing spermicides and areas for possible innovation are mentioned.

Influence of enamel preservation on failure rates of porcelain laminate veneers.

PubMed

Gurel, Galip; Sesma, Newton; Calamita, Marcelo A; Coachman, Christian; Morimoto, Susana

2013-01-01

The purpose of this study was to evaluate the failure rates of porcelain laminate veneers (PLVs) and the influence of clinical parameters on these rates in a retrospective survey of up to 12 years. Five hundred eighty laminate veneers were bonded in 66 patients. The following parameters were analyzed: type of preparation (depth and margin), crown lengthening, presence of restoration, diastema, crowding, discoloration, abrasion, and attrition. Survival was analyzed using the Kaplan-Meier method. Cox regression modeling was used to determine which factors would predict PLV failure. Forty-two veneers (7.2%) failed in 23 patients, and an overall cumulative survival rate of 86% was observed. A statistically significant association was noted between failure and the limits of the prepared tooth surface (margin and depth). The most frequent failure type was fracture (n = 20). The results revealed no significant influence of crown lengthening apically, presence of restoration, diastema, discoloration, abrasion, or attrition on failure rates. Multivariable analysis (Cox regression model) also showed that PLVs bonded to dentin and teeth with preparation margins in dentin were approximately 10 times more likely to fail than PLVs bonded to enamel. Moreover, coronal crown lengthening increased the risk of PLV failure by 2.3 times. A survival rate of 99% was observed for veneers with preparations confined to enamel and 94% for veneers with enamel only at the margins. Laminate veneers have high survival rates when bonded to enamel and provide a safe and predictable treatment option that preserves tooth structure.

Accelerated Fatigue Resistance of Thick CAD/CAM Composite Resin Overlays Bonded with Light- and Dual-polymerizing Luting Resins.

PubMed

Goldberg, Jack; Güth, Jan-Frederik; Magne, Pascal

To evaluate the accelerated fatigue resistance of thick CAD/CAM composite resin overlays luted with three different bonding methods. Forty-five sound human second mandibular molars were organized and distributed into three experimental groups. All teeth were restored with a 5-mm-thick CAD/CAM composite resin overlay. Group A: immediate dentin sealing (IDS) with Optibond FL and luted with light-polymerizing composite (Herculite XRV). Group B: IDS with Optibond FL and luted with dual-polymerizing composite (Nexus 3). Group C: direct luting with Optibond FL and dual-polymerizing composite (Nexus 3). Masticatory forces at a frequency of 5 Hz were simulated using closed-loop servo-hydraulics and forces starting with a load of 200 N for 5000 cycles, followed by steps of 400, 600, 800, 1000, 1200 and 1400 N for a maximum of 30,000 cycles. Each step was applied through a flat steel cylinder at a 45-degree angle under submerged conditions. The fatigue test generated one failure in group A, three failures in group B, and no failures in group C. The survival table analysis for the fatigue test did not demonstrate any significant difference between the groups (p = 0.154). The specimens that survived the fatigue test were set up for the load-to-failure test with a limit of 4600 N. The survival table analysis for the load-to-failure test demonstrates an average failure load of 3495.20 N with survival of four specimens in group A, an average failure load of 4103.60 N with survival of six specimens in group B, and an average failure load of 4075.33 N with survival of nine specimens in group C. Pairwise comparisons revealed no significant differences (p < 0.016 after Bonferroni correction). Within the limitations of this in vitro study, it can be concluded that although the dual-polymerizing luting material seems to provide better results under extreme conditions, light-polymerizing luting composites in combination with IDS are not contraindicated with thick restorations.

Complications of short versus long cephalomedullary nail for intertrochanteric femur fractures, minimum 1 year follow-up.

PubMed

Vaughn, Josh; Cohen, Eric; Vopat, Bryan G; Kane, Patrick; Abbood, Emily; Born, Christopher

2015-05-01

Hip fractures are becoming increasingly common resulting in significant morbidity, mortality and raising healthcare costs. Both short and long cephalomedullary devices are currently employed to treat intertrochanteric hip fractures. However, which device is optimal continues to be debated as each implant has unique characteristics and theoretical advantages. This study looked to identify rates of complications associated with both long and short cephalomedullary nails for the treatment of intertrochanteric hip fractures. We retrospectively reviewed charts from 2006 to 2011, and we identified 256 patients were identified with AO class 31.1-32.3 fractures. Sixty were treated with short nails and 196 with long nails. Radiographs and charts were then analysed for failures and hardware complications. Catastrophic failure and hardware complication rates were not statistically different between short or long cephalomedullary nails. The overall catastrophic failure rate was 3.1 %; there was a 5 % failure rate in the short-nail group compared with a 2.6 % failure rate in the long-nail group (p = 0.191). There was a 3.33 % secondary femur fracture rate in the short-nail group, compared with none in the long-nail cohort (p = 0.054). The rate of proximal fixation failure was 1.67 % for the short-nail group and 2.0 % in the long-nail group (p = 0.406). Our data suggests equivocal outcomes as measured by similar catastrophic failure rate between both short and long cephalomedullary nails for intertrochanteric femur fractures. However, there was an increased risk of secondary femur fracture with short cephalomedullary nails when compared to long nails that approached statistical significance.

The Advanced Glaucoma Intervention Study (AGIS): 9. Comparison of glaucoma outcomes in black and white patients within treatment groups.

PubMed

2001-09-01

To compare in eyes of black and white patients the progression of glaucoma after failure of medical therapy and upon start of surgical intervention. Cohort study analysis of data from a randomized clinical trial. This multicenter study included open-angle glaucoma patients who had failed medical therapy: 451 eyes of 332 black patients, 325 eyes of 249 white patients. Eyes were randomly assigned to an argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy (ATT) sequence or a trabeculectomy-ALT-trabeculectomy (TAT) sequence; they had been followed for 7 to 11 years at database closure. Main outcome measures were decrease of visual field (DVF), sustained decrease of visual field (SDVF), decrease of visual acuity (DVA), sustained decrease of visual acuity (SDVA), and failure of first surgical glaucoma intervention. Statistical methods included logistic regression to obtain average adjusted black-white odds ratios for binary outcomes, and Cox regression to estimate adjusted black-white risk ratios for time-to-event outcomes. In the ATT sequence blacks were at lower risk than whites of failure of first intervention (ALT, RR = 0.68, P = 0.040). In the TAT sequence blacks were at higher risk than whites of failure of the first intervention (trabeculectomy, RR = 1.79, P = 0.033), of intraocular pressure > or =18 mm Hg (average OR = 1.41, P = 0.026), and of DVF (average OR = 1.78, P = 0.007). In both treatment sequences, the average number of prescribed medications was greater for blacks than whites (P < or = 0.002). The results support the hypothesis that after failure of medical therapy and upon initiation of surgical intervention, an initial intervention with trabeculectomy retards the progression of glaucoma more effectively in white than in black patients. The data provide a weak suggestion that an initial surgical intervention with ALT retards the progression of glaucoma more effectively in black than in white patients.

Patellofemoral arthroplasty conversion to total knee arthroplasty: Retrieval analysis and clinical correlation.

PubMed

Christ, Alexander B; Baral, Elexis; Koch, Chelsea; Shubin Stein, Beth E; Gonzalez Della Valle, Alejandro; Strickland, Sabrina M

2017-10-01

Patellofemoral arthroplasty (PFA) can be a successful, bone-sparing treatment for isolated patellofemoral arthritis. However, progression of tibio-femoral arthritis or incorrect indications may predispose patients to early conversion to total knee arthroplasty (TKA). The purpose of this study was to review the clinical cases and perform retrieval analysis of PFA conversions to TKA at our institution. Twenty one patellofemoral arthroplasties in 18 patients that were converted to TKA were identified through our implant retrieval registry. Sixteen implants were available for review by biomechanical engineers, who recorded surface markings, wear patterns, and integrity of fixation. Patient charts were reviewed and time to conversion, tourniquet time, conversion implant, additional surgeries, infections, and Kellgren & Lawrence grade of the tibio-femoral joint on pre-operative radiographs were recorded. PFAs converted to TKAs at our institution were implanted for an average of 2.7years. The most common reason for conversion was pain, but most patients had significant tibio-femoral arthritis, as indicated by an average Kellgren & Lawrence grade of 2.6. The average tourniquet time for these conversions was 67min. These patients underwent an average of one additional surgery per PFA converted, and the infection rate of these conversions was approximately 14%. Success of PFA depends upon correct patient selection rather than implant failure or wear. Conversion of PFA to TKA is technically similar to primary TKA, with similar post-operative pain relief and range of motion. However, infection rates and complications requiring further surgery are more consistent with results seen in revision TKA. IV. Copyright © 2017 Elsevier B.V. All rights reserved.

A method to characterize average cervical spine ligament response based on raw data sets for implementation into injury biomechanics models.

PubMed

Mattucci, Stephen F E; Cronin, Duane S

2015-01-01

Experimental testing on cervical spine ligaments provides important data for advanced numerical modeling and injury prediction; however, accurate characterization of individual ligament response and determination of average mechanical properties for specific ligaments has not been adequately addressed in the literature. Existing methods are limited by a number of arbitrary choices made during the curve fits that often misrepresent the characteristic shape response of the ligaments, which is important for incorporation into numerical models to produce a biofidelic response. A method was developed to represent the mechanical properties of individual ligaments using a piece-wise curve fit with first derivative continuity between adjacent regions. The method was applied to published data for cervical spine ligaments and preserved the shape response (toe, linear, and traumatic regions) up to failure, for strain rates of 0.5s(-1), 20s(-1), and 150-250s(-1), to determine the average force-displacement curves. Individual ligament coefficients of determination were 0.989 to 1.000 demonstrating excellent fit. This study produced a novel method in which a set of experimental ligament material property data exhibiting scatter was fit using a characteristic curve approach with a toe, linear, and traumatic region, as often observed in ligaments and tendons, and could be applied to other biological material data with a similar characteristic shape. The resultant average cervical spine ligament curves provide an accurate representation of the raw test data and the expected material property effects corresponding to varying deformation rates. Copyright © 2014 Elsevier Ltd. All rights reserved.

A correlational study of illness knowledge, self-care behaviors, and quality of life in elderly patients with heart failure.

PubMed

Liu, Min-Hui; Wang, Chao-Hung; Huang, Yu-Yen; Cherng, Wen-Jin; Wang, Kai-Wei Katherine

2014-06-01

Patients with heart failure experience adverse physical symptoms that affect quality of life. The number of patients with heart failure in Taiwan has been growing in recent years. This article examines correlations among illness knowledge, self-care behaviors, and quality of life in elderly patients with heart failure. A cross-sectional research design using three questionnaires was adopted. The study was undertaken in an outpatient department of a teaching hospital in Taiwan from January to June 2008. Potential participants aged 65 years or older were selected by a physician based on several diagnostic findings of heart failure that included an International Classification of Diseases' code 4280 or 4289. Patients who were bedridden or had a prognosis of less than 6 months were excluded from consideration. One hundred forty-one patients with heart failure were recruited. Most participants were men (51.8%), older adults (49.6% older than 71 years old), and either educated to an elementary school level or illiterate (69.5%) and have New York Heart Association class II (61.0%). Participants had an average left ventricular ejection fraction of 41.1%. The illness knowledge of participants was poor (accuracy rate: 29.3%), and most were unaware of the significance of self-care. Illness knowledge correlated with both self-care behaviors (r = -.42, p < .01) and quality of life (r = -.22, p < .01). Illness knowledge and age were identified as significant correlated factors of self-care behaviors (R = .22); and functional class, living independently, and age were identified as significant correlated factors of quality of life (R = .41). Participants in this study with higher self-reported self-care behaviors and quality of life were younger in age and had better illness knowledge. Furthermore, physical function and independence in daily living significantly affected quality of life. Care for patients with heart failure, particularly older adults, should focus on teaching these patients about heart failure illness and symptom management. Assisting elderly patients with heart failure to promote and maintain physical functions to handle activities of daily living independently is critical to improving patient quality of life.

Association between the rapid shallow breathing index and extubation success in patients with traumatic brain injury

PubMed Central

dos Reis, Helena França Correia; Almeida, Mônica Lajana Oliveira; da Silva, Mário Ferreira; Moreira, Julião Oliveira; Rocha, Mário de Seixas

2013-01-01

Objective To investigate the association between the rapid shallow breathing index and successful extubation in patients with traumatic brain injury. Methods This study was a prospective study conducted in patients with traumatic brain injury of both genders who underwent mechanical ventilation for at least two days and who passed a spontaneous breathing trial. The minute volume and respiratory rate were measured using a ventilometer, and the data were used to calculate the rapid shallow breathing index (respiratory rate/tidal volume). The dependent variable was the extubation outcome: reintubation after up to 48 hours (extubation failure) or not (extubation success). The independent variable was the rapid shallow breathing index measured after a successful spontaneous breathing trial. Results The sample comprised 119 individuals, including 111 (93.3%) males. The average age of the sample was 35.0±12.9 years old. The average duration of mechanical ventilation was 8.1±3.6 days. A total of 104 (87.4%) participants achieved successful extubation. No association was found between the rapid shallow breathing index and extubation success. Conclusion The rapid shallow breathing index was not associated with successful extubation in patients with traumatic brain injury. PMID:24213084

DIETARY SODIUM ADHERENCE IS POOR IN CHRONIC HEART FAILURE PATIENTS

PubMed Central

Basuray, Anupam; Dolansky, Mary; Josephson, Richard; Sattar, Abdus; Grady, Ellen M.; Vehovec, Anton; Gunstad, John; Redle, Joseph; Fang, James; Hughes, Joel W.

2015-01-01

Background We sought to determine the rates and predictors of dietary sodium restriction, while evaluating the reliability of the 24-hour urine collection as a tool to estimate dietary sodium intake in heart failure (HF) patients. Methods and Results We evaluated the 24-hour urinary sodium excretion of 305 outpatients with HF and reduced ejection fraction who were educated on following a <2 gm sodium diet. The mean sodium excretion using a single sample from each participant was 3.15 ± 1.58 grams, and 23% were adherent to the <2 gm recommendation. 168 participants provided two samples with urinary creatinine excretion within normative range. Averaging both resulted in a mean sodium excretion of 3.21 ± 1.20 grams and lower adherence rates to the <2-gram diet: 14% versus 23% (p=0.019). Multivariate logistic regression showed only male sex and higher BMI was associated with non-adherence (OR male: 2.20, 95% CI: 1.25-3.88, OR one unit BMI: 1.05, 95% CI: 1.01-1.10). Bland-Altman plots of urinary sodium and creatinine showed poor reproducibility between samples. Conclusions In this chronic HF population, sodium consumption probably exceeds recommended amounts, particularly in men and those with higher BMI. Urine analyses were not highly reproducible, suggesting variation in both diet and urine collection. PMID:25576680

A homogenized localizing gradient damage model with micro inertia effect

NASA Astrophysics Data System (ADS)

Wang, Zhao; Poh, Leong Hien

2018-07-01

The conventional gradient enhancement regularizes structural responses during material failure. However, it induces a spurious damage growth phenomenon, which is shown here to persist in dynamics. Similar issues were reported with the integral averaging approach. Consequently, the conventional nonlocal enhancement cannot adequately describe the dynamic fracture of quasi-brittle materials, particularly in the high strain rate regime, where a diffused damage profile precludes the development of closely spaced macrocracks. To this end, a homogenization theory is proposed to translate the micro processes onto the macro scale. Starting with simple elementary models at the micro scale to describe the fracture mechanisms, an additional kinematic field is introduced to capture the variations in deformation and velocity within a unit cell. An energetic equivalence between micro and macro is next imposed to ensure consistency at the two scales. The ensuing homogenized microforce balance resembles closely the conventional gradient expression, albeit with an interaction domain that decreases with damage, complemented by a micro inertia effect. Considering a direct single pressure bar example, the homogenized model is shown to resolve the non-physical responses obtained with conventional nonlocal enhancement. The predictive capability of the homogenized model is furthermore demonstrated by considering the spall tests of concrete, with good predictions on failure characteristics such as fragmentation profiles and dynamic tensile strengths, at three different loading rates.

[A project to ameliorate nurses working overtime in psychiatry ward].

PubMed

Feng, Yuen-Hsiang; Li, Hsiu-Chen; Fang, Mao-So

2009-12-01

The authors found nurses working in psychiatry wards were frequently required to work overtime, with average overtime measuring 85 minutes. After analysis, we found main factors leading to overtime to be late new patient admissions, tardy ward inspections by attending physicians, failure to implement workplace regulations, failure by nurses to implement proper shift transfer procedures, and meeting-related delays. This paper proposes an approach by which average overtime for psychiatry ward nurses may be reduced from 85 to 30 minutes. Based on findings, the researchers adjusted the schedule for ward visits by attending physicians, updated and streamlined workplace regulations, ensured administrative procedures were precisely followed, and updated and streamlined standing orders. Average overtime was reduced from 85 to 25 minutes. This research facilitated a reduction in the amount of overtime registered by nurses.

Impact of obstructive sleep apnea in transsphenoidal pituitary surgery: An analysis of inpatient data.

PubMed

Chung, Sei Y; Sylvester, Michael J; Patel, Varesh R; Zaki, Michael; Baredes, Soly; Liu, James K; Eloy, Jean Anderson

2018-05-01

Although previous studies have reported increased perioperative complications among obstructive sleep apnea (OSA) patients undergoing any surgery requiring general anesthesia, there is a paucity of literature addressing the impact of OSA on postoperative transsphenoidal surgery (TSS) complications. The aim of this study was to analyze postoperative outcomes in transsphenoidal pituitary surgery patients with OSA. Secondarily, we examined patient characteristics and comorbidities. Retrospective analysis. The 2002 to 2013 National Inpatient Sample was queried for patients undergoing TSS for pituitary neoplasm. Patients with an additional diagnosis of OSA were identified, and compared to a non-OSA cohort. There were 17,777 patients identified; 5.0% (N = 889) had an additional diagnosis of OSA. The OSA cohort had more comorbidities including diabetes mellitus, congestive heart failure, chronic pulmonary disease, coagulopathy, hypertension, hypothyroidism, liver disease, obesity, peripheral vascular disease, renal failure, acromegaly, and Cushing's syndrome. Postoperatively, OSA was independently associated with increased risks of tracheostomy (P = .015) and hypoxemia (P < .001), and decreased risk of cardiac complications (P = .034). OSA patients did not have increased rates of cerebrospinal fluid rhinorrhea, diabetes insipidus, reintubation, aspiration pneumonia, infectious pneumonia, thromboembolic complications, or urinary/renal complications. In-hospital mortality rates did not vary between the two cohorts. In patients who underwent transsphenoidal pituitary surgery, OSA was associated with higher rates of certain pulmonary and airway complications. OSA was not associated with increased non-pulmonary/airway complications or inpatient mortality, despite older average age and higher comorbidity rates. 2C. Laryngoscope, 128:1027-1032, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Strategy for the management of uncomplicated retinal detachments: the European vitreo-retinal society retinal detachment study report 1.

PubMed

Adelman, Ron A; Parnes, Aaron J; Ducournau, Didier

2013-09-01

To study success and failure in the treatment of uncomplicated rhegmatogenous retinal detachments (RRDs). Nonrandomized, multicenter retrospective study. One hundred seventy-six surgeons from 48 countries spanning 5 continents provided information on the primary procedures for 7678 cases of RRDs including 4179 patients with uncomplicated RRDs. Reported data included specific clinical findings, the method of repair, and the outcome after intervention. Final failure of retinal detachment repair (level 1 failure rate), remaining silicone oil at the study's conclusion (level 2 failure rate), and need for additional procedures to repair the detachment (level 3 failure rate). Four thousand one hundred seventy-nine uncomplicated cases of RRD were included. Combining phakic, pseudophakic, and aphakic groups, those treated with scleral buckle alone (n = 1341) had a significantly lower final failure rate than those treated with vitrectomy, with or without a supplemental buckle (n = 2723; P = 0.04). In phakic patients, final failure rate was lower in the scleral buckle group compared with those who had vitrectomy, with or without a supplemental buckle (P = 0.028). In pseudophakic patients, the failure rate of the initial procedure was lower in the vitrectomy group compared with the scleral buckle group (P = 3×10(-8)). There was no statistically significant difference in failure rate between segmental (n = 721) and encircling (n = 351) buckles (P = 0.5). Those who underwent vitrectomy with a supplemental scleral buckle (n = 488) had an increased failure rate compared with those who underwent vitrectomy alone (n = 2235; P = 0.048). Pneumatic retinopexy was found to be comparable with scleral buckle when a retinal hole was present (P = 0.65), but not in cases with a flap tear (P = 0.034). In the treatment of uncomplicated phakic retinal detachments, repair using scleral buckle may be a good option. There was no significant difference between segmental versus 360-degree buckle. For pseudophakic uncomplicated retinal detachments, the surgeon should balance the risks and benefits of vitrectomy versus scleral buckle and keep in mind that the single-surgery reattachment rate may be higher with vitrectomy. However, if a vitrectomy is to be performed, these data suggest that a supplemental buckle is not helpful. The author(s) have no proprietary or commercial interest in any materials discussed in this article. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Validity testing and neuropsychology practice in the VA healthcare system: results from recent practitioner survey (.).

PubMed

Young, J Christopher; Roper, Brad L; Arentsen, Timothy J

2016-05-01

A survey of neuropsychologists in the Veterans Health Administration examined symptom/performance validity test (SPVT) practices and estimated base rates for patient response bias. Invitations were emailed to 387 psychologists employed within the Veterans Affairs (VA), identified as likely practicing neuropsychologists, resulting in 172 respondents (44.4% response rate). Practice areas varied, with 72% at least partially practicing in general neuropsychology clinics and 43% conducting VA disability exams. Mean estimated failure rates were 23.0% for clinical outpatient, 12.9% for inpatient, and 39.4% for disability exams. Failure rates were the highest for mTBI and PTSD referrals. Failure rates were positively correlated with the number of cases seen and frequency and number of SPVT use. Respondents disagreed regarding whether one (45%) or two (47%) failures are required to establish patient response bias, with those administering more measures employing the more stringent criterion. Frequency of the use of specific SPVTs is reported. Base rate estimates for SPVT failure in VA disability exams are comparable to those in other medicolegal settings. However, failure in routine clinical exams is much higher in the VA than in other settings, possibly reflecting the hybrid nature of the VA's role in both healthcare and disability determination. Generally speaking, VA neuropsychologists use SPVTs frequently and eschew pejorative terms to describe their failure. Practitioners who require only one SPVT failure to establish response bias may overclassify patients. Those who use few or no SPVTs may fail to identify response bias. Additional clinical and theoretical implications are discussed.

Scoping review: Hospital nursing factors associated with 30-day readmission rates of patients with heart failure.

PubMed

Jun, Jin; Faulkner, Kenneth M

2018-04-01

To review the current literature on hospital nursing factors associated with 30-day readmission rates of patients with heart failure. Heart failure is a common, yet debilitating chronic illness with high mortality and morbidity. One in five patients with heart failure will experience unplanned readmission to a hospital within 30 days. Given the significance of heart failure to individuals, families and healthcare system, the Center for Medicare and Medicaid Services has made reducing 30-day readmission rates a priority. Scoping review, which maps the key concepts of a research area, is used. Published primary studies in English assessing factors related to nurses in hospitals and readmission of patients with heart failure were included. Other inclusion criteria were written in English and published in peer-reviewed journals. The search resulted in 2,782 articles. After removing duplicates and reviewing the inclusion and exclusion criteria, five articles were selected. Three nursing workforce factors emerged as follows: (i) nursing staffing, (ii) nursing care and work environment, and (iii) nurses' knowledge of heart failure. This is the first scoping review examining the association between hospital nursing factors and 30-day readmission rates of patients with heart failure. Further studies examining the extent of nursing structural and process factors influencing the outcomes of patients with heart failure are needed. Nurses are an integral part of the healthcare system. Identifying the factors related to nurses in hospitals is important to ensure comprehensive delivery of care to the chronically ill population. Hospital administrators, managers and policymakers can use the findings from this review to implement strategies to reduce 30-day readmission rates of patients with heart failure. © 2018 John Wiley & Sons Ltd.

Comparative study of the failure rates among 3 implantable defibrillator leads.

PubMed

van Malderen, Sophie C H; Szili-Torok, Tamas; Yap, Sing C; Hoeks, Sanne E; Zijlstra, Felix; Theuns, Dominic A M J

2016-12-01

After the introduction of the Biotronik Linox S/SD high-voltage lead, several cases of early failure have been observed. The purpose of this article was to assess the performance of the Linox S/SD lead in comparison to 2 other contemporary leads. We used the prospective Erasmus MC ICD registry to identify all implanted Linox S/SD (n = 408), Durata (St. Jude Medical, model 7122) (n = 340), and Endotak Reliance (Boston Scientific, models 0155, 0138, and 0158) (n = 343) leads. Lead failure was defined by low- or high-voltage impedance, failure to capture, sense or defibrillate, or the presence of nonphysiological signals not due to external interference. During a median follow-up of 5.1 years, 24 Linox (5.9%), 5 Endotak (1.5%), and 5 Durata (1.5%) leads failed. At 5-year follow-up, the cumulative failure rate of Linox leads (6.4%) was higher than that of Endotak (0.4%; P < .0001) and Durata (2.0%; P = .003) leads. The incidence rate was higher in Linox leads (1.3 per 100 patient-years) than in Endotak and Durata leads (0.2 and 0.3 per 100 patient-years, respectively; P < .001). A log-log analysis of the cumulative hazard for Linox leads functioning at 3-year follow-up revealed a stable failure rate of 3% per year. The majority of failures consisted of noise (62.5%) and abnormal impedance (33.3%). This study demonstrates a higher failure rate of Linox S/SD high-voltage leads compared to contemporary leads. Although the mechanism of lead failure is unclear, the majority presents with abnormal electrical parameters. Comprehensive monitoring of Linox S/SD high-voltage leads includes remote monitoring to facilitate early detection of lead failure. Copyright © 2016. Published by Elsevier Inc.

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

Royer, Michael P.; McCullough, Jeffrey J.; Tucker, Joseph C.

The lumen depreciation and color shift of 17 different A lamps (15 LED, 1 CFL, 1 halogen) was monitored in the automated long-term test apparatus (ALTA) for more than 7,500 hours. Ten samples of each lamp model were tested, with measurements recorded on a weekly basis. The lamps were operated continuously at an ambient temperature of 45°C (-1°C). Importantly, the steady-state test conditions were not optimized for inducing catastrophic failure for any of the lamp technologies—to which thermal cycling is a strong contributor— and are not typical of normal use patterns—which usually include off periods where the lamp cools down.more » Further, the test conditions differ from those used in standardized long-term test methods (i.e., IES LM-80, IES LM-84), so the results should not be directly compared. On the other hand, the test conditions are similar to those used by ENERGY STAR (when elevated temperature testing is called for). Likewise, the conditions and assumptions used by manufacturers to generated lifetime claims may vary; the CALiPER long-term data is informative, but cannot necessarily be used to discredit manufacturer claims. The test method used for this investigation should be interpreted as one more focused on the long-term effects of elevated temperature operation, at an ambient temperature that is not uncommon in luminaires. On average, the lumen maintenance of the LED lamps monitored in the ALTA was better than benchmark lamps, but there was considerable variation from lamp model to lamp model. While three lamp models had average lumen maintenance above 99% at the end of the study period, two products had average lumen maintenance below 65%, constituting a parametric failure. These two products, along with a third, also exhibited substantial color shift, another form of parametric failure. While none of the LED lamps exhibited catastrophic failure—and all of the benchmarks did—the early degradation of performance is concerning, especially with a new technology trying to build a reputation with consumers. Beyond the observed parametric failures nearly half of the products failed to meet early-life thresholds for lumen maintenance, which were borrowed from ENERGY STAR specifications. That is, the lumen maintenance was sufficiently low at 6,000 hours that seven of the products are unlikely to have lumen maintenance above 70% at their rated lifetime (which was usually 25,000 hours). Given the methods used for this investigation—most notably continuous operation—the results should not be interpreted as indicative of a lamp’s performance in a typical environment. Likewise, these results are not directly relatable to manufacturer lifetime claims. This report is best used to understand the variation in LED product performance, compare the robustness of LED lamps and benchmark conventional lamps, and understand the characteristics of lumen and chromaticity change. A key takeaway is that the long-term performance of LED lamps can vary greatly from model to model (i.e., the technology is not homogenous), although the lamp-to-lamp consistency within a given model is relatively good. Further, operation of LED lamps in an enclosed luminaire (or otherwise in high ambient temperatures), can induce parametric failure of LEDs much earlier than their rated lifetime; manufacturer warnings about such conditions should be followed if performance degradation is unacceptable.« less

Analysis of Emergency Diesel Generators Failure Incidents in Nuclear Power Plants

NASA Astrophysics Data System (ADS)

Hunt, Ronderio LaDavis

In early years of operation, emergency diesel generators have had a minimal rate of demand failures. Emergency diesel generators are designed to operate as a backup when the main source of electricity has been disrupted. As of late, EDGs (emergency diesel generators) have been failing at NPPs (nuclear power plants) around the United States causing either station blackouts or loss of onsite and offsite power. These failures occurred from a specific type called demand failures. This thesis evaluated the current problem that raised concern in the nuclear industry which was averaging 1 EDG demand failure/year in 1997 to having an excessive event of 4 EDG demand failure year which occurred in 2011. To determine the next occurrence of the extreme event and possible cause to an event of such happening, two analyses were conducted, the statistical and root cause analysis. Considering the statistical analysis in which an extreme event probability approach was applied to determine the next occurrence year of an excessive event as well as, the probability of that excessive event occurring. Using the root cause analysis in which the potential causes of the excessive event occurred by evaluating, the EDG manufacturers, aging, policy changes/ maintenance practices and failure components. The root cause analysis investigated the correlation between demand failure data and historical data. Final results from the statistical analysis showed expectations of an excessive event occurring in a fixed range of probability and a wider range of probability from the extreme event probability approach. The root-cause analysis of the demand failure data followed historical statistics for the EDG manufacturer, aging and policy changes/ maintenance practices but, indicated a possible cause regarding the excessive event with the failure components. Conclusions showed the next excessive demand failure year, prediction of the probability and the next occurrence year of such failures, with an acceptable confidence level, was difficult but, it was likely that this type of failure will not be a 100 year event. It was noticeable to see that the majority of the EDG demand failures occurred within the main components as of 2005. The overall analysis of this study provided from percentages, indicated that it would be appropriate to make the statement that the excessive event was caused by the overall age (wear and tear) of the Emergency Diesel Generators in Nuclear Power Plants. Future Work will be to better determine the return period of the excessive event once the occurrence has happened for a second time by implementing the extreme event probability approach.

Hypertension, Obesity, Diabetes, and Heart Failure-Free Survival: The Cardiovascular Disease Lifetime Risk Pooling Project.

PubMed

Ahmad, Faraz S; Ning, Hongyan; Rich, Jonathan D; Yancy, Clyde W; Lloyd-Jones, Donald M; Wilkins, John T

2016-12-01

This study was designed to quantify the relationship between the absence of heart failure risk factors in middle age and incident heart failure, heart failure-free survival, and overall survival. Quantification of years lived free from heart failure in the context of risk factor burden in mid-life may improve risk communication and prevention efforts. We conducted a pooled, individual-level analysis sampling from communities across the United States as part of 4 cohort studies: the Framingham Heart, Framingham Offspring, Chicago Heart Association Detection Project in Industry, and ARIC (Atherosclerosis Risk In Communities) studies. Participants with and without hypertension (blood pressure ≥140/90 mm Hg or treatment), obesity (body mass index ≥30 kg/m 2 ), or diabetes (fasting glucose ≥126 mg/dl or treatment), and combinations of these factors, at index ages of 45 years and 55 years through 95 years. Competing risk-adjusted Cox models, a modified Kaplan-Meier estimator, and Irwin's restricted mean were used to estimate the association between the absence of risk factors at mid-life and incident heart failure, heart failure-free survival, and overall survival. For participants at age 45 years, over 516,537 person-years of follow-up, 1,677 incident heart failure events occurred. Men and women with no risk factors, compared to those with all 3, had 73% to 85% lower risks of incident heart failure. Men and women without hypertension, obesity, or diabetes at age 45 years lived on average 34.7 years and 38.0 years without incident heart failure, and they lived on average an additional 3 years to 15 years longer free of heart failure than those with 1, 2, or 3 risk factors. Similar trends were seen when stratified by race and at index age 55 years. Prevention of hypertension, obesity, and diabetes by ages 45 years and 55 years may substantially prolong heart failure-free survival, decrease heart failure-related morbidity, and reduce the public health impact of heart failure. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Is routine voiding cystourethrogram necessary following double hit for primary vesicoureteral reflux?

PubMed

Arlen, Angela M; Scherz, Hal C; Filimon, Eleonora; Leong, Traci; Kirsch, Andrew J

2015-02-01

Current AUA guidelines recommend voiding cystourethrogram (VCUG) following endoscopic treatment of vesicoureteral reflux (VUR). We evaluated the clinical and radiographic outcomes of children undergoing Double HIT (hydrodistention implantation technique) for primary VUR to determine success rates and the necessity of postoperative VCUG. Children with a history of febrile urinary tract infection (fUTI) undergoing Double HIT for primary VUR between 2009 and 2012 were identified. Patients were prospectively classified as high or low clinical and radiographic risk. Children were categorized as high clinical risk if they had ≥ 3 fUTIs or documented bladder bowel dysfunction (BBD). High radiographic risk included those <2 years of age or with grade 4-5 VUR. Initially, all children underwent postoperative VCUG ("routine" group), while only those with an indication (high radiographic risk or clinical failure) did so during the latter portion of the study ("indicated" group). Clinical success was defined as no postoperative fUTI and radiographic success as negative postoperative VCUG. Average clinical follow-up was 34.7 ± 17.2 months. Two hundred and twenty-two children (198 girls, 24 boys) underwent Double HIT at a mean age of 4.1 ± 2.7 years. Mean maximum VUR grade was 3 ± 0.8. Sixty-eight children (30.6%) had documented BBD. Fourteen children (6.3%) experienced postoperative fUTI, for a clinical success rate of 93.7%. One hundred and fourteen patients (51.4%) underwent postoperative VCUG; 76 were "routine" and 38 were "indicated" [Figure]. Of children classified as low clinical/radiographic risk, 96.6% did not have a postoperative fUTI, compared to 91.1% for high risk patients (P = 0.771). Odds of clinical success for routine VCUG group were 9.9 times higher than for the indicated VCUG group (95% CI, 2-50). Odds of radiographic success for the routine cohort were 13 times higher than for the indicated group (95% CI, 4.2-40). Nine children (4.1%) underwent additional procedures. We found no difference in clinical success among the different risk groups; the number of children with postoperative fUTI was relatively few so there was not statistical power to discern any differences between patients who experienced clinical success versus clinical failure. However, children with an "indicated" VCUG (i.e. those less than 2 years of age, grade 4-5 VUR or those with a fUTI) were 13 times more likely to experience a radiographic failure. This cohort of 38 patients had a 50% radiographic cure rate and a 78.9% clinical cure rate, compared to the overall long-term clinical success rate of 93.7%. Our data demonstrates that we can predict failures with relatively high sensitivity, and it may therefore be prudent to selectively obtain postoperative VCUG rather than recommend it for all children undergoing dextranomer hyaluronic acid co-polymer (Dx/HA) injection. Our study has several limitations that warrant consideration. Not all children underwent a postoperative VCUG, so the true radiographic success rate is unknown. Incidence of fUTI may also be artificially low, as some radiographic failures proceeded directly to another injection or reimplantation. While we were able to demonstrate that children undergoing an "indicated" VCUG were more likely to experience radiographic failure, a larger patient cohort is necessary to determine whether age or VUR grade is more predictive of failure. Finally all patients underwent endoscopic Dx/HA injection, therefore the incidence "spontaneous resolution" is unknown. Long-term clinical success following Double HIT for the endoscopic correction of primary VUR is high, and the majority of children avoid additional procedures. Unless indicated by high-grade, young age, clinical failure, or family/surgeon preference, consideration should be given to making postoperative VCUG an option rather than a recommendation in children undergoing endoscopic treatment of primary VUR using the Double HIT method. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Failure Investigation of a Cage Suspension Gear Chain used in Coal Mines

NASA Astrophysics Data System (ADS)

Ghosh, Debashis; Dutta, Shamik; Shukla, Awdhesh Kumar; Roy, Himadri

2016-10-01

This investigation is primarily aimed to examine the probable causes of in-service failure of cage suspension gear chain used in coal mines. Preliminary visual examination, dimensional measurement, chemical analysis, magnetic particle inspection and estimation of mechanical properties are necessary supplement to this investigation. Optical microscopic analysis along with scanning electron microscopy examinations are carried out to understand the metallurgical reasons for failure. The visual examination and magnetic particle investigations reveal presence of fissure cracks at weld joint for both un-failed and failed end link chain. The average hardness value has been found to increase gradually with the distance from the weld interface. The macro and microstructural examinations of the samples prepared from both failed and un-failed specimens depict presence of continuous as well as aligned linear inclusions randomly distributed along with decarburized layer at weld interface/fusion zone. Fractographic examination shows flat fracture covering major portion of cross-section, which is surrounded by a narrow annular metallic fracture surface having a texture different from that of the remaining surface. Fracture mechanics principles have been used to study the fatigue crack growth rate in both weld region and base region of the un-failed gear chain material. Detailed stress analyses are also carried out to evaluate the stress generated along the chain periphery. Finally, it is concluded that presence of serious weld defect due to use of improper welding parameters/procedure caused failure of the end links of the investigated chain link.

