Research on CPFR pattern of the Internet of things based on B2C

NASA Astrophysics Data System (ADS)

Zhou, Ling; Yang, Jie

2013-03-01

The CPFR pattern proposed by this article is based on the internet of things platform, using frontier technology of internet of things to realize real-time monitoring and the feedback in logistics, information stream in B2C mode, and simultaneously construct an e-business mode which takes the customer guidance as the center to be possible to meet the customers' need and realize the service made by customer. This new pattern uses the coordination, plan, prediction and replenishment of CPFR to realize custom-made stock based on B2C for terminal customer and specialized service for commodity stock. Moreover, it can bring suppliers real-time monitoring of terminal logistics, storage and users' notes for use, and feed back users' bugs, adjustment of orders and plan of replenishment. Furthermore, based on new pattern, we can data min users' interests and undertake a study in increment modeling, process reengineering in enterprise, optimizing enterprise's interior resources and conformity industry of supply chain. Above all it provides a new mentality and the operation pattern for the electronic commerce marketing.

Gamma ray spectroscopy monitoring method and apparatus

DOEpatents

Stagg, William R; Policke, Timothy A

2017-05-16

The present invention relates generally to the field of gamma ray spectroscopy monitoring and a system for accomplishing same to monitor one or more aspects of various isotope production processes. In one embodiment, the present invention relates to a monitoring system, and method of utilizing same, for monitoring one or more aspects of an isotope production process where the monitoring system comprises: (A) at least one sample cell; (B) at least one measuring port; (C) at least one adjustable collimator device; (D) at least one shutter; and (E) at least one high resolution gamma ray spectrometer.

Regional variations in frequency of glycosylated hemoglobin (HbA1c) monitoring in Korea: A multilevel analysis of nationwide data.

PubMed

Yoo, Kyoung-Hun; Shin, Dong-Wook; Cho, Mi-Hee; Kim, Sang-Hyuck; Bahk, Hyun-Jung; Kim, Shin-Hye; Jeong, Su-Min; Yun, Jae-Moon; Park, Jin-Ho; Kim, Heesun; Cho, BeLong

2017-09-01

Suboptimal frequency of glycosylated hemoglobin (HbA1c) monitoring is associated with poor diabetes control. We aimed to analyze compliance to HbA1c testing guidelines and explore associated individual and area-level determinants, focusing on regional variation. This cross-sectional study between the period of 2012-2013 was conducted by using the Korean National Health Insurance Research Database, and included 45,634 patients diagnosed with diabetes mellitus, who were prescribed any anti-diabetic medications, including insulin. We calculated the proportion of each HbA1c testing frequency (≥1, ≥2, or ≥4 times per year) stratified by 17 administrative regions. Multilevel and multivariate logistic analyses were performed with regional (proportion of farmer population) and individual characteristics (age, sex, income level, duration of diabetes, and most visited medical institution). Overall, 67.3% of the patients received≥1 HbA1c test per year; 37.8% and 6.1% received ≥2 and ≥4 tests per year, respectively. Those managed in secondary-level hospitals or clinics and those living in rural areas were less likely to receive HbA1c testing. Even after adjusting for individual and regional level characteristics, significant area level variation was observed (variance participant coefficients were 7.91%, 9.58%, and 14.43% for testing frequencies of ≥1, ≥2, and ≥4 times a year, respectively). The frequency of HbA1c monitoring is suboptimal in Korea, especially in rural areas. Moreover, significant regional variation was observed, implying a contextual effect. This suggests the need for developing policy actions to improve HbA1c monitoring. In particular, access to HbA1c testing in rural primary care clinics must be improved. Copyright © 2017 Elsevier B.V. All rights reserved.

Effect of prandial treatment timing adjustment, based on continuous glucose monitoring, in patients with type 2 diabetes uncontrolled with once-daily basal insulin: A randomized, phase IV study.

PubMed

Ilany, Jacob; Bhandari, Hamad; Nabriski, Dan; Toledano, Yoel; Konvalina, Noa; Cohen, Ohad

2018-05-01

To evaluate the glycaemic control achieved by prandial once-daily insulin glulisine injection timing adjustment, based on a continuous glucose monitoring sensor, in comparison to once-daily insulin glulisine injection before breakfast in patients with type 2 diabetes who are uncontrolled with once-daily basal insulin glargine. This was a 24-week open-label, randomized, controlled, multicentre trial. At the end of an 8-week period of basal insulin optimization, patients with HbA1c ≥ 7.5% and FPG < 130 mg/dL were randomized (1:1) to either arm A (no sensor) or arm B (sensor) to receive 16-week intensified prandial glulisine treatment. Patients in arm A received pre-breakfast glulisine, and patients in arm B received glulisine before the meal with the highest glucose elevation based on sensor data. The primary outcome was mean HbA1c at week 24 and secondary outcomes included rates of hypoglycaemic events and insulin dosage. A total of 121 patients were randomized to arm A (n = 61) or arm B (n = 60). There was no difference in mean HbA1c at week 24 between arms A and B (8.5% ± 1.2% vs 8.4% ± 1.0%; P = .66). The prandial insulin glulisine dosage for arm A and arm B was 9.3 and 10.1 units, respectively (P = .39). The frequency of hypoglycaemic events did not differ between study arms (36.1% vs 51.7%; P = .08). Using a CGM sensor to identify the meal with the highest glucose excursion and adjusting the timing of prandial insulin treatment did not show any advantage in terms of glycaemic control or safety in our patients. © 2018 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

An educational program for insulin self-adjustment associated with structured self-monitoring of blood glucose significantly improves glycemic control in patients with type 2 diabetes mellitus after 12 weeks: a randomized, controlled pilot study.

PubMed

Silva, Daniel Dutra Romualdo; Bosco, Adriana Aparecida

2015-01-01

Self-monitoring of blood glucose (SMBG) has been recommended as a useful tool for improving glycemic control, but is still an underutilized strategy and most diabetic patients are not aware of the actions that must be taken in response to its results and do not adjust their treatment. The purpose of this study was to evaluate the effectiveness and safety of an educational program for insulin self-adjustment based on SMBG in poorly controlled patients with type 2 diabetes (T2DM). A prospective, randomized, controlled 12-week intervention study was conducted on poorly controlled insulin-requiring patients with T2DM. Twenty-three subjects were randomized to two educational programs: a 2-week basic program with guidance about SMBG and types and techniques of insulin administration (group A, n = 12) and a 6-week program including the basic one and additional instructions about self-titration of insulin doses according to a specific protocol (group B, n = 11). Patients were reviewed after 12 weeks and baseline to endpoint changes in glycated hemoglobin (A1C), insulin doses, body weight and incidence of hypoglycemia were compared by paired and independent Student t-tests. After 12 weeks, there was a significant reduction in A1C only in group B, but group comparison showed no significant difference (p = 0.051). A higher percentage of subjects in group B achieved an A1C near the treatment target (<7.5%) than in group A. Daily insulin dose increased non-significantly in the two groups and there was no significant difference in the incidence of hypoglycemia or body weight changes between groups. Training for self-titrating insulin doses combined with structured SMBG can safely improve glycemic control in poorly controlled insulin-treated T2DM patients. This strategy may facilitate effective insulin therapy in routine medical practice, compensating for any reluctance on the part of physicians to optimize insulin therapy and thus to improve the achievement of recommended targets of diabetes care.

Discriminative power of Campylobacter phenotypic and genotypic typing methods.

PubMed

Duarte, Alexandra; Seliwiorstow, Tomasz; Miller, William G; De Zutter, Lieven; Uyttendaele, Mieke; Dierick, Katelijne; Botteldoorn, Nadine

2016-06-01

The aim of this study was to compare different typing methods, individually and combined, for use in the monitoring of Campylobacter in food. Campylobacter jejuni (n=94) and Campylobacter coli (n=52) isolated from different broiler meat carcasses were characterized using multilocus sequence typing (MLST), flagellin gene A restriction fragment length polymorphism typing (flaA-RFLP), antimicrobial resistance profiling (AMRp), the presence/absence of 5 putative virulence genes; and, exclusively for C. jejuni, the determination of lipooligosaccharide (LOS) class. Discriminatory power was calculated by the Simpson's index of diversity (SID) and the congruence was measured by the adjusted Rand index and adjusted Wallace coefficient. MLST was individually the most discriminative typing method for both C. jejuni (SID=0.981) and C. coli (SID=0.957). The most discriminative combination with a SID of 0.992 for both C. jejuni and C. coli was obtained by combining MLST with flaA-RFLP. The combination of MLST with flaA-RFLP is an easy and feasible typing method for short-term monitoring of Campylobacter in broiler meat carcass. Copyright © 2016 Elsevier B.V. All rights reserved.

Relationship of glycated hemoglobin, and fasting and postprandial hyperglycemia in type 2 diabetes mellitus patients in Malaysia.

PubMed

Lim, Lee Ling; Brnabic, Alan Jm; Chan, Siew Pheng; Ibrahim, Luqman; Paramasivam, Sharmila Sunita; Ratnasingam, Jeyakantha; Vethakkan, Shireene Ratna; Tan, Alexander Tong Boon

2017-07-01

Studies on the relative contributions of fasting and postprandial hyperglycemia (FH and PPH) to glycated hemoglobin (HbA 1c ) in patients with type 2 diabetes have yielded inconsistent results. We aimed to assess the relationship by using continuous glucose monitoring in a multi-ethnic cohort. A total of 100 adults with type 2 diabetes were assessed with 6-day continuous glucose monitoring and HbA 1c . Area under the curve (AUC) ≥5.6 mmol/L was defined as AUC TOTAL . AUC equal to or greater than each preprandial glucose for 4-h duration was defined as AUC PPH . The total PPH (AUC TPPH ) was the sum of the various AUC PPH . The postprandial contribution to overall hyperglycemia was calculated as (AUC TPPH / AUC TOTAL ) × 100%. The present study comprised of Malay, Indian, and Chinese type 2 diabetes patients at 34, 34 and 28% respectively. Overall, the mean PPH significantly decreased as HbA 1c advanced (mixed model repeated measures adjusted, beta-estimate = -3.0, P = 0.009). Age (P = 0.010) and hypoglycemia (P = 0.006) predicted the contribution difference. In oral antidiabetic drug-treated patients (n = 58), FH contribution increased from 54% (HbA 1c 6-6.9%) to 67% (HbA 1c ≥10%). FH predominance was significant in poorly-controlled groups (P = 0.028 at HbA 1c 9-9.9%; P = 0.015 at HbA 1c ≥10%). Among insulin users (n = 42), FH predominated when HbA 1c was ≥10% before adjustment for hypoglycemia (P = 0.047), whereas PPH was numerically greater when HbA 1c was <8%. FH and PPH contributions were equal in well-controlled Malaysian type 2 diabetes patients in real-world practice. FH predominated when HbA 1c was ≥9 and ≥10% in oral antidiabetic drug- and insulin-treated patients, respectively. A unique observation was the greater PPH contribution when HbA 1c was <8% despite the use of basal and mealtime insulin in this multi-ethnic cohort, which required further validation. © 2016 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

Harmonizing Landsat and Sentinel-2 Reflectances for Better Land Monitoring

NASA Technical Reports Server (NTRS)

Masek, Jeffrey; Vermote, Eric; Franch, Belen; Roger, Jean-Claude; Skakun, Sergii; Claverie, Martin; Dungan, Jennifer

2016-01-01

When combined, Landsat and ESA Sentinel-2 observations can provide 2-4 day coverage for the global land area. A collaboration among NASA GSFC (Goddard Space Flight Center), University of Maryland, and NASA Ames has developed a processing chain to create seamless, "harmonized" reflectance products using standardized atmospheric correction, BRDF (Bidirectional Reflectance Distribution Function) adjustment, spectral bandpass adjustment, and gridding algorithms. These products point the way to a "30-m MODIS (Moderate Resolution Imaging Spectroradiometer)" capability for agricultural and ecosystem monitoring by leveraging international sensors.

Improving the Quality of Outpatient Diabetes Care Using an Information Management System

PubMed Central

Weissmann, Joerg; Mueller, Angelika; Messinger, Diethelm; Parkin, Christopher G.; Amann-Zalan, Ildiko

2015-01-01

Background: This study aimed to evaluate the effects of information management system (IMS) use with individuals with type 1 and type 2 diabetes who were treated in outpatient settings. Methods: In this 7-month, prospective, observational study, 965 adults with diabetes, mean (SD) baseline HbA1c 8.61(1.2)% (70.6[13.1] mmol/mol), were recruited from 132 outpatient care centers in Germany and Denmark. HbA1c was measured at baseline, month 4, and month 7. IMS reports were generated from uploaded self-monitored blood glucose data and therapy adjustments were documented at months 1 and 4. Hypoglycemic events were documented. Results: Mean (SD) HbA1c decreased from baseline in type 1 and type 2 diabetes patients at month 4 (–0.61[1.03]% (–6.7[11.3] mmol/mol), n = 213; –0.88[1.22]% (–9.6[13.3] mmol/mol), n = 589, respectively) and month 7 (–0.64[1.02]% (–7.0[11.1] mmol/mol), n = 219; –0.93[1.27]% (–10.2[13.9] mmol/mol), n = 594, respectively), all P < .0001, with no increase in hypoglycemic events. Therapy was adjusted in 106(42.7)% type 1 and 349(52.4)% type 2 diabetes patients at months 1 and 105(42.3)% type 1 and 282(42.3)% type 2 diabetes patients at month 4. Physicians used IMS reports to make therapy adjustments in 90% of patients at month 1 and 86% of patients at month 4. Conclusions: Integration of the IMS into outpatient care facilitates significant improvements in glycemic control. PMID:26224760

Improving the Quality of Outpatient Diabetes Care Using an Information Management System: Results From the Observational VISION Study.

PubMed

Weissmann, Joerg; Mueller, Angelika; Messinger, Diethelm; Parkin, Christopher G; Amann-Zalan, Ildiko

2015-07-29

This study aimed to evaluate the effects of information management system (IMS) use with individuals with type 1 and type 2 diabetes who were treated in outpatient settings. In this 7-month, prospective, observational study, 965 adults with diabetes, mean (SD) baseline HbA1c 8.61(1.2)% (70.6[13.1] mmol/mol), were recruited from 132 outpatient care centers in Germany and Denmark. HbA1c was measured at baseline, month 4, and month 7. IMS reports were generated from uploaded self-monitored blood glucose data and therapy adjustments were documented at months 1 and 4. Hypoglycemic events were documented. Mean (SD) HbA1c decreased from baseline in type 1 and type 2 diabetes patients at month 4 (-0.61[1.03]% (-6.7[11.3] mmol/mol), n = 213; -0.88[1.22]% (-9.6[13.3] mmol/mol), n = 589, respectively) and month 7 (-0.64[1.02]% (-7.0[11.1] mmol/mol), n = 219; -0.93[1.27]% (-10.2[13.9] mmol/mol), n = 594, respectively), all P < .0001, with no increase in hypoglycemic events. Therapy was adjusted in 106(42.7)% type 1 and 349(52.4)% type 2 diabetes patients at months 1 and 105(42.3)% type 1 and 282(42.3)% type 2 diabetes patients at month 4. Physicians used IMS reports to make therapy adjustments in 90% of patients at month 1 and 86% of patients at month 4. Integration of the IMS into outpatient care facilitates significant improvements in glycemic control. © 2015 Diabetes Technology Society.

Implementation of telehealth support for patients with type 2 diabetes using insulin treatment: an exploratory study.

PubMed

Turner, Jane; Larsen, Mark; Tarassenko, Lionel; Neil, Andrew; Farmer, Andrew

2009-01-01

Initiating and adjusting insulin treatment for people with type 2 diabetes (T2D) requires frequent clinician contacts both face-to-face and by telephone. We explored the use of a telehealth system to offer additional support to these patients. Twenty-three patients with uncontrolled T2D were recruited from nine general practices to assess the feasibility and acceptability of telehealth monitoring and support for insulin initiation and adjustment. The intervention included a standard algorithm for self-titration of insulin dose, a Bluetooth enabled glucose meter linked to a mobile phone, an integrated diary to record insulin dose, feedback of charted blood glucose data and telehealth nurse review with telephone follow-up. Additional contact with patients was initiated when no readings were transmitted for >3 days or when persistent hyper- or hypoglycaemia was identified. Reponses of patients and clinicians to the system were assessed informally. The mean (SD) patient age was 58 years (12) with 78% male. The mean (SD) diabetes duration was 6.4 years (4.5), HbA1c at baseline was 9.5% (2.2), and the decrease in HbA1c at three months was 0.52% (0.91) with an insulin dose increase of 9 units (26). A mean (SD) of 160 (93) blood glucose readings was transmitted per patient in these three months. Practice nurses and general practitioners (GPs) viewed the technology as having the potential to improve patient care. Most patients were able to use the equipment with training and welcomed review of their blood glucose readings by a telehealth nurse. Although the concept of telehealth monitoring is unfamiliar to most patients and practice nurses, the technology improved the support available for T2D patients commencing insulin treatment.

Simulation and Real-Time Verification of Video Algorithms on the TI C6400 Using Simulink

DTIC Science & Technology

2004-08-20

SPONSOR/MONITOR’S ACRONYM(S) 11. SPONSOR/MONITOR’S REPORT NUMBER(S) 12 . DISTRIBUTION/AVAILABILITY STATEMENT Approved for public release...plot estimates over time (scrolling data) Adjust detection threshold (click mouse on graph) Monitor video capture Input video frames Captured frames 12 ...Video App: Surveillance Recording 1 2 7 3 4 9 5 6 11 SL for video Explanation of GUI 12 Target Options8 Build Process 10 13 14 15 16 M-code snippet

Strain Analysis in Horizontal Geodetic Network of Dams for Control of Stability and Monitoring Deformation

NASA Astrophysics Data System (ADS)

Roohi, S.; Ardalan, A. A.; Khodakarami, M.

2009-04-01

Dams as one of the engineering structures play very important role in human life. Because, from primary human needs such as providing drinking water to professional needs such as water powerhouse creation in order to provide power for industrial centers, hospitals, manufactures and agriculture, have considerable dependent on dams. In addition destruction of a dam can be as dangerous as earthquake. Therefore maintenance, stability control and monitoring deformation of them is indispensable. In order to control stability of dams and their around lands and monitoring deformation a network is created by surveyor, geologist and dam experts on crest and body of dam or on land near the dam. Geodetic observations are done in this network by precise surveying instrument in deferent time then by using linear least square parametric adjustment method, adjusted coordinates with their variance- covariance matrix and error ellipses, redundancy numbers for observation, blunders and … are estimated in each epoch. Then displacement vectors are computed in each point of network, After that by use of Lagrangeian deformation idea and constitution of deformation equations movement, displacement model is determined and strain tensor is computed. we can induce deformation information from strain tensor in different ways such as strain ellipse then interpret deformation that happen in each point of network. Also we can compute rigid rotation from anti-symmetric part of displacement gradient tensor. After processing tow consequence epochs observations of horzontal geodetic network of Hnna dam in southwest of Esfahan, the most semi-major axis of error ellipse is estimated about 0.9mm for point D10, largest displacement is 1.4mm for point C3 that it's semimajor axis of displacement error ellipse is 1.3mm and there is different shear in all of network points exceptional points D2,C3 and C2. There is different dilatation in most of points. These amount of maximum shear and dilatation are justified because of horizontal displacement and subsidence of dam due to pressure of water that conserve behind it. Key word: strain tensor, monitoring deformation, Geodetic network, deformation equation movement, error ellipse, strain ellipse, shear, dilatation

Glycaemic control and self-management behaviours in Type 2 diabetes: results from a 1-year longitudinal cohort study.

PubMed

Houle, J; Beaulieu, M-D; Chiasson, J-L; Lespérance, F; Côté, J; Strychar, I; Bherer, L; Meunier, S; Lambert, J

2015-09-01

To better understand the associations between changes in self-management behaviours and glycaemic control. We conducted a prospective observational study of 295 adult patients with Type 2 diabetes evaluated at baseline, 6 and 12 months. Four self-management behaviours were evaluated using the Summary of Diabetes Self-Care Activities instrument, which assesses healthy diet, physical activity, medication taking and self-monitoring of blood glucose. Using hierarchical linear regression models, we tested whether changes in self-management behaviours were associated with short-term (6-month) or long-term (12-month) changes in glycaemic control, after controlling for demographic and clinical characteristics. Improved diet was associated with a decrease in HbA1c level, both at 6 and 12 months. Improved medication taking was associated with short-term improvement in glycaemic control, while increased self-monitoring of blood glucose frequency was associated with a 12-month improvement in HbA1c . Completely stopping exercise after being physically active at baseline was associated with a rise in HbA1c level at 6-month follow-up. Interaction analysis indicated that a healthy diet benefitted all participant subgroups, but that medication taking was associated with glycaemic control only for participants living in poverty and more strongly for those with lower educational levels. Finally, a higher self-monitoring of blood glucose frequency was associated with better glycaemic control only in insulin-treated participants. Even after adjusting for potential confounders (including baseline HbA1c ), increased frequency of healthy diet, medication taking and self-monitoring of blood glucose were associated with improved HbA1c levels. These self-management behaviours should be regularly monitored to identify patients at risk of deterioration in glycaemic control. Barriers to optimum self-management should be removed, particularly among socio-economically disadvantaged populations. © 2015 The Authors. Diabetic Medicine © 2015 Diabetes UK.

Drug-Drug Interactions Between the Anti-Hepatitis C Virus 3D Regimen of Ombitasvir, Paritaprevir/Ritonavir, and Dasabuvir and Eight Commonly Used Medications in Healthy Volunteers.

PubMed

Polepally, Akshanth R; King, Jennifer R; Ding, Bifeng; Shuster, Diana L; Dumas, Emily O; Khatri, Amit; Chiu, Yi-Lin; Podsadecki, Thomas J; Menon, Rajeev M

2016-08-01

The three direct-acting antiviral regimen of ombitasvir/paritaprevir/ritonavir and dasabuvir (3D regimen) is approved for treatment of hepatitis C virus (HCV) genotype 1 infection. Drug-drug interaction (DDI) studies of the 3D regimen and commonly used medications were conducted in healthy volunteers to provide information on coadministering these medications with or without dose adjustments. Three phase I studies evaluated DDIs between the 3D regimen (ombitasvir/paritaprevir/ritonavir 25/150/100 mg once daily + dasabuvir 250 mg twice daily) and hydrocodone bitartrate/acetaminophen (5/300 mg), metformin hydrochloride (500 mg), diazepam (2 mg), cyclobenzaprine hydrochloride (5 mg), carisoprodol (250 mg), or sulfamethoxazole/trimethoprim (SMZ/TMP) (800/160 mg twice daily), all administered orally. DDI magnitude was determined using geometric mean ratios and 90 % confidence intervals for the maximum plasma concentration (C max) and area under the plasma concentration-time curve (AUC). Changes in exposures (C max and AUC geometric mean ratios) of acetaminophen, metformin, sulfamethoxazole, trimethoprim, and diazepam were ≤25 % upon coadministration with the 3D regimen. The C max and AUC of nordiazepam, an active metabolite of diazepam, increased by 10 % and decreased by 44 %, respectively. Exposures of cyclobenzaprine and carisoprodol decreased by ≤40 and ≤46 %, respectively, whereas exposures of hydrocodone increased up to 90 %. Ombitasvir, paritaprevir, ritonavir, and dasabuvir exposures changed by ≤25 %, except for a 37 % decrease in paritaprevir C max with metformin and a 33 % increase in dasabuvir AUC with SMZ/TMP. Acetaminophen, metformin, sulfamethoxazole, and trimethoprim can be coadministered with the 3D regimen without dose adjustment. Higher doses may be needed for diazepam, cyclobenzaprine, and carisoprodol based on clinical monitoring. A 50 % lower dose and/or clinical monitoring should be considered for hydrocodone. No dose adjustment is necessary for the 3D regimen.

Response Monitoring and Adjustment: Differential Relations with Psychopathic Traits

PubMed Central

Bresin, Konrad; Finy, M. Sima; Sprague, Jenessa; Verona, Edelyn

2014-01-01

Studies on the relation between psychopathy and cognitive functioning often show mixed results, partially because different factors of psychopathy have not been considered fully. Based on previous research, we predicted divergent results based on a two-factor model of psychopathy (interpersonal-affective traits and impulsive-antisocial traits). Specifically, we predicted that the unique variance of interpersonal-affective traits would be related to increased monitoring (i.e., error-related negativity) and adjusting to errors (i.e., post-error slowing), whereas impulsive-antisocial traits would be related to reductions in these processes. Three studies using a diverse selection of assessment tools, samples, and methods are presented to identify response monitoring correlates of the two main factors of psychopathy. In Studies 1 (undergraduates), 2 (adolescents), and 3 (offenders), interpersonal-affective traits were related to increased adjustment following errors and, in Study 3, to enhanced monitoring of errors. Impulsive-antisocial traits were not consistently related to error adjustment across the studies, although these traits were related to a deficient monitoring of errors in Study 3. The results may help explain previous mixed findings and advance implications for etiological models of psychopathy. PMID:24933282

Quantum Information Science Research and Technical Assessment Project

DTIC Science & Technology

2010-08-01

parameter space. This system incorporates heaters, deposition monitors, temperature sensors , and adjustable substrate holders and masks under high...thickness monitor; G = glass surfaces for transmission measurements; PD = photodiode; TC = thermocouple temperature sensors . Substrate Preparation...crystal due to the mass of material deposited on the crystal. By adjusting the distance of the sensor relative to the source and employing the ~1/R2

"Symptom-based insulin adjustment for glucose normalization" (SIGN) algorithm: a pilot study.

PubMed

Lee, Joyce Yu-Chia; Tsou, Keith; Lim, Jiahui; Koh, Feaizen; Ong, Sooim; Wong, Sabrina

2012-12-01

Lack of self-monitoring of blood glucose (SMBG) records in actual practice settings continues to create therapeutic challenges for clinicians, especially in adjusting insulin therapy. In order to overcome this clinical obstacle, a "Symptom-based Insulin adjustment for Glucose Normalization" (SIGN) algorithm was developed to guide clinicians in caring for patients with uncontrolled type 2 diabetes who have few to no SMBG records. This study examined the clinical outcome and safety of the SIGN algorithm. Glycated hemoglobin (HbA1c), insulin usage, and insulin-related adverse effects of a total of 114 patients with uncontrolled type 2 diabetes who refused to use SMBG or performed SMBG once a day for less than three times per week were studied 3 months prior to the implementation of the algorithm and prospectively at every 3-month interval for a total of 6 months after the algorithm implementation. Patients with type 1 diabetes, nonadherence to diabetes medications, or who were not on insulin therapy at any time during the study period were excluded from this study. Mean HbA1c improved by 0.29% at 3 months (P = 0.015) and 0.41% at 6 months (P = 0.006) after algorithm implementation. A slight increase in HbA1c was observed when the algorithm was not implemented. There were no major hypoglycemic episodes. The number of minor hypoglycemic episodes was minimal with the majority of the cases due to irregular meal habits. The SIGN algorithm appeared to offer a viable and safe approach when managing uncontrolled patients with type 2 diabetes who have few to no SMBG records.

Monitoring substrate enables real-time regulation of a protein localization pathway.

PubMed

Ito, Koreaki; Mori, Hiroyuki; Chiba, Shinobu

2018-06-01

Protein localization machinery supports cell survival and physiology, suggesting the potential importance of its expression regulation. Here, we summarize a remarkable scheme of regulation, which allows real-time feedback regulation of the machinery expression. A class of regulatory nascent polypeptides, called monitoring substrates, undergoes force-sensitive translation arrest. The resulting ribosome stalling on the mRNA then affects mRNA folding to expose the ribosome-binding site of the downstream target gene and upregulate its translation. The target gene encodes a component of the localization machinery, whose physical action against the monitoring substrate leads to arrest cancellation. Thus, this scheme of feedback loop allows the cell to adjust the amount of the machinery to correlate inversely with the effectiveness of the process at a given moment. The system appears to have emerged late in evolution, in which a narrow range of organisms selected a distinct monitoring substrate-machinery combination. Currently, regulatory systems of SecM-SecA, VemP-SecDF2 and MifM-YidC2 are known to occur in different bacterial species.

Real time monitoring of risk-adjusted paediatric cardiac surgery outcomes using variable life-adjusted display: implementation in three UK centres

PubMed Central

Pagel, Christina; Utley, Martin; Crowe, Sonya; Witter, Thomas; Anderson, David; Samson, Ray; McLean, Andrew; Banks, Victoria; Tsang, Victor; Brown, Katherine

2013-01-01

Objective To implement routine in-house monitoring of risk-adjusted 30-day mortality following paediatric cardiac surgery. Design Collaborative monitoring software development and implementation in three specialist centres. Patients and methods Analyses incorporated 2 years of data routinely audited by the National Institute of Cardiac Outcomes Research (NICOR). Exclusion criteria were patients over 16 or undergoing non-cardiac or only catheter procedures. We applied the partial risk adjustment in surgery (PRAiS) risk model for death within 30 days following surgery and generated variable life-adjusted display (VLAD) charts for each centre. These were shared with each clinical team and feedback was sought. Results Participating centres were Great Ormond Street Hospital, Evelina Children's Hospital and The Royal Hospital for Sick Children in Glasgow. Data captured all procedures performed between 1 January 2010 and 31 December 2011. This incorporated 2490 30-day episodes of care, 66 of which were associated with a death within 30 days.The VLAD charts generated for each centre displayed trends in outcomes benchmarked to recent national outcomes. All centres ended the 2-year period within four deaths from what would be expected. The VLAD charts were shared in multidisciplinary meetings and clinical teams reported that they were a useful addition to existing quality assurance initiatives. Each centre is continuing to use the prototype software to monitor their in-house surgical outcomes. Conclusions Timely and routine monitoring of risk-adjusted mortality following paediatric cardiac surgery is feasible. Close liaison with hospital data managers as well as clinicians was crucial to the success of the project. PMID:23564473

Continuous glucose monitoring: A review of the technology and clinical use.

PubMed

Klonoff, David C; Ahn, David; Drincic, Andjela

2017-11-01

Continuous glucose monitoring (CGM) is an increasingly adopted technology for insulin-requiring patients that provides insights into glycemic fluctuations. CGM can assist patients in managing their diabetes with lifestyle and medication adjustments. This article provides an overview of the technical and clinical features of CGM based on a review of articles in PubMed on CGM from 1999 through January 31, 2017. A detailed description is presented of three professional (retrospective), three personal (real-time) continuous glucose monitors, and three sensor integrated pumps (consisting of a sensor and pump that communicate with each other to determine an optimal insulin dose and adjust the delivery of insulin) that are currently available in United States. We have reviewed outpatient CGM outcomes, focusing on hemoglobin A1c (A1C), hypoglycemia, and quality of life. Issues affecting accuracy, detection of glycemic variability, strategies for optimal use, as well as cybersecurity and future directions for sensor design and use are discussed. In conclusion, CGM is an important tool for monitoring diabetes that has been shown to improve outcomes in patients with type 1 diabetes mellitus. Given currently available data and technological developments, we believe that with appropriate patient education, CGM can also be considered for other patient populations. Copyright © 2017 Elsevier B.V. All rights reserved.

Monitoring of early humoral immunity to identify lung recipients at risk for development of serious infections: A multicenter prospective study.

PubMed

Sarmiento, Elizabeth; Cifrian, Jose; Calahorra, Leticia; Bravo, Carles; Lopez, Sonia; Laporta, Rosalia; Ussetti, Piedad; Sole, Amparo; Morales, Carmen; de Pablos, Alicia; Jaramillo, Maria; Ezzahouri, Ikram; García, Sandra; Navarro, Joaquin; Lopez-Hoyos, Marcos; Carbone, Javier

2018-04-06

Infection is still a leading cause of death during the first year after lung transplantation. We performed a multicenter study among teaching hospitals to assess monitoring of early humoral immunity as a means of identifying lung recipients at risk of serious infections. We prospectively analyzed 82 adult lung recipients at 5 centers in Spain. Data were collected before transplantation and at 7 and 30 days after transplantation. Biomarkers included IgG, IgM, IgA, complement factors C3 and C4, titers of antibodies to pneumococcal polysaccharide antigens (IgG, IgA, IgM) and antibodies to cytomegalovirus (IgG), and serum B-cell activating factor (BAFF) levels. The clinical follow-up period lasted 6 months. Clinical outcomes were bacterial infections requiring intravenous anti-microbial agents, cytomegalovirus (CMV) disease, and fungal infections requiring therapy. We found that 33 patients (40.2%) developed at least 1 serious bacterial infection, 8 patients (9.8%) had CMV disease, and 10 patients (12.2%) had fungal infections. Lower IgM antibody levels against pneumococcal polysaccharide antigens at Day 7 (defined as <5 mg/dl) were a risk factor for serious bacterial infection (adjusted odds ratio [OR] 3.96; 95% confidence interval [CI] 1.39 to 11.26; p = 0.0099). At Day 7 after transplantation, IgG hypogammaglobulinemia (defined as IgG <600 mg/dl) was associated with a higher risk of CMV disease (after adjustment for CMV mismatch: OR 8.15; 95% CI 1.27 to 52.55; p = 0.028) and fungal infection (adjusted OR 8.03, 95% CI 1.51 to 42.72; p = 0.015). Higher BAFF levels before transplantation were associated with a higher rate of development of serious bacterial infection and acute cellular rejection. Early monitoring of specific humoral immunity parameters proved useful for the identification of lung recipients who are at risk of serious infections. Copyright © 2018 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Hemoglobin A1c Accurately Predicts Continuous Glucose Monitoring-Derived Average Glucose in Youth and Young Adults With Cystic Fibrosis.

PubMed

Chan, Christine L; Hope, Emma; Thurston, Jessica; Vigers, Timothy; Pyle, Laura; Zeitler, Philip S; Nadeau, Kristen J

2018-04-19

In cystic fibrosis (CF), HbA 1c is thought to underestimate glycemia. However, few studies have directly assessed the relationship between HbA 1c and average glucose in CF. We determined the relationships among glycemic markers-HbA 1c , fructosamine (FA), glycated albumin (%GA), and 1,5-anhydroglucitol (1,5-AG)-and continuous glucose monitoring (CGM) in CF, hypothesizing that alternate markers would better predict average sensor glucose (ASG) than HbA 1c . CF participants and a group of healthy control subjects (HC), ages 6-25 years, wore CGM for up to 7 days. Pearson correlations assessed the relationships between CGM variables and HbA 1c , FA, %GA, and 1,5-AG. The regression line between HbA 1c and ASG was compared in CF versus HC. Linear regressions determined whether alternate markers predicted ASG after adjustment for HbA 1c . CF ( n = 93) and HC ( n = 29) groups wore CGM for 5.2 ± 1 days. CF participants were 14 ± 3 years of age and 47% were male, with a BMI z score -0.1 ± 0.8 and no different from HCs in age, sex, or BMI. Mean HbA 1c in CF was 5.7 ± 0.8% (39 ± 9 mmol/mol) vs. HC 5.1 ± 0.2% (32 ± 2 mmol/mol) ( P < 0.0001). All glycemic markers correlated with ASG ( P ≤ 0.01): HbA 1c ( r = 0.86), FA ( r = 0.69), %GA ( r = 0.83), and 1,5-AG ( r = -0.26). The regression line between ASG and HbA 1c did not differ in CF versus HC ( P = 0.44). After adjustment for HbA 1c , %GA continued to predict ASG ( P = 0.0009) in CF. HbA 1c does not underestimate ASG in CF as previously assumed. No alternate glycemic marker correlated more strongly with ASG than HbA 1c . %GA shows strong correlation with ASG and added to the prediction of ASG beyond HbA 1c . However, we are not advocating use of HbA 1c for diabetes screening in CF based on these results. Further study will determine whether glycemic measures other than ASG differ among different types of diabetes for a given HbA 1c . © 2018 by the American Diabetes Association.

Carbon dioxide emission prediction using support vector machine

NASA Astrophysics Data System (ADS)

Saleh, Chairul; Rachman Dzakiyullah, Nur; Bayu Nugroho, Jonathan

2016-02-01

In this paper, the SVM model was proposed for predict expenditure of carbon (CO2) emission. The energy consumption such as electrical energy and burning coal is input variable that affect directly increasing of CO2 emissions were conducted to built the model. Our objective is to monitor the CO2 emission based on the electrical energy and burning coal used from the production process. The data electrical energy and burning coal used were obtained from Alcohol Industry in order to training and testing the models. It divided by cross-validation technique into 90% of training data and 10% of testing data. To find the optimal parameters of SVM model was used the trial and error approach on the experiment by adjusting C parameters and Epsilon. The result shows that the SVM model has an optimal parameter on C parameters 0.1 and 0 Epsilon. To measure the error of the model by using Root Mean Square Error (RMSE) with error value as 0.004. The smallest error of the model represents more accurately prediction. As a practice, this paper was contributing for an executive manager in making the effective decision for the business operation were monitoring expenditure of CO2 emission.

39 CFR 3010.2 - Types of rate adjustments for market dominant products.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., authorized under 39 U.S.C. 3622(d)(1)(E), is based on exigent circumstances. (b) Upon the establishment of... adjustment, authorized under 39 U.S.C. 3622(d)(1)(D), is based on the statutory annual limitation. A Type 1-B rate adjustment, authorized under 39 U.S.C. 3622(d)(2)(C), is based on an exception to the annual...

42 CFR 422.264 - Calculation of savings.

Code of Federal Regulations, 2010 CFR

2010-10-01

...), adjusted using the factors described in paragraph (c) of this section. (3) The risk adjusted MA region... the upcoming calendar year the risk adjustment factors described in paragraph (c)(1) or (c)(2) of this... of calculating savings for MA local plans CMS has the authority to apply risk adjustment factors that...

42 CFR 422.264 - Calculation of savings.

Code of Federal Regulations, 2011 CFR

2011-10-01

...), adjusted using the factors described in paragraph (c) of this section. (3) The risk adjusted MA region... the upcoming calendar year the risk adjustment factors described in paragraph (c)(1) or (c)(2) of this... of calculating savings for MA local plans CMS has the authority to apply risk adjustment factors that...

Value of self-monitoring blood glucose pattern analysis in improving diabetes outcomes.

PubMed

Parkin, Christopher G; Davidson, Jaime A

2009-05-01

Self-monitoring of blood glucose (SMBG) is an important adjunct to hemoglobin A1c (HbA1c) testing. This action can distinguish between fasting, preprandial, and postprandial hyperglycemia; detect glycemic excursions; identify and monitor resolution of hypoglycemia; and provide immediate feedback to patients about the effect of food choices, activity, and medication on glycemic control. Pattern analysis is a systematic approach to identifying glycemic patterns within SMBG data and then taking appropriate action based upon those results. The use of pattern analysis involves: (1) establishing pre- and postprandial glucose targets; (2) obtaining data on glucose levels, carbohydrate intake, medication administration (type, dosages, timing), activity levels and physical/emotional stress; (3) analyzing data to identify patterns of glycemic excursions, assessing any influential factors, and implementing appropriate action(s); and (4) performing ongoing SMBG to assess the impact of any therapeutic changes made. Computer-based and paper-based data collection and management tools can be developed to perform pattern analysis for identifying patterns in SMBG data. This approach to interpreting SMBG data facilitates rational therapeutic adjustments in response to this information. Pattern analysis of SMBG data can be of equal or greater value than measurement of HbA1c levels. 2009 Diabetes Technology Society.

Developing an operational rangeland water requirement satisfaction index

USGS Publications Warehouse

Senay, Gabriel B.; Verdin, James P.; Rowland, James

2011-01-01

Developing an operational water requirement satisfaction index (WRSI) for rangeland monitoring is an important goal of the famine early warning systems network. An operational WRSI has been developed for crop monitoring, but until recently a comparable WRSI for rangeland was not successful because of the extremely poor performance of the index when based on published crop coefficients (K c) for rangelands. To improve the rangeland WRSI, we developed a simple calibration technique that adjusts the K c values for rangeland monitoring using long-term rainfall distribution and reference evapotranspiration data. The premise for adjusting the K c values is based on the assumption that a viable rangeland should exhibit above-average WRSI (values >80%) during a normal year. The normal year was represented by a median dekadal rainfall distribution (satellite rainfall estimate from 1996 to 2006). Similarly, a long-term average for potential evapotranspiration was used as input to the famine early warning systems network WRSI model in combination with soil-water-holding capacity data. A dekadal rangeland WRSI has been operational for east and west Africa since 2005. User feedback has been encouraging, especially with regard to the end-of-season WRSI anomaly products that compare the index's performance to ‘normal’ years. Currently, rangeland WRSI products are generated on a dekadal basis and posted for free distribution on the US Geological Survey early warning website at http://earlywarning.usgs.gov/adds/

Racial Disparities in HIV Care Extend to Common Comorbidities: Implications for Implementation of Interventions to Reduce Disparities in HIV Care.

PubMed

Richardson, Kelly K; Bokhour, Barbara; McInnes, D Keith; Yakovchenko, Vera; Okwara, Leonore; Midboe, Amanda M; Skolnik, Avy; Vaughan-Sarrazin, Mary; Asch, Steven M; Gifford, Allen L; Ohl, Michael E

2016-01-01

Prior studies have described racial disparities in the quality of care for persons with HIV infection, but it is unknown if these disparities extend to common comorbid conditions. To inform implementation of interventions to reduce disparities in HIV care, we examined racial variation in a set of quality measures for common comorbid conditions among Veterans in care for HIV in the United States. The cohort included 23,974 Veterans in care for HIV in 2013 (53.4% black; 46.6% white). Measures extracted from electronic health record and administrative data were receipt of combination antiretroviral therapy (cART), HIV viral control (serum RNA < 200 copies/ml among those on cART), hypertension control (blood pressure < 140/90 mm Hg among those with hypertension), diabetes control (hemoglobin A1C < 9% among those with diabetes), lipid monitoring, guideline-concordant antidepressant prescribing, and initiation and engagement in substance use disorder (SUD) treatment. Black persons were less likely than their white counterparts to receive cART (90.2% vs. 93.2%, p<.001), and experience viral control (84.6% vs. 91.3%, p<.001), hypertension control (61.9% vs. 68.3%, p<.001), diabetes control (85.5% vs. 89.5%, p<.001), and lipid monitoring (81.5% vs. 85.2%, p<.001). Initiation and engagement in SUD treatment were similar among blacks and whites. Differences remained after adjusting for age, comorbidity, retention in HIV care, and a measure of neighborhood social disadvantage created from census data. Implementation of interventions to reduce racial disparities in HIV care should comprehensively address and monitor processes and outcomes of care for key comorbidities. Published by Elsevier Inc.

Autolytic degradation of skipjack tuna during heating as affected by initial quality and processing conditions.

PubMed

Stagg, Nicola J; Amato, Penny M; Giesbrecht, Francis; Lanier, Tyre C

2012-02-01

Several factors were studied as affecting protein degradation and texture of skipjack tuna muscle following ambient pressure thermal processing (precooking). These included degree of mushy tuna syndrome (MTS) evidenced in the raw meat, raw meat pH, abusive thawing/holding, and precooking temperature/time. Slurries and intact pieces from frozen skipjack tuna, either tempered for 2 h or thawed and held at 25 °C for 22 h (abusive treatment) were heated at temperatures ranging from 40 to 80 °C for up to 2 h, and also at 90 °C for 1 h, with or without prior adjustment of pH to 5 or 7 to favor cathepsin or calpain activity, respectively. Proteolysis of precooked samples was monitored by Lowry assay and SDS-PAGE; cooked texture of intact meat was measured using a Kramer shear press and by sensory profile analysis. Proteolysis maximally occurred in slurries of skipjack tuna muscle that had been abusively stored (22 h at 25 °C) and adjusted to pH 5 prior to heating at 55 °C. Intact pieces of tuna abusively thawed/held for 22 h with subsequent heating at 55 °C also evidenced the most proteolysis and were the least firm in texture. Raw fish that evidenced higher severity of MTS when raw displayed higher levels of proteolysis prior to cooking, which were further increased after cooking at 55 °C. The kinetic data presented here can be used to optimize processing conditions for skipjack tuna canning to minimize textural degradation and optimize quality. © 2012 Institute of Food Technologists®

Impact of graphic format on perception of change in biological data: implications for health monitoring in conditions such as asthma.

PubMed

Jansen, Jesse; McCaffery, Kirsten J; Hayen, Andrew; Ma, David; Reddel, Helen K

2012-03-01

Variation in graphic format can substantially influence interpretation of data. Despite a large body of literature on the optimal design of graphs, little attention has been paid to the format of charts for health monitoring. This study assessed the effect of aspect ratio (x:y ratio) and interconnecting lines on visual identification of change in biological data, such as during asthma exacerbations. Eighty volunteers viewed 72 sets of six consecutive blocks of unidentified biological data, recording if each block of data was increasing, decreasing, or the same as the previous block. Three chart aspect ratios were examined (A, 5.2:1; B, 3.0:1; C, 1.1:1), with or without lines between data points. Datasets from lung function monitoring by asthma patients included a mild/moderate/severe fall ('exacerbation') or no exacerbation. False negative (missing true exacerbations) and false positive (identifying non-existent exacerbations) responses were calculated. 84% of exacerbation blocks were correctly identified. There was a significant interaction between exacerbation severity and aspect ratio (p=0.0048). The most compressed chart (C) had the fewest false negative responses. Moderate falls were missed in 24%, 12%, and 5% of trials on charts A, B, and C, respectively (C vs A: adjusted relative risk 0.19 (95% CI 0.12 to 0.30)). False positive responses were infrequent (A, 2.5%; B, 3.8%; C, 8.3%), increasing slightly if data points were joined with lines (4.3% vs 5.1%, p=0.004) . Compressed charts can improve the visual detection of change in biological data by up to 80%. The aspect ratio of charts should be standardised to facilitate clinical pattern recognition.

