Plasma-Lyte 148: A clinical review

PubMed Central

Weinberg, Laurence; Collins, Neil; Van Mourik, Kiara; Tan, Chong; Bellomo, Rinaldo

2016-01-01

AIM To outline the physiochemical properties and specific clinical uses of Plasma-Lyte 148 as choice of solution for fluid intervention in critical illness, surgery and perioperative medicine. METHODS We performed an electronic literature search from Medline and PubMed (via Ovid), anesthesia and pharmacology textbooks, and online sources including studies that compared Plasma-Lyte 148 to other crystalloid solutions. The following keywords were used: “surgery”, “anaesthesia”, “anesthesia”, “anesthesiology”, “anaesthesiology”, “fluids”, “fluid therapy”, “crystalloid”, “saline”, “plasma-Lyte”, “plasmalyte”, “hartmann’s”, “ringers” “acetate”, “gluconate”, “malate”, “lactate”. All relevant articles were accessed in full. We summarized the data and reported the data in tables and text. RESULTS We retrieved 104 articles relevant to the choice of Plasma-Lyte 148 for fluid intervention in critical illness, surgery and perioperative medicine. We analyzed the data and reported the results in tables and text. CONCLUSION Plasma-Lyte 148 is an isotonic, buffered intravenous crystalloid solution with a physiochemical composition that closely reflects human plasma. Emerging data supports the use of buffered crystalloid solutions in preference to saline in improving physicochemical outcomes. Further large randomized controlled trials assessing the comparative effectiveness of Plasma-Lyte 148 and other crystalloid solutions in measuring clinically important outcomes such as morbidity and mortality are needed. PMID:27896148

Fluid therapy LiDCO controlled trial-optimization of volume resuscitation of extensively burned patients through noninvasive continuous real-time hemodynamic monitoring LiDCO.

PubMed

Tokarik, Monika; Sjöberg, Folke; Balik, Martin; Pafcuga, Igor; Broz, Ludomir

2013-01-01

This pilot trial aims at gaining support for the optimization of acute burn resuscitation through noninvasive continuous real-time hemodynamic monitoring using arterial pulse contour analysis. A group of 21 burned patients meeting preliminary criteria (age range 18-75 years with second- third- degree burns and TBSA ≥10-75%) was randomized during 2010. A hemodynamic monitoring through lithium dilution cardiac output was used in 10 randomized patients (LiDCO group), whereas those without LiDCO monitoring were defined as the control group. The modified Brooke/Parkland formula as a starting resuscitative formula, balanced crystalloids as the initial solutions, urine output of 0.5 ml/kg/hr as a crucial value of adequate intravascular filling were used in both groups. Additionally, the volume and vasopressor/inotropic support were based on dynamic preload parameters in the LiDCO group in the case of circulatory instability and oligouria. Statistical analysis was done using t-tests. Within the first 24 hours postburn, a significantly lower consumption of crystalloids was registered in LiDCO group (P = .04). The fluid balance under LiDCO control in combination with hourly diuresis contributed to reducing the cumulative fluid balance approximately by 10% compared with fluid management based on standard monitoring parameters. The amount of applied solutions in the LiDCO group got closer to Brooke formula whereas the urine output was at the same level in both groups (0.8 ml/kg/hr). The new finding in this study is that when a fluid resuscitation is based on the arterial waveform analysis, the initial fluid volume provided was significantly lower than that delivered on the basis of physician-directed fluid resuscitation (by urine output and mean arterial pressure).

State of the art in fluid and volume therapy : A user-friendly staged concept. English version.

PubMed

Rehm, M; Hulde, N; Kammerer, T; Meidert, A S; Hofmann-Kiefer, K

2017-04-10

Adequate intraoperative infusion therapy is essential for the perioperative outcome of a patient. Both hypo- and hypervolemia can lead to an increased rate of perioperative complications and to a worse outcome. Perioperative infusion therapy should therefore be needs-based. The primary objective is the maintenance of preoperative normovolemia using a rational infusion strategy. Perioperative fluid losses should be differentiated from volume losses due to surgical bleeding or protein losses into the interstitial space. Fluid loss via urine excretion or insensible perspiration (0.5-1.0 ml/kg/h) should be replaced with balanced, isooncotic, crystalloid infusion solutions in a ratio of 1:1. Volume therapy stage 1: intraoperative volume losses up to a blood loss corresponding to 20% of the patient's total blood volume are compensated for by balanced crystalloids in a ratio of 4-5:1. Stage 2: blood losses exceeding this level are to be treated with isooncotic colloids (preferably balanced) in a 1:1 ratio. In this regard taking into consideration the contraindications, e. g., sepsis, burns, critical illness (usually patients in the intensive care unit), impaired renal function or renal replacement therapy, intracranial hemorrhage, or severe coagulopathy, artificial colloids such as hydroxyethyl starch (HES) can be used perioperatively for volume replacement. Stage 3: if an allogeneic blood transfusion is indicated, blood and blood products are applied in a differentiated manner.

Choice of Fluid Therapy in the Initial Management of Sepsis, Severe Sepsis, and Septic Shock.

PubMed

Chang, Ronald; Holcomb, John B

2016-07-01

Sepsis results in disruption of the endothelial glycocalyx layer and damage to the microvasculature, resulting in interstitial accumulation of fluid and subsequently edema. Fluid resuscitation is a mainstay in the initial treatment of sepsis, but the choice of fluid is unclear. The ideal resuscitative fluid is one that restores intravascular volume while minimizing edema; unfortunately, edema and edema-related complications are common consequences of current resuscitation strategies. Crystalloids are recommended as first-line therapy, but the type of crystalloid is not specified. There is increasing evidence that normal saline is associated with increased mortality and kidney injury; balanced crystalloids may be a safer alternative. Albumin is similar to crystalloids in terms of outcomes in the septic population but is costlier. Hydroxyethyl starches appear to increase mortality and kidney injury in the critically ill and are no longer indicated in these patients. In the trauma population, the shift to plasma-based resuscitation with decreased use of crystalloid and colloid in the treatment of hemorrhagic shock has led to decreased inflammatory and edema-mediated complications. Studies are needed to determine if these benefits also occur with a similar resuscitation strategy in the setting of sepsis.

A hyperosmolar-colloidal additive to the CPB-priming solution reduces fluid load and fluid extravasation during tepid CPB.

PubMed

Kvalheim, V; Farstad, M; Haugen, O; Brekke, H; Mongstad, A; Nygreen, E; Husby, P

2008-01-01

Cardiopulmonary bypass(CPB) is associated with fluid overload. We hypothesized that fluid gain during CPB could be reduced by substituting parts of a crystalloid prime with 7.2% hypertonic saline and 6% poly (O-2-hydroxyethyl) starch solution (HyperHaes). 14 animals were randomized to a control group (Group C) or to Group H. CPB-prime in Group C was Ringer's solution. In group H, 4 ml/kg of Ringer's solution was replaced by the hypertonic saline/hydroxyethyl starch solution. After 60 min stabilization, CPB was initiated and continued for 120 min. All animals were allowed drifting of normal temperature (39.0 degrees C) to about 35.0 degrees C. Fluid was added to the CPB circuit as needed to maintain a 300-ml level in the venous reservoir. Blood chemistry, hemodynamic parameters, fluid balance, plasma volume, fluid extravasation rate (FER), tissue water content and acid-base parameters were measured/calculated. Total fluid need during 120 min CPB was reduced by 60% when hypertonic saline/hydroxyethyl starch solution was added to the CPB prime (p < 0.01). The reduction was related to a lowered FER. The effect was most pronounced during the first 30 min on CPB, with 0.6 (0.43) (Group H) compared with 1.5 (0.40) ml/kg/min (Group C) (p < 0.01). Hemodynamics and laboratory parameters were similar in both groups. Serum concentrations of sodium and chloride increased to maximum levels of 148 (1.5) and 112 (1.6) mmol/l in Group H. To conclude: addition of 7.2% hypertonic saline and 6% poly (O-2-hydroxyethyl) starch solution to crystalloid CPB prime reduces fluid needs and FER during tepid CPB.

[Sodium chloride 0.9%: nephrotoxic crystalloid?].

PubMed

Dombre, Vincent; De Seigneux, Sophie; Schiffer, Eduardo

2016-02-03

Sodium chloride 0.9%, often incorrectly called physiological saline, contains higher concentration of chloride compared to plasma. It is known that the administration of sodium chloride 0.9% can cause hyperchloremic metabolic acidosis in a reproducible manner. The elevated chloride concentration in 0.9% NaCl solution can also adversely affect renal perfusion. This effect is thought to be induced by hyperchloremia that causes renal artery vasoconstriction. For these reasons, the use of 0.9% NaCl solution is raising attention and some would advocate the use of a more "physiological" solution, such as balanced solutions that contain a level of chloride closer to that of plasma. Few prospective, randomized, controlled trials are available today and most were done in a perioperative setting. Some studies suggest that the chloride excess in 0.9% NaCl solution could have clinical consequences; however, this remains to be established by quality randomized controlled trials.

Acid-base and hemodynamic status of patients with intraoperative hemorrhage using two solution types: Crystalloid Ringer lactate and 1.3% sodium bicarbonate in half-normal saline solution.

PubMed

Hashemi, Sayed Jalal; Heidari, Sayed Morteza; Yaraghi, Ahmad; Seirafi, Reza

2016-01-01

Intraoperative hemorrhage is one of the problems during surgery and, if it happens in a high volume without an immediate action to control, it can be fatal. Nowadays, various injectable solutions are used. The aim of this study was to compare the acid-base and hemodynamic status of the patient using two solutions, Ringer lactate and 1.3% sodium bicarbonate, in half saline solution. This clinical trial was performed at the Al-Zahra Hospital in 2013 on 66 patients who were randomly selected and put in two studied groups at the onset of hemorrhage. For the first group, crystalloid Ringer lactate solution and for the second group, 1.3% sodium bicarbonate in half-normal saline solution was used. Electrocardiogram, heart rate, O2 saturation non-invasive blood pressure and end-tidal CO2 were monitored. The arterial blood gas, blood electrolytes, glucose and blood urea nitrogen were measured before serum and blood injection. After the infusion of solutions and before blood transfusions, another sample was sent for measurement of blood parameters. Data were analyzed using SPSS software. The mean arterial pressure was significantly higher in the second group than in the first group at some times after the infusion of solutions. pHh levels, base excess, bicarbonate, sodium, strong ion differences and osmolarity were significantly greater and potassium and chloride were significantly lower in the second group than in the first group after the infusion of solutions. 1.3% sodium bicarbonate in half-normal saline solution can lead to a proper correction of hemodynamic instability. By maintaining hemodynamic status, osmolarity and electrolytes as well as better balance of acid-base, 1.3% sodium bicarbonate solution in half-normal saline solution can be more effective than Ringer lactate solution during intraoperative bleeding.

[FEATURES OF FLUID THERAPY IN CHILDREN WITH SEVERE MAJOR TRAUMA].

PubMed

Pshenisnov, K V; Aleksandrovich, Yu S; Mironov, P I; Suhanov, Yu V; Kuzmin, O V; Blinov, S A; Kondin, A N

2016-01-01

Fluid and transfusion therapy is proved to be a required component of treating children with severe major trauma significantly influencing the case outcome. To analyze efficiency of fluid and transfusion therapy in children with severe major trauma and assess its correspondence with current recommendations. 150 children aged from 0 to 18 years getting treatment in intensive care units of children's city hospitals of Saint Petersburg, Archangelsk, Ufa, Samara, and Leningrad region were included in the research. The main course of severe major trauma were car injury and catatrauma. The coefficient according to Pediatric trauma score (PTS) was 6.4 points. The mean duration of hospitalization in emergencies units was 3 (2-7) days, the duration of artificial lung ventilation was 48 ± 99.9 hours, the duration of hospitalization in the department ward was 24 (15-32) days. Favorable outcome (transferring from emergencies units to department wards) was reported in 147 (98%) children, death cases were registered in 4 (2.6%) children. There was determined that the basic crystalloid solutions used for infusion therapy in children were the following: Ringer solution, Plasma-lit solution and 10% glucose solution. "Gelofisin" and "Voluven" had more frequent administration rate among colloidal solutions. Transfusion of blood was performed in 26% patients. The infusion therapy in the first three days did not exceed the necessary physiological requirements that provided stabilization of the patient's condition and did not produce a negative influence on the status of hemodynamics and gas exchange. Administration of current well-balanced crystalloid and colloidal solutions to children with severe combined trauma in an amount within the limits of required physiological indicators does not produce a negative influence on the status of gas exchange and the case outcome.

Comparison of the effects of albumin 5%, hydroxyethyl starch 130/0.4 6%, and Ringer's lactate on blood loss and coagulation after cardiac surgery.

PubMed

Skhirtladze, K; Base, E M; Lassnigg, A; Kaider, A; Linke, S; Dworschak, M; Hiesmayr, M J

2014-02-01

Infusion of 5% human albumin (HA) and 6% hydroxyethyl starch 130/0.4 (HES) during cardiac surgery expand circulating volume to a greater extent than crystalloids and would be suitable for a restrictive fluid therapy regimen. However, HA and HES may affect blood coagulation and could contribute to increased transfusion requirements. We randomly assigned 240 patients undergoing elective cardiac surgery to receive up to 50 ml kg(-1) day(-1) of either HA, HES, or Ringer's lactate (RL) as the main infusion fluid perioperatively. Study solutions were supplied in identical bottles dressed in opaque covers. The primary outcome was chest tube drainage over 24 h. Blood transfusions, thromboelastometry variables, perioperative fluid balance, renal function, mortality, intensive care unit, and hospital stay were also assessed. The median cumulative blood loss was not different between the groups (HA: 835, HES: 700, and RL: 670 ml). However, 35% of RL patients required blood products, compared with 62% (HA) and 64% (HES group; P=0.0003). Significantly, more study solution had to be administered in the RL group compared with the colloid groups. Total perioperative fluid balance was least positive in the HA group [6.2 (2.5) litre] compared with the HES [7.4 (3.0) litre] and RL [8.3 (2.8) litre] groups (P<0.0001). Both colloids affected clot formation and clot strength and caused slight increases in serum creatinine. Despite equal blood loss from chest drains, both colloids interfered with blood coagulation and produced greater haemodilution, which was associated with more transfusion of blood products compared with crystalloid use only.

Safety of gelatin solutions for the priming of cardiopulmonary bypass in cardiac surgery: a systematic review and meta-analysis.

PubMed

Ghijselings, Idris; Himpe, Dirk; Rex, Steffen

2017-07-01

This systematic review and meta-analysis was conducted to evaluate the safety of gelatin versus hydroxyethyl starches (HES) and crystalloids when used for cardiopulmonary bypass (CPB)-priming in cardiac surgery. MEDLINE (Pubmed), Embase and CENTRAL were searched. We included only randomized, controlled trials comparing CPB-priming with gelatin with either crystalloids or HES-solutions of the newest generation. The primary endpoint was the blood loss during the first 24 hours. Secondary outcomes included perioperative transfusion requirements, postoperative kidney function, postoperative ventilation times and length of stay on the intensive care unit. Sixteen studies were identified, of which only ten met the inclusion criteria, representing a total of 824 adult patients: 4 studies compared gelatin with crystalloid, and 6 studies gelatin with HES priming. Only 2 of the studies comparing HES and gelatin reported postoperative blood loss after 24 hours. No significant difference in postoperative blood loss was found when results of both studies were pooled (SMD -0.12; 95% CI: -0.49, 0.25; P=0.52). Likewise, the pooled results of 3 studies comparing gelatin and crystalloids as a priming solution could not demonstrate significant differences in postoperative bleeding after 24 hours (SMD -0.07; 95% CI: -0.40, 0.26; P=0.68). No differences regarding any of the secondary outcomes could be identified. This systematic review suggests gelatins to have a safety profile which is non-inferior to modern-generation tetrastarches or crystalloids. However, the grade of evidence is rated low owing to the poor methodological quality of the included studies, due to inconsistent outcome reporting and lack of uniform endpoint definitions.

Colloids versus crystalloids in objective-guided fluid therapy, systematic review and meta-analysis. Too early or too late to draw conclusions.

PubMed

Ripollés, Javier; Espinosa, Ángel; Casans, Rubén; Tirado, Ana; Abad, Alfredo; Fernández, Cristina; Calvo, José

2015-01-01

Several clinical trials on Goal directed fluid therapy (GDFT) were carried out, many of those using colloids in order to optimize the preload. After the decision of European Medicines Agency, there is such controversy regarding its use, benefits, and possible contribution to renal failure. The objective of this systematic review and meta-analysis is to compare the use of last-generation colloids, derived from corn, with crystalloids in GDFT to determine associated complications and mortality. A bibliographic research was carried out in MEDLINE PubMed, EMBASE and Cochrane Library, corroborating randomized clinical trials where crystalloids are compared to colloids in GDFT for major non-cardiac surgery in adults. One hundred thirty references were found and among those 38 were selected and 29 analyzed; of these, six were included for systematic review and meta-analysis, including 390 patients. It was observed that the use of colloids is not associated with the increase of complications, but rather with a tendency to a higher mortality (RR [95% CI] 3.87 [1.121-13.38]; I(2)=0.0%; p=0.635). Because of the limitations of this meta-analysis due to the small number of randomized clinical trials and patients included, the results should be taken cautiously, and the performance of new randomized clinical trials is proposed, with enough statistical power, comparing balanced and unbalanced colloids to balanced and unbalanced crystalloids, following the protocols of GDFT, considering current guidelines and suggestions made by groups of experts. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

Risk factors for and the prevention of acute kidney injury after abdominal surgery.

PubMed

An, Yongbo; Shen, Kai; Ye, Yingjiang

2018-06-01

Postoperative acute kidney injury in patients undergoing abdominal surgery is not rare and often results in bad outcomes for patients. The incidence of postoperative acute kidney injury is hard to evaluate reliably due to its non-unified definitions in different studies. Risk factors for acute kidney injury specific to abdominal surgery include preoperative renal insufficiency, intraabdominal hypertension, blood transfusion, bowel preparation, perioperative dehydration, contrast agent and nephrotoxic drug use. Among these, preoperative renal insufficiency is the strongest predictor of acute kidney injury. The peri-operative management of high-risk patients should include meticulous selection of fluid solutions. Balanced crystalloid solutions and albumin are generally thought to be relatively safe, while the safety of hydroxyethyl starch solutions has been controversial. The purpose of the present review is to discuss the current knowledge regarding postoperative acute kidney injury in abdominal surgical settings to help surgeons make better decisions concerning the peri-operative management.

Colloids and the Microcirculation.

PubMed

He, Huaiwu; Liu, Dawei; Ince, Can

2018-05-01

Colloid solutions have been advocated for use in treating hypovolemia due to their expected effect on improving intravascular retention compared with crystalloid solutions. Because the ultimate desired effect of fluid resuscitation is the improvement of microcirculatory perfusion and tissue oxygenation, it is of interest to study the effects of colloids and crystalloids at the level of microcirculation under conditions of shock and fluid resuscitation, and to explore the potential benefits of using colloids in terms of recruiting the microcirculation under conditions of hypovolemia. This article reviews the physiochemical properties of the various types of colloid solutions (eg, gelatin, dextrans, hydroxyethyl starches, and albumin) and the effects that they have under various conditions of hypovolemia in experimental and clinical scenarios.

The Effect of Ringer versus Haemaccel Preload on Incidence of Postoperative Nausea and Vomiting

PubMed Central

Ghafourifard, Mansour; Zirak, Mohammad; Broojerdi, Mohammad Hossein; Bayendor, Ali; Moradi, Abolfaz

2015-01-01

Introduction: Postoperative nausea and vomiting (PONV) is the most common and unpleasant postoperative complication. There is much controversy on preoperative fluid therapy. The aim of this study was to examine the effect of crystalloid fluid (Ringer solution) versus colloid (Haemaccel solution) on the incidence of postoperative nausea and vomiting in patients receiving spinal anesthesia. Methods: In this double-blinded clinical trial, 46 patients were selected according to the inclusion and exclusion criteria. Patients were randomly allocated to one of two groups. The crystalloid group received Ringer solution at a volume of 7 ml/kg and colloid group received 7ml/kg of 3% Modified Gelatin (Haemaccel) as a preoperative intravenous bolus. We used a Verbal Rating Scale (VRS) for assessing the nausea and vomiting occurrence. Data were analyzed using SPSS software ver.13 and χ2 test and independent t-test. Results: The result showed that the incidence of PONV was less frequent in both Ringer and Haemaccel groups, but the incidence of vomiting and the intensity of nausea was not significantly different in any time point after anesthesia. Conclusion: We conclude that preoperative fluid administration decreases the incidence of PONV, and both Crystalloids (Ringer) and colloids (haemaccel) solution were found to be equivalent in prevention of PONV. Therefore using of either Ringer or haemaccel solution is recommended for prevention of PONV. PMID:26161365

The Effect of Ringer versus Haemaccel Preload on Incidence of Postoperative Nausea and Vomiting.

PubMed

Ghafourifard, Mansour; Zirak, Mohammad; Broojerdi, Mohammad Hossein; Bayendor, Ali; Moradi, Abolfaz

2015-06-01

Postoperative nausea and vomiting (PONV) is the most common and unpleasant postoperative complication. There is much controversy on preoperative fluid therapy. The aim of this study was to examine the effect of crystalloid fluid (Ringer solution) versus colloid (Haemaccel solution) on the incidence of postoperative nausea and vomiting in patients receiving spinal anesthesia. In this double-blinded clinical trial, 46 patients were selected according to the inclusion and exclusion criteria. Patients were randomly allocated to one of two groups. The crystalloid group received Ringer solution at a volume of 7 ml/kg and colloid group received 7ml/kg of 3% Modified Gelatin (Haemaccel) as a preoperative intravenous bolus. We used a Verbal Rating Scale (VRS) for assessing the nausea and vomiting occurrence. Data were analyzed using SPSS software ver.13 and χ(2) test and independent t-test. The result showed that the incidence of PONV was less frequent in both Ringer and Haemaccel groups, but the incidence of vomiting and the intensity of nausea was not significantly different in any time point after anesthesia. We conclude that preoperative fluid administration decreases the incidence of PONV, and both Crystalloids (Ringer) and colloids (haemaccel) solution were found to be equivalent in prevention of PONV. Therefore using of either Ringer or haemaccel solution is recommended for prevention of PONV.

Blood autotransfusion outcomes compared with Ringer lactate infusion in dogs with hemorrhagic shock induced by controlled bleeding.

PubMed

Safaei, Mansour; Takami, Hassan Mousavi

2011-10-01

The most common cause of shock in the surgical or trauma patient is hemorrhage. Crystalloid solutions and blood transfusion are the mainstays of treatment of hemorrhagic shock. Considering the disadvantages of allogeneic blood transfusion, such as risk of transmission of infectious diseases, and access and maintenance limitations, treatment of shock with autologous blood seems to be a decent solution. Autologous blood accumulated in body cavities in traumatic bleeding (such hemothorax), and bloodshed in operation field during open heart or vascular surgeries, and similar situations, can be utilized again. In this study, autotransfusion effects compared with crystalloid fluid in the treatment of hemorrhagic shock was investigated. After induction of hemorrhagic shock in dogs by Wiggers type controlled bleeding, treating them in a group with autologous blood and another group with Ringer lactate were performed, and the results of treatment were studied. There was no mortality in both treatment approaches. Immediately after treatment, crystalloid positive effects such as renormalized vital signs and appropriate consciousness were more noticeable than autotransfusion, while twenty-four hours after, the desired effects of autologous blood were more pronounced like decreased metabolic acidosis and improvement of diuresis. Crystalloid during the first hours after treatment of hemorrhagic shock may be better than autologous blood as preferred treatment, while autotransfusion showed its benefits some hours after. This finding can be used to develop better strategies for treatment of hemorrhagic shock.

Comparison of high glucose concentration blood and crystalloid cardioplegia in paediatric cardiac surgery: a randomized clinical trial

PubMed Central

Mimic, Branko; Ilic, Slobodan; Vulicevic, Irena; Milovanovic, Vladimir; Tomic, Danijela; Mimic, Ana; Stankovic, Sanja; Zecevic, Tatjana; Davies, Ben; Djordjevic, Miroslav

2016-01-01

OBJECTIVES This study investigates the effects of high glucose content on patients undergoing cold crystalloid versus cold blood cardioplegia in terms of early clinical results, functional myocardial recovery and ischaemia–reperfusion injury in patients undergoing repair of acyanotic cardiac lesions. METHODS Patients were randomly assigned to receive either crystalloid (n = 31) or blood cardioplegia (n = 31). Early clinical results were assessed. Changes in left ventricular fractional shortening, arterial blood lactate levels, central venous saturation, cardiac Troponin I release and blood glucose concentration were measured during the first 24 h after ischaemia. RESULTS There was no significant difference in clinical outcomes and postoperative complication rates between groups. The postoperative changes in left ventricular function, lactate levels, central venous saturation and Troponin I were not significantly different between groups. The use of crystalloid cardioplegia was associated with significant increases in serum glucose compared with blood cardioplegia. CONCLUSIONS A high glucose content blood cardioplegia does not show any advantage compared with crystalloid cardioplegia in terms of clinical outcomes, functional recovery and the degree of ischaemic injury in infants and children undergoing repair of acyanotic heart lesions. High glucose concentration of the cardioplegic solution might potentiate ischaemia–reperfusion injury and diminish the beneficial effects of blood cardioplegia. PMID:26831677

Colloid vs. crystalloid infusions in gastrointestinal surgery and their different impact on the healing of intestinal anastomoses.

PubMed

Marjanovic, Goran; Villain, Christian; Timme, Sylvia; zur Hausen, Axel; Hoeppner, Jens; Makowiec, Frank; Holzner, Philipp; Hopt, Ulrich Theodor; Obermaier, Robert

2010-04-01

The aim of this study was to investigate if colloid infusions have different effects on intestinal anastomotic healing when compared to crystalloid infusions depending on the amount of the administered volume. Twenty-eight Wistar rats were randomly assigned to four groups receiving different amounts of either a crystalloid (Cry) or a colloid (Col) infusion solution. Animals with volume restriction (Cry (-) or Col (-)) were treated with a low and animals with volume overcharge (Cry (+) or Col (+)) with a high flow rate. All animals received an infusion for a 60-min period, while an end-to-end small bowel anastomosis was performed. At reoperation, the anastomotic bursting pressure (millimeters of mercury) was measured, as well as anastomotic hydroxyproline concentration. The presence of bowel wall edema was assessed histologically. Median bursting pressures were comparable in the Col (-) [118 mm Hg (range 113-170)], the Cry (-) [118 mm Hg (78-139)], and the Col (+) [97 mm Hg (65-152)] group. A significantly lower median bursting pressure was found in animals with crystalloid volume overload Cry (+) [73 mm Hg (60-101)]. Corresponding results were found for hydroxyproline concentration. Histology revealed submucosal edema in Cry (+) animals. In case of a fixed, high-volume load, colloids seem to have benefits on intestinal anastomotic healing when compared to crystalloid infusions.

Blood autotransfusion outcomes compared with Ringer lactate infusion in dogs with hemorrhagic shock induced by controlled bleeding*

PubMed Central

Safaei, Mansour; Takami, Hassan Mousavi

2011-01-01

BACKGROUND: The most common cause of shock in the surgical or trauma patient is hemorrhage. Crystalloid solutions and blood transfusion are the mainstays of treatment of hemorrhagic shock. Considering the disadvantages of allogeneic blood transfusion, such as risk of transmission of infectious diseases, and access and maintenance limitations, treatment of shock with autologous blood seems to be a decent solution. Autologous blood accumulated in body cavities in traumatic bleeding (such hemothorax), and bloodshed in operation field during open heart or vascular surgeries, and similar situations, can be utilized again. In this study, autotransfusion effects compared with crystalloid fluid in the treatment of hemorrhagic shock was investigated. METHODS: After induction of hemorrhagic shock in dogs by Wiggers type controlled bleeding, treating them in a group with autologous blood and another group with Ringer lactate were performed, and the results of treatment were studied. RESULTS: There was no mortality in both treatment approaches. Immediately after treatment, crystalloid positive effects such as renormalized vital signs and appropriate consciousness were more noticeable than autotransfusion, while twenty-four hours after, the desired effects of autologous blood were more pronounced like decreased metabolic acidosis and improvement of diuresis. CONCLUSIONS: Crystalloid during the first hours after treatment of hemorrhagic shock may be better than autologous blood as preferred treatment, while autotransfusion showed its benefits some hours after. This finding can be used to develop better strategies for treatment of hemorrhagic shock. PMID:22973328

Controversies in fluid therapy: Type, dose and toxicity

PubMed Central

McDermid, Robert C; Raghunathan, Karthik; Romanovsky, Adam; Shaw, Andrew D; Bagshaw, Sean M

2014-01-01

Fluid therapy is perhaps the most common intervention received by acutely ill hospitalized patients; however, a number of critical questions on the efficacy and safety of the type and dose remain. In this review, recent insights derived from randomized trials in terms of fluid type, dose and toxicity are discussed. We contend that the prescription of fluid therapy is context-specific and that any fluid can be harmful if administered inappropriately. When contrasting ‘‘crystalloid vs colloid’’, differences in efficacy are modest but differences in safety are significant. Differences in chloride load and strong ion difference across solutions appear to be clinically important. Phases of fluid therapy in acutely ill patients are recognized, including acute resuscitation, maintaining homeostasis, and recovery phases. Quantitative toxicity (fluid overload) is associated with adverse outcomes and can be mitigated when fluid therapy based on functional hemodynamic parameters that predict volume responsiveness and minimization of non-essential fluid. Qualitative toxicity (fluid type), in particular for iatrogenic acute kidney injury and metabolic acidosis, remain a concern for synthetic colloids and isotonic saline, respectively. Physiologically balanced crystalloids may be the ‘‘default’’ fluid for acutely ill patients and the role for colloids, in particular hydroxyethyl starch, is increasingly unclear. We contend the prescription of fluid therapy is analogous to the prescription of any drug used in critically ill patients. PMID:24834399

Does fluid resuscitation with balanced solutions induce electrolyte and metabolic abnormalities? An in vitro assessment.

PubMed

Krzych, Łukasz J; Czempik, Piotr F

2017-01-01

Popular intravenous fluids in clinical use may have an impact on electrolyte concentration and metabolic balance and should be considered as powerful pharmacological agents. There is a growing body of evidence that fluid therapy should be more individualised and preferably based on balanced solutions. We sought to investigate the impact of three commonly used balanced fluids on electrolytes and metabolic equilibrium in an in vitro setting. Study group comprised 32 healthy male volunteers (without history of any acute/chronic disorder or known metabolic abnormality), aged 21-35 (29 ± 4) years, weight 59-103 (81.2 ± 9.8) kg, from whom blood samples were withdrawn. The whole blood was diluted in 4:1 ratio with the study solutions to make an end-concentration of 20 vol.% of each solution. The test solutions included balanced crystalloid (Plasmalyte®, Baxter, Poland [PL]), succinylated gelatin (Geloplasma®, Fresenius Kabi, Poland [GEL]) and 6% HES 130/0.4 (Volulyte®, Fresenius Kabi, Poland [HES]). All fluids caused comparable degree of haemodilution. PL and GEL decreased (104 mmol/L, interquartile range [IQR] 103-105; and 106 mmol/L, IQR 105-107.5, respectively), whereas HES increased the concentration of Cl- to 109 (IQR 108-110) mmol/L. PL and HES decreased (136, IQR 136-137 mmol/L; and 138 mmol/L, IQR 137-139, respectively), whereas GEL increased the Na+ level to 140.5 (IQR 140-141) mmol/L. PL and HES decreased osmolality (277.2 mOsm/kg, IQR 275.7-278.4; and 280.9 mOsm/kg, IQR 279.3-282.0, respectively). GEL increased it to 285.7 (IQR 283.7-286.8) mOsm/kg. All test solutions caused a similar statistically significant (p < 0.05) drop in base excess and bicarbonate concentration, and these fell outside the reference values. Due to its composition, GEL caused a significant increase in lactate concentration. HES and GEL caused a statistically significant drop in strong ion difference value. Due to high lactate level, the effect of GEL was most pronounced. Balanced intravenous solutions should be safe in terms of their impact on human plasma electrolyte and meta-bolic equilibrium when administered to replace up to 20% of blood volume. In metabolic acidosis, balanced succinylated gelatin should be used with caution. Therefore, arterial blood gas analysis should be performed in patients in whom significant amounts of fluid are administrated, preferably with assessment of Cl-, Na+, lactate concentrations as well as pH, osmolality, and strong ion difference.

Impact of high doses of 6% hydroxyethyl starch 130/0.42 and 4% gelatin on renal function in a pediatric animal model.

PubMed

Witt, Lars; Glage, Silke; Lichtinghagen, Ralf; Pape, Lars; Boethig, Dietmar; Dennhardt, Nils; Heiderich, Sebastian; Leffler, Andreas; Sümpelmann, Robert

2016-03-01

Despite serious renal side effects in critically ill adult patients, artificial colloids are still fundamental components of perioperative fluid therapy in infants and children, although the impact of 6% hydroxyethyl starch (HES) and 4% gelatin (GEL) on renal function during pediatric surgery has not been identified yet. To determine the impact of high doses of artificial colloids on renal function, we conducted an experimental animal study and hypothesized that neither the infusion of HES nor of GEL would have a serious impact on renal function. Fifteen sedated piglets were randomly assigned to receive an infusion of either 50 ml · kg(-1) HES or GEL, or a balanced electrolyte solution (crystalloid group). Before and 1 week after infusion, serum and urine renal function tests were recorded and renal biopsies were taken. Serum and urine renal function tests revealed no increase after administration of HES and GEL, and only a discrete increase in serum creatinine (median 9.8 μmol · l(-1), 95% CI 4.0-19.1) in the crystalloid group. Histopathological examination indicated a sparsely, multifocal infiltration of mononuclear cells in all groups and an unspecific pyelectasia of one animal in the GEL group. After high doses of HES or GEL in piglets, no relevant impact on renal function could be found. These results confirm that AKI after HES or GEL is very unlikely in hemodynamically stable perioperative patients with normal renal function. © 2015 John Wiley & Sons Ltd.

Crystalloid Fluid Choice and Clinical Outcomes in Pediatric Sepsis: A Matched Retrospective Cohort Study.

PubMed

Weiss, Scott L; Keele, Luke; Balamuth, Fran; Vendetti, Neika; Ross, Rachael; Fitzgerald, Julie C; Gerber, Jeffrey S

2017-03-01

To test the hypothesis that resuscitation with balanced fluids (lactated Ringer [LR]) is associated with improved outcomes compared with normal saline (NS) in pediatric sepsis. We performed matched analyses using data from 12 529 patients <18 years of age with severe sepsis/septic shock at 382 US hospitals between 2000 and 2013 to compare outcomes with vs without LR as part of initial resuscitation. Patients receiving LR were matched 1:1 to patients receiving only NS (NS group), including separate matches for any (LR-any group) or exclusive (LR-only group) LR use. Outcomes included 30-day hospital mortality, acute kidney injury, new dialysis, and length of stay. The LR-any group was older, received larger crystalloid volumes, and was less likely to have malignancies than the NS group. After matching, mortality was not different between LR-any (7.2%) and NS (7.9%) groups (risk ratio 0.99, 95% CI 0.98, 1.01; P = .20). There were no differences in secondary outcomes except longer hospital length of stay in LR-any group (absolute difference 2.4, 95% CI 1.4, 5.0 days; P < .001). Although LR was preferentially used as adjunctive fluid with large-volume resuscitation or first-line fluid in patients with lower illness severity, outcomes were not different after matching stratified by volume and proportionate LR utilization, including for patients in the LR-only group. Balanced fluid resuscitation with LR was not associated with improved outcomes compared with NS in pediatric sepsis. Although the current practice of NS resuscitation is justified, selective LR use necessitates a prospective trial to definitively determine comparative effectiveness among crystalloids. Copyright © 2016 Elsevier Inc. All rights reserved.

Crystalloid Fluid Choice and Clinical Outcomes in Pediatric Sepsis: A Matched Retrospective Cohort Study

PubMed Central

Weiss, Scott L.; Keele, Luke; Balamuth, Fran; Vendetti, Neika; Ross, Rachael; Fitzgerald, Julie C.; Gerber, Jeffrey S.

2017-01-01

Objective To test the hypothesis that resuscitation with balanced fluids (lactated Ringer [LR]) is associated with improved outcomes compared with normal saline (NS) in pediatric sepsis. Study design We performed matched analyses using data from 12 529 patients <18 years of age with severe sepsis/septic shock at 382 US hospitals between 2000 and 2013 to compare outcomes with vs without LR as part of initial resuscitation. Patients receiving LR were matched 1:1 to patients receiving only NS (NS group), including separate matches for any (LR-any group) or exclusive (LR-only group) LR use. Outcomes included 30-day hospital mortality, acute kidney injury, new dialysis, and length of stay. Results The LR-any group was older, received larger crystalloid volumes, and was less likely to have malignancies than the NS group. After matching, mortality was not different between LR-any (7.2%) and NS (7.9%) groups (risk ratio 0.99, 95% CI 0.98, 1.01; P = .20). There were no differences in secondary outcomes except longer hospital length of stay in LR-any group (absolute difference 2.4, 95% CI 1.4, 5.0 days; P < .001). Although LR was preferentially used as adjunctive fluid with large-volume resuscitation or first-line fluid in patients with lower illness severity, outcomes were not different after matching stratified by volume and proportionate LR utilization, including for patients in the LR-only group. Conclusions Balanced fluid resuscitation with LR was not associated with improved outcomes compared with NS in pediatric sepsis. Although the current practice of NS resuscitation is justified, selective LR use necessitates a prospective trial to definitively determine comparative effectiveness among crystalloids. PMID:28063688

[State of the art in fluid and volume therapy : A user-friendly staged concept].

PubMed

Rehm, M; Hulde, N; Kammerer, T; Meidert, A S; Hofmann-Kiefer, K

2017-03-01

Adequate fluid therapy is highly important for the perioperative outcome of our patients. Both, hypovolemia and hypervolemia can lead to an increase in perioperative complications and can impair the outcome. Therefore, perioperative infusion therapy should be target-oriented. The main target is to maintain the patient's preoperative normovolemia by using a sophisticated, rational infusion strategy.Perioperative fluid losses should be discriminated from volume losses (surgical blood loss or interstitial volume losses containing protein). Fluid losses as urine or perspiratio insensibilis (0.5-1.0 ml/kg/h) should be replaced by balanced crystalloids in a ratio of 1:1. Volume therapy step 1: Blood loss up to a maximum value of 20% of the patient's blood volume should be replaced by balanced crystalloids in a ratio of 4(-5):1. Volume therapy step 2: Higher blood losses should be treated by using iso-oncotic, preferential balanced colloids in a ratio of 1:1. For this purpose hydroxyethyl starch can also be used perioperatively if there is no respective contraindication, such as sepsis, burn injuries, critically ill patients, renal impairment or renal replacement therapy, and severe coagulopathy. Volume therapy step 3: If there is an indication for red cell concentrates or coagulation factors, a differentiated application of blood and blood products should be performed.

Plasma osmotic changes during major abdominal surgery.

PubMed

Malone, R A; McLeavey, C A; Arens, J F

1977-12-01

Fluid balance across the capillary membrane is maintained normally by a balance of hydrostatic and colloid osmotic pressures (COP). In 12 patients having major intra-abdominal procedures, the COP was followed during the operative and immediate postoperative periods. The patients' intraoperative fluid management consisted of replacing shed blood with blood and following Shires' concept of crystalloid replacement. Significant decreases in COP to approximately two thirds of the initial value occurred in patients having intra-abdominal procedures versus only a 10 percent decrease in those having peripheral procedures (greater than .001). As a result of this decrease in COP, the balance between hydrostatic and colloid osmotic pressures is lost and risk of pulmonary intersitial edema is increased.

Continuous vasopressin replacement in diabetes insipidus.

PubMed Central

Ralston, C; Butt, W

1990-01-01

Five children who developed diabetes insipidus as a manifestation of severe brain injury received continuous intravenous treatment with a solution containing both aqueous vasopressin and appropriate crystalloid replacement. Polyuria, hypernatraemia, and decreased urine osmolalities were safely corrected in all patients within eight to 28 hours. PMID:2400231

Comparison of Hb-200 and 6% hetastarch 450/0.7 during initial fluid resuscitation of 20 dogs with gastric dilatation-volvulus.

PubMed

Haak, Carol E; Rudloff, Elke; Kirby, Rebecca

2012-04-01

To compare the use of polymerized stroma-free bovine hemoglobin (Hb-200) and 6% hetastarch 450/0.7 (HES 450/0.7) in 0.9% saline during fluid resuscitation of dogs with gastric dilatation-volvulus (GDV). Prospective, randomized clinical case series. Private specialty and referral clinic. Twenty client-owned dogs presenting with GDV. Dogs presenting with GDV and abnormal perfusion parameters first received rapid IV infusion of a buffered isotonic replacement crystalloid (15 mL/kg) and IV opioids. Patients were then randomized to receive either Hb-200 (N = 10) or HES 450/0.7 (N = 10). Balanced isotonic replacement crystalloids (10-20 mL/kg IV) were rapidly infused along with either Hb-200 or HES in 5 mL/kg IV aliquots to meet resuscitation end points. Resuscitation was defined as meeting at least 2 of 3 criteria: (1) capillary refill time 1-2 seconds, pink mucous membrane color, strong femoral pulse quality; (2) heart rate (HR) ≤ 150/min; or (3) indirect arterial systolic blood pressure (SBP) > 90 mm Hg. HR, SBP, packed cell volume, hemoglobin, glucose, venous pH, bicarbonate, base excess, anion gap, and colloid osmotic pressure were compared at hospital entry and within 30 minutes post-resuscitation. Compared to the HES group, the Hb-200 group required significantly less colloid (4.2 versus 18.4 mL/kg) and crystalloid (31.3 versus 48.1 mL/kg) to reach resuscitation end points (P = 0.001). Time to resuscitation was significantly shorter in the Hb-200 group (12.5 versus 52.5 min). Dogs with GDV receiving Hb-200 during initial resuscitation required smaller volumes of both crystalloid and colloid fluids and reached resuscitation end points faster than dogs receiving HES 450/0.7 (P = 0.02). © Veterinary Emergency and Critical Care Society 2012.

Reversible Calcium-Regulated Stopcocks in Legume Sieve TubesW⃞

PubMed Central

Knoblauch, Michael; Peters, Winfried S.; Ehlers, Katrin; van Bel, Aart J. E.

2001-01-01

Sieve tubes of legumes (Fabaceae) contain characteristic P-protein crystalloids with controversial function. We studied their behavior by conventional light, electron, and confocal laser scanning microscopy. In situ, crystalloids are able to undergo rapid (<1 sec) and reversible conversions from the condensed resting state into a dispersed state, in which they occlude the sieve tubes. Crystalloid dispersal is triggered by plasma membrane leakage induced by mechanical injury or permeabilizing substances. Similarly, abrupt turgor changes imposed by osmotic shock cause crystalloid dispersal. Because chelators generally prevent the response, divalent cations appear to be the decisive factor in crystalloid expansion. Cycling between dispersal and condensation can be induced in opened cells by repetitive exchange of bathing media containing either Ca2+ or chelators. Sr2+ and Ba2+, but not Mg2+, are equally active. In conclusion, the fabacean P-protein crystalloids represent a novel class of mechanically active proteinaceous structures, which provide an efficient mechanism with which to control sieve tube conductivity. PMID:11340193

Distribution of crystalloid fluid changes with the rate of infusion: a population-based study.

PubMed

Hahn, R G; Drobin, D; Zdolsek, J

2016-05-01

Crystalloid fluid requires 30 min for complete distribution throughout the extracellular fluid space and tends to cause long-standing peripheral edema. A kinetic analysis of the distribution of Ringer's acetate with increasing infusion rates was performed to obtain a better understanding of these characteristics of crystalloids. Data were retrieved from six studies in which 76 volunteers and preoperative patients had received between 300 ml and 2375 ml of Ringer's acetate solution at a rate of 20-80 ml/min (0.33-0.83 ml/min/kg). Serial measurements of the blood hemoglobin concentration were used as inputs in a kinetic analysis based on a two-volume model with micro-constants, using software for nonlinear mixed effects. The micro-constants describing distribution (k12) and elimination (k10) were unchanged when the rate of infusion increased, with half-times of 16 and 26 min, respectively. In contrast, the micro-constant describing how rapidly the already distributed fluid left the peripheral space (k21) decreased by 90% when the fluid was infused more rapidly, corresponding to an increase in the half-time from 3 to 30 min. The central volume of distribution (V(c)) doubled. The return of Ringer's acetate from the peripheral fluid compartment to the plasma was slower with high than with low infusion rates. Edema is a normal consequence of plasma volume expansion with this fluid, even in healthy volunteers. The results are consistent with the view that the viscoelastic properties of the interstitial matrix are responsible for the distribution and redistribution characteristics of crystalloid fluid. © 2016 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Influences of red blood cell and platelet counts on the distribution and elimination of crystalloid fluid.

PubMed

Hahn, Robert G

2017-01-01

A high number of blood cells increases the viscosity of the blood. The present study explored whether variations in blood cell counts are relevant to the distribution and elimination of infused crystalloid fluid. On three different occasions, 10 healthy male volunteers received an intravenous infusion of 25mL/kg of Ringer's acetate, Ringer's lactate, and isotonic saline over 30min. Blood hemoglobin and urinary excretion were monitored for 4h and used as input in a two-volume kinetic model, using nonlinear mixed effects software. The covariates used in the kinetic model were red blood cell and platelet counts, the total leukocyte count, the use of isotonic saline, and the arterial pressure. Red blood cell and platelet counts in the upper end of the normal range were associated with a decreased rate of distribution and redistribution of crystalloid fluid. Simulations showed that high counts were correlated with volume expansion of the peripheral (interstitial) fluid space, while the plasma volume was less affected. In contrast, the total leukocyte count had no influence on the distribution, redistribution, or elimination. The use of isotonic saline caused a transient reduction in the systolic arterial pressure (P<0.05) and doubled the half-life of infused fluid in the body when compared to the two Ringer solutions. Isotonic saline did not decrease the serum potassium concentration, despite the fact that saline is potassium-free. High red blood cell and platelet counts are associated with peripheral accumulation of infused crystalloid fluid. Copyright © 2017 The Lithuanian University of Health Sciences. Production and hosting by Elsevier Sp. z o.o. All rights reserved.

Custodiol for myocardial protection and preservation: a systematic review

PubMed Central

Seco, Michael; Dunne, Ben; Matzelle, Shannon J.; Murphy, Michelle; Joshi, Pragnesh; Yan, Tristan D.; Wilson, Michael K.; Bannon, Paul G.; Vallely, Michael P.; Passage, Jurgen

2013-01-01

Introduction Custodiol cardioplegia is attractive for minimally invasive cardiac surgery, as a single dose provides a long period of myocardial protection. Despite widespread use in Europe, there is little data confirming its efficacy compared with conventional (blood or crystalloid) cardioplegia. There is similar enthusiasm for its use in organ preservation for transplant, but also a lack of data. This systematic review aimed to assess the evidence for the efficacy of Custodiol in myocardial protection and as a preservation solution in heart transplant. Methods Electronic searches were performed of six databases from inception to October 2013. Reviewers independently identified studies that compared Custodiol with conventional cardioplegia (blood or extracellular crystalloid) in adult patients for meta-analysis; large case series that reported results using Custodiol were analyzed. Next, we identified studies that compared Custodiol with other organ preservation solutions for organ preservation in heart transplant. Results Fourteen studies compared Custodiol with conventional cardioplegia for myocardial protection in adult cardiac surgery. No difference was identified in mortality; there was a trend for increased incidence of ventricular fibrillation in the Custodiol group that did not reach statistical significance. No difference was identified in studies that compared Custodiol with other solutions for heart transplant. Conclusions Despite widespread clinical use, the evidence supporting the superiority of Custodiol over other solutions for myocardial protection or organ preservation is limited. Large randomised trials are required. PMID:24349972

Development and Retrospective Clinical Assessment of a Patient-Specific Closed-Form Integro-Differential Equation Model of Plasma Dilution.

PubMed

Atlas, Glen; Li, John K-J; Amin, Shawn; Hahn, Robert G

2017-01-01

A closed-form integro-differential equation (IDE) model of plasma dilution (PD) has been derived which represents both the intravenous (IV) infusion of crystalloid and the postinfusion period. Specifically, PD is mathematically represented using a combination of constant ratio, differential, and integral components. Furthermore, this model has successfully been applied to preexisting data, from a prior human study, in which crystalloid was infused for a period of 30 minutes at the beginning of thyroid surgery. Using Euler's formula and a Laplace transform solution to the IDE, patients could be divided into two distinct groups based on their response to PD during the infusion period. Explicitly, Group 1 patients had an infusion-based PD response which was modeled using an exponentially decaying hyperbolic sine function, whereas Group 2 patients had an infusion-based PD response which was modeled using an exponentially decaying trigonometric sine function. Both Group 1 and Group 2 patients had postinfusion PD responses which were modeled using the same combination of hyperbolic sine and hyperbolic cosine functions. Statistically significant differences, between Groups 1 and 2, were noted with respect to the area under their PD curves during both the infusion and postinfusion periods. Specifically, Group 2 patients exhibited a response to PD which was most likely consistent with a preoperative hypovolemia. Overall, this IDE model of PD appears to be highly "adaptable" and successfully fits clinically-obtained human data on a patient-specific basis, during both the infusion and postinfusion periods. In addition, patient-specific IDE modeling of PD may be a useful adjunct in perioperative fluid management and in assessing clinical volume kinetics, of crystalloid solutions, in real time.

Development and Retrospective Clinical Assessment of a Patient-Specific Closed-Form Integro-Differential Equation Model of Plasma Dilution

PubMed Central

Atlas, Glen; Li, John K-J; Amin, Shawn; Hahn, Robert G

2017-01-01

A closed-form integro-differential equation (IDE) model of plasma dilution (PD) has been derived which represents both the intravenous (IV) infusion of crystalloid and the postinfusion period. Specifically, PD is mathematically represented using a combination of constant ratio, differential, and integral components. Furthermore, this model has successfully been applied to preexisting data, from a prior human study, in which crystalloid was infused for a period of 30 minutes at the beginning of thyroid surgery. Using Euler’s formula and a Laplace transform solution to the IDE, patients could be divided into two distinct groups based on their response to PD during the infusion period. Explicitly, Group 1 patients had an infusion-based PD response which was modeled using an exponentially decaying hyperbolic sine function, whereas Group 2 patients had an infusion-based PD response which was modeled using an exponentially decaying trigonometric sine function. Both Group 1 and Group 2 patients had postinfusion PD responses which were modeled using the same combination of hyperbolic sine and hyperbolic cosine functions. Statistically significant differences, between Groups 1 and 2, were noted with respect to the area under their PD curves during both the infusion and postinfusion periods. Specifically, Group 2 patients exhibited a response to PD which was most likely consistent with a preoperative hypovolemia. Overall, this IDE model of PD appears to be highly “adaptable” and successfully fits clinically-obtained human data on a patient-specific basis, during both the infusion and postinfusion periods. In addition, patient-specific IDE modeling of PD may be a useful adjunct in perioperative fluid management and in assessing clinical volume kinetics, of crystalloid solutions, in real time. PMID:29123436

Effects of crystalloid on lung fluid balance after smoke inhalation.

PubMed Central

Clark, W R; Nieman, G F; Goyette, D; Gryzboski, D

1988-01-01

Inhalation injury occurs in 21% of flame burn victims who require large fluid volumes for resuscitation and have a mortality rate greater than 30%. This study was done to determine how vulnerable the smoke-injured lung is to fluid accumulation when crystalloids are infused rapidly. Mongrel dogs were exposed to smoke and 10% body-weight Ringer's lactate in three groups: (I) fluid only, (II) smoke only, and (III) smoke and fluid. The increase in wet-dry lung weight ratio was 2% in Group I, 28% in Group II, and 42% in Group III, consistent with pulmonary edema present only in Group III. The decrease in colloid oncotic pressure was similar in both of the groups that were given fluid, and the rise in the surface tension minimum of lung extracts was similar in both of the groups that were exposed to smoke. The smoke-injured lung loses the ability to protect itself when challenged with fluid. Reduced oncotic pressure is not responsible. Changes in microvascular pressure, endothelial and epithelial damage, and surfactant inactivation interact to cause this increase in extravascular lung water. PMID:3389945

Comparison of the effects of a balanced crystalloid-based and a saline-based tetrastarch solution on canine whole blood coagulation and platelet function.

PubMed

Reuteler, Annina; Axiak-Flammer, Shannon; Howard, Judith; Adamik, Katja-Nicole

2017-01-01

To evaluate the effects of a 6% hydroxyethyl starch (130/0.42) solution in either a buffered, electrolyte-balanced (HES-BAL), or a saline (HES-SAL) carrier solution on canine platelet function and whole blood coagulation. Prospective, randomized study. University teaching hospital. Thirty-seven client-owned dogs undergoing general anesthesia for arthroscopy or imaging studies. Dogs received a 15 mL/kg intravenous bolus of HES-SAL (n = 13), HES-BAL (n = 14), or a modified Ringer's solution (n = 10) over 30-40 minutes. Coagulation was analyzed using a Platelet Function Analyzer-100 (closure time [Ct PFA ]), and whole blood thromboelastometry (ROTEM) with extrinsically (ex-tem and fib-tem) and intrinsically (in-tem) activated assays, which assessed clotting time (CT), clot formation time (CFT), maximal clot firmness (MCF), and lysis index (LI). Coagulation samples were assayed prior to fluid administration (T0), and 5 minutes (T1), and 3 hours (T2) following fluid bolus administration, respectively. Both HES solutions resulted in impaired platelet function as indicated by a significant prolongation of Ct PFA at T1 as compared to T0, but which resolved by T2. An IV bolus of Ringer's solution did not alter platelet function. In both HES groups, whole blood coagulation was significantly impaired at T1 as indicated by a significant increase in in-tem CFT, and a significant decrease in ex-tem, in-tem, and fib-tem MCF compared to T0. Furthermore, a significant increase in ex-tem CFT at T1 compared to T0 was found in the HES-SAL group. With the exception of in-tem MCF after HES-BAL, these effects were not present at T2. No significant differences were found in Ct PFA or any ROTEM variable at any time point between HES-SAL and HES-BAL. Administration of a single bolus of 15 mL/kg 6% HES 130/0.42 results in significant but short-lived impairment of canine platelet function and whole blood coagulation, regardless of carrier solution. © Veterinary Emergency and Critical Care Society 2016.

Diagnosis, medical treatment, and prognosis of feline urolithiasis.

PubMed

Osborne, C A; Lulich, J P; Thumchai, R; Bartges, J W; Sanderson, S L; Ulrich, L K; Koehler, L A; Bird, K A; Swanson, L L

1996-05-01

Radiographic or ultrasonographic evaluation of the urinary tract is required to consistently detect feline uroliths. Evaluation of clinical, laboratory, and radiographic findings facilitate "guesstimation" of the mineral composition of uroliths. Therapy should not be initiated before appropriate samples have been collected for diagnosis. The objectives of medical management of uroliths are to arrest further growth and to promote urolith dissolution by correcting or controlling underlying abnormalities. For therapy to be effective, it must induce undersaturation of urine with calculogenic crystalloids by (1) increasing the solubility of crystalloids in urine, (2) increasing the volume of urine in which crystalloids are dissolved or suspended, and (3) reducing the quantity of calculogenic crystalloids in urine.

Crystalloids in apparent autophagic plastids: remnants of plastids or peroxisomes?

PubMed

Papini, Alessio; van Doorn, Wouter G

2015-02-01

Plant macroautophagy is carried out by autophagosome-type organelles. Recent evidence suggests that plastids also can carry out macroautophagy. The double membrane at the surface of plastids apparently invaginates, forming an intraplastidial space. This space contains a portion of cytoplasm that apparently becomes degraded. Here we report, in Tillandsia sp. and Aechmaea sp., the presence of almost square or diamond-shaped crystalloids inside what seems the intraplastidial space of autophagous plastids. The same type of crystalloids were observed in chloroplasts and other plastids, but were not found in the cytoplasm or the vacuole. Peroxisomes contained smaller and more irregularly shaped crystalloids compared to the ones observed in 'autophagous' plastids. It is hypothesized that plastids are able to sequester chloroplasts and other plastids. Copyright © 2014 Elsevier GmbH. All rights reserved.

Evaluation of an oral electrolyte solution for treatment of mild to moderate dehydration in dogs with hemorrhagic diarrhea.

PubMed

Reineke, Erica L; Walton, Karie; Otto, Cynthia M

2013-09-15

To determine the safety and efficacy of an electrolyte solution for oral administration (OES) for the correction of mild to moderate dehydration associated with hemorrhagic diarrhea in dogs. Nonrandomized, noncontrolled clinical trial. 20 dogs that had hemorrhagic diarrhea with < 3 episodes of vomiting. All dogs underwent testing for parvovirus infection, were given maropitant citrate to control emesis, and were offered an OES. Intravenous crystalloid fluid administration was performed when dogs refused the OES or had vomiting, a 5% increase in PCV, 5% decrease in body weight, serum creatinine or BUN concentration higher than at admission, or clinically important alterations in blood electrolyte or serum glucose concentrations. 13 (65%) dogs voluntarily consumed the OES; 7 (35%) dogs refused the OES and received a balanced electrolyte solution IV instead. All 13 dogs in the OES group consumed the solution ≤ 5 hours after hospital admission. Eight and 16 hours after admission, PCV and serum total protein and BUN concentrations were significantly lower than at hospital admission in the OES group, whereas no significant changes were identified in venous blood pH, base excess, and concentrations of sodium, potassium, chloride, ionized calcium, ionized magnesium, and lactate. The cost of treatment was significantly less for the OES group than for the IV treated group. Rehydration therapy with an OES was effective and safe in dogs with mild to moderate dehydration associated with hemorrhagic diarrhea. Potential benefits of this treatment approach for gastroenteritis in dogs, compared with traditional IV fluid administration, include lower owner-related veterinary costs and decreased staff time associated with treatment.

Intraoperative crystalloid overload leads to substantial inflammatory infiltration of intestinal anastomoses-a histomorphological analysis.

PubMed

Kulemann, Birte; Timme, Sylvia; Seifert, Gabriel; Holzner, Philipp A; Glatz, Torben; Sick, Olivia; Chikhladze, Sophia; Bronsert, Peter; Hoeppner, Jens; Werner, Martin; Hopt, Ulrich T; Marjanovic, Goran

2013-09-01

It has been shown that crystalloid fluid-overload promotes anastomotic instability. As physiologic anastomotic healing requires the sequential infiltration of different cells, we hypothesized this to be altered by liberal fluid regimes and performed a histomorphological analysis. 36 Wistar rats were randomized into 4 groups (n=8-10 rats/group) and treated with either liberal (+) or restrictive (-) perioperative crystalline (Jonosteril = Cry) or colloidal fluid (Voluven = Col). Anastomotic samples were obtained on postoperative day 4, routinely stained and histophathologically reviewed. Anastomotic healing was assessed using a semiquantitative score, assessing inflammatory cells, anastomotic repair and collagenase activity. Overall, the crystalloid overload group (Cry (+)) showed the worst healing score (P < 0.01). A substantial increase of lymphocytes and macrophages was found in this group compared to the other three (P < 0.01). Both groups that received colloidal fluid (Col (+) and Col (-)) as well as the group that received restricted crystalloid fluid resuscitation (Cry (-)) had better intestinal healing. Collagenase activity was significantly higher in the Cry (+) group. Intraoperative infusion of high-volume crystalloid fluid leads to a pathological anastomotic inflammatory response with a marked infiltration of leukocytes and macrophages resulting in accelerated collagenolysis. Copyright © 2013 Mosby, Inc. All rights reserved.

Does intraoperative fluid management in spine surgery predict intensive care unit length of stay?

PubMed

Nahtomi-Shick, O; Kostuik, J P; Winters, B D; Breder, C D; Sieber, A N; Sieber, F E

2001-05-01

To determine whether intraoperative fluid management in spine surgery predicts postoperative intensive care unit length of stay (ICU LOS). Retrospective case series. University-affiliated medical center. 103 adult ASA physical status I, II, and III patients undergoing spine surgery. Patients were divided into three LOS groups: no ICU stay (LOS0) (n = 26), 1 day ICU stay (LOS1) (n = 48), and ICU stay > 1 day (LOS2) (n = 29). Measurements were analyzed by groups using the Kruskal-Wallis and Mann-Whitney tests, and linear regression. Demographics, comorbidity, length of surgery, surgical procedure, and intraoperative fluids were recorded. The important differences in perioperative fluid management among the three groups included estimated blood loss (612 +/- 480 mL, 1853 +/- 1175 mL, 2702 +/- 1771 mL, means +/- SD); total crystalloid administration (2715 +/- 1396 mL, 5717 +/- 2574 mL, 7281 +/- 3417 mL); and total blood administration (92 +/- 279 mL, 935 +/- 757 mL, 1542 +/- 1230 mL) in LOS0, LOS1, and LOS2, respectively. The mixture of surgical procedures was similar in LOS1 and LOS2; and differed from LOS0. Predictors of ICU LOS included age, ASA physical status, surgical procedure, total crystalloid administration, and platelet administration. Surgical procedure and total crystalloid administration correlated (Pearson correlation coefficient = 0.441; p = 0.000) and were not related to age or ASA physical status. Total crystalloid administration during spine surgery does predict ICU LOS. In addition, total crystalloid administration is closely related to the surgical procedure. Given that the mixture of surgical procedures was similar in LOS1 and LOS2, but differed in estimated blood loss, total crystalloid administration, and total blood administration; intraoperative fluid management during spine surgery only predicts ICU LOS insofar as total crystalloid administration is related to the surgical procedure.

Novel therapy for renal protection.

PubMed

Zarbock, Alexander; Milles, Kindgen

2015-08-01

Acute kidney injury (AKI) is a common and serious complication that significantly increases morbidity, mortality, and cost of care after surgery. In this article, we review recent studies that deal with strategies for renal protection and the prevention of AKI after surgery. A prerequisite for any prophylactic intervention is the identification of patients at risk for AKI or those with acute kidney damage before kidney function deteriorates. In this context, new biomarkers can help to detect cellular injury early. This way, a window for interventions can be opened. Several studies demonstrated the tissue-protective effect of remote ischemic preconditioning in various organs. There is clear evidence that use of balanced crystalloid fluids and the avoidance of hyperchloremic solutions for infusion therapy can reduce the incidence of AKI. Preliminary data show a protective effect if dexmedetomidine is used as a sedative agent following cardiac surgery. The most important intervention with proven efficacy to protect from AKI is aggressive hemodynamic stabilization. Early identification of patients at risk for AKI is crucial to apply any protective intervention. An improved perioperative management is required to prevent AKI. Although pharmacological therapies aiming to protect AKI are under evaluation, hemodynamic optimization and avoidance of nephrotoxic drugs are critical for perioperative patient.

Pharmacology of colloids and crystalloids.

PubMed

Griffel, M I; Kaufman, B S

1992-04-01

We have attempted to review body fluid distribution by compartments so that the reader understands the physiology of ICF and ECF, and the relationship between interstitial and intravascular fluids. Crystalloids such as NS and RL are distributed to the ECF, whereas colloids primarily remain intravascular for longer periods. Although effective, crystalloids tend to require larger volumes for infusion, and edema remains a problem. Colloids as a group are extremely effective volume expanders, but none is ideal. Albumin, hetastarch, dextran, and the less commonly used colloids each have significant toxicities that must be considered when using them. Intelligent choices can be made to optimize use of these fluids.

Needleless connectors substantially reduce flow of crystalloid and red blood cells during rapid infusion.

PubMed

Lehn, Robert A; Gross, Jeffrey B; McIsaac, Joseph H; Gipson, Keith E

2015-04-01

Although needleless connectors (NC) are frequently used in the perioperative setting, the potential of modern NCs to slow delivery of IV fluids has not been thoroughly studied. We examined flow characteristics of 5 NC models during pressurized delivery of crystalloid and banked red blood cells from a Level 1 warmer through various IV catheters. Crystalloid flow rates were reduced by 29% to 85% from control in catheters >18 gauge, while red blood cell flow reductions ranged from 22% to 76% in these catheters (all P < 0.0050). We suggest that practitioners consider eliminating NCs when large IV catheters are inserted for rapid fluid administration.

A randomized, controlled, double-blind crossover study on the effects of 1-L infusions of 6% hydroxyethyl starch suspended in 0.9% saline (voluven) and a balanced solution (Plasma Volume Redibag) on blood volume, renal blood flow velocity, and renal cortical tissue perfusion in healthy volunteers.

PubMed

Chowdhury, Abeed H; Cox, Eleanor F; Francis, Susan T; Lobo, Dileep N

2014-05-01

We compared the effects of intravenous administration of 6% hydroxyethyl starch (maize-derived) in 0.9% saline (Voluven; Fresenius Kabi, Runcorn, United Kingdom) and a "balanced" preparation of 6% hydroxyethyl starch (potato-derived) [Plasma Volume Redibag (PVR); Baxter Healthcare, Thetford, United Kingdom] on renal blood flow velocity and renal cortical tissue perfusion in humans using magnetic resonance imaging. Hyperchloremia resulting from 0.9% saline infusion may adversely affect renal hemodynamics when compared with balanced crystalloids. This phenomenon has not been studied with colloids. Twelve healthy adult male subjects received 1-L intravenous infusions of Voluven or PVR over 30 minutes in a randomized, double-blind manner, with crossover studies 7 to 10 days later. Magnetic resonance imaging proceeded for 60 minutes after commencement of infusion to measure renal artery blood flow velocity and renal cortical perfusion. Blood was sampled, and weight was recorded at 0, 30, 60, 120, 180, and 240 minutes. Mean peak serum chloride concentrations were 108 and 106 mmol/L, respectively, after Voluven and PVR infusion (P = 0.032). Changes in blood volume (P = 0.867), strong ion difference (P = 0.219), and mean renal artery flow velocity (P = 0.319) were similar. However, there was a significant increase in mean renal cortical tissue perfusion after PVR when compared with Voluven (P = 0.033). There was no difference in urinary neutrophil gelatinase-associated liopcalin to creatinine ratios after the infusion (P = 0.164). There was no difference in the blood volume-expanding properties of the 2 preparations of 6% hydroxyethyl starch. The balanced starch produced an increase in renal cortical tissue perfusion, a phenomenon not seen with starch in 0.9% saline.

Current aspects in sepsis approach. Turning things around.

PubMed

Candel, F J; Borges Sá, M; Belda, S; Bou, G; Del Pozo, J L; Estrada, O; Ferrer, R; González Del Castillo, J; Julián-Jiménez, A; Martín-Loeches, I; Maseda, E; Matesanz, M; Ramírez, P; Ramos, J T; Rello, J; Suberviola, B; Suárez de la Rica, A; Vidal, P

2018-06-25

The incidence and prevalence of sepsis depend on the definitions and records that we use and we may be underestimating their impact. Up to 60% of the cases come from the community and in 30-60% we obtain microbiological information. Sometimes its presentation is ambiguous and there may be a delay in its detection, especially in the fragile population. Procalcitonin is the most validated biomarker for bacterial sepsis and the one that best discriminates the non-infectious cause. Presepsin and pro-adrenomedullin are useful for early diagnosis, risk stratification and prognosis in septic patients. The combination of biomarkers is even more useful to clarify an infectious cause than any isolated biomarker. Resuscitation with artificial colloids has worse results than crystalloids, especially in patients with renal insufficiency. The combination of saline solution and balanced crystalloids is associated with a better prognosis. Albumin is only recommended in patients who require a large volume of fluids. The modern molecular methods on the direct sample or the identification by MALDI-TOF on positive blood culture have helped to shorten the response times in diagnosis, to optimize the antibiotic treatment and to facilitate stewardship programs. The hemodynamic response in neonates and children is different from that in adults. In neonatal sepsis, persistent pulmonary hypertension leads to an increase in right ventricular afterload and heart failure with hepatomegaly. Hypotension, poor cardiac output with elevated systemic vascular resistance (cold shock) is often a terminal sign in septic shock. Developing ultra-fast Point-of-Care tests (less than 30 minutes), implementing technologies based on omics, big data or massive sequencing or restoring "healthy" microbiomes in critical patients after treatment are the main focuses of research in sepsis. The main benefits of establishing a sepsis code are to decrease the time to achieve diagnosis and treatment, improve organization, unify criteria, promote teamwork to achieve common goals, increase participation, motivation and satisfaction among team members, and reduce costs. ©The Author 2018. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).

A combination of levobupivacaine and lidocaine for paravertebral block in breast cancer patients undergoing quadrantectomy causes greater hemodynamic oscillations than levobupivacaine alone

PubMed Central

Župčić, Miroslav; Graf, Sandra; Župčić; Duzel, Viktor; Šimurina, Tatjana; Šakić, Livija; Fudurić, Jurica; Peršec, Jasminka; Milošević, Milan; Stanec, Zdenko; Korušić, Anđelko; Barišin, Stjepan

2017-01-01

Aim To test for differences in hemodynamic and analgesic properties in patients with breast cancer undergoing quadrantectomy with paravertebral block (PVB) induced with a solution of either one or two local anesthetics. Method A prospective, single-center, randomized, double-blinded, controlled trial was conducted from June 2014 until September 2015. A total of 85 women with breast cancer were assigned to receive PVB with either 0.5% levobupivacaine (n = 42) or 0.5% levobupivacaine with 2% lidocaine (n = 43). Hemodynamic variables of interest included intraoperative stroke volume variation (SVV), mean arterial pressure, heart rate, cardiac output, episodes of hypotension, use of crystalloids, and use of inotropes. Analgesic variables of interest were time to block onset, duration of analgesia, and postoperative serial pain assessment using a visual analogue scale. Results Although the use of 0.5% levobupivacaine with 2% lidocaine solution for PVB decreased the mean time-to-block onset (14 minutes; P < 0.001), it also caused significantly higher SVV values over the 60 minutes of monitoring (mean difference: 4.33; P < 0.001). Furthermore, the patients who received 0.5% levobupivacaine with 2% lidocaine experienced shorter mean duration of analgesia (105 minutes; P = 0.006) and more episodes of hypotension (17.5%; P = 0.048) and received more intraoperative crystalloids (mean volume: 550 mL; P < 0.001). Conclusion The use of 0.5% levobupivacaine in comparison with 0.5% levobupivacaine with 2% lidocaine solution for PVB had a longer time-to-block onset, but it also reduced hemodynamic disturbances and prolonged the analgesic effect. Registration No.: NTC02004834 PMID:28857520

Accuracy of non-invasive measurement of haemoglobin concentration by pulse co-oximetry during steady-state and dynamic conditions in liver surgery.

PubMed

Vos, J J; Kalmar, A F; Struys, M M R F; Porte, R J; Wietasch, J K G; Scheeren, T W L; Hendriks, H G D

2012-10-01

The Masimo Radical 7 (Masimo Corp., Irvine, CA, USA) pulse co-oximeter(®) calculates haemoglobin concentration (SpHb) non-invasively using transcutaneous spectrophotometry. We compared SpHb with invasive satellite-lab haemoglobin monitoring (Hb(satlab)) during major hepatic resections both under steady-state conditions and in a dynamic phase with fluid administration of crystalloid and colloid solutions. Thirty patients undergoing major hepatic resection were included and randomized to receive a fluid bolus of 15 ml kg(-1) colloid (n=15) or crystalloid (n=15) solution over 30 min. SpHb was continuously measured on the index finger, and venous blood samples were analysed in both the steady-state phase (from induction until completion of parenchymal transection) and the dynamic phase (during fluid bolus). Correlation was significant between SpHb and Hb(satlab) (R(2)=0.50, n=543). The modified Bland-Altman analysis for repeated measurements showed a bias (precision) of -0.27 (1.06) and -0.02 (1.07) g dl(-1) for the steady-state and dynamic phases, respectively. SpHb accuracy increased when Hb(satlab) was <10 g dl(-1), with a bias (precision) of 0.41 (0.47) vs -0.26 (1.12) g dl(-1) for values >10 g dl(-1), but accuracy decreased after colloid administration (R(2)=0.25). SpHb correlated moderately with Hb(satlab) with a slight underestimation in both phases in patients undergoing major hepatic resection. Accuracy increased for lower Hb(satlab) values but decreased in the presence of colloid solution. Further improvements are necessary to improve device accuracy under these conditions, so that SpHb might become a sensitive screening device for clinically significant anaemia.

Comparison of the effects of albumin and crystalloid on mortality in adult patients with severe sepsis and septic shock: a meta-analysis of randomized clinical trials.

PubMed

Xu, Jing-Yuan; Chen, Qi-Hong; Xie, Jian-Feng; Pan, Chun; Liu, Song-Qiao; Huang, Li-Wei; Yang, Cong-Shan; Liu, Ling; Huang, Ying-Zi; Guo, Feng-Mei; Yang, Yi; Qiu, Hai-Bo

2014-12-15

The aim of this study was to examine whether albumin reduced mortality when employed for the resuscitation of adult patients with severe sepsis and septic shock compared with crystalloid by meta-analysis. We searched for and gathered data from MEDLINE, Elsevier, Cochrane Central Register of Controlled Trials and Web of Science databases. Studies were eligible if they compared the effects of albumin versus crystalloid therapy on mortality in adult patients with severe sepsis and septic shock. Two reviewers extracted data independently. Disagreements were resolved by discussion with other two reviewers until a consensus was achieved. Data including mortality, sample size of the patients with severe sepsis, sample size of the patients with septic shock and resuscitation endpoints were extracted. Data were analyzed by the methods recommended by the Cochrane Collaboration Review Manager 4.2 software. A total of 5,534 records were identified through the initial search. Five studies compared albumin with crystalloid. In total, 3,658 severe sepsis and 2,180 septic shock patients were included in the meta-analysis. The heterogeneity was determined to be non-significant (P = 0.86, I(2) = 0%). Compared with crystalloid, a trend toward reduced 90-day mortality was observed in severe sepsis patients resuscitated with albumin (odds ratio (OR) 0.88; 95% CI, 0.76 to 1.01; P = 0.08). However, the use of albumin for resuscitation significantly decreased 90-day mortality in septic shock patients (OR 0.81; 95% CI, 0.67 to 0.97; P = 0.03). Compared with saline, the use of albumin for resuscitation slightly improved outcome in severe sepsis patients (OR 0.81; 95% CI, 0.64 to 1.08; P = 0.09). In this meta-analysis, a trend toward reduced 90-day mortality was observed in severe sepsis patients resuscitated with albumin compared with crystalloid and saline. Moreover, the 90-day mortality of patients with septic shock decreased significantly.

Fluid management in acute kidney injury.

PubMed

Perner, Anders; Prowle, John; Joannidis, Michael; Young, Paul; Hjortrup, Peter B; Pettilä, Ville

2017-06-01

Acute kidney injury (AKI) and fluids are closely linked through oliguria, which is a marker of the former and a trigger for administration of the latter. Recent progress in this field has challenged the physiological and clinical rational of using oliguria as a trigger for the administration of fluid and brought attention to the delicate balance between benefits and harms of different aspects of fluid management in critically ill patients, in particular those with AKI. This narrative review addresses various aspects of fluid management in AKI outlining physiological aspects, the effects of crystalloids and colloids on kidney function and the effect of various resuscitation and de-resuscitation strategies on the course and outcome of AKI.

History and Use of del Nido Cardioplegia Solution at Boston Children’s Hospital

PubMed Central

Matte, Gregory S.; del Nido, Pedro J.

2012-01-01

Abstract: Cardioplegia is an integral and essential method of myocardial protection for patients of all ages requiring cardiac surgery in which the heart must be stopped. Numerous cardioplegia solutions and delivery methods have been developed. The del Nido cardioplegia solution has been in use for 18 years at Boston Children’s Hospital. This is a unique four parts crystalloid to one part whole blood formulation that is generally used in a single-dose fashion. Although the formulation was originally developed for use in pediatric and infant patients, its use for adult cardiac surgery has been expanding. National and international inquiries to our institution regarding this cardioplegia have been increasing over the last 2 years. We present the developmental history, supporting theory, and current protocol for use of what is now referred to as del Nido cardioplegia. PMID:23198389

History and use of del Nido cardioplegia solution at Boston Children's Hospital.