Failure Rates and Patterns of Recurrence in Patients With Resected N1 Non-Small-Cell Lung Cancer

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

Varlotto, John M., E-mail: jvarlotto@hmc.psu.edu; Medford-Davis, Laura Nyshel; Recht, Abram

2011-10-01

Purpose: To examine the local and distant recurrence rates and patterns of failure in patients undergoing potentially curative resection of N1 non-small-cell lung cancer. Methods and Materials: The study included 60 consecutive unirradiated patients treated from 2000 to 2006. Median follow-up was 30 months. Failure rates were calculated by the Kaplan-Meier method. A univariate Cox proportional hazard model was used to assess factors associated with recurrence. Results: Local and distant failure rates (as the first site of failure) at 2, 3, and 5 years were 33%, 33%, and 46%; and 26%, 26%, and 32%, respectively. The most common site ofmore » local failure was in the mediastinum; 12 of 18 local recurrences would have been included within proposed postoperative radiotherapy fields. Patients who received chemotherapy were found to be at increased risk of local failure, whereas those who underwent pneumonectomy or who had more positive nodes had significantly increased risks of distant failure. Conclusions: Patients with resected non-small-cell lung cancer who have N1 disease are at substantial risk of local recurrence as the first site of relapse, which is greater than the risk of distant failure. The role of postoperative radiotherapy in such patients should be revisited in the era of adjuvant chemotherapy.« less

A Decreasing Failure Rate, Mixed Exponential Model Applied to Reliability.

DTIC Science & Technology

1981-06-01

Trident missile systems have been observed. The mixed exponential distribu- tion has been shown to fit the life data for the electronic equipment on...these systems . This paper discusses some of the estimation problems which occur with the decreasing failure rate mixed exponential distribution when...assumption of constant or increasing failure rate seemed to be incorrect. 2. However, the design of this electronic equipment indicated that

High-Strain Rate Failure Modeling Incorporating Shear Banding and Fracture

DTIC Science & Technology

2017-11-22

High Strain Rate Failure Modeling Incorporating Shear Banding and Fracture The views, opinions and/or findings contained in this report are those of...SECURITY CLASSIFICATION OF: 1. REPORT DATE (DD-MM-YYYY) 4. TITLE AND SUBTITLE 13. SUPPLEMENTARY NOTES 12. DISTRIBUTION AVAILIBILITY STATEMENT 6. AUTHORS...Report as of 05-Dec-2017 Agreement Number: W911NF-13-1-0238 Organization: Columbia University Title: High Strain Rate Failure Modeling Incorporating

Mechanistic Considerations Used in the Development of the PROFIT PCI Failure Model

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

Pankaskie, P. J.

A fuel Pellet-Zircaloy Cladding (thermo-mechanical-chemical) Interactions (PC!) failure model for estimating the probability of failure in !ransient increases in power (PROFIT) was developed. PROFIT is based on 1) standard statistical methods applied to available PC! fuel failure data and 2) a mechanistic analysis of the environmental and strain-rate-dependent stress versus strain characteristics of Zircaloy cladding. The statistical analysis of fuel failures attributable to PCI suggested that parameters in addition to power, transient increase in power, and burnup are needed to define PCI fuel failures in terms of probability estimates with known confidence limits. The PROFIT model, therefore, introduces an environmentalmore » and strain-rate dependent strain energy absorption to failure (SEAF) concept to account for the stress versus strain anomalies attributable to interstitial-disloction interaction effects in the Zircaloy cladding. Assuming that the power ramping rate is the operating corollary of strain-rate in the Zircaloy cladding, then the variables of first order importance in the PCI fuel failure phenomenon are postulated to be: 1. pre-transient fuel rod power, P{sub I}, 2. transient increase in fuel rod power, {Delta}P, 3. fuel burnup, Bu, and 4. the constitutive material property of the Zircaloy cladding, SEAF.« less

Failure on the American Board of Surgery Examinations of General Surgery Residency Graduates Correlates Positively with States' Malpractice Risk.

PubMed

Dent, Daniel L; Al Fayyadh, Mohammed J; Rawlings, Jeremy A; Hassan, Ramy A; Kempenich, Jason W; Willis, Ross E; Stewart, Ronald M

2018-03-01

It has been suggested that in environments where there is greater fear of litigation, resident autonomy and education is compromised. Our aim was to examine failure rates on American Board of Surgery (ABS) examinations in comparison with medical malpractice payments in 47 US states/territories that have general surgery residency programs. We hypothesized higher ABS examination failure rates for general surgery residents who graduate from residencies in states with higher malpractice risk. We conducted a retrospective review of five-year (2010-2014) pass rates of first-time examinees of the ABS examinations. States' malpractice data were adjusted based on population. ABS examinations failure rates for programs in states with above and below median malpractice payments per capita were 31 and 24 per cent (P < 0.01) respectively. This difference was seen in university and independent programs regardless of size. Pearson correlation confirmed a significant positive correlation between board failure rates and malpractice payments per capita for Qualifying Examination (P < 0.02), Certifying Examination (P < 0.02), and Qualifying and Certifying combined index (P < 0.01). Malpractice risk correlates positively with graduates' failure rates on ABS examinations regardless of program size or type. We encourage further examination of training environments and their relationship to surgical residency graduate performance.

Origin of Slope Failure in the Ursa Region, Northern Gulf of Mexico

NASA Astrophysics Data System (ADS)

Stigall, J.; Dugan, B.

2008-12-01

We use one-dimensional fluid flow and stability models to predict the evolution of overpressure and stability conditions of IODP Expedition Sites U1322 and U1324 in the Ursa region, northern Gulf of Mexico. Simulations of homogenous mud deposited at 3 and 12 mm/yr for Sites U1322 and U1324, with permeability (k) on the order of 10-17m2 and bulk compressibility of .4 /MPa, predict overpressures up to .45MPa and 1MPa in shallow sediments (<200m below sea floor). With limit equilibrium calculations for an infinite slope, these overpressures equate to a factor of safety (FS) greater than 10 and 4.5 for a internal friction angle of 26° and a seafloor slope of 2°. This implies stability throughout the last 50,000 years. Seismic and core observations, however, document major slope failures that span the entire Ursa region. Permeability in this region is well constrained by laboratory experiments, so we investigate how pulsed (high-to-low) sedimentation rates could have created unstable conditions, FS <1. Models with periods of high sedimentation generate overpressure that create unstable conditions while maintaining the time-averaged sedimentation rates. Other factors which are not possible to simulate in one dimension, such as a complex basin geometry, also influence the conditions that caused the past failures. A two-dimensional model linking lateral flow between the sites with the interpreted geometry from seismic stratigraphy gives a better picture of the flow field and instability within the basin. Asymmetrical loading of permeable sediments could have created a lateral difference in pore pressures which would have driven lateral flow from Site U1324 to Site U1322 where overpressures are higher than our one-dimensional models suggest. We anticipate that two-dimensional models with transient sedimentation patterns will enhance our understanding of flow in marginally stable environments and triggers of slope failures in passive margin systems.

Heart failure with preserved left ventricular systolic function: a hospital cohort study

PubMed Central

Berry, C; Hogg, K; Norrie, J; Stevenson, K; Brett, M; McMurray, J

2005-01-01

Objective: To investigate how patients with heart failure with preserved left ventricular systolic function (LVSF) compare with patients with reduced LVSF. Design: Cohort study. Setting: Urban university hospital. Patients: 528 index emergency admissions with heart failure during the year 2000. Information on LVSF and follow up was available for 445 (84%) of these patients. Results: 130 (29%) patients had preserved LVSF (defined as an ejection fraction > 40%). The median follow up was 814 days (range 632–978 days). The average (SD) age was 72 (13) years. Women accounted for 62% and 45% of patients with preserved and reduced LVSF, respectively (p  =  0.001). Patients with preserved LVSF (compared with those with reduced LVSF) had a higher prevalence of left ventricular hypertrophy (56% v 29%) and aortic valve disease (mean gradient > 20 mm Hg; 31% v 9%). Fewer patients with preserved LVSF received an angiotensin converting enzyme inhibitor (65% v 78%, p  =  0.008) or spironolactone (12% v 21%, p  =  0.027). Anaemia tended to occur more often in patients with preserved LVSF than in those with reduced LVSF (43% v 33% for women, p  =  0.12; 59% v 49% for men, p  =  0.22). There was a similarly high prevalence of significant renal dysfunction in both groups (estimated glomerular filtration rate < 60 ml/min/1.73 m2 in 68% with preserved and 64% with reduced LVSF, p  =  0.40). Mortality was similar in both groups (preserved versus reduced 51 (39%) v 132 (42%), p  =  0.51). Compared with patients with reduced LVSF, patients with preserved LVSF tended to have a lower risk of death or hospital admission for heart failure (56 (42%) v 165 (53%), p  =  0.072) but a similar rate of death or readmission for any reason. Conclusion: Patients with preserved LVSF had more co-morbid problems than those with reduced LVSF; however, prognosis was similar for both groups. PMID:15958359

Use of Climatological Data in Weather Insurance.

NASA Astrophysics Data System (ADS)

Changnon, Stanley A.; Changnon, Joyce M.

1990-05-01

There are three major types of crop-related weather insurance: hail, all perlis, and rain insurance. The development of rates is an exercise in applied climatology, and the importance of the historical data selected for assessing risk (and developing rates) is revealed by the problems encountered by firms insuring against deficient summer rainfall during the drought of 1988. Extensive purchase of premiums costing $9 million for coverage ($400 million) in the Midwest occurred with buyers (farmers) apparently aware during May and June 1988 that an unusually dry event was in progress. The levels of loss (50% or less of average June-August rainfall) offered by insurance firms were exceeded throughout the Midwest. The firms attempted to refund the record number of premiums accepted in June, and in turn, 8000 farmers filed a class-action suit against the firms for failure to accept premiums and to provide coverage. The insurance firms ultimately settled by agreeing to pay $48 million in claims. The coverage offered was based on the most recent 25 years of data, and this unusually wet period did not represent the longer-term likelihood of areally extensive dry summers. Uses of climatic data by the insurance industry include planning for the occurrence of such extreme event considerations, plus point vs area probabilities of these anomalous events; choosing the periods to select for routinely establishing new rates (rerating is typically done an 2- to 10-year cycles); and for determining the averages most appropriate to use for rate levels and sales considerations.

40 CFR 51.352 - Basic I/M performance standard.

Code of Federal Regulations, 2010 CFR

2010-07-01

...% emission test failure rate among pre-1981 model year vehicles. (10) Waiver rate. A 0% waiver rate. (11... 20% emission test failure rate among pre-1981 model year vehicles. (11) Waiver rate. A 0% waiver rate... Requirements § 51.352 Basic I/M performance standard. (a) Basic I/M programs shall be designed and implemented...

40 CFR 51.352 - Basic I/M performance standard.

Code of Federal Regulations, 2014 CFR

2014-07-01

...% emission test failure rate among pre-1981 model year vehicles. (10) Waiver rate. A 0% waiver rate. (11... 20% emission test failure rate among pre-1981 model year vehicles. (11) Waiver rate. A 0% waiver rate... Requirements § 51.352 Basic I/M performance standard. (a) Basic I/M programs shall be designed and implemented...

40 CFR 51.352 - Basic I/M performance standard.

Code of Federal Regulations, 2011 CFR

2011-07-01

...% emission test failure rate among pre-1981 model year vehicles. (10) Waiver rate. A 0% waiver rate. (11... 20% emission test failure rate among pre-1981 model year vehicles. (11) Waiver rate. A 0% waiver rate... Requirements § 51.352 Basic I/M performance standard. (a) Basic I/M programs shall be designed and implemented...

40 CFR 51.352 - Basic I/M performance standard.

Code of Federal Regulations, 2012 CFR

2012-07-01

...% emission test failure rate among pre-1981 model year vehicles. (10) Waiver rate. A 0% waiver rate. (11... 20% emission test failure rate among pre-1981 model year vehicles. (11) Waiver rate. A 0% waiver rate... Requirements § 51.352 Basic I/M performance standard. (a) Basic I/M programs shall be designed and implemented...

40 CFR 51.352 - Basic I/M performance standard.

Code of Federal Regulations, 2013 CFR

2013-07-01

...% emission test failure rate among pre-1981 model year vehicles. (10) Waiver rate. A 0% waiver rate. (11... 20% emission test failure rate among pre-1981 model year vehicles. (11) Waiver rate. A 0% waiver rate... Requirements § 51.352 Basic I/M performance standard. (a) Basic I/M programs shall be designed and implemented...

A Review of Statistical Failure Time Models with Application of a Discrete Hazard Based Model to 1Cr1Mo-0.25V Steel for Turbine Rotors and Shafts

PubMed Central

2017-01-01

Producing predictions of the probabilistic risks of operating materials for given lengths of time at stated operating conditions requires the assimilation of existing deterministic creep life prediction models (that only predict the average failure time) with statistical models that capture the random component of creep. To date, these approaches have rarely been combined to achieve this objective. The first half of this paper therefore provides a summary review of some statistical models to help bridge the gap between these two approaches. The second half of the paper illustrates one possible assimilation using 1Cr1Mo-0.25V steel. The Wilshire equation for creep life prediction is integrated into a discrete hazard based statistical model—the former being chosen because of its novelty and proven capability in accurately predicting average failure times and the latter being chosen because of its flexibility in modelling the failure time distribution. Using this model it was found that, for example, if this material had been in operation for around 15 years at 823 K and 130 MPa, the chances of failure in the next year is around 35%. However, if this material had been in operation for around 25 years, the chance of failure in the next year rises dramatically to around 80%. PMID:29039773

A study on the dynamic behavior of the Meuse/Haute-Marne argillite

NASA Astrophysics Data System (ADS)

Cai, M.; Kaiser, P. K.; Suorineni, F.; Su, K.

Excavation of underground tunnels can be conducted by tunnel boring machines (TBM) or drill-and-blast. TBMs cause minimum damage to excavation walls. Blasting effects on excavation walls depend on the care with which the blasting is executed. For blast-induced damage in excavation walls, two issues have to be addressed: rate of loss of confinement (rate of excavation) and dynamic loading from wave propagation that causes both intended and unintended damage. To address these two aspects, laboratory dynamic tests were conducted for the determination of the dynamic properties of the Meuse/Haute-Marne argillite. In the present study, 17 tensile (Brazilian) and 15 compression split Hopkinson pressure bar (SHPB) tests were conducted. The test revealed that the dynamic strengths of the argillite are strain rate dependent. The average dynamic increase factors (ratio of dynamic strength to static strength) for tensile and compressive strength are about 3.3 and 2.4, respectively. A high-speed video camera was used to visualize the initiation of failure and subsequent deformation of the specimens. The direct compression specimens were found to deform and fail uniformly around the circumference of the specimen, by a spalling process. The SHPB Brazilian tests indicated that failure occurred in tension along the line of load application. Radial fractures were also observed. The test results can be used for the development of a dynamic constitutive model for the argillite for the prediction of damage in underground excavation utilizing the drill-and blast method.

Urethral pull-through operation for the management of pelvic fracture urethral distraction defects.

PubMed

Yin, Lei; Li, Zhenhua; Kong, Chuize; Yu, Xiuyue; Zhu, Yuyan; Zhang, Yuxi; Jiang, Yuanjun

2011-10-01

To present our institutional experience in the management of pelvic fracture urethral distraction defects with urethral pull-through operation. Seventy-six patients (average age 34.5 years) with posterior urethral strictures caused by pelvic fracture urethral distraction defects underwent urethral pull-through operation at our department from July 1995 to September 2009. The estimated urethral stricture length was 2.0-3.5 cm (mean 2.5). Of these patients, 31 (41%) had undergone failed urethroplasty or urethrotomy after the initial management, and 5 (7%) had urethrorectal fistula. Urethral pull-through operation was performed 4-7 months (mean 4.9) after initial treatment or failed urethral reconstruction. The clinical outcome was considered a failure when any postoperative intervention was needed. Follow-up was 14-74 months (mean 42.5). The overall success rate was 89% (68/76). All treatment failures occurred within the first 6 months postoperatively. Failed repairs were successfully managed with internal urethrotomy in 1 patient, by urethral dilation in 6, and by another urethroplasty in 1. All patients were urinary-continent postoperatively. Of the potent patients, 2 (5%) became impotent after urethroplasty. There was no chordee, penile shortening, or urethral fistula recurrence. Urethral pull-through operation might be a less demanding and less time-consuming procedure. It does not increase the rate of impotence or incontinence and, with a high success rate, might serve as an alternative method for the management of pelvic fracture urethral distraction defects. Copyright © 2011 Elsevier Inc. All rights reserved.

On rate-state and Coulomb failure models

USGS Publications Warehouse

Gomberg, J.; Beeler, N.; Blanpied, M.

2000-01-01

We examine the predictions of Coulomb failure stress and rate-state frictional models. We study the change in failure time (clock advance) Δt due to stress step perturbations (i.e., coseismic static stress increases) added to "background" stressing at a constant rate (i.e., tectonic loading) at time t0. The predictability of Δt implies a predictable change in seismicity rate r(t)/r0, testable using earthquake catalogs, where r0 is the constant rate resulting from tectonic stressing. Models of r(t)/r0, consistent with general properties of aftershock sequences, must predict an Omori law seismicity decay rate, a sequence duration that is less than a few percent of the mainshock cycle time and a return directly to the background rate. A Coulomb model requires that a fault remains locked during loading, that failure occur instantaneously, and that Δt is independent of t0. These characteristics imply an instantaneous infinite seismicity rate increase of zero duration. Numerical calculations of r(t)/r0 for different state evolution laws show that aftershocks occur on faults extremely close to failure at the mainshock origin time, that these faults must be "Coulomb-like," and that the slip evolution law can be precluded. Real aftershock population characteristics also may constrain rate-state constitutive parameters; a may be lower than laboratory values, the stiffness may be high, and/or normal stress may be lower than lithostatic. We also compare Coulomb and rate-state models theoretically. Rate-state model fault behavior becomes more Coulomb-like as constitutive parameter a decreases relative to parameter b. This is because the slip initially decelerates, representing an initial healing of fault contacts. The deceleration is more pronounced for smaller a, more closely simulating a locked fault. Even when the rate-state Δt has Coulomb characteristics, its magnitude may differ by some constant dependent on b. In this case, a rate-state model behaves like a modified Coulomb failure model in which the failure stress threshold is lowered due to weakening, increasing the clock advance. The deviation from a non-Coulomb response also depends on the loading rate, elastic stiffness, initial conditions, and assumptions about how state evolves.

Failure rates of leads, pulse generators, and programmers have not diminished over the last 20 years: formal monitoring of performance is still needed. BILITCH Registry and STIMAREC.

PubMed

Kawanishi, D T; Song, S; Furman, S; Parsonnet, V; Pioger, G; Petitot, J C; Godin, J F

1996-11-01

Formal Monitoring of Performance is Still Needed. In order to detect trends in the number of device or component failures that have occurred among permanent pacemaker systems since the 1970s, we reviewed the data of the five largest pacemaker manufacturers from the Bilitch Registry of permanent pacemaker pulse generators, the Stimarec failure registry, the general accounting office summaries of the United States Veterans Administration (VA) Registry of Pacemaker Leads, and the Implantable Lead Registry, from the Cleveland Clinic Lead registry, and the recalls and safety alerts issued by the United States Food and Drug Administration (FDA) over the last 20 years. The definition of failure followed the criterion, or criteria, developed within each registry and differed significantly between the registries. The 20-year period between 1976 and 1995 was divided into 5-year quartiles (QT): QT 1 = 1976-1980; QT2 = 1981-1985; QT3 = 1986-1990; and QT4 = 1991-1995. For pulse generators, the number of models with failures in each quartile in the Bilitch Registry were: QT 1 = 9; QT 2 = 11; QT3 = 17; QT4 = 13. In Stimarec, the number of units reported as having reached a dangerous condition were: QT1 = 710; QT2 = 212; QT3 = 114; QT4 = 310. From the FDA reports, the number of units included in recalls or safety alerts were: QT3 = 6,085; QT4 = 135,766. For permanent pacemaker leads, the numbers of failed or dangerous leads recorded in Stimarec were: QT3 = 16; QT4 = 32. In the VA Registry, the number of models having a below average survival was 2/92 (2.7%). In the Implantable Lead Registry, the number of models having a below average survival was 3/21 (14%). In the Cleveland Clinic series, 6/13 (46%) of lead models were recognized to have some failure involving the conductor, insulation, or connector. In the FDA reports, the number of leads involved in either recall or safety alert were: QT3 = 20,354; QT4 = 332,105. For programmers, the number of units involved either in a recall or safety alert were: QT3 = 11,124; QT4 = 3,528. In all of these series, each of the five largest manufacturers had some models or units involved in each time period. This review of programs has revealed: 1. The incidence of failures, recalls, or safety alerts did not decline over time; and 2. Despite changes in technology, formal monitoring of pacemaker systems is still warranted.

Mechanical Properties of Transgenic Silkworm Silk Under High Strain Rate Tensile Loading

NASA Astrophysics Data System (ADS)

Chu, J.-M.; Claus, B.; Chen, W.

2017-12-01

Studies have shown that transgenic silkworm silk may be capable of having similar properties of spider silk while being mass-producible. In this research, the tensile stress-strain response of transgenic silkworm silk fiber is systematically characterized using a quasi-static load frame and a tension Kolsky bar over a range of strain-rates between 10^{-3} and 700/s. The results show that transgenic silkworm silk tends to have higher overall ultimate stress and failure strain at high strain rate (700/s) compared to quasi-static strain rates, indicating rate sensitivity of the material. The failure strain at the high strain rate is higher than that of spider silk. However, the stress levels are significantly below that of spider silk, and far below that of high-performance fiber. Failure surfaces are examined via scanning electron microscopy and reveal that the failure modes are similar to those of spider silk.

Vocal fold tissue failure: preliminary data and constitutive modeling.

PubMed

Chan, Roger W; Siegmund, Thomas

2004-08-01

In human voice production (phonation), linear small-amplitude vocal fold oscillation occurs only under restricted conditions. Physiologically, phonation more often involves large-amplitude oscillation associated with tissue stresses and strains beyond their linear viscoelastic limits, particularly in the lamina propria extracellular matrix (ECM). This study reports some preliminary measurements of tissue deformation and failure response of the vocal fold ECM under large-strain shear The primary goal was to formulate and test a novel constitutive model for vocal fold tissue failure, based on a standard-linear cohesive-zone (SL-CZ) approach. Tissue specimens of the sheep vocal fold mucosa were subjected to torsional deformation in vitro, at constant strain rates corresponding to twist rates of 0.01, 0.1, and 1.0 rad/s. The vocal fold ECM demonstrated nonlinear stress-strain and rate-dependent failure response with a failure strain as low as 0.40 rad. A finite-element implementation of the SL-CZ model was capable of capturing the rate dependence in these preliminary data, demonstrating the model's potential for describing tissue failure. Further studies with additional tissue specimens and model improvements are needed to better understand vocal fold tissue failure.

Associations between bovine viral diarrhoea virus (BVDV) seropositivity and performance indicators in beef suckler and dairy herds.

PubMed

Gates, M C; Humphry, R W; Gunn, G J

2013-12-01

Data from 255 Scottish beef suckler herds and 189 Scottish dairy herds surveyed as part of national bovine viral diarrhoea virus (BVDV) prevalence studies from October 2006 to May 2008 were examined retrospectively to determine the relationship between serological status and key performance indicators derived from national cattle movement records. On average, calf mortality rates were 1.35 percentage points higher in seropositive beef herds and 3.05 percentage points higher in seropositive dairy herds than in negative control herds. Seropositive beef herds were also more likely to show increases in calf mortality rates and culling rates between successive years. There were no discernible effects of BVDV on the average age at first calving or calving interval for either herd type. Accompanying questionnaire data revealed that only 27% of beef farmers and 25% of dairy farmers with seropositive herds thought their cattle were affected by BVDV, which suggests that the clinical effects of exposure may be inapparent under field conditions or masked by other causes of reproductive failure and culling. Beef farmers were significantly more likely to perceive a problem when their herd experienced acute changes in calf mortality rates, culling rates, and calving intervals between successive years. However, only 35% of these perceived positive herds were actually seropositive for BVDV. These findings emphasize both the importance of routinely screening herds to determine their true infection status and the potential for using national cattle movement records to identify herds that may be experiencing outbreaks from BVDV or other infectious diseases that impact herd performance. Copyright © 2013 Elsevier Ltd. All rights reserved.

Immunosuppressant dose reduction and long-term rejection risk in renal transplant recipients with severe bacterial pneumonia.

PubMed

Shih, Chia-Jen; Tarng, Der-Cherng; Yang, Wu-Chang; Yang, Chih-Yu

2014-07-01

Due to lifelong immunosuppression, renal transplant recipients (RTRs) are at risk of infectious complications such as pneumonia. Severe pneumonia results in respiratory failure and is life‑threatening. We aimed to examine the influence of immunosuppressant dose reduction on RTRs with bacterial pneumonia and respiratory failure. From January 2001 to January 2011, 33 of 1,146 RTRs at a single centre developed bacterial pneumonia with respiratory failure. All patients were treated using mechanical ventilation and aggressive therapies in the intensive care unit. Average time from kidney transplantation to pneumonia with respiratory failure was 6.8 years. In-hospital mortality rate was 45.5% despite intensive care and aggressive therapies. Logistic regression analysis indicated that a high serum creatinine level at the time of admission to the intensive care unit (odds ratio 1.77 per mg/dL, 95% confidence interval 1.01-3.09; p = 0.045) was a mortality determinant. Out of the 33 patients, immunosuppressive agents were reduced in 17 (51.5%). We found that although immunosuppressant dose reduction tended to improve in-hospital mortality, this was not statistically significant. Nevertheless, during a mean follow-up period of two years, none of the survivors (n = 18) developed acute rejection or allograft necrosis. In RTRs with bacterial pneumonia and respiratory failure, higher serum creatinine levels were a mortality determinant. Although temporary immunosuppressant dose reduction might not reduce mortality, it was associated with a minimal risk of acute rejection during the two-year follow-up. Our results suggest that early immunosuppressant reduction in RTRs with severe pneumonia of indeterminate microbiology may be safe even when pathogens are bacterial in nature.

Failure to Rescue, Rescue Surgery and Centralization of Postoperative Complications: A Challenge for General and Acute Care Surgeons.

PubMed

Zago, Mauro; Bozzo, Samantha; Carrara, Giulia; Mariani, Diego

2017-01-01

To explore the current literature on the failure to rescue and rescue surgery concepts, to identify the key items for decreasing the failure to rescue rate and improve outcome, to verify if there is a rationale for centralization of patients suffering postoperative complications. There is a growing awareness about the need to assess and measure the failure to rescue rate, on institutional, regional and national basis. Many factors affect failure to rescue, and all should be individually analyzed and considered. Rescue surgery is one of these factors. Rescue surgery assumes an acute care surgery background. Measurement of failure to rescue rate should become a standard for quality improvement programs. Implementation of all clinical and organizational items involved is the key for better outcomes. Preparedness for rescue surgery is a main pillar in this process. Centralization of management, audit, and communication are important as much as patient centralization. Celsius.

Failure Rates of Orthodontic Fixed Lingual Retainers bonded with Two Flowable Light-cured Adhesives: A Comparative Prospective Clinical Trial.

PubMed

Talic, Nabeel F

2016-08-01

This comparative prospective randomized clinical trial examined the in vivo failure rates of fixed mandibular and maxillary lingual retainers bonded with two light-cured flowable composites over 6 months. Consecutive patients were divided into two groups on a 1:1 basis. Two hundred fixed lingual retainers were included, and their failures were followed for 6 months. One group (n = 50) received retainers bonded with a nano-hybrid composite based on nano-optimized technology (Tetric-N-Flow, Ivoclar Vivadent). Another group (n = 50) received retainers bonded with a low viscosity (LV) composite (Transbond Supreme LV, 3M Unitek). There was no significant difference between the overall failure rates of mandibular retainers bonded with Transbond (8%) and those bonded with Tetric-N-Flow (18%). However, the odds ratio for failure using Tetric-N-flow was 2.52-fold greater than that of Transbond. The failure rate of maxillary retainers bonded with Transbond was higher (14%), but not significantly different, than that of maxillary retainers bonded with Tetric-N-flow (10%). There was no significant difference in the estimated mean survival times of the maxillary and mandibular retainers bonded with the two composites. Both types of composites tested in the current study can be used to bond fixed maxillary and mandibular lingual retainers, with low failure rates.

[Therapy of heart failure with beta-blockers?].

PubMed

Osterziel, K J; Dietz, R

1997-01-01

In heart failure the chronic sympathetic stimulation alters the cardiac beta-adrenergic pathway. This alteration leads to a diminished contractile response to stimulation of the cardiac beta 1 receptor. A blockade of the beta 1 receptor partly restores the physiologic response to sympathetic stimulation at rest and during exercise. Several mechanisms resulting from the competitive blockade of the beta 1 receptor may be important. The major effect of beta-blockers seems to be triggered by a reduction of the heart rate at rest resulting in an increase of the left ventricular ejection fraction on the average by 7-8%. Patients with heart failure who are treated with a beta-blocker experience initially a slight decrease of the left ventricular function. beta-blocker therapy should therefore be initiated only in patients with stable heart failure. The starting dose of the beta-blocker has to be very small, e.g, 5 mg Metoprolol, 1.25 mg Bisoprolol or 3.125 mg Carvedilol. In a stepwise fashion the dose has to be increased to a full beta blocking effect over a period of 4-8 weeks. Despite a careful dose titration only 90% of the patients tolerate this regimen. Patients with high resting heart rates and/or dilated cardiomyopathy will have the greatest benefit. The two main reasons for withdrawal of the beta-blocker are deterioration of heart failure or symptomatic hypotension. Symptomatic improvement and a significant increase of exercise capacity appear gradually and can be measured only after more than 1 month duration of therapy. Three multicenter studies (MDC. CIBIS I, Carvedilol) evaluated the influence of beta-blockers on prognosis of heart failure. The MDC trial demonstrated a slower progression of heart failure with Metoprolol. The MDC and the CIBIS I trial could not show a significant improvement of prognosis. The larger trial with carvedilol was the first study to demonstrate a decreased mortality in patients who initially tolerate the beta-blocker therapy. One major concern in that study is the evaluation and classification of patients in the run-in phase who do not tolerate the beta-blocker. Definite studies (BEST, CIBIS II; COMET; RESOLVED; MERIT) are designed to answer these problems and to evaluate the effect of beta-blockers on mortality. Until the results of these studies are available the main goal of treatment with beta-blockers remains symptomatic improvement. Further, there is good evidence for an additional increase in life expectancy. In order to achieve optimal medical treatment and to avoid side-effects careful clinical evaluation and management of the patients is mandatory during therapy with beta-blockers.

Sensitivity analysis by approximation formulas - Illustrative examples. [reliability analysis of six-component architectures

NASA Technical Reports Server (NTRS)

White, A. L.

1983-01-01

This paper examines the reliability of three architectures for six components. For each architecture, the probabilities of the failure states are given by algebraic formulas involving the component fault rate, the system recovery rate, and the operating time. The dominant failure modes are identified, and the change in reliability is considered with respect to changes in fault rate, recovery rate, and operating time. The major conclusions concern the influence of system architecture on failure modes and parameter requirements. Without this knowledge, a system designer may pick an inappropriate structure.

[Assessment of chronic glucose metabolism disorders coexisting with respiratory failure in non-critical ill patients hospitalized with lower respiratory tract infections].

PubMed

Sobocińska, Magdalena Barbara; Loba, Jerzy

2015-01-01

Lungs are the target organ in chronic hyperglycemia, but its large reserves causes a subclinical course of these changes. Given the results of other researchers indicating reduced active surface of gas exchange and pulmonary capillary damage, it can be assumed that diabetes and other hyperglycemic states diminish these reserves and impair effectiveness of respiratory gas exchange during pneumonia. So it is plausible to observe coexistence of glucose metabolism disorders and respiratory failure in patients hospitalized with lower respiratory tract infection. An observational study was conducted on 130 patients hospitalized with bacteriologically confirmed pneumonia. 63 patients suffering from chronic glucose metabolism disorders (A) and 67 randomly selected patients in control group (B) were observed on laboratory and clinical findings. There was no significant difference in prevalence of acute respiratory failure, although in the study group a slightly greater number of patients diagnosed with acute respiratory failure was observed. There was a significantly greater number of patients with previously confirmed chronic respiratory failure using long-term oxygen theraphy in A group (p = 0.029). The B patients with average blood glucose level > 108 mg/dl had significantly lower partial pressure of oxygen (PaO2)(gIc ≤ 108: 58.6 +/- 9.8; glc > 108: 51.7 +/- 11.1; p = 0.042). There was a statistically significant negative correlation of the average blood glucose level and PaO2 in the control group (p = 0.0152) and a significant inverse association between the average blood glucose level and the partial pressure of oxygen in patients without COPD belonging to the control group (p = 0.049). Respiratory failure is frequent in patients hospitalized with pneumonia. In patients without chronic glucose metabolism disorders with blood glucose level rising the oxygen tension decreases The association is stronger in patients without COPD.

Hemodynamic-guided heart-failure management using a wireless implantable sensor: Infrastructure, methods, and results in a community heart failure disease-management program.

PubMed

Jermyn, Rita; Alam, Amit; Kvasic, Jessica; Saeed, Omar; Jorde, Ulrich

2017-03-01

The real-world impact of remote pulmonary artery pressure (PAP) monitoring on New York Heart Association (NYHA) class improvement and heart failure (HF) hospitalization rate is presented here from a single center. METHODS: Seventy-seven previously hospitalized outpatients with NYHA class III HF were offered PAP monitoring via device implantation in a multidisciplinary HF-management program. Prospective effectiveness analyses compared outcomes in 34 hemodynamically monitored patients to a group of similar patients (n = 32) who did not undergo device implantation but received usual care. NYHA class and 6-minute walk testing were assessed at baseline and 90 days. All hospitalizations were collected after 6 months of the implantation date (average follow-up, 15 months) and compared with the number of hospitalizations experienced prior to hemodynamic monitoring. Patients in both groups had similar distributions of age, sex, and ejection fraction. After 90 days, 61.8% of the monitored patients had NYHA class improvement of ≥1, compared with 12.5% in the controls (P < 0.001). Distance walked in 6 minutes increased by 54.5 meters in the monitored group (253.0 ± 25.6 meters to 307.4 ± 26.3 meters; P < 0.005), whereas no change was seen in the usual-care group. After implantation, 19.4% of the monitored group had ≥1 HF hospitalization, compared with 100% who had been hospitalized in the year prior to implantation. The monitored group had a significantly lower HF hospitalization rate (0.16; 95% confidence interval: 0.06-0.35 hospitalizations/patient-year) compared with the year prior (1.0 hospitalizations/patient-year; P < 0.001). Hemodynamic-guided HF management leads to significant improvements in NYHA class and HF hospitalization rate in a real-world setting compared with usual care delivered in a comprehensive disease-management program. © 2016 Wiley Periodicals, Inc.

Sports Participation, Functional Outcome, and Complications After Ankle Arthrodesis: Midterm Follow-up.