Dynamics of spacing adjustment and recovery mechanisms of ABAC-type growth pattern in ternary eutectic systems

NASA Astrophysics Data System (ADS)

Mohagheghi, Samira; Şerefoğlu, Melis

2017-07-01

In directionally solidified 2D samples at ternary eutectic compositions, the stable three-phase pattern is established to be lamellar structure with ABAC stacking, where A, B, and C are crystalline phases. Beyond the stability limits of the ABAC pattern, the system uses various spacing adjustment mechanisms to revert to the stable regime. In this study, the dynamics of spacing adjustment and recovery mechanisms of isotropic ABAC patterns were investigated using three-phase In-Bi-Sn alloy. Unidirectional solidification experiments were performed on 23.0 and 62.7 μm-thick samples, where solidification front was monitored in real-time from both sides of the sample using a particular microscopy system. At these thicknesses, the pattern was found to be 2D during steady-state growth, i.e. both top and bottom microstructures were the same. However, during spacing adjustment and recovery mechanisms, 3D features were observed. Dynamics of two major instabilities, lamellae branching and elimination, were quantified. After these instabilities, two key ABAC pattern recovery mechanisms, namely, phase invasion and phase exchange processes, were identified and analyzed. After elimination, ABAC pattern is recovered by either continuous eliminations of all phases or by phase exchange. After branching, the recovery mechanisms are established to be phase invasion and phase exchange.

Changes in body temperature in king penguins at sea: the result of fine adjustments in peripheral heat loss?

PubMed

Schmidt, Alexander; Alard, Frank; Handrich, Yves

2006-09-01

To investigate thermoregulatory adjustments at sea, body temperatures (the pectoral muscle and the brood patch) and diving behavior were monitored during a foraging trip of several days at sea in six breeding king penguins Aptenodytes patagonicus. During inactive phases at sea (water temperature: 4-7 degrees C), all tissues measured were maintained at normothermic temperatures. The brood patch temperature was maintained at the same values as those measured when brooding on shore (38 degrees C). This high temperature difference causes a significant loss of heat. We hypothesize that high-energy expenditure associated with elevated peripheral temperature when resting at sea is the thermoregulatory cost that a postabsorptive penguin has to face for the restoration of its subcutaneous body fat. During diving, mean pectoral temperature was 37.6 +/- 1.6 degrees C. While being almost normothermic on average, the temperature of the pectoral muscle was still significantly lower than during inactivity in five out of the six birds and underwent temperature drops of up to 5.5 degrees C. Mean brood patch temperature was 29.6 +/- 2.5 degrees C during diving, and temperature decreases of up to 21.6 degrees C were recorded. Interestingly, we observed episodes of brood patch warming during the descent to depth, suggesting that, in some cases, king penguins may perform active thermolysis using the brood patch. It is hypothesized that functional pectoral temperature may be regulated through peripheral adjustments in blood perfusion. These two paradoxical features, i.e., lower temperature of deep tissues during activity and normothermic peripheral tissues while inactive, may highlight the key to the energetics of this diving endotherm while foraging at sea.

Lack of insurance coverage for testing supplies is associated with poorer glycemic control in patients with type 2 diabetes

PubMed Central

Bowker, Samantha L.; Mitchell, Chad G.; Majumdar, Sumit R.; Toth, Ellen L.; Johnson, Jeffrey A.

2004-01-01

Background Public insurance for testing supplies for self-monitoring of blood glucose is highly variable across Canada. We sought to determine if insured patients were more likely than uninsured patients to use self-monitoring and whether they had better glycemic control. Methods We used baseline survey and laboratory data from patients enrolled in a randomized controlled trial examining the effect of paying for testing supplies on glycemic control. We recruited patients through community pharmacies in Alberta and Saskatchewan from Nov. 2001 to June 2003. To avoid concerns regarding differences in provincial coverage of self-monitoring and medications, we report the analysis of Alberta patients only. Results Among our sample of 405 patients, 41% had private or public insurance coverage for self-monitoring testing supplies. Patients with insurance had significantly lower hemoglobin A1c concentrations than those without insurance coverage (7.1% v. 7.4%, p = 0.03). Patients with insurance were younger, had a higher income, were less likely to have a high school education and were less likely to be married or living with a partner. In multivariate analyses that controlled for these and other potential confounders, lack of insurance coverage for self-monitoring testing supplies was still significantly associated with higher hemoglobin A1c concentrations (adjusted difference 0.5%, p = 0.006). Interpretation Patients without insurance for self-monitoring test strips had poorer glycemic control. PMID:15238494

40 CFR 63.7113 - What are my monitoring installation, operation, and maintenance requirements?

Code of Federal Regulations, 2010 CFR

2010-07-01

... continuity, and all mechanical connections for leakage. (d) For each bag leak detection system (BLDS), you... mechanical connections for leakage. (c) For each pressure measurement device, you must meet the requirements... instrumentation and alarm. (6) Bag leak detection systems must be installed, operated, adjusted, and maintained...

Relation of four nontraditional lipid profiles to diabetes in rural Chinese H-type hypertension population.

PubMed

Wang, Haoyu; Guo, Xiaofan; Chen, Yintao; Li, Zhao; Xu, Jiaqi; Sun, Yingxian

2017-10-11

Mounting evidence suggested that nontraditional lipid profiles have been recognized as a reliable indicator for unfavorable cardiovascular events. The purpose of this study was to explore the role of nontraditional lipid profiles as potential clinical indices for the assessment of prevalent diabetes in rural Chinese H-type hypertension population. During 2012 to 2013, we conducted a large cross-sectional study of 2944 H-type hypertension participants (≥35 years of age) from rural areas in northeast China. Subjects underwent accurate assessment of lipid profiles, fasting plasma glucose (FPG), homocysteine (Hcy) according to standard protocols. The proportion of diabetes showed a graded and linear increase across the quartiles for all four nontraditional lipid parameters. Nontraditional lipid variables were independent determinants of FPG, and its correlation for TG/HDL-C was strongest, whether potential confounders were adjusted or not. Multivariable logistic regression analysis established that the highest triglycerides (TG)/ high-density lipoprotein cholesterol (HDL-C) quartile manifested the largest ORs of prevalent diabetes (OR: 3.275, 95%CI: 2.109-5.087) compared with the lowest quartile. The fully adjusted ORs (95%CI) were 2.753 (1.783-4.252), 2.178 (1.415-2.351), 1.648 (1.097-2.478) for the top quartile of total cholesterol (TC)/HDL-C, low-density lipoprotein cholesterol (LDL-C)/HDL-C, and non-high-density lipoprotein cholesterol (non-HDL-C), respectively. On the basis of the area under receiver-operating characteristic curve (AUC), TG/HDL-C showed the optimal discriminating power for diabetes (AUC: 0.684, 95% CI: 0.650-0.718). Nontraditional lipid profiles (TG/HDL-C, TC/HDL-C, LDL-C/HDL-C and non-HDL-C) were all consistently and independently correlated with prevalent diabetes among the H-type hypertension population in rural China. TG/HDL-C was prone to be more profitable in assessing the risk of prevalent diabetes and should be encouraged as an effective clinical tool for monitoring and targeted intervention of diabetes in H-type hypertension adults.

Prediction of autonomic dysreflexia during urodynamics: a prospective cohort study.

PubMed

Walter, Matthias; Knüpfer, Stephanie C; Cragg, Jacquelyn J; Leitner, Lorenz; Schneider, Marc P; Mehnert, Ulrich; Krassioukov, Andrei V; Schubert, Martin; Curt, Armin; Kessler, Thomas M

2018-04-13

Autonomic dysreflexia is a severe and potentially life-threatening condition in patients with spinal cord injury, as it can lead to myocardial ischemia, brain hemorrhage, or even death. Urodynamic investigation is the gold standard to assess neurogenic lower urinary tract dysfunction due to spinal cord injury and reveal crucial pathological findings, such as neurogenic detrusor overactivity. However, neurogenic detrusor overactivity and urodynamic investigation are known to be leading triggers of autonomic dysreflexia. Therefore, we aimed to determine predictors of autonomic dysreflexia in individuals with spinal cord injury during urodynamic investigation. This prospective cohort study included 300 patients with spinal cord injuries and complete datasets of continuous non-invasive cardiovascular monitoring, recorded during same session repeat urodynamic investigation. We used logistic regression to reveal predictors of autonomic dysreflexia during urodynamic investigation. We found that level of injury and presence of neurogenic detrusor overactivity were the only two independent significant predictors for autonomic dysreflexia during urodynamic investigation. A lesion at spinal segment T6 or above (odds ratio (OR) 5.5, 95% CI 3.2-9.4) compared to one at T7 or below, and presence of neurogenic detrusor overactivity (OR 2.7, 95% confidence interval (CI) 1.4-4.9) were associated with a significant increased odds of autonomic dysreflexia during urodynamic investigation. Both odds persisted after adjustment for age, sex, and completeness and stage of injury (adjusted OR (AOR) 6.6, 95% CI 3.8-11.7, and AOR 2.2, 95% CI 1.1-4.5, respectively). Further stratification by lesion level showed level-dependent significantly increased adjusted odds of autonomic dysreflexia, i.e., from C1-C4 (AOR 16.2, 95% CI 5.9-57.9) to T4-T6 (AOR 2.6, 95% CI 1.3-5.2), compared to lesions at T7 or below. In patients with neurogenic lower urinary tract dysfunction due to spinal cord injury, autonomic dysreflexia is independently predicted by lesion level and presence of neurogenic detrusor overactivity. Considering the health risks associated with autonomic dysreflexia, such as seizures, stroke, retinal bleeding, or even death, we recommend both continuous cardiovascular monitoring during urodynamic investigation in all spinal cord-injured patients with emphasis on those with cervical lesions, and appropriate neurogenic detrusor overactivity treatment to reduce the probability of potentially life-threatening complications. ClinicalTrials.gov, NCT01293110 .

Adjusting insulin doses in patients with type 1 diabetes that use insulin pump and continuous glucose monitoring - Variations among countries and physicians.

PubMed

Nimri, Revital; Dassau, Eyal; Segall, Tomer; Muller, Ido; Bratina, Natasa; Kordonouri, Olga; Bello, Rachel; Biester, Torben; Dovc, Klemen; Tenenbaum, Ariel; Brener, Avivit; Šimunović, Marko; Sakka, Sophia D; Nevo Shenker, Michal; Passone, Caroline Gb; Rutigliano, Irene; Tinti, Davide; Bonura, Clara; Caiulo, Silvana; Ruszala, Anna; Piccini, Barbara; Giri, Dinesh; Stein, Ronnie; Rabbone, Ivana; Bruzzi, Patrizia; Omladič, Jasna Šuput; Steele, Caroline; Beccuti, Guglielmo; Yackobovitch-Gavan, Michal; Battelino, Tadej; Danne, Thomas; Atlas, Eran; Phillip, Moshe

2018-06-08

To evaluate physicians' adjustments of insulin pump settings based on continuous glucose monitoring (CGM) for patients with type 1 diabetes and to compare physicians' to automated insulin dose adjustments. 26 physicians from 16 centers in Europe, Israel and South-America participated in the study. All were asked to adjust insulin dosing based on insulin pump, CGM and glucometer downloads of 15 patients (mean age 16.2 ± 4.3 y, 6 females, mean A1c 8.3 ± 0.9%) gathered over a 3-week period. Recommendations were compared for the relative changes in the basal, carbohydrate-ratio (CR) and correction-factor (CF) plans among physicians, among centers and between the physicians and an automated algorithm (DreaMed Advisor Pro). Study endpoints were the percentage of comparison points for which there was full agreement on the trend of insulin dose adjustments (same trend), partial agreement (increase/decrease vs. no change) and full disagreement (opposite trend). Percentage of full agreement between physicians on the trend of insulin adjustments of the basal, CR and CF plans was 41±9%, 45±11% and 45.5±13%, and of complete disagreement was 12±7%, 9.5±7% and 10±8%, respectively. Significantly similar results were found between the physicians and the DreaMed Advisor Pro. The Advisor magnitude of insulin dose change was at least equal or less than proposed by the physicians. Physicians provide different insulin dose recommendations based on the same data sets. The automated advice of the DreaMed Advisor Pro didn't differ significantly from the advice given by the physicians in the direction or magnitude of the insulin dosing. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Quantification of allantoin in various Zea mays L. hybrids by RP-HPLC with UV detection.

PubMed

Maksimović, Z; Malenović, A; Jancić, B; Kovacević, N

2004-07-01

A RP-HPLC method for quantification of allantoin in silk of fifteen maize hybrids (Zea mays L., Poaceae) was described. Following extraction of the plant material with an acetone-water (7:3, VN) mixture, filtration and dilution, the extracts were analyzed without previous chemical derivatization. Separation and quantification were achieved using an Alltech Econosil C18 column under isocratic conditions at 40 degrees C. The mobile phase flow (20% methanol--80% water with 5 mM sodium laurylsulfate added at pH 2.5, adjusted with 85% orthophosphoric acid; pH of water phase was finally adjusted at 6.0 by addition of triethylamine) was maintained at 1.0 mL/min. Column effluent was monitored at 235 nm. This simple procedure afforded efficient separation and quantification of allantoin in plant material, without interference of polyphenols or other plant constituents of medium to high polarity, or similar UV absorption. Our study revealed that the silk of all investigated maize hybrids could be considered relatively rich in allantoin, covering the concentration range between 215 and 289 mg per 100 g of dry plant material.

Evaluating commercial marine emissions and their role in air quality policy using observations and the CMAQ model

NASA Astrophysics Data System (ADS)

Ring, Allison M.; Canty, Timothy P.; Anderson, Daniel C.; Vinciguerra, Timothy P.; He, Hao; Goldberg, Daniel L.; Ehrman, Sheryl H.; Dickerson, Russell R.; Salawitch, Ross J.

2018-01-01

We investigate the representation of emissions from the largest (Class 3) commercial marine vessels (c3 Marine) within the Community Multiscale Air Quality (CMAQ) model. In present emissions inventories developed by the United States Environmental Protection Agency (EPA), c3 Marine emissions are divided into off-shore and near-shore files. Off-shore c3 Marine emissions are vertically distributed within the atmospheric column, reflecting stack-height and plume rise. Near-shore c3 Marine emissions, located close to the US shoreline, are erroneously assumed to occur only at the surface. We adjust the near-shore c3 Marine emissions inventory by vertically distributing these emissions to be consistent with the off-shore c3 Marine inventory. Additionally, we remove near-shore c3 Marine emissions that overlap with off-shore c3 Marine emissions within the EPA files. The CMAQ model generally overestimates surface ozone (O3) compared to Air Quality System (AQS) site observations, with the largest discrepancies occurring near coastal waterways. We compare modeled O3 from two CMAQ simulations for June, July, and August (JJA) 2011 to surface O3 observations from AQS sites to examine the efficacy of the c3 Marine emissions improvements. Model results at AQS sites show average maximum 8-hr surface O3 decreases up to ∼6.5 ppb along the Chesapeake Bay, and increases ∼3-4 ppb around Long Island Sound, when the adjusted c3 Marine emissions are used. Along with the c3 Marine emissions adjustments, we reduce on-road mobile NOX emissions by 50%, motivated by work from Anderson et al. 2014, and reduce the lifetime of the alkyl nitrate species group from ∼10 days to ∼1 day based on work by Canty et al. 2015, to develop the ;c3 Science; model scenario. Simulations with these adjustments further improve model representation of the atmosphere. We calculate the ratio of column formaldehyde (HCHO) and tropospheric column nitrogen dioxide (NO2) using observations from the Ozone Monitoring Instrument and CMAQ model output to investigate the photochemical O3 production regime (VOC or NOX-limited) of the observed and modeled atmosphere. Compared to the baseline, the c3 Science model scenario more closely simulates the HCHO/NO2 ratio calculated from OMI data. Model simulations for JJA 2018 using the c3 Science scenario show a reduction of surface O3 by as much as ∼13 ppb for areas around the Chesapeake Bay and ∼2-3 ppb at locations in NY and CT downwind of New York City. These reductions are larger in 2018 than in 2011 due to a change in the photochemical O3 production regime in the Long Island Sound region and the projected decline of other (non-c3 Marine) sources of O3 precursors, highlighting the importance of proper representation of c3 Marine emissions in future modeling scenarios.

The Risks and Benefits of Internal Monitors in Laboring Patients

PubMed Central

Harper, Lorie M.; Shanks, Anthony L.; Tuuli, Methodius G.; Roehl, Kimberly A.; Cahill, Alison G.

2013-01-01

Objective To estimate the impact of internal monitors (fetal scalp electrodes [FSE] and intrauterine pressure catheters [IUPC]) on maternal and neonatal outcomes. Study Design Retrospective cohort of all women admitted for labor 2004–2008. Women with internal monitors (FSE, IUPC, or both) were compared to women without internal monitors. Maternal outcomes were maternal fever and cesarean delivery (CD). Neonatal outcomes were a composite of 5-minute Apgar≤3, cord pH<7.1, cord base excess <-12, or admission to level 3 nursery. Logistic regression was performed to estimate the impact of internal monitors while adjusting for confounding variables, including time in labor. Results Of 6,445 subjects, 3,944 (61.2%) had internal monitors. Women with internal monitors were more likely to develop a fever than women without internal monitors (11.7% versus 4.5%, adjusted odds ratio (AOR) 2.0, 95% confidence interval (CI) 1.6-2.5). FSE alone was not associated with an increased risk of fever (AOR 1.5, 95% CI 1.0-2.1), but IUPC alone was (AOR 2.4, 95% CI 1.8-3.2). The risk of CD was higher in women with internal monitors (18.6% versus 9.7%, AOR 1.3, 95% CI 1.0-1.5). Risk of CD was lower in women with FSE alone (AOR 0.5, 95% CI 0.4-0.7) but higher in women with both an FSE and IUPC (AOR 1.6, 95% CI 1.4-2.0). Risk of the composite neonatal outcome was not higher in women with internal monitors (3.3% versus 3.6%, AOR 0.8, 95% CI 0.6-1.1). Conclusions Routine use of IUPC in laboring patient should be avoided due to increased risk of maternal fever. PMID:23562354

Continuous monitoring of haemoglobin concentration after in-vivo adjustment in patients undergoing surgery with blood loss.

PubMed

Frasca, D; Mounios, H; Giraud, B; Boisson, M; Debaene, B; Mimoz, O

2015-07-01

Non-invasive monitoring of haemoglobin concentration provides real-time measurement of haemoglobin concentration (SpHb) using multi-wavelength pulse co-oximetry. We hypothesised that in-vivo adjustment using the mean of three haemoglobinometer (HemoCue®) measurements from an arterial blood sample at the first SpHb measurement (HCueART) would increase the accuracy of the monitor. The study included 41 adults for a total of 173 measurements of haemoglobin concentration. In-vivo adjusted SpHb was automatically calculated by the following formula: in-vivo adjusted SpHb = unadjusted SpHb - (SpHb - HCueART). The accuracy of in-vivo adjusted SpHb was compared with SpHb retrospectively adjusted using the same formula, except for haemoglobin level which was assessed at the central laboratory and then compared with all other available invasive methods of haemoglobin measurement (co-oximetry, HbSAT; arterial HemoCue, HCueART; capillary HemoCue, HCueCAP). Compared with laboratory measurement of haemoglobin concentration, bias (precision) for unadjusted SpHb, in-vivo adjusted SpHb, retrospectively adjusted SpHb, HbSAT, HCueART and HCueCAP were -0.4 (1.4), -0.3 (1.1), -0.3 (1.1), -0.6 (0.7), 0.0 (0.4) and -0.5 (1.2) g.dl(-1) , respectively. In-vivo adjustment of SpHb values using the mean of three arterial HemoCue measurements improved the accuracy of the device similar to those observed after a retrospective adjustment using central laboratory haemoglobin level. © 2015 The Association of Anaesthetists of Great Britain and Ireland.

Correlation and agreement between the bispectral index vs. state entropy during hypothermic cardio-pulmonary bypass.

PubMed

Meybohm, P; Gruenewald, M; Höcker, J; Renner, J; Graesner, J-T; Ilies, C; Scholz, J; Bein, B

2010-02-01

The bispectral index (BIS) and spectral entropy enable monitoring the depth of anaesthesia. Mild hypothermia has been shown to affect the ability of electroencephalography monitors to reflect the anaesthetic drug effect. The purpose of this study was to investigate the effect of hypothermia during a cardio-pulmonary bypass on the correlation and agreement between the BIS and entropy variables compared with normothermic conditions. This prospective clinical study included coronary artery bypass grafting patients (n=25) evaluating correlation and agreement (Bland-Altman analysis) between the BIS and both spectral and response entropy during a hypothermic cardio-pulmonary bypass (31-34 degrees C) compared with nomothermic conditions (34-37.5 degrees C). Anaesthesia was maintained with propofol and sufentanil and adjusted clinically, while the anaesthetist was blinded to the monitors. The BIS and entropy values decreased during cooling (P<0.05), but the decrease was more pronounced for entropy variables compared with BIS (P<0.05). The correlation coefficients (bias+/-SD; percentage error) between the BIS vs. spectral state entropy and response entropy were r(2)=0.56 (1+/-11; 42%) and r(2)=0.58 (-2+/-11; 43%) under normothermic conditions, and r(2)=0.17 (10+/-12; 77%) and r(2)=0.18 (9+/-11; 68%) under hypothermic conditions, respectively. Bias was significantly increased under hypothermic conditions (P<0.001 vs. normothermia). Acceptable agreement was observed between the BIS and entropy variables under normothermic but not under hypothermic conditions. The BIS and entropy variables may therefore not be interchangeable during a hypothermic cardio-pulmonary bypass.

Saxagliptin efficacy and safety in patients with type 2 diabetes mellitus stratified by cardiovascular disease history and cardiovascular risk factors: analysis of 3 clinical trials.

PubMed

Cook, William; Minervini, Gianmaria; Bryzinski, Brian; Hirshberg, Boaz

2014-10-01

To test the effectiveness and safety of saxagliptin 5 mg/d in patients with type 2 diabetes mellitus (T2DM) with and without history of cardiovascular disease (CVD) or cardiovascular (CV) risk factors. The authors conducted a post hoc analysis of data from 3 randomized studies that compared saxagliptin versus placebo as initial combination therapy with metformin for 24 weeks (N = 648) and versus placebo as an add-on to insulin with and without metformin for 24 weeks (N = 455), and assessed noninferiority to glipizide as an add-on to metformin for 52 weeks (N = 858). Efficacy outcomes were the adjusted mean change from baseline in glycated hemoglobin (HbA1c) level, fasting plasma glucose concentration, and body weight and the proportion of patients achieving an HbA1c level < 7%. Pairwise comparisons were performed in subgroups with 1) history/no history of CVD, 2) ≥ 2 versus 0 to 1 CV risk factors, 3) hypertension/no hypertension, and 4) statin use/no statin use. Adverse events (AE) and hypoglycemia were monitored. In the initial combination therapy study, reductions in HbA1c level from baseline were greater with saxagliptin versus placebo in all subgroups (difference [saxagliptin - placebo], -0.38% to -0.67%). In the add-on to insulin ± metformin study, differences in adjusted mean change in HbA1c level versus placebo ranged from -0.23% to -0.58% across subgroups. In the noninferiority to glipizide study, adjusted mean changes in HbA1c level were comparable between saxagliptin and glipizide, across subgroups (difference, 0.08%-0.21%). No evidence suggested clinically relevant treatment-by-subgroup interactions in pairwise comparison. Incidences of ≥ 1 AE were comparable across subgroups. Incidences of confirmed hypoglycemia with saxagliptin were 0 in both metformin add-on studies and 1.2% to 7.8% with saxagliptin + insulin ± metformin. In patients with T2DM, saxagliptin 5 mg/d was similarly effective in improving glycemic control, with an AE profile similar to that of placebo, irrespective of CVD history, number of CV risk factors, hypertension, or statin use. www.ClinicalTrials.gov identifiers: NCT00327015, NCT00575588, NCT00757588.

The Relationship between Self-Management and Glycemic Control in a Cohort of Children with Type 1 and Type 2 Diabetes.

PubMed

Rodriguez, Luisa M; Hassan, Krishnavathana V; Rhodes, Jeffrey; McKay, Siripoom V; Heptulla, Rubina A

2013-12-15

Self-management of diabetes improves glycemic control. The development of a quick, objective questionnaire in the clinic setting may provide data to the clinician caring for the patient in overall evaluation. We developed a 23 question tool (clinic preparedness score) and administered it to type 1 and 2 (T1DM & T2DM) diabetes patients. Clinicians of patients were surveyed to determine their perception of adherence by patients. A total of 350 T1DM patients and families and 137 T2DM families were administered the questionnaire. Additionally, HbA1C was correlated to the various parameters that are related to improved glycemic control such as having a meter, carrying glucose tablets for hypoglycemia, and downloading/ writing blood sugars in log book in T1DM and T2DM. T1DM subjects had a lower HbA1C with better clinic preparedness (8.2 ± 1.3 vs. 9.4 ± 1.9%) However, this did not hold true for T2DM (p NS). If T1DM subjects adjusted their insulin dose and reported that their parent was involved they had better HbA1C than those that did not change insulin dose and if parent was uninvolved in the care. Clinicians of patients were able to accurately predict that appropriate dose adjustments resulted in good glycemic control. Pediatric T2DM adherence measures do not mirror similar characteristics of T1DM in childhood. The variability in glucose monitoring, medication and insulin administration may affect T2DM differently than T1DM.

Evidence-based guideline: Antiepileptic drug selection for people with HIV/AIDS

PubMed Central

Birbeck, G.L.; French, J.A.; Perucca, E.; Simpson, D.M.; Fraimow, H.; George, J.M.; Okulicz, J.F.; Clifford, D.B.; Hachad, H.; Levy, R.H.

2012-01-01

Objective: To develop guidelines for selection of antiepileptic drugs (AEDs) among people with HIV/AIDS. Methods: The literature was systematically reviewed to assess the global burden of relevant comorbid entities, to determine the number of patients who potentially utilize AEDs and antiretroviral agents (ARVs), and to address AED-ARV interactions. Results and Recommendations: AED-ARV administration may be indicated in up to 55% of people taking ARVs. Patients receiving phenytoin may require a lopinavir/ritonavir dosage increase of ∼50% to maintain unchanged serum concentrations (Level C). Patients receiving valproic acid may require a zidovudine dosage reduction to maintain unchanged serum zidovudine concentrations (Level C). Coadministration of valproic acid and efavirenz may not require efavirenz dosage adjustment (Level C). Patients receiving ritonavir/atazanavir may require a lamotrigine dosage increase of ∼50% to maintain unchanged lamotrigine serum concentrations (Level C). Coadministration of raltegravir/atazanavir and lamotrigine may not require lamotrigine dosage adjustment (Level C). Coadministration of raltegravir and midazolam may not require midazolam dosage adjustment (Level C). Patients may be counseled that it is unclear whether dosage adjustment is necessary when other AEDs and ARVs are combined (Level U). It may be important to avoid enzyme-inducing AEDs in people on ARV regimens that include protease inhibitors or nonnucleoside reverse transcriptase inhibitors, as pharmacokinetic interactions may result in virologic failure, which has clinical implications for disease progression and development of ARV resistance. If such regimens are required for seizure control, patients may be monitored through pharmacokinetic assessments to ensure efficacy of the ARV regimen (Level C). PMID:22218281

[Intermittent hypoxia due to sleep apnea syndrome in patients with type 2 diabetes mellitus].

PubMed

Burchakov, D I; Mayorov, A Yu

To evaluate the possible association between intermittent hypoxia (IH) and HbA1c in patients with insufficient control type of 2 diabetes mellitus (T2DM). In this cross-sectional study 183 patients with HbAc1≥7% underwent three-channel overnight monitoring (ApneaLink) and completed Berlin Questionnaire, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index. Patients were divided in two groups, based on the cut-off value of oxygen desaturation index≥15. There were 79 (43%) patients with intermittent hypoxia, which was associated with poorer glycaemic control, defined as HbA1c>8.7% (sample median) in the univariate analysis and after adjustment for body mass index OR 2,40 (CI 1.21-4.95, p=0.021). Neither of three questionnaires yielded satisfactory results as a screening method in patients with T2DM. There is a need to implement instrumental screening of sleep-disordered breathing in this population and to study the effects of CPAP-therapy on glycaemic control and carbohydrate metabolism.

Effect of irrigation water salinity on the organic carbon mineralization in soil (laboratory incubation)

NASA Astrophysics Data System (ADS)

Mancer, Halima; Bouhoun, Mustapha Daddi

2018-05-01

In a laboratory study, the impact of salts on mineralization of organic carbon of soil was examined through the monitoring of the amount of CO2-C released from soil. The soil used was classified as a nonsaline soil which has been irrigated with artificially salinized water, a factorial combination of three types of salts (NaCl, MgCl2, CaCl2) with three levels of electrical conductivities (3, 6, and 9 dS.m-1) was used to assess the Carbon mineralization. The incubation was carried out under aerobic conditions and at a constant temperature of 28 °C during 70 days with moisture adjusted to 2/3 of the field capacity. No significant (P > 0.05) variation in the amount of CO2-C release from soil was observed until day 56 of the incubation, but it was significantly different due to the irrigation with salt solutions during the days: 70 (p ≤ 0.05). The results suggest that the rate of C-CO2 evolution decreased with the increase in water salinity compared to the control. Also this decrease of C-mineralization in the soils irrigated by the salts solutions of NaCl was the greatest compared to the other two salts (CaCl2, and MgCl2). These results suggest that C mineralization depended on the type of salts as well as the duration of incubation.

78 FR 78508 - Quarterly Rail Cost Adjustment Factor

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-26

... Procedures--Productivity Adjustment, 5 I.C.C.2d 434 (1989), aff'd sub nom. Edison Electric Institute v. ICC... quarterly index for a measure of productivity. The provisions of 49 U.S.C. 10708 direct the Surface Transportation Board (Board) to continue to publish both an unadjusted RCAF and a productivity-adjusted RCAF. In...

Overview of the Impact of Depression and Anxiety in Chronic Obstructive Pulmonary Disease.

PubMed

Montserrat-Capdevila, Josep; Godoy, Pere; Marsal, Josep Ramon; Barbé, Ferran; Pifarré, Josep; Alsedà, Miquel; Ortega, Marta

2017-02-01

Anxiety and depression are common entities in patients diagnosed with COPD. However, the impact that they have on the exacerbation of illness is scarcely studied. To determine if the presence of anxiety and depression is associated with a greater risk of frequent exacerbation (≥2 per year) in patients diagnosed with COPD. A cohort study that analysed frequent exacerbation and associated factors in 512 patients monitored during 2 years. Exacerbations were defined as events that required antibiotic/s and/or systemic corticosteroids (moderate) or hospitalization (serious). Variables of interest were recorded for each patient, including anxiety and depression (Hospital Anxiety and Depression Scale), and we analysed their association with frequent exacerbation through the adjusted odds ratio (aOR) by means of a logistic regression model. The prevalence of anxiety/depression at the start of the study was of 15.6%. During the 2 years of monitoring, 77.9% of the patients suffered at least moderate-to-severe exacerbation. 54.1% were frequent exacerbators. Anxiety/depression were strongly associated with moderate-severe frequent exacerbation in the crude analysis (OR c  = 2.28). In the multivariate analysis, the risk factors also associated with frequent exacerbation were being overweight (aOR 2.78); obesity (aOR 3.02); diabetes (aOR 2.56) and the associated comorbidity (BODEx) (ORa = 1.45). The prevalence of anxiety/depression in COPD patients is high, and they are relevant risk factors in frequent exacerbation although the effect is lower in the multivariate analysis when adjusting for different variables strongly associated with exacerbation.

Use of risk-adjusted CUSUM charts to monitor 30-day mortality in Danish hospitals.

PubMed

Rasmussen, Thomas Bøjer; Ulrichsen, Sinna Pilgaard; Nørgaard, Mette

2018-01-01

Monitoring hospital outcomes and clinical processes as a measure of clinical performance is an integral part of modern health care. The risk-adjusted cumulative sum (CUSUM) chart is a frequently used sequential analysis technique that can be implemented to monitor a wide range of different types of outcomes. The aim of this study was to describe how risk-adjusted CUSUM charts based on population-based nationwide medical registers were used to monitor 30-day mortality in Danish hospitals and to give an example on how alarms of increased hospital mortality from the charts can guide further in-depth analyses. We used routinely collected administrative data from the Danish National Patient Registry and the Danish Civil Registration System to create risk-adjusted CUSUM charts. We monitored 30-day mortality after hospital admission with one of 77 selected diagnoses in 24 hospital units in Denmark in 2015. The charts were set to detect a 50% increase in 30-day mortality, and control limits were determined by simulations. Among 1,085,576 hospital admissions, 441,352 admissions had one of the 77 selected diagnoses as their primary diagnosis and were included in the risk-adjusted CUSUM charts. The charts yielded a total of eight alarms of increased mortality. The median of the hospitals' estimated average time to detect a 50% increase in 30-day mortality was 50 days (interquartile interval, 43;54). In the selected example of an alarm, descriptive analyses indicated performance problems with 30-day mortality following hip fracture surgery and diagnosis of chronic obstructive pulmonary disease. The presented implementation of risk-adjusted CUSUM charts can detect significant increases in 30-day mortality within 2 months, on average, in most Danish hospitals. Together with descriptive analyses, it was possible to use an alarm from a risk-adjusted CUSUM chart to identify potential performance problems.

Virtual Center for Renal Support: Definition of a Novel Knowledge-Based Telemedicine System

DTIC Science & Technology

2001-10-25

USA were monitorized by the HbA1c test (Hemoglobin A1c or fraction of Glycosilated hemoglobin) in 1998 [6] and only a little percentage was...lipid tests (lipid panel, cholesterol, HDL, LDL, VLDL, Triglycerides ) performed in 1998. Quality of life of patients is related to their morbidity...meals may require adjustments in the concentration of calcium in the dialysate fluid to prevent hypercalcemia and consequent deposition of calcium

EEG Monitoring Technique Influences the Management of Hypoxic-Ischemic Seizures in Neonates Undergoing Therapeutic Hypothermia.

PubMed

Jan, Saber; Northington, Frances J; Parkinson, Charlamaine M; Stafstrom, Carl E

2017-01-01

Electroencephalogram (EEG) monitoring techniques for neonatal hypoxia-ischemia (HI) are evolving over time, and the specific type of EEG utilized could influence seizure diagnosis and management. We examined whether the type of EEG performed affected seizure treatment decisions (e.g., the choice and number of antiseizure drugs [ASDs]) in therapeutic hypothermia-treated neonates with HI from 2007 to 2015 in the Johns Hopkins Hospital Neonatal Intensive Care Unit. During this period, 3 different EEG monitoring protocols were utilized: Period 1 (2007-2009), single, brief conventional EEG (1 h duration) at a variable time during therapeutic hypothermia treatment, i.e., ordered when a seizure was suspected; Period 2 (2009-2013), single, brief conventional EEG followed by amplitude-integrated EEG for the duration of therapeutic hypothermia treatment and another brief conventional EEG after rewarming; and Period 3 (2014-2015), continuous video-EEG (cEEG) for the duration of therapeutic hypothermia treatment (72 h) plus for an additional 12 h during and after rewarming. One hundred and sixty-two newborns were included in this retrospective cohort study. As a function of the type and duration of EEG monitoring, we assessed the risk (likelihood) of receiving no ASD, at least 1 ASD, or ≥2 ASDs. We found that the risk of a neonate being prescribed an ASD was 46% less during Period 3 (cEEG) than during Period 1 (brief conventional EEG only) (95% CI 6-69%, p = 0.03). After adjusting for initial EEG and MRI results, compared with Period 1, there was a 38% lower risk of receiving an ASD during Period 2 (95% CI: 9-58%, p = 0.02) and a 67% lower risk during Period 3 (95% CI: 23-86%, p = 0.01). The risk ratio of receiving ≥2 ASDs was not significantly different across the 3 periods. In conclusion, in addition to the higher sensitivity and specificity of continuous video-EEG monitoring, fewer infants are prescribed an ASD when undergoing continuous forms of EEG monitoring (aEEG or cEEG) than those receiving conventional EEG. We recommend that use of continuous video-EEG be considered whenever possible, both to treat seizures more specifically and to avoid overtreatment. © 2017 S. Karger AG, Basel.

Global Land Use Regression Model for Nitrogen Dioxide Air Pollution.

PubMed

Larkin, Andrew; Geddes, Jeffrey A; Martin, Randall V; Xiao, Qingyang; Liu, Yang; Marshall, Julian D; Brauer, Michael; Hystad, Perry

2017-06-20

Nitrogen dioxide is a common air pollutant with growing evidence of health impacts independent of other common pollutants such as ozone and particulate matter. However, the worldwide distribution of NO 2 exposure and associated impacts on health is still largely uncertain. To advance global exposure estimates we created a global nitrogen dioxide (NO 2 ) land use regression model for 2011 using annual measurements from 5,220 air monitors in 58 countries. The model captured 54% of global NO 2 variation, with a mean absolute error of 3.7 ppb. Regional performance varied from R 2 = 0.42 (Africa) to 0.67 (South America). Repeated 10% cross-validation using bootstrap sampling (n = 10,000) demonstrated a robust performance with respect to air monitor sampling in North America, Europe, and Asia (adjusted R 2 within 2%) but not for Africa and Oceania (adjusted R 2 within 11%) where NO 2 monitoring data are sparse. The final model included 10 variables that captured both between and within-city spatial gradients in NO 2 concentrations. Variable contributions differed between continental regions, but major roads within 100 m and satellite-derived NO 2 were consistently the strongest predictors. The resulting model can be used for global risk assessments and health studies, particularly in countries without existing NO 2 monitoring data or models.

Evaluative priming reveals dissociable effects of cognitive versus physiological anxiety on action monitoring.

PubMed

De Saedeleer, Lien; Pourtois, Gilles

2016-06-01

Performance monitoring enables the rapid detection of mismatches between goals or intentions and actions, as well as subsequent behavioral adjustment by means of enhanced attention control. These processes are not encapsulated, but they are readily influenced by affective or motivational variables, including negative affect. Here we tested the prediction that worry, the cognitive component of anxiety, and arousal, its physiological counterpart, can each influence specific processes during performance monitoring. In 2 experiments, participants were asked to discriminate the valence of emotional words that were preceded by either correct (good) or incorrect (bad) actions, serving as primes in a standard evaluative priming procedure. In Experiment 1 (n = 36) we examined the influence of trait worry and arousal. Additionally, we included a face priming task to examine the specificity of this effect. Stepwise linear regression analyses showed that increased worry, but not arousal, weakened the evaluative priming effect and therefore the rapid and automatic processing of actions as good or bad. By contrast, arousal, but not worry, increased posterror slowing. In Experiment 2 (n = 30) state worry was induced using an anagram task. Effects of worry on action monitoring were trait but not state dependent, and only evidenced when actions were directly used as primes. These results suggest a double dissociation between worry and arousal during performance monitoring. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Optimizing and Validating a Brief Assessment for Identifying Children of Service Members at Risk for Psychological Health Problems Following Parent Deployment

DTIC Science & Technology

2013-07-01

interpersonal competence and social adjustment in the classroom . Preschool Social Competence Scale – Teachers will complete this 39-item measure which...Children (BASC) ADHD Monitor. Circle Pines, MN: American Guidance Service. Keane, T., Fairbank, J., Caddell, J., Zimering, R., Taylor, K., & Mora, C

40 CFR 60.2945 - Is there a minimum amount of operating parameter monitoring data I must obtain?

Code of Federal Regulations, 2014 CFR

2014-07-01

... Standards of Performance for Other Solid Waste Incineration Units for Which Construction is Commenced After... activities (including, as applicable, calibration checks and required zero and span adjustments of the... municipal or institutional solid waste. (c) If you do not obtain the minimum data required in paragraphs (a...

40 CFR 60.2945 - Is there a minimum amount of operating parameter monitoring data I must obtain?

Code of Federal Regulations, 2013 CFR

2013-07-01

... Standards of Performance for Other Solid Waste Incineration Units for Which Construction is Commenced After... activities (including, as applicable, calibration checks and required zero and span adjustments of the... municipal or institutional solid waste. (c) If you do not obtain the minimum data required in paragraphs (a...

Automated Instrumentation, Monitoring and Visualization of PVM Programs Using AIMS

NASA Technical Reports Server (NTRS)

Mehra, Pankaj; VanVoorst, Brian; Yan, Jerry; Tucker, Deanne (Technical Monitor)

1994-01-01

We present views and analysis of the execution of several PVM codes for Computational Fluid Dynamics on a network of Sparcstations, including (a) NAS Parallel benchmarks CG and MG (White, Alund and Sunderam 1993); (b) a multi-partitioning algorithm for NAS Parallel Benchmark SP (Wijngaart 1993); and (c) an overset grid flowsolver (Smith 1993). These views and analysis were obtained using our Automated Instrumentation and Monitoring System (AIMS) version 3.0, a toolkit for debugging the performance of PVM programs. We will describe the architecture, operation and application of AIMS. The AIMS toolkit contains (a) Xinstrument, which can automatically instrument various computational and communication constructs in message-passing parallel programs; (b) Monitor, a library of run-time trace-collection routines; (c) VK (Visual Kernel), an execution-animation tool with source-code clickback; and (d) Tally, a tool for statistical analysis of execution profiles. Currently, Xinstrument can handle C and Fortran77 programs using PVM 3.2.x; Monitor has been implemented and tested on Sun 4 systems running SunOS 4.1.2; and VK uses X11R5 and Motif 1.2. Data and views obtained using AIMS clearly illustrate several characteristic features of executing parallel programs on networked workstations: (a) the impact of long message latencies; (b) the impact of multiprogramming overheads and associated load imbalance; (c) cache and virtual-memory effects; and (4significant skews between workstation clocks. Interestingly, AIMS can compensate for constant skew (zero drift) by calibrating the skew between a parent and its spawned children. In addition, AIMS' skew-compensation algorithm can adjust timestamps in a way that eliminates physically impossible communications (e.g., messages going backwards in time). Our current efforts are directed toward creating new views to explain the observed performance of PVM programs. Some of the features planned for the near future include: (a) ConfigView, showing the physical topology of the virtual machine, inferred using specially formatted IP (Internet Protocol) packets; and (b) LoadView, synchronous animation of PVM-program execution and resource-utilization patterns.

Intercomparison of an Aerosol Chemical Speciation Monitor (ACSM) with ambient fine aerosol measurements in downtown Atlanta, Georgia

NASA Astrophysics Data System (ADS)

Budisulistiorini, S. H.; Canagaratna, M. R.; Croteau, P. L.; Baumann, K.; Edgerton, E. S.; Kollman, M. S.; Ng, N. L.; Verma, V.; Shaw, S. L.; Knipping, E. M.; Worsnop, D. R.; Jayne, J. T.; Weber, R. J.; Surratt, J. D.

2014-07-01

Currently, there are a limited number of field studies that evaluate the long-term performance of the Aerodyne Aerosol Chemical Speciation Monitor (ACSM) against established monitoring networks. In this study, we present seasonal intercomparisons of the ACSM with collocated fine aerosol (PM2.5) measurements at the Southeastern Aerosol Research and Characterization (SEARCH) Jefferson Street (JST) site near downtown Atlanta, GA, during 2011-2012. Intercomparison of two collocated ACSMs resulted in strong correlations (r2 > 0.8) for all chemical species, except chloride (r2 = 0.21) indicating that ACSM instruments are capable of stable and reproducible operation. In general, speciated ACSM mass concentrations correlate well (r2 > 0.7) with the filter-adjusted continuous measurements from JST, although the correlation for nitrate is weaker (r2 = 0.55) in summer. Correlations of the ACSM NR-PM1 (non-refractory particulate matter with aerodynamic diameter less than or equal to 1 μm) plus elemental carbon (EC) with tapered element oscillating microbalance (TEOM) PM2.5 and Federal Reference Method (FRM) PM1 mass are strong with r2 > 0.7 and r2 > 0.8, respectively. Discrepancies might be attributed to evaporative losses of semi-volatile species from the filter measurements used to adjust the collocated continuous measurements. This suggests that adjusting the ambient aerosol continuous measurements with results from filter analysis introduced additional bias to the measurements. We also recommend to calibrate the ambient aerosol monitoring instruments using aerosol standards rather than gas-phase standards. The fitting approach for ACSM relative ionization for sulfate was shown to improve the comparisons between ACSM and collocated measurements in the absence of calibrated values, suggesting the importance of adding sulfate calibration into the ACSM calibration routine.