PubMed

Matte, Gregory S; del Nido, Pedro J

2012-09-01

Cardioplegia is an integral and essential method of myocardial protection for patients of all ages requiring cardiac surgery in which the heart must be stopped. Numerous cardioplegia solutions and delivery methods have been developed. The del Nido cardioplegia solution has been in use for 18 years at Boston Children's Hospital. This is a unique four parts crystalloid to one part whole blood formulation that is generally used in a single-dose fashion. Although the formulation was originally developed for use in pediatric and infant patients, its use for adult cardiac surgery has been expanding. National and international inquiries to our institution regarding this cardioplegia have been increasing over the last 2 years. We present the developmental history, supporting theory, and current protocol for use of what is now referred to as del Nido cardioplegia.

Effect of tetrastarch (hydroxyethyl starch 130/0.4) on plasma creatinine concentration in cats: a retrospective analysis (2010-2015).

PubMed

Yozova, Ivayla D; Howard, Judith; Adamik, Katja N

2017-10-01

Objectives The objective was to determine survival and changes in creatinine concentrations after administration of 6% tetrastarch (hydroxyethyl starch [HES] 130/0.4) vs crystalloids in critically ill cats. Methods The medical records were reviewed for cats admitted to the intensive care unit with at least two plasma creatinine measurements and initial concentrations not exceeding the upper reference interval. Cats were excluded if they had received HES prior to admission or if they had received fluid therapy for <24 h between initial and subsequent measurements. Changes in creatinine concentrations were evaluated as the percentage change from initial values to the maximum subsequent measurements. Cats receiving only crystalloids were assigned to the crystalloid group; cats receiving only HES or HES and crystalloids were assigned to the HES group. Results Ninety-three cats were included in the study (62 in the crystalloid group, 31 in the HES group). The total median cumulative HES dose was 94 ml/kg (range 26-422 ml/kg) and 24 ml/kg/day (range 16-42 ml/kg/day). No difference was detected between the groups for age, sex, body weight or mortality. The HES group had a significantly longer length of hospitalisation ( P = 0.012), lower albumin concentrations ( P <0.001), higher Acute Patient Physiologic and Laboratory Evaluation scores ( P = 0.037) and higher incidence of systemic inflammatory response syndrome ( P = 0.009) and sepsis ( P = 0.013). There was no significant difference in initial, maximum or maximum change in creatinine concentrations between the groups. Moreover, there was no significant difference in maximum change in creatinine concentrations in the subgroups of cats with systemic inflammatory response syndrome or sepsis. Conclusions and relevance In this population of cats, the administration of HES did not result in a significantly greater increase in creatinine from values measured on admission or higher mortality compared with administration of crystalloids. Further prospective studies are needed to assess both safety and efficacy of HES in cats before recommendations can be made.

Systemic complications of fluid resuscitation.

PubMed

Weinstein, P D; Doerfler, M E

1992-04-01

Fluid administration in critically ill individuals is frequently a major component of their therapy. There are important effects on blood pressure and maintenance of cardiac output and oxygen delivery, as detailed elsewhere in this text. There are also potentially negative side effects of this therapy, which have been less well defined. Edema of the gastrointestinal tract has been well described, primarily with crystalloid infusions. Gastrointestinal edema may have very complicated effects on albumin kinetics, fluid flux, and ion flux. It may lead to development of ileus. Increased nasogastric tube output may be incorrectly construed as unremitting obstruction rather than a result of the aforementioned changes and increased crystalloid loads. The relationships of intestinal edema to intestinal absorptive function and diarrhea are less clear. At present, changes in type of fluid infusion or correction of serum albumin level to normal cannot be uniformly recommended. The myocardium, although showing evidence of edema with crystalloid infusion, may appear to benefit from colloidal, osmotically active suspensions in the all too few studies that have been done. To date, there is no study giving evidence of clinically different outcome using a variety of fluids that cause, reduce, or prevent this edema. The presence or absence of myocardial edema may be important in patients who demonstrate decreased ventricular function during sepsis or other disorders in which aggressive fluid administration is routine. Edema of the skin has been associated primarily with decreased oxygen tension. Other studies have shown an association with impaired wound healing or increased risk of infection. A direct causal relationship can only be inferred. We are left with a sense that aggressive fluid resuscitation with crystalloid, although improving oxygen delivery, may have other deleterious effects on organ systems, such as the gastrointestinal tract, myocardium, and integument. The edema resulting from crystalloid administration may lessen or negate the benefits of increased oxygen delivery. Care needs to be taken in interpreting any alteration in organ function with respect to the fluid type and volume being administered. An alternative choice of therapy is lacking at present. The role of colloid has not been as well investigated as that of crystalloid and further study is warranted before any benefits become clear.

Fluid Therapy Management in Hospitalized Patients: Results From a Cross-sectional Study.

PubMed

Brugnolli, Anna; Canzan, Federica; Bevilacqua, Anita; Marognolli, Oliva; Verlato, Giuseppe; Vincenzi, Silvia; Ambrosi, Elisa

2017-02-01

Intravenous (IV) fluid therapy is widely used in hospitalized patients. It has been internationally studied in surgical patients, but little attention to date has been dedicated to medical patients within the Italian context. The aims of the present study were to describe the prevalence of fluid therapy and associated factors among Italian patients admitted to medical and surgical units, describe the methods used to manage fluid therapy, and analyze the monitoring of patients by clinical staff. In this cross-sectional study of 7 hospitals in northern Italy, data on individual and monitoring variables were collected, and their associations with in-hospital fluid therapy were analyzed by using logistic regression analysis. Patients aged ≥18 years who were admitted to medical and surgical units were included. Patients who received at least 500 mL of continuous fluids were included in the fluid therapy group. In total, 785 (median age, 72 years; women, 52%) patients were included in the study, and 293 (37.3%) received fluid therapy. Maintenance was the most frequent reason for prescribing IV fluid therapy (59%). The mean (SD) volume delivered was 1177 (624) mL/d, and the highest volume was infused for replacement therapy (1660 [931] mL/d). The mean volume infused was 19.55 (13) mL/kg/d. The most commonly used fluid solutions were 0.9% sodium chloride (65.7%) and balanced crystalloid without glucose (32.9%). The proportion of patients assessed for urine output (52.6% vs 36.8%; P < 0.001), serum electrolyte concentrations (74.4% vs 65.0%; P = 0.005), and renal function (70.0% vs 58.7%; P = 0.002) was significantly higher in patients who did receive fluid therapy versus those who did not. In contrast, the use of weight and fluid assessments was not significantly different between the 2 groups (P = 0.216 and 0.256, respectively). Patients admitted for gastrointestinal disorders (odds ratio [OR], 3.5 [95% CI, 1.8-7.05) and for fluid/electrolyte imbalances (OR, 3.35 [95% CI, 1.06-10.52) were more likely to receive fluids. However, the likelihood of receiving fluids was lower for patients admitted to a surgical unit (OR, 0.36 [95% CI, 0.22-0.59]) and with cardiovascular diseases (OR, 0.37 [95% CI, 0.17-0.79). Only one third of the study patients received fluid therapy. Crystalloid fluids, are the fluids of choice for maintaining plasma volume. During fluid therapy, measurement of the serum electrolyte concentrations, renal function, and urine output was largely used while weight and fluid balance were rarely assessed. Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved.

Trypanosoma cruzi Epimastigotes Are Able to Store and Mobilize High Amounts of Cholesterol in Reservosome Lipid Inclusions

PubMed Central

Pereira, Miria G.; Nakayasu, Ernesto S.; Sant'Anna, Celso; De Cicco, Nuccia N. T.; Atella, Georgia C.; de Souza, Wanderley; Almeida, Igor C.; Cunha-e-Silva, Narcisa

2011-01-01

Background Reservosomes are lysosome-related organelles found in Trypanosoma cruzi epimastigotes. They represent the last step in epimastigote endocytic route, accumulating a set of proteins and enzymes related to protein digestion and lipid metabolism. The reservosome matrix contains planar membranes, vesicles and lipid inclusions. Some of the latter may assume rectangular or sword-shaped crystalloid forms surrounded by a phospholipid monolayer, resembling the cholesterol crystals in foam cells. Methodology/Principal Findings Using Nile Red fluorimetry and fluorescence microscopy, as well as electron microscopy, we have established a direct correlation between serum concentration in culture medium and the presence of crystalloid lipid inclusions. Starting from a reservosome purified fraction, we have developed a fractionation protocol to isolate lipid inclusions. Gas-chromatography mass-spectrometry (GC-MS) analysis revealed that lipid inclusions are composed mainly by cholesterol and cholesterol esters. Moreover, when the parasites with crystalloid lipid-loaded reservosomes were maintained in serum free medium for 48 hours the inclusions disappeared almost completely, including the sword shaped ones. Conclusions/Significance Taken together, our results suggest that epimastigote forms of T. cruzi store high amounts of neutral lipids from extracellular medium, mostly cholesterol or cholesterol esters inside reservosomes. Interestingly, the parasites are able to disassemble the reservosome cholesterol crystalloid inclusions when submitted to serum starvation. PMID:21818313

Parenteral fluid regimens for improving functional outcome in people with acute stroke.

PubMed

Visvanathan, Akila; Dennis, Martin; Whiteley, William

2015-09-01

Parenteral fluids are commonly used in people with acute stroke with poor oral fluid intake. However, the balance between benefit and harm for different fluid regimens is unclear. To assess whether different parenteral fluid regimens lead to differences in death, or death or dependence, after stroke based on fluid type, fluid volume, duration of fluid administration, and mode of delivery. We searched the Cochrane Stroke Group Trials Register (May 2015), the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR) and the Database of Abstracts of Reviews of Effects (DARE) (Cochrane Library 2015, Issue 5), MEDLINE (2008 to May 2015), EMBASE (2008 to May 2015), and CINAHL (1982 to May 2015). We also searched ongoing trials registers (May 2015) and reference lists, performed cited reference searches, and contacted authors. Randomised trials of parenteral fluid regimens in adults with ischaemic or haemorrhagic stroke within seven days of stroke onset that reported death or dependence. One review author screened titles and abstracts. We obtained the full-text articles of relevant studies, and two review authors independently selected trials for inclusion and extracted data. We used Cochrane's tool for bias assessment. We included 12 studies (2351 participants: range 27 to 841).Characteristics: The 12 included studies compared hypertonic (colloids) with isotonic fluids (crystalloids); of these, five studies (1420 participants) also compared 0.9% saline with another fluid. No data were available to make other comparisons. Delay from stroke to recruitment varied from less than 24 hours to 72 hours. Duration of fluid delivery was between two hours and 10 days.Bias assessment: Investigators and participants in eight of the 12 included studies were blind to treatment allocation, seven of the 12 included studies gave details of randomisation, and eight of the 12 included studies reported all outcomes measured. There were no relevant completed trials that addressed the effect of volume, duration, or mode of fluid delivery on death or dependence in people with stroke.The odds of death or dependence were similar in participants allocated to colloids or crystalloid fluid regimens (odds ratio (OR) 0.97, 95% confidence interval (CI) 0.79 to 1.21, five studies, I² = 58%, low-quality evidence), and between 0.9% saline or other fluid regimens (OR 1.04, 95% CI 0.82 to 1.32, three studies, I² = 71%, low-quality evidence). There was substantial heterogeneity in these estimates.The odds of death were similar between colloids and crystalloids (OR 1.02, 95% CI 0.82 to 1.27, 12 studies, I² = 24%, moderate-quality evidence), and 0.9% saline and other fluids (OR 0.87, 95% CI 0.67 to 1.12, five studies, I² = 53%, low-quality evidence). The odds of pulmonary oedema were higher in participants allocated to colloids (OR 2.34, 95% CI 1.28 to 4.29, I² = 0%). Although the studies observed a higher risk of cerebral oedema (OR 0.20, 95% CI 0.02 to 1.74) and pneumonia (OR 0.58, 95% CI 0.17 to 2.01) with crystalloids, we could not exclude clinically important benefits or harms. We found no evidence that colloids were associated with lower odds of death or dependence in the medium term after stroke compared with crystalloids, though colloids were associated with greater odds of pulmonary oedema. We found no evidence to guide the best volume, duration, or mode of parenteral fluid delivery for people with acute stroke.

Albumin versus crystalloid solutions in patients with the acute respiratory distress syndrome: a systematic review and meta-analysis

PubMed Central

2014-01-01

Introduction In patients with acute respiratory distress syndrome (ARDS) fluid therapy might be necessary. The aim of this systematic review and meta-analysis is to determine the effects of colloid therapy compared to crystalloids on mortality and oxygenation in adults with ARDS. Methods Randomized controlled trials (RCTs) were identified through a systematic literature search of MEDLINE, EMBASE, CENTRAL and LILACS. Articles published up to 15th February 2013 were independently screened, abstracted, and assessed (Cochrane Risk of Bias Tool) to provide evidence-based therapy recommendations. RCTs were eligible if they compared colloid versus crystalloid therapy on lung function, inflammation, damage or mortality in adults with ARDS. Primary outcome parameters were respiratory mechanics, gas exchange lung inflammation and damage as well as hospital mortality. Kidney function, need for renal replacement therapy, hemodynamic stabilization and intensive care unit (ICU) length of stay served as secondary outcomes. Results A total of 3 RCTs out of 4130 potential trials found in the databases were selected for qualitative and quantitative analysis totaling 206 patients who received either albumin or saline. Overall risk of bias was unclear to high in the identified trials. Calculated pooled risk of death was not statistically significant (albumin 34 of 100 (34.0%) versus 40 of 104 (38.5%), relative risk (RR) = 0.89, 95% confidence interval (CI) 0.62 to 1.28, P = 0.539). Weighted mean difference (WMD) in PaO2/FiO2 (mmHg) improved in the first 48 hours (WMD = 62, 95% CI 47 to 77, P <0.001, I2 = 0%) after therapy start and remained stable after 7 days (WMD = 20, 95% CI 4 to 36, P = 0.017, I2 = 0%). Conclusions There is a high need for RCTs investigating the effects of colloids in ARDS patients. Based on the findings of this review, colloid therapy with albumin improved oxygenation but did not affect mortality. PMID:24405693

A novel combination technique of cold crystalloid perfusion but not cold storage facilitates transplantation of canine hearts donated after circulatory death.

PubMed

Rosenfeldt, Franklin; Ou, Ruchong; Salamonsen, Robert; Marasco, Silvana; Zimmet, Adam; Byrne, Joshua; Cosic, Filip; Saxena, Pankaj; Esmore, Donald

2016-11-01

Donation after circulatory death (DCD) represents a potential new source of hearts to increase the donor pool. We showed previously that DCD hearts in Greyhound dogs could be resuscitated and preserved by continuous cold crystalloid perfusion but not by cold static storage and could demonstrate excellent contractile and metabolic function on an in vitro system. In the current study, we demonstrate that resuscitated DCD hearts are transplantable. Donor Greyhound dogs (n = 12) were divided into perfusion (n = 8) and cold static storage (n = 4) groups. General anesthesia was induced and ventilation ceased for 30 minutes to achieve circulatory death. Donor cardiectomy was performed, and for 4 hours the heart was preserved by controlled reperfusion, followed by continuous cold perfusion with an oxygenated crystalloid perfusate or by static cold storage, after which orthotopic heart transplantation was performed. Recovery was assessed over 4 hours by hemodynamic monitoring. During cold perfusion, hearts showed continuous oxygen consumption and low lactate levels, indicating aerobic metabolism. The 8 dogs in the perfusion group were weaned off bypass, and 4 hours after bypass produced cardiac output of 4.73 ± 0.51 liters/min, left ventricular power of 7.63 ± 1.32 J/s, right ventricular power of 1.40 ± 0.43 J/s, and left ventricular fractional area shortening of 39.1% ± 5.2%, all comparable to pre-transplant values. In the cold storage group, 3 of 4 animals could not be weaned from cardiopulmonary bypass, and the fourth exhibited low-level function. Cold crystalloid perfusion, but not cold static storage, can resuscitate and preserve the DCD donor heart in a canine model of heart transplantation, thus rendering it transplantable. Controlled reperfusion and cold crystalloid perfusion have potential for clinical application in DCD transplantation. Copyright © 2016. Published by Elsevier Inc.

Multicenter study of crystalloid boluses and transfusion in pediatric trauma-When to go to blood?

PubMed

Polites, Stephanie F; Nygaard, Rachel M; Reddy, Pooja N; Zielinski, Martin D; Richardson, Chad J; Elsbernd, Terri A; Petrun, Branden M; Weinberg, Sean L; Murphy, Sherrie; Potter, Donald D; Klinkner, Denise B; Moir, Christopher R

2018-07-01

The 9th edition of Advanced Trauma Life Support recommends up to three crystalloid boluses in pediatric trauma patients with consideration of transfusion after the second bolus; however, this approach is debated. We aimed to determine if requirement of more than one fluid bolus predicts the need for transfusion. The 2010 to 2016 highest tier activation patients younger than 15 years from two ACS Level I pediatric trauma centers were identified from prospectively maintained trauma databases. Those with a shock index (heart rate/systolic blood pressure) greater than 0.9 were included. Crystalloid boluses (20 ± 10 mL/kg) and transfusions administered prehospital and within 12 hours of hospital arrival were determined. Univariate and multivariable analyses were conducted to determine association between crystalloid volume and transfusion. Among 208 patients, the mean age was 5 ± 4 years (60% male), 91% sustained blunt injuries, and median (interquartile range) Injury Severity Score was 11 (6,25). Twenty-nine percent received one bolus, 17% received two, and 10% received at least three. Transfusion of any blood product occurred in 50 (24%) patients; mean (range) red blood cells was 23 (0-89) mL/kg, plasma 8 (0-69), and platelets 1 (0-18). The likelihood of transfusion increased logarithmically from 11% to 43% for those requiring 2 or more boluses (Fig. 1). This relationship persisted on multivariable analysis that adjusted for institution, age, and shock index with good discrimination (Area under the Receiver Operating Characteristic, 0.84). Shock index was also strongly associated with transfusion. Almost half of pediatric trauma patients with elevated shock index require transfusion following two crystalloid boluses and the odds of requiring a transfusion plateau at this point in resuscitation. This supports consideration of blood with the second bolus in conjunction with shock index though prospective studies are needed to confirm this and its impact on outcomes. Therapeutic study, level IV.

Peripheral Venous Waveform Analysis for Detecting Hemorrhage and Iatrogenic Volume Overload in a Porcine Model.

PubMed

Hocking, Kyle M; Sileshi, Ban; Baudenbacher, Franz J; Boyer, Richard B; Kohorst, Kelly L; Brophy, Colleen M; Eagle, Susan S

2016-10-01

Unrecognized hemorrhage and unguided resuscitation is associated with increased perioperative morbidity and mortality. The authors investigated peripheral venous waveform analysis (PIVA) as a method for quantitating hemorrhage as well as iatrogenic fluid overload during resuscitation. The authors conducted a prospective study on Yorkshire Pigs (n = 8) undergoing hemorrhage, autologous blood return, and administration of balanced crystalloid solution beyond euvolemia. Intra-arterial blood pressure, electrocardiogram, and pulse oximetry were applied to each subject. Peripheral venous pressure was measured continuously through an upper extremity standard peripheral IV catheter and analyzed with LabChart. The primary outcome was comparison of change in the first fundamental frequency (f1) of PIVA with standard and invasive monitoring and shock index (SI). Hemorrhage, return to euvolemia, and iatrogenic fluid overload resulted in significantly non-zero slopes of f1 amplitude. There were no significant differences in heart rate or mean arterial pressure, and a late change in SI. For the detection of hypovolemia the PIVA f1 amplitude change generated an receiver operator curves (ROC) curve with an area under the curve (AUC) of 0.93; heart rate AUC = 0.61; mean arterial pressure AUC = 0.48, and SI AUC = 0.72. For hypervolemia the f1 amplitude generated an ROC curve with an AUC of 0.85, heart rate AUC = 0.62, mean arterial pressure AUC = 0.63, and SI AUC = 0.65. In this study, PIVA demonstrated a greater sensitivity for detecting acute hemorrhage, return to euvolemia, and iatrogenic fluid overload compared with standard monitoring and SI. PIVA may provide a low-cost, minimally invasive monitoring solution for monitoring and resuscitating patients with perioperative hemorrhage.

A second-generation blood substitute (perfluorodichlorooctane emulsion) does not activate complement during an ex vivo circulation model of bypass.

PubMed

Rosoff, J D; Soltow, L O; Vocelka, C R; Schmer, G; Chandler, W L; Cochran, R P; Kunzelman, K S; Spiess, B D

1998-08-01

To examine whether a second-generation perfluorocarbon (PFC) blood substitute added to the cardiopulmonary bypass (CPB) prime influences complement production. A prospective, randomized, single-blinded, ex vivo model. A university hospital, laboratory, and clinics. Ten healthy adult consented volunteer blood donors (five men, five women). Ex vivo closed-loop extracorporeal circuit including membrane oxygenator, tubing, and filter primed with crystalloid or crystalloid plus PFC was circulated for 1 hour with the addition of 500 mL of heparinized fresh human whole blood. Laboratory specimens were drawn from the circuit at 10-minute intervals for 1 hour and measured for complement (C3a, Bb fragment) concentrations, blood gases, fibrinogen concentration, platelet count, and hematocrit. In the PFC group, C3a and Bb fragments were equal to or less than those in the group that received crystalloid alone. The second-generation PFC added to the prime of a CPB circuit does not independently increase complement production.

Freeze-dried plasma at the point of injury: from concept to doctrine.

PubMed

Glassberg, Elon; Nadler, Roy; Gendler, Sami; Abramovich, Amir; Spinella, Philip C; Gerhardt, Robert T; Holcomb, John B; Kreiss, Yitshak

2013-12-01

While early plasma transfusion for the treatment of patients with ongoing major hemorrhage is widely accepted as part of the standard of care in the hospital setting, logistic constraints have limited its use in the out-of-hospital setting. Freeze-dried plasma (FDP), which can be stored at ambient temperatures, enables early treatment in the out-of-hospital setting. Point-of-injury plasma transfusion entails several significant advantages over currently used resuscitation fluids, including the avoidance of dilutional coagulopathy, by minimizing the need for crystalloid infusion, beneficial effects on endothelial function, physiological pH level, and better maintenance of intravascular volume compared with crystalloid-based solutions. The Israel Defense Forces Medical Corps policy is that plasma is the resuscitation fluid of choice for selected, severely wounded patients and has thus included FDP as part of its armamentarium for use at the point of injury by advanced life savers, across the entire military. We describe the clinical rationale behind the use of FDP at the point-of-injury, the drafting of the administration protocol now being used by Israel Defense Forces advanced life support providers, the process of procurement and distribution, and preliminary data describing the first casualties treated with FDP at the point of injury. It is our hope that others will be able to learn from our experience, thus improving trauma casualty care around the world.

The Plasma-Lyte 148 v Saline (PLUS) study protocol: a multicentre, randomised controlled trial of the effect of intensive care fluid therapy on mortality.

PubMed

Hammond, Naomi E; Bellomo, Rinaldo; Gallagher, Martin; Gattas, David; Glass, Parisa; Mackle, Diane; Micallef, Sharon; Myburgh, John; Saxena, Manoj; Taylor, Colman; Young, Paul; Finfer, Simon

2017-09-01

0.9% sodium chloride (saline) is the most commonly administered resuscitation fluid on a global basis but emerging evidence suggests that its high chloride content may have important adverse effects. To describe the study protocol for the Plasma- Lyte 148 v Saline study, which will test the hypothesis that in critically ill adult patients the use of Plasma-Lyte 148 (a buffered crystalloid solution) for fluid therapy results in different 90-day all-cause mortality when compared with saline. We will conduct this multicentre, blinded, randomised controlled trial in approximately 50 intensive care units in Australia and New Zealand. We will randomly assign 8800 patients to either Plasma-Lyte 148 or saline for all resuscitation fluid, maintenance fluid and compatible drug dilution therapy while in the ICU for up to 90 days after randomisation. The primary outcome is 90-day all-cause mortality; secondary outcomes include mean and peak creatinine concentration, incidence of renal replacement therapy, incidence and duration of vasoactive drug treatment, duration of mechanical ventilation, ICU and hospital length of stay, and quality of life and health services use at 6 months. The PLUS study will provide high-quality data on the comparative safety and efficacy of Plasma-Lyte 148 compared with saline for resuscitation and compatible crystalloid fluid therapy in critically ill adult patients.

Crystalloids versus colloids for goal-directed fluid therapy in major surgery

PubMed Central

Hiltebrand, Luzius B; Kimberger, Oliver; Arnberger, Michael; Brandt, Sebastian; Kurz, Andrea; Sigurdsson, Gisli H

2009-01-01

Introduction Perioperative hypovolemia arises frequently and contributes to intestinal hypoperfusion and subsequent postoperative complications. Goal-directed fluid therapy might reduce these complications. The aim of this study was to compare the effects of goal-directed administration of crystalloids and colloids on the distribution of systemic, hepatosplanchnic, and microcirculatory (small intestine) blood flow after major abdominal surgery in a clinically relevant pig model. Methods Twenty-seven pigs were anesthetized and mechanically ventilated and underwent open laparotomy. They were randomly assigned to one of three treatment groups: the restricted Ringer lactate (R-RL) group (n = 9) received 3 mL/kg per hour of RL, the goal-directed RL (GD-RL) group (n = 9) received 3 mL/kg per hour of RL and intermittent boluses of 250 mL of RL, and the goal-directed colloid (GD-C) group (n = 9) received 3 mL/kg per hour of RL and boluses of 250 mL of 6% hydroxyethyl starch (130/0.4). The latter two groups received a bolus infusion when mixed venous oxygen saturation was below 60% ('lockout' time of 30 minutes). Regional blood flow was measured in the superior mesenteric artery and the celiac trunk. In the small bowel, microcirculatory blood flow was measured using laser Doppler flowmetry. Intestinal tissue oxygen tension was measured with intramural Clark-type electrodes. Results After 4 hours of treatment, arterial blood pressure, cardiac output, mesenteric artery flow, and mixed oxygen saturation were significantly higher in the GD-C and GD-RL groups than in the R-RL group. Microcirculatory flow in the intestinal mucosa increased by 50% in the GD-C group but remained unchanged in the other two groups. Likewise, tissue oxygen tension in the intestine increased by 30% in the GD-C group but remained unchanged in the GD-RL group and decreased by 18% in the R-RL group. Mesenteric venous glucose concentrations were higher and lactate levels were lower in the GD-C group compared with the two crystalloid groups. Conclusions Goal-directed colloid administration markedly increased microcirculatory blood flow in the small intestine and intestinal tissue oxygen tension after abdominal surgery. In contrast, goal-directed crystalloid and restricted crystalloid administrations had no such effects. Additionally, mesenteric venous glucose and lactate concentrations suggest that intestinal cellular substrate levels were higher in the colloid-treated than in the crystalloid-treated animals. These results support the notion that perioperative goal-directed therapy with colloids might be beneficial during major abdominal surgery. PMID:19302713

Patterns of intravenous fluid resuscitation use in adult intensive care patients between 2007 and 2014: An international cross-sectional study

PubMed Central

Hammond, Naomi E.; Taylor, Colman; An, YouZhong; Cavalcanti, Alexandre Biasi; Du, Bin; McIntryre, Lauralyn; Saxena, Manoj; Schortgen, Frédérique; Watts, Nicola R.; Myburgh, John

2017-01-01

Background In 2007, the Saline versus Albumin Fluid Evaluation—Translation of Research Into Practice Study (SAFE-TRIPS) reported that 0.9% sodium chloride (saline) and hydroxyethyl starch (HES) were the most commonly used resuscitation fluids in intensive care unit (ICU) patients. Evidence has emerged since 2007 that these fluids are associated with adverse patient-centred outcomes. Based on the published evidence since 2007, we sought to determine the current type of fluid resuscitation used in clinical practice and the predictors of fluid choice and determine whether these have changed between 2007 and 2014. Methods In 2014, an international, cross-sectional study was conducted (Fluid-TRIPS) to document current patterns of intravenous resuscitation fluid use and determine factors associated with fluid choice. We examined univariate and multivariate associations between patients and prescriber characteristics, geographical region and fluid type. Additionally, we report secular trends of resuscitation fluid use in a cohort of ICUs that participated in both the 2007 and 2014 studies. Regression analysis were conducted to determine changes in the administration of crystalloid or colloid between 2007 and 2014. Findings In 2014, a total of 426 ICUs in 27 countries participated. Over the 24 hour study day, 1456/6707 (21.7%) patients received resuscitation fluid during 2716 resuscitation episodes. Crystalloids were administered to 1227/1456 (84.3%) patients during 2208/2716 (81.3%) episodes and colloids to 394/1456 (27.1%) patients during 581/2716 (21.4%) episodes. In multivariate analyses, practice significantly varied between geographical regions. Additionally, patients with a traumatic brain injury were less likely to receive colloid when compared to patients with no trauma (adjusted OR 0.24; 95% CI 0.1 to 0.62; p = 0.003). Patients in the ICU for one or more days where more likely to receive colloid compared to patients in the ICU on their admission date (adjusted OR 1.75; 95% CI 1.27 to 2.41; p = <0.001). For secular trends in fluid resuscitation, 84 ICUs in 17 countries contributed data. In 2007, 527/1663 (31.7%) patients received fluid resuscitation during 1167 episodes compared to 491/1763 (27.9%) patients during 960 episodes in 2014. The use of crystalloids increased from 498/1167 (42.7%) in 2007 to 694/960 (72.3%) in 2014 (odds ratio (OR) 3.75, 95% confidence interval (CI) 2.95 to 4.77; p = <0.001), primarily due to a significant increase in the use of buffered salt solutions. The use of colloids decreased from 724/1167 (62.0%) in 2007 to 297/960 (30.9%) in 2014 (OR 0.29, 95% CI 0.19 to 0.43; p = <0.001), primarily due to a decrease in the use of HES, but an overall increase in the use of albumin. Conclusions Clinical practices of intravenous fluid resuscitation have changed between 2007 and 2014. Geographical location remains a strong predictor of the type of fluid administered for fluid resuscitation. Overall, there is a preferential use of crystalloids, specifically buffered salt solutions, over colloids. There is now an imperative to conduct a trial determining the safety and efficacy of these fluids on patient-centred outcomes. Trial registration Clinicaltrials.gov: Fluid-Translation of research into practice study (Fluid-TRIPS) NCT02002013 PMID:28498856

[Prophylaxis and treatment of arterial hypotension during caesarean with spinal anaesthesia].

PubMed

Arias, J; Lacassie, H J

2013-11-01

Caesarean section is one of the most common surgical procedures worldwide. Arterial hypotension is the most prevalent adverse effect after spinal anaesthesia. Various methods have been used to prevent or treat hypotension. Since there is no treatment 100% effective by itself, a multimodal management is required to achieve an optimum balance and avoidance of hemodynamic imbalance. Strategies to avoid this side effect are analyzed on the basis of the best evidence available so far, summarized as mechanical factors, anesthetics, fluids and vasopressors. After spinal anaesthesia for caesarean section, the best strategy available for prevention of hypotension appears to be the combination of crystalloids along with an alpha 1 agonist vasopressor. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

Management of prolonged post-operative ileus: evidence-based recommendations.

PubMed

Vather, Ryash; Bissett, Ian

2013-05-01

Prolonged post-operative ileus (PPOI) occurs in up to 25% of patients following major elective abdominal surgery. It is associated with a higher risk of developing post-operative complications, prolongs hospital stay and confers a significant financial load on health-care institutions. Literature outlining best-practice management strategies for PPOI is nebulous. The aim of this text was to review the literature and provide concise evidence-based recommendations for its management. A literature search through the Ovid MEDLINE, EMBASE, Google Scholar and Cochrane databases was performed from inception to July 2012 using a combination of keywords and MeSH terms. Review of the literature was followed by synthesis of concise recommendations for management accompanied by Strength of Recommendation Taxonomy (either A, B or C). Recommendations for management include regular evaluation and correction of electrolytes (B); review of analgesic prescription with weaning of narcotics and substitution with regular paracetamol, regular non-steroidal anti-inflammatory drugs if not contraindicated, and regular or as-required Tramadol (A); nasogastric decompression for those with nausea or vomiting as prominent features (C); isotonic dextrose-saline crystalloid maintenance fluids administered within a restrictive regimen (B); balanced isotonic crystalloid replacement fluids containing supplemental potassium, in equivalent volume to losses (C); regular ambulation (C); parenteral nutrition if unable to tolerate an adequate oral intake for more than 7 days post-operatively (A) and exclusion of precipitating pathology or alternate diagnoses if clinically suspected (C). Recommendations have a variable and frequently inconsistent evidence base. Further research is required to validate many of the outlined recommendations and to investigate novel interventions that may be used to shorten duration of PPOI. © 2013 The Authors. ANZ Journal of Surgery © 2013 Royal Australasian College of Surgeons.

Analysis of Variability in Intraoperative Fluid Administration for Colorectal Surgery: An Argument for Goal-Directed Fluid Therapy.

PubMed

Quinn, Timothy D; Brovman, Ethan Y; Urman, Richard D

2017-09-01

Fluid therapy in the perioperative period varies greatly between anesthesia providers and may have a negative impact on surgical outcomes. We conducted a retrospective analysis of 705 elective colorectal cases consisting of colectomies, ileocolic resections, and low anterior resections at an academic institution from January 1, 2010 to May 29, 2015, collected by our electronic medical record before implementation of Enhanced Recovery After Surgery (ERAS ® ) pathways. The mean for total crystalloid administration was 2578 mL with a standard deviation (SD) that was approximately 50% of the mean value. A combination of both normal saline and lactated Ringer's solution was used in almost all cases without a clear rationale for fluid choice. Fluid administered to patients was disproportional to measured intraoperative fluid losses (estimated blood loss and urine output) by a factor of 10. The average rate of fluid given was 1050 mL/h with an SD of nearly the same amount (951 mL). There was a variability of over 67% in total crystalloid administered based on both ideal body weight and total body weight. We found that a wide variability in the amount and type of fluid therapy administered existed at our institution before implementation of a colorectal ERAS pathway or routine use of goal-directed fluid therapy (GDFT). ERAS pathways with GDFT protocols could lead to more rational and consistent fluid therapy leading to improved outcomes.

Comparison of fluid types for resuscitation after acute blood loss in mallard ducks (Anas platyrhynchos).

PubMed

Lichtenberger, Marla; Orcutt, Connie; Cray, Carolyn; Thamm, Douglas H; DeBehnke, Daniel; Page, Cheryl; Mull, Lori; Kirby, Rebecca

2009-10-01

The purpose of this study was to determine the LD(50) for acute blood loss in mallard ducks (Anas platyrhynchos), compare the mortality rate among 3 fluid resuscitation groups, and determine the time required for a regenerative RBC response. Prospective study. Medical College of Wisconsin Research facility. Eighteen mallard ducks were included for the LD(50) study and 28 for the fluid resuscitation study. Phlebotomy was performed during both the LD(50) and fluid resuscitation studies. Ducks in the fluid resuscitation study received a 5 mL/kg intravenous bolus of crystalloids, hetastarch (HES), or a hemoglobin-based oxygen-carrying solution (HBOCS). The LD(50) for acute blood loss was 60% of total blood volume. This blood volume was removed in the fluid resuscitation study to create a model of acute blood loss. Following fluid administration, 6 birds in the crystalloid group (66%), 4 birds in the HES group (40%), and 2 birds in the HBOCS group (20%) died. No statistical difference in mortality rate was seen among the 3 fluid resuscitation groups. Relative polychromasia evaluated post-phlebotomy demonstrated regeneration starting at 24 hours and continuing through 48 hours. The LD(50) for acute blood loss in mallard ducks was 60% of their total blood volume. Although no statistical difference in mortality rate was appreciated among the 3 fluid resuscitation groups, a trend of decreased mortality rate was observed in the HBOCS group. An early regenerative response was apparent following acute blood loss.

Association between intravenous chloride load during resuscitation and in-hospital mortality among patients with SIRS.

PubMed

Shaw, Andrew D; Raghunathan, Karthik; Peyerl, Fred W; Munson, Sibyl H; Paluszkiewicz, Scott M; Schermer, Carol R

2014-12-01

Recent data suggest that both elevated serum chloride levels and volume overload may be harmful during fluid resuscitation. The purpose of this study was to examine the relationship between the intravenous chloride load and in-hospital mortality among patients with systemic inflammatory response syndrome (SIRS), with and without adjustment for the crystalloid volume administered. We conducted a retrospective analysis of 109,836 patients ≥ 18 years old that met criteria for SIRS and received fluid resuscitation with crystalloids. We examined the association between changes in serum chloride concentration, the administered chloride load and fluid volume, and the 'volume-adjusted chloride load' and in-hospital mortality. In general, increases in the serum chloride concentration were associated with increased mortality. Mortality was lowest (3.7%) among patients with minimal increases in serum chloride concentration (0-10 mmol/L) and when the total administered chloride load was low (3.5% among patients receiving 100-200 mmol; P < 0.05 versus patients receiving ≥ 500 mmol). After controlling for crystalloid fluid volume, mortality was lowest (2.6%) when the volume-adjusted chloride load was 105-115 mmol/L. With adjustment for severity of illness, the odds of mortality increased (1.094, 95% CI 1.062, 1.127) with increasing volume-adjusted chloride load (≥ 105 mmol/L). Among patients with SIRS, a fluid resuscitation strategy employing lower chloride loads was associated with lower in-hospital mortality. This association was independent of the total fluid volume administered and remained significant after adjustment for severity of illness, supporting the hypothesis that crystalloids with lower chloride content may be preferable for managing patients with SIRS.

Sequential N-Terminal Pro-B-Type Natriuretic Peptide and High-Sensitivity Cardiac Troponin Measurements During Albumin Replacement in Patients With Severe Sepsis or Septic Shock.

PubMed

Masson, Serge; Caironi, Pietro; Fanizza, Caterina; Carrer, Sara; Caricato, Anselmo; Fassini, Paola; Vago, Tarcisio; Romero, Marilena; Tognoni, Gianni; Gattinoni, Luciano; Latini, Roberto

2016-04-01

Myocardial dysfunction is a frequent complication in patients with severe sepsis and can worsen the prognosis. We investigated whether circulating biomarkers related to myocardial function and injury predicted outcome and were associated with albumin replacement. A multicenter, randomized clinical trial about albumin replacement in severe sepsis or septic shock (the Albumin Italian Outcome Sepsis trial). Forty ICUs in Italy. Nine hundred and ninety-five patients with severe sepsis or septic shock. Randomization to albumin and crystalloid solutions or crystalloid solutions alone. Plasma concentrations of N- terminal pro-B-type natriuretic peptide and high-sensitivity cardiac troponin T were measured 1, 2, and 7 days after enrollment. We tested the relationship of single marker measurements or changes over time with clinical events, organ dysfunctions, albumin replacement, and ICU or 90-day mortality in the overall population and after stratification by shock. N-terminal pro-B-type natriuretic peptide levels were abnormal in 97.4% of the patients and high-sensitivity cardiac troponin T in 84.5%, with higher concentrations in those with shock. After extensive adjustments, N-terminal pro-B-type natriuretic peptide concentrations predicted ICU or 90-day mortality, better than high-sensitivity cardiac troponin T. Early changes in N-terminal pro-B-type natriuretic peptide or high-sensitivity cardiac troponin T concentrations were independently associated with subsequent mortality in patients with shock. Patients given albumin had significantly higher N-terminal pro-B-type natriuretic peptide levels; in addition, early rise in N-terminal pro-B-type natriuretic peptide was associated with a better outcome in this subgroup. Circulating N-terminal pro-B-type natriuretic peptide and high-sensitivity cardiac troponin T are frequently elevated in severe sepsis or septic shock and have relevant prognostic value, which may be important in monitoring the clinical efficacy of supporting therapy.

Cold-induced fluid extravasation during cardiopulmonary bypass in piglets can be counteracted by use of iso-oncotic prime.

PubMed

Farstad, Marit; Kvalheim, Venny Lise; Husby, Paul

2005-08-01

Hypothermic cardiopulmonary bypass is associated with increased fluid extravasation. This study aimed to compare whether iso-oncotic priming solutions, in contrast to crystalloids, could reduce the cold-induced fluid extravasation during cardiopulmonary bypass in piglets. Three groups were studied: the control group (CT group; n = 10), the albumin group (Alb group; n = 7), and the hydroxyethyl starch group (HES group; n = 7). Prime (1000 mL) and supplemental fluid were acetated Ringer solution, 4% albumin, and 6% hydroxyethyl starch, respectively. After 1 hour of normothermic cardiopulmonary bypass, hypothermic cardiopulmonary bypass (cooling to 28 degrees C within 15 minutes) was initiated and continued to 90 minutes. Fluid needs, plasma volume, changes in colloid osmotic pressure in plasma and interstitial fluid, hematocrit levels, and tissue water content were recorded, and protein masses and fluid extravasation rates were calculated. Colloid osmotic pressure in plasma decreased immediately after the start of cardiopulmonary bypass in the CT group but remained stable in the Alb and HES groups. Colloid osmotic pressure in interstitial fluid tended to decrease in the CT group and remained unchanged in the Alb group, whereas a slight increase was observed in the HES group. Immediately after the start of cooling, fluid extravasation rates increased from 0.15 +/- 0.10 to 0.64 +/- 0.12 mL . kg -1 . min -1 in the CT group, whereas no such increase was observed in the Alb and HES groups. The changes in fluid extravasation rates were reflected by corresponding changes in tissue water content. The use of albumin or hydroxyethyl starch as prime to preserve the colloid osmotic pressure during cardiopulmonary bypass causes a reduction in the cold-induced fluid extravasation compared with that seen with crystalloids. Albumin seems more effective than hydroxyethyl starch to limit cold-induced fluid shifts during cardiopulmonary bypass.

Major publications in the critical care pharmacotherapy literature: January-December 2017.

PubMed

Hammond, Drayton A; Baumgartner, Laura; Cooper, Craig; Donahey, Elisabeth; Harris, Serena A; Mercer, Jessica M; Morris, Mandy; Patel, Mona K; Plewa-Rusiecki, Angela M; Poore, Alia A; Szaniawski, Ryan; Horner, Deanna

2018-06-01

To summarize selected meta-analyses and trials related to critical care pharmacotherapy published in 2017. The Critical Care Pharmacotherapy Literature Update (CCPLU) Group screened 32 journals monthly for impactful articles and reviewed 115 during 2017. Two meta-analyses and eight original research trials were reviewed here from those included in the monthly CCPLU. Meta-analyses on early, goal-directed therapy for septic shock and statin therapy for acute respiratory distress syndrome were summarized. Original research trials that were included evaluate thrombolytic therapy in severe stroke, hyperoxia and hypertonic saline in septic shock, intraoperative ketamine for prevention of post-operative delirium, intravenous ketorolac dosing regimens for acute pain, angiotensin II for vasodilatory shock, dabigatran reversal with idarucizumab, bivalirudin versus heparin monotherapy for myocardial infarction, and balanced crystalloids versus saline fluid resuscitation. This clinical review provides perspectives on impactful critical care pharmacotherapy publications in 2017. Copyright © 2018 Elsevier Inc. All rights reserved.

Ultrastructure of the mink parotid gland.

PubMed Central

Tandler, B

1991-01-01

Acini in the parotid gland of the North American mink (Mustela vision) are composed of seromucous cells that contain secretory granules of peculiar morphology. Many of the granules consist of a light matrix in which is embedded an inclusion made up of dense, frequently parallel rodlets in a fibrillar material of moderate density. Like the submandibular gland of the same animal, the tall cells of the parotid striated ducts contain numerous polygonal, often rhomboidal, crystalloids in their apical cytoplasm. These crystalloids are present equally in both sexes and are as abundant in the parotid as in the submandibular gland. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 PMID:1769893

Perioperative intravenous fluid prescribing: a multi-centre audit.

PubMed

Harris, Benjamin; Schopflin, Christian; Khaghani, Clare; Edwards, Mark

2015-01-01

Excessive or inadequate intravenous fluid given in the perioperative period can affect outcomes. A number of guidelines exist but these can conflict with the entrenched practice, evidence base and prescriber knowledge. We conducted a multi-centre audit of intraoperative and postoperative intravenous fluid therapy to investigate fluid administration practice and frequency of postoperative electrolyte disturbances. A retrospective audit was done in five hospitals of adult patients undergoing elective major abdominal, gastrointestinal tract or orthopaedic surgery. The type, volume and quantity of fluid and electrolytes administered during surgery and in 3 days postoperatively was calculated, and electrolyte disturbances were studied using clinical records. Data from four hundred thirty-one patients in five hospitals covering 1157 intravenous fluid days were collected. Balanced crystalloid solutions were almost universally used in the operating theatre and were also the most common fluid administered postoperatively, followed by hypotonic dextrose-saline solutions and 0.9 % sodium chloride. For three common uncomplicated elective operations, the volume of fluid administered intraoperatively demonstrated considerable variability. Over half of the patients received no postoperative fluid on day 1, and even more were commenced on free oral fluids immediately postoperatively or on day 1. Postoperative quantities of sodium exceeded the recommended amounts for maintenance in half of the patients who continued to receive intravenous fluids. Potassium administration in those receiving intravenous fluids was almost universally inadequate. Hypokalaemia and hyponatraemia were the common findings. We documented the current clinical practice and confirmed that early free oral fluids and cessation of any intravenous fluids is common postoperatively in keeping with the aims of enhanced recovery after surgery programmes. Excessive sodium and water and inadequate potassium in those given intravenous fluids postoperatively is common and needs to be investigated. The variation in intraoperative fluid volume administration for three common procedures is considerable and in keeping with other international studies. Future trials of fluid therapy should include the intraoperative and postoperative phases.

Defining Dogma: Quantifying Crystalloid Hemodilution in a Prospective Randomized Control Trial with Blood Donation as a Model for Hemorrhage.

PubMed

Ross, Samuel Wade; Christmas, A Britton; Fischer, Peter E; Holway, Haley; Seymour, Rachel; Huntington, Ciara R; Heniford, B Todd; Sing, Ronald F

2018-06-04

The concept of hemodilution after blood loss and crystalloid infusion is a surgical maxim that remains unproven in humans. We sought to quantify the effect of hemodilution after crystalloid administration in voluntary blood donors as a model for acute hemorrhage. A prospective, randomized control trial was conducted in conjunction with community blood drives. Donors were randomized to receive no IV fluid(noIVF), two liters normal saline(NS), or two liters lactated ringers(LR) after blood donation. Blood samples were taken before donation of 500 mL of blood, immediately after donation, and following IV fluid administration. Hemoglobin(Hgb) was measured at each time point. Hgb between time points were compared between groups using standard statistical tests and the Bonferroni correction for multiple comparisons. Statistical significance was set at p≤0.0167. Of 165 patients consented, 157 patients completed the study. Average pre-donation Hgb was 14.3 g/dL. There was no difference in the mean Hgb levels after blood donation between the three groups(p>0.05). Compared to the control group, there was a significant drop in Hgb in the crystalloid infused groups from the post-donation level to post-resuscitation(13.2 vs 12.1 vs 12.2 g/dL, p<0.0001). A formula was created to predict hemoglobin levels from a given estimated blood loss(EBL) and volume replacement(VR): Hemodilution Hgb=(MeanPre-donation Hgb - hemorrhage Hgb drop - equilibration hemoglobin drop - resuscitation Hgb drop)=MeanPre-donation Hgb - [(EBL/TBV)*l] - [(EBL/TBV)*h] - [(VR/TBV)*r], l = 5.111g/dL = blood loss coefficient, h=6.722 g/dL=equilibration coefficient, r= 2.617g/dL= resuscitation coefficient. This study proves the concept of hemodilution and derived a mathematical relationship between blood loss and resuscitation. This data may help to estimate response of hemoglobin levels to blood loss and fluid resuscitation in clinical practice. Copyright © 2018. Published by Elsevier Inc.

Arterioportal shunting, splanchnic capillary perfusion, and the effects of colloids during capnoperitoneum in neonatal and adolescent pigs.

PubMed

Kuebler, J F; Schukfeh, N; Vieten, G; Osthaus, W A; Huber, D; Dennhard, N; Suempelmann, R; Ure, B M; Metzelder, M L

2018-06-01

Clinical and experimental data indicate that neonates are sensitive to the CO 2 pneumoperitoneum. An impaired splanchnic perfusion during laparoscopy in adults has been reported. We recently confirmed that intravenous colloids improve macrocirculatory function in neonates. We aimed to determine the impact of CO 2 pneumoperitoneum on the perfusion of splanchnic organs in the young including effects of colloid application. Male piglets (n = 25) were divided into four groups: (1) neonatal controls, (2) neonates with crystalloid restitution, (3) neonates with colloidal restitution, and (4) adolescents with crystalloid restitution. Animals were ventilated and subjected to a 3-h, 10 mmHg CO 2 pneumoperitoneum followed by 2 h resuscitation. Hepatic, splanchnic, and arteriovenous shunt perfusion was assessed via central and portal venous catheters. Capillary organ flow was detected by fluorescent microspheres. The rate of bile flow was measured. The neonatal crystalloid group showed a significant decrease in the intestinal capillary perfusion at the end of the recovery period. This was not detectable in the adolescent and colloid group. There was a significant increase in microcirculatory arterioportal shunt flow during the CO 2 pneumoperitoneum in both neonatal groups but not in the sham and adolescent groups (p < 0.05). Hepatic arterial perfusion increased after insufflation in all groups and dropped during capnoperitoneum to levels of about 70% baseline. There was no significant impairment of splanchnic perfusion or bile flow as a result of the pneumoperitoneum in all groups. Capillary perfusion of the abdominal organs was stable during capnoperitoneum and recovery in adolescents and neonates with colloid restitution, but not with crystalloid restitution. Significant arterioportal shunting during capnoperitoneum could affect hepatic microcirculation in neonates. Our data confirm that moderate pressure capnoperitoneum has no major effect on the perfusion of abdominal organs in neonates with adequate substitution.

Review of a fluid resuscitation protocol: "fluid creep" is not due to nursing error.

PubMed

Faraklas, Iris; Cochran, Amalia; Saffle, Jeffrey

2012-01-01

Recent reviews of burn resuscitation have included the suggestion that "fluid creep" may be influenced by practitioner error. Our center uses a nursing-driven resuscitation protocol that permits titration of fluid based on hourly urine output, including the addition of colloid when patients fail to respond appropriately. The purpose of this study was to examine protocol compliance. We reviewed 140 patients (26 children) with burns of ≥20% TBSA who received protocol-directed resuscitation from 2005 to 2010. We compared each patient's actual hourly fluid infusion with that predicted by the protocol. Sixty-seven patients (48%) completed resuscitation using crystalloid alone, whereas 73 patients required colloid supplementation. Groups did not differ in age, gender, weight, or time from injury to admission. Patients requiring colloid had larger median total burns (33.0 vs 23.5% TBSA) and full-thickness burns (15.5 vs 4.5% TBSA) and more inhalation injuries (60.3 vs 28.4%; P < .001) than those who resuscitated with crystalloid alone. Because we included basic maintenance fluids in their regimen, patients had median predicted requirements of 5.4 ml/kg/%TBSA. Crystalloid-only patients required fluid volumes close to Parkland predictions (4.7 ml/kg/%TBSA), whereas patients who received colloid required more fluid than the predicted volume (7.5 ml/kg/%TBSA). However, the hourly difference between the predicted and received fluids was a median of only 1.0% (interquartile range: -6.1 to 11.1%) and did not differ between groups. Pediatric patients had greater calculated differences than adults. Crystalloid patients exhibited higher urine outputs than colloid patients until colloid was started, suggesting that early over-resuscitation did not contribute to fluid creep. Adherence to our protocol for burn shock resuscitation was excellent overall. Fluid creep exhibited by more seriously injured patients was not due to nurses' failure to follow the protocol. This review has illuminated some opportunities for practice improvement, possibly using a computerized decision support system.

Large-Volume Crystalloid Fluid Is Associated with Increased Hyaluronan Shedding and Inflammation in a Canine Hemorrhagic Shock Model.

PubMed

Smart, Lisa; Boyd, C J; Claus, M A; Bosio, E; Hosgood, G; Raisis, A

2018-05-04

Shedding of the endothelial glycocalyx precedes leukocyte activation and adherence in acute inflammation. Rapid administration of crystalloid or colloid fluids for treating hemorrhagic shock may cause endothelial glycocalyx shedding, thereby increasing inflammation. This study aimed to compare the effect of different fluid treatments in a canine shock model on glycocalyx biomarker, hyaluronan, and inflammatory biomarkers. Greyhound dogs under general anesthesia subject to hemorrhage for 60 min were given 20 mL kg -1 of either fresh whole blood (FWB), hydroxyethyl starch (HES) 130/0.4, 4% succinylated gelatin (GELO), or 80 mL kg -1 of isotonic crystalloid (CRYST) over 20 min (n = 6 per group). Plasma biomarkers hyaluronan, interleukin (IL) 6, 8, 10, tumor necrosis factor-α, monocyte chemoattractant protein-1, keratinocyte chemokine-like, and atrial natriuretic peptide were measured at baseline, end of hemorrhage (Shock), end of fluid administration (T20), and then 40 (T60), 100 (T120), and 160 (T180) minutes later. Biomarker concentrations were compared between groups using the Kruskal-Wallis test or Fisher's exact test (measurable versus unmeasurable) (significance set at P < 0.05). Hyaluronan concentration peaked early in the CRYST group at T20, compared to HES (P = 0.005) and GELO (P = 0.018), and later in the GELO group at T60, compared to FWB (P < 0.001). The CRYST group had significantly more samples with measurable IL6 at T180 (P = 0.015), compared to GELO, and IL10 at T60, T120, and T180 (all P = 0.015), compared to FWB. There were no significant differences in other biomarker concentrations. In conclusion, rapid large-volume crystalloid administered for hemorrhagic shock was associated with increased hyaluronan and a greater inflammatory response.

The crystalloid cardioplegia: advantages with a word of caution.

PubMed

Angeli, E

2011-05-01

Technical success and absence of iatrogenic injury from inadequate myocardial protection are the foremost targets of every cardiac surgical procedure. The current trends of pediatric cardiac surgery are aimed to achieve definitive repair of complex cardiac defects at birth as to avoid the risks related with palliative surgery and to reduce the long term impact of the untreated defect on the cardiac function. Thus, even newborn patients are exposed to a prolonged time of myocardial ischemia. The aim of this paper is to describe the impact of crystalloid HKT Custodiol cardioplegia infusion on myocardial protection in the early and late outcome of newborn patients who underwent arterial switch operation (ASO) for transposition of the great arteries (TGA). Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Accuracy of noninvasive haemoglobin measurement by pulse oximetry depends on the type of infusion fluid.

PubMed

Bergek, Christian; Zdolsek, Joachim H; Hahn, Robert G

2012-12-01

Measurement of blood haemoglobin concentration by pulse oximetry could be of value in determining when erythrocytes should be transfused during surgery, but the effect of infusion fluids on the results is unclear. To study the effect of crystalloid and colloid fluid on the accuracy (bias) and precision of pulse oximetry haemoglobin estimation to indicate the venous haemoglobin concentration in volunteers. Open interventional crossover study. Single university hospital. Ten male volunteers aged 18-28 (mean 22) years. Each volunteer underwent three infusion experiments on separate days and in random order. The infusions were Ringer's acetate (20 ml kg), hydroxyethyl starch 130/0.4 (10 ml kg) and a combination of both. At the end of the infusions of Ringer's acetate, pulse oximetry haemoglobin concentration had decreased more than the true haemoglobin concentration (15 vs. 8%; P < 0.005; n = 10) whereas starch solution decreased pulse oximetry haemoglobin concentration less than true haemoglobin concentration (7 vs. 11%; P < 0.02; n = 20). The same differences were seen when the fluids were infused separately and when they were combined. The overall difference between all 956 pairs of pulse oximetry haemoglobin concentration and true haemoglobin concentrations (the bias) averaged only -0.7 g l whereas the 95% prediction interval was wide, ranging from -24.9 to 23.7 g l. In addition to the choice of infusion fluid, the bias was strongly dependent on the volunteer (each factor, P < 0.001). The bias of measuring haemoglobin concentration by pulse oximetry is dependent on whether a crystalloid or a colloid fluid is infused. Trial registration ClinicalTrials identifier: NCT01195025.

Hemorrhage-induced hepatic injury and hypoperfusion can be prevented by direct peritoneal resuscitation.

PubMed

Hurt, Ryan T; Zakaria, El Rasheid; Matheson, Paul J; Cobb, Mahoney E; Parker, John R; Garrison, R Neal

2009-04-01

Crystalloid fluid resuscitation after hemorrhagic shock (HS) that restores/maintains central hemodynamics often culminates in multi-system organ failure and death due to persistent/progressive splanchnic hypoperfusion and end-organ damage. Adjunctive direct peritoneal resuscitation (DPR) using peritoneal dialysis solution reverses HS-induced splanchnic hypoperfusion and improves survival. We examined HS-mediated hepatic perfusion (galactose clearance), tissue injury (histopathology), and dysfunction (liver enzymes). Anesthetized rats were randomly assigned (n = 8/group): (1) sham (no HS); (2) HS (40% mean arterial pressure for 60 min) plus conventional i.v. fluid resuscitation (CR; shed blood + 2 volumes saline); (3) HS + CR + 30 mL intraperitoneal (IP) DPR; or (4) HS + CR + 30 mL IP saline. Hemodynamics and hepatic blood flow were measured for 2 h after CR completion. In duplicate animals, liver and splanchnic tissues were harvested for histopathology (blinded, graded), hepatocellular function (liver enzymes), and tissue edema (wet-dry ratio). Group 2 decreased liver blood flow, caused liver injuries (focal to submassive necrosis, zones 2 and 3) and tissue edema, and elevated liver enzymes (alanine aminotransferase (ALT), 149 +/- 28 microg/mL and aspartate aminotransferase (AST), 234 +/- 24 microg/mL; p < 0.05) compared to group 1 (73 +/- 9 and 119 +/- 10 microg/mL, respectively). Minimal/no injuries were observed in group 3; enzymes were normalized (ALT 89 +/- 9 microg/mL and AST 150 +/- 17 microg/mL), and tissue edema was similar to sham. CR from HS restored and maintained central hemodynamics but did not restore or maintain liver perfusion and was associated with significant hepatocellular injury and dysfunction. DPR added to conventional resuscitation (blood and crystalloid) restored and maintained liver perfusion, prevented hepatocellular injury and edema, and preserved liver function.

Colloid normalizes resuscitation ratio in pediatric burns.

PubMed

Faraklas, Iris; Lam, Uyen; Cochran, Amalia; Stoddard, Gregory; Saffle, Jeffrey

2011-01-01

Fluid resuscitation of burned children is challenging because of their small size and intolerance to over- or underresuscitation. Our American Burn Association-verified regional burn center has used colloid "rescue" as part of our pediatric resuscitation protocol. With Institutional Review Board approval, the authors reviewed children with ≥15% TBSA burns admitted from January 1, 2004, to May 1, 2009. Resuscitation was based on the Parkland formula, which was adjusted to maintain urine output. Patients requiring progressive increases in crystalloid were placed on a colloid protocol. Results were expressed as an hourly resuscitation ratio (I/O ratio) of fluid infusion (ml/kg/%TBSA/hr) to urine output (ml/kg/hr). We reviewed 53 patients; 29 completed resuscitation using crystalloid alone (lactated Ringer's solution [LR]), and 24 received colloid supplementation albumin (ALB). Groups were comparable in age, gender, weight, and time from injury to admission. ALB patients had more inhalation injuries and larger total and full-thickness burns. LR patients maintained a median I/O of 0.17 (range, 0.08-0.31), whereas ALB patients demonstrated escalating ratios until the institution of albumin produced a precipitous return of I/O comparable with that of the LR group. Hospital stay was lower for LR patients than ALB patients (0.59 vs 1.06 days/%TBSA, P = .033). Twelve patients required extremity or torso escharotomy, but this did not differ between groups. There were no decompressive laparotomies. The median resuscitation volume for ALB group was greater than LR group (9.7 vs 6.2 ml/kg/%TBSA, P = .004). Measuring hourly I/O is a helpful means of evaluating fluid demands during burn shock resuscitation. The addition of colloid restores normal I/O in pediatric patients.

The Na+/H+ exchange inhibitor cariporide is washed out of the myocardium by crystalloid cardioplegia.

PubMed

Bechtel, J F M; Eichler, W; Toerber, K; Weidtmann, B; Hernandez, M; Klotz, K F; Sievers, H H; Bartels, C

2006-08-01

Inhibition of the Na (+)/H (+) exchanger (NHE) is cardioprotective, but dosage and timing of NHE-inhibitors are critical for their efficacy. We studied the effect of a new dosing regime of the NHE-inhibitor cariporide on myocardial function and damage after cardioplegic arrest (CPA) and determined its myocardial and serum concentrations. 3 pigs received a bolus of 180 mg cariporide intravenously (i. v.) and were sacrificed shortly thereafter to allow measurement of the myocardial concentrations of cariporide. Subsequently, 10 pigs were randomized to receive either i. v. cariporide (bolus followed by an infusion of 40 mg/h) or placebo. Cardiopulmonary bypass was initiated, and the heart was arrested for 60 minutes by infusion of St. Thomas Hospital solution. Left ventricular (LV) function was studied using microsonometry. Myocardial damage was assessed by troponin T. Serum concentrations of cariporide were measured throughout the study, and myocardial concentrations were measured before the end of CPA and 180 minutes thereafter. Cariporide was present in all myocardial specimens (median: 1.4 ng/mg) studied previously. In the main study, LV function or myocardial damage did not differ significantly between the groups at any time point. Stable serum cariporide concentrations were achieved (3.4 +/- 0.5 microg/ml). Cariporide was detectable in only one of the myocardial biopsies obtained before the end of CPA, but 180 minutes thereafter, the myocardial cariporide concentration was 2.5 +/- 0.3 ng/mg. We observed no effect of i. v. cariporide on LV function or myocardial damage after cardioplegic arrest. Our data suggest that cariporide is washed out of the myocardium by repeated application of crystalloid cardioplegia. Thus, the mode of delivery also appears to be critical for cardioprotection with NHE-inhibitors.

Permissive hypotension in bleeding trauma patients: helpful or not and when?

PubMed

Gourgiotis, Stavros; Gemenetzis, George; Kocher, Hemant M; Aloizos, Stavros; Salemis, Nikolaos S; Grammenos, Stylianos

2013-12-01

Severity of hemorrhage and rate of bleeding are fundamental factors in the outcomes of trauma. Intravenous administration of fluid is the basic treatment to maintain blood pressure until bleeding is controlled. The main guideline, used almost worldwide, Advanced Trauma Life Support, established by the American College of Surgeons in 1976, calls for aggressive administration of intravenous fluids, primarily crystalloid solutions. Several other guidelines, such as Prehospital Trauma Life Support, Trauma Evaluation and Management, and Advanced Trauma Operative Management, are applied according to a patient's current condition. However, the ideal strategy remains unclear. With permissive hypotension, also known as hypotensive resuscitation, fluid administration is less aggressive. The available models of permissive hypotension are based on hypotheses in hypovolemic physiology and restricted clinical trials in animals. Before these models can be used in patients, randomized, controlled clinical trials are necessary.

Warm blood cardioplegia versus cold crystalloid cardioplegia for myocardial protection during coronary artery bypass grafting surgery.

PubMed

Nardi, Paolo; Pisano, Calogera; Bertoldo, Fabio; Vacirca, Sara R; Saitto, Guglielmo; Costantino, Antonino; Bovio, Emanuele; Pellegrino, Antonio; Ruvolo, Giovanni

2018-12-01

We retrospectively analyzed early results of coronary artery bypass grafting (CABG) surgery using two different types of cardioplegia for myocardial protection: antegrade intermittent warm blood or cold crystalloid cardioplegia. From January 2015 to October 2016, 330 consecutive patients underwent isolated on-pump CABG. Cardiac arrest was obtained with use of warm blood cardioplegia (WBC group, n  = 297) or cold crystalloid cardioplegia (CCC group, n  = 33), according to the choice of the surgeon. Euroscore II and preoperative characteristics were similar in both groups, except for the creatinine clearance, slightly lower in WBC group (77.33 ± 27.86 mL/min versus 88.77 ± 51.02 mL/min) ( P  < 0.05). Complete revascularization was achieved in both groups. In-hospital mortality was 2.0% ( n  = 6) in WBC group, absent in CCC group. The required mean number of cardioplegia's doses per patient was higher in WBC group (2.3 ± 0.8) versus CCC group (2.0 ± 0.7) ( P  = 0.045), despite a lower number of distal coronary artery anastomoses (2.7 ± 0.8 versus 3.2 ± 0.9) ( P  = 0.0001). Cardiopulmonary and aortic cross-clamp times were similar in both groups. The incidence of perioperative myocardial infarction (WBC group 3.4% versus CCC group 3.0%) and low cardiac output syndrome (4.4% versus 3.0%) were similar in both groups. As compared with WBC group, in CCC group CK-MB/CK ratio >10% was lower during each time points of evaluation, with a statistical significant difference at time 0 (4% ± 1.6% versus 5% ± 2.5%) ( P  = 0.021). In presence of complete revascularization, despite the value of CK-MB/CK ratio >10% was less in the CCC group, clinical results were not affected by both types of cardioplegia adopted to myocardial protection. As compared with cold crystalloid, warm blood cardioplegia requires a shorter interval of administration to achieve better myocardial protection.

Application of the Berlin definition in PROMMTT patients: the impact of resuscitation on the incidence of hypoxemia.

PubMed

Robinson, Bryce R H; Cotton, Bryan A; Pritts, Timothy A; Branson, Richard; Holcomb, John B; Muskat, Peter; Fox, Erin E; Wade, Charles E; del Junco, Deborah J; Bulger, Eileen M; Cohen, Mitchell J; Schreiber, Martin A; Myers, John G; Brasel, Karen J; Phelan, Herbert A; Alarcon, Louis H; Rahbar, Mohammad H; Callcut, Rachael A

2013-07-01

Acute lung injury following trauma resuscitation remains a concern despite recent advances. With the use of the PROMMTT study population, the risk of hypoxemia and potential modifiable risk factors are studied. Patients with survival for 24 hours or greater with at least one intensive care unit day were included in the analysis. Hypoxemia was categorized using the Berlin definition for adult respiratory distress syndrome: none (PaO₂-to-FIO₂ ratio [P/F] > 300 mm Hg), mild (P/F, 201-300 mm Hg), moderate (P/F, 101-200 mm Hg) or severe (P/F ≤ 100 mm Hg). The cohort was dichotomized into those with none or mild hypoxemia and those with moderate or severe injury. Early resuscitation was defined as that occurring 0 hour to 6 hours from arrival; late resuscitation was defined as that occurring 7 hours to 24 hours. Multivariate logistic regression models were developed controlling for age, sex, mechanisms of injury, arrival physiology, individual Abbreviated Injury Scale (AIS) scores, blood transfusions, and crystalloid administration. Of the patients 58.7% (731 of 1,245) met inclusion criteria. Hypoxemia occurred in 69% (mild, 24%; moderate, 28%; severe, 17%). Mortality was highest (24%) in the severe group. During early resuscitation (0-6 h), logistic regression revealed age (odd ratio [OR], 1.02; 95% confidence interval [CI], 1.00-1.04), chest AIS score (OR, 1.31; 95% CI, 1.10-1.57), and intravenously administered crystalloid fluids given in 500 mL increments (OR, 1.12; 95% CI, 1.01-1.25) as predictive of moderate or severe hypoxemia. During late resuscitation, age (OR, 1.02; 95% CI, 1.00-1.04), chest AIS score (OR, 1.33; 95% CI, 1.11-1.59), and crystalloids given during this period (OR, 1.05; 95% CI, 1.01-1.10) were also predictive of moderate-to-severe hypoxemia. Red blood cell, plasma, and platelet transfusions (whether received during early or late resuscitation) failed to demonstrate an increased risk of developing moderate/severe hypoxemia. Severe chest injury, increasing age, and crystalloid-based resuscitation, but not blood transfusions, were associated with increased risk of developing moderate-to-severe hypoxemia following injury.

Recovery of fibrinogen concentrate after intraosseous application is equivalent to the intravenous route in a porcine model of hemodilution

PubMed Central

Schlimp, Christoph J.; Solomon, Cristina; Keibl, Claudia; Zipperle, Johannes; Nürnberger, Sylvia; Öhlinger, Wolfgang; Redl, Heinz; Schöchl, Herbert

2014-01-01

BACKGROUND Fibrinogen concentrate is increasingly considered as a hemostatic agent for trauma patients experiencing bleeding. Placing a venous access is sometimes challenging during severe hemorrhage. Intraosseous access may be considered instead. Studies of intraosseous infusion of coagulation factor concentrates are limited. We investigated in vivo recovery following intraosseous administration of fibrinogen concentrate and compared the results with intravenous administration. METHODS This study was performed on 12 pigs (mean [SD] body weight, 34.1 [2.8] kg). Following controlled blood loss (35 mL/kg) and fluid replacement with balanced crystalloid solution, intraosseous (n = 6) administration of fibrinogen concentrate (80 mg per kilogram of bodyweight) in the proximal tibia was compared with intravenous (n = 6) administration of the same dose (fibrinogen infusion time approximately 5 minutes in both groups). The following laboratory parameters were assessed: blood cell count, prothrombin time index, activated partial thromboplastin time, and plasma fibrinogen concentration (Clauss assay). Coagulation status was also assessed by thromboelastometry. RESULTS All tested laboratory parameters were comparable between the intraosseous and intravenous groups at baseline, hemodilution, and 30 minutes after fibrinogen concentrate administration. In vivo recovery of fibrinogen was also similar in the two groups (89% [23%] and 91% [22%], respectively). There were no significant between-group differences in any of the thromboelastometric parameters. Histologic examination indicated no adverse effects on the tissue surrounding the intraosseous administration site. CONCLUSION This study suggests that intraosseous administration of fibrinogen concentrate results in a recovery of fibrinogen similar to that of intravenous administration. The intraosseous route of fibrinogen concentrate could be a valuable alternative in situations where intravenous access is not feasible or would be time consuming. LEVEL OF EVIDENCE Prospective, randomized, therapeutic feasibility study in an animal model, level V. PMID:24747454

A protocol for the 0.9% saline versus Plasma-Lyte 148 for intensive care fluid therapy (SPLIT) study.

PubMed

Reddy, Sumeet K; Bailey, Michael J; Beasley, Richard W; Bellomo, Rinaldo; Henderson, Seton J; Mackle, Diane M; McArthur, Colin J; Mehrtens, Jan E; Myburgh, John A; McGuinness, Shay P; Psirides, Alex J; Young, Paul J

2014-12-01

0.9% saline is the most commonly used intravenous (IV) fluid in the world. However, recent data raise the possibility that, compared with buffered crystalloid fluids such as Plasma-Lyte 148, the administration of 0.9% saline to intensive care unit patients might increase their risk of acute kidney injury (AKI). To describe the protocol for the 0.9% Saline v Plasma-Lyte 148 for ICU Fluid Therapy (SPLIT) study. This is a multicentre, cluster-randomised, double crossover feasibility study to be conducted in four New Zealand tertiary ICUs over a 28-week period and will enroll about 2300 participants. All ICU patients who need crystalloid IV fluid therapy (except those with established renal failure needing dialysis and those admitted to the ICU for palliative care) will be enrolled. Participating ICUs will be randomly assigned to 0.9% saline or Plasma-Lyte 148 as the routine crystalloid IV fluid, in a blinded fashion, in four alternating 7-week blocks. The primary outcome will be the proportion of patients who develop AKI in the ICU. Secondary outcomes will include the difference between the most recent serum creatinine level measured before study enrollment and the peak serum creatinine level in the ICU; use of renal replacement therapy; and ICU and in hospital mortality. All analyses will be conducted on an intention-to-treat basis. The SPLIT study started on 1 April 2014 and will provide preliminary data on the comparative effectiveness of using 0.9% saline v Plasma- Lyte 148 as the routine IV fluid therapy in ICU patients.

Combining creatinine and volume kinetics identifies missed cases of acute kidney injury following cardiac arrest

PubMed Central

2013-01-01

Introduction Fluid resuscitation in the critically ill often results in a positive fluid balance, potentially diluting the serum creatinine concentration and delaying diagnosis of acute kidney injury (AKI). Methods Dilution during AKI was quantified by combining creatinine and volume kinetics to account for fluid type, and rates of fluid infusion and urine output. The model was refined using simulated patients receiving crystalloids or colloids under four glomerular filtration rate (GFR) change scenarios and then applied to a cohort of critically ill patients following cardiac arrest. Results The creatinine concentration decreased during six hours of fluid infusion at 1 litre-per-hour in simulated patients, irrespective of fluid type or extent of change in GFR (from 0% to 67% reduction). This delayed diagnosis of AKI by 2 to 9 hours. Crystalloids reduced creatinine concentration by 11 to 19% whereas colloids reduced concentration by 36 to 43%. The greatest reduction was at the end of the infusion period. Fluid dilution alone could not explain the rapid reduction of plasma creatinine concentration observed in 39 of 49 patients after cardiac arrest. Additional loss of creatinine production could account for those changes. AKI was suggested in six patients demonstrating little change in creatinine, since a 52 ± 13% reduction in GFR was required after accounting for fluid dilution and reduced creatinine production. Increased injury biomarkers within a few hours of cardiac arrest, including urinary cystatin C and plasma and urinary Neutrophil-Gelatinase-Associated-Lipocalin (biomarker-positive, creatinine-negative patients) also indicated AKI in these patients. Conclusions Creatinine and volume kinetics combined to quantify GFR loss, even in the absence of an increase in creatinine. The model improved disease severity estimation, and demonstrated that diagnostic delays due to dilution are minimally affected by fluid type. Creatinine sampling should be delayed at least one hour following a large fluid bolus to avoid dilution. Unchanged plasma creatinine post cardiac arrest signifies renal injury and loss of function. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12610001012066. PMID:23327106

The Impact of Pre-Hospital Administration of Lactated Ringer's Solution versus Normal Saline in Patients with Traumatic Brain Injury

PubMed Central

Rowell, Susan E.; Barbosa, Ronald R.; Watters, Jennifer M.; Bulger, Eileen M.; Holcomb, John B.; Cohen, Mitchell J.; Rahbar, Mohammad H.; Fox, Erin E.; Schreiber, Martin A.

2016-01-01

Abstract Lactated Ringer's (LR) and normal saline (NS) are both used for resuscitation of injured patients. NS has been associated with increased resuscitation volume, blood loss, acidosis, and coagulopathy compared with LR. We sought to determine if pre-hospital LR is associated with improved outcome compared with NS in patients with and without traumatic brain injury (TBI). We included patients receiving pre-hospital LR or NS from the PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study. Patients with TBI (Abbreviated Injury Scale [AIS] head ≥3) and without TBI (AIS head ≤2) were compared. Cox proportional hazards models including Injury Severity Score (ISS), AIS head, AIS extremity, age, fluids, intubation status, and hospital site were generated for prediction of mortality. Linear regression models were generated for prediction of red blood cell (RBC) and crystalloid requirement, and admission biochemical/physiological parameters. Seven hundred ninety-one patients received either LR (n = 117) or NS (n = 674). Median ISS, AIS head, AIS extremity, and pre-hospital fluid volume were higher in TBI and non-TBI patients receiving LR compared with NS (p < 0.01). In patients with TBI (n = 308), LR was associated with higher adjusted mortality compared with NS (hazard rate [HR] = 1.78, confidence interval [CI] 1.04–3.04, p = 0.035). In patients without TBI (n = 483), no difference in mortality was demonstrated (HR = 1.49, CI 0.757–2.95, p = 0.247). Fluid type had no effect on admission biochemical or physiological parameters, 6-hour RBC, or crystalloid requirement in either group. LR was associated with increased mortality compared with NS in patients with TBI. These results underscore the need for a prospective randomized trial comparing pre-hospital LR with NS in patients with TBI. PMID:26914721

Physician survey to determine how dengue is diagnosed, treated and reported in puerto rico.