PubMed

Kerkhoff, Yvonne R A; Keijsers, Noël L W; Louwerens, Jan Willem K

2017-10-01

Ankle arthrodesis provides satisfactory functional outcome based on basic daily activities, but information regarding more demanding tasks is limited. Also, studies reporting longer term survival and complication rates are sparse and concern small study populations. This study reports functional outcome with more focus on demanding tasks and sports and reports the mid- to long-term union and complication rates in a large study population. Between 2005 and 2010, an ankle arthrodesis was performed on 185 ankles. Clinical results were retrospectively assessed with the Foot Function Index (FFI), visual analog scale (VAS) for pain, and the Foot and Ankle Ability Measure (FAAM). Information regarding sports pre- and postoperatively was obtained through a questionnaire. In addition, postoperative complications, reoperations, and failures (defined as nonunion of the ankle arthrodesis) were determined. Mean follow-up time was 8 years. FFI scores significantly improved, the FAAM ADL score was 70%, and the mean VAS for pain at the ankle/hindfoot at follow-up was 20. Sports participation slightly diminished from 79.5% prior to the onset of disabling complaints to 68.9% postoperatively. Of the patients, 73.1% were able to hike with a median hiking time of 40 minutes (range, 2-600 minutes). Kneeling could be performed on average 10 minutes (range, 2-60 minutes) in 39.8% and jumping down from steps by 23.5% of the patients. A small selection of patients was able to sprint (14%), and 16.8% of the patients were able to run a median distance of 60 meters (range, 3-1000 meters). Failure occurred in 9.2% and other postoperative complications were present in 21.6%, requiring reoperation in 8.6% of the cases. Ankle arthrodesis led to satisfactory functional outcome and pain reduction. Most patients remained active in sports, but a transition to less demanding sporting activities was seen. The complication and failure rates were similar with previous literature, and the incidence of nonrevision secondary surgery was relatively low. Level III, retrospective comparative study.

Remote operation of an orbital maneuvering vehicle in simulated docking maneuvers

NASA Technical Reports Server (NTRS)

Brody, Adam R.

1990-01-01

Simulated docking maneuvers were performed to assess the effect of initial velocity on docking failure rate, mission duration, and delta v (fuel consumption). Subjects performed simulated docking maneuvers of an orbital maneuvering vehicle (OMV) to a space station. The effect of the removal of the range and rate displays (simulating a ranging instrumentation failure) was also examined. Naive subjects were capable of achieving a high success rate in performing simulated docking maneuvers without extensive training. Failure rate was a function of individual differences; there was no treatment effect on failure rate. The amount of time subjects reserved for final approach increased with starting velocity. Piloting of docking maneuvers was not significantly affected in any way by the removal of range and rate displays. Radial impulse was significant both by subject and by treatment. NASA's 0.1 percent rule, dictating an approach rate no greater than 0.1 percent of the range, is seen to be overly conservative for nominal docking missions.

Analysis of factors affecting failure of glass cermet tunnel restorations in a multi-center study.

PubMed

Pilebro, C E; van Dijken, J W

2001-06-01

The aim of this study was to analyze factors influencing the failures of tunnel restorations performed with a glass cermet cement (Ketac Silver). Caries activity, lesion size, tunnel cavity opening size, partial or total tunnel, composite lamination or operating time showed no significant correlation to failure rate. Twelve dentists in eight clinics clinically experienced and familiar with the tunnel technique placed 374 restorations. The occlusal sections of fifty percent of the restorations were laminated with hybrid resin composite. The results of the yearly clinical and radiographic evaluations over the course of 3 years were correlated to factors that could influence the failure rate using logistic regression analysis. At the 3-year recall a cumulative number of 305 restorations were available. The cumulative replacement rate was 20%. The main reasons for replacement were marginal ridge fracture (14%) and dentin caries (3%). Another 7% of the restorations which had not been replaced were classified as failures because of untreated dentin caries. The only significant variable observed was the individual failure rate of the participating dentists varying between 9 and 50% (p=0.013).

Increase in hospital admission rates for heart failure in The Netherlands, 1980-1993.

PubMed Central

Reitsma, J. B.; Mosterd, A.; de Craen, A. J.; Koster, R. W.; van Capelle, F. J.; Grobbee, D. E.; Tijssen, J. G.

1996-01-01

OBJECTIVE: To study the trend in hospital admission rates for heart failure in the Netherlands from 1980 to 1993. DESIGN: All hospital admissions in the Netherlands with a principal discharge diagnosis of heart failure were analysed. In addition, individual records of heart failure patients from a subset of 7 hospitals were analysed to estimate the frequency and timing of readmissions. RESULTS: The total number of discharges for men increased from 7377 in 1980 to 13 022 in 1993, and for women from 7064 to 12 944. From 1980 through 1993 age adjusted discharge rates rose 48% for men and 40% for women. Age adjusted in-hospital mortality for heart failure decreased from 19% in 1980 to 15% in 1993. For all age groups in-hospital mortality for men was higher than for women. The mean length of hospital admissions in 1993 was 14.0 days for men and 16.4 days for women. A review of individual patient records from a 6.3% sample of all hospital admissions in the Netherlands indicated that within a 2 year period 18% of the heart failure patients were admitted more than once and 5% more than twice. CONCLUSIONS: For both men and women a pronounced increase in age adjusted discharge rates for heart failure was observed in the Netherlands from 1980 to 1993. Readmissions were a prominent feature among heart failure patients. Higher survival rates after acute myocardial infarction and the longer survival of patients with heart disease, including heart failure may have contributed to the observed increase. The importance of advances in diagnostic tools and of possible changes in admission policy remain uncertain. PMID:8944582

First time description of early lead failure of the Linox Smart lead compared to other contemporary high-voltage leads.

PubMed

Weberndörfer, Vanessa; Nyffenegger, Tobias; Russi, Ian; Brinkert, Miriam; Berte, Benjamin; Toggweiler, Stefan; Kobza, Richard

2018-05-01

Early lead failure has recently been reported in ICD patients with Linox SD leads. We aimed to compare the long-term performance of the following lead model Linox Smart SD with other contemporary high-voltage leads. All patients receiving high-voltage leads at our center between November 2009 and May 2017 were retrospectively analyzed. Lead failure was defined as the occurrence of one or more of the following: non-physiological high-rate episodes, low- or high-voltage impedance anomalies, undersensing, or non-capture. In total, 220 patients were included (Linox Smart SD, n = 113; contemporary lead, n = 107). During a median follow-up of 3.8 years (IQR 1.6-5.9 years), a total of 16 (14 in Linox Smart SD and 2 in contemporary group) lead failures occurred, mostly due to non-physiological high-rate sensing or impedance abnormalities. Lead failure incidence rates per 100 person-years were 2.9 (95% CI 1.7-4.9) and 0.6 (95% CI 0.1-2.3) for Linox Smart SD compared to contemporary leads respectively. Kaplan Meier estimates of 5-year lead failure rates were 14.0% (95% CI 8.1-23.6%) and 1.3% (95% CI 0.2-8.9%), respectively (log-rank p = 0.028). Implantation of a Linox Smart SD lead increased the risk of lead failure with a hazard ratio (HR) of 4.53 (95% CI 1.03-19.95, p = 0.046) and 4.44 (95% CI 1.00-19.77, p = 0.05) in uni- and multivariable Cox models. The new Linox Smart SD lead model was associated with high failure rates and should be monitored closely to detect early signs of lead failure.

Failure to activate the in-hospital emergency team: causes and outcomes.

PubMed

Barbosa, Vera; Gomes, Ernestina; Vaz, Senio; Azevedo, Gustavo; Fernandes, Gonçalo; Ferreira, Amélia; Araujo, Rui

2016-01-01

To determine the incidence of afferent limb failure of the in-hospital Medical Emergency Team, characterizing it and comparing the mortality between the population experiencing afferent limb failure and the population not experiencing afferent limb failure. A total of 478 activations of the Medical Emergency Team of Hospital Pedro Hispano occurred from January 2013 to July 2015. A sample of 285 activations was obtained after excluding incomplete records and activations for patients with less than 6 hours of hospitalization. The sample was divided into two groups: the group experiencing afferent limb failure and the group not experiencing afferent limb failure of the Medical Emergency Team. Both populations were characterized and compared. Statistical significance was set at p ≤ 0.05. Afferent limb failure was observed in 22.1% of activations. The causal analysis revealed significant differences in Medical Emergency Team activation criteria (p = 0.003) in the group experiencing afferent limb failure, with higher rates of Medical Emergency Team activation for cardiac arrest and cardiovascular dysfunction. Regarding patient outcomes, the group experiencing afferent limb failure had higher immediate mortality rates and higher mortality rates at hospital discharge, with no significant differences. No significant differences were found for the other parameters. The incidence of cardiac arrest and the mortality rate were higher in patients experiencing failure of the afferent limb of the Medical Emergency Team. This study highlights the need for health units to invest in the training of all healthcare professionals regarding the Medical Emergency Team activation criteria and emergency medical response system operations.

The failure of earthquake failure models

USGS Publications Warehouse

Gomberg, J.

2001-01-01

In this study I show that simple heuristic models and numerical calculations suggest that an entire class of commonly invoked models of earthquake failure processes cannot explain triggering of seismicity by transient or "dynamic" stress changes, such as stress changes associated with passing seismic waves. The models of this class have the common feature that the physical property characterizing failure increases at an accelerating rate when a fault is loaded (stressed) at a constant rate. Examples include models that invoke rate state friction or subcritical crack growth, in which the properties characterizing failure are slip or crack length, respectively. Failure occurs when the rate at which these grow accelerates to values exceeding some critical threshold. These accelerating failure models do not predict the finite durations of dynamically triggered earthquake sequences (e.g., at aftershock or remote distances). Some of the failure models belonging to this class have been used to explain static stress triggering of aftershocks. This may imply that the physical processes underlying dynamic triggering differs or that currently applied models of static triggering require modification. If the former is the case, we might appeal to physical mechanisms relying on oscillatory deformations such as compaction of saturated fault gouge leading to pore pressure increase, or cyclic fatigue. However, if dynamic and static triggering mechanisms differ, one still needs to ask why static triggering models that neglect these dynamic mechanisms appear to explain many observations. If the static and dynamic triggering mechanisms are the same, perhaps assumptions about accelerating failure and/or that triggering advances the failure times of a population of inevitable earthquakes are incorrect.

An Efficient Implementation of Fixed Failure-Rate Ratio Test for GNSS Ambiguity Resolution.

PubMed

Hou, Yanqing; Verhagen, Sandra; Wu, Jie

2016-06-23

Ambiguity Resolution (AR) plays a vital role in precise GNSS positioning. Correctly-fixed integer ambiguities can significantly improve the positioning solution, while incorrectly-fixed integer ambiguities can bring large positioning errors and, therefore, should be avoided. The ratio test is an extensively used test to validate the fixed integer ambiguities. To choose proper critical values of the ratio test, the Fixed Failure-rate Ratio Test (FFRT) has been proposed, which generates critical values according to user-defined tolerable failure rates. This contribution provides easy-to-implement fitting functions to calculate the critical values. With a massive Monte Carlo simulation, the functions for many different tolerable failure rates are provided, which enriches the choices of critical values for users. Moreover, the fitting functions for the fix rate are also provided, which for the first time allows users to evaluate the conditional success rate, i.e., the success rate once the integer candidates are accepted by FFRT. The superiority of FFRT over the traditional ratio test regarding controlling the failure rate and preventing unnecessary false alarms is shown by a simulation and a real data experiment. In the real data experiment with a baseline of 182.7 km, FFRT achieved much higher fix rates (up to 30% higher) and the same level of positioning accuracy from fixed solutions as compared to the traditional critical value.

Electronics Reliability Fracture Mechanics, Volume 1. Causes of Failures of Shop Replaceable Units and Hybrid Microcircuits

DTIC Science & Technology

1992-05-01

Plate Figure H-1. Temperature Coefficient Test Circuit The forward voltage was measured at 3 different termperatures. The average TC was calculated to be...AT, rather than the average figure given by the large area Isolation diffusion. The peak temperature , rather than the average temperature , is the...components would cause the temperatures of the components to be nearer the average , particularly those near the minimum and maximum. X-I The largest

Applying the payoff time framework to carotid artery disease management.

PubMed

Yuo, Theodore H; Roberts, Mark S; Braithwaite, R Scott; Chang, Chung-Chou H; Kraemer, Kevin L

2013-11-01

and Asymptomatic stenosis of the carotid arteries is associated with stroke. Carotid revascularization can reduce the future risk of stroke but can also trigger an immediate stroke. The objective was to model the generic relationship between immediate risk, long-term benefit, and life expectancy for any one-time prophylactic treatment and then apply the model to the use of revascularization in the management of asymptomatic carotid disease. In the "payoff time" framework, the possibility of losing quality-adjusted life-years (QALYs) because of revascularization failure is conceptualized as an "investment" that is eventually recouped over time, on average. Using this framework, we developed simple mathematical forms that define relationships between the following: perioperative probability of stroke (P); annual stroke rate without revascularization (r0); annual stroke rate after revascularization, conditional on not having suffered perioperative stroke (r1); utility levels assigned to the asymptomatic state (ua) and stroke state (us); and mortality rates (λ). In patients whose life expectancy is below a critical life expectancy (CLE = P/(1-P)r0-r1, the "investment" will never pay off, and revascularization will lead to loss of QALYs, on average. CLE is independent of utilities assigned to the health states if a rank ordering exists in which ua > us. For clinically relevant values (P = 3%, r0 = 1%, r1 = 0.5%), the CLE is approximately 6.4 years, which is longer than published guidelines regarding patient selection for revascularization. In managing asymptomatic carotid disease, the payoff time framework specifies a CLE beneath which patients, on average, will not benefit from revascularization. This formula is suitable for clinical use at the patient's bedside and can account for patient variability, the ability of clinicians who perform revascularization, and the particular revascularization technology that is chosen.

Promotion of artery occlusion in dogs by percutaneous rotational atherectomy.

PubMed

Hou, Chuan-Ju; Zhang, Duan-Zhen; Wang, Qi-Guang; Cui, Chun-Sheng; Kuang, Li; Chen, Bing; Wang, Yang

2014-07-01

This study aims to offer experimental data and indirect evidences for the application of percutaneous rotational atherectomy to treat patent ductus arteriosus (PDA). Eleven dogs (6 male dogs and 5 female dogs; aged 14-20 months, with an average of 16.7±3.2 months; weight 20-25 kg, with an average of 22.7±2.5 kg) were enrolled in this study. The diameters of the left and right arteries ranged from 3.2 to 4.8 mm (average 3.9±0.6 mm) on percutaneous angiography. Percutaneous rotational atherectomy with proper rotablator (the size was 1-1.5 mm larger than the artery diameter) was performed in the arterial intima. After 4 weeks from percutaneous rotational atherectomy, arteriography was conducted to observe the changes in artery diameter. Then all dogs were sacrificed and the pathologic examination was conducted on the left and right axillary arteries. There were obvious changes with different degrees in 22 arteries, including 8 arteries with complete occlusion and 12 arteries with stenosis (≥2/3, 1/2, and 1/3 stenosis in 4, 4, and 4 arteries, respectively). The occlusion rate was 36.4% and the total effective rate was 90.9%. It was considered failure in other 2 arteries with <1/3 of stenosis. Percutaneous rotational atherectomy of arterial intima can promote the occlusion of arteries. This has provided a new choice for the treatment of PDA. Copyright © 2014 Elsevier Inc. All rights reserved.

Microcircuit Device Reliability. Digital Failure Rate Data

DTIC Science & Technology

1981-01-01

Center Staff I IT Research Institute Under Contract to: Rome Air Development Center Griffiss AFB, NY 13441 fortes Ordering No. MDR- 17 biKi frbi...r ■■ ■—■ — SECURITY CLASSIFICATION Or THIS PAGE (Whin Dmlm Enlti»<l) REPORT DOCUMENTATION PAGE «EPO«TNUMBER MDR- 17 4. TITLE (md...MDR- 17 presents com- parisons between actual field experienced failure rates and MIL-HDBK-217C, Notice 1, predicted failure rates. The use of

Infraclavicular versus axillary nerve catheters: A retrospective comparison of early catheter failure rate.

PubMed

Quast, Michaela B; Sviggum, Hans P; Hanson, Andrew C; Stoike, David E; Martin, David P; Niesen, Adam D

2018-05-01

Continuous brachial plexus catheters are often used to decrease pain following elbow surgery. This investigation aimed to assess the rate of early failure of infraclavicular (IC) and axillary (AX) nerve catheters following elbow surgery. Retrospective study. Postoperative recovery unit and inpatient hospital floor. 328 patients who received IC or AX nerve catheters and underwent elbow surgery were identified by retrospective query of our institution's database. Data collected included unplanned catheter dislodgement, catheter replacement rate, postoperative pain scores, and opioid administration on postoperative day 1. Catheter failure was defined as unplanned dislodging within 24 h of placement or requirement for catheter replacement and evaluated using a covariate adjusted model. 119 IC catheters and 209 AX catheters were evaluated. There were 8 (6.7%) failed IC catheters versus 13 (6.2%) failed AX catheters. After adjusting for age, BMI, and gender there was no difference in catheter failure rate between IC and AX nerve catheters (p = 0.449). These results suggest that IC and AX nerve catheters do not differ in the rate of early catheter failure, despite differences in anatomic location and catheter placement techniques. Both techniques provided effective postoperative analgesia with median pain scores < 3/10 for patients following elbow surgery. Reasons other than rate of early catheter failure should dictate which approach is performed. Copyright © 2018. Published by Elsevier Inc.

The Advanced Glaucoma Intervention Study (AGIS): 13. Comparison of treatment outcomes within race: 10-year results.

PubMed

Ederer, Fred; Gaasterland, Douglas A; Dally, Leonard G; Kim, Jonghyeon; VanVeldhuisen, Paul C; Blackwell, Beth; Prum, Bruce; Shafranov, George; Allen, Robert C; Beck, Allen

2004-04-01

To present for black and white patients with medically uncontrolled glaucoma 10-year results of treatment with 1 of 2 randomly assigned surgical intervention sequences. Randomized clinical trial. Three hundred thirty-two black patients (451 eyes) and 249 white patients (325 eyes). Eyes had glaucoma that could not be controlled with medications alone. Eyes were randomly assigned to 1 of 2 sequences: argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy (ATT) or trabeculectomy-ALT-trabeculectomy (TAT). Second and third interventions were offered after failure of the preceding intervention. Minimum required intraocular pressure (IOP) for intervention failure ranged upward from 18 mmHg, the value depending on whether recent optic disc or visual field (VF) deterioration occurred, and on the magnitude of the field defect. Patients were observed every 6 months, with total potential follow-up ranging from 8 years, 4 months to 13 years. The averages over follow-up of (1) the percentage of eyes having moderate loss of VF and (2) the percentage of eyes having moderate loss of visual acuity (VA). Race-treatment interactions in VF and VA loss are significant for the 2 main outcome measures; therefore, results of treatment sequence differences are presented by race. In black patients the average percent of eyes with VF loss was less in the ATT sequence than in the TAT sequence, a difference that is not statistically significant at any visit. In white patients, conversely, after 18 months the average percent of eyes with VF loss was less in the TAT sequence, a difference that increases and is statistically significant in years 8 to 10. In both black and white patients, the average percent of eyes with VA loss was less in the ATT sequence; this difference is statistically significant throughout 10 follow-up years in black patients and is statistically significant only for the first year in white patients. In both black and white patients, average IOP reductions were greater in the TAT sequence, though the TAT-ATT difference was substantially greater in white patients. In both black and white patients, first-intervention failure rates were substantially lower for trabeculectomy than for trabeculoplasty. Ten-year cumulative incidence of unilateral VF impairment comparable to legal blindness was modest in eyes of black (ATT 11.9%, TAT 18.5%) and white (ATT 9.9%, TAT 7.3%) patients. Although IOP was lowered in both sequences in black and white patients with medically uncontrolled glaucoma, long-term visual function outcomes were better for the ATT sequence in black patients and better for the TAT sequence in white patients.

National trends in rates of death and hospital admissions related to acute myocardial infarction, heart failure and stroke, 1994–2004

PubMed Central

Tu, Jack V.; Nardi, Lorelei; Fang, Jiming; Liu, Juan; Khalid, Laila; Johansen, Helen

2009-01-01

Background Rates of death from cardiovascular and cerebrovascular diseases have been steadily declining over the past few decades. Whether such declines are occurring to a similar degree for common disorders such as acute myocardial infarction, heart failure and stroke is uncertain. We examined recent national trends in mortality and rates of hospital admission for these 3 conditions. Methods We analyzed mortality data from Statistic Canada’s Canadian Mortality Database and data on hospital admissions from the Canadian Institute for Health Information’s Hospital Morbidity Database for the period 1994–2004. We determined age- and sex-standardized rates of death and hospital admissions per 100 000 population aged 20 years and over as well as in-hospital case-fatality rates. Results The overall age- and sex-standardized rate of death from cardiovascular disease in Canada declined 30.0%, from 360.6 per 100 000 in 1994 to 252.5 per 100 000 in 2004. During the same period, the rate fell 38.1% for acute myocardial infarction, 23.5% for heart failure and 28.2% for stroke, with improvements observed across most age and sex groups. The age- and sex-standardized rate of hospital admissions decreased 27.6% for stroke and 27.2% for heart failure. The rate for acute myocardial infarction fell only 9.2%. In contrast, the relative decline in the inhospital case-fatality rate was greatest for acute myocardial infarction (33.1%; p < 0.001). Much smaller relative improvements in case-fatality rates were noted for heart failure (8.1%) and stroke (8.9%). Interpretation The rates of death and hospital admissions for acute myocardial infarction, heart failure and stroke in Canada changed at different rates over the 10-year study period. Awareness of these trends may guide future efforts for health promotion and health care planning and help to determine priorities for research and treatment. PMID:19546444

Using Generic Data to Establish Dormancy Failure Rates

NASA Technical Reports Server (NTRS)

Reistle, Bruce

2014-01-01

Many hardware items are dormant prior to being operated. The dormant period might be especially long, for example during missions to the moon or Mars. In missions with long dormant periods the risk incurred during dormancy can exceed the active risk contribution. Probabilistic Risk Assessments (PRAs) need to account for the dormant risk contribution as well as the active contribution. A typical method for calculating a dormant failure rate is to multiply the active failure rate by a constant, the dormancy factor. For example, some practitioners use a heuristic and divide the active failure rate by 30 to obtain an estimate of the dormant failure rate. To obtain a more empirical estimate of the dormancy factor, this paper uses the recently updated database NPRD-2011 [1] to arrive at a set of distributions for the dormancy factor. The resulting dormancy factor distributions are significantly different depending on whether the item is electrical, mechanical, or electro-mechanical. Additionally, this paper will show that using a heuristic constant fails to capture the uncertainty of the possible dormancy factors.

Accounting for Epistemic Uncertainty in Mission Supportability Assessment: A Necessary Step in Understanding Risk and Logistics Requirements

NASA Technical Reports Server (NTRS)

Owens, Andrew; De Weck, Olivier L.; Stromgren, Chel; Goodliff, Kandyce; Cirillo, William

2017-01-01

Future crewed missions to Mars present a maintenance logistics challenge that is unprecedented in human spaceflight. Mission endurance – defined as the time between resupply opportunities – will be significantly longer than previous missions, and therefore logistics planning horizons are longer and the impact of uncertainty is magnified. Maintenance logistics forecasting typically assumes that component failure rates are deterministically known and uses them to represent aleatory uncertainty, or uncertainty that is inherent to the process being examined. However, failure rates cannot be directly measured; rather, they are estimated based on similarity to other components or statistical analysis of observed failures. As a result, epistemic uncertainty – that is, uncertainty in knowledge of the process – exists in failure rate estimates that must be accounted for. Analyses that neglect epistemic uncertainty tend to significantly underestimate risk. Epistemic uncertainty can be reduced via operational experience; for example, the International Space Station (ISS) failure rate estimates are refined using a Bayesian update process. However, design changes may re-introduce epistemic uncertainty. Thus, there is a tradeoff between changing a design to reduce failure rates and operating a fixed design to reduce uncertainty. This paper examines the impact of epistemic uncertainty on maintenance logistics requirements for future Mars missions, using data from the ISS Environmental Control and Life Support System (ECLS) as a baseline for a case study. Sensitivity analyses are performed to investigate the impact of variations in failure rate estimates and epistemic uncertainty on spares mass. The results of these analyses and their implications for future system design and mission planning are discussed.

A prospective study on the impact of heart rate control achieved with metoprolol on cardiac performance, motor function and quality of life in Chinese chronic heart failure patients.

PubMed

Meng, Yong; Liu, Xuelu; Liu, Juan; Cheng, Xianliang

2017-01-15

To prospectively evaluate the impact of metoprolol achieved heart rate (HR) on cardiac-motor function and quality of life (QoL) in chronic heart failure (CHF) patients. Between February 2013 to April 2016, association of HR reduction with haemodynamic indices, motor function and QoL in CHF patients with HR>80bpm receiving metoprolol 23.75mg or 47.5mgq.d was studied. Overall, 154 patients (median age, 66.39years; males, n=101; females, n=53) were enrolled, whose average resting HR decreased significantly from baseline value of 82.72±6.73 to 69.38±3.57, 67.72±2.61, 66.50±3.14 and 64.86±3.21bpm in the 1st, 3rd, 6th and 12th months post metoprolol intervention, respectively (P<0.0001). Similarly, the ejection fraction (r=-0.6461, P<0.0001), cardiac output (r=-0.5238, P<0.0001), cardiac index (r=-0.5378, P<0.0001) and veterans specific activity questionnaire scores (r=-0.4088, P<0.0001) were significantly associated with the reduction in HR after 12months. The improvement in 6-min walk test was independent of HR reduction (P=0.005). Similarly, QoL as measured by short form-8 questionnaire (SF-8) but not Minnesota Living with Heart Failure was significantly improved at the 12th-month. However, this was not associated with the reductions in HR. Metoprolol achieved HR control was associated with improvement in cardiac performance and motor function but not QoL in patients with CHF. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Presurgical motor, somatosensory and language fMRI: Technical feasibility and limitations in 491 patients over 13 years.

PubMed

Tyndall, Anthony J; Reinhardt, Julia; Tronnier, Volker; Mariani, Luigi; Stippich, Christoph

2017-01-01

To analyse the long-term feasibility and limitations of presurgical fMRI in a cohort of tumour and epilepsy patients with different MR-scanners at 1.5 and 3.0 T. Four hundred and ninety-one consecutive patients undergoing presurgical fMRI between 2000 and 2012 on five different MR-scanners using established paradigms and semi-automated data processing were included. Success rates of task performance and BOLD-activation were determined for motor and somatosensory somatotopic mapping and language localisation. Procedural success, failures and imaging artifacts were analysed. MR-field strengths were compared. Two thousand three hundred fifteen of 2348 (98.6 %) attempted paradigms (1033 motor, 1220 speech, 95 somatosensory) were successfully performed. 100 paradigms (4.3 %) were repetition runs. 23 speech, 6 motor and 2 sensory paradigms failed for non-compliance and technical issues. Most language paradigm failures were noted in overt sentence generation. Average significant BOLD-activation was higher for motor than language paradigms (95.8 vs. 81.6 %). Most language paradigms showed significantly higher activation rates at 3 T compared to 1.5 T, whereas no significant difference was found for motor paradigms. fMRI proved very robust for the presurgical localisation of the different motor and somatosensory body representations, as well as Broca's and Wernicke's language areas across different MR-scanners at 1.5 and 3.0 T over 13 years. • Standardised presurgical motor and language fMRI is robust across various MRI platforms. • Motor fMRI is less dependent on field strength than language fMRI. • fMRI task failures are relatively low and are reduced by paradigm repetition.

Long-term effects of oxygen-enriched high-flow nasal cannula treatment in COPD patients with chronic hypoxemic respiratory failure.

PubMed

Storgaard, Line Hust; Hockey, Hans-Ulrich; Laursen, Birgitte Schantz; Weinreich, Ulla Møller

This study investigated the long-term effects of humidified high-flow nasal cannula (HFNC) in COPD patients with chronic hypoxemic respiratory failure treated with long-term oxygen therapy (LTOT). A total of 200 patients were randomized into usual care ± HFNC. At inclusion, acute exacerbation of COPD (AECOPD) and hospital admissions 1 year before inclusion, modified Medical Research Council (mMRC) score, St George's Respiratory Questionnaire (SGRQ), forced expiratory volume in 1 second (FEV 1 ), 6-minute walk test (6MWT) and arterial carbon dioxide (PaCO 2 ) were recorded. Patients completed phone interviews at 1, 3 and 9 months assessing mMRC score and AECOPD since the last contact. At on-site visits (6 and 12 months), mMRC, number of AECOPD since last contact and SGRQ were registered and FEV 1 , FEV 1 %, PaCO 2 and, at 12 months, 6MWT were reassessed. Hospital admissions during the study period were obtained from hospital records. Hours of the use of HFNC were retrieved from the high-flow device. The average daily use of HFNC was 6 hours/day. The HFNC group had a lower AECOPD rate (3.12 versus 4.95/patient/year, p <0.001). Modeled hospital admission rates were 0.79 versus 1.39/patient/year for 12- versus 1-month use of HFNC, respectively ( p <0.001). The HFNC group had improved mMRC scores from 3 months onward ( p <0.001) and improved SGRQ at 6 and 12 months ( p =0.002, p =0.033) and PaCO 2 ( p =0.005) and 6MWT ( p =0.005) at 12 months. There was no difference in all-cause mortality. HFNC treatment reduced AECOPD, hospital admissions and symptoms in COPD patients with hypoxic failure.

Features and prognostic factors for elderly with acute poisoning in the emergency department.

PubMed

Hu, Yu-Hui; Chou, Hsiu-Ling; Lu, Wen-Hua; Huang, Hsien-Hao; Yang, Cheng-Chang; Yen, David H T; Kao, Wei-Fong; Deng, Jou-Fan; Huang, Chun-I

2010-02-01

Elderly persons with acute poisoning in the emergency department (ED) and prognostic factors of outcomes have not been well addressed in previous research. This study aimed to investigate the characteristics of elderly patients with acute poisoning visiting the ED, and to identify the possible predictive factors of mortality. Patients aged > or = 65 years with acute poisoning who visited the ED in Taipei Veterans General Hospital from January 1, 2006 through to September 30, 2008 were enrolled in the study. We collected demographic information on underlying diseases, initial presentations, causes and toxic substances, complications, dispositions, and outcomes. Analyses were conducted among different groups categorized according to age, suicide attempt, and outcome. Multiple logistic regression was applied to identify possible predictive clinical factors influencing mortality in the elderly with acute poisoning. A total of 250 patients were enrolled in the study, with a mean age of 77 years and male predominance. The most common cause of intoxication was unintentional poisoning. Medication accounted for 57.6% of poisonous substances, of which benzodiazepine was the most common drug, followed by warfarin. The overall mortality rate was 9.6%. The average length of stay in the ED increased significantly in the old (65-74 years), very old (75-84 years) and extremely old (> or = 85 years) groups. Suicide attempt patients experienced more complications including respiratory failure, aspiration pneumonia, hypotension and mortality. Three clinical predictive factors of mortality were identified: herbicide poisoning, hypotension and respiratory failure upon presentation. Our results demonstrated that elderly patients with acute poisoning had a mortality rate of 9.6%. Suicide attempts resulted in more serious complications. The risk factors for mortality were herbicide intoxication, hypotension and respiratory failure. Copyright 2010 Elsevier. Published by Elsevier B.V. All rights reserved.

Medical malpractice claims in relation to colorectal malignancy in the national health service.

PubMed

Markides, G A; Newman, C M

2014-01-01

Under the current increased financial constraints affecting the National Health Service (NHS), clinical negligence claims and associated compensations are constantly rising. Our aim was to identify the magnitude, trends and causes of malpractice claims in relation to a common pathology such as colorectal malignancy in the NHS. Data requests were submitted to the NHS Litigation Authority (NHSLA) and to the Medical Defence Union (MDU) and Medical Protection Society (MPS). Data were reviewed, categorized clinically and analysed in terms of causes and costs behind claims. Data from the MPS and MDU were unavailable. In all, 169 claims were identified from the NHSLA database between 2003 and 2012; 123 (73%) cases had been closed, 80 (65%) of which were successful. An increasing overall claim frequency and success rate were found over the last few years. Total litigation expenses were £8.6 million, with 39% paid out as legal expenses. The commonest cause of complaint in successful claims was in relation to diagnostic delays or failures (58%, £5.1 million), with a delay or failure by the clinician to take action in response to an abnormal investigation result being a major factor. The occurrence of peri-operative complications (20%, £1.6 million) was the second commonest cause. Average frequency and success rates of malpractice claims in secondary care in the NHS are rising, leading to significant overall payouts. The failure or delay in diagnosing colorectal malignancy or its postoperative complications is a common cause behind malpractice claims. Improvement in these areas could enhance patient care and reduce future claims. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

Ongoing right ventricular hemodynamics in heart failure: clinical value of measurements derived from an implantable monitoring system.

PubMed

Adamson, Philip B; Magalski, Anthony; Braunschweig, Frieder; Böhm, Michael; Reynolds, Dwight; Steinhaus, David; Luby, Allyson; Linde, Cecilia; Ryden, Lars; Cremers, Bodo; Takle, Teri; Bennett, Tom

2003-02-19

This study examined the characteristics of continuously measured right ventricular (RV) hemodynamic information derived from an implantable hemodynamic monitor (IHM) in heart failure patients. Hemodynamic monitoring might improve the day-to-day management of patients with chronic heart failure (CHF). Little is known about the characteristics of long-term hemodynamic information in patients with CHF or how such information relates to meaningful clinical events. Thirty-two patients with CHF received a permanent RV IHM system similar to a single-lead pacemaker. Right ventricular systolic and diastolic pressures, heart rate, and pressure derivatives were continuously measured for nine months without using the data for clinical decision-making or management of patients. Data were then made available to clinical providers, and the patients were followed up for 17 months. Pressure characteristics during optimal volume, clinically determined volume-overload exacerbations, and volume depletion events were examined. The effect of IHM on hospitalizations was examined using the patients' historical controls. Long-term RV pressure measurements had either marked variability or minimal time-related changes. During 36 volume-overload events, RV systolic pressures increased by 25 +/- 4% (p < 0.05) and heart rate increased by 11 +/- 2% (p < 0.05). Pressure increases occurred in 9 of 12 events 4 +/- 2 days before the exacerbations requiring hospitalization. Hospitalizations before using IHM data for clinical management averaged 1.08 per patient year and decreased to 0.47 per patient-year (57% reduction, p < 0.01) after hemodynamic data were used. Long-term ambulatory pressure measurements from an IHM may be helpful in guiding day-to-day clinical management, with a potentially favorable impact on CHF hospitalizations.

Rapid and safe learning of robotic gastrectomy for gastric cancer: multidimensional analysis in a comparison with laparoscopic gastrectomy.

PubMed

Kim, H-I; Park, M S; Song, K J; Woo, Y; Hyung, W J

2014-10-01

The learning curve of robotic gastrectomy has not yet been evaluated in comparison with the laparoscopic approach. We compared the learning curves of robotic gastrectomy and laparoscopic gastrectomy based on operation time and surgical success. We analyzed 172 robotic and 481 laparoscopic distal gastrectomies performed by single surgeon from May 2003 to April 2009. The operation time was analyzed using a moving average and non-linear regression analysis. Surgical success was evaluated by a cumulative sum plot with a target failure rate of 10%. Surgical failure was defined as laparoscopic or open conversion, insufficient lymph node harvest for staging, resection margin involvement, postoperative morbidity, and mortality. Moving average and non-linear regression analyses indicated stable state for operation time at 95 and 121 cases in robotic gastrectomy, and 270 and 262 cases in laparoscopic gastrectomy, respectively. The cumulative sum plot identified no cut-off point for surgical success in robotic gastrectomy and 80 cases in laparoscopic gastrectomy. Excluding the initial 148 laparoscopic gastrectomies that were performed before the first robotic gastrectomy, the two groups showed similar number of cases to reach steady state in operation time, and showed no cut-off point in analysis of surgical success. The experience of laparoscopic surgery could affect the learning process of robotic gastrectomy. An experienced laparoscopic surgeon requires fewer cases of robotic gastrectomy to reach steady state. Moreover, the surgical outcomes of robotic gastrectomy were satisfactory. Copyright © 2013 Elsevier Ltd. All rights reserved.

Improving the Estimates of International Space Station (ISS) Induced K-Factor Failure Rates for On-Orbit Replacement Unit (ORU) Supportability Analyses

NASA Technical Reports Server (NTRS)

Anderson, Leif F.; Harrington, Sean P.; Omeke, Ojei, II; Schwaab, Douglas G.

2009-01-01

This is a case study on revised estimates of induced failure for International Space Station (ISS) on-orbit replacement units (ORUs). We devise a heuristic to leverage operational experience data by aggregating ORU, associated function (vehicle sub -system), and vehicle effective' k-factors using actual failure experience. With this input, we determine a significant failure threshold and minimize the difference between the actual and predicted failure rates. We conclude with a discussion on both qualitative and quantitative improvements the heuristic methods and potential benefits to ISS supportability engineering analysis.

Intramedullary knee arthrodesis as a salvage procedure after failed total knee replacement.