Supported Telemonitoring and Glycemic Control in People with Type 2 Diabetes: The Telescot Diabetes Pragmatic Multicenter Randomized Controlled Trial

PubMed Central

Wild, Sarah H.; Hanley, Janet; Lewis, Stephanie C.; McKnight, John A.; Padfield, Paul L.; Parker, Richard A.; Pinnock, Hilary; Sheikh, Aziz; McKinstry, Brian

2016-01-01

Background Self-monitoring of blood glucose among people with type 2 diabetes not treated with insulin does not appear to be effective in improving glycemic control. We investigated whether health professional review of telemetrically transmitted self-monitored glucose results in improved glycemic control in people with poorly controlled type 2 diabetes. Methods and Findings We performed a randomized, parallel, investigator-blind controlled trial with centralized randomization in family practices in four regions of the United Kingdom among 321 people with type 2 diabetes and glycated hemoglobin (HbA1c) >58 mmol/mol. The supported telemonitoring intervention involved self-measurement and transmission to a secure website of twice-weekly morning and evening glucose for review by family practice clinicians who were not blinded to allocation group. The control group received usual care, with at least annual review and more frequent reviews for people with poor glycemic or blood pressure control. HbA1c assessed at 9 mo was the primary outcome. Intention-to-treat analyses were performed. 160 people were randomized to the intervention group and 161 to the usual care group between June 6, 2011, and July 19, 2013. HbA1c data at follow-up were available for 146 people in the intervention group and 139 people in the control group. The mean (SD) HbA1c at follow-up was 63.0 (15.5) mmol/mol in the intervention group and 67.8 (14.7) mmol/mol in the usual care group. For primary analysis, adjusted mean HbA1c was 5.60 mmol/mol / 0.51% lower (95% CI 2.38 to 8.81 mmol/mol/ 95% CI 0.22% to 0.81%, p = 0·0007). For secondary analyses, adjusted mean ambulatory systolic blood pressure was 3.06 mmHg lower (95% CI 0.56–5.56 mmHg, p = 0.017) and mean ambulatory diastolic blood pressure was 2.17 mmHg lower (95% CI 0.62–3.72, p = 0.006) among people in the intervention group when compared with usual care after adjustment for baseline differences and minimization strata. No significant differences were identified between groups in weight, treatment pattern, adherence to medication, or quality of life in secondary analyses. There were few adverse events and these were equally distributed between the intervention and control groups. In secondary analysis, there was a greater number of telephone calls between practice nurses and patients in the intervention compared with control group (rate ratio 7.50 (95% CI 4.45–12.65, p < 0.0001) but no other significant differences between groups in use of health services were identified between groups. Key limitations include potential lack of representativeness of trial participants, inability to blind participants and health professionals, and uncertainty about the mechanism, the duration of the effect, and the optimal length of the intervention. Conclusions Supported telemonitoring resulted in clinically important improvements in control of glycaemia in patients with type 2 diabetes in family practice. Current Controlled Trials, registration number ISRCTN71674628. Trial Registration Current Controlled Trials ISRCTN 71674628 PMID:27458809

Antiepileptic drug selection for people with HIV/AIDS: evidence-based guidelines from the ILAE and AAN.

PubMed

Birbeck, Gretchen L; French, Jacqueline A; Perucca, Emilio; Simpson, David M; Fraimow, Henry; George, Jomy M; Okulicz, Jason F; Clifford, David B; Hachad, Houda; Levy, René H

2012-01-01

A joint panel of the American Academy of Neurology (AAN) and the International League Against Epilepsy (ILAE) convened to develop guidelines for selection of antiepileptic drugs (AEDs) among people with HIV/AIDS. The literature was systematically reviewed to assess the global burden of relevant comorbid entities, to determine the number of patients who potentially utilize AEDs and antiretroviral agents (ARVs), and to address AED-ARV interactions. Key findings from this literature search included the following: AED-ARV administration may be indicated in up to 55% of people taking ARVs. Patients receiving phenytoin may require a lopinavir/ritonavir dosage increase of approximately 50% to maintain unchanged serum concentrations (Level C). Patients receiving valproic acid may require a zidovudine dosage reduction to maintain unchanged serum zidovudine concentrations (Level C). Coadministration of valproic acid and efavirenz may not require efavirenz dosage adjustment (Level C). Patients receiving ritonavir/atazanavir may require a lamotrigine dosage increase of approximately 50% to maintain unchanged lamotrigine serum concentrations (Level C). Coadministration of raltegravir/atazanavir and lamotrigine may not require lamotrigine dosage adjustment (Level C). Coadministration of raltegravir and midazolam may not require midazolam dosage adjustment (Level C). Patients may be counseled that it is unclear whether dosage adjustment is necessary when other AEDs and ARVs are combined (Level U). It may be important to avoid enzyme-inducing AEDs in people on ARV regimens that include protease inhibitors or nonnucleoside reverse transcriptase inhibitors because pharmacokinetic interactions may result in virologic failure, which has clinical implications for disease progression and development of ARV resistance. If such regimens are required for seizure control, patients may be monitored through pharmacokinetic assessments to ensure efficacy of the ARV regimen (Level C). Wiley Periodicals, Inc. © 2011 International League Against Epilepsy.

Principles of self-adjustment of insulin dose in people with diabetes type 2 and flexible insulin therapy.

PubMed

Kramer, G; Kuniss, N; Kloos, C; Lehmann, T; Müller, N; Sanow, B; Lorkowski, S; Wolf, G; Müller, U A

2016-06-01

Structured treatment and education programmes for people with type 2 diabetes mellitus (T2DM) and flexible insulin therapy provide rules for self-adjustment of insulin dose, that are extensively trained. The aim of this cohort study was to register current principles and the frequency of self-adjustment of insulin dose and their association with metabolic control in people with T2DM. Details of insulin dose adjustment were assessed by a structured interview in 149 people with T2DM on flexible insulin therapy (mean HbA1c 7.1%/53.8mmol/mol, age 65y, diabetes duration 19.0y, BMI 33.8kg/m(2)) in a tertiary care centre. The frequency of insulin dose adjustments was obtained from the last 28days of the patients' diaries. Insulin dose adjustment by adjustment rules was used by 33 people (22.1%) and by personal experience/feeling in 111 participants (74.5%). People adjusting by rules were younger (60.9±9.8 vs. 65.7±9.2, p=0.011) and did more insulin dose adjustments per 28days (50.0±31.0 vs. 33.4±23.5, p=0.016). HbA1c and incidence of hypoglycaemia were comparable. There were no differences in satisfaction of treatment, quality of life as well as current well-being between the groups. Only a fifth of the participants used the rule trained within the education programme to adjust their insulin dose. The majority adjusted their insulin dose by personal experience/feeling. However, people in both groups were able to adjust their insulin dose. Although people using adjustment rules adjust their insulin dose more frequently, HbA1c and the incidence of hypoglycaemia was similar compared to those using personal experience/feeling. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

25 CFR Appendix B to Subpart C - Population Adjustment Factor

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Population Adjustment Factor B Appendix B to Subpart C...—Population Adjustment Factor 1. The Population Adjustment Factor allows for participation in the IRR Program... Distribution factor* Number of tribes** Funding amount per tribe Less than 25 1 N1 MBA*** × 1 25-100 3.5 N2 MBA...

Is adherence to weight monitoring or weight-based diuretic self-adjustment associated with fewer heart failure-related emergency department visits or hospitalizations?

PubMed

Jones, Christine D; Holmes, George M; Dewalt, Darren A; Erman, Brian; Broucksou, Kimberly; Hawk, Victoria; Cene, Crystal W; Wu, Jia-Rong; Pignone, Michael

2012-07-01

Heart failure (HF) self-care interventions can improve outcomes, but less than optimal adherence may limit their effectiveness. We evaluated if adherence to weight monitoring and diuretic self-adjustment was associated with HF-related emergency department (ED) visits or hospitalizations. We performed a case-control analysis nested in a HF self-care randomized trial. Participants received HF self-care training, including weight monitoring and diuretic self-adjustment, which they were to record in a diary. We defined case time periods as HF-related ED visits or hospitalizations in the 7 preceding days; control time periods were defined as 7-day periods free of ED visits and hospitalizations. We used logistic regression to compare weight monitoring and diuretic self-adjustment adherence in case and control time periods, adjusted for demographic and clinical covariates. Among 303 participants, we identified 81 HF-related ED visits or hospitalizations (cases) in 54 patients over 1 year of follow-up. Weight monitoring adherence (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.23-0.76) and diuretic self-adjustment adherence (OR 0.44, 95% CI 0.19-0.98) were both associated with lower adjusted odds of HF-related ED visits or hospitalizations. Adherence to weight monitoring and diuretic self-adjustment was associated with lower odds of HF-related ED visits or hospitalizations. Adherence to these activities may reduce HF-related morbidity. Copyright © 2012 Elsevier Inc. All rights reserved.

Association of blood lead levels with urinary F2-8α Isoprostane and 8-hydroxy-2-deoxy-Guanosine concentrations in first-grade Uruguayan children

PubMed Central

Roy, Aditi; Queirolo, Elena; Peregalli, Fabiana; Mañay, Nelly; Martínez, Gabriela; Kordas, Katarzyna

2015-01-01

Oxidative stress (OS) is a potential molecular mechanism for lead-induced toxicities, yet, we have limited understanding of the relation between low-level lead (Pb) exposure and OS, especially in children. This cross-sectional study examines the association between blood lead level (BLL) and two OS markers—urinary F2-8α isoprostane or isoprostane (a marker of lipid peroxidation) and 8-hydroxy-2-deoxy-Guanosine or 8-OH-dG (a marker of DNA damage) in 211 children, aged 5–8 years, from Montevideo, Uruguay. The role of dietary intakes of vitamin C and zinc in modifying the relation between BLL and OS was also examined. The mean (SD) BLL of the study children was 4.7 (2.2) μg/dL, with 30.2% children having BLL ≥5 μg/dL, the current reference level set by the US Centre for Disease Control for identifying, monitoring and management of children with elevated BLL. In covariate-adjusted analysis, there was a weak positive association between BLL and urinary isoprostane (adjusted for specific gravity) [β = 0.09, p< 0.1]. No association was found between children’s BLL and urinary 8-OH-dG. Interactions between dietary intakes of vitamin C or zinc and BLL on OS biomarkers were not consistent. However, when BLL and vitamin C or BLL and zinc were modeled together, BLL was independently associated with isoprostane concentration [β = 0.10, p< 0.05] but vitamin C or zinc intake was not. These findings suggest that there may be a potential adverse effect of BLL on OS in children with low-level Pb exposure. There is a need to study the effects of Pb on other OS measures, as well as the role of OS in mediating low-level Pb toxicity on functional outcomes. PMID:25863186

Method & apparatus for monitoring plasma processing operations

DOEpatents

Smith, Jr., Michael Lane; Ward, Pamela Denise; Stevenson, Joel O'Don

2004-10-19

The invention generally relates to various aspects of a plasma process and, more specifically, to the monitoring of such plasma processes. One aspect relates to a plasma monitoring module that may be adjusted in at least some manner so as to re-evaluate a previously monitored plasma process. For instance, optical emissions data on a plasma process that was previously monitored by the plasma monitoring module may be replayed through the plasma monitoring module after making at least one adjustment in relation to the plasma monitoring module.

A Global Land Use Regression Model for Nitrogen Dioxide Air Pollution

PubMed Central

Larkin, Andrew; Geddes, Jeffrey A.; Martin, Randall V.; Xiao, Qingyang; Liu, Yang; Marshall, Julian D.; Brauer, Michael; Hystad, Perry

2017-01-01

Nitrogen dioxide is a common air pollutant with growing evidence of health impacts independent of other common pollutants such as ozone and particulate matter. However, the global distribution of NO2 exposure and associated impacts on global health is still largely uncertain. To advance global exposure estimates we created a global nitrogen dioxide (NO2) land use regression model for 2011 using annual measurements from 5,220 air monitors in 58 countries. The model captured 54% of global NO2 variation, with a mean absolute error of 3.7 ppb. Regional performance varied from R2 = 0.42 (Africa) to 0.67 (South America). Repeated 10% cross-validation using bootstrap sampling (n=10,000) demonstrated robust performance with respect to air monitor sampling in North America, Europe, and Asia (adjusted R2 within 2%) but not for Africa and Oceania (adjusted R2 within 11%) where NO2 monitoring data are sparse. The final model included 10 variables that captured both between and within-city spatial gradients in NO2 concentrations. Variable contributions differed between continental regions but major roads within 100m and satellite-derived NO2 were consistently the strongest predictors. The resulting model will be made available and can be used for global risk assessments and health studies, particularly in countries without existing NO2 monitoring data or models. PMID:28520422

A Multicenter Real-Life Study on the Effect of Flash Glucose Monitoring on Glycemic Control in Patients with Type 1 and Type 2 Diabetes.

PubMed

Anjana, Ranjit Mohan; Kesavadev, Jothydev; Neeta, Deshpande; Tiwaskar, Mangesh; Pradeepa, Rajendra; Jebarani, Saravanan; Thangamani, Suresh; Sastry, Nadiminty Ganapathi; Brijendra Kumar, Srivastava; Ramu, Muthu; Gupta, Pokal Prasanna Kumar; Vignesh, Jayaprakash; Chandru, Sundramoorthy; Kayalvizhi, Sengottuvel; Jagdish, Padoor Sethuraman; Uthra, Subash Chandra Bose; Lovelena, Munawar; Jyoti, Sah; Suguna Priya, Sengodan; Kannan, Alagarsamy; Mohan, Viswanathan; Unnikrishnan, Ranjit

2017-09-01

To assess the efficacy of ambulatory glucose profiling (AGP) generated by FreeStyle LibrePro ™ flash glucose monitoring (FCGM) on glycemic control in patients with uncontrolled type 1 diabetes (T1D) and type 2 diabetes (T2D). Clinical and biochemical data were obtained from 5072 patients with diabetes who had an A1c ≥7% (2536 who had been initiated on FCGM-based AGP between March 2015 and October 2016 [cases] and 2536 age-, gender-, A1c-, site- and time-matched controls who were not initiated on AGP) across seven diabetes clinics in India. Anthropometric and clinical measurements were obtained through standardized techniques. Fasting and postprandial plasma glucose and glycated hemoglobin(A1c) were estimated before and after initiation of AGP. Overall, there was a significant decrease in A1c both in cases and controls; however, the magnitude of reduction was higher among cases (1% vs.0.7%; P < 0.001).The overall reduction in A1c among cases was higher in T2D (9.2% to 8.3%) compared with T1D (9.6% to 9.4%); however, the absolute difference in A1c reduction between cases and controls was higher among T1D (0.5% vs. 0.2%) patients. The reduction in glycemic parameters was irrespective of age or gender (P for trend <0.001) across all study sites. The greatest reductions in A1c were noted within 6 months of AGP initiation. Multiple logistic regression showed that those who did not use AGP had a 1.42 higher risk (95% CI: 1.24-1.64) of not achieving even 0.1% reduction in A1c compared with those who were initiated on AGP even after adjusting for age, gender, body-mass index, systolic blood pressure, time to follow-up A1c, and medication use. This study shows that FCGM-based AGP with FreeStyle LibrePro is associated with significant reductions in A1c levels in both T1D and T2D. In addition, improvement in A1c levels was maintained across all age groups and in patients enrolled at different diabetes clinics in India.

49 CFR 1135.1 - Quarterly adjustment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... railroad productivity as prescribed in Railroad Cost Recovery Procedures, 1 I.C.C.2d 207 (1984), and any subsequent amendments thereto. In addition, the AAR shall calculate the productivity-adjusted RCAF as...

Randomized clinical trial to assess the effectiveness of remote patient monitoring and physician care in reducing office blood pressure.

PubMed

Kim, Yoon-Nyun; Shin, Dong Gu; Park, Sungha; Lee, Chang Hee

2015-07-01

The effectiveness of remote patient monitoring and physician care for the treatment of hypertension has not been demonstrated in a randomized clinical trial. The objective of this study was to evaluate the effectiveness of remote patient monitoring with or without remote physician care in reducing office blood pressure in patients with hypertension. A total of 374 hypertensive patients over 20 years of age were randomized into the following three groups: group (1) control, the patients received usual clinical care with home BP monitoring; group (2) the patients were remotely monitored and received office follow-up; and group (3) the patients received remote monitoring without physician office care using the remote monitoring device. For each group, in-office follow-up care was scheduled every 8 weeks for 24 weeks. The primary end point was the difference in sitting SBP at the 24-week follow-up. No difference between the three groups was observed in the primary end point (adjusted mean sitting SBP was as follows: group 1: -8.9±15.5 mm Hg, group 2: -11.3±15.9 mm Hg, group 3: -11.6±19.8 mm Hg, (NS). Significant differences in achieving the target BP at the 24th week of follow-up were observed between groups 1 and 2. The subjects over 55-years old had a significant decrease in the adjusted mean sitting SBP in groups 2 and 3 compared with that of the control group. Remote monitoring alone or remote monitoring coupled with remote physician care was as efficacious as the usual office care for reducing blood pressure with comparable safety and efficacy in hypertensive patients.

Task feedback effects on conflict monitoring and executive control: relationship to subclinical measures of depression.

PubMed

Holmes, Avram J; Pizzagalli, Diego A

2007-02-01

Emerging evidence suggests that depression is associated with executive dysfunction, particularly after committing errors or receiving negative performance feedback. To test this hypothesis, 57 participants performed two executive tasks known to elicit errors (the Simon and Stroop Tasks) during positive or negative performance feedback. Participants with elevated depressive symptoms (Beck Depression Inventory scores >or= 13) were characterized by impaired posterror and postconflict performance adjustments, especially during emotionally negative task-related feedback. Additionally, for both tasks, depressive symptoms were inversely related to postconflict reaction time adjustments following negative, but not positive, feedback. These findings suggest that subclinical depression is associated with impairments in behavioral adjustments after internal (perceived failure) and external feedback about deficient task performance. (c) 2007 APA, all rights reserved.

Process monitoring in intensive care with the use of cumulative expected minus observed mortality and risk-adjusted P charts.

PubMed

Cockings, Jerome G L; Cook, David A; Iqbal, Rehana K

2006-02-01

A health care system is a complex adaptive system. The effect of a single intervention, incorporated into a complex clinical environment, may be different from that expected. A national database such as the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme in the UK represents a centralised monitoring, surveillance and reporting system for retrospective quality and comparative audit. This can be supplemented with real-time process monitoring at a local level for continuous process improvement, allowing early detection of the impact of both unplanned and deliberately imposed changes in the clinical environment. Demographic and UK Acute Physiology and Chronic Health Evaluation II (APACHE II) data were prospectively collected on all patients admitted to a UK regional hospital between 1 January 2003 and 30 June 2004 in accordance with the ICNARC Case Mix Programme. We present a cumulative expected minus observed (E-O) plot and the risk-adjusted p chart as methods of continuous process monitoring. We describe the construction and interpretation of these charts and show how they can be used to detect planned or unplanned organisational process changes affecting mortality outcomes. Five hundred and eighty-nine adult patients were included. The overall death rate was 0.78 of predicted. Calibration showed excess survival in ranges above 30% risk of death. The E-O plot confirmed a survival above that predicted. Small transient variations were seen in the slope that could represent random effects, or real but transient changes in the quality of care. The risk-adjusted p chart showed several observations below the 2 SD control limits of the expected mortality rate. These plots provide rapid analysis of risk-adjusted performance suitable for local application and interpretation. The E-O chart provided rapid easily visible feedback of changes in risk-adjusted mortality, while the risk-adjusted p chart allowed statistical evaluation. Local analysis of risk-adjusted mortality data with an E-O plot and a risk-adjusted p chart is feasible and allows the rapid detection of changes in risk-adjusted outcome of intensive care patients. This complements the centralised national database, which is more archival and comparative in nature.

Melperone but not bisoprolol or metoprolol is a clinically relevant inhibitor of CYP2D6: evidence from a therapeutic drug monitoring survey.

PubMed

Hefner, Gudrun; Unterecker, Stefan; Shams, Mohamed E E; Wolf, Margarete; Falter, Tanja; Haen, Ekkehard; Hiemke, Christoph

2015-11-01

Cytochrome P450 enzymes (CYP) can be inhibited or induced by drugs, resulting in clinically significant drug-drug interactions that can cause unanticipated adverse reactions or therapeutic failures. The objective of the study was to analyze the in vivo inhibitory potential of the beta-blockers bisoprolol and metoprolol as well as the low-potency antipsychotic melperone on CYP2D6. By utilizing a large therapeutic drug monitoring database of 2874 samples, data from patients who had been treated with venlafaxine (VEN) either without (control group) or with a concomitant medication with bisoprolol, metoprolol or melperone were evaluated retrospectively to study the CYP2D6-catalyzed O-demethylation to O-desmethylvenlafaxine (ODVEN). Dose-adjusted serum levels (C/D) of VEN and ODVEN as well as the metabolic ratios (ODVEN/VEN) were computed for the four groups and compared using Kruskal-Wallis test. In total, 381 patients could be included for analysis. No significant difference was found in the median C/D (VEN), C/D (ODVEN) or C/D of the active moiety (VEN + ODVEN) in either the metoprolol (N = 103) or bisoprolol group (N = 101), compared to the control group (N = 108). In contrast, a significantly higher median C/D (VEN) (0.79 ng/ml/mg, range 0.13-5.73 ng/ml/mg) (P < 0.01) was found in the melperone group (N = 69), compared to the control group (0.46 ng/ml/mg, range 0.02-7.39 ng/ml/mg). A significant decrease (P < 0.01) was solely found in the median metabolic ratios of ODVEN/VEN between the melperone group (0.90, range 0.14-15.15), compared to the control group (2.39, range 0.06-15.31). The results of this study provided evidence that melperone but not bisoprolol or metoprolol has a clinically relevant inhibitory potential on CYP2D6.

Real-time complication monitoring in pediatric cardiac surgery.

PubMed

Belliveau, Daniel; Burton, Hayley J; O'Blenes, Stacy B; Warren, Andrew E; Hancock Friesen, Camille L

2012-11-01

As overall mortality rates have fallen in pediatric cardiac surgical procedures, complication monitoring is becoming an increasingly important metric of patient outcome. Currently there is no standardized method available to monitor severity-adjusted complications in congenital cardiac surgical procedures. Complications associated with pediatric cardiac surgical procedures were prospectively collected from consecutive cases in a single pediatric cardiac surgical unit from October 1, 2009 to September 31, 2011. Complications were accounted for by frequency and severity and then stratified by surgical complexity, using the Risk Adjustment for Congenital Heart Surgery (RACHS) method, giving an average morbidity burden per RACHS category. "Expected" morbidity burden for each RACHS category was derived from year 1 (2009-2010) data. Observed minus expected (O:E) plots were then generated for the entire series of complications from year 2 (2010-2011) data. Separate O:E plots were also created for 5 complication classes and monitored for increases. There were 181 index surgical procedures performed in 178 patients. Two hundred and seventeen complications occurred in 80 procedures. The frequency and severity of complications increased with surgical complexity. The overall O:E plot was flagged twice for unanticipated increases in severity-adjusted complications. When the class-specific O:E plots were monitored for increases, the overall flags were found to originate from increased rates of infections and cardiac/operative complications. The O:E plot provides a simple and effective system to monitor complication rates over time based on severity-adjusted complication data. Grouping complications into classes allows us to identify specific subsets of complications that can be focused on to improve patient outcomes. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Risk-adjusted monitoring of survival times

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

Sego, Landon H.; Reynolds, Marion R.; Woodall, William H.

2009-02-26

We consider the monitoring of clinical outcomes, where each patient has a di®erent risk of death prior to undergoing a health care procedure.We propose a risk-adjusted survival time CUSUM chart (RAST CUSUM) for monitoring clinical outcomes where the primary endpoint is a continuous, time-to-event variable that may be right censored. Risk adjustment is accomplished using accelerated failure time regression models. We compare the average run length performance of the RAST CUSUM chart to the risk-adjusted Bernoulli CUSUM chart, using data from cardiac surgeries to motivate the details of the comparison. The comparisons show that the RAST CUSUM chart is moremore » efficient at detecting a sudden decrease in the odds of death than the risk-adjusted Bernoulli CUSUM chart, especially when the fraction of censored observations is not too high. We also discuss the implementation of a prospective monitoring scheme using the RAST CUSUM chart.« less

Variation in Intracranial Pressure Monitoring and Outcomes in Pediatric Traumatic Brain Injury

PubMed Central

Bennett, Tellen D.; Riva-Cambrin, Jay; Keenan, Heather T.; Korgenski, E. Kent; Bratton, Susan L.

2015-01-01

Objectives In children with traumatic brain injury (TBI), to describe between-hospital and patient-level variation in intracranial pressure (ICP) monitoring, and to evaluate ICP monitoring in association with hospital features and outcome Design Retrospective cohort study Setting Children’s hospitals participating in the Pediatric Health Information System database, January, 2001 to June, 2011 Participants Children (age < 18 years) with TBI and head/neck Abbreviated Injury Scale (AIS) score ≥ 3 who were ventilated for ≥ 96 consecutive hours or died in the first 4 days after admission Interventions None Outcome Measures ICP monitoring Results 4,667 children met study criteria. Hospital mortality was 41% (1,919/4,667). Overall, 55% (2,586/4,667) of patients received ICP monitoring. Expected hospital ICP monitoring rates after adjustment for patient age, cardiac arrest, inflicted injury, craniotomy or craniectomy, head/neck AIS, and injury severity score (ISS) were 47-60%. Observed hospital ICP monitoring rates were 14-83%. Hospitals with more observed ICP monitoring, relative to expected, and hospitals with higher patient volumes had lower rates of mortality or severe disability. After adjustment for between-hospital variation and patient severity of injury, ICP monitoring was independently associated with age ≥ 1 year (odds ratio [OR] 3.1, 95% confidence interval 2.5-3.8) versus age < 1 year. Conclusions There was significant between-hospital variation in ICP monitoring that cannot be attributed solely to differences in case mix. Hospitals that monitor ICP more often and hospitals with higher patient volumes had better patient outcomes. Infants with TBI are less likely to receive ICP monitoring than older children. PMID:22751878

Firefly luciferase-based dynamic bioluminescence imaging: a noninvasive technique to assess tumor angiogenesis.

PubMed

Sun, Amy; Hou, Lewis; Prugpichailers, Tiffany; Dunkel, Jason; Kalani, Maziyar A; Chen, Xiaoyuan; Kalani, M Yashar S; Tse, Victor

2010-04-01

Bioluminescence imaging (BLI) is emerging as a cost-effective, high-throughput, noninvasive, and sensitive imaging modality to monitor cell growth and trafficking. We describe the use of dynamic BLI as a noninvasive method of assessing vessel permeability during brain tumor growth. With the use of stereotactic technique, 10 firefly luciferase-transfected GL26 mouse glioblastoma multiforme cells were injected into the brains of C57BL/6 mice (n = 80). After intraperitoneal injection of D-luciferin (150 mg/kg), serial dynamic BLI was performed at 1-minute intervals (30 seconds exposure) every 2 to 3 days until death of the animals. The maximum intensity was used as an indirect measurement of tumor growth. The adjusted slope of initial intensity (I90/Im) was used as a proxy to monitor the flow rate of blood into the vascular tree. Using a modified Evans blue perfusion protocol, we calculated the relative permeability of the vascular tree at various time points. Daily maximum intensity correlated strongly with tumor volume. At postinjection day 23, histology and BLI demonstrated an exponential growth of the tumor mass. Slopes were calculated to reflect the flow in the vessels feeding the tumor (adjusted slope = I90/Im). The increase in BLI intensity was correlated with a decrease in adjusted slope, reflecting a decrease in the rate of blood flow as tumor volume increased (y = 93.8e-0.49, R2 = 0.63). Examination of calculated slopes revealed a peak in permeability around postinjection day 20 (n = 42, P < .02 by 1-way analysis of variance) and showed a downward trend in relation to both postinjection day and maximum intensity observed; as angiogenesis progressed, tumor vessel caliber increased dramatically, resulting in sluggish but increased flow. This trend was correlated with Evans blue histology, revealing an increase in Evans blue dye uptake into the tumor, as slope calculated by BLI increases. Dynamic BLI is a practical, noninvasive technique that can semiquantitatively monitor changes in vascular permeability and therefore facilitate the study of tumor angiogenesis in animal models of disease.

Continuous glucose monitoring in acute coronary syndrome.

PubMed

Rodríguez-Quintanilla, Karina Alejandra; Lavalle-González, Fernando Javier; Mancillas-Adame, Leonardo Guadalupe; Zapata-Garrido, Alfonso Javier; Villarreal-Pérez, Jesús Zacarías; Tamez-Pérez, Héctor Eloy

2013-01-01

Diabetes mellitus is an independent risk factor for cardiovascular disease. To compare the efficacy of devices for continuous glucose monitoring and capillary glucose monitoring in hospitalized patients with acute coronary syndrome using the following parameters: time to achieve normoglycemia, period of time in normoglycemia, and episodes of hypoglycemia. We performed a pilot, non-randomized, unblinded clinical trial that included 16 patients with acute coronary artery syndrome, a capillary or venous blood glucose ≥ 140 mg/dl, and treatment with a continuous infusion of fast acting human insulin. These patients were randomized into 2 groups: a conventional group, in which capillary measurement and recording as well as insulin adjustment were made every 4h, and an intervention group, in which measurement and recording as well as insulin adjustment were made every hour with a subcutaneous continuous monitoring system. Student's t-test was applied for mean differences and the X(2) test for qualitative variables. We observed a statistically significant difference in the mean time for achieving normoglycemia, favoring the conventional group with a P = 0.02. Continuous monitoring systems are as useful as capillary monitoring for achieving normoglycemia. Copyright © 2012 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

Deferred modification of antiretroviral regimen following documented treatment failure in Asia: results from the TREAT Asia HIV Observational Database (TAHOD)

PubMed Central

Zhou, J; Li, PCK; Kumarasamy, N; Boyd, M; Chen, YMA; Sirisanthana, T; Sungkanuparph, S; Oka, S; Tau, G; Phanuphak, P; Saphonn, V; Zhang, FJ; Omar, SFS; Lee, CKC; Ditangco, R; Merati, TP; Lim, PL; Choi, JY; Law, MG; Pujari, S

2010-01-01

Objective The aim of the study was to examine the rates and predictors of treatment modification following combination antiretroviral therapy (cART) failure in Asian patients with HIV enrolled in the TREAT Asia HIV Observational Database (TAHOD). Methods Treatment failure (immunological, virological and clinical) was defined by World Health Organization criteria. Countries were categorized as high or low income by World Bank criteria. Results Among 2446 patients who initiated cART, 447 were documented to have developed treatment failure over 5697 person-years (7.8 per 100 person-years). A total of 253 patients changed at least one drug after failure (51.6 per 100 person-years). There was no difference between patients from high- and low-income countries [adjusted hazard ratio (HR) 1.02; P = 0.891]. Advanced disease stage [Centers for Disease Control and Prevention (CDC) category C vs. A; adjusted HR 1.38, P = 0.040], a lower CD4 count (≥ 51 cells/μL vs. ≤ 50 cells/μL; adjusted HR 0.61, P = 0.022) and a higher HIV viral load (≥ 400 HIV-1 RNA copies/mL vs. < 400 copies/mL; adjusted HR 2.69, P < 0.001) were associated with a higher rate of treatment modification after failure. Compared with patients from low-income countries, patients from high-income countries were more likely to change two or more drugs (67% vs. 49%; P = 0.009) and to change to a protease-inhibitor-containing regimen (48% vs. 16%; P< 0.001). Conclusions In a cohort of Asian patients with HIV infection, nearly half remained on the failing regimen in the first year following documented treatment failure. This deferred modification is likely to have negative implications for accumulation of drug resistance and response to second-line treatment. There is a need to scale up the availability of second-line regimens and virological monitoring in this region. PMID:19601993

11 CFR 9008.5 - Adjustment of entitlement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... of 2 U.S.C. 441a(c). (b) The entitlements established by 11 CFR 9008.4 shall be adjusted so as not to... in 11 CFR 9008.12(b)(7), in calculating these adjustments, amounts expended by Government agencies... committees in accordance with 11 CFR 9008.52; expenditures to participate in or attend the convention under...

11 CFR 9008.5 - Adjustment of entitlement.

Code of Federal Regulations, 2014 CFR

2014-01-01

... of 2 U.S.C. 441a(c). (b) The entitlements established by 11 CFR 9008.4 shall be adjusted so as not to... in 11 CFR 9008.12(b)(7), in calculating these adjustments, amounts expended by Government agencies... committees in accordance with 11 CFR 9008.52; expenditures to participate in or attend the convention under...

11 CFR 9008.5 - Adjustment of entitlement.

Code of Federal Regulations, 2011 CFR

2011-01-01

... of 2 U.S.C. 441a(c). (b) The entitlements established by 11 CFR 9008.4 shall be adjusted so as not to... in 11 CFR 9008.12(b)(7), in calculating these adjustments, amounts expended by Government agencies... committees in accordance with 11 CFR 9008.52; expenditures to participate in or attend the convention under...

11 CFR 9008.5 - Adjustment of entitlement.

Code of Federal Regulations, 2012 CFR

2012-01-01

... of 2 U.S.C. 441a(c). (b) The entitlements established by 11 CFR 9008.4 shall be adjusted so as not to... in 11 CFR 9008.12(b)(7), in calculating these adjustments, amounts expended by Government agencies... committees in accordance with 11 CFR 9008.52; expenditures to participate in or attend the convention under...

Influence of CYP2C9 polymorphism and phenytoin co-administration on acenocoumarol dose in patients with cerebral venous thrombosis.

PubMed

De, Tanima; Christopher, Rita; Nagaraja, Dindagur

2014-05-01

The study aimed at evaluating the contribution of genetic variations in the drug metabolizing enzyme, CYP2C9, and the influence of co-medication with the antiepileptic drug, phenytoin, to variability in acenocoumarol response, in patients with cerebral venous thrombosis (CVT). 476 acenocoumarol-treated CVT patients (153 males and 323 females) were genotyped for CYP2C9*2 and CYP2C9*3 polymorphisms by PCR-RFLP method. Mean acenocoumarol dose required for achieving and maintaining a stable international normalized ratio (INR) was calculated for different genotypes. The effect of co-administration with phenytoin was determined. Genotype distributions of CYP2C9 were as follows: 83%CYP2C9*1/*1, 8.6%CYP2C9*1/*3, 5.9%CYP2C9*1/*2, 1.9%CYP2C9*3/*3, 0.4%CYP2C9*2/*3 and 0.2%CYP2C9*2/*2. During the initiation phase of anticoagulation the CYP2C9*2 allele was independently associated with low acenocoumarol dose requirement (Adjusted OR 5.38; 95%CI 1.65-17.49; p=0.005). Similarly, the adjusted odds ratio for requiring a low dose during the induction phase in patients bearing the CYP2C9*3 allele was 12.79 (95%CI 4.74-34.57; p<0.0001). During the maintenance phase, CYP2C9*2 and CYP2C9*3 alleles were associated with 19-fold (Adjusted OR 19.67; 95%CI 2.46-157.19; p=0.005) and 11.9-fold odds (Adjusted OR 11.98; 95%CI 2.61-55.08; p=0.001) of requiring a low dose. Clinical covariates such as age, alcohol consumption, postpartum state and oral contraceptive intake also influenced acenocoumarol dosage. Co-medication with phenytoin was associated with lower dose requirement across genotypes during the initiation phase. However, during the maintenance phase, phenytoin-treated patients of all genotypes required higher doses of acenocoumarol. This study emphasizes the fact that polymorphisms in CYP2C9 gene and co-medication with phenytoin alter the anticoagulant effect of acenocoumarol. Copyright © 2014 Elsevier Ltd. All rights reserved.

Wideband Communications Equipment, Ground Radio Communication, Space Comm Systems Equipment. 304X0/X4/X6. Appendix A - Task Analysis

DTIC Science & Technology

1990-05-01

ALARM LAMPS A CHECK TWT POWER SUPPLY VOLTAGE AND CURRENT A ADJUST POWER ALARM THRESHOLD AND TRANSMITTER OUTPUT A CHECK HELIX MONITOR K INTERPRET AN/FRC...POWER SUPPLY A CHECK TRAVELING WAVE TUBE ( TWT ) POWER SUPPLY HELIX CURRENT AND BEAM CURRENT A CHECK TWT RF POWER OUTPUT A CHECK TRANSMITTER POWER...A ADJUST TRANSMITTER LINEARITY A CALIBRATE TRANSMIT DEVIATION AND ADJUST MODULATION AMPLIFIER A ADJUST TWT PERFORMANCE MONITOR A ADJUST TWT OUTPUT

50 CFR 648.55 - Framework adjustments to management measures.

Code of Federal Regulations, 2014 CFR

2014-10-01

... establish OFL, ABC, ACL, ACT, DAS allocations, rotational area management programs, percentage allocations... measures will be adjusted. (c) OFL, ABC, ACL, ACT, and AMs. The Council shall specify OFL, ABC, ACL, ACT... derive specifications for ABC, ACL, and ACT, as specified in paragraphs (c)(2) through (c)(5) of this...

50 CFR 648.55 - Framework adjustments to management measures.

Code of Federal Regulations, 2013 CFR

2013-10-01

... establish OFL, ABC, ACL, ACT, DAS allocations, rotational area management programs, percentage allocations... measures will be adjusted. (c) OFL, ABC, ACL, ACT, and AMs. The Council shall specify OFL, ABC, ACL, ACT... derive specifications for ABC, ACL, and ACT, as specified in paragraphs (c)(2) through (c)(5) of this...

50 CFR 648.55 - Framework adjustments to management measures.

Code of Federal Regulations, 2012 CFR

2012-10-01

... establish OFL, ABC, ACL, ACT, DAS allocations, rotational area management programs, percentage allocations... measures will be adjusted. (c) OFL, ABC, ACL, ACT, and AMs. The Council shall specify OFL, ABC, ACL, ACT... derive specifications for ABC, ACL, and ACT, as specified in paragraphs (c)(2) through (c)(5) of this...

A prospective, randomized, open-label study comparing the efficacy and safety of preprandial and prandial insulin in combination with acarbose in elderly, insulin-requiring patients with type 2 diabetes mellitus.

PubMed

Yang, Guang; Li, Chunlin; Gong, Yanping; Li, Jian; Cheng, Xiaoling; Tian, Hui

2013-06-01

By delaying absorption of carbohydrates, acarbose can reduce preprandial hyperglycemia and delay the emergence of postprandial hyperglycemia. To evaluate whether acarbose can shorten the desirable time interval between insulin injection and meals, 60 elderly (≥60 years) patients with unsatisfactorily controlled type 2 diabetes mellitus despite insulin use were enrolled in a randomized, open-label study of 16 weeks' duration. Two groups (n=20 each) were randomized to receive isophane protamine biosynthetic human insulin 70/30 injections twice daily 30 min before meals plus acarbose 50 mg once daily (Group A) or three times daily (Group B) before meals, whereas the third group (n=20) received isophane protamine biosynthetic human insulin 70/30 injections twice daily immediately before meals plus acarbose 50 mg three times daily before meals (Group C). The required insulin dosage at study end was significantly less in Groups B and C than in Group A. Both continuous glucose monitoring data and the patients' self-monitoring data indicated that blood glucose variability parameters were significantly improved in Groups B and C in comparison with Group A, but there were no significant differences between Groups B and C. The incidence of hypoglycemia was low in all three groups. The absence of a significant difference in glucose variability between Groups B and C suggests that the addition of acarbose permitted adjustment of the insulin administration time from 30 min before meals to immediately before meals-which may be more convenient for patients-without affecting glycemic control.

25 CFR 162.223 - Must the rent be adjusted under an agricultural lease?

Code of Federal Regulations, 2011 CFR

2011-04-01

... adjustments are required, the lease must specify: (1) How adjustments are made; (2) Who makes the adjustments; (3) When the adjustments are effective; and (4) How disputes about the adjustments are resolved. (c...? 162.223 Section 162.223 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER...

25 CFR 162.223 - Must the rent be adjusted under an agricultural lease?

Code of Federal Regulations, 2010 CFR

2010-04-01

... adjustments are required, the lease must specify: (1) How adjustments are made; (2) Who makes the adjustments; (3) When the adjustments are effective; and (4) How disputes about the adjustments are resolved. (c...? 162.223 Section 162.223 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER...

Exploiting differential vegetation phenology for satellite-based mapping of semiarid grass vegetation in the southwestern United States and northern Mexico

USGS Publications Warehouse

Dye, Dennis G.; Middleton, Barry R.; Vogel, John M.; Wu, Zhuoting; Velasco, Miguel G.

2016-01-01

We developed and evaluated a methodology for subpixel discrimination and large-area mapping of the perennial warm-season (C4) grass component of vegetation cover in mixed-composition landscapes of the southwestern United States and northern Mexico. We describe the methodology within a general, conceptual framework that we identify as the differential vegetation phenology (DVP) paradigm. We introduce a DVP index, the Normalized Difference Phenometric Index (NDPI) that provides vegetation type-specific information at the subpixel scale by exploiting differential patterns of vegetation phenology detectable in time-series spectral vegetation index (VI) data from multispectral land imagers. We used modified soil-adjusted vegetation index (MSAVI2) data from Landsat to develop the NDPI, and MSAVI2 data from MODIS to compare its performance relative to one alternate DVP metric (difference of spring average MSAVI2 and summer maximum MSAVI2), and two simple, conventional VI metrics (summer average MSAVI2, summer maximum MSAVI2). The NDPI in a scaled form (NDPIs) performed best in predicting variation in perennial C4 grass cover as estimated from landscape photographs at 92 sites (R2 = 0.76, p < 0.001), indicating improvement over the alternate DVP metric (R2 = 0.73, p < 0.001) and substantial improvement over the two conventional VI metrics (R2 = 0.62 and 0.56, p < 0.001). The results suggest DVP-based methods, and the NDPI in particular, can be effective for subpixel discrimination and mapping of exposed perennial C4 grass cover within mixed-composition landscapes of the Southwest, and potentially for monitoring of its response to drought, climate change, grazing and other factors, including land management. With appropriate adjustments, the method could potentially be used for subpixel discrimination and mapping of grass or other vegetation types in other regions where the vegetation components of the landscape exhibit contrasting seasonal patterns of phenology.

42 CFR 416.172 - Adjustments to national payment rates.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Adjustments to national payment rates. 416.172... Adjustments to national payment rates. (a) General rule. Contractors adjust the payment rates established for...; or (2) The geographically adjusted payment rate determined under this subpart. (c) Geographic...

42 CFR 416.172 - Adjustments to national payment rates.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Adjustments to national payment rates. 416.172... Adjustments to national payment rates. (a) General rule. Contractors adjust the payment rates established for...; or (2) The geographically adjusted payment rate determined under this subpart. (c) Geographic...

Yogurt made from milk heated at different pH values.

PubMed

Ozcan, Tulay; Horne, David S; Lucey, John A

2015-10-01

Milk for yogurt manufacture is subjected to high heat treatment to denature whey proteins. Low milk pH values (≤ 6.5) at heating result in most denatured whey proteins becoming associated with casein micelles, whereas high milk pH values (≥ 7.0) at heating result in the formation of mostly soluble (nonmicellar) denatured whey protein complexes. There are conflicting reports on the relative importance of soluble and casein-bound whey protein aggregates on the properties of acid gels. Prior studies investigating the effect of pH of milk at heating used model gels in which milk was acidified by glucono-δ-lactone; in this study, we prepared yogurt gels using commercial starter cultures. Model acid gels can have very different texture and physical properties from those made by fermentation with starter cultures. In this study, we investigated the effects of different pH values of milk at heating on the rheological, light backscatter, and microstructural properties of yogurt gels. Reconstituted skim milk was adjusted to pH values 6.2, 6.7, and 7.2 and heated at 85°C for 30 min. A portion of the heated milk samples was readjusted back to pH 6.7 after heating. Milks were inoculated with 3% (wt/wt) yogurt starter culture and incubated at 40°C until pH 4.6. Gel formation was monitored using dynamic oscillatory rheology, and parameters measured included the storage modulus (G') and loss tangent (LT) values. Light-backscattering properties, such as the backscatter ratio (R) and the first derivative of light backscatter ratio (R'), were also monitored during fermentation. Fluorescence microscopy was used to observe gel microstructure. The G' values at pH 4.6 were highest in gels made from milk heated at pH 6.7 and lowest in milk heated at pH 6.2, with or without pH adjustment after heating. The G' values at pH 4.6 were lower in samples after adjustment back to pH 6.7 after heating. No maximum in the LT parameter was observed during gelation for yogurts made from milk heated at pH 6.2; a maximum in LT was observed at pH ~4.8 for samples heated at pH 6.7 or 7.2, with or without pH adjustment after heating. Higher R-values were observed with an increase in pH of heating, with or without pH adjustment after heating. The sample heated at pH 6.2 had only one major peak in its R' profile during acidification, whereas samples heated at pH 6.7 and 7.2 had 2 large peaks. The lack of a maximum in LT parameter and the presence of a single peak in the R' profile for the samples heated at pH 6.2 were likely due to the partial solubilization of insoluble calcium phosphate when milk was acidified to this lower pH value. No clear differences were observed in the microstructures of gels between the different treatments. This study indicates that heating milk at the natural pH (~6.7) created an optimum balance of casein-bound and soluble denatured whey proteins, which resulted in yogurt with the highest gel stiffness. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

40 CFR 63.11224 - What are my monitoring, installation, operation, and maintenance requirements?

Code of Federal Regulations, 2012 CFR

2012-07-01

... assurance or control activities (including, as applicable, calibration checks and required zero and span... applicable, calibration checks and required zero and span adjustments) do not constitute monitoring... required zero and span adjustments), you must conduct all monitoring in continuous operation at all times...