PubMed

Tomashek, Kay M; Biggerstaff, Brad J; Ramos, Mary M; Pérez-Guerra, Carmen L; Garcia Rivera, Enid J; Sun, Wellington

2014-10-01

Dengue is a major cause of morbidity in Puerto Rico and is well-known to its physicians. Early case identification and timely initiation of treatment for patients with severe dengue can reduce medical complications and mortality. To determine clinical management and reporting practices, and assess knowledge of dengue and its management, a survey was sent to 2,512 physicians with a medical license in Puerto Rico. Of the 2,313 physicians who received the survey, 817 (35%) completed the questionnaire. Of the respondents, 708 were currently practicing medicine; 138 were board certified (Group 1), 282 were board eligible (Group 2), and 288 had not finished residency (Group 3). Although respondents clinically diagnosed, on average, 12 cases of dengue in the preceding three months, 31% did not report any suspected cases to public health officials while about half (56%) reported all cases. Overall, 29% of respondents correctly identified early signs of shock and 48% identified severe abdominal pain and persistent vomiting as warning signs for severe dengue with the proportion of correct respondents highest in Group 1. Reportedly about sixty percent (57%) appropriately never give corticosteroids or prophylactic platelet transfusions to dengue patients. One third (30%) of respondents correctly identified administration of intravenous colloid solution as the best treatment option for dengue patients with refractory shock and elevated hematocrit after an initial trial of intravenous crystalloids, and nearly one half (46%) correctly identified administration of a blood transfusion as the best option for dengue patients with refractory shock and decreased hematocrit after a trial of intravenous crystalloids. Even though dengue has been endemic in Puerto Rico for nearly 4 decades, knowledge of dengue management is still limited, compliance with WHO treatment guidelines is suboptimal, and underreporting is significant. These findings were used to design a post graduate training course to improve the clinical management of dengue.

Physician Survey to Determine How Dengue Is Diagnosed, Treated and Reported in Puerto Rico

PubMed Central

Tomashek, Kay M.; Biggerstaff, Brad J.; Ramos, Mary M.; Pérez-Guerra, Carmen L.; Garcia Rivera, Enid J.; Sun, Wellington

2014-01-01

Dengue is a major cause of morbidity in Puerto Rico and is well-known to its physicians. Early case identification and timely initiation of treatment for patients with severe dengue can reduce medical complications and mortality. To determine clinical management and reporting practices, and assess knowledge of dengue and its management, a survey was sent to 2,512 physicians with a medical license in Puerto Rico. Of the 2,313 physicians who received the survey, 817 (35%) completed the questionnaire. Of the respondents, 708 were currently practicing medicine; 138 were board certified (Group 1), 282 were board eligible (Group 2), and 288 had not finished residency (Group 3). Although respondents clinically diagnosed, on average, 12 cases of dengue in the preceding three months, 31% did not report any suspected cases to public health officials while about half (56%) reported all cases. Overall, 29% of respondents correctly identified early signs of shock and 48% identified severe abdominal pain and persistent vomiting as warning signs for severe dengue with the proportion of correct respondents highest in Group 1. Reportedly about sixty percent (57%) appropriately never give corticosteroids or prophylactic platelet transfusions to dengue patients. One third (30%) of respondents correctly identified administration of intravenous colloid solution as the best treatment option for dengue patients with refractory shock and elevated hematocrit after an initial trial of intravenous crystalloids, and nearly one half (46%) correctly identified administration of a blood transfusion as the best option for dengue patients with refractory shock and decreased hematocrit after a trial of intravenous crystalloids. Even though dengue has been endemic in Puerto Rico for nearly 4 decades, knowledge of dengue management is still limited, compliance with WHO treatment guidelines is suboptimal, and underreporting is significant. These findings were used to design a post graduate training course to improve the clinical management of dengue. PMID:25299251

Changes in colloid solution sales in Nordic countries.

PubMed

Kongsgaard, U E; Holtan, A; Perner, A

2018-04-01

Administration of resuscitation fluid is a common intervention in the treatment of critically ill patients, but the right choice of fluid is still a matter of debate. Changes in medical practice are based on new evidence and guidelines as well as traditions and personal preferences. Official warnings against the use of hydroxyl-ethyl-starch (HES) solutions have been issued. Nordic guidelines have issued several strong recommendations favouring crystalloids over colloids in all patient groups. Our objective was to describe the patterns of colloid use in Nordic countries from 2012 to 2016. The data were obtained from companies that provide pharmaceutical statistics in different countries. The data are sales figures from pharmaceutical companies to pharmacies and health institutions. We found a 56% reduction in the total sales of all colloids in Nordic countries over a 5-year period. These findings were mainly related to a 92% reduction in the sales of HES solutions. A reduction in sales of other synthetic colloids has also occurred. During the same period, we found a 46% increase in albumin sales, but these numbers varied between Nordic countries. The general reduction in colloid sales likely reflects the recommendation that colloids should be used only in special circumstances. The dramatic reduction in the sales of HES solutions was expected given evidence of harm and the official warnings. The steady increase in albumin sales and the notable differences between the five Nordic countries cannot be explained. © 2018 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Potential drug sequestration during extracorporeal membrane oxygenation: results from an ex vivo experiment.

PubMed

Mehta, Nilesh M; Halwick, David R; Dodson, Brenda L; Thompson, John E; Arnold, John H

2007-06-01

Using an ex vivo simulation model we set out to estimate the amount of drug lost due to sequestration within the extracorporeal circuit over time. Simulated closed-loop extracorporeal membrane oxygenation (ECMO) circuits were prepared using a 1.5-m2 silicone membrane oxygenator. Group A consisted of heparin, dopamine, ampicillin, vancomycin, phenobarbital and fentanyl. Group B consisted of epinephrine, cefazolin, hydrocortisone, fosphenytoin and morphine. Drugs were tested in crystalloid and blood-primed circuits. After administration of a one-time dose of drugs in the priming fluid, baseline drug concentrations were obtained (P0). A simultaneous specimen was stored for stability testing at 24 h (P4). Serial post-membrane drug concentrations were then obtained at 30 min (P1), 3 h (P2) and 24 h (P3) from circuit fluid. One hundred and one samples were analyzed. At the end of 24 h in crystalloid-primed circuits, 71.8% of ampicillin, 96.7% of epinephrine, 17.6% of fosphenytoin, 33.3% of heparin, 17.5% of morphine and 87% of fentanyl was lost. At the end of 24 h in blood-primed extracorporeal circuits, 15.4% of ampicillin, 21% of cefazolin, 71% of voriconazole, 31.4% of fosphenytoin, 53.3% of heparin and 100% of fentanyl was lost. There was a significant decrease in overall drug concentrations from 30 min to 24 h for both crystalloid-primed circuits (p = 0.023) and blood-primed circuits (p = 0.04). Our ex vivo study demonstrates serial losses of several drugs commonly used during ECMO therapy. Therapeutic concentrations of fentanyl, voriconazole, antimicrobials and heparin cannot be guaranteed in patients on ECMO.

Perioperative Characteristics of Siblings Undergoing Liver or Kidney Transplant.

PubMed

Ersoy, Zeynep; Ozdemirkan, Aycan; Pirat, Arash; Torgay, Adnan; Arslan, Gulnaz; Haberal, Mehmet

2015-11-01

Reasons for chronic liver and kidney failure may vary; sometimes more than 1 family member may be affected, and may require a transplant. The aim of this study was to examine the similarities or differences between the perioperative characteristics of siblings undergoing liver or kidney transplant. The medical records of 6 pairs of siblings who underwent liver transplant and 4 pairs of siblings who underwent kidney transplant at Baskent University Hospital between 1989 and 2014 were retrospectively analyzed. Collected data included demographic features; comorbidities; reasons for liver and kidney failure; perioperative laboratory values; intraoperative hemodynamic parameters; use and volume of crystalloids, colloids, blood products, cell saver system, and albumin; duration of anesthesia; urine output; and postoperative follow-up data. The mean age of the 6 sibling pairs who underwent liver transplant was 16.3 ± 12.2 years. All 12 patients had Child-Pugh grade B cirrhosis, with mean disease duration of 7.8 ± 3.9 years. There were no significant differences between siblings with respect to intraoperative blood product transfusion, crystalloid and colloid fluid replacements, hypotension frequency, blood gas analyses, urinary output, duration of anhepatic phase, inotropic agent administration, postoperative laboratory values, need for mechanical ventilation and vasopressors, occurrence of acute renal failure and infections, and duration intensive care unit stay (P > .05). The mean age of the 4 sibling pairs who underwent kidney transplant was 21.3 ± 6.4 years, with mean duration of renal insufficiency of 2.2 ± 1.6 years. There were no significant differences between siblings with respect to intraoperative crystalloid and colloid fluid administration, duration of anesthesia, intraoperative mannitol and furosemide administration, and postoperative laboratory values (P > .05). In conclusion, the 6 sibling pairs who underwent liver transplant and 4 sibling pairs who underwent kidney transplant in our cohort had similar perioperative characteristics.

Real-time visualization and quantification of retrograde cardioplegia delivery using near infrared fluorescent imaging.

PubMed

Rangaraj, Aravind T; Ghanta, Ravi K; Umakanthan, Ramanan; Soltesz, Edward G; Laurence, Rita G; Fox, John; Cohn, Lawrence H; Bolman, R M; Frangioni, John V; Chen, Frederick Y

2008-01-01

Homogeneous delivery of cardioplegia is essential for myocardial protection during cardiac surgery. Presently, there exist no established methods to quantitatively assess cardioplegia distribution intraoperatively and determine when retrograde cardioplegia is required. In this study, we evaluate the feasibility of near infrared (NIR) imaging for real-time visualization of cardioplegia distribution in a porcine model. A portable, intraoperative, real-time NIR imaging system was utilized. NIR fluorescent cardioplegia solution was developed by incorporating indocyanine green (ICG) into crystalloid cardioplegia solution. Real-time NIR imaging was performed while the fluorescent cardioplegia solution was infused via the retrograde route in five ex vivo normal porcine hearts and in five ex vivo porcine hearts status post left anterior descending (LAD) coronary artery ligation. Horizontal cross-sections of the hearts were obtained at proximal, middle, and distal LAD levels. Videodensitometry was performed to quantify distribution of fluorophore content. The progressive distribution of cardioplegia was clearly visualized with NIR imaging. Complete visualization of retrograde distribution occurred within 4 minutes of infusion. Videodensitometry revealed retrograde cardioplegia, primarily distributed to the left ventricle (LV) and anterior septum. In hearts with LAD ligation, antegrade cardioplegia did not distribute to the anterior LV. This deficiency was compensated for with retrograde cardioplegia supplementation. Incorporation of ICG into cardioplegia allows real-time visualization of cardioplegia delivery via NIR imaging. This technology may prove useful in guiding intraoperative decisions pertaining to when retrograde cardioplegia is mandated.

Low Volume Resuscitation with Cell Impermeants

DTIC Science & Technology

2014-10-01

function even in the low volume state. This is likely due to low resistance to flow in the peripheral capillaries due to prevention of cell swelling...limited in their effectiveness. Attempts to modify basic intravenous crystalloids for prehospital resuscitation by adding hypertonic NaCl or starch

A nanostructure based on metasurfaces for optical interconnects

NASA Astrophysics Data System (ADS)

Lin, Shulang; Gu, Huarong

2017-08-01

Optical-electronic Integrated Neural Co-processor takes vital part in optical neural network, which is mainly realized by optical interconnects. Because of the accuracy requirement and long-term goal of integration, optical interconnects should be effective and pint-size. In traditional solutions of optical interconnects, holography built on crystalloid or law of Fresnel diffraction exploited on zone plate was used. However, holographic method cannot meet the efficiency requirement and zone plate is too bulk to make the optical neural unit miniaturization. Thus, this paper aims to find a way to replace holographic method or zone plate with enough diffraction efficiency and smaller size. Metasurfaces are composed of subwavelength-spaced phase shifters at an interface of medium. Metasurfaces allow for unprecedented control of light properties. They also have advanced optical technology of enabling versatile functionalities in a planar structure. In this paper, a nanostructure is presented for optical interconnects. The comparisons of light splitting ability and simulated crosstalk between nanostructure and zone plate are also made.

Effect of peritoneal lavage solution temperature on body temperature in anaesthetised cats and small dogs.

PubMed

Barnes, D C; Leece, E A; Trimble, T A; Demetriou, J L

2017-05-20

A prospective, randomised, non-blinded, clinical study to assess the effect of peritoneal lavage using warmed fluid on body temperature in anesthetised cats and dogs of less than 10 kg body mass undergoing coeliotomy. A standardised anaesthetic protocol was used. Oesophageal and rectal temperatures were measured at various time points. At the end of surgery, group 1 patients (n=10) were lavaged with 200 ml/kg sterile isotonic saline at 34±1°C and group 2 (n=10) at 40±1°C. Groups were similar with respect to age, mass, body condition and surgical incision length. Duration of anaesthesia, surgical procedures and peritoneal lavage was similar between groups. Linear regression showed no significant change in oesophageal temperature during the lavage period for group 1 (P=0.64), but a significant increase for group 2 patients (P<0.0001), with mean temperature changes of -0.5°C (from (36.3°C to 35.9°C) and +0.9°C (from 35.4°C to 36.3°C), respectively. Similar results were found for rectal temperature, with mean changes of -0.5°C and +0.8°C (P=0.922 and 0.045), respectively. The use of isotonic crystalloid solution for peritoneal lavage at a temperature of 40±1°C significantly warms small animal patients, when applied in a clinical setting, compared with lavage solution at 34±1°C. British Veterinary Association.

Real-time Visualization and Quantification of Retrograde Cardioplegia Delivery using Near Infrared Fluorescent Imaging

PubMed Central

Rangaraj, Aravind T.; Ghanta, Ravi K.; Umakanthan, Ramanan; Soltesz, Edward G.; Laurence, Rita G.; Fox, John; Cohn, Lawrence H.; Bolman, R. M.; Frangioni, John V.; Chen, Frederick Y.

2009-01-01

Background and Aim of the Study Homogeneous delivery of cardioplegia is essential for myocardial protection during cardiac surgery. Presently, there exist no established methods to quantitatively assess cardioplegia distribution intraoperatively and determine when retrograde cardioplegia is required. In this study, we evaluate the feasibility of near infrared (NIR) imaging for real-time visualization of cardioplegia distribution in a porcine model. Methods A portable, intraoperative, real-time NIR imaging system was utilized. NIR fluorescent cardioplegia solution was developed by incorporating indocyanine green (ICG) into crystalloid cardioplegia solution. Real-time NIR imaging was performed while the fluorescent cardioplegia solution was infused via the retrograde route in 5 ex-vivo normal porcine hearts and in 5 ex-vivo porcine hearts status post left anterior descending (LAD) coronary artery ligation. Horizontal cross-sections of the hearts were obtained at proximal, middle, and distal LAD levels. Videodensitometry was performed to quantify distribution of fluorophore content. Results The progressive distribution of cardioplegia was clearly visualized with NIR imaging. Complete visualization of retrograde distribution occurred within 4 minutes of infusion. Videodensitometry revealed that retrograde cardioplegia primarily distributed to the left ventricle and anterior septum. In hearts with LAD ligation, antegrade cardioplegia did not distribute to the anterior left ventricle. This deficiency was compensated for with retrograde cardioplegia supplementation. Conclusions Incorporation of ICG into cardioplegia allows real-time visualization of cardioplegia delivery via NIR imaging. This technology may prove useful in guiding intraoperative decisions pertaining to when retrograde cardioplegia is mandated. PMID:19016995

Effects of zonal flows on correlation between energy balance and energy conservation associated with nonlinear nonviscous atmospheric dynamics in a thin rotating spherical shell

NASA Astrophysics Data System (ADS)

Ibragimov, Ranis N.

2018-03-01

The nonlinear Euler equations are used to model two-dimensional atmosphere dynamics in a thin rotating spherical shell. The energy balance is deduced on the basis of two classes of functorially independent invariant solutions associated with the model. It it shown that the energy balance is exactly the conservation law for one class of the solutions whereas the second class of invariant solutions provides and asymptotic convergence of the energy balance to the conservation law.

Impact of Improved Combat Casualty Care on Combat Wounded Undergoing Exploratory Laparotomy and Massive Transfusion

DTIC Science & Technology

2011-07-01

given to evidence - based medicine in the 20th century has not only allowed improved dissemination of information to civilian providers but has also...limiting the amount of crystalloid used to resuscitate patients by 61%. This is further confirmation that evidence - based medicine changes in practice are at

Virus present in the reproductive tract of asymptomatic drones of honey bee (Apis mellifera l.), and possible infection of queen during mating.

PubMed

Da Cruz-Landim, Carminda; Roat, Thaisa C; Fernadez, Fernanda C

2012-07-01

Virus particles and viral inclusions were detected by transmission electron microscopy examination of sections of the seminal vesicles and mucus gland of asymptomatic young drones from colonies of Apis mellifera lightly infested by Varroa mite. In the mucus gland the infection was found in the muscular sheath and epithelium, while in the seminal vesicle in cells of the outer serosa. Isolated viral particles were also observed in the hemolymph occupying the intercellular spaces of the muscular sheath fibers. In the muscle the virus appeared as polygonal crystalloid inclusions, while in the epithelium mainly inside cytoplasmic vesicles. The infected cells apparently are not damaged. The virus particles are present in the hemolymph and forming more mature structures, as crystalloids, in the muscle. This suggests that the virus is liberated in the body fluid and infects the tissues penetrating the cells through endocytosis. The presence of virus in mucus gland epithelial vesicles raise the possibility of its transference to the gland secretion and therefore, to the semen. Copyright © 2012 Wiley Periodicals, Inc.

Early goal-directed therapy (EGDT) for severe sepsis/septic shock: which components of treatment are more difficult to implement in a community-based emergency department?

PubMed

O'Neill, Rory; Morales, Javier; Jule, Michael

2012-05-01

Early goal-directed therapy (EGDT) has been shown to reduce mortality in patients with severe sepsis/septic shock, however, implementation of this protocol in the emergency department (ED) is sometimes difficult. We evaluated our sepsis protocol to determine which EGDT elements were more difficult to implement in our community-based ED. This was a non-concurrent cohort study of adult patients entered into a sepsis protocol at a single community hospital from July 2008 to March 2009. Charts were reviewed for the following process measures: a predefined crystalloid bolus, antibiotic administration, central venous catheter insertion, central venous pressure measurement, arterial line insertion, vasopressor utilization, central venous oxygen saturation measurement, and use of a standardized order set. We also compared the individual component adherence with survival to hospital discharge. A total of 98 patients presented over a 9-month period. Measures with the highest adherence were vasopressor administration (79%; 95% confidence interval [CI] 69-89%) and antibiotic use (78%; 95% CI 68-85%). Measures with the lowest adherence included arterial line placement (42%; 95% CI 32-52%), central venous pressure measurement (27%; 95% CI 18-36%), and central venous oxygen saturation measurement (15%; 95% CI 7-23%). Fifty-seven patients survived to hospital discharge (Mortality: 33%). The only element of EDGT to demonstrate a statistical significance in patients surviving to hospital discharge was the crystalloid bolus (79% vs. 46%) (respiratory rate [RR] = 1.76, 95% CI 1.11-2.58). In our community hospital, arterial line placement, central venous pressure measurement, and central venous oxygen saturation measurement were the most difficult elements of EGDT to implement. Patients who survived to hospital discharge were more likely to receive the crystalloid bolus. Copyright © 2012 Elsevier Inc. All rights reserved.

Modified harmonic balance method for the solution of nonlinear jerk equations

NASA Astrophysics Data System (ADS)

Rahman, M. Saifur; Hasan, A. S. M. Z.

2018-03-01

In this paper, a second approximate solution of nonlinear jerk equations (third order differential equation) can be obtained by using modified harmonic balance method. The method is simpler and easier to carry out the solution of nonlinear differential equations due to less number of nonlinear equations are required to solve than the classical harmonic balance method. The results obtained from this method are compared with those obtained from the other existing analytical methods that are available in the literature and the numerical method. The solution shows a good agreement with the numerical solution as well as the analytical methods of the available literature.

Albumin extravasation and tissue washout of hyaluronan after plasma volume expansion with crystalloid or hypooncotic colloid solutions.

PubMed

Berg, S; Golster, M; Lisander, B

2002-02-01

Intravascular volume expansion is followed by loss of fluid from the circulation. The extravasation of albumin in this readjustment is insufficiently known. Twelve male volunteers participated, each in three separate sessions, in a controlled, randomised, open fashion. They received one of the following: albumin 40 g/L,(7.1 mL/kg, i.e. 500 mL per 70 kg); Ringer's acetate (21.4 mL/kg), or dextran 30 g/L (7.1 mL/kg). The fluids were infused during 30 min and the subjects were followed for 180 min. ECG, arterial oxygen saturation and non-invasive arterial pressure were recorded. Haemoglobin, haematocrit, serum albumin and osmolality, plasma colloid osmotic pressure and hyaluronan concentration were determined in venous samples. The serum albumin concentration decreased (P < 0.05, anova) following Ringer's acetate or dextran, whereas serum osmolality was unchanged in all groups. The colloid osmotic pressure decreased (P < 0.05) after the Ringer solution. The blood volume increase was estimated from the decrease in haemoglobin concentration and did not differ between the three fluids. The cumulated extravasation of albumin was largest following albumin (10.4 +/- 5.4 g, mean +/- SD), less following dextran (5.6 +/- 5.0 g) and negligible in the Ringer group (0.5 +/- 10.0 g; P < 0.05 against albumin). However, the Ringer solution increased the plasma concentration of hyaluronan drastically. Infusion of hypotonic colloidal solutions entails net loss of albumin from the vascular space. This is not the case after Ringer's acetate. Increased interstitial hydration from the latter fluid is followed by lymphatic wash out of hyaluronan.

High order finite volume WENO schemes for the Euler equations under gravitational fields

NASA Astrophysics Data System (ADS)

Li, Gang; Xing, Yulong

2016-07-01

Euler equations with gravitational source terms are used to model many astrophysical and atmospheric phenomena. This system admits hydrostatic balance where the flux produced by the pressure is exactly canceled by the gravitational source term, and two commonly seen equilibria are the isothermal and polytropic hydrostatic solutions. Exact preservation of these equilibria is desirable as many practical problems are small perturbations of such balance. High order finite difference weighted essentially non-oscillatory (WENO) schemes have been proposed in [22], but only for the isothermal equilibrium state. In this paper, we design high order well-balanced finite volume WENO schemes, which can preserve not only the isothermal equilibrium but also the polytropic hydrostatic balance state exactly, and maintain genuine high order accuracy for general solutions. The well-balanced property is obtained by novel source term reformulation and discretization, combined with well-balanced numerical fluxes. Extensive one- and two-dimensional simulations are performed to verify well-balanced property, high order accuracy, as well as good resolution for smooth and discontinuous solutions.

Physiological and biochemical principles underlying volume-targeted therapy--the "Lund concept".

PubMed

Nordström, Carl-Henrik

2005-01-01

The optimal therapy of sustained increase in intracranial pressure (ICP) remains controversial. The volume-targeted therapy ("Lund concept") discussed in this article focuses on the physiological volume regulation of the intracranial compartments. The balance between effective transcapillary hydrostatic and osmotic pressures constitutes the driving force for transcapillary fluid exchange. The low permeability for sodium and chloride combined with the high crystalloid osmotic pressure (approximately 5700 mmHg) on both sides of the blood-brain barrier (BBB) counteracts fluid exchange across the intact BBB. Additionally, variations in systemic blood pressure generally are not transmitted to these capillaries because cerebral intracapillary hydrostatic pressure (and blood flow) is physio-logically tightly autoregulated. Under pathophysiological conditions, the BBB may be partially disrupted. Transcapillary water exchange is then determined by the differences in hydrostatic and colloid osmotic pressure between the intra- and extracapillary compartments. Pressure autoregulation of cerebral blood flow is likely to be impaired in these conditions. A high cerebral perfusion pressure accordingly increases intracapillary hydrostatic pressure and leads to increased intracerebral water content and an increase in ICP. The volume-targeted "Lund concept" has been evaluated in experimental and clinical studies to examine the physiological and biochemical (utilizing intracerebral microdialysis) effects, and the clinical experiences have been favorable.

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

Xing, Yulong; Shu, Chi-wang; Noelle, Sebastian

This note aims at demonstrating the advantage of moving-water well-balanced schemes over still-water well-balanced schemes for the shallow water equations. We concentrate on numerical examples with solutions near a moving-water equilibrium. For such examples, still-water well-balanced methods are not capable of capturing the small perturbations of the moving-water equilibrium and may generate significant spurious oscillations, unless an extremely refined mesh is used. On the other hand, moving-water well-balanced methods perform well in these tests. The numerical examples in this note clearly demonstrate the importance of utilizing moving-water well-balanced methods for solutions near a moving-water equilibrium.

Comparison of Glaciological and Gravimetric Glacier Mass Balance Measurements of Taku and Lemon Creek Glaciers, Southeast Alaska

NASA Astrophysics Data System (ADS)

Vogler, K.; McNeil, C.; Bond, M.; Getraer, B.; Huxley-Reicher, B.; McNamara, G.; Reinhardt-Ertman, T.; Silverwood, J.; Kienholz, C.; Beedle, M. J.

2017-12-01

Glacier-wide annual mass balances (Ba) have been calculated for Taku (726 km2) and Lemon Creek glaciers (10.2 km2) since 1946 and 1953 respectively. These are the longest mass balance records in North America, and the only Ba time-series available for Southeast Alaska, making them particularly valuable for the global glacier mass balance monitoring network. We compared Ba time-series from Taku and Lemon Creek glaciers to Gravity Recovery and Climate Experiment (GRACE) mascon solutions (1352 and 1353) during the 2004-2015 period to assess how well these gravimetric solutions reflect individual glaciological records. Lemon Creek Glacier is a challenging candidate for this comparison because it is small compared to the 12,100 km2 GRACE mascon solutions. Taku Glacier is equally challenging because its mass balance is stable compared to the negative balances dominating its neighboring glaciers. Challenges notwithstanding, a high correlation between the glaciological and gravimetrically-derived Ba for Taku and Lemon Creek glaciers encourage future use of GRACE to measure glacier mass balance. Additionally, we employed high frequency ground penetrating radar (GPR) to measure the variability of accumulation around glaciological sites to assess uncertainty in our glaciological measurements, and the resulting impact to Ba. Finally, we synthesize this comparison of glaciological and gravimetric mass balance solutions with a discussion of potential sources of error in both methods and their combined utility for measuring regional glacier change during the 21st century.

The intravascular volume effect of Ringer's lactate is below 20%: a prospective study in humans.

PubMed

Jacob, Matthias; Chappell, Daniel; Hofmann-Kiefer, Klaus; Helfen, Tobias; Schuelke, Anna; Jacob, Barbara; Burges, Alexander; Conzen, Peter; Rehm, Markus

2012-05-16

Isotonic crystalloids play a central role in perioperative fluid management. Isooncotic preparations of colloids (for example, human albumin or hydroxyethyl starch) remain nearly completely intravascular when infused to compensate for acute blood losses. Recent data were interpreted to indicate a comparable intravascular volume effect for crystalloids, challenging the occasionally suggested advantage of using colloids to treat hypovolemia. General physiological knowledge and clinical experience, however, suggest otherwise. In a prospective study, double-tracer blood volume measurements were performed before and after intended normovolemic hemodilution in ten female adults, simultaneously substituting the three-fold amount of withdrawn blood with Ringer's lactate. Any originated deficits were substituted with half the volume of 20% human albumin, followed by a further assessment of blood volume. To assess significance between the measurements, repeated measures analysis of variance (ANOVA) according to Fisher were performed. If significant results were shown, paired t tests (according to Student) for the singular measurements were taken. P < 0.05 was considered to be significant. A total of 1,097 ± 285 ml of whole blood were withdrawn (641 ± 155 ml/m(2) body surface area) and simultaneously replaced by 3,430 ± 806 ml of Ringer's lactate. All patients showed a significant decrease in blood volume after hemodilution (-459 ± 185 ml; P < 0.05) that did not involve relevant hemodynamical changes, and a significant increase in interstitial water content (+2,157 ± 606 ml; P < 0.05). The volume effect of Ringer's lactate was 17 ± 10%. The infusion of 245 ± 64 ml of 20% human albumin in this situation restored blood volume back to baseline values, the volume effect being 184 ± 63%. Substitution of isolated intravascular deficits in cardiopulmonary healthy adults with the three-fold amount of Ringer's lactate impedes maintenance of intravascular normovolemia. The main side effect was an impressive interstitial fluid accumulation, which was partly restored by the intravenous infusion of 20% human albumin. We recommend to substitute the five-fold amount of crystalloids or to use an isooncotic preparation in the face of acute bleeding in patients where edema prevention might be advantageous.

Development and application of a unified balancing approach with multiple constraints

NASA Technical Reports Server (NTRS)

Zorzi, E. S.; Lee, C. C.; Giordano, J. C.

1985-01-01

The development of a general analytic approach to constrained balancing that is consistent with past influence coefficient methods is described. The approach uses Lagrange multipliers to impose orbit and/or weight constraints; these constraints are combined with the least squares minimization process to provide a set of coupled equations that result in a single solution form for determining correction weights. Proper selection of constraints results in the capability to: (1) balance higher speeds without disturbing previously balanced modes, thru the use of modal trial weight sets; (2) balance off-critical speeds; and (3) balance decoupled modes by use of a single balance plane. If no constraints are imposed, this solution form reduces to the general weighted least squares influence coefficient method. A test facility used to examine the use of the general constrained balancing procedure and application of modal trial weight ratios is also described.

Acute Kidney Injury: Quoi de Neuf?

PubMed Central

Reichel, Ronald R.

2014-01-01

Background Acute kidney injury (AKI) is frequently encountered in the nephrology practice. Serum creatinine, with its many shortcomings, is still the main biomarker used to detect AKI. Methods This review focuses on recent advances in definition, diagnosis, risk factors, and molecular mechanisms of AKI. In addition, specific AKI syndromes such as contrast-induced AKI, hepatorenal syndrome, and acute decompensated heart failure are discussed. The connection between AKI and subsequent chronic kidney disease and recent developments in renal replacement therapy are also covered. Results Novel biomarkers such as cystatin C and neutrophil gelatinase–associated lipocalin (NGAL) are being investigated to replace serum creatinine in the detection of AKI. Recent studies suggest that intravenous (IV) fluid use is beneficial for the prevention of contrast-induced AKI, while N-acetylcysteine use is not as well established. Diuretics are clearly beneficial in the treatment of acute decompensated heart failure. Ultrafiltration is less promising and can lead to adverse side effects. Although terlipressin use in hepatorenal syndrome is associated with reduced mortality, it is not available in the United States; combination therapy with midodrine, octreotide, and albumin provides an alternative. Fluid resuscitation is frequently used in critically ill patients with AKI; however, overly aggressive fluid resuscitation is frequently associated with an increased risk of mortality. A 3-step approach that combines guided fluid resuscitation, establishment of an even fluid balance, and an appropriate rate of fluid removal may be beneficial. If fluid resuscitation is needed, crystalloid solutions are preferred over hetastarch solutions. Renal replacement therapy is the last resort in AKI treatment, and timing, modality, and dosing are discussed. Research suggests that AKI leads to an increased incidence of subsequent chronic kidney disease. However, this relationship has not been fully established and additional studies are needed for clarification. Conclusion Despite major advances in AKI research, serum creatinine remains the major biomarker for the detection of AKI. The following interventions have shown to be beneficial: IV fluids for contrast-induced AKI; diuretics for acute decompensated heart failure/cardiorenal syndrome; and combination therapy with midodrine, octreotide, and albumin for hepatorenal syndrome. Fluid resuscitation in a patient with AKI should be used with caution because too liberal use of fluids can be associated with increased mortality. AKI appears to be related to increased rates of subsequent chronic kidney disease, and patients with AKI should therefore be monitored closely. Recent studies on renal replacement therapy have neither revealed an optimal timing for initiation of dialysis nor a clear advantage for a specific dialysis modality. PMID:25249802

The Pathogenesis of Traumatic Coagulopathy

DTIC Science & Technology

2015-01-01

reduction in death due to haemorrhage in trauma patients given tranexamic acid (TXA), which inhibits activation of plasminogen to plasmin [36, 37]. Other...in combination with red cells and tranexamic acid , with extremely limited use of colloid or crystalloid infusions [76–82], a practice known as...blocked by tranexamic acid . Journal of Trauma and Acute Care Surgery 2013; 74: 482–8. 15. Martini WZ, Pusateri AE, Uscilowicz JM, Delgado AV, Holcomb

Predictors of Complications in Patients Receiving Head and Neck Free Flap Reconstructive Procedures.

PubMed

Eskander, Antoine; Kang, Stephen; Tweel, Ben; Sitapara, Jigar; Old, Matthew; Ozer, Enver; Agrawal, Amit; Carrau, Ricardo; Rocco, James W; Teknos, Theodoros N

2018-05-01

Objective To (1) determine the overall complication rate, wound healing, and wound infection complications and (2) identify preoperative, intraoperative, and postoperative predictors of these complications. Study Design Case series with chart review. Setting Tertiary academic cancer hospital. Subjects and Methods All head and neck free flap patients at The Ohio State University (2006-2012) were assessed. Multivariable logistic regression assessed the impact of patient factors, flap and wound factors, and intraoperative factors on the aforementioned quality metric outcomes. Results Of the 515 patients identified, 54% had a complication predicted by longer operating room (OR) time, higher comorbidity index, and oral cavity and pharyngeal tumor sites. Predictors of wound-healing complications (15%) were longer OR time, volume of crystalloid given intraoperatively, and oral cavity and pharyngeal tumor sites. Predictors of wound infection (12%) were younger age, diabetes mellitus, and malnutrition. Conclusions Wound healing and infectious complications account for most complications in patients with head and neck cancer undergoing free flap reconstruction. Clean contaminated wounds are a significant predictor of wound complications. Advanced OR time, advanced age, and comorbidity status, including diabetes mellitus and malnutrition, are other important predictors. Crystalloid administration is also an important predictor of wound-healing complications, and this warrants further study.

[Fluid management and cause of death during shock period in patients with severe burns or burns complicated by inhalation injury].

PubMed

Zhang, Ming-liang; Li, Chi; Ma, Chun-xu

2003-11-01

To explore fluid management and cause of death during shock period in severe burns or burns with inhalation injury. One hundred and twelve patients with severe burns or burn complicated by inhalation injury admitted to our hospital from 1991 to 2000 were analyzed. The fluid management and death conditions during shock period were discussed. The fluid volume for resuscitation could be described as follows: the total fluid volume was 2.2 ml/(%TBSA.kg) including colloid fluid 0.5 ml/(%TBSA.kg), crystalloid fluid 1 ml/(%TBSA.kg)and water 0.7 ml/(%TBSA.kg) during first 24 hours. The total fluid volume was 1.8 ml/(%TBSA.kg) including colloid fluid 0.4 ml/(%TBSA.kg), crystalloid fluid 0.7 ml/(%TBSA.kg) and water 0.7 ml/(%TBSA.kg) during second 24 hours. There were no difference in fluid management between burns and burns with inhalation injury. Seven patients died due to respiratory failure during shock period. Many fluid formula can provide guidance for resuscitation and it is very important that early fluid therapy should accord with concrete clinical conditions of patients in order to pass smoothly through shock period. Early fluid management is not different between burns and burns with inhalation injury.

Detection of dehydration by using volume kinetics.

PubMed

Zdolsek, Joachim; Li, Yuhong; Hahn, Robert G

2012-10-01

Patients admitted to surgery may be dehydrated, which is difficult to diagnose except when it is severe (>5% Gl116 of the body weight). We hypothesized that modest dehydration can be detected by kinetic analysis of the blood hemoglobin concentration after a bolus infusion of crystalloid fluid. Four series of experiments were performed on 10 conscious, healthy male volunteers. Separated by at least 2 days, they received 5 or 10 mL/kg acetated Ringer's solution over 15 minutes. Before starting half of the IV infusions, volume depletion amounting to 1.5 to 2.0 L (approximately 2% of body weight) was induced with furosemide. The elimination clearance and the half-life of the infused fluid were calculated based on blood hemoglobin over 120 minutes. The perfusion index and the pleth variability index were monitored by pulse oximetry after a change of body position. Dehydration decreased the elimination clearance of acetated Ringer's solution [median (25th-75th percentile)] from 1.84 (1.23-2.57) to 0.53 (0.41-0.79) mL/kg/min (Wilcoxon matched-pair test P < 0.001) and increased the half-life from 23 (12-37) to 76 (57-101) minutes (P < 0.001). The smaller infusion, 5 mL/kg, fully discriminated between experiments performed in the euhydrated and dehydrated states, whereas the urinary excretion provided a less-reliable indication of hydration status. Dehydration decreased the perfusion index but did not affect the pleth variability index. Dehydration amounting to 2% of the body weight could be detected from the elimination clearance and the half-life of an infusion of 5 mL/kg Ringer's solution.

An efficient algorithm using matrix methods to solve wind tunnel force-balance equations

NASA Technical Reports Server (NTRS)

Smith, D. L.

1972-01-01

An iterative procedure applying matrix methods to accomplish an efficient algorithm for automatic computer reduction of wind-tunnel force-balance data has been developed. Balance equations are expressed in a matrix form that is convenient for storing balance sensitivities and interaction coefficient values for online or offline batch data reduction. The convergence of the iterative values to a unique solution of this system of equations is investigated, and it is shown that for balances which satisfy the criteria discussed, this type of solution does occur. Methods for making sensitivity adjustments and initial load effect considerations in wind-tunnel applications are also discussed, and the logic for determining the convergence accuracy limits for the iterative solution is given. This more efficient data reduction program is compared with the technique presently in use at the NASA Langley Research Center, and computational times on the order of one-third or less are demonstrated by use of this new program.

Isoflurane in contrast to propofol promotes fluid extravasation during cardiopulmonary bypass in pigs.

PubMed

Brekke, Hege Kristin; Hammersborg, Stig Morten; Lundemoen, Steinar; Mongstad, Arve; Kvalheim, Venny Lise; Haugen, Oddbjørn; Husby, Paul

2013-10-01

A highly positive intraoperative fluid balance should be prevented as it negatively impacts patient outcome. Analysis of volume-kinetics has identified an increase in interstitial fluid volume after crystalloid fluid loading during isoflurane anesthesia. Isoflurane has also been associated with postoperative hypoxemia and may be associated with an increase in alveolar epithelial permeability, edema formation, and hindered oxygen exchange. In this article, the authors compare fluid extravasation rates before and during cardiopulmonary bypass (CPB) with isoflurane- versus propofol-based anesthesia. Fourteen pigs underwent 2 h of tepid CPB with propofol (P-group; n = 7) or isoflurane anesthesia (I-group; n = 7). Fluid requirements, plasma volume, colloid osmotic pressures in plasma and interstitial fluid, hematocrit levels, and total tissue water content were recorded, and fluid extravasation rates calculated. Fluid extravasation rates increased in the I-group from the pre-CPB level of 0.27 (0.13) to 0.92 (0.36) ml·kg·min, but remained essentially unchanged in the P-group with significant between-group differences during CPB (pb = 0.002). The results are supported by corresponding changes in interstitial colloid osmotic pressure and total tissue water content. During CPB, isoflurane, in contrast to propofol, significantly contributes to a general increase in fluid shifts from the intravascular to the interstitial space with edema formation and a possible negative impact on postoperative organ function.

Fluid resuscitation: past, present, and the future.

PubMed

Santry, Heena P; Alam, Hasan B

2010-03-01

Hemorrhage remains a major cause of preventable death following both civilian and military trauma. The goals of resuscitation in the face of hemorrhagic shock are restoring end-organ perfusion and maintaining tissue oxygenation while attempting definitive control of bleeding. However, if not performed properly, resuscitation can actually exacerbate cellular injury caused by hemorrhagic shock, and the type of fluid used for resuscitation plays an important role in this injury pattern. This article reviews the historical development and scientific underpinnings of modern resuscitation techniques. We summarized data from a number of studies to illustrate the differential effects of commonly used resuscitation fluids, including isotonic crystalloids, natural and artificial colloids, hypertonic and hyperoncotic solutions, and artificial oxygen carriers, on cellular injury and how these relate to clinical practice. The data reveal that a uniformly safe, effective, and practical resuscitation fluid when blood products are unavailable and direct hemorrhage control is delayed has been elusive. Yet, it is logical to prevent this cellular injury through wiser resuscitation strategies than attempting immunomodulation after the damage has already occurred. Thus, we describe how some novel resuscitation strategies aimed at preventing or ameliorating cellular injury may become clinically available in the future.

Clinician Survey to Determine Knowledge of Dengue and Clinical Management Practices, Texas, 2014.

PubMed

Adam, Jessica K; Abeyta, Roman; Smith, Brian; Gaul, Linda; Thomas, Dana L; Han, George; Sharp, Tyler M; Waterman, Stephen H; Tomashek, Kay M

2017-03-01

AbstractDengue, a mosquito-borne viral disease, is increasingly being identified as a cause of outbreaks in the United States. During July-December 2013, a total of three south Texas counties reported 53 laboratory-confirmed dengue cases; 26 were locally acquired, constituting the largest outbreak in Texas since 2005. Because dengue outbreaks are expected to continue in south Texas and early case identification and timely treatment can reduce mortality, we sought to determine clinicians' knowledge of dengue and its clinical management. A survey was sent to 2,375 south Texas clinicians; 217 (9%) completed the survey. Approximately half of participants demonstrated knowledge needed to identify dengue cases, including symptoms (56%), early indicators of shock (54%), or timing of thrombocytopenia (48%). Fewer than 20% correctly identified all prevention messages, severe dengue warning signs, or circumstances in which a dengue patient should return for care. Knowledge of clinical management was limited; few participants correctly identified scenarios when plasma leakage occurred (10%) or a crystalloid solution was indicated (7%); however, 45% correctly identified when a blood transfusion was indicated. Because of the ongoing threat of dengue, we recommend clinicians in south Texas receive dengue clinical management training.

Clinician Survey to Determine Knowledge of Dengue and Clinical Management Practices, Texas, 2014

PubMed Central

Adam, Jessica K.; Abeyta, Roman; Smith, Brian; Gaul, Linda; Thomas, Dana L.; Han, George; Sharp, Tyler M.; Waterman, Stephen H.; Tomashek, Kay M.

2017-01-01

Dengue, a mosquito-borne viral disease, is increasingly being identified as a cause of outbreaks in the United States. During July–December 2013, a total of three south Texas counties reported 53 laboratory-confirmed dengue cases; 26 were locally acquired, constituting the largest outbreak in Texas since 2005. Because dengue outbreaks are expected to continue in south Texas and early case identification and timely treatment can reduce mortality, we sought to determine clinicians' knowledge of dengue and its clinical management. A survey was sent to 2,375 south Texas clinicians; 217 (9%) completed the survey. Approximately half of participants demonstrated knowledge needed to identify dengue cases, including symptoms (56%), early indicators of shock (54%), or timing of thrombocytopenia (48%). Fewer than 20% correctly identified all prevention messages, severe dengue warning signs, or circumstances in which a dengue patient should return for care. Knowledge of clinical management was limited; few participants correctly identified scenarios when plasma leakage occurred (10%) or a crystalloid solution was indicated (7%); however, 45% correctly identified when a blood transfusion was indicated. Because of the ongoing threat of dengue, we recommend clinicians in south Texas receive dengue clinical management training. PMID:28138048

The plasticity of clays

USGS Publications Warehouse

Group, F.F.

1905-01-01

(1) Sand injures plasticity little at first because the grains are suspended in a plastic mass. It is only when grains are abundant enough to come in contact with their neighbors, that the effect becomes serious, and then both strength and amount of possible flow are injured. (2) Certain rare organic colloids increase the plasticity by rendering the water viscous. (3) Fineness also tends to increase plasticity. (4) Plane surfaces (plates) increase the amount of possible flow. They also give a chance for lubrication by thinner films, thus increasing the friction of film, and the strength of the whole mass. The action of plates is thus twofold ; but fineness may be carried to such an extent as to break up plate-like grains into angular fragments. The beneficial effects of plates are also decreased by the fact that each is so closely surrounded by others in the mass. (5) Molecular attraction is twofold in increasing plasticity. As the attraction increases, the coherence and strength of the mass increase, and the amount of possible deformation before crumbling also increases. Fineness increases this action by requiring more water. Colloids and crystalloids in solution may also increase the attraction. It is thus seen to be more active than any other single factor.

The Potential Role of Recombinant Activated Factor VIIa (rFVIIa) in Military Pre-Hospital Setting

DTIC Science & Technology

2004-09-01

coagulation factors and platelets by crystalloids, colloids, or blood products The severity of dilutional coagulopathy is determined by both volume and...RTO-MP-HFM-109 3 - 1 The Potential Role of Recombinant Activated Factor VIIa (rFVIIa) in Military Pre-Hospital Setting LTC (ret.) Uri...decrease mortality from exsanguinations. Recombinant factor VIIa (rFVIIa) has been shown to overcome a variety of coagulation and platelet disorders

Automatic computation and solution of generalized harmonic balance equations

NASA Astrophysics Data System (ADS)

Peyton Jones, J. C.; Yaser, K. S. A.; Stevenson, J.

2018-02-01

Generalized methods are presented for generating and solving the harmonic balance equations for a broad class of nonlinear differential or difference equations and for a general set of harmonics chosen by the user. In particular, a new algorithm for automatically generating the Jacobian of the balance equations enables efficient solution of these equations using continuation methods. Efficient numeric validation techniques are also presented, and the combined algorithm is applied to the analysis of dc, fundamental, second and third harmonic response of a nonlinear automotive damper.

Effects of adenosine and defibrotide adjunct to a standard crystalloid cardioplegic solution.

PubMed

Mantovani, V; Mariscalco, G; Borsani, P; Tenconi, S; Bruno, V D; Leva, C; Ferrarese, S; Sala, A

2005-06-01

Adenosine has many actions potentially useful as adjunct to a cardioplegia. Defibrotide was recently shown to have protective effects during cardiac arrest. The aim of this study was to compare these 2 substances to delineate their profile of action in the setting of cardioplegic arrest. A Langendorff model for isolated rat hearts was employed: 3 groups of 8 hearts each were used, respectively with plain St. Thomas cardioplegia as control (group C), and the same solution added with adenosine (group A) or defibrotide (group D). The hearts had a baseline perfusion for 30 minutes with Krebs-Henseleit solution at 37 degrees C, cardioplegia administration for 3 minutes, then 30 minutes of ischemia without any perfusion and finally 30 minutes of reperfusion with Krebs-Henseleit solution at 37 degrees C. The time to attain heart arrest was 20% shorter in group A, but this difference did not reach statistical significance (A: 13.6+/-1.5; D: 16.8+/-2.7; C: 17.3+/-2.2 s). The heart rate during reperfusion in group A was almost identical to baseline, while in both group C and D it was significantly lower (A: 101%, D: 93.4%, C: 82.4%, p<0.01).A and D decreased significantly the release of creatine phospokinase compared to group C (p=0.006). Lactate dehydrogenase release was lower in both treatment groups, although statistical significance was not reached. Peak positive dP/dT decreased more in controls during reperfusion (A: -23+/-6%, D: -17+/-5%, C: -31+/-5%, p=ns). Negative dP/dT was significantly worse in controls compared to both treatments (A: -19+/-6%, D: -12+/-5%, C: -34+/-7%, p=0.035). Both adenosine and defibrotide have protective effects in an isolated model of cardioplegic arrest. Adenosine is significantly more active on heart rate while defibrotide is more active on contractily. Further studies are justified in order to test the combination of these 2 drugs.

[Striking the work-life balance].

PubMed

Dumas, Marc

2014-11-01

Solutions for finding a satisfactory balance between home life and work lie in the organisation of work and the work environment. Line managers in particular have a key role to play in helping their staff maintain this balance.

[The concept of small volume resuscitation for preclinical trauma management. Experiences in the Air Rescue Service].

PubMed

Helm, M; Hauke, J; Kohler, J; Lampl, L

2013-04-01

Prompt hemorrhage control and adequate fluid resuscitation are the key components of early trauma care. However, the optimal resuscitation strategy remains controversial. In this context the small volume resuscitation (SVR) concept with hypertonic-hyperoncotic solutions is a new strategy. This was a retrospective study in the Helicopter Emergency Medical Service over a 5-year period. Included were all major trauma victims if they were candidates for SVR (initially 4 ml HyperHaes/kg body weight, followed by conventional fluid resuscitation with crystalloids and colloids). Demographic data, type and cause of injury and injury severity score (ISS) were recorded and the amount of fluid volume and the hemodynamic profile were analyzed. Negative side-effects as well as sodium chloride serum levels on hospital admission were recorded. A total of 342 trauma victims (male 70.2%, mean age 39.0 ± 18.8 years, ISS 31.6 ± 16.9, ISS>16, 81.6%) underwent prehospital SVR. A blunt trauma mechanism was predominant (96.8%) and the leading cause of injury was motor vehicle accidents (61.5%) and motorcycle accidents (22.3%). Multiple trauma and polytrauma were noted in 87.4% of the cases. Predominant was traumatic brain injury (73.1%) as well as chest injury (73.1%) followed by limb injury (69.9%) and abdominal/pelvic trauma (45.0%). Within the whole study group in addition to 250 ml HyperHaes, mean volumes of 1214 ± 679 ml lactated Ringers and 1288 ± 954 ml hydroxethylstarch were infused during the prehospital treatment phase. There were no statistically significant differences in the amount of crystalloids and colloids infused regarding the subgroups multisystem trauma (ISS>16), severe traumatic brain injury (GCS<9) and entrapment trauma compared to the total study group. In patients with an initial systolic blood pressure (SBP) >80 mmHg significantly less colloids (1035 ± 659 ml vs. 1288 ± 954 ml, p<0.006) were infused, whereas in patients with an initial SBP ≤ 80 mmHg significantly more colloids were infused (1609 ± 1159 ml vs. 1288 ± 954 ml, p<0.002). There was a statistically significant increase in systolic as well as diastolic blood pressure at all times of blood pressure measurement during prehospital treatment after bolus infusion of HyperHaes within the whole study group. The same applies to the subgroups multisystem trauma, severe traumatic brain injury and entrapment trauma. Minor negative side-effects were observed in 4 cases (1.2%). The mean serum sodium chloride profile on hospital admission was 146.9 ± 5.0 mmol/l, the base excess (BE) was -5.7 ± 5.3 mmol/l) and the pH was 7.3 ± 0.1. The concept of small volume resuscitation provides early and effective hemodynamic control. Clinical side-effects associated with bolus infusion of hypertonic-hyperoncotic solutions are rare.

Clinical Risk Factors of Death From Pneumonia in Children with Severe Acute Malnutrition in an Urban Critical Care Ward of Bangladesh

PubMed Central

Chisti, Mohammod Jobayer; Salam, Mohammed Abdus; Ashraf, Hasan; Faruque, Abu S. G.; Bardhan, Pradip Kumar; Hossain, Md Iqbal; Shahid, Abu S. M. S. B.; Shahunja, K. M.; Das, Sumon Kumar; Imran, Gazi; Ahmed, Tahmeed

2013-01-01

Background Risks of death are high when children with pneumonia also have severe acute malnutrition (SAM) as a co-morbidity. However, there is limited published information on risk factors of death from pneumonia in SAM children. We evaluated clinically identifiable factors associated with death in under-five children who were hospitalized for the management of pneumonia and SAM. Methods For this unmatched case-control design, SAM children of either sex, aged 0–59 months, admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) during April 2011 to July 2012 with radiological pneumonia were studied. The SAM children with pneumonia who had fatal outcome constituted the cases (n = 35), and randomly selected SAM children with pneumonia who survived constituted controls (n = 105). Results The median (inter-quartile range) age (months) was comparable among the cases and the controls [8.0 (4.9, 11.0) vs. 9.7 (5.0, 18.0); p = 0.210)]. In logistic regression analysis, after adjusting for potential confounders, such as vomiting, abnormal mental status, and systolic hypotension (<70 mm of Hg) in absence of dehydration, fatal cases of severely malnourished under-five children with pneumonia were more often hypoxemic (OR = 23.15, 95% CI = 4.38–122.42), had clinical dehydration (some/severe) (OR = 9.48, 95% CI = 2.42–37.19), abdominal distension at admission (OR = 4.41, 95% CI = 1.12–16.52), and received blood transfusion (OR = 5.50, 95% CI = 1.21–24.99) for the management of crystalloid resistant systolic hypotension. Conclusion and Significance We identified hypoxemia, clinical dehydration, and abdominal distension as the independent predictors of death in SAM children with pneumonia. SAM children with pneumonia who required blood transfusion for the management of crystalloid resistant systolic hypotension were also at risk for death. Thus, early identification and prompt management of these simple clinically recognizable predictors of death and discourage the use of blood transfusion for the management of crystalloid resistant systolic hypotension may help reduce deaths in such population. PMID:24040043

The energy balance within a bubble column evaporator

NASA Astrophysics Data System (ADS)

Fan, Chao; Shahid, Muhammad; Pashley, Richard M.

2018-05-01

Bubble column evaporator (BCE) systems have been studied and developed for many applications, such as thermal desalination, sterilization, evaporative cooling and controlled precipitation. The heat supplied from warm/hot dry bubbles is to vaporize the water in various salt solutions until the solution temperature reaches steady state, which was derived into the energy balance of the BCE. The energy balance and utilization involved in each BCE process form the fundamental theory of these applications. More importantly, it opened a new field for the thermodynamics study in the form of heat and vapor transfer in the bubbles. In this paper, the originally derived energy balance was reviewed on the basis of its physics in the BCE process and compared with new proposed energy balance equations in terms of obtained the enthalpy of vaporization (Δ H vap) values of salt solutions from BCE experiments. Based on the analysis of derivation and Δ H vap values comparison, it is demonstrated that the original balance equation has high accuracy and precision, within 2% over 19-55 °C using improved systems. Also, the experimental and theoretical techniques used for determining Δ H vap values of salt solutions were reviewed for the operation conditions and their accuracies compared to the literature data. The BCE method, as one of the most simple and accurate techniques, offers a novel way to determine Δ H vap values of salt solutions based on its energy balance equation, which had error less than 3%. The thermal energy required to heat the inlet gas, the energy used for water evaporation in the BCE and the energy conserved from water vapor condensation were estimated in an overall energy balance analysis. The good agreement observed between input and potential vapor condensation energy illustrates the efficiency of the BCE system. Typical energy consumption levels for thermal desalination for producing pure water using the BCE process was also analyzed for different inlet air temperatures, and indicated the better energy efficiency, of 7.55 kW·h per m3 of pure water, compared to traditional thermal desalination techniques.

Weak periodic solutions of xẍ + 1 = 0 and the Harmonic Balance Method

NASA Astrophysics Data System (ADS)

García-Saldaña, J. D.; Gasull, A.

2017-02-01

We prove that the differential equation xẍ + 1 = 0 has continuous weak periodic solutions and compute their periods. Then, we use the Harmonic Balance Method until order six to approximate these periods and to illustrate how the accuracy of the method increases with the order. Our computations rely on the Gröbner basis approach.

Potential Resuscitation Strategies for Treatment of Hemorrhagic Shock

DTIC Science & Technology

2004-09-01

thrombus (the “pop-clot” pressure); 2) an injectable clot stabilizer (“fix-a-leak”) that is a naturally occurring factor in the clotting cascade (human...recombinant Factor VIIa); and 3) the maximum time up to 24 hours for hypotensive resuscitation below the “pop-the-clot” pressure (“how low for how long...To prevent this blood products are given as soon as possible in the emergency department. Only crystalloids and colloids are currently available on

Marine Corps CASEVAC: Determining Medical Supply Requirements for Long-Range Casualty Evacuation Aircraft

DTIC Science & Technology

2003-08-01

Force of blades Extreme Moderate Moderate Moderate Temperature Heating, no A/C Heating, no A/C Heating, no A/C Heating, no A/C In-flight refueling Yes...CASEVAC CUBE CASEVAC PRICE 6515013215211 Airway Kit Percutaneous Emergency Adult Sterile Disposable 1.00 EA 0.2000 0.0500 $206.27 6515011676637...UI CASEVAC WEIGHT CASEVAC CUBE CASEVAC PRICE 6515014661488 Crystalloid and Colloid Pump Cartridges And IV Sets for the Power Infuser. Sterile

Preload assessment and optimization in critically ill patients.

PubMed

Voga, Gorazd

2010-01-01

Preload assessment and optimization is the basic hemodynamic intervention in critically ill. Beside clinical assessment, non-invasive or invasive assessment by measurement of various pressure or volume hemodynamic variables, are helpful for estimation of preload and fluid responsiveness. The use of dynamic variables is useful in particular subgroup of critically ill patients. In patients with inadequate preload, fluid responsiveness and inadequate flow, treatment with crystalloids or colloids is mandatory. When rapid hemodynamic response is necessary colloids are preferred.

Characterization of chromoplasts and carotenoids of red- and yellow-fleshed papaya (Carica papaya L.).

PubMed

Schweiggert, Ralf M; Steingass, Christof B; Heller, Annerose; Esquivel, Patricia; Carle, Reinhold

2011-11-01

Chromoplast morphology and ultrastructure of red- and yellow-fleshed papaya (Carica papaya L.) were investigated by light and transmission electron microscopy. Carotenoid analyses by LC-MS revealed striking similarity of nutritionally relevant carotenoid profiles in both the red and yellow varieties. However, while yellow fruits contained only trace amounts of lycopene, the latter was found to be predominant in red papaya (51% of total carotenoids). Comparison of the pigment-loaded chromoplast ultrastructures disclosed tubular plastids to be abundant in yellow papaya, whereas larger crystalloid substructures characterized most frequent red papaya chromoplasts. Exclusively existent in red papaya, such crystalloid structures were associated with lycopene accumulation. Non-globular carotenoid deposition was derived from simple solubility calculations based on carotenoid and lipid contents of the differently colored fruit pulps. Since the physical state of carotenoid deposition may be decisive regarding their bioavailability, chromoplasts from lycopene-rich tomato fruit (Lycopersicon esculentum L.) were also assessed and compared to red papaya. Besides interesting analogies, various distinctions were ascertained resulting in the prediction of enhanced lycopene bioavailability from red papaya. In addition, the developmental pathway of red papaya chromoplasts was investigated during fruit ripening and carotenogenesis. In the early maturation stage of white-fleshed papaya, undifferentiated proplastids and globular plastids were predominant, corresponding to incipient carotenoid biosynthesis. Since intermediate plastids, e.g., amyloplasts or chloroplasts, were absent, chromoplasts are likely to emerge directly from proplastids.

Systematic Approach to Calculate the Concentration of Chemical Species in Multi-Equilibrium Problems

ERIC Educational Resources Information Center

Baeza-Baeza, Juan Jose; Garcia-Alvarez-Coque, Maria Celia

2011-01-01

A general systematic approach is proposed for the numerical calculation of multi-equilibrium problems. The approach involves several steps: (i) the establishment of balances involving the chemical species in solution (e.g., mass balances, charge balance, and stoichiometric balance for the reaction products), (ii) the selection of the unknowns (the…

Water--Problems and Solutions. A Report Concerning the Problems and Solutions of Negative Water Balance.

ERIC Educational Resources Information Center

Ewert, Alan

Outdoor leaders constantly face problems created by water shortage and, to act effectively, must thoroughly understand the body's use of water and the ways to delay dehydration when water shortage occurs. Dehydration begins when there is a negative water balance, or more water lost than ingested, and progresses from the stage of dryness, to the…

Positivity-preserving well-balanced discontinuous Galerkin methods for the shallow water flows in open channels

NASA Astrophysics Data System (ADS)

Qian, Shouguo; Li, Gang; Shao, Fengjing; Xing, Yulong

2018-05-01

We construct and study efficient high order discontinuous Galerkin methods for the shallow water flows in open channels with irregular geometry and a non-flat bottom topography in this paper. The proposed methods are well-balanced for the still water steady state solution, and can preserve the non-negativity of wet cross section numerically. The well-balanced property is obtained via a novel source term separation and discretization. A simple positivity-preserving limiter is employed to provide efficient and robust simulations near the wetting and drying fronts. Numerical examples are performed to verify the well-balanced property, the non-negativity of the wet cross section, and good performance for both continuous and discontinuous solutions.

GRACE time-variable gravity field recovery using an improved energy balance approach

NASA Astrophysics Data System (ADS)

Shang, Kun; Guo, Junyi; Shum, C. K.; Dai, Chunli; Luo, Jia

2015-12-01

A new approach based on energy conservation principle for satellite gravimetry mission has been developed and yields more accurate estimation of in situ geopotential difference observables using K-band ranging (KBR) measurements from the Gravity Recovery and Climate Experiment (GRACE) twin-satellite mission. This new approach preserves more gravity information sensed by KBR range-rate measurements and reduces orbit error as compared to previous energy balance methods. Results from analysis of 11 yr of GRACE data indicated that the resulting geopotential difference estimates agree well with predicted values from official Level 2 solutions: with much higher correlation at 0.9, as compared to 0.5-0.8 reported by previous published energy balance studies. We demonstrate that our approach produced a comparable time-variable gravity solution with the Level 2 solutions. The regional GRACE temporal gravity solutions over Greenland reveals that a substantially higher temporal resolution is achievable at 10-d sampling as compared to the official monthly solutions, but without the compromise of spatial resolution, nor the need to use regularization or post-processing.

Efficiency of the Thermal Jacket on the Delivered Temperature of Prewarmed Crystalloid Intravenous Fluid

DTIC Science & Technology

1989-01-01

intervals over a 60 minute period at flow rates of 100, 250, 500, 750, and 1,000 ml/hr. Analysis of variance showed a highly significant group effect with a...significant difference between all groups except Group 3 and Group 4. Analysis of - .riance aiso showed a highly significant flow rate effect on...as effective as the conventional method of delivering warmed fluids. Also, within the range of flow rates studied, faster flow rates tended to yield a

Effects of Crystalloid and Colloid Resuscitation on Hemorrhage-Induced Vascular Hyporesponsiveness to Norepinephrine in the Rat

DTIC Science & Technology

2003-05-01

SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT SAR 18. NUMBER OF PAGES 10 19a. NAME OF RESPONSIBLE PERSON a. REPORT unclassified b ...the basis of the following equation: The relative change in blood flow after NE (A B )/A, where A blood flow before NE administration and B the...baseline and at the end of the experiment were used for determination of hematocrit (Hct) and blood Na, K , and Cl according to standard clinical

Use of an Impedance Threshold Device in Spontaneously Breathing Patients with Hypotension Secondary to Trauma: An Observational Cohort Feasibility Study

DTIC Science & Technology

2014-09-09

hypotensive patient. Crystalloid infusion is not necessarily benign.1,2 Difficult vascular access, hemodilution, acidosis , decreased oxygen delivery, and...blood pressure, heart rate (HR), respiratory rate, and arterial oxygen saturation (SpO2) were recorded im- mediately before application of the ITD...per minute (p = 0.007). The respiratory rate was constant: 19 (7) breaths before to 18 (4) breaths (p = 0.31) per minute after ITD use. Oxygen

Preventing Hypothermia: Comparison of Current Devices Used by the U.S. Army with an In Vitro Warmed Crystalloid Fluid Model

DTIC Science & Technology

2010-04-01

the start of the experiment and remained so throughout the rest of the experimental period (Fig 4, Table 2). Mean core temperature observed was 36.72...removal [4, 9]. At temperatures less than 32ºC the body experiences a severe decrease in intrinsic metabolic rate. At less than 24ºC endocrine...in the field are thus forced to base their procurement decisions on either personal anecdotal experience or manufacturer claims of performance or

A multi-harmonic generalized energy balance method for studying autonomous oscillations of nonlinear conservative systems

NASA Astrophysics Data System (ADS)

Balaji, Nidish Narayanaa; Krishna, I. R. Praveen; Padmanabhan, C.

2018-05-01

The Harmonic Balance Method (HBM) is a frequency-domain based approximation approach used for obtaining the steady state periodic behavior of forced dynamical systems. Intrinsically these systems are non-autonomous and the method offers many computational advantages over time-domain methods when the fundamental period of oscillation is known (generally fixed as the forcing period itself or a corresponding sub-harmonic if such behavior is expected). In the current study, a modified approach, based on He's Energy Balance Method (EBM), is applied to obtain the periodic solutions of conservative systems. It is shown that by this approach, periodic solutions of conservative systems on iso-energy manifolds in the phase space can be obtained very efficiently. The energy level provides the additional constraint on the HBM formulation, which enables the determination of the period of the solutions. The method is applied to the linear harmonic oscillator, a couple of nonlinear oscillators, the elastic pendulum and the Henon-Heiles system. The approach is used to trace the bifurcations of the periodic solutions of the last two, being 2 degree-of-freedom systems demonstrating very rich dynamical behavior. In the process, the advantages offered by the current formulation of the energy balance is brought out. A harmonic perturbation approach is used to evaluate the stability of the solutions for the bifurcation diagram.

The effect of low glucose degradation product, neutral pH versus standard peritoneal dialysis solutions on peritoneal membrane function: the balANZ trial

PubMed Central

Johnson, David W.; Brown, Fiona G.; Clarke, Margaret; Boudville, Neil; Elias, Tony J.; Foo, Marjorie W.Y.; Jones, Bernard; Kulkarni, Hemant; Langham, Robyn; Ranganathan, Dwarakanathan; Schollum, John; Suranyi, Michael G.; Tan, Seng H.; Voss, David

2012-01-01

Background The balANZ trial recently reported that neutral pH, low glucose degradation product (biocompatible) peritoneal dialysis (PD) solutions significantly delayed anuria and reduced peritonitis rates compared with conventional solutions. This article reports a secondary outcome analysis of the balANZ trial with respect to peritoneal membrane function. Methods Adult, incident PD patients with residual renal function were randomized to receive either biocompatible or conventional (control) PD solutions for 2 years. Peritoneal equilibration tests were performed at 1, 6, 12, 18 and 24 months. Peritoneal small solute clearances and ultra-filtration (UF) were measured at 3, 6, 9, 12, 18 and 24 months. Results Of the 185 patients recruited into the trial, 85 patients in the Balance group and 82 patients in the control group had peritoneal membrane function evaluated. Mean 4-h dialysate:plasma creatinine ratios (D:P Cr 4h) at 1 month were significantly higher in the Balance group compared with controls (0.67 ± 0.10 versus 0.62 ± 0.10, P = 0.002). Over the 2-year study period, mean D:P Cr 4 h measurements remained stable in the Balance group but increased significantly in controls [difference −0.004 per month, 95% confidence interval (95% CI) −0.005 to −0.002, P < 0.001]. Similar results were obtained for dialysate glucose ratios (D/D0 glucose). Peritoneal UF was significantly lower in the Balance group than in controls at 3 and 6 months. Over the 2-year study period, peritoneal UF increased significantly in the Balance group but remained stable in controls (difference 24 mL/day/month, 95% CI 9–39, P = 0.002). No differences in peritoneal small solute clearances, prescribed dialysate fill volumes or peritoneal glucose exposure were observed between the two groups. Conclusions Biocompatible and conventional PD solutions exert differential effects on peritoneal small solute transport rate and UF over time. Adequately powered trials assessing the impact of these differential membrane effects on PD technique and patient survival rates are warranted. PMID:22859794

Method of Harmonic Balance in Full-Scale-Model Tests of Electrical Devices

NASA Astrophysics Data System (ADS)

Gorbatenko, N. I.; Lankin, A. M.; Lankin, M. V.

2017-01-01

Methods for determining the weber-ampere characteristics of electrical devices, one of which is based on solution of direct problem of harmonic balance and the other on solution of inverse problem of harmonic balance by the method of full-scale-model tests, are suggested. The mathematical model of the device is constructed using the describing function and simplex optimization methods. The presented results of experimental applications of the method show its efficiency. The advantage of the method is the possibility of application for nondestructive inspection of electrical devices in the processes of their production and operation.

Bayer Digester Optimization Studies using Computer Techniques

NASA Astrophysics Data System (ADS)

Kotte, Jan J.; Schleider, Victor H.

Theoretically required heat transfer performance by the multistaged flash heat reclaim system of a high pressure Bayer digester unit is determined for various conditions of discharge temperature, excess flash vapor and indirect steam addition. Solution of simultaneous heat balances around the digester vessels and the heat reclaim system yields the magnitude of available heat for representation of each case on a temperature-enthalpy diagram, where graphical fit of the number of flash stages fixes the heater requirements. Both the heat balances and the trial-and-error graphical solution are adapted to solution by digital computer techniques.

Balanced Central Schemes for the Shallow Water Equations on Unstructured Grids

NASA Technical Reports Server (NTRS)

Bryson, Steve; Levy, Doron

2004-01-01

We present a two-dimensional, well-balanced, central-upwind scheme for approximating solutions of the shallow water equations in the presence of a stationary bottom topography on triangular meshes. Our starting point is the recent central scheme of Kurganov and Petrova (KP) for approximating solutions of conservation laws on triangular meshes. In order to extend this scheme from systems of conservation laws to systems of balance laws one has to find an appropriate discretization of the source terms. We first show that for general triangulations there is no discretization of the source terms that corresponds to a well-balanced form of the KP scheme. We then derive a new variant of a central scheme that can be balanced on triangular meshes. We note in passing that it is straightforward to extend the KP scheme to general unstructured conformal meshes. This extension allows us to recover our previous well-balanced scheme on Cartesian grids. We conclude with several simulations, verifying the second-order accuracy of our scheme as well as its well-balanced properties.

An Iterated Global Mascon Solution with Focus on Land Ice Mass Evolution

NASA Technical Reports Server (NTRS)

Luthcke, S. B.; Sabaka, T.; Rowlands, D. D.; Lemoine, F. G.; Loomis, B. D.; Boy, J. P.

2012-01-01

Land ice mass evolution is determined from a new GRACE global mascon solution. The solution is estimated directly from the reduction of the inter-satellite K-band range rate observations taking into account the full noise covariance, and formally iterating the solution. The new solution increases signal recovery while reducing the GRACE KBRR observation residuals. The mascons are estimated with 10-day and 1-arc-degree equal area sampling, applying anisotropic constraints for enhanced temporal and spatial resolution of the recovered land ice signal. The details of the solution are presented including error and resolution analysis. An Ensemble Empirical Mode Decomposition (EEMD) adaptive filter is applied to the mascon solution time series to compute timing of balance seasons and annual mass balances. The details and causes of the spatial and temporal variability of the land ice regions studied are discussed.

Littoral Combat Ship Crew Scheduling

DTIC Science & Technology

2015-03-01

events and schedules. The selection of u for each sub-problem also has the same tradeoff considerations of balancing solve time and overly myopic ...extending them beyond four months in a phase. Results are compared based on solve time and penalty value. The MIP solution has the best quality...benefits to crew alignment for longer-range schedules. The planner must balance solve time and solution quality when determining the approach to

Cerebral Microvascular and Systemic Effects Following Intravenous Administration of the Perfluorocarbon Emulsion Perftoran

PubMed Central

Abutarboush, Rania; Saha, Biswajit K.; Mullah, Saad H.; Arnaud, Francoise G.; Haque, Ashraful; Aligbe, Chioma; Pappas, Georgina; Auker, Charles R.; McCarron, Richard M.; Moon-Massat, Paula F.; Scultetus, Anke H.

2016-01-01

Oxygen-carrying perfluorocarbon (PFC) fluids have the potential to increase tissue oxygenation during hypoxic states and to reduce ischemic cell death. Regulatory approval of oxygen therapeutics was halted due to concerns over vasoconstrictive side effects. The goal of this study was to assess the potential vasoactive properties of Perftoran by measuring brain pial arteriolar diameters in a healthy rat model. Perftoran, crystalloid (saline) or colloid (Hextend) solutions were administered as four sequential 30 min intravenous (IV) infusions, thus allowing an evaluation of cumulative dose-dependent effects. There were no overall changes in diameters of small-sized (<50 μm) pial arterioles within the Perftoran group, while both saline and Hextend groups exhibited vasoconstriction. Medium-sized arterioles (50–100 μm) showed minor (~8–9%) vasoconstriction within saline and Hextend groups and only ~5% vasoconstriction within the Perftoran group. For small- and medium-sized pial arterioles, the mean percent change in vessel diameters was not different among the groups. Although there was a tendency for arterial blood pressures to increase with Perftoran, pressures were not different from the other two groups. These data show that Perftoran, when administered to healthy anesthetized rats, does not cause additional vasoconstriction in cerebral pial arterioles or increase systemic blood pressure compared with saline or Hextend. PMID:27869709

Resection of subvalvular aortic stenosis. Surgical and perioperative management in seven dogs.

PubMed

Komtebedde, J; Ilkiw, J E; Follette, D M; Breznock, E M; Tobias, A H

1993-01-01

Open heart surgery was performed during cardiopulmonary bypass (CPB) to surgically correct subvalvular aortic stenosis in seven dogs. After initiation of total CPB, cardiac arrest was induced by antegrade and retrograde administration of blood cardioplegia. The subvalvular fibrous stenosis was resected through a transverse aortotomy. Intraoperatively and postoperatively, dobutamine, nitroprusside, lidocaine, blood(-products), and crystalloid solutions were used to manage hypotension and optimize cardiac index. Aortic cross-clamp time varied from 73 to 166 minutes, and duration of CPB varied from 130 to 210 minutes. Iatrogenic incision into the mitral valve in two dogs was the most significant intraoperative complication. Postoperative complications included: hypoproteinemia (n = 7), premature ventricular depolarization (n = 6), increased systemic vascular resistance index (n = 5), increased O2 extraction (n = 3), pulmonary edema (n = 2), and decreased cardiac index (n = 1). All seven dogs were discharged alive and in stable condition. Six dogs are alive and in stable condition after a mean follow up of 15.8 months. This is the first detailed report of CPB in a series of clinical veterinary patients. Using the techniques described in this paper, open heart surgery of considerable duration can be performed successfully in dogs with significant myocardial hypertrophy and endomyocardial fibrosis secondary to subvalvular aortic stenosis.

Cerebral Microvascular and Systemic Effects Following Intravenous Administration of the Perfluorocarbon Emulsion Perftoran.

PubMed

Abutarboush, Rania; Saha, Biswajit K; Mullah, Saad H; Arnaud, Francoise G; Haque, Ashraful; Aligbe, Chioma; Pappas, Georgina; Auker, Charles R; McCarron, Richard M; Moon-Massat, Paula F; Scultetus, Anke H

2016-11-18

Oxygen-carrying perfluorocarbon (PFC) fluids have the potential to increase tissue oxygenation during hypoxic states and to reduce ischemic cell death. Regulatory approval of oxygen therapeutics was halted due to concerns over vasoconstrictive side effects. The goal of this study was to assess the potential vasoactive properties of Perftoran by measuring brain pial arteriolar diameters in a healthy rat model. Perftoran, crystalloid (saline) or colloid (Hextend) solutions were administered as four sequential 30 min intravenous (IV) infusions, thus allowing an evaluation of cumulative dose-dependent effects. There were no overall changes in diameters of small-sized (<50 μm) pial arterioles within the Perftoran group, while both saline and Hextend groups exhibited vasoconstriction. Medium-sized arterioles (50-100 μm) showed minor (~8-9%) vasoconstriction within saline and Hextend groups and only ~5% vasoconstriction within the Perftoran group. For small- and medium-sized pial arterioles, the mean percent change in vessel diameters was not different among the groups. Although there was a tendency for arterial blood pressures to increase with Perftoran, pressures were not different from the other two groups. These data show that Perftoran, when administered to healthy anesthetized rats, does not cause additional vasoconstriction in cerebral pial arterioles or increase systemic blood pressure compared with saline or Hextend.

Crystalloid flush with backward unclamping may decrease post-reperfusion cardiac arrest and improve short-term graft function when compared to portal blood flush with forward unclamping during liver transplantation.

PubMed

Fukazawa, Kyota; Nishida, Seigo; Hibi, Taizo; Pretto, Ernesto A

2013-01-01

During liver transplant (LT), the release of vasoactive substances into the systemic circulation is associated with severe hemodynamic instability that is injurious to the recipient and/or the post-ischemic graft. Crystalloid flush with backward unclamping (CB) and portal blood flush with forward unclamping (PF) are two reperfusion methods to reduce reperfusion-related cardiovascular perturbations in our center. The primary aim of this study was to compare these two methods. After institutional review board (IRB) approval, cadaveric whole LT cases performed between 2003 and 2008 were reviewed. Patients were divided into two groups based on reperfusion methods: CB or PF. After background matching with propensity score, the effect of each method on post-operative graft function was assessed in detail. In our cohort of 478 patients, CB was used in 313 grafts and PF in 165. Thirty-day graft survival was lower, and risk of retransplantation was higher in PF. Multivariable model showed that CB is an independent factor to reduce primary non-function, cardiac arrest and improve 30-d graft survival. Also, the incidence of ischemic-type biliary lesions was significantly higher in the PF group. Reperfusion methods affect intraoperative hemodynamics and post-transplant outcome. CB allows for control over temperature and composition of the perfusate, perfusion pressure, and the rate of infusion. © 2013 John Wiley & Sons A/S.

IV crystalloid fluid for acute alcoholic intoxication prolongs ED length of stay.