PubMed

Panagiotopoulos, E; Kouzelis, A; Matzaroglou, Ch; Saridis, A; Lambiris, E

2006-12-01

Septic and aseptic loosening with or without extensive bone loss after total knee replacement are the most common indications for knee fusion. Both external fixation and intramedullary nailing can be used for the treatment, though the latter appears to be the method of choice for most patients. Nine patients were treated after a total knee replacement failure using intramedullary nailing. A long intramedullary nail with a proximal interlocking screw was used in five cases, and a customised nail was used in four cases. Successful fusion occurred in eight of nine patients (89%). Average time for the joint union was 6.5 months, and average operative blood loss was 860 ml. In two patients, iliac crest and patellar bone graft were also used. In conclusion, intramedullary nailing can give excellent results in achieving knee fusion after a failed knee replacement as it allows early weight bearing and at the same time offers stability, pain relief, and a high rate of union, even though the surgical technique is demanding.

Vulnerability of Quick Disconnect Connectors to Carbon Fibers

NASA Technical Reports Server (NTRS)

Meyers, J. A.

1979-01-01

Unprotected quick disconnect electrical connectors were exposed to fibers of 3mm, 7mm, and 12mm lengths. The average exposure to failure was determined. Results indicate that when the fiber length divided by the airgap is less than one, multiple fibers are required to bridge the gap, and the exposure time to failure rises rapidly.

Predicting Quarantine Failure Rates

PubMed Central

2004-01-01

Preemptive quarantine through contact-tracing effectively controls emerging infectious diseases. Occasionally this quarantine fails, however, and infected persons are released. The probability of quarantine failure is typically estimated from disease-specific data. Here a simple, exact estimate of the failure rate is derived that does not depend on disease-specific parameters. This estimate is universally applicable to all infectious diseases. PMID:15109418

High rate of virological failure and low rate of switching to second-line treatment among adolescents and adults living with HIV on first-line ART in Myanmar, 2005-2015

PubMed Central

Harries, Anthony D.; Kumar, Ajay M. V.; Oo, Myo Minn; Kyaw, Khine Wut Yee; Win, Than; Aung, Thet Ko; Min, Aung Chan; Oo, Htun Nyunt

2017-01-01

Background The number of people living with HIV on antiretroviral treatment (ART) in Myanmar has been increasing rapidly in recent years. This study aimed to estimate rates of virological failure on first-line ART and switching to second-line ART due to treatment failure at the Integrated HIV Care program (IHC). Methods Routinely collected data of all adolescent and adult patients living with HIV who were initiated on first-line ART at IHC between 2005 and 2015 were retrospectively analyzed. The cumulative hazard of virological failure on first-line ART and switching to second-line ART were estimated. Crude and adjusted hazard ratios were calculated using the Cox regression model to identify risk factors associated with the two outcomes. Results Of 23,248 adults and adolescents, 7,888 (34%) were tested for HIV viral load. The incidence rate of virological failure among those tested was 3.2 per 100 person-years follow-up and the rate of switching to second-line ART among all patients was 1.4 per 100 person-years follow-up. Factors associated with virological failure included: being adolescent; being lost to follow-up at least once; having WHO stage 3 and 4 at ART initiation; and having taken first-line ART elsewhere before coming to IHC. Of the 1032 patients who met virological failure criteria, 762 (74%) switched to second-line ART. Conclusions We found high rates of virological failure among one third of patients in the cohort who were tested for viral load. Of those failing virologically on first-line ART, about one quarter were not switched to second-line ART. Routine viral load monitoring, especially for those identified as having a higher risk of treatment failure, should be considered in this setting to detect all patients failing on first-line ART. Strategies also need to be put in place to prevent treatment failure and to treat more of those patients who are actually failing. PMID:28182786

Is rhythm-control superior to rate-control in patients with atrial fibrillation and diastolic heart failure?

PubMed

Kong, Melissa H; Shaw, Linda K; O'Connor, Christopher; Califf, Robert M; Blazing, Michael A; Al-Khatib, Sana M

2010-07-01

Although no clinical trial data exist on the optimal management of atrial fibrillation (AF) in patients with diastolic heart failure, it has been hypothesized that rhythm-control is more advantageous than rate-control due to the dependence of these patients' left ventricular filling on atrial contraction. We aimed to determine whether patients with AF and heart failure with preserved ejection fraction (EF) survive longer with rhythm versus rate-control strategy. The Duke Cardiovascular Disease Database was queried to identify patients with EF > 50%, heart failure symptoms and AF between January 1,1995 and June 30, 2005. We compared baseline characteristics and survival of patients managed with rate- versus rhythm-control strategies. Using a 60-day landmark view, Kaplan-Meier curves were generated and results were adjusted for baseline differences using Cox proportional hazards modeling. Three hundred eighty-two patients met the inclusion criteria (285 treated with rate-control and 97 treated with rhythm-control). The 1-, 3-, and 5-year survival rates were 93.2%, 69.3%, and 56.8%, respectively in rate-controlled patients and 94.8%, 78.0%, and 59.9%, respectively in rhythm-controlled patients (P > 0.10). After adjustments for baseline differences, no significant difference in mortality was detected (hazard ratio for rhythm-control vs rate-control = 0.696, 95% CI 0.453-1.07, P = 0.098). Based on our observational data, rhythm-control seems to offer no survival advantage over rate-control in patients with heart failure and preserved EF. Randomized clinical trials are needed to verify these findings and examine the effect of each strategy on stroke risk, heart failure decompensation, and quality of life.

Fatigue resistance of ultrathin CAD/CAM complete crowns with a simplified cementation process.

PubMed

Magne, Pascal; Carvalho, Adriana O; Bruzi, Greciana; Giannini, Marcelo

2015-10-01

Traditional tooth preparation for complete crowns requires a substantial amount of hard tissue reduction. This is in contrast with the principles of minimally invasive dentistry. An ultrathin complete crown preparation is proposed instead. The purpose of this in vitro study was to assess the fatigue resistance and failure mode of computer-aided design and computer-aided manufacturing (CAD/CAM) ultrathin complete molar crowns placed with self-adhesive cement. Different restorative materials (resin nanoceramic [RNC], feldspathic ceramic [FEL], and lithium disilicate [LD]) were compared. Forty-five extracted molars with a standardized crown preparation were restored with the Cerec 3 CAD/CAM system using FEL, LD, or RNC (n=15). FEL and LD restorations were etched with hydrofluoric acid and silanated. RNC restorations and all preparations were treated with airborne-particle abrasion. All restorations (thickness=0.7 mm) were cemented with RelyX Unicem II Automix cement and submitted to cyclic isometric loading, beginning with a load of 200 N (5000 cycles) and followed by stages of 400, 600, 800, 1000, 1200, and 1400 N at a maximum of 30 000 cycles each. The specimens were loaded until failure or for a maximum of 185 000 cycles. The failure mode was categorized as "catastrophic," "possibly reparable," or "reparable." The groups were compared using life table survival analysis (log rank test at α=.05). Previously published data from the same authors about traditional complete crowns (thickness 1.5 mm) using the same experimental design were included for comparison. All specimens survived the fatigue test until the 600 N step. RNC, LD, and FEL failed at an average load of 1014 N (1 survival), 1123 N (2 survivals), and 987 N (no survivals), and no difference in survival rate was found. No catastrophic failures were reported after the fatigue test. Comparison with previously published data showed that 1.5-mm thick complete crowns demonstrated higher survival rates than the ultrathin restorations, independent of the material. The fatigue resistance of ultrathin complete molar crowns (placed with a simplified cementation process) made of RNC, LD, and FEL was not significantly different. All materials survived the normal range of masticatory forces. All failures were re-restorable. Regular crowns of 1.5 to 2.0 mm thickness may present higher survival rates than ultrathin ones. Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

[Acute novel drugs poisoning among patients of Nofer Institute of Occupational Medicine in Lodz, Toxicology Unit, hospitalized in the years 2008-2012--epidemiology, clinical state].

PubMed

Sawicka, Joanna; Czyzewska, Sylwia; Winnicka, Renata; Politański, Piotr; Swiderska-Kiełbik, Sylwia; Kołaciński, Zbigniew; Czerniak, Paweł; Krakowiak, Anna

2013-01-01

Intoxication with novel recreational drugs poses significant challenge for medical staff due to diagnostic difficulties, complex clinical pattern, resulting from polyethiology of poisoning and potential risk of life threatening complications. Description of clinical pattern novel drug intoxication. retrospective review of medical records patients hospitalized in the Toxicology Unit (TU) with diagnosis of intoxication with novel recreational drugs. During the period from 2008-2010--431 patients were admitted to TU with mentioned above diagnosis. 159 (36.9%) patients were positive for ethanol with its average concentration in blood 150 mg%. Presence of other substances like amphetamine, cannabinoids, atropine, ephedrine, carbamazepine, benzodiazepines and dextrometorphan was confirmed. The most frequent clinical symptoms observed on admission were: anxiety, agitation, complaints associated with circulatory system and vertigo Average pulse rate and both: diastolic and systolic pressure were within normal limits, however authors noted slight tendency toward tachycardia. One patients died due to multiorgan failure. Average period of hospitalization amounted 2.24 days. Co-poisoning with ethanol was associated with higher frequency of circulatory system disturbances. Clinical pattern of poisoning with novel drugs could partially correspond with mild sympathomime. tic syndrome.

Augmentation plating in management of failed femoral nailing.

PubMed

Verma, Rahul; Sharma, Pulak; Gaur, Sanjiv

2017-08-01

Non-union following interlocking nailing is a troubling complication in treatment of shaft femur fractures. There is no clear consensus on the treatment of this problem. This research was undertaken to study the role of augmentation plating combined with exchange nailing in such cases. A prospective clinical study was undertaken from January 2010 to December 2015. Patients with aseptic femoral shaft non-union, with or without implant failure following intramedullary nailing were included in the study. Augmentation plating combined with Exchange Nailing with a 4.5mm LCP was done. Fifteen patients (nine male and six female) with an average age of 43.7 years (range 18-67 years) were treated. Average timing from the first surgery was 7.3 months. Complete clinical and radiological union was achieved in all cases in a mean duration of 5.2 months. Average duration of follow up was 12.6 months. All the patients retained the preoperative hip and knee range of motion till the last follow up. Augmentation plating combined with exchange nailing in non-unions following intramedullary nailing of femur shaft fractures is a reasonably good and effective procedure with a very high success rate. © 2017 Elsevier Ltd. All rights reserved.

Limits on rock strength under high confinement

NASA Astrophysics Data System (ADS)

Renshaw, Carl E.; Schulson, Erland M.

2007-06-01

Understanding of deep earthquake source mechanisms requires knowledge of failure processes active under high confinement. Under low confinement the compressive strength of rock is well known to be limited by frictional sliding along stress-concentrating flaws. Under higher confinement strength is usually assumed limited by power-law creep associated with the movement of dislocations. In a review of existing experimental data, we find that when the confinement is high enough to suppress frictional sliding, rock strength increases as a power-law function only up to a critical normalized strain rate. Within the regime where frictional sliding is suppressed and the normalized strain rate is below the critical rate, both globally distributed ductile flow and localized brittle-like failure are observed. When frictional sliding is suppressed and the normalized strain rate is above the critical rate, failure is always localized in a brittle-like manner at a stress that is independent of the degree of confinement. Within the high-confinement, high-strain rate regime, the similarity in normalized failure strengths across a variety of rock types and minerals precludes both transformational faulting and dehydration embrittlement as strength-limiting mechanisms. The magnitude of the normalized failure strength corresponding to the transition to the high-confinement, high-strain rate regime and the observed weak dependence of failure strength on strain rate within this regime are consistent with a localized Peierls-type strength-limiting mechanism. At the highest strain rates the normalized strengths approach the theoretical limit for crystalline materials. Near-theoretical strengths have previously been observed only in nano- and micro-scale regions of materials that are effectively defect-free. Results are summarized in a new deformation mechanism map revealing that when confinement and strain rate are sufficient, strengths approaching the theoretical limit can be achieved in cm-scale sized samples of rocks rich in defects. Thus, non-frictional failure processes must be considered when interpreting rock deformation data collected under high confinement and low temperature. Further, even at higher temperatures the load-bearing ability of crustal rocks under high confinement may not be limited by a frictional process under typical geologic strain rates.

Reliability analysis based on the losses from failures.

PubMed

Todinov, M T

2006-04-01

The conventional reliability analysis is based on the premise that increasing the reliability of a system will decrease the losses from failures. On the basis of counterexamples, it is demonstrated that this is valid only if all failures are associated with the same losses. In case of failures associated with different losses, a system with larger reliability is not necessarily characterized by smaller losses from failures. Consequently, a theoretical framework and models are proposed for a reliability analysis, linking reliability and the losses from failures. Equations related to the distributions of the potential losses from failure have been derived. It is argued that the classical risk equation only estimates the average value of the potential losses from failure and does not provide insight into the variability associated with the potential losses. Equations have also been derived for determining the potential and the expected losses from failures for nonrepairable and repairable systems with components arranged in series, with arbitrary life distributions. The equations are also valid for systems/components with multiple mutually exclusive failure modes. The expected losses given failure is a linear combination of the expected losses from failure associated with the separate failure modes scaled by the conditional probabilities with which the failure modes initiate failure. On this basis, an efficient method for simplifying complex reliability block diagrams has been developed. Branches of components arranged in series whose failures are mutually exclusive can be reduced to single components with equivalent hazard rate, downtime, and expected costs associated with intervention and repair. A model for estimating the expected losses from early-life failures has also been developed. For a specified time interval, the expected losses from early-life failures are a sum of the products of the expected number of failures in the specified time intervals covering the early-life failures region and the expected losses given failure characterizing the corresponding time intervals. For complex systems whose components are not logically arranged in series, discrete simulation algorithms and software have been created for determining the losses from failures in terms of expected lost production time, cost of intervention, and cost of replacement. Different system topologies are assessed to determine the effect of modifications of the system topology on the expected losses from failures. It is argued that the reliability allocation in a production system should be done to maximize the profit/value associated with the system. Consequently, a method for setting reliability requirements and reliability allocation maximizing the profit by minimizing the total cost has been developed. Reliability allocation that maximizes the profit in case of a system consisting of blocks arranged in series is achieved by determining for each block individually the reliabilities of the components in the block that minimize the sum of the capital, operation costs, and the expected losses from failures. A Monte Carlo simulation based net present value (NPV) cash-flow model has also been proposed, which has significant advantages to cash-flow models based on the expected value of the losses from failures per time interval. Unlike these models, the proposed model has the capability to reveal the variation of the NPV due to different number of failures occurring during a specified time interval (e.g., during one year). The model also permits tracking the impact of the distribution pattern of failure occurrences and the time dependence of the losses from failures.

On a Stochastic Failure Model under Random Shocks

NASA Astrophysics Data System (ADS)

Cha, Ji Hwan

2013-02-01

In most conventional settings, the events caused by an external shock are initiated at the moments of its occurrence. In this paper, we study a new classes of shock model, where each shock from a nonhomogeneous Poisson processes can trigger a failure of a system not immediately, as in classical extreme shock models, but with delay of some random time. We derive the corresponding survival and failure rate functions. Furthermore, we study the limiting behaviour of the failure rate function where it is applicable.

Relation between lowered colloid osmotic pressure, respiratory failure, and death.

PubMed

Tonnesen, A S; Gabel, J C; McLeavey, C A

1977-01-01

Plasma colloid osmotic pressure was measured each day in 84 intensive care unit patients. Probit analysis demonstrated a direct relationship between colloid osmotic pressure (COP) and survival. The COP associated with a 50% survival rate was 15.0 torr. COP was higher in survivors than in nonsurvivors without respiratory failure and in patients who recovered from respiratory failure. We conclude that lowered COP is associated with an elevated mortality rate. However, the relationship to death is not explained by the relationship to respiratory failure.

Failure analysis and modeling of a VAXcluster system

NASA Technical Reports Server (NTRS)

Tang, Dong; Iyer, Ravishankar K.; Subramani, Sujatha S.

1990-01-01

This paper discusses the results of a measurement-based analysis of real error data collected from a DEC VAXcluster multicomputer system. In addition to evaluating basic system dependability characteristics such as error and failure distributions and hazard rates for both individual machines and for the VAXcluster, reward models were developed to analyze the impact of failures on the system as a whole. The results show that more than 46 percent of all failures were due to errors in shared resources. This is despite the fact that these errors have a recovery probability greater than 0.99. The hazard rate calculations show that not only errors, but also failures occur in bursts. Approximately 40 percent of all failures occur in bursts and involved multiple machines. This result indicates that correlated failures are significant. Analysis of rewards shows that software errors have the lowest reward (0.05 vs 0.74 for disk errors). The expected reward rate (reliability measure) of the VAXcluster drops to 0.5 in 18 hours for the 7-out-of-7 model and in 80 days for the 3-out-of-7 model.

Historic and Current Launcher Success Rates

NASA Technical Reports Server (NTRS)

Rust, Randy

2002-01-01

This presentation reviews historic and current space launcher success rates from all nations with a mature launcher industry. Data from the 1950's through present day is reviewed for possible trends such as when in the launch timeline a failure occurred, which stages had the highest failure rate, overall launcher reliability, a decade by decade look at launcher reliability, when in a launchers history did failures occur, and the reliability of United States human-rated launchers. This information is useful in determining where launcher reliability can be improved and where additional measures for crew survival (i.e., Crew Escape systems) will have the greatest emphasis

[Reduction of rehospitalisation on elderly heart failure patients: A retrospective cohort VISage network].

PubMed

Labranche, D; Mestre-Fernandes, C; Delahaye, F; Sanchez, S

2016-11-01

Heart failure was a public health problem for one million of French patients. Patients are particularly concerned in rehospitalisation for this chronic pathology. A specific healthcare network was created to take care of patients with heart failure directly at home. This healthcare network (named VISage) brings a specific and adapted monitoring in heart failure. The main of this study was to evaluate the impact of healthcare network in rehospitalisation rate for heart failure of patients. We conducted a retrospective cohort study with patients' hospital files of the CH Vienne. Patients who were included in our healthcare network (VISage) were screened. Primary endpoint was 30days, 6 months, and 1year rehospitalisation rate for heart failure before and after using healthcare network. One hundred and four patients with comorbidities were included between February 2009 and November 2015. A significant reduction of rehospitalisation rate for heart failure was observed before and after network: 0.65 (±0.52) vs. 0.17 (±0.43) 30days, 1.17 (±0.74) vs. 0.42 (±0.71) at 6 months and 1.35 (±0.95) vs. 0.47 (±0.74) at 1 year (P<0.0001). Results were significant for global rehospitalisation rate too. No significant differences were shown on hospital length of stay. Coordinated healthcare by a specific network at home for elderly is benefic for the rehospitalisation rate. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Failure prediction using machine learning and time series in optical network.

PubMed

Wang, Zhilong; Zhang, Min; Wang, Danshi; Song, Chuang; Liu, Min; Li, Jin; Lou, Liqi; Liu, Zhuo

2017-08-07

In this paper, we propose a performance monitoring and failure prediction method in optical networks based on machine learning. The primary algorithms of this method are the support vector machine (SVM) and double exponential smoothing (DES). With a focus on risk-aware models in optical networks, the proposed protection plan primarily investigates how to predict the risk of an equipment failure. To the best of our knowledge, this important problem has not yet been fully considered. Experimental results showed that the average prediction accuracy of our method was 95% when predicting the optical equipment failure state. This finding means that our method can forecast an equipment failure risk with high accuracy. Therefore, our proposed DES-SVM method can effectively improve traditional risk-aware models to protect services from possible failures and enhance the optical network stability.

Local Failure in Resected N1 Lung Cancer: Implications for Adjuvant Therapy

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

Higgins, Kristin A., E-mail: kristin.higgins@duke.edu; Chino, Junzo P.; Berry, Mark

2012-06-01

Purpose: To evaluate actuarial rates of local failure in patients with pathologic N1 non-small-cell lung cancer and to identify clinical and pathologic factors associated with an increased risk of local failure after resection. Methods and Materials: All patients who underwent surgery for non-small-cell lung cancer with pathologically confirmed N1 disease at Duke University Medical Center from 1995-2008 were identified. Patients receiving any preoperative therapy or postoperative radiotherapy or with positive surgical margins were excluded. Local failure was defined as disease recurrence within the ipsilateral hilum, mediastinum, or bronchial stump/staple line. Actuarial rates of local failure were calculated with the Kaplan-Meiermore » method. A Cox multivariate analysis was used to identify factors independently associated with a higher risk of local recurrence. Results: Among 1,559 patients who underwent surgery during the time interval, 198 met the inclusion criteria. Of these patients, 50 (25%) received adjuvant chemotherapy. Actuarial (5-year) rates of local failure, distant failure, and overall survival were 40%, 55%, and 33%, respectively. On multivariate analysis, factors associated with an increased risk of local failure included a video-assisted thoracoscopic surgery approach (hazard ratio [HR], 2.5; p = 0.01), visceral pleural invasion (HR, 2.1; p = 0.04), and increasing number of positive N1 lymph nodes (HR, 1.3 per involved lymph node; p = 0.02). Chemotherapy was associated with a trend toward decreased risk of local failure that was not statistically significant (HR, 0.61; p = 0.2). Conclusions: Actuarial rates of local failure in pN1 disease are high. Further investigation of conformal postoperative radiotherapy may be warranted.« less

Citrobacter Peritoneal Dialysis Peritonitis: Rare Occurrence with Poor Outcomes

PubMed Central

Chao, Chia-Ter; Lee, Szu-Ying; Yang, Wei-Shun; Chen, Huei-Wen; Fang, Cheng-Chung; Yen, Chung-Jen; Chiang, Chih-Kang; Hung, Kuan-Yu; Huang, Jenq-Wen

2013-01-01

Introduction: Non-Pseudomonas gram-negative bacteria are responsible for an increasing proportion of cases of peritoneal dialysis (PD)-related peritonitis. The role of Citrobacter species in the etiology of PD-related peritonitis is often underestimated. In the present study, we aimed to describe the clinical features, laboratory findings, and short- and long-term outcomes in PD-related peritonitis caused by Citrobacter. Methods: A retrospective review of all episodes of PD-related peritonitis caused by Citrobacter from a single center between 1990 and 2010 was performed. Clinical features, microbiological data, and outcomes of these episodes were analyzed. Results: Citrobacter species was responsible for 11 PD-related episodes (1.8% of all peritonitis episodes) in 8 patients. Citrobacter freundii was the most common etiologic species (73%), and mixed growth was found in the other 3 episodes (27%). Approximately half (46%) of the episodes were associated with constipation and/or diarrhea. Of the Citrobacter isolates from all episodes, 54% were resistant to cefazolin, and only 18% were susceptible to cefmetazole. All isolates were susceptible to ceftazidime, cefepime, carbapenem, and aminoglycosides. More than half of the patients (54%) were hospitalized for index peritonitis, and 27% of the episodes involved a change in antibiotic medication. One patient had relapsing peritonitis caused by C. koseri (9%). The mortality rate of PD-related peritonitis caused by Citrobacter was 18%, and 89% of surviving patients developed technique failure requiring a modality switch after an average of 12 months of follow-up (range 1.2-31.2 months). Conclusion: PD-related peritonitis caused by Citrobacter is associated with poor outcomes, including high rates of antibiotic resistance, a high mortality rate, and a high rate of technique failure among survivors during the follow-up period. PMID:23869184

Impact of Pretreatment Hydronephrosis on the Success Rate of Shock Wave Lithotripsy in Patients with Ureteral Stone.

PubMed

Chang, Ki Don; Lee, Joo Yong; Park, Sung Yoon; Kang, Dong Hyuk; Lee, Hyung Ho; Cho, Kang Su

2017-09-01

To evaluate predictors of the success rate for one session of shock wave lithotripsy (SWL), focusing on the relationships between pretreatment hydronephrosis grade and one-session SWL success rates. The medical records of 1824 consecutive patients who underwent an initial session of SWL for treatment of urinary stones between 2005 and 2013 were reviewed. After exclusion, 700 patients with a single, 4-20 mm diameter radiopaque calculus were included in the study. The mean maximal stone length (MSL) and skin-to-stone distance were 9.2±3.9 and 110.8±18.9 mm, respectively. The average values for mean stone density (MSD) and stone heterogeneity index (SHI) were 707.0±272.1 and 244.9±110.1, respectively. One-session success rates were 68.4, 75.0, 75.1, 54.0, and 10.5% in patients with hydronephrosis grade 0, 1, 2, 3, and 4, respectively. Patients were classified into success or failure groups based on SWL outcome. Multivariate logistic regression analyses revealed that MSL [odds ratio (OR) 0.888, 95% confidence intervals (CI): 0.841-0.934, p<0.001], MSD (OR 0.996, 95% CI: 0.995-0.997, p<0.001), SHI (OR 1.007, 95% CI: 1.005-1.010, p<0.001), and pretreatment hydronephrosis grade (OR 0.601, 95% CI: 0.368-0.988, p=0.043) were significantly associated with one-session success. Pretreatment grades 3 or 4 hydronephrosis were associated with failure of SWL in patients with a single ureteral stone. In the presence of severe hydronephrosis, especially hydronephrosis grade 4; physicians should proceed cautiously in choosing and offering SWL as the primary treatment for ureteral stone. © Copyright: Yonsei University College of Medicine 2017

Impact of Pretreatment Hydronephrosis on the Success Rate of Shock Wave Lithotripsy in Patients with Ureteral Stone

PubMed Central

Chang, Ki Don; Lee, Joo Yong; Park, Sung Yoon; Kang, Dong Hyuk; Lee, Hyung Ho

2017-01-01

Purpose To evaluate predictors of the success rate for one session of shock wave lithotripsy (SWL), focusing on the relationships between pretreatment hydronephrosis grade and one-session SWL success rates. Materials and Methods The medical records of 1824 consecutive patients who underwent an initial session of SWL for treatment of urinary stones between 2005 and 2013 were reviewed. After exclusion, 700 patients with a single, 4–20 mm diameter radiopaque calculus were included in the study. Results The mean maximal stone length (MSL) and skin-to-stone distance were 9.2±3.9 and 110.8±18.9 mm, respectively. The average values for mean stone density (MSD) and stone heterogeneity index (SHI) were 707.0±272.1 and 244.9±110.1, respectively. One-session success rates were 68.4, 75.0, 75.1, 54.0, and 10.5% in patients with hydronephrosis grade 0, 1, 2, 3, and 4, respectively. Patients were classified into success or failure groups based on SWL outcome. Multivariate logistic regression analyses revealed that MSL [odds ratio (OR) 0.888, 95% confidence intervals (CI): 0.841–0.934, p<0.001], MSD (OR 0.996, 95% CI: 0.995–0.997, p<0.001), SHI (OR 1.007, 95% CI: 1.005–1.010, p<0.001), and pretreatment hydronephrosis grade (OR 0.601, 95% CI: 0.368–0.988, p=0.043) were significantly associated with one-session success. Conclusion Pretreatment grades 3 or 4 hydronephrosis were associated with failure of SWL in patients with a single ureteral stone. In the presence of severe hydronephrosis, especially hydronephrosis grade 4; physicians should proceed cautiously in choosing and offering SWL as the primary treatment for ureteral stone. PMID:28792145

Comparative evaluation of different forms of calcium hydroxide in apexification.

PubMed

Ghosh, Subhankar; Mazumdar, Dibyendu; Ray, Pradip Kumar; Bhattacharya, Bhaswar

2014-01-01

One out of every two children sustains a dental injury most often between 8 and 10 years of age. Majority of these teeth subsequently become non-vital and most often with immature apex. Management of these teeth is an enormous challenge for lack of apical stop. Calcium hydroxide in various formulations has maximum literature support in favor of successful apexification or induced apical closure. The aim of the following study is to determine the efficacy of calcium hydroxide in a different formulation to induce apexification. The present study was undertaken on 51 children of 8-10 years of age (both sexes) at Dr. R Ahmed Dental College and Hospital from April 2006 to March 2007. All children had one or two maxillary permanent central incisor (s), non-vital and apices open. In all the cases, apexification was attempted with either calcium hydroxide mixed with sterile distilled water, or calcium hydroxide plus iodoform in methyl cellulose base, or calcium hydroxide plus iodoform in polysilicone oil base. The success of apexification was determined on the basis of clinical and radiographic criteria. In the pre-operative asymptomatic cases (72.55%), failure occurred in only 5.45% cases and pre-operative symptomatic cases failure rate was as high as 35.71%. Success rate was 94.6% in cases with narrow open apices, whereas 64.28% in wide open apices. In cases with pre-existing apical radiolucencies, successful apexification occurred in 63.63% and success rate was 92.5% in the cases without pre-existing apical radiolucencies. Average time consumed for apexification was minimum with calcium hydroxide plus iodoform in polysilicone oil base. The overall success rate observed to be 86.27%, which is in close proximity to the findings of most of the previous studies across the globe.

Addition of immunosuppressive treatment to hemoperfusion is associated with improved survival after paraquat poisoning: a nationwide study.

PubMed

Wu, Wen-Pyng; Lai, Ming-Nan; Lin, Ching-Heng; Li, Yu-Fen; Lin, Ching-Yuang; Wu, Ming-Ju

2014-01-01

Paraquat poisoning associates very high mortality rate. Early treatment with hemoperfusion is strongly suggested by animal and human studies. Although the survival benefit of additional immunosuppressive treatment (IST) in combination with hemoperfusion is also reported since 1971, the large-scale randomized control trials to confirm the effects of IST is difficult to be executed. Therefore, we designed this nationwide large-scale population-based retrospective cohort study to investigate the outcome of paraquat poisoning with hemoperfusion and the additional effects of IST combined with hemoperfusion. This nationwide retrospective cohort study utilized data retrieved from the National Health Insurance Research Database (NHIRD) of Taiwan. A total of 1811 hospitalized patients with a diagnosis of paraquat poisoning who received hemoperfusion between 1997 and 2009 were enrolled. The mean age of all 1811 study subjects was 47.3 years. 70% was male. The overall survival rate was only 26.4%. Respiratory failure and renal failure were diagnosed in 56.2% and 36% patients. The average frequency of hemoperfusion was twice. IST was added in 42.2% patients. IST significantly increases survival rate (from 24.3% to 29.3%, P<0.001). The combined IST with methylprednisolone, cyclophosphamide and dexamethasone associates with the highest survival rate (48%, P<0.001). Moreover, patients younger than 45 years of age in the IST group had the best survival (41.0% vs. 33.7%, p<0.001). Our results support the use of IST with hemoperfusion for paraquat-poisoned patients. The best survival effect of IST is the combination of methylprednisolone, cyclophosphamide and daily dexamethasone, especially in patients with younger age.

Addition of Immunosuppressive Treatment to Hemoperfusion Is Associated with Improved Survival after Paraquat Poisoning: A Nationwide Study

PubMed Central

Wu, Wen-Pyng; Lai, Ming-Nan; Lin, Ching-Heng; Li, Yu-Fen

2014-01-01

Paraquat poisoning associates very high mortality rate. Early treatment with hemoperfusion is strongly suggested by animal and human studies. Although the survival benefit of additional immunosuppressive treatment (IST) in combination with hemoperfusion is also reported since 1971, the large-scale randomized control trials to confirm the effects of IST is difficult to be executed. Therefore, we designed this nationwide large-scale population-based retrospective cohort study to investigate the outcome of paraquat poisoning with hemoperfusion and the additional effects of IST combined with hemoperfusion. This nationwide retrospective cohort study utilized data retrieved from the National Health Insurance Research Database (NHIRD) of Taiwan. A total of 1811 hospitalized patients with a diagnosis of paraquat poisoning who received hemoperfusion between 1997 and 2009 were enrolled. The mean age of all 1811 study subjects was 47.3 years. 70% was male. The overall survival rate was only 26.4%. Respiratory failure and renal failure were diagnosed in 56.2% and 36% patients. The average frequency of hemoperfusion was twice. IST was added in 42.2% patients. IST significantly increases survival rate (from 24.3% to 29.3%, P<0.001). The combined IST with methylprednisolone, cyclophosphamide and dexamethasone associates with the highest survival rate (48%, P<0.001). Moreover, patients younger than 45 years of age in the IST group had the best survival (41.0% vs. 33.7%, p<0.001). Our results support the use of IST with hemoperfusion for paraquat-poisoned patients. The best survival effect of IST is the combination of methylprednisolone, cyclophosphamide and daily dexamethasone, especially in patients with younger age. PMID:24475310

Molecular Dynamics Modeling of PPTA Crystals in Aramid Fibers

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

Mercer, Brian Scott

2016-05-19

In this work, molecular dynamics modeling is used to study the mechanical properties of PPTA crystallites, which are the fundamental microstructural building blocks of polymer aramid bers such as Kevlar. Particular focus is given to constant strain rate axial loading simulations of PPTA crystallites, which is motivated by the rate-dependent mechanical properties observed in some experiments with aramid bers. In order to accommodate the covalent bond rupture that occurs in loading a crystallite to failure, the reactive bond order force eld ReaxFF is employed to conduct the simulations. Two major topics are addressed: The rst is the general behavior ofmore » PPTA crystallites under strain rate loading. Constant strain rate loading simulations of crystalline PPTA reveal that the crystal failure strain increases with increasing strain rate, while the modulus is not a ected by the strain rate. Increasing temperature lowers both the modulus and the failure strain. The simulations also identify the C N bond connecting the aromatic rings as weakest primary bond along the backbone of the PPTA chain. The e ect of chain-end defects on PPTA micromechanics is explored, and it is found that the presence of a chain-end defect transfers load to the adjacent chains in the hydrogen-bonded sheet in which the defect resides, but does not in uence the behavior of any other chains in the crystal. Chain-end defects are found to lower the strength of the crystal when clustered together, inducing bond failure via stress concentrations arising from the load transfer to bonds in adjacent chains near the defect site. The second topic addressed is the nature of primary and secondary bond failure in crystalline PPTA. Failure of both types of bonds is found to be stochastic in nature and driven by thermal uctuations of the bonds within the crystal. A model is proposed which uses reliability theory to model bonds under constant strain rate loading as components with time-dependent failure rate functions. The model is shown to work well for predicting the onset of primary backbone bond failure, as well as the onset of secondary bond failure via chain slippage for the case of isolated non-interacting chain-end defects.« less

Assessment of the Accuracy and Cut-Failure Rates of Eye Bank-Cut Corneas for Use in Endothelial Keratoplasty: A Comparison of Outcomes Between 2010 and 2013.

PubMed

Katzman, Lee R; Hoover, Caroline K; Khalifa, Yousuf M; Jeng, Bennie H

2015-11-01

To evaluate the accuracy of eye bank-prepared precut donor corneas over time by comparing cut-failure rates and corneal thickness measurements in 2010 and 2013. A total of 2511 human corneas cut by a technician-operated mechanical microkeratome intended for endothelial keratoplasty were evaluated prospectively at one large eye bank facility in 2010 and in 2013. The endothelium was evaluated by slit lamp, and specular microscopy both before and after cutting was performed. Graft thickness as measured by pachymetry and/or optical coherence tomography was collected to assess the accuracy of the cut tissue. Cut-failure rates were compared between normal donor tissue and tissue with significant preexisting scarring. The combined cut-failure rate in 2010 and 2013 was 2.3% (23/1000) and 1.6% (24/1511), respectively (P = 0.23). The cut-failure rate among normal tissue in 2010 and 2013 was 2.0% (19/927) and 1.4% (19/1400), respectively (P = 0.24). The cut-failure rate among previously scarred tissue in 2010 and 2013 was 5.5% (4/73) and 4.5% (5/111), respectively (P = 0.74). The mean surgeon-requested graft thickness was 144.7 μm (range 100-150, SD 13.6) and 127.2 μm (range 75-150, SD 25.2) in 2010 and 2013, respectively (P < 0.0001). The mean deviation from target graft thickness was 21.3 μm (SD 16.3) and 13.6 μm (SD 12.5) in 2010 and 2013, respectively (P < 0.0001). From 2010 to 2013, the combined cut-failure rates trended toward improvement, while the accuracy of graft thickness improved. This study suggests that the accuracy and success rates of tissue preparation for endothelial keratoplasty improve with experience and volume.

Explaining reduction of pedestrian-motor vehicle crashes in Arkhangelsk, Russia, in 2005-2010.