40 CFR 63.11224 - What are my monitoring, installation, operation, and maintenance requirements?

Code of Federal Regulations, 2011 CFR

2011-07-01

... assurance or control activities (including, as applicable, calibration checks and required zero and span... applicable, calibration checks and required zero and span adjustments) do not constitute monitoring... required zero and span adjustments), you must conduct all monitoring in continuous operation at all times...

Rapid determination of minoxidil in human plasma using ion-pair HPLC.

PubMed

Zarghi, A; Shafaati, A; Foroutan, S M; Khoddam, A

2004-10-29

A rapid, simple and sensitive ion-pair high-performance liquid chromatography (HPLC) method has been developed for quantification of minoxidil in plasma. The assay enables the measurement of minoxidil for therapeutic drug monitoring with a minimum detectable limit of 0.5 ng ml(-1). The method involves simple, one-step extraction procedure and analytical recovery was complete. The separation was performed on an analytical 150 x 4.6 mm i.d. microbondapak C18 column. The wavelength was set at 281 nm. The mobile phase was a mixture of 0.01 M sodium dihydrogen phosphate buffer and acetonitrile (60:40, v/v) containing 2.5 mM sodium dodecyl sulphate adjusted to pH 3.5 at a flow rate of 1 ml/min. The column temperature was set at 50 degrees C. The calibration curve was linear over the concentration range 2-100 ng ml(-1). The coefficients of variation for inter-day and intra-day assay were found to be less than 8%.

Flood Detection/Monitoring Using Adjustable Histogram Equalization Technique

PubMed Central

Riaz, Muhammad Mohsin; Ghafoor, Abdul

2014-01-01

Flood monitoring technique using adjustable histogram equalization is proposed. The technique overcomes the limitations (overenhancement, artifacts, and unnatural look) of existing technique by adjusting the contrast of images. The proposed technique takes pre- and postimages and applies different processing steps for generating flood map without user interaction. The resultant flood maps can be used for flood monitoring and detection. Simulation results show that the proposed technique provides better output quality compared to the state of the art existing technique. PMID:24558332

Association of chemokine receptor gene (CCR2-CCR5) haplotypes with acquisition and control of HIV-1 infection in Zambians

PubMed Central

2011-01-01

Background Polymorphisms in chemokine (C-C motif) receptors 2 and 5 genes (CCR2 and CCR5) have been associated with HIV-1 infection and disease progression. We investigated the impact of CCR2-CCR5 haplotypes on HIV-1 viral load (VL) and heterosexual transmission in an African cohort. Between 1995 and 2006, cohabiting Zambian couples discordant for HIV-1 (index seropositive and HIV-1 exposed seronegative {HESN}) were monitored prospectively to determine the role of host genetic factors in HIV-1 control and heterosexual transmission. Genotyping for eight CCR2 and CCR5 variants resolved nine previously recognized haplotypes. By regression and survival analytic techniques, controlling for non-genetic factors, we estimated the effects of these haplotypic variants on a) index partner VL, b) seroconverter VL, c) HIV-1 transmission by index partners, d) HIV-1 acquisition by HESN partners. Results Among 567 couples, 240 virologically linked transmission events had occurred through 2006. HHF*2 homozygosity was associated with significantly lower VL in seroconverters (mean beta = -0.58, log10 P = 0.027) and the HHD/HHE diplotype was associated with significantly higher VL in the seroconverters (mean beta = 0.54, log10 P = 0.014) adjusted for age and gender in multivariable model. HHD/HHE was associated with more rapid acquisition of infection by the HESNs (HR = 2.0, 95% CI = 1.20-3.43, P = 0.008), after adjustments for index partner VL and the presence of genital ulcer or inflammation in either partner in Cox multivariable models. The HHD/HHE effect was stronger in exposed females (HR = 2.1, 95% CI = 1.14-3.95, P = 0.018). Conclusions Among Zambian discordant couples, HIV-1 coreceptor gene haplotypes and diplotypes appear to modulate HIV-1 VL in seroconverters and alter the rate of HIV-1 acquisition by HESNs. These associations replicate or resemble findings reported in other African and European populations. PMID:21429204

Heat index and adjusted temperature as surrogates for wet bulb globe temperature to screen for occupational heat stress.

PubMed

Bernard, Thomas E; Iheanacho, Ivory

2015-01-01

Ambient temperature and relative humidity are readily ava-ilable and thus tempting metrics for heat stress assessment. Two methods of using air temperature and relative humidity to create an index are Heat Index and Adjusted Temperature. The purposes of this article are: (1) to examine how well Heat Index and Adjusted Temperature estimated the wet bulb globe temperature (WBGT) index, and (2) to suggest how Heat Index and Adjusted Temperature can be used to screen for heat stress level. Psychrometric relationships were used to estimate values of actual WBGT for conditions of air temperature, relative humidity, and radiant heat at an air speed of 0.5 m/s. A relationship between Heat Index [°F] and WBGT [°C] was described by WBGT = -0.0034 HI(2) + 0.96 HI - 34. At lower Heat Index values, the equation estimated WBGTs that were ± 2 °C-WBGT around the actual value, and to about ± 0.5 °C-WBGT for Heat Index values > 100 °F. A relationship between Adjusted Temperature [°F] and WBGT [°C] was described by WBGT = 0.45 Tadj - 16. The actual WBGT was between 1 °C-WBGT below the estimated value and 1.4 °C-WBGT above. That is, there was a slight bias toward overestimating WBGT from Adjusted Temperature. Heat stress screening tables were constructed for metabolic rates of 180, 300, and 450 W. The screening decisions were divided into four categories: (1) < alert limit, (2) < exposure limit, (3) hourly time-weighted averages (TWAs) of work and recovery, and (4) a caution zone for an exposure > exposure limit at rest. The authors do not recommend using Heat Index or Adjusted Temperature instead of WBGT, but they may be used to screen for circumstances when a more detailed analysis using WBGT is appropriate. A particular weakness is accounting for radiant heat; and neither air speed nor clothing was considered.

Determination of itopride in human plasma by liquid chromatography coupled to tandem mass spectrometric detection: application to a bioequivalence study.

PubMed

Lee, Heon-Woo; Seo, Ji-Hyung; Choi, Seung-Ki; Lee, Kyung-Tae

2007-01-30

A simple method using a one-step liquid-liquid extraction (LLE) with butyl acetate followed by high-performance liquid chromatography (HPLC) with positive ion electrospray ionization tandem mass spectrometric (ESI-MS/MS) detection was developed for the determination of itopride in human plasma, using sulpiride as an internal standard (IS). Acquisition was performed in multiple reaction monitoring (MRM) mode, by monitoring the transitions: m/z 359.5>166.1 for itopride and m/z 342.3>111.6 for IS, respectively. Analytes were chromatographed on an YMC C18 reverse-phase chromatographic column by isocratic elution with 1 mM ammonium acetate buffer-methanol (20: 80, v/v; pH 4.0 adjusted with acetic acid). Results were linear (r2=0.9999) over the studied range (0.5-1000 ng mL(-1)) with a total analysis time per run of 2 min for LC-MS/MS. The developed method was validated and successfully applied to bioequivalence studies of itopride hydrochloride in healthy male volunteers.

Real-time adjusting of rainfall estimates from commercial microwave links

NASA Astrophysics Data System (ADS)

Fencl, Martin; Dohnal, Michal; Bareš, Vojtěch

2017-04-01

Urban stormwater predictions require reliable rainfall information with space-time resolution higher than commonly provided by standard rainfall monitoring networks of national weather services. Rainfall data from commercial microwave links (CMLs) could fill this gap. CMLs are line-of-sight radio connections widely used by cellular operators which operate at millimeter bands, where radio waves are attenuated by raindrops. Attenuation data of each single CML in the cellular network can be remotely accessed in (near) real-time with virtually arbitrary sampling frequency and convert to rainfall intensity. Unfortunately, rainfall estimates from CMLs can be substantially biased. Fencl et al., (2017), therefore, proposed adjusting method which enables to correct for this bias. They used rain gauge (RG) data from existing rainfall monitoring networks, which would have otherwise insufficient spatial and temporal resolution for urban rainfall monitoring when used alone without CMLs. In this investigation, we further develop the method to improve its performance in a real-time setting. First, a shortcoming of the original algorithm which delivers unreliable results at the beginning of a rainfall event is overcome by introducing model parameter prior distributions estimated from previous parameter realizations. Second, weights reflecting variance between RGs are introduced into cost function, which is minimized when optimizing model parameters. Finally, RG data used for adjusting are preprocessed by moving average filter. The performance of improved adjusting method is evaluated on four short CMLs (path length < 2 km) located in the small urban catchment (2.3 km2) in Prague-Letnany (CZ). The adjusted CMLs are compared to reference rainfall calculated from six RGs in the catchment. The suggested improvements of the method lead on average to 10% higher Nash-Sutcliffe efficiency coefficient (median value 0.85) for CML adjustment to hourly RG data. Reliability of CML rainfall estimates is especially improved at the beginning of rainfall events and during strong convective rainfalls, whereas performance during longer frontal rainfalls is almost unchanged. Our results clearly demonstrate that adjusting of CMLs to existing RGs represents a viable approach with great potential for real-time applications in stormwater management. This work was supported by the project of Czech Science Foundation (GACR) No.17-16389S. References: Fencl, M., Dohnal, M., Rieckermann, J. and Bareš, V.: Gauge-Adjusted Rainfall Estimates from Commercial Microwave Links, Hydrol Earth Syst. Sci., 2017 (accepted).

Reduced risk of hypoglycemia with once-daily glargine versus twice-daily NPH and number needed to harm with NPH to demonstrate the risk of one additional hypoglycemic event in type 2 diabetes: Evidence from a long-term controlled trial

PubMed Central

Rosenstock, Julio; Fonseca, Vivian; Schinzel, Stefan; Dain, Marie-Paule; Mullins, Peter; Riddle, Matthew

2016-01-01

Aims This analysis evaluated HbA1c-adjusted hypoglycemia risk with glargine versus neutral protamine Hagedorn (NPH) over a 5-year study in patients with Type 2 diabetes mellitus (T2DM). Clinical significance was assessed using number needed to harm (NNH) to demonstrate the risk of one additional patient experiencing at least one hypoglycemic event. Methods Individual patient-level data for symptomatic documented hypoglycemia and HbA1c values from a 5-year randomized study comparing once-daily glargine (n = 513) with twice-daily NPH (n = 504) were analyzed. Symptomatic hypoglycemia was categorized according to concurrent self-monitoring blood glucose levels and need for assistance. Hypoglycemic events per patient-year as a function of HbA1c were fitted by negative binomial regression using treatment and HbA1c at endpoint as independent variables. An estimate of NNH was derived from logistic regression models. Results The cumulative number of symptomatic hypoglycemia events was consistently lower with glargine compared with NPH over 5 years. Compared with twice-daily NPH, once-daily glargine treatment resulted in significantly lower adjusted odds ratios (OR) for all daytime hypoglycemia (OR 0.74; p = 0.030) and any severe event (OR 0.64; p = 0.035), representing a 26% and 36% reduction in the odds of daytime and severe hypoglycemia, respectively. Our model predicts that, if 25 patients were treated with NPH instead of glargine, then one additional patient would experience at least one severe hypoglycemic event. Conclusions This analysis of long-term insulin treatment confirms findings from short-term studies and demonstrates that glargine provides sustained, clinically meaningful reductions in risk of hypoglycemia compared with NPH in patients with T2DM. PMID:24856612

Multi-wavelength optical measurement to enhance thermal/optical analysis for carbonaceous aerosol

NASA Astrophysics Data System (ADS)

Chen, L.-W. A.; Chow, J. C.; Wang, X. L.; Robles, J. A.; Sumlin, B. J.; Lowenthal, D. H.; Zimmermann, R.; Watson, J. G.

2015-01-01

A thermal/optical carbon analyzer equipped with seven-wavelength light source/detector (405-980 nm) for monitoring spectral reflectance (R) and transmittance (T) of filter samples allowed "thermal spectral analysis (TSA)" and wavelength (λ)-dependent organic-carbon (OC)-elemental-carbon (EC) measurements. Optical sensing was calibrated with transfer standards traceable to absolute R and T measurements, adjusted for loading effects to report spectral light absorption (as absorption optical depth (τa, λ)), and verified using diesel exhaust samples. Tests on ambient and source samples show OC and EC concentrations equivalent to those from conventional carbon analysis when based on the same wavelength (~ 635 nm) for pyrolysis adjustment. TSA provides additional information that evaluates black-carbon (BC) and brown-carbon (BrC) contributions and their optical properties in the near infrared to the near ultraviolet parts of the solar spectrum. The enhanced carbon analyzer can add value to current aerosol monitoring programs and provide insight into more accurate OC and EC measurements for climate, visibility, or health studies.

Multi-wavelength optical measurement to enhance thermal/optical analysis for carbonaceous aerosol

NASA Astrophysics Data System (ADS)

Chen, L.-W. A.; Chow, J. C.; Wang, X. L.; Robles, J. A.; Sumlin, B.; Lowenthal, D. H.; Zimmermann, R.; Watson, J. G.

2014-09-01

A thermal/optical carbon analyzer equipped with seven-wavelength light source/detector (405-980 nm) for monitoring spectral reflectance (R) and transmittance (T) of filter samples allows "thermal spectral analysis (TSA)" and wavelength (λ)-dependent organic carbon (OC)-elemental carbon (EC) measurements. Optical sensing is calibrated with transfer standards traceable to absolute R and T measurements and adjusted for loading effects to determine spectral light absorption (as absorption optical depth [τa, λ]) using diesel exhaust samples as a reference. Tests on ambient and source samples show OC and EC concentrations equivalent to those from conventional carbon analysis when based on the same wavelength (~635 nm) for pyrolysis adjustment. TSA provides additional information that evaluates black carbon (BC) and brown carbon (BrC) contributions and their optical properties in the near-IR to the near-UV parts of the solar spectrum. The enhanced carbon analyzer can add value to current aerosol monitoring programs and provide insight into more accurate OC and EC measurements for climate, visibility, or health studies.

31 CFR 544.701 - Penalties.

Code of Federal Regulations, 2010 CFR

2010-07-01

... REGULATIONS Penalties § 544.701 Penalties. (a) Attention is directed to section 206 of the International... Adjustment Act of 1990 (Pub. L. 101-410, as amended, 28 U.S.C. 2461 note). (2) The criminal penalties provided in IEEPA are subject to adjustment pursuant to 18 U.S.C. 3571. (c) Attention is also directed to...

31 CFR 539.701 - Penalties.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Penalties § 539.701 Penalties. (a) Attention is directed to section 206 of the International Emergency... Penalties Inflation Adjustment Act of 1990 (Pub. L. 101-410, as amended, 28 U.S.C. 2461 note). (2) The criminal penalties provided in the Act are subject to adjustment pursuant to 18 U.S.C. 3571. (c) Attention...

31 CFR 544.701 - Penalties.

Code of Federal Regulations, 2011 CFR

2011-07-01

... REGULATIONS Penalties § 544.701 Penalties. (a) Attention is directed to section 206 of the International... Adjustment Act of 1990 (Pub. L. 101-410, as amended, 28 U.S.C. 2461 note). (2) The criminal penalties provided in IEEPA are subject to adjustment pursuant to 18 U.S.C. 3571. (c) Attention is also directed to...

31 CFR 539.701 - Penalties.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Penalties § 539.701 Penalties. (a) Attention is directed to section 206 of the International Emergency... Penalties Inflation Adjustment Act of 1990 (Pub. L. 101-410, as amended, 28 U.S.C. 2461 note). (2) The criminal penalties provided in the Act are subject to adjustment pursuant to 18 U.S.C. 3571. (c) Attention...

31 CFR 540.701 - Penalties.

Code of Federal Regulations, 2011 CFR

2011-07-01

... REGULATIONS Penalties § 540.701 Penalties. (a) Attention is directed to section 206 of the International... Penalties Inflation Adjustment Act of 1990 (Pub. L. 101-410, as amended, 28 U.S.C. 2461 note). (2) The criminal penalties provided in the Act are subject to adjustment pursuant to 18 U.S.C. 3571. (c) Attention...

31 CFR 540.701 - Penalties.

Code of Federal Regulations, 2010 CFR

2010-07-01

... REGULATIONS Penalties § 540.701 Penalties. (a) Attention is directed to section 206 of the International... Penalties Inflation Adjustment Act of 1990 (Pub. L. 101-410, as amended, 28 U.S.C. 2461 note). (2) The criminal penalties provided in the Act are subject to adjustment pursuant to 18 U.S.C. 3571. (c) Attention...

Development of a diagnosis- and procedure-based risk model for 30-day outcome after pediatric cardiac surgery.

PubMed

Crowe, Sonya; Brown, Kate L; Pagel, Christina; Muthialu, Nagarajan; Cunningham, David; Gibbs, John; Bull, Catherine; Franklin, Rodney; Utley, Martin; Tsang, Victor T

2013-05-01

The study objective was to develop a risk model incorporating diagnostic information to adjust for case-mix severity during routine monitoring of outcomes for pediatric cardiac surgery. Data from the Central Cardiac Audit Database for all pediatric cardiac surgery procedures performed in the United Kingdom between 2000 and 2010 were included: 70% for model development and 30% for validation. Units of analysis were 30-day episodes after the first surgical procedure. We used logistic regression for 30-day mortality. Risk factors considered included procedural information based on Central Cardiac Audit Database "specific procedures," diagnostic information defined by 24 "primary" cardiac diagnoses and "univentricular" status, and other patient characteristics. Of the 27,140 30-day episodes in the development set, 25,613 were survivals, 834 were deaths, and 693 were of unknown status (mortality, 3.2%). The risk model includes procedure, cardiac diagnosis, univentricular status, age band (neonate, infant, child), continuous age, continuous weight, presence of non-Down syndrome comorbidity, bypass, and year of operation 2007 or later (because of decreasing mortality). A risk score was calculated for 95% of cases in the validation set (weight missing in 5%). The model discriminated well; the C-index for validation set was 0.77 (0.81 for post-2007 data). Removal of all but procedural information gave a reduced C-index of 0.72. The model performed well across the spectrum of predicted risk, but there was evidence of underestimation of mortality risk in neonates undergoing operation from 2007. The risk model performs well. Diagnostic information added useful discriminatory power. A future application is risk adjustment during routine monitoring of outcomes in the United Kingdom to assist quality assurance. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

26 CFR 1.367(e)-2 - Distributions described in section 367(e)(2).

Code of Federal Regulations, 2014 CFR

2014-04-01

... paragraphs (c)(1) and (2) of this section. Paragraph (d) of this section contains an anti-abuse rule. Finally... capital assets: Asset A, which has a fair market value of $100 and an adjusted basis of $40; Asset B, which has a fair market value of $60 and an adjusted basis of $80; and, Asset C, which has a fair market...

26 CFR 1.367(e)-2 - Distributions described in section 367(e)(2).

Code of Federal Regulations, 2012 CFR

2012-04-01

... paragraphs (c)(1) and (2) of this section. Paragraph (d) of this section contains an anti-abuse rule. Finally... capital assets: Asset A, which has a fair market value of $100 and an adjusted basis of $40; Asset B, which has a fair market value of $60 and an adjusted basis of $80; and, Asset C, which has a fair market...

26 CFR 1.367(e)-2 - Distributions described in section 367(e)(2).

Code of Federal Regulations, 2013 CFR

2013-04-01

... paragraphs (c)(1) and (2) of this section. Paragraph (d) of this section contains an anti-abuse rule. Finally... capital assets: Asset A, which has a fair market value of $100 and an adjusted basis of $40; Asset B, which has a fair market value of $60 and an adjusted basis of $80; and, Asset C, which has a fair market...

26 CFR 1.367(e)-2 - Distributions described in section 367(e)(2).

Code of Federal Regulations, 2011 CFR

2011-04-01

... paragraphs (c)(1) and (2) of this section. Paragraph (d) of this section contains an anti-abuse rule. Finally... capital assets: Asset A, which has a fair market value of $100 and an adjusted basis of $40; Asset B, which has a fair market value of $60 and an adjusted basis of $80; and, Asset C, which has a fair market...

Economic Value of Improved Accuracy for Self-Monitoring of Blood Glucose Devices for Type 1 and Type 2 Diabetes in England.

PubMed

McQueen, Robert Brett; Breton, Marc D; Craig, Joyce; Holmes, Hayden; Whittington, Melanie D; Ott, Markus A; Campbell, Jonathan D

2018-04-01

The objective was to model clinical and economic outcomes of self-monitoring blood glucose (SMBG) devices with varying error ranges and strip prices for type 1 and insulin-treated type 2 diabetes patients in England. We programmed a simulation model that included separate risk and complication estimates by type of diabetes and evidence from in silico modeling validated by the Food and Drug Administration. Changes in SMBG error were associated with changes in hemoglobin A1c (HbA1c) and separately, changes in hypoglycemia. Markov cohort simulation estimated clinical and economic outcomes. A SMBG device with 8.4% error and strip price of £0.30 (exceeding accuracy requirements by International Organization for Standardization [ISO] 15197:2013/EN ISO 15197:2015) was compared to a device with 15% error (accuracy meeting ISO 15197:2013/EN ISO 15197:2015) and price of £0.20. Outcomes were lifetime costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). With SMBG errors associated with changes in HbA1c only, the ICER was £3064 per QALY in type 1 diabetes and £264 668 per QALY in insulin-treated type 2 diabetes for an SMBG device with 8.4% versus 15% error. With SMBG errors associated with hypoglycemic events only, the device exceeding accuracy requirements was cost-saving and more effective in insulin-treated type 1 and type 2 diabetes. Investment in devices with higher strip prices but improved accuracy (less error) appears to be an efficient strategy for insulin-treated diabetes patients at high risk of severe hypoglycemia.

Effect of insulin therapy and dietary adjustments on safety and performance during simulated soccer tests in people with type 1 diabetes: study protocol for a randomized controlled trial.

PubMed

Calvo-Marín, Javier; Torrealba-Acosta, Gabriel; Campbell, Matthew; Gaboury, Jesse; Ali, Ajmol; Chen-Ku, Chih Hao

2017-07-20

Despite the reduction in glycemic derangement in patients with type 1 diabetes mellitus (T1D) through dietary and therapeutic adjustments implemented before, during and after continuous exercise, evidence for its effectiveness with intermittent forms of exercise, such as soccer, is still lacking. We designed a study protocol for a randomized, crossover, double-blinded, controlled trial, for the evaluation of the effect that a strategy of dietary and therapeutic modifications may have on safety and performance of persons with T1D in soccer training sessions and cognitive testing. Inclusion criteria comprise: age older than 18 years, more than 2 years since T1D diagnosis, low C-peptide level, a stable insulin regimen, HbA1c less than 9.0% and regular participation in soccer activities. Our primary outcome evaluates safety regarding hypoglycemia events in patients using dietary and therapeutic adjustments, compared with the performance under the implementation of current American Diabetes Association (ADA) usual recommendations for nutritional and pharmacological adjustments for exercise. Additionally, we will evaluate as secondary outcomes: soccer performance, indexed by performance in well-established soccer skill tests, cognitive functions (indexed by Stroop, digital vigilance test (DVT), Corsi block-tapping task (CBP), and rapid visual information processing (RVIP) tests), and glycemic control measured with a continuous glucose monitor (CGM). Dietary and insulin adjustments standardized under a 4-step method strategy have never been tested in a clinical trial setting with intermittent forms of exercise, such as soccer. We hypothesize that through this strategy we will observe better performance by persons with T1D in soccer and cognitive evaluations, and more stable control of glycemic parameters before, during and after exercise execution, indexed by CGM measurements. ISRCTN, ISRCTN17447843. Registered on 5 January 2017.

[Comparisons and analysis of the spectral response functions' difference between FY-2E's and FY2C's split window channels].

PubMed

Zhang, Yong; Li, Yuan; Rong, Zhi-Guo

2010-06-01

Remote sensors' channel spectral response function (SRF) was one of the key factors to influence the quantitative products' inversion algorithm, accuracy and the geophysical characteristics. Aiming at the adjustments of FY-2E's split window channels' SRF, detailed comparisons between the FY-2E and FY-2C corresponding channels' SRF differences were carried out based on three data collections: the NOAA AVHRR corresponding channels' calibration look up tables, field measured water surface radiance and atmospheric profiles at Lake Qinghai and radiance calculated from the PLANK function within all dynamic range of FY-2E/C. The results showed that the adjustments of FY-2E's split window channels' SRF would result in the spectral range's movements and influence the inversion algorithms of some ground quantitative products. On the other hand, these adjustments of FY-2E SRFs would increase the brightness temperature differences between FY-2E's two split window channels within all dynamic range relative to FY-2C's. This would improve the inversion ability of FY-2E's split window channels.

Automatic Adjustments of a Trans-oesophageal Ultrasound Robot for Monitoring Intra-operative Catheters

NASA Astrophysics Data System (ADS)

Wang, Shuangyi; Housden, James; Singh, Davinder; Rhode, Kawal

2017-12-01

3D trans-oesophageal echocardiography (TOE) has become a powerful tool for monitoring intra-operative catheters used during cardiac procedures in recent years. However, the control of the TOE probe remains as a manual task and therefore the operator has to hold the probe for a long period of time and sometimes in a radiation environment. To solve this problem, an add-on robotic system has been developed for holding and manipulating a commercial TOE probe. This paper focuses on the application of making automatic adjustments to the probe pose in order to accurately monitor the moving catheters. The positioning strategy is divided into an initialization step based on a pre-planning method and a localized adjustments step based on the robotic differential kinematics and related image servoing techniques. Both steps are described in the paper along with simulation experiments performed to validate the concept. The results indicate an error less than 0.5 mm for the initialization step and an error less than 2 mm for the localized adjustments step. Compared to the much bigger live 3D image volume, it is concluded that the methods are promising. Future work will focus on evaluating the method in the real TOE scanning scenario.

Individual and Joint Associations of Methylenetetrahydrofolate Reductase C677T Genotype and Plasma Homocysteine With Dyslipidemia in a Chinese Population With Hypertension.

PubMed

Liu, Yanhong; Li, Kang; Venners, Scott A; Hsu, Yi-Hsiang; Jiang, Shanqun; Weinstock, Justin; Wang, Binyan; Tang, Genfu; Xu, Xiping

2017-04-01

We aimed to examine the cross-sectional associations of plasma total homocysteine (tHcy) concentrations and methylenetetrahydrofolate reductase ( MTHFR) C677T genotype with dyslipidemia. A total of 231 patients with mild-to-moderate essential hypertension were enrolled from the Huoqiu and Yuexi communities in Anhui Province, China. Plasma tHcy levels were measured by high-performance liquid chromatography. Genotyping was performed by TaqMan allelic discrimination technique. Compared with MTHFR 677 CC + CT genotype carriers, TT genotype carriers had higher odds of hypercholesterolemia (adjusted odds ratio [OR] [95% confidence interval (CI)]: 2.7 [1.4-5.2]; P = .004) and higher odds of abnormal low-density lipoprotein cholesterol (adjusted OR [95% CI]: 2.3 [1.1-4.8]; P = .030). The individuals with the TT genotype had higher concentrations of log(tHcy) than those with the 677 CC + CT genotype (adjusted β [standard error]: .2 [0.03]; P < .001). Patients with tHcy ≥ 10 μmol/L had significantly higher odds of hypercholesterolemia (adjusted OR [95% CI]: 2.4 [1.2-4.7]; P = .010). Furthermore, patients with both the TT genotype and the tHcy ≥ 10 μmol/L had the highest odds of hypercholesterolemia (adjusted OR [95% CI]: 4.1 [1.8-9.4]; P = .001) and low-density lipoprotein cholesterol (adjusted OR [95% CI]: 2.4 [1.0-6.0]; P = .064). This study suggests that both tHcy and the MTHFR C677T gene polymorphism may be important determinants of the incidence of dyslipidemia in Chinese patients with essential hypertension. Further studies are needed to confirm the role of tHcy and the MTHFR C677T mutation in the development of dyslipidemia in a larger sample.

The association of AGTR2 polymorphisms with preeclampsia and uterine artery bilateral notching is modulated by maternal BMI.

PubMed

Zhou, A; Dekker, G A; Lumbers, E R; Lee, S Y; Thompson, S D; McCowan, L M E; Roberts, C T

2013-01-01

This study aimed to determine the association of AGTR1 and AGTR2 polymorphisms with preeclampsia and whether these are affected by environmental factors and fetal sex. Overall 3234 healthy nulliparous women, their partners and babies were recruited prospectively to the SCOPE study in Adelaide and Auckland. Data analyses were confined to 2121 Caucasian parent-infant trios, among whom 123 had preeclamptic pregnancies. 1185 uncomplicated pregnancies served as controls. DNA was extracted from buffy coats and genotyped by utilizing the Sequenom MassARRAY system. Doppler sonography on the uterine arteries was performed at 20 weeks' gestation. Four polymorphisms in AGTR1 and AGTR2 genes, including AGTR1 A1166C, AGTR2 C4599A, AGTR2 A1675G and AGTR2 T1134C, were selected and significant associations were predominately observed for AGTR2 C4599A. When the cohort was stratified by maternal BMI, in women with BMI ≥ 25 kg/m(2), the AGTR2 C4599A AA genotype in mothers and neonates was associated with an increased risk for preeclampsia compared with the CC genotype [adjusted OR 2.1 (95% CI 1.0-4.2) and adjusted OR 3.0 (95% CI 1.4-6.4), respectively]. In the same subset of women, paternal AGTR2 C4599A A allele was associated with an increased risk for preeclampsia and uterine artery bilateral notching at 20 weeks' gestation compared with the C allele [adjusted OR 1.9 (95% CI 1.1-3.3) and adjusted OR 2.1 (95% CI 1.3-3.4), respectively]. AGTR2 C4599A in mothers, fathers and babies was associated with preeclampsia and this association was only apparent in pregnancies in which the women had a BMI ≥ 25 kg/m(2), suggesting a gene-environment interaction. Copyright © 2012 Elsevier Ltd. All rights reserved.

Clinical indicators for recurrent cardiovascular events in acute coronary syndrome patients treated with statins under routine practice in Thailand: an observational study.

PubMed

Chinwong, Dujrudee; Patumanond, Jayanton; Chinwong, Surarong; Siriwattana, Khanchai; Gunaparn, Siriluck; Hall, John Joseph; Phrommintikul, Arintaya

2015-06-16

Acute coronary syndrome (ACS) patients are at very high cardiovascular risk and tend to have recurrent cardiovascular events. The clinical indicators for subsequent cardiovascular events are limited and need further investigation. This study aimed to explore clinical indicators that were associated with recurrent cardiovascular events following index hospitalization. The data of patients hospitalized with ACS at a tertiary care hospital in northern Thailand between January 2009 and December 2012 were retrospectively reviewed from medical charts and the electronic hospital database. The patients were classified into three groups based on the frequency of recurrent cardiovascular events (nonfatal ACS, nonfatal stroke, or all-cause death) they suffered: no recurrent events (0), single recurrent event (1), and multiple recurrent events (≥2). Ordinal logistic regression was performed to explore the clinical indicators for recurrent cardiovascular events. A total of 405 patients were included; 60 % were male; the average age was 64.9 ± 11.5 years; 40 % underwent coronary revascularization during admission. Overall, 359 (88.6 %) had no recurrent events, 36 (8.9 %) had a single recurrent event, and 10 (2.5 %) had multiple recurrent events. The significant clinical indicators associated with recurrent cardiovascular events were achieving an LDL-C goal of < 70 mg/dL (Adjusted OR = 0.43; 95 % CI = 0.27-0.69, p-value < 0.001), undergoing revascularization during admission (Adjusted OR = 0.44; 95 % CI = 0.24-0.81, p-value = 0.009), being male (Adjusted OR = 1.85; 95 % CI = 1.29-2.66, p-value = 0.001), and decrease estimated glomerular filtration rate (Adjusted OR = 2.46; 95 % CI = 2.21-2.75, p-value < 0.001). The routine clinical practice indicators assessed in ACS patients that were associated with recurrent cardiovascular events were that achieving the LDL-C goal and revascularization are protective factors, while being male and having decreased estimated glomerular filtration rate are risk factors for recurrent cardiovascular events. These clinical indicators should be used for routinely monitoring patients to prevent recurrent cardiovascular events in ACS patients.

A comprehensive estimate of recent carbon sinks in China using both top-down and bottom-up approaches.

PubMed

Jiang, Fei; Chen, Jing M; Zhou, Lingxi; Ju, Weimin; Zhang, Huifang; Machida, Toshinobu; Ciais, Philippe; Peters, Wouter; Wang, Hengmao; Chen, Baozhang; Liu, Lixin; Zhang, Chunhua; Matsueda, Hidekazu; Sawa, Yousuke

2016-02-29

Atmospheric inversions use measurements of atmospheric CO2 gradients to constrain regional surface fluxes. Current inversions indicate a net terrestrial CO2 sink in China between 0.16 and 0.35 PgC/yr. The uncertainty of these estimates is as large as the mean because the atmospheric network historically contained only one high altitude station in China. Here, we revisit the calculation of the terrestrial CO2 flux in China, excluding emissions from fossil fuel burning and cement production, by using two inversions with three new CO2 monitoring stations in China as well as aircraft observations over Asia. We estimate a net terrestrial CO2 uptake of 0.39-0.51 PgC/yr with a mean of 0.45 PgC/yr in 2006-2009. After considering the lateral transport of carbon in air and water and international trade, the annual mean carbon sink is adjusted to 0.35 PgC/yr. To evaluate this top-down estimate, we constructed an independent bottom-up estimate based on ecosystem data, and giving a net land sink of 0.33 PgC/yr. This demonstrates closure between the top-down and bottom-up estimates. Both top-down and bottom-up estimates give a higher carbon sink than previous estimates made for the 1980s and 1990s, suggesting a trend towards increased uptake by land ecosystems in China.

40 CFR 75.57 - General recordkeeping provisions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... stack gas (percent H2O, rounded to the nearest tenth). If the continuous moisture monitoring system... record daily the following information for CO2 mass emissions: (i) Date; (ii) Daily combustion-formed CO2... whether optional procedure to adjust combustion-formed CO2 mass emissions for carbon retained in flyash...

40 CFR 75.57 - General recordkeeping provisions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... stack gas (percent H2O, rounded to the nearest tenth). If the continuous moisture monitoring system... record daily the following information for CO2 mass emissions: (i) Date; (ii) Daily combustion-formed CO2... whether optional procedure to adjust combustion-formed CO2 mass emissions for carbon retained in flyash...

40 CFR 75.57 - General recordkeeping provisions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... stack gas (percent H2O, rounded to the nearest tenth). If the continuous moisture monitoring system... record daily the following information for CO2 mass emissions: (i) Date; (ii) Daily combustion-formed CO2... whether optional procedure to adjust combustion-formed CO2 mass emissions for carbon retained in flyash...

40 CFR 75.57 - General recordkeeping provisions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... stack gas (percent H2O, rounded to the nearest tenth). If the continuous moisture monitoring system... record daily the following information for CO2 mass emissions: (i) Date; (ii) Daily combustion-formed CO2... whether optional procedure to adjust combustion-formed CO2 mass emissions for carbon retained in flyash...

Field testing of new-technology ambient air ozone monitors.

PubMed

Ollison, Will M; Crow, Walt; Spicer, Chester W

2013-07-01

Multibillion-dollar strategies control ambient air ozone (O3) levels in the United States, so it is essential that the measurements made to assess compliance with regulations be accurate. The predominant method employed to monitor O3 is ultraviolet (UV) photometry. Instruments employ a selective manganese dioxide or heated silver wool "scrubber" to remove O3 to provide a zero reference signal. Unfortunately, such scrubbers remove atmospheric constituents that absorb 254-nm light, causing measurement interference. Water vapor also interferes with the measurement under some circumstances. We report results of a 3-month field test of two new instruments designed to minimize interferences (2B Technologies model 211; Teledyne-API model 265E) that were operated in parallel with a conventional Thermo Scientific model 49C O3 monitor. The field test was hosted by the Houston Regional Monitoring Corporation (HRM). The model 211 photometer scrubs O3 with excess nitric oxide (NO) generated in situ by photolysis of added nitrous oxide (N2O) to provide a reference signal, eliminating the need for a conventional O3 scrubber. The model 265E analyzer directly measures O3-NO chemiluminescence from added excess NO to quantify O3 in the sample stream. Extensive quality control (QC) and collocated monitoring data are assessed to evaluate potential improvements to the accuracy of O3 compliance monitoring. Two new-technology ozone monitors were compared with a conventional monitor under field conditions. Over 3 months the conventional monitor reported more exceedances of the current standard than the new instruments, which could potentially result in an area being misjudged as "nonattainment." Instrument drift can affect O3 data accuracy, and the same degree of drift has a proportionally greater compliance effect as standard stringency is increased. Enhanced data quality assurance and data adjustment may be necessary to achieve the improved accuracy required to judge compliance with tighter standards.

Validation of a skinfold based index for tracking proportional changes in lean mass

PubMed Central

Slater, G J; Duthie, G M; Pyne, D B; Hopkins, W G

2006-01-01

Background The lean mass index (LMI) is a new empirical measure that tracks within‐subject proportional changes in body mass adjusted for changes in skinfold thickness. Objective To compare the ability of the LMI and other skinfold derived measures of lean mass to monitor changes in lean mass. Methods 20 elite rugby union players undertook full anthropometric profiles on two occasions 10 weeks apart to calculate the LMI and five skinfold based measures of lean mass. Hydrodensitometry, deuterium dilution, and dual energy x ray absorptiometry provided a criterion choice, four compartment (4C) measure of lean mass for validation purposes. Regression based measures of validity, derived for within‐subject proportional changes through log transformation, included correlation coefficients and standard errors of the estimate. Results The correlation between change scores for the LMI and 4C lean mass was moderate (0.37, 90% confidence interval −0.01 to 0.66) and similar to the correlations for the other practical measures of lean mass (range 0.26 to 0.42). Standard errors of the estimate for the practical measures were in the range of 2.8–2.9%. The LMI correctly identified the direction of change in 4C lean mass for 14 of the 20 athletes, compared with 11 to 13 for the other practical measures of lean mass. Conclusions The LMI is probably as good as other skinfold based measures for tracking lean mass and is theoretically more appropriate. Given the impracticality of the 4C criterion measure for routine field use, the LMI may offer a convenient alternative for monitoring physique changes, provided its utility is established under various conditions. PMID:16505075

49 CFR 571.208a - Optional test procedures for vehicles manufactured between January 27, 2004 and August 31, 2004.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 20.6 °C and 22.2 °C (69 °F to 72 °F). S16.2.9 Steering wheel adjustment. S16.2.9.1 Adjust a tiltable steering wheel, if possible, so that the steering wheel hub is at the geometric center of its full range of driving positions. S16.2.9.2 If there is no setting detent at the mid-position, lower the steering wheel...

30 CFR 75.1506 - Refuge alternatives.

Code of Federal Regulations, 2010 CFR

2010-07-01

... alternative. (2) Directional signs made of a reflective material shall be posted leading to each refuge... shall be monitored. Changes or adjustments shall be made to reduce the concentration of methane to less...

Differences in Hemoglobin A1c Between Hispanics/Latinos and Non-Hispanic Whites: An Analysis of the Hispanic Community Health Study/Study of Latinos and the 2007–2012 National Health and Nutrition Examination Survey

PubMed Central

Hsu, Lucy L.; Arredondo, Mario; Menke, Andy; Werner, Ellen; Thyagarajan, Bharat; Heiss, Gerardo; Teng, Yanping; Schneiderman, Neil; Giachello, Aida L.; Gallo, Linda C.; Talavera, Gregory A.; Cowie, Catherine C.

2016-01-01

OBJECTIVE To determine whether, after adjustment for glycemia and other selected covariates, hemoglobin A1c (HbA1c) differed among adults from six Hispanic/Latino heritage groups (Central American, Cuban, Dominican, Mexican, Puerto Rican, and South American) and between Hispanic/Latino and non-Hispanic white adults without self-reported diabetes. RESEARCH DESIGN AND METHODS We performed a cross-sectional analysis of data from 13,083 individuals without self-reported diabetes from six Hispanic/Latino heritage groups, enrolled from 2008 to 2011 in the Hispanic Community Health Study/Study of Latinos, and 2,242 non-Hispanic white adults enrolled during the 2007–2012 cycles of the National Health and Nutrition Examination Survey. We compared HbA1c levels among Hispanics/Latinos and between Hispanics/Latinos and non-Hispanic whites before and after adjustment for age, sex, fasting (FPG) and 2-h post–oral glucose tolerance test (2hPG) glucose, anthropometric measurements, and selected biochemical and hematologic variables and after stratification by diabetes status: unrecognized diabetes (FPG ≥7.1 mmol/L or 2hPG ≥11.2 mmol/L), prediabetes (FPG 5.6–7.0 mmol/L or 2hPG 7.8–11.1 mmol/L), and normal glucose tolerance (FPG <5.6 mmol/L and 2hPG <7.8 mmol/L). RESULTS Adjusted mean HbA1c differed significantly across all seven groups (P < 0.001). Non-Hispanic whites had significantly lower HbA1c (P < 0.05) than each individual Hispanic/Latino heritage group. Upon stratification by diabetes status, statistically significant differences (P < 0.001) in adjusted mean HbA1c persisted across all seven groups. CONCLUSIONS HbA1c differs among Hispanics/Latinos of diverse heritage groups and between non-Hispanic whites and Hispanics/Latinos after adjustment for glycemia and other covariates. The clinical significance of these differences is unknown. PMID:27208330

Effect of shivering on brain tissue oxygenation during induced normothermia in patients with severe brain injury.

PubMed

Oddo, Mauro; Frangos, Suzanne; Maloney-Wilensky, Eileen; Andrew Kofke, W; Le Roux, Peter D; Levine, Joshua M

2010-02-01

We analyzed the impact of shivering on brain tissue oxygenation (PbtO(2)) during induced normothermia in patients with severe brain injury. We studied patients with severe brain injury who developed shivering during induced normothermia. Induced normothermia was applied to treat refractory fever (body temperature [BT] > or =38.3 degrees C, refractory to conventional treatment) using a surface cooling device with computerized adjustment of patient BT target to 37 +/- 0.5 degrees C. PbtO(2), intracranial pressure, mean arterial pressure, cerebral perfusion pressure, and BT were monitored continuously. Circulating water temperature of the device system was measured to assess the intensity of cooling. Fifteen patients (10 with severe traumatic brain injury, 5 with aneurysmal subarachnoid hemorrhage) were treated with induced normothermia for an average of 5 +/- 2 days. Shivering caused a significant decrease in PbtO(2) levels both in SAH and TBI patients. Compared to baseline, shivering was associated with an overall reduction of PbtO(2) from 34.1 +/- 7.3 to 24.4 +/- 5.5 mmHg (P < 0.001). A significant correlation was found between the magnitude of shivering-associated decrease of PbtO(2) (DeltaPbtO(2)) and circulating water temperature (R = 0.82, P < 0.001). In patients with severe brain injury treated with induced normothermia, shivering was associated with a significant decrease of PbtO(2), which correlated with the intensity of cooling. Monitoring of therapeutic cooling with computerized thermoregulatory systems may help prevent shivering and optimize the management of induced normothermia. The clinical significance of shivering-induced decrease in brain tissue oxygenation remains to be determined.

Correlation between Glycated Hemoglobin and Triglyceride Level in Type 2 Diabetes Mellitus.