PubMed

Homma, Yosuke; Shiga, Takashi; Hoshina, Yuiko; Numata, Kenji; Mizobe, Michiko; Nakashima, Yoshiyuki; Takahashi, Jin; Inoue, Tetsuya; Takahashi, Osamu; Funakoshi, Hiraku

2018-04-01

Acute alcohol intoxication is often treated in emergency departments by intravenous crystalloid fluid (IVF), but it is not clear that this shortens the time to achieving sobriety. The study aim was to investigate the association of IVF infusion and length of stay in the ED. This single-center retrospective cohort study was conducted in Japan and included patients aged ≥20years of age and treated for acute alcohol intoxication without or with IVF. The primary outcome was the length of the ED stay and the treatments were compared by time-to-event analysis. A total of 106 patients, 42 treated without IVF and 64 with IVF. The baseline characteristics of the two groups were similar. Kaplan-Meier analysis and the generalized Wilcoxon test found no significant difference between the two treatments in the time to ED discharge. The median time was 189 (IQR 160-230) minutes without IVF and 254.5 (203-267 minutes with IVF; p=0.052). A Cox proportional hazards regression model adjusted for potential confounding variables found that patients treated with IVF were less likely to be discharged earlier than those treated without IVF (HR 0.54, 95% CI: 0.35-0.84, p=0.006). IVF for treatment of acute alcoholic intoxication prolonged ED length of stay even after adjustment for potential confounders. Patients given IVF for acute alcohol intoxication should be selected with care. Copyright © 2017 Elsevier Inc. All rights reserved.

More complications in patients with septic shock treated with dextran compared with crystalloids.

PubMed

Rasmussen, Anders Mølgaard; Jakobsen, Rasmus; Strøm, Thomas; Carlsson, Marcela; Dahler-Eriksen, Bjarne; Toft, Palle

2015-02-01

In recent years, the safety-profile of synthetic colloids has been questioned. The purpose of the present study was to elucidate the safety-profile of the colloid dextran-70 in relation to acute kidney injury (AKI) and death. We conducted a retrospective, observational study of patients admitted to our intensive care unit with septic shock and treated with dextran-70 in the period from 1 January 2009 to 31 December 2009. The controls were included from 1 March 2012 to 28 February 2013 when dextran-70 was replaced with crystalloids. There were 91 patients in the dextran group and 150 patients in the non-dextran group. The urinary output was 17.93 ml/kg/24 h in the dextran group and 27.87 in the non-dextran group (p < 0.05). Continuous renal replacement therapy (CRRT) was used in 48% in the dextran group and in 23% in the non-dextran group (p < 0.05). Major bleeding episodes occurred in 32% in the dextran group compared with 15% in the control group (p < 0.05). The 90-day mortality was 42% in the dextran group and 35% in the non-dextran group (p = 0.08). Patients in the dextran group had significantly more bleeding episodes, a higher need for CRRT and a lower urinary output than patients in the non-dextran group. Due to study design, it cannot be concluded that the use of dextran-70 is causally related to the development of AKI.

The method and accuracy of documentation of intraoperative fluids management in liver transplantation recipients.

PubMed

Liao, Hsiu-Lan; Chen, Chao-Long; Wang, Chih-Hsien; Chen, Chi-Ling; Huang, Chia-Jung; Cheng, Kwok-Wai; Wang, Chih-Chi; Concejero, Allan M; Wang, Shir-Hor; Liu, Yueh-Wei; Jawade, Kailash; Wu, Shao-Chun; Jawan, Bruno

2011-01-01

In liver transplantation, blood loss can be massive, requiring timely and rapid fluid resuscitation. Maintaining proper documentation of fluids during such situations can be difficult and may often lead to counting errors. We report our method of documentation of fluid management during liver transplantation. Each unit of red blood cells (125 cc) that comes from the blood bank had a serial number of 10 Arabic numbers which were verified and double-checked. Each unit was then numbered and labeled as encircled absolute numbers (e.g., 1, 2, 3). Both the encircled number and the serial number of the bag were recorded in the anesthesia chart. Each liter of crystalloids and colloids were similarly numbered and labeled in sequence for ease of calculation. At the end of the operation, the nurse anesthetist ascertains that the number of units of blood products used matched with the number of units supplied by the blood bank. The total amounts of crystalloids and colloids given during the operation was also calculated, rechecked and written in a tabulated form. Since the introduction of this method, we have detected and readily corrected 3 incidences of counting discrepancy in the total units of blood products transfused and the products supplied by the blood bank. Moreover, our records have now become transparent data that are easily retrievable for future scientific research. Our method of documentation of fluid management during liver transplantation is easy, accurate and effective.

Exact solutions of the population balance equation including particle transport, using group analysis

NASA Astrophysics Data System (ADS)

Lin, Fubiao; Meleshko, Sergey V.; Flood, Adrian E.

2018-06-01

The population balance equation (PBE) has received an unprecedented amount of attention in recent years from both academics and industrial practitioners because of its long history, widespread use in engineering, and applicability to a wide variety of particulate and discrete-phase processes. However it is typically impossible to obtain analytical solutions, although in almost every case a numerical solution of the PBEs can be obtained. In this article, the symmetries of PBEs with homogeneous coagulation kernels involving aggregation, breakage and growth processes and particle transport in one dimension are found by direct solving the determining equations. Using the optimal system of one and two-dimensional subalgebras, all invariant solutions and reduced equations are obtained. In particular, an explicit analytical physical solution is also presented.

Role of permissive hypotension, hypertonic resuscitation and the global increased permeability syndrome in patients with severe hemorrhage: adjuncts to damage control resuscitation to prevent intra-abdominal hypertension.

PubMed

Duchesne, Juan C; Kaplan, Lewis J; Balogh, Zsolt J; Malbrain, Manu L N G

2015-01-01

Secondary intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are closely related to fluid resuscitation. IAH causes major deterioration of the cardiac function by affecting preload, contractility and afterload. The aim of this review is to discuss the different interactions between IAH, ACS and resuscitation, and to explore a new hypothesis with regard to damage control resuscitation, permissive hypotension and global increased permeability syndrome. Review of the relevant literature via PubMed search. The recognition of the association between the development of ACS and resuscitation urged the need for new approach in traumatic shock management. Over a decade after wide spread application of damage control surgery damage control resuscitation was developed. DCR differs from previous resuscitation approaches by attempting an earlier and more aggressive correction of coagulopathy, as well as metabolic derangements like acidosis and hypothermia, often referred to as the 'deadly triad' or the 'bloody vicious cycle'. Permissive hypotension involves keeping the blood pressure low enough to avoid exacerbating uncontrolled haemorrhage while maintaining perfusion to vital end organs. The potential detrimental mechanisms of early, aggressive crystalloid resuscitation have been described. Limitation of fluid intake by using colloids, hypertonic saline (HTS) or hyperoncotic albumin solutions have been associated with favourable effects. HTS allows not only for rapid restoration of circulating intravascular volume with less administered fluid, but also attenuates post-injury oedema at the microcirculatory level and may improve microvascular perfusion. Capillary leak represents the maladaptive, often excessive, and undesirable loss of fluid and electrolytes with or without protein into the interstitium that generates oedema. The global increased permeability syndrome (GIPS) has been articulated in patients with persistent systemic inflammation failing to curtail transcapillary albumin leakage and resulting in increasingly positive net fluid balances. GIPS may represent a third hit after the initial insult and the ischaemia reperfusion injury. Novel markers like the capillary leak index, extravascular lung water and pulmonary permeability index may help the clinician in guiding appropriate fluid management. Capillary leak is an inflammatory condition with diverse triggers that results from a common pathway that includes ischaemia-reperfusion, toxic oxygen metabolite generation, cell wall and enzyme injury leading to a loss of capillary endothelial barrier function. Fluid overload should be avoided in this setting.

Computing multiple periodic solutions of nonlinear vibration problems using the harmonic balance method and Groebner bases

NASA Astrophysics Data System (ADS)

Grolet, Aurelien; Thouverez, Fabrice

2015-02-01

This paper is devoted to the study of vibration of mechanical systems with geometric nonlinearities. The harmonic balance method is used to derive systems of polynomial equations whose solutions give the frequency component of the possible steady states. Groebner basis methods are used for computing all solutions of polynomial systems. This approach allows to reduce the complete system to an unique polynomial equation in one variable driving all solutions of the problem. In addition, in order to decrease the number of variables, we propose to first work on the undamped system, and recover solution of the damped system using a continuation on the damping parameter. The search for multiple solutions is illustrated on a simple system, where the influence of the retained number of harmonic is studied. Finally, the procedure is applied on a simple cyclic system and we give a representation of the multiple states versus frequency.

Lactated ringer's solution and hetastarch but not plasma resuscitation after rat hemorrhagic shock is associated with immediate lung apoptosis by the up-regulation of the Bax protein.

PubMed

Deb, S; Sun, L; Martin, B; Talens, E; Burris, D; Kaufmann, C; Rich, N; Rhee, P

2000-07-01

We previously demonstrated that the type of resuscitation fluid used in hemorrhagic shock affects apoptosis. Unlike crystalloid, whole blood seems to attenuate programmed cell death. The purpose of this study was to determine whether the acellular components of whole blood (plasma, albumin) attenuated apoptosis and to determine whether this process involved the Bax protein pathway. Rats were hemorrhaged 27.5 mL/kg, kept in hypovolemic shock for 75 minutes, then resuscitated over 1 hour (n = 44). Control animals underwent anesthesia only (sham, n = 7). Treatment animals were bled then randomly assigned to the following resuscitation groups: no resuscitation (n = 6), whole blood (n = 6), plasma (n = 6), 5% human albumin (n = 6), 6% hetastarch (n = 7), and lactated Ringer's solution (LR, n = 6). Hetastarch was used to control for any colloid effect. LR was used as positive control. Immediately after resuscitation, the lung was collected and evaluated for apoptosis by using two methods. TUNEL stain was used to determine general DNA damage, and Bax protein was used to specifically determine intrinsic pathway involvement. LR and hetastarch treatment resulted in significantly increased apoptosis in the lung as determined by both TUNEL and Bax expression (p < 0.05). Plasma infusion resulted in significantly less apoptosis than LR and hetastarch resuscitation. Multiple cell types (epithelium, endothelium, smooth muscle, monocytes) underwent apoptosis in the lung as demonstrated by the TUNEL stain, whereas Bax expression was limited to cells residing in the perivascular and peribronchial spaces. Apoptosis after volume resuscitation of hemorrhagic shock can be affected by the type of resuscitation fluid used. Manufactured fluids such as lactated Ringer's solution and 6% hetastarch resuscitation resulted in the highest degree of lung apoptosis. The plasma component of whole blood resulted in the least apoptosis. The process of apoptosis after hemorrhagic shock resuscitation involves the Bax protein.

Small-dose hypobaric lidocaine-fentanyl spinal anesthesia for short duration outpatient laparoscopy. I. A randomized comparison with conventional dose hyperbaric lidocaine.

PubMed

Vaghadia, H; McLeod, D H; Mitchell, G W; Merrick, P M; Chilvers, C R

1997-01-01

A randomized, single-blind trial of two spinal anesthetic solutions for outpatient laparoscopy was conducted to compare intraoperative conditions and postoperative recovery. Thirty women (ASA physical status I and II) were assigned to one of two groups. Group I patients received a small-dose hypobaric solution of 1% lidocaine 25 mg made up to 3 mL by the addition of fentanyl 25 micrograms. Group II patients received a conventional-dose hyperbaric solution of 5% lidocaine 75 mg (in 7.5% dextrose) made up to 3 mL by the addition of 1.5 mL 10% dextrose. All patients received 500 mL of crystalloid preloading. Spinal anesthesia was performed at L2-3 or L3-4 with a 27-gauge Quincke point needle. Surgery commenced when the level of sensory anesthesia reached T-6. Intraoperative hypotension requiring treatment with ephedrine occurred in 54% of Group II patients but not in any Group I patients. Median (range) time for full motor recovery was 50 (0-95) min in Group I patients compared to 90 (50-120) min in Group II patients (P = 0.0005). Sensory recovery also occurred faster in Group I patients (100 +/- 22 min) compared with Group II patients (140 +/- 27 min, P = 0.0001). Postoperative headache occurred in 38% of all patients and 70% of these were postural in nature. Oral analgesia was the only treatment required. Spinal anesthesia did not result in a significant incidence of postoperative backache. On follow-up, 96% said they found spinal needle insertion acceptable, 93% found surgery comfortable, and 90% said they would request spinal anesthesia for laparoscopy in future. Overall, this study found spinal anesthesia for outpatient laparoscopy to have high patient acceptance and a comparable complication rate to other studies. The small-dose hypobaric lidocaine-fentanyl technique has advantages over conventional-dose hyperbaric lidocaine of no hypotension and faster recovery.

Catheter for Cleaning Surgical Optics During Surgical Procedures: A Possible Solution for Residue Buildup and Fogging in Video Surgery.

PubMed

de Abreu, Igor Renato Louro Bruno; Abrão, Fernando Conrado; Silva, Alessandra Rodrigues; Corrêa, Larissa Teresa Cirera; Younes, Riad Nain

2015-05-01

Currently, there is a tendency to perform surgical procedures via laparoscopic or thoracoscopic access. However, even with the impressive technological advancement in surgical materials, such as improvement in quality of monitors, light sources, and optical fibers, surgeons have to face simple problems that can greatly hinder surgery by video. One is the formation of "fog" or residue buildup on the lens, causing decreased visibility. Intracavitary techniques for cleaning surgical optics and preventing fog formation have been described; however, some of these techniques employ the use of expensive and complex devices designed solely for this purpose. Moreover, these techniques allow the cleaning of surgical optics when they becomes dirty, which does not prevent the accumulation of residue in the optics. To solve this problem we have designed a device that allows cleaning the optics with no surgical stops and prevents the fogging and residue accumulation. The objective of this study is to evaluate through experimental testing the effectiveness of a simple device that prevents the accumulation of residue and fogging of optics used in surgical procedures performed through thoracoscopic or laparoscopic access. Ex-vivo experiments were performed simulating the conditions of residue presence in surgical optics during a video surgery. The experiment consists in immersing the optics and catheter set connected to the IV line with crystalloid solution in three types of materials: blood, blood plus fat solution, and 200 mL of distilled water and 1 vial of methylene blue. The optics coupled to the device were immersed in 200 mL of each type of residue, repeating each immersion 10 times for each distinct residue for both thirty and zero degrees optics, totaling 420 experiments. A success rate of 98.1% was observed after the experiments, in these cases the device was able to clean and prevent the residue accumulation in the optics.

Protectant activity of defibrotide in cardioplegia followed by ischemia/reperfusion injury in the isolated rat heart.

PubMed

Rossoni, G; Pompilio, G; Biglioli, P; Alamanni, F; Tartara, P; Rona, P; Porqueddu, M; Berti, F

1999-01-01

Previous studies have shown that defibrotide, a polydeoxyribonucleotide obtained by depolymerization of DNA from porcine tissues, has important protective effects on myocardial ischemia, which may be associated with a prostacyclin-related mechanism. The purpose of this study was to investigate the direct effects of defibrotide (given in cardioplegia or after ischemia) on a model of rat heart recovery after cardioplegia followed by ischemia/reperfusion injury. Isolated rat hearts, undergoing 5 minutes of warm cardioplegic arrest followed by 20 minutes of global ischemia and 30 minutes of reperfusion, were studied using the modified Langendorff model. The cardioplegia consisted of St. Thomas' Hospital solution augmented with defibrotide (50, 100, and 200 microg/mL) or without defibrotide (controls). Left ventricular mechanical function and the levels of creatine kinase, lactate dehydrogenase, and 6-keto-prostaglandin F1alpha (6-keto-PGF1alpha; the stable metabolite of prostacyclin) were measured during preischemic and reperfusion periods. After global ischemia, hearts receiving defibrotide in the cardioplegic solution (n = 8) manifested in a concentration-dependent fashion lower left ventricular end-diastolic pressure (p < 0.001), higher left ventricular developed pressure (p < 0.01), and lower coronary perfusion pressure (p < 0.001) compared to the control group. After reperfusion, hearts receiving defibrotide in the cardioplegic solution also had, in a dose-dependent way, lower levels of creatine-kinase (p < 0.01), lactate dehydrogenase (p < 0.001), and higher levels of 6-keto-PGF1alpha (p < 0.001) compared to the control group. Furthermore, when defibrotide was given alone to the hearts at the beginning of reperfusion (n = 7), the recovery of postischemic left ventricular function was inferior (p < 0.05) to that obtained when defibrotide was given in cardioplegia. Defibrotide confers to conventional crystalloid cardioplegia a potent concentration-dependent protective effect on the recovery of isolated rat heart undergoing ischemia/reperfusion injury. The low cost and the absence of contraindications (cardiac toxicity and hemodynamic effects) make defibrotide a promising augmentation to cardioplegia.

Performance tradeoffs in static and dynamic load balancing strategies

NASA Technical Reports Server (NTRS)

Iqbal, M. A.; Saltz, J. H.; Bokhart, S. H.

1986-01-01

The problem of uniformly distributing the load of a parallel program over a multiprocessor system was considered. A program was analyzed whose structure permits the computation of the optimal static solution. Then four strategies for load balancing were described and their performance compared. The strategies are: (1) the optimal static assignment algorithm which is guaranteed to yield the best static solution, (2) the static binary dissection method which is very fast but sub-optimal, (3) the greedy algorithm, a static fully polynomial time approximation scheme, which estimates the optimal solution to arbitrary accuracy, and (4) the predictive dynamic load balancing heuristic which uses information on the precedence relationships within the program and outperforms any of the static methods. It is also shown that the overhead incurred by the dynamic heuristic is reduced considerably if it is started off with a static assignment provided by either of the other three strategies.

Multithreaded Model for Dynamic Load Balancing Parallel Adaptive PDE Computations

NASA Technical Reports Server (NTRS)

Chrisochoides, Nikos

1995-01-01

We present a multithreaded model for the dynamic load-balancing of numerical, adaptive computations required for the solution of Partial Differential Equations (PDE's) on multiprocessors. Multithreading is used as a means of exploring concurrency in the processor level in order to tolerate synchronization costs inherent to traditional (non-threaded) parallel adaptive PDE solvers. Our preliminary analysis for parallel, adaptive PDE solvers indicates that multithreading can be used an a mechanism to mask overheads required for the dynamic balancing of processor workloads with computations required for the actual numerical solution of the PDE's. Also, multithreading can simplify the implementation of dynamic load-balancing algorithms, a task that is very difficult for traditional data parallel adaptive PDE computations. Unfortunately, multithreading does not always simplify program complexity, often makes code re-usability not an easy task, and increases software complexity.

Geochemical mole-balance modeling with uncertain data

USGS Publications Warehouse

Parkhurst, David L.

1997-01-01

Geochemical mole-balance models are sets of chemical reactions that quantitatively account for changes in the chemical and isotopic composition of water along a flow path. A revised mole-balance formulation that includes an uncertainty term for each chemical and isotopic datum is derived. The revised formulation is comprised of mole-balance equations for each element or element redox state, alkalinity, electrons, solvent water, and each isotope; a charge-balance equation and an equation that relates the uncertainty terms for pH, alkalinity, and total dissolved inorganic carbon for each aqueous solution; inequality constraints on the size of the uncertainty terms; and inequality constraints on the sign of the mole transfer of reactants. The equations and inequality constraints are solved by a modification of the simplex algorithm combined with an exhaustive search for unique combinations of aqueous solutions and reactants for which the equations and inequality constraints can be solved and the uncertainty terms minimized. Additional algorithms find only the simplest mole-balance models and determine the ranges of mixing fractions for each solution and mole transfers for each reactant that are consistent with specified limits on the uncertainty terms. The revised formulation produces simpler and more robust mole-balance models and allows the significance of mixing fractions and mole transfers to be evaluated. In an example from the central Oklahoma aquifer, inclusion of up to 5% uncertainty in the chemical data can reduce the number of reactants in mole-balance models from seven or more to as few as three, these being cation exchange, dolomite dissolution, and silica precipitation. In another example from the Madison aquifer, inclusion of the charge-balance constraint requires significant increases in the mole transfers of calcite, dolomite, and organic matter, which reduce the estimated maximum carbon 14 age of the sample by about 10,000 years, from 22,700 years to 12,600 years.

New modified multi-level residue harmonic balance method for solving nonlinearly vibrating double-beam problem

NASA Astrophysics Data System (ADS)

Rahman, Md. Saifur; Lee, Yiu-Yin

2017-10-01

In this study, a new modified multi-level residue harmonic balance method is presented and adopted to investigate the forced nonlinear vibrations of axially loaded double beams. Although numerous nonlinear beam or linear double-beam problems have been tackled and solved, there have been few studies of this nonlinear double-beam problem. The geometric nonlinear formulations for a double-beam model are developed. The main advantage of the proposed method is that a set of decoupled nonlinear algebraic equations is generated at each solution level. This heavily reduces the computational effort compared with solving the coupled nonlinear algebraic equations generated in the classical harmonic balance method. The proposed method can generate the higher-level nonlinear solutions that are neglected by the previous modified harmonic balance method. The results from the proposed method agree reasonably well with those from the classical harmonic balance method. The effects of damping, axial force, and excitation magnitude on the nonlinear vibrational behaviour are examined.

Common toads (Bufo arenarum) learn to anticipate and avoid hypertonic saline solutions.

PubMed

Daneri, M Florencia; Papini, Mauricio R; Muzio, Rubén N

2007-11-01

Toads (Bufo arenarum) were exposed to pairings between immersion in a neutral saline solution (i.e., one that caused no significant variation in fluid balance), followed by immersion in a highly hypertonic saline solution (i.e., one that caused water loss). In Experiment 1, solutions were presented in a Pavlovian conditioning arrangement. A group receiving a single neutral-highly hypertonic pairing per day exhibited a greater conditioned increase in heart rate than groups receiving either the same solutions in an explicitly unpaired fashion, or just the neutral solution. Paired toads also showed a greater ability to compensate for water loss across trials than that of the explicitly unpaired group. Using the same reinforcers and a similar apparatus, Experiment 2 demonstrated that toads learn a one-way avoidance response motivated by immersion in the highly hypertonic solution. Cardiac and avoidance conditioning are elements of an adaptive system for confronting aversive situations involving loss of water balance. Copyright 2007 APA.

Sampling with poling-based flux balance analysis: optimal versus sub-optimal flux space analysis of Actinobacillus succinogenes.

PubMed

Binns, Michael; de Atauri, Pedro; Vlysidis, Anestis; Cascante, Marta; Theodoropoulos, Constantinos

2015-02-18

Flux balance analysis is traditionally implemented to identify the maximum theoretical flux for some specified reaction and a single distribution of flux values for all the reactions present which achieve this maximum value. However it is well known that the uncertainty in reaction networks due to branches, cycles and experimental errors results in a large number of combinations of internal reaction fluxes which can achieve the same optimal flux value. In this work, we have modified the applied linear objective of flux balance analysis to include a poling penalty function, which pushes each new set of reaction fluxes away from previous solutions generated. Repeated poling-based flux balance analysis generates a sample of different solutions (a characteristic set), which represents all the possible functionality of the reaction network. Compared to existing sampling methods, for the purpose of generating a relatively "small" characteristic set, our new method is shown to obtain a higher coverage than competing methods under most conditions. The influence of the linear objective function on the sampling (the linear bias) constrains optimisation results to a subspace of optimal solutions all producing the same maximal fluxes. Visualisation of reaction fluxes plotted against each other in 2 dimensions with and without the linear bias indicates the existence of correlations between fluxes. This method of sampling is applied to the organism Actinobacillus succinogenes for the production of succinic acid from glycerol. A new method of sampling for the generation of different flux distributions (sets of individual fluxes satisfying constraints on the steady-state mass balances of intermediates) has been developed using a relatively simple modification of flux balance analysis to include a poling penalty function inside the resulting optimisation objective function. This new methodology can achieve a high coverage of the possible flux space and can be used with and without linear bias to show optimal versus sub-optimal solution spaces. Basic analysis of the Actinobacillus succinogenes system using sampling shows that in order to achieve the maximal succinic acid production CO₂ must be taken into the system. Solutions involving release of CO₂ all give sub-optimal succinic acid production.

Justification of Filter Selection for Robot Balancing in Conditions of Limited Computational Resources

NASA Astrophysics Data System (ADS)

Momot, M. V.; Politsinskaia, E. V.; Sushko, A. V.; Semerenko, I. A.

2016-08-01

The paper considers the problem of mathematical filter selection, used for balancing of wheeled robot in conditions of limited computational resources. The solution based on complementary filter is proposed.

Design and Optimization of New Metallic Materials (Metal Foams) for the Reduction of the Noise of the Aeronautical Turbo Engines

DTIC Science & Technology

2005-02-01

AApproved for Public Release Distribution Unlimited SANS MENTION DE PROTECTION MATERIALS AND STRUCTURES -1- ONERA BP 72 - 29. avenue de la Division Leclerc...reduction. Finding the best solution in terns balancing structural strength and acoustic properties was the main thrust of this project. Acoustic...material system for noise reduction. Finding the best solution in terms balancing structural strength and acoustic properties was the main thrust of this

Effect of intravitreal triamcinolone acetonide on healing of retinal photocoagulation lesions.

PubMed

Nomoto, Hiroyuki; Lavinsky, Daniel; Paulus, Yannis M; Leung, Loh-Shan; Dalal, Roopa; Blumenkranz, Mark S; Palanker, Daniel

2013-01-01

To evaluate the effect of intravitreal triamcinolone acetonide (TA) on healing of retinal photocoagulation lesions using drug and laser dosing typically employed in clinical practice. Laser burns with a 267-μm retinal beam size at 532-nm wavelength were applied to 40 eyes of Dutch belted rabbits. Barely visible to intense lesions were produced with pulses of 5, 10, 20, and 50 milliseconds and power of 175 mW. Eyes received intravitreal injections of either 2 mg TA/50 μL or balanced salt solution administered either 1 week before or immediately after laser treatment. Lesion grades were assessed acutely ophthalmoscopically and by a masked observer histologically at 1, 3, 7, 30, and 60 days. Both TA groups demonstrated significant reduction in retinal thickness throughout follow-up compared with balanced salt solution groups (P < 0.001). The width of the lesions at 1 day after injection was not significantly different between groups. However, by 7 days, the lesions in balanced salt solution groups contracted much more than in the TA groups, especially the more intense burns, and this difference persisted to 2 months. The healing rate of the barely visible burns was not significantly affected by TA compared with the balanced salt solution control eyes. Triamcinolone acetonide injection previously or concurrently with photocoagulation significantly decreases laser-induced edema but interferes with lesions healing, thereby leaving wider residual scarring, especially persistent in more intense burns.

A Comparison of Red Cell Rejuvenation versus Mechanical Washing for the Prevention of Transfusion-associated Organ Injury in Swine.

PubMed

Woźniak, Marcin J; Qureshi, Saqib; Sullo, Nikol; Dott, William; Cardigan, Rebecca; Wiltshire, Michael; Nath, Mintu; Patel, Nishith N; Kumar, Tracy; Goodall, Alison H; Murphy, Gavin J

2018-02-01

We evaluated the effects of two interventions that modify the red cell storage lesion on kidney and lung injury in experimental models of transfusion. White-landrace pigs (n = 32) were allocated to receive sham transfusion (crystalloid), 14-day stored allogeneic red cells, 14-day red cells washed using the red cells washing/salvage system (CATS; Fresenius, Germany), or 14-day red cells rejuvenated using the inosine solution (Rejuvesol solution; Zimmer Biomet, USA) and washed using the CATS device. Functional, biochemical, and histologic markers of organ injury were assessed for up to 24 h posttransfusion. Transfusion of 14 day red cells resulted in lung injury (lung injury score vs. sham, mean difference -0.3 (95% CI, -0.6 to -0.1; P = 0.02), pulmonary endothelial dysfunction, and tissue leukocyte sequestration. Mechanical washing reduced red cell-derived microvesicles but increased cell-free hemoglobin in 14-day red cell units. Transfusion of washed red cells reduced leukocyte sequestration but did not reduce the lung injury score (mean difference -0.2; 95% CI, -0.5 to 0.1; P = 0.19) relative to 14-day cells. Transfusion of washed red cells also increased endothelial activation and kidney injury. Rejuvenation restored adenosine triphosphate to that of fresh red cells and reduced microvesicle concentrations without increasing cell-free hemoglobin release. Transfusion of rejuvenated red cells reduced plasma cell-free hemoglobin, leukocyte sequestration, and endothelial dysfunction in recipients and reduced lung and kidney injury relative to 14-day or washed 14-day cells. Reversal of the red cell storage lesion by rejuvenation reduces transfusion-associated organ injury in swine.

Myocardial Protective Effects of L-Carnitine on Ischemia-Reperfusion Injury in Patients With Rheumatic Valvular Heart Disease Undergoing Cardiac Surgery.

PubMed

Li, Ming; Xue, Li; Sun, Haifeng; Xu, Suochun

2016-12-01

The authors used L-carnitine as an ingredient in cardioplegic solution during valve replacement surgery to investigate the protective effect of L-carnitine on myocardial ischemia-reperfusion injury (MIRI) and its possible mechanism. Prospective, randomized study. A tertiary-care hospital. The study comprised 90 patients undergoing valve replacement under cardiopulmonary bypass. Patients were divided randomly into 3 groups. L-carnitine was added to the crystalloid cardioplegic solution for experimental group 1 (3 g/L) and experimental group 2 (6 g/L), whereas no L-carnitine was used in the control group. The remainder of the treatment was identical for all 3 groups. Serum was collected from each patient 1 hour before the surgery and at 2, 6, 24, and 72 hours after unclamping the aorta, and tissue samples were obtained before cardiac arrest and after unclamping the aorta. The postoperative levels of serum aspartate aminotransferase, creatine kinase, creatine kinase-MB isozyme, and lactic acid dehydrogenase and the apoptotic index were all lower in the 2 experimental groups than those in the control group. In addition, each of the aforementioned serum enzyme levels and the apoptotic index in all 3 groups significantly increased after unclamping the aorta compared with baseline levels taken before surgery. Bcl-2 expression was higher and Bax was lower in the 2 experimental groups compared with those of the control group after unclamping the aorta. However, there was no significant difference in all the postoperative indices between the 2 experimental groups. L-carnitine may reduce cardiopulmonary bypass-induced myocardial apoptosis through modulating the expressions of Bcl-2 and Bax, resulting in a protective effect from MIRI. Copyright © 2016 Elsevier Inc. All rights reserved.

A stability theorem for energy-balance climate models

NASA Technical Reports Server (NTRS)

Cahalan, R. F.; North, G. R.

1979-01-01

The paper treats the stability of steady-state solutions of some simple, latitude-dependent, energy-balance climate models. For north-south symmetric solutions of models with an ice-cap-type albedo feedback, and for the sum of horizontal transport and infrared radiation given by a linear operator, it is possible to prove a 'slope stability' theorem, i.e., if the local slope of the steady-state iceline latitude versus solar constant curve is positive (negative) the steady-state solution is stable (unstable). Certain rather weak restrictions on the albedo function and on the heat transport are required for the proof, and their physical basis is discussed.

Hamiltonian formulation of systems with balanced loss-gain and exactly solvable models

NASA Astrophysics Data System (ADS)

Ghosh, Pijush K.; Sinha, Debdeep

2018-01-01

A Hamiltonian formulation of generic many-body systems with balanced loss and gain is presented. It is shown that a Hamiltonian formulation is possible only if the balancing of loss and gain terms occurs in a pairwise fashion. It is also shown that with the choice of a suitable co-ordinate, the Hamiltonian can always be reformulated in the background of a pseudo-Euclidean metric. If the equations of motion of some of the well-known many-body systems like Calogero models are generalized to include balanced loss and gain, it appears that the same may not be amenable to a Hamiltonian formulation. A few exactly solvable systems with balanced loss and gain, along with a set of integrals of motion are constructed. The examples include a coupled chain of nonlinear oscillators and a many-particle Calogero-type model with four-body inverse square plus two-body pair-wise harmonic interactions. For the case of nonlinear oscillators, stable solution exists even if the loss and gain parameter has unbounded upper range. Further, the range of the parameter for which the stable solutions are obtained is independent of the total number of the oscillators. The set of coupled nonlinear equations are solved exactly for the case when the values of all the constants of motions except the Hamiltonian are equal to zero. Exact, analytical classical solutions are presented for all the examples considered.

Analysis of a GRACE Global Mascon Solution for Gulf of Alaska Glaciers

NASA Technical Reports Server (NTRS)

Arendt, Anthony; Luthcke, Scott B.; Gardner, Alex; O'Neel, Shad; Hill, David; Moholdt, Geir; Abdalati, Waleed

2013-01-01

We present a high-resolution Gravity Recovery and Climate Experiment (GRACE) mascon solution for Gulf of Alaska (GOA) glaciers and compare this with in situ glaciological, climate and other remote-sensing observations. Our GRACE solution yields a GOA glacier mass balance of -6511 Gt a(exp.-1) for the period December 2003 to December 2010, with summer balances driving the interannual variability. Between October/November 2003 and October 2009 we obtain a mass balance of -6111 Gt a(exp. -1) from GRACE, which compares well with -6512 Gt a(exp. -1) from ICESat based on hypsometric extrapolation of glacier elevation changes. We find that mean summer (June-August) air temperatures derived from both ground and lower-troposphere temperature records were good predictors of GRACE-derived summer mass balances, capturing 59% and 72% of the summer balance variability respectively. Large mass losses during 2009 were likely due to low early melt season surface albedos, measured by the Moderate Resolution Imaging Spectroradiometer (MODIS) and likely associated with the 31 March 2009 eruption of Mount Redoubt, southwestern Alaska. GRACE data compared well with in situ measurements atWolverine Glacier (maritime Alaska), but poorly with those at Gulkana Glacier (interior Alaska). We conclude that, although GOA mass estimates from GRACE are robust over the entire domain, further constraints on subregional and seasonal estimates are necessary to improve fidelity to ground observations.

Analysis of a GRACE global mascon solution for Gulf of Alaska glaciers

USGS Publications Warehouse

Arendt, Anthony; Luthcke, Scott; Gardner, Alex; O'Neel, Shad; Hill, David; Moholdt, Geir; Abdalati, Waleed

2013-01-01

We present a high-resolution Gravity Recovery and Climate Experiment (GRACE) mascon solution for Gulf of Alaska (GOA) glaciers and compare this with in situ glaciological, climate and other remote-sensing observations. Our GRACE solution yields a GOA glacier mass balance of –65 ± 11 Gt a–1 for the period December 2003 to December 2010, with summer balances driving the interannual variability. Between October/November 2003 and October 2009 we obtain a mass balance of –61 ± 11 Gt a–1 from GRACE, which compares well with –65 ± 12 Gt a–1 from ICESat based on hypsometric extrapolation of glacier elevation changes. We find that mean summer (June–August) air temperatures derived from both ground and lower-troposphere temperature records were good predictors of GRACE-derived summer mass balances, capturing 59% and 72% of the summer balance variability respectively. Large mass losses during 2009 were likely due to low early melt season surface albedos, measured by the Moderate Resolution Imaging Spectroradiometer (MODIS) and likely associated with the 31 March 2009 eruption of Mount Redoubt, southwestern Alaska. GRACE data compared well with in situ measurements at Wolverine Glacier (maritime Alaska), but poorly with those at Gulkana Glacier (interior Alaska). We conclude that, although GOA mass estimates from GRACE are robust over the entire domain, further constraints on subregional and seasonal estimates are necessary to improve fidelity to ground observations.

Global Load Balancing with Parallel Mesh Adaption on Distributed-Memory Systems

NASA Technical Reports Server (NTRS)

Biswas, Rupak; Oliker, Leonid; Sohn, Andrew

1996-01-01

Dynamic mesh adaption on unstructured grids is a powerful tool for efficiently computing unsteady problems to resolve solution features of interest. Unfortunately, this causes load imbalance among processors on a parallel machine. This paper describes the parallel implementation of a tetrahedral mesh adaption scheme and a new global load balancing method. A heuristic remapping algorithm is presented that assigns partitions to processors such that the redistribution cost is minimized. Results indicate that the parallel performance of the mesh adaption code depends on the nature of the adaption region and show a 35.5X speedup on 64 processors of an SP2 when 35% of the mesh is randomly adapted. For large-scale scientific computations, our load balancing strategy gives almost a sixfold reduction in solver execution times over non-balanced loads. Furthermore, our heuristic remapper yields processor assignments that are less than 3% off the optimal solutions but requires only 1% of the computational time.

A Solution to the C-Value Paradox and the Function of Junk DNA: The Genome Balance Hypothesis.

PubMed

Freeling, Michael; Xu, Jie; Woodhouse, Margaret; Lisch, Damon

2015-06-01

The Genome Balance Hypothesis originated from a recent study that provided a mechanism for the phenomenon of genome dominance in ancient polyploids: unique 24nt RNA coverage near genes is greater in genes on the recessive subgenome irrespective of differences in gene expression. 24nt RNAs target transposons. Transposon position effects are now hypothesized to balance the expression of networked genes and provide spring-like tension between pericentromeric heterochromatin and microtubules. The balance (coordination) of gene expression and centromere movement is under selection. Our hypothesis states that this balance can be maintained by many or few transposons about equally well. We explain known balanced distributions of junk DNA within genomes and between subgenomes in allopolyploids (and our hypothesis passes "the onion test" for any so-called solution to the C-value paradox). Importantly, when the allotetraploid maize chromosomes delete redundant genes, their nearby transposons are also lost; this result is explained if transposons near genes function. The Genome Balance Hypothesis is hypothetical because the position effect mechanisms implicated are not proved to apply to all junk DNA, and the continuous nature of the centromeric and gene position effects have not yet been studied as a single phenomenon. Copyright © 2015 The Author. Published by Elsevier Inc. All rights reserved.

Oral salt supplements to compensate for jejunostomy losses: comparison of sodium chloride capsules, glucose electrolyte solution, and glucose polymer electrolyte solution.

PubMed

Nightingale, J M; Lennard-Jones, J E; Walker, E R; Farthing, M J

1992-06-01

Six patients with jejunostomies and residual jejunal lengths of 105 to 250 cm took the same food and water each day for eight study days. In random order, three methods of salt replacement were tested, each over 48 hours, against a period without added salt. During the three test periods the patients took 120 mmol of sodium chloride daily, as salt in gelatine capsules, as an isotonic glucose electrolyte (280 mOsmol/kg; 30 kcal) solution, and as a glucose polymer (Maxijul) solution (280 mOsmol/kg; 200 kcal). The daily stomal output remained constant for each patient during the four test periods but varied between patients from 0.60 to 2.84 kg (daily intestinal fluid balance 0.74-2.61 kg). Without a salt supplement, three patients lost more sodium from the stoma than they took in by mouth (-25, -94, and -101 mmol/day) and the mean sodium balance for all six subjects was -16 mmol (range -101 to 79) daily. Extra salt was absorbed with each form of supplement (p less than 0.05); no patient with the glucose electrolyte solution (mean 96, range 0 to 226 mmol), but one patient with the glucose-polymer solution (mean 96, range -25 to 164 mmol) and two with the salt capsules (mean 66, range -8 to 145 mmol) were in negative balance. Two patients vomited with the salt capsules. There was only a small increase in energy absorption (mean 115 kcal) with the glucose polymer solution compared with the glucose electrolyte solution. A sipped glucose electrolyte solution seems to be the optimal mode of sodium replacement in patients with a high output jejunostomy.

Oral salt supplements to compensate for jejunostomy losses: comparison of sodium chloride capsules, glucose electrolyte solution, and glucose polymer electrolyte solution.

PubMed Central

Nightingale, J M; Lennard-Jones, J E; Walker, E R; Farthing, M J

1992-01-01

Six patients with jejunostomies and residual jejunal lengths of 105 to 250 cm took the same food and water each day for eight study days. In random order, three methods of salt replacement were tested, each over 48 hours, against a period without added salt. During the three test periods the patients took 120 mmol of sodium chloride daily, as salt in gelatine capsules, as an isotonic glucose electrolyte (280 mOsmol/kg; 30 kcal) solution, and as a glucose polymer (Maxijul) solution (280 mOsmol/kg; 200 kcal). The daily stomal output remained constant for each patient during the four test periods but varied between patients from 0.60 to 2.84 kg (daily intestinal fluid balance 0.74-2.61 kg). Without a salt supplement, three patients lost more sodium from the stoma than they took in by mouth (-25, -94, and -101 mmol/day) and the mean sodium balance for all six subjects was -16 mmol (range -101 to 79) daily. Extra salt was absorbed with each form of supplement (p less than 0.05); no patient with the glucose electrolyte solution (mean 96, range 0 to 226 mmol), but one patient with the glucose-polymer solution (mean 96, range -25 to 164 mmol) and two with the salt capsules (mean 66, range -8 to 145 mmol) were in negative balance. Two patients vomited with the salt capsules. There was only a small increase in energy absorption (mean 115 kcal) with the glucose polymer solution compared with the glucose electrolyte solution. A sipped glucose electrolyte solution seems to be the optimal mode of sodium replacement in patients with a high output jejunostomy. PMID:1624155

The impact of a massive transfusion protocol (1:1:1) on major hepatic injuries: does it increase abdominal wall closure rates?

PubMed

Ball, Chad G; Dente, Christopher J; Shaz, Beth; Wyrzykowski, Amy D; Nicholas, Jeffrey M; Kirkpatrick, Andrew W; Feliciano, David V

2013-10-01

Massive transfusion protocols (MTPs) using high plasma and platelet ratios for exsanguinating trauma patients are increasingly popular. Major liver injuries often require massive resuscitations and immediate hemorrhage control. Current published literature describes outcomes among patients with mixed patterns of injury. We sought to identify the effects of an MTP on patients with major liver trauma. Patients with grade 3, 4 or 5 liver injuries who required a massive blood component transfusion were analyzed. We compared patients with high plasma:red blood cell:platelet ratio (1:1:1) transfusions (2007-2009) with patients injured before the creation of an institutional MTP (2005-2007). Among 60 patients with major hepatic injuries, 35 (58%) underwent resuscitation after the implementation of an MTP. Patient and injury characteristics were similar between cohorts. Implementation of the MTP significantly improved plasma: red blood cell:platelet ratios and decreased crystalloid fluid resuscitation (p = 0.026). Rapid improvement in early acidosis and coagulopathy was superior with an MTP (p = 0.009). More patients in the MTP group also underwent primary abdominal fascial closure during their hospital stay (p = 0.021). This was most evident with grade 4 injuries (89% vs. 14%). The mean time to fascial closure was 4.2 days. The overall survival rate for all major liver injuries was not affected by an MTP (p = 0.61). The implementation of a formal MTP using high plasma and platelet ratios resulted in a substantial increase in abdominal wall approximation. This occurred concurrently to a decrease in the delivered volume of crystalloid fluid.

Influence of fluid and volume state on PaO2 oscillations in mechanically ventilated pigs.

PubMed

Bodenstein, Marc; Bierschock, Stephan; Boehme, Stefan; Wang, Hemei; Vogt, Andreas; Kwiecien, Robert; David, Matthias; Markstaller, Klaus

2013-03-01

Varying pulmonary shunt fractions during the respiratory cycle cause oxygen oscillations during mechanical ventilation. In artificially damaged lungs, cyclical recruitment of atelectasis is responsible for varying shunt according to published evidence. We introduce a complimentary hypothesis that cyclically varying shunt in healthy lungs is caused by cyclical redistribution of pulmonary perfusion. Administration of crystalloid or colloid infusions would decrease oxygen oscillations if our hypothesis was right. Therefore, n=14 mechanically ventilated healthy pigs were investigated in 2 groups: crystalloid (fluid) versus no-fluid administration. Additional volume interventions (colloid infusion, blood withdrawal) were carried out in each pig. Intra-aortal PaO2 oscillations were recorded using fluorescence quenching technique. Phase shift of oxygen oscillations during altered inspiratory to expiratory (I:E) ventilation ratio and electrical impedance tomography (EIT) served as control methods to exclude that recruitment of atelectasis is responsible for oxygen oscillations. In hypovolemia relevant oxygen oscillations could be recorded. Fluid and volume state changed PaO2 oscillations according to our hypothesis. Fluid administration led to a mean decline of 105.3 mmHg of the PaO2 oscillations amplitude (P<0.001). The difference of the amplitudes between colloid administration and blood withdrawal was 62.4 mmHg in pigs not having received fluids (P=0.0059). Fluid and volume state also changed the oscillation phase during altered I:E ratio. EIT excluded changes of regional ventilation (i.e., recruitment of atelectasis) to be responsible for these oscillations. In healthy pigs, cyclical redistribution of pulmonary perfusion can explain the size of respiratory-dependent PaO2 oscillations.

Impaired thrombin generation and fibrin clot formation in patients with dilutional coagulopathy during major surgery.

PubMed

Schols, S E M; Lancé, M D; Feijge, M A H; Damoiseaux, J; Marcus, M A; Hamulyák, K; Ten Cate, H; Heemskerk, J W M; van Pampus, E C M

2010-02-01

Patients subjected to haemodilution during surgery are at increased risk of bleeding. We hypothesised that, in the acquired dilutional coagulopathy, insufficient haemostasis is due to either insufficient thrombin generation or insufficient fibrin clot formation. In tissue factor-activated plasmas from patients with coagulation deficiency, we measured time curves of thrombin generation and fibrin clot formation (thromboelastography). Investigated were in study A: 10 patients treated with vitamin K antagonist and five healthy subjects; in study B: 30 patients undergoing cardiopulmonary bypass (CPB) surgery and infused with on average 2,000 ml crystalloids and colloids (no major bleeding); in study C: 58 patients undergoing major general surgery, and transfused with >5,000 ml crystalloids, colloids and red cell concentrates, who experienced major bleeding and were post-transfused with fresh frozen plasma. The treatment with vitamin K antagonist led to a progressive reduction in thrombin generation but not fibrin clot formation. In CPB patients, plasma factor levels post-surgery were 53-60% of normal. This was accompanied by moderate reduction in both haemostatic processes. In plasmas from patients undergoing major surgery, factor levels were 38-41% of normal, and these levels increased after plasma transfusion. Taking preset thresholds for normal thrombin generation and fibrin clot formation, at least one of these processes was low in 88-93% of the patients with (persistent) bleeding, but only in 40-53% of the patients without bleeding. In conclusion, the ability of thrombin generation and fibrin clot formation is independently reduced in acquired dilutional coagulopathy, while minimal levels of both are required for adequate haemostasis.

A prospective randomized trial of two solutions for intrapartum amnioinfusion: effects on fetal electrolytes, osmolality, and acid-base status.

PubMed

Pressman, E K; Blakemore, K J

1996-10-01

Our purpose was to compare the effects of intrapartum amnioinfusion with normal saline solution versus lactated Ringer's solution plus physiologic glucose on neonatal electrolytes and acid-base balance. Patients undergoing amnioinfusion for obstetric indications were randomized to receive normal saline solution or lactated Ringer's solution plus physiologic glucose at standardized amnioinfusion rates. Data were collected prospectively on maternal demographics, course of labor, and maternal and neonatal outcome. Arterial cord blood was obtained for analysis of electrolytes, glucose, osmolality, lactic acid, and blood gases. Control subjects with normal fetal heart rate patterns, and clear amniotic fluid not receiving amnioinfusion were studied concurrently. Data were collected on 59 patients (21 normal saline solution, 18 lactated Ringer's solution plus physiologic glucose, and 20 controls). Maternal demographics, course of labor, and neonatal outcome were similar in all three groups. Cesarean sections were performed more often in the amnioinfusion groups (33.3% for normal saline solution, 38.9% for lactated Ringer's solution plus physiologic glucose) than in the control group (5.0%), p < 0.05. Cord arterial electrolytes, glucose, osmolality, lactic acid, and blood gases were not altered by amnioinfusion with either solution. Intrapartum amnioinfusion with normal saline solution or lactated Ringer's solution plus physiologic glucose has no effect on neonatal electrolytes or acid-base balance.

Chloride imbalance in rivers from landscapes undergoing hydrological change

NASA Astrophysics Data System (ADS)

Cartwright, I.; Gilfedder, B.; Hofmann, H.

2012-12-01

There has been much research into the sources of solutes in river systems; however, there has been little emphasis on determining whether medium or large catchments are in long-term chemical balance (i.e., whether the flux of solutes into a catchment is balanced by the export from that catchment). Where surface water and groundwater catchments coincide, the mass balance of a conservative solute (X) is: P*X(P) = SW*X(SW) - GW*X(GW) - ΔST*X(ST) where P, SW, and GW, are precipitation, surface water outflows, and groundwater outflows (in m3/year). ΔST accounts for changes to water held in storage in soils, groundwater, or surface water bodies. X is the concentration of solute X in the various stores (mg/m3). Precipitation and river discharges are commonly well constrained and in many regions there are also rainfall, groundwater, and surface water geochemistry data. Groundwater fluxes and changes to volumes of solutes held in storage are less well known and it is difficult to perform accurate solute balances. However, if the flux of a conservative solute out of a catchment via the river system is larger than the input from rainfall (i.e. where SW*X(SW) > P*X(P)), the catchment is a net exporter of solutes. In turn this implies a change to the amount of water stored in the catchment and/or a change in chemistry of the water in the various stores. We use this approach to assess the chemical balance in several regional-scale catchments (areas up to 15,000 km2) in Victoria, southeast Australia. Rivers from many of these catchments are saline (Total Dissolved Solids, TDS, contents >1000 mg/L). Groundwater in this area is also saline (TDS contents locally up to 100,000 mg/L). Major ion geochemistry indicates that the source of Cl in all catchments dominantly from rainfall and the major geochemical process controlling the salinity of surface water and groundwater is evapotranspiration. Cl concentrations and EC values are well correlated allowing a continual record of Cl fluxes to be estimated from long-term (up to 25 years) sub-daily discharge and EC records. The records span several drought and high rainfall periods allowing variation in individual years to be accounted for. Many of the rivers in southeast Victoria export significantly higher volumes of Cl than is delivered via rainfall (up to ~2700%) with average annual fluxes of up to ~200 kg/ha/year. These catchments are not in chemical balance and are net exporters of solutes. Two scenarios may explain the high rates of Cl export in individual catchments. Firstly, saline marshes and lakes developed on young (<1 Ma) basaltic lava plains have gradually drained as blocked river systems have been re-established. Evapotranspiration within these lakes and wetlands produced high Cl loads in shallow groundwater and soil water that is currently being exported via the river systems. Additionally, in many catchments land-clearing over the last 200 years resulted in increased recharge that has resulted in a rise of the regional water table. In turn this has increased the baseflow component to the rivers and Cl from the groundwater that has relatively long residence time is being exported. In both cases, the catchments are adjusting to a new hydrological balance.

A Well-Balanced Path-Integral f-Wave Method for Hyperbolic Problems with Source Terms

PubMed Central

2014-01-01

Systems of hyperbolic partial differential equations with source terms (balance laws) arise in many applications where it is important to compute accurate time-dependent solutions modeling small perturbations of equilibrium solutions in which the source terms balance the hyperbolic part. The f-wave version of the wave-propagation algorithm is one approach, but requires the use of a particular averaged value of the source terms at each cell interface in order to be “well balanced” and exactly maintain steady states. A general approach to choosing this average is developed using the theory of path conservative methods. A scalar advection equation with a decay or growth term is introduced as a model problem for numerical experiments. PMID:24563581

[Severe fat embolism in perioperative abdominal liposuction and fat grafting].

PubMed

de Lima E Souza, Rodrigo; Apgaua, Bruno Tavares; Milhomens, João Daniel; Albuquerque, Francisco Tadeu Motta; Carneiro, Luiz Antônio; Mendes, Márcio Henrique; Garcia, Tiago Carvalho; Paiva, Clerisson; Ladeia, Felipe; Jeunon, Deiler Célio

2016-01-01

Fat embolism syndrome (FES) may occur in patients suffering from multiple trauma (long bone fractures) or plastic surgery (liposuction), compromising the circulatory, respiratory and/or central nervous systems. This report shows the evolution of severe FES after liposuction and fat grafting. SSS, 42 years old, ASA 1, no risk factors for thrombosis, candidate for abdominal liposuction and breast implant prosthesis. Subjected to balanced general anesthesia with basic monitoring and controlled ventilation. After 45minutes of procedure, there was a sudden and gradual decrease of capnometry, severe hypoxemia and hypotension. The patient was immediately monitored for MAP and central catheter, treated with vasopressors, inotropes, and crystalloid infusion, stabilizing her condition. Arterial blood sample showed pH = 7.21; PCO2 = 51mmHg; PO2 = 52mmHg; BE = -8; HCO3 = 18 mEq/L, and lactate = 6.0 mmol/L. Transthoracic echocardiogram showed PASP = 55mmHg, hypocontractile VD and LVEF = 60%. Diagnosis of pulmonary embolism. After 24h of intensive treatment, the patient developed anisocoria and coma (glasgow coma scale = 3). A brain CT was performed which showed severe cerebral hemispheric ischemia with signs of fat emboli in right middle cerebral artery; transesophageal echocardiography showed a patent foramen ovale. Finally, after 72h of evolution, the patient progressed to brain death. FES usually occurs in young people. Treatment is based mainly on the infusion of fluids and vasoactive drugs, mechanical ventilation, and triggering factor correction (early fixation of fractures or suspension of liposuction). The multiorgânico involvement indicates a worse prognosis. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

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

Ghosh, Debojyoti; Constantinescu, Emil M.

The numerical simulation of meso-, convective-, and microscale atmospheric flows requires the solution of the Euler or the Navier-Stokes equations. Nonhydrostatic weather prediction algorithms often solve the equations in terms of derived quantities such as Exner pressure and potential temperature (and are thus not conservative) and/or as perturbations to the hydrostatically balanced equilibrium state. This paper presents a well-balanced, conservative finite difference formulation for the Euler equations with a gravitational source term, where the governing equations are solved as conservation laws for mass, momentum, and energy. Preservation of the hydrostatic balance to machine precision by the discretized equations is essentialmore » because atmospheric phenomena are often small perturbations to this balance. The proposed algorithm uses the weighted essentially nonoscillatory and compact-reconstruction weighted essentially nonoscillatory schemes for spatial discretization that yields high-order accurate solutions for smooth flows and is essentially nonoscillatory across strong gradients; however, the well-balanced formulation may be used with other conservative finite difference methods. The performance of the algorithm is demonstrated on test problems as well as benchmark atmospheric flow problems, and the results are verified with those in the literature.« less

Multi-agent grid system Agent-GRID with dynamic load balancing of cluster nodes

NASA Astrophysics Data System (ADS)

Satymbekov, M. N.; Pak, I. T.; Naizabayeva, L.; Nurzhanov, Ch. A.

2017-12-01

In this study the work presents the system designed for automated load balancing of the contributor by analysing the load of compute nodes and the subsequent migration of virtual machines from loaded nodes to less loaded ones. This system increases the performance of cluster nodes and helps in the timely processing of data. A grid system balances the work of cluster nodes the relevance of the system is the award of multi-agent balancing for the solution of such problems.

Burnout: An Occupational Hazard.

ERIC Educational Resources Information Center

Hamann, Donald L.; Gordon, Debra G.

2000-01-01

Describes a five-step pattern of burnout and discusses various stress factors that can contribute to burnout. Explores solutions to burnout, such as keeping a balance in life, exercising, and relaxation. Includes sections on balanced breathing, imagery relaxation, and resources for stress reduction. (CMK)

Rates and time scales of clay-mineral formation by weathering in saprolitic regoliths of the southern Appalachians from geochemical mass balance

Treesearch

Jason R. Price; Michael A. Velbel; Lina C. Patino

2005-01-01

Rates of clay formation in three watersheds located at the Coweeta Hydrologic Laboratory, western North Carolina, have been determined from solute flux-based mass balance methods. A system of mass balance equations with enough equations and unknowns to allow calculation of secondary mineral formation rates as well as the more commonly determined primary-...

Hemodynamic parameters in a surgical devascularization model of fulminant hepatic failure in the minipig.

PubMed

Kieslichová, E; Ryska, M; Pantoflícek, T; Ryska, O; Zazula, R; Skobová, J

2005-01-01

Animal models of fulminant hepatic failure (FHF) are important for studying the pathophysiology of this process and for evaluation of the efficacy of artificial and bioartificial liver support systems. In experiments, hemodynamic parameters were monitored in a group of minipigs with FHF induced by surgical devascularization, and compared with those in a control group. During the experiment, animals were analgosedated and were on mechanical lung ventilation. Crystalloid and colloidal solutions were administered and norepinephrine in continuous infusion was applied if mean arterial pressure (MAP) decreased below 60 mm Hg despite adequate intravascular volumes. An increase in heart rate, and decreases in MAP and systemic vascular resistance, compared with the baseline, occurred in the FHF group from 6 h after surgery. A comparison of FHF and control groups revealed no significant differences in systemic vascular resistance and MAP until after 12 h after surgery (systemic vascular resistance index: 953 FHF vs. 1658 controls; p < 0.05; MAP: 58.1 FHF vs. 76 controls; p < 0.05). No significant differences in CI were seen between the FHF group and controls. FHF animals survived for about 13 h after surgery, i.e. a period, which we consider long enough to test a support device. The parameters are believed to be quite adequate, as we were able to maintain satisfactory hemodynamic stability in all experimental animals with induced acute hepatic failure.

Air elimination capability in rapid infusion systems.

PubMed

Zoremba, N; Gruenewald, C; Zoremba, M; Rossaint, R; Schaelte, G

2011-11-01

Pressure infusion devices are used in clinical practice to apply large volumes of fluid over a short period of time. Although air infusion is a major complication, they have limited capability to detect and remove air during pressure infusion. In this investigation, we tested the air elimination capabilities of the Fluido(®) (The Surgical Company), Level 1(®) (Level 1 Technologies Inc.) and Ranger(®) (Augustine Medical GmbH) pressure infusion devices. Measurements were undertaken with a crystalloid solution during an infusion flow of 100, 200, 400 and 800 ml.min(-1). Four different volumes of air (25, 50, 100 and 200 ml) were injected as boluses in one experimental setting, or infused continuously over the time needed to perfuse 2 l saline in the other setting. The perfusion fluid was collected in an airtight infusion bag and the amount of air obtained in the bag was measured. The delivered air volume was negligible and would not cause any significant air embolism in all experiments. In our experimental setting, we found, during high flow, an increased amount of uneliminated air in all used devices compared with lower perfusion flows. All tested devices had a good air elimination capability. The use of ultrasonic air detection coupled with an automatic shutoff is a significant safety improvement and can reliably prevent accidental air embolism at rapid flows. © 2011 The Authors. Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland.

Acute kidney injury in critically burned patients resuscitated with a protocol that includes low doses of Hydroxyethyl Starch.

PubMed

Sánchez-Sánchez, M; Garcia-de-Lorenzo, A; Cachafeiro, L; Herrero, E; Asensio, M J; Agrifoglio, A; Flores, E; Estebanez, B; Extremera, P; Iglesias, C; Martinez, J R

2016-09-30

Acute kidney injury (AKI) is an important complication in burn patients. Recently, it has been recommended that hydroxyethyl starch (HES) be avoided in burn patients because it increases the incidence of AKI. Our purpose was to study incidence of AKI in critically ill burn patients resuscitated with Ringer's solution and supplements of HES. We conducted an observational study of 165 patients admitted to the critical care burn unit (with 30 ± 15% TBSA burned). The main outcome measures were incidence of AKI, contributions of colloids and crystalloids, various severity scores, comorbidities, complications and mortality. According to the RIFLE criteria, 10 (6.1%) patients presented with Risk, 11 (6.7%) presented with Injury and 11 (6.7%) presented with Failure. According to the AKIN criteria, 9.7% presented stage I, 3% stage II and 10.3% stage III. Replacement therapy (RRT) was performed in 15 patients (9.1%), but in 6 of them RRT was employed in the final stages of multi-organ failure. The incidence of AKI in severe burn patients is high according to the RIFLE or AKIN criteria and these patients experience more complications and higher mortality. Our study suggests that the use of HES in low doses in the burn resuscitation phase does not cause more AKI than resuscitation without HES, but further evaluation is required. Further studies should be conducted.

THE CLIMATIC AND HYDROLOGIC FACTORS AFFECTING THE REDISTRIBUTION OF SR-90

DTIC Science & Technology

leaching solution present and the chemical and cation exchange properties of the soil solution ; a mathematical model of movement was established...manual for using high speed computers to compute the factors of the daily water balance was prepared; the influence of the soil solution in

Lacticemia After Acute Overdose of Metformin in an Adolescent Managed Without Intravenous Sodium Bicarbonate or Extracorporeal Therapy.

PubMed

Bebarta, Vikhyat S; Pead, Joshua; Varney, Shawn M

2015-08-01

Metformin-associated lactic acidosis or lacticemia has been widely reported as an adverse drug effect in diabetic patients with other significant comorbidities and in acute overdose in adults. Lacticemia has been reported twice in a previously healthy pediatric population, both of which were suicide attempts and required hemodialysis. We report a case of a 17-year-old, nondiabetic, healthy adolescent girl with metformin-associated lacticemia who intentionally overdosed on metformin, had no coingestants, and was treated only with crystalloids. Furthermore, she did not require intravenous bicarbonate administration or extracorporeal removal.

Analysis of bacterial migration; 1: Numerical solution of balance equation

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

Frymier, P.D.; Ford, R.M.; Cummings, P.T.

1994-04-01

Chemotaxis describes the ability of motile bacteria to bias their motion in the direction of increasing gradients of chemicals, usually energy sources, known as attractants. In experimental studies of the migration of chemotactic bacteria, 1-D phenomenological cell balance equations have been used to quantitatively analyze experimental observations. While attractive for their simplicity and the ease of solution, they are limited in the strict mathematical sense to the situation in which individual bacteria are confined to motion in one dimension and respond to attractant gradients in one dimension only. Recently, Ford and Cummings (1992) reduced the general 3-D cell balance equationmore » of Alt (1980) to obtain an equation describing the migration of a bacterial population in response to a 1-D attractant gradient. Solutions of this equation for single gradients of attractants are compared to those of 1-D balance equations, results from cellular dynamics simulations, and experimental data from the authors' laboratory for E. coli responding to [alpha]-methylaspartate. The authors also investigate two aspects of the experimentally derived expression for the tumbling probability: the effect of different models for the down-gradient swimming behavior of the bacteria and the validity of ignoring the temporal derivative of the attractant concentration.« less

Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012.

PubMed

Dellinger, R P; Levy, Mitchell M; Rhodes, Andrew; Annane, Djillali; Gerlach, Herwig; Opal, Steven M; Sevransky, Jonathan E; Sprung, Charles L; Douglas, Ivor S; Jaeschke, Roman; Osborn, Tiffany M; Nunnally, Mark E; Townsend, Sean R; Reinhart, Konrad; Kleinpell, Ruth M; Angus, Derek C; Deutschman, Clifford S; Machado, Flavia R; Rubenfeld, Gordon D; Webb, Steven; Beale, Richard J; Vincent, Jean-Louis; Moreno, Rui

2013-02-01

To provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," last published in 2008. A consensus committee of 68 international experts representing 30 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict of interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. A stand-alone meeting was held for all subgroup heads, co- and vice-chairs, and selected individuals. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations as strong (1) or weak (2). The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. Recommendations were classified into three groups: (1) those directly targeting severe sepsis; (2) those targeting general care of the critically ill patient and considered high priority in severe sepsis; and (3) pediatric considerations. Key recommendations and suggestions, listed by category, include: early quantitative resuscitation of the septic patient during the first 6 h after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm a potential source of infection (UG); administration of broad-spectrum antimicrobials therapy within 1 h of the recognition of septic shock (1B) and severe sepsis without septic shock (1C) as the goal of therapy; reassessment of antimicrobial therapy daily for de-escalation, when appropriate (1B); infection source control with attention to the balance of risks and benefits of the chosen method within 12 h of diagnosis (1C); initial fluid resuscitation with crystalloid (1B) and consideration of the addition of albumin in patients who continue to require substantial amounts of crystalloid to maintain adequate mean arterial pressure (2C) and the avoidance of hetastarch formulations (1B); initial fluid challenge in patients with sepsis-induced tissue hypoperfusion and suspicion of hypovolemia to achieve a minimum of 30 mL/kg of crystalloids (more rapid administration and greater amounts of fluid may be needed in some patients (1C); fluid challenge technique continued as long as hemodynamic improvement is based on either dynamic or static variables (UG); norepinephrine as the first-choice vasopressor to maintain mean arterial pressure ≥65 mmHg (1B); epinephrine when an additional agent is needed to maintain adequate blood pressure (2B); vasopressin (0.03 U/min) can be added to norepinephrine to either raise mean arterial pressure to target or to decrease norepinephrine dose but should not be used as the initial vasopressor (UG); dopamine is not recommended except in highly selected circumstances (2C); dobutamine infusion administered or added to vasopressor in the presence of (a) myocardial dysfunction as suggested by elevated cardiac filling pressures and low cardiac output, or (b) ongoing signs of hypoperfusion despite achieving adequate intravascular volume and adequate mean arterial pressure (1C); avoiding use of intravenous hydrocortisone in adult septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability (2C); hemoglobin target of 7-9 g/dL in the absence of tissue hypoperfusion, ischemic coronary artery disease, or acute hemorrhage (1B); low tidal volume (1A) and limitation of inspiratory plateau pressure (1B) for acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure (PEEP) in ARDS (1B); higher rather than lower level of PEEP for patients with sepsis-induced moderate or severe ARDS (2C); recruitment maneuvers in sepsis patients with severe refractory hypoxemia due to ARDS (2C); prone positioning in sepsis-induced ARDS patients with a PaO (2)/FiO (2) ratio of ≤100 mm Hg in facilities that have experience with such practices (2C); head-of-bed elevation in mechanically ventilated patients unless contraindicated (1B); a conservative fluid strategy for patients with established ARDS who do not have evidence of tissue hypoperfusion (1C); protocols for weaning and sedation (1A); minimizing use of either intermittent bolus sedation or continuous infusion sedation targeting specific titration endpoints (1B); avoidance of neuromuscular blockers if possible in the septic patient without ARDS (1C); a short course of neuromuscular blocker (no longer than 48 h) for patients with early ARDS and a PaO (2)/FI O (2) <150 mm Hg (2C); a protocolized approach to blood glucose management commencing insulin dosing when two consecutive blood glucose levels are >180 mg/dL, targeting an upper blood glucose ≤180 mg/dL (1A); equivalency of continuous veno-venous hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1B); use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding in patients with bleeding risk factors (1B); oral or enteral (if necessary) feedings, as tolerated, rather than either complete fasting or provision of only intravenous glucose within the first 48 h after a diagnosis of severe sepsis/septic shock (2C); and addressing goals of care, including treatment plans and end-of-life planning (as appropriate) (1B), as early as feasible, but within 72 h of intensive care unit admission (2C). Recommendations specific to pediatric severe sepsis include: therapy with face mask oxygen, high flow nasal cannula oxygen, or nasopharyngeal continuous PEEP in the presence of respiratory distress and hypoxemia (2C), use of physical examination therapeutic endpoints such as capillary refill (2C); for septic shock associated with hypovolemia, the use of crystalloids or albumin to deliver a bolus of 20 mL/kg of crystalloids (or albumin equivalent) over 5-10 min (2C); more common use of inotropes and vasodilators for low cardiac output septic shock associated with elevated systemic vascular resistance (2C); and use of hydrocortisone only in children with suspected or proven "absolute"' adrenal insufficiency (2C). Strong agreement existed among a large cohort of international experts regarding many level 1 recommendations for the best care of patients with severe sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for this important group of critically ill patients.

Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.

PubMed

Dellinger, R Phillip; Levy, Mitchell M; Rhodes, Andrew; Annane, Djillali; Gerlach, Herwig; Opal, Steven M; Sevransky, Jonathan E; Sprung, Charles L; Douglas, Ivor S; Jaeschke, Roman; Osborn, Tiffany M; Nunnally, Mark E; Townsend, Sean R; Reinhart, Konrad; Kleinpell, Ruth M; Angus, Derek C; Deutschman, Clifford S; Machado, Flavia R; Rubenfeld, Gordon D; Webb, Steven A; Beale, Richard J; Vincent, Jean-Louis; Moreno, Rui

2013-02-01

To provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," last published in 2008. A consensus committee of 68 international experts representing 30 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict of interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. A stand-alone meeting was held for all subgroup heads, co- and vice-chairs, and selected individuals. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations as strong (1) or weak (2). The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. Some recommendations were ungraded (UG). Recommendations were classified into three groups: 1) those directly targeting severe sepsis; 2) those targeting general care of the critically ill patient and considered high priority in severe sepsis; and 3) pediatric considerations. Key recommendations and suggestions, listed by category, include: early quantitative resuscitation of the septic patient during the first 6 hrs after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm a potential source of infection (UG); administration of broad-spectrum antimicrobials therapy within 1 hr of recognition of septic shock (1B) and severe sepsis without septic shock (1C) as the goal of therapy; reassessment of antimicrobial therapy daily for de-escalation, when appropriate (1B); infection source control with attention to the balance of risks and benefits of the chosen method within 12 hrs of diagnosis (1C); initial fluid resuscitation with crystalloid (1B) and consideration of the addition of albumin in patients who continue to require substantial amounts of crystalloid to maintain adequate mean arterial pressure (2C) and the avoidance of hetastarch formulations (1C); initial fluid challenge in patients with sepsis-induced tissue hypoperfusion and suspicion of hypovolemia to achieve a minimum of 30 mL/kg of crystalloids (more rapid administration and greater amounts of fluid may be needed in some patients) (1C); fluid challenge technique continued as long as hemodynamic improvement, as based on either dynamic or static variables (UG); norepinephrine as the first-choice vasopressor to maintain mean arterial pressure ≥ 65 mm Hg (1B); epinephrine when an additional agent is needed to maintain adequate blood pressure (2B); vasopressin (0.03 U/min) can be added to norepinephrine to either raise mean arterial pressure to target or to decrease norepinephrine dose but should not be used as the initial vasopressor (UG); dopamine is not recommended except in highly selected circumstances (2C); dobutamine infusion administered or added to vasopressor in the presence of a) myocardial dysfunction as suggested by elevated cardiac filling pressures and low cardiac output, or b) ongoing signs of hypoperfusion despite achieving adequate intravascular volume and adequate mean arterial pressure (1C); avoiding use of intravenous hydrocortisone in adult septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability (2C); hemoglobin target of 7-9 g/dL in the absence of tissue hypoperfusion, ischemic coronary artery disease, or acute hemorrhage (1B); low tidal volume (1A) and limitation of inspiratory plateau pressure (1B) for acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure (PEEP) in ARDS (1B); higher rather than lower level of PEEP for patients with sepsis-induced moderate or severe ARDS (2C); recruitment maneuvers in sepsis patients with severe refractory hypoxemia due to ARDS (2C); prone positioning in sepsis-induced ARDS patients with a PaO2/FIO2 ratio of ≤ 100 mm Hg in facilities that have experience with such practices (2C); head-of-bed elevation in mechanically ventilated patients unless contraindicated (1B); a conservative fluid strategy for patients with established ARDS who do not have evidence of tissue hypoperfusion (1C); protocols for weaning and sedation (1A); minimizing use of either intermittent bolus sedation or continuous infusion sedation targeting specific titration endpoints (1B); avoidance of neuromuscular blockers if possible in the septic patient without ARDS (1C); a short course of neuromuscular blocker (no longer than 48 hrs) for patients with early ARDS and a Pao2/Fio2 < 150 mm Hg (2C); a protocolized approach to blood glucose management commencing insulin dosing when two consecutive blood glucose levels are > 180 mg/dL, targeting an upper blood glucose ≤ 180 mg/dL (1A); equivalency of continuous veno-venous hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1B); use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding in patients with bleeding risk factors (1B); oral or enteral (if necessary) feedings, as tolerated, rather than either complete fasting or provision of only intravenous glucose within the first 48 hrs after a diagnosis of severe sepsis/septic shock (2C); and addressing goals of care, including treatment plans and end-of-life planning (as appropriate) (1B), as early as feasible, but within 72 hrs of intensive care unit admission (2C). Recommendations specific to pediatric severe sepsis include: therapy with face mask oxygen, high flow nasal cannula oxygen, or nasopharyngeal continuous PEEP in the presence of respiratory distress and hypoxemia (2C), use of physical examination therapeutic endpoints such as capillary refill (2C); for septic shock associated with hypovolemia, the use of crystalloids or albumin to deliver a bolus of 20 mL/kg of crystalloids (or albumin equivalent) over 5 to 10 mins (2C); more common use of inotropes and vasodilators for low cardiac output septic shock associated with elevated systemic vascular resistance (2C); and use of hydrocortisone only in children with suspected or proven "absolute"' adrenal insufficiency (2C). Strong agreement existed among a large cohort of international experts regarding many level 1 recommendations for the best care of patients with severe sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for this important group of critically ill patients.

iBEST: intelligent Balance assessment and Stability Training system using smartphone.

PubMed

Wai, Aung Aung Phyo; Duc, Pham Duy; Syin, Chan; Zhang, Haihong

2014-01-01

Patients with postural instability could lead to falls and injuries while walking due to balance disorders. So those patients need regular balance training and evaluation to improve and examine balance deficiencies. But many do not notice such balance issues; resulting lack of timely preventive measures. This shows the needs of affordable and accessible solution for balance training and assessment. So iBEST (intelligent Balance assessment and Stability Training) is proposed enabling to train and assess balance conveniently anywhere anytime. Moreover, therapists can remotely evaluate and manage their recovery progress. These benefits can be realized leveraging sensors from smartphone, cloud-based data analytics and web applications. iBEST employs sensorised automated balance assessment in digitizing Berg Balance Scale (BBS) clinical risk assessment tool. The initial feasibility study showed average accuracy of 90.22% using smartphone in classifying the specified BBS test items.

Exact period-four solutions of a family of n-dimensional quadratic maps via harmonic balance and Gröbner bases.

PubMed

D'Amico, María Belén; Calandrini, Guillermo L

2015-11-01

Analytical solutions of the period-four orbits exhibited by a classical family of n-dimensional quadratic maps are presented. Exact expressions are obtained by applying harmonic balance and Gröbner bases to a single-input single-output representation of the system. A detailed study of a generalized scalar quadratic map and a well-known delayed logistic model is included for illustration. In the former example, conditions for the existence of bistability phenomenon are also introduced.

Exact period-four solutions of a family of n-dimensional quadratic maps via harmonic balance and Gröbner bases

NASA Astrophysics Data System (ADS)

D'Amico, María Belén; Calandrini, Guillermo L.

2015-11-01

Analytical solutions of the period-four orbits exhibited by a classical family of n-dimensional quadratic maps are presented. Exact expressions are obtained by applying harmonic balance and Gröbner bases to a single-input single-output representation of the system. A detailed study of a generalized scalar quadratic map and a well-known delayed logistic model is included for illustration. In the former example, conditions for the existence of bistability phenomenon are also introduced.

[Optimal solution and analysis of muscular force during standing balance].

PubMed

Wang, Hongrui; Zheng, Hui; Liu, Kun

2015-02-01

The present study was aimed at the optimal solution of the main muscular force distribution in the lower extremity during standing balance of human. The movement musculoskeletal system of lower extremity was simplified to a physical model with 3 joints and 9 muscles. Then on the basis of this model, an optimum mathematical model was built up to solve the problem of redundant muscle forces. Particle swarm optimization (PSO) algorithm is used to calculate the single objective and multi-objective problem respectively. The numerical results indicated that the multi-objective optimization could be more reasonable to obtain the distribution and variation of the 9 muscular forces. Finally, the coordination of each muscle group during maintaining standing balance under the passive movement was qualitatively analyzed using the simulation results obtained.

One-dimensional Vlasov-Maxwell equilibrium for the force-free Harris sheet.

PubMed

Harrison, Michael G; Neukirch, Thomas

2009-04-03

In this Letter, the first nonlinear force-free Vlasov-Maxwell equilibrium is presented. One component of the equilibrium magnetic field has the same spatial structure as the Harris sheet, but whereas the Harris sheet is kept in force balance by pressure gradients, in the force-free solution presented here force balance is maintained by magnetic shear. Magnetic pressure, plasma pressure and plasma density are constant. The method used to find the equilibrium is based on the analogy of the one-dimensional Vlasov-Maxwell equilibrium problem to the motion of a pseudoparticle in a two-dimensional conservative potential. The force-free solution can be generalized to a complete family of equilibria that describe the transition between the purely pressure-balanced Harris sheet to the force-free Harris sheet.

Redox Redone.

ERIC Educational Resources Information Center

Petty, John T.