PubMed

Kudryavtsev, Alexander V; Nilssen, Odd; Lund, Johan; Grjibovski, Andrej M; Ytterstad, Børge

2012-01-01

To explain a reduction in pedestrian-motor vehicle crashes in Arkhangelsk, Russia, in 2005-2010. Retrospective ecological study. For 2005-2010, police data on pedestrian-motor vehicle crashes, traffic violations, and total motor vehicles (MVs) were combined with data on changes in national road traffic legislation and municipal road infrastructure. Negative binomial regression was used to investigate trends in monthly rates of pedestrian-motor vehicle crashes per total MVs and estimate changes in these rates per unit changes in the safety measures. During the 6 years, the police registered 2,565 pedestrian-motor vehicle crashes: 1,597 (62%) outside crosswalks, 766 (30%) on non-signalized crosswalks, and 202 (8%) on signalized crosswalks. Crash rates outside crosswalks and on signalized crosswalks decreased on average by 1.1% per month, whereas the crash rate on non-signalized crosswalks remained unchanged. Numbers of signalized and non-signalized crosswalks increased by 14 and 19%, respectively. Also, 10% of non-signalized crosswalks were combined with speed humps, and 4% with light-reflecting vertical signs. Pedestrian penalties for traffic violations increased 4-fold. Driver penalties for ignoring prohibiting signal and failure to give way to pedestrian on non-signalized crosswalk increased 7- and 8-fold, respectively. The rate of total registered drivers' traffic violations per total MVs decreased on average by 0.3% per month. All studied infrastructure and legislative measures had inverse associations with the rate of crashes outside crosswalks. The rate of crashes on signalized crosswalks showed inverse associations with related monetary penalties. The introduction of infrastructure and legislative measures is the most probable explanation of the reduction of pedestrian-motor vehicle crashes in Arkhangelsk. The overall reduction is due to decreases in rates of crashes outside crosswalks and on signalized crosswalks. No change was observed in the rate of crashes on non-signalized crosswalks.

An FMEA evaluation of intensity modulated radiation therapy dose delivery failures at tolerance criteria levels.

PubMed

Faught, Jacqueline Tonigan; Balter, Peter A; Johnson, Jennifer L; Kry, Stephen F; Court, Laurence E; Stingo, Francesco C; Followill, David S

2017-11-01

The objective of this work was to assess both the perception of failure modes in Intensity Modulated Radiation Therapy (IMRT) when the linac is operated at the edge of tolerances given in AAPM TG-40 (Kutcher et al.) and TG-142 (Klein et al.) as well as the application of FMEA to this specific section of the IMRT process. An online survey was distributed to approximately 2000 physicists worldwide that participate in quality services provided by the Imaging and Radiation Oncology Core - Houston (IROC-H). The survey briefly described eleven different failure modes covered by basic quality assurance in step-and-shoot IMRT at or near TG-40 (Kutcher et al.) and TG-142 (Klein et al.) tolerance criteria levels. Respondents were asked to estimate the worst case scenario percent dose error that could be caused by each of these failure modes in a head and neck patient as well as the FMEA scores: Occurrence, Detectability, and Severity. Risk probability number (RPN) scores were calculated as the product of these scores. Demographic data were also collected. A total of 181 individual and three group responses were submitted. 84% were from North America. Most (76%) individual respondents performed at least 80% clinical work and 92% were nationally certified. Respondent medical physics experience ranged from 2.5 to 45 yr (average 18 yr). A total of 52% of individual respondents were at least somewhat familiar with FMEA, while 17% were not familiar. Several IMRT techniques, treatment planning systems, and linear accelerator manufacturers were represented. All failure modes received widely varying scores ranging from 1 to 10 for occurrence, at least 1-9 for detectability, and at least 1-7 for severity. Ranking failure modes by RPN scores also resulted in large variability, with each failure mode being ranked both most risky (1st) and least risky (11th) by different respondents. On average MLC modeling had the highest RPN scores. Individual estimated percent dose errors and severity scores positively correlated (P < 0.01) for each FM as expected. No universal correlations were found between the demographic information collected and scoring, percent dose errors or ranking. Failure modes investigated overall were evaluated as low to medium risk, with average RPNs less than 110. The ranking of 11 failure modes was not agreed upon by the community. Large variability in FMEA scoring may be caused by individual interpretation and/or experience, reflecting the subjective nature of the FMEA tool. © 2017 American Association of Physicists in Medicine.

Trends and Variations in the Rates of Hospital Complications, Failure-to-Rescue and 30-Day Mortality in Surgical Patients in New South Wales, Australia, 2002-2009

PubMed Central

Ou, Lixin; Chen, Jack; Assareh, Hassan; Hollis, Stephanie J.; Hillman, Ken; Flabouris, Arthas

2014-01-01

Background Despite the increased acceptance of failure-to-rescue (FTR) as an important patient safety indicator (defined as the percentage of deaths among surgical patients with treatable complications), there has not been any large epidemiological study reporting FTR in an Australian setting nor any evaluation on its suitability as a performance indicator. Methods We conducted a population-based study on elective surgical patients from 82 public acute hospitals in New South Wales, Australia between 2002 and 2009, exploring the trends and variations in rates of hospital complications, FTR and 30-day mortality. We used Poisson regression models to derive relative risk ratios (RRs) after adjusting for a range of patient and hospital characteristics. Results The average rates of complications, FTR and 30-day mortality were 13.8 per 1000 admissions, 14.1% and 6.1 per 1000 admission, respectively. The rates of complications and 30-day mortality were stable throughout the study period however there was a significant decrease in FTR rate after 2006, coinciding with the establishment of national and state-level peak patient safety agencies. There were marked variations in the three rates within the top 20% of hospitals (best) and bottom 20% of hospitals (worst) for each of the four peer-hospital groups. The group comprising the largest volume hospitals (principal referral/teaching hospitals) had a significantly higher rate of FTR in comparison to the other three groups of smaller-sized peer hospital groups (RR = 0.78, 0.57, and 0.61, respectively). Adjusted rates of complications, FTR and 30-day mortality varied widely for individual surgical procedures between the best and worst quintile hospitals within the principal referral hospital group. Conclusions The decrease in FTR rate over the study period appears to be associated with a wide range of patient safety programs. The marked variations in the three rates between- and within- peer hospital groups highlight the potential for further quality improvement intervention opportunities. PMID:24788787

A Study to Compare the Failure Rates of Current Space Shuttle Ground Support Equipment with the New Pathfinder Equipment and Investigate the Effect that the Proposed GSE Infrastructure Upgrade Might Have to Reduce GSE Infrastructure Failures

NASA Technical Reports Server (NTRS)

Kennedy, Barbara J.

2004-01-01

The purposes of this study are to compare the current Space Shuttle Ground Support Equipment (GSE) infrastructure with the proposed GSE infrastructure upgrade modification. The methodology will include analyzing the first prototype installation equipment at Launch PAD B called the "Pathfinder". This study will begin by comparing the failure rate of the current components associated with the "Hardware interface module (HIM)" at the Kennedy Space Center to the failure rate of the neW Pathfinder components. Quantitative data will be gathered specifically on HIM components and the PAD B Hypergolic Fuel facility and Hypergolic Oxidizer facility areas which has the upgraded pathfinder equipment installed. The proposed upgrades include utilizing industrial controlled modules, software, and a fiber optic network. The results of this study provide evidence that there is a significant difference in the failure rates of the two studied infrastructure equipment components. There is also evidence that the support staff for each infrastructure system is not equal. A recommendation to continue with future upgrades is based on a significant reduction of failures in the new' installed ground system components.

Effect of reducing interns' weekly work hours on sleep and attentional failures.

PubMed

Lockley, Steven W; Cronin, John W; Evans, Erin E; Cade, Brian E; Lee, Clark J; Landrigan, Christopher P; Rothschild, Jeffrey M; Katz, Joel T; Lilly, Craig M; Stone, Peter H; Aeschbach, Daniel; Czeisler, Charles A

2004-10-28

Knowledge of the physiological effects of extended (24 hours or more) work shifts in postgraduate medical training is limited. We aimed to quantify work hours, sleep, and attentional failures among first-year residents (postgraduate year 1) during a traditional rotation schedule that included extended work shifts and during an intervention schedule that limited scheduled work hours to 16 or fewer consecutive hours. Twenty interns were studied during two three-week rotations in intensive care units, each during both the traditional and the intervention schedule. Subjects completed daily sleep logs that were validated with regular weekly episodes (72 to 96 hours) of continuous polysomnography (r=0.94) and work logs that were validated by means of direct observation by study staff (r=0.98). Seventeen of 20 interns worked more than 80 hours per week during the traditional schedule (mean, 84.9; range, 74.2 to 92.1). All interns worked less than 80 hours per week during the intervention schedule (mean, 65.4; range, 57.6 to 76.3). On average, interns worked 19.5 hours per week less (P<0.001), slept 5.8 hours per week more (P<0.001), slept more in the 24 hours preceding each working hour (P<0.001), and had less than half the rate of attentional failures while working during on-call nights (P=0.02) on the intervention schedule as compared with the traditional schedule. Eliminating interns' extended work shifts in an intensive care unit significantly increased sleep and decreased attentional failures during night work hours. Copyright 2004 Massachusetts Medical Society.

SU-F-T-245: The Investigation of Failure Mode and Effects Analysis and PDCA for the Radiotherapy Risk Reduction

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

Xie, J; Wang, J; P, J

2016-06-15

Purpose: To optimize the clinical processes of radiotherapy and to reduce the radiotherapy risks by implementing the powerful risk management tools of failure mode and effects analysis(FMEA) and PDCA(plan-do-check-act). Methods: A multidiciplinary QA(Quality Assurance) team from our department consisting of oncologists, physicists, dosimetrists, therapists and administrator was established and an entire workflow QA process management using FMEA and PDCA tools was implemented for the whole treatment process. After the primary process tree was created, the failure modes and Risk priority numbers(RPNs) were determined by each member, and then the RPNs were averaged after team discussion. Results: 3 of 9 failuremore » modes with RPN above 100 in the practice were identified in the first PDCA cycle, which were further analyzed to investigate the RPNs: including of patient registration error, prescription error and treating wrong patient. New process controls reduced the occurrence, or detectability scores from the top 3 failure modes. Two important corrective actions reduced the highest RPNs from 300 to 50, and the error rate of radiotherapy decreased remarkably. Conclusion: FMEA and PDCA are helpful in identifying potential problems in the radiotherapy process, which was proven to improve the safety, quality and efficiency of radiation therapy in our department. The implementation of the FMEA approach may improve the understanding of the overall process of radiotherapy while may identify potential flaws in the whole process. Further more, repeating the PDCA cycle can bring us closer to the goal: higher safety and accuracy radiotherapy.« less

Nonmelanoma Skin Cancers After Kidney Transplant: Our 15 Years of Experience With Mammalian Target of Rapamycin Inhibitors.

PubMed

Okut, Gokalp; Alp, Alper; Tatar, Erhan; Simsek, Cenk; Tugmen, Cem; Uslu, Adam

2017-02-01

We evaluated patients with nonmelanoma skin cancer after kidney transplant and the effects of immunosuppression reduction and switching to a mammalian target of rapamycin inhibitor drugs. Kidney transplant recipients were evaluated retrospectively from patient medical records (between January 2000 and December 2014). A 30% increase in serum creatinine was accepted as indicating renal failure progression. Of 18 patients included (mean follow-up 98 ± 66 mo), 7 (38.8%) had squamous cell carcinoma, 7 (38.8%) had Kaposi sarcoma, and 4 (22.2%) had basal cell carcinoma. At cancer diagnosis, average serum creatinine was 1.6 ± 0.7 mg/dL and proteinuria was 410 ± 766 mg/d. Immunosuppression regimen was changed in 15 patients (83.3%), with new regimen being a single-drug (only prednisolone) in 4 patients, double-drug in 6 patients, and triple-drug protocol in 8 patients. Eight patients were switched to a mammalian target of rapamycin inhibitor-based double (4 patients) or triple (4 patients) regimen. During follow-up after starting new treatment (average 46 ± 50 mo), 6 patients (33.3%) had progressive kidney failure (0 were receiving triple regimen). Those that progressed were using mammalian target of rapamycin inhibitor-based drugs relatively less (33% vs 50%), although often receiving a single-drug immunosuppression treatment (50% vs 8.3%). Three patients (33.3%) had acute rejection (2 receiving double and 1 receiving single immunosuppression treatment). Five patients (27.7%) had local recurrence of the primary tumor. Mammalian target of rapamycin inhibitor use was relatively less common in patients with tumor relapse (20% vs 46%). One patient died (heart failure), and 1 with chronic rejection returned to dialysis. Mammalian target of rapamycin inhibitorbased drugs could reduce local recurrence rate in kidney transplant recipients with nonmelanoma skin cancers. Aggressive reduction and/or cessation of immunosuppressive drugs after skin cancer can lead to graft rejection.

Costs of postoperative sepsis: the business case for quality improvement to reduce postoperative sepsis in veterans affairs hospitals.

PubMed

Vaughan-Sarrazin, Mary S; Bayman, Levent; Cullen, Joseph J

2011-08-01

To estimate the incremental costs associated with sepsis as a complication of general surgery, controlling for patient risk factors that may affect costs (eg, surgical complexity and comorbidity) and hospital-level variation in costs. Database analysis. One hundred eighteen Veterans Health Affairs hospitals. A total of 13 878 patients undergoing general surgery during fiscal year 2006 (October 1, 2005, through September 30, 2006). Incremental costs associated with sepsis as a complication of general surgery (controlling for patient risk factors and hospital-level variation of costs), as well as the increase in costs associated with complications that co-occur with sepsis. Costs were estimated using the Veterans Health Affairs Decision Support System, and patient risk factors and postoperative complications were identified in the Veterans Affairs Surgical Quality Improvement Program database. Overall, 564 of 13 878 patients undergoing general surgery developed postoperative sepsis, for a rate of 4.1%. The average unadjusted cost for patients with no sepsis was $24 923, whereas the average cost for patients with sepsis was 3.6 times higher at $88 747. In risk-adjusted analyses, the relative costs were 2.28 times greater for patients with sepsis relative to patients without sepsis (95% confidence interval, 2.19-2.38), with the difference in risk-adjusted costs estimated at $26 972 (ie, $21 045 vs $48 017). Sepsis often co-occurred with other types of complications, most frequently with failure to wean the patient from mechanical ventilation after 48 hours (36%), postoperative pneumonia (31%), and reintubation for respiratory or cardiac failure (29%). Costs were highest when sepsis occurred with pneumonia or failure to wean the patient from mechanical ventilation after 48 hours. Given the high cost of treating sepsis, a business case can be made for quality improvement initiatives that reduce the likelihood of postoperative sepsis.

The Impact of Early Life Stress on Growth and Cardiovascular Risk: A Possible Example for Autonomic Imprinting?

PubMed

Buchhorn, Reiner; Meint, Sebastian; Willaschek, Christian

2016-01-01

Early life stress is imprinting regulatory properties with life-long consequences. We investigated heart rate variability in a group of small children with height below the third percentile, who experienced an episode of early life stress due to heart failure or intra uterine growth retardation. These children appear to develop autonomic dysfunction in later life. Compared to the healthy control group heart rate variability (HRV) is reduced on average in a group of 101 children with short stature. Low HRV correlates to groups of children born small for gestational age (SGA), children with cardiac growth failure and children with congenital syndromes, but not to those with constitutional growth delay (CGD), who had normal HRV. Reduced HRV indicated by lower RMSSD and High Frequency (HF)-Power is indicating reduced vagal activity as a sign of autonomic imbalance. It is not short stature itself, but rather the underlying diseases that are the cause for reduced HRV in children with height below the third percentile. These high risk children-allocated in the groups with an adverse autonomic imprinting in utero or infancy (SGA, congenital heart disease and congenital syndromes)-have the highest risk for 'stress diseases' such as cardiovascular disease in later life. The incidence of attention deficit disorder is remarkably high in our group of short children.

The Impact of Early Life Stress on Growth and Cardiovascular Risk: A Possible Example for Autonomic Imprinting?

PubMed Central

Buchhorn, Reiner; Meint, Sebastian

2016-01-01

Introduction Early life stress is imprinting regulatory properties with life-long consequences. We investigated heart rate variability in a group of small children with height below the third percentile, who experienced an episode of early life stress due to heart failure or intra uterine growth retardation. These children appear to develop autonomic dysfunction in later life. Results Compared to the healthy control group heart rate variability (HRV) is reduced on average in a group of 101 children with short stature. Low HRV correlates to groups of children born small for gestational age (SGA), children with cardiac growth failure and children with congenital syndromes, but not to those with constitutional growth delay (CGD), who had normal HRV. Reduced HRV indicated by lower RMSSD and High Frequency (HF)-Power is indicating reduced vagal activity as a sign of autonomic imbalance. Conclusion It is not short stature itself, but rather the underlying diseases that are the cause for reduced HRV in children with height below the third percentile. These high risk children—allocated in the groups with an adverse autonomic imprinting in utero or infancy (SGA, congenital heart disease and congenital syndromes)—have the highest risk for ‘stress diseases’ such as cardiovascular disease in later life. The incidence of attention deficit disorder is remarkably high in our group of short children. PMID:27861527

Factors that influence vital rates of Seaside and Saltmarsh sparrows in coastal New Jersey, USA

PubMed Central

Roberts, Samuel G.; Longenecker, Rebecca A.; Etterson, Matthew A.; Ruskin, Katharine J.; Elphick, Chris S.; Olsen, Brian J.; Shriver, W. Gregory

2018-01-01

As saltmarsh habitat continues to disappear, understanding the factors that influence saltmarsh breeding bird population dynamics is an important step for the conservation of these declining species. Using five years (2011 – 2015) of demographic data, we evaluated and compared Seaside (Ammodramus maritimus) and Saltmarsh (A. caudacutus) sparrow apparent adult survival and nest survival at the Edwin B. Forsythe National Wildlife Refuge, New Jersey, USA. We determined the effect of site management history (unditched vs. ditched marsh) on adult and nest survival to aid in prioritizing future management or restoration actions. Seaside Sparrow apparent adult survival (61.6%, 95% CI: 52.5 – 70.0%) averaged >1.5 times greater than Saltmarsh Sparrow apparent adult survival (39.9%, 95% CI: 34.0 – 46.2%). Nest survival and predation and flooding rates did not differ between species, and predation was the primary cause of failure for both species. Apparent adult survival and nest survival did not differ between unditched and ditched marshes for either species, indicating that marsh ditching history may not affect breeding habitat quality for these species. With predation as the primary cause of nest failure for both species in New Jersey, we suggest that future research should focus on identification of predator communities in salt marshes and the potential for implementing predator-control programs to limit population declines. PMID:29479129

Experience of the posterior lip augmentation device in a regional hip arthroplasty unit as a treatment for recurrent dislocation.

PubMed

Hoggett, L; Cross, C; Helm, T

2017-12-01

Dislocation after total hip arthroplasty (THA) remains a significant complication of the procedure and is the third leading cause for revision THA. One technique for treatment of this complication is the use of the posterior lip augmentation device (PLAD). We describe our experience using the PLAD including complication rates. A retrospective review of 55 PLADs (54 patients) was carried out following identification from electronic theatre records. Basic patient demographics, operative records and radiographs were collected and reviewed and data was analysed using Microsoft Excel. Failure of the PLAD was defined as further operative intervention after PLAD insertion and included: dislocation, implant breakage, infection and revision of the THA for loosening of either component. 55 PLADs were implanted in 54 patients with an average age of 77 years. There was a significant preponderance of females and a variety of surgical approaches had been used for the original hip replacement, including trochanteric osteotomy, posterior and antero-lateral. 9 (16%) patients had recurrent dislocations,1 (2%) failed secondary to screw breakage, 3 (5%) had and infection requiring intervention and 2 (4%) underwent further revision for aseptic loosening of the femoral component. The overall failure rate was 25% with 14 patients requiring intervention post PLAD. Our results are inferior to other published results and indicate that the PLAD should be used with caution for recurrent dislocations of the Charnley hip replacement.

A numerical study of the effect of catheter angle on the blood flow characteristics in a graft during hemodialysis

NASA Astrophysics Data System (ADS)

Ryou, Hong Sun; Kim, Soyoon; Ro, Kyoungchul

2013-02-01

For patients with renal failure, renal replacement therapies are needed. Hemodialysis is a widely used renal replacement method to remove waste products. It is important to improve the patency rate of the vascular access for efficient dialysis. Since some complications such as an intimal hyperplasia are associated with the flow pattern, the hemodynamics in the vascular access must be considered to achieve a high patency rate. In addition, the blood flow from an artificial kidney affects the flow in the vascular access. Generally, the clinical techniques of hemodialysis such as the catheter angle or dialysis dose have been set up empirically. In this study, a numerical analysis is performed on the effect of the catheter angle on the flow in the graft. Blood is assumed to be a non-Newtonian fluid. According to the high average wall shear stress value, the leucocytes and platelets can be activated not only at the arterial anastomosis, but also at the bottom of the venous graft, when the catheter angle is not zero. For a catheter angle less than five degrees, there is a low shear and high oscillatory shear index region that appears at the venous graft and the venous anastomosis. Thus, a catheter angle less than five degrees should be avoided to prevent graft failure.

A dietary assessment of selenium risk to aquatic birds on a coal mine affected stream in Alberta, Canada

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

Wayland, M.; Casey, R.; Woodsworth, E.

In this article, we present the results of a dietary-based assessment of the risk that selenium may pose to two aquatic bird species, the American Dipper (Cinclus mexicanus) and the Harlequin Duck (Histrionicus histrionicus), on one of the coal mine-affected streams, the Gregg River. The study consisted of (1) a literature-based toxicity assessment, (2) simulation of selenium exposure in the diets and eggs of the two species, and (3) a risk assessment that coupled information on toxicity and exposure. Diet and egg selenium concentrations associated with a 20% hatch failure rate were 6.4 and 17 {mu} g {center_dot} g{sup -1}more » dry wt, respectively. Simulated dietary selenium concentrations were about 2.0-2.5 {mu} g {center_dot} g{sup -1} higher on the Gregg River than on reference streams for both species. When simulated dietary concentrations were considered, hatch failure rates on the Gregg River were predicted to average 12% higher in American Dippers and 8% higher in Harlequin Ducks than at reference streams. Corresponding values were only 3% for both species when predicted egg concentrations were used. Elevated levels of selenium in insects in some of the reference streams were unexpected and raised a question as to whether aquatic birds have evolved a higher tolerance level for dietary selenium in these areas.« less

Dietary sodium adherence is poor in chronic heart failure patients.

PubMed

Basuray, Anupam; Dolansky, Mary; Josephson, Richard; Sattar, Abdus; Grady, Ellen M; Vehovec, Anton; Gunstad, John; Redle, Joseph; Fang, James; Hughes, Joel W

2015-04-01

We sought to determine the rates and predictors of dietary sodium restriction and to evaluate the reliability of 24-hour urine collection as a tool to estimate dietary sodium intake in heart failure (HF) patients. We evaluated the 24-hour urinary sodium excretion of 305 outpatients with HF and reduced ejection fraction who were educated on following a <2 g sodium diet. The mean sodium excretion according to a single sample from each participant was 3.15 ± 1.58 g, and 23% were adherent to the <2 g recommendation. One hundred sixty-eight participants provided 2 samples with urinary creatinine excretion within normative range. Averaging both resulted in a mean sodium excretion of 3.21 ± 1.20 g and lower adherence rates to the <2-gram diet: 14% versus 23% (P = .019). Multivariate logistic regression showed only male sex and higher body mass index (BMI) to be associated with nonadherence (male: odds ratio [OR] 2.20, 95% confidence interval [CI] 1.25-3.88; 1 unit BMI: OR 1.05, 95% CI 1.01-1.10). Bland-Altman plots of urinary sodium and creatinine showed poor reproducibility between samples. In this chronic HF population, sodium consumption probably exceeds recommended amounts, particularly in men and those with higher BMI. Urine analyses were not highly reproducible, suggesting variation in both diet and urine collection. Copyright © 2015 Elsevier Inc. All rights reserved.

Mechanisms, predictors, and trends of electrical failure of Riata leads.

PubMed

Cheung, Jim W; Al-Kazaz, Mohamed; Thomas, George; Liu, Christopher F; Ip, James E; Bender, Seth R; Siddiqi, Faisal K; Markowitz, Steven M; Lerman, Bruce B

2013-10-01

Riata and Riata ST implantable cardioverter-defibrillator leads have been shown to be prone to structural and electrical failure. To determine predictors, mechanisms, and temporal patterns of Riata/ST lead electrical failure. All 314 patients who underwent Riata/ST lead implantation at our institution with greater than or equal to 90 days of follow-up were studied. The Kaplan-Meier analysis of lead survival was performed. Results from the returned product analysis of explanted leads with electrical lead failure were recorded. During a median follow-up of 4.1 years, the Riata lead electrical failure rate was 6.6%. The rate of externalized conductors among failed leads was 57%. The engineering analysis of 10 explanted leads revealed 5 (50%) leads with electrical failure owing to breach of ethylene tetrafluoroethylene conductor coating. Female gender (hazard ratio 2.7; 95% confidence interval 1.1-6.7; P = .04) and age (hazard ratio 0.95; 95% confidence interval 0.92-0.97; P < .001) were multivariate predictors of lead failure. By using log-log analysis, we noted that the rate of Riata lead failure initially increased exponentially with a power of 2.1 but leads surviving past 4 years had a linear pattern of lead failure with a power of 1.0. Younger age and female gender are independent predictors of Riata lead failure. Loss of integrity of conductor cables with ethylene tetrafluoroethylene coating is an important mode of electrical failure of the Riata lead. Further study of Riata lead failure trends is warranted to guide lead management. © 2013 Heart Rhythm Society. All rights reserved.

Percutaneous radiofrequency ablation of hepatic tumours: factors affecting technical failure of artificial ascites formation using an angiosheath.

PubMed

Kang, T W; Lee, M W; Hye, M J; Song, K D; Lim, S; Rhim, H; Lim, H K; Cha, D I

2014-12-01

To evaluate the technical feasibility of artificial ascites formation using an angiosheath before percutaneous radiofrequency ablation (RFA) for hepatic tumours and to determine predictive factors affecting the technical failure of artificial ascites formation. This retrospective study was approved by the institutional review board. One hundred and thirteen patients underwent percutaneous RFA of hepatic tumours after trying to make artificial ascites using an angiosheath to avoid collateral thermal damage. The technical success rate of making artificial ascites using an angiosheath and conversion rate to other techniques after initial failure of making artificial ascites were evaluated. The technical success rate for RFA was assessed. In addition, potential factors associated with technical failure including previous history of transcatheter arterial chemoembolization (TACE) or RFA, type of abdominal surgery, and adjacent perihepatic structures were reviewed. Predictive factors for the technical failure of artificial ascites formation were analysed using multivariate analysis. The technical success rates of artificial ascites formation by angiosheath and that of RFA were 84.1% (95/113) and 97.3% (110/113), respectively. The conversion rate to other techniques after the failure of artificial ascites formation using an angiosheath was 15.9% (18/113). Previous hepatic resection was the sole independent predictive factor affecting the technical failure of artificial ascites formation (p<0.001, odds ratio = 29.03, 95% confidence interval: 4.56-184.69). Making artificial ascites for RFA of hepatic tumours using an angiosheath was technically feasible in most cases. However, history of hepatic resection was a significant predictive factor affecting the technical failure of artificial ascites formation. Copyright © 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Failure rate of inferior alveolar nerve block among dental students and interns

PubMed Central

AlHindi, Maryam; Rashed, Bayan; AlOtaibi, Noura

2016-01-01

Objectives: To report the failure rate of inferior alveolar nerve block (IANB) among dental students and interns, causes of failure, investigate awareness of different IANB techniques, and to report IANB-associated complications. Methods: A 3-page questionnaire containing 13 questions was distributed to a random sample of 350 third to fifth years students and interns at the College of Dentistry, King Saud University, Riyadh, Saudi Arabia on January 2011. It included demographic questions (age, gender, and academic level) and questions on IANB failure frequency and reasons, actions taken to overcome the failure, and awareness of different anesthetic techniques, supplementary techniques, and complications. Results: Of the 250 distributed questionnaires, 238 were returned (68% response rate). Most (85.7%) of surveyed sample had experienced IANB failure once or twice. The participants attributed the failures most commonly (66.45%) to anatomical variations. The most common alternative technique used was intraligamentary injection (57.1%), although 42.8% of the sample never attempted any alternatives. Large portion of the samples stated that they either lacked both knowledge of and training for other techniques (44.9%), or that they had knowledge of them but not enough training to perform them (45.8%). Conclusion: To decrease IANB failure rates for dental students and interns, knowledge of landmarks, anatomical variation and their training in alternatives to IANB, such as the Gow-Gates and Akinosi techniques, both theoretically and clinically in the dental curriculum should be enhanced. PMID:26739980

Failure rate of inferior alveolar nerve block among dental students and interns.

PubMed

AlHindi, Maryam; Rashed, Bayan; AlOtaibi, Noura

2016-01-01

To report the failure rate of inferior alveolar nerve block (IANB) among dental students and interns, causes of failure, investigate awareness of different IANB techniques, and to report IANB-associated complications.   A 3-page questionnaire containing 13 questions was distributed to a random sample of 350 third to fifth years students and interns at the College of Dentistry, King Saud University, Riyadh, Saudi Arabia on January 2011. It included demographic questions (age, gender, and academic level) and questions on IANB failure frequency and reasons, actions taken to overcome the failure, and awareness of different anesthetic techniques, supplementary techniques, and complications.   Of the 250 distributed questionnaires, 238 were returned (68% response rate). Most (85.7%) of surveyed sample had experienced IANB failure once or twice. The participants attributed the failures most commonly (66.45%) to anatomical variations. The most common alternative technique used was intraligamentary injection (57.1%), although 42.8% of the sample never attempted any alternatives. Large portion of the samples stated that they either lacked both knowledge of and training for other techniques (44.9%), or that they had knowledge of them but not enough training to perform them (45.8%).  To  decrease IANB failure rates for dental students and interns, knowledge of landmarks, anatomical variation and their training in alternatives to IANB, such as the Gow-Gates and Akinosi techniques, both theoretically and clinically in the dental curriculum should be enhanced.

Disease management: remote monitoring in heart failure patients with implantable defibrillators, resynchronization devices, and haemodynamic monitors.

PubMed

Abraham, William T

2013-06-01

Heart failure represents a major public health concern, associated with high rates of morbidity and mortality. A particular focus of contemporary heart failure management is reduction of hospital admission and readmission rates. While optimal medical therapy favourably impacts the natural history of the disease, devices such as cardiac resynchronization therapy devices and implantable cardioverter defibrillators have added incremental value in improving heart failure outcomes. These devices also enable remote patient monitoring via device-based diagnostics. Device-based measurement of physiological parameters, such as intrathoracic impedance and heart rate variability, provide a means to assess risk of worsening heart failure and the possibility of future hospitalization. Beyond this capability, implantable haemodynamic monitors have the potential to direct day-to-day management of heart failure patients to significantly reduce hospitalization rates. The use of a pulmonary artery pressure measurement system has been shown to significantly reduce the risk of heart failure hospitalization in a large randomized controlled study, the CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients (CHAMPION) trial. Observations from a pilot study also support the potential use of a left atrial pressure monitoring system and physician-directed patient self-management paradigm; these observations are under further investigation in the ongoing LAPTOP-HF trial. All these devices depend upon high-intensity remote monitoring for successful detection of parameter deviations and for directing and following therapy.

Redefining "Critical" Bone Loss in Shoulder Instability: Functional Outcomes Worsen With "Subcritical" Bone Loss.

PubMed

Shaha, James S; Cook, Jay B; Song, Daniel J; Rowles, Douglas J; Bottoni, Craig R; Shaha, Steven H; Tokish, John M

2015-07-01

Glenoid bone loss is a common finding in association with anterior shoulder instability. This loss has been identified as a predictor of failure after operative stabilization procedures. Historically, 20% to 25% has been accepted as the "critical" cutoff where glenoid bone loss should be addressed in a primary procedure. Few data are available, however, on lesser, "subcritical" amounts of bone loss (below the 20%-25% range) on functional outcomes and failure rates after primary arthroscopic stabilization for shoulder instability. To evaluate the effect of glenoid bone loss, especially in subcritical bone loss (below the 20%-25% range), on outcomes assessments and redislocation rates after an isolated arthroscopic Bankart repair for anterior shoulder instability. Cohort study; Level of evidence, 3. Subjects were 72 consecutive anterior instability patients (73 shoulders) who underwent isolated anterior arthroscopic labral repair at a single military institution by 1 of 3 sports medicine fellowship-trained orthopaedic surgeons. Data were collected on demographics, the Western Ontario Shoulder Instability (WOSI) score, Single Assessment Numeric Evaluation (SANE) score, and failure rates. Failure was defined as recurrent dislocation. Glenoid bone loss was calculated via a standardized technique on preoperative imaging. The average bone loss across the group was calculated, and patients were divided into quartiles based on the percentage of glenoid bone loss. Outcomes were analyzed for the entire cohort, between the quartiles, and within each quartile. Outcomes were then further stratified between those sustaining a recurrence versus those who remained stable. The mean age at surgery was 26.3 years (range, 20-42 years), and the mean follow-up was 48.3 months (range, 23-58 months). The cohort was divided into quartiles based on bone loss. Quartile 1 (n = 18) had a mean bone loss of 2.8% (range, 0%-7.1%), quartile 2 (n = 19) had 10.4% (range, 7.3%-13.5%), quartile 3 (n = 18) had 16.1% (range, 13.5%-19.8%), and quartile 4 (n = 18) had 24.5% (range, 20.0%-35.5%). The overall mean WOSI score was 756.8 (range, 0-2097). The mean WOSI score correlated with SANE scores and worsened as bone loss increased in each quartile. There were significant differences (P < .05) between quartile 1 (mean WOSI/SANE, 383.3/62.1) and quartile 2 (mean, 594.0/65.2), between quartile 2 and quartile 3 (mean, 839.5/52.0), and between quartile 3 and quartile 4 (mean, 1187.6/46.1). Additionally, between quartiles 2 and 3 (bone loss, 13.5%), the WOSI score increased to rates consistent with a poor clinical outcome. There was an overall failure rate of 12.3%. The percentage of glenoid bone loss was significantly higher among those repairs that failed versus those that remained stable (24.7% vs 12.8%, P < .01). There was no significant difference in failure rate between quartiles 1, 2, and 3, but there was a significant increase in failure (P < .05) between quartiles 1, 2, and 3 (7.3%) when compared with quartile 4 (27.8%). Notably, even when only those patients who did not sustain a recurrent dislocation were compared, bone loss was predictive of outcome as assessed by the WOSI score, with each quartile's increasing bone loss predictive of a worse functional outcome. While critical bone loss has yet to be defined for arthroscopic Bankart reconstruction, our data indicate that "critical" bone loss should be lower than the 20% to 25% threshold often cited. In our population with a high level of mandatory activity, bone loss above 13.5% led to a clinically significant decrease in WOSI scores consistent with an unacceptable outcome, even in patients who did not sustain a recurrence of their instability. © 2015 The Author(s).

Being on sick leave due to heart failure: self-rated health, encounters with healthcare professionals and social insurance officers and self-estimated ability to return to work.

PubMed

Nordgren, Lena; Söderlund, Anne

2015-01-01

Younger people with heart failure often experience poor self-rated health. Furthermore, poor self-rated health is associated with long-term sick leave and disability pension. Socio-demographic factors affect the ability to return to work. However, little is known about people on sick leave due to heart failure. The aim of this study was to investigate associations between self-rated health, mood, socio-demographic factors, sick leave compensation, encounters with healthcare professionals and social insurance officers and self-estimated ability to return to work, for people on sick leave due to heart failure. This population-based investigation had a cross-sectional design. Data were collected in Sweden in 2012 from two official registries and from a postal questionnaire. In total, 590 subjects, aged 23-67, responded (response rate 45.8%). Descriptive statistics, correlation analyses (Spearman bivariate analysis) and logistic regression analyses were used to investigate associations. Poor self-rated health was strongly associated with full sick leave compensation (OR = 4.1, p < .001). Compared self-rated health was moderately associated with low income (OR =  .6, p =  .003). Good self-rated health was strongly associated with positive encounters with healthcare professionals (OR = 3.0, p =  .022) and to the impact of positive encounters with healthcare professionals on self-estimated ability to return to work (OR = 3.3, p < .001). People with heart failure are sicklisted for long periods of time and to a great extent receive disability pension. Not being able to work imposes reduced quality of life. Positive encounters with healthcare professionals and social insurance officers can be supportive when people with heart failure struggle to remain in working life.

Scaling of coupled dilatancy-diffusion processes in space and time

NASA Astrophysics Data System (ADS)

Main, I. G.; Bell, A. F.; Meredith, P. G.; Brantut, N.; Heap, M.