PubMed

Naqvi, Syeda; Naveed, Shabnam; Ali, Zeeshan; Ahmad, Syed Masroor; Asadullah Khan, Raad; Raj, Honey; Shariff, Shoaib; Rupareliya, Chintan; Zahra, Fatima; Khan, Saba

2017-06-13

Dyslipidemia is quite prevalent in non-insulin dependent diabetes mellitus. Maintaining tight glycemic along with lipid control plays an essential role in preventing micro- and macro-vascular complications associated with diabetes. The main purpose of the study was to highlight the relationship between glycosylated hemoglobin (HbA1c) and triglyceride levels. This may in turn help in predicting the triglyceride status of type 2 diabetics and therefore identifying patients at increased risk from cardiovascular events. Hypertriglyceridemia is one of the common risk factors for coronary artery disease in type 2 diabetes mellitus (DM). Careful monitoring of the blood glucose level can be used to predict lipid status and can prevent most of the complications associated with the disease. This is a cross-sectional study using data collected from the outpatient diabetic clinic of Jinnah Postgraduate Medical Centre (JPMC) Karachi, Pakistan. Patients of age 18 years and above were recruited from the clinic. A total of consenting 509 patients of type 2 diabetes mellitus were enrolled over a period of 11 months.  For statistical analysis, SPSS Statistics for Windows, Version 17.0 ( IBM Corp, Armonk, New York) was used and Chi-square and Pearson's correlation coefficient was used to find the association between triglyceride and HbA1c. The HbA1c was dichotomized into four groups on the basis of cut-off. Chi-square was used for association between HbA1c with various cut-off values and high triglyceride levels. Odds-ratio and its 95% confidence interval were calculated to estimate the level of risk between high triglyceride levels and HbA1c groups. The p-value < 0.05 was considered statistically significant for all the tests applied for significance. The association of high triglyceride was evaluated in four different groups of HbA1c, with a cut-off seven, eight, nine and 10 respectively. With HbA1c cut-off value of 7%, 74% patients had high triglycerides and showed a significant association with high triglyceride levels at p < 0.001 and odds ratio was 2.038 (95% confidence interval: 1.397 - 2.972). Logistic regression models were adjusted for demographic factors (age, race, gender), lifestyle factors (smoking, body mass index, lifestyle) and health status factors (blood pressure, physician-rated health status). After adjusting for relevant covariates, glycated hemoglobin was positively correlated with high triglyceride. Hence, HbA1c can be an indicator of triglyceride level and can be one of the predictors of cardiovascular risk factors in type 2 diabetes mellitus.

Optimisation and validation of a remote monitoring system (Onco-TreC) for home-based management of oral anticancer therapies: an Italian multicentre feasibility study

PubMed Central

Passardi, Alessandro; Rizzo, Mimma; Maines, Francesca; Tondini, Carlo; Zambelli, Alberto; Vespignani, Roberto; Andreis, Daniele; Massa, Ilaria; Dianti, Marco; Forti, Stefano; Piras, Enrico Maria; Eccher, Claudio

2017-01-01

Introduction Despite the growing number of oral agents available for cancer treatment, their efficacy may be reduced due to the lack of adherence, inappropriate adverse event self-management and arbitrary dose adjustment. The management of anticancer therapies could exponentially benefit from the introduction of mobile health technologies in a highly integrated electronic oncology system. Methods and analysis We plan to customise and fine-tune an existing monitoring TreC platform used in different chronic diseases in the oncology setting. This project follows a multistep approach with two major purposes: 1. participatory design techniques driven by Health Literacy and Patient Reported Outcomes principles in order to adapt the system to the oncology setting involving patients and healthcare providers; 2. a prospective training-validation, interventional, non-pharmacological, multicentre study on a series of consecutive patients with cancer (20 and 60 patients in the training and validation steps, respectively) in order to assess system capability, usability and acceptability. The novel Onco-TreC 2.0 is expected to contribute to improving the adherence and safety of cancer care, promoting patient empowerment and patient–doctor communication. Ethics and dissemination Ethical approval was obtained from the Independent Ethics Committees of the participating institutions (CEIIAV protocol Number 2549/2015; reference Number 1315-PU). Informed consent will be obtained from all study participants. Findings will be disseminated through peer-reviewed journals, conferences and event presentations. Trial registration number ClinicalTrials.gov (NCT02921724); (Pre-results). Other study ID Number: IRST100.18. PMID:28554917

Improving organisational systems for diabetes care in Australian Indigenous communities.

PubMed

Bailie, Ross; Si, Damin; Dowden, Michelle; O'Donoghue, Lynette; Connors, Christine; Robinson, Gary; Cunningham, Joan; Weeramanthri, Tarun

2007-05-06

Indigenous Australians experience disproportionately high prevalence of, and morbidity and mortality from diabetes. There is an urgent need to understand how Indigenous primary care systems are organised to deliver diabetes services to those most in need, to monitor the quality of diabetes care received by Indigenous people, and to improve systems for better diabetes care. The intervention featured two annual cycles of assessment, feedback workshops, action planning, and implementation of system changes in 12 Indigenous community health centres. Assessment included a structured review of health service systems and audit of clinical records. Main process of care measures included adherence to guideline-scheduled services and medication adjustment. Main patient outcome measures were HbA1c, blood pressure and total cholesterol levels. There was good engagement of health centre staff, with significant improvements in system development over the study period. Adherence to guideline-scheduled processes improved, including increases in 6 monthly testing of HbA1c from 41% to 74% (Risk ratio 1.93, 95% CI 1.71-2.10), 3 monthly checking of blood pressure from 63% to 76% (1.27, 1.13-1.37), annual testing of total cholesterol from 56% to 74% (1.36, 1.20-1.49), biennial eye checking by a ophthalmologist from 34% to 54% (1.68, 1.39-1.95), and 3 monthly feet checking from 20% to 58% (3.01, 2.52-3.47). Medication adjustment rates following identification of elevated HbA1c and blood pressure were low, increasing from 10% to 24%, and from 13% to 21% respectively at year 1 audit. However, improvements in medication adjustment were not maintained at the year 2 follow-up. Mean HbA1c value improved from 9.3 to 8.9% (mean difference -0.4%, 95% CI -0.7;-0.1), but there was no improvement in blood pressure or cholesterol control. This quality improvement (QI) intervention has proved to be highly acceptable in the Indigenous Australian primary care setting and has been associated with significant improvements in systems and processes of care and some intermediate outcomes. However, improvements appear to be limited by inadequate attention to abnormal clinical findings and medication management. Greater improvement in intermediate outcomes may be achieved by specifically addressing system barriers to therapy intensification through more effective engagement of medical staff in QI activities and/or greater use of nurse-practitioners.

Is There a Cardiotoxicity Associated With Metallic Head Hip Prostheses? A Cohort Study in the French National Health Insurance Databases.

PubMed

Lassalle, Marion; Colas, Sandrine; Rudnichi, Annie; Zureik, Mahmoud; Dray-Spira, Rosemary

2018-07-01

There are four distinguishable types of THA devices in wide use, as defined by the femoral and acetabular bearing surfaces: metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), metal-on-metal (MoM), and ceramic-on-ceramic (CoC). Metallic head THAs (MoP and MoM) can potentially induce cardiac toxicity because cobalt species, generated at the head-neck trunnion, and in the case of MoM devices, at the articular surface as well, can be absorbed systemically. However, studies have provided inconsistent results. The purpose of this study was to assess the risk of dilated cardiomyopathy (DCM) or heart failure (HF) associated with metallic head THAs using data from the French national health insurance databases. Between 2008 and 2011 in France, 399,968 patients ≥ 55 years had a first THA. A total of 127,481 were excluded after we applied the exclusion criteria regarding arthroplasty and 17,137 as a result of a history of DCM/HF, recorded in the French national health insurance reimbursement databases, between January 1, 2006, and the date of inclusion. The final cohort included 255,350 individuals (43% men; mean age 72 ± 9 years). Of them, 93,581 (37%) had been implanted with MoP, 58,095 (23%) with CoP, 11,298 (4%) with MoM, and 92,376 (36%) with CoC THAs. Patients were followed until December 2015. Patients with incident DCM/HF were identified by a new entitlement to the long-term disease scheme or a first hospitalization with a diagnosis of DCM or HF. MoP and CoP THAs are generally implanted in old patients, whereas MoM and CoC are mostly indicated in young, active male patients. Thus, to consider the specific indications of the bearing couples, analyses were separately performed in two distinct subcohorts, one comprising patients with MoP or CoP and one comprising patients with MoM or CoC THA. In each subcohort, the DCM/HF risk was compared between patients with metallic head versus nonmetallic head THAs (MoP versus CoP, MoM versus CoC). Hazard ratios (adjusted HRs) of incident DCM/HF were estimated using Cox models adjusted for baseline sex, age, THA characteristics (fixation technique with cement, use of a modular femoral neck), and comorbidities at baseline. Cox models were stratified by sex and age. The crude incidence of DCM/HF per 100 person-years was 2.4 in patients with MoP, 1.8 with CoP, 1.2 with MoM, and 1.1 with CoC THAs. Overall, metallic head THAs were associated with a slight increase in DCM/HF risk (MoP versus CoP: adjusted HR, 1.08; 95% confidence interval [CI], 1.05-1.12; p < 0.001; MoM versus CoC: adjusted HR, 1.11; 95% CI, 1.03-1.19; p = 0.007). In the MoM-CoC subcohort, the risk tended to be more pronounced with MoM versus CoC THAs in women (MoM versus CoC: adjusted HR, 1.20; 95% CI, 1.07-1.35; p = 0.002) and patients aged ≥ 75 years (MoM versus CoC: adjusted HR, 1.16; 95% CI, 1.04-1.29; p = 0.009). Metallic head THAs were associated with a slightly increased DCM/HF risk, especially with MoM in women and older patients. Some caveats should be mentioned: severity of DCM or HF was not available and residual confounding cannot be ruled out despite considering many covariates. Our findings suggest that cardiac function should be regularly monitored in patients with metallic head THAs. Further investigations should be planned on large international cohorts. Level III, therapeutic study.

What parents know, how they know it, and several forms of adolescent adjustment: further support for a reinterpretation of monitoring.

PubMed

Kerr, M; Stattin, H

2000-05-01

Parental monitoring has been conceptualized as tracking and surveillance but operationalized as knowledge of daily activities. This study tested the tracking and surveillance explanation of why parental knowledge is linked to better adolescent adjustment. Participants were 1,186 14-year-olds in central Sweden and their parents. The results supported and extended a reinterpretation of parental monitoring (H. Stattin & M. Kerr, in press). Across sex and informant, high parental knowledge was linked to multiple measures of good adjustment. But children's spontaneous disclosure of information explained more of these relations than parents' tracking and surveillance efforts did. Parents' control efforts were related to good adjustment only after the child's feelings of being controlled, which were linked to poor adjustment, were partialed out. The findings suggest that parents' tracking and surveillance efforts are not as effective as previously thought.

Cytochrome P450 Gene Variants, Race, and Mortality Among Clopidogrel Treated Patients Following Acute Myocardial Infarction

PubMed Central

Cresci, Sharon; Depta, Jeremiah P.; Lenzini, Petra A.; Li, Allie Y.; Lanfear, David E.; Province, Michael A.; Spertus, John A.; Bach, Richard G.

2014-01-01

Background Clopidogrel is recommended after acute myocardial infarction (AMI) but has variable efficacy and safety, in part related to the effect of cytochrome P450 (CYP) polymorphisms on its metabolism. The effect of CYP polymorphisms on cardiovascular events among clopidogrel-treated patients after AMI remains controversial, and no studies to date have investigated the association of CYP variants with outcomes in African American patients. Methods and Results 2732 subjects (2062 Caucasians; 670 African Americans) hospitalized with AMI enrolled in the prospective, multicenter TRIUMPH study were genotyped for CYP polymorphisms. The majority of Caucasians (79%) and African Americans (64.4%) were discharged on clopidogrel. Among Caucasians, carriers of the loss-of-function CYP2C19*2 allele had significantly increased 1-year mortality (adjusted HR: 1.70; CI: 1.01 to 2.86; p=0.046), and a trend toward increased rate of recurrent MI (adjusted HR: 2.10; CI 0.95 to 4.63; p= 0.066). Among African Americans, increased 1-year mortality was associated with the gain of function CYP2C19*17 allele (adjusted HR for *1/*17 vs. *1/*1: 2.02; CI: 0.92 to 4.44; *17/*17 vs. *1/*1: 8.97; CI: 3.34 to 24.10; p< 0.0001) and the CYP1A2*1C allele (adjusted HR for *1/*1C vs. *1/*1: 1.89; CI: 0.85 to 4.22; *1C/*1C vs. *1/*1: 4.96; CI: 1.69 to 14.56; p= 0.014). Bleeding events were significantly more common among African American carriers of CYP2C19*17 or CYP1A2*1C. Conclusions Both loss of function and gain of function CYP polymorphisms affecting clopidogrel metabolism are associated with increased mortality among clopidogrel treated patients following AMI; the specific polymorphism and the putative mechanism vary according to race. PMID:24762860

The Impact of AUC-Based Monitoring on Pharmacist-Directed Vancomycin Dose Adjustments in Complicated Methicillin-Resistant Staphylococcus aureus Infection.

PubMed

Stoessel, Andrew M; Hale, Cory M; Seabury, Robert W; Miller, Christopher D; Steele, Jeffrey M

2018-01-01

This study aimed to assess the impact of area under the curve (AUC)-based vancomycin monitoring on pharmacist-initiated dose adjustments after transitioning from a trough-only to an AUC-based monitoring method at our institution. A retrospective cohort study of patients treated with vancomycin for complicated methicillin-resistant Staphylococcus aureus (MRSA) infection between November 2013 and December 2016 was conducted. The frequency of pharmacist-initiated dose adjustments was assessed for patients monitored via trough-only and AUC-based approaches for trough ranges: 10 to 14.9 mg/L and 15 to 20 mg/L. Fifty patients were included: 36 in the trough-based monitoring and 14 in the AUC-based-monitoring group. The vancomycin dose was increased in 71.4% of patients when troughs were 10 to 14.9 mg/L when a trough-only approach was used and in only 25% of patients when using AUC estimation ( P = .048). In the AUC group, the dose was increased only when AUC/minimum inhibitory concentration (MIC) <400; unchanged regimens had an estimated AUC/MIC ≥400. The AUC-based monitoring did not significantly increase the frequency of dose reductions when trough concentrations were 15 to 20 mg/L (AUC: 33.3% vs trough: 4.6%; P = .107). The AUC-based monitoring resulted in fewer patients with dose adjustments when trough levels were 10 to 14.9 mg/L. The AUC-based monitoring has the potential to reduce unnecessary vancomycin exposure and warrants further investigation.

Effects of Cytochrome P450 (CYP) 2C19 Genotypes on Steady-State Plasma Concentrations of Escitalopram and its Desmethyl Metabolite in Japanese Patients With Depression.

PubMed

Tsuchimine, Shoko; Ochi, Shinichiro; Tajiri, Misuzu; Suzuki, Yutaro; Sugawara, Norio; Inoue, Yoshimasa; Yasui-Furukori, Norio

2018-06-01

Plasma concentrations of the S-enantiomer of citalopram were different between extensive and poor CYP2C19 metabolizers in healthy subjects and depressed patients. However, most studies applied dose-corrected concentrations. Thus, we studied the effects of polymorphisms of the CYP2C19 gene on raw plasma drug concentrations in Japanese patients with depression. Subjects in this study consisted of 412 depressed patients receiving 5, 10, 15, or 20 mg of escitalopram once a day. Plasma concentrations of escitalopram and desmethylescitalopram were quantified using HPLC. CYP2C19 genotypes were identified using polymerase chain reaction methods. There were no differences in the steady-state plasma concentrations of escitalopram or desmethylescitalopram in each dose group (5, 10, 15, or 20 mg of escitalopram) among CYP2C19 genotype groups. However, 1-way analysis of variance showed significant effects of CYP2C19 genotypes on the dose-adjusted plasma concentration of escitalopram but not in the dose-adjusted plasma concentration of desmethylescitalopram. Analysis of covariance including age, sex, and body weight showed significant effects of CYP2C19 genotypes on the dose-adjusted plasma concentration of escitalopram and the ratio of desmethylescitalopram to escitalopram. These findings suggest that the CYP2C19 variants are associated with steady-state plasma concentrations of escitalopram to some extent but are not associated with desmethylescitalopram.

Longitudinal Study of New and Prevalent Use of Self-Monitoring of Blood Glucose

PubMed Central

Karter, Andrew J.; Parker, Melissa M.; Moffet, Howard H.; Spence, Michele M.; Chan, James; Ettner, Susan L.; Selby, Joe V.

2008-01-01

OBJECTIVE We sought to assess longitudinal association between self-monitoring of blood glucose (SMBG) and glycemic control in diabetic patients from an integrated health plan (Kaiser Permanente Northern California). RESEARCH DESIGN AND METHODS Longitudinal analyses of glycemic control among 1) 16,091 patients initiating SMBG (new-user cohort) and 2) 15,347 ongoing users of SMBG (prevalent-user cohort). SMBG frequency was based on pharmacy use (number of blood glucose test strips dispensed), and glycemic control was based on HbA1c (A1C). In the new-user cohort, ANCOVA models (pre- and posttest design) were used to assess the effect of initiating SMBG. In the prevalent-user cohort, repeated-measure, mixed-effects models with random-intercept and time-dependent covariates were used to assess changes in SMBG and A1C. All models were stratified by therapy (no medications, oral agents only, or insulin) and adjusted for baseline A1C, sociodemographics, insulin injection frequency, comorbidity index, medication adherence, smoking status, health care use, and provider specialty. RESULTS Greater SMBG practice frequency among new users was associated with a graded decrease in A1C (relative to nonusers) regardless of diabetes therapy (P < 0.0001). Changes in SMBG frequency among prevalent users were associated with an inverse graded change in A1C only among pharmacologically treated patients (P < 0.0001). CONCLUSIONS These observational findings are consistent with short-term benefits of initiating SMBG practice for all patients but continuing benefits only for pharmacologically treated patients. Differences in effectiveness between new versus prevalent users of SMBG have implications for guideline development and interpretation of observational outcomes data. PMID:16873776

Respiratory monitoring by inductive plethysmography in unrestrained subjects using position sensor-adjusted calibration.

PubMed

Brüllmann, Gregor; Fritsch, Karsten; Thurnheer, Robert; Bloch, Konrad E

2010-01-01

Portable respiratory inductive plethysmography (RIP) is promising for noninvasive monitoring of breathing patterns in unrestrained subjects. However, its use has been hampered by requiring recalibration after changes in body position. To facilitate RIP application in unrestrained subjects, we developed a technique for adjustment of RIP calibration using position sensor feedback. Five healthy subjects and 12 patients with lung disease were monitored by portable RIP with sensors incorporated within a body garment. Unrestrained individuals were studied during 40-60 min while supine, sitting and upright/walking. Position was changed repeatedly every 5-10 min. Initial qualitative diagnostic calibration followed by volume scaling in absolute units during 20 breaths in different positions by flow meter provided position-specific volume-motion coefficients for RIP. These were applied during subsequent monitoring in corresponding positions according to feedback from 4 accelerometers placed at the chest and thigh. Accuracy of RIP was evaluated by face mask pneumotachography. Position sensor feedback allowed accurate adjustment of RIP calibration during repeated position changes in subjects and patients as reflected in a minor mean difference (bias) in breath-by-breath tidal volumes estimated by RIP and flow meter of 0.02 liters (not significant) and limits of agreement (+/-2 SD) of +/-19% (2,917 comparisons). An average of 10 breaths improved precision of RIP (limits of agreement +/-14%). RIP calibration incorporating position sensor feedback greatly enhances the application of RIP as a valuable, unobtrusive tool to investigate respiratory physiology and ventilatory limitation in unrestrained healthy subjects and patients with lung disease during everyday activities including position changes. Copyright 2009 S. Karger AG, Basel.

78 FR 10263 - Proposed Collection; Comment Request for Form 8082

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-13

..., Public Law 104-13 (44 U.S.C. 3506(c)(2)(A)). Currently, the IRS is soliciting comments concerning Form 8082, Notice of Inconsistent Treatment or Administrative Adjustment Request (AAR). DATES: Written... Inconsistent Treatment or Administrative Adjustment Request (AAR). OMB Number: 1545-0790. Form Number: 8082...

Daily variations in the thermoregulatory behaviors of naked neck broilers in an equatorial semi-arid environment.

PubMed

de Queiroz, João Paulo Araújo Fernandes; de Souza, João Batista Freire; de Lima, Hiagos Felipe Ferreira; de Oliveira Costa, Monik Kelly; de Macedo Costa, Leonardo Lelis; de Arruda, Alex Martins Varela

2014-08-01

The aim of this study was to evaluate the daily variations in the thermoregulatory behavior of 4- to 6-week-old naked neck broilers (Label Rouge) in an equatorial semi-arid environment. A total of 220 birds were monitored for 5 days starting at 0600 hours and ending at 1800 hours. The period of observation was divided into classes of hours (C H). The observed behaviors were as follows: feed and water intake, wing-spreading, sitting or lying, and beak-opening. A total of 14,300 behavioral data values were registered. In C H 2 (0900 hours to 1100 hours) and 3 (1200 hours to 1500 hours), the greatest average body surface temperature was recorded (34.67 ± 0.25 °C and 35.12 ± 0.22 °C, respectively). The C H had an effect on the exhibition of all behaviors with the exception of the water intake behavior. Feed intake was more frequent in C H 1 (0600 hours to 0800 hours) and 4 (1600 hours to 1800 hours). In C H 2 and 3, the highest frequency of sitting or lying behavior was observed. Beak-opening and wing-spreading behaviors occurred more frequently in C H 3 where the body surface temperature (35.12 ± 0.22 °C), radiant heat load (519.38 ± 2.22 W m(-2)), and enthalpy (82.74 ± 0.36 kJ kg(-1) of dry air) reached maximum recorded averages. Thus, it can be concluded that naked neck broilers adjust their behavior in response to daily variations in the thermal environment. Wing-spreading and beak-opening behaviors are important adaptive responses to the thermal challenges posed by the equatorial semi-arid environment.

Curvature-correction-based time-domain CMOS smart temperature sensor with an inaccuracy of -0.8 °C-1.2 °C after one-point calibration from -40 °C to 120 °C

NASA Astrophysics Data System (ADS)

Chen, Chun-Chi; Lin, Shih-Hao; Lin, Yi

2014-06-01

This paper proposes a time-domain CMOS smart temperature sensor featuring on-chip curvature correction and one-point calibration support for thermal management systems. Time-domain inverter-based temperature sensors, which exhibit the advantages of low power and low cost, have been proposed for on-chip thermal monitoring. However, the curvature is large for the thermal transfer curve, which substantially affects the accuracy as the temperature range increases. Another problem is that the inverter is sensitive to process variations, resulting in difficulty for the sensors to achieve an acceptable accuracy for one-point calibration. To overcome these two problems, a temperature-dependent oscillator with curvature correction is proposed to increase the linearity of the oscillatory width, thereby resolving the drawback caused by a costly off-chip second-order master curve fitting. For one-point calibration support, an adjustable-gain time amplifier was adopted to eliminate the effect of process variations, with the assistance of a calibration circuit. The proposed circuit occupied a small area of 0.073 mm2 and was fabricated in a TSMC CMOS 0.35-μm 2P4M digital process. The linearization of the oscillator and the effect cancellation of process variations enabled the sensor, which featured a fixed resolution of 0.049 °C/LSB, to achieve an optimal inaccuracy of -0.8 °C to 1.2 °C after one-point calibration of 12 test chips from -40 °C to 120 °C. The power consumption was 35 μW at a sample rate of 10 samples/s.

Delayed heart rate recovery after exercise as a risk factor of incident type 2 diabetes mellitus after adjusting for glycometabolic parameters in men.

PubMed

Yu, Tae Yang; Jee, Jae Hwan; Bae, Ji Cheol; Hong, Won-Jung; Jin, Sang-Man; Kim, Jae Hyeon; Lee, Moon-Kyu

2016-10-15

Some studies have reported that delayed heart rate recovery (HRR) after exercise is associated with incident type 2 diabetes mellitus (T2DM). This study aimed to investigate the longitudinal association of delayed HRR following a graded exercise treadmill test (GTX) with the development of T2DM including glucose-associated parameters as an adjusting factor in healthy Korean men. Analyses including fasting plasma glucose, HOMA-IR, HOMA-β, and HbA1c as confounding factors and known confounders were performed. HRR was calculated as peak heart rate minus heart rate after a 1-min rest (HRR 1). Cox proportional hazards model was used to quantify the independent association between HRR and incident T2DM. During 9082 person-years of follow-up between 2006 and 2012, there were 180 (10.1%) incident cases of T2DM. After adjustment for age, BMI, systolic BP, diastolic BP, smoking status, peak heart rate, peak oxygen uptake, TG, LDL-C, HDL-C, fasting plasma glucose, HOMA-IR, HOMA-β, and HbA1c, the hazard ratios (HRs) [95% confidence interval (CI)] of incident T2DM comparing the second and third tertiles to the first tertile of HRR 1 were 0.867 (0.609-1.235) and 0.624 (0.426-0.915), respectively (p for trend=0.017). As a continuous variable, in the fully-adjusted model, the HR (95% CI) of incident T2DM associated with each 1 beat increase in HRR 1 was 0.980 (0.960-1.000) (p=0.048). This study demonstrated that delayed HRR after exercise predicts incident T2DM in men, even after adjusting for fasting glucose, HOMA-IR, HOMA-β, and HbA1c. However, only HRR 1 had clinical significance. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

17 CFR Table III to Subpart E of... - Civil Monetary Penalty Inflation Adjustments

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Civil Monetary Penalty Inflation Adjustments III Table III to Subpart E of Part 201 Commodity and Securities Exchanges SECURITIES... pursuant to last adjustment Adjusted maximum penalty amount Securities and Exchange Commission 15 U.S.C...

NASA JSC water monitor system: City of Houston field demonstration

NASA Technical Reports Server (NTRS)

Taylor, R. E.; Jeffers, E. L.; Fricks, D. H.

1979-01-01

A water quality monitoring system with on-line and real time operation similar to the function in a spacecraft was investigated. A system with the capability to determine conformance to future high effluent quality standards and to increase the potential for reclamation and reuse of water was designed. Although all system capabilities were not verified in the initial field trial, fully automated operation over a sustained period with only routine manual adjustments was accomplished. Two major points were demonstrated: (1) the water monitor system has great potential in water monitoring and/or process control applications; and (2) the water monitor system represents a vast improvement over conventional (grab sample) water monitoring techniques.

How do working-memory-related demand, reasoning ability and aversive reinforcement modulate conflict monitoring?

PubMed Central

Leue, Anja; Weber, Bernd; Beauducel, André

2014-01-01

Conflict monitoring is a process of stimulus evaluation and a pre-requisite for subsequent recruitment of cognitive control and behavioral adaptations. This study investigated how experimentally manipulated working-memory-related cognitive demand and aversive reinforcement modulate individual differences of conflict monitoring intensity and behavioral adjustments. Individual differences were assessed by means of an anxiety-related trait dimension (trait-BIS) and by means of reasoning abilities—a core determinant of intelligence. Moreover, we investigated the special role of verbal reasoning ability and figural reasoning ability for the modulation of the conflict monitoring intensity. Ninety participants performed a go/nogo task with four conditions each comprising a combination of low vs. high working-memory-related cognitive demand and low vs. high aversive reinforcement. No effect of aversive reinforcement was observed for the N2 amplitude. The fronto-central nogo N2 amplitude was more pronounced for high demand vs. low demand suggesting that cognitive demand served as an aversive costly event. Higher total reasoning abilities were associated with more intense conflict monitoring and shorter response times with increasing aversive reinforcement (defined as verbal error-feedback vs. monetary loss). Individuals with higher trait-BIS scores demonstrated a more intense conflict monitoring even in conditions with low aversive reinforcement and also a more cautious responding (i.e., response times slowing) with increasing aversive reinforcement indicating a focus on negative feedback prevention. The findings provide evidence for the conflict monitoring theory and suggest that working-memory-related demand overrules the impact of aversive reinforcement on conflict monitoring intensity. Reasoning abilities and anxiety-related traits go along with an intensification of conflict monitoring but differences in the flexibility of behavioral adjustment. PMID:24782739

Dynamic Angular Control Of Thermal Therapy With Stationary Multi-Sectored Tubular Ultrasound Applicators Under MR Temperature Monitoring

NASA Astrophysics Data System (ADS)

Kinsey, Adam M.; Diederich, Chris J.; Nau, William H.; Ross, Anthony B.; Butts Pauly, Kim; Rieke, Viola; Sommer, Graham

2006-05-01

Multi-sectored ultrasound heating applicators with dynamic angular and longitudinal control of heating profiles are being investigated for the thermal treatment of tumors in sites such as prostate, uterus, and brain. Multi-sectored tubular ultrasound transducers with independent sector power control were incorporated into interstitial and transurethral applicators and provided dynamic angular control of a heating pattern without requiring device manipulation during treatment. Acoustic beam measurements of each applicator type demonstrated a 35-40° acoustic dead zone between each independent sector, with negligible mechanical or electrical coupling. Despite the acoustic dead zone between sectors, simulations and experiments under MR temperature (MRT) monitoring showed that the variance from the maximum lesion radius (scalloping) with all elements activated on a transducer was minimal and did not affect conformal heating of a target area. A biothermal model with a multi-point controller was used to adjust the applied power and treatment time of individual transducer segments as the tissue temperature changed in simulations of thermal lesions with both interstitial and transurethral applicators. Transurethral ultrasound applicators for benign prostatic hyperplasia (BPH) treatment with either three or four sectors conformed a thermal dose to a simulated target area in the angular and radial dimensions. The simulated treatment was controlled to a maximum temperature of 85°C, and had a maximum duration of 5 min when power was turned off as the 52°C temperature contour reach a predetermined control point for each sector in the tissue. Experiments conducted with multi-sectored applicators under MRT monitoring showed thermal ablation and hyperthermia treatments had little or no border `scalloping', conformed to a pretreatment target area, and correlated very well with the simulated thermal lesions. The radial penetration of the heat treatments in tissue with interstitial (1.5-1.8 mm OD transducer) and transurethral (2.5-4.0 mm OD transducer) applicators was at least 1.5 cm and 2.0 cm, respectively, for a treatment duration of 10 min. Angular control of thermal ablation and hyperthermia therapy often relies upon non-adjustable angular power deposition patterns and/or mechanical manipulation of the heating device. The multi-sectored ultrasound applicators developed in this study provide dynamic control of the angular heating distribution during treatment without device manipulation and maintain previously reported heating penetration and spatial control characteristics of similar ultrasound devices.

Telemonitoring and/or self-monitoring of blood pressure in hypertension (TASMINH4): protocol for a randomised controlled trial.

PubMed

Franssen, Marloes; Farmer, Andrew; Grant, Sabrina; Greenfield, Sheila; Heneghan, Carl; Hobbs, Richard; Hodgkinson, James; Jowett, Susan; Mant, Jonathan; Martin, Una; Milner, Siobhan; Monahan, Mark; Ogburn, Emma; Perera-Salazar, Rafael; Schwartz, Claire; Yu, Ly-Mee; McManus, Richard J

2017-02-13

Self-monitoring of hypertension is associated with lower systolic blood pressure (SBP). However, evidence for the use of self-monitoring to titrate antihypertensive medication by physicians is equivocal. Furthermore, there is some evidence for the efficacy of telemonitoring in the management of hypertension but it is not clear what this adds over and above self-monitoring. This trial aims to evaluate whether GP led antihypertensive titration using self-monitoring results in lower SBP compared to usual care and whether telemonitoring adds anything to self-monitoring alone. This will be a pragmatic primary care based, unblinded, randomised controlled trial of self-monitoring of BP with or without telemonitoring compared to usual care. Eligible patients will have poorly controlled hypertension (>140/90 mmHg) and will be recruited from primary care. Participants will be individually randomised to either usual care, self-monitoring alone, or self-monitoring with telemonitoring. The primary outcome of the trial will be difference in clinic SBP between intervention and control groups at 12 months adjusted for baseline SBP, gender, BP target and practice. At least 1110 patients will be sufficient to detect a difference in SBP between self-monitoring with or without telemonitoring and usual care of 5 mmHg with 90% power with an adjusted alpha of 0.017 (2-sided) to adjust for all three pairwise comparisons. Other outcomes will include adherence of anti-hypertensive medication, lifestyle behaviours, health-related quality of life, and adverse events. An economic analysis will consider both within trial costs and a model extrapolating the results thereafter. A qualitative sub study will gain insights into the views, experiences and decision making processes of patients and health care professionals focusing on the acceptability of self-monitoring and telemonitoring in the routine management of hypertension. The results of the trial will be directly applicable to primary care in the UK. If successful, self-monitoring of BP in people with hypertension would be applicable to hundreds of thousands of individuals in the UK. ISRCTN 83571366 . Registered 17 July 2014.

Association of Burden of Atrial Fibrillation With Risk of Ischemic Stroke in Adults With Paroxysmal Atrial Fibrillation: The KP-RHYTHM Study.

PubMed

Go, Alan S; Reynolds, Kristi; Yang, Jingrong; Gupta, Nigel; Lenane, Judith; Sung, Sue Hee; Harrison, Teresa N; Liu, Taylor I; Solomon, Matthew D

2018-05-16

Atrial fibrillation is a potent risk factor for stroke, but whether the burden of atrial fibrillation in patients with paroxysmal atrial fibrillation independently influences the risk of thromboembolism remains controversial. To determine if the burden of atrial fibrillation characterized using noninvasive, continuous ambulatory monitoring is associated with the risk of ischemic stroke or arterial thromboembolism in adults with paroxysmal atrial fibrillation. This retrospective cohort study conducted from October 2011 and October 2016 at 2 large integrated health care delivery systems used an extended continuous cardiac monitoring system to identify adults who were found to have paroxysmal atrial fibrillation on 14-day continuous ambulatory electrocardiographic monitoring. The burden of atrial fibrillation was defined as the percentage of analyzable wear time in atrial fibrillation or flutter during the up to 14-day monitoring period. Ischemic stroke and other arterial thromboembolic events occurring while patients were not taking anticoagulation were identified through November 2016 using electronic medical records and were validated by manual review. We evaluated the association of the burden of atrial fibrillation with thromboembolism while not taking anticoagulation after adjusting for the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) or CHA2DS2-VASc stroke risk scores. Among 1965 adults with paroxysmal atrial fibrillation, the mean (SD) age was 69 (11.8) years, 880 (45%) were women, 496 (25%) were persons of color, the median ATRIA stroke risk score was 4 (interquartile range [IQR], 2-7), and the median CHA2DS2-VASc score was 3 (IQR, 1-4). The median burden of atrial fibrillation was 4.4% (IQR ,1.1%-17.23%). Patients with a higher burden of atrial fibrillation were less likely to be women or of Hispanic ethnicity, but had more prior cardioversion attempts compared with those who had a lower burden. After adjusting for either ATRIA or CHA2DS2-VASc stroke risk scores, the highest tertile of atrial fibrillation burden (≥11.4%) was associated with a more than 3-fold higher adjusted rate of thromboembolism while not taking anticoagulants (adjusted hazard ratios, 3.13 [95% CI, 1.50-6.56] and 3.16 [95% CI, 1.51-6.62], respectively) compared with the combined lower 2 tertiles of atrial fibrillation burden. Results were consistent across demographic and clinical subgroups. A greater burden of atrial fibrillation is associated with a higher risk of ischemic stroke independent of known stroke risk factors in adults with paroxysmal atrial fibrillation.

Auditory brainstem evoked responses and temperature monitoring during pediatric cardiopulmonary bypass.

PubMed

Rodriguez, R A; Edmonds, H L; Auden, S M; Austin, E H

1999-09-01

To examine the effects of temperature on auditory brainstem responses (ABRs) in infants during hypothermic cardiopulmonary bypass for total circulatory arrest (TCA). The relationship between ABRs (as a surrogate measure of core-brain temperature) and body temperature as measured at several temperature monitoring sites was determined. In a prospective, observational study, ABRs were recorded non-invasively at normothermia and at every 1 or 2 degrees C change in ear-canal temperature during cooling and rewarming in 15 infants (ages: 2 days to 14 months) that required TCA. The ABR latencies and amplitudes and the lowest temperatures at which an ABR was identified (the threshold) were measured during both cooling and rewarming. Temperatures from four standard temperature monitoring sites were simultaneously recorded. The latencies of ABRs increased and amplitudes decreased with cooling (P < 0.01), but rewarming reversed these effects. The ABR threshold temperature as related to each monitoring site (ear-canal, nasopharynx, esophagus and bladder) was respectively determined as 23 +/- 2.2 degrees C, 20.8 +/- 1.7 degrees C, 14.6 +/- 3.4 degrees C, and 21.5 +/- 3.8 degrees C during cooling and 21.8 +/- 1.6 degrees C, 22.4 +/- 2.0 degrees C, 27.6 +/- 3.6 degrees C, and 23.0 +/- 2.4 degrees C during rewarming. The rewarming latencies were shorter and Q10 latencies smaller than the corresponding cooling values (P < 0.01). Esophageal and bladder sites were more susceptible to temperature variations as compared with the ear-canal and nasopharynx. No temperature site reliably predicted an electrophysiological threshold. A faster latency recovery during rewarming suggests that body temperature monitoring underestimates the effects of rewarming in the core-brain. ABRs may be helpful to monitor the effects of cooling and rewarming on the core-brain during pediatric cardiopulmonary bypass.

Case-mix adjustment for diabetes indicators: a systematic review.

PubMed

Calsbeek, Hiske; Markhorst, Joekle G M; Voerman, Gerlienke E; Braspenning, Jozé C C

2016-02-01

Case-mix adjustment is generally considered indispensable for fair comparison of healthcare performance. Inaccurate results are also unfair to patients as they are ineffective for improving quality. However, little is known about what factors should be adjusted for. We reviewed case-mix factors included in adjustment models for key diabetes indicators, the rationale for their inclusion, and their impact on performance. Systematic review. This systematic review included studies published up to June 2013 addressing case-mix factors for 6 key diabetes indicators: 2 outcomes and 2 process indicators for glycated hemoglobin (A1C), low-density lipoprotein cholesterol, and blood pressure. Factors were categorized as demographic, diabetes-related, comorbidity, generic health, geographic, or care-seeking, and were evaluated on the rationale for inclusion in the adjustment models, as well as their impact on indicator scores and ranking. Thirteen studies were included, mainly addressing A1C value and measurement. Twenty-three different case-mix factors, mostly demographic and diabetes-related, were identified, and varied from 1 to 14 per adjustment model. Six studies provided selection motives for the inclusion of case-mix factors. Marital status and body mass index showed a significant impact on A1C value. For the other factors, either no or conflicting associations were reported, or too few studies (n ≤ 2) investigated this association. Scientific knowledge about the relative importance of case-mix factors for diabetes indicators is emerging, especially for demographic and diabetes-related factors and indicators on A1C, but is still limited. Because arbitrary adjustment potentially results in inaccurate quality information, meaningful stratification that demonstrates inequity in care might be a better guide, as it can be a driver for quality improvement.

CONTINUOUS GLUCOSE MONITORING: A CONSENSUS CONFERENCE OF THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY.

PubMed

Fonseca, Vivian A; Grunberger, George; Anhalt, Henry; Bailey, Timothy S; Blevins, Thomas; Garg, Satish K; Handelsman, Yehuda; Hirsch, Irl B; Orzeck, Eric A; Roberts, Victor Lawrence; Tamborlane, William

2016-08-01

Barriers to continuous glucose monitoring (CGM) use continue to hamper adoption of this valuable technology for the management of diabetes. The American Association of Clinical Endocrinologists and the American College of Endocrinology convened a public consensus conference February 20, 2016, to review available CGM data and propose strategies for expanding CGM access. Conference participants agreed that evidence supports the benefits of CGM in type 1 diabetes and that these benefits are likely to apply whenever intensive insulin therapy is used, regardless of diabetes type. CGM is likely to reduce healthcare resource utilization for acute and chronic complications, although real-world analyses are needed to confirm potential cost savings and quality of life improvements. Ongoing technological advances have improved CGM accuracy and usability, but more innovations in human factors, data delivery, reporting, and interpretation are needed to foster expanded use. The development of a standardized data report using similar metrics across all devices would facilitate clinician and patient understanding and utilization of CGM. Expanded CGM coverage by government and private payers is an urgent need. CGM improves glycemic control, reduces hypoglycemia, and may reduce overall costs of diabetes management. Expanding CGM coverage and utilization is likely to improve the health outcomes of people with diabetes. A1C = glycated hemoglobin AACE = American Association of Clinical Endocrinologists ACE = American College of Endocrinology ASPIRE = Automation to Simulate Pancreatic Insulin Response CGM = continuous glucose monitoring HRQOL = health-related quality of life ICER = incremental cost-effectiveness ratio JDRF = Juvenile Diabetes Research Foundation MARD = mean absolute relative difference MDI = multiple daily injections QALY = quality-adjusted life years RCT = randomized, controlled trial SAP = sensor-augmented pump SMBG = self-monitoring of blood glucose STAR = Sensor-Augmented Pump Therapy for A1C Reduction T1D = type 1 diabetes T2D = type 2 diabetes.

CO2 concentration and occupancy density in the critical zones served by the VAV system

NASA Astrophysics Data System (ADS)

Etoua Evina, Ghislaine; Kajl, Stanislaw; Lamarche, Louis; Beltran-Galindo, Javier

2017-11-01

This article presents the results obtained from monitoring a VAV system with highly diversified zone occupancy density are presented in the article. The investigated VAV system meets the load for 72 zones (68 perimeters and 4 interiors) consisting of classrooms, offices, conference rooms, etc. with highly diversified occupancy densities from 1.875 to 2.5 m2/person for the classrooms and from 10 to 15 m2/person for the offices. The monitoring shows that the CO2 concentration can exceed the set point in the critical rooms. Simulation results are also presented in the article to show that it is often impossible to adjust the operation of such VAV systems because the adjusted System Outdoor Air Fractions, % OA, can reach 100% even where the zone CO2 concentration is not respected. The presented monitoring and simulation results were obtained in the winter, with the VAV system operating at partial load and with the minimum outdoor air flowrate required by the economizer system. As shown in the article, to respect the zone set point CO2 concentration in such period, the VAV system must operate mostly at a %OA equal to 100% instead of its minimum value. To circumvent this, the supply zone air flow rate may have to be designed taking into account the CO2 concentration resulting from the critical zones occupancy density.

Basal-Bolus Insulin Therapy with Gla-300 During Hospitalization Reduces Nocturnal Hypoglycemia in Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Study.

PubMed

Okajima, Fumitaka; Nakamura, Yuko; Yamaguchi, Yuji; Shuto, Yuki; Kato, Katsuhito; Sugihara, Hitoshi; Emoto, Naoya

2018-04-04

Although reduction in the incidence of nocturnal hypoglycemia, as estimated by symptom or self-monitored plasma glucose, was shown to be more pronounced with 300 units/mL insulin glargine (Gla-300) than with 100 units/mL insulin glargine (Gla-100) in type 2 diabetes patients, the exact frequency of nocturnal hypoglycemia estimated with continuous glucose monitoring (CGM) has not been reported. Forty patients with type 2 diabetes who were admitted for glycemic control with basal-bolus insulin therapy (BBT) were randomized into the Gla-100 and Gla-300 groups. Insulin doses were adjusted to maintain blood glucose levels within 100-120 mg/dL at each meal. Plasma glucose and C-peptide profiles were estimated serially after admission and before discharge. Daily CGM was also performed before discharge. In the Gla-100 and Gla-300 groups, the mean duration of hospitalization was 15 ± 2 and 15 ± 1 days, respectively, and the mean basal insulin dose before discharge was 13 ± 7 and 15 ± 10 units, respectively. The dose of meal-time insulin was not different between the two groups. Compared with the Gla-300 group, the Gla-100 group had significantly lower nocturnal profiles of plasma glucose and C-peptide, but significantly higher frequency of CGM-estimated nocturnal hypoglycemia (10.7% ± 18.4% versus 1.2% ± 3.6%, P = 0.033). In type 2 diabetic patients, reduction in the incidence of CGM-estimated nocturnal hypoglycemia by BBT under tightly controlled diet therapy was higher with Gla-300 than with Gla-100. UMIN clinical trials registry (UMIN000023360).

An Efficient Bundle Adjustment Model Based on Parallax Parametrization for Environmental Monitoring

NASA Astrophysics Data System (ADS)

Chen, R.; Sun, Y. Y.; Lei, Y.

2017-12-01

With the rapid development of Unmanned Aircraft Systems (UAS), more and more research fields have been successfully equipped with this mature technology, among which is environmental monitoring. One difficult task is how to acquire accurate position of ground object in order to reconstruct the scene more accurate. To handle this problem, we combine bundle adjustment method from Photogrammetry with parallax parametrization from Computer Vision to create a new method call APCP (aerial polar-coordinate photogrammetry). One impressive advantage of this method compared with traditional method is that the 3-dimensional point in space is represented using three angles (elevation angle, azimuth angle and parallax angle) rather than the XYZ value. As the basis for APCP, bundle adjustment could be used to optimize the UAS sensors' pose accurately, reconstruct the 3D models of environment, thus serving as the criterion of accurate position for monitoring. To verity the effectiveness of the proposed method, we test on several UAV dataset obtained by non-metric digital cameras with large attitude angles, and we find that our methods could achieve 1 or 2 times better efficiency with no loss of accuracy than traditional ones. For the classical nonlinear optimization of bundle adjustment model based on the rectangular coordinate, it suffers the problem of being seriously dependent on the initial values, making it unable to converge fast or converge to a stable state. On the contrary, APCP method could deal with quite complex condition of UAS when conducting monitoring as it represent the points in space with angles, including the condition that the sequential images focusing on one object have zero parallax angle. In brief, this paper presents the parameterization of 3D feature points based on APCP, and derives a full bundle adjustment model and the corresponding nonlinear optimization problems based on this method. In addition, we analyze the influence of convergence and dependence on the initial values through math formulas. At last this paper conducts experiments using real aviation data, and proves that the new model can effectively solve bottlenecks of the classical method in a certain degree, that is, this paper provides a new idea and solution for faster and more efficient environmental monitoring.