1996-01-01

Presents an extension of the change in oxidation number method that is used for balancing skeletal redox reactions in aqueous solutions. Retains most of the simplicity of the change in oxidation number method but provides the additional step-by-step process necessary for the beginner to balance an equation. (JRH)

Global Load Balancing with Parallel Mesh Adaption on Distributed-Memory Systems

NASA Technical Reports Server (NTRS)

Biswas, Rupak; Oliker, Leonid; Sohn, Andrew

1996-01-01

Dynamic mesh adaptation on unstructured grids is a powerful tool for efficiently computing unsteady problems to resolve solution features of interest. Unfortunately, this causes load inbalances among processors on a parallel machine. This paper described the parallel implementation of a tetrahedral mesh adaption scheme and a new global load balancing method. A heuristic remapping algorithm is presented that assigns partitions to processors such that the redistribution coast is minimized. Results indicate that the parallel performance of the mesh adaption code depends on the nature of the adaption region and show a 35.5X speedup on 64 processors of an SP2 when 35 percent of the mesh is randomly adapted. For large scale scientific computations, our load balancing strategy gives an almost sixfold reduction in solver execution times over non-balanced loads. Furthermore, our heuristic remappier yields processor assignments that are less than 3 percent of the optimal solutions, but requires only 1 percent of the computational time.

The Role of Deformation Energetics in Long-Term Tectonic Modeling

NASA Astrophysics Data System (ADS)

Ahamed, S.; Choi, E.

2017-12-01

The deformation-related energy budget is usually considered in the simplest form or even entirely omitted from the energy balance equation. We derive a full energy balance equation that accounts not only for heat energy but also for mechanical (elastic, plastic and viscous) work. The derived equation is implemented in DES3D, an unstructured finite element solver for long-term tectonic deformation. We verify the implementation by comparing numerical solutions to the corresponding semi-analytic solutions in three benchmarks extended from the classical oedometer test. We also investigate the long-term effects of deformation energetics on the evolution of large offset normal faults. We find that the models considering the full energy balance equation tend to produce more secondary faults and an elongated core complex. Our results for the normal fault system confirm that persistent inelastic deformation has a significant impact on the long-term evolution of faults, motivating further exploration of the role of the full energy balance equation in other geodynamic systems.

Strong-field dynamo action in rapidly rotating convection with no inertia.

PubMed

Hughes, David W; Cattaneo, Fausto

2016-06-01

The earth's magnetic field is generated by dynamo action driven by convection in the outer core. For numerical reasons, inertial and viscous forces play an important role in geodynamo models; however, the primary dynamical balance in the earth's core is believed to be between buoyancy, Coriolis, and magnetic forces. The hope has been that by setting the Ekman number to be as small as computationally feasible, an asymptotic regime would be reached in which the correct force balance is achieved. However, recent analyses of geodynamo models suggest that the desired balance has still not yet been attained. Here we adopt a complementary approach consisting of a model of rapidly rotating convection in which inertial forces are neglected from the outset. Within this framework we are able to construct a branch of solutions in which the dynamo generates a strong magnetic field that satisfies the expected force balance. The resulting strongly magnetized convection is dramatically different from the corresponding solutions in which the field is weak.

Computer model of hydroponics nutrient solution pH control using ammonium.

PubMed

Pitts, M; Stutte, G

1999-01-01

A computer simulation of a hydroponics-based plant growth chamber using ammonium to control pH was constructed to determine the feasibility of such a system. In nitrate-based recirculating hydroponics systems, the pH will increase as plants release hydroxide ions into the nutrient solution to maintain plant charge balance. Ammonium is an attractive alternative to traditional pH controls in an ALSS, but requires careful monitoring and control to avoid overdosing the plants with ammonium. The primary advantage of using NH4+ for pH control is that it exploits the existing plant nutrient uptake charge balance mechanisms to maintain solution pH. The simulation models growth, nitrogen uptake, and pH of a l-m2 stand of wheat. Simulation results indicated that ammonium-based control of nutrient solution pH is feasible using a proportional integral controller. Use of a 1 mmol/L buffer (Ka = 1.6 x 10(-6)) in the nutrient solution is required.

A well-balanced scheme for Ten-Moment Gaussian closure equations with source term

NASA Astrophysics Data System (ADS)

Meena, Asha Kumari; Kumar, Harish

2018-02-01

In this article, we consider the Ten-Moment equations with source term, which occurs in many applications related to plasma flows. We present a well-balanced second-order finite volume scheme. The scheme is well-balanced for general equation of state, provided we can write the hydrostatic solution as a function of the space variables. This is achieved by combining hydrostatic reconstruction with contact preserving, consistent numerical flux, and appropriate source discretization. Several numerical experiments are presented to demonstrate the well-balanced property and resulting accuracy of the proposed scheme.

Variations in surface water-ground water interactions along a headwater mountain stream : comparisons between transient storage and water balance analyses

USGS Publications Warehouse

Ward, Adam S.; Payn, Robert A.; Gooseff, Michael N.; McGlynn, Brian L.; Bencala, Kenneth E.; Kelleher, Christa A.; Wondzell, Steven M.; Wagener, Thorsten

2013-01-01

The accumulation of discharge along a stream valley is frequently assumed to be the primary control on solute transport processes. Relationships of both increasing and decreasing transient storage, and decreased gross losses of stream water have been reported with increasing discharge; however, we have yet to validate these relationships with extensive field study. We conducted transient storage and mass recovery analyses of artificial tracer studies completed for 28 contiguous 100 m reaches along a stream valley, repeated under four base-flow conditions. We calculated net and gross gains and losses, temporal moments of tracer breakthrough curves, and best fit transient storage model parameters (with uncertainty estimates) for 106 individual tracer injections. Results supported predictions that gross loss of channel water would decrease with increased discharge. However, results showed no clear relationship between discharge and transient storage, and further analysis of solute tracer methods demonstrated that the lack of this relation may be explained by uncertainty and equifinality in the transient storage model framework. Furthermore, comparison of water balance and transient storage approaches reveals complications in clear interpretation of either method due to changes in advective transport time, which sets a the temporal boundary separating transient storage and channel water balance. We have little ability to parse this limitation of solute tracer methods from the physical processes we seek to study. We suggest the combined analysis of both transient storage and channel water balance more completely characterizes transport of solutes in stream networks than can be inferred from either method alone.

Geoboard and Balance Activities for the Gifted Child.

ERIC Educational Resources Information Center

Bondy, Kay W.

1979-01-01

The author describes mathematics activities for gifted children which make use of the geoboard and balance. The problem, solutions, and theoretical backing are provided for determining areas of squares, areas of irregular shapes, the weight of popped and unpopped popcorn, kernels, and liquid mass and density. (SBH)

Emergency department blood transfusion: the first two units are free.

PubMed

Ley, Eric J; Liou, Douglas Z; Singer, Matthew B; Mirocha, James; Melo, Nicolas; Chung, Rex; Bukur, Marko; Salim, Ali

2013-09-01

Studies on blood product transfusions after trauma recommend targeting specific ratios to reduce mortality. Although crystalloid volumes as little as 1.5 L predict increased mortality after trauma, little data is available regarding the threshold of red blood cell (RBC) transfusion volume that predicts increased mortality. Data from a level I trauma center between January 2000 and December 2008 were reviewed. Trauma patients who received at least 100 mL RBC in the emergency department (ED) were included. Each unit of RBC was defined as 300 mL. Demographics, RBC transfusion volume, and mortality were analyzed in the nonelderly (<70 y) and elderly (≥70 y). Multivariate logistic regression was performed at various volume cutoffs to determine whether there was a threshold transfusion volume that independently predicted mortality. A total of 560 patients received ≥100 mL RBC in the ED. Overall mortality was 24.3%, with 22.5% (104 deaths) in the nonelderly and 32.7% (32 deaths) in the elderly. Multivariate logistic regression demonstrated that RBC transfusion of ≥900 mL was associated with increased mortality in both the nonelderly (adjusted odds ratio 2.06, P = 0.008) and elderly (adjusted odds ratio 5.08, P = 0.006). Although transfusion of greater than 2 units in the ED was an independent predictor of mortality, transfusion of 2 units or less was not. Interestingly, unlike crystalloid volume, stepwise increases in blood volume were not associated with stepwise increases in mortality. The underlying etiology for mortality discrepancies, such as transfusion ratios, hypothermia, or immunosuppression, needs to be better delineated. Copyright © 2013 Elsevier Inc. All rights reserved.

A randomized study to compare the efficacy of two intravenous fluid regimens of normal saline on the incidence of postoperative nausea and vomiting

PubMed Central

Bhukal, Ishwar; Srinivas, N.; Solanki, Sohan Lal; Yaddanapudi, L. N.; Jain, Amit

2012-01-01

Background: The purpose of this study was to evaluate the effect of two different volume of crystalloid given intraoperatively on postoperative nausea and vomiting (PONV). Materials and Methods: Eighty adult patients of either sex belonging to ASA I and II class undergoing elective surgeries under general anesthesia for 1–2 h were studied in this prospective, randomized double blinded study. First group (group L) (n=40) received normal saline 4 mL/kg and second group (group H) (n=40) received 10 mL/kg of normal saline. This was in excess of the fasting requirement of the patients. No propofol or antiemetic drugs were given. PONV was evaluated by verbal descriptive score (VDS) [0 = none, 1 = mild, 2 = moderate, 3 = severe, and 4 = unbearable]. Ondansetron (4 mg i.v.) was given if VDS score was 3 or more. Results: The median immediate PONV score was 2 and 1 in group L and H, respectively. The median 2 h PONV score in group L was 3 and in group H was 1. The median 6 h PONV score in group L was 3 and in group H was 1. The 24 h median postoperative PONV score was 1 and 0 in group L and H, respectively. In all these period of time the differences were statistically significant. The incidence of vomiting was more in group L [72.5% (29/40)] than in group H [30% (12/40)]. This was statistically significant (P=0.0003). Conclusion: From the current study it was concluded that patients who received larger volume of crystalloid intraoperatively have lesser incidence of PONV. PMID:25885496

Blood Versus Crystalloid Cardioplegia in Pediatric Cardiac Surgery: A Systematic Review and Meta-analysis.

PubMed

Mylonas, Konstantinos S; Tzani, Aspasia; Metaxas, Panagiotis; Schizas, Dimitrios; Boikou, Vasileios; Economopoulos, Konstantinos P

2017-12-01

The benefit of blood cardioplegia (BCP) compared to crystalloid cardioplegia (CCP) is still debatable. Our aim was to systematically review and synthesize all available evidence on the use of BCP and CCP to assess if any modality provides superior outcomes in pediatric cardiac surgery. A systematic literature search of the PubMed and Cochrane databases was performed with respect to the PRISMA statement (end-of-search date: January 30th, 2017). We extracted data on study design, demographics, cardioplegia regimens, and perioperative outcomes as well as relevant biochemical markers, namely cardiac troponin I (cTnI), lactate, and ATP levels at baseline, after reperfusion and postoperatively at 1, 4, 12, and 24 h as applicable. Data were appropriately pooled using random and mixed effects models. Our systematic review includes 56 studies reporting on a total of 7711 pediatric patients. A meta-analysis of the 10 eligible studies directly comparing BCP (n = 416) to CCP (n = 281) was also performed. There was no significant difference between the two groups with regard to cTnI and Lac at any measured time point, ATP levels after reperfusion, length of intensive care unit stay (WMD: -0.08, 95% CI -1.52 to 1.36), length of hospital stay (WMD: 0.13, 95% CI -0.85 to 1.12), and 30-day mortality (OR 1.11, 95% CI 0.43-2.88). Only cTnI levels at 4 h postoperatively were significantly lower with BCP (WMD: -1.62, 95% CI -2.07 to -1.18). Based on the available data, neither cardioplegia modality seems to be superior in terms of clinical outcomes, ischemia severity, and overall functional recovery.

Convergence to equilibrium of renormalised solutions to nonlinear chemical reaction–diffusion systems

NASA Astrophysics Data System (ADS)

Fellner, Klemens; Tang, Bao Quoc

2018-06-01

The convergence to equilibrium for renormalised solutions to nonlinear reaction-diffusion systems is studied. The considered reaction-diffusion systems arise from chemical reaction networks with mass action kinetics and satisfy the complex balanced condition. By applying the so-called entropy method, we show that if the system does not have boundary equilibria, i.e. equilibrium states lying on the boundary of R_+^N, then any renormalised solution converges exponentially to the complex balanced equilibrium with a rate, which can be computed explicitly up to a finite-dimensional inequality. This inequality is proven via a contradiction argument and thus not explicitly. An explicit method of proof, however, is provided for a specific application modelling a reversible enzyme reaction by exploiting the specific structure of the conservation laws. Our approach is also useful to study the trend to equilibrium for systems possessing boundary equilibria. More precisely, to show the convergence to equilibrium for systems with boundary equilibria, we establish a sufficient condition in terms of a modified finite-dimensional inequality along trajectories of the system. By assuming this condition, which roughly means that the system produces too much entropy to stay close to a boundary equilibrium for infinite time, the entropy method shows exponential convergence to equilibrium for renormalised solutions to complex balanced systems with boundary equilibria.

A framework for multi-stakeholder decision-making and ...

EPA Pesticide Factsheets

We propose a decision-making framework to compute compromise solutions that balance conflicting priorities of multiple stakeholders on multiple objectives. In our setting, we shape the stakeholder dis-satisfaction distribution by solving a conditional-value-at-risk (CVaR) minimization problem. The CVaR problem is parameterized by a probability level that shapes the tail of the dissatisfaction distribution. The proposed approach allows us to compute a family of compromise solutions and generalizes multi-stakeholder settings previously proposed in the literature that minimize average and worst-case dissatisfactions. We use the concept of the CVaR norm to give a geometric interpretation to this problem +and use the properties of this norm to prove that the CVaR minimization problem yields Pareto optimal solutions for any choice of the probability level. We discuss a broad range of potential applications of the framework that involve complex decision-making processes. We demonstrate the developments using a biowaste facility location case study in which we seek to balance stakeholder priorities on transportation, safety, water quality, and capital costs. This manuscript describes the methodology of a new decision-making framework that computes compromise solutions that balance conflicting priorities of multiple stakeholders on multiple objectives as needed for SHC Decision Science and Support Tools project. A biowaste facility location is employed as the case study

Shallow-water sloshing in a moving vessel with variable cross-section and wetting-drying using an extension of George's well-balanced finite volume solver

NASA Astrophysics Data System (ADS)

Alemi Ardakani, Hamid; Bridges, Thomas J.; Turner, Matthew R.

2016-06-01

A class of augmented approximate Riemann solvers due to George (2008) [12] is extended to solve the shallow-water equations in a moving vessel with variable bottom topography and variable cross-section with wetting and drying. A class of Roe-type upwind solvers for the system of balance laws is derived which respects the steady-state solutions. The numerical solutions of the new adapted augmented f-wave solvers are validated against the Roe-type solvers. The theory is extended to solve the shallow-water flows in moving vessels with arbitrary cross-section with influx-efflux boundary conditions motivated by the shallow-water sloshing in the ocean wave energy converter (WEC) proposed by Offshore Wave Energy Ltd. (OWEL) [1]. A fractional step approach is used to handle the time-dependent forcing functions. The numerical solutions are compared to an extended new Roe-type solver for the system of balance laws with a time-dependent source function. The shallow-water sloshing finite volume solver can be coupled to a Runge-Kutta integrator for the vessel motion.

A Simple Heat of Crystallization Experiment.

ERIC Educational Resources Information Center

De Nevers, Noel

1991-01-01

A demonstration used in a heat and material balances class that explains how a reusable heat pack works is described. An initial homework problem or exam question is provided with its solution. A discussion of the solution is included. (KR)

Improving traditional balancing methods for high-speed rotors

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

Ling, J.; Cao, Y.

1996-01-01

This paper introduces frequency response functions, analyzes the relationships between the frequency response functions and influence coefficients theoretically, and derives corresponding mathematical equations for high-speed rotor balancing. The relationships between the imbalance masses on the rotor and frequency response functions are also analyzed based upon the modal balancing method, and the equations related to the static and dynamic imbalance masses and the frequency response function are obtained. Experiments on a high-speed rotor balancing rig were performed to verify the theory, and the experimental data agree satisfactorily with the analytical solutions. The improvement on the traditional balancing method proposed in thismore » paper will substantially reduce the number of rotor startups required during the balancing process of rotating machinery.« less

Solution-Processable Balanced Ambipolar Field-Effect Transistors Based on Carbonyl-Regulated Copolymers.

PubMed

Yang, Chengdong; Fang, Renren; Yang, Xiongfa; Chen, Ru; Gao, Jianhua; Fan, Hanghong; Li, Hongxiang; Hu, Wenping

2018-04-04

It is very important to develop ambipolar field effect transistors to construct complementary circuits. To obtain balanced hole- and electron-transport properties, one of the key issues is to regulate the energy levels of the frontier orbitals of the semiconductor materials by structural tailoring, so that they match well with the electrode Fermi levels. Five conjugated copolymers were synthesized and exhibited low LUMO energy levels and narrow bandgaps on account of the strong electron-withdrawing effect of the carbonyl groups. Polymer thin film transistors were prepared by using a solution method and exhibited high and balanced hole and electron mobility of up to 0.46 cm 2  V -1  s -1 , which suggested that these copolymers are promising ambipolar semiconductor materials. © 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

Linear systems on balancing chemical reaction problem

NASA Astrophysics Data System (ADS)

Kafi, R. A.; Abdillah, B.

2018-01-01

The concept of linear systems appears in a variety of applications. This paper presents a small sample of the wide variety of real-world problems regarding our study of linear systems. We show that the problem in balancing chemical reaction can be described by homogeneous linear systems. The solution of the systems is obtained by performing elementary row operations. The obtained solution represents the finding coefficients of chemical reaction. In addition, we present a computational calculation to show that mathematical software such as Matlab can be used to simplify completion of the systems, instead of manually using row operations.

Nonlocal systems of balance laws in several space dimensions with applications to laser technology

NASA Astrophysics Data System (ADS)

Colombo, Rinaldo M.; Marcellini, Francesca

2015-12-01

For a class of systems of nonlinear and nonlocal balance laws in several space dimensions, we prove the local in time existence of solutions and their continuous dependence on the initial datum. The choice of this class is motivated by a new model devoted to the description of a metal plate being cut by a laser beam. Using realistic parameters, solutions to this model obtained through numerical integrations meet qualitative properties of real cuts. Moreover, the class of equations considered comprises a model describing the dynamics of solid particles along a conveyor belt.

Water and solute balances as a basis for sustainable irrigation agriculture

NASA Astrophysics Data System (ADS)

Pla-Sentís, Ildefonso

2015-04-01

The growing development of irrigated agriculture is necessary for the sustainable production of the food required by the increasing World's population. Such development is limited by the increasing scarcity and low quality of the available water resources and by the competitive use of the water for other purposes. There are also increasing problems of contamination of surface and ground waters to be used for other purposes by the drainage effluents of irrigated lands. Irrigation and drainage may cause drastic changes in the regime and balance of water and solutes (salts, sodium, contaminants) in the soil profile, resulting in problems of water supply to crops and problems of salinization, sodification and contamination of soils and ground waters. This is affected by climate, crops, soils, ground water depth, irrigation and groundwater composition, and by irrigation and drainage management. In order to predict and prevent such problems for a sustainable irrigated agriculture and increased efficiency in water use, under each particular set of conditions, there have to be considered both the hydrological, physical and chemical processes determining such water and solute balances in the soil profile. In this contribution there are proposed the new versions of two modeling approaches (SOMORE and SALSODIMAR) to predict those balances and to guide irrigation water use and management, integrating the different factors involved in such processes. Examples of their application under Mediterranean and tropical climate conditions are also presented.

The method of perturbation-harmonic balance for analysing nonlinear free vibration of MDOF systems and structures

NASA Astrophysics Data System (ADS)

Tang, Qiangang; Sun, Shixian

1992-03-01

In this paper, the perturbation technique is introduced into the method of harmonic balance. A new method used for analyzing nonlinear free vibration of multidegree-of-freedom systems and structures is obtained. The form of solution is expanded into a series of small parameters and harmonics, so no term will be lost in the solution and the algebraic equations are linear. With the linear transformations, the matrices of the equations become diagonal. As soon as the modes related to linear vibration are found, the solution can be obtained. This method is superior to the method of linearized iteration. The examples show that the method has high accuracy for small-amplitude problems and the results for rather large amplitudes are satisfactory.

Battery Cell Balancing Optimisation for Battery Management System

NASA Astrophysics Data System (ADS)

Yusof, M. S.; Toha, S. F.; Kamisan, N. A.; Hashim, N. N. W. N.; Abdullah, M. A.

2017-03-01

Battery cell balancing in every electrical component such as home electronic equipment and electric vehicle is very important to extend battery run time which is simplified known as battery life. The underlying solution to equalize the balance of cell voltage and SOC between the cells when they are in complete charge. In order to control and extend the battery life, the battery cell balancing is design and manipulated in such way as well as shorten the charging process. Active and passive cell balancing strategies as a unique hallmark enables the balancing of the battery with the excellent performances configuration so that the charging process will be faster. The experimental and simulation covers an analysis of how fast the battery can balance for certain time. The simulation based analysis is conducted to certify the use of optimisation in active or passive cell balancing to extend battery life for long periods of time.

High molecular weight hydroxyethyl starch solutions are not more effective than a low wmolecular weight hydroxyethyl starch solution in a porcine model of septic shock.

PubMed

Simon, T-P; Schuerholz, T; Haugvik, S P; Forberger, C; Burmeister, M-A; Marx, G

2013-01-01

There is evidence that suggests that early fluid resuscitation is beneficial in the treatment of sepsis. We previously demonstrated that hydroxyethyl starch (HES) 130/0.42 attenuated capillary leakage better than HES 200/0.5. Using a similar porcine fecal sepsis model, we tested the effects of two new synthetic high molecular weight (700 kDa) hydroxyethyl starches with the same molar substitution of 0.42 but with a different C2/C6 ratio compared to 6% HES 130/0.42 on plasma volume (PV), systemic and tissue oxygenation. This was a prospective, randomized, controlled animal study. Twenty-five anesthetized and mechanically ventilated pigs (28.4±2.3 kg) were observed over 8 h. Septic shock was induced with fecal peritonitis. Animals were randomized for volume-replacement therapy with HES 700/0.42 C2/C6/2.5:1 (N.=5), HES 700/0.42 C2/C6/6:1 (N.=5), HES 130/0.42 C2/C6/5:1 (N.=5) or Ringer’s Solution (RS, N.=5), and compared to non-septic controls receiving RS (N.=5). The albumin escape rate (AER) was calculated and plasma volume was determined at the end of the study. Tissue Oxygen Saturation was measured with the InSpectra™ Device (InSpectra Tissue Spectrometer, Hutchinson Technology Inc., Hutchinson, MN, USA). The AER increased in all groups compared to control. All colloids (HES 700/6:1 68±15; HES 130 67±4; HES 700/2.5:1 71±12; P<0.05) but not RS (44±7) stabilized PV (mL/kg BW) after eight hours of sepsis. Systemic oxygenation was significantly lower in the RS group (44±17%; P<0.05) compared to all other groups at study end (P<0.05). In this porcine fecal peritonitis model, the high molecular weight artificial colloids HES 700/2.5:1 and HES 700/6:1 were not more effective in maintaining plasma volume and systemic and tissue oxygenation than HES 130. In comparison to crystalloid RS, all HES solutions were more effective at maintaining plasma volume, mean arterial pressure (MAP), and systemic and tissue oxygenation.

Perioperative Fluid and Electrolyte Management in Cardiac Surgery: A Review

PubMed Central

Young, Robert

2012-01-01

Abstract: This article can be broken down into three sections. First is a review of extracellular fluid volume management and some of the key physiological principles involved. Second, there is an appraisal of the merits or otherwise of crystalloids and colloids for volume replacement, and finally, a summary of the key points in our appreciation of the behavior of various cations in the perioperative period. In all these areas, there has been much academic endeavor. Sometimes this has generated more heat than light, and the lack of consensus in many areas serves to highlight the need for further work and better understanding. PMID:22730868

Fluid Therapy in Lung Disease.

PubMed

Rozanski, Elizabeth; Lynch, Alex

2017-03-01

Fluid therapy is the cornerstone of supportive care in veterinary medicine. In dogs and cats with preexisting confirmed or suspected pulmonary disease, concerns may exist that the fluid therapy may impair gas exchange, either through increases in hydrostatic pressures or extravasation. Colloidal therapy is more likely to magnify lung injury compared with isotonic crystalloids. Radiographic evidence of fluid overload is a late-stage finding, whereas point-of-care ultrasound may provide earlier information that can also be assessed periodically at the patient side. Cases should be evaluated individually, but generally a conservative fluid therapy plan is preferred with close monitoring of its tolerance. Copyright © 2016 Elsevier Inc. All rights reserved.

Damage control resuscitation: history, theory and technique

PubMed Central

Ball, Chad G.

2014-01-01

Damage control resuscitation (DCR) represents the natural evolution of the initial concept of damage control surgery. It currently includes early blood product transfusion, immediate arrest and/or temporization of ongoing hemorrhage (i.e., temporary intravascular shunts and/or balloon tamponade) as well as restoration of blood volume and physiologic/hematologic stability. As a result, DCR addresses the early coagulopathy of trauma, avoids massive crystalloid resuscitation and leaves the peritoneal cavity open when a patient approaches physiologic exhaustion without improvement. This concept also applies to severe injuries within anatomical transition zones as well as extremities. This review will discuss each of these concepts in detail. PMID:24461267

Asymptotically and exactly energy balanced augmented flux-ADER schemes with application to hyperbolic conservation laws with geometric source terms

NASA Astrophysics Data System (ADS)

Navas-Montilla, A.; Murillo, J.

2016-07-01

In this work, an arbitrary order HLL-type numerical scheme is constructed using the flux-ADER methodology. The proposed scheme is based on an augmented Derivative Riemann solver that was used for the first time in Navas-Montilla and Murillo (2015) [1]. Such solver, hereafter referred to as Flux-Source (FS) solver, was conceived as a high order extension of the augmented Roe solver and led to the generation of a novel numerical scheme called AR-ADER scheme. Here, we provide a general definition of the FS solver independently of the Riemann solver used in it. Moreover, a simplified version of the solver, referred to as Linearized-Flux-Source (LFS) solver, is presented. This novel version of the FS solver allows to compute the solution without requiring reconstruction of derivatives of the fluxes, nevertheless some drawbacks are evidenced. In contrast to other previously defined Derivative Riemann solvers, the proposed FS and LFS solvers take into account the presence of the source term in the resolution of the Derivative Riemann Problem (DRP), which is of particular interest when dealing with geometric source terms. When applied to the shallow water equations, the proposed HLLS-ADER and AR-ADER schemes can be constructed to fulfill the exactly well-balanced property, showing that an arbitrary quadrature of the integral of the source inside the cell does not ensure energy balanced solutions. As a result of this work, energy balanced flux-ADER schemes that provide the exact solution for steady cases and that converge to the exact solution with arbitrary order for transient cases are constructed.

Severe fat embolism in perioperative abdominal liposuction and fat grafting.

PubMed

de Lima E Souza, Rodrigo; Apgaua, Bruno Tavares; Milhomens, João Daniel; Albuquerque, Francisco Tadeu Motta; Carneiro, Luiz Antônio; Mendes, Márcio Henrique; Garcia, Tiago Carvalho; Paiva, Clerisson; Ladeia, Felipe; Jeunon, Deiler Célio

2016-01-01

Fat embolism syndrome may occur in patients suffering from multiple trauma (long bone fractures) or plastic surgery (liposuction), compromising the circulatory, respiratory and/or central nervous systems. This report shows the evolution of severe fat embolism syndrome after liposuction and fat grafting. SSS, 42 years old, ASA 1, no risk factors for thrombosis, candidate for abdominal liposuction and breast implant prosthesis. Subjected to balanced general anesthesia with basic monitoring and controlled ventilation. After 45min of procedure, there was a sudden and gradual decrease of capnometry, severe hypoxemia and hypotension. The patient was immediately monitored for MAP and central catheter, treated with vasopressors, inotropes, and crystalloid infusion, stabilizing her condition. Arterial blood sample showed pH=7.21; PCO2=51mmHg; PO2=52mmHg; BE=-8; HCO3=18mEqL(-1), and lactate=6.0mmolL(-1). Transthoracic echocardiogram showed PASP=55mmHg, hypocontractile VD and LVEF=60%. Diagnosis of pulmonary embolism. After 24h of intensive treatment, the patient developed anisocoria and coma (Glasgow coma scale=3). A brain CT was performed which showed severe cerebral hemispheric ischemia with signs of fat emboli in right middle cerebral artery; transesophageal echocardiography showed a patent foramen ovale. Finally, after 72h of evolution, the patient progressed to brain death. Fat embolism syndrome usually occurs in young people. Treatment is based mainly on the infusion of fluids and vasoactive drugs, mechanical ventilation, and triggering factor correction (early fixation of fractures or suspension of liposuction). The multiorgânico involvement indicates a worse prognosis. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

Incidence and perioperative risk factors for early acute kidney injury after radical cystectomy and urinary diversion.

PubMed

Furrer, Marc A; Schneider, Marc P; Burkhard, Fiona C; Wuethrich, Patrick Y

2018-06-01

Early postoperative acute kidney injury (AKI) is associated with increased morbidity and mortality following major surgery. Only few reports exist on postoperative AKI and specifically its risk factors after radical cystectomy (RC) and urinary diversion (UD). We aimed to identify risk factors for AKI in patients undergoing RC and UD. In an observational single-center cohort study, 912 consecutive bladder cancer patients undergoing RC and UD from 2000 to 2016 were evaluated for risk factors for AKI. Multiple logistic regression analysis was performed to model the association between variables and AKI. Early postoperative AKI occurred in 100/912 patients (11%). An increased risk was seen in patients with surgery lasting>400minutes, male and obese patients (>25kg/m²). Independent predictors were duration of surgery (P = 0.020), intraoperative blood loss (P = 0.049), preoperative serum creatinine values (P = 0.004), intraoperative administration of crystalloids (P = 0.032), body mass index (P = 0.031), and fluid balance (P = 0.006). Patients with AKI had a longer hospitalization time (18d vs 17d, P = 0.040). Limitations include the potential bias due to the design as a case series with prospectively collected data with some missing values. An increased risk for AKI was seen in patients with an operative time>400 minutes. Hence, in this group of patients the role of postoperative fluid management for preserving renal function should be considered. Further independent predictors of postoperative AKI were male sex, obesity, intraoperative blood loss, and a low preoperative plasma creatinine. So specially in male and obese patients, optimized perioperative nephroprotective strategies are of importance. Copyright © 2018 Elsevier Inc. All rights reserved.

Perfusion Techniques Toward Bloodless Pediatric Open Heart Surgery

PubMed Central

Olshove, Vincent F.; Preston, Thomas; Gomez, Daniel; Phillips, Alistair; Galantowicz, Mark

2010-01-01

Abstract: There continues to be evidence regarding the negative impact of blood transfusion on morbidity and mortality in the adult literature, including infection risk, increased hospital and intensive care length of stay, and costs. More effort has been put into reducing the use of blood components in adult surgical centers but blood transfusions continue to be used frequently in pediatric centers. From 2002 through 2005, we embarked on a mission of reduced prime volume in an effort toward bloodless cardiac surgery to meet the needs of the Jehovah’s Witness patient. The same bloodless surgical and perfusion techniques were applied to all patients undergoing cardiopulmonary bypass beginning in 2006. Circuit size was minimized and acute normovolemic hemodilution (ANH) was considered and attempted more often, especially if a re-operation. Retrograde arterial prime (RAP) and venous antegrade prime (VAP), dilutional or balanced ultrafiltration during cardiopulmonary bypass, modified arteriovenous ultrafiltration post bypass, and cell salvage of remaining circuit contents after flushing with crystalloid were recorded. ANH, RAP, and VAP, separately or in combination, were used less than 1% of the time prior to 2006. From 2006–2008 ANH was performed on 42% of the patients and RAP/VAP was performed on 70% of the patients. From 2006–2008, 43% (287 of 662) of the open heart surgeries were performed bloodless in the operating room versus 30% (193 of 633) from 2003–2005. Bloodless surgery more than doubled for the 0–6, 6–15, and 15–20 kg groups from 3.5%, 23%, and 23% respectively in 2003–2005 to 9%, 44%, and 58%, respectively in 2006–2008. With the cooperation of the entire cardiac surgical team, bloodless open heart surgery is achievable in a pediatric cardiac surgical center, including neonates. PMID:20648896

Enhanced method of fast re-routing with load balancing in software-defined networks

NASA Astrophysics Data System (ADS)

Lemeshko, Oleksandr; Yeremenko, Oleksandra

2017-11-01

A two-level method of fast re-routing with load balancing in a software-defined network (SDN) is proposed. The novelty of the method consists, firstly, in the introduction of a two-level hierarchy of calculating the routing variables responsible for the formation of the primary and backup paths, and secondly, in ensuring a balanced load of the communication links of the network, which meets the requirements of the traffic engineering concept. The method provides implementation of link, node, path, and bandwidth protection schemes for fast re-routing in SDN. The separation in accordance with the interaction prediction principle along two hierarchical levels of the calculation functions of the primary (lower level) and backup (upper level) routes allowed to abandon the initial sufficiently large and nonlinear optimization problem by transiting to the iterative solution of linear optimization problems of half the dimension. The analysis of the proposed method confirmed its efficiency and effectiveness in terms of obtaining optimal solutions for ensuring balanced load of communication links and implementing the required network element protection schemes for fast re-routing in SDN.

On delay adjustment for dynamic load balancing in distributed virtual environments.

PubMed

Deng, Yunhua; Lau, Rynson W H

2012-04-01

Distributed virtual environments (DVEs) are becoming very popular in recent years, due to the rapid growing of applications, such as massive multiplayer online games (MMOGs). As the number of concurrent users increases, scalability becomes one of the major challenges in designing an interactive DVE system. One solution to address this scalability problem is to adopt a multi-server architecture. While some methods focus on the quality of partitioning the load among the servers, others focus on the efficiency of the partitioning process itself. However, all these methods neglect the effect of network delay among the servers on the accuracy of the load balancing solutions. As we show in this paper, the change in the load of the servers due to network delay would affect the performance of the load balancing algorithm. In this work, we conduct a formal analysis of this problem and discuss two efficient delay adjustment schemes to address the problem. Our experimental results show that our proposed schemes can significantly improve the performance of the load balancing algorithm with neglectable computation overhead.

What can we do with sodium retention in peritoneal dialysis patients?

PubMed

Lichodziejewska-Niemierko, M

2008-01-01

Salt intake in XXI century in an average person exceeds 10-15 grams per day. The key organ responsible for sodium regulation is kidney and renal failure patients present with positive sodium balance. In peritoneal dialysis (PD) patients rising hypertension is often connected with volume overload and sodium retention. The reasons for inadequate sodium removal in PD patients are: too small gradient between standard 134 mmol/l sodium PD solutions, sodium seiving effect and lack of residual renal function. APD patients are at higher risk of sodium overload in comparison to CAPD ones. As it has been shown that a degree of sodium removal correlates with survival, sodium management appears to be crucial in these patients. The concept of low sodium solutions has been developed over the years with single-dwell ultra-low solutions and recently with low sodium balance solution given as a continuous treatment in CAPD patients. Preliminary results show that low sodium solutions may be a safe and viable option of treatment of PD patients with sodium and fluid overload.

A two-phase micromorphic model for compressible granular materials

NASA Astrophysics Data System (ADS)

Paolucci, Samuel; Li, Weiming; Powers, Joseph

2009-11-01

We introduce a new two-phase continuum model for compressible granular material based on micromorphic theory and treat it as a two-phase mixture with inner structure. By taking an appropriate number of moments of the local micro scale balance equations, the average phase balance equations result from a systematic averaging procedure. In addition to equations for mass, momentum and energy, the balance equations also include evolution equations for microinertia and microspin tensors. The latter equations combine to yield a general form of a compaction equation when the material is assumed to be isotropic. When non-linear and inertial effects are neglected, the generalized compaction equation reduces to that originally proposed by Bear and Nunziato. We use the generalized compaction equation to numerically model a mixture of granular high explosive and interstitial gas. One-dimensional shock tube and piston-driven solutions are presented and compared with experimental results and other known solutions.

Well-balanced high-order solver for blood flow in networks of vessels with variable properties.

PubMed

Müller, Lucas O; Toro, Eleuterio F

2013-12-01

We present a well-balanced, high-order non-linear numerical scheme for solving a hyperbolic system that models one-dimensional flow in blood vessels with variable mechanical and geometrical properties along their length. Using a suitable set of test problems with exact solution, we rigorously assess the performance of the scheme. In particular, we assess the well-balanced property and the effective order of accuracy through an empirical convergence rate study. Schemes of up to fifth order of accuracy in both space and time are implemented and assessed. The numerical methodology is then extended to realistic networks of elastic vessels and is validated against published state-of-the-art numerical solutions and experimental measurements. It is envisaged that the present scheme will constitute the building block for a closed, global model for the human circulation system involving arteries, veins, capillaries and cerebrospinal fluid. Copyright © 2013 John Wiley & Sons, Ltd.

On exact solutions for disturbances to the asymptotic suction boundary layer: transformation of Barnes integrals to convolution integrals

NASA Astrophysics Data System (ADS)

Russell, John

2000-11-01

A modified Orr-Sommerfeld equation that applies to the asymptotic suction boundary layer was reported by Bussmann & Münz in a wartime report dated 1942 and by Hughes & Reid in J.F.M. ( 23, 1965, p715). Fundamental systems of exact solutions of the Orr-Sommerfeld equation for this mean velocity distribution were reported by D. Grohne in an unpublished typescript dated 1950. Exact solutions of the equation of Bussmann, Münz, Hughes, & Reid were reported by P. Baldwin in Mathematika ( 17, 1970, p206). Grohne and Baldwin noticed that these exact solutions may be expressed either as Barnes integrals or as convolution integrals. In a later paper (Phil. Trans. Roy. Soc. A, 399, 1985, p321), Baldwin applied the convolution integrals in the contruction of large-Reynolds number asymptotic approximations that hold uniformly. The present talk discusses the subtleties that arise in the construction of such convolution integrals, including several not reported by Grohne or Baldwin. The aim is to recover the full set of seven solutions (one well balanced, three balanced, and three dominant-recessive) postulated by W.H. Reid in various works on the uniformly valid solutions.

Comparison of soymilk, powdered milk, Hank's balanced salt solution and tap water on periodontal ligament cell survival.

PubMed

Moazami, Fariborz; Mirhadi, Hosein; Geramizadeh, Bita; Sahebi, Safoura

2012-04-01

The purpose of this study was to evaluate the ability of soymilk, powdered milk, and Hank's balanced salt solution (HBSS) to maintain human periodontal ligament (PDL) cell viability in vitro. PDL cells were obtained from extracted healthy third molars and cultured in Dulbecco's modified Eagles medium (DMEM). The cultures were exposed for 1, 2, 4, and 8 h to experimental solutions (tap water served as negative control and DMEM as positive control) at 37°C. The viable cells were then counted using the trypan blue exclusion technique. Data were analyzed by using one-way anova, post hoc Scheffe and two-way anova test. Statistical analysis showed that HBSS, powdered baby formula, and soymilk maintain cell viability equally well in different periods of times. Tap water cannot keep cells viable as well as other solutions. Soymilk and powdered baby formula can be recommended as suitable storage media for avulsed teeth for up to 8 h. © 2011 John Wiley & Sons A/S.

Combined geometric and algebraic solutions for removal of bSSFP banding artifacts with performance comparisons.

PubMed

Hoff, Michael N; Andre, Jalal B; Xiang, Qing-San

2017-02-01

Balanced steady state free precession (bSSFP) imaging suffers from off-resonance artifacts such as signal modulation and banding. Solutions for removal of bSSFP off-resonance dependence are described and compared, and an optimal solution is proposed. An Algebraic Solution (AS) that complements a previously described Geometric Solution (GS) is derived from four phase-cycled bSSFP datasets. A composite Geometric-Algebraic Solution (GAS) is formed from a noise-variance-weighted average of the AS and GS images. Two simulations test the solutions over a range of parameters, and phantom and in vivo experiments are implemented. Image quality and performance of the GS, AS, and GAS are compared with the complex sum and a numerical parameter estimation algorithm. The parameter estimation algorithm, GS, AS, and GAS remove most banding and signal modulation in bSSFP imaging. The variable performance of the GS and AS on noisy data justifies generation of the GAS, which consistently provides the highest performance. The GAS is a robust technique for bSSFP signal demodulation that balances the regional efficacy of the GS and AS to remove banding, a feat not possible with prevalent techniques. Magn Reson Med 77:644-654, 2017. © 2016 International Society for Magnetic Resonance in Medicine. © 2016 International Society for Magnetic Resonance in Medicine.

Dynamic analysis of a magnetic bearing system with flux control

NASA Technical Reports Server (NTRS)

Knight, Josiah; Walsh, Thomas; Virgin, Lawrence

1994-01-01

Using measured values of two-dimensional forces in a magnetic actuator, equations of motion for an active magnetic bearing are presented. The presence of geometric coupling between coordinate directions causes the equations of motion to be nonlinear. Two methods are used to examine the unbalance response of the system: simulation by direct integration in time; and determination of approximate steady state solutions by harmonic balance. For relatively large values of the derivative control coefficient, the system behaves in an essentially linear manner, but for lower values of this parameter, or for higher values of the coupling coefficient, the response shows a split of amplitudes in the two principal directions. This bifurcation is sensitive to initial conditions. The harmonic balance solution shows that the separation of amplitudes actually corresponds to a change in stability of multiple coexisting solutions.

AN ANALYTIC MODEL OF DUSTY, STRATIFIED, SPHERICAL H ii REGIONS

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

Rodríguez-Ramírez, J. C.; Raga, A. C.; Lora, V.

2016-12-20

We study analytically the effect of radiation pressure (associated with photoionization processes and with dust absorption) on spherical, hydrostatic H ii regions. We consider two basic equations, one for the hydrostatic balance between the radiation-pressure components and the gas pressure, and another for the balance among the recombination rate, the dust absorption, and the ionizing photon rate. Based on appropriate mathematical approximations, we find a simple analytic solution for the density stratification of the nebula, which is defined by specifying the radius of the external boundary, the cross section of dust absorption, and the luminosity of the central star. Wemore » compare the analytic solution with numerical integrations of the model equations of Draine, and find a wide range of the physical parameters for which the analytic solution is accurate.« less

A single-stage optical load-balanced switch for data centers.

PubMed

Huang, Qirui; Yeo, Yong-Kee; Zhou, Luying

2012-10-22

Load balancing is an attractive technique to achieve maximum throughput and optimal resource utilization in large-scale switching systems. However current electronic load-balanced switches suffer from severe problems in implementation cost, power consumption and scaling. To overcome these problems, in this paper we propose a single-stage optical load-balanced switch architecture based on an arrayed waveguide grating router (AWGR) in conjunction with fast tunable lasers. By reuse of the fast tunable lasers, the switch achieves both functions of load balancing and switching through the AWGR. With this architecture, proof-of-concept experiments have been conducted to investigate the feasibility of the optical load-balanced switch and to examine its physical performance. Compared to three-stage load-balanced switches, the reported switch needs only half of optical devices such as tunable lasers and AWGRs, which can provide a cost-effective solution for future data centers.

Energy-balance climate models

NASA Technical Reports Server (NTRS)

North, G. R.; Cahalan, R. F.; Coakley, J. A., Jr.

1980-01-01

An introductory survey of the global energy balance climate models is presented with an emphasis on analytical results. A sequence of increasingly complicated models involving ice cap and radiative feedback processes are solved and the solutions and parameter sensitivities are studied. The model parameterizations are examined critically in light of many current uncertainties. A simple seasonal model is used to study the effects of changes in orbital elements on the temperature field. A linear stability theorem and a complete nonlinear stability analysis for the models are developed. Analytical solutions are also obtained for the linearized models driven by stochastic forcing elements. In this context the relation between natural fluctuation statistics and climate sensitivity is stressed.

Energy balance climate models

NASA Technical Reports Server (NTRS)

North, G. R.; Cahalan, R. F.; Coakley, J. A., Jr.

1981-01-01

An introductory survey of the global energy balance climate models is presented with an emphasis on analytical results. A sequence of increasingly complicated models involving ice cap and radiative feedback processes are solved, and the solutions and parameter sensitivities are studied. The model parameterizations are examined critically in light of many current uncertainties. A simple seasonal model is used to study the effects of changes in orbital elements on the temperature field. A linear stability theorem and a complete nonlinear stability analysis for the models are developed. Analytical solutions are also obtained for the linearized models driven by stochastic forcing elements. In this context the relation between natural fluctuation statistics and climate sensitivity is stressed.

Stability of the Martian climate system under the seasonal change condition of solar radiation

NASA Astrophysics Data System (ADS)

Nakamura, Takasumi; Tajika, Eiichi

2002-11-01

Previous studies on stability of the Martian climate system used essentially zero-dimensional energy balance climate models (EBMs) under the condition of annual mean solar radiation income. However, areal extent of polar ice caps should affect the Martian climate through the energy balance and the CO2 budget, and results under the seasonal change condition of solar radiation will be different from those under the annual mean condition. We therefore construct a one-dimensional energy balance climate model with CO2-dependent outgoing radiation, seasonal changes of solar radiation income, changes of areal extent of CO2 ice caps, and adsorption of CO2 by regolith. We have investigated behaviors of the Martian climate system and, in particular, examined the effect of the seasonal changes of solar radiation by comparing the results of previous studies under the condition of annual mean solar radiation. One of the major discrepancies between them is the condition for multiple solutions of the Martian climate system. Although the Martian climate system always has multiple solutions under the annual mean condition, under the seasonal change condition, existence of multiple solutions depends on the present amounts of CO2 in the ice caps and the regolith.

Using Zero Balance Ultrafiltration with Dialysate as a Replacement Fluid for Hyperkalemia during Cardiopulmonary Bypass

PubMed Central

Heath, Michele; Raghunathan, Karthik; Welsby, Ian; Maxwell, Cory

2014-01-01

Abstract: Avoiding or managing hyperkalemia during cardiac surgery, especially in a patient with chronic renal insufficiency, can be challenging. Hyperkalemic cardioplegia solution is usually administered to achieve and maintain an electrical arrest of the heart. This solution eventually mixes in with the systemic circulation, contributing to elevated systemic potassium levels. Administration of packed red blood cells, hemolysis, tissue damage, and acidosis are also common causes of hyperkalemia. Current strategies to avoid or manage hyperkalemia include minimizing the volume of cardioplegia administered, shifting potassium from the extracellular into the intracellular space (by the administration of sodium bicarbonate when the pH is low and/or dextrose–insulin when effects relatively independent of serum pH are desired), using zero-balanced ultrafiltration (Z-BUF) with normal saline as the replacement fluid (to remove potassium from the body rather than simply shift the electrolyte across cellular membranes), and, occasionally, hemodialysis (1). We report the application of Z-BUF using an electrolyte-balanced, low potassium dialysate solution rather than isotonic saline to avoid a high chloride load and the potential for hyperchloremic acidosis to successfully treat hyperkalemia while on cardiopulmonary bypass. PMID:26357794

Goal-Directed Resuscitation Aiming Cardiac Index Masks Residual Hypovolemia: An Animal Experiment.

PubMed

Tánczos, Krisztián; Németh, Márton; Trásy, Domonkos; László, Ildikó; Palágyi, Péter; Szabó, Zsolt; Varga, Gabriella; Kaszaki, József

2015-01-01

The aim of this study was to compare stroke volume (SVI) to cardiac index (CI) guided resuscitation in a bleeding-resuscitation experiment. Twenty six pigs were randomized and bled in both groups till baseline SVI (T bsl) dropped by 50% (T 0), followed by resuscitation with crystalloid solution until initial SVI or CI was reached (T 4). Similar amount of blood was shed but animals received significantly less fluid in the CI-group as in the SVI-group: median = 900 (interquartile range: 850-1780) versus 1965 (1584-2165) mL, p = 0.02, respectively. In the SVI-group all variables returned to their baseline values, but in the CI-group animals remained underresuscitated as indicated by SVI, heart rate (HR) and stroke volume variation (SVV), and central venous oxygen saturation (ScvO2) at T 4 as compared to T bsl: SVI = 23.8 ± 5.9 versus 31.4 ± 4.7 mL, HR: 117 ± 35 versus 89 ± 11/min SVV: 17.4 ± 7.6 versus 11.5 ± 5.3%, and ScvO2: 64.1 ± 11.6 versus 79.2 ± 8.1%, p < 0.05, respectively. Our results indicate that CI-based goal-directed resuscitation may result in residual hypovolaemia, as bleeding caused stress induced tachycardia "normalizes" CI, without restoring adequate SVI. As the SVI-guided approach normalized most hemodynamic variables, we recommend using SVI instead of CI as the primary goal of resuscitation during acute bleeding.

Effects of in vitro hemodilution with crystalloids, colloids, and plasma on canine whole blood coagulation as determined by kaolin-activated thromboelastography.

PubMed

Morris, Bari R; deLaforcade, Armelle; Lee, Joyce; Palmisano, Joseph; Meola, Dawn; Rozanski, Elizabeth

2016-01-01

To investigate the effects of in vitro hemodilution with lactated Ringers solution (LRS), hetastarch (HES), and fresh frozen plasma (FFP) on whole blood coagulation in dogs as assessed by kaolin-activated thromboelastography. In vitro experimental study. University teaching hospital. Six healthy client-owned dogs. Whole blood was collected and diluted in vitro at a 33% and 67% dilution with either LRS, HES, or FFP. Kaolin-activated thromboelastography was performed on each sample as well as a control. Thromboelastographic parameters R (min), alpha (deg), K (min), and MA (mm) were measured and compared to the sample control for each dilution using mixed model methodology. Prolongation in coagulation times were seen at both dilutions with LRS and HES. There was no significant difference in R times at the 33% dilution, but R time was significantly prolonged at the 67% dilution with HES (P = 0.004). MA was significantly decreased for LRS at both dilutions (P = 0.013, P < 0.001) and more profoundly decreased for HES (P < 0.001, P = 0.006). No significant difference in any parameter was found for FFP. In vitro hemodilution of whole blood with both LRS and HES but not FFP resulted in significant effects on coagulation with HES having a more profound effect. In vivo evaluation of changes in coagulation with various resuscitation fluids is warranted and may be clinically relevant. © Veterinary Emergency and Critical Care Society 2015.

Transfusion-Free Cardiopulmonary Bypass in Jehovah’s Witness Patients Weighing Less Than 5 kg

PubMed Central

Boettcher, Wolfgang; Merkle, Frank; Huebler, Michael; Koster, Andreas; Schulz, Fritz; Kopitz, Michael; Kuppe, Hermann; Lange, Peter; Hetzer, Roland

2005-01-01

Abstract: Performing cardiac surgery on pediatric Jehovah’s Witness patients is a great challenge for the surgical team and especially for the perfusionist. Jehovah’s Witnesses reject blood transfusions on the grounds of their literal interpretation of passages of the Bible. In accordance with this belief, Jehovah’s Witnesses feel that it is also forbidden to retransfuse autologous blood that has been separated from their own circulatory system. We report the use of cardiopulmonary bypass (CPB) during open-heart surgery in three infants with a body weight of 4.5 kg, 3.5 kg, and 3.1 kg, respectively, without transfusion of blood components. A small-volume CPB circuit with a priming volume of 200 mL, including the arterial line filter, was designed to decrease the degree of hemodilution. A dedicated pediatric heart lung machine console with remote pump heads and intensive blood conservation efforts allowed the operation without the use of donor blood. The CPB circuits were primed with crystalloid solution only. The procedures were performed in normothermia or in moderate hypothermia. Pre-CPB hemoglobin levels were 10.8 g/dL, 10.6 g/dL, and 8.5 g/dL. The hemoglobin concentrations measured during CPB ranged from 5.9 to 6.5 g/dL, 6.4 to 6.8 g/dL, and 5.5 to 5.9 g/dL, respectively. The patients did not receive any blood or blood products during their entire hospital stay. PMID:16350381

Torque Balances on the Taylor Cylinders in the Geomagnetic Data Assimilation

NASA Technical Reports Server (NTRS)

Kuang, Weijia; Tangborn, Andrew

2004-01-01

In this presentation we report on our continuing effort in geomagnetic data assimilation, aiming at understanding and predicting geomagnetic secular variation on decadal time scales. In particular, we focus on the effect of the torque balances on the cylindrical surfaces in the core co-axial with the Earth's rotation axis (the Taylor cylinders) on the time evolution of assimilated solutions. We use our MoSST core dynamics,model and observed geomagnetic field at the Earth's surface derived via Comprehensive Field Model (CFM) for the geomagnetic data assimilation. In our earlier studies, a model solution is selected randomly from our numerical database. It is then assimilated with the observations such that the poloidal field possesses the same field tomography on the core-mantel boundary (CMB) continued downward from surface observations. This tomography change is assumed to be effective through out the outer core. While this approach allows rapid convergence between model solutions and the observations, it also generates sevee numerical instabilities: the delicate balance between weak fluid inertia and the magnetic torques on the Taylor cylinders are completely altered. Consequently, the assimilated solution diverges quickly (in approximately 10% of the magnetic free-decay time in the core). To improve the assimilation, we propose a partial penetration of the assimilation from the CMB: The full-scale modification at the CMB decreases linearly and vanish at an interior radius r(sub a). We shall examine from our assimilation tests possible relationships between the convergence rate of the model solutions to observations and the cut-off radius r(sub a). A better assimilation shall serve our nudging tests in near future.

Torque Balances on the Taylor Cylinders in the Geomagnetic Data Assimilation

NASA Astrophysics Data System (ADS)

Kuang, W.; Tangborn, A.

2004-05-01

In this presentation we report on our continuing effort in geomagnetic data assimilation, aiming at understanding and predicting geomagnetic secular variation on decadal time scales. In particular, we focus on the effect of the torque balances on the cylindrical surfaces in the core co-axial with the Earth's rotation axis (the Taylor cylinders) on the time evolution of assimilated solutions. We use our MoSST core dynamics model and observed geomagnetic field at the Earth's surface derived via Comprehensive Field Model (CFM) for the geomagnetic data assimilation. In our earlier studies, a model solution is selected randomly from our numerical database. It is then assimilated with the observations such that the poloidal field possesses the same field tomography on the core-mantel boundary (CMB) continued downward from surface observations. This tomography change is assumed to be effective through out the outer core. While this approach allows rapid convergence between model solutions and the observations, it also generates sever numerical instabilities: the delicate balance between weak fluid inertia and the magnetic torques on the Taylor cylinders are completely altered. Consequently, the assimilated solution diverges quickly (in approximately 10% of the magnetic free-decay time in the core). To improve the assimilation, we propose a partial penetration of the assimilation from the CMB: The full-scale modification at the CMB decreases linearly and vanish at an interior radius ra. We shall examine from our assimilation tests possible relationships between the convergence rate of the model solutions to observations and the cut-off radius ra. A better assimilation shall serve our nudging tests in near future.

Analysis, calculation and utilization of the k-balance attribute in interdependent networks

NASA Astrophysics Data System (ADS)

Liu, Zheng; Li, Qing; Wang, Dan; Xu, Mingwei

2018-05-01

Interdependent networks, where two networks depend on each other, are becoming more and more significant in modern systems. From previous work, it can be concluded that interdependent networks are more vulnerable than a single network. The robustness in interdependent networks deserves special attention. In this paper, we propose a metric of robustness from a new perspective-the balance. First, we define the balance-coefficient of the interdependent system. Based on precise analysis and derivation, we prove some significant theories and provide an efficient algorithm to compute the balance-coefficient. Finally, we propose an optimal solution to reduce the balance-coefficient to enhance the robustness of the given system. Comprehensive experiments confirm the efficiency of our algorithms.

On Pell, Pell-Lucas, and balancing numbers.

PubMed

Karadeniz Gözeri, Gül

2018-01-01

In this paper, we derive some identities on Pell, Pell-Lucas, and balancing numbers and the relationships between them. We also deduce some formulas on the sums, divisibility properties, perfect squares, Pythagorean triples involving these numbers. Moreover, we obtain the set of positive integer solutions of some specific Pell equations in terms of the integer sequences mentioned in the text.

A balanced approach: Dr. Biswell's solution to fire issues in urban interface and wildland ecosystems

Treesearch

Carol Rice

1995-01-01

Dr. Biswell's approach to fire management balanced fire prevention, suppression, and fuel management. Dr. Biswell maintained that with increased support for fire prevention and fuel management, several profound changes would be anticipated, including a decrease in the number of wildfires, as well as a decrease in requirements for suppression. Interested persons...

Pursuing and Completing an Undergraduate Computing Degree from a Female Perspective: A Quantitative and Qualitative Analysis

ERIC Educational Resources Information Center

Ragsdale, Scott

2013-01-01

The computing profession in the United States would benefit from an increasingly diverse workforce, specifically a larger female presence, because a more gender-balanced workforce would likely result in better technological solutions to difficulties in many areas of American life. However, to achieve this balance, more women with a solid…

Lesson "Balance in Nature

NASA Astrophysics Data System (ADS)

Chapanova, V.

2012-04-01

Lesson "Balance in Nature" This simulation game-lesson (Balance in Nature) gives an opportunity for the students to show creativity, work independently, and to create models and ideas. It creates future-oriented thought connected to their experience, allowing them to propose solutions for global problems and personal responsibility for their activities. The class is divided in two teams. Each team chooses questions. 1. Question: Pollution in the environment. 2. Question: Care for nature and climate. The teams work on the chosen tasks. They make drafts, notes and formulate their solutions on small pieces of paper, explaining the impact on nature and society. They express their points of view using many different opinions. This generates alternative thoughts and results in creative solutions. With the new knowledge and positive behaviour defined, everybody realizes that they can do something positive towards nature and climate problems and the importance of individuals for solving global problems is evident. Our main goal is to recover the ecological balance, and everybody explains his or her own well-grounded opinions. In this work process the students obtain knowledge, skills and more responsible behaviour. This process, based on his or her own experience, dialogue and teamwork, helps the participant's self-development. Making the model "human↔ nature" expresses how human activities impact the natural Earth and how these impacts in turn affect society. Taking personal responsibility, we can reduce global warming and help the Earth. By helping nature we help ourselves. Teacher: Veselina Boycheva-Chapanova " Saint Patriarch Evtimii" Scholl Str. "Ivan Vazov"-19 Plovdiv Bulgaria

Research concerning the balancing of a plane mechanism

NASA Astrophysics Data System (ADS)

Bădoiu, D.; Petrescu, M. G.; Antonescu, N. N.; Toma, G.

2018-01-01

By statically balancing of the plane mechanisms and especially those functioning at high speeds is being pursued the decrease of the value of the resultant force of all inertia forces that work on the component elements, thus obtaining a significant decrease in vibrations and shocks during the functioning. On the other hand, the existence of balancing masses which ensure the balancing of the mechanism leads to increased gauge and its mass. In this paper are presented some possibilities of statically balancing a plane mechanism which is composed of three independent contours. First is analyzed the case when the mechanism is totally balanced. Then a solution is proposed for a partial balancing of the mechanism based on the balancing of the first harmonic of the inertia force developed in a piston of the mechanism. Finally, are presented some simulation results concerning the variation of the value of the resultant inertia force during a cinematic cycle when the mechanism is unbalanced and when it is partially balanced. Also, it is analyzed the variation of the motor moment when the mechanism is unbalanced and when is totally and partially balanced.

Multiple periodic-soliton solutions of the (3+1)-dimensional generalised shallow water equation

NASA Astrophysics Data System (ADS)

Li, Ye-Zhou; Liu, Jian-Guo

2018-06-01

Based on the extended variable-coefficient homogeneous balance method and two new ansätz functions, we construct auto-Bäcklund transformation and multiple periodic-soliton solutions of (3 {+} 1)-dimensional generalised shallow water equations. Completely new periodic-soliton solutions including periodic cross-kink wave, periodic two-solitary wave and breather type of two-solitary wave are obtained. In addition, cross-kink three-soliton and cross-kink four-soliton solutions are derived. Furthermore, propagation characteristics and interactions of the obtained solutions are discussed and illustrated in figures.

Solving Nonlinear Coupled Differential Equations

NASA Technical Reports Server (NTRS)

Mitchell, L.; David, J.

1986-01-01

Harmonic balance method developed to obtain approximate steady-state solutions for nonlinear coupled ordinary differential equations. Method usable with transfer matrices commonly used to analyze shaft systems. Solution to nonlinear equation, with periodic forcing function represented as sum of series similar to Fourier series but with form of terms suggested by equation itself.

Compact Apparatus Grows Protein Crystals

NASA Technical Reports Server (NTRS)

Bugg, Charles E.; Delucas, Lawrence J.; Suddath, Fred L.; Snyder, Robert S.; Herren, Blair J.; Carter, Daniel C.; Yost, Vaughn H.

1989-01-01

Laboratory apparatus provides delicately balanced combination of materials and chemical conditions for growth of protein crystals. Apparatus and technique for growth based on hanging-drop method for crystallization of macromolecules. Includes pair of syringes with ganged plungers. One syringe contains protein solution; other contains precipitating-agent solution. Syringes intrude into cavity lined with porous reservoir material saturated with 1 mL or more of similar precipitating-agent solution. Prior to activation, ends of syringes plugged to prevent transport of water vapor among three solutions.

Gain and loss of esteem, direct reciprocity and Heider balance

NASA Astrophysics Data System (ADS)

Hassanibesheli, Forough; Hedayatifar, Leila; Gawroński, Przemysław; Stojkow, Maria; Żuchowska-Skiba, Dorota; Kułakowski, Krzysztof

2017-02-01

The effect of gain and loss of esteem is introduced into the equations of time evolution of social relations, hostile or friendly, in a group of actors. The equations allow for asymmetric relations. We prove that in the presence of this asymmetry, the majority of stable solutions are jammed states, i.e. the Heider balance is not attained there. A phase diagram is constructed with three phases: the jammed phase, the balanced phase with two mutually hostile groups, and the phase of so-called paradise, where all relations are friendly.

A Well-Balanced Central-Upwind Scheme for the 2D Shallow Water Equations on Triangular Meshes

NASA Technical Reports Server (NTRS)

Bryson, Steve; Levy, Doron

2004-01-01

We are interested in approximating solutions of the two-dimensional shallow water equations with a bottom topography on triangular meshes. We show that there is a certain flexibility in choosing the numerical fluxes in the design of semi-discrete Godunov-type central schemes. We take advantage of this fact to generate a new second-order, central-upwind method for the two-dimensional shallow water equations that is well-balanced. We demonstrate the accuracy of our method as well as its balance properties in a variety of examples.

Parallel Tetrahedral Mesh Adaptation with Dynamic Load Balancing

NASA Technical Reports Server (NTRS)

Oliker, Leonid; Biswas, Rupak; Gabow, Harold N.

1999-01-01

The ability to dynamically adapt an unstructured grid is a powerful tool for efficiently solving computational problems with evolving physical features. In this paper, we report on our experience parallelizing an edge-based adaptation scheme, called 3D_TAG. using message passing. Results show excellent speedup when a realistic helicopter rotor mesh is randomly refined. However. performance deteriorates when the mesh is refined using a solution-based error indicator since mesh adaptation for practical problems occurs in a localized region., creating a severe load imbalance. To address this problem, we have developed PLUM, a global dynamic load balancing framework for adaptive numerical computations. Even though PLUM primarily balances processor workloads for the solution phase, it reduces the load imbalance problem within mesh adaptation by repartitioning the mesh after targeting edges for refinement but before the actual subdivision. This dramatically improves the performance of parallel 3D_TAG since refinement occurs in a more load balanced fashion. We also present optimal and heuristic algorithms that, when applied to the default mapping of a parallel repartitioner, significantly reduce the data redistribution overhead. Finally, portability is examined by comparing performance on three state-of-the-art parallel machines.

Strong diabetes

PubMed Central

Young, James; Anwar, Aresh

2007-01-01

The case of a 36‐year‐old male professional bodybuilder is reported. He presented to the accident and emergency department with right upper quadrant pain. This was on the background of a 15‐year history of anabolic steroid and growth hormone misuse. Examination revealed mild hepatomegaly and a random blood sugar of 30.2 mmol/l. There was no evidence of ketonuria or acidosis. Biochemical evidence of hepatitis was found, and the patient was in acute renal failure. He was given a sliding scale of insulin and an intravenous infusion of crystalloid. The hepatitis and hyperglycaemia settled with conservative treatment. It is believed that this is the first reported case of frank diabetes precipitated by supraphysiological recreational growth hormone misuse. PMID:17324962

[Ultrastructure of granulocytes of bony fishes (orders Salmoniformes, Cypriniformes, Perciformes)].

PubMed

Flerova, E A; Balabanova, L V

2013-01-01

Analysis of data on utrastructure of granulocytes of freshwater and marine bony fish of orders Salmoniformes, Cypriniformes, and Perciformes showed that in all studied species there were revealed two types of granulocytes - neutrophils and eosinophils. The exception was the bluefish Pomatomus saltatrix L. whose pronephros hemopoietic tissue was found to contain one type of the granulocytic line - neutrophils. The identification parameters of granular leukocytes are specific granules filling the cytoplasm. The main form of specific granules in neutrophils of bony fish of various phylogenetic groups is an elongated granule with different distribution of fibrils or a granule that has crystalloid formed from fibrils. The main form of eosinophil granules - large, electron-dense, homogenous.

Balancing anisotropic curvature with gauge fields in a class of shear-free cosmological models

NASA Astrophysics Data System (ADS)

Thorsrud, Mikjel

2018-05-01

We present a complete list of general relativistic shear-free solutions in a class of anisotropic, spatially homogeneous and orthogonal cosmological models containing a collection of n independent p-form gauge fields, where p\\in\\{0, 1, 2, 3\\} , in addition to standard ΛCDM matter fields modelled as perfect fluids. Here a (collection of) gauge field(s) balances anisotropic spatial curvature on the right-hand side of the shear propagation equation. The result is a class of solutions dynamically equivalent to standard FLRW cosmologies, with an effective curvature constant Keff that depends both on spatial curvature and the energy density of the gauge field(s). In the case of a single gauge field (n  =  1) we show that the only spacetimes that admit such solutions are the LRS Bianchi type III, Bianchi type VI0 and Kantowski–Sachs metric, which are dynamically equivalent to open (Keff<0 ), flat (Keff=0 ) and closed (Keff>0 ) FLRW models, respectively. With a collection of gauge fields (n  >  1) also Bianchi type II admits a shear-free solution (Keff>0 ). We identify the LRS Bianchi type III solution to be the unique shear-free solution with a gauge field Hamiltonian bounded from below in the entire class of models.

Impact of Load Balancing on Unstructured Adaptive Grid Computations for Distributed-Memory Multiprocessors

NASA Technical Reports Server (NTRS)

Sohn, Andrew; Biswas, Rupak; Simon, Horst D.

1996-01-01

The computational requirements for an adaptive solution of unsteady problems change as the simulation progresses. This causes workload imbalance among processors on a parallel machine which, in turn, requires significant data movement at runtime. We present a new dynamic load-balancing framework, called JOVE, that balances the workload across all processors with a global view. Whenever the computational mesh is adapted, JOVE is activated to eliminate the load imbalance. JOVE has been implemented on an IBM SP2 distributed-memory machine in MPI for portability. Experimental results for two model meshes demonstrate that mesh adaption with load balancing gives more than a sixfold improvement over one without load balancing. We also show that JOVE gives a 24-fold speedup on 64 processors compared to sequential execution.

Autobalancing of a rigid rotor in viscoelastic orthotropic supports considering eccentricity of the automatic ball balancer

NASA Astrophysics Data System (ADS)

Bykov, V. G.; Kovachev, A. S.

2018-05-01

A statically unbalanced rotor in viscoelastic orthotropic supports equipped with an automatic ball balancer (ABB), the axis of symmetry of which does not coincide with the symmetry axis of the rotor, is considered. Based on an analysis of the equations describing the stationary modes of motion of the system, the principal impossibility of complete balancing of the rotor is shown. The possibility of the existence of two types of stationary modes is established, one of which has a constant average amplitude of residual vibration equal to the eccentricity of the ABB. The solution corresponding to this almost balanced mode is constructed analytically. A study is made of its asymptotic stability.

Analysis of periodically excited non-linear systems by a parametric continuation technique

NASA Astrophysics Data System (ADS)

Padmanabhan, C.; Singh, R.

1995-07-01

The dynamic behavior and frequency response of harmonically excited piecewise linear and/or non-linear systems has been the subject of several recent investigations. Most of the prior studies employed harmonic balance or Galerkin schemes, piecewise linear techniques, analog simulation and/or direct numerical integration (digital simulation). Such techniques are somewhat limited in their ability to predict all of the dynamic characteristics, including bifurcations leading to the occurrence of unstable, subharmonic, quasi-periodic and/or chaotic solutions. To overcome this problem, a parametric continuation scheme, based on the shooting method, is applied specifically to a periodically excited piecewise linear/non-linear system, in order to improve understanding as well as to obtain the complete dynamic response. Parameter regions exhibiting bifurcations to harmonic, subharmonic or quasi-periodic solutions are obtained quite efficiently and systematically. Unlike other techniques, the proposed scheme can follow period-doubling bifurcations, and with some modifications obtain stable quasi-periodic solutions and their bifurcations. This knowledge is essential in establishing conditions for the occurrence of chaotic oscillations in any non-linear system. The method is first validated through the Duffing oscillator example, the solutions to which are also obtained by conventional one-term harmonic balance and perturbation methods. The second example deals with a clearance non-linearity problem for both harmonic and periodic excitations. Predictions from the proposed scheme match well with available analog simulation data as well as with multi-term harmonic balance results. Potential savings in computational time over direct numerical integration is demonstrated for some of the example cases. Also, this work has filled in some of the solution regimes for an impact pair, which were missed previously in the literature. Finally, one main limitation associated with the proposed procedure is discussed.

Predicting water-to-cyclohexane partitioning of the SAMPL5 molecules using dielectric balancing of force fields.

PubMed

Paranahewage, S Shanaka; Gierhart, Cassidy S; Fennell, Christopher J

2016-11-01

Alchemical transformation of solutes using classical fixed-charge force fields is a popular strategy for assessing the free energy of transfer in different environments. Accurate estimations of transfer between phases with significantly different polarities can be difficult because of the static nature of the force fields. Here, we report on an application of such calculations in the SAMPL5 experiment that also involves an effort in balancing solute and solvent interactions via their expected static dielectric constants. This strategy performs well with respect to predictive accuracy and correlation with unknown experimental values. We follow this by performing a series of retrospective investigations which highlight the potential importance of proper balancing in these systems, and we use a null hypothesis analysis to explore potential biases in the comparisons with experiment. The collective findings indicate that considerations of force field compatibility through dielectric behavior is a potential strategy for future improvements in transfer processes between disparate environments.

A multi-objective genetic algorithm for a mixed-model assembly U-line balancing type-I problem considering human-related issues, training, and learning

NASA Astrophysics Data System (ADS)

Rabbani, Masoud; Montazeri, Mona; Farrokhi-Asl, Hamed; Rafiei, Hamed

2016-12-01

Mixed-model assembly lines are increasingly accepted in many industrial environments to meet the growing trend of greater product variability, diversification of customer demands, and shorter life cycles. In this research, a new mathematical model is presented considering balancing a mixed-model U-line and human-related issues, simultaneously. The objective function consists of two separate components. The first part of the objective function is related to balance problem. In this part, objective functions are minimizing the cycle time, minimizing the number of workstations, and maximizing the line efficiencies. The second part is related to human issues and consists of hiring cost, firing cost, training cost, and salary. To solve the presented model, two well-known multi-objective evolutionary algorithms, namely non-dominated sorting genetic algorithm and multi-objective particle swarm optimization, have been used. A simple solution representation is provided in this paper to encode the solutions. Finally, the computational results are compared and analyzed.

Hidden Connections between Regression Models of Strain-Gage Balance Calibration Data

NASA Technical Reports Server (NTRS)

Ulbrich, Norbert

2013-01-01

Hidden connections between regression models of wind tunnel strain-gage balance calibration data are investigated. These connections become visible whenever balance calibration data is supplied in its design format and both the Iterative and Non-Iterative Method are used to process the data. First, it is shown how the regression coefficients of the fitted balance loads of a force balance can be approximated by using the corresponding regression coefficients of the fitted strain-gage outputs. Then, data from the manual calibration of the Ames MK40 six-component force balance is chosen to illustrate how estimates of the regression coefficients of the fitted balance loads can be obtained from the regression coefficients of the fitted strain-gage outputs. The study illustrates that load predictions obtained by applying the Iterative or the Non-Iterative Method originate from two related regression solutions of the balance calibration data as long as balance loads are given in the design format of the balance, gage outputs behave highly linear, strict statistical quality metrics are used to assess regression models of the data, and regression model term combinations of the fitted loads and gage outputs can be obtained by a simple variable exchange.

Automated sensing of hydroponic macronutrients using a computer-controlled system with an array of ion-selective electrodes

USDA-ARS?s Scientific Manuscript database

Hydroponic production systems grow plants without soil, relying on a circulating solution to provide the necessary nutrients. Maintaining an optimum nutrient balance in this solution is important for maximizing crop growth and yield. Particularly in closed hydroponic systems it is important to monit...

Viscous Corrections of the Time Incremental Minimization Scheme and Visco-Energetic Solutions to Rate-Independent Evolution Problems

NASA Astrophysics Data System (ADS)

Minotti, Luca; Savaré, Giuseppe

2018-02-01

We propose the new notion of Visco-Energetic solutions to rate-independent systems {(X, E,} d) driven by a time dependent energy E and a dissipation quasi-distance d in a general metric-topological space X. As for the classic Energetic approach, solutions can be obtained by solving a modified time Incremental Minimization Scheme, where at each step the dissipation quasi-distance d is incremented by a viscous correction {δ} (for example proportional to the square of the distance d), which penalizes far distance jumps by inducing a localized version of the stability condition. We prove a general convergence result and a typical characterization by Stability and Energy Balance in a setting comparable to the standard energetic one, thus capable of covering a wide range of applications. The new refined Energy Balance condition compensates for the localized stability and provides a careful description of the jump behavior: at every jump the solution follows an optimal transition, which resembles in a suitable variational sense the discrete scheme that has been implemented for the whole construction.

Methods for Combination of GRACE Gravimetry and ICESat Altimetry over Antarctica on Monthly Timescales

NASA Astrophysics Data System (ADS)

Hardy, R. A.; Nerem, R. S.; Wiese, D. N.

2017-12-01

Gravity and surface elevation change data altimetry provide different perspectives on mass variability in Antarctica. In anticipation of the concurrent operation of the successors of GRACE and ICESat, GRACE Follow-On and ICESat-2, we approach the problem of combining these data for enhanced spatial resolution and disaggregation of Antarctica's major mass transport processes. Using elevation changes gathered from over 500 million overlapping ICESat laser shot pairs between 2003 and 2009, we construct gridded models of Antarctic elevation change for each ICESat operational period. Comparing these elevation grids with temporally registered JPL RL05M mascon solutions, we exploit the relationship between surface mass flux and elevation change to inform estimates of effective surface density. These density estimates enable solutions for glacial isostatic adjustment and monthly estimates of surface mass change. These are used alongside spatial statistics from both the data and models of surface mass balance to produce enhanced estimates of Antarctic mass balance. We validate our solutions by modeling the effects of elastic loading and GIA from these solutions on the vertical motion of Antarctica's GNSS sites.