2012-04-01

Coupled dilatancy-diffusion processes resulting from microscopically brittle damage due to precursory cracking have been observed in the laboratory and suggested as a mechanism for earthquake precursors. One reason precursors have proven elusive may be the scaling in space: recent geodetic and seismic data placing strong limits on the spatial extent of the nucleation zone for recent earthquakes. Another may be the scaling in time: recent laboratory results on axi-symmetric samples show both a systematic decrease in circumferential extensional strain at failure and a delayed and a sharper acceleration of acoustic emission event rate as strain rate is decreased. Here we examine the scaling of such processes in time from laboratory to field conditions using brittle creep (constant stress loading) to failure tests, in an attempt to bridge part of the strain rate gap to natural conditions, and discuss the implications for forecasting the failure time. Dilatancy rate is strongly correlated to strain rate, and decreases to zero in the steady-rate creep phase at strain rates around 10-9 s-1 for a basalt from Mount Etna. The data are well described by a creep model based on the linear superposition of transient (decelerating) and accelerating micro-crack growth due to stress corrosion. The model produces good fits to the failure time in retrospect using the accelerating acoustic emission event rate, but in prospective tests on synthetic data with the same properties we find failure-time forecasting is subject to systematic epistemic and aleatory uncertainties that degrade predictability. The next stage is to use the technology developed to attempt failure forecasting in real time, using live streamed data and a public web-based portal to quantify the prospective forecast quality under such controlled laboratory conditions.

Age and admission times as predictive factors for failure of admissions to discharge-stream short-stay units.

PubMed

Shetty, Amith L; Shankar Raju, Savitha Banagar; Hermiz, Arsalan; Vaghasiya, Milan; Vukasovic, Matthew

2015-02-01

Discharge-stream emergency short-stay units (ESSU) improve ED and hospital efficiency. Age of patients and time of hospital presentations have been shown to correlate with increasing complexity of care. We aim to determine whether an age and time cut-off could be derived to subsequently improve short-stay unit success rates. We conducted a retrospective audit on 6703 (5522 inclusions) patients admitted to our discharge-stream short-stay unit. Patients were classified as appropriate or inappropriate admissions, and deemed successful if discharged out of the unit within 24 h; and failures if they needed inpatient admission into the hospital. We calculated short-stay unit length of stay for patients in each of these groups. A 15% failure rate was deemed as acceptable key performance indicator (KPI) for our unit. There were 197 out of 4621 (4.3%, 95% CI 3.7-4.9%) patients up to the age of 70 who failed admission to ESSU compared with 67 out of 901 (7.4%, 95% CI 5.9-9.3%, P < 0.01) of patients over the age of 70, reflecting an increased failure rate in geriatric population. When grouped according to times of admission to the ESSU (in-office 06.00-22.00 hours vs out-of-office 22.00-06.00 hours) no significant difference rates in discharge failure (4.7% vs 5.2%, P = 0.46) were noted. Patients >70 years of age have higher rates of failure after admission to discharge-stream ESSU. Although in appropriately selected discharge-stream patients, no age group or time-band of presentation was associated with increased failure rate beyond the stipulated KPI. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Rapid core measure improvement through a "business case for quality".

PubMed

Perlin, Jonathan B; Horner, Stephen J; Englebright, Jane D; Bracken, Richard M

2014-01-01

Incentives to improve performance are emerging as revenue or financial penalties are linked to the measured quality of service provided. The HCA "Getting to Green" program was designed to rapidly increase core measure performance scores. Program components included (1) the "business case for quality"-increased awareness of how quality drives financial performance; (2) continuous communication of clinical and financial performance data; and (3) evidence-based clinical protocols, incentives, and tools for process improvement. Improvement was measured by comparing systemwide rates of adherence to national quality measures for heart failure (HF), acute myocardial infarction (AMI), pneumonia (PN), and surgical care (SCIP) to rates from all facilities reporting to the Centers for Medicare and Medicaid Services (CMS). As of the second quarter of 2011, 70% of HCA total measure set composite scores were at or above the 90th percentile of CMS scores. A test of differences in regression coefficients between the CMS national average and the HCA average revealed significant differences for AMI (p = .001), HF (p = .012), PN (p < .001), and SCIP (p = .015). This program demonstrated that presentation of the financial implications of quality, transparency in performance data, and clearly defined goals could cultivate the desire to use improvement tools and resources to raise performance. © 2012 National Association for Healthcare Quality.

Nonunion After Clavicle Osteosynthesis: High Incidence of Propionibacterium acnes.

PubMed

Gausden, Elizabeth B; Villa, Jordan; Warner, Stephen J; Redko, Mariya; Pearle, Andrew; Miller, Andy; Henry, Michael; Lorich, Dean G; Helfet, David L; Wellman, David S

2017-04-01

The objective of this study was to review the etiology of clavicle nonunions after osteosynthesis and investigate the outcomes of a treatment with a single-stage revision. Retrospective case series. Orthopaedic specialty hospital. Twenty cases of nonunion after osteosynthesis of the clavicle were identified. The average age was 44 years (±13 years). In 9 cases, there was catastrophic implant failure that prompted the revision surgery. In the 18 cases in which cultures were taken, 15 of the 18 (83%) were treated as infections with a course of antibiotics. In 14 cases, the cultures were positive for Propionibacterium acnes. Fifteen patients were treated with a prolonged course of antibiotics. Eighteen patients had follow-up, and the average time to radiographic union was 22 weeks. There were no cases of nonunion after revision surgery. There is a high rate of positive cultures in cases of nonunion after osteosynthesis of the clavicle. This suggests the etiology of midshaft clavicle nonunions may result from a combination of suboptimal mechanical fixation and latent infection. Our treatment protocol of superior and anterior plating, interfragmentary fixation, bone grafting, and appropriate antimicrobial treatment of latent infections has resulted in 100% union rate. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Achieving cost-neutrality with long-acting reversible contraceptive methods.

PubMed

Trussell, James; Hassan, Fareen; Lowin, Julia; Law, Amy; Filonenko, Anna

2015-01-01

This analysis aimed to estimate the average annual cost of available reversible contraceptive methods in the United States. In line with literature suggesting long-acting reversible contraceptive (LARC) methods become increasingly cost-saving with extended duration of use, it aimed to also quantify minimum duration of use required for LARC methods to achieve cost-neutrality relative to other reversible contraceptive methods while taking into consideration discontinuation. A three-state economic model was developed to estimate relative costs of no method (chance), four short-acting reversible (SARC) methods (oral contraceptive, ring, patch and injection) and three LARC methods [implant, copper intrauterine device (IUD) and levonorgestrel intrauterine system (LNG-IUS) 20 mcg/24 h (total content 52 mg)]. The analysis was conducted over a 5-year time horizon in 1000 women aged 20-29 years. Method-specific failure and discontinuation rates were based on published literature. Costs associated with drug acquisition, administration and failure (defined as an unintended pregnancy) were considered. Key model outputs were annual average cost per method and minimum duration of LARC method usage to achieve cost-savings compared to SARC methods. The two least expensive methods were copper IUD ($304 per women, per year) and LNG-IUS 20 mcg/24 h ($308). Cost of SARC methods ranged between $432 (injection) and $730 (patch), per women, per year. A minimum of 2.1 years of LARC usage would result in cost-savings compared to SARC usage. This analysis finds that even if LARC methods are not used for their full durations of efficacy, they become cost-saving relative to SARC methods within 3 years of use. Previous economic arguments in support of using LARC methods have been criticized for not considering that LARC methods are not always used for their full duration of efficacy. This study calculated that cost-savings from LARC methods relative to SARC methods, with discontinuation rates considered, can be realized within 3 years. Copyright © 2014 Elsevier Inc. All rights reserved.

Needle thoracostomy in the treatment of a tension pneumothorax in trauma patients: what size needle?

PubMed

Zengerink, Imme; Brink, Peter R; Laupland, Kevin B; Raber, Earl L; Zygun, Dave; Kortbeek, John B

2008-01-01

A tension pneumothorax requires immediate decompression using a needle thoracostomy. According to advanced trauma life support guidelines this procedure is performed in the second intercostal space (ICS) in the midclavicular line (MCL), using a 4.5-cm (2-inch) catheter (5-cm needle). Previous studies have shown a failure rate of up to 40% using this technique. Case reports have suggested that this high failure rate could be because of insufficient length of the needle. To analyze the average chest wall thickness (CWT) at the second ICS in the MCL in a trauma population and to evaluate the length of the needle used in needle thoracostomy for emergency decompression of tension pneumothoraces. Retrospective review of major trauma admissions (Injury Severity Score >12) at the Foothills Medical Centre in Calgary, Canada, who underwent a computed tomography chest scan admitted in the period from October 2001 until March 2004. Subgroup analysis on men and women, <40 years of age and >/=40 years of age was defined a priori. CWT was measured to the nearest 0.01 cm at the second ICS in the MCL. The mean CWT in the 604 male patients and 170 female patients studied averaged 3.50 cm at the left second ICS MCL and 3.51 cm on the right. The mean CWT was significantly higher for women than men (p < 0.0001). About 9.9% to 19.3% of the men had a CWT >4.5 cm and 24.1% to 35.4% of the women studied. A catheter length of 4.5 cm may not penetrate the chest wall of a substantial amount (9.9%-35.4%) of the population, depending on age and gender. This study demonstrates the need for a variable needle length for relief of a tension pneumothorax in certain population groups to improve effectiveness of needle thoracostomy.

Breathing-motion-compensated robotic guided stereotactic body radiation therapy : Patterns of failure analysis.

PubMed

Stera, Susanne; Balermpas, Panagiotis; Chan, Mark K H; Huttenlocher, Stefan; Wurster, Stefan; Keller, Christian; Imhoff, Detlef; Rades, Dirk; Dunst, Jürgen; Rödel, Claus; Hildebrandt, Guido; Blanck, Oliver

2018-02-01

We retrospectively evaluated the patterns of failure for robotic guided real-time breathing-motion-compensated (BMC) stereotactic body radiation therapy (SBRT) in the treatment of tumors in moving organs. Between 2011 and 2016, a total of 198 patients with 280 lung, liver, and abdominal tumors were treated with BMC-SBRT. The median gross tumor volume (GTV) was 12.3 cc (0.1-372.0 cc). Medians of mean GTV BED α/β = 10   Gy (BED = biological effective dose) was 148.5 Gy 10 (31.5-233.3 Gy 10 ) and prescribed planning target volume (PTV) BED α/β = 10   Gy was 89.7 Gy 10 (28.8-151.2 Gy 10 ), respectively. We analyzed overall survival (OS) and local control (LC) based on various factors, including BEDs with α/β ratios of 15 Gy (lung metastases), 21 Gy (primary lung tumors), and 27 Gy (liver metastases). Median follow-up was 10.4 months (2.0-59.0 months). The 2‑year actuarial LC was 100 and 86.4% for primary early and advanced stage lung tumors, respectively, 100% for lung metastases, 82.2% for liver metastases, and 90% for extrapulmonary extrahepatic metastases. The 2‑year OS rate was 47.9% for all patients. In uni- and multivariate analysis, comparatively lower PTV prescription dose (equivalence of 3 × 12-13 Gy) and higher average GTV dose (equivalence of 3 × 18 Gy) to current practice were significantly associated with LC. For OS, Karnofsky performance score (100%), gender (female), and SBRT without simultaneous chemotherapy were significant prognostic factors. Grade 3 side effects were rare (0.5%). Robotic guided BMC-SBRT can be considered a safe and effective treatment for solid tumors in moving organs. To reach sufficient local control rates, high average GTV doses are necessary. Further prospective studies are warranted to evaluate these points.

Multi-scale approach to the modeling of fission gas discharge during hypothetical loss-of-flow accident in gen-IV sodium fast reactor

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

Behafarid, F.; Shaver, D. R.; Bolotnov, I. A.

The required technological and safety standards for future Gen IV Reactors can only be achieved if advanced simulation capabilities become available, which combine high performance computing with the necessary level of modeling detail and high accuracy of predictions. The purpose of this paper is to present new results of multi-scale three-dimensional (3D) simulations of the inter-related phenomena, which occur as a result of fuel element heat-up and cladding failure, including the injection of a jet of gaseous fission products into a partially blocked Sodium Fast Reactor (SFR) coolant channel, and gas/molten sodium transport along the coolant channels. The computational approachmore » to the analysis of the overall accident scenario is based on using two different inter-communicating computational multiphase fluid dynamics (CMFD) codes: a CFD code, PHASTA, and a RANS code, NPHASE-CMFD. Using the geometry and time history of cladding failure and the gas injection rate, direct numerical simulations (DNS), combined with the Level Set method, of two-phase turbulent flow have been performed by the PHASTA code. The model allows one to track the evolution of gas/liquid interfaces at a centimeter scale. The simulated phenomena include the formation and breakup of the jet of fission products injected into the liquid sodium coolant. The PHASTA outflow has been averaged over time to obtain mean phasic velocities and volumetric concentrations, as well as the liquid turbulent kinetic energy and turbulence dissipation rate, all of which have served as the input to the core-scale simulations using the NPHASE-CMFD code. A sliding window time averaging has been used to capture mean flow parameters for transient cases. The results presented in the paper include testing and validation of the proposed models, as well the predictions of fission-gas/liquid-sodium transport along a multi-rod fuel assembly of SFR during a partial loss-of-flow accident. (authors)« less

Achieving cost-neutrality with long-acting reversible contraceptive methods⋆

PubMed Central

Trussell, James; Hassan, Fareen; Lowin, Julia; Law, Amy; Filonenko, Anna

2014-01-01

Objectives This analysis aimed to estimate the average annual cost of available reversible contraceptive methods in the United States. In line with literature suggesting long-acting reversible contraceptive (LARC) methods become increasingly cost-saving with extended duration of use, it aimed to also quantify minimum duration of use required for LARC methods to achieve cost-neutrality relative to other reversible contraceptive methods while taking into consideration discontinuation. Study design A three-state economic model was developed to estimate relative costs of no method (chance), four short-acting reversible (SARC) methods (oral contraceptive, ring, patch and injection) and three LARC methods [implant, copper intrauterine device (IUD) and levonorgestrel intrauterine system (LNG-IUS) 20 mcg/24 h (total content 52 mg)]. The analysis was conducted over a 5-year time horizon in 1000 women aged 20–29 years. Method-specific failure and discontinuation rates were based on published literature. Costs associated with drug acquisition, administration and failure (defined as an unintended pregnancy) were considered. Key model outputs were annual average cost per method and minimum duration of LARC method usage to achieve cost-savings compared to SARC methods. Results The two least expensive methods were copper IUD ($304 per women, per year) and LNG-IUS 20 mcg/24 h ($308). Cost of SARC methods ranged between $432 (injection) and $730 (patch), per women, per year. A minimum of 2.1 years of LARC usage would result in cost-savings compared to SARC usage. Conclusions This analysis finds that even if LARC methods are not used for their full durations of efficacy, they become cost-saving relative to SARC methods within 3 years of use. Implications Previous economic arguments in support of using LARC methods have been criticized for not considering that LARC methods are not always used for their full duration of efficacy. This study calculated that cost-savings from LARC methods relative to SARC methods, with discontinuation rates considered, can be realized within 3 years. PMID:25282161

Forecasting overhaul or replacement intervals based on estimated system failure intensity

NASA Astrophysics Data System (ADS)

Gannon, James M.

1994-12-01

System reliability can be expressed in terms of the pattern of failure events over time. Assuming a nonhomogeneous Poisson process and Weibull intensity function for complex repairable system failures, the degree of system deterioration can be approximated. Maximum likelihood estimators (MLE's) for the system Rate of Occurrence of Failure (ROCOF) function are presented. Evaluating the integral of the ROCOF over annual usage intervals yields the expected number of annual system failures. By associating a cost of failure with the expected number of failures, budget and program policy decisions can be made based on expected future maintenance costs. Monte Carlo simulation is used to estimate the range and the distribution of the net present value and internal rate of return of alternative cash flows based on the distributions of the cost inputs and confidence intervals of the MLE's.

Skeletal muscle mass and exercise performance in stable ambulatory patients with heart failure.

PubMed

Lang, C C; Chomsky, D B; Rayos, G; Yeoh, T K; Wilson, J R

1997-01-01

The purpose of this study was to determine whether skeletal muscle atrophy limits the maximal exercise capacity of stable ambulatory patients with heart failure. Body composition and maximal exercise capacity were measured in 100 stable ambulatory patients with heart failure. Body composition was assessed by using dual-energy X-ray absorption. Peak exercise oxygen consumption (VO2peak) and the anaerobic threshold were measured by using a Naughton treadmill protocol and a Medical Graphics CardioO2 System. VO2peak averaged 13.4 +/- 3.3 ml.min-1.kg-1 or 43 +/- 12% of normal. Lean body mass averaged 52.9 +/- 10.5 kg and leg lean mass 16.5 +/- 3.6 kg. Leg lean mass correlated linearly with VO2peak (r = 0.68, P < 0.01), suggesting that exercise performance is influences by skeletal muscle mass. However, lean body mass was comparable to levels noted in 1,584 normal control subjects, suggesting no decrease in muscle mass. Leg muscle mass was comparable to levels noted in 34 normal control subjects, further supporting this conclusion. These findings suggest that exercise intolerance in stable ambulatory patients with heart failure is not due to skeletal muscle atrophy.

In-Flight Validation of a Pilot Rating Scale for Evaluating Failure Transients in Electronic Flight Control Systems

NASA Technical Reports Server (NTRS)

Kalinowski, Kevin F.; Tucker, George E.; Moralez, Ernesto, III

2006-01-01

Engineering development and qualification of a Research Flight Control System (RFCS) for the Rotorcraft Aircrew Systems Concepts Airborne Laboratory (RASCAL) JUH-60A has motivated the development of a pilot rating scale for evaluating failure transients in fly-by-wire flight control systems. The RASCAL RFCS includes a highly-reliable, dual-channel Servo Control Unit (SCU) to command and monitor the performance of the fly-by-wire actuators and protect against the effects of erroneous commands from the flexible, but single-thread Flight Control Computer. During the design phase of the RFCS, two piloted simulations were conducted on the Ames Research Center Vertical Motion Simulator (VMS) to help define the required performance characteristics of the safety monitoring algorithms in the SCU. Simulated failures, including hard-over and slow-over commands, were injected into the command path, and the aircraft response and safety monitor performance were evaluated. A subjective Failure/Recovery Rating (F/RR) scale was developed as a means of quantifying the effects of the injected failures on the aircraft state and the degree of pilot effort required to safely recover the aircraft. A brief evaluation of the rating scale was also conducted on the Army/NASA CH-47B variable stability helicopter to confirm that the rating scale was likely to be equally applicable to in-flight evaluations. Following the initial research flight qualification of the RFCS in 2002, a flight test effort was begun to validate the performance of the safety monitors and to validate their design for the safe conduct of research flight testing. Simulated failures were injected into the SCU, and the F/RR scale was applied to assess the results. The results validate the performance of the monitors, and indicate that the Failure/Recovery Rating scale is a very useful tool for evaluating failure transients in fly-by-wire flight control systems.

Chopper-controlled discharge life cycling studies on lead-acid batteries

NASA Technical Reports Server (NTRS)

Kraml, J. J.; Ames, E. P.

1982-01-01

State-of-the-art 6 volt lead-acid golf car batteries were tested. A daily charge/discharge cycling to failure points under various chopper controlled pulsed dc and continuous current load conditions was undertaken. The cycle life and failure modes were investigated for depth of discharge, average current chopper frequency, and chopper duty cycle. It is shown that battery life is primarily and inversely related to depth of discharge and discharge current. Failure mode is characterized by a gradual capacity loss with consistent evidence of cell element aging.

Surgical treatment of chronic exertional compartment syndrome of the leg: failure rates and postoperative disability in an active patient population.

PubMed

Waterman, Brian R; Laughlin, Matthew; Kilcoyne, Kelly; Cameron, Kenneth L; Owens, Brett D

2013-04-03

Chronic exertional compartment syndrome of the leg is a frequent source of lower-extremity pain in military personnel, competitive athletes, and runners. We are not aware of any previous study in which the authors rigorously evaluated the rates of return to full activity, persistent disability, and surgical revision after operative management of chronic exertional compartment syndrome of the leg in a large, physically active population. Individuals who had undergone surgical fasciotomy of the anterior, lateral, and/or posterior compartments (current procedural terminology [CPT] codes 27600, 27601, and 27602) for nontraumatic compartment syndrome of the lower extremity (International Classification of Diseases, Ninth Revision [ICD-9] code 729.72) between 2003 and 2010 were identified from the Military Health System Management Analysis and Reporting Tool (M2). Demographic variables including age, sex, and rank were extracted, and rates of postoperative complications, activity limitations, and revision surgery or medical discharge were obtained from the electronic medical record and U.S. Army Physical Disability Agency database. A total of 611 patients underwent 754 surgical procedures. The average patient age was 28.0 years, and 91.8% of the patients were male. Of the surgical procedures, 77.4% involved only anterior and lateral compartment releases; 19.4% addressed the anterior, lateral, and posterior compartments; and 2.2% addressed the posterior compartments alone. Symptom recurrence was reported by 44.7% of the patients, and 27.7% were unable to return to full activity. Surgical complications were documented for 15.7% of the patients, 5.9% underwent surgical revision, and 17.3% were referred for medical discharge because of chronic exertional compartment syndrome. Univariate analysis of prognostic factors revealed that surgical failure was associated with bilateral involvement (odds ratio [OR], 1.64), perioperative complications (OR, 2.12), activity limitations (OR, 4.41), and persistence of preoperative symptoms (OR, 8.46). Multivariable analysis confirmed significant associations between surgical failure and perioperative complications (OR, 1.72), activity limitations (OR, 2.23), and persistence of preoperative symptoms (OR, 5.47), whereas other factors were not significantly associated with surgical failure. Chronic exertional compartment syndrome is a substantial contributor to lower-extremity disability in the military population. Nearly half of all service members undergoing fasciotomy reported persistent symptoms, and one in five individuals had unsuccessful surgical treatment.

A new kid on the block: The Memory Validity Profile (MVP) in children with neurological conditions.

PubMed

Brooks, Brian L; Fay-McClymont, Taryn B; MacAllister, William S; Vasserman, Marsha; Sherman, Elisabeth M S

2018-06-06

Determining the validity of obtained data is an inherent part of a neuropsychological assessment. The purpose of this study was investigate the failure rate of the Memory Validity Profile (MVP) in a large clinical sample of children and adolescents with neurological diagnoses. Data were obtained from 261 consecutive patients (mean age = 12.0, SD = 3.9, range = 5-19) who were referred for a neuropsychological assessment in a tertiary care pediatric hospital and were administered the MVP. In this sample, 4.6% of youth failed the MVP. Mean administration time for the MVP was 7.4 min, although time to complete was not associated with failure rates. Failure rates were held relatively consistent at approximately 5% across age ranges, diagnoses, and psychomotor processing speed abilities. Having very low, below normal, or above normal intellectual abilities did not alter failure rate on the MVP. However, those with intellectual disability (i.e., IQ<70) had a higher fail rate at 12% on MVP Total Score, but only 6% on the MVP Visual portion. Failure rates on the MVP were associated with lower scores on memory tests. This study provides support for using the MVP in children as young as 5 years with neurological diagnoses.

Effect of Strain Rate on Joint Strength and Failure Mode of Lead-Free Solder Joints

NASA Astrophysics Data System (ADS)

Lin, Jian; Lei, Yongping; Fu, Hanguang; Guo, Fu

2018-03-01

In surface mount technology, the Sn-3.0Ag-0.5Cu solder joint has a shorter impact lifetime than a traditional lead-tin solder joint. In order to improve the impact property of SnAgCu lead-free solder joints and identify the effect of silver content on tensile strength and impact property, impact experiments were conducted at various strain rates on three selected SnAgCu based solder joints. It was found that joint failure mainly occurred in the solder material with large plastic deformation under low strain rate, while joint failure occurred at the brittle intermetallic compound layer without any plastic deformation at a high strain rate. Joint strength increased with the silver content in SnAgCu alloys in static tensile tests, while the impact property of the solder joint decreased with increasing silver content. When the strain rate was low, plastic deformation occurred with failure and the tensile strength of the Sn-3.0Ag-0.5Cu solder joint was higher than that of Sn-0.3Ag-0.7Cu; when the strain rate was high, joint failure mainly occurred at the brittle interface layer and the Sn-0.3Ag-0.7Cu solder joint had a better impact resistance with a thinner intermetallic compound layer.

Clinical efficacy of crataegus extract WS 1442 in congestive heart failure NYHA class II.

PubMed

Zapfe jun, G

2001-07-01

In a randomised, placebo-controlled, double-blind clinical study the clinical efficacy and safety of Crataegus extract WS 1442, standardised to 18.75% oligomeric procyanidines, were investigated in 40 female and male outpatients suffering from congestive heart failure NYHA class II. Following a wash-out period of up to seven days, the patients were randomised to be treated for 12 weeks with either WS 1442 (3 x 1 capsule) or placebo. The primary outcome variable was exercise tolerance determined with bicycle exercise testing; as a secondary outcome variable the difference of the double product was calculated. On average, the exercise tolerance increased by 66.3 W x min (10.8%) in the WS 1442 group while in the placebo group a reduction of 105.3 W x min (16.9%) was measured. This difference between the groups was borderline statistically significant (p = 0.06). During the three month therapy the difference of the double product (heart rate x systolic blood pressure x 10(-2)) decreased by 14.4 mmHg s(-1) (26.8%) in the WS 1442 group and by 1.3 mmHg s(-1) (2.7%) in the placebo group, respectively. Recording of laboratory parameters and adverse events showed that WS 1442 was safe and well tolerated. The data show that Crataegus extract WS 1442 is clinically effective in patients with congestive heart failure corresponding to NYHA class II.

Selection criteria of residents for residency programs in Kuwait

PubMed Central

2013-01-01

Background In Kuwait, 21 residency training programs were offered in the year 2011; however, no data is available regarding the criteria of selecting residents for these programs. This study aims to provide information about the importance of these criteria. Methods A self-administered questionnaire was used to collect data from members (e.g. chairmen, directors, assistants …etc.) of residency programs in Kuwait. A total of 108 members were invited to participate. They were asked to rate the importance level (scale from 1 to 5) of criteria that may affect the acceptance of an applicant to their residency programs. Average scores were calculated for each criterion. Results Of the 108 members invited to participate, only 12 (11.1%) declined to participate. Interview performance was ranked as the most important criteria for selecting residents (average score: 4.63/5.00), followed by grade point average (average score: 3.78/5.00) and honors during medical school (average score: 3.67/5.00). On the other hand, receiving disciplinary action during medical school and failure in a required clerkship were considered as the most concerning among other criteria used to reject applicants (average scores: 3.83/5.00 and 3.54/5.00 respectively). Minor differences regarding the importance level of each criterion were noted across different programs. Conclusions This study provided general information about the criteria that are used to accept/reject applicants to residency programs in Kuwait. Future studies should be conducted to investigate each criterion individually, and to assess if these criteria are related to residents' success during their training. PMID:23331670

Surgical outcomes of trabeculectomy and glaucoma drainage implant for uveitic glaucoma and relationship with uveitis activity.

PubMed

Kwon, Hye Jin; Kong, Yu Xiang George; Tao, Lingwei William; Lim, Lyndell L; Martin, Keith R; Green, Catherine; Ruddle, Jonathan; Crowston, Jonathan G

2017-07-01

This study provides ophthalmologists who manage uveitic glaucoma with important information on factors that can affect the success of surgical management of this challenging disease. This study examines surgical outcomes of trabeculectomy and glaucoma device implant (GDI) surgery for uveitic glaucoma, in particular the effect of uveitis activity on surgical outcomes. Retrospective chart review at a tertiary institution. Eighty-two cases with uveitic glaucoma (54 trabeculectomies and 28 (GDI) surgeries) performed between 1 December 2006 and 30 November 2014. Associations of factors with surgical outcomes were examined using univariate and multivariate analysis. Surgical outcomes as defined in Guidelines from World Glaucoma Association. Average follow up was 26.4 ± 21.5 months. Overall qualified success rate of the trabeculectomies was not statistically different from GDI, being 67% and 75%, respectively (P = 0.60). Primary and secondary GDI operations showed similar success rates. The most common postoperative complication was hypotony (~30%). Active uveitis at the time of operation was higher in trabeculectomy compared with GDI group (35% vs. 14%). Active uveitis at the time of surgery did not significantly increase risk of failure for trabeculectomies. Recurrence of uveitis was significantly associated with surgical failure in trabeculectomy group (odds ratio 4.8, P = 0.02) but not in GDI group. Surgical success rate of GDI was not significantly different from trabeculectomy for uveitic glaucoma in this study. Regular monitoring, early and prolonged intensive treatment of ocular inflammation is important for surgical success particularly following trabeculectomy. © 2017 Royal Australian and New Zealand College of Ophthalmologists.

Real-world effectiveness for 12 weeks of ledipasvir-sofosbuvir for genotype 1 hepatitis C: the Trio Health study.

PubMed

Tapper, E B; Bacon, B R; Curry, M P; Dieterich, D T; Flamm, S L; Guest, L E; Kowdley, K V; Lee, Y; Tsai, N C; Younossi, Z M; Afdhal, N H

2017-01-01

Early data regarding the "real-world" experience with novel therapies for hepatitis C (HCV) are encouraging. Data are still limited, however, regarding real-world rates of sustained virologic response (SVR) for ledipasvir-sofosbuvir (LDV-SOF), particularly for patients with prior treatment failure. We performed a retrospective cohort study of 1597 patients with chronic genotype 1 HCV who were treated using 12 weeks of the following regimens LDV-SOF±ribavirin (RBV) (n=1521 without RBV, n=76 with RBV). The primary outcome was SVR-determined at 12 weeks in an intention-to-treat design. Prescription according to Food and Drug Administration (FDA) approved labelling (adding RBV for patients with cirrhosis and treatment failure) was assessed in multivariate models. The study population was aged 60 years on average (range 19-89), 60% male, 50% Caucasian, 43% cared for at an academic centre and 30% cirrhotic. Overall, LDV-SOF resulted in a 94% SVR rate. Only 44 (2.9%) patients relapsed. LDV-SOF+RBV yielded SVR in 97% with 0 viral relapses. While cirrhosis and thrombocytopenia were associated with lower odds of SVR, in a multivariable regression model, only treatment at an academic centre and prescriptions contrary to FDA labelling were significantly associated with lower SVR-odds ratios, 0.56 95% CI (0.35-0.87) and 0.29 95% CI(0.12-0.68), respectively. The real-world experience with LDV-SOF mirrors the SVR rates observed in clinical trials. Efforts to promote prescription within FDA recommendations are warranted. © 2016 John Wiley & Sons Ltd.

Surgical Outcomes of Gonioscopy-assisted Transluminal Trabeculotomy (GATT) in Patients With Open-angle Glaucoma.

PubMed

Rahmatnejad, Kamran; Pruzan, Noelle L; Amanullah, Sarah; Shaukat, Bilal A; Resende, Arthur F; Waisbourd, Michael; Zhan, Tingting; Moster, Marlene R

2017-12-01

To evaluate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma. A retrospective chart review of adult patients who underwent GATT due to inadequately controlled intraocular pressure (IOP) or intolerance to medication. Main outcome measures were success rate, IOP, and number of glaucoma medications. Success was defined as IOP reduction >20% from baseline or IOP between 5 to 21 mm Hg, and no need for further glaucoma surgery. When success criteria were not met for any postoperative visit >3 months after surgery, failure was determined. In total, 66 patients, average age 62.9±14.9 years (50.8% female) were included in the analysis. Average follow-up was 11.9 months (range, 3 to 30 mo) and overall success rate was 63.0%. Mean IOP was 26.1±9.9 mm Hg preoperatively and 14.6±4.7 mm Hg at 12 months (44% IOP decrease; P<0.001). Mean number of medications decreased from 3.1±1.1 preoperatively to 1.2±0.9 at 12 months (P<0.001). No significant differences between patients with primary open-angle glaucoma and other types of glaucoma were found.The rate of hyphema at 1 week and 1 month postoperatively was 38% and 6%, respectively. Overall GATT success rate among white and black patients was 69% and 42%, respectively, which was statistically significant (P<0.05). The future of GATT as a minimally invasive glaucoma surgery in adults seems promising. This position is supported by its low rate of long-term complications and the conjunctiva-sparing nature of the surgery.

Clinical outcomes in heart failure: report from a community hospital-based registry.

PubMed

Philbin, E F; Rocco, T A; Lindenmuth, N W; Ulrich, K; Jenkins, P L

1999-12-01

Most of the recent information on the prognosis of patients with heart failure has come from large clinical trials or tertiary care centers. This study reports current information from a community hospital-based heart failure registry. We compiled data from 2,906 unselected consecutive patients with heart failure who were admitted to 10 acute care community hospitals in New York State between 1995 and 1997. Patients were followed prospectively for 6 months after hospital discharge or until their death. The mean (+/- SI)) age of the sample was 76 +/- 11 years. The majority of the patients were women (56%) and most were white (95%). Hospital length of stay averaged 7.4 +/- 7.6 days; hospital charges averaged $7,460 +/- $6,114. Mortality during the index admission was 5%. Among the 2,508 patients for whom mortality or follow-up data were available, an additional 411 died during follow-up, for a cumulative 6-month mortality of 23%. Progressive pump failure was the predominant cause of death in the hospital and after discharge. Although mean functional class (on a 1 to 4 scale) improved from 3.4 +/- 0.7 at hospital admission to 2.3 +/- 0.9 at 1 month after discharge, 43% of patients had at least one hospital readmission during follow-up and 25% had at least one recurrent admission for heart failure. The mean time from index discharge to first rehospitalization was 60 +/- 56 days. In all, 55% of patients (1,370 of 2,508) were rehospitalized or died during the study period. Despite advances in the management of heart failure, patients recently hospitalized for this disorder remain at high risk of death, hospital readmission, and poor clinical outcome. Discovery or implementation of new or existing methods of prevention and treatment remain a high priority.

Effect of low-velocity or ballistic impact damage on the strength of thin composite and aluminum shear panels

NASA Technical Reports Server (NTRS)

Farley, G. L.

1985-01-01

Impact tests were conducted on shear panels fabricated from 6061-T6 aluminum and from woven fabric prepreg of Du Pont Kevlara fiber/epoxy resin and graphite fiber/epoxy resin. The shear panels consisted of three different composite laminates and one aluminum material configuration. Three panel aspect ratios were evaluated for each material configuration. Composite panels were impacted with a 1.27-cm (0.05-in) diameter aluminum sphere at low velocities of 46 m/sec (150 ft/sec) and 67 m/sec (220 ft/sec). Ballistic impact conditions consisted of a tumbled 0.50-caliber projectile impacting loaded composite and aluminum shear panels. The results of these tests indicate that ballistic threshold load (the lowest load which will result in immediate failure upon penetration by the projectile) varied between 0.44 and 0.61 of the average failure load of undamaged panels. The residual strengths of the panels after ballistic impact varied between 0.55 and 0.75 of the average failure strength of the undamaged panels. The low velocity impacts at 67 m/sec (220 ft/sec) caused a 15 to 20 percent reduction in strength, whereas the impacts at 46 m/sec (150 ft/sec) resulted in negligible strength loss. Good agreement was obtained between the experimental failure strengths and the predicted strength with the point stress failure criterion.

Mechanistic analysis of time-dependent failure of oxynitride glass-joined silicon nitride below 1000 degree C

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

O'Brien, M.H.; Coon, D.M.

Time-dependent failure at elevated temperatures currently governs the service life of oxynitride glass-joined silicon nitride. Creep, devitrification, stress- aided oxidation-controlled slow crack growth, and viscous cabitation-controlled failure are examined as possible controlling mechanisms. Creep deformation failure is observed above 1000{degrees}C. Fractographic evidence indicates cavity formation and growth below 1000{degrees}C. Auger electron spectroscopy verified that the oxidation rate of the joining glass is governed by the oxygen supply rate. Time-to-failure data and those predicted using the Tsai and Raj, and Raj and Dang viscous cavitation models. It is concluded that viscous relaxation and isolated cavity growth control the rate of failuremore » in oxynitride glass-filled silicon nitride joints below 1000{degrees}C. Several possible methods are also proposed for increasing the service lives of these joints.« less

Externalized conductors and insulation failure in Biotronik defibrillator leads: History repeating or a false alarm?

PubMed

De Maria, Elia; Borghi, Ambra; Bonetti, Lorenzo; Fontana, Pier Luigi; Cappelli, Stefano

2017-02-16

Conductor externalization and insulation failure are frequent complications with the recalled St. Jude Medical Riata implantable cardioverter-defibrillator (ICD) leads. Conductor externalization is a "unique" failure mechanism: Cables externalize through the insulation ("inside-out" abrasion) and appear outside the lead body. Recently, single reports described a similar failure also for Biotronik leads. Moreover, some studies reported a high rate of electrical dysfunction (not only insulation failure) with Biotronik Linox leads and a reduced survival rate in comparison with the competitors. In this paper we describe the case of a patient with a Biotronik Kentrox ICD lead presenting with signs of insulation failure and conductor externalization at fluoroscopy. Due to the high risk of extraction we decided to implant a new lead, abandoning the damaged one; lead reimplant was uneventful. Subsequently, we review currently available literature about Biotronik Kentrox and Linox ICD lead failure and in particular externalized conductors. Some single-center studies and a non-prospective registry reported a survival rate between 88% and 91% at 5 years for Linox leads, significantly worse than that of other manufacturers. However, the preliminary results of two ongoing multicenter, prospective registries (GALAXY and CELESTIAL) showed 96% survival rate at 5 years after implant, well within industry standards. Ongoing data collection is needed to confirm longer-term performance of this family of ICD leads.