48 CFR 52.216-4 - Economic Price Adjustment-Labor and Material.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Economic Price Adjustment... Clauses 52.216-4 Economic Price Adjustment—Labor and Material. As prescribed in 16.203-4(c), when... specified in subparagraph (c)(4), upon approval by the chief of the contracting office. Economic Price...

48 CFR 52.216-4 - Economic Price Adjustment-Labor and Material.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 2 2014-10-01 2014-10-01 false Economic Price Adjustment... Clauses 52.216-4 Economic Price Adjustment—Labor and Material. As prescribed in 16.203-4(c), when... specified in subparagraph (c)(4), upon approval by the chief of the contracting office. Economic Price...

48 CFR 52.216-4 - Economic Price Adjustment-Labor and Material.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 2 2011-10-01 2011-10-01 false Economic Price Adjustment... Clauses 52.216-4 Economic Price Adjustment—Labor and Material. As prescribed in 16.203-4(c), when... specified in subparagraph (c)(4), upon approval by the chief of the contracting office. Economic Price...

48 CFR 52.216-4 - Economic Price Adjustment-Labor and Material.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 2 2012-10-01 2012-10-01 false Economic Price Adjustment... Clauses 52.216-4 Economic Price Adjustment—Labor and Material. As prescribed in 16.203-4(c), when... specified in subparagraph (c)(4), upon approval by the chief of the contracting office. Economic Price...

48 CFR 52.216-4 - Economic Price Adjustment-Labor and Material.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 2 2013-10-01 2013-10-01 false Economic Price Adjustment... Clauses 52.216-4 Economic Price Adjustment—Labor and Material. As prescribed in 16.203-4(c), when... specified in subparagraph (c)(4), upon approval by the chief of the contracting office. Economic Price...

26 CFR 1.904-6 - Allocation and apportionment of taxes.

Code of Federal Regulations, 2010 CFR

2010-04-01

... accrued. Gross income, as determined under foreign law, in the passive category shall first be reduced by... 954(b)(5) and § 1.904-5(c)(2)(ii)(C) (adjusted gross passive income). Gross income in all separate categories (including adjusted gross passive income) is next reduced by deducting any expenses, losses, or...

26 CFR 1.904-6 - Allocation and apportionment of taxes.

Code of Federal Regulations, 2011 CFR

2011-04-01

... accrued. Gross income, as determined under foreign law, in the passive category shall first be reduced by... 954(b)(5) and § 1.904-5(c)(2)(ii)(C) (adjusted gross passive income). Gross income in all separate categories (including adjusted gross passive income) is next reduced by deducting any expenses, losses, or...

Electronic fetal heart rate monitoring and its relationship to neonatal and infant mortality in the United States.

PubMed

Chen, Han-Yang; Chauhan, Suneet P; Ananth, Cande V; Vintzileos, Anthony M; Abuhamad, Alfred Z

2011-06-01

To examine the association between electronic fetal heart rate monitoring and neonatal and infant mortality, as well as neonatal morbidity. We used the United States 2004 linked birth and infant death data. Multivariable log-binomial regression models were fitted to estimate risk ratio for association between electronic fetal heart rate monitoring and mortality, while adjusting for potential confounders. In 2004, 89% of singleton pregnancies had electronic fetal heart rate monitoring. Electronic fetal heart rate monitoring was associated with significantly lower infant mortality (adjusted relative risk, 0.75); this was mainly driven by the lower risk of early neonatal mortality (adjusted relative risk, 0.50). In low-risk pregnancies, electronic fetal heart rate monitoring was associated with decreased risk for Apgar scores <4 at 5 minutes (relative risk, 0.54); in high-risk pregnancies, with decreased risk of neonatal seizures (relative risk, 0.65). In the United States, the use of electronic fetal heart rate monitoring was associated with a substantial decrease in early neonatal mortality and morbidity that lowered infant mortality. Copyright © 2011 Mosby, Inc. All rights reserved.

Optical power of VCSELs stabilized to 35 ppm/°C without a TEC

NASA Astrophysics Data System (ADS)

Downing, John

2015-03-01

This paper reports a method and system comprising a light source, an electronic method, and a calibration procedure for stabilizing the optical power of vertical-cavity surface-emitting lasers (VCSELs) and laser diodes (LDs) without the use thermoelectric coolers (TECs). The system eliminates the needs for custom interference coatings, polarization adjustments, and the exact alignment required by the optical method reported in 2013 [1]. It can precisely compensate for the effects of temperature and wavelength drift on photodiode responsivity as well as changes in VCSEL beam quality and polarization angle over a 50°C temperature range. Data obtained from light sources built with single-mode polarization-locked VCSELs demonstrate that 30 ppm/°C stability can be readily obtained. The system has advantages over TECstabilized laser modules that include: 1) 90% lower relative RMS optical power and temperature sensitivity, 2) a five-fold enhancement of wall-plug efficiency, 3) less component testing and sorting, 4) lower manufacturing costs, and 5) automated calibration in batches at time of manufacture is practical. The system is ideally suited for battery-powered environmental and in-home medical monitoring applications.

Correlation of molecular expression with diel rhythm of oviposition in Calliphora vicina (Robineau-Desvoidy) (Diptera: Calliphoridae) and implications for forensic entomology.

PubMed

George, Kelly A; Archer, Melanie S; Toop, Tes

2015-01-01

This study explored the molecular mechanisms potentially underlying blow fly nocturnal oviposition. A behavioral study revealed that Calliphora vicina (Robineau-Desvoidy) (Diptera: Calliphoridae) possesses a diel rhythm of oviposition in light under 12:12 light/dark conditions. Reversal to 12:12 dark/light resulted in oviposition behavior changing to align with the adjusted regime in most females, but four of 59 experimental females lacked a diel rhythm of oviposition (were arrhythmic). Real-time PCR was used to monitor the molecular expression levels of known circadian genes per and tim in C. vicina to determine whether gene expression and behavior correlated. As with behavior, reversing light/dark conditions changed rhythmic gene expression to align with an adjusted light regime. This suggests that although it is unlikely that C. vicina will colonize dead bodies at night, arrhythmic females and oviposition in the dark was demonstrated. © 2014 American Academy of Forensic Sciences.

Alcohol effects on performance monitoring and adjustment: affect modulation and impairment of evaluative cognitive control.

PubMed

Bartholow, Bruce D; Henry, Erika A; Lust, Sarah A; Saults, J Scott; Wood, Phillip K

2012-02-01

Alcohol is known to impair self-regulatory control of behavior, though mechanisms for this effect remain unclear. Here, we tested the hypothesis that alcohol's reduction of negative affect (NA) is a key mechanism for such impairment. This hypothesis was tested by measuring the amplitude of the error-related negativity (ERN), a component of the event-related brain potential (ERP) posited to reflect the extent to which behavioral control failures are experienced as distressing, while participants completed a laboratory task requiring self-regulatory control. Alcohol reduced both the ERN and error positivity (Pe) components of the ERP following errors and impaired typical posterror behavioral adjustment. Structural equation modeling indicated that effects of alcohol on both the ERN and posterror adjustment were significantly mediated by reductions in NA. Effects of alcohol on Pe amplitude were unrelated to posterror adjustment, however. These findings indicate a role for affect modulation in understanding alcohol's effects on self-regulatory impairment and more generally support theories linking the ERN with a distress-related response to control failures. PsycINFO Database Record (c) 2012 APA, all rights reserved.

Estradiol and inflammatory markers in older men.

PubMed

Maggio, Marcello; Ceda, Gian Paolo; Lauretani, Fulvio; Bandinelli, Stefania; Metter, E Jeffrey; Artoni, Andrea; Gatti, Elisa; Ruggiero, Carmelinda; Guralnik, Jack M; Valenti, Giorgio; Ling, Shari M; Basaria, Shehzad; Ferrucci, Luigi

2009-02-01

Aging is characterized by a mild proinflammatory state. In older men, low testosterone levels have been associated with increasing levels of proinflammatory cytokines. It is still unclear whether estradiol (E2), which generally has biological activities complementary to testosterone, affects inflammation. We analyzed data obtained from 399 men aged 65-95 yr enrolled in the Invecchiare in Chianti study with complete data on body mass index (BMI), serum E2, testosterone, IL-6, soluble IL-6 receptor, TNF-alpha, IL-1 receptor antagonist, and C-reactive protein. The relationship between E2 and inflammatory markers was examined using multivariate linear models adjusted for age, BMI, smoking, physical activity, chronic disease, and total testosterone. In age-adjusted analysis, log (E2) was positively associated with log (IL-6) (r = 0.19; P = 0.047), and the relationship was statistically significant (P = 0.032) after adjustments for age, BMI, smoking, physical activity, chronic disease, and serum testosterone levels. Log (E2) was not significantly associated with log (C-reactive protein), log (soluble IL-6 receptor), or log (TNF-alpha) in both age-adjusted and fully adjusted analyses. In older men, E2 is weakly positively associated with IL-6, independent of testosterone and other confounders including BMI.

Triglyceride to high-density lipoprotein cholesterol ratio predicts cardiovascular outcomes in prevalent dialysis patients.

PubMed

Chen, Hung-Yuan; Tsai, Wan-Chuan; Chiu, Yen-Ling; Hsu, Shih-Ping; Pai, Mei-Fen; Yang, Ju-Yeh; Peng, Yu-Sen

2015-03-01

Triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, an indicator of atherogenic dyslipidemia, is a predictor of cardiovascular (CV) outcomes in the general population and has been correlated with atherosclerotic events. Whether the TG/HDL-C ratio can predict CV outcomes and survival in dialysis patients is unknown. We performed this prospective, observational cohort study and enrolled 602 dialysis patients (539 hemodialysis and 63 peritoneal dialysis) from a single center in Taiwan followed up for a median of 3.9 years. The outcomes were the occurrence of CV events, CV death, and all-cause mortality during follow-up. The association of baseline TG/HDL-C ratio with outcomes was explored with Cox regression models, which were adjusted for demographic parameters and inflammatory/nutritional markers. Overall, 203 of the patients experienced CV events and 169 patients died, of whom 104 died due to CV events. Two hundred fifty-four patients reached the composite CV outcome. Patients with higher TG/HDL-C levels (quintile 5) had a higher incidence of CV events (adjusted hazard ratio [HR] 2.03, 95% confidence interval [CI] 1.19-3.47), CV mortality (adjusted HR 1.91, 95% CI 1.07-3.99), composite CV outcome (adjusted HR 2.2, 95% CI 1.37-3.55), and all-cause mortality (adjusted HR 1.94, 95% CI 1.1-3.39) compared with the patients in quintile 1. However, in diabetic dialysis patients, the TG/HDL-C ratio did not predict the outcomes. The TG/HDL-C ratio is a reliable and easily accessible predictor to evaluate CV outcomes and survival in prevalent nondiabetic dialysis patients. ClinicalTrials.gov: NCT01457625.

Triglyceride to High-Density Lipoprotein Cholesterol Ratio Predicts Cardiovascular Outcomes in Prevalent Dialysis Patients

PubMed Central

Chen, Hung-Yuan; Tsai, Wan-Chuan; Chiu, Yen-Ling; Hsu, Shih-Ping; Pai, Mei-Fen; Yang, Ju-Yeh; Peng, Yu-Sen

2015-01-01

Abstract Triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, an indicator of atherogenic dyslipidemia, is a predictor of cardiovascular (CV) outcomes in the general population and has been correlated with atherosclerotic events. Whether the TG/HDL-C ratio can predict CV outcomes and survival in dialysis patients is unknown. We performed this prospective, observational cohort study and enrolled 602 dialysis patients (539 hemodialysis and 63 peritoneal dialysis) from a single center in Taiwan followed up for a median of 3.9 years. The outcomes were the occurrence of CV events, CV death, and all-cause mortality during follow-up. The association of baseline TG/HDL-C ratio with outcomes was explored with Cox regression models, which were adjusted for demographic parameters and inflammatory/nutritional markers. Overall, 203 of the patients experienced CV events and 169 patients died, of whom 104 died due to CV events. Two hundred fifty-four patients reached the composite CV outcome. Patients with higher TG/HDL-C levels (quintile 5) had a higher incidence of CV events (adjusted hazard ratio [HR] 2.03, 95% confidence interval [CI] 1.19–3.47), CV mortality (adjusted HR 1.91, 95% CI 1.07–3.99), composite CV outcome (adjusted HR 2.2, 95% CI 1.37–3.55), and all-cause mortality (adjusted HR 1.94, 95% CI 1.1–3.39) compared with the patients in quintile 1. However, in diabetic dialysis patients, the TG/HDL-C ratio did not predict the outcomes. The TG/HDL-C ratio is a reliable and easily accessible predictor to evaluate CV outcomes and survival in prevalent nondiabetic dialysis patients. ClinicalTrials.gov: NCT01457625 PMID:25761189

Sensor and software use for the glycaemic management of insulin-treated type 1 and type 2 diabetes patients.

PubMed

Ajjan, Ramzi A; Abougila, Kamal; Bellary, Srikanth; Collier, Andrew; Franke, Bernd; Jude, Edward B; Rayman, Gerry; Robinson, Anthony; Singh, Baldev M

2016-05-01

Lowering glucose levels, while avoiding hypoglycaemia, can be challenging in insulin-treated patients with diabetes. We evaluated the role of ambulatory glucose profile in optimising glycaemic control in this population. Insulin-treated patients with type 1 and type 2 diabetes were recruited into a prospective, multicentre, 100-day study and randomised to control (n = 28) or intervention (n = 59) groups. The intervention group used ambulatory glucose profile, generated by continuous glucose monitoring, to assess daily glucose levels, whereas the controls relied on capillary glucose testing. Patients were reviewed at days 30 and 45 by the health care professional to adjust insulin therapy. Comparing first and last 2 weeks of the study, ambulatory glucose profile-monitored type 2 diabetes patients (n = 28) showed increased time in euglycaemia (mean ± standard deviation) by 1.4 ± 3.5 h/day (p = 0.0427) associated with reduction in HbA1c from 77 ± 15 to 67 ± 13 mmol/mol (p = 0.0002) without increased hypoglycaemia. Type 1 diabetes patients (n = 25) showed reduction in hypoglycaemia from 1.4 ± 1.7 to 0.8 ± 0.8 h/day (p = 0.0472) associated with a marginal HbA1c decrease from 75 ± 10 to 72 ± 8 mmol/mol (p = 0.0508). Largely similar findings were observed comparing intervention and control groups at end of study. In conclusion, ambulatory glucose profile helps glycaemic management in insulin-treated diabetes patients by increasing time spent in euglycaemia and decreasing HbA1c in type 2 diabetes patients, while reducing hypoglycaemia in type 1 diabetes patients. © The Author(s) 2016.

Survival in Women Versus Men Following Implantation of Pacemakers, Defibrillators, and Cardiac Resynchronization Therapy Devices in a Large, Nationwide Cohort.

PubMed

Varma, Niraj; Mittal, Suneet; Prillinger, Julie B; Snell, Jeff; Dalal, Nirav; Piccini, Jonathan P

2017-05-10

Whether outcomes differ between sexes following treatment with pacemakers (PM), implantable cardioverter defibrillators, and cardiac resynchronization therapy (CRT) devices is unclear. Consecutive US patients with newly implanted PM, implantable cardioverter defibrillators, and CRT devices from a large remote monitoring database between 2008 and 2011 were included in this observational cohort study. Sex-specific all-cause survival postimplant was compared within each device type using a multivariable Cox proportional hazards model, stratified on age and adjusted for remote monitoring utilization and ZIP-based socioeconomic variables. A total of 269 471 patients were assessed over a median 2.9 [interquartile range, 2.2, 3.6] years. Unadjusted mortality rates (MR; deaths/100 000 patient-years) were similar between women versus men receiving PMs (n=115 076, 55% male; MR 4193 versus MR 4256, respectively; adjusted hazard ratio, 0.87; 95% CI, 0.84-0.90; P <0.001) and implantable cardioverter defibrillators (n=85 014, 74% male; MR 4417 versus MR 4479, respectively; adjusted hazard ratio, 0.98; 95% CI, 0.93-1.02; P =0.244). In contrast, survival was superior in women receiving CRT defibrillators (n=61 475, 72% male; MR 5270 versus male MR 7175; adjusted hazard ratio, 0.73; 95% CI, 0.70-0.76; P <0.001) and also CRT pacemakers (n=7906, 57% male; MR 5383 versus male MR 7625, adjusted hazard ratio, 0.69; 95% CI, 0.61-0.78; P <0.001). This relative difference increased with time. These results were unaffected by age or remote monitoring utilization. Women accounted for less than 30% of high-voltage implants and fewer than half of low-voltage implants in a large, nation-wide cohort. Survival for women and men receiving implantable cardioverter defibrillators and PMs was similar, but dramatically greater for women receiving both defibrillator- and PM-based CRT. © 2017 The Authors and St. Jude Medical. Published on behalf of the American Heart Association, Inc., by Wiley.

Short-term trajectories of use of a caloric-monitoring mobile phone app among patients with type 2 diabetes mellitus in a primary care setting.

PubMed

Goh, Glenn; Tan, Ngiap Chuan; Malhotra, Rahul; Padmanabhan, Uma; Barbier, Sylvaine; Allen, John Carson; Østbye, Truls

2015-02-03

Self-management plays an important role in maintaining good control of diabetes mellitus, and mobile phone interventions have been shown to improve such self-management. The Health Promotion Board of Singapore has created a caloric-monitoring mobile health app, the "interactive Diet and Activity Tracker" (iDAT). The objective was to identify and describe short-term (8-week) trajectories of use of the iDAT app among patients with type 2 diabetes mellitus in a primary care setting in Singapore, and identify patient characteristics associated with each trajectory. A total of 84 patients with type 2 diabetes mellitus from a public primary care clinic in Singapore who had not previously used the iDAT app were enrolled. The app was demonstrated and patients' weekly use of the app was monitored over 8 weeks. Weekly use was defined as any record in terms of food entry or exercise workout entry in that week. Information on demographics, diet and exercise motivation, diabetes self-efficacy (Diabetes Empowerment Scale-Short Form), and clinical variables (body mass index, blood pressure, and glycosylated hemoglobin/HbA1c) were collected at baseline. iDAT app use trajectories were delineated using latent-class growth modeling (LCGM). Association of patient characteristics with the trajectories was ascertained using logistic regression analysis. Three iDAT app use trajectories were observed: Minimal Users (66 out of 84 patients, 78.6%, with either no iDAT use at all or use only in the first 2 weeks), Intermittent-Waning Users (10 out of 84 patients, 11.9%, with occasional weekly use mainly in the first 4 weeks), and Consistent Users (8 out of 84 patients, 9.5%, with weekly use throughout all or most of the 8 weeks). The adjusted odds ratio of being a Consistent User, relative to a Minimal User, was significantly higher for females (OR 19.55, 95% CI 1.78-215.42) and for those with higher exercise motivation scores at baseline (OR 4.89, 95% CI 1.80-13.28). The adjusted odds ratio of being an Intermittent-Waning User relative to a Minimal User was also significantly higher for those with higher exercise motivation scores at baseline (OR 1.82, 95% CI 1.00-3.32). This study provides insight into the nature and extent of usage of a caloric-monitoring app among patients with type 2 diabetes and managed in primary care. The application of LCGM provides a useful framework for evaluating future app use in other patient populations.

Perceived parental monitoring and health risk behavior among public secondary school students in El Salvador.

PubMed

Springer, Andrew E; Sharma, Shreela; de Guardado, Alba Margarita; Nava, Francisco Vázquez; Kelder, Steven H

2006-12-28

Although parental monitoring has received considerable attention in studies of U.S. adolescents, few published studies have examined how parents' knowledge of their children's whereabouts may influence health risk behaviors in adolescents living in Latin America. We investigated the association between perceived parental monitoring and substance use, fighting, and sexual behaviors in rural and urban Salvadoran adolescents (n = 982). After adjusting for several sociodemographic covariates, multilevel regression analyses indicated that students reporting low parental monitoring were between 2 to 3.5 times more likely to report risk behaviors examined. The promotion of specific parenting practices such as parental monitoring may hold promise for reducing adolescent risk behaviors in El Salvador.

Conflict adaptation in prefrontal cortex: now you see it, now you don't.

PubMed

Kim, Chobok; Johnson, Nathan F; Gold, Brian T

2014-01-01

Daily life requires people to monitor and resolve conflict arising from distracting information irrelevant to current goals. The highly influential conflict monitoring theory (CMT) holds that the anterior cingulate cortex (ACC) detects conflict and subsequently triggers the dorsolateral prefrontal cortex (DLPFC) to regulate that conflict. Multiple lines of evidence have provided support for CMT. For example, performance is faster on incongruent trials that follow other incongruent trials (iI), and is accompanied by reduced ACC and increased DLPFC activation (the conflict adaptation effect). In this fMRI study, we explored whether ACC-DLPFC conflict signaling can result in behavioral adjustments beyond on-line contexts. Participants completed a modified version of the Stroop conflict adaptation paradigm which tested for conflict adaptation effects on the current (N) trial associated with not only the immediately preceding (N - 1) trial, but also 2-back (N - 2) trials. Results demonstrated evidence for direct relationships between ACC activity on N - 2 trials and both N trial DLPFC activity and behavioral adjustment when intervening trials were congruent (i.e., icI). In contrast, when N - 1 trials were incongruent (i.e., iiI), ACC-DLPFC signaling failed and conflict adaptation was absent. These results provide new evidence demonstrating that the conflict monitor-controller maintains previously experienced conflict in the service of subsequent behavioral adjustment. However, the processing of multiple, temporally proximal conflict signals takes a toll on the working memory (WM) system, which appears to require resetting in order to adapt our behavior to frequently changing environmental demands. Copyright © 2013 Elsevier Ltd. All rights reserved.

An automated growth enclosure for metabolic labeling of Arabidopsis thaliana with 13C-carbon dioxide - an in vivo labeling system for proteomics and metabolomics research

PubMed Central

2011-01-01

Background Labeling whole Arabidopsis (Arabidopsis thaliana) plants to high enrichment with 13C for proteomics and metabolomics applications would facilitate experimental approaches not possible by conventional methods. Such a system would use the plant's native capacity for carbon fixation to ubiquitously incorporate 13C from 13CO2 gas. Because of the high cost of 13CO2 it is critical that the design conserve the labeled gas. Results A fully enclosed automated plant growth enclosure has been designed and assembled where the system simultaneously monitors humidity, temperature, pressure and 13CO2 concentration with continuous adjustment of humidity, pressure and 13CO2 levels controlled by a computer running LabView software. The enclosure is mounted on a movable cart for mobility among growth environments. Arabidopsis was grown in the enclosure for up to 8 weeks and obtained on average >95 atom% enrichment for small metabolites, such as amino acids and >91 atom% for large metabolites, including proteins and peptides. Conclusion The capability of this labeling system for isotope dilution experiments was demonstrated by evaluation of amino acid turnover using GC-MS as well as protein turnover using LC-MS/MS. Because this 'open source' Arabidopsis 13C-labeling growth environment was built using readily available materials and software, it can be adapted easily to accommodate many different experimental designs. PMID:21310072

Automated Instrumentation, Monitoring and Visualization of PVM Programs Using AIMS

NASA Technical Reports Server (NTRS)

Mehra, Pankaj; VanVoorst, Brian; Yan, Jerry; Lum, Henry, Jr. (Technical Monitor)

1994-01-01

We present views and analysis of the execution of several PVM (Parallel Virtual Machine) codes for Computational Fluid Dynamics on a networks of Sparcstations, including: (1) NAS Parallel Benchmarks CG and MG; (2) a multi-partitioning algorithm for NAS Parallel Benchmark SP; and (3) an overset grid flowsolver. These views and analysis were obtained using our Automated Instrumentation and Monitoring System (AIMS) version 3.0, a toolkit for debugging the performance of PVM programs. We will describe the architecture, operation and application of AIMS. The AIMS toolkit contains: (1) Xinstrument, which can automatically instrument various computational and communication constructs in message-passing parallel programs; (2) Monitor, a library of runtime trace-collection routines; (3) VK (Visual Kernel), an execution-animation tool with source-code clickback; and (4) Tally, a tool for statistical analysis of execution profiles. Currently, Xinstrument can handle C and Fortran 77 programs using PVM 3.2.x; Monitor has been implemented and tested on Sun 4 systems running SunOS 4.1.2; and VK uses XIIR5 and Motif 1.2. Data and views obtained using AIMS clearly illustrate several characteristic features of executing parallel programs on networked workstations: (1) the impact of long message latencies; (2) the impact of multiprogramming overheads and associated load imbalance; (3) cache and virtual-memory effects; and (4) significant skews between workstation clocks. Interestingly, AIMS can compensate for constant skew (zero drift) by calibrating the skew between a parent and its spawned children. In addition, AIMS' skew-compensation algorithm can adjust timestamps in a way that eliminates physically impossible communications (e.g., messages going backwards in time). Our current efforts are directed toward creating new views to explain the observed performance of PVM programs. Some of the features planned for the near future include: (1) ConfigView, showing the physical topology of the virtual machine, inferred using specially formatted IP (Internet Protocol) packets: and (2) LoadView, synchronous animation of PVM-program execution and resource-utilization patterns.

Cot-side electro-encephalography and interstitial glucose monitoring during insulin-induced hypoglycaemia in newborn lambs.

PubMed

Harris, Deborah L; Battin, Malcolm R; Williams, Chris E; Weston, Philip J; Harding, Jane E

2009-01-01

The optimal approach to detection and management of neonatal hypoglycaemia remains unclear. We sought to demonstrate whether electro-encephalography (EEG) changes could be detected on the amplitude-integrated EEG monitor during induced hypoglycaemia in newborn lambs, and also to determine the accuracy of continuously measured interstitial glucose in this situation. Needle electrodes were placed in the P3-P4, O1-O2 montages. The interstitial glucose sensor was placed subcutaneously. After 30 min baseline recordings, hypoglycaemia was induced by insulin infusion and blood glucose levels were monitored every 5 min. The infusion was adjusted to reduce blood glucose levels by 0.5 mmol/l every 15 min and then maintain a blood glucose level <1.0 mmol/l for 4 h. EEG parameters analysed included amplitude, continuity and spectral edge frequency. The interstitial and blood glucose levels were compared. All lambs (n = 15, aged 3-11 days) became hypoglycaemic, with median blood glucose levels falling from 6.5 to 1.0 mmol/l, p < 0.0001. There were no detectable changes in any of the measured EEG parameters related to hypoglycaemia, although seizures occurred in 2 lambs. There was moderate agreement between the intermittent blood glucose and continuous interstitial glucose measurements in the baseline, decline, and hypoglycaemia periods (mean difference -0.7 mmol/l, 95% confidence interval, CI, -2.8 to 1.4 mmol/l). However, agreement was poor during reversal of hypoglycaemia (mean difference 4.5 mmol/l, 95% CI -1.1 to 10.7 mmol/l). The cot-side EEG may not be a useful clinical tool in the detection of neurological changes induced by hypoglycaemia. However, continuous interstitial glucose monitoring may be useful in the management of babies at risk of hypoglycaemia. (c) 2008 S. Karger AG, Basel.

Association of TP53 codon 72 and CDH1 genetic polymorphisms with colorectal cancer risk in Bangladeshi population.

PubMed

Rivu, Sanzana Fareen; Apu, Mohd Nazmul Hasan; Shabnaz, Samia; Nahid, Noor Ahmed; Islam, Md Reazul; Al-Mamun, Mir Md Abdullah; Nahar, Zabun; Rabbi, Sikder Nahidul Islam; Ahmed, Maizbha Uddin; Islam, Mohammad Safiqul; Hasnat, Abul

2017-08-01

Till now no pharmacogenetic study of TP53 codon 72 (Arg72Pro) and CDH1 rs16260 (-160C

Monitoring the freely dissolved concentrations of polycyclic aromatic hydrocarbons (PAH) and alkylphenols (AP) around a Norwegian oil platform by holistic passive sampling.

PubMed

Harman, Christopher; Thomas, Kevin V; Tollefsen, Knut Erik; Meier, Sonnich; Bøyum, Olav; Grung, Merete

2009-11-01

In order to assess the environmental impact of aquatic discharges from the offshore oil industry, polar organic chemical integrative samplers (POCIS) and semipermeable membrane devices (SPMDs) were deployed around an oil platform and at reference locations in the North Sea. Exposure to polycyclic aromatic hydrocarbons (PAH) and alkylated phenols (AP) was determined from passive sampler accumulations using an empirical uptake model, the dissipation of performance reference compounds and adjusted laboratory derived sampling rates. Exposure was relatively similar within 1-2 km of the discharge point, with levels dominated by short chained C1-C3 AP isomers (19-51 ngL(-1)) and alkylated naphthalenes, phenanthrenes and dibenzothiophenes (NPD, 29-45 ngL(-1)). Exposure stations showed significant differences to reference sites for NPD, but not always for more hydrophobic PAH. These concentrations are several orders of magnitude lower than those reported to give both acute and sub-lethal effects, although their long term consequences are unknown.

26 CFR 301.6222(b)-2 - Effect of notification of inconsistent treatment.

Code of Federal Regulations, 2014 CFR

2014-04-01

... item on the partnership return, the Internal Revenue Service may make a computational adjustment to.... Any additional tax resulting from that computational adjustment may be assessed without either the... from computational adjustments under section 6222(c) only with respect to those partnership items the...

26 CFR 301.6222(b)-2 - Effect of notification of inconsistent treatment.

Code of Federal Regulations, 2011 CFR

2011-04-01

... item on the partnership return, the Internal Revenue Service may make a computational adjustment to.... Any additional tax resulting from that computational adjustment may be assessed without either the... from computational adjustments under section 6222(c) only with respect to those partnership items the...

26 CFR 301.6222(b)-2 - Effect of notification of inconsistent treatment.

Code of Federal Regulations, 2010 CFR

2010-04-01

... item on the partnership return, the Internal Revenue Service may make a computational adjustment to.... Any additional tax resulting from that computational adjustment may be assessed without either the... from computational adjustments under section 6222(c) only with respect to those partnership items the...

26 CFR 301.6222(b)-2 - Effect of notification of inconsistent treatment.

Code of Federal Regulations, 2013 CFR

2013-04-01

... item on the partnership return, the Internal Revenue Service may make a computational adjustment to.... Any additional tax resulting from that computational adjustment may be assessed without either the... from computational adjustments under section 6222(c) only with respect to those partnership items the...

26 CFR 301.6222(b)-2 - Effect of notification of inconsistent treatment.

Code of Federal Regulations, 2012 CFR

2012-04-01

... item on the partnership return, the Internal Revenue Service may make a computational adjustment to.... Any additional tax resulting from that computational adjustment may be assessed without either the... from computational adjustments under section 6222(c) only with respect to those partnership items the...

48 CFR 22.407 - Solicitation provision and contract clauses.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Adjustment (None or Separately Specified Pricing Method), in solicitations and contracts if the contract is... determines the most appropriate contract price adjustment method is the method at 22.404-12(c)(1) or (2); or....222-31, Davis-Bacon Act—Price Adjustment (Percentage Method), in solicitations and contracts if the...

Optimisation and validation of a remote monitoring system (Onco-TreC) for home-based management of oral anticancer therapies: an Italian multicentre feasibility study.

PubMed

Passardi, Alessandro; Rizzo, Mimma; Maines, Francesca; Tondini, Carlo; Zambelli, Alberto; Vespignani, Roberto; Andreis, Daniele; Massa, Ilaria; Dianti, Marco; Forti, Stefano; Piras, Enrico Maria; Eccher, Claudio

2017-05-29

Despite the growing number of oral agents available for cancer treatment, their efficacy may be reduced due to the lack of adherence, inappropriate adverse event self-management and arbitrary dose adjustment. The management of anticancer therapies could exponentially benefit from the introduction of mobile health technologies in a highly integrated electronic oncology system. We plan to customise and fine-tune an existing monitoring TreC platform used in different chronic diseases in the oncology setting. This project follows a multistep approach with two major purposes: 1. participatory design techniques driven by Health Literacy and Patient Reported Outcomes principles in order to adapt the system to the oncology setting involving patients and healthcare providers; 2. a prospective training-validation, interventional, non-pharmacological, multicentre study on a series of consecutive patients with cancer (20 and 60 patients in the training and validation steps, respectively) in order to assess system capability, usability and acceptability. The novel Onco-TreC 2.0 is expected to contribute to improving the adherence and safety of cancer care, promoting patient empowerment and patient-doctor communication. Ethical approval was obtained from the Independent Ethics Committees of the participating institutions (CEIIAV protocol Number 2549/2015; reference Number 1315-PU). Informed consent will be obtained from all study participants. Findings will be disseminated through peer-reviewed journals, conferences and event presentations. ClinicalTrials.gov (NCT02921724); (Pre-results). Other study ID Number: IRST100.18. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

DNA sensors to assess the effect of VKORC1 and CYP2C9 gene polymorphisms on warfarin dose requirement in Chinese patients with atrial fibrillation.

PubMed

Huang, Tao-Sheng; Zhang, Ling; He, Qiong; Li, Yu-Bin; Dai, Zhong-Li; Zheng, Jian-Rui; Cheng, Pei-Qi; He, Yun-Shao

2017-03-01

The optimal dose of warfarin depends on polymorphisms in the VKORC1 (the vitamin K epoxide reductase complex subunit (1) and CYP2C9 (cytochrome P450 2C9) genes. To minimize the risk of adverse reactions, warfarin dosages should be adjusted according to results from rapid and simple monitoring methods. However, there are few pharmacogenetic-guided warfarin dosing algorithms that are based on large cohorts from the Chinese population, especially patients with atrial fibrillation. This study aimed to validate a pharmacogenetic-guided warfarin dosing algorithm based on results from a new rapid electrochemical detection method used in a multicenter study. Three SNPs (CYP2C9 *2, *3 and VKORC1 c.-1639G > A) were genotyped by electrochemical detection using a sandwich-type format that included a 3' short thiol capture probe and a 5' ferrocene-labeled signal probe. A total of 1285 samples from four clinical hospitals were evaluated. Concordance rates between the results from the electrochemical DNA biosensor and the sequencing test were 99.8%. The results for gene distribution showed that most Chinese patients had higher warfarin susceptibility because mutant-type and heterozygotes were present in the majority of subjects (99.4%) at locus c.-1639G > A. When the International Warfarin Pharmacogenetics Consortium algorithm was used to estimate therapeutic dosages for 362 patients with AF and the values were compared with their actual dosages, the results revealed that 56.9% were similar to actual dosages (within the 20% range). A novel electrochemical detection method of CYP2C9 *2, *3and VKORC1 c.-1639G > A alleles was evaluated. The warfarin dosing algorithm based on data gathered from a large patient cohort can facilitate the reasonable and effective use of warfarin in Chinese patients with AF.

Case complexity scores in congenital heart surgery: a comparative study of the Aristotle Basic Complexity score and the Risk Adjustment in Congenital Heart Surgery (RACHS-1) system.

PubMed

Al-Radi, Osman O; Harrell, Frank E; Caldarone, Christopher A; McCrindle, Brian W; Jacobs, Jeffrey P; Williams, M Gail; Van Arsdell, Glen S; Williams, William G

2007-04-01

The Aristotle Basic Complexity score and the Risk Adjustment in Congenital Heart Surgery system were developed by consensus to compare outcomes of congenital cardiac surgery. We compared the predictive value of the 2 systems. Of all index congenital cardiac operations at our institution from 1982 to 2004 (n = 13,675), we were able to assign an Aristotle Basic Complexity score, a Risk Adjustment in Congenital Heart Surgery score, and both scores to 13,138 (96%), 11,533 (84%), and 11,438 (84%) operations, respectively. Models of in-hospital mortality and length of stay were generated for Aristotle Basic Complexity and Risk Adjustment in Congenital Heart Surgery using an identical data set in which both Aristotle Basic Complexity and Risk Adjustment in Congenital Heart Surgery scores were assigned. The likelihood ratio test for nested models and paired concordance statistics were used. After adjustment for year of operation, the odds ratios for Aristotle Basic Complexity score 3 versus 6, 9 versus 6, 12 versus 6, and 15 versus 6 were 0.29, 2.22, 7.62, and 26.54 (P < .0001). Similarly, odds ratios for Risk Adjustment in Congenital Heart Surgery categories 1 versus 2, 3 versus 2, 4 versus 2, and 5/6 versus 2 were 0.23, 1.98, 5.80, and 20.71 (P < .0001). Risk Adjustment in Congenital Heart Surgery added significant predictive value over Aristotle Basic Complexity (likelihood ratio chi2 = 162, P < .0001), whereas Aristotle Basic Complexity contributed much less predictive value over Risk Adjustment in Congenital Heart Surgery (likelihood ratio chi2 = 13.4, P = .009). Neither system fully adjusted for the child's age. The Risk Adjustment in Congenital Heart Surgery scores were more concordant with length of stay compared with Aristotle Basic Complexity scores (P < .0001). The predictive value of Risk Adjustment in Congenital Heart Surgery is higher than that of Aristotle Basic Complexity. The use of Aristotle Basic Complexity or Risk Adjustment in Congenital Heart Surgery as risk stratification and trending tools to monitor outcomes over time and to guide risk-adjusted comparisons may be valuable.

Session: Monitoring wind turbine project sites for avian impacts

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

Erickson, Wally

This third session at the Wind Energy and Birds/Bats workshop consisted of one presentation followed by a discussion/question and answer period. The focus of the session was on existing wind projects that are monitored for their impacts on birds and bats. The presentation given was titled ''Bird and Bat Fatality Monitoring Methods'' by Wally Erickson, West, Inc. Sections included protocol development and review, methodology, adjusting for scavenging rates, and adjusting for observer detection bias.

Prevalence of depression in adults with type 2 diabetes in the Basque Country: relationship with glycaemic control and health care costs.

PubMed

Alonso-Morán, Edurne; Satylganova, Altynai; Orueta, Juan F; Nuño-Solinis, Roberto

2014-07-30

The aim of the study was to estimate the prevalence of depression in the population diagnosed with diabetes type 2 and to test the hypothesis that the presence of depression in such cases was associated with a) worse glycaemic control, and b) higher healthcare costs. We conducted a cross-sectional analysis, from 1st September 2010 to 31st August 2011, among patients with type 2 diabetes aged 35 years and over in the Basque Country. It was identified how many of them had also depression. The database included administrative individual level information on age, sex, healthcare costs, other comorbidities, and values of glycaemic control (HbA1c). Deprivation index variable was used as socioeconomic measure and, to observe the coexistent pathologies, all the patients diagnoses were categorized by Adjusted Clinical Groups. We used a measure of association, a logistic and a linear regression for analysis. 12.392 (9.8%) of type 2 diabetes patients were diagnosed with depression, being the prevalence 5.2% for males and 15.1% for females. This comorbidity was higher among the most deprived population. There was no association between the presence of depression and glycaemic control. We estimated that the comorbidity average cost per patient/year was 516€ higher than in patients with just type 2 diabetes (P < 0.001) adjusted by the other covariates. We did not find any relationship between depression and glycaemic control in patients with type 2 diabetes. However, the comorbidity was associated with significantly high healthcare costs compared to that of type 2 diabetes occurring alone, after adjusting by other illness. Thus, there is a need of more precise recognition, screening and monitoring of depression among diabetic population. Evidence-based treatment for depression should be included in type 2 diabetes clinical guidelines.

Actively controlling coolant-cooled cold plate configuration

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

Chainer, Timothy J.; Parida, Pritish R.

A method is provided to facilitate active control of thermal and fluid dynamic performance of a coolant-cooled cold plate. The method includes: monitoring a variable associated with at least one of the coolant-cooled cold plate or one or more electronic components being cooled by the cold plate; and dynamically varying, based on the monitored variable, a physical configuration of the cold plate. By dynamically varying the physical configuration, the thermal and fluid dynamic performance of the cold plate are adjusted to, for example, optimally cool the one or more electronic components, and at the same time, reduce cooling power consumptionmore » used in cooling the electronic component(s). The physical configuration can be adjusted by providing one or more adjustable plates within the coolant-cooled cold plate, the positioning of which may be adjusted based on the monitored variable.« less

Return period adjustment for runoff coefficients based on analysis in undeveloped Texas watersheds

USGS Publications Warehouse

Dhakal, Nirajan; Fang, Xing; Asquith, William H.; Cleveland, Theodore G.; Thompson, David B.

2013-01-01

The rational method for peak discharge (Qp) estimation was introduced in the 1880s. The runoff coefficient (C) is a key parameter for the rational method that has an implicit meaning of rate proportionality, and the C has been declared a function of the annual return period by various researchers. Rate-based runoff coefficients as a function of the return period, C(T), were determined for 36 undeveloped watersheds in Texas using peak discharge frequency from previously published regional regression equations and rainfall intensity frequency for return periods T of 2, 5, 10, 25, 50, and 100 years. The C(T) values and return period adjustments C(T)/C(T=10  year) determined in this study are most applicable to undeveloped watersheds. The return period adjustments determined for the Texas watersheds in this study and those extracted from prior studies of non-Texas data exceed values from well-known literature such as design manuals and textbooks. Most importantly, the return period adjustments exceed values currently recognized in Texas Department of Transportation design guidance when T>10  years.

48 CFR 52.216-2 - Economic Price Adjustment-Standard Supplies.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Economic Price Adjustment... Clauses 52.216-2 Economic Price Adjustment—Standard Supplies. As prescribed in 16.203-4(a), insert the... specified in subparagraph (c)(1), upon approval by the chief of the contracting office. Economic Price...

48 CFR 52.216-2 - Economic Price Adjustment-Standard Supplies.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 2 2011-10-01 2011-10-01 false Economic Price Adjustment... Clauses 52.216-2 Economic Price Adjustment—Standard Supplies. As prescribed in 16.203-4(a), insert the... specified in subparagraph (c)(1), upon approval by the chief of the contracting office. Economic Price...

48 CFR 52.216-2 - Economic Price Adjustment-Standard Supplies.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 2 2013-10-01 2013-10-01 false Economic Price Adjustment... Clauses 52.216-2 Economic Price Adjustment—Standard Supplies. As prescribed in 16.203-4(a), insert the... specified in subparagraph (c)(1), upon approval by the chief of the contracting office. Economic Price...

48 CFR 52.216-2 - Economic Price Adjustment-Standard Supplies.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 2 2012-10-01 2012-10-01 false Economic Price Adjustment... Clauses 52.216-2 Economic Price Adjustment—Standard Supplies. As prescribed in 16.203-4(a), insert the... specified in subparagraph (c)(1), upon approval by the chief of the contracting office. Economic Price...

48 CFR 52.216-2 - Economic Price Adjustment-Standard Supplies.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 2 2014-10-01 2014-10-01 false Economic Price Adjustment... Clauses 52.216-2 Economic Price Adjustment—Standard Supplies. As prescribed in 16.203-4(a), insert the... specified in subparagraph (c)(1), upon approval by the chief of the contracting office. Economic Price...

Distribution and Characterization of Antigens Found in Subcellular Fractions of African Trypanosomes.

DTIC Science & Technology

1982-08-01

CLASSIFICATION AUTHORITY 3. DISTRIBUTION /AVAILABILITY OF REPORT 2b. DECLASSIFICATION / DOWNGRADING SCHEDULE 4. PERFORMING ORGANIZATION REPORT NUMBER(S...S. MONITORING ORGANIZATION REPORT NUMBER(S) 6a. NAME OF PERFORMING ORGANIZATION 6b OFFICE SYMBOL 7a. NAME OF MONITORING ORGANIZATION University of...was passed through the column using a peristaltic pump adjusted to flow rate of 8.0 ml/h. To allow full binding of sugar residues to lectin the eluent

The effect of pioglitazone on glycemic and lipid parameters and adverse events in elderly patients with type 2 diabetes mellitus: a post hoc analysis of four randomized trials.