Numerical simulation of advective-dispersive multisolute transport with sorption, ion exchange and equilibrium chemistry

USGS Publications Warehouse

Lewis, F.M.; Voss, C.I.; Rubin, Jacob

1986-01-01

A model was developed that can simulate the effect of certain chemical and sorption reactions simultaneously among solutes involved in advective-dispersive transport through porous media. The model is based on a methodology that utilizes physical-chemical relationships in the development of the basic solute mass-balance equations; however, the form of these equations allows their solution to be obtained by methods that do not depend on the chemical processes. The chemical environment is governed by the condition of local chemical equilibrium, and may be defined either by the linear sorption of a single species and two soluble complexation reactions which also involve that species, or binary ion exchange and one complexation reaction involving a common ion. Partial differential equations that describe solute mass balance entirely in the liquid phase are developed for each tenad (a chemical entity whose total mass is independent of the reaction process) in terms of their total dissolved concentration. These equations are solved numerically in two dimensions through the modification of an existing groundwater flow/transport computer code. (Author 's abstract)

On the Meaning of Feedback Parameter, Transient Climate Response, and the Greenhouse Effect: Basic Considerations and the Discussion of Uncertainties

NASA Astrophysics Data System (ADS)

Kramm, Gerhard

2010-07-01

In this paper we discuss the meaning of feedback parameter, greenhouse effect and transient climate response usually related to the globally averaged energy balance model of Schneider and Mass. After scrutinizing this model and the corresponding planetary radiation balance we state that (a) the this globally averaged energy balance model is flawed by unsuitable physical considerations, (b) the planetary radiation balance for an Earth in the absence of an atmosphere is fraught by the inappropriate assumption of a uniform surface temperature, the so-called radiative equilibrium temperature of about 255 K, and (c) the effect of the radiative anthropogenic forcing, considered as a perturbation to the natural system, is much smaller than the uncertainty involved in the solution of the model of Schneider and Mass. This uncertainty is mainly related to the empirical constants suggested by various authors and used for predicting the emission of infrared radiation by the Earth's skin. Furthermore, after inserting the absorption of solar radiation by atmospheric constituents and the exchange of sensible and latent heat between the Earth and the atmosphere into the model of Schneider and Mass the surface temperatures become appreciably lesser than the radiative equilibrium temperature. Moreover, neither the model of Schneider and Mass nor the Dines-type two-layer energy balance model for the Earth-atmosphere system, both contain the planetary radiation balance for an Earth in the absence of an atmosphere as an asymptotic solution, do not provide evidence for the existence of the so-called atmospheric greenhouse effect if realistic empirical data are used.

Acute transfusion-related abdominal injury in trauma patients: a case report.

PubMed

Michel, P; Wähnert, D; Freistühler, M; Laukoetter, M G; Rehberg, S; Raschke, M J; Garcia, P

2016-10-19

Secondary abdominal compartment syndrome is well known as a life-threatening complication in critically ill patients in an intensive care unit. Massive crystalloid fluid resuscitation has been identified as the most important risk factor. The time interval from hospital admittance to the development of manifest abdominal compartment syndrome is usually greater than 24 hours. In the absence of any direct abdominal trauma, we observed a rapidly evolving secondary abdominal compartment syndrome shortly after hospital admittance associated with massive transfusion of blood products and only moderate crystalloid resuscitation. We report the case of an acute secondary abdominal compartment syndrome developing within 3 to 4 hours in a 74-year-old polytraumatized white woman. Although multiple fractures of her extremities and a B-type pelvic ring fracture were diagnosed by a full body computed tomography scan, no intra-abdominal injury could be detected. Hemorrhagic shock with a drop in her hemoglobin level to 5.7 g/dl was treated by massive transfusion of blood products and high doses of catecholamines. Shortly afterwards, her pulmonary gas exchange progressively deteriorated and mechanical ventilation became almost impossible with peak airway pressures of up to 60 cmH 2 O. Her abdomen appeared rigid and tense accompanied by a progressive hemodynamic decompensation necessitating mechanic cardiopulmonary resuscitation. Although preoperative computed tomography scans showed no signs of intra-abdominal fluid, a decompressive laparotomy under cardiopulmonary resuscitation conditions was performed and 2 liters of ascites-like fluid disgorged. Her hemodynamics and pulmonary ventilation improved immediately. This case report describes for the first time acute secondary abdominal compartment syndrome in a trauma patient, evolving in a very short time period. We hypothesize that the massive transfusion of blood products along with high doses of catecholamines triggered the acute development of abdominal compartment syndrome. Trauma teams need to consider a rapidly developing secondary abdominal compartment syndrome to be a potential cause of hemodynamic decompensation not only in the later phase of treatment but also in the emergency phase of treatment.

Delay Within the 3-Hour Surviving Sepsis Campaign Guideline on Mortality for Patients With Severe Sepsis and Septic Shock.

PubMed

Pruinelli, Lisiane; Westra, Bonnie L; Yadav, Pranjul; Hoff, Alexander; Steinbach, Michael; Kumar, Vipin; Delaney, Connie W; Simon, Gyorgy

2018-04-01

To specify when delays of specific 3-hour bundle Surviving Sepsis Campaign guideline recommendations applied to severe sepsis or septic shock become harmful and impact mortality. Retrospective cohort study. One health system composed of six hospitals and 45 clinics in a Midwest state from January 01, 2011, to July 31, 2015. All adult patients hospitalized with billing diagnosis of severe sepsis or septic shock. Four 3-hour Surviving Sepsis Campaign guideline recommendations: 1) obtain blood culture before antibiotics, 2) obtain lactate level, 3) administer broad-spectrum antibiotics, and 4) administer 30 mL/kg of crystalloid fluid for hypotension (defined as "mean arterial pressure" < 65) or lactate (> 4). To determine the effect of t minutes of delay in carrying out each intervention, propensity score matching of "baseline" characteristics compensated for differences in health status. The average treatment effect in the treated computed as the average difference in outcomes between those treated after shorter versus longer delay. To estimate the uncertainty associated with the average treatment effect in the treated metric and to construct 95% CIs, bootstrap estimation with 1,000 replications was performed. From 5,072 patients with severe sepsis or septic shock, 1,412 (27.8%) had in-hospital mortality. The majority of patients had the four 3-hour bundle recommendations initiated within 3 hours. The statistically significant time in minutes after which a delay increased the risk of death for each recommendation was as follows: lactate, 20.0 minutes; blood culture, 50.0 minutes; crystalloids, 100.0 minutes; and antibiotic therapy, 125.0 minutes. The guideline recommendations showed that shorter delays indicates better outcomes. There was no evidence that 3 hours is safe; even very short delays adversely impact outcomes. Findings demonstrated a new approach to incorporate time t when analyzing the impact on outcomes and provide new evidence for clinical practice and research.

Assessing and training standing balance in older adults: a novel approach using the 'Nintendo Wii' Balance Board.

PubMed

Young, William; Ferguson, Stuart; Brault, Sébastien; Craig, Cathy

2011-02-01

Older adults, deemed to be at a high risk of falling, are often unable to participate in dynamic exercises due to physical constraints and/or a fear of falling. Using the Nintendo 'Wii Balance Board' (WBB) (Nintendo, Kyoto, Japan), we have developed an interface that allows a user to accurately calculate a participant's centre of pressure (COP) and incorporate it into a virtual environment to create bespoke diagnostic or training programmes that exploit real-time visual feedback of current COP position. This platform allows researchers to design, control and validate tasks that both train and test balance function. This technology provides a safe, adaptable and low-cost balance training/testing solution for older adults, particularly those at high-risk of falling. Copyright © 2010 Elsevier B.V. All rights reserved.

Work-life balance and welfare.

PubMed

Evans, Lois; Young, Greg

2017-04-01

An online survey and focus groups were conducted, providing qualitative information on the work-life balance of psychiatrists and trainees in Australasia. An invitation to participate in an anonymous online welfare survey was emailed to all the Royal Australian and New Zealand College of Psychiatrists trainees, Fellows, and Affiliates. Following this, nine focus groups were held across Australia and New Zealand. Responses received were thematically analysed. The emergent patterns are presented in this report. Our research suggests that work-life balance can be subjectively and objectively measured. There are phases of good and bad work-life balance, depending on stage of career and other commitments. Work-life balance may be an indicator of the health of individuals and organisations. Due to its complexity, with intrinsic and extrinsic factors involved, solutions are unlikely to be simple. Further studies are needed to substantiate our findings.

Fluid balance concepts in medicine: Principles and practice

PubMed Central

Roumelioti, Maria-Eleni; Glew, Robert H; Khitan, Zeid J; Rondon-Berrios, Helbert; Argyropoulos, Christos P; Malhotra, Deepak; Raj, Dominic S; Agaba, Emmanuel I; Rohrscheib, Mark; Murata, Glen H; Shapiro, Joseph I; Tzamaloukas, Antonios H

2018-01-01

The regulation of body fluid balance is a key concern in health and disease and comprises three concepts. The first concept pertains to the relationship between total body water (TBW) and total effective solute and is expressed in terms of the tonicity of the body fluids. Disturbances in tonicity are the main factor responsible for changes in cell volume, which can critically affect brain cell function and survival. Solutes distributed almost exclusively in the extracellular compartment (mainly sodium salts) and in the intracellular compartment (mainly potassium salts) contribute to tonicity, while solutes distributed in TBW have no effect on tonicity. The second body fluid balance concept relates to the regulation and measurement of abnormalities of sodium salt balance and extracellular volume. Estimation of extracellular volume is more complex and error prone than measurement of TBW. A key function of extracellular volume, which is defined as the effective arterial blood volume (EABV), is to ensure adequate perfusion of cells and organs. Other factors, including cardiac output, total and regional capacity of both arteries and veins, Starling forces in the capillaries, and gravity also affect the EABV. Collectively, these factors interact closely with extracellular volume and some of them undergo substantial changes in certain acute and chronic severe illnesses. Their changes result not only in extracellular volume expansion, but in the need for a larger extracellular volume compared with that of healthy individuals. Assessing extracellular volume in severe illness is challenging because the estimates of this volume by commonly used methods are prone to large errors in many illnesses. In addition, the optimal extracellular volume may vary from illness to illness, is only partially based on volume measurements by traditional methods, and has not been determined for each illness. Further research is needed to determine optimal extracellular volume levels in several illnesses. For these reasons, extracellular volume in severe illness merits a separate third concept of body fluid balance. PMID:29359117

Technology Solutions Case Study: Balancing Hydronic Systems in Multifamily Buildings, Chicago, Illinois

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

None

2014-09-01

In multifamily building hydronic systems, temperature imbalance may be caused by undersized piping, improperly adjusted balancing valves, inefficient water temperature and flow levels, and owner/occupant interaction with the boilers, distribution and controls. The effects of imbalance include tenant discomfort, higher energy use intensity and inefficient building operation. In this case study , Partnership for Advanced Residential Retrofit and Elevate Energy. explores cost-effective distribution upgrades and balancing measures in multifamily hydronic systems, providing a resource to contractors, auditors, and building owners on best practices to improve tenant comfort and lower operating costs.

A complete analytical solution of the Fokker-Planck and balance equations for nucleation and growth of crystals

NASA Astrophysics Data System (ADS)

Makoveeva, Eugenya V.; Alexandrov, Dmitri V.

2018-01-01

This article is concerned with a new analytical description of nucleation and growth of crystals in a metastable mushy layer (supercooled liquid or supersaturated solution) at the intermediate stage of phase transition. The model under consideration consisting of the non-stationary integro-differential system of governing equations for the distribution function and metastability level is analytically solved by means of the saddle-point technique for the Laplace-type integral in the case of arbitrary nucleation kinetics and time-dependent heat or mass sources in the balance equation. We demonstrate that the time-dependent distribution function approaches the stationary profile in course of time. This article is part of the theme issue `From atomistic interfaces to dendritic patterns'.

KRASH 85 User’s Guide - Input/Output Format.

DTIC Science & Technology

1985-07-01

speaking, any significant .crror in the model will result in a very large value for EPSILON (1>0.1) or will ca;use the NASTRAN solution to terminate with...with NASTRAN ) * A comprehensive energy balance, * Center of gravity (c.g.) displacement, velocity, acceleration and force time histories * Revised...initial conditions subroutine (combined with NASTRAN ) * A comprehensive energy balance * Center of gravity (e.g.) displacement, velocity, acceleration and

Experimental design for evaluating WWTP data by linear mass balances.

PubMed

Le, Quan H; Verheijen, Peter J T; van Loosdrecht, Mark C M; Volcke, Eveline I P

2018-05-15

A stepwise experimental design procedure to obtain reliable data from wastewater treatment plants (WWTPs) was developed. The proposed procedure aims at determining sets of additional measurements (besides available ones) that guarantee the identifiability of key process variables, which means that their value can be calculated from other, measured variables, based on available constraints in the form of linear mass balances. Among all solutions, i.e. all possible sets of additional measurements allowing the identifiability of all key process variables, the optimal solutions were found taking into account two objectives, namely the accuracy of the identified key variables and the cost of additional measurements. The results of this multi-objective optimization problem were represented in a Pareto-optimal front. The presented procedure was applied to a full-scale WWTP. Detailed analysis of the relation between measurements allowed the determination of groups of overlapping mass balances. Adding measured variables could only serve in identifying key variables that appear in the same group of mass balances. Besides, the application of the experimental design procedure to these individual groups significantly reduced the computational effort in evaluating available measurements and planning additional monitoring campaigns. The proposed procedure is straightforward and can be applied to other WWTPs with or without prior data collection. Copyright © 2018 Elsevier Ltd. All rights reserved.

The effect of EIF dynamics on the cryopreservation process of a size distributed cell population.

PubMed

Fadda, S; Briesen, H; Cincotti, A

2011-06-01

Typical mathematical modeling of cryopreservation of cell suspensions assumes a thermodynamic equilibrium between the ice and liquid water in the extracellular solution. This work investigates the validity of this assumption by introducing a population balance approach for dynamic extracellular ice formation (EIF) in the absence of any cryo-protectant agent (CPA). The population balance model reflects nucleation and diffusion-limited growth in the suspending solution whose driving forces are evaluated in the relevant phase diagram. This population balance description of the extracellular compartment has been coupled to a model recently proposed in the literature [Fadda et al., AIChE Journal, 56, 2173-2185, (2010)], which is capable of quantitatively describing and predicting internal ice formation (IIF) inside the cells. The cells are characterized by a size distribution (i.e. through another population balance), thus overcoming the classic view of a population of identically sized cells. From the comparison of the system behavior in terms of the dynamics of the cell size distribution it can be concluded that the assumption of a thermodynamic equilibrium in the extracellular compartment is not always justified. Depending on the cooling rate, the dynamics of EIF needs to be considered. Copyright © 2011 Elsevier Inc. All rights reserved.

Stochastic weighted particle methods for population balance equations with coagulation, fragmentation and spatial inhomogeneity

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

Lee, Kok Foong; Patterson, Robert I.A.; Wagner, Wolfgang

2015-12-15

Graphical abstract: -- Highlights: •Problems concerning multi-compartment population balance equations are studied. •A class of fragmentation weight transfer functions is presented. •Three stochastic weighted algorithms are compared against the direct simulation algorithm. •The numerical errors of the stochastic solutions are assessed as a function of fragmentation rate. •The algorithms are applied to a multi-dimensional granulation model. -- Abstract: This paper introduces stochastic weighted particle algorithms for the solution of multi-compartment population balance equations. In particular, it presents a class of fragmentation weight transfer functions which are constructed such that the number of computational particles stays constant during fragmentation events. Themore » weight transfer functions are constructed based on systems of weighted computational particles and each of it leads to a stochastic particle algorithm for the numerical treatment of population balance equations. Besides fragmentation, the algorithms also consider physical processes such as coagulation and the exchange of mass with the surroundings. The numerical properties of the algorithms are compared to the direct simulation algorithm and an existing method for the fragmentation of weighted particles. It is found that the new algorithms show better numerical performance over the two existing methods especially for systems with significant amount of large particles and high fragmentation rates.« less

Acute effects of intradialytic aerobic exercise on solute removal, blood gases and oxidative stress in patients with chronic kidney disease.

PubMed

Böhm, Joseane; Monteiro, Mariane Borba; Andrade, Francini Porcher; Veronese, Francisco Veríssimo; Thomé, Fernando Saldanha

2017-01-01

Hemodialysis contributes to increased oxidative stress and induces transitory hypoxemia. Compartmentalization decreases the supply of solutes to the dialyzer during treatment. The aim of this study was to investigate the acute effects of intradialytic aerobic exercise on solute removal, blood gases and oxidative stress in patients with chronic kidney disease during a single hemodialysis session. Thirty patients were randomized to perform aerobic exercise with cycle ergometer for lower limbs during 30 minutes with intensity between 60-70% of maximal heart rate, or control group (CG). Blood samples were collected prior to and immediately after exercise or the equivalent time in CG. Analysis of blood and dialysate biochemistry as well as blood gases were performed. Mass removal and solute clearance were calculated. Oxidative stress was determined by lipid peroxidation and by the total antioxidant capacity. Serum concentrations of solutes increased with exercise, but only phosphorus showed a significant elevation (p = 0.035). There were no significant changes in solute removal and in the acid-base balance. Both oxygen partial pressure and saturation increased with exercise (p = 0.035 and p = 0.024, respectivelly), which did not occur in the CG. The total antioxidant capacity decreased significantly (p = 0.027). The acute intradialytic aerobic exercise increased phosphorus serum concentration and decreased total antioxidant capacity, reversing hypoxemia resulting from hemodialysis. The intradialytic exercise did not change the blood acid-base balance and the removal of solutes.

In vitro evaluation of the Medtronic cardioplegia safety system.

PubMed

Trowbridge, C C; Woods, K R; Muhle, M L; Niimi, K S; Tremain, K D; Jiang, J; Stammers, A H

2000-03-01

Myocardial preservation demands the precise and accurate delivery of cardioplegic solutions to provide nutritive delivery and metabolic waste removal. The purpose of this study was to evaluate the performance characteristics of the Medtronic CSS Cardioplegia Safety System in an in vitro setting. The CSS was evaluated under the following conditions: blood to crystalloid ratios of 1:0, 1:1, 4:1, 8:1, 0:1; potassium concentrations of 10, 20, and 40 mEq L-1; volumetric delivery collection at 100, 250, 500, 750, and 990 mL/min; pressure accuracy at 100 and 300 mmHg; and system safety mechanisms. Measured and predicted values from the CSS were compared using one way ANOVA, with statistical significance accepted at p < or = 0.05. The measured values for the tested ratios and volume collections were all within the manufacturer's technical parameters. Potassium concentration results were all within expected values except at 100 mL/min, where the measured value of 17.1 +/- 2.1 mmol was lower than the expected 20.0 +/- 0.2 mmol (p < .034). As flow rates changed, the CSS line pressure error was constant (0.5 to 3.7%), and the only significant difference was observed at 100 mmHg, 500 mL/min (102.3 +/- 1.7 vs. 100.0 +/- 0.0 mmHg, P < .003). The device performed accurately and reliably under all simulated safety conditions, including bubble detection, over pressurization and battery backup. In conclusion, the performance of the CSS was within the manufacturer's specifications for the majority of the tested conditions and operated safely when challenged under varying conditions.

Use of high-frequency ultrasonography for evaluation of skin thickness in relation to hydration status and fluid distribution at various cutaneous sites in dogs.

PubMed

Diana, Alessia; Guglielmini, Carlo; Fracassi, Federico; Pietra, Marco; Balletti, Erika; Cipone, Mario

2008-09-01

To assess the usefulness of high-frequency diagnostic ultrasonography for evaluation of changes of skin thickness in relation to hydration status and fluid distribution at various cutaneous sites in dogs. 10 clinically normal adult dogs (6 males and 4 females) of various breeds. Ultrasonographic examination of the skin was performed before and after hydration via IV administration of an isotonic crystalloid solution (30 mL/kg/h for 30 minutes). A 13-MHz linear-array transducer was used to obtain series of ultrasonographic images at 4 different cutaneous sites (the frontal, sacral, flank, and metatarsal regions). Weight and various clinicopathologic variables (PCV; serum osmolality; and serum total protein, albumin, and sodium concentrations) were determined before and after the infusion. These variables and ultrasonographic measurements of skin thickness before and after hydration were compared. Among the 10 dogs, mean preinfusion skin thickness ranged from 2,211 microm (metatarsal region) to 3,249 microm (sacral region). Compared with preinfusion values, weight was significantly increased, whereas PCV; serum osmolality; and serum total protein, albumin, and sodium concentrations were significantly decreased after infusion. After infusion, dermal echogenicity decreased and skin thickness increased significantly by 21%, 14%, 15%, and 13% in the frontal, sacral, flank, and metatarsal regions, respectively. Cutaneous site and hydration were correlated with cutaneous characteristics and skin thickness determined by use of high-frequency ultrasonography in dogs. Thus, diagnostic ultrasonography may be a useful tool for the noninvasive evaluation of skin hydration in healthy dogs and in dogs with skin edema.

Cognitive changes after saline or plasmalyte infusion in healthy volunteers: a multiple blinded, randomized, cross-over trial.

PubMed

Story, David A; Lees, Lucy; Weinberg, Laurence; Teoh, Soon-Yee; Lee, Katherine J; Velissaris, Sarah; Bellomo, Rinaldo; Wilson, Sarah J

2013-09-01

In an incidental finding, during a study of plasma chemistry after crystalloid infusion, participants reported subjective cognitive changes, particularly slower thinking, after saline but not Hartmann's (Ringer's lactate) solution. The authors tested the hypothesis that saline infusion would produce greater adverse cognitive changes than Plasmalyte infusion. The authors conducted a randomized, cross-over, multiple blinded study of healthy adult volunteers. On separate days, participants received 30 ml/kg over 1 h of either 0.9% saline or Plasmalyte with the order randomly allocated. Plasma chemistry was tested on venous samples. As part of a battery of cognitive tests our primary endpoint was the reaction time index after infusion. The authors studied 25 participants. Plasma chloride was greater after saline than after Plasmalyte: mean difference 5.4 mM (95% CI, 4.1-6.6 mM; P < 0.001). Saline was also associated with greater metabolic acidosis: base-excess 2.5 mM more negative (95% CI, 1.9-3.0 mM more negative; P < 0.001). There was no evidence of a difference in the reaction time index between the two interventions: mean reaction time index 394 ms (SD, 72) after saline versus 385 ms (SD, 55) after Plasmalyte. Difference: saline 9 ms slower (95% CI, 30 ms slower to 12 ms faster; P = 0.39). There were minimal differences in the other cognitive and mood tests. Despite expected differences in plasma chemistry, the authors found that measures of cognition did not differ after infusions of Plasmalyte or saline.

Well-balanced schemes for the Euler equations with gravitation: Conservative formulation using global fluxes

NASA Astrophysics Data System (ADS)

Chertock, Alina; Cui, Shumo; Kurganov, Alexander; Özcan, Şeyma Nur; Tadmor, Eitan

2018-04-01

We develop a second-order well-balanced central-upwind scheme for the compressible Euler equations with gravitational source term. Here, we advocate a new paradigm based on a purely conservative reformulation of the equations using global fluxes. The proposed scheme is capable of exactly preserving steady-state solutions expressed in terms of a nonlocal equilibrium variable. A crucial step in the construction of the second-order scheme is a well-balanced piecewise linear reconstruction of equilibrium variables combined with a well-balanced central-upwind evolution in time, which is adapted to reduce the amount of numerical viscosity when the flow is at (near) steady-state regime. We show the performance of our newly developed central-upwind scheme and demonstrate importance of perfect balance between the fluxes and gravitational forces in a series of one- and two-dimensional examples.

Performance Comparison of High-Speed Dual-Pneumatic Vitrectomy Cutters during Simulated Vitrectomy with Balanced Salt Solution.

PubMed

Abulon, Dina Joy K; Buboltz, David C

2015-02-01

To measure flow rate of balanced salt solution and IOP during simulated vitrectomy using two sets of high-speed dual-pneumatic probes. A closed-model eye system measured IOP and flow rate of a balanced salt solution through infusion cannula. The Constellation Vision System was tested with two sets of high-speed dual-pneumatic probes (UltraVit 23-gauge and enhanced 25+-gauge 5000-cpm probes; UltraVit 23-gauge and enhanced 25+-gauge 7500-cpm probes; n = 6 each) under different vacuum levels and cut rates in three duty cycle modes. In both probe sets, flow rates were dependent on cut rate with the biased open and biased closed duty cycles. Flow rates were highest with the biased open duty cycle, lower with the 50/50 duty cycle, and lowest with the biased closed duty cycle. IOP, as expected, was inversely associated with flow rate using both probe sets. The 7500-cpm probes offer greater control and customization compared with 5000-cpm probes under certain experimental conditions. At maximum cut rates, performance of 7500-cpm probes was similar to that of 5000-cpm probes, suggesting that 7500-cpm probes may be used without sacrifice of flow rate and IOP stability. Customization of vitrectomy parameters allows greater surgeon control during vitrectomy and may expand the usefulness of vitrectomy probes.

A simple performance calculation method for LH2/LOX engines with different power cycles

NASA Technical Reports Server (NTRS)

Schmucker, R. H.

1973-01-01

A simple method for the calculation of the specific impulse of an engine with a gas generator cycle is presented. The solution is obtained by a power balance between turbine and pump. Approximate equations for the performance of the combustion products of LH2/LOX are derived. Performance results are compared with solutions of different engine types.

Balancing Osmotic Pressure of Electrolytes for Nanoporous Membrane Vanadium Redox Flow Battery with a Draw Solute.

PubMed

Yan, Ligen; Li, Dan; Li, Shuaiqiang; Xu, Zhi; Dong, Junhang; Jing, Wenheng; Xing, Weihong

2016-12-28

Vanadium redox flow batteries with nanoporous membranes (VRFBNM) have been demonstrated to be good energy storage devices. Yet the capacity decay due to permeation of vanadium and water makes their commercialization very difficult. Inspired by the forward osmosis (FO) mechanism, the VRFBNM battery capacity decrease was alleviated by adding a soluble draw solute (e.g., 2-methylimidazole) into the catholyte, which can counterbalance the osmotic pressure between the positive and negative half-cell. No change of the electrolyte volume has been observed after VRFBNM being operated for 55 h, revealing that the permeation of water and vanadium ions was effectively limited. Consequently, the Coulombic efficiency (CE) of nanoporous TiO 2 vanadium redox flow battery (VRFB) was enhanced from 93.5% to 95.3%, meanwhile, its capacity decay was significantly suppressed from 60.7% to 27.5% upon the addition of soluble draw solute. Moreover, the energy capacity of the VRFBNM was noticeably improved from 297.0 to 406.4 mAh remarkably. These results indicate balancing the osmotic pressure via the addition of draw solute can restrict pressure-dependent vanadium permeation and it can be established as a promising method for up-scaling VRFBNM application.

Multiple solutions and numerical analysis to the dynamic and stationary models coupling a delayed energy balance model involving latent heat and discontinuous albedo with a deep ocean.

PubMed

Díaz, J I; Hidalgo, A; Tello, L

2014-10-08

We study a climatologically important interaction of two of the main components of the geophysical system by adding an energy balance model for the averaged atmospheric temperature as dynamic boundary condition to a diagnostic ocean model having an additional spatial dimension. In this work, we give deeper insight than previous papers in the literature, mainly with respect to the 1990 pioneering model by Watts and Morantine. We are taking into consideration the latent heat for the two phase ocean as well as a possible delayed term. Non-uniqueness for the initial boundary value problem, uniqueness under a non-degeneracy condition and the existence of multiple stationary solutions are proved here. These multiplicity results suggest that an S-shaped bifurcation diagram should be expected to occur in this class of models generalizing previous energy balance models. The numerical method applied to the model is based on a finite volume scheme with nonlinear weighted essentially non-oscillatory reconstruction and Runge-Kutta total variation diminishing for time integration.

Simplified model for determining local heat flux boundary conditions for slagging wall

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

Bingzhi Li; Anders Brink; Mikko Hupa

2009-07-15

In this work, two models for calculating heat transfer through a cooled vertical wall covered with a running slag layer are investigated. The first one relies on a discretization of the velocity equation, and the second one relies on an analytical solution. The aim is to find a model that can be used for calculating local heat flux boundary conditions in computational fluid dynamics (CFD) analysis of such processes. Two different cases where molten deposits exist are investigated: the black liquor recovery boiler and the coal gasifier. The results show that a model relying on discretization of the velocity equationmore » is more flexible in handling different temperature-viscosity relations. Nevertheless, a model relying on an analytical solution is the one fast enough for a potential use as a CFD submodel. Furthermore, the influence of simplifications to the heat balance in the model is investigated. It is found that simplification of the heat balance can be applied when the radiation heat flux is dominant in the balance. 9 refs., 7 figs., 10 tabs.« less

Multiple solutions and numerical analysis to the dynamic and stationary models coupling a delayed energy balance model involving latent heat and discontinuous albedo with a deep ocean

PubMed Central

Díaz, J. I.; Hidalgo, A.; Tello, L.

2014-01-01

We study a climatologically important interaction of two of the main components of the geophysical system by adding an energy balance model for the averaged atmospheric temperature as dynamic boundary condition to a diagnostic ocean model having an additional spatial dimension. In this work, we give deeper insight than previous papers in the literature, mainly with respect to the 1990 pioneering model by Watts and Morantine. We are taking into consideration the latent heat for the two phase ocean as well as a possible delayed term. Non-uniqueness for the initial boundary value problem, uniqueness under a non-degeneracy condition and the existence of multiple stationary solutions are proved here. These multiplicity results suggest that an S-shaped bifurcation diagram should be expected to occur in this class of models generalizing previous energy balance models. The numerical method applied to the model is based on a finite volume scheme with nonlinear weighted essentially non-oscillatory reconstruction and Runge–Kutta total variation diminishing for time integration. PMID:25294969

Hydrogeochemical Investigation of Recharge Pathways to Intermediate and Regional Groundwater in Canon de Valle and Technical Area 16, Los Alamos National Laboratory

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

Brady, Brendan W.

In aquifers consisting of fractured or porous igneous rocks, as well as conglomerate and sandstone products of volcanic formations, silicate minerals actively dissolve and precipitate (Eby, 2004; Eriksson, 1985; Drever, 1982). Dissolution of hydrated volcanic glass is also known to influence the character of groundwater to which it is exposed (White et al., 1980). Hydrochemical evolution, within saturated zones of volcanic formations, is modeled here as a means to resolve the sources feeding a perched groundwater zone. By observation of solute mass balances in groundwater, together with rock chemistry, this study characterizes the chemical weathering processes active along recharge pathwaysmore » in a mountain front system. Inverse mass balance modeling, which accounts for mass fluxes between solid phases and solution, is used to contrive sets of quantitative reactions that explain chemical variability of water between sampling points. Model results are used, together with chloride mass balance estimation, to evaluate subsurface mixing scenarios generated by further modeling. Final model simulations estimate contributions of mountain block and local recharge to various contaminated zones.« less

Virtual Reality-Based Center of Mass-Assisted Personalized Balance Training System.

PubMed

Kumar, Deepesh; González, Alejandro; Das, Abhijit; Dutta, Anirban; Fraisse, Philippe; Hayashibe, Mitsuhiro; Lahiri, Uttama

2017-01-01

Poststroke hemiplegic patients often show altered weight distribution with balance disorders, increasing their risk of fall. Conventional balance training, though powerful, suffers from scarcity of trained therapists, frequent visits to clinics to get therapy, one-on-one therapy sessions, and monotony of repetitive exercise tasks. Thus, technology-assisted balance rehabilitation can be an alternative solution. Here, we chose virtual reality as a technology-based platform to develop motivating balance tasks. This platform was augmented with off-the-shelf available sensors such as Nintendo Wii balance board and Kinect to estimate one's center of mass (CoM). The virtual reality-based CoM-assisted balance tasks (Virtual CoMBaT) was designed to be adaptive to one's individualized weight-shifting capability quantified through CoM displacement. Participants were asked to interact with Virtual CoMBaT that offered tasks of varying challenge levels while adhering to ankle strategy for weight shifting. To facilitate the patients to use ankle strategy during weight-shifting, we designed a heel lift detection module. A usability study was carried out with 12 hemiplegic patients. Results indicate the potential of our system to contribute to improving one's overall performance in balance-related tasks belonging to different difficulty levels.

RAF and Intelligence Warfighting Function

DTIC Science & Technology

2015-02-01

Warfighting Function 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT...meet the CCDR’s need to leverage the entire Intelligence Enterprise. Balancing IWfF RAF “solutions against an ever reducing budget will require...right balance is important. Using DOTMLPF as a framework can assist in seeing how the IWfF can support RAF implementation. Furthermore, identifying gaps

Steady state magnetic field configurations for the earth's magnetotail

NASA Technical Reports Server (NTRS)

Hau, L.-N.; Wolf, R. A.; Voigt, G.-H.; Wu, C. C.

1989-01-01

A two-dimensional, force-balance magnetic field model is presented. The theoretical existence of a steady state magnetic field configuration that is force-balanced and consistent with slow, lossless, adiabatic, earthward convection within the limit of the ideal MHD is demonstrated. A numerical solution is obtained for a two-dimensional magnetosphere with a rectangular magnetopause and nonflaring tail. The results are consistent with the convection time sequences reported by Erickson (1985).

A mass-balanced definition of corrected retention volume in gas chromatography.

PubMed

Kurganov, A

2007-05-25

The mass balance equation of a chromatographic system using a compressible moving phase has been compiled for mass flow of the mobile phase instead of traditional volumetric flow allowing solution of the equation in an analytical form. The relation obtained correlates retention volume measured under ambient conditions with the partition coefficient of the solute. Compared to the relation in the ideal chromatographic system the equation derived contains an additional correction term accounting for the compressibility of the moving phase. When the retention volume is measured under the mean column pressure and column temperature the correction term is reduced to unit and the relation is simplified to those known for the ideal system. This volume according to International Union of Pure and Applied Chemistry (IUPAC) is called the corrected retention volume.

Hydration patterns and salting effects in sodium chloride solution.

PubMed

Li, Weifeng; Mu, Yuguang

2011-10-07

The salting effects of 2M sodium chloride electrolyte are studied based on a series of model solutes with properties ranging from hydrophobic to hydrophilic. Generally, hydrophobic solutes will be salted out and hydrophilic solutes will be salted in by NaCl solution. The solvation free energy changes are highly correlated with Kirkwood-Buff integrals. The underlying mechanism resorts to the preferential binding of ions and water to solutes. Our results demonstrate that the salting effect not only depends on the salt's position in Hofmeister series, but also on the solutes' specifics. Taking the hydration free energies of solutes and ions as independent variables, a schematic diagram of salting effects is suggested. The resolved multifaceted salting effects rely on the sensitive balance of the tripartite interaction among solutes, ions, and water. © 2011 American Institute of Physics

Boundary integral solutions for faults in flowing rock

NASA Astrophysics Data System (ADS)

Wei, Wei

We develop new boundary-integral solutions for faulting in viscous rock and implement solutions numerically with a boundary-element computer program, called Faux_Pas. In the solutions, large permanent rock deformations near faults are treated with velocity discontinuities within linear, incompressible, creeping, viscous flows. The faults may have zero strength or a finite strength that can be a constant or varying with deformation. Large deformations are achieved by integrating step by step with the fourth-order Runge-Kutta method. With this method, the boundaries and passive markers are updated dynamically. Faux_Pas has been applied to straight and curved elementary faults, and to listric and dish compound faults, composed of two or more elementary faults, such as listric faults and dish faults, all subjected to simple shear, shortening and lengthening. It reproduces the essential geometric elements seen in seismic profiles of fault-related folds associated with listric thrust faults in the Bighorn Basin of Wyoming, with dish faults in the Appalachians in Pennsylvania, Parry Islands of Canada and San Fernando Valley, California, and with listric normal faults in the Gulf of Mexico. Faux_Pas also predicts that some of these fault-related structures will include fascinating minor folds, especially in the footwall of the fault, that have been recognized earlier but have not been known to be related to the faulting. Some of these minor folds are potential structural traps. Faux_Pas is superior in several respects to current geometric techniques of balancing profiles, such as the "fault-bend fold" construction. With Faux_Pas, both the hanging wall and footwall are deformable, the faults are mechanical features, the cross sections are automatically balanced and, most important, the solutions are based on the first principles of mechanics. With the geometric techniques, folds are drawn only in the hanging wall, the faults are simply lines, the cross sections are arbitrarily balanced and, most important, the drawings are based on unsubstantiated rules of thumb. Faux_Pas provides the first rational tool for the study of fault-related folds.

Balance point characterization of interstitial fluid volume regulation.

PubMed

Dongaonkar, R M; Laine, G A; Stewart, R H; Quick, C M

2009-07-01

The individual processes involved in interstitial fluid volume and protein regulation (microvascular filtration, lymphatic return, and interstitial storage) are relatively simple, yet their interaction is exceedingly complex. There is a notable lack of a first-order, algebraic formula that relates interstitial fluid pressure and protein to critical parameters commonly used to characterize the movement of interstitial fluid and protein. Therefore, the purpose of the present study is to develop a simple, transparent, and general algebraic approach that predicts interstitial fluid pressure (P(i)) and protein concentrations (C(i)) that takes into consideration all three processes. Eight standard equations characterizing fluid and protein flux were solved simultaneously to yield algebraic equations for P(i) and C(i) as functions of parameters characterizing microvascular, interstitial, and lymphatic function. Equilibrium values of P(i) and C(i) arise as balance points from the graphical intersection of transmicrovascular and lymph flows (analogous to Guyton's classical cardiac output-venous return curves). This approach goes beyond describing interstitial fluid balance in terms of conservation of mass by introducing the concept of inflow and outflow resistances. Algebraic solutions demonstrate that P(i) and C(i) result from a ratio of the microvascular filtration coefficient (1/inflow resistance) and effective lymphatic resistance (outflow resistance), and P(i) is unaffected by interstitial compliance. These simple algebraic solutions predict P(i) and C(i) that are consistent with reported measurements. The present work therefore presents a simple, transparent, and general balance point characterization of interstitial fluid balance resulting from the interaction of microvascular, interstitial, and lymphatic function.

Self-balancing dynamic scheduling of electrical energy for energy-intensive enterprises

NASA Astrophysics Data System (ADS)

Gao, Yunlong; Gao, Feng; Zhai, Qiaozhu; Guan, Xiaohong

2013-06-01

Balancing production and consumption with self-generation capacity in energy-intensive enterprises has huge economic and environmental benefits. However, balancing production and consumption with self-generation capacity is a challenging task since the energy production and consumption must be balanced in real time with the criteria specified by power grid. In this article, a mathematical model for minimising the production cost with exactly realisable energy delivery schedule is formulated. And a dynamic programming (DP)-based self-balancing dynamic scheduling algorithm is developed to obtain the complete solution set for such a multiple optimal solutions problem. For each stage, a set of conditions are established to determine whether a feasible control trajectory exists. The state space under these conditions is partitioned into subsets and each subset is viewed as an aggregate state, the cost-to-go function is then expressed as a function of initial and terminal generation levels of each stage and is proved to be a staircase function with finite steps. This avoids the calculation of the cost-to-go of every state to resolve the issue of dimensionality in DP algorithm. In the backward sweep process of the algorithm, an optimal policy is determined to maximise the realisability of energy delivery schedule across the entire time horizon. And then in the forward sweep process, the feasible region of the optimal policy with the initial and terminal state at each stage is identified. Different feasible control trajectories can be identified based on the region; therefore, optimising for the feasible control trajectory is performed based on the region with economic and reliability objectives taken into account.

[Organizational and individual determinants of using initiatives conducive to successful work-life balance].

PubMed

Andysz, Aleksandra; Najder, Anna; Merecz-Kot, Dorota

2014-01-01

Appropriate distribution of time and energy between work and personal life poses a challenge to many working people. Unfortunately, many professionally active people experience work-family conflict. In order to minimize it, employees are offered various solutions aimed at reconciling professional and private spheres (work-life balance (WLB) initiatives). The authors attempt to answer what makes employees use WLB initiatives and what influences the decision to reject the available options. The review is based on the articles published after 2000, searched by Google Scholar and Web of Knowledge with use of the key words: work-life balance, work-family conflict, work-life balance initiatives, work-life balance initiatives use, use of WLB solutions. We focused on organizational and individual determinants of WLB initiatives use, such as organizational culture, stereotypes and values prevailing in the work environment that may result in stigmatization of workers - flexibility stigma. We discuss the reasons why supervisors and co-workers stigmatize their colleagues, and what are the consequences of experiencing such stigmatization. Among the individual determinants of WLB initiatives use, we have inter alia focused on the preference for integration vs. separation of the spheres of life. The presented material shows that social factors - cultural norms prevailing in a society, relationships in the workplace and individual factors, such as the level of self-control - are of equal importance for decisions of using WLB initiatives as their existence. Our conclusion is that little attention has been paid to the research on determinants of WLB initiatives use, especially to individual ones.

Osmolality urine test

MedlinePlus

... balance and urine concentration. Osmolality is a more exact measurement of urine concentration than the urine specific ... must be authorized in writing by ADAM Health Solutions. About MedlinePlus Site Map FAQs Customer Support Get ...

Fluid and Electrolyte Balance model (FEB)

NASA Technical Reports Server (NTRS)

Fitzjerrell, D. G.

1973-01-01

The effects of various oral input water loads on solute and water distribution throughout the body are presented in the form of a model. The model was a three compartment model; the three compartments being plasma, interstitial fluid and cellular fluid. Sodium, potassium, chloride and urea were the only major solutes considered explicitly. The control of body water and electrolyte distribution was affected via drinking and hormone levels.

A Simple, Low-cost, and Robust System to Measure the Volume of Hydrogen Evolved by Chemical Reactions with Aqueous Solutions

PubMed Central

Brack, Paul; Dann, Sandie; Wijayantha, K. G. Upul; Adcock, Paul; Foster, Simon

2016-01-01

There is a growing research interest in the development of portable systems which can deliver hydrogen on-demand to proton exchange membrane (PEM) hydrogen fuel cells. Researchers seeking to develop such systems require a method of measuring the generated hydrogen. Herein, we describe a simple, low-cost, and robust method to measure the hydrogen generated from the reaction of solids with aqueous solutions. The reactions are conducted in a conventional one-necked round-bottomed flask placed in a temperature controlled water bath. The hydrogen generated from the reaction in the flask is channeled through tubing into a water-filled inverted measuring cylinder. The water displaced from the measuring cylinder by the incoming gas is diverted into a beaker on a balance. The balance is connected to a computer, and the change in the mass reading of the balance over time is recorded using data collection and spreadsheet software programs. The data can then be approximately corrected for water vapor using the method described herein, and parameters such as the total hydrogen yield, the hydrogen generation rate, and the induction period can also be deduced. The size of the measuring cylinder and the resolution of the balance can be changed to adapt the setup to different hydrogen volumes and flow rates. PMID:27584581

Edemagenic gain and interstitial fluid volume regulation.

PubMed

Dongaonkar, R M; Quick, C M; Stewart, R H; Drake, R E; Cox, C S; Laine, G A

2008-02-01

Under physiological conditions, interstitial fluid volume is tightly regulated by balancing microvascular filtration and lymphatic return to the central venous circulation. Even though microvascular filtration and lymphatic return are governed by conservation of mass, their interaction can result in exceedingly complex behavior. Without making simplifying assumptions, investigators must solve the fluid balance equations numerically, which limits the generality of the results. We thus made critical simplifying assumptions to develop a simple solution to the standard fluid balance equations that is expressed as an algebraic formula. Using a classical approach to describe systems with negative feedback, we formulated our solution as a "gain" relating the change in interstitial fluid volume to a change in effective microvascular driving pressure. The resulting "edemagenic gain" is a function of microvascular filtration coefficient (K(f)), effective lymphatic resistance (R(L)), and interstitial compliance (C). This formulation suggests two types of gain: "multivariate" dependent on C, R(L), and K(f), and "compliance-dominated" approximately equal to C. The latter forms a basis of a novel method to estimate C without measuring interstitial fluid pressure. Data from ovine experiments illustrate how edemagenic gain is altered with pulmonary edema induced by venous hypertension, histamine, and endotoxin. Reformulation of the classical equations governing fluid balance in terms of edemagenic gain thus yields new insight into the factors affecting an organ's susceptibility to edema.

Rehydration after exercise in the heat: a comparison of 4 commonly used drinks.

PubMed

Shirreffs, Susan M; Aragon-Vargas, Luis F; Keil, Mhairi; Love, Thomas D; Phillips, Sian

2007-06-01

To determine the effectiveness of 3 commonly used beverages in restoring fluid and electrolyte balance, 8 volunteers dehydrated by 1.94% +/- 0.17% of body mass by intermittent exercise in the heat, then ingested a carbohydrate-electrolyte solution (Gatorade), carbonated water/apple-juice mixture (Apfelschorle), and San Benedetto mineral water in a volume equal to 150% body-mass loss. These drinks are all are perceived to be effective rehydration solutions, and their effectiveness was compared with the rehydration effectiveness of Evian mineral water, which is not perceived in this way by athletes. Four hours after rehydration, the subjects were in a significantly lower hydration status than the pretrial situation on trials with Apfelschorle (-365 +/- 319 mL, P = 0.030), Evian (-529 +/- 319 mL, P < 0.0005), and San Benedetto (-401 +/- 353 mL, P = 0.016) but were in the same hydration status as before the dehydrating exercise on Gatorade (-201 +/- 388 mL, P = 0.549). Sodium balance was negative on all trials throughout the study; only with Apfelschorle did subjects remain in positive potassium balance. In this scenario, recovery of fluid balance can only be achieved when significant, albeit insufficient, quantities of sodium are ingested after exercise. There is a limited range of commercially available products that have a composition sufficient to achieve this, even though the public thinks that some of the traditional drinks are effective for this purpose.

Groundwater discharge to wetlands driven by storm and flood events: Quantification using continuous Radon-222 and electrical conductivity measurements and dynamic mass-balance modelling

NASA Astrophysics Data System (ADS)

Gilfedder, B. S.; Frei, S.; Hofmann, H.; Cartwright, I.

2015-09-01

The dynamic response of groundwater discharge to external influences such as rainfall is an often neglected part of water and solute balances in wetlands. Here we develop a new field platform for long-term continuous 222Rn and electrical conductivity (EC) measurements at Sale Wetland, Australia to study the response of groundwater discharge to storm and flood events. The field measurements, combined with dynamic mass-balance modelling, demonstrate that the groundwater flux can increase from 3 to ∼20 mm d-1 following storms and up to 5 mm d-1 on the receding limb of floods. The groundwater pulses are likely produced by activation of local groundwater flow paths by water ponding on the surrounding flood plains. While 222Rn is a sensitive tracer for quantifying transient groundwater discharge, the mass-balance used to estimate fluxes is sensitive to parameterisation of gas exchange (k) with the atmosphere. Comparison of six equations for calculating k showed that, based on parameterisation of k alone, the groundwater flux estimate could vary by 58%. This work shows that neglecting transient processes will lead to errors in water and solute flux estimates based on infrequent point measurements. This could be particularly important for surface waters connected to contaminated or saline groundwater systems.

Simulation of flux during electro-membrane extraction based on the Nernst-Planck equation.

PubMed

Gjelstad, Astrid; Rasmussen, Knut Einar; Pedersen-Bjergaard, Stig

2007-12-07

The present work has for the first time described and verified a theoretical model of the analytical extraction process electro-membrane extraction (EME), where target analytes are extracted from an aqueous sample, through a thin layer of 2-nitrophenyl octylether immobilized as a supported liquid membrane (SLM) in the pores in the wall of a porous hollow fibre, and into an acceptor solution present inside the lumen of the hollow fibre by the application of an electrical potential difference. The mathematical model was based on the Nernst-Planck equation, and described the flux over the SLM. The model demonstrated that the magnitude of the electrical potential difference, the ion balance of the system, and the absolute temperature influenced the flux of analyte across the SLM. These conclusions were verified by experimental data with five basic drugs. The flux was strongly dependent of the potential difference over the SLM, and increased potential difference resulted in an increase in the flux. The ion balance, defined as the sum of ions in the donor solution divided by the sum of ions in the acceptor solution, was shown to influence the flux, and high ionic concentration in the acceptor solution relative to the sample solution was advantageous for high flux. Different temperatures also led to changes in the flux in the EME system.

Bioimpedance Spectroscopy for Assessment of Volume Status in Patients before and after General Anaesthesia

PubMed Central

Ernstbrunner, Matthäus; Kostner, Lisa; Kimberger, Oliver; Wabel, Peter; Säemann, Marcus; Markstaller, Klaus; Fleischmann, Edith; Kabon, Barbara; Hecking, Manfred

2014-01-01

Background Technically assisted assessment of volume status before surgery may be useful to direct intraoperative fluid administration. We therefore tested a recently developed whole-body bioimpedance spectroscopy device to determine pre- to postoperative fluid distribution. Methods Using a three-compartment physiologic tissue model, the body composition monitor (BCM, Fresenius Medical Care, Germany) measures total body fluid volume, extracellular volume, intracellular volume and fluid overload as surplus or deficit of ‘normal’ extracellular volume. BCM-measurements were performed before and after standardized general anaesthesia for gynaecological procedures (laparotomies, laparoscopies and vaginal surgeries). BCM results were blinded to the attending anaesthesiologist and data analysed using the 2-sided, paired Student’s t-test and multiple linear regression. Results In 71 females aged 45±15 years with body weight 67±13 kg and duration of anaesthesia 154±68 min, pre- to postoperative fluid overload increased from −0.7±1.1 L to 0.1±1.0 L, corresponding to −5.1±7.5% and 0.8±6.7% of normal extracellular volume, respectively (both p<0.001), after patients had received 1.9±0.9 L intravenous crystalloid fluid. Perioperative urinary excretion was 0.4±0.3 L. The increase in extracellular volume was paralleled by an increase in total body fluid volume, while intracellular volume increased only slightly and without reaching statistical significance (p = 0.15). Net perioperative fluid balance (administered fluid volume minus urinary excretion) was significantly associated with change in extracellular volume (r2 = 0.65), but was not associated with change in intracellular volume (r2 = 0.01). Conclusions Routine intraoperative fluid administration results in a significant, and clinically meaningful increase in the extracellular compartment. BCM-measurements yielded plausible results and may become useful to guide intraoperative fluid therapy in future studies. PMID:25360698

21 CFR 864.2875 - Balanced salt solutions or formulations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Cell And Tissue Culture Products § 864.2875... of most cell culture systems. This media component controls for pH, osmotic pressure, energy source...

21 CFR 864.2875 - Balanced salt solutions or formulations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Cell And Tissue Culture Products § 864.2875... of most cell culture systems. This media component controls for pH, osmotic pressure, energy source...

21 CFR 864.2875 - Balanced salt solutions or formulations.

Code of Federal Regulations, 2013 CFR

2013-04-01

... (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Cell And Tissue Culture Products § 864.2875... of most cell culture systems. This media component controls for pH, osmotic pressure, energy source...

21 CFR 864.2875 - Balanced salt solutions or formulations.

Code of Federal Regulations, 2014 CFR

2014-04-01

... (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Cell And Tissue Culture Products § 864.2875... of most cell culture systems. This media component controls for pH, osmotic pressure, energy source...

21 CFR 864.2875 - Balanced salt solutions or formulations.

Code of Federal Regulations, 2012 CFR

2012-04-01

... (CONTINUED) MEDICAL DEVICES HEMATOLOGY AND PATHOLOGY DEVICES Cell And Tissue Culture Products § 864.2875... of most cell culture systems. This media component controls for pH, osmotic pressure, energy source...

Multistate outbreak of toxic anterior segment syndrome, 2005.

PubMed

Kutty, Preeta K; Forster, Terri S; Wood-Koob, Carol; Thayer, Nancy; Nelson, Robert B; Berke, Stanley J; Pontacolone, Lillian; Beardsley, Thomas L; Edelhauser, Henry F; Arduino, Matthew J; Mamalis, Nick; Srinivasan, Arjun

2008-04-01

To present the findings of an outbreak of toxic anterior segment syndrome (TASS). Six states, 7 ophthalmology surgical centers, United States. Cases were identified through electronic communication networks and via reports to a national TASS referral center. Information on the procedure, details of instrument reprocessing, and products used during cataract surgery were also collected. Medications used during the procedures were tested for endotoxin using a kinetic assay. The search identified 112 case patients (median age 74 years) from 7 centers from July 19, 2005, through November 28, 2005. Common presenting clinical features included blurred vision (60%), anterior segment inflammation (49%), and cell deposition (56%). Of the patients, 100 (89%) had been exposed to a single brand of balanced salt solution manufactured by Cytosol Laboratories and distributed by Advanced Medical Optics as AMO Endosol. Two patients continued to have residual symptoms. There were no reports of significant breaches in sterile technique or instrument reprocessing. Of 14 balanced salt solution lots, 5 (35%) had levels exceeding the endotoxin limit (0.5 EU/mL). Based on these findings, the balanced salt solution product was withdrawn, resulting in a termination of the outbreak. This is the first known report of an outbreak of TASS caused by intrinsic contamination of a product with endotoxin. Ophthalmologists and epidemiologists should be aware of TASS and its common causes. To facilitate investigations of adverse outcomes such as TASS, those performing cataract surgeries should document the type and lot numbers of products used intraoperatively.

Iris reconstruction using autologous iris preserved in cold balanced salt solution for 8 hours in iatrogenic total iridodialysis during cataract surgery: a case report.

PubMed

Bang, Seung Pil; Jun, Jong Hwa

2017-04-04

A large iris defect or extensive iridodialysis can be an intractable cause of visual disturbance, photophobia, glare, monocular diplopia, or cosmetic deformity. The implantation of an artificial iris substitute could be an effective option, but this can cause a reduction in endothelial cell density. We succeeded in the anatomical restoration of iris tissue that was totally dialyzed out of the eye, and was preserved in cold balanced salt solution for 8 h. Engrafted iris tissue was maintained within the aqueous humor. A 71-year-old man was referred to our clinic for management of an iatrogenic total iridodialysis. The totally dialyzed iris tissue was immediately preserved in sterile cold balanced salt solution and packed in a sterile biopsy bottle that was surrounded with ice cubes. Under general anesthesia, a pars plana vitrectomy was performed to remove the remaining lens cortex and vitreous fiber anterior to the equator. A sulcus-positioned intraocular lens (IOL) was repositioned and fixed by ab externo scleral sutures. Preserved iris tissue was inserted and ironed using both iris spatula and ocular viscoelastic devices. Five-point ab interno scleral sutures were made 1.0 mm posterior to the limbus. The engrafted iris was successfully maintained for 6 months and did not undergo any atrophic change or depigmentation, which may be caused by primary implantation failure due to a blocked blood supply.

Diagnosis and management of pyothorax in a domestic ferret (Mustela putorius furo).

PubMed

Sladakovic, Izidora; Brainard, Benjamin M; Lane, Selena L; Secrest, Scott A; Fox, Andrew J; Tarigo, Jaime L; Yeuroukis, Corry K; Sanchez, Susan; Proenca, Laila M; Mayer, Joerg

2017-07-01

To describe the diagnosis, management, and outcome of pyothorax in a domestic ferret (Mustela putorius furo). A domestic ferret was evaluated for a history of lethargy, anorexia, and pyrexia. Pleural effusion was detected with radiography and ultrasonography, and a diagnosis of pyothorax was made following cytologic evaluation of pleural fluid. Bilateral thoracostomy tubes were placed for thoracic drainage and lavage, and the ferret was treated with intravenous crystalloid fluids, antimicrobials, and analgesics. Bacterial culture of the pleural fluid yielded Fusobacterium spp. and Actinomyces hordeovulneris. This treatment protocol resulted in resolution of pyothorax, and a positive clinical outcome. This is the first reported case of successful management of pyothorax caused by Fusobacterium spp. and A. hordeovulneris in a ferret. © Veterinary Emergency and Critical Care Society 2017.

An update on the use of massive transfusion protocols in obstetrics.

PubMed

Pacheco, Luis D; Saade, George R; Costantine, Maged M; Clark, Steven L; Hankins, Gary D V

2016-03-01

Obstetrical hemorrhage remains a leading cause of maternal mortality worldwide. New concepts involving the pathophysiology of hemorrhage have been described and include early activation of both the protein C and fibrinolytic pathways. New strategies in hemorrhage treatment include the use of hemostatic resuscitation, although the optimal ratio to administer the various blood products is still unknown. Massive transfusion protocols involve the early utilization of blood products and limit the traditional approach of early massive crystalloid-based resuscitation. The evidence behind hemostatic resuscitation has changed in the last few years, and debate is ongoing regarding optimal transfusion strategies. The use of tranexamic acid, fibrinogen concentrates, and prothrombin complex concentrates has emerged as new potential alternative treatment strategies with improved safety profiles. Copyright © 2016 Elsevier Inc. All rights reserved.

The two-dimensional Stefan problem with slightly varying heat flux

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

Gammon, J.; Howarth, J.A.

1995-09-01

The authors solve the two-dimensional stefan problem of solidification in a half-space, where the heat flux at the wall is a slightly varying function of positioning along the wall, by means of a large Stefan number approximation (which turns out to be equivalent to a small time solution), and then by means of the Heat Balance Integral Method, which is valid for all time, and which agrees with the large Stefan number solution for small times. A representative solution is given for a particular form of the heat flux perturbation.

Virtual Reality-Based Center of Mass-Assisted Personalized Balance Training System

PubMed Central

Kumar, Deepesh; González, Alejandro; Das, Abhijit; Dutta, Anirban; Fraisse, Philippe; Hayashibe, Mitsuhiro; Lahiri, Uttama

2018-01-01

Poststroke hemiplegic patients often show altered weight distribution with balance disorders, increasing their risk of fall. Conventional balance training, though powerful, suffers from scarcity of trained therapists, frequent visits to clinics to get therapy, one-on-one therapy sessions, and monotony of repetitive exercise tasks. Thus, technology-assisted balance rehabilitation can be an alternative solution. Here, we chose virtual reality as a technology-based platform to develop motivating balance tasks. This platform was augmented with off-the-shelf available sensors such as Nintendo Wii balance board and Kinect to estimate one’s center of mass (CoM). The virtual reality-based CoM-assisted balance tasks (Virtual CoMBaT) was designed to be adaptive to one’s individualized weight-shifting capability quantified through CoM displacement. Participants were asked to interact with Virtual CoMBaT that offered tasks of varying challenge levels while adhering to ankle strategy for weight shifting. To facilitate the patients to use ankle strategy during weight-shifting, we designed a heel lift detection module. A usability study was carried out with 12 hemiplegic patients. Results indicate the potential of our system to contribute to improving one’s overall performance in balance-related tasks belonging to different difficulty levels. PMID:29359128

Models for mirror symmetry breaking via β-sheet-controlled copolymerization: (i) mass balance and (ii) probabilistic treatment.

PubMed

Blanco, Celia; Hochberg, David

2012-12-06

Experimental mechanisms that yield the growth of homochiral copolymers over their heterochiral counterparts have been advocated by Lahav and co-workers. These chiral amplification mechanisms proceed through racemic β-sheet-controlled polymerization operative in both surface crystallites as well as in solution. We develop two complementary theoretical models for these template-induced desymmetrization processes leading to multicomponent homochiral copolymers. First, assuming reversible β-sheet formation, the equilibrium between the free monomer pool and the polymer strand within the template is assumed. This yields coupled nonlinear mass balance equations whose solutions are used to calculate enantiomeric excesses and average lengths of the homochiral chains formed. The second approach is a probabilistic treatment based on random polymerization. The occlusion probabilities depend on the polymerization activation energies for each monomer species and are proportional to the concentrations of the monomers in solution in the constant pool approximation. The monomer occlusion probabilities are represented geometrically in terms of unit simplexes from which conditions for maximizing or minimizing the likelihood for mirror symmetry breaking can be determined.

Green rusts synthesis by coprecipitation of Fe II-Fe III ions and mass-balance diagram

NASA Astrophysics Data System (ADS)

Ruby, Christian; Aïssa, Rabha; Géhin, Antoine; Cortot, Jérôme; Abdelmoula, Mustapha; Génin, Jean-Marie

2006-06-01

A basic solution is progressively added to various mixed Fe II-Fe III solutions. The nature and the relative quantities of the compounds that form can be visualised in a mass-balance diagram. The formation of hydroxysulphate green rust {GR( SO42-)} is preceded by the precipitation of a sulphated ferric basic salt that transforms in a badly ordered ferric oxyhydroxide. Then octahedrally coordinated Fe II species and SO42- anions are adsorbed on the FeOOH surface and GR( SO42-) is formed at the solid/solution interface. By using the same method of preparation, other types of green rust were synthesised, e.g. hydroxycarbonate green rust {GR( CO32-)}. Like other layered double hydroxides, green rusts obey the general chemical formula [ṡ[ṡmHO]x+ with x⩽1/3. Al-substituted hydroxysulphate green rust consists of small hexagonal crystals with a lateral size ˜50 nm, which is significantly smaller than the size of the GR( SO42-) crystals (˜500 nm). To cite this article: C. Ruby et al., C. R. Geoscience 338 (2006).

Validation of polyethylene glycol 3350 as a poorly absorbable marker for intestinal perfusion studies.

PubMed

Schiller, L R; Santa Ana, C A; Porter, J; Fordtran, J S

1997-01-01

Polyethylene glycol (PEG) has been used as a poorly absorbable marker in intestinal perfusion studies, but there is controversy about the absorbability of PEG, particularly when glucose-sodium cotransport is occurring. Total intestinal perfusion studies were done in five normal humans using three solutions containing 1 g/liter PEG 3350 and designed to produce low rates of water absorption, high rates of water absorption, or high rates of glucose-sodium cotransport. Water absorption rates were calculated by traditional nonabsorbable marker equations and by a novel balance technique in which absorption was taken as the difference between the volumes of solution infused and recovered during steady-state conditions. Effluent PEG recovery was 99 +/- 4%, 109 +/- 2%, and 104 +/- 6% of the amount infused with each solution. Water absorption rates measured by use of PEG concentrations were similar to those calculated by the balance technique (r = 0.99). The complete recovery of PEG confirms the poor absorbability of PEG 3350, and the excellent agreement between techniques validates PEG as a poorly absorbed marker, even when glucose-sodium cotransport is occurring.

Features of electric drive sucker rod pumps for oil production

NASA Astrophysics Data System (ADS)

Gizatullin, F. A.; Khakimyanov, M. I.; Khusainov, F. F.

2018-01-01

This article is about modes of operation of electric drives of downhole sucker rod pumps. Downhole oil production processes are very energy intensive. Oil fields contain many oil wells; many of them operate in inefficient modes with significant additional losses. Authors propose technical solutions to improve energy performance of a pump unit drives: counterweight balancing, reducing of electric motor power, replacing induction motors with permanent magnet motors, replacing balancer drives with chain drives, using of variable frequency drives.

Reconstruction of coded aperture images

NASA Technical Reports Server (NTRS)

Bielefeld, Michael J.; Yin, Lo I.

1987-01-01

Balanced correlation method and the Maximum Entropy Method (MEM) were implemented to reconstruct a laboratory X-ray source as imaged by a Uniformly Redundant Array (URA) system. Although the MEM method has advantages over the balanced correlation method, it is computationally time consuming because of the iterative nature of its solution. Massively Parallel Processing, with its parallel array structure is ideally suited for such computations. These preliminary results indicate that it is possible to use the MEM method in future coded-aperture experiments with the help of the MPP.

Making a successful transition to cash balance. Using employee choice and financial education.

PubMed

Scahill, P; Wiley, P

2000-01-01

As employee work patterns change, the need for flexible plan design has increased. Hybrid plans such as cash balance plans offer a plan design variation that incorporates elements of the traditional defined benefit plan as well as those of defined contribution plans. This article examines plan design trends and discusses both negative and positive reactions to those trends. Finally, the solution of offering choice to plan participants is suggested, and the issues that must be considered are discussed.

Eliminating Undesirable Variation in Neonatal Practice: Balancing Standardization and Customization.

PubMed

Balakrishnan, Maya; Raghavan, Aarti; Suresh, Gautham K

2017-09-01

Consistency of care and elimination of unnecessary and harmful variation are underemphasized aspects of health care quality. This article describes the prevalence and patterns of practice variation in health care and neonatology; discusses the potential role of standardization as a solution to eliminating wasteful and harmful practice variation, particularly when it is founded on principles of evidence-based medicine; and proposes ways to balance standardization and customization of practice to ultimately improve the quality of neonatal care. Copyright © 2017 Elsevier Inc. All rights reserved.

Impact of different disassembly line balancing algorithms on the performance of dynamic kanban system for disassembly line

NASA Astrophysics Data System (ADS)

Kizilkaya, Elif A.; Gupta, Surendra M.

2005-11-01

In this paper, we compare the impact of different disassembly line balancing (DLB) algorithms on the performance of our recently introduced Dynamic Kanban System for Disassembly Line (DKSDL) to accommodate the vagaries of uncertainties associated with disassembly and remanufacturing processing. We consider a case study to illustrate the impact of various DLB algorithms on the DKSDL. The approach to the solution, scenario settings, results and the discussions of the results are included.

What Can Interfacial Water Molecules Tell Us About Solute Structure?

NASA Astrophysics Data System (ADS)

Willard, Adam

The molecular structure of bulk liquid water reflects a molecular tendency to engage in tetrahedrally coordinated hydrogen bonding. At a solute interface waters preferred three-dimensional hydrogen bonding network must conform to a locally anisotropy interfacial environment. Interfacial water molecules adopt configurations that balance water-solute and water-water interactions. The arrangements of interfacial water molecules, therefore encode information about the effective solute-water interactions. This solute-specific information is difficult to extract, however, because interfacial structure also reflects waters collective response to an anisotropic hydrogen bonding environment. Here I present a methodology for characterizing the molecular-level structure of liquid water interface from simulation data. This method can be used to explore waters static and/or dynamic response to a wide range of chemically and topologically heterogeneous solutes such as proteins.

A simple model of fluid flow and electrolyte balance in the body

NASA Technical Reports Server (NTRS)

White, R. J.; Neal, L.

1973-01-01

The model is basically a three-compartment model, the three compartments being the plasma, interstitial fluid and cellular fluid. Sodium, potassium, chloride and urea are the only major solutes considered explicitly. The control of body water and electrolyte distribution is affected via drinking and hormone levels. Basically, the model follows the effect of various oral input water loads on solute and water distribution throughout the body.

A multigroup radiation diffusion test problem: Comparison of code results with analytic solution

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

Shestakov, A I; Harte, J A; Bolstad, J H

2006-12-21

We consider a 1D, slab-symmetric test problem for the multigroup radiation diffusion and matter energy balance equations. The test simulates diffusion of energy from a hot central region. Opacities vary with the cube of the frequency and radiation emission is given by a Wien spectrum. We compare results from two LLNL codes, Raptor and Lasnex, with tabular data that define the analytic solution.

Control of deaths from diarrheal disease in rural communities. I. Design of an intervention study and effects on child mortality.

PubMed

Kielmann, A A; Mobarak, A B; Hammamy, M T; Gomaa, A I; Abou-el-Saad, S; Lotfi, R K; Mazen, I; Nagaty, A

1985-12-01

From May through October 1980, the "Strengthening Rural Health Delivery" project (SRHD) under the Rural Health Department of the Ministry of Health of Egypt had conducted an investigation into prevention of child mortality from diarrheal disease through testing various modules of Oral Rehydration Therapy delivery mechanisms. In a six-cell design counting a total of almost 29,000 children, ORT was provided both as hypotonic sucrose/salt solution prepared and administered by mothers and normotonic, balanced electrolyte solution in the hands of both mothers and health care providers and the effects on child mortality during the peak season of diarrheal incidence were measured. In addition, utilization and effects of ORT when made readily available through commercial channels was similarly examined. A cost-benefit analysis was performed on the cost of the services as well as on the outcome for each of five study cells using the sixth, the control, as reference. Results showed that early rehydration with a sucrose/salt solution in the hands of mothers, backed by balanced oral rehydration solution in the hands of health care providers proved the most cost-effective means of reducing diarrhea-specific mortality as well as being as safe as prepackaged commercial preparations.

Eolian transport, saline lake basins, and groundwater solutes

USGS Publications Warehouse

Wood, Warren W.; Sanford, Ward E.

1995-01-01

Eolian processes associated with saline lakes are shown to be important in determining solute concentration in groundwater in arid and semiarid areas. Steady state mass balance analyses of chloride in the groundwater at Double Lakes, a saline lake basin in the southern High Plains of Texas, United States, suggest that approximately 4.5 × 105 kg of chloride is removed from the relatively small (4.7 km2) basin floor each year by deflation. This mass enters the groundwater down the wind gradient from the lake, degrading the water quality. The estimates of mass transport were independently determined by evaluation of solutes in the unsaturated zone and by solute mass balance calculations of groundwater flux. Transport of salts from the lake was confirmed over a short term (2 years) by strategically placed dust collectors. Results consistent with those at Double Lake were obtained from dune surfaces collected upwind and downwind from a sabkha near the city of Abu Dhabi in the United Arab Emirates. The eolian transport process provides an explanation of the degraded groundwater quality associated with the 30–40 saline lake basins on the southern half of the southern High Plains of Texas and New Mexico and in many other arid and semiarid areas.

IoT for Real-Time Measurement of High-Throughput Liquid Dispensing in Laboratory Environments.

PubMed

Shumate, Justin; Baillargeon, Pierre; Spicer, Timothy P; Scampavia, Louis

2018-04-01

Critical to maintaining quality control in high-throughput screening is the need for constant monitoring of liquid-dispensing fidelity. Traditional methods involve operator intervention with gravimetric analysis to monitor the gross accuracy of full plate dispenses, visual verification of contents, or dedicated weigh stations on screening platforms that introduce potential bottlenecks and increase the plate-processing cycle time. We present a unique solution using open-source hardware, software, and 3D printing to automate dispenser accuracy determination by providing real-time dispense weight measurements via a network-connected precision balance. This system uses an Arduino microcontroller to connect a precision balance to a local network. By integrating the precision balance as an Internet of Things (IoT) device, it gains the ability to provide real-time gravimetric summaries of dispensing, generate timely alerts when problems are detected, and capture historical dispensing data for future analysis. All collected data can then be accessed via a web interface for reviewing alerts and dispensing information in real time or remotely for timely intervention of dispense errors. The development of this system also leveraged 3D printing to rapidly prototype sensor brackets, mounting solutions, and component enclosures.

Schrödinger and Dirac solutions to few-body problems

NASA Astrophysics Data System (ADS)

Muolo, Andrea; Reiher, Markus

We elaborate on the variational solution of the Schrödinger and Dirac equations for small atomic and molecular systems without relying on the Born-Oppenheimer approximation. The all-particle equations of motion are solved in a numerical procedure that relies on the variational principle, Cartesian coordinates and parametrized explicitly correlated Gaussians functions. A stochastic optimization of the variational parameters allows the calculation of accurate wave functions for ground and excited states. Expectation values such as the radial and angular distribution functions or the dipole moment can be calculated. We developed a simple strategy for the elimination of the global translation that allows to generally adopt laboratory-fixed cartesian coordinates. Simple expressions for the coordinates and operators are then preserved throughout the formalism. For relativistic calculations we devised a kinetic-balance condition for explicitly correlated basis functions. We demonstrate that the kinetic-balance condition can be obtained from the row reduction process commonly applied to solve systems of linear equations. The resulting form of kinetic balance establishes a relation between all components of the spinor of an N-fermion system. ETH Zürich, Laboratorium für Physikalische Chemie, CH-8093 Zürich, Switzerland.

Common Problems and Solutions for Being Physically Active

MedlinePlus

... such as walking, dancing and tennis. Do your stretching, balance and flexibility activities while you watch TV. ... a nearby health club. Print and take the Stretching and Flexibility and Strengthening sheets with you. All ...

Approximate analytic solutions to 3D unconfined groundwater flow within regional 2D models

NASA Astrophysics Data System (ADS)

Luther, K.; Haitjema, H. M.

2000-04-01

We present methods for finding approximate analytic solutions to three-dimensional (3D) unconfined steady state groundwater flow near partially penetrating and horizontal wells, and for combining those solutions with regional two-dimensional (2D) models. The 3D solutions use distributed singularities (analytic elements) to enforce boundary conditions on the phreatic surface and seepage faces at vertical wells, and to maintain fixed-head boundary conditions, obtained from the 2D model, at the perimeter of the 3D model. The approximate 3D solutions are analytic (continuous and differentiable) everywhere, including on the phreatic surface itself. While continuity of flow is satisfied exactly in the infinite 3D flow domain, water balance errors can occur across the phreatic surface.

Measure-valued solutions to the complete Euler system revisited

NASA Astrophysics Data System (ADS)

Březina, Jan; Feireisl, Eduard

2018-06-01

We consider the complete Euler system describing the time evolution of a general inviscid compressible fluid. We introduce a new concept of measure-valued solution based on the total energy balance and entropy inequality for the physical entropy without any renormalization. This class of so-called dissipative measure-valued solutions is large enough to include the vanishing dissipation limits of the Navier-Stokes-Fourier system. Our main result states that any sequence of weak solutions to the Navier-Stokes-Fourier system with vanishing viscosity and heat conductivity coefficients generates a dissipative measure-valued solution of the Euler system under some physically grounded constitutive relations. Finally, we discuss the same asymptotic limit for the bi-velocity fluid model introduced by H.Brenner.

Comparison of 7.2% hypertonic saline - 6% hydroxyethyl starch solution and 6% hydroxyethyl starch solution after the induction of anesthesia in patients undergoing elective neurosurgical procedures.

PubMed

Shao, Liujiazi; Wang, Baoguo; Wang, Shuangyan; Mu, Feng; Gu, Ke

2013-01-01

The ideal solution for fluid management during neurosurgical procedures remains controversial. The aim of this study was to compare the effects of a 7.2% hypertonic saline - 6% hydroxyethyl starch (HS-HES) solution and a 6% hydroxyethyl starch (HES) solution on clinical, hemodynamic and laboratory variables during elective neurosurgical procedures. Forty patients scheduled for elective neurosurgical procedures were randomly assigned to the HS-HES group orthe HES group. Afterthe induction of anesthesia, patients in the HS-HES group received 250 mL of HS-HES (500 mL/h), whereas the patients in the HES group received 1,000 mL of HES (1000 mL/h). The monitored variables included clinical, hemodynamic and laboratory parameters. Chictr.org: ChiCTR-TRC-12002357 The patients who received the HS-HES solution had a significant decrease in the intraoperative total fluid input (p<0.01), the volume of Ringer's solution required (p<0.05), the fluid balance (p<0.01) and their dural tension scores (p<0.05). The total urine output, blood loss, bleeding severity scores, operation duration and hemodynamic variables were similar in both groups (p>0.05). Moreover, compared with the HES group, the HS-HES group had significantly higher plasma concentrations of sodium and chloride, increasing the osmolality (p<0.01). Our results suggest that HS-HES reduced the volume of intraoperative fluid required to maintain the patients undergoing surgery and led to a decrease in the intraoperative fluid balance. Moreover, HS-HES improved the dural tension scores and provided satisfactory brain relaxation. Our results indicate that HS-HES may represent a new avenue for volume therapy during elective neurosurgical procedures.

Comparison of 7.2% hypertonic saline - 6% hydroxyethyl starch solution and 6% hydroxyethyl starch solution after the induction of anesthesia in patients undergoing elective neurosurgical procedures

PubMed Central

Shao, Liujiazi; Wang, Baoguo; Wang, Shuangyan; Mu, Feng; Gu, Ke

2013-01-01

OBJECTIVE: The ideal solution for fluid management during neurosurgical procedures remains controversial. The aim of this study was to compare the effects of a 7.2% hypertonic saline - 6% hydroxyethyl starch (HS-HES) solution and a 6% hydroxyethyl starch (HES) solution on clinical, hemodynamic and laboratory variables during elective neurosurgical procedures. METHODS: Forty patients scheduled for elective neurosurgical procedures were randomly assigned to the HS-HES group or the HES group. After the induction of anesthesia, patients in the HS-HES group received 250 mL of HS-HES (500 mL/h), whereas the patients in the HES group received 1,000 mL of HES (1000 mL/h). The monitored variables included clinical, hemodynamic and laboratory parameters. Chictr.org: ChiCTR-TRC-12002357 RESULTS: The patients who received the HS-HES solution had a significant decrease in the intraoperative total fluid input (p<0.01), the volume of Ringer's solution required (p<0.05), the fluid balance (p<0.01) and their dural tension scores (p<0.05). The total urine output, blood loss, bleeding severity scores, operation duration and hemodynamic variables were similar in both groups (p>0.05). Moreover, compared with the HES group, the HS-HES group had significantly higher plasma concentrations of sodium and chloride, increasing the osmolality (p<0.01). CONCLUSION: Our results suggest that HS-HES reduced the volume of intraoperative fluid required to maintain the patients undergoing surgery and led to a decrease in the intraoperative fluid balance. Moreover, HS-HES improved the dural tension scores and provided satisfactory brain relaxation. Our results indicate that HS-HES may represent a new avenue for volume therapy during elective neurosurgical procedures. PMID:23644851

Effect of varying the concentrations of carbohydrate and milk protein in rehydration solutions ingested after exercise in the heat.