Externalized conductors and insulation failure in Biotronik defibrillator leads: History repeating or a false alarm?

PubMed Central

De Maria, Elia; Borghi, Ambra; Bonetti, Lorenzo; Fontana, Pier Luigi; Cappelli, Stefano

2017-01-01

Conductor externalization and insulation failure are frequent complications with the recalled St. Jude Medical Riata implantable cardioverter-defibrillator (ICD) leads. Conductor externalization is a “unique” failure mechanism: Cables externalize through the insulation (“inside-out” abrasion) and appear outside the lead body. Recently, single reports described a similar failure also for Biotronik leads. Moreover, some studies reported a high rate of electrical dysfunction (not only insulation failure) with Biotronik Linox leads and a reduced survival rate in comparison with the competitors. In this paper we describe the case of a patient with a Biotronik Kentrox ICD lead presenting with signs of insulation failure and conductor externalization at fluoroscopy. Due to the high risk of extraction we decided to implant a new lead, abandoning the damaged one; lead reimplant was uneventful. Subsequently, we review currently available literature about Biotronik Kentrox and Linox ICD lead failure and in particular externalized conductors. Some single-center studies and a non-prospective registry reported a survival rate between 88% and 91% at 5 years for Linox leads, significantly worse than that of other manufacturers. However, the preliminary results of two ongoing multicenter, prospective registries (GALAXY and CELESTIAL) showed 96% survival rate at 5 years after implant, well within industry standards. Ongoing data collection is needed to confirm longer-term performance of this family of ICD leads. PMID:28255544

Comparative study of LDR (Manchester system) and HDR image-guided conformal brachytherapy of cervical cancer: patterns of failure, late complications, and survival.

PubMed

Narayan, Kailash; van Dyk, Sylvia; Bernshaw, David; Rajasooriyar, Chrishanthi; Kondalsamy-Chennakesavan, Srinivas

2009-08-01

To compare patterns of failure, late toxicities, and survival in locally advanced cervical cancer patients treated by either low-dose-rate (LDR) or conformal high-dose-rate (HDRc) brachytherapy as a part of curative radiotherapy. A retrospective comparative study of 217 advanced cervix cancer patients was conducted; 90 of these patients received LDR and 127 received HDRc brachytherapy. All patients were staged using International Federation of Gynecology and Obstetrics (FIGO) rules, had pretreatment magnetic resonance imaging (MRI), and were treated with concurrent cisplatin chemoradiotherapy. Both groups matched for FIGO stage, MRI tumor volume, and uterine invasion status. Local and pelvic failures were similar 12-13% and 14% both in both groups. Abdominal and systemic failures in LDR group were 21% and 24%, whereas corresponding failures in HDRc group were 20% and 24%. Sixty-eight percent (87/127) of patients treated by HDRc remained asymptomatic, whereas 42% (38/90) of patients were asymptomatic from the bowel and bladder symptoms after treatment with LDR. The 5-year OS rate was 60% (SE = 4%). The 5-year failure-free survival rate was 55% (SE = 3%). There was no significant difference between the groups. Image-guided HDRc planning led to a large decrease in late radiation effects in patients treated by HDRc. Patterns of failure and survival were similar in patients treated either by LDR or HDRc.

Microcircuit Device Reliability Memory/Digital LSI

DTIC Science & Technology

1982-01-01

has been performed. Each failure event record reveals the particular device and test characteristics, as well as associated stress values and other...given by: « s logio (Vxp) where X0 is the observed failure rate Xp is the predicted failure rate « is the residual Values of « are then plotted...n...... ||^||tpMMMWiWMM*i»""l’’൓ iŕŕ" ’• of failures per point). Some "funnelling" in Figure 17 shows this, although there is a fair amount of

24 CFR 902.62 - Failure to submit data.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 4 2013-04-01 2013-04-01 false Failure to submit data. 902.62... DEVELOPMENT PUBLIC HOUSING ASSESSMENT SYSTEM PHAS Scoring § 902.62 Failure to submit data. (a) Failure to... receive a presumptive rating of failure for its unaudited information and shall receive zero points for...

24 CFR 902.62 - Failure to submit data.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 4 2012-04-01 2012-04-01 false Failure to submit data. 902.62... DEVELOPMENT PUBLIC HOUSING ASSESSMENT SYSTEM PHAS Scoring § 902.62 Failure to submit data. (a) Failure to... receive a presumptive rating of failure for its unaudited information and shall receive zero points for...

24 CFR 902.62 - Failure to submit data.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 4 2014-04-01 2014-04-01 false Failure to submit data. 902.62... DEVELOPMENT PUBLIC HOUSING ASSESSMENT SYSTEM PHAS Scoring § 902.62 Failure to submit data. (a) Failure to... receive a presumptive rating of failure for its unaudited information and shall receive zero points for...

Study of relapse and failure cases of CAT I retreated with CAT II under RNTCP--an eleven year follow up.

PubMed

Mehra, R K; Dhingra, V K; Nish, Aggarwal; Vashist, R P

2008-10-01

To analyse the treatment outcome of Cat I smear positive relapse and failure cases and their fate when treated with Cat II regimen under RNTCP. All Cat I smear positive relapse and failure TB patients treated with Category II regimen from 1994 to 2005 in a chest clinic of Delhi were analysed in this retrospective study. The re-treatment outcome data for relapse and failure cases of Cat I when treated with Cat II regimen was reviewed. The study population included 5576 registered as Cat I sputum positive cases in Gulabi Bagh chest clinic from 1994 to 2005. A total of 190 (3.4%) failed on Cat I regimen. Further out of 4905 (87.9%) successfully treated Cat I patients, 442 (9%) presented as relapses. The treatment success rate for relapse and failure cases of Cat I when subsequently treated with Cat II regimen were 76.4% and 48.8% respectively, with a significantly higher failure rate (27.6%) among Cat I failures subsequently treated with Cat II regimen. The failure cases of Cat I subsequently treated with Cat II were observed to have a significantly lower success rates (p < 0.05) as compared to relapse cases. The need for reappraisal of Cat II re-treatment regimen for failure cases among Cat I is suggested.

Stochastic Availability of a Repairable System with an Age - and Maintenance - Dependent Failure Rate,

DTIC Science & Technology

1982-06-01

STOCKATZC LV AaMIQ.YN 0gp M@lIm iii s m -r ANAs WgLMSZIb 940=04 WoeU-O PolytechnicInstitute June 1982 Stochastic Availability of a Repairable System ...STOCHASTIC AVAILABILITY OF A REPAIRABLE SYSTEM WITH AN AGE AND MAINTENANCE DEPENDENT FAILURE RATE by JACK-KANG CHAN June 1982 Report No..Poly EE/CS 82-004...1.1 Concepts of System Availability 1 1.2 Maintenance and Failure Rate 7 1.3 Summary Chapter 2 SYSTEM4 MODEL 2.1 A Repairable System with Lintenance

Using cosmogenic nuclides to contrast rates of erosion and sediment yield in a semi-arid, arroyo-dominated landscape, Rio Puerco Basin, New Mexico

USGS Publications Warehouse

Bierman, P.R.; Reuter, J.M.; Pavich, M.; Gellis, A.C.; Caffee, M.W.; Larsen, J.

2005-01-01

Analysis of in-situ-produced 10Be and 26Al in 52 fluvial sediment samples shows that millennial-scale rates of erosion vary widely (7 to 366 m Ma-1) through the lithologically and topographically complex Rio Puerco Basin of northern New Mexico. Using isotopic analysis of both headwater and downstream samples, we determined that the semi-arid, Rio Puerco Basin is eroding, on average, about 100 m Ma-1. This rapid rate of erosion is consistent with estimates made using other techniques and is likely to result from a combination of easily eroded lithologies, sparse vegetation, and monsoon-dominated rainfall. Data from 331 stream water samples collected by the US Geological Survey between 1960 and 1995 are consistent with basin-wide, average chemical denudation rates of only about 1??4 m Ma-1; thus, the erosion rates we calculate may be considered rates of sediment generation because physical weathering accounts for almost 99 per cent of mass loss. The isotopic data reveal that sediment is generally well mixed downstream with the area-weighted average sediment generation rate for 16 headwater samples (234 ton km-2 a-1 for basin area 170 to 1169 km2) matching well that estimated from a single sample collected far downstream (238 ton km-2 a-1, basin area = 14 225 km2). A series of 15 samples, collected from an arroyo wall and representing deposition through the late Holocene, indicates that 10Be concentration in sediment delivered by the fluvial system has not changed appreciably over the last 1200 years despite at least two cycles of arroyo cutting and filling. Other samples (n = 21) were collected along the drainage network. Rio Puerco erosion rates scale directly with a variety of metrics describing vegetation, precipitation, and rock erodibility. Using the headwater basins for calibration, the erosion rates for both the downstream samples and also the data set as a whole, are best modelled by considering a combination of relief and vegetation metrics, both of which co-vary with precipitation and erodibility as inferred from lithology. On average, contemporary sediment yields, determined by monitoring suspended-sediment discharge, exceed cosmogenically determined millennial-scale erosion rates by nearly a factor of two. This discrepancy, between short-term rates of sediment yield and long-term rates of erosion, suggests that more sediment is currently being exported from the basin than is being produced. Because the failure of incised channel walls and the head cutting of arroyo complexes appear to be the main sources of channel sediment today, this incongruence between rates of sediment supply and sediment yield is likely to be transitory, reflecting the current states of the arroyo cycle and perhaps the influence of current or past land-use patterns. Copyright ?? 2005 John Wiley & Sons, Ltd.

Catch rates relative to angler party size with implications for monitoring angler success

USGS Publications Warehouse

Miranda, L.E.

2005-01-01

Angler catch rates often are used to monitor angler success, assess the need for additional management actions, and evaluate the effectiveness of management practices. Potential linkages between catch rate and angler party size were examined to assess how party size might affect the use of catch rate as an index of angler success in recreational fisheries. Data representing 22,355 completed interviews conducted at access points in lakes and reservoirs throughout Mississippi during 1987-2003 were analyzed. Total party catch was not proportional to total party effort; thus, catch rate decreased as party size increased. Depending on the taxa targeted, the average catch rate per angler decreased 40-50% between parties of one and parties of two, although subsequent decreases were less substantial. Because party size accounted for a considerable portion of the variability in catch rate over time and space, failure to remove this variability weakens the manager's ability to detect differences or changes in catch rates. Therefore, the use of catch rates to monitor fisheries may be inappropriate unless party size is taken into account. Party size may influence the angler's ability to catch fish through a variety of processes, including partitioning a limited number of catchable fish among members of a party and party composition. When catch rates are used to estimate total catch rather than to index angler success, party size is not a concern.

Statistics-related and reliability-physics-related failure processes in electronics devices and products

NASA Astrophysics Data System (ADS)

Suhir, E.

2014-05-01

The well known and widely used experimental reliability "passport" of a mass manufactured electronic or a photonic product — the bathtub curve — reflects the combined contribution of the statistics-related and reliability-physics (physics-of-failure)-related processes. When time progresses, the first process results in a decreasing failure rate, while the second process associated with the material aging and degradation leads to an increased failure rate. An attempt has been made in this analysis to assess the level of the reliability physics-related aging process from the available bathtub curve (diagram). It is assumed that the products of interest underwent the burn-in testing and therefore the obtained bathtub curve does not contain the infant mortality portion. It has been also assumed that the two random processes in question are statistically independent, and that the failure rate of the physical process can be obtained by deducting the theoretically assessed statistical failure rate from the bathtub curve ordinates. In the carried out numerical example, the Raleigh distribution for the statistical failure rate was used, for the sake of a relatively simple illustration. The developed methodology can be used in reliability physics evaluations, when there is a need to better understand the roles of the statistics-related and reliability-physics-related irreversible random processes in reliability evaluations. The future work should include investigations on how powerful and flexible methods and approaches of the statistical mechanics can be effectively employed, in addition to reliability physics techniques, to model the operational reliability of electronic and photonic products.

Comparison of hand laid-up tape and filament wound composite cylinders and panels with and without impact damage

NASA Technical Reports Server (NTRS)

Jegley, Dawn C.; Lopez, Osvaldo F.

1991-01-01

Experimentally determined axial compressive failure loads, strains and failure modes of composite flat panels and cylinders are presented. A comparison of two types of filament wound flat graphite-epoxy panels indicates that the winding pattern can influence structural response. A comparison of hand laid-up tape and filament wound composite cylinders indicates that fabrication method may not significantly influence the failure mode or average failure strain of thick-walled (radius-to-thickness ratio less than 15) graphite-epoxy cylinders. The interaction of manufacturing-induced features (fiber cross-overs) and low-speed impact damage for graphite-epoxy specimens is also presented. Filament would flat panels with many fiber cross-overs exhibited lower failure strains than filament wound panels without fiber cross-overs for all impact speeds examined. Graphite-thermoplastic cylinders exhibited a significantly different failure mode from the graphite-epoxy cylinders.

Slow crack growth versus creep cavity coalescence: Competing failure mechanisms during high-temperature deformation of advanced ceramics

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

Jenkins, M.G.; Kohles, S.S.; Stevens, T.L.

1996-12-31

Duality of failure mechanisms (slow crack growth from pre-existing defects versus cumulative creep damage) is examined in a silicon nitride advanced ceramic recently tested at elevated-temperatures. Static (constant stress over time), dynamic (monotonically-increasing stress over time), and cyclic (fluctuating stress over time) fatigue behaviors were evaluated in tension in ambient air at temperatures of 1150, 1260, and 1370{degrees}C for a hot-isostatically pressed monolithic {beta}-silicon nitride. At 1150{degrees}C, all three types of fatigue results showed the similar failure mechanism of slow crack growth (SCG). At 1260 and 1370{degrees}C the failure mechanism was more complex. Failure under static fatigue was dominated bymore » the accumulation of creep damage via diffusion-controlled cavities. In dynamic fatigue, failure occurred by SCG at high stress rates (>10{sup {minus}2}MPa/s) and by creep damage at low stress rates ({le}10{sup {minus}2} MPa/s). For cyclic fatigue, such rate effects influenced the stress rupture results in which times to failure were greater for dynamic and cyclic fatigue than for static fatigue. Elucidation of failure mechanisms is necessary for accurate prediction of long-term survivability and reliability of structural ceramics.« less

Dialysis Arteriovenous Fistula Failure and Angioplasty: Intimal Hyperplasia and Other Causes of Access Failure.

PubMed

Duque, Juan C; Tabbara, Marwan; Martinez, Laisel; Cardona, Jose; Vazquez-Padron, Roberto I; Salman, Loay H

2017-01-01

The arteriovenous fistula (AVF) is the preferred hemodialysis access type because it has better patency rates and fewer complications than other access types. However, primary failure remains a common problem impeding AVF maturation and adding to patients' morbidity and mortality. Juxta-anastomotic (or inflow) stenosis is the most common reason leading to primary failure, and percutaneous transluminal angioplasty continues to be the gold-standard treatment with excellent success rates. Intimal hyperplasia (IH) has been traditionally blamed as the main pathophysiologic culprit, but new evidence raises doubts regarding the contribution of IH alone to primary failure. We report a 64-year-old man with a 2-stage brachiobasilic AVF that was complicated by failure 4 months after creation. An angiogram showed multiple juxta-anastomotic and midfistula stenotic lesions. Percutaneous transluminal angioplasty was successful in assisting maturation and subsequently cannulating the AVF for hemodialysis treatment. We failed to identify the underlying cause of stenosis because biopsy specimens from fistula tissue obtained at the time of transposition revealed no occlusive IH. This case emphasizes the need for additional research on factors contributing to AVF failure besides IH and highlights the need for more therapeutic options to reduce AVF failure rate. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Material properties of rat middle cerebral arteries at high strain rates.

PubMed

Bell, E David; Converse, Matthew; Mao, Haojie; Unnikrishnan, Ginu; Reifman, Jaques; Monson, Kenneth L

2018-03-19

Traumatic brain injury (TBI), resulting from either impact- or non-impact blast-related mechanisms, is a devastating cause of death and disability. The cerebral blood vessels, which provide critical support for brain tissue in both health and disease, are commonly injured in TBI. However, little is known about how vessels respond to traumatic loading, particularly at rates relevant to blast. To better understand vessel responses to trauma, the objective of this project was to characterize the high-rate response of passive cerebral arteries. Rat middle cerebral arteries were isolated and subjected to high-rate deformation in the axial direction. Vessels were perfused at physiological pressures and stretched to failure at strain rates ranging from approximately 100 to 1300 s-1. Although both in vivo stiffness and failure stress increased significantly with strain rate, failure stretch did not depend on rate.

Biomechanical Comparison of 3 Inferiorly Directed Versus 3 Superiorly Directed Locking Screws on Stability in a 3-Part Proximal Humerus Fracture Model.

PubMed

Donohue, David M; Santoni, Brandon G; Stoops, T Kyle; Tanner, Gregory; Diaz, Miguel A; Mighell, Mark

2018-06-01

To quantify the stability of 3 points of inferiorly directed versus 3 points of superiorly directed locking screw fixation compared with the full contingent of 6 points of locked screw fixation in the treatment of a 3-part proximal humerus fracture. A standardized 3-part fracture was created in 10 matched pairs (experimental groups) and 10 nonmatched humeri (control group). Osteosynthesis was performed using 3 locking screws in the superior hemisphere of the humeral head (suspension), 3 locking screws in the inferior hemisphere (buttress), or the full complement of 6 locking screws (control). Specimens were tested in varus cantilever bending (7.5 Nm) to 10,000 cycles or failure. Construct survival (%) and the cycles to failure were compared. Seven of 10 controls survived the 10,000-cycle runout (70%: 8193 average cycles to failure). No experimental constructs survived the 10,000-cycle runout. Suspension and buttress screw groups failed an average of 331 and 516 cycles, respectively (P = 1.00). The average number of cycles to failure and the number of humeri surviving the 10,000-cycle runout were greater in the control group than in the experimental groups (P ≤ 0.006). Data support the use of a full contingent of 6 points of locking screw fixation over 3 superior or 3 inferior points of fixation in the treatment of a 3-part proximal humerus fracture with a locking construct. No biomechanical advantage to the 3 buttress or 3 suspension screws used in isolation was observed.

Patterns of failure after involved field radiotherapy for locally advanced esophageal squamous cell carcinoma.

PubMed

Li, Duo-Jie; Li, Hong-Wei; He, Bin; Wang, Geng-Ming; Cai, Han-Fei; Duan, Shi-Miao; Liu, Jing-Jing; Zhang, Ya-Jun; Cui, Zhen; Jiang, Hao

2016-01-01

To retrospectively analyze the patterns of failure and the treatment effects of involved-field irradiation (IFI) on patients treated with locally advanced esophageal squamous cell carcinoma (ESCC) and to determine whether IFI is practicable in these patients. A total of 79 patients with locally advanced ESCC underwent three dimensional conformal (3D)CRT) or intensity modulated radiotherapy (IMRT) using IFI or elective nodal irradiation (ENI) according to the target volume. The patterns of failure were defined as local/regional, in-field, out)of)field regional lymph node (LN) and distant failure. With a median follow)up of 32.0 months, failures were observed in 66 (83.6%) patients. The cumulative incidence of local/regional failure (55.8 vs 52.8%) and in)field regional lymph node failure (25.6 vs 19.4%) showed no statistically significant difference between the IFI and the ENI group (p=0.526 and 0.215, respectively). Out)of)field nodal relapse rate of only 7.0% was seen in the IFI group. Three)year survival rates for the ENI and IFI group were 22.2 and 18.6%, respectively (p=0.240), and 3)year distant metastasis rates were 27.8 and 32.6%, respectively (p=0.180). The lung V10, V20, V30 and mean lung dose of the ENI group were greater than those of the IFI group, while the mean lung dose and V10 had statistically significant difference. The patterns of failure and survival rates in the IFI group were similar as in the ENI group; the regional recurrence and distant metastasis are the main cause of treatment failure. IFI is feasible for locally advanced ESCC. Further investigation is needed to increase local control and decrease distant metastasis in these patients.

Does an inter-flaw length control the accuracy of rupture forecasting in geological materials?

NASA Astrophysics Data System (ADS)

Vasseur, Jérémie; Wadsworth, Fabian B.; Heap, Michael J.; Main, Ian G.; Lavallée, Yan; Dingwell, Donald B.

2017-10-01

Multi-scale failure of porous materials is an important phenomenon in nature and in material physics - from controlled laboratory tests to rockbursts, landslides, volcanic eruptions and earthquakes. A key unsolved research question is how to accurately forecast the time of system-sized catastrophic failure, based on observations of precursory events such as acoustic emissions (AE) in laboratory samples, or, on a larger scale, small earthquakes. Until now, the length scale associated with precursory events has not been well quantified, resulting in forecasting tools that are often unreliable. Here we test the hypothesis that the accuracy of the forecast failure time depends on the inter-flaw distance in the starting material. We use new experimental datasets for the deformation of porous materials to infer the critical crack length at failure from a static damage mechanics model. The style of acceleration of AE rate prior to failure, and the accuracy of forecast failure time, both depend on whether the cracks can span the inter-flaw length or not. A smooth inverse power-law acceleration of AE rate to failure, and an accurate forecast, occurs when the cracks are sufficiently long to bridge pore spaces. When this is not the case, the predicted failure time is much less accurate and failure is preceded by an exponential AE rate trend. Finally, we provide a quantitative and pragmatic correction for the systematic error in the forecast failure time, valid for structurally isotropic porous materials, which could be tested against larger-scale natural failure events, with suitable scaling for the relevant inter-flaw distances.

Analysis of the Factors Affecting Surgical Success of Implants Placed in Iranian Warfare Victims

PubMed Central

Jafarian, Mohammad; Bayat, Mohammad; Pakravan, Amir-Hossein; Emadi, Naghmeh

2016-01-01

Objective The aim was to evaluate the survival time and success rates of dental implants in warfare victims and factors that affect implant success. Subjects and Methods This retrospective study involved 250 Iranian warfare victims who received dental implants from 2003 to 2013. Patients' demographic characteristics, as well as the brand, diameter, length, location and failure rate of the implants were retrieved from patients' dental records and radiographs. The associations between these data and the survival rate were analyzed. Statistical analysis was carried out with χ2 and log-rank tests. Results Overall, out of the 1,533 dental implants, 61 (4s%) failed. The maxillary canine area had the highest failure rate [9 of 132 implants (6.8s%)], while the mandibular incisor region had the least number of failures [3 of 147 implants (2.0s%)] and the longest survival time (approximately 3,182 days). Maxillary canine areas had the shortest survival (about 2,996 days). The longest survival time was observed in implants with 11 mm length (3,179.72 ± 30.139 days) and 3.75-4 mm diameter (3,131.161 ± 35.96 days), and the shortest survival was found in implants with 11.5 mm length (2,317.79 ± 18.71 days) and 6.5 mm diameter (2,241.45 ± 182.21 days). Moreover, implants with 10 mm length (10.7s%) and 5.5-6 mm diameter (22.2s%) had the highest failure rate; however, the least failure rate occurred when the implants were 11.5 mm in length (1.9s%) and 3-3.5 mm in diameter (3.1s%). Conclusions The brand, length and diameter of implants affected the survival time, failure rate and time to failure. The location of the implant was not statistically significant regarding the mentioned factors, although it has clinical significance. PMID:27322534

Earthquake prediction analysis based on empirical seismic rate: the M8 algorithm

NASA Astrophysics Data System (ADS)

Molchan, G.; Romashkova, L.

2010-12-01

The quality of space-time earthquake prediction is usually characterized by a 2-D error diagram (n, τ), where n is the fraction of failures-to-predict and τ is the local rate of alarm averaged in space. The most reasonable averaging measure for analysis of a prediction strategy is the normalized rate of target events λ(dg) in a subarea dg. In that case the quantity H = 1 - (n + τ) determines the prediction capability of the strategy. The uncertainty of λ(dg) causes difficulties in estimating H and the statistical significance, α, of prediction results. We investigate this problem theoretically and show how the uncertainty of the measure can be taken into account in two situations, viz., the estimation of α and the construction of a confidence zone for the (n, τ)-parameters of the random strategies. We use our approach to analyse the results from prediction of M >= 8.0 events by the M8 method for the period 1985-2009 (the M8.0+ test). The model of λ(dg) based on the events Mw >= 5.5, 1977-2004, and the magnitude range of target events 8.0 <= M < 8.5 are considered as basic to this M8 analysis. We find the point and upper estimates of α and show that they are still unstable because the number of target events in the experiment is small. However, our results argue in favour of non-triviality of the M8 prediction algorithm.

Reduced withdrawal and failure rates of accelerated nursing students enrolled in pharmacology is associated with a supportive intervention.

PubMed

Doggrell, Sheila Anne; Schaffer, Sally

2016-02-01

To reduce nursing shortages, accelerated nursing programs are available for domestic and international students. However, the withdrawal and failure rates from these programs may be different than for the traditional programs. The main aim of our study was to improve the retention and experience of accelerated nursing students. The academic background, age, withdrawal and failure rates of the accelerated and traditional students were determined. Data from 2009 and 2010 were collected prior to intervention. In an attempt to reduce the withdrawal of accelerated students, we set up an intervention, which was available to all students. The assessment of the intervention was a pre-post-test design with non-equivalent groups (the traditional and the accelerated students). The elements of the intervention were a) a formative website activity of some basic concepts in anatomy, physiology and pharmacology, b) a workshop addressing study skills and online resources, and c) resource lectures in anatomy/physiology and microbiology. The formative website and workshop was evaluated using questionnaires. The accelerated nursing students were five years older than the traditional students (p < 0.0001). The withdrawal rates from a pharmacology course are higher for accelerated nursing students, than for traditional students who have undertaken first year courses in anatomy and physiology (p = 0.04 in 2010). The withdrawing students were predominantly the domestic students with non-university qualifications or equivalent experience. The failure rates were also higher for this group, compared to the traditional students (p = 0.05 in 2009 and 0.03 in 2010). In contrast, the withdrawal rates for the international and domestic graduate accelerated students were very low. After the intervention, the withdrawal and failure rates in pharmacology for domestic accelerated students with non-university qualifications were not significantly different than those of traditional students. The accelerated international and domestic graduate nursing students have low withdrawal rates and high success rates in a pharmacology course. However, domestic students with non-university qualifications have higher withdrawal and failure rates than other nursing students and may be underprepared for university study in pharmacology in nursing programs. The introduction of an intervention was associated with reduced withdrawal and failure rates for these students in the pharmacology course.

Assessment of heart rate, acidosis, consciousness, oxygenation, and respiratory rate to predict noninvasive ventilation failure in hypoxemic patients.

PubMed

Duan, Jun; Han, Xiaoli; Bai, Linfu; Zhou, Lintong; Huang, Shicong

2017-02-01

To develop and validate a scale using variables easily obtained at the bedside for prediction of failure of noninvasive ventilation (NIV) in hypoxemic patients. The test cohort comprised 449 patients with hypoxemia who were receiving NIV. This cohort was used to develop a scale that considers heart rate, acidosis, consciousness, oxygenation, and respiratory rate (referred to as the HACOR scale) to predict NIV failure, defined as need for intubation after NIV intervention. The highest possible score was 25 points. To validate the scale, a separate group of 358 hypoxemic patients were enrolled in the validation cohort. The failure rate of NIV was 47.8 and 39.4% in the test and validation cohorts, respectively. In the test cohort, patients with NIV failure had higher HACOR scores at initiation and after 1, 12, 24, and 48 h of NIV than those with successful NIV. At 1 h of NIV the area under the receiver operating characteristic curve was 0.88, showing good predictive power for NIV failure. Using 5 points as the cutoff value, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for NIV failure were 72.6, 90.2, 87.2, 78.1, and 81.8%, respectively. These results were confirmed in the validation cohort. Moreover, the diagnostic accuracy for NIV failure exceeded 80% in subgroups classified by diagnosis, age, or disease severity and also at 1, 12, 24, and 48 h of NIV. Among patients with NIV failure with a HACOR score of >5 at 1 h of NIV, hospital mortality was lower in those who received intubation at ≤12 h of NIV than in those intubated later [58/88 (66%) vs. 138/175 (79%); p = 0.03). The HACOR scale variables are easily obtained at the bedside. The scale appears to be an effective way of predicting NIV failure in hypoxemic patients. Early intubation in high-risk patients may reduce hospital mortality.

Pharmacotherapeutic failure in a large cohort of patients with insomnia presenting to a sleep medicine center and laboratory: subjective pretest predictions and objective diagnoses.

PubMed

Krakow, Barry; Ulibarri, Victor A; McIver, Natalia D

2014-12-01

To measure the frequency of pharmacotherapeutic failure and its association with the diagnosis of sleep-disordered breathing among patients with chronic insomnia disorder. In a retrospective review of medical records from January 1, 2005, through December 31, 2012, we identified an inclusive, consecutive series of 1210 patients with insomnia disorder, 899 (74.3%) of whom used sleep aids either occasionally (168 [18.7%]) or regularly (731 [81.3%]). Patients presented to a community-based sleep medicine center in Albuquerque, New Mexico, with typical referral patterns: 743 (61.4%) were referred by primary care physicians, 211 (17.4%) by specialists, 117 (9.7%) by mental health professionals, and 139 (11.5%) by self-referral. Pharmacotherapeutic failure was assessed from subjective insomnia reports and a validated insomnia severity scale. Polysomnography with pressure transducer (an advanced respiratory technology not previously used in a large cohort of patients with insomnia) measured sleep-disordered breathing. Objective data yielded accuracy rates for 3 pretest screening tools used to measure risk for sleep-disordered breathing. Of the total sample of 1210 patients, all 899 (74.3%) who were taking over-the-counter or prescription sleep aids had pharmacotherapeutic failure. The 710 patients taking prescription drugs (79.0%) reported the most severe insomnia, the fewest sleep-associated breathing symptoms, and the most medical and psychiatric comorbidity. Of the 942 patients objectively tested (77.9%), 860 (91.3%) met standard criteria, on average, for a moderate to severe sleep-associated breathing disorder, yet pretest screening sensitivity for sleep-disordered breathing varied widely from 63.7% to 100%. Positive predictive values were high (about 90%) for all screens, but a tool commonly used in primary care misclassified 301 patients (32.0% false-negative results). Pharmacotherapeutic failure and sleep-disordered breathing were extremely common among treatment-seeking patients with chronic insomnia disorder. Screening techniques designed from the field of sleep medicine predicted high rates for sleep-disordered breathing, whereas a survey common to primary care yielded many false-negative results. Although the relationship between insomnia and sleep-disordered breathing remains undefined, this research raises salient clinical questions about the management of insomnia in primary care before sleep center encounters. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Similar Outcomes After Osteochondral Allograft Transplantation in Anterior Cruciate Ligament-Intact and -Reconstructed Knees: A Comparative Matched-Group Analysis With Minimum 2-Year Follow-Up.

PubMed

Wang, Dean; Eliasberg, Claire D; Wang, Tim; Fader, Ryan R; Coxe, Francesca R; Pais, Mollyann D; Williams, Riley J

2017-12-01

To compare failure rates and clinical outcomes of osteochondral allograft transplantation (OCA) in anterior cruciate ligament (ACL)-intact versus ACL-reconstructed knees at midterm follow-up. After a priori power analysis, a prospective registry of patients treated with OCA for focal chondral lesions ≥2 cm 2 in size with minimum 2-year follow-up was used to match ACL-reconstructed knees with ACL-intact knees by age, sex, and primary chondral defect location. Exclusion criteria included meniscus transplantation, realignment osteotomy, or other ligamentous injury. Complications, reoperations, and patient responses to validated outcome measures were reviewed. Failure was defined by any procedure involving allograft removal/revision or conversion to arthroplasty. Kaplan-Meier analysis and multivariate Cox regression were performed to evaluate the association of ACL reconstruction (ACLR) with failure. A total of 50 ACL-intact and 25 ACL-reconstructed (18 prior, 7 concomitant) OCA patients were analyzed. The mean age was 36.2 years (range, 14-62 years). Mean follow-up was 3.9 years (range, 2-14 years). Patient demographics and chondral lesion characteristics were similar between groups. ACL-reconstructed patients averaged 2.2 ± 1.9 prior surgeries on the ipsilateral knee compared with 1.4 ± 1.4 surgeries for ACL-intact patients (P = .014). Grafts used for the last ACLR included bone-patellar tendon-bone autograft, hamstring autograft, Achilles tendon allograft, and tibialis allograft (data available for only 11 of 25 patients). At final follow-up, 22% of ACL-intact and 32% of ACL-reconstructed patients had undergone reoperation. OCA survivorship was 90% and 96% at 2 years and 79% and 85% at 5 years in ACL-intact and ACL-reconstructed patients, respectively (P = .774). ACLR was not independently associated with failure. Both groups demonstrated clinically significant improvements in the Short Form-36 pain and physical functioning, International Knee Documentation Committee subjective, and Knee Outcome Survey-Activities of Daily Living scores at final follow-up (P < .001), with no significant differences in preoperative, postoperative, and change scores between groups. OCA in the setting of prior or concomitant ACLR does not portend higher failure rates or compromise clinical outcomes. Level III, retrospective comparative study. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Systolic blood pressure, cardiovascular outcomes and efficacy and safety of sacubitril/valsartan (LCZ696) in patients with chronic heart failure and reduced ejection fraction: results from PARADIGM-HF.

PubMed

Böhm, Michael; Young, Robin; Jhund, Pardeep S; Solomon, Scott D; Gong, Jianjian; Lefkowitz, Martin P; Rizkala, Adel R; Rouleau, Jean L; Shi, Victor C; Swedberg, Karl; Zile, Michael R; Packer, Milton; McMurray, John J V

2017-04-14

Compared to heart failure patients with higher systolic blood pressure (SBP), those with lower SBP have a worse prognosis. To make matters worse, the latter patients often do not receive treatment with life-saving therapies that might lower blood pressure further. We examined the association between SBP and outcomes in the Prospective Comparison of angiotensin receptor-neprilysin inhibitor (ARNI) with an angiotensin-converting enzyme (ACE) inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure trial (PARADIGM-HF), as well as the effect of sacubitril/valsartan, compared with enalapril, according to baseline SBP. We analysed the effect of treatment on SBP and on the primary composite outcome (cardiovascular death or heart failure hospitalization), its components and all-cause death. We examined baseline SBP as a categorical (<110, 110 to < 120, 120 to < 130, 130 to < 140 and ≥140 mmHg) and continuous variable, as well as average in-trial SBP and time-updated SBP. All-cause and cardiovascular mortality rates were highest in patients with the lowest SBP whereas there was a U-shaped relationship between SBP and the rate of heart failure hospitalization. The benefit of sacubitril/valsartan over enalapril was consistent across all baseline SBP categories for all outcomes. For example, the sacubitril/valsartan versus enalapril hazard ratio for the primary endpoint was 0.88 (95%CI 0.74-1.06) in patients with a baseline SBP <110 mmHg and 0.81 (0.65-1.02) for those with a SBP ≥140 mmHg (P for interaction = 0.55). Symptomatic hypotension, study drug dose-reduction and discontinuation were more frequent in patients with a lower SBP. In PARADIGM-HF, patients with lower SBP at randomization, notably after tolerating full doses of both study drugs during a run-in period, were at higher risk but generally tolerated sacubitril/valsartan and had the same relative benefit over enalapril as patients with higher baseline SBP. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For Permissions, please email: journals.permissions@oup.com.

Heart failure rehospitalization of the Medicare FFS patient: a state-level analysis exploring 30-day readmission factors.

PubMed

Schmeida, Mary; Savrin, Ronald A

2012-01-01

Heart failure readmission among the elderly is frequent and costly to both the patient and the Medicare trust fund. In this study, the authors explore the factors that are associated with states having heart failure readmission rates that are higher than the U.S. national rate. Acute inpatient hospital settings. 50 state-level data and multivariate regression analysis is used. The dependent variable Heart Failure 30-day Readmission Worse than U.S. Rate is based on adult Medicare Fee-for-Service patients hospitalized with a primary discharge diagnosis of heart failure and for which a subsequent inpatient readmission occurred within 30 days of their last discharge. One key variable found--states with a higher resident population speaking a primary language other than English at home--that is significantly associated with a decrease in probability in states ranking "worse" on heart failure 30-day readmission. Whereas, states with a higher median income, more total days of care per 1,000 Medicare enrollees, and a greater percentage of Medicare enrollees with prescription drug coverage have a greater probability for heart failure 30-day readmission to be "worse" than the U.S. national rate. Case management interventions targeting health literacy may be more effective than other factors to improve state-level hospital status on heart failure 30-day readmission. Factors such as total days of care per 1,000 Medicare enrollees and improving patient access to postdischarge medication(s) may not be as important as literacy. Interventions aimed to prevent disparities should consider higher income population groups as vulnerable for readmission.