PubMed

Rajagopalan, Rukmini; Xu, Yaping; Abbadessa, Michael

2006-06-01

This analysis was conducted to evaluate the impact of pioglitazone (PIO), both as monotherapy and as part of combination therapy, on glycemic and lipid parameters and adverse events in elderly patients with type 2 diabetes. This was a post hoc analysis of pooled data, truncated at 1 year, from patients aged > or =65 years with type 2 diabetes in 4 multicenter, randomized, double-blind, parallel-group trials. For inclusion in these trials, patients were required to be between the ages of 35 and 75 years and to have had poorly controlled type 2 diabetes, a glycosylated hemoglobin (HbA(1c)) value between 7.5% and 11.0%, and stable or worsening glycemic control for at least 3 months. Blood samples were obtained at baseline and every 4 to 10 weeks thereafter for determination of HbA(1c), fasting plasma glucose (FPG), and lipid parameters (high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], triglycerides [TG], total cholesterol [TC], TC:HDL-C ratio, and free fatty acids). Data from 891 elderly patients (age range, 69.1-69.8 years) were included: 282 who received PIO, 123 metformin (MET), 142 sulfonylurea (SU), 105 SU + PIO, 107 SU + MET, 63 MET + PIO, and 69 MET + SU. With a few exceptions, all treatment groups were similar at baseline. From baseline to week 52, none of the changes in HbA(1c) and FPG between each treatment group and its comparator were significant. The adjusted mean (SE) percent changes in HDL-C for the monotherapies were 17.95% (1.11) for PIO, 10.71% (1.70) for MET, and 5.17% (1.51) for SU (both comparisons, P < 0.05). For the combination therapies, the adjusted mean percent changes in HDL-C were 16.77% (1.84) for SUPIO versus 7.87% (1.75) for SUMET (P < 0.05), and 16.34% (2.34) for MET + PIO versus 0.11% (2.19) for METSU (P < 0.05). The adjusted mean percent changes in LDL-C for the monotherapies were 7.00% (1.28) for PIO, -0.68% (1.91) for MET, and -6.77% (1.73) for SU (both comparisons, P < 0.05). For the combination therapies, the adjusted mean percent change in LDL-C was significant for METPIO compared with METSU (13.62% [2.69] vs -4.32% [2.58], respectively; P < 0.05). The adjusted mean percent change in TG was significant for MET + PIO compared with MET + SU (-10.93% [4.44] vs 8.37% [4.15], respectively; P < 0.05). The adjusted mean percent changes in TC for the monotherapies were 6.16% (0.88) for PIO, -1.77% (1.35) for MET, and -6.90% (1.19) for SU (both comparisons, P < 0.05). For the combination therapies, the adjusted mean percent changes in TC were 2.67% (1.45) for SUPIO versus -1.40% (1.39) for SUMET (P < 0.05) and 7.89% (1.85) for METPIO compared with -1.19% (1.73) for METSU (P < 0.05). The differences in change in the TC:HDL-C ratio were not significant between groups. The adjusted mean changes in free fatty acids for the monotherapies were -0.14 (0.02) mmol/L for PIO, -0.001 (0.03) mmol/L for MET, and -0.07 (0.02) mmol/L for SU (both comparisons, P < 0.05). For the combination therapies, the adjusted mean change in free fatty acids was significant for SU + PIO compared with SUMET (-0.12 [0.03] vs 0.06 [0.03] mmol/L, respectively; P < 0.05). PIO monotherapy was associated with the lowest incidence of hypoglycemia (1.4%) among the 7 treatment groups. The SUPIO group had the highest incidence of weight gain (4.8%). The rate of deaths was <2% in all the treatment groups; no adverse event associated with death was considered related to study medication. In this post hoc analysis of data from elderly patients participating in 4 randomized clinical trials, PIO effectively controlled glycemic and lipid parameters over 52 weeks and was well tolerated. The effects seen in this analysis were comparable to those in the overall study populations.

LINC00673 rs11655237 C>T confers neuroblastoma susceptibility in Chinese population.

PubMed

Zhang, Zhuorong; Chang, Yitian; Jia, Wei; Zhang, Jiao; Zhang, Ruizhong; Zhu, Jinhong; Yang, Tianyou; Xia, Huimin; Zou, Yan; He, Jing

2018-02-28

Neuroblastoma, which accounts for approximately 10% of all pediatric cancer-related deaths, has become a therapeutic challenge and global burden attributed to poor outcomes and mortality rates of its high-risk form. Previous genome-wide association studies (GWASs) identified the LINC00673 rs11655237 C>T polymorphism to be associated with the susceptibility of several malignant tumors. However, the association between this polymorphism and neuroblastoma susceptibility is not clear. We genotyped LINC00673 rs11655237 C>T in 393 neuroblastoma patients in comparison with 812 age-, gender-, and ethnicity-matched healthy controls. We found a significant association between the LINC00673 rs11655237 C>T polymorphism and neuroblastoma risk (TT compared with CC: adjusted odds ratio (OR) =1.80, 95% confidence interval (CI) =1.06-3.06, P =0.029; TT/CT compared with CC: adjusted OR =1.31, 95% CI =1.02-1.67, P =0.033; and T compared with C: adjusted OR =1.29, 95% CI =1.06-1.58, P =0.013). Furthermore, stratified analysis indicated that the rs11655237 T allele carriers were associated with increased neuroblastoma risk for patients with tumor originating from the adrenal gland (adjusted OR =1.51, 95% CI =1.06-2.14, P =0.021) and International Neuroblastoma Staging System (INSS) stage IV disease (adjusted OR =1.60, 95% CI =1.12-2.30, P =0.011). In conclusion, we verified that the LINC00673 rs11655237 C>T polymorphism might be associated with neuroblastoma susceptibility. Prospective studies with a large sample size and different ethnicities are needed to validate our findings. © 2018 The Author(s).

Association between interleukin 10 gene polymorphisms and risk of type 2 diabetes mellitus in a Chinese population.

PubMed

Bai, Hua; Jing, Danqing; Guo, Aitao; Yin, Shinan

2014-06-01

To investigate the relationship between the interleukin 10 (IL10) gene single nucleotide polymorphisms (SNP) -1082 G/A (rs1800896), -819 T/C (rs1800871) and -592 A/C (rs1800872) and risk of type 2 diabetes mellitus in a Chinese population. This case-control study recruited patients with type 2 diabetes mellitus and healthy control subjects. Genotyping of the -1082 G/A (rs1800896), -819 T/C (rs1800871) and -592 A/C (rs1800872) SNPs was conducted and genotype frequencies were compared between the two groups. The study recruited 364 patients with type 2 diabetes mellitus and 677 healthy controls. Patients carrying the -1082 GG genotype had a significantly increased risk of type 2 diabetes mellitus (adjusted odds ratio [OR] 1.57, 95% confidence interval [CI] 1.03, 2.68), as did those patients carrying the -592 AA genotype (adjusted OR 1.63, 95% CI 1.06, 2.53). Subjects carrying both the -1082 GA + GG and -592 AC + AA genotypes had a significantly increased risk of type 2 diabetes mellitus (adjusted OR 2.03, 95% CI 1.24, 3.15). The SNPs -1082G/A and -592 A/C increased the risk for type 2 diabetes mellitus, and could be potential targets for screening for the early detection of the risk of type 2 diabetes mellitus. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Insulin during pregnancy, labour and delivery.

PubMed

de Valk, Harold W; Visser, Gerard H A

2011-02-01

Optimal glycaemic control is of the utmost importance to achieve the best possible outcome of a pregnancy complicated by diabetes. This holds for pregnancies in women with preconceptional type 1 or type 2 diabetes as well as for pregnancies complicated by gestational diabetes. Glycaemic control is conventionally expressed in the HbA1c value but the HbA1c value does not completely capture the complexity of glycaemic control. The daily glucose profile measured by the patients themselves through measurements performed in capillary blood obtained by finger stick provides valuable information needed to adjust insulin therapy. Hypoglycaemia is the major threat to the pregnant woman or the woman with tight glycaemic control in the run-up to pregnancy. Repetitive hypoglycaemia can lead to hypoglycaemia unawareness, which is reversible with prevention of hypoglycaemia. A delicate balance should be struck between preventing hyperglycaemia and hypoglycaemia. Insulin requirements are not uniform across the day: it is low during the night with a more or less pronounced rise at dawn, followed by a gradual decrease during the remainder of the day. A basal amount of insulin is needed to regulate the endogenous glucose production, short-acting insulin shots are needed to handle exogenous glucose loads. Insulin therapy means two choices: the type of insulin used and the method of insulin administration. Regarding the type of insulin, the choice is between human and analogue insulins. The analogue short-acting insulin aspart has been shown to be safe during pregnancy in a randomised trial and has received registration for this indication; the short-acting analogue insulin lispro has been shown to be safe in observational studies. No such information is available on the long-acting insulin analogues detemir and glargine and both are prescribed off-label with human long-acting insulin as obvious alternatives. Randomised trials have not been able to show superiority of continuous subcutaneous insulin administration (CSII (insulin pump)) over intensive insulin injection therapy (multiple-dose insulin (MDI)) on any maternal or foeto-neonatal end point. However, group sizes were far too small to allow assessment of superiority and issues such as manageability of the disease and quality of life were never assessed. These two issues are of major importance to patients. The first trimester is often the period of most hypoglycaemic events, and insulin therapy should be especially closely monitored and adjusted in this period. After midterm, insulin requirements increase. Continuous glucose monitoring can offer better insights into the glycaemic profile than self-monitoring of blood glucose levels by the patients but the place of these new monitoring techniques has yet to be established more clearly. Insulin therapy during labour means short-acting insulin adjusted to achieve glucose levels between 4 and 8 mmol l(-1) to prevent neonatal hypoglycaemia as much as possible. After delivery, glycaemic control must be relaxed to prevent hypoglycaemia, especially in women who breastfeed. Copyright © 2010 Elsevier Ltd. All rights reserved.

Effects of Dexmedetomidine on motor- and somatosensory-evoked potentials in patients with thoracic spinal cord tumor: a randomized controlled trial.

PubMed

Li, Yan; Meng, Lingzhong; Peng, Yuming; Qiao, Hui; Guo, Lanjun; Han, Ruquan; Gelb, Adrian W

2016-08-02

We hypothesized that the addition of dexmedetomidine in a clinically relevant dose to propofol-remifentanil anesthesia regimen does not exert an adverse effect on motor-evoked potentials (MEP) and somatosensory-evoked potentials (SSEP) in adult patients undergoing thoracic spinal cord tumor resection. Seventy-one adult patients were randomized into three groups. Propofol group (n = 25): propofol-remifentanil regimenand the dosage was adjusted to maintain the bispectral index (BIS) between 40 and 50. DP adjusted group (n = 23): Dexmedetomidine (0.5 μg/kg loading dose infused over 10 min followed by a constant infusion of 0.5 μg/kg/h) was added to the propofol-remifentanil regimen and propofol was adjusted to maintain BIS between 40 and 50. DP unadjusted group (n = 23): Dexmedetomidine (administer as DP adjusted group) was added to the propofol-remifentanil regimen and propofol was not adjusted. All patients received MEP, SSEP and BIS monitoring. There were no significant changes in the amplitude and latency of MEP and SSEP among different groups (P > 0.05). The estimated propofol plasma concentration in DP adjusted group (2.7 ± 0.3 μg/ml) was significantly lower than in propofol group (3.1 ± 0.2 μg/ml) and DP unadjusted group (3.1 ± 0.2 μg/ml) (P = 0.000). BIS in DP unadjusted group (35 ± 5) was significantly lower than in propofol group (44 ± 3) (P = 0.000). The addition of dexmedetomidine to propofol-remifentanil regimen does not exert an adverse effect on MEP and SSEP monitoring in adult patients undergoing thoracic spinal cord tumor resection. The study was registered with the Chinese Clinical Trial Registry on January 31st, 2014. The reference number was ChiCTR-TRC-14004229.

[Limits of cardiac functional adaptation in "top level" resistance athletes].

PubMed

Carù, B; Righetti, G; Bossi, M; Gerosa, C; Gazzotti, G; Maranetto, D

2001-02-01

Sports activity, particularly when performed at high level, provokes cardiovascular adjustments depending on the type of sport and on the level of the load. We evaluated 15 athletes from the Italian national team during a non-agonistic period of cross country skiing, with non-invasive tests including exercise test, color Doppler echocardiography, Holter monitoring, physical examination and standard rest electrocardiogram. Physical examination, rest electrocardiogram, exercise testing and echocardiography were all within the range of the expected values for this type of subjects. Holter monitoring recorded during the periods of agonistic activity revealed significant hypokinetic arrhythmias such as severe bradycardia, pauses, I and II degree atrioventricular blocks, and complete atrioventricular block in 2 cases; these features were not observed on Holter monitoring recorded during the non-agonistic period. The perfect health status of subjects and their racing results may bring about physiological functional adjustments, but these observations suggest the need for a follow-up to evaluate possible pathologic outcomes.

[Efficacy of therapeutic monitoring of cyclosporine through C2 and AUC(0-4) during the first 24 months following kidney transplantation].

PubMed

Vavić, Neven; Ignjatović, Ljiljana; Drasković, Biljana; Hrvacević, Rajko; Kovacević, Zoran; Paunić, Zoran

2008-02-01

Cyclosporine (CyA) therapeutic drug monitoring (TDM) through the measurement of drug concentration in blood two hours after the administration (C2), and/or according to the calculated value of the area under the concentration-time curve during the first four hours following administration (AUC(0-4)) shows favourable correlation with clinical manifestations in patients with kidney transplantation (Tx). The aim of this study was to analyze clinical efficiency and usability of TDM CyA through C2 and AUC(0-4) in the group of our kidney transplanted patients during the first 24 months following Tx. The study included 50 patients who had undergone kidney Tx using living donors at the Clinic of Nephrology Military Medical Academy, from 1996 to 2003. The first group (group C2) consisted of 25 patients in whom CyA dose was adjusted according to the target C2 and AUC(0-4) (calculated by the regression formula based on C1, C2 and C3), while the second group (group CO) consisted of 25 "historical" patients in whom the dose of this drug was adjusted according to CO. On the 6th day the average daily dose of CyA in the group C2 was 10.1 +/- 0.8 mg/kg, while in the group CO it was 7.6 +/- 1.6 (p < 0.05). One month following the Tx, daily drug doses were quite similar in the two observed groups (6.2 mg/kg in CO and 6.6 mg/kg in group C2, p = NS). In the group C2, target C2/AUC(0-4) (C2 1700 ng/ml, AUC(0-4) 4400 ng h/ml) on the sixth day was achieved in 36.3%, and on day 14 in 76% of the patients. The target AUC(0-4), in relation with C2, in each observed time interval was reached in the higher number of patients. Maximum CyA concentrations in the group C2 were registered 2 hours following the administration (C2), when compared with the concentrations registered after the first and the third hour (C1 and C3). In relation with C1 and C3, C2 concentration correlated most favorably with AUC(0-4), both on the 6th (r = 0.85) and on the 9th day (r = 0.87). During the first three months following the Tx, in the group CO, 10 episodes (40%) of acute cell rejection (AR) were registered, while in the group C2, two episodes (8%, p = 0.07) were registered; in the observed period covering the first two years, a total of 13 (52%) AR episodes in the group CO and 5 AR episodes (20%) in the group C2 (p = 0.03) were registered. All of five episodes of steroid resistant AR were registered in the group CO. In the group C2, all five patients with AR had lower C2 during AR: the average C2 at the moment of AR was 933.8 ng/ml, and in the patients without rejections was 1364.2 ng/ml (p = 0.008). In the same group, the average C0 at the moment of AR was 263.2 ng/ml, and 240.0 ng/ml (p = 0.486) in the patients without AR. In the C0 group, average C0 concentration at the moment of AR was 227.1 ng/ml, while in the patients without AR it was 227.7 ng/ml (p = 0.95). Totally 68% of the patients showed signs of acute CyA nephrotoxicity during the first year in the group C2, and 52% in the group CO (p = 0.38). In seven patients (28%) of the group C2 and six patients of the group C0 (24%, p = 0.96) in the first two years following Tx, administration of CyA was interrupted due to nephrotoxicity. Overall graft function was good in both groups during the period of two years. One graft was lost in the group CO due to chronic allograft nephropathy. The patients in the group C2 had better early and the same late graft function. Five patients in the group C2 who did not reach the target C2/AUC during the first 30 days, did not have more AR or worse graft function, comparing with the patients who reached the target concentrations. In the patients with CyA TDM through with the C2 and AUC(0-4), AR frequency was considerably lower, and AR episodes had a milder flow than in those with CyA TDM through the CO. The drug concentration in blood two hours after administration (C2) was a good predictor of acute graft rejection, while CO failed to point to the patients with the insufficient drug concentration. Higher drug doses were administered in the group C2 during the first month following Tx, and these patients did not show significantly higher frequency of acute nephrotoxicity and more frequent requirement of the drug use interruption. Graft function in both groups was good during the period of two years. CyA dose determination through C2 and AUC(0-4) is efficient TDM method, relatively simple for use in day to day clinical practice.

Pedagogical monitoring as a tool to reduce dropout in distance learning in family health.

PubMed

de Castro E Lima Baesse, Deborah; Grisolia, Alexandra Monteiro; de Oliveira, Ana Emilia Figueiredo

2016-08-22

This paper presents the results of a study of the Monsys monitoring system, an educational support tool designed to prevent and control the dropout rate in a distance learning course in family health. Developed by UNA-SUS/UFMA, Monsys was created to enable data mining in the virtual learning environment known as Moodle. This is an exploratory study using documentary and bibliographic research and analysis of the Monsys database. Two classes (2010 and 2011) were selected as research subjects, one with Monsys intervention and the other without. The samples were matched (using a ration of 1:1) by gender, age, marital status, graduation year, previous graduation status, location and profession. Statistical analysis was performed using the chi-square test and a multivariate logistic regression model with a 5 % significance level. The findings show that the dropout rate in the class in which Monsys was not employed (2010) was 43.2 %. However, the dropout rate in the class of 2011, in which the tool was employed as a pedagogical team aid, was 30.6 %. After statistical adjustment, the Monsys monitoring system remained in correlation with the course completion variable (adjusted OR = 1.74, IC95% = 1.17-2.59; p = 0.005), suggesting that the use of the Monsys tool, isolated to the adjusted variables, can enhance the likelihood that students will complete the course. Using the chi-square test, a profile analysis of students revealed a higher completion rate among women (67.7 %) than men (52.2 %). Analysis of age demonstrated that students between 40 and 49 years dropped out the least (32.1 %) and, with regard to professional training, nurses have the lowest dropout rates (36.3 %). The use of Monsys significantly reduced the dropout, with results showing greater association between the variables denoting presence of the monitoring system and female gender.

Smart Care Based on Telemonitoring and Telemedicine for Type 2 Diabetes Care: Multi-center Randomized Controlled Trial.

PubMed

Jeong, Ji Yun; Jeon, Jae-Han; Bae, Kwi-Hyun; Choi, Yeon-Kyung; Park, Keun-Gyu; Kim, Jung-Guk; Won, Kyu Chang; Cha, Bong Soo; Ahn, Chul Woo; Kim, Dong Won; Lee, Chang Hee; Lee, In-Kyu

2018-01-17

This study was performed to determine the effectiveness of the Smart Care service on glucose control based on telemedicine and telemonitoring compared with conventional treatment in patients with type 2 diabetes. This 24-week prospective multi-center randomized controlled trial involved 338 adult patients with type 2 diabetes at four university hospitals in South Korea. The patients were randomly assigned to a control group (group A, n = 113), a telemonitoring group (group B, n = 113), or a telemedicine group (group C, n = 112). Patients in the telemonitoring group visited the outpatient clinic regularly, accompanied by an additional telemonitoring service that included remote glucose monitoring with automated patient decision support by text. Remote glucose monitoring was identical in the telemedicine group, but assessment by outpatient visits was replaced by video conferencing with an endocrinologist. The adjusted net reductions in HbA1c concentration after 24 weeks were similar in the conventional, telemonitoring, and telemedicine groups (-0.66% ± 1.03% vs. -0.66% ± 1.09% vs. -0.81% ± 1.05%; p > 0.05 for each pairwise comparison). Fasting glucose concentrations were lower in the telemonitoring and telemedicine groups than in the conventional group. Rates of hypoglycemia were lower in the telemedicine group than in the other two groups, and compliance with medication was better in the telemonitoring and telemedicine than in the conventional group. No serious adverse events were associated with telemedicine. Telehealthcare was as effective as conventional care at improving glycemia in patients with type 2 diabetes without serious adverse effects.

Effects and Clinical Characteristics of Intracranial Pressure Monitoring-Targeted Management for Subsets of Traumatic Brain Injury: An Observational Multicenter Study.

PubMed

Yuan, Qiang; Wu, Xing; Yu, Jian; Sun, Yirui; Li, Zhiqi; Du, Zhuoying; Mao, Ying; Zhou, Liangfu; Hu, Jin

2015-07-01

To evaluate the efficacy of traumatic brain injury management guided by intracranial pressure monitoring and to explore the specific subgroups for which intracranial pressure monitoring might be significantly associated with improved outcomes based on a classification of the various traumatic brain injury pathophysiologies using the clinical features and CT scans. Retrospective observational multicenter study. Twenty-two hospitals (16 level I trauma centers and six level II trauma centers) in nine provinces in China. Moderate or severe traumatic brain injury patients who were more than 14 years old. Intracranial pressure monitoring. All data were collected by physicians from medical records. The 6-month mortality and favorable outcome were assessed with the Glasgow Outcome Scale Extended score. An intracranial pressure monitor was inserted into 838 patients (58.1%). The mean duration of intracranial pressure monitoring was 4.44 ± 3.65 days. The significant predictors of intracranial pressure monitoring included the mechanism of injury, a Glasgow Coma Scale score of 9-12 at admission that dropped to a score of 3-8 within 24 hours after injury, a Marshall CT classification of III-IV, the presence of a major extracranial injury, subdural hematoma, intraparenchymal lesions, trauma center level, and intracranial pressure monitoring utilization of hospital. The intracranial pressure monitoring and no intracranial pressure monitoring groups did not significantly differ in terms of complications. For the total sample, the placement of intracranial pressure monitoring was not associated with either 6-month mortality (16.9% vs 20.5%; p = 0.086) or 6-month unfavorable outcome (49.4% vs 45.8%; p = 0.175). For patients with a Glasgow Coma Scale score of 3-8 at admission, intracranial pressure monitoring was also not significantly associated with 6-month mortality (20.9% vs 26.0%; p = 0.053) or an unfavorable outcome (56.9% vs 55.5%; p = 0.646). Multivariate logistic regression analyses showed that intracranial pressure monitoring resulted in a significantly lower 6-month mortality for patients who had a Glasgow Coma Scale score of 3-5 at admission (adjusted odds ratio, 0.57; 95% CI, 0.36-0.90; adjusted p = 0.016), those who had a Glasgow Coma Scale score of 9-12 at admission that dropped to 3-8 within 24 hours after injury (adjusted odds ratio, 0.28; 95% CI, 0.08-0.96; adjusted p = 0.043), and those who had a probability of death at 6 months greater than 0.6 (adjusted odds ratio, 0.55; 95% CI, 0.32-0.94; adjusted p = 0.029). There were multiple differences between the intracranial pressure monitoring and no intracranial pressure monitoring groups regarding patient characteristics, injury severity, characteristics of CT scan, and hospital type. Intracranial pressure monitoring in conjunction with intracranial pressure-targeted therapies is significantly associated with lower mortality in some special traumatic brain injury subgroups. The prospective randomized controlled trials specifically investigating these subgroups will be required to further characterize the effects of intracranial pressure monitoring on behavioral outcomes in patients with traumatic brain injury.

Association of Peak Changes in Plasma Cystatin C and Creatinine With Death After Cardiac Operations.

PubMed

Park, Meyeon; Shlipak, Michael G; Thiessen-Philbrook, Heather; Garg, Amit X; Koyner, Jay L; Coca, Steven G; Parikh, Chirag R

2016-04-01

Acute kidney injury is a risk factor for death in cardiac surgical patients. Plasma cystatin C and creatinine have different temporal profiles in the postoperative setting, but the associations of simultaneous changes in both filtration markers compared with change in only one marker with prognosis after hospital discharge are not well described. This is a longitudinal study of 1,199 high-risk adult cardiac surgical patients in the TRIBE-AKI (Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury) Consortium who survived hospitalization. We examined in-hospital peak changes of cystatin C and creatinine in the 3 days after cardiac operations. We evaluated associations of these filtration markers with death, adjusting for demographics, operative characteristics, medical comorbidities, preoperative estimated glomerular filtration rate, preoperative urinary albumin-to-creatinine ratio, and site. During the first 3 days of hospitalization, nearly twice as many patients had a 25% or higher rise in creatinine (30%) compared with a 25% or higher peak rise in cystatin C (15%). The risk of death was higher in those with elevations in cystatin C (adjusted hazard ratio [HR], 1.83; 95% confidence interval [CI], 1.4 to 2.37) or creatinine (adjusted HR, 1.90; 95% CI, 1.32 to 2.72) compared with patients who experienced a postoperative decrease in either filtration marker. Patients who had simultaneous elevations of 25% or higher in cystatin C and creatinine were at similar adjusted risk for 3-year mortality (HR, 1.79; 95% CI, 1.03 to 3.1) as those with a 25% or higher increase in cystatin C alone (HR, 2.2; 95% CI, 1.09 to 4.47). Elevations in creatinine postoperatively are more common than elevations in cystatin C. However, elevations in cystatin C appeared to be associated with a higher risk of death after hospital discharge. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

75 FR 12518 - Publication of Housing Price Inflation Adjustment Under 50 U.S.C. App. 531

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-16

...: Notice. SUMMARY: The Servicemembers Civil Relief Act, as codified at 50 U.S.C. App. 531, prohibits a... military service except by court order. The law as originally passed by Congress applied to dwellings with monthly rents of $2,400 or less. The law requires the Department of Defense to adjust this amount annually...

Low-cost and high-resolution interrogation scheme for LPG-based temperature sensor

NASA Astrophysics Data System (ADS)

Venkata Reddy, M.; Srimannarayana, K.; Venkatappa Rao, T.; Vengal Rao, P.

2015-09-01

A low-cost and high-resolution interrogation scheme for a long-period fiber grating (LPG) temperature sensor with adjustable temperature range has been designed, developed and tested. In general LPGs are widely used as optical sensors and can be used as optical edge filters to interrogate the wavelength encoded signal from sensors such as fiber Bragg grating (FBG) by converting it into intensity modulated signal. But the interrogation of LPG sensors using FBG is a bit novel and it is to be studied experimentally. The sensor works based on measurement of shift in attenuation band of LPG corresponding to the applied temperature. The wavelength shift of LPG attenuation band is monitored using an optical spectrum analyser (OSA). Further the bulk and expensive OSA is replaced with a low-cost interrogation system that employ an FBG, photodiode and a transimpedance amplifier (TIA). The designed interrogation scheme makes the system low-cost, fast in response, and also enhances its resolution up to 0.1°C. The measurable temperature range using the proposed scheme is limited to 120 °C. However this range can be shifted within 15-450 °C by means of adjusting the Bragg wavelength of FBG.

Association of 1,5-anhydroglucitol with diabetes and microvascular conditions

PubMed Central

Selvin, Elizabeth; Rawlings, Andreea M.; Grams, Morgan; Klein, Ronald; Steffes, Michael; Coresh, Josef

2014-01-01

Background 1,5-anhydroglucitol (1,5-AG) is inversely related to hyperglycemia and may be a useful indicator of short-term (1-2 week) hyperglycemia and glycemic excursions but its prognostic value is unclear. We sought to evaluate the associations of 1,5-AG with risk of diabetes and microvascular disease. Methods We measured 1,5-AG in blood samples from over 10,000 participants in the ARIC Study (baseline, 1990-1992) and characterized the independent associations with prevalent retinopathy, and with incident chronic kidney disease and incident diabetes during approximately 20 years of follow-up. Results We found that 1,5-AG was associated with prevalent retinopathy, driven primarily by the strong association in persons with diagnosed diabetes: adjusted OR 11.26 (95%CI 6.17-20.53) for <6 ug/mL compared to 1,5-AG ≥10 ug/mL. This result remained significant after further adjustment for HbA1c (OR 4.85, 95%CI 2.42-9.74). In persons with diagnosed diabetes: low 1,5-AG (<6 ug/mL vs ≥10 ug/mL) was also associated with a greater than 2-fold increased risk of incident chronic kidney disease (adjusted HR 2.83, 95% CI 2.15-3.74) and remained significant after adjustment for HbA1c (HR 1.43, 95%CI 1.02-2.00). Nondiabetic participants with high 1,5-AG (≥ 10 ug/mL) had the lowest prevalence of retinopathy and lowest risk of kidney disease. In persons without diagnosed diabetes at baseline, 1,5-AG <10 ug/mL was also associated with incident diabetes (adjusted HR 2.29, 95%CI 2.03-2.58). Conclusions 1,5-AG was associated with long-term risk of important microvascular outcomes, particularly in persons with diagnosed diabetes and even after adjustment for HbA1c. Our results suggest 1,5-AG may capture risk information associated with hyperglycemic excursions. PMID:25200356

Abbreviated AUC monitoring of cyclosporine more adequately identified patients at risk for acute rejection during induction of immunosuppressive therapy after kidney transplantation than recommended C2 concentration values.

PubMed

Troncoso, P; Ortiz, A M; Jara, A; Vilches, S

2009-01-01

Monitoring of cyclosporine (CsA) is critical during the induction of immunosuppressive therapy. Although most centers have incorporated C2 levels, our unit still uses an abbreviated AUC model which includes concentrations at C1, C2, and C6 post-dose (AUC(1-6)). The objective of this study was to compare both strategies of CsA monitoring during the first 30 days after kidney transplantation. The study included 89 recipients induced with CsA microemulsion and steroids. AUC(1-6) profiles were performed around days 3, 10, and 30 after transplantation with a target of 5500 to 6000 ng*h/mL considered therapeutic. For comparison purposes, a value of C2 >/= 1500 ng/mL was also considered therapeutic. Mean C2 and AUC(1-6) values were low dated with biopsy-proven acute rejection episodes (BPAR) during the study period. Twenty patients received living donor kidneys and overall there were 46 females. During this period, 253 AUC(1-6) were performed including 44 (17.4%) below the therapeutic range. When the analysis included only C2, 171 (67.6%) were below the therapeutic target (P < .001). Five patients experience BPAR and only AUC(1-6) at day 10 discriminated rejectors versus nonrejectors (5645 +/- 1390 and 8221 +/- 2502, respectively; P = .008). C2 was not significantly different at any time in either group. In this study, abbreviated AUC monitoring more adequately identified patients at risk for acute rejection than C2. Recommended C2 concentration levels need to be redefined in our patients.

The impact of ambient temperature on HbA1c in Taiwanese type 2 diabetic patients: The most vulnerable subgroup.

PubMed

Tien, Kai-Jen; Yang, Chwen-Yi; Weng, Shih-Feng; Liu, Su-Yen; Hsieh, Ming-Chia; Chou, Chien-Wen

2016-05-01

The relationship between temperature variability and HbA1c has been reported in Caucasians, but not for Asians of Taiwanese origin. This study investigated the impact of temperature on HbA1c in various groups of Taiwanese with type 2 diabetes in Taiwan. For this longitudinal follow-up study which started in 2006, we recruited a total of 4399 patients with type 2 diabetes who had been regularly followed up at Chi Mei Medical Center and obtained local temperature data for 2006 to 2011 from Taiwan's Central Weather Bureau. We used a generalized estimated equation (GEE) to analyze the HbA1c level and its change over time with temperature and temperature changes, respectively. We found a negative correlation between HbA1c and temperature (R = -0.475, p = 0.001). For every 1°C decrement in temperature, there was an increase in the risk of having a HbA1c level >7% [p < 0.001, adjusted odds ratio (OR): 1.01]. There was a significantly higher risk of HbA1c > 7% among those in the lowest quartile of temperatures than the highest quartile (p = 0.0038, adjusted OR: 1.13). Patients with diabetic patients were at higher risk of HbA1C > 7% in the winter and spring than those in the summer (adjusted OR: 1.13, p = 0.0027; adjusted OR: 1.14, p = 0.0022). After adjusting for various confounders, we found people who were younger than 65 years old, people who had diabetes for longer than 6 years, and people who had a body mass index (BMI) < 24 to be more susceptible to temperature changes (p = 0.0022, β: 0.0095; p < 0.0001, β: 0.0125; p < 0.0001, β: 0.016, respectively). Our study suggests cold weather may adversely affect HbA1c levels in Taiwanese people with type 2 diabetes, especially in people under 65 years old, people with diabetes for longer than 6 years, and those with a BMI < 24. Copyright © 2015. Published by Elsevier B.V.

Therapeutic management of orally treated type 2 diabetic patients, by French general practitioners in 2010: the DIAttitude Study.

PubMed

Halimi, S; Balkau, B; Attali, C; Detournay, B; Amelineau, E; Blickle, J-F

2012-03-01

To describe the behaviour of French general practitioners (GP) regarding intensification of hypoglycaemic agents in orally treated type 2 diabetic (T2D) patients, according to their HbA(1c) level. General practitioners were recruited from a panel of office-based general practitioners. T2D patients who had been orally treated for at least 6 months were included in the study; their characteristics were recorded, and their HbA(1c) values and hypoglycaemic treatments over the previous 24 months extracted from electronic records The major reasons for intensification (or no intensification) of hypoglycaemic agents were recorded at the inclusion visit. A total of 236 general practitioners recruited 2109 T2D patients: 1732 had at least one HbA(1c) value recorded in the previous 6 months, and 52%, 33% and 14% had been treated, with oral hypoglycaemic agents in monotherapy, bitherapy or tri-or quadritherapy, respectively. Of these patients, 702 (41%) remained uncontrolled (47%, 39% and 20% respectively) and according to the current French guidelines needed treatment intensification. Only 46 (7%) had their treatment intensified at inclusion. Of those without intensified treatment, 60% were treated with monotherapy; the main reason given by the general practitioners for not intensifying treatment was a satisfactory HbA(1c) level (53%), although 32% had an HbA(1c)>7%. Other reasons were: lifestyle advice had greater priority (20%); decision was postponed until the next visit (11%); HbA(1c) had decreased since last visit (7%; not confirmed by available data in 58% of cases); a medical priority other than diabetes (6%) and other reasons related to the patient (3%). For T2D patients managed by French general practitioners, guidelines are not consistently followed: HbA(1c) should be monitored more frequently and treatment adjusted according to HbA(1c) levels. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

26 CFR 1.312-4 - Examples of adjustments provided in section 312(c).

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 4 2010-04-01 2010-04-01 false Examples of adjustments provided in section 312... (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES Effects on Corporation § 1.312-4 Examples of adjustments... examples: Example 1. On December 2, 1954, Corporation X distributed to its sole shareholder, A, an...

26 CFR 1.1502-18 - Inventory adjustment.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 12 2010-04-01 2010-04-01 false Inventory adjustment. 1.1502-18 Section 1.1502... (CONTINUED) INCOME TAXES Computation of Separate Taxable Income § 1.1502-18 Inventory adjustment. (a... inventories of any member of the group. See § 1.1502-13(c)(2) with respect to the determination of profits...

77 FR 19127 - Defense Federal Acquisition Regulation Supplement; Inflation Adjustment of Threshold for...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-30

...-AH65 Defense Federal Acquisition Regulation Supplement; Inflation Adjustment of Threshold for..., and to adjust the threshold, as appropriate. 10 U.S.C. 2253(a)(2) is based on section 101(b) of the Fiscal Year 1986 Department of Defense Appropriations Act (Pub. L. 99-190). The threshold was previously...

Impact of flash glucose monitoring on hypoglycaemia in adults with type 1 diabetes managed with multiple daily injection therapy: a pre-specified subgroup analysis of the IMPACT randomised controlled trial.

PubMed

Oskarsson, Per; Antuna, Ramiro; Geelhoed-Duijvestijn, Petronella; Krӧger, Jens; Weitgasser, Raimund; Bolinder, Jan

2018-03-01

Evidence for the effectiveness of interstitial glucose monitoring in individuals with type 1 diabetes using multiple daily injection (MDI) therapy is limited. In this pre-specified subgroup analysis of the Novel Glucose-Sensing Technology and Hypoglycemia in Type 1 Diabetes: a Multicentre, Non-masked, Randomised Controlled Trial' (IMPACT), we assessed the impact of flash glucose technology on hypoglycaemia compared with capillary glucose monitoring. This multicentre, prospective, non-masked, RCT enrolled adults from 23 European diabetes centres. Individuals were eligible to participate if they had well-controlled type 1 diabetes (diagnosed for ≥5 years), HbA 1c ≤ 58 mmol/mol [7.5%], were using MDI therapy and on their current insulin regimen for ≥3 months, reported self-monitoring of blood glucose on a regular basis (equivalent to ≥3 times/day) for ≥2 months and were deemed technically capable of using flash glucose technology. Individuals were excluded if they were diagnosed with hypoglycaemia unawareness, had diabetic ketoacidosis or myocardial infarction in the preceding 6 months, had a known allergy to medical-grade adhesives, used continuous glucose monitoring (CGM) within the previous 4 months or were currently using CGM or sensor-augmented pump therapy, were pregnant or planning pregnancy or were receiving steroid therapy for any disorders. Following 2 weeks of blinded (to participants and investigator) sensor wear by all participants, participants with sensor data for more than 50% of the blinded wear period (or ≥650 individual sensor results) were randomly assigned, in a 1:1 ratio by a central interactive web response system (IWRS) using the biased-coin minimisation method, to flash sensor-based glucose monitoring (intervention group) or self-monitoring of capillary blood glucose (control group). The control group had two further 14 day blinded sensor-wear periods at the 3 and 6 month time points. Participants, investigators and staff were not masked to group allocation. The primary outcome was the change in time in hypoglycaemia (<3.9 mmol/l) between baseline and 6 months in the full analysis set. Between 4 September 2014 and 12 February 2015, 167 participants using MDI were enrolled. After screening and the baseline phase, participants were randomised to intervention (n = 82) and control groups (n = 81). One woman from each group was excluded owing to pregnancy; the full analysis set included 161 randomised participants. At 6 months, mean time in hypoglycaemia was reduced by 46.0%, from 3.44 h/day to 1.86 h/day in the intervention group (baseline adjusted mean change, -1.65 h/day), and from 3.73 h/day to 3.66 h/day in the control group (baseline adjusted mean change, 0.00 h/day), with a between-group difference of -1.65 (95% CI -2.21, -1.09; p < 0.0001). For participants in the intervention group, the mean ± SD daily sensor scanning frequency was 14.7 ± 10.7 (median 12.3) and the mean number of self-monitored blood glucose tests performed per day reduced from 5.5 ± 2.0 (median 5.4) at baseline to 0.5 ± 1.0 (median 0.1). The baseline frequency of self-monitored blood glucose tests by control participants was maintained (from 5.6 ± 1.9 [median 5.2] to 5.5 ± 2.6 [median 5.1] per day). Treatment satisfaction and perception of hypo/hyperglycaemia were improved compared with control. No device-related hypoglycaemia or safety-related issues were reported. Nine serious adverse events were reported for eight participants (four in each group), none related to the device. Eight adverse events for six of the participants in the intervention group were also reported, which were related to sensor insertion/wear; four of these participants withdrew because of the adverse event. Use of flash glucose technology in type 1 diabetes controlled with MDI therapy significantly reduced time in hypoglycaemia without deterioration of HbA 1c , and improved treatment satisfaction. ClinicalTrials.gov NCT02232698 FUNDING: Abbott Diabetes Care, Witney, UK.

Estradiol and Inflammatory Markers in Older Men

PubMed Central

Maggio, Marcello; Ceda, Gian Paolo; Lauretani, Fulvio; Bandinelli, Stefania; Metter, E. Jeffrey; Artoni, Andrea; Gatti, Elisa; Ruggiero, Carmelinda; Guralnik, Jack M.; Valenti, Giorgio; Ling, Shari M.; Basaria, Shehzad; Ferrucci, Luigi

2009-01-01

Background: Aging is characterized by a mild proinflammatory state. In older men, low testosterone levels have been associated with increasing levels of proinflammatory cytokines. It is still unclear whether estradiol (E2), which generally has biological activities complementary to testosterone, affects inflammation. Methods: We analyzed data obtained from 399 men aged 65–95 yr enrolled in the Invecchiare in Chianti study with complete data on body mass index (BMI), serum E2, testosterone, IL-6, soluble IL-6 receptor, TNF-α, IL-1 receptor antagonist, and C-reactive protein. The relationship between E2 and inflammatory markers was examined using multivariate linear models adjusted for age, BMI, smoking, physical activity, chronic disease, and total testosterone. Results: In age-adjusted analysis, log (E2) was positively associated with log (IL-6) (r = 0.19; P = 0.047), and the relationship was statistically significant (P = 0.032) after adjustments for age, BMI, smoking, physical activity, chronic disease, and serum testosterone levels. Log (E2) was not significantly associated with log (C-reactive protein), log (soluble IL-6 receptor), or log (TNF-α) in both age-adjusted and fully adjusted analyses. Conclusions: In older men, E2 is weakly positively associated with IL-6, independent of testosterone and other confounders including BMI. PMID:19050054

An inexpensive light-scattering particle monitor: field validation

PubMed Central

Edwards, Rufus D.; Johnson, Michael; Shields, Kyra Naumoff; Allen, Tracy; Canuz, Eduardo; Smith, Kirk R.

2014-01-01

We have developed a small, light, passive, inexpensive, datalogging particle monitor called the “UCB” (University of California Berkeley particle monitor). Following previously published laboratory assessments, we present here results of tests of its performance in field settings at high particle concentrations. We demonstrate the mass sensitivity of the UCB in relation to gravimetric filter-based PM2.5 mass estimates as well as commercial light-scattering instruments co-located in field chamber tests and in kitchens of wood-burning households. The coefficient of variation of the unadjusted UCB mass response in relation to gravimetric estimates was 15%. Although requiring adjustment for differences in sensitivity, inter-monitor performance was consistently high (r2 > 0.99). Moreover, the UCB can consistently estimate PM2.5 mass concentrations in wood-burning kitchens (Pearson r2 = 0.89; N = 99), with good agreement between duplicate measures (Pearson r2 = 0.94; N = 88). In addition, with appropriate cleaning of the sensing chamber, UCB mass sensitivity does not decrease with time when used intensively in open woodfire kitchens, demonstrating the significant potential of this monitor. PMID:17909644

Bioequivalence of two levothyroxine tablet formulations without and with mathematical adjustment for basal thyroxine levels in healthy Argentinian volunteers: a single-dose, randomized, open-label, crossover study.

PubMed

Di Girolamo, Guillermo; Keller, Guillermo A; de Los Santos, Antonio R; Schere, Daniel; Gonzalez, Claudio D

2008-11-01

Levothyroxine has a narrow therapeutic index; therefore, precise and accurate assessment of the bioequivalence of different levothyroxine products is critical. Bioavailability estimates of levothyroxine formulations might be affected by baseline concentrations of the hormone. The aim of this study was to assess the bioequivalence of 100 microg of a test (T4 Montpellier 100, Química Montpellier S.A., Buenos Aires, Argentina) and reference (Synthroid, Abbott Laboratories, Abbott Park, Illinois) formulation of levothyroxine. We also compared 2 methods of levothyroxine measurements: without and with baseline correction for endogenous levothyroxine. This randomized, open-label, 2-sequence, crossover study with a 65-day washout period was carried out in healthy, white, euthyroid volunteers following a single dose of sodium levothyroxine 600 microg. Blood samples were collected at 30 and 15 minutes prior to administration, and 0 (baseline), 0.5, 1, 1.5, 2, 2.5, 3, 4, 6, 8, 10, 12, 24, and 48 hours to determine thyroxine; serum thyrotropin (TSH) concentrations were determined 30 minutes before administration and 48 hours after administration. Serum concentrations of thyroxine were determined through radioimmunoassay and serum TSH concentrations were determined by a validated 2-site immunoradiometric assay. The formulations are considered to be equivalent if the 90% CI ratios for C(max) and AUC(0-last) are within 80% to 125%, per the US Food and Drug Administration (FDA). Adverse event monitoring was performed throughout the study by assessing clinical parameters (eg, blood pressure, electrocardiogram) and patient reports. A total of 24 volunteers (16 male, 8 female; mean [SD] age, 30.2 [4.6] years [range, 21-40 years]; mean [SD] weight, 71.71 [7.52] kg [range, 58-83 kg]) were included in the study. Without adjustment for baseline levels of endogenous levothyroxine, geometric mean C(max) for the test and reference formulations were 8.92 and 9.39 microg/dL, respectively; AUC(0-last) values were 368.40 and 383.37 microg/mL . h(-1). The 90% CI of the geometric mean for the percent ratios (test: reference) of C(max) and AUC(0-last) were 95.1% (90% CI, 91.9-98.3) and 96.1% (90% CI, 94.0-98.2), respectively. With adjustment for baseline levels of endogenous levothyroxine, the geometric mean C(max) for the test and reference formulations were 3.16 and 3.39 microg/dL, respectively; AUC(0-last) values were 88.33 and 95.60 microg/mL . h(-1). Despite performing the adjustment, the 90% CI of the geometric mean for Cmax and AUC(0-last) test:reference ratios were 93.1% (90% CI, 84.9-102.2) and 92.4% (90% CI, 85.2-100.2), respectively. No significant between-group differences were found with regard to pharmacokinetic parameters. No adverse events were observed or reported. The results of this study suggest that the test formulation was bioequivalent to the reference formulation of levothyroxine in these healthy volunteers, according to the US FDA definition of bioequivalence. This was supported by the analysis of concentration-time profiles without and with correction for basal endogenous levothyroxine.