PubMed

James, Lewis J; Evans, Gethin H; Madin, Joshua; Scott, Darren; Stepney, Michael; Harris, Russell; Stone, Robert; Clayton, David J

2013-10-01

The present study investigated the relationship between the milk protein content of a rehydration solution and fluid balance after exercise-induced dehydration. On three occasions, eight healthy males were dehydrated to an identical degree of body mass loss (BML, approximately 1·8%) by intermittent cycling in the heat, rehydrating with 150% of their BML over 1 h with either a 60 g/l carbohydrate solution (C), a 40 g/l carbohydrate, 20 g/l milk protein solution (CP20) or a 20 g/l carbohydrate, 40 g/l milk protein solution (CP40). Urine samples were collected pre-exercise, post-exercise, post-rehydration and for a further 4 h. Subjects produced less urine after ingesting the CP20 or CP40 drink compared with the C drink (P<0·01), and at the end of the study, more of the CP20 (59 (SD 12)%) and CP40 (64 (SD 6)%) drinks had been retained compared with the C drink (46 (SD 9)%) (P<0·01). At the end of the study, whole-body net fluid balance was more negative for trial C (- 470 (SD 154) ml) compared with both trials CP20 (- 181 (SD 280) ml) and CP40 (2107 (SD 126) ml) (P<0·01). At 2 and 3 h after drink ingestion, urine osmolality was greater for trials CP20 and CP40 compared with trial C (P<0·05). The present study further demonstrates that after exercise-induced dehydration, a carbohydrate--milk protein solution is better retained than a carbohydrate solution. The results also suggest that high concentrations of milk protein are not more beneficial in terms of fluid retention than low concentrations of milk protein following exercise-induced dehydration.

LBMR: Load-Balanced Multipath Routing for Wireless Data-Intensive Transmission in Real-Time Medical Monitoring.

PubMed

Tseng, Chinyang Henry

2016-05-31

In wireless networks, low-power Zigbee is an excellent network solution for wireless medical monitoring systems. Medical monitoring generally involves transmission of a large amount of data and easily causes bottleneck problems. Although Zigbee's AODV mesh routing provides extensible multi-hop data transmission to extend network coverage, it originally does not, and needs to support some form of load balancing mechanism to avoid bottlenecks. To guarantee a more reliable multi-hop data transmission for life-critical medical applications, we have developed a multipath solution, called Load-Balanced Multipath Routing (LBMR) to replace Zigbee's routing mechanism. LBMR consists of three main parts: Layer Routing Construction (LRC), a Load Estimation Algorithm (LEA), and a Route Maintenance (RM) mechanism. LRC assigns nodes into different layers based on the node's distance to the medical data gateway. Nodes can have multiple next-hops delivering medical data toward the gateway. All neighboring layer-nodes exchange flow information containing current load, which is the used by the LEA to estimate future load of next-hops to the gateway. With LBMR, nodes can choose the neighbors with the least load as the next-hops and thus can achieve load balancing and avoid bottlenecks. Furthermore, RM can detect route failures in real-time and perform route redirection to ensure routing robustness. Since LRC and LEA prevent bottlenecks while RM ensures routing fault tolerance, LBMR provides a highly reliable routing service for medical monitoring. To evaluate these accomplishments, we compare LBMR with Zigbee's AODV and another multipath protocol, AOMDV. The simulation results demonstrate LBMR achieves better load balancing, less unreachable nodes, and better packet delivery ratio than either AODV or AOMDV.

LBMR: Load-Balanced Multipath Routing for Wireless Data-Intensive Transmission in Real-Time Medical Monitoring

PubMed Central

Tseng, Chinyang Henry

2016-01-01

In wireless networks, low-power Zigbee is an excellent network solution for wireless medical monitoring systems. Medical monitoring generally involves transmission of a large amount of data and easily causes bottleneck problems. Although Zigbee’s AODV mesh routing provides extensible multi-hop data transmission to extend network coverage, it originally does not, and needs to support some form of load balancing mechanism to avoid bottlenecks. To guarantee a more reliable multi-hop data transmission for life-critical medical applications, we have developed a multipath solution, called Load-Balanced Multipath Routing (LBMR) to replace Zigbee’s routing mechanism. LBMR consists of three main parts: Layer Routing Construction (LRC), a Load Estimation Algorithm (LEA), and a Route Maintenance (RM) mechanism. LRC assigns nodes into different layers based on the node’s distance to the medical data gateway. Nodes can have multiple next-hops delivering medical data toward the gateway. All neighboring layer-nodes exchange flow information containing current load, which is the used by the LEA to estimate future load of next-hops to the gateway. With LBMR, nodes can choose the neighbors with the least load as the next-hops and thus can achieve load balancing and avoid bottlenecks. Furthermore, RM can detect route failures in real-time and perform route redirection to ensure routing robustness. Since LRC and LEA prevent bottlenecks while RM ensures routing fault tolerance, LBMR provides a highly reliable routing service for medical monitoring. To evaluate these accomplishments, we compare LBMR with Zigbee’s AODV and another multipath protocol, AOMDV. The simulation results demonstrate LBMR achieves better load balancing, less unreachable nodes, and better packet delivery ratio than either AODV or AOMDV. PMID:27258297

Buffer capacity of 4% succinylated gelatin does not provide any advantages over acidic 6% hydroxyethyl starch 130/0.4 for acid-base balance during experimental mixed acidaemia in a porcine model.

PubMed

Esche, V; Russ, M; Melzer, S; Grossmann, B; Boemke, W; Unger, J K

2008-11-01

Four percent gelatine is an alkaline compound due to NH2 groups, whereas 6% hydroxyethyl starch 130/0.4 (HES130) has acidic features. We investigated whether these solutions lead to differences in acid-base balance in pigs during acidaemia and correction of pH. Anaesthetized pigs were randomized to HES130 or gelatine infusion (n = 5 per group). Animals received acid infusion (0.4 M solution of lactic acid and HCl diluted in normal saline) and low tidal volume ventilation (6-7 mL kg(-1), PaCO2 of 80-85 mmHg, pH 7.19-7.24). Measurements were made before and after induction of acidaemia, before and after correction of pH with haemofiltration (continuous venovenous haemofiltration) and tris-hydroxymethylaminomethane infusion. We measured parameters describing acid-base balance according to Stewart's approach, ketone body formation, oxygen delivery, haemodynamics, diuresis and urinary pH. Acid-base balance did not differ significantly between the groups. In HES130-treated pigs, the haemodilution-based drop of haemoglobin (1.4 +/- 1.0 g dL(-1), median +/- SD) was paralleled by an increase in the cardiac output (0.5 +/- 0.4 L min(-1). Lacking increases in cardiac output, gelatine-treated pigs demonstrated a reduction in oxygen delivery (149.4 +/- 106.0 mL min(-1)). Tris-hydroxymethylaminomethane volumes required for pH titration to desired values were significantly higher in the gelatine group (0.7 +/- 0.1 mL kg(-1) h(-1) vs. HES130: 0.5 +/- 0.2 mL kg(-1) h(-1)). The buffer capacity of gelatine did not lead to favourable differences in acid-base balance in comparison to HES130.

Neuromotor Activity, Anxiety and Cognitive Function in the In Vivo Model of Alimentary Hyperlipidemia and Obesity.

PubMed

Apryatin, S A; Sidorova, Yu S; Shipelin, V A; Balakina, A; Trusov, N V; Mazo, V K

2017-05-01

Behavioral indicators characterizing specific features of the pathological process of alimentary-dependent diseases were studied using in vivo model of alimentary hyperlipidemia in rats and mice. Rats and mice of the control groups received balanced semisynthetic diet for 63 days; animals of the experimental groups received a diet with high fat content (30% dry weight), balanced or high-fat diet with fructose solution instead of water, balanced cholesterol-enriched diet (0.5% dry weight), or balanced cholesterol-enriched diet with fructose solution. During the experiment, the mass of food, consumed by the animals, was monitored daily. Muscle tone was assessed by the front paw grip strength on days 33 and 54 of the experiment. Anxiety was tested in the elevated plus maze on days 36 and 57. Behavior and memory were assessed by conditioned passive avoidance reflex on days 39, 40, and 61. A significant increase in muscle tone was revealed on day 54 in rats fed with a balanced diet with fructose, and in mice, that received a similar diet, supplemented with fructose and cholesterol. Anxiety in the second test (day 57) was significantly decreased in rats fed high-fat diet and increased in mice fed high fat diet and high fat diet with fructose. In the second test, additional amount of cholesterol in the diet was the factor that significantly improved both short-term and long-term memory in both species. In mice, in contrast to rats, addition of fructose, including combination with high-fat diet, significantly worsened short-term and long-term memory. Thus, dietary factors, contributing to alimentary dyslipidemia development in rats and mice, can significantly affect the indices of neuromotor activity, anxiety level and cognitive functions, and the nature and direction of these changes are largely species-specific.

High temperature calorimetric studies of heat of solution of NiO, CuO, La2O3, TiO2, HfO2 in sodium silicate liquids

NASA Astrophysics Data System (ADS)

Linard, Yannick; Wilding, Martin C.; Navrotsky, Alexandra

2008-01-01

The enthalpies of solution of La2O3, TiO2, HfO2, NiO and CuO were measured in sodium silicate melts at high temperature. When the heat of fusion was available, we derived the corresponding liquid-liquid enthalpies of mixing. These data, combined with previously published work, provide insight into the speciation reactions in sodium silicate melts. The heat of solution of La2O3 in these silicate solvents is strongly exothermic and varies little with La2O3 concentration. The variation of heat of solution with composition of the liquid reflects the ability of La(III) to perturb the transient silicate framework and compete with other cations for oxygen. The enthalpy of solution of TiO2 is temperature-dependent and indicates that the formation of Na-O-Si species is favored over Na-O-Ti at low temperature. The speciation reactions can be interpreted in terms of recent spectroscopic studies of titanium-bearing melts which identify a dual role of Ti4+ as both a network-former end network-modifier. The heats of solution of oxides of transition elements (Ni and Cu) are endothermic, concentration-dependent and reach a maximum with concentration. These indicate a charge balanced substitution which diminishes the network modifying role of Na+ by addition of Ni2+ or Cu2+. The transition metal is believed to be in tetrahedral coordination, charge balanced by the sodium cation in the melts.

A mass-balance model to separate and quantify colloidal and solute redistributions in soil

USGS Publications Warehouse

Bern, C.R.; Chadwick, O.A.; Hartshorn, A.S.; Khomo, L.M.; Chorover, J.

2011-01-01

Studies of weathering and pedogenesis have long used calculations based upon low solubility index elements to determine mass gains and losses in open systems. One of the questions currently unanswered in these settings is the degree to which mass is transferred in solution (solutes) versus suspension (colloids). Here we show that differential mobility of the low solubility, high field strength (HFS) elements Ti and Zr can trace colloidal redistribution, and we present a model for distinguishing between mass transfer in suspension and solution. The model is tested on a well-differentiated granitic catena located in Kruger National Park, South Africa. Ti and Zr ratios from parent material, soil and colloidal material are substituted into a mixing equation to quantify colloidal movement. The results show zones of both colloid removal and augmentation along the catena. Colloidal losses of 110kgm-2 (-5% relative to parent material) are calculated for one eluviated soil profile. A downslope illuviated profile has gained 169kgm-2 (10%) colloidal material. Elemental losses by mobilization in true solution are ubiquitous across the catena, even in zones of colloidal accumulation, and range from 1418kgm-2 (-46%) for an eluviated profile to 195kgm-2 (-23%) at the bottom of the catena. Quantification of simultaneous mass transfers in solution and suspension provide greater specificity on processes within soils and across hillslopes. Additionally, because colloids include both HFS and other elements, the ability to quantify their redistribution has implications for standard calculations of soil mass balances using such index elements. ?? 2011.

ROTATING ACCRETION FLOWS: FROM INFINITY TO THE BLACK HOLE

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

Li, Jason; Ostriker, Jeremiah; Sunyaev, Rashid, E-mail: jgli@astro.princeton.edu

2013-04-20

Accretion onto a supermassive black hole of a rotating inflow is a particularly difficult problem to study because of the wide range of length scales involved. There have been broadly utilized analytic and numerical treatments of the global properties of accretion flows, but detailed numerical simulations are required to address certain critical aspects. We use the ZEUS code to run hydrodynamical simulations of rotating, axisymmetric accretion flows with Bremsstrahlung cooling, considering solutions for which the centrifugal balance radius significantly exceeds the Schwarzschild radius, with and without viscous angular momentum transport. Infalling gas is followed from well beyond the Bondi radiusmore » down to the vicinity of the black hole. We produce a continuum of solutions with respect to the single parameter M-dot{sub B}/ M-dot{sub Edd}, and there is a sharp transition between two general classes of solutions at an Eddington ratio of M-dot{sub B}/M-dot{sub Edd}{approx}few Multiplication-Sign 10{sup -2}. Our high inflow solutions are very similar to the standard Shakura and Sunyaev results. But our low inflow results are to zeroth order the stationary Papaloizou and Pringle solution, which has no accretion. To next order in the small, assumed viscosity they show circulation, with disk and conical wind outflows almost balancing inflow. These solutions are characterized by hot, vertically extended disks, and net accretion proceeds at an extremely low rate, only of order {alpha} times the inflow rate. Our simulations have converged with respect to spatial resolution and temporal duration, and they do not depend strongly on our choice of boundary conditions.« less

Intraoperative fluid replacement and postoperative creatine phosphokinase levels in laparoscopic bariatric patients.

PubMed

Wool, Daniel B; Lemmens, Harry J M; Brodsky, Jay B; Solomon, Houman; Chong, Karen P; Morton, John M

2010-06-01

Morbid obesity and bariatric surgery are both risk factors for the development of postoperative rhabdomyolysis (RML). RML results from injury to skeletal muscle, and a serum creatine phosphokinase (CK) level >1,000 IU/L is considered diagnostic of RML. The aim of this study was to determine if intraoperative intravenous fluid (IVF) volume affects postoperative CK levels following laparoscopic bariatric operations. Prospective, single blinded, and randomized trial was conducted. Patients scheduled to undergo laparoscopic sleeve gastrectomy, adjustable gastric band, or Roux-en-Y gastric bypass operations were randomized into two groups. Subjects in Group A received 15 ml/kg total body weight (TBW) of IV crystalloid solution during surgery, while subjects in Group B received 40 ml/kg TBW. Preoperative and postoperative CK and creatinine levels and intra- and postoperative urine output were monitored and recorded. Forty-seven patients were assigned to Group A and 53 patients to Group B. Group B patients had significantly higher urine output in the operating room, in the post-anesthesia care unit (PACU), and on postoperative days 0 and 1. Group B patients also had significantly lower serum creatinine level in the PACU and a trend towards lower creatinine levels on postoperative days 0, 1, and 2. There were no statistical differences in CK levels at any time between the two groups. Four patients in Group A and three patients in Group B developed postoperative RML. Conservative (15 ml/kg) versus liberal (40 ml/kg) intraoperative IVF administration did not change the incidence of RML in patients undergoing laparoscopic bariatric operations. Since the occurrence of RML in this patient population is relatively high, postoperative CK levels should be routinely obtained in patients at special risk.

Effects of fibrinogen concentrate after shock/resuscitation – A comparison between in vivo microvascular clot formation and thromboelastometry

PubMed Central

Martini, Judith; Cabrales, Pedro; Fries, Dietmar; Intaglietta, Marcos; Tsai, Amy G.

2014-01-01

Objective Dilutional coagulopathy after resuscitation with crystalloids/colloids clinically often appears as diffuse microvascular bleeding. Administration of fibrinogen reduces bleeding and increases maximum clot firmness (MCF), measured by thromboelastometry. Study objective was to implement a model where microvascular bleeding can be directly assessed by visualizing clot formation in microvessels, and correlations can be made to thromboelastometry. Design Randomized animal study. Setting University research laboratory. Subjects Male Syrian Golden hamsters. Interventions Microvessels of Syrian Golden hamsters fitted with a dorsal window chamber were studied using videomicroscopy. After 50% hemorrhage followed by 1 hr of hypovolemia resuscitation with 35% of blood volume using a high molecular weight (MW) HES solution (Hextend®, Hospira, MW 670 kD) occurred. Animals were then treated with 250 mg/kg fibrinogen iv (Laboratoire français du Fractionnement et des Biotechnologies (LFB), Paris, France) or an equal volume of saline before venular vessel wall injuries were made by directed laser irradiation and the ability of microthrombus formation was assessed. Measurements and main results Thromboelastometric measurements of MCF were performed at the beginning and at the end of the experiment. Resuscitation with HES and sham treatment significantly decreased FIBTEM MCF from 32 ± 9 at baseline vs. 13 ± 5 mm after sham treatment (p < 0.001). Infusion of fibrinogen concentrate significantly increased MCF, restoring baseline levels (baseline 32 ± 9 mm; after fibrinogen administration 29 ± 2 mm). In vivo microthrombus formation in laser injured vessels significantly increased in fibrinogen treated animals compared with sham (77% vs. 18%). Conclusions Fibrinogen treatment leads to increased clot firmness in dilutional coagulopathy as measured with thromboelastometry. At the microvascular level this increased clot strength, corresponds to an increased incidence of thrombus formation in vessels injured by focused laser irradiation. PMID:23978812

[Severe upper abdominal pain during a long distance flight].

PubMed

Bestehorn, D; Schmidt, C; Lock, G

2014-10-01

A 43-year-old woman of Ghanaian origin presented with severe upper abdominal pain starting on a long distance flight. Physical examination revealed tenderness on palpation in the left upper abdomen and flank. There was no report of pre-existing conditions or permanent medication in the medical history. Laboratory tests showed signs of haemolytic anemia and elevated inflammatory parameters. The "thick blood smear" was normal. Ultrasonography revealed an enlarged spleen (14×5 cm) with inhomogeneous parenchyma and vast, diffusely spread hypoechoic lesions in perihilar location, interpreted as extended splenic infarction. Symptom onset on a long distance flight, haemolytic anemia and extended splenic infarction led to the assumption of a vasoocclusive crisis with haemolysis. Moleculargenetic tests proved the presence of HbSC-sickle cell disease and heterozygous alpha-thalassemia. After infusion of crystalloid solution the patient was asymptomatic further on. Due to splenic infarction she received prophylactic treatment with Cefuroxim. A vaccination against pneumococci, meningococci and Haemophilus influenza B was recommended. Mild hypoxia and dehydration on a long distance flight can trigger a sickle cell crisis and may contribute to late clinical manifestation and diagnosis of sickle cell disease in some cases. Patients suffering from HbSC-sickle cell disease are at risk for the same life-threatening complications as patients with HbSS-sickle cell disease. HbSC-sickle cell disease should not be considered as a mild form of HbSS-sickle cell disease but as a separate disease with specific clinical manifestations. In contrast-enhanced ultrasonography, splenic infarction due to sickle cell crisis may markedly differ from "typical" arterial thromboembolic infarction. © Georg Thieme Verlag KG Stuttgart · New York.

Hemofiltration in ex vivo lung perfusion-a study in experimentally induced pulmonary edema.

PubMed

Nilsson, Tobias; Hansson, Christoffer; Wallinder, Andreas; Malm, Carl-Johan; Silverborn, Martin; Ricksten, Sven-Erik; Dellgren, Göran

2016-02-01

Ex vivo lung perfusion (EVLP) can potentially reduce pulmonary edema. In a pig model with induced pulmonary edema, we evaluated the effect of hemofiltration (HF) during EVLP on lung function, perfusate oncotic pressure, and lung weight. In anesthetized pigs (n = 14), pulmonary edema was induced by a balloon in the left atrium, combined with crystalloid infusion (20 mL/kg), for 2 hours. The lungs were harvested, stored cold for 2 hours, and randomized to EVLP, with or without a hemofilter (HF and noHF groups, respectively, n = 7 for each). EVLP was performed with cellular perfusate at a hematocrit of 10% to 15%. Oncotic pressure, lung performance, and weight were measured before and after 180 minutes of EVLP reconditioning with or without HF. After in vivo induction of edema, arterial oxygen tension (Pao2)/inspired oxygen fraction (Fio2), and compliance decreased by 63% and 16%, respectively. Pao2/Fio2 was considerably improved at first evaluation ex vivo in both groups. HF increased oncotic pressure by 43% and decreased lung weight by 15%. The effects were negligible in the noHF group. Compliance decreased in both groups during reconditioning, although less so in the HF group (P < .05). Pao2/Fio2, shunt fraction, and oxygen saturation remained unchanged in both groups. Pulmonary flow index decreased in both groups, and was partially reversed by nitroglycerin. Dorsal atelectatic consolidations were seen in both groups. In this lung-edema model, EVLP reconditioning with hyperoncotic solution did not affect the degree of lung edema. HF during EVLP increased perfusate oncotic pressure, decreased lung weight with beneficial effects on compliance, but did not improve lung oxygenation capacity. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Use of albumin as a risk factor for hospital mortality among burn patients in Brazil: non-concurrent cohort study.

PubMed

Caleman, Gilson; Morais, José Fausto de; Puga, Maria Eduarda Dos Santos; Riera, Rachel; Atallah, Alvaro Nagib

2010-01-01

among burn patients, it is common to use colloidal substances under the justification that it is necessary to correct the oncotic pressure of the plasma, thereby reducing the edema in the burnt area and the hypotension. The aim here was to assess the risk of hospital mortality, comparing the use of albumin and crystalloid solutions for these patients. non-concurrent historical cohort study at Faculdade de Medicina de Marília; within the Postgraduate program on Internal and Therapeutic Medicine, Universidade Federal de São Paulo; and at the Brazilian Cochrane Center. burn patients hospitalized between 2000 and 2001, with registration in the Hospital Information System, who received albumin, were compared with those who received other types of volume replacement. The primary outcome was the hospital mortality rate. The data were collected from files within the Datasus software. 39,684 patients were included: 24,116 patients with moderate burns and 15,566 patients with major burns. Among the men treated with albumin, the odds ratio for the risk of death was 20.58 (95% confidence interval, CI: 11.28-37.54) for moderate burns and 6.24 (CI 5.22-7.45) for major burns. Among the women, this risk was 40.97 for moderate burns (CI 21.71-77.30) and 7.35 for major burns (CI 5.99-9.01). The strength of the association between the use of albumin and the risk of death was maintained for the other characteristics studied, with statistical significance. the use of albumin among patients with moderate and major burns was associated with considerably increased mortality.

Prevention of altered hemodynamics after spinal anesthesia: A comparison of volume preloading with tetrastarch, succinylated gelatin and ringer lactate solution for the patients undergoing lower segment caesarean section

PubMed Central

Mitra, Tapobrata; Das, Anjan; Majumdar, Saikat; Bhattacharyya, Tapas; Mandal, Rahul Deb; Hajra, Bimal Kumar

2014-01-01

Background: Spinal anesthesia has replaced general anesthesia in obstetric practice. Hemodynamic instability is a common, but preventable complication of spinal anesthesia. Preloading the circulation with intravenous fluids is considered a safe and effective method of preventing hypotension following spinal anesthesia. We had conducted a study to compare the hemodynamic stability after volume preloading with either Ringer's lactate (RL) or tetrastarch hydroxyethyl starch (HES) or succinylated gelatin (SG) in the patients undergoing cesarean section under spinal anesthesia. Materials and Methods: It was a prospective, double-blinded and randomized controlled study. Ninety six ASA-I healthy, nonlaboring parturients were randomly divided in 3 groups HES, SG, RL (n = 32 each) and received 10 ml/kg HES 130/0.4; 10 ml/kg SG (4% modified fluid gelatin) and 20 ml/kg RL respectively prior to SA scheduled for cesarean section. Heart rate, blood pressure (BP), oxygen saturation was measured. Results: The fall in systolic blood pressure (SBP) (<100 mm Hg) noted among 5 (15.63%), 12 (37.5%) and 14 (43.75%) parturients in groups HES, SG, RL respectively. Vasopressor (phenylephrine) was used to treat hypotension when SBP <90 mm Hg. Both the results and APGAR scores were comparable in all the groups. Lower preloading volume and less intra-operative vasopressor requirement was noted in HES group for maintaining BP though it has no clinical significance. Conclusion: RL which is cheap, physiological and widely available crystalloid can preload effectively and maintain hemodynamic stability well in cesarean section and any remnant hypotension can easily be manageable with vasopressor. PMID:25422601

Management of bleeding in vascular surgery.

PubMed

Chee, Y E; Liu, S E; Irwin, M G

2016-09-01

Management of acute coagulopathy and blood loss during major vascular procedures poses a significant haemostatic challenge to anaesthetists. The acute coagulopathy is multifactorial in origin with tissue injury and hypotension as the precipitating factors, followed by dilution, hypothermia, acidemia, hyperfibrinolysis and systemic inflammatory response, all acting as a self-perpetuating spiral of events. The problem is confounded by the high prevalence of antithrombotic agent use in these patients and intraoperative heparin administration. Trials specifically examining bleeding management in vascular surgery are lacking, and much of the literature and guidelines are derived from studies on patients with trauma. In general, it is recommended to adopt permissive hypotension with a restrictive fluid strategy, using a combination of crystalloid and colloid solutions up to one litre during the initial resuscitation, after which blood products should be administered. A restrictive transfusion trigger for red cells remains the mainstay of treatment except for the high-risk patients, where the trigger should be individualized. Transfusion of blood components should be initiated by clinical evidence of coagulopathy such as diffuse microvascular bleeding, and then guided by either laboratory or point-of-care coagulation testing. Prophylactic antifibrinolytic use is recommended for all surgery where excessive bleeding is anticipated. Fibrinogen and prothrombin complex concentrates administration are recommended during massive transfusion, whereas rFVIIa should be reserved until all means have failed. While debates over the ideal resuscitative strategy continue, the approach to vascular haemostasis should be scientific, rational, and structured. As far as possible, therapy should be monitored and goal directed. © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Dynamics of Opinion Forming in Structurally Balanced Social Networks

PubMed Central

Altafini, Claudio

2012-01-01

A structurally balanced social network is a social community that splits into two antagonistic factions (typical example being a two-party political system). The process of opinion forming on such a community is most often highly predictable, with polarized opinions reflecting the bipartition of the network. The aim of this paper is to suggest a class of dynamical systems, called monotone systems, as natural models for the dynamics of opinion forming on structurally balanced social networks. The high predictability of the outcome of a decision process is explained in terms of the order-preserving character of the solutions of this class of dynamical systems. If we represent a social network as a signed graph in which individuals are the nodes and the signs of the edges represent friendly or hostile relationships, then the property of structural balance corresponds to the social community being splittable into two antagonistic factions, each containing only friends. PMID:22761667

Global Existence Analysis of Cross-Diffusion Population Systems for Multiple Species

NASA Astrophysics Data System (ADS)

Chen, Xiuqing; Daus, Esther S.; Jüngel, Ansgar

2018-02-01

The existence of global-in-time weak solutions to reaction-cross-diffusion systems for an arbitrary number of competing population species is proved. The equations can be derived from an on-lattice random-walk model with general transition rates. In the case of linear transition rates, it extends the two-species population model of Shigesada, Kawasaki, and Teramoto. The equations are considered in a bounded domain with homogeneous Neumann boundary conditions. The existence proof is based on a refined entropy method and a new approximation scheme. Global existence follows under a detailed balance or weak cross-diffusion condition. The detailed balance condition is related to the symmetry of the mobility matrix, which mirrors Onsager's principle in thermodynamics. Under detailed balance (and without reaction) the entropy is nonincreasing in time, but counter-examples show that the entropy may increase initially if detailed balance does not hold.

Electrical neurostimulation with imbalanced waveform mitigates dissolution of platinum electrodes

PubMed Central

Kumsa, Doe; Hudak, Eric M; Montague, Fred W; Kelley, Shawn C; Untereker, Darrel F; Hahn, Benjamin P; Condit, Chris; Cholette, Martin; Lee, Hyowon; Bardot, Dawn; Takmakov, Pavel

2017-01-01

Objective Electrical neurostimulation has traditionally been limited to the use of charge-balanced waveforms. Charge-imbalanced and monophasic waveforms are not used to deliver clinical therapy, because it is believed that these stimulation paradigms may generate noxious electrochemical species that cause tissue damage. Approach In this study, we investigated the dissolution of platinum as one of such irreversible reactions over a range of charge densities up to 160 µC cm−2 with current-controlled first phase, capacitive discharge second phase waveforms of both cathodic-first and anodic-first polarity. We monitored the concentration of platinum in solution under different stimulation delivery conditions including charge-balanced, charge-imbalanced, and monophasic pulses. Main results We observed that platinum dissolution decreased during charge-imbalanced and monophasic stimulation when compared to charge-balanced waveforms. Significance This observation provides an opportunity to re-evaluate the charge-balanced waveform as the primary option for sustainable neural stimulation. PMID:27650936

Review of Evidence for Adult Diabetic Ketoacidosis Management Protocols.

PubMed

Tran, Tara T T; Pease, Anthony; Wood, Anna J; Zajac, Jeffrey D; Mårtensson, Johan; Bellomo, Rinaldo; Ekinci, Elif I I

2017-01-01

Diabetic ketoacidosis (DKA) is an endocrine emergency with associated risk of morbidity and mortality. Despite this, DKA management lacks strong evidence due to the absence of large randomised controlled trials (RCTs). To review existing studies investigating inpatient DKA management in adults, focusing on intravenous (IV) fluids; insulin administration; potassium, bicarbonate, and phosphate replacement; and DKA management protocols and impact of DKA resolution rates on outcomes. Ovid Medline searches were conducted with limits "all adult" and published between "1973 to current" applied. National consensus statements were also reviewed. Eligibility was determined by two reviewers' assessment of title, abstract, and availability. A total of 85 eligible articles published between 1973 and 2016 were reviewed. The salient findings were (i) Crystalloids are favoured over colloids though evidence is lacking. The preferred crystalloid and hydration rates remain contentious. (ii) IV infusion of regular human insulin is preferred over the subcutaneous route or rapid acting insulin analogues. Administering an initial IV insulin bolus before low-dose insulin infusions obviates the need for supplemental insulin. Consensus-statements recommend fixed weight-based over "sliding scale" insulin infusions although evidence is weak. (iii) Potassium replacement is imperative although no trials compare replacement rates. (iv) Bicarbonate replacement offers no benefit in DKA with pH > 6.9. In severe metabolic acidosis with pH < 6.9, there is lack of both data and consensus regarding bicarbonate administration. (v) There is no evidence that phosphate replacement offers outcome benefits. Guidelines consider replacement appropriate in patients with cardiac dysfunction, anaemia, respiratory depression, or phosphate levels <0.32 mmol/L. (vi) Upon resolution of DKA, subcutaneous insulin is recommended with IV insulin infusions ceased with an overlap of 1-2 h. (vii) DKA resolution rates are often used as end points in studies, despite a lack of evidence that rapid resolution improves outcome. (viii) Implementation of DKA protocols lacks strong evidence for adherence but may lead to improved clinical outcomes. There are major deficiencies in evidence for optimal management of DKA. Current practice is guided by weak evidence and consensus opinion. All aspects of DKA management require RCTs to affirm or redirect management and formulate consensus evidence-based practice to improve patient outcomes.

Does Intravenous Midazolam Dose Influence the Duration of Recovery Room Stay Following Outpatient Third Molar Surgery?

PubMed

Ettinger, Kyle S; Jacob, Adam K; Viozzi, Christopher F; Van Ess, James M; Fillmore, W Jonathan; Arce, Kevin

2015-12-01

To evaluate the impact of intravenous midazolam dose on the duration of recovery room stay for patients undergoing outpatient third molar surgery. Using a retrospective cohort study design, a sample of patients undergoing outpatient third molar surgery under intravenous sedation at Mayo Clinic from 2010 to 2014 was identified. All patients underwent extraction of all 4 third molars during a single operative procedure and the age range was limited to 14 to 29 years. The primary predictor variable was the total dose of intravenous midazolam administered during sedation. The primary outcome variable was recovery room length of stay (LOS) after completion of surgery. Multiple covariates also abstracted included patient age, gender, American Society of Anesthesiologists (ASA) score, duration of surgical procedure, complexity of surgical procedure, types and dosages of all intravenous medications administered during sedation, and volume of crystalloid fluid administered perioperatively. Univariable and multivariable models were developed to evaluate associations between the primary predictor variable and covariates relative to the primary outcome variable. The study sample was composed of 2,610 patients. Mean age was 18.3 years (SD, 3.0 yr; range, 14 to 29 yr) and gender distribution was 52% female. Mean dosage of midazolam administered was 4.1 mg (SD, 1.1 mg; range, 0.5 to 10.0 mg). Variables predicting shorter LOS at multivariable analysis included older age (P < .001), male gender (P = .004), and administration of larger crystalloid fluid volumes (P < .001). Variables predicting longer LOS included higher ASA score (P < .001), administration of ketamine (P < .001), and administration of ketorolac (P < .001). The dose of midazolam administered during sedation was not found to be significantly associated with prolonged recovery room LOS in univariable or multivariable settings. Dosage of intravenous midazolam does not appear to significantly impact the duration of recovery room stay in the prototypical patients undergoing sedation for outpatient third molar surgery. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Cold crystalloid versus warm blood cardioplegia in patients undergoing aortic valve replacement.

PubMed

Nardi, Paolo; Vacirca, Sara R; Russo, Marco; Colella, Dionisio F; Bassano, Carlo; Scafuri, Antonio; Pellegrino, Antonio; Melino, Gerry; Ruvolo, Giovanni

2018-03-01

Myocardial protection techniques during cardiac arrest have been extensively investigated in the clinical setting of coronary revascularization. Fewer studies have been carried out of patients affected by left ventricular hypertrophy, where the choice of type and temperature of cardioplegia remain controversial. We have retrospectively investigated myocardial injury and short-term outcome in patients undergoing aortic valve replacement plus or minus coronary artery bypass grafting with using cold crystalloid cardioplegia (CCC) or warm blood cardioplegia (WBC). From January 2015 to October 2016, 191 consecutive patients underwent aortic valve replacement plus or minus coronary artery bypass grafting in normothermic cardiopulmonary bypass. Cardiac arrest was obtained with use of intermittent antegrade CCC group (n=32) or WBC group (n=159), according with the choice of the surgeon. As compared with WBC group, in CCC group creatine-kinase-MB (CK-MB), cardiac troponin I (cTnI), aspartate aminotransferase (AST) release, and their peak levels, were lower during each time points of evaluation, with the greater statistically significant difference at time 0 (P<0.05, for all comparisons). A time 0, CK-MB/CK ratio >10% was 5.9% in CCC group versus 7.8% in WBC group (P<0.0001). At time 0 CK-MB/CK ratio >10% in patients undergoing isolated aortic valve replacement was 6.0% in CCC group versus 8.0% in WBC group (P<0.01). No any difference was found in perioperative myocardial infarction (0% versus 3.8%), postoperative (PO) major complications (15.6% versus 16.4%), in-hospital mortality (3.1% versus 1.3%). In aortic valve surgery a significant decrease of myocardial enzymes release is observed in favor of CCC, but this difference does not translate into different clinical outcome. However, this study suggests that in presence of cardiac surgical conditions associated with significant left ventricular hypertrophy, i.e., the aortic valve disease, a better myocardial protection can be achieved with the use of a cold rather than a warm cardioplegia. Therefore, CCC can be still safely used.

Other ways of measuring `Big G'

NASA Astrophysics Data System (ADS)

Rothleitner, Christian

2016-03-01

In 1798, the British scientist Henry Cavendish performed the first laboratory experiment to determine the gravitational force between two massive bodies. From his result, Newton's gravitational constant, G, was calculated. Cavendish's measurement principle was the torsion balance invented by John Michell some 15 years before. During the following two centuries, more than 300 new measurements followed. Although technology - and physics - developed rapidly during this time, surprisingly, most experiments were still based on the same principle. In fact, the most accurate determination of G to date is a measurement based on the torsion balance principle. Despite the fact that G was one of the first fundamental physical constants ever measured, and despite the huge number of experiments performed on it to this day, its CODATA recommended value still has the highest standard measurement uncertainty when compared to other fundamental physical constants. Even more serious is the fact that even measurements based on the same principle often do not overlap within their attributed standard uncertainties. It must be assumed that various experiments are subject to one or more unknown biases. In this talk I will present some alternative experimental setups to the torsion balance which have been performed or proposed to measure G. Although their estimated uncertainties are often higher than most torsion balance experiments, revisiting such ideas is worthwhile. Advances in technology could offer solutions to problems which were previously insurmountable, these solutions could result in lower measurement uncertainties. New measurement principles could also help to uncover hidden systematic effects.

Tuning rules for robust FOPID controllers based on multi-objective optimization with FOPDT models.

PubMed

Sánchez, Helem Sabina; Padula, Fabrizio; Visioli, Antonio; Vilanova, Ramon

2017-01-01

In this paper a set of optimally balanced tuning rules for fractional-order proportional-integral-derivative controllers is proposed. The control problem of minimizing at once the integrated absolute error for both the set-point and the load disturbance responses is addressed. The control problem is stated as a multi-objective optimization problem where a first-order-plus-dead-time process model subject to a robustness, maximum sensitivity based, constraint has been considered. A set of Pareto optimal solutions is obtained for different normalized dead times and then the optimal balance between the competing objectives is obtained by choosing the Nash solution among the Pareto-optimal ones. A curve fitting procedure has then been applied in order to generate suitable tuning rules. Several simulation results show the effectiveness of the proposed approach. Copyright © 2016. Published by Elsevier Ltd.

Steady-state solutions of a diffusive energy-balance climate model and their stability

NASA Technical Reports Server (NTRS)

Ghil, M.

1975-01-01

A diffusive energy-balance climate model, governed by a nonlinear parabolic partial differential equation, was studied. Three positive steady-state solutions of this equation are found; they correspond to three possible climates of our planet: an interglacial (nearly identical to the present climate), a glacial, and a completely ice-covered earth. Models similar to the main one are considered, and the number of their steady states was determined. All the models have albedo continuously varying with latitude and temperature, and entirely diffusive horizontal heat transfer. The stability under small perturbations of the main model's climates was investigated. A stability criterion is derived, and its application shows that the present climate and the deep freeze are stable, whereas the model's glacial is unstable. The dependence was examined of the number of steady states and of their stability on the average solar radiation.

A spectral multi-domain technique applied to high-speed chemically reacting flows

NASA Technical Reports Server (NTRS)

Macaraeg, Michele G.; Streett, Craig L.; Hussaini, M. Yousuff

1989-01-01

The first applications of a spectral multidomain method for viscous compressible flow is presented. The method imposes a global flux balance condition at the interface so that high-order continuity of the solution is preserved. The global flux balance is imposed in terms of a spectral integral of the discrete equations across adjoining domains. Since the discretized equations interior to each domain solved are uncoupled from each other, and since the interface relation has a block structure, the solution scheme can be adapted to the particular requirements of each subdomain. The spectral multidomain technique presented is well-suited for the multiple scales associated with the chemically reacting and transition flows in hypersonic research. A nonstaggered multidomain discretization is used for the chemically reacting flow calculation, and the first implementation of a staggered multidomain mesh is presented for accurately solving the stability equation for a viscous compressible fluid.

Evolution of fluid therapy.

PubMed

Kampmeier, Tim; Rehberg, Sebastian; Ertmer, Christian

2014-09-01

The human organism consists of evolutionary conserved mechanisms to prevent death from hypovolaemia. Intravenous fluid therapy to support these mechanisms had first been published about 180 years ago. The present review depicts the evolution of fluid therapy from early, not well-defined solutions up to modern balanced fluids. Notably, evidence accumulates that the most commonly used fluid (i.e. 0.9% saline) has no advantage over balanced solutions, increases the risk of acute kidney injury and should therefore be abandoned. Notably, in published trials, the prognostically important 'golden hours' of shock, where fluid therapy may be essential, have not been adequately addressed. It is therefore unclear whether negative data on colloids in some trials reflect real harm or rather inadequate use. Future studies should focus on optimal protocols for initiation, dosing and discontinuation of fluid therapy in specific disease entities. Moreover, the practice of de-resuscitation after fluid-based haemodynamic stabilization should be further investigated. Copyright © 2014 Elsevier Ltd. All rights reserved.

Effects of ionic compositions of the medium on monosodium glutamate binding to taste epithelial cells.

PubMed

Hayashi, Y; Tsunenari, T; Mori, T

1999-03-01

Monosodium glutamate and nucleotides are umami taste substances in animals and have a synergistic effect on each other. We studied the ligand-binding properties of the glutamate receptors in taste epithelial cells isolated from bovine tongue. Specific glutamate binding was observed in an enriched suspension of taste receptor cells in Hanks' balanced salt solution, while no specific glutamate binding was apparent in the absence of divalent ions or when the cells had been depolarized by a high content of potassium in Hanks' balanced salt solution. There was no significant difference between the release of glutamate under depolarized or divalent ion-free conditions and under normal conditions. However, glutamate was easily released from the depolarized cells in the absence of divalent ions. These data suggest that the binding of glutamate to receptors depends on divalent ions, which also have an effect on maintaining binding between glutamate and receptors.

Multidimensional heuristic process for high-yield production of astaxanthin and fragrance molecules in Escherichia coli.

PubMed

Zhang, Congqiang; Seow, Vui Yin; Chen, Xixian; Too, Heng-Phon

2018-05-11

Optimization of metabolic pathways consisting of large number of genes is challenging. Multivariate modular methods (MMMs) are currently available solutions, in which reduced regulatory complexities are achieved by grouping multiple genes into modules. However, these methods work well for balancing the inter-modules but not intra-modules. In addition, application of MMMs to the 15-step heterologous route of astaxanthin biosynthesis has met with limited success. Here, we expand the solution space of MMMs and develop a multidimensional heuristic process (MHP). MHP can simultaneously balance different modules by varying promoter strength and coordinating intra-module activities by using ribosome binding sites (RBSs) and enzyme variants. Consequently, MHP increases enantiopure 3S,3'S-astaxanthin production to 184 mg l -1 day -1 or 320 mg l -1 . Similarly, MHP improves the yields of nerolidol and linalool. MHP may be useful for optimizing other complex biochemical pathways.

Second-wave hydrodissection for aspiration of cortical remains after femtosecond laser-assisted cataract surgery.

PubMed

Lake, Jonathan C; Boianovsky, Celso; de Faria Pacini, Thiago; Crema, Armando

2018-06-14

We describe the technique of second-wave hydrodissection (the first wave being the initial cortical cleaving hydrodissection) performed after the removal of the cataract nucleus in femtosecond laser-assisted cataract surgery. After femtosecond laser application, the cortex is typically found adhered to the anterior capsule. Under high magnification, a steady stream of a balanced salt solution is directed toward the anterior capsule using a hydrodissection cannula. Full cleavage of the remaining cortex is observed by noting the appearance of a dark inner circle by the capsulotomy edge once the balanced salt solution wave has separated the cortex from the capsule. Irrigation/aspiration (I/A) of the cortical remains after the second wave is faster than I/A without this step in femtosecond laser-assisted cataract surgery. Copyright © 2018 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

A class of traveling wave solutions for space-time fractional biological population model in mathematical physics

NASA Astrophysics Data System (ADS)

Akram, Ghazala; Batool, Fiza

2017-10-01

The (G'/G)-expansion method is utilized for a reliable treatment of space-time fractional biological population model. The method has been applied in the sense of the Jumarie's modified Riemann-Liouville derivative. Three classes of exact traveling wave solutions, hyperbolic, trigonometric and rational solutions of the associated equation are characterized with some free parameters. A generalized fractional complex transform is applied to convert the fractional equations to ordinary differential equations which subsequently resulted in number of exact solutions. It should be mentioned that the (G'/G)-expansion method is very effective and convenient for solving nonlinear partial differential equations of fractional order whose balancing number is a negative integer.

Load Balancing Strategies for Multi-Block Overset Grid Applications

NASA Technical Reports Server (NTRS)

Djomehri, M. Jahed; Biswas, Rupak; Lopez-Benitez, Noe; Biegel, Bryan (Technical Monitor)

2002-01-01

The multi-block overset grid method is a powerful technique for high-fidelity computational fluid dynamics (CFD) simulations about complex aerospace configurations. The solution process uses a grid system that discretizes the problem domain by using separately generated but overlapping structured grids that periodically update and exchange boundary information through interpolation. For efficient high performance computations of large-scale realistic applications using this methodology, the individual grids must be properly partitioned among the parallel processors. Overall performance, therefore, largely depends on the quality of load balancing. In this paper, we present three different load balancing strategies far overset grids and analyze their effects on the parallel efficiency of a Navier-Stokes CFD application running on an SGI Origin2000 machine.

Load Balancing in Structured P2P Networks

NASA Astrophysics Data System (ADS)

Zhu, Yingwu

In this chapter we start by addressing the importance and necessity of load balancing in structured P2P networks, due to three main reasons. First, structured P2P networks assume uniform peer capacities while peer capacities are heterogeneous in deployed P2P networks. Second, resorting to pseudo-uniformity of the hash function used to generate node IDs and data item keys leads to imbalanced overlay address space and item distribution. Lastly, placement of data items cannot be randomized in some applications (e.g., range searching). We then present an overview of load aggregation and dissemination techniques that are required by many load balancing algorithms. Two techniques are discussed including tree structure-based approach and gossip-based approach. They make different tradeoffs between estimate/aggregate accuracy and failure resilience. To address the issue of load imbalance, three main solutions are described: virtual server-based approach, power of two choices, and address-space and item balancing. While different in their designs, they all aim to improve balance on the address space and data item distribution. As a case study, the chapter discusses a virtual server-based load balancing algorithm that strives to ensure fair load distribution among nodes and minimize load balancing cost in bandwidth. Finally, the chapter concludes with future research and a summary.

Steady state phosphorus mass balance model during hemodialysis based on a pseudo one-compartment kinetic model.

PubMed

Leypoldt, John K; Agar, Baris U; Akonur, Alp; Gellens, Mary E; Culleton, Bruce F

2012-11-01

Mathematical models of phosphorus kinetics and mass balance during hemodialysis are in early development. We describe a theoretical phosphorus steady state mass balance model during hemodialysis based on a novel pseudo one-compartment kinetic model. The steady state mass balance model accounted for net intestinal absorption of phosphorus and phosphorus removal by both dialysis and residual kidney function. Analytical mathematical solutions were derived to describe time-dependent intradialytic and interdialytic serum phosphorus concentrations assuming hemodialysis treatments were performed symmetrically throughout a week. Results from the steady state phosphorus mass balance model are described for thrice weekly hemodialysis treatment prescriptions only. The analysis predicts 1) a minimal impact of dialyzer phosphorus clearance on predialysis serum phosphorus concentration using modern, conventional hemodialysis technology, 2) variability in the postdialysis-to-predialysis phosphorus concentration ratio due to differences in patient-specific phosphorus mobilization, and 3) the importance of treatment time in determining the predialysis serum phosphorus concentration. We conclude that a steady state phosphorus mass balance model can be developed based on a pseudo one-compartment kinetic model and that predictions from this model are consistent with previous clinical observations. The predictions from this mass balance model are theoretical and hypothesis-generating only; additional prospective clinical studies will be required for model confirmation.

Applying graph partitioning methods in measurement-based dynamic load balancing

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

Bhatele, Abhinav; Fourestier, Sebastien; Menon, Harshitha

Load imbalance leads to an increasing waste of resources as an application is scaled to more and more processors. Achieving the best parallel efficiency for a program requires optimal load balancing which is a NP-hard problem. However, finding near-optimal solutions to this problem for complex computational science and engineering applications is becoming increasingly important. Charm++, a migratable objects based programming model, provides a measurement-based dynamic load balancing framework. This framework instruments and then migrates over-decomposed objects to balance computational load and communication at runtime. This paper explores the use of graph partitioning algorithms, traditionally used for partitioning physical domains/meshes, formore » measurement-based dynamic load balancing of parallel applications. In particular, we present repartitioning methods developed in a graph partitioning toolbox called SCOTCH that consider the previous mapping to minimize migration costs. We also discuss a new imbalance reduction algorithm for graphs with irregular load distributions. We compare several load balancing algorithms using microbenchmarks on Intrepid and Ranger and evaluate the effect of communication, number of cores and number of objects on the benefit achieved from load balancing. New algorithms developed in SCOTCH lead to better performance compared to the METIS partitioners for several cases, both in terms of the application execution time and fewer number of objects migrated.« less

Implementing eco friendly highly reliable upload feature using multi 3G service

NASA Astrophysics Data System (ADS)

Tanutama, Lukas; Wijaya, Rico

2017-12-01

The current trend of eco friendly Internet access is preferred. In this research the understanding of eco friendly is minimum power consumption. The devices that are selected have operationally low power consumption and normally have no power consumption as they are hibernating during idle state. To have the reliability a router of a router that has internal load balancing feature will provide the improvement of previous research on multi 3G services for broadband lines. Previous studies emphasized on accessing and downloading information files from Public Cloud residing Web Servers. The demand is not only for speed but high reliability of access as well. High reliability will mean mitigating both direct and indirect high cost due to repeated attempts of uploading and downloading the large files. Nomadic and mobile computer users need viable solution. Following solution for downloading information has been proposed and tested. The solution is promising. The result is now extended to providing reliable access line by means of redundancy and automatic reconfiguration for uploading and downloading large information files to a Web Server in the Cloud. The technique is taking advantage of internal load balancing feature to provision a redundant line acting as a backup line. A router that has the ability to provide load balancing to several WAN lines is chosen. The WAN lines are constructed using multiple 3G lines. The router supports the accessing Internet with more than one 3G access line which increases the reliability and availability of the Internet access as the second line immediately takes over if the first line is disturbed.

Bifurcation analysis of an automatic dynamic balancing mechanism for eccentric rotors

NASA Astrophysics Data System (ADS)

Green, K.; Champneys, A. R.; Lieven, N. J.

2006-04-01

We present a nonlinear bifurcation analysis of the dynamics of an automatic dynamic balancing mechanism for rotating machines. The principle of operation is to deploy two or more masses that are free to travel around a race at a fixed distance from the hub and, subsequently, balance any eccentricity in the rotor. Mathematically, we start from a Lagrangian description of the system. It is then shown how under isotropic conditions a change of coordinates into a rotating frame turns the problem into a regular autonomous dynamical system, amenable to a full nonlinear bifurcation analysis. Using numerical continuation techniques, curves are traced of steady states, limit cycles and their bifurcations as parameters are varied. These results are augmented by simulations of the system trajectories in phase space. Taking the case of a balancer with two free masses, broad trends are revealed on the existence of a stable, dynamically balanced steady-state solution for specific rotation speeds and eccentricities. However, the analysis also reveals other potentially attracting states—non-trivial steady states, limit cycles, and chaotic motion—which are not in balance. The transient effects which lead to these competing states, which in some cases coexist, are investigated.

An ecologically-controlled exoskeleton can improve balance recovery after slippage

NASA Astrophysics Data System (ADS)

Monaco, V.; Tropea, P.; Aprigliano, F.; Martelli, D.; Parri, A.; Cortese, M.; Molino-Lova, R.; Vitiello, N.; Micera, S.

2017-05-01

The evolution to bipedalism forced humans to develop suitable strategies for dynamically controlling their balance, ensuring stability, and preventing falling. The natural aging process and traumatic events such as lower-limb loss can alter the human ability to control stability significantly increasing the risk of fall and reducing the overall autonomy. Accordingly, there is an urgent need, from both end-users and society, for novel solutions that can counteract the lack of balance, thus preventing falls among older and fragile citizens. In this study, we show a novel ecological approach relying on a wearable robotic device (the Active Pelvis Orthosis, APO) aimed at facilitating balance recovery after unexpected slippages. Specifically, if the APO detects signs of balance loss, then it supplies counteracting torques at the hips to assist balance recovery. Experimental tests conducted on eight elderly persons and two transfemoral amputees revealed that stability against falls improved due to the “assisting when needed” behavior of the APO. Interestingly, our approach required a very limited personalization for each subject, and this makes it promising for real-life applications. Our findings demonstrate the potential of closed-loop controlled wearable robots to assist elderly and disabled subjects and to improve their quality of life.

Applications of IBSOM and ETEM for solving the nonlinear chains of atoms with long-range interactions

NASA Astrophysics Data System (ADS)

Foroutan, Mohammadreza; Zamanpour, Isa; Manafian, Jalil

2017-10-01

This paper presents a number of new solutions obtained for solving a complex nonlinear equation describing dynamics of nonlinear chains of atoms via the improved Bernoulli sub-ODE method (IBSOM) and the extended trial equation method (ETEM). The proposed solutions are kink solitons, anti-kink solitons, soliton solutions, hyperbolic solutions, trigonometric solutions, and bellshaped soliton solutions. Then our new results are compared with the well-known results. The methods used here are very simple and succinct and can be also applied to other nonlinear models. The balance number of these methods is not constant contrary to other methods. The proposed methods also allow us to establish many new types of exact solutions. By utilizing the Maple software package, we show that all obtained solutions satisfy the conditions of the studied model. More importantly, the solutions found in this work can have significant applications in Hamilton's equations and generalized momentum where solitons are used for long-range interactions.

Environmental Accounting Using Emergy: Evaluation of Minnesota

EPA Science Inventory

Often questions related to environmental policy are difficult to resolve successfully, because robust solutions depend on accurately balancing the needs of both human and natural systems. To accomplish this end the socioeconomic and environmental effects of policies must be expre...

[The influence of cardiosurgical intervention type and conditions of artificial blood circulation of perioperative dynamics of cardiac biomarkers].

PubMed

Dement'eva, I I; Morozov, Iu A; Charnaia, M A

2013-01-01

125 patients after cardiac surgery operated on with the use of artificial blood circulation (ABC) were followed-up. Blood levels of cardiac protein, binding aliphatic acids and troponin 1 and 3 days after the operation were registered. The study showed that aorta clamping more then 90 minutes and hypothermic perfusion regimen influence cardiomyocites negatively. The state of "surgical trauma" and reperfusional myocardium damage was approximately the same during aortic surgery, myocardium revascularization with the use of aortic clamping and cardioplegia, and correction of the acquired heart disease, according to the dynamics of the studied proteins in blood. The minimal blood level of cardiac protein, binding aliphatic acids after coronary by-pass surgery on the working heart witnesses about negative influence of crystalloid hypothermic cardioplegia on coronary microcirculation.

The effect of electromagnetic radiation of wireless connections on morphology of amniotic fluid

NASA Astrophysics Data System (ADS)

Novikov, Vsevolod O.; Titova, Natalia; Azarhov, Olexand; Wójcik, Waldemar; GrÄ dz, Å.»aklin; Mussabekova, Assel

2016-09-01

The article considers the effect of wireless networks on the morphology of amniotic fluid (AF) to demonstrate possible risks involving pregnant women. The analysis of AF thesiograms after exposure of the model fluid to Wi-Fi, 3G and β- radiation was chosen as the research method. A comparative analysis of facies structures is carried out, and depth maps of the facies structure are created. This comparative analysis permits an evaluation of the efficiency of morphological changes. It is shown that AF control facies differ in the concentration of areas with a narrow peripheral area and ellipsoidal formations of crystalloids in circumferences center. After exposure of different types of radiation onto AF, the facies structures collapse and form their own conglomerates. The obtained results show that the considered types of radiation have a negative effect on AF.

Construction of Low Dissipative High Order Well-Balanced Filter Schemes for Non-Equilibrium Flows

NASA Technical Reports Server (NTRS)

Wang, Wei; Yee, H. C.; Sjogreen, Bjorn; Magin, Thierry; Shu, Chi-Wang

2009-01-01

The goal of this paper is to generalize the well-balanced approach for non-equilibrium flow studied by Wang et al. [26] to a class of low dissipative high order shock-capturing filter schemes and to explore more advantages of well-balanced schemes in reacting flows. The class of filter schemes developed by Yee et al. [30], Sjoegreen & Yee [24] and Yee & Sjoegreen [35] consist of two steps, a full time step of spatially high order non-dissipative base scheme and an adaptive nonlinear filter containing shock-capturing dissipation. A good property of the filter scheme is that the base scheme and the filter are stand alone modules in designing. Therefore, the idea of designing a well-balanced filter scheme is straightforward, i.e., choosing a well-balanced base scheme with a well-balanced filter (both with high order). A typical class of these schemes shown in this paper is the high order central difference schemes/predictor-corrector (PC) schemes with a high order well-balanced WENO filter. The new filter scheme with the well-balanced property will gather the features of both filter methods and well-balanced properties: it can preserve certain steady state solutions exactly; it is able to capture small perturbations, e.g., turbulence fluctuations; it adaptively controls numerical dissipation. Thus it shows high accuracy, efficiency and stability in shock/turbulence interactions. Numerical examples containing 1D and 2D smooth problems, 1D stationary contact discontinuity problem and 1D turbulence/shock interactions are included to verify the improved accuracy, in addition to the well-balanced behavior.

Brine evolution and mineral deposition in hydrologically open evaporite basins

USGS Publications Warehouse

Sanford, W.E.; Wood, W.W.

1991-01-01

A lumped-parameter, solute mass-balance model is developed to define the role of water outflow from a well-mixed basin. A mass-balance model is analyzed with a geochemical model designed for waters with high ionic strengths. Two typical waters, seawater and a Na-HCO3 ground water, are analyzed to illustrate the control that the leakage ratio (or hydrologic openness of the basin) has on brine evolution and the suite and thicknesses of evaporite minerals deposited. The analysis suggests that brines evolve differently under different leakage conditions. -from Authors

What is Wrong with the Boundary Conditions in Column Tracer Tests

NASA Astrophysics Data System (ADS)

Zhan, H.

2007-12-01

Solute transport in a column is probably one of the most fundamental problems investigated in contaminant hydrology and soil physics because it serves as a benchmark for testing transport theories, for measuring dispersivities, etc. Despite its importance, there are still dispute and inconsistency on how to deal with the boundary conditions involved in such problems. The boundary condition could impose great influence upon transport in a column, particularly when the length of the column is relatively short, or the so-called Peclet number is not large. There are three types of boundary conditions to choose for transport in a column. Among these three types of boundary conditions, only the third-type boundary satisfies the mass balance requirement rigorously. The first type boundary, despite its frequent use in previous studies, could lead to serious mass balance problems. The most serious problem is on how to deal with the outlet boundary. Some studies have used a zero concentration gradient at the outlet (the so-called Danckwerts' boundary condition). This is named the model A. Another idea is to treat the finite length column as a part of an infinitely long column and to calculate the concentration at the outlet based on a formula developed for an infinitely long column. This is named the model B. The model A satisfies the mass balance requirement but was found to fit with the experimental data poorly. The model B does not satisfy the mass balance requirement, but usually agree well with the experimental data. So, the dilemma is: which model to choose? At present, most investigators prefer to choose the model B because of its close agreement with the experimental data, despite of its violation of the mass balance requirement. But the question is: why the model A, which satisfies the mass balance requirement, does not fit with the experimental data? It turns out that the advection-dispersion equation (ADE) that uses the Fick's first law to describe the hydrodynamic dispersion has some problems, particularly in the regions near the two boundaries. Taylor (1921) has pointed out that the dispersion coefficient varies linearly with time at the beginning and tends to its asymptotic, Fickian value after a travel time of a few correlation scales. Dagan and Bresler (1985) have further pointed out that the constant dispersivity is attained after the solute body has traveled tens of conductivity integral scales. For transport in a homogeneous column, the integral scale of the conductivity is probably around the pore scale or equivalent to the dispersivity value. Therefore, for a finite column whose length is not much greater than the dispersivity value, the transition zones in which solute transport is non-Fickian could consist of a significant portion of the column length. It is such non-Fickian transport in the column that is responsible for the failure of the model A. But still, why does the model B yield the right solution? There is no answer to this question based on a rigorous quantitative analysis yet. To resolve the dilemma, one must carry out a non-Fickian transport study to deal with the transition zones. It is my hypothesis that if the non-Fickian transport analysis succeeds, one will find that the mass balance requirement is indeed satisfied in the model B. Dagan and Bresler (1985) have pointed to the right direction, but a rigorous analysis has not followed. This is something interesting and worthwhile to investigate. REFERENCES CITED Dagan, G., and Bresler, E., 1985. Comment on ¡°Flux-averaged and volume-averaged concentration in continuum approaches to solute transport¡± by J.C. Parker and M.Th. van Genuchten. Water Resources Research, 21: 1299- 1300. Taylor, G.I., 1921. Diffusion by continuous movements. Proc. London Math Soc. 2: 196-212.

The Euro-Balance Trial: the effect of a new biocompatible peritoneal dialysis fluid (balance) on the peritoneal membrane.

PubMed

Williams, John D; Topley, Nicholas; Craig, Kathrine J; Mackenzie, Ruth K; Pischetsrieder, Monika; Lage, Cristina; Passlick-Deetjen, Jutta

2004-07-01

Although peritoneal dialysis (PD) is a widely accepted form of renal replacement therapy (RRT), concerns remain regarding the bioincompatible nature of standard PD fluid. In order to evaluate whether a newly formulated fluid of neutral pH, and containing low levels of glucose degradation products (GDP), resulted in improved in vivo biocompatibility, it was compared in a clinical study to a standard PD fluid. In a multicenter, open, randomized, prospective study with a crossover design and parallel arms, a conventional, acidic, lactate-buffered fluid (SPDF) was compared with a pH neutral, lactate-buffered, low GDP fluid (balance). Overnight effluent was collected and assayed for cancer antigen 125 (CA125), hyaluronic acid (HA), procollagen peptide (PICP), vascular endothelial growth factor (VEGF), and tumor necrosis factor alpha (TNFalpha). Serum samples were assayed for circulating advanced glycosylation end products (AGE), N(epsilon)-(carboxymethyl)lysine (CML), and imidazolone. Clinical end points were residual renal function (RRF), adequacy of dialysis, ultrafiltration, and peritoneal membrane function. Eighty-six patients were randomized to either group I starting with SPDF for 12 weeks (Phase I), then switching to "balance" for 12 weeks (Phase II), or group II, which was treated vice versa. Seventy-one patients completed the study with data suitable for entry into the per protocol analysis. Effluent and serum samples, together with peritoneal function tests and adequacy measurements, were undertaken at study centers on three occasions during the study: after the four-week run-in period, after Phase I, and again after Phase II. In patients treated with balance there were significantly higher effluent levels of CA125 and PICP in both arms of the study. Conversely, levels of HA were lower in patients exposed to balance, while there was no change in the levels of either VEGF or TNFalpha. Serum CML and imidazolone levels fell significantly in balance-treated patients. Renal urea and creatinine clearances were higher in both treatment arms after patients were exposed to balance. Urine volume was higher in patients exposed to balance. In contrast, peritoneal ultrafiltration was higher in patients on SPDF. When anuric patients were analyzed as a subgroup, there was no significant difference in peritoneal transport characteristics or in ultrafiltration on either fluid. There were no changes in peritonitis incidence on either solution. This study indicates that the use of balance, a neutral pH, low GDP fluid, is accompanied by a significant improvement in effluent markers of peritoneal membrane integrity and significantly decreased circulating AGE levels. Clinical parameters suggest an improvement in residual renal function on balance, with an accompanying decrease in peritoneal ultrafiltration. It would appear that balance solution results in an improvement in local peritoneal homeostasis, as well as having a positive impact on systemic parameters, including circulating AGE and residual renal function.

The Balanced Cross-Layer Design Routing Algorithm in Wireless Sensor Networks Using Fuzzy Logic.

PubMed

Li, Ning; Martínez, José-Fernán; Hernández Díaz, Vicente

2015-08-10

Recently, the cross-layer design for the wireless sensor network communication protocol has become more and more important and popular. Considering the disadvantages of the traditional cross-layer routing algorithms, in this paper we propose a new fuzzy logic-based routing algorithm, named the Balanced Cross-layer Fuzzy Logic (BCFL) routing algorithm. In BCFL, we use the cross-layer parameters' dispersion as the fuzzy logic inference system inputs. Moreover, we give each cross-layer parameter a dynamic weight according the value of the dispersion. For getting a balanced solution, the parameter whose dispersion is large will have small weight, and vice versa. In order to compare it with the traditional cross-layer routing algorithms, BCFL is evaluated through extensive simulations. The simulation results show that the new routing algorithm can handle the multiple constraints without increasing the complexity of the algorithm and can achieve the most balanced performance on selecting the next hop relay node. Moreover, the Balanced Cross-layer Fuzzy Logic routing algorithm can adapt to the dynamic changing of the network conditions and topology effectively.

The Balanced Cross-Layer Design Routing Algorithm in Wireless Sensor Networks Using Fuzzy Logic

PubMed Central

Li, Ning; Martínez, José-Fernán; Díaz, Vicente Hernández

2015-01-01

Recently, the cross-layer design for the wireless sensor network communication protocol has become more and more important and popular. Considering the disadvantages of the traditional cross-layer routing algorithms, in this paper we propose a new fuzzy logic-based routing algorithm, named the Balanced Cross-layer Fuzzy Logic (BCFL) routing algorithm. In BCFL, we use the cross-layer parameters’ dispersion as the fuzzy logic inference system inputs. Moreover, we give each cross-layer parameter a dynamic weight according the value of the dispersion. For getting a balanced solution, the parameter whose dispersion is large will have small weight, and vice versa. In order to compare it with the traditional cross-layer routing algorithms, BCFL is evaluated through extensive simulations. The simulation results show that the new routing algorithm can handle the multiple constraints without increasing the complexity of the algorithm and can achieve the most balanced performance on selecting the next hop relay node. Moreover, the Balanced Cross-layer Fuzzy Logic routing algorithm can adapt to the dynamic changing of the network conditions and topology effectively. PMID:26266412

Balancing Hole and Electron Conduction in Ambipolar Split-Gate Thin-Film Transistors.

PubMed

Yoo, Hocheon; Ghittorelli, Matteo; Lee, Dong-Kyu; Smits, Edsger C P; Gelinck, Gerwin H; Ahn, Hyungju; Lee, Han-Koo; Torricelli, Fabrizio; Kim, Jae-Joon

2017-07-10

Complementary organic electronics is a key enabling technology for the development of new applications including smart ubiquitous sensors, wearable electronics, and healthcare devices. High-performance, high-functionality and reliable complementary circuits require n- and p-type thin-film transistors with balanced characteristics. Recent advancements in ambipolar organic transistors in terms of semiconductor and device engineering demonstrate the great potential of this route but, unfortunately, the actual development of ambipolar organic complementary electronics is currently hampered by the uneven electron (n-type) and hole (p-type) conduction in ambipolar organic transistors. Here we show ambipolar organic thin-film transistors with balanced n-type and p-type operation. By manipulating air exposure and vacuum annealing conditions, we show that well-balanced electron and hole transport properties can be easily obtained. The method is used to control hole and electron conductions in split-gate transistors based on a solution-processed donor-acceptor semiconducting polymer. Complementary logic inverters with balanced charging and discharging characteristics are demonstrated. These findings may open up new opportunities for the rational design of complementary electronics based on ambipolar organic transistors.

Small-seeded Hakea species tolerate cotyledon loss better than large-seeded congeners

PubMed Central

El-Amhir, Sh-hoob; Lamont, Byron B.; He, Tianhua; Yan, George

2017-01-01

Six Hakea species varying greatly in seed size were selected for cotyledon damage experiments. The growth of seedlings with cotyledons partially or completely removed was monitored over 90 days. All seedlings perished by the fifth week when both cotyledons were removed irrespective of seed size. Partial removal of cotyledons caused a significant delay in the emergence of the first leaf, and reduction in root and shoot growth of the large-seeded species. The growth of seedlings of small-seeded species was less impacted by cotyledon damage. The rate of survival, root and shoot lengths and dry biomass of the seedlings were determined after 90 days. When seedlings were treated with balanced nutrient solutions following removal of the cotyledons, survival was 95–98%, but 0% when supplied with nutrient solutions lacking N or P or with water only. The addition of a balanced nutrient solution failed to restore complete growth of any species, but the rate of root elongation for the small-seeded species was maintained. Cotyledons provide nutrients to support early growth of Hakea seedlings, but other physiological roles for the cotyledons are also implicated. In conclusion, small-seeded Hakea species can tolerate cotyledons loss better than large-seeded species. PMID:28139668

Linear and nonlinear response of a rotating tokamak plasma to a resonant error-field

NASA Astrophysics Data System (ADS)

Fitzpatrick, Richard

2014-09-01

An in-depth investigation of the effect of a resonant error-field on a rotating, quasi-cylindrical, tokamak plasma is preformed within the context of constant-ψ, resistive-magnetohydrodynamical theory. General expressions for the response of the plasma at the rational surface to the error-field are derived in both the linear and nonlinear regimes, and the extents of these regimes mapped out in parameter space. Torque-balance equations are also obtained in both regimes. These equations are used to determine the steady-state plasma rotation at the rational surface in the presence of the error-field. It is found that, provided the intrinsic plasma rotation is sufficiently large, the torque-balance equations possess dynamically stable low-rotation and high-rotation solution branches, separated by a forbidden band of dynamically unstable solutions. Moreover, bifurcations between the two stable solution branches are triggered as the amplitude of the error-field is varied. A low- to high-rotation bifurcation is invariably associated with a significant reduction in the width of the magnetic island chain driven at the rational surface, and vice versa. General expressions for the bifurcation thresholds are derived and their domains of validity mapped out in parameter space.

Solubilizing properties of new surface-active agents, products of catalytic oxyethylation of cholic acid.

PubMed

Kołodziejczyk, Michał Krzysztof; Nachajski, Michal Jakub; Lukosek, Marek; Zgoda, Marian Mikołaj

2013-01-01

Solubilizing properties of aqueous solutions of a series of surface-active agents, products of oxyethylation of cholic acid, were examined in the present study. The content of oxyethylated segments determined by means of the 1H NMR method enabled the verification of the molecular mass of surfactants along with the calculation of the structural hydrophilic-lipophilic balance (HLB), the solubility parameter delta1/2, and the required solubility level of balance HLB(R). Viscosimetric measurements enabled the calculation of the limiting viscosity number, the content-average molecular mass, the effective volume, the hydrodynamic radius of the surfactant micelle and their equilibrium adducts with rutin, diclofenac and loratadine (BCS Class II and III). By means of the spectrophotometric method (UV) the amount of the solubilized diclofenac, loratadine and rutin (rutoside) was determined in the equilibrium system (saturated solution) in the environment of aqueous solutions of cholic acid derivatives of n(TE) = 20-70. The obtained results serve as a basis for determining the solubilization mechanism of lipophilic therapeutic products and indirectly for estimating the influence of the above process on pharmaceutical as well as biological availability of a micellar adduct from model drug forms (Lindbladt lithogenolitic index).

Knowledge Of Maintenance Intravenous Fluid Therapy In Acutely Ill Hospitalized Children Among Residents.

PubMed

Haque, Anwarul; Mirza, Sadiq; Jafri, Sidra Kaleem; Naseem, Faizia; Khan, Khalid Mahmood; Afzal, Muhammad Faheem; Hamid, Muhammad Haroon

2016-01-01

Isotonic saline is recommended as maintenance intravenous fluid therapy (MIVFT) for most of the acutely ill hospitalized children. The aim of this study is to assess the current knowledge of paediatric residents regarding the selection of MIVFT in hospitalized children. We conducted a paper-based questionnaire survey to paediatric residents from ten centres asking selection of MIVFT in four common clinical scenarios in 6-month and 10-year old patients as well as monitoring of fluid balance and electrolyte. 445 responses were collected (>90% response rate). Majority [78.3% (n=348)] of them were FCPS-trainees. The 0.9%, 0.45% and 0.2% solution were selected by 45.8%, 43.98% and 10.92% respectively. The isotonic and hypotonic solution was prescribed in 6- mo (35.22% vs. 64.76% [p<0.001]) and 10-year (54.49% vs. 44.98%) in four different clinical scenarios respectively. 0.45% solution was most commonly prescribed MIVFT in pneumonia (50.22%) and meningitis (45.39%) and 0.9% solution was most commonly selected in acute gastroenteritis (55.05%) and post-operative patients (51.23%). Fluid balance and electrolyte monitoring were selected by 96.9% and 55.7% respondents respectively. Our survey reports that more than fifty percent of paediatric residents have inadequate knowledge about maintenance intravenous fluid therapy in acutely ill hospitalized children.

Aqueous geochemistry and diagenesis in the eastern Snake River Plain aquifer system, Idaho

USGS Publications Warehouse

Wood, Warren W.; Low, Walton H.

1986-01-01

Water budget and isotopic analyses of water in the eastern Snake River Plain aquifer system confirm that most, if not all, of the water is local meteoric in origin. Solute mass-balance arguments suggest that ∼5 × 109 moles of calcite and 2.6 × 109 moles of silica are precipitated annually in the aquifer. Isotopic evaluations of calcite and petrographic observation of silica support the low-temperature origin of these deposits. Approximately 2.8 × 109 moles of chloride, 4.5 × 109 moles of sodium, 1.4 × 109 moles of sulfate, and 2 × 109 moles of magnesium are removed annually from the aquifer framework by solution. Proposed weathering reactions are shown to be consistent with mass balance, carbon isotopes, observed mineralogy, and chemical thermodynamics. Large quantities of sodium, chloride, and sulfate are being removed from the system relative to their abundances in the rock. Sedimentary interbeds, which are estimated to compose <10% of the aquifer volume, may yield as much as 20% of the solutes generated within the aquifer. Weathering rate of the aquifer framework of the eastern Snake River Plain is 14 (Mg/km2)/yr or less than half the average of the North American continent. This contrasts with the rate for the eastern Snake River basin, 34 (Mg/km2)/yr, which is almost identical to the average for the North American continent. Identification and quantification of reactions controlling solute concentrations in ground water in the eastern plain indicate that the aquifer is not an “inert bathtub” that simply stores and transmits water and solutes but is undergoing active diagenesis and is both a source and sink for solutes.

Recycling of inorganic nutrients for hydroponic crop production following incineration of inedible biomass.

PubMed

Bubenheim, D L; Wignarajah, K

1997-01-01

The goal of resource recovery in a regenerative life support system is maintenance of product quality to sure support of reliable and predictable levels of life support function performance by the crop plant component. Further, these systems must be maintained over extended periods of time, requiring maintenance of nutrient solutions to avoid toxicity and deficiencies. The focus of this study was to determine the suitability of the ash product following incineration of inedible biomass as a source of inorganic nutrients for hydroponic crop production. Inedible wheat biomass was incinerated and ash quality characterized. The incinerator ash was dissolved in adequate nitric acid to establish a consistent nitrogen concentration is all nutrient solution treatments. Four experimental nutrient treatments were included: control, ash only, ash supplemented to match the control treatment, and ash only quality formulated with reagent grade chemicals. When nutrient solutions were formulated using only ash following incineration of inedible biomass, a balance in solution is established representing elemental retention following incineration and nutrient proportions present in the original biomass. The resulting solution is not identical to the control. This imbalance resulted in a suppression of crop growth. When the ash is supplemented with reagent grade chemicals to establish the same balance as in the control--growth is identical to the control. The ash appears to carry no phytotoxic materials. Growth in solution formulated with reagent grade chemicals but matching the quality of the ash only treatment resulted in similar growth to that of the ash only treatment. The ash product resulting from incineration of inedible biomass appears to be a suitable form for recycle of inorganic nutrients to crop production.

Subtle charge balance controls surface-nucleated self-assembly of designed biopolymers.

PubMed

Charbonneau, Céline; Kleijn, J Mieke; Cohen Stuart, Martien A

2014-03-25

We report the surface-nucleated self-assembly into fibrils of a biosynthetic amino acid polymer synthesized by the yeast Pichia pastoris. This polymer has a block-like architecture, with a central silk-like block labeled SH, responsible for the self-assembly into fibrils, and two collagen-like random coil end blocks (C) that colloidally stabilize the fibers in aqueous solution. The silk-like block contains histidine residues (pKa≈6) that are positively charged in the low pH region, which hinders self-assembly. In aqueous solution, CSHC self-assembles into fibers above a pH-dependent critical nucleation concentration Ccb. Below Ccb, where no self-assembly occurs in solution, fibril formation can be induced by a negatively charged surface (silica) in the pH range of 3.5-7. The density of the fibers at the surface and their length are controlled by a subtle balance in charge between the protein polymer and the silica surface, which is evidenced from the dependence on pH. With increasing number density of the fibers at the surface, their average length decreases. The results can be explained on the basis of a nucleation-and-growth mechanism: the surface density of fibers depends on the rate of nucleation, while their growth rate is limited by transport of proteins from solution. Screening of the charges on the surface and histidine units by adding NaCl influences the nucleation-and-growth process in a complicated fashion: at low pH, the growth is improved, while at high pH, the nucleation is limited. Under conditions where nucleation in the bulk solution is not possible, growth of the surface-nucleated fibers into the solution--away from the surface--can still occur.

Water and solute mass balance of five small, relatively undisturbed watersheds in the U.S.

USGS Publications Warehouse

Peters, N.E.; Shanley, J.B.; Aulenbach, Brent T.; Webb, R.M.; Campbell, D.H.; Hunt, R.; Larsen, M.C.; Stallard, R.F.; Troester, J.; Walker, J.F.