Network Adaptability from WMD Disruption and Cascading Failures

DTIC Science & Technology

2016-04-01

Figure 1(b) shows a typical timeline before and after an attack with an example of average offered and requested bandwidth utilization. Telecom ...and security of our nation. Telecom networks and the Internet were originally designed to provide end-to-end communications which can survive failures...technology transfer The techniques developed for WMD-aware reprovisioning are also applicable for any disaster-aware provisioning on telecom

Patterns of recurrence after trimodality therapy for esophageal cancer.

PubMed

Dorth, Jennifer A; Pura, John A; Palta, Manisha; Willett, Christopher G; Uronis, Hope E; D'Amico, Thomas A; Czito, Brian G

2014-07-15

Patterns of failure after neoadjuvant chemoradiotherapy and surgery for esophageal cancer are poorly defined. All patients in the current study were treated with trimodality therapy for nonmetastatic esophageal cancer from 1995 to 2009. Locoregional failure included lymph node failure (NF), anastomotic failure, or both. Abdominal paraaortic failure (PAF) was defined as disease recurrence at or below the superior mesenteric artery. Among 155 patients, the primary tumor location was the upper/middle esophagus in 18%, the lower esophagus in 32%, and the gastroesophageal junction in 50% (adenocarcinoma in 79% and squamous cell carcinoma in 21%) of patients. Staging methods included endoscopic ultrasound (73%), computed tomography (46%), and positron emission tomography/computed tomography (54%). Approximately 40% of patients had American Joint Committee on Cancer stage II disease and 60% had stage III disease. The median follow-up was 1.3 years. The 2-year locoregional control, event-free survival, and overall survival rates were 86%, 36%, and 48%, respectively. The 2-year NF rate was 14%, the isolated NF rate was 3%, and the anastomotic failure rate was 6%. The 2-year PAF rate was 9% and the isolated PAF rate was 5%. PAF was found to be increased among patients with gastroesophageal junction tumors (12% vs 6%), especially for the subset with ≥ 2 clinically involved lymph nodes at the time of diagnosis (19% vs 4%). Few patients experience isolated NF or PAF as their first disease recurrence. Therefore, it is unlikely that targeting additional regional lymph node basins with radiotherapy would significantly improve clinical outcomes. © 2014 American Cancer Society.

[Assessment of medical management of heart failure at National Hospital Blaise COMPAORE].

PubMed

Kambiré, Y; Konaté, L; Diallo, I; Millogo, G R C; Kologo, K J; Tougouma, J B; Samadoulougou, A K; Zabsonré, P

2018-05-09

The aim of this study was to assess the quality of medical management of heart failure at the National Hospital Blaise Compaoré according to the international guidelines. A retrospective study was performed including consecutive patients admitted for heart failure documented sonographically from October 2012 to March 2015 in the Medicine and Medical Specialties Department of National Hospital Blaise Compaore with a minimum follow-up of six weeks. Data analysis was made by the SPSS 20.0 software. Eighty-four patients, mean age of 57.61±18.24 years, were included. It was an acute heart failure in 84.5% of patients with systolic left ventricular function impaired (77.4%). The rate of prescription of different drugs in heart failure any type was 88.1% for loop diuretics; 77.1% for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and 65.5% for betablockers. In patients with systolic dysfunction, 84.62% of patients were received the combination of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and 75.38% for betablockers. Exercise rehabilitation was undergoing in 10.7% of patients. The death rate was 16.7% and hospital readmission rate of 16.7%. The prescription rate of major heart failure drugs is satisfactory. Cardiac rehabilitation should be developed. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

[Frequency, etiology, and outcomes of acute renal failure (data of Kaunas University of Medicine Hospital in 1995-2006)].

PubMed

Skarupskiene, Inga; Kuzminskis, Vytautas; Ziginskiene, Edita

2007-01-01

The aim of this study was to determine the frequency, etiology, and outcomes of acute renal failure. We retrospectively collected data on all patients (n=1653) who received renal replacement therapy for acute renal failure at the Kaunas University of Medicine Hospital during 1995-2006. The number of patients with acute renal failure increased nine times during the 11-year period. The mean age of patients was 59.76+/-17.52 years and increased from 44.97+/-17.1 years in 1995 to 62.84+/-16.49 years in 2006. The most common causes of acute renal failure were renal (n=646, 39%), prerenal (n=380, 23%), and obstructive (n=145, 9%). The renal replacement therapy was discontinued because of recovery of renal function in 49.9% of cases. The overall hospital mortality rate was 45.1%. Renal function did not recover in 6.7% of patients. The mortality rate over the 11-year period varied from 37.8 to 57.5%. The highest mortality rate was in the neurosurgical (62.3%) and cardiac surgical (61.8%) intensive care units. High mortality rate (more than 50%) was in the groups of patients with acute renal failure that was caused by hepatorenal syndrome, shock, sepsis, and reduced cardiac output.

PREDICE score as a predictor of 90 days mortality in patients with heart failure

NASA Astrophysics Data System (ADS)

Purba, D. P. S.; Hasan, R.

2018-03-01

Hospitalization in chronic heart failure patients associated with high mortality and morbidity rate. The 90 days post-discharge period following hospitalization in heart failure patients is known as the vulnerable phase, it carries the high risk of poor outcomes. Identification of high-risk individuals by using prognostic evaluation was intended to do a closer follow up and more intensive to decreasing the morbidity and mortality rate of heart failure.To determine whether PREDICE score could predict mortality within 90 days in patients with heart failure, an observational cohort study in patients with heart failure who were hospitalized due to worsening chronic heart failure. Patients were in following-up for up to 90 days after initial evaluation with the primary endpoint is death.We found a difference of the significantstatistical between PREDICE score in survival and mortality group (p=0.001) of 84% (95% CI: 60.9% - 97.4%).In conclusion, PREDICE score has a good ability to predict mortality within 90 days in patients with heart failure.

Implantable Hemodynamic Monitoring for Heart Failure Patients.

PubMed

Abraham, William T; Perl, Leor

2017-07-18

Rates of heart failure hospitalization remain unacceptably high. Such hospitalizations are associated with substantial patient, caregiver, and economic costs. Randomized controlled trials of noninvasive telemedical systems have failed to demonstrate reduced rates of hospitalization. The failure of these technologies may be due to the limitations of the signals measured. Intracardiac and pulmonary artery pressure-guided management has become a focus of hospitalization reduction in heart failure. Early studies using implantable hemodynamic monitors demonstrated the potential of pressure-based heart failure management, whereas subsequent studies confirmed the clinical utility of this approach. One large pivotal trial proved the safety and efficacy of pulmonary artery pressure-guided heart failure management, showing a marked reduction in heart failure hospitalizations in patients randomized to active pressure-guided management. "Next-generation" implantable hemodynamic monitors are in development, and novel approaches for the use of this data promise to expand the use of pressure-guided heart failure management. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Reliability analysis and fault-tolerant system development for a redundant strapdown inertial measurement unit. [inertial platforms

NASA Technical Reports Server (NTRS)

Motyka, P.

1983-01-01

A methodology is developed and applied for quantitatively analyzing the reliability of a dual, fail-operational redundant strapdown inertial measurement unit (RSDIMU). A Markov evaluation model is defined in terms of the operational states of the RSDIMU to predict system reliability. A 27 state model is defined based upon a candidate redundancy management system which can detect and isolate a spectrum of failure magnitudes. The results of parametric studies are presented which show the effect on reliability of the gyro failure rate, both the gyro and accelerometer failure rates together, false alarms, probability of failure detection, probability of failure isolation, and probability of damage effects and mission time. A technique is developed and evaluated for generating dynamic thresholds for detecting and isolating failures of the dual, separated IMU. Special emphasis is given to the detection of multiple, nonconcurrent failures. Digital simulation time histories are presented which show the thresholds obtained and their effectiveness in detecting and isolating sensor failures.

Prospective trial of angiography and embolization for all grade III to V blunt splenic injuries: nonoperative management success rate is significantly improved.

PubMed

Miller, Preston R; Chang, Michael C; Hoth, J Jason; Mowery, Nathan T; Hildreth, Amy N; Martin, R Shayn; Holmes, James H; Meredith, J Wayne; Requarth, Jay A

2014-04-01

Nonoperative management (NOM) of blunt splenic injury is well accepted. Substantial failure rates in higher injury grades remain common, with one large study reporting rates of 19.6%, 33.3%, and 75% for grades III, IV, and V, respectively. Retrospective data show angiography and embolization can increase salvage rates in these severe injuries. We developed a protocol requiring referral of all blunt splenic injuries, grades III to V, without indication for immediate operation for angiography and embolization. We hypothesized that angiography and embolization of high-grade blunt splenic injury would reduce NOM failure rates in this population. This was a prospective study at our Level I trauma center as part of a performance-improvement project. Demographics, injury characteristics, and outcomes were compared with historic controls. The protocol required all stable patients with grade III to V splenic injuries be referred for angiography and embolization. In historic controls, referral was based on surgeon preference. From January 1, 2010 to December 31, 2012, there were 168 patients with grades III to V spleen injuries admitted; NOM was undertaken in 113 (67%) patients. The protocol was followed in 97 patients, with a failure rate of 5%. Failure rate in the 16 protocol deviations was 25% (p = 0.02). Historic controls from January 1, 2007 to December 31, 2009 were compared with the protocol group. One hundred and fifty-three patients with grade III to V injuries were admitted during this period, 80 (52%) patients underwent attempted NOM. Failure rate was significantly higher than for the protocol group (15%, p = 0.04). Use of a protocol requiring angiography and embolization for all high-grade spleen injuries slated for NOM leads to a significantly decreased failure rate. We recommend angiography and embolization as an adjunct to NOM for all grade III to V splenic injuries. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Ceramic capacitor insulation resistance failures accelerated by low voltage

NASA Technical Reports Server (NTRS)

Brennan, T. F.

1978-01-01

Ceramic capacitors failed insulation resistance testing at less than one-tenth their rated voltage. Many failures recovered as the voltage was increased. Comprehensive failure analysis techniques, some of which are unprecedented, were used to examine these failures. It was determined that there was more than one failure mechanism, and the results indicate a need for special additional screening.

Benefit of extracorporeal membrane oxygenation in major burns after stun grenade explosion: Experience from a single military medical center.

PubMed

Hsu, Po-Shun; Tsai, Yi-Ting; Lin, Chih-Yuan; Chen, Shyi-Gen; Dai, Niann-Tzyy; Chen, Cheng-Jung; Chen, Jia-Lin; Tsai, Chien-Sung

2017-05-01

Explosion injury is very common on the battlefield and is associated with major burn and inhalation injuries and subsequent high mortality and morbidity rates. Here we report six victims who suffered from explosion injuries caused by stun grenade; all were treated with extracorporeal membrane oxygenation (ECMO) as salvage therapy. This study was aimed to evaluate the indications and efficacy of ECMO in acute and critically ill major burn patients. This was a retrospective analysis of six patients from Tri-Service General Hospital, National Defense Medical Center in Taiwan. All suffered from major burns with 89.0±19.1% average of total body surface area over second degree (TBSA; range, 50-99%). ECMO was used due to inhalation injury in five patients and cardiogenic shock in one patient. The average interval to start ECMO was 26.5±19.0h (range, 14-63h). Venoarterial ECMO was used on in four patients due to unstable hemodynamic status, whereas venovenous ECMO was used in two patients for sustained hypoxemia. All patients had rhabdomyolysis with acute renal failure. The average duration of ECMO was 169.6±180.9h (range, 27-401h). All patients developed coagulopathy and needed debridement surgery during ECMO support, and five underwent torso escharotomy due to inspiratory compromise. Only one patient whose second and third degree burns covered 50% TBSA was successfully weaned from ECMO and survived; he was discharged after 221 hospital days. All patients who died had second and third degree burns covering over 90% of their TBSA. Three patients died of multiple organ failure, one died of septic shock, and the other died of cardiogenic shock. Overall survival rate was 16.7%. In acute and critically ill major burn patients, ECMO could be considered as a salvage therapy, particularly in those with inhalation injury and burn-related acute respiratory distress syndrome. However, ECMO does not seem to provide benefits for circulatory support in those with hemodynamic compromise. The use of ECMO in these patients is still investigational, as our data provided no benefit in terms of the outcomes or survival, particularly in those with more than 90% TBSA burns. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

[Case-control study on measurement of coracoclavicular and acromioclavicular ligament injuries during internal fixation operation for the treatment of fresh acromioclavicular joint dislocation of Tossy type III].

PubMed

Guan, Ting-Jin; Sun, Peng; Zheng, Liang-Guo; Qi, Xiang-Yang

2014-01-01

To study measurement methods of acromioclavicular and coracoclavicular ligament injuries,its therapeutic effects and complications during internal fixation operation for the treatment of fresh acromioclavicular joint dislocations of Tossy type III. From July 2003 to May 2012,127 patients with acromioclavicular joint dislocations of Tossy type III were treated with wire fixation from coracoid process to clavicle or hook-plate fixation. The patients were divided into group A (63 cases) and group B (64 cases) according to whether acromioclavicular ligament and coracoclavicular ligament were repaired or not. In group A (ligaments repaired), there were 39 males and 24 females with an average age of (33.25 +/- 8.46) years old (ranged from 17 to 59 years). And in group B (no ligaments repaired), there were 41 males and 23 females with an average age of (34.10 +/- 7.19) years (ranged from 19 to 57 years). The operation times, intraoperative blood loss, postoperative infections, internal fixation failure, recurrence and other complications, together with therapeutic effects were compared between two groups. The outcome was analyzed according to Karlsson standard. In group A, 54 patients got an excellent result and 9 good according to Karlsson standard;the average operative time was (55.90 +/- 26.56) min; the average intraoperative bleeding amount was (99.80 +/- 50.30) ml; 1 patient had wire broken without re-dislocation at 16 weeks after operation, 3 patients got wound fat liquefaction and recovered after treatment, 1 patient had pain after shoulder joint motion and pain disappeared after implants were taken out. In group B, 52 patients got an excellent result and 12 good according to Karlsson standard; the average operative time was (49.50 +/- 23.14) min; the average intraoperative bleeding amount was (87.30 +/- 46.41) ml; 2 patients got wound fat liquefaction, and 2 patients had pain after shoulder joint motion. All the patients were followed up, and the duration ranged from 9 to 16 months. All internal steel-wire or hook plate were taken out during 4 to 9 months without acromioclavicular joint re dislocation. There were no significant difference in the average operative time, the average intraoperative blood less, complication recurrence rates of fixation failure, wound fat liquefaction, postoperative infection, acromioclavicular joint re-dislocation, and therapeutic effects between two groups. Both wire and clavicular hook plate fixation, performed for fresh acromioclavicular joint dislocation with Tossy type III, are simple, effective, less invasive method with less blood loss. In addition, the treatment without ligaments repaired could not increase incidence of complications.

Matrix Dominated Failure of Fiber-Reinforced Composite Laminates Under Static and Dynamic Loading

NASA Astrophysics Data System (ADS)

Schaefer, Joseph Daniel

Hierarchical material systems provide the unique opportunity to connect material knowledge to solving specific design challenges. Representing the quickest growing class of hierarchical materials in use, fiber-reinforced polymer composites (FRPCs) offer superior strength and stiffness-to-weight ratios, damage tolerance, and decreasing production costs compared to metals and alloys. However, the implementation of FRPCs has historically been fraught with inadequate knowledge of the material failure behavior due to incomplete verification of recent computational constitutive models and improper (or non-existent) experimental validation, which has severely slowed creation and development. Noted by the recent Materials Genome Initiative and the Worldwide Failure Exercise, current state of the art qualification programs endure a 20 year gap between material conceptualization and implementation due to the lack of effective partnership between computational coding (simulation) and experimental characterization. Qualification processes are primarily experiment driven; the anisotropic nature of composites predisposes matrix-dominant properties to be sensitive to strain rate, which necessitates extensive testing. To decrease the qualification time, a framework that practically combines theoretical prediction of material failure with limited experimental validation is required. In this work, the Northwestern Failure Theory (NU Theory) for composite lamina is presented as the theoretical basis from which the failure of unidirectional and multidirectional composite laminates is investigated. From an initial experimental characterization of basic lamina properties, the NU Theory is employed to predict the matrix-dependent failure of composites under any state of biaxial stress from quasi-static to 1000 s-1 strain rates. It was found that the number of experiments required to characterize the strain-rate-dependent failure of a new composite material was reduced by an order of magnitude, and the resulting strain-rate-dependence was applicable for a large class of materials. The presented framework provides engineers with the capability to quickly identify fiber and matrix combinations for a given application and determine the failure behavior over the range of practical loadings cases. The failure-mode-based NU Theory may be especially useful when partnered with computational approaches (which often employ micromechanics to determine constituent and constitutive response) to provide accurate validation of the matrix-dominated failure modes experienced by laminates during progressive failure.

Factors Affecting the Clinical Success Rate of Miniscrew Implants for Orthodontic Treatment.

PubMed

Jing, Zheng; Wu, Yeke; Jiang, Wenlu; Zhao, Lixing; Jing, Dian; Zhang, Nian; Cao, Xiaoqing; Xu, Zhenrui; Zhao, Zhihe

2016-01-01

The purpose of this study was to evaluate the various factors that influence the success rate of miniscrew implants used as orthodontic anchorage. Potential confounding variables examined were sex, age, vertical (FMA) and sagittal (ANB) skeletal facial pattern, site of placement (labial and buccal, palatal, and retromandibular triangle), arch of placement (maxilla and mandible), placement soft tissue type, oral hygiene, diameter and length of miniscrew implants, insertion method (predrilled or drill-free), angle of placement, onset and strength of force application, and clinical purpose. The correlations between success rate and overall variables were investigated by logistic regression analysis, and the effect of each variable on the success rate was utilized by variance analysis. One hundred fourteen patients were included with a total of 253 miniscrew implants. The overall success rate was 88.54% with an average loading period of 9.5 months in successful cases. Age, oral hygiene, vertical skeletal facial pattern (FMA), and general placement sites (maxillary and mandibular) presented significant differences in success rates both by logistic regression analysis and variance analysis (P < .05). To minimize the failure of miniscrew implants, proper oral hygiene instruction and effective supervision should be given for patients, especially young (< 12 years) high-angle patients with miniscrew implants placed in the mandible.

Failure-to-rescue after injury is associated with preventability: The results of mortality panel review of failure-to-rescue cases in trauma.

PubMed

Kuo, Lindsay E; Kaufman, Elinore; Hoffman, Rebecca L; Pascual, Jose L; Martin, Niels D; Kelz, Rachel R; Holena, Daniel N

2017-03-01

Failure-to-rescue is defined as the conditional probability of death after a complication, and the failure-to-rescue rate reflects a center's ability to successfully "rescue" patients after complications. The validity of the failure-to-rescue rate as a quality measure is dependent on the preventability of death and the appropriateness of this measure for use in the trauma population is untested. We sought to evaluate the relationship between preventability and failure-to-rescue in trauma. All adjudications from a mortality review panel at an academic level I trauma center from 2005-2015 were merged with registry data for the same time period. The preventability of each death was determined by panel consensus as part of peer review. Failure-to-rescue deaths were defined as those occurring after any registry-defined complication. Univariate and multivariate logistic regression models between failure-to-rescue status and preventability were constructed and time to death was examined using survival time analyses. Of 26,557 patients, 2,735 (10.5%) had a complication, of whom 359 died for a failure-to-rescue rate of 13.2%. Of failure-to-rescue deaths, 272 (75.6%) were judged to be non-preventable, 65 (18.1%) were judged potentially preventable, and 22 (6.1%) were judged to be preventable by peer review. After adjusting for other patient factors, there remained a strong association between failure-to-rescue status and potentially preventable (odds ratio 2.32, 95% confidence interval, 1.47-3.66) and preventable (odds ratio 14.84, 95% confidence interval, 3.30-66.71) judgment. Despite a strong association between failure-to-rescue status and preventability adjudication, only a minority of deaths meeting the definition of failure to rescue were judged to be preventable or potentially preventable. Revision of the failure-to-rescue metric before use in trauma care benchmarking is warranted. Copyright © 2016 Elsevier Inc. All rights reserved.

Failure-to-rescue after injury is associated with preventability: The results of mortality panel review of failure-to-rescue cases in trauma

PubMed Central

Kuo, Lindsay E.; Kaufman, Elinore; Hoffman, Rebecca L.; Pascual, Jose L.; Martin, Niels D.; Kelz, Rachel R.; Holena, Daniel N.

2018-01-01

Background Failure-to-rescue is defined as the conditional probability of death after a complication, and the failure-to-rescue rate reflects a center’s ability to successfully “rescue” patients after complications. The validity of the failure-to-rescue rate as a quality measure is dependent on the preventability of death and the appropriateness of this measure for use in the trauma population is untested. We sought to evaluate the relationship between preventability and failure-to-rescue in trauma. Methods All adjudications from a mortality review panel at an academic level I trauma center from 2005–2015 were merged with registry data for the same time period. The preventability of each death was determined by panel consensus as part of peer review. Failure-to-rescue deaths were defined as those occurring after any registry-defined complication. Univariate and multivariate logistic regression models between failure-to-rescue status and preventability were constructed and time to death was examined using survival time analyses. Results Of 26,557 patients, 2,735 (10.5%) had a complication, of whom 359 died for a failure-to-rescue rate of 13.2%. Of failure-to-rescue deaths, 272 (75.6%) were judged to be non-preventable, 65 (18.1%) were judged potentially preventable, and 22 (6.1%) were judged to be preventable by peer review. After adjusting for other patient factors, there remained a strong association between failure-to-rescue status and potentially preventable (odds ratio 2.32, 95% confidence interval, 1.47–3.66) and preventable (odds ratio 14.84, 95% confidence interval, 3.30–66.71) judgment. Conclusion Despite a strong association between failure-to-rescue status and preventability adjudication, only a minority of deaths meeting the definition of failure to rescue were judged to be preventable or potentially preventable. Revision of the failure-to-rescue metric before use in trauma care benchmarking is warranted. PMID:27788924

Retrospective Evaluation of the Effect of Heart Rate on Survival in Dogs with Atrial Fibrillation.

PubMed

Pedro, B; Dukes-McEwan, J; Oyama, M A; Kraus, M S; Gelzer, A R

2018-01-01

Atrial fibrillation (AF) usually is associated with a rapid ventricular rate. The optimal heart rate (HR) during AF is unknown. Heart rate affects survival in dogs with chronic AF. Forty-six dogs with AF and 24-hour ambulatory recordings were evaluated. Retrospective study. Holter-derived HR variables were analyzed as follows: mean HR (meanHR, 24-hour average), minimum HR (minHR, 1-minute average), maximum HR (maxHR, 1-minute average). Survival times were recorded from the time of presumed adequate rate control. The primary endpoint was all-cause mortality. Cox proportional hazards analysis identified variables independently associated with survival; Kaplan-Meier survival analysis estimated the median survival time of dogs with meanHR <125 bpm versus ≥125 bpm. All 46 dogs had structural heart disease; 31 of 46 had congestive heart failure (CHF), 44 of 46 received antiarrhythmic drugs. Of 15 dogs with cardiac death, 14 had CHF. Median time to all-cause death was 524 days (Interquartile range (IQR), 76-1,037 days). MeanHR was 125 bpm (range, 62-203 bpm), minHR was 82 bpm (range, 37-163 bpm), maxHR was 217 bpm (range, 126-307 bpm). These were significantly correlated with all-cause and cardiac-related mortality. For every 10 bpm increase in meanHR, the risk of all-cause mortality increased by 35% (hazard ratio, 1.35; 95% CI, 1.17-1.55; P < 0.001). Median survival time of dogs with meanHR<125 bpm (n = 23) was significantly longer (1,037 days; range, 524-open) than meanHR ≥125 bpm (n = 23; 105 days; range, 67-267 days; P = 0.0012). Mean HR was independently associated with all-cause and cardiovascular mortality (P < 0.003). Holter-derived meanHR affects survival in dogs with AF. Dogs with meanHR <125 bpm lived longer than those with meanHR ≥ 125 bpm. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

Failure mechanisms of fibrin-based surgical tissue adhesives

NASA Astrophysics Data System (ADS)

Sierra, David Hugh

A series of studies was performed to investigate the potential impact of heterogeneity in the matrix of multiple-component fibrin-based tissue adhesives upon their mechanical and biomechanical properties both in vivo and in vitro. Investigations into the failure mechanisms by stereological techniques demonstrated that heterogeneity could be measured quantitatively and that the variation in heterogeneity could be altered both by the means of component mixing and delivery and by the formulation of the sealant. Ex vivo tensile adhesive strength was found to be inversely proportional to the amount of heterogeneity. In contrast, in vivo tensile wound-closure strength was found to be relatively unaffected by the degree of heterogeneity, while in vivo parenchymal organ hemostasis in rabbits was found to be affected: greater heterogeneity appeared to correlate with an increase in hemostasis time and amount of sealant necessary to effect hemostasis. Tensile testing of the bulk sealant showed that mechanical parameters were proportional to fibrin concentration and that the physical characteristics of the failure supported a ductile mechanism. Strain hardening as a function of percentage of strain, and strain rate was observed for both concentrations, and syneresis was observed at low strain rates for the lower fibrin concentration. Blister testing demonstrated that burst pressure and failure energy were proportional to fibrin concentration and decreased with increasing flow rate. Higher fibrin concentration demonstrated predominately compact morphology debonds with cohesive failure loci, demonstrating shear or viscous failure in a viscoelastic rubbery adhesive. The lower fibrin concentration sealant exhibited predominately fractal morphology debonds with cohesive failure loci, supporting an elastoviscous material condition. The failure mechanism for these was hypothesized and shown to be flow-induced ductile fracture. Based on these findings, the failure mechanism was stochastic in nature because the mean failure energy and burst pressure values were not predictive of locus and morphology. Instead, flow rate and fibrin concentration showed the most predictive value, with the outcome best described as a probability distribution rather than a specific deterministic outcome.

How Often and Why MODIS Cloud Property Retrievals Fail for Liquid-Phase Clouds over Ocean? a Comprehensive Analysis Based on a-Train Observations

NASA Astrophysics Data System (ADS)

Zhang, Z.; Cho, H. M.; Platnick, S. E.; Meyer, K.; Lebsock, M. D.

2014-12-01

The cloud optical thickness (τ) and droplet effective radius (re) are two key cloud parameters retrieved by MODIS (Moderate Resolution Imaging Spectroradiometer). These MODIS cloud products are widely used in a broad range of earth system science applications. In this paper, we present a comprehensive analysis of the failed cloud τ and/or re retrievals for liquid-phase clouds over ocean in the Collection 6 MODIS cloud product. The main findings from this study are summarized as follows: MODIS retrieval failure rates for marine boundary layer (MBL) clouds have a strong dependence on the spectral combination used for retrieval (e.g., 0.86 + 2.1 µm vs. 0.8 + 3.7 µm) and the cloud morphology (i.e., "good" pixels vs. partly cloudy (PCL) pixels). Combining all clear-sky-restoral (CSR) categories (CSR=0,1 and 3), the 0.86 + 2.1 µm and 0.86 + 3.7 µm spectral combinations have an overall failure rate of about 20% and 12%, respectively (See figure below). The PCL pixels (CSR=1 & 3) have significantly higher failure rates and contribute more to the total failure population than the "good" (CSR=0) pixels. The majority of the failed retrievals are caused by the re too large failure, which explains about 85% and 70% of the failed 0.86 + 2.1 µm and 0.86 + 3.7 µm retrievals, respectively. The remaining failures are either due to the re too small failure or τ retrieval failure. The geographical distribution of failure rates has a significant dependence on cloud regime, lower over the coastal stratocumulus cloud regime and higher over the broken trade-wind cumulus cloud regime over open oceans. Enhanced retrieval failure rates are found when MBL clouds have high sub-pixel inhomogeneity , or are located at special Sun-satellite viewing geometries, such as sunglint, large viewing or solar zenith angle, or cloudbow and glory angles, or subject to cloud masking, cloud overlapping and/or cloud phase retrieval issues. About 80% of the failure retrievals can be attributed to at least one or more potential reasons mentioned above. Collocated radar reflectivity observations from CloudSat suggest that the remaining 20% are unlikely to be retrieval artifacts, but reflection of true cloud microphysics, i.e., the true is either truly very small or very large.

Prediction of failure pressure and leak rate of stress corrosion.

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

Majumdar, S.; Kasza, K.; Park, J. Y.

2002-06-24

An ''equivalent rectangular crack'' approach was employed to predict rupture pressures and leak rates through laboratory generated stress corrosion cracks and steam generator tubes removed from the McGuire Nuclear Station. Specimen flaws were sized by post-test fractography in addition to a pre-test advanced eddy current technique. The predicted and observed test data on rupture and leak rate are compared. In general, the test failure pressures and leak rates are closer to those predicted on the basis of fractography than on nondestructive evaluation (NDE). However, the predictions based on NDE results are encouraging, particularly because they have the potential to determinemore » a more detailed geometry of ligamented cracks, from which failure pressure and leak rate can be more accurately predicted. One test specimen displayed a time-dependent increase of leak rate under constant pressure.« less

Least Squares Shadowing sensitivity analysis of chaotic limit cycle oscillations

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

Wang, Qiqi, E-mail: qiqi@mit.edu; Hu, Rui, E-mail: hurui@mit.edu; Blonigan, Patrick, E-mail: blonigan@mit.edu

2014-06-15

The adjoint method, among other sensitivity analysis methods, can fail in chaotic dynamical systems. The result from these methods can be too large, often by orders of magnitude, when the result is the derivative of a long time averaged quantity. This failure is known to be caused by ill-conditioned initial value problems. This paper overcomes this failure by replacing the initial value problem with the well-conditioned “least squares shadowing (LSS) problem”. The LSS problem is then linearized in our sensitivity analysis algorithm, which computes a derivative that converges to the derivative of the infinitely long time average. We demonstrate ourmore » algorithm in several dynamical systems exhibiting both periodic and chaotic oscillations.« less

Assuring reliability program effectiveness.

NASA Technical Reports Server (NTRS)

Ball, L. W.

1973-01-01

An attempt is made to provide simple identification and description of techniques that have proved to be most useful either in developing a new product or in improving reliability of an established product. The first reliability task is obtaining and organizing parts failure rate data. Other tasks are parts screening, tabulation of general failure rates, preventive maintenance, prediction of new product reliability, and statistical demonstration of achieved reliability. Five principal tasks for improving reliability involve the physics of failure research, derating of internal stresses, control of external stresses, functional redundancy, and failure effects control. A final task is the training and motivation of reliability specialist engineers.

Importance of teamwork, communication and culture on failure-to-rescue in the elderly.

PubMed

Ghaferi, A A; Dimick, J B

2016-01-01

Surgical mortality increases significantly with age. Wide variations in mortality rates across hospitals suggest potential levers for improvement. Failure-to-rescue has been posited as a potential mechanism underlying these differences. A review was undertaken of the literature evaluating surgery, mortality, failure-to-rescue and the elderly. This was followed by a review of ongoing studies and unpublished work aiming to understand better the mechanisms underlying variations in surgical mortality in elderly patients. Multiple hospital macro-system factors, such as nurse staffing, available hospital technology and teaching status, are associated with differences in failure-to-rescue rates. There is emerging literature regarding important micro-system factors associated with failure-to-rescue. These are grouped into three broad categories: hospital resources, attitudes and behaviours. Ongoing work to produce interventions to reduce variations in failure-to-rescue rates include a focus on teamwork, communication and safety culture. Researchers are using novel mixed-methods approaches and theories adapted from organizational studies in high-reliability organizations in an effort to improve the care of elderly surgical patients. Although elderly surgical patients experience failure-to-rescue events at much higher rates than their younger counterparts, patient-level effects do not sufficiently explain these differences. Increased attention to the role of organizational dynamics in hospitals' ability to rescue these high-risk patients will establish high-yield interventions aimed at improving patient safety. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

Press-fit bipolar radial head arthroplasty, midterm results.

PubMed

Kodde, Izaäk F; Heijink, Andras; Kaas, Laurens; Mulder, Paul G H; van Dijk, C Niek; Eygendaal, Denise

2016-08-01

Theoretical advantages of bipolar compared with monopolar radial head arthroplasty include better accommodation of radiocapitellar malalignment, reduction of capitellar abrasion, and reduction of stress at the bone-implant interfaces. Our purpose was to report the midterm results of press-fit bipolar radial head arthroplasty. Thirty patients were treated by press-fit bipolar radial head arthroplasty for acute fracture of the radial head, failed earlier treatment, or post-traumatic sequelae. Three patients were lost to follow-up. Results are presented for the remaining 27 patients. At mean follow-up of 48 months (range, 28-73), there had been 3 (11%) revisions. Two involved conversion to prosthetic radiocapitellar hemiarthroplasty for symptomatic capitellar abrasion; a third involved exchange of the articular component (ie, head) for instability. In all, the stems appeared well fixed. A prosthesis in a subluxed position accounted for the 1 (4%) additional radiologic failure. The average flexion-extension arc was 136° (range, 120°-145°), and the average pronation-supination arc was 138° (range, 70°-180°). According to the Mayo Elbow Performance Score, the combined excellent and good results accounted for 70%. The overall midterm outcome of this series of 30 press-fit bipolar radial head arthroplasties can be considered favorable. Although the revision rate was 11%, the stems were well fixed in all. There was 1 (4%) additional radiologic failure. We suggest considering a press-fit bipolar radial head prosthesis for acute comminuted radial head fractures with limited bone loss of the proximal radius. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Immediate loading of implants placed in patients with untreated periodontal disease: a 5-year prospective cohort study.

PubMed

Maló, Paulo; Nobre, Miguel de Araújo; Lopes, Armando; Ferro, Ana; Gravito, Inês

2014-01-01

To report the 5-year outcome of immediately loaded dental implants in patients with untreated periodontal disease. This prospective cohort study included 103 consecutive patients (51 females and 52 males) with an average age of 52 years (range: 22 to 80 years) who were rehabilitated with 380 implants supporting 145 prostheses in both jaws (40 single; 33 partial and 72 complete rehabilitations). The implants were inserted in patients with active and untreated periodontitis. The patients did not receive any previous periodontal treatment before implant surgery, except for an oral hygiene session immediately before the implant surgery. In maintenance (every 6 months) patients received periodontal treatment as needed. Outcome measures were: prostheses failures; implant failures; complications; and marginal bone level changes. Fifteen patients dropped out of the study (14.6%). Two patients lost two implants (FDI positions nos.12 and 42), rendering a cumulative survival rate of 97.9% and 99.4% at 5 years of followup using the patient and implant as unit of analysis, respectively. The average (standard deviation) marginal bone resorption was 0.71 mm (0.42 mm) at 5 years. Mechanical complications occurred in 14 patients, consisting of prostheses fractures (10 provisional prostheses and 4 definitive prostheses). Thirteen implants (3.9%) in 13 patients (14.8%) presented peri-implant pathology. Within the limitations of this study, it is possible to conclude that the rehabilitation of patients with untreated periodontitis using immediately loaded dental implants is feasible in the medium-term, when periodontal therapy is provided after rehabilitation and the patients are regularly maintained.

Impact of implant size on cement filling in hip resurfacing arthroplasty.

PubMed

de Haan, Roel; Buls, Nico; Scheerlinck, Thierry

2014-01-01

Larger proportions of cement within femoral resurfacing implants might result in thermal bone necrosis. We postulate that smaller components are filled with proportionally more cement, causing an elevated failure rate. A total of 19 femoral heads were fitted with polymeric replicas of ReCap (Biomet) resurfacing components fixed with low-viscosity cement. Two specimens were used for each even size between 40 and 56 mm and one for size 58 mm. All specimens were imaged with computed tomography, and the cement thickness and bone density were analyzed. The average cement mantle thickness was 2.63 mm and was not correlated with the implant size. However, specimen with low bone density had thicker cement mantles regardless of size. The average filling index was 36.65% and was correlated to both implant size and bone density. Smaller implants and specimens with lower bone density contained proportionally more cement than larger implants. According to a linear regression model, bone density but not implant size influenced cement thickness. However, both implant size and bone density had a significant impact on the filling index. Large proportions of cement within the resurfacing head have the potential to generate thermal bone necrosis and implant failure. When considering hip resurfacing in patients with a small femoral head and/or osteoporotic bone, extra care should be taken to avoid thermal bone necrosis, and alternative cementing techniques or even cementless implants should be considered. This study should help delimiting the indications for hip resurfacing and to choose an optimal cementing technique taking implant size into account.