2006-01-01

Geochemical mass balances were computed for water years 1992-1997 (October 1991 through September 1997) for the five watersheds of the U.S. Geological Survey Water, Energy, and Biogeochemical Budgets (WEBB) Program to determine the primary regional controls on yields of the major dissolved inorganic solutes. The sites, which vary markedly with respect to climate, geology, physiography, and ecology, are: Allequash Creek, Wisconsin (low-relief, humid continental forest); Andrews Creek, Colorado (cold alpine, taiga/tundra, and subalpine boreal forest); Ri??o Icacos, Puerto Rico (lower montane, wet tropical forest); Panola Mountain, Georgia (humid subtropical piedmont forest); and Sleepers River, Vermont (humid northern hardwood forest). Streamwater output fluxes were determined by constructing empirical multivariate concentration models including discharge and seasonal components. Input fluxes were computed from weekly wet-only or bulk precipitation sampling. Despite uncertainties in input fluxes arising from poorly defined elevation gradients, lack of dry-deposition and occult-deposition measurements, and uncertain sea-salt contributions, the following was concluded: (1) for solutes derived primarily from rock weathering (Ca, Mg, Na, K, and H4SiO4), net fluxes (outputs in streamflow minus inputs in deposition) varied by two orders of magnitude, which is attributed to a large gradient in rock weathering rates controlled by climate and geologic parent material; (2) the net flux of atmospherically derived solutes (NH4, NO3, SO4, and Cl) was similar among sites, with SO4 being the most variable and NH4 and NO3 generally retained (except for NO 3 at Andrews); and (3) relations among monthly solute fluxes and differences among solute concentration model parameters yielded additional insights into comparative biogeochemical processes at the sites. ?? 2005 Elsevier B.V. All rights reserved.

Global Properties of Fully Convective Accretion Disks from Local Simulations

NASA Astrophysics Data System (ADS)

Bodo, G.; Cattaneo, F.; Mignone, A.; Ponzo, F.; Rossi, P.

2015-08-01

We present an approach to deriving global properties of accretion disks from the knowledge of local solutions derived from numerical simulations based on the shearing box approximation. The approach consists of a two-step procedure. First, a local solution valid for all values of the disk height is constructed by piecing together an interior solution obtained numerically with an analytical exterior radiative solution. The matching is obtained by assuming hydrostatic balance and radiative equilibrium. Although in principle the procedure can be carried out in general, it simplifies considerably when the interior solution is fully convective. In these cases, the construction is analogous to the derivation of the Hayashi tracks for protostars. The second step consists of piecing together the local solutions at different radii to obtain a global solution. Here we use the symmetry of the solutions with respect to the defining dimensionless numbers—in a way similar to the use of homology relations in stellar structure theory—to obtain the scaling properties of the various disk quantities with radius.

Bidirectional reaction steps in metabolic networks: I. Modeling and simulation of carbon isotope labeling experiments.

PubMed

Wiechert, W; de Graaf, A A

1997-07-05

The extension of metabolite balancing with carbon labeling experiments, as described by Marx et al. (Biotechnol. Bioeng. 49: 11-29), results in a much more detailed stationary metabolic flux analysis. As opposed to basic metabolite flux balancing alone, this method enables both flux directions of bidirectional reaction steps to be quantitated. However, the mathematical treatment of carbon labeling systems is much more complicated, because it requires the solution of numerous balance equations that are bilinear with respect to fluxes and fractional labeling. In this study, a universal modeling framework is presented for describing the metabolite and carbon atom flux in a metabolic network. Bidirectional reaction steps are extensively treated and their impact on the system's labeling state is investigated. Various kinds of modeling assumptions, as usually made for metabolic fluxes, are expressed by linear constraint equations. A numerical algorithm for the solution of the resulting linear constrained set of nonlinear equations is developed. The numerical stability problems caused by large bidirectional fluxes are solved by a specially developed transformation method. Finally, the simulation of carbon labeling experiments is facilitated by a flexible software tool for network synthesis. An illustrative simulation study on flux identifiability from available flux and labeling measurements in the cyclic pentose phosphate pathway of a recombinant strain of Zymomonas mobilis concludes this contribution.

Compact, Energy-Efficient High-Frequency Switched Capacitor Neural Stimulator With Active Charge Balancing.

PubMed

Hsu, Wen-Yang; Schmid, Alexandre

2017-08-01

Safety and energy efficiency are two major concerns for implantable neural stimulators. This paper presents a novel high-frequency, switched capacitor (HFSC) stimulation and active charge balancing scheme, which achieves high energy efficiency and well-controlled stimulation charge in the presence of large electrode impedance variations. Furthermore, the HFSC can be implemented in a compact size without any external component to simultaneously enable multichannel stimulation by deploying multiple stimulators. The theoretical analysis shows significant benefits over the constant-current and voltage-mode stimulation methods. The proposed solution was fabricated using a 0.18 μm high-voltage technology, and occupies only 0.035 mm 2 for a single stimulator. The measurement result shows 50% peak energy efficiency and confirms the effectiveness of active charge balancing to prevent the electrode dissolution.

The energy balance of the solar transition region

NASA Technical Reports Server (NTRS)

Jordan, C.

1980-01-01

It is shown how the observed distribution of the emission measure with temperature can be used to limit the range of energy deposition functions suitable for heating the solar transition region and inner corona. The minimum energy loss solution is considered in view of the work by Hearn (1975) in order to establish further scaling laws between the transition region pressure, the maximum coronal temperature and the parameter giving the absolute value of the emission measure. Also discussed is the absence of a static energy balance at the base of the transition region in terms of measurable atmospheric parameters, and the condition for a static energy balance is given. In addition, the possible role of the emission from He II in stabilizing the atmosphere by providing enhanced radiation loss is considered.

Balancing innovation with commercialization in NASA's Science Mission Directorate SBIR Program

NASA Astrophysics Data System (ADS)

Terrile, R. J.; Jackson, B. L.

The NASA Science Mission Directorate (SMD) administers a portion of the Small Business Innovative Research (SBIR) Program. One of the challenges of administrating this program is to balance the need to foster innovation in small businesses and the need to demonstrate commercialization by infusion into NASA. Because of the often risky nature of innovation, SBIR programs will tend to drift into a status that rewards proposals that promise to deliver a product that is exactly what was specified in the call. This often will satisfy the metric of providing a clear demonstration of infusion and thus also providing a publishable success story. However, another goal of the SBIR program is to foster innovation as a national asset. Even though data from commercially successful SMD SBIR tasks indicate a higher value for less innovative efforts, there are programmatic and national reasons to balance the program toward risking a portion of the portfolio on higher innovation tasks. Establishing this balance is made difficult because there is a reward metric for successful infusion and commercialization, but none for successful innovation. In general, the ultimate infusion and commercialization of innovative solutions has a lower probability than implementation of established ideas, but they can also have a much higher return on investment. If innovative ideas are valued and solicited in the SBIR program, then NASA technology requirements need to be specified in a way that defines the problem and possible solution, but will also allow for different approaches and unconventional methods. It may also be necessary to establish a guideline to risk a percentage of awards on these innovations.

Export of excess Cl by river systems indicates long-term changes to groundwater-surface water interaction

NASA Astrophysics Data System (ADS)

Cartwright, Ian; Hofmann, Harald; Gilfedder, Ben

2013-04-01

Understanding whether catchments are in chemical mass balance is important in understand long-term groundwater-surface water interactions. The mass balance of a conservative solute such as Cl in a catchment is: P*Cl(P) = SW*Cl(SW) + GW*Cl(GW) + dST*Cl(ST) where P, SW, and GW, are net precipitation, surface water outflows, and groundwater outflows and dST accounts for changes to water held in storage, primarily in the groundwater system. Cl() is the concentration of Cl in the various water components. Precipitation and river discharges are commonly well constrained and in many regions there are also rainfall, groundwater, and surface water geochemistry data. Groundwater fluxes and changes to water in storage are less well known meaning that it is difficult to perform accurate solute balances. However, if the flux of a conservative solute out of a catchment via the river system is larger than the input from rainfall (i.e., if SW*Cl(SW) > P*Cl(P)), the catchment is a net exporter of solutes. In turn this implies a change to the amount of water stored in the catchment and/or a change in chemistry of water in storage. We apply this technique to several regional-scale catchments (areas up to 15,000 km2) from Victoria, southeast Australia. Cl/Br ratios indicate that the Cl in groundwater and surface water in this region is derived from evapotranspiration of rainfall. Rivers from several catchments in Victoria are saline (Cl >500 mg/L) due mainly to groundwater inflows. Cl concentrations and EC values are well correlated allowing a long-term (up to 25 years) continual record of Cl fluxes to be estimated from sub-daily river discharge and EC data. Many of the rivers export significantly higher volumes of Cl than is delivered via rainfall (up to 1800%). Two scenarios may explain this chemical imbalance. Firstly, saline marshes and lakes developed on young (<1 Ma) basaltic lava plains have gradually drained as blocked river systems re-established. Evapotranspiration and repeated recharge-discharge cycles within these lakes and wetlands produced shallow groundwater with high Cl concentrations that is currently being exported via the re-established river systems. Secondly, in many catchments land-clearing over the last 200 years has resulted in lower evapotranspiration rates and increased recharge. The increased recharge has resulted in a rise of regional water tables and increased baseflow to the rivers. As a consequence, Cl from the groundwater that has relatively long residence time is now being exported. In both cases, the catchments are adjusting to a new hydrological balance and the Cl mass balance indicates that the present patterns of groundwater-surface water interaction are transitory. Both scenarios involve a decrease in evapotranspiration in the catchments that results in groundwater salinities decreasing. Thus, over time, the Cl concentrations in these rivers will decrease as fresher groundwater increasingly forms the baseflow to the rivers and the catchments will tend toward chemical balance; the timescale of change however may be several ka.

Particle swarm optimization - Genetic algorithm (PSOGA) on linear transportation problem

NASA Astrophysics Data System (ADS)

Rahmalia, Dinita

2017-08-01

Linear Transportation Problem (LTP) is the case of constrained optimization where we want to minimize cost subject to the balance of the number of supply and the number of demand. The exact method such as northwest corner, vogel, russel, minimal cost have been applied at approaching optimal solution. In this paper, we use heurisitic like Particle Swarm Optimization (PSO) for solving linear transportation problem at any size of decision variable. In addition, we combine mutation operator of Genetic Algorithm (GA) at PSO to improve optimal solution. This method is called Particle Swarm Optimization - Genetic Algorithm (PSOGA). The simulations show that PSOGA can improve optimal solution resulted by PSO.

Stability and bifurcation analysis of oscillators with piecewise-linear characteristics - A general approach

NASA Technical Reports Server (NTRS)

Noah, S. T.; Kim, Y. B.

1991-01-01

A general approach is developed for determining the periodic solutions and their stability of nonlinear oscillators with piecewise-smooth characteristics. A modified harmonic balance/Fourier transform procedure is devised for the analysis. The procedure avoids certain numerical differentiation employed previously in determining the periodic solutions, therefore enhancing the reliability and efficiency of the method. Stability of the solutions is determined via perturbations of their state variables. The method is applied to a forced oscillator interacting with a stop of finite stiffness. Flip and fold bifurcations are found to occur. This led to the identification of parameter ranges in which chaotic response occurred.

A Membrane Gas Separation Experiment for the Undergraduate Laboratory.

ERIC Educational Resources Information Center

Davis, Richard A.; Sandall, Orville C.

1991-01-01

Described is a membrane experiment that provides students with experience in fundamental engineering skills such as mass balances, modeling, and using the computer as a research tool. Included are the experimental design, theory, method of solution, sample calculations, and conclusions. (KR)

A framework for multi-stakeholder decision-making and conflict resolution

EPA Science Inventory

We propose a decision-making framework to compute compromise solutions that balance conflicting priorities of multiple stakeholders on multiple objectives. In our setting, we shape the stakeholder dis-satisfaction distribution by solving a conditional-value-at-risk (CVaR) minimiz...

Stability of the Einstein static universe in open cosmological models

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

Canonico, Rosangela; Parisi, Luca; INFN, Sezione di Napoli, GC di Salerno, Via Ponte Don Melillo, I-84081 Baronissi

2010-09-15

The stability properties of the Einstein static solution of general relativity are altered when corrective terms arising from modification of the underlying gravitational theory appear in the cosmological equations. In this paper the existence and stability of static solutions are considered in the framework of two recently proposed quantum gravity models. The previously known analysis of the Einstein static solutions in the semiclassical regime of loop quantum cosmology with modifications to the gravitational sector is extended to open cosmological models where a static neutrally stable solution is found. A similar analysis is also performed in the framework of Horava-Lifshitz gravitymore » under detailed balance and projectability conditions. In the case of open cosmological models the two solutions found can be either unstable or neutrally stable according to the admitted values of the parameters.« less

An auto-Bäcklund transformation and exact solutions for Wick-type stochastic generalized KdV equations

NASA Astrophysics Data System (ADS)

Xie, Yingchao

2004-05-01

Wick-type stochastic generalized KdV equations are researched. By using the homogeneous balance, an auto-Bäcklund transformation to the Wick-type stochastic generalized KdV equations is derived. And stochastic single soliton and stochastic multi-soliton solutions are shown by using the Hermite transform. Research supported by the National Natural Science Foundation of China (19971072) and the Natural Science Foundation of Education Committee of Jiangsu Province of China (03KJB110135).

To Compare the Effects of Storage Solutions 0.05% Thymol vs. 6% Sodium Hypochlorite vs. Hank’s Balanced Salt Solution on the Flexural Strength of Dentin Bars

DTIC Science & Technology

2016-05-20

ridge thicknesses, restored with composite resin and composite resin reinforced with Ribbond . Indian Journal of Dental Research . Manisha, T. (2014...in the internal structure of an extracted tooth, used to test dental materials in vitro could result in findings that cannot be replicated or...roots restored with different post systems. International Endodontic Journal . Barbosa, S. V. (1994). Influence of sodium hypochlorite on the

From Drought to Flood: An Analysis of the Water Balance of the Tuolumne River Basin During Extreme Conditions (2015 - 2017)

NASA Astrophysics Data System (ADS)

Hedrick, A. R.; Marks, D. G.; Havens, S.; Robertson, M.; Johnson, M.; Sandusky, M.; Bormann, K. J.; Painter, T. H.

2017-12-01

Closing the water balance of a snow-dominated mountain basin has long been a focal point of the hydrologic sciences. This study attempts to more precisely quantify the solid precipitation inputs to a basin using the iSnobal energy balance snowmelt model and assimilated snow depth information from the Airborne Snow Observatory (ASO). Throughout the ablation seasons of three highly dissimilar consecutive water years (2015 - 2017), the ASO captured high resolution snow depth snapshots over the Tuolumne River Basin in California's Central Sierra Nevada. These measurements were used to periodically update the snow depth state variable of iSnobal, thereby nudging the estimates of water storage (snow water equivalent, or SWE) and melt (surface water input, or SWI) toward a more accurate solution. Once precipitation inputs and streamflow outputs are better constrained, the additional loss terms of the water mass balance equation (i.e. groundwater recharge and evapotranspiration) can be estimated with less uncertainty.

Clinical and Antiviral Efficacy of an Ophthalmic Formulation of Dexamethasone Povidone-Iodine in a Rabbit Model of Adenoviral Keratoconjunctivitis

PubMed Central

Clement, Christian; Capriotti, Joseph A.; Kumar, Manish; Hobden, Jeffery A.; Foster, Timothy P.; Bhattacharjee, Partha S.; Thompson, Hilary W.; Mahmud, Rashed; Liang, Bo

2011-01-01

Purpose. To determine the efficacy of a new formulation of topical dexamethasone 0.1%/povidone-iodine 0.4% (FST-100) in reducing clinical symptoms and infectious viral titers in a rabbit model of adenoviral keratoconjunctivitis. Methods. Rabbit corneas were inoculated bilaterally with 2 × 106 plaque-forming-units (PFU) of adenovirus type 5 (Ad5) after corneal scarification. Animals were randomized 1:1:1:1 (five rabbits per group) to FST-100, 0.5% cidofovir, tobramycin/dexamethasone (Tobradex; Alcon Laboratories, Fort Worth, TX) ophthalmic suspension, and balanced salt solution (BSS; Alcon Laboratories). Treatment began 12 hours after viral inoculation and continued for 7 consecutive days. The eyes were clinically scored daily for scleral inflammation (injection), ocular neovascularization, eyelid inflammation (redness), friability of vasculature, inflammatory discharge (pus), and epiphora (excessive tearing). Eye swabs were collected daily before treatment for the duration of the study. Virus was eluted from the swabs and PFU determined by titration on human A549 cells, according to standard procedures. Results. The FST-100 treatment resulted in significantly lower clinical scores (P < 0.05) than did the other treatments. The 0.5% cidofovir exhibited the most ocular toxicity compared with FST-100, tobramycin/dexamethasone, and balanced salt solution treatments. FST-100 and 0.5% cidofovir significantly (P < 0.05) reduced viral titers compared with tobramycin/dexamethasone or balanced salt solution. Conclusions. FST-100 was the most efficacious in minimizing the clinical symptoms of adenovirus infection in rabbit eyes. FST-100 and 0.5% cidofovir were both equally effective in reducing viral titers and decreasing the duration of viral shedding. By providing symptomatic relief in addition to reducing infectious virus titers, FST-100 should be a valuable addition to treatment of epidemic adenoviral keratoconjunctivitis. PMID:20702820

Could solutions low in glucose degradation products preserve residual renal function in incident peritoneal dialysis patients? A 1-year multicenter prospective randomized controlled trial (Balnet Study).

PubMed

Kim, Sung Gyun; Kim, Sejoong; Hwang, Young-Hwan; Kim, Kiwon; Oh, Ji Eun; Chung, Wookyung; Oh, Kook-Hwan; Kim, Hyung Jik; Ahn, Curie

2008-06-01

In vitro studies of peritoneal dialysis (PD) solutions demonstrated that a lactate-buffered fluid with neutral pH and low glucose degradation products (LF) has better biocompatibility than a conventional acidic lactate-buffered fluid (CF). However, few clinical trials have evaluated the long-term benefit of the biocompatible solution on residual renal function (RRF). To compare LF with CF, we performed a prospective, randomized study with patients starting PD. After 1-month run-in period, 91 new PD patients were randomized for 12 months of treatment with either LF (Balance: Fresenius Medical Care, Bad Homburg, Germany; n = 48) or CF (Stay Safe: Fresenius; n = 43). We measured RRF, acid-base balance, peritoneal equilibration test, and adequacy of dialysis every 6 months after the run-in period. After 12 months of treatment, the residual glomerular filtration rate (GFR) in patients using LF tended to be higher than that of patients on CF (p = 0.057 by repeated-measures analysis of variance). We observed a significant difference in the changes of residual GFR between the two groups (p = 0.009), a difference that was especially marked in the subgroup whose baseline residual GFR was more than 2 mL/min/1.73 m(2). In addition, serum total CO(2) levels were higher (p = 0.001) and serum anion gap was lower (p = 0.019) in the LF group. We observed no differences between groups for Kt/V, C-reactive protein, or normalized protein equivalent of nitrogen appearance. In incident PD patients with significant residual GFR, LF may better preserve RRF over a 12-month treatment period. Additionally, pH-neutral PD fluid may improve acid-base balance as compared with CF.

Evidence for less irritation to the peritoneal membrane in rats dialyzed with solutions low in glucose degradation products.

PubMed

Wieczorowska-Tobis, Katarzyna; Brelinska, Renata; Witowski, Janusz; Passlick-Deetjen, Jutta; Schaub, Thomas P; Schilling, Holger; Breborowicz, Andrzej

2004-01-01

Acidic pH and the presence of glucose degradation products (GDP) are believed to compromise the biocompatibility of peritoneal dialysis fluids (PDF). The present study examines the effects of long-term exposure to GDP and low pH by comparing conventional PDF and a new, neutral pH, low GDP solution. All experiments were performed using a chronic infusion model of dialysis in nonuremic rats. The animals were treated for 6 weeks with 2 daily injections of 4.25% glucose-containing PDF. The following PDF were tested: CAPD3 (single-chamber bag, low pH, high GDP), CAPD3 pH 7.4 (single-chamber bag, neutral pH, high GDP), CAPD3-Balance (double-chamber bag, neutral pH, low GDP). All test solutions were obtained from Fresenius Medical Care, Bad Homburg, Germany. After 6 weeks of exposure, peritoneal permeability to water, urea, creatinine, glucose, and sodium, assessed by peritoneal equilibration test, was similar in all groups. However, compared to other PDF, dialysis with CAPD3-Balance was associated with reduced concentrations of protein and hyaluronan in the dialysate, decreased peritoneal eosinophilia, and reduced dialysate levels of chemokines CCL2/MCP-1 and CCL5/RANTES. Morphologic changes in the peritoneal membrane of CAPD3-Balance-treated animals were much less pronounced and included reduced vascular density, preservation of the mesothelial monolayer and intercellular junction, and no reduplication of the submesothelial basement membrane. A new generation of PDF with physiologic pH and low GDP level produce less irritation to the peritoneal membrane and better preserve its structural integrity. This effect seems to be related predominantly to minimized GDP concentrations.

A Stochastic Water Balance Framework for Lowland Watersheds

NASA Astrophysics Data System (ADS)

Thompson, Sally; MacVean, Lissa; Sivapalan, Murugesu

2017-11-01

The water balance dynamics in lowland watersheds are influenced not only by local hydroclimatic controls on energy and water availability, but also by imports of water from the upstream watershed. These imports result in a stochastic extent of inundation in lowland watersheds that is determined by the local flood regime, watershed topography, and the rate of loss processes such as drainage and evaporation. Thus, lowland watershed water balances depend on two stochastic processes—rainfall and local inundation dynamics. Lowlands are high productivity environments that are disproportionately associated with urbanization, high productivity agriculture, biodiversity, and flood risk. Consequently, they are being rapidly altered by human development—generally with clear economic and social motivation—but also with significant trade-offs in ecosystem services provision, directly related to changes in the components and variability of the lowland water balance. We present a stochastic framework to assess the lowland water balance and its sensitivity to two common human interventions—replacement of native vegetation with alternative land uses, and construction of local flood protection levees. By providing analytical solutions for the mean and PDF of the water balance components, the proposed framework provides a mechanism to connect human interventions to hydrologic outcomes, and, in conjunction with ecosystem service production estimates, to evaluate trade-offs associated with lowland watershed development.

Balance Maintenance in High-Speed Motion of Humanoid Robot Arm-Based on the 6D Constraints of Momentum Change Rate

PubMed Central

Zhang, Da-song; Chu, Jian

2014-01-01

Based on the 6D constraints of momentum change rate (CMCR), this paper puts forward a real-time and full balance maintenance method for the humanoid robot during high-speed movement of its 7-DOF arm. First, the total momentum formula for the robot's two arms is given and the momentum change rate is defined by the time derivative of the total momentum. The author also illustrates the idea of full balance maintenance and analyzes the physical meaning of 6D CMCR and its fundamental relation to full balance maintenance. Moreover, discretization and optimization solution of CMCR has been provided with the motion constraint of the auxiliary arm's joint, and the solving algorithm is optimized. The simulation results have shown the validity and generality of the proposed method on the full balance maintenance in the 6 DOFs of the robot body under 6D CMCR. This method ensures 6D dynamics balance performance and increases abundant ZMP stability margin. The resulting motion of the auxiliary arm has large abundance in joint space, and the angular velocity and the angular acceleration of these joints lie within the predefined limits. The proposed algorithm also has good real-time performance. PMID:24883404

Structures and properties of molecular torsion balances to decipher the nature of substituent effects on the aromatic edge-to-face interaction.

PubMed

Gardarsson, Haraldur; Schweizer, W Bernd; Trapp, Nils; Diederich, François

2014-04-14

Various recent computational studies initiated this systematic re-investigation of substituent effects on aromatic edge-to-face interactions. Five series of Tröger base derived molecular torsion balances (MTBs), initially introduced by Wilcox and co-workers, showing an aromatic edge-to-face interaction in the folded, but not in the unfolded form, were synthesized. A fluorine atom or a trifluoromethyl group was introduced onto the edge ring in ortho-, meta-, and para-positions to the C-H group interacting with the face component. The substituents on the face component were varied from electron-donating to electron-withdrawing. Extensive X-ray crystallographic data allowed for a discussion on the conformational behavior of the torsional balances in the solid state. While most systems adopt the folded conformation, some were found to form supramolecular intercalative dimers, lacking the intramolecular edge-to-face interaction, which is compensated by the gain of aromatic π-stacking interactions between four aryl rings of the two molecular components. This dimerization does not take place in solution. The folding free enthalpy ΔG(fold) of all torsion balances was determined by (1)H NMR measurements by using 10 mM solutions of samples in CDCl3 and C6D6. Only the ΔG(fold) values of balances bearing an edge-ring substituent in ortho-position to the interacting C-H show a steep linear correlation with the Hammett parameter (σ(meta)) of the face-component substituent. Thermodynamic analysis using van't Hoff plots revealed that the interaction is enthalpy-driven. The ΔG(fold) values of the balances, in addition to partial charge calculations, suggest that increasing the polarization of the interacting C-H group makes a favorable contribution to the edge-to-face interaction. The largest contribution, however, seems to originate from local direct interactions between the substituent in ortho-position to the edge-ring C-H and the substituted face ring. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

An Algebraic Approach to Guarantee Harmonic Balance Method Using Gröbner Base

NASA Astrophysics Data System (ADS)

Yagi, Masakazu; Hisakado, Takashi; Okumura, Kohshi

Harmonic balance (HB) method is well known principle for analyzing periodic oscillations on nonlinear networks and systems. Because the HB method has a truncation error, approximated solutions have been guaranteed by error bounds. However, its numerical computation is very time-consuming compared with solving the HB equation. This paper proposes an algebraic representation of the error bound using Gröbner base. The algebraic representation enables to decrease the computational cost of the error bound considerably. Moreover, using singular points of the algebraic representation, we can obtain accurate break points of the error bound by collisions.

Estimating ground-water exchange with lakes using water-budget and chemical mass-balance approaches for ten lakes in ridge areas of Polk and Highlands counties, Florida

USGS Publications Warehouse

Sacks, L.A.; Swancar, Amy; Lee, T.M.

1998-01-01

Water budget and chemical mass-balance approaches were used to estimate ground-water exchange with 10 lakes in ridge areas of Polk and Highlands Counties, Florida. At each lake, heads were monitored in the surficial aquifer system and deeper Upper Floridan aquifer, lake stage and rainfall were measured continuously, and lakes and wells were sampled three times between October 1995 and December 1996. The water-budget approach computes net ground-water flow (ground-water inflow minus outflow) as the residual of the monthly waterbudget equation. Net ground-water flow varied seasonally at each of the 10 lakes, and was notably different between lakes, illustrating short-term differences in ground-water fluxes. Monthly patterns in net ground-water flow were related to monthly patterns of other hydrologic variables such as rainfall, ground-water flow patterns, and head differences between the lake and the Upper Floridan aquifer. The chemical mass-balance approach combines the water budget and solute or isotope mass-balance equations, and assumes steady-state conditions. Naturally occurring tracers that were analyzed for include calcium, magnesium, sodium, potassium, chloride, and bromide, the isotopes deuterium and oxygen-18. Chloride and sodium were the most successful solute tracers; however, their concentrations in ground water typically varied spatially, and in places were similar to that in lake water, limiting their sensitivity as tracers. In contrast, the isotopes were more robust tracers because the isotopic composition of ground water was relatively uniform and was distinctly different from the lake water. Groundwater inflow computed using the chemical massbalance method varied significantly between lakes, and ranged from less than 10 to more than 150 inches per year. Both water-budget and chemical mass-balance approaches had limitations, but the multiple lines of evidence gained using both approaches improved the understanding of the role of ground water in the water budget of the lakes.

The Griffiss Institute Summer Faculty Program

DTIC Science & Technology

2013-05-01

can inherit the advantages of the static approach while overcoming its drawbacks . Our solution is centered on the following: (i) application-layer web...inverted pendulum balancing problem. In these challenging environments we show that our algorithm not only allows NEAT to scale to high-dimensional spaces

The Perils of "Progress."

ERIC Educational Resources Information Center

Schultz, Fred C.

2001-01-01

Reveals how seeking simplicity can help bring indoor air quality (IAQ) solutions to grade schools by balancing IAQ needs, cost, and energy. Issues involving ventilation rate requirements are reexamined, as are compliance with outside-air requirements, dealing with variable-air-volume air distribution regulators, and retrofitting issues involving…

School Boundaries: Finding Solutions While Gaining Community Support

ERIC Educational Resources Information Center

Lazarus, William

2010-01-01

Some of the most complicated issues facing school districts across the country revolve around resource allocation and student assignment planning. Determining school attendance boundaries, selecting sites for new schools, closing existing ones, balancing seat utilization while minimizing travel costs, and achieving socioeconomic diversity are all…

ENVIRONMENTAL ACCOUNTING USING EMERGY: EVALUATION OF THE STATE OF WEST VIRGINIA

EPA Science Inventory

Historically, questions related to environmental policy have been difficult to solve, because solutions depend on accurately balancing the needs of both human and natural systems. In addition, there has been no good way to express the socioeconomic and environmental effects of p...

Contribution to harmonic balance calculations of self-sustained periodic oscillations with focus on single-reed instruments.

PubMed

Farner, Snorre; Vergez, Christophe; Kergomard, Jean; Lizée, Aude

2006-03-01

The harmonic balance method (HBM) was originally developed for finding periodic solutions of electronical and mechanical systems under a periodic force, but has been adapted to self-sustained musical instruments. Unlike time-domain methods, this frequency-domain method does not capture transients and so is not adapted for sound synthesis. However, its independence of time makes it very useful for studying any periodic solution, whether stable or unstable, without care of particular initial conditions in time. A computer program for solving general problems involving nonlinearly coupled exciter and resonator, HARMBAL, has been developed based on the HBM. The method as well as convergence improvements and continuation facilities are thoroughly presented and discussed in the present paper. Applications of the method are demonstrated, especially on problems with severe difficulties of convergence: the Helmholtz motion (square signals) of single-reed instruments when no losses are taken into account, the reed being modeled as a simple spring.

Ciprofloxacin and statin interaction: a cautionary tale of rhabdomyolysis.

PubMed

Goldie, Fraser Charles; Brogan, Amy; Boyle, James Graham

2016-07-28

A 62-year-old woman presented to hospital, on general practitioner (GP) advice, with a 15-day history of slowly progressing muscle weakness. Results showed newly deranged liver function and creatine kinase (CK) of >24 000. Prior medical history includes previous myocardial infarction and recurrent urinary tract infection. 4 days prior to symptom onset, the patient developed typical urinary tract infection symptoms, treated with ciprofloxacin. The patient had been taking simvastatin (40 mg nocte) for 13 years and had never previously taken ciprofloxacin. Initial management included intravenous crystalloid fluids and discontinuation of simvastatin. CK level fell, liver function slowly improved and renal function remained stable. Muscle weakness improved and the patient became independently able to perform activities of daily living. While the interactions between statins and other antibiotics are well documented, the interaction between statins and ciprofloxacin is less so. The consequences of this interaction can have potentially serious outcomes. 2016 BMJ Publishing Group Ltd.

High feline trypsin-like immunoreactivity in a cat with pancreatitis and hepatic lipidosis.

PubMed

Bruner, J M; Steiner, J M; Williams, D A; Van Alstine, W G; Blevins, W

1997-06-15

A 1.5-year-old domestic shorthair cat was examined because of vomiting and icterus. Clinicopathologic abnormalities included high alanine transaminase, alkaline phosphatase, and gamma-glutamyltransferase activities and high total bilirubin concentration. During abdominal ultrasonography, the left limb and body of the pancreas appeared hypoechoic, and a small quantity of peritoneal effusion was seen. The liver was diffusely hyperechoic, with echogenicity similar to that of the spleen, indicating hepatic lipidosis. Feline trypsin-like immunoreactivity was high, suggesting that the cat also had pancreatitis. The cat was treated with crystalloid fluids and was fed a protein-restricted diet via a percutaneous endoscopically placed gastrostomy tube. The cat's condition continued to deteriorate despite medical treatment, and it was euthanatized. Necropsy confirmed the clinical suspicion of acute pancreatitis and hepatic lipidosis. This case suggests that measurement of trypsin-like immunoreactivity may be useful in cats suspected of having pancreatitis.

The symmetry of man.

PubMed

Ermolenko, Alexander E; Perepada, Elena A

2007-01-01

The paper contains a description of basic regularities in the manifestation of symmetry of human structural organization and its ontogenetic and phylogenetic development. A concept of macrobiocrystalloid with inherent complex symmetry is proposed for the description of the human organism in its integrity. The symmetry can be characterized as two-plane radial (quadrilateral), where the planar symmetry is predominant while the layout of organs of radial symmetry is subordinated to it. Out of the two planes of symmetry (sagittal and horizontal), the sagittal plane is predominant. The symmetry of the chromosome, of the embrio at the early stages of cell cleavage as well as of some organs and systems in their phylogenetic development is described. An hypothesis is postulated that the two-plane symmetry is formed by two mechanisms: a) the impact of morphogenetic fields of the whole crystalloid organism during embriogenesis and, b) genetic mechanisms of the development of chromosomes having two-plane symmetry.

Effects of thermal stress and exercise on blood volume in humans

NASA Technical Reports Server (NTRS)

Harrison, M. H.

1985-01-01

The available experimental data base on the effects of exercise, posture and the environment (heat) on the blood volume, composition and concentration in humans is surveyed in depth to synthesize supportable conclusions. A large disparity is noted in the effective controls which were initiated in previous experimental conditions, resulting in contradictory findings regarding, e.g., hemoconcentrations and hemodilution in response to exercise. Comparisons between the results of exercise and of supine, seated and upright subjects has underscored the importance of gravity in hemoconcentration, particularly in the legs, and the generation of aldotestosterone. Hemoconcentration has been confirmed to increase with exercise in a seated or supine position. Exercise in a heated environment transfers cardiac output from core areas and reduces filtration efficiencies. Also, plasma volume increases, an action which cannot yet be associated with crystalloidal or colloidal influences on the osmotic behavior of cell walls.

Pharmacological management of pediatric patients with sepsis.

PubMed

Simmons, Marroyln L; Durham, Spencer H; Carter, Chenita W

2012-01-01

With an overall mortality rate of 4.2%, sepsis is one of the most common causes of death in children worldwide. The Surviving Sepsis Campaign outlines rapid initiation of volume resuscitation with crystalloids and timely administration of broad-spectrum antibiotics as the backbone of sepsis treatment. Initial antibiotics should be broad enough to cover the most likely pathogens, but antibiotic therapy should be de-escalated when culture results become available. Therapy with a vasopressor and/or an inotrope is often necessary in patients with sepsis to improve blood pressure and cardiac output. Adjunctive therapy with hydrocortisone is sometimes beneficial in the setting of catecholamine resistance and/or adrenal insufficiency. Insulin may also be needed in some patients for the treatment of hyperglycemia. Current guidelines have improved the treatment of sepsis, but more research is needed. This article reviews sepsis pathophysiology, treatment, and supportive care specifically as they relate to pediatric patients.

Escape rate for nonequilibrium processes dominated by strong non-detailed balance force

NASA Astrophysics Data System (ADS)

Tang, Ying; Xu, Song; Ao, Ping

2018-02-01

Quantifying the escape rate from a meta-stable state is essential to understand a wide range of dynamical processes. Kramers' classical rate formula is the product of an exponential function of the potential barrier height and a pre-factor related to the friction coefficient. Although many applications of the rate formula focused on the exponential term, the prefactor can have a significant effect on the escape rate in certain parameter regions, such as the overdamped limit and the underdamped limit. There have been continuous interests to understand the effect of non-detailed balance on the escape rate; however, how the prefactor behaves under strong non-detailed balance force remains elusive. In this work, we find that the escape rate formula has a vanishing prefactor with decreasing friction strength under the strong non-detailed balance limit. We both obtain analytical solutions in specific examples and provide a derivation for more general cases. We further verify the result by simulations and propose a testable experimental system of a charged Brownian particle in electromagnetic field. Our study demonstrates that a special care is required to estimate the effect of prefactor on the escape rate when non-detailed balance force dominates.

Electrochemical Ion-Exchange Regeneration and Fluidized Bed Crystallization for Zero-Liquid-Discharge Water Softening.

PubMed

Chen, Yingying; Davis, Jake R; Nguyen, Chi H; Baygents, James C; Farrell, James

2016-06-07

This research investigated the use of an electrochemical system for regenerating ion-exchange media and for promoting the crystallization of hardness minerals in a fluidized bed crystallization reactor (FBCR). The closed-loop process eliminates the creation of waste brine solutions that are normally produced when regenerating ion-exchange media. A bipolar membrane electrodialysis stack was used to generate acids and bases from 100 mM salt solutions. The acid was used to regenerate weak acid cation (WAC) ion-exchange media used for water softening. The base solutions were used to absorb CO2 gas and to provide a source of alkalinity for removing noncarbonate hardness by WAC media operated in H(+) form. The base solutions were also used to promote the crystallization of CaCO3 and Mg(OH)2 in a FBCR. The overall process removes hardness ions from the water being softened and replaces them with H(+) ions, slightly decreasing the pH value of the softened water. The current utilization efficiency for acid and base production was ∼75% over the operational range of interest, and the energy costs for producing acids and bases were an order of magnitude lower than the costs for purchasing acid and base in bulk quantities. Ion balances indicate that the closed-loop system will accumulate SO4(2-), Cl(-), and alkali metal ions. Acid and base balances indicate that for a typical water, small amounts of base will be accumulated.

Impact of Spatial Pumping Patterns on Groundwater Management

NASA Astrophysics Data System (ADS)

Yin, J.; Tsai, F. T. C.

2017-12-01

Challenges exist to manage groundwater resources while maintaining a balance between groundwater quantity and quality because of anthropogenic pumping activities as well as complex subsurface environment. In this study, to address the impact of spatial pumping pattern on groundwater management, a mixed integer nonlinear multi-objective model is formulated by integrating three objectives within a management framework to: (i) maximize total groundwater withdrawal from potential wells; (ii) minimize total electricity cost for well pumps; and (iii) attain groundwater level at selected monitoring locations as close as possible to the target level. Binary variables are used in the groundwater management model to control the operative status of pumping wells. The NSGA-II is linked with MODFLOW to solve the multi-objective problem. The proposed method is applied to a groundwater management problem in the complex Baton Rouge aquifer system, southeastern Louisiana. Results show that (a) non-dominated trade-off solutions under various spatial distributions of active pumping wells can be achieved. Each solution is optimal with regard to its corresponding objectives; (b) operative status, locations and pumping rates of pumping wells are significant to influence the distribution of hydraulic head, which in turn influence the optimization results; (c) A wide range of optimal solutions is obtained such that decision makers can select the most appropriate solution through negotiation with different stakeholders. This technique is beneficial to finding out the optimal extent to which three objectives including water supply concern, energy concern and subsidence concern can be balanced.

Antarctica, Greenland and Gulf of Alaska Land-ice Evolution from an Iterated GRACE Global Mascon Solution

NASA Technical Reports Server (NTRS)

Luthcke, Scott B.; Sabaka, T. J.; Loomis, B. D.; Arendt, A. A.; McCarthy, J. J.; Camp, J.

2013-01-01

We have determined the ice mass evolution of the Antarctica and Greenland ice sheets (AIS and GIS) and Gulf of Alaska (GOA) glaciers from a new GRACE global solution of equal-area surface mass concentration parcels (mascons) in equivalent height of water. The mascons were estimated directly from the reduction of the inter-satellite K-band range-rate (KBRR) observations, taking into account the full noise covariance, and formally iterating the solution. The new solution increases signal recovery while reducing the GRACE KBRR observation residuals. The mascons were estimated with 10 day and 1 arc degree equal-area sampling, applying anisotropic constraints. An ensemble empirical mode decomposition adaptive filter was applied to the mascon time series to compute annual mass balances. The details and causes of the spatial and temporal variability of the land-ice regions studied are discussed. The estimated mass trend over the total GIS, AIS and GOA glaciers for the time period 1 December 2003 to 1 December 2010 is -380 plus or minus 31 Gt a(exp -1), equivalent to -1.05 plus or minus 0.09 mma(exp -1) sea-level rise. Over the same time period we estimate the mass acceleration to be -41 plus or minus 27 Gt a(exp -2), equivalent to a 0.11 plus or minus 0.08 mm a(exp -2) rate of change in sea level. The trends and accelerations are dependent on significant seasonal and annual balance anomalies.

Antarctica, Greenland and Gulf of Alaska Land-Ice Evolution from an Iterated GRACE Global Mascon Solution

NASA Technical Reports Server (NTRS)

Luthcke, Scott B.; Sabaka, T. J.; Loomis, B. D.; Arendt, A. A.; McCarthy, J. J.; Camp, J.

2013-01-01

We have determined the ice mass evolution of the Antarctica and Greenland ice sheets (AIS and GIS) and Gulf of Alaska (GOA) glaciers from a new GRACE global solution of equal-area surface mass concentration parcels (mascons) in equivalent height of water. The mascons were estimated directly from the reduction of the inter-satellite K-band range-rate (KBRR) observations, taking into account the full noise covariance, and formally iterating the solution. The new solution increases signal recovery while reducing the GRACE KBRR observation residuals. The mascons were estimated with 10 day and 1 arc degree equal-area sampling, applying anisotropic constraints. An ensemble empirical mode decomposition adaptive filter was applied to the mascon time series to compute annual mass balances. The details and causes of the spatial and temporal variability of the land-ice regions studied are discussed. The estimated mass trend over the total GIS, AIS and GOA glaciers for the time period 1 December 2003 to 1 December 2010 is -380 plus or minus 31 Gt a(exp -1), equivalent to -1.05 plus or minus 0.09 mma(exp -1) sea-level rise. Over the same time period we estimate the mass acceleration to be -41 plus or minus 27 Gt a(exp -2), equivalent to a 0.11 plus or minus 0.08 mm a(exp -2) rate of change in sea level. The trends and accelerations are dependent on significant seasonal and annual balance anomalies.

Latency Hiding in Dynamic Partitioning and Load Balancing of Grid Computing Applications

NASA Technical Reports Server (NTRS)

Das, Sajal K.; Harvey, Daniel J.; Biswas, Rupak

2001-01-01

The Information Power Grid (IPG) concept developed by NASA is aimed to provide a metacomputing platform for large-scale distributed computations, by hiding the intricacies of highly heterogeneous environment and yet maintaining adequate security. In this paper, we propose a latency-tolerant partitioning scheme that dynamically balances processor workloads on the.IPG, and minimizes data movement and runtime communication. By simulating an unsteady adaptive mesh application on a wide area network, we study the performance of our load balancer under the Globus environment. The number of IPG nodes, the number of processors per node, and the interconnected speeds are parameterized to derive conditions under which the IPG would be suitable for parallel distributed processing of such applications. Experimental results demonstrate that effective solution are achieved when the IPG nodes are connected by a high-speed asynchronous interconnection network.

Thermo-solutal growth of an anisotropic dendrite with six-fold symmetry

NASA Astrophysics Data System (ADS)

Alexandrov, D. V.; Galenko, P. K.

2018-03-01

A stable growth of dendritic crystal with the six-fold crystalline anisotropy is analyzed in a binary nonisothermal mixture. A selection criterion representing a relationship between the dendrite tip velocity and its tip diameter is derived on the basis of morphological stability analysis and solvability theory. A complete set of nonlinear equations, consisting of the selection criterion and undercooling balance condition, which determines implicit dependencies of the dendrite tip velocity and tip diameter as functions of the total undercooling, is formulated. Exact analytical solutions of these nonlinear equations are found in a parametric form. Asymptotic solutions describing the crystal growth at small Péclet numbers are determined. Theoretical predictions are compared with experimental data obtained for ice dendrites growing in binary water-ethylenglycol solutions as well as in pure water.

On the evolution of perturbations to solutions of the Kadomtsev-Petviashvilli equation using the Benney-Luke equation

NASA Astrophysics Data System (ADS)

Ablowitz, Mark J.; Curtis, Christopher W.

2011-05-01

The Benney-Luke equation, which arises as a long wave asymptotic approximation of water waves, contains the Kadomtsev-Petviashvilli (KP) equation as a leading-order maximal balanced approximation. The question analyzed is how the Benney-Luke equation modifies the so-called web solutions of the KP equation. It is found that the Benney-Luke equation introduces dispersive radiation which breaks each of the symmetric soliton-like humps well away from the interaction region of the KP web solution into a tail of multi-peaked oscillating profiles behind the main solitary hump. Computation indicates that the wave structure is modified near the center of the interaction region. Both analytical and numerical techniques are employed for working with non-periodic, non-decaying solutions on unbounded domains.

Highly Accurate Analytical Approximate Solution to a Nonlinear Pseudo-Oscillator

NASA Astrophysics Data System (ADS)

Wu, Baisheng; Liu, Weijia; Lim, C. W.

2017-07-01

A second-order Newton method is presented to construct analytical approximate solutions to a nonlinear pseudo-oscillator in which the restoring force is inversely proportional to the dependent variable. The nonlinear equation is first expressed in a specific form, and it is then solved in two steps, a predictor and a corrector step. In each step, the harmonic balance method is used in an appropriate manner to obtain a set of linear algebraic equations. With only one simple second-order Newton iteration step, a short, explicit, and highly accurate analytical approximate solution can be derived. The approximate solutions are valid for all amplitudes of the pseudo-oscillator. Furthermore, the method incorporates second-order Taylor expansion in a natural way, and it is of significant faster convergence rate.

Linear and Nonlinear Response of a Rotating Tokamak Plasma to a Resonant Error-Field

NASA Astrophysics Data System (ADS)

Fitzpatrick, Richard

2014-10-01

An in-depth investigation of the effect of a resonant error-field on a rotating, quasi-cylindrical, tokamak plasma is preformed within the context of resistive-MHD theory. General expressions for the response of the plasma at the rational surface to the error-field are derived in both the linear and nonlinear regimes, and the extents of these regimes mapped out in parameter space. Torque-balance equations are also obtained in both regimes. These equations are used to determine the steady-state plasma rotation at the rational surface in the presence of the error-field. It is found that, provided the intrinsic plasma rotation is sufficiently large, the torque-balance equations possess dynamically stable low-rotation and high-rotation solution branches, separated by a forbidden band of dynamically unstable solutions. Moreover, bifurcations between the two stable solution branches are triggered as the amplitude of the error-field is varied. A low- to high-rotation bifurcation is invariably associated with a significant reduction in the width of the magnetic island chain driven at the rational surface, and vice versa. General expressions for the bifurcation thresholds are derived, and their domains of validity mapped out in parameter space. This research was funded by the U.S. Department of Energy under Contract DE-FG02-04ER-54742.

Modeling radium and radon transport through soil and vegetation

USGS Publications Warehouse

Kozak, J.A.; Reeves, H.W.; Lewis, B.A.

2003-01-01

A one-dimensional flow and transport model was developed to describe the movement of two fluid phases, gas and water, within a porous medium and the transport of 226Ra and 222Rn within and between these two phases. Included in this model is the vegetative uptake of water and aqueous 226Ra and 222Rn that can be extracted from the soil via the transpiration stream. The mathematical model is formulated through a set of phase balance equations and a set of species balance equations. Mass exchange, sink terms and the dependence of physical properties upon phase composition couple the two sets of equations. Numerical solution of each set, with iteration between the sets, is carried out leading to a set-iterative compositional model. The Petrov-Galerkin finite element approach is used to allow for upstream weighting if required for a given simulation. Mass lumping improves solution convergence and stability behavior. The resulting numerical model was applied to four problems and was found to produce accurate, mass conservative solutions when compared to published experimental and numerical results and theoretical column experiments. Preliminary results suggest that the model can be used as an investigative tool to determine the feasibility of phytoremediating radium and radon-contaminated soil. ?? 2003 Elsevier Science B.V. All rights reserved.

Comparative genomics reveals tissue-specific regulation of prolactin receptor gene expression

USDA-ARS?s Scientific Manuscript database

Prolactin (PRL), acting via the prolactin receptor, fulfills a diversity of biological functions including the maintenance of solute balance and mineral homeostasis via tissues such as the heart, kidneys and intestine. Expression and activity of the prolactin receptor (PRLR) is regulated by various ...

Leading Generative Groups: A Conceptual Model

ERIC Educational Resources Information Center

London, Manuel; Sobel-Lojeski, Karen A.; Reilly, Richard R.

2012-01-01

This article presents a conceptual model of leadership in generative groups. Generative groups have diverse team members who are expected to develop innovative solutions to complex, unstructured problems. The challenge for leaders of generative groups is to balance (a) establishing shared goals with recognizing members' vested interests, (b)…

The imbalanced surfing-life of humanity to survival in the global changes

NASA Astrophysics Data System (ADS)

Kontar, V. A.

2013-12-01

We have written many times about the imbalance of Nature as the cause of the global change. Here, we offer some method for the humanity survival in the face of global change of the imbalanced anisotropic real Nature. There are two logics of understanding the real Nature: the traditional balanced, and the new imbalanced. The balanced logic presupposes that Nature is balanced, isotropic, etc. The imbalanced logic presupposes opposite that Nature is imbalanced, anisotropic, etc. Respectively can be two styles of the people life: balanced and imbalanced. The image of the flat earth corresponds well with the balanced lifestyle of people. On the balanced life people spend activities to achieve the balance by reducing the change, stabilization, leveling any level changes, etc. If there is a mountain on the road, it must be align the track or make the tunnel. If there is a ravine on the road, then it need backfilled or to build a bridge. If someone is in restless, it must be calm, etc. As example of the happiness in the balanced life is the stability, balance, and therefore the global changes of Nature are perceived as a catastrophe. In the balanced lifestyle people can easily decide to use force, especially if there is not enough knowledge. But Nature has power which in billions times greater than the forces of humanity. Therefore, humanity will beaten in struggle with Nature and disappear. The imbalanced lifestyle is the fundamentally different. The imbalanced lifestyle complies with the surface of the ocean, which always changes, but sometimes can be and flat. But the flat calm ocean surface is inconvenient for the imbalanced life. You need to pull boat yourself because is no wind in the sails. The anisotropic imbalanced Nature has gradients in all parameters. At a certain level of knowledge and experience, people can use this multi-dimensional gradient essence of the real Nature for human's discretion. The imbalanced life is like a surfing. If properly understood Nature, you can find a route slip through the waves of Nature, which will bring closer the person to the desired goals. Of course, the changeable ocean is much more complicated than a flat surface. The imbalanced logic also is much more complex than the simplified balanced logic. As the calm ocean is like the flat surface, so same the balanced logic solutions are sometimes looks like as the truth, but only in the calm weather. At the normal ocean weather the balanced solutions are incorrect and mislead people. The river can be as image of the imbalanced surfing life. The river starts as small stream and running through all the obstacles to ocean. The water of river is flowing at the bottom of the potential trench of the Earth gravity and the Coriolis acceleration. For the imbalanced surfing life is most important not a steamroller of force, but the knowledge and perseverance in the search for the best path to the desirable goals. The example of happiness in the surfing imbalanced life can be joy from successfully usage the suitable trends of the anisotropic imbalanced real Nature. At the imbalanced surfing life should be the main guide: Nature doesn't have the bad weather. The global changes it is not catastrophe, but the normal state of the real anisotropic imbalanced Nature. Just everybody has to choose the weather which will be good for their personal surfing.

The incidence of thromboembolism formation following the use of recombinant factor VIIa in patients suffering from blunt force trauma compared with penetrating trauma: a systematic review.

PubMed

Devlin, Raymond; Bonanno, Laura; Badeaux, Jennifer

2016-03-01

Rapid replacement of blood loss is critical in patients suffering from traumatic hemorrhage. When the availability of blood products is limited, certain interventions have shown promise in conserving blood supplies. Recombinant factor (rF) VIIa has been administered, as an off-label use, to assist in controlling hemorrhage in trauma patients. Although rFVIIa has a tendency to remain localized to areas of vascular insult, there may be an increase in thromboembolism formation when patients suffer multiple sites of injury as seen in blunt force trauma. This review aimed to synthesize the best available evidence regarding the incidence of thromboembolism formation after receiving rFVIIa as an adjunct to hemorrhage control measures (standard resuscitation efforts consisting of varying amounts of packed red blood cells [PRBCs], fresh frozen plasma [FFP], platelets and crystalloid solutions) in patients suffering from traumatic injuries (blunt force and penetrating trauma). Civilian and combat trauma patients who were 15 years and older suffering from blunt force and penetrating traumatic injuries. Use of rFVIIa as an adjunct to hemorrhage control measures (standard resuscitation efforts consisting of varying amounts of PRBCs, FFP, platelets and crystalloid solutions). This review considered both experimental and epidemiological study designs. Confirmed formation of thromboembolism (confirmation based on specific diagnostic tests such as ultrasound, ventilation-perfusion scan or angiography). The databases searched included CINAHL, Ovid MEDLINE, Web of Science, EMBASE and the Cochrane Control Register of Clinical Trials. Studies published after June 1986 were considered for inclusion in this review. Search for unpublished studies was performed. Studies selected for inclusion were critically appraised by two independent reviewers using standardized critical appraisal instruments from the Joanna Briggs Institute (JBI). Data was extracted from articles using standardized data extraction instruments from the JBI. Quantitative results were pooled in statistical meta-analysis using the Joanna Briggs software for meta-analysis. Two studies with a total of 831 participants were included. Both the studies were randomized, placebo-controlled, double-blind trials. No studies of combat trauma patients met the inclusion criteria for this review. A meta-analysis was performed. In blunt force trauma patients, the incidence of thromboembolism formation on administering rFVIIa revealed an overall relative risk of 1.17 with a 95% confidence interval (CI) from 0.77 to 1.79; results not statistically significant (P = 0.4594); large CI and imprecise estimate. In penetrating trauma patients, the incidence of thromboembolism formation on administering rFVIIa revealed an overall relative risk of 0.77 with a 95% CI from 0.27 to 2.20; results not statistically significant (P = 0.6242); very large CI and imprecise estimate. The estimates of the effects are imprecise, results are compatible with effects in opposite directions, increase or decrease of thromboembolism formation, and an increase of thromboembolism formation cannot be excluded. When rFVIIa is administered to trauma patients, there does not appear to be an increased risk of thromboembolism formation favoring one type of injury over the other (blunt force versus penetrating trauma). Owing to large CIs and imprecise estimates, the overall risk of thromboembolism cannot be excluded. The use of rFVIIa does appear to decrease the overall need for blood products in trauma patients with no statistically significant improvement in survival rates. With the high cost of rFVIIa, its use is limited to those facilities that can afford it. In situations wherein blood supply is limited, rFVIIa could conserve limited supplies of blood products with no difference in thromboembolism risk between blunt force versus penetrating trauma, but the high cost will ultimately limit its use to facilities that can afford it. The use of rFVIIa in blunt force and penetrating trauma patients has a JBI Grade B Recommendation (Appendix I). This review excluded patients receiving pharmacologic anticoagulation such as warfarin sodium or heparin. The actions of these drugs will most likely counteract the desired coagulation effect of rFVIIa. Many studies do not account for the effects of rFVIIa in trauma patients receiving pharmacologic anticoagulation and this could be a future area of research.

GLOBAL PROPERTIES OF FULLY CONVECTIVE ACCRETION DISKS FROM LOCAL SIMULATIONS

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

Bodo, G.; Ponzo, F.; Rossi, P.

2015-08-01

We present an approach to deriving global properties of accretion disks from the knowledge of local solutions derived from numerical simulations based on the shearing box approximation. The approach consists of a two-step procedure. First, a local solution valid for all values of the disk height is constructed by piecing together an interior solution obtained numerically with an analytical exterior radiative solution. The matching is obtained by assuming hydrostatic balance and radiative equilibrium. Although in principle the procedure can be carried out in general, it simplifies considerably when the interior solution is fully convective. In these cases, the construction ismore » analogous to the derivation of the Hayashi tracks for protostars. The second step consists of piecing together the local solutions at different radii to obtain a global solution. Here we use the symmetry of the solutions with respect to the defining dimensionless numbers—in a way similar to the use of homology relations in stellar structure theory—to obtain the scaling properties of the various disk quantities with radius.« less

Ultrahigh-efficiency solution-processed simplified small-molecule organic light-emitting diodes using universal host materials

PubMed Central

Han, Tae-Hee; Choi, Mi-Ri; Jeon, Chan-Woo; Kim, Yun-Hi; Kwon, Soon-Ki; Lee, Tae-Woo

2016-01-01

Although solution processing of small-molecule organic light-emitting diodes (OLEDs) has been considered as a promising alternative to standard vacuum deposition requiring high material and processing cost, the devices have suffered from low luminous efficiency and difficulty of multilayer solution processing. Therefore, high efficiency should be achieved in simple-structured small-molecule OLEDs fabricated using a solution process. We report very efficient solution-processed simple-structured small-molecule OLEDs that use novel universal electron-transporting host materials based on tetraphenylsilane with pyridine moieties. These materials have wide band gaps, high triplet energy levels, and good solution processabilities; they provide balanced charge transport in a mixed-host emitting layer. Orange-red (~97.5 cd/A, ~35.5% photons per electron), green (~101.5 cd/A, ~29.0% photons per electron), and white (~74.2 cd/A, ~28.5% photons per electron) phosphorescent OLEDs exhibited the highest recorded electroluminescent efficiencies of solution-processed OLEDs reported to date. We also demonstrate a solution-processed flexible solid-state lighting device as a potential application of our devices. PMID:27819053

Analysis of biochemical phase shift oscillators by a harmonic balancing technique.

PubMed

Rapp, P

1976-11-25

The use of harmonic balancing techniques for theoretically investigating a large class of biochemical phase shift oscillators is outlined and the accuracy of this approximate technique for large dimension nonlinear chemical systems is considered. It is concluded that for the equations under study these techniques can be successfully employed to both find periodic solutions and to indicate those cases which can not oscillate. The technique is a general one and it is possible to state a step by step procedure for its application. It has a substantial advantage in producing results which are immediately valid for arbitrary dimension. As the accuracy of the method increases with dimension, it complements classical small dimension methods. The results obtained by harmonic balancing analysis are compared with those obtained by studying the local stability properties of the singular points of the differential equation. A general theorem is derived which identifies those special cases where the results of first order harmonic balancing are identical to those of local stability analysis, and a necessary condition for this equivalence is derived. As a concrete example, the n-dimensional Goodwin oscillator is considered where p, the Hill coefficient of the feedback metabolite, is equal to three and four. It is shown that for p = 3 or 4 and n less than or equal to 4 the approximation indicates that it is impossible to construct a set of physically permissible reaction constants such that the system possesses a periodic solution. However for n greater than or equal to 5 it is always possible to find a large domain in the reaction constant space giving stable oscillations. A means of constructing such a parameter set is given. The results obtained here are compared with previously derived results for p = 1 and p = 2.

[Kinetic theory and boundary conditions for highly inelastic spheres]. Quarterly progress report, April 1, 1993--June 30, 1993

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

Richman, M.

1993-12-31

In this quarter, a kinetic theory was employed to set up the boundary value problem for steady, fully developed, gravity-driven flows of identical, smooth, highly inelastic spheres down bumpy inclines. The solid fraction, mean velocity, and components of the full second moment of fluctuation velocity were treated as mean fields. In addition to the balance equations for mass and momentum, the balance of the full second moment of fluctuation velocity was treated as an equation that must be satisfied by the mean fields. However, in order to simplify the resulting boundary value problem, fluxes of second moments in its isotropicmore » piece only were retained. The constitutive relations for the stresses and collisional source of second moment depend explicitly on the second moment of fluctuation velocity, and the constitutive relation for the energy flux depends on gradients of granular temperature, solid fraction, and components of the second moment. The boundary conditions require that the flows are free of stress and energy flux at their tops, and that momentum and energy are balanced at the bumpy base. The details of the boundary value problem are provided. In the next quarter, a solution procedure will be developed, and it will be employed to obtain sample numerical solutions to the boundary value problem described here.« less

Geochemical investigation of weathering processes in a forested headwater catchment: Mass-balance weathering fluxes

USGS Publications Warehouse

Jones, B.F.; Herman, J.S.

2008-01-01

Geochemical research on natural weathering has often been directed towards explanations of the chemical composition of surface water and ground water resulting from subsurface water-rock interactions. These interactions are often defined as the incongruent dissolution of primary silicates, such as feldspar, producing secondary weathering products, such as clay minerals and oxyhydroxides, and solute fluxes (Meunier and Velde, 1979). The chemical composition of the clay-mineral product is often ignored. However, in earlier investigations, the saprolitic weathering profile at the South Fork Brokenback Run (SFBR) watershed, Shenandoah National Park, Virginia, was characterized extensively in terms of its mineralogical and chemical composition (Piccoli, 1987; Pochatila et al., 2006; Jones et al., 2007) and its basic hydrology. O'Brien et al. (1997) attempted to determine the contribution of primary mineral weathering to observed stream chemistry at SFBR. Mass-balance model results, however, could provide only a rough estimate of the weathering reactions because idealized mineral compositions were utilized in the calculations. Making use of detailed information on the mineral occurrence in the regolith, the objective of the present study was to evaluate the effects of compositional variation on mineral-solute mass-balance modelling and to generate plausible quantitative weathering reactions that support both the chemical evolution of the surface water and ground water in the catchment, as well as the mineralogical evolution of the weathering profile. ?? 2008 The Mineralogical Society.

Computer Simulation in Predicting Biochemical Processes and Energy Balance at WWTPs

NASA Astrophysics Data System (ADS)

Drewnowski, Jakub; Zaborowska, Ewa; Hernandez De Vega, Carmen

2018-02-01

Nowadays, the use of mathematical models and computer simulation allow analysis of many different technological solutions as well as testing various scenarios in a short time and at low financial budget in order to simulate the scenario under typical conditions for the real system and help to find the best solution in design or operation process. The aim of the study was to evaluate different concepts of biochemical processes and energy balance modelling using a simulation platform GPS-x and a comprehensive model Mantis2. The paper presents the example of calibration and validation processes in the biological reactor as well as scenarios showing an influence of operational parameters on the WWTP energy balance. The results of batch tests and full-scale campaign obtained in the former work were used to predict biochemical and operational parameters in a newly developed plant model. The model was extended with sludge treatment devices, including anaerobic digester. Primary sludge removal efficiency was found as a significant factor determining biogas production and further renewable energy production in cogeneration. Water and wastewater utilities, which run and control WWTP, are interested in optimizing the process in order to save environment, their budget and decrease the pollutant emissions to water and air. In this context, computer simulation can be the easiest and very useful tool to improve the efficiency without interfering in the actual process performance.

Importance of the effective strong ion difference of an intravenous solution in the treatment of diarrheic calves with naturally acquired acidemia and strong ion (metabolic) acidosis.

PubMed

Müller, K R; Gentile, A; Klee, W; Constable, P D

2012-01-01

The effect of sodium bicarbonate on acid-base balance in metabolic acidosis is interpreted differently by Henderson-Hasselbalch and strong ion acid-base approaches. Application of the traditional bicarbonate-centric approach indicates that bicarbonate administration corrects the metabolic acidosis by buffering hydrogen ions, whereas strong ion difference theory indicates that the co-administration of the strong cation sodium with a volatile buffer (bicarbonate) corrects the strong ion acidosis by increasing the strong ion difference (SID) in plasma. To investigate the relative importance of the effective SID of IV solutions in correcting acidemia in calves with diarrhea. Twenty-two Holstein-Friesian calves (4-21 days old) with naturally acquired diarrhea and strong ion (metabolic) acidosis. Calves were randomly assigned to IV treatment with a solution of sodium bicarbonate (1.4%) or sodium gluconate (3.26%). Fluids were administered over 4 hours and the effect on acid-base balance was determined. Calves suffered from acidemia owing to moderate to strong ion acidosis arising from hyponatremia and hyper-D-lactatemia. Sodium bicarbonate infusion was effective in correcting the strong ion acidosis. In contrast, sodium gluconate infusion did not change blood pH, presumably because the strong anion gluconate was minimally metabolized. A solution containing a high effective SID (sodium bicarbonate) is much more effective in alkalinizing diarrheic calves with strong ion acidosis than a solution with a low effective SID (sodium gluconate). Sodium gluconate is ineffective in correcting acidemia, which can be explained using traditional acid-base theory but requires a new parameter, effective SID, to be understood using the strong ion approach. Copyright © 2012 by the American College of Veterinary Internal Medicine.

An approximate solution for a penny-shaped hydraulic fracture that accounts for fracture toughness, fluid viscosity and leak-off.

PubMed

Dontsov, E V

2016-12-01

This paper develops a closed-form approximate solution for a penny-shaped hydraulic fracture whose behaviour is determined by an interplay of three competing physical processes that are associated with fluid viscosity, fracture toughness and fluid leak-off. The primary assumption that permits one to construct the solution is that the fracture behaviour is mainly determined by the three-process multiscale tip asymptotics and the global fluid volume balance. First, the developed approximation is compared with the existing solutions for all limiting regimes of propagation. Then, a solution map, which indicates applicability regions of the limiting solutions, is constructed. It is also shown that the constructed approximation accurately captures the scaling that is associated with the transition from any one limiting solution to another. The developed approximation is tested against a reference numerical solution, showing that accuracy of the fracture width and radius predictions lie within a fraction of a per cent for a wide range of parameters. As a result, the constructed approximation provides a rapid solution for a penny-shaped hydraulic fracture, which can be used for quick fracture design calculations or as a reference solution to evaluate accuracy of various hydraulic fracture simulators.

An approximate solution for a penny-shaped hydraulic fracture that accounts for fracture toughness, fluid viscosity and leak-off

NASA Astrophysics Data System (ADS)

Dontsov, E. V.

2016-12-01

This paper develops a closed-form approximate solution for a penny-shaped hydraulic fracture whose behaviour is determined by an interplay of three competing physical processes that are associated with fluid viscosity, fracture toughness and fluid leak-off. The primary assumption that permits one to construct the solution is that the fracture behaviour is mainly determined by the three-process multiscale tip asymptotics and the global fluid volume balance. First, the developed approximation is compared with the existing solutions for all limiting regimes of propagation. Then, a solution map, which indicates applicability regions of the limiting solutions, is constructed. It is also shown that the constructed approximation accurately captures the scaling that is associated with the transition from any one limiting solution to another. The developed approximation is tested against a reference numerical solution, showing that accuracy of the fracture width and radius predictions lie within a fraction of a per cent for a wide range of parameters. As a result, the constructed approximation provides a rapid solution for a penny-shaped hydraulic fracture, which can be used for quick fracture design calculations or as a reference solution to evaluate accuracy of various hydraulic fracture simulators.

Recycle of Inorganic Nutrients for Hydroponic Crop Production Following Incineration of Inedible Biomass

NASA Technical Reports Server (NTRS)

Bubenheim, David L.; Wignarajah, Kanapathipillai; Kliss, Mark H. (Technical Monitor)

1996-01-01

Recovery of resources from waste streams is essential for future implementation and reliance on a regenerative life support system. The major waste streams of concern are from human activities and plant wastes. Carbon, water and inorganics are the primary desired raw materials of interest. The goal of resource recovery is maintenance of product quality to insure support of reliable and predictable levels of life support function performance by the crop plant component. Further, these systems must be maintained over extended periods of time, requiring maintenance of nutrient solutions to avoid toxicity and deficiencies. Today, reagent grade nutrients are used to make nutrient solutions for hydroponic culture and these solutions are frequently changed during the life cycle or sometimes managed for only one crop life cycle. The focus of this study was to determine the suitability of the ash product following incineration of inedible biomass as a source of inorganic nutrients for hydroponic crop production. Inedible wheat biomass was incinerated and ash quality characterized. The incinerator ash was dissolved in adequate nitric acid to establish a consistent nitrogen concentration in all nutrient solution treatments. Four experimental nutrient treatments were included: control, ash only, ash supplemented to match control, and ash only quality formulated with reagent grade chemicals. When nutrient solutions are formulated using only ash following-incineration of inedible biomass, a balance in solution is established representing elemental retention following incineration and nutrient proportions present in the original biomass. The resulting solution is not identical to the control. This imbalance resulted in suppression of crop growth. When the ash is supplemented with nutrients to establish the same balance as in the control, growth is identical to the control. The ash appears to carry no phytotoxic materials. Growth in solution formulated with reagent grade chemicals but matching the quality of the ash only treatment resulted in growth similar to that of the ash only treatment. The ash product resulting from incineration of inedible biomass appears to be a suitable form for recycle of inorganic nutrients to crop production.

Solubility of Plutonium (IV) Oxalate During Americium/Curium Pretreatment

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

Rudisill, T.S.

1999-08-11

Approximately 15,000 L of solution containing isotopes of americium and curium (Am/Cm) will undergo stabilization by vitrification at the Savannah River Site (SRS). Prior to vitrification, an in-tank pretreatment will be used to remove metal impurities from the solution using an oxalate precipitation process. Material balance calculations for this process, based on solubility data in pure nitric acid, predict approximately 80 percent of the plutonium in the solution will be lost to waste. Due to the uncertainty associated with the plutonium losses during processing, solubility experiments were performed to measure the recovery of plutonium during pretreatment and a subsequent precipitationmore » process to prepare a slurry feed for a batch melter. A good estimate of the plutonium content of the glass is required for planning the shipment of the vitrified Am/Cm product to Oak Ridge National Laboratory (ORNL).The plutonium solubility in the oxalate precipitation supernate during pretreatment was 10 mg/mL at 35 degrees C. In two subsequent washes with a 0.25M oxalic acid/0.5M nitric acid solution, the solubility dropped to less than 5 mg/mL. During the precipitation and washing steps, lanthanide fission products in the solution were mostly insoluble. Uranium, and alkali, alkaline earth, and transition metal impurities were soluble as expected. An elemental material balance for plutonium showed that greater than 94 percent of the plutonium was recovered in the dissolved precipitate. The recovery of the lanthanide elements was generally 94 percent or higher except for the more soluble lanthanum. The recovery of soluble metal impurities from the precipitate slurry ranged from 15 to 22 percent. Theoretically, 16 percent of the soluble oxalates should have been present in the dissolved slurry based on the dilution effects and volumes of supernate and wash solutions removed. A trace level material balance showed greater than 97 percent recovery of americium-241 (from the beta dec ay of plutonium-241) in the dissolved precipitate, a value consistent with the recovery of europium, the americium surrogate.In a subsequent experiment, the plutonium solubility following an oxalate precipitation to simulate the preparation of a slurry feed for a batch melter was 21 mg/mL at 35 degrees C. The increase in solubility compared to the value measured during the pretreatment experiment was attributed to the increased nitrate concentration and ensuing increase in plutonium complexation. The solubility of the plutonium following a precipitant wash with 0.1M oxalic acid was unchanged. The recovery of plutonium from the precipitate slurry was greater than 97 percent allowing an estimation that approximately 92 percent of the plutonium in Tank 17.1 will report to the glass. The behavior of the lanthanides and soluble metal impurities was consistent with the behavior seen during the pretreatment experiment. A trace level material balance showed that 99.9 percent of the americium w as recovered from the precipitate slurry. The overall recovery of americium from the pretreatment and feed preparation processes was greater than 97 percent, which was consistent with the measured recovery of the europium surrogate.« less

Energetics of slope flows: linear and weakly nonlinear solutions of the extended Prandtl model

NASA Astrophysics Data System (ADS)

Güttler, Ivan; Marinović, Ivana; Večenaj, Željko; Grisogono, Branko

2016-07-01

The Prandtl model succinctly combines the 1D stationary boundary-layer dynamics and thermodynamics of simple anabatic and katabatic flows over uniformly inclined surfaces. It assumes a balance between the along-the-slope buoyancy component and adiabatic warming/cooling, and the turbulent mixing of momentum and heat. In this study, energetics of the Prandtl model is addressed in terms of the total energy (TE) concept. Furthermore, since the authors recently developed a weakly nonlinear version of the Prandtl model, the TE approach is also exercised on this extended model version, which includes an additional nonlinear term in the thermodynamic equation. Hence, interplay among diffusion, dissipation and temperature-wind interaction of the mean slope flow is further explored. The TE of the nonlinear Prandtl model is assessed in an ensemble of solutions where the Prandtl number, the slope angle and the nonlinearity parameter are perturbed. It is shown that nonlinear effects have the lowest impact on variability in the ensemble of solutions of the weakly nonlinear Prandtl model when compared to the other two governing parameters. The general behavior of the nonlinear solution is similar to the linear solution, except that the maximum of the along-the-slope wind speed in the nonlinear solution reduces for larger slopes. Also, the dominance of PE near the sloped surface, and the elevated maximum of KE in the linear and nonlinear energetics of the extended Prandtl model are found in the PASTEX-94 measurements. The corresponding level where KE>PE most likely marks the bottom of the sublayer subject to shear-driven instabilities. Finally, possible limitations of the weakly nonlinear solutions of the extended Prandtl model are raised. In linear solutions, the local storage of TE term is zero, reflecting the stationarity of solutions by definition. However, in nonlinear solutions, the diffusion, dissipation and interaction terms (where the height of the maximum interaction is proportional to the height of the low-level jet by the factor ≈4/9) do not balance and the local storage of TE attains non-zero values. In order to examine the issue of non-stationarity, the inclusion of velocity-pressure covariance in the momentum equation is suggested for future development of the extended Prandtl model.

Beyond wilderness: Broadening the applicability of limits of acceptable change

Treesearch

Mark W. Brunson

1977-01-01

The Limits of Acceptable Change (LAC) process helps managers preserve wilderness attributes along with recreation opportunities. Ecosystem management likewise requires managers to balance societal and ecosystem needs. Both are more likely to succeed through collaborative planning. Consequently, LAC can offer a conceptual framework for achieving sustainable solutions...

Pathways to Safety

ERIC Educational Resources Information Center

Kennedy, Mike

2006-01-01

Education administrators have many tools available to them as they strive to establish a safe climate for learning, but no one strategy or piece of equipment is a magic solution that keeps potential trouble beyond the campus boundaries. Creating and maintaining a safe and secure school environment requires a balance of many strategies: (1)…

A CASE STUDY IN RISK MANAGEMENT ISSUES: PERCHLORATE IN POTABLE WATER

EPA Science Inventory

Risk management brings together many issues. While some of these are scientific in nature, many come down to policy and even emotion. As a result, striking a balance among competing objectives can be difficult. This is especially true when problems are localized or solutions are ...

The Mole Concept

ERIC Educational Resources Information Center

Duncan, I. M.; Johnstone, A. H.

1973-01-01

Reports a study of difficulties encountered by 14.5- to 15.0- year-old children in learning the mole concept with a programed instruction. Concludes that three respective disturbing factors were embedded in manipulation of molarity of solutions, balancing equations, and misapprehension that one mole of a compound always reacts with one mole of…

Stability of strongly nonlinear normal modes

NASA Astrophysics Data System (ADS)

Recktenwald, Geoffrey; Rand, Richard

2007-10-01

It is shown that a transformation of time can allow the periodic solution of a strongly nonlinear oscillator to be written as a simple cosine function. This enables the stability of strongly nonlinear normal modes in multidegree of freedom systems to be investigated by standard procedures such as harmonic balance.

Lesson 3: A Case Study of Mountain Tourism in Vietnam.

ERIC Educational Resources Information Center

Byers, Alton; Gilligan, Nancy; Golston, Syd; Linville, Rex

1999-01-01

Presents a lesson in which students examine the characteristics of successful and unsuccessful tourism development projects in mountains by utilizing the included list of websites. Expounds that, based on their search of the websites, the students propose solutions for maintaining a balance among environmental conservation, cultural advancement,…

Effects of ultralow oxygen and vacuum treatments on bed bug (Heteroptera: Cimicidae) survival

USDA-ARS?s Scientific Manuscript database

Control of bed bugs has always been problematic, balancing among efficacy, safety, and cost. In this study, ultralow oxygen (ULO) and vacuum treatments were tested on bed bugs to develop a safer, effective, and environmental friendly solution to bed bug infestations. ULO treatments were establishe...

Training Spaces

ERIC Educational Resources Information Center

Weinstein, Margery

2010-01-01

Creating a balanced learning space for employees is about more than trying different types of seating. It is a challenge that an affect how well employees absorb the lessons and whether they will be able to product better results for the company. The possible solutions are as diverse as the learners. This article describes how three companies…

Reading and Writing Journals: Balancing Skills and Humanities in the English Classroom.

ERIC Educational Resources Information Center

Pezzulich, Evelyn

Interdepartmental rivalries between literature instruction and composition instruction have contributed to viewing reading and writing as disconnected activities. One solution to this divisiveness is a course in "the journal as a literary tradition," which combines reading and writing in equal portions. Students first learn about the…