Structure of weakly 2-dependent siphons

NASA Astrophysics Data System (ADS)

Chao, Daniel Yuh; Chen, Jiun-Ting

2013-09-01

Deadlocks arising from insufficiently marked siphons in flexible manufacturing systems can be controlled by adding monitors to each siphon - too many for large systems. Li and Zhou add monitors to elementary siphons only while controlling the rest of (called dependent) siphons by adjusting control depth variables of elementary siphons. Only a linear number of monitors are required. The control of weakly dependent siphons (WDSs) is rather conservative since only positive terms were considered. The structure for strongly dependent siphons (SDSs) has been studied earlier. Based on this structure, the optimal sequence of adding monitors has been discovered earlier. Better controllability has been discovered to achieve faster and more permissive control. The results have been extended earlier to S3PGR2 (systems of simple sequential processes with general resource requirements). This paper explores the structures for WDSs, which, as found in this paper, involve elementary resource circuits interconnecting at more than (for SDSs, exactly) one resource place. This saves the time to compute compound siphons, their complementary sets and T-characteristic vectors. Also it allows us (1) to improve the controllability of WDSs and control siphons and (2) to avoid the time to find independent vectors for elementary siphons. We propose a sufficient and necessary test for adjusting control depth variables in S3PR (systems of simple sequential processes with resources) to avoid the sufficient-only time-consuming linear integer programming test (LIP) (Nondeterministic Polynomial (NP) time complete problem) required previously for some cases.

40 CFR Appendix to Subpart Eee of... - Quality Assurance Procedures for Continuous Emissions Monitors Used for Hazardous Waste Combustors

Code of Federal Regulations, 2012 CFR

2012-07-01

... capabilities. 2.2Relative Accuracy (RA). The absolute mean difference between the pollutant concentration... adjustment took place. 2.4Zero Drift (ZD). The difference in CEMS output readings at the zero pollutant level... Evaluation for CO, O2, and HC CEMS Carbon Monoxide (CO), Oxygen (O2), and Hydrocarbon (HC) CEMS. An Absolute...

40 CFR Appendix to Subpart Eee of... - Quality Assurance Procedures for Continuous Emissions Monitors Used for Hazardous Waste Combustors

Code of Federal Regulations, 2011 CFR

2011-07-01

... capabilities. 2.2Relative Accuracy (RA). The absolute mean difference between the pollutant concentration... adjustment took place. 2.4Zero Drift (ZD). The difference in CEMS output readings at the zero pollutant level... Evaluation for CO, O2, and HC CEMS Carbon Monoxide (CO), Oxygen (O2), and Hydrocarbon (HC) CEMS. An Absolute...

Evaluation of risk for late language emergence after in utero antiretroviral drug exposure in HIV-exposed uninfected infants.

PubMed

Rice, Mabel L; Zeldow, Bret; Siberry, George K; Purswani, Murli; Malee, Kathleen; Hoffman, Howard J; Frederick, Toni; Buchanan, Ashley; Sirois, Patricia A; Allison, Susannah M; Williams, Paige L

2013-10-01

Combination antiretroviral (cARV) regimens are recommended for pregnant women with HIV to prevent perinatal HIV transmission. Safety is a concern for infants who were HIV-exposed but uninfected, particularly for neurodevelopmental problems, such as language delays. We studied late language emergence (LLE) in HIV-exposed but uninfected children enrolled in a US-based prospective cohort study. LLE was defined as a caregiver-reported score ≤10th percentile in any of 4 domains of the MacArthur-Bates Communicative Development Inventory for 1-year olds and as ≥1 standard deviation below age-specific norms for the Ages and Stages Questionnaire for 2-year olds. Logistic regression models were used to evaluate associations of in utero cARV exposure with LLE, adjusting for infant, maternal and environmental characteristics. 1129 language assessments were conducted among 792 1- and 2-year-old children (50% male, 62% black and 37% Hispanic). Overall, 86% had in utero exposure to cARV and 83% to protease inhibitors. LLE was identified in 26% of 1-year olds and 23% of 2-year olds, with higher rates among boys. In adjusted models, LLE was not associated with maternal cARV or ARV drug classes in either age group. Among cARV-exposed 1-year olds, increased odds of LLE was observed for those exposed to atazanavir (adjusted odds ratio = 1.83, 95% confidence interval: 1.10-3.04), particularly after the first trimester (adjusted odds ratio = 3.56, P = 0.001), compared with atazanavir-unexposed infants. No associations of individual ARV drugs with LLE were observed among 2-year olds. In utero cARV exposure showed little association with LLE, except for a higher risk of language delay observed in 1-year-old infants with atazanavir exposure.

Adjusting Mitigation Pathways to Stabilize Climate at 1.5°C and 2.0°C Rise in Global Temperatures to Year 2300

NASA Astrophysics Data System (ADS)

Goodwin, Philip; Brown, Sally; Haigh, Ivan David; Nicholls, Robert James; Matter, Juerg M.

2018-03-01

To avoid the most dangerous consequences of anthropogenic climate change, the Paris Agreement provides a clear and agreed climate mitigation target of stabilizing global surface warming to under 2.0°C above preindustrial, and preferably closer to 1.5°C. However, policy makers do not currently know exactly what carbon emissions pathways to follow to stabilize warming below these agreed targets, because there is large uncertainty in future temperature rise for any given pathway. This large uncertainty makes it difficult for a cautious policy maker to avoid either: (1) allowing warming to exceed the agreed target or (2) cutting global emissions more than is required to satisfy the agreed target, and their associated societal costs. This study presents a novel Adjusting Mitigation Pathway (AMP) approach to restrict future warming to policy-driven targets, in which future emissions reductions are not fully determined now but respond to future surface warming each decade in a self-adjusting manner. A large ensemble of Earth system model simulations, constrained by geological and historical observations of past climate change, demonstrates our self-adjusting mitigation approach for a range of climate stabilization targets ranging from 1.5°C to 4.5°C, and generates AMP scenarios up to year 2300 for surface warming, carbon emissions, atmospheric CO2, global mean sea level, and surface ocean acidification. We find that lower 21st century warming targets will significantly reduce ocean acidification this century, and will avoid up to 4 m of sea-level rise by year 2300 relative to a high-end scenario.

Should Studies of Diabetes Treatment Stratification Correct for Baseline HbA1c?

PubMed Central

Jones, Angus G.; Lonergan, Mike; Henley, William E.; Pearson, Ewan R.; Hattersley, Andrew T.; Shields, Beverley M.

2016-01-01

Aims Baseline HbA1c is a major predictor of response to glucose lowering therapy and therefore a potential confounder in studies aiming to identify other predictors. However, baseline adjustment may introduce error if the association between baseline HbA1c and response is substantially due to measurement error and regression to the mean. We aimed to determine whether studies of predictors of response should adjust for baseline HbA1c. Methods We assessed the relationship between baseline HbA1c and glycaemic response in 257 participants treated with GLP-1R agonists and assessed whether it reflected measurement error and regression to the mean using duplicate ‘pre-baseline’ HbA1c measurements not included in the response variable. In this cohort and an additional 2659 participants treated with sulfonylureas we assessed the relationship between covariates associated with baseline HbA1c and treatment response with and without baseline adjustment, and with a bias correction using pre-baseline HbA1c to adjust for the effects of error in baseline HbA1c. Results Baseline HbA1c was a major predictor of response (R2 = 0.19,β = -0.44,p<0.001).The association between pre-baseline and response was similar suggesting the greater response at higher baseline HbA1cs is not mainly due to measurement error and subsequent regression to the mean. In unadjusted analysis in both cohorts, factors associated with baseline HbA1c were associated with response, however these associations were weak or absent after adjustment for baseline HbA1c. Bias correction did not substantially alter associations. Conclusions Adjustment for the baseline HbA1c measurement is a simple and effective way to reduce bias in studies of predictors of response to glucose lowering therapy. PMID:27050911

14 CFR 171.259 - Performance requirements: General.

Code of Federal Regulations, 2011 CFR

2011-01-01

... components: (1) C-Band (5000 MHz-5030 MHz) localizer equipment, associated monitor system, and remote indicator equipment; (2) C-Band (5220 MHz-5250 MHz) glide path equipment, associated monitor system, and remote indicator equipment; (3) VHF marker beacons (75 MHz), associated monitor systems, and remote...

14 CFR 171.259 - Performance requirements: General.

Code of Federal Regulations, 2013 CFR

2013-01-01

... components: (1) C-Band (5000 MHz-5030 MHz) localizer equipment, associated monitor system, and remote indicator equipment; (2) C-Band (5220 MHz-5250 MHz) glide path equipment, associated monitor system, and remote indicator equipment; (3) VHF marker beacons (75 MHz), associated monitor systems, and remote...

14 CFR 171.259 - Performance requirements: General.

Code of Federal Regulations, 2012 CFR

2012-01-01

... components: (1) C-Band (5000 MHz-5030 MHz) localizer equipment, associated monitor system, and remote indicator equipment; (2) C-Band (5220 MHz-5250 MHz) glide path equipment, associated monitor system, and remote indicator equipment; (3) VHF marker beacons (75 MHz), associated monitor systems, and remote...

14 CFR 171.259 - Performance requirements: General.

Code of Federal Regulations, 2014 CFR

2014-01-01

... components: (1) C-Band (5000 MHz-5030 MHz) localizer equipment, associated monitor system, and remote indicator equipment; (2) C-Band (5220 MHz-5250 MHz) glide path equipment, associated monitor system, and remote indicator equipment; (3) VHF marker beacons (75 MHz), associated monitor systems, and remote...

Clinical Use of Continuous Glucose Monitoring in Adults with Type 2 Diabetes

PubMed Central

Mullen, Deborah M.; Bergenstal, Richard M.

2017-01-01

Abstract Background: Hemoglobin A1c is an excellent population health measure for the risk of vascular complications in diabetes, while continuous glucose monitoring (CGM) is a tool to help personalize a diabetes treatment plan. The value of CGM in individuals with type 1 diabetes (T1D) has been well demonstrated when compared with utilizing self-monitoring of blood glucose (SMBG) to guide treatment decisions. CGM is a tool for patients and clinicians to visualize the important role that diet, exercise, stress management, and the appropriate selection of diabetes medications can have in managing type 2 diabetes (T2D). Several diabetes organizations have recently reviewed the literature on the appropriate use of CGM in diabetes management and concluded CGM may be a useful educational and management tool particularly for patients on insulin therapy. The indications for using CGM either as a clinic-based loaner distribution model for intermittent use (professional CGM) or a CGM system owned by the patient and used at home with real-time glucose reading (personal CGM) are only beginning to be addressed in T2D. Most summaries of CGM studies conclude that having a standardized glucose pattern report, such as the ambulatory glucose profile (AGP) report, should help facilitate effective shared decision-making sessions. The future of CGM indications for the use of CGM is evolving rapidly. In some instances, CGM is now approved for making medication adjustments without SMBG confirmation and it appears that some forms of CGM will be approved for use in the Medicare population in the United States in the near future. Many individuals with T1D and T2D and their care teams will come to depend on CGM as a key tool for diabetes management. PMID:28541137

Demonstration of the frequency offset errors introduced by an incorrect setting of the Zeeman/magnetic field adjustment on the cesium beam frequency standard

NASA Technical Reports Server (NTRS)

Kaufmann, D. C.

1976-01-01

The fine frequency setting of a cesium beam frequency standard is accomplished by adjusting the C field control with the appropriate Zeeman frequency applied to the harmonic generator. A novice operator in the field, even when using the correct Zeeman frequency input, may mistakenly set the C field to any one of seven major Beam I peaks (fingers) represented by the Ramsey curve. This can result in frequency offset errors of as much as 2.5 parts in ten to the tenth. The effects of maladjustment are demonstrated and suggestions are discussed on how to avoid the subtle traps associated with C field adjustments.

Reduced anticoagulation variability in patients on warfarin monitored with Fiix-prothrombin time associates with reduced thromboembolism: The Fiix-trial.

PubMed

Oskarsdóttir, Alma Rut; Gudmundsdottir, Brynja R; Indridason, Olafur S; Lund, Sigrun H; Arnar, David O; Bjornsson, Einar S; Magnusson, Magnus K; Jensdottir, Hulda M; Vidarsson, Brynjar; Francis, Charles W; Onundarson, Pall T

2017-05-01

Fiix-prothrombin time (Fiix-PT) differs from traditional PT in being affected by reduced factor (F) II or FX only. In the randomized controlled Fiix-trial, patients on warfarin monitored with Fiix-PT (Fiix-warfarin patients) had fewer thromboembolisms (TE), similar major bleeding (MB) and more stable anticoagulation than patients monitored with PT (PT-warfarin patients). In the current Fiix-trial report we analyzed how reduced anticoagulation variability during Fiix-PT monitoring was reflected in patients with TE or bleeding. Data from 1143 randomized patients was used. We analyzed the groups for anticoagulation intensity (time within target range; TTR), international normalized ratio (INR) variability (variance growth rate B 1 ; VGR) and dose adjustment frequency. We assessed how these parameters associated with clinically relevant vascular events (CRVE), ie TE or MB or clinically relevant non-MB. TTR was highest in Fiix-warfarin patients without CRVE (median 82%;IQR 72-91) and lowest in PT-warfarin patients with TE (62%;56-81). VGR was lowest in Fiix-warfarin patients without CRVE (median VGR B 1 0.17; 95% CI 0.08-0.38) and with TE (0.20;0.07-0.26) and highest in PT-warfarin patients with TE (0.50;0.27-0.90) or MB (0.59;0.07-1.36). The mean annual dose adjustment frequency was lowest in Fiix-warfarin patients with TE (mean 5.4;95% CI 3.9-7.3) and without CRVE (mean 6.0; 5.8-6.2) and highest in PT-warfarin patients with TE (14.2;12.2-16.3). Frequent dose changes predicted MB in both study arms. Compared to patients monitored with PT, high anticoagulation stability in Fiix-warfarin patients coincided with their low TE rate. Those with bleeding had high variability irrespective of monitoring method. Thus, although further improvements are needed to reduce bleeding, stabilization of anticoagulation by Fiix-PT monitoring associates with reduced TE.

Ag-doped manganite nanoparticles: new materials for temperature-controlled medical hyperthermia.

PubMed

Melnikov, O V; Gorbenko, O Yu; Markelova, M N; Kaul, A R; Atsarkin, V A; Demidov, V V; Soto, C; Roy, E J; Odintsov, B M

2009-12-15

The purpose of this study was to introduce newly synthesized nanomaterials as an alternative to superparamagnetic ironoxide based particles (SPIO) and thus to launch a new platform for highly controllable hyperthermia cancer therapy and imaging. The new material that forms the basis for this article is lanthanum manganite particles with silver ions inserted into the perovskite lattice: La(1-x)Ag(x)MnO(3+delta). Adjusting the silver doping level, it is possible to control the Curie temperature (T(c)) in the hyperthermia range of interest (41-44 degrees C). A new class of nanoparticles based on silver-doped manganites La(1-x)Ag(x)MnO(3+delta) is suggested. New nanoparticles are stable, and their properties were not affected by the typical ambient conditions in the living tissue. It is possible to monitor the particle uptake and retention by MRI. When these particles are placed into an alternating magnetic field, their temperature increases to the definite value near T(c) and then remains constant if the magnetic field is maintained. During the hyperthermia procedure, the temperature can be restricted, thereby preventing the necrosis of normal tissue. A new class of nanoparticles based on silver-doped manganites La(1-x)Ag(x)MnO(3+delta) was suggested. Ag-doped perovskite manganites particles clearly demonstrated the effect of adjustable Curie temperature necessary for highly controllable cellular hyperthermia. The magnetic relaxation properties of the particles are comparable with that of SPIO, and so we were able to monitor the particle movement and retention by MRI. Thus, the new material combines the MRI contrast enhancement capability with targeted hyperthermia treatment.

Real-time pH monitoring of industrially relevant enzymatic reactions in a microfluidic side-entry reactor (μSER) shows potential for pH control.

PubMed

Gruber, Pia; Marques, Marco P C; Sulzer, Philipp; Wohlgemuth, Roland; Mayr, Torsten; Baganz, Frank; Szita, Nicolas

2017-06-01

Monitoring and control of pH is essential for the control of reaction conditions and reaction progress for any biocatalytic or biotechnological process. Microfluidic enzymatic reactors are increasingly proposed for process development, however typically lack instrumentation, such as pH monitoring. We present a microfluidic side-entry reactor (μSER) and demonstrate for the first time real-time pH monitoring of the progression of an enzymatic reaction in a microfluidic reactor as a first step towards achieving pH control. Two different types of optical pH sensors were integrated at several positions in the reactor channel which enabled pH monitoring between pH 3.5 and pH 8.5, thus a broader range than typically reported. The sensors withstood the thermal bonding temperatures typical of microfluidic device fabrication. Additionally, fluidic inputs along the reaction channel were implemented to adjust the pH of the reaction. Time-course profiles of pH were recorded for a transketolase and a penicillin G acylase catalyzed reaction. Without pH adjustment, the former showed a pH increase of 1 pH unit and the latter a pH decrease of about 2.5 pH units. With pH adjustment, the pH drop of the penicillin G acylase catalyzed reaction was significantly attenuated, the reaction condition kept at a pH suitable for the operation of the enzyme, and the product yield increased. This contribution represents a further step towards fully instrumented and controlled microfluidic reactors for biocatalytic process development. © 2017 The Authors. Biotechnology Journal published by WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Worldwide Esophageal Cancer Collaboration: clinical staging data.

PubMed

Rice, T W; Apperson-Hansen, C; DiPaola, L M; Semple, M E; Lerut, T E M R; Orringer, M B; Chen, L-Q; Hofstetter, W L; Smithers, B M; Rusch, V W; Wijnhoven, B P L; Chen, K N; Davies, A R; D'Journo, X B; Kesler, K A; Luketich, J D; Ferguson, M K; Räsänen, J V; van Hillegersberg, R; Fang, W; Durand, L; Allum, W H; Cecconello, I; Cerfolio, R J; Pera, M; Griffin, S M; Burger, R; Liu, J-F; Allen, M S; Law, S; Watson, T J; Darling, G E; Scott, W J; Duranceau, A; Denlinger, C E; Schipper, P H; Ishwaran, H; Blackstone, E H

2016-10-01

To address uncertainty of whether clinical stage groupings (cTNM) for esophageal cancer share prognostic implications with pathologic groupings after esophagectomy alone (pTNM), we report data-simple descriptions of patient characteristics, cancer categories, and non-risk-adjusted survival-for clinically staged patients from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty-three institutions from six continents submitted data using variables with standard definitions: demographics, comorbidities, clinical cancer categories, and all-cause mortality from first management decision. Of 22,123 clinically staged patients, 8,156 had squamous cell carcinoma, 13,814 adenocarcinoma, 116 adenosquamous carcinoma, and 37 undifferentiated carcinoma. Patients were older (62 years) men (80%) with normal body mass index (18.5-25 mg/kg 2 , 47%), little weight loss (2.4 ± 7.8 kg), 0-1 ECOG performance status (67%), and history of smoking (67%). Cancers were cT1 (12%), cT2 (22%), cT3 (56%), cN0 (44%), cM0 (95%), and cG2-G3 (89%); most involved the distal esophagus (73%). Non-risk-adjusted survival for squamous cell carcinoma was not distinctive for early cT or cN; for adenocarcinoma, it was distinctive for early versus advanced cT and for cN0 versus cN+. Patients with early cancers had worse survival and those with advanced cancers better survival than expected from equivalent pathologic categories based on prior WECC pathologic data. Thus, clinical and pathologic categories do not share prognostic implications. This makes clinically based treatment decisions difficult and pre-treatment prognostication inaccurate. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient characteristics, cancer categories, and treatment characteristics and should direct 9th edition data collection. © 2016 International Society for Diseases of the Esophagus.

Worldwide Esophageal Cancer Collaboration: clinical staging data

PubMed Central

Rice, T. W.; Apperson-Hansen, C.; DiPaola, L. M.; Semple, M. E.; Lerut, T. E. M. R.; Orringer, M. B.; Chen, L.-Q.; Hofstetter, W. L.; Smithers, B. M.; Rusch, V. W.; Wijnhoven, B. P. L.; Chen, K. N.; Davies, A. R.; D’Journo, X. B.; Kesler, K. A.; Luketich, J. D.; Ferguson, M. K.; Räsänen, J. V.; van Hillegersberg, R.; Fang, W.; Durand, L.; Allum, W. H.; Cecconello, I.; Cerfolio, R. J.; Pera, M.; Griffin, S. M.; Burger, R.; Liu, J.-F; Allen, M. S.; Law, S.; Watson, T. J.; Darling, G. E.; Scott, W. J.; Duranceau, A.; Denlinger, C. E.; Schipper, P. H.; Ishwaran, H.; Blackstone, E. H.

2017-01-01

SUMMARY To address uncertainty of whether clinical stage groupings (cTNM) for esophageal cancer share prognostic implications with pathologic groupings after esophagectomy alone (pTNM), we report data—simple descriptions of patient characteristics, cancer categories, and non-risk-adjusted survival—for clinically staged patients from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty-three institutions from six continents submitted data using variables with standard definitions: demographics, comorbidities, clinical cancer categories, and all-cause mortality from first management decision. Of 22,123 clinically staged patients, 8,156 had squamous cell carcinoma, 13,814 adenocarcinoma, 116 adenosquamous carcinoma, and 37 undifferentiated carcinoma. Patients were older (62 years) men (80%) with normal body mass index (18.5–25 mg/kg2, 47%), little weight loss (2.4 ± 7.8 kg), 0–1 ECOG performance status (67%), and history of smoking (67%). Cancers were cT1 (12%), cT2 (22%), cT3 (56%), cNO (44%), cMO (95%), and cG2–G3 (89%); most involved the distal esophagus (73%). Non-risk-adjusted survival for squamous cell carcinoma was not distinctive for early cT or cN; for adenocarcinoma, it was distinctive for early versus advanced cT and for cNO versus cN+. Patients with early cancers had worse survival and those with advanced cancers better survival than expected from equivalent pathologic categories based on prior WECC pathologic data. Thus, clinical and pathologic categories do not share prognostic implications. This makes clinically based treatment decisions difficult and pre-treatment prognostication inaccurate. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient characteristics, cancer categories, and treatment characteristics and should direct 9th edition data collection. PMID:27731549

Novel SNPs of WNK1 and AKR1C3 are associated with preeclampsia.

PubMed

Sun, Cheng-Juan; Li, Lin; Li, Xueyan; Zhang, Wei-Yuan; Liu, Xiao-Wei

2018-08-20

Preeclampsia is a hypertensive disorder of pregnancy and is one of the most common causes of poor perinatal outcomes. Preeclampsia increases the risk of hypertension in the future. Variants of WNK1 (lysine deficient protein kinase 1), ADRB2 (β2 adrenergic receptor), NEDD4L (ubiquitin-protein ligase NEDD4-like), KLK1 (kallikrein 1) contribute to hypertension, and AKR1C3 (aldo-keto reductase family1 member C3), is associated with preeclampsia. The association of single nucleotide polymorphisms (SNPs) in these five candidate preeclampsia susceptibility genes and the related traits in Chinese individuals were investigated. In this study, 13 SNPs of the five genes were genotyped in 276 preeclampsia patients and 229 age- and area-matched normal pregnancies in women of Chinese Northern Han origin. The 95% confidence interval (CI) and odds ratio (OR) were estimated by binary logistic regression. No obvious linkage disequilibrium or haplotypes were observed among these SNPs. Those with GG genotype and allele G of AKR1C3 (rs10508293) had a decreased risk of preeclampsia (adjusted OR = 3.011, 95% CI = 1.758-5.159, and adjusted OR = 1.745, 95% CI = 1.349-2.257, respectively). The AA genotype and allele A of WNK1 (rs1468326) were significantly associated with an increased risk in preeclampsia (adjusted OR = 2.307, 95% CI = 1.206-3.443, and adjusted OR = 1.663, 95% CI = 1.283-2.157, respectively). The findings indicate that the GG genotype of AKR1C3 rs10508293 is associated with decreased risk for preeclampsia and the AA genotype of WNK1 rs1468326 are related with an increased risk for preeclampsia. Copyright © 2018 Elsevier B.V. All rights reserved.

Efficacy and safety of teneligliptin in addition to insulin therapy in type 2 diabetes mellitus patients on hemodialysis evaluated by continuous glucose monitoring.

PubMed

Yajima, Takahiro; Yajima, Kumiko; Hayashi, Makoto; Takahashi, Hiroshi; Yasuda, Keigo

2016-12-01

Appropriate glycemic control without hypoglycemia is important in patients with type 2 diabetes on hemodialysis. Teneligliptin, a novel dipeptidyl peptidase-4 inhibitor, can be used without dose adjustment for these patients. Using continuous glucose monitoring (CGM), we evaluated the efficacy and safety of adding teneligliptin to insulin therapy. Twenty-one type 2 diabetes mellitus patients on hemodialysis treated with insulin were enrolled. After the adjustment of insulin dose, their blood glucose level was monitored by CGM. Insulin dose was reduced after teneligliptin administration. The median total daily insulin dose significantly reduced from 18 (9-24)U to 6 (0-14)U (p<0.0001). Maximum, mean, and standard deviation of blood glucose level on the hemodialysis and non-hemodialysis days did not change after teneligliptin administration. However, minimum blood glucose level was significantly elevated on the hemodialysis day after teneligliptin administration (from 3.9±1.0mmol/L to 4.4±0.9mmol/L, p=0.040). The incidence of asymptomatic hypoglycemia on the hemodialysis day detected by CGM significantly decreased from 38.1% to 19.0% (p=0.049). Teneligliptin may contribute toward reducing the total daily insulin dose and preventing hypoglycemic events on the hemodialysis day in type 2 diabetes mellitus patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Radiocarbon as a Reactive Tracer for Tracking Permanent CO 2 Storage in Basaltic Rocks

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

Matter, Juerg; Stute, Martin; Schlosser, Peter

In view of concerns about the long-term integrity and containment of CO 2 storage in geologic reservoirs, many efforts have been made to improve the monitoring, verification and accounting methods for geologically stored CO 2. Our project aimed to demonstrate that carbon-14 ( 14C) could be used as a reactive tracer to monitor geochemical reactions and evaluate the extent of mineral trapping of CO 2 in basaltic rocks. The capacity of a storage reservoir for mineral trapping of CO 2 is largely a function of host rock composition. Mineral carbonation involves combining CO 2 with divalent cations including Ca 2+,more » Mg 2+ and Fe 2+. The most abundant geological sources for these cations are basaltic rocks. Based on initial storage capacity estimates, we know that basalts have the necessary capacity to store million to billion tons of CO 2 via in situ mineral carbonation. However, little is known about CO2-fluid-rock reactions occurring in a basaltic storage reservoir during and post-CO 2 injection. None of the common monitoring and verification techniques have been able to provide a surveying tool for mineral trapping. The most direct method for quantitative monitoring and accounting involves the tagging of the injected CO 2 with 14C because 14C is not present in deep geologic reservoirs prior to injection. Accordingly, we conducted two CO 2 injection tests at the CarbFix pilot injection site in Iceland to study the feasibility of 14C as a reactive tracer for monitoring CO 2-fluid-rock reactions and CO 2 mineralization. Our newly developed monitoring techniques, using 14C as a reactive tracer, have been successfully demonstrated. For the first time, permanent and safe disposal of CO 2 as environmentally benign carbonate minerals in basaltic rocks could be shown. Over 95% of the injected CO 2 at the CarbFix pilot injection site was mineralized to carbonate minerals in less than two years after injection. Our monitoring results confirm that CO 2 mineralization in basaltic rocks is far faster than previously postulated.« less

Actively controlling coolant-cooled cold plate configuration

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

Chainer, Timothy J.; Parida, Pritish R.

Cooling apparatuses are provided to facilitate active control of thermal and fluid dynamic performance of a coolant-cooled cold plate. The cooling apparatus includes the cold plate and a controller. The cold plate couples to one or more electronic components to be cooled, and includes an adjustable physical configuration. The controller dynamically varies the adjustable physical configuration of the cold plate based on a monitored variable associated with the cold plate or the electronic component(s) being cooled by the cold plate. By dynamically varying the physical configuration, the thermal and fluid dynamic performance of the cold plate are adjusted to, formore » example, optimally cool the electronic component(s), and at the same time, reduce cooling power consumption used in cooling the electronic component(s). The physical configuration can be adjusted by providing one or more adjustable plates within the cold plate, the positioning of which may be adjusted based on the monitored variable.« less

Single and multiple in-season measurements as indicators of at-harvest cotton boll damage caused by verde plant bug (Hemiptera: Miridae).

PubMed

Brewer, Michael J; Armstrong, J Scott; Parker, Roy D

2013-06-01

The ability to monitor verde plant bug, Creontiades signatus Distant (Hemiptera: Miridae), and the progression of cotton, Gossypium hirsutum L., boll responses to feeding and associated cotton boll rot provided opportunity to assess if single in-season measurements had value in evaluating at-harvest damage to bolls and if multiple in-season measurements enhanced their combined use. One in-season verde plant bug density measurement, three in-season plant injury measurements, and two at-harvest damage measurements were taken in 15 cotton fields in South Texas, 2010. Linear regression selected two measurements as potentially useful indicators of at-harvest damage: verde plant bug density (adjusted r2 = 0.68; P = 0.0004) and internal boll injury of the carpel wall (adjusted r2 = 0.72; P = 0.004). Considering use of multiple measurements, a stepwise multiple regression of the four in-season measurements selected a univariate model (verde plant bug density) using a 0.15 selection criterion (adjusted r2 = 0.74; P = 0.0002) and a bivariate model (verde plant bug density-internal boll injury) using a 0.25 selection criterion (adjusted r2 = 0.76; P = 0.0007) as indicators of at-harvest damage. In a validation using cultivar and water regime treatments experiencing low verde plant bug pressure in 2011 and 2012, the bivariate model performed better than models using verde plant bug density or internal boll injury separately. Overall, verde plant bug damaging cotton bolls exemplified the benefits of using multiple in-season measurements in pest monitoring programs, under the challenging situation when at-harvest damage results from a sequence of plant responses initiated by in-season insect feeding.

On-orbit figure sensing and figure correction control for 0.5 arc-second adjustable X-ray optics

NASA Astrophysics Data System (ADS)

Reid, Paul

This investigation seeks to develop the technology to directly monitor on-orbit changes to imaging performance of adjustable X-ray optics so as to be able to efficiently correct adverse changes at a level consistent with 0.5 arc-second X-ray telescope imaging. Adjustable X-ray optics employ thin film piezoelectric material deposited on the back of a thin glass Wolter mirror segment to introduce localized stresses in the mirror. These stresses are used in a deterministic way to improve mirror figure from 10 arc-sec, half power diameter (HPD), to 0.5 arc-sec, HPD, without the need for a heavy reaction structure. This is a realizable technology for potential future X-ray telescope missions with 0.5 arc-second resolution and several square meters effective area, such as SMART-X. We are pursuing such mirror development under an existing APRA grant. Here we propose a new investigation to accomplish the monitoring and control of the mirrors by monitoring the health of the piezoelectric actuators of the adjustable optics to a level consistent with 0.5 arcsec imaging. Such measurements are beyond the capability of conventional, thin metal film strain gauges using DC measurements. Instead, we propose to develop the technology to deposit different types of strain gauges (metal film, semiconductor) directly on the piezoelectric cells; to investigate the use of additional thin layers of piezoelectric materials such as lead zirconate titanate or zinc oxide as strain and temperature gauges; and to use AC measurement of strain gauges for precise measurement of piezoelectric adjuster performance. The intent is to use this information to correct changes in mirror shape by adjusting the voltages on the piezoelectric adjustors. Adjustable X-ray optics are designed to meet the challenge of large collecting area and high angular resolution. The mirrors are called adjustable rather than active as mirror figure error is corrected (adjusted) once or infrequently, as opposed to being changed constantly at several cycles/sec (active). In our approach, the mirror figure is corrected based on ground measurements, accounting for figure errors due to mirror manufacturing, mounting induced deformations, modeled gravity release, and modeled on-orbit thermal effects. The piezoelectric strain monitoring we seek to develop in this program extends adjustable mirror technology development, as it enables efficient adjustment and correction of mirror figure on-orbit, as required. This unprecedented level of system robustness will make telescopes less expensive to build because requirements for the non-optical systems can be looser, and it will also make the system more resistant to degradation, promoting mission success. The largest drivers for changes from ground calibration to on-orbit performance are piezoelectric material aging and an unexpected thermal environment (i.e., larger gradients than modeled or other thermal control system problem). Developing the capability to accurately monitor the health of each piezoelectric cell and the local mirror surface temperature will enable the real time sensing of any of these potential issues, help determine the cause, and enable corrections via updating models of on-orbit conditions and re-optimizing the required piezoelectric cell voltages for mirror figure correction. Our 3 year research program includes the development of the strain monitoring technology, its deposition on the adjustable optics, modeling and performance simulation, accelerated lifetime testing, and optical and electrical metrology of sample adjustable optics that incorporate monitoring sensors. Development of the capability to remotely monitor piezo performance and temperature to necessary precision will vastly improve reliability of the SMART-X mission concept, or the sub-arc-second X-ray Surveyor mission described in the 2013 NASA Astrophysics Roadmap, Enduring Quests Daring Visions.

Association Between Cystatin C and 20-Year Cumulative Incidence of Hearing Impairment in the Epidemiology of Hearing Loss Study.

PubMed

Schubert, Carla R; Paulsen, Adam J; Nondahl, David M; Dalton, Dayna S; Fischer, Mary E; Klein, Barbara E K; Klein, Ronald; Tweed, Ted S; Cruickshanks, Karen J

2018-06-01

Hearing impairment (HI) is one of the most common conditions affecting older adults. Identification of factors associated with the development of HI may lead to ways to reduce the incidence of this condition. To investigate the association between cystatin C, both as an independent biomarker and as a marker of kidney function, and the 20-year incidence of HI. Data were obtained from the Epidemiology of Hearing Loss Study (EHLS), a longitudinal, population-based study in Beaver Dam, Wisconsin. Baseline examinations began in 1993 and continued through 1995, and participants were examined approximately every 5 years, with the most recent examination phase completed in 2015. The EHLS participants with serum cystatin C concentration data and without HI at the baseline examination were included in this study. Participants without HI were followed up for incident HI (pure-tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz >25 dB hearing level in either ear) for 20 years. Cystatin C was analyzed as a biomarker (concentration) and used to determine estimated glomerular filtration rate (eGFRCysC). Discrete-time Cox proportional hazards regression models were used to analyze the association between cystatin C concentration and eGFRCysC and the 20-year cumulative incidence of HI. There were 863 participants aged 48 to 86 years with cystatin C data and without HI at baseline. Of these, 599 (69.4%) were women. In models adjusted for age and sex, cystatin C was associated with an increased risk of developing HI (hazard ratio [HR], 1.20; 95% CI, 1.07-1.34 per 0.2-mg/L increase in cystatin C concentration), but the estimate was attenuated after further adjusting for educational level, current smoking, waist circumference, and glycated hemoglobin (HR, 1.11; 95% CI, 0.98-1.27 per 0.2-mg/L increase in cystatin C concentration). Low eGFRCysC was significantly associated with the 20-year cumulative incidence of HI in both the age- and sex-adjusted model (HR, 1.70; 95% CI, 1.16-2.48; <60 vs ≥60 mL/min/1.73 m2) and the multivariable-adjusted model (HR, 1.50; 95% CI, 1.02-2.22; <60 vs ≥60 mL/min/1.73 m2). Reduced kidney function as estimated using cystatin C, but not cystatin C alone, was associated with the 20-year cumulative incidence of HI, suggesting that some age-related HI may occur in conjunction with or as the result of reduced kidney function.

Performance Monitoring of a Nearshore Berm at Ft. Myers Beach, Florida

DTIC Science & Technology

2013-08-01

prototype designs. Coastal Zone ’93, American Society of Civil Engineers, pp. 2938 -2950. Andrassy, C . J. 1991. Monitoring of a nearshore disposal mound at...ER D C / CH L TR -1 3 -1 1 Performance Monitoring of a Nearshore Berm at Ft. Myers Beach, Florida: Final Report C oa st al a n d H yd...122  Appendix C : USF-CRL Survey Data: morphologic evolution during the first 2 years post construction

LINC00673 rs11655237 C>T confers neuroblastoma susceptibility in Chinese population

PubMed Central

Zhang, Zhuorong; Chang, Yitian; Jia, Wei; Zhang, Jiao; Zhang, Ruizhong; Zhu, Jinhong; Yang, Tianyou

2018-01-01

Neuroblastoma, which accounts for approximately 10% of all pediatric cancer-related deaths, has become a therapeutic challenge and global burden attributed to poor outcomes and mortality rates of its high-risk form. Previous genome-wide association studies (GWASs) identified the LINC00673 rs11655237 C>T polymorphism to be associated with the susceptibility of several malignant tumors. However, the association between this polymorphism and neuroblastoma susceptibility is not clear. We genotyped LINC00673 rs11655237 C>T in 393 neuroblastoma patients in comparison with 812 age-, gender-, and ethnicity-matched healthy controls. We found a significant association between the LINC00673 rs11655237 C>T polymorphism and neuroblastoma risk (TT compared with CC: adjusted odds ratio (OR) =1.80, 95% confidence interval (CI) =1.06–3.06, P=0.029; TT/CT compared with CC: adjusted OR =1.31, 95% CI =1.02–1.67, P=0.033; and T compared with C: adjusted OR =1.29, 95% CI =1.06–1.58, P=0.013). Furthermore, stratified analysis indicated that the rs11655237 T allele carriers were associated with increased neuroblastoma risk for patients with tumor originating from the adrenal gland (adjusted OR =1.51, 95% CI =1.06–2.14, P=0.021) and International Neuroblastoma Staging System (INSS) stage IV disease (adjusted OR =1.60, 95% CI =1.12–2.30, P=0.011). In conclusion, we verified that the LINC00673 rs11655237 C>T polymorphism might be associated with neuroblastoma susceptibility. Prospective studies with a large sample size and different ethnicities are needed to validate our findings. PMID:29339420

Regional differences in rates of HIV-1 viral load monitoring in Canada: Insights and implications for antiretroviral care in high income countries.

PubMed

Raboud, Janet M; Loutfy, Mona R; Su, DeSheng; Bayoumi, Ahmed M; Klein, Marina B; Cooper, Curtis; Machouf, Nima; Rourke, Sean; Walmsley, Sharon; Rachlis, Anita; Harrigan, P Richard; Smieja, Marek; Tsoukas, Christos; Montaner, Julio S G; Hogg, Robert S

2010-02-25

Viral load (VL) monitoring is an essential component of the care of HIV positive individuals. Rates of VL monitoring have been shown to vary by HIV risk factor and clinical characteristics. The objective of this study was to determine whether there are differences among regions in Canada in the rates of VL testing of HIV-positive individuals on combination antiretroviral therapy (cART), where the testing is available without financial barriers under the coverage of provincial health insurance programs. The Canadian Observational Cohort (CANOC) is a collaboration of nine Canadian cohorts of HIV-positive individuals who initiated cART after January 1, 2000. The study included participants with at least one year of follow-up. Generalized Estimating Equation (GEE) regression models were used to determine the effect of geographic region on (1) the occurrence of an interval of 9 months or more between two consecutive recorded VL tests and (2) the number of days between VL tests, after adjusting for demographic and clinical covariates. Overall and regional annual rates of VL testing were also reported. 3,648 individuals were included in the analysis with a median follow-up of 42.9 months and a median of 15 VL tests. In multivariable GEE logistic regression models, gaps in VL testing >9 months were more likely in Quebec (Odds Ratio (OR) = 1.72, p < 0.0001) and Ontario (OR = 1.78, p < 0.0001) than in British Columbia and among injection drug users (OR = 1.68, p < 0.0001) and were less likely among older individuals (OR = 0.77 per 10 years, p < 0.0001), among men having sex with men (OR = 0.62, p < 0.0001), within the first year of cART (OR = 0.15, p < 0.0001), among individuals on cART at the time of the blood draw (OR = 0.34, p < 0.0001) and among individuals with VL < 50 copies/ml at the previous visit (OR = 0.56, p < .0001). Significant variation in rates of VL testing and the probability of a significant gap in testing were related to geographic region, HIV risk factor, age, year of cART initiation, type of cART regimen, being in the first year of cART, AIDS-defining illness and whether or not the previous VL was below the limit of detection.

[Correlations between serine hydroxymethyltransferase1 C1420T polymorphisms and susceptibilities to esophageal squamous cell carcinoma and gastric cardiac adenocarcinoma].

PubMed

Wang, Yi-Min; Guo, Wei; Zhang, Xiu-Feng; Li, Yan; Wang, Na; Ge, Hui; Wei, Li-Zhen; Wen, Deng-Gui; Zhang, Jian-Hui

2006-03-01

Serine hydroxymethyltransferase (SHMT), a key enzyme in the folate metabolism, affects gene methylation and DNA synthesis through providing one-carbon units for purine, thymidylate, and methionine. It is closely related to the development and progression of tumors. This study was to investigate the correlations between SHMT1 C1420T single nucleotide polymorphisms (SNP) and susceptibilities to esophageal squamous cell carcinoma (ESCC) and gastric cardiac adenocarcinoma (GCA). SHMT1 C1420T SNP was genotyped by polymerase chain reaction-confronting two-pair primers (PCR-CTPP) analysis in 584 ESCC patients, 467 GCA patients, and 540 healthy controls. The correlations between SHMT1 C1420T SNP polymorphisms and susceptibilities to ESCC and GCA were analyzed with Logistic regression model. Family history of upper gastrointestinal cancer (UGIC) significantly enhanced the risk of developing ESCC and GCA [the age, gender, smoking status, and family history of UGIC adjusted odds ratio (OR)=2.89, 95% confident interval (CI)=2.23-3.73; OR =1.68, 95% CI=1.28-2.23]. The frequency of 1420C/T genotype was significantly lower in ESCC and GCA patients than in healthy controls (12.0% vs. 16.5%, P<0.05; 10.9% vs. 16.5%, P<0.01). Compared with C/C genotype, C/T genotype significantly reduced susceptibilities to ESCC and GCA, with adjusted OR of 0.70 (95% CI=0.50-0.98) for ESCC and 0.55 (95% CI=0.38-0.81) for GCA. Stratification analysis showed that C/T genotype significantly reduced susceptibilities to ESCC and GCA among non-smokers, with adjusted OR of 0.54 (95% CI=0.33-0.90) for ESCC and 0.56 (95% CI=0.33-0.95) for GCA. In addition, C/T genotype significantly reduced susceptibility to GCA among individuals with or without UGIC history, with adjusted OR of 0.46 (95%CI=0.24-0.90) and 0.62 (95% CI=0.38-0.99) respectively, and reduced susceptibility to ESCC only among individuals with UGIC history, with adjusted OR of 0.51 (95% CI=0.29-0.89). SHMT1 1420C/T genotype could significantly reduce susceptibilities to ESCC and GCA among individuals from high risk areas in Hebei Province of China.

Using Leaf Chlorophyll to Parameterize Light-Use-Efficiency Within a Thermal-Based Carbon, Water and Energy Exchange Model

NASA Technical Reports Server (NTRS)

Houlborg, Rasmus; Anderson, Martha C.; Daughtry, C. S. T.; Kustas, W. P.; Rodell, Matthew

2010-01-01

Chlorophylls absorb photosynthetically active radiation and thus function as vital pigments for photosynthesis, which makes leaf chlorophyll content (C(sub ab) useful for monitoring vegetation productivity and an important indicator of the overall plant physiological condition. This study investigates the utility of integrating remotely sensed estimates of C(sub ab) into a thermal-based Two-Source Energy Balance (TSEB) model that estimates land-surface CO2 and energy fluxes using an analytical, light-use-efficiency (LUE) based model of canopy resistance. The LUE model component computes canopy-scale carbon assimilation and transpiration fluxes and incorporates LUE modifications from a nominal (species-dependent) value (LUE(sub n)) in response to short term variations in environmental conditions, However LUE(sub n) may need adjustment on a daily timescale to accommodate changes in plant phenology, physiological condition and nutrient status. Day to day variations in LUE(sub n) were assessed for a heterogeneous corn crop field in Maryland, U,S.A. through model calibration with eddy covariance CO2 flux tower observations. The optimized daily LUE(sub n) values were then compared to estimates of C(sub ab) integrated from gridded maps of chlorophyll content weighted over the tower flux source area. The time continuous maps of daily C(sub ab) over the study field were generated by focusing in-situ measurements with retrievals generated with an integrated radiative transfer modeling tool (accurate to within +/-10%) using at-sensor radiances in green, red and near-infrared wavelengths acquired with an aircraft imaging system. The resultant daily changes in C(sub ab) within the tower flux source area generally correlated well with corresponding changes in daily calibrated LUE(sub n) derived from the tower flux data, and hourly water, energy and carbon flux estimation accuracies from TSEB were significantly improved when using C(sub ab) for delineating spatio-temporal variations in LUE(sub n). The results demonstrate the synergy between thermal infrared and shortwave reflective wavebands in producing valuable remote sensing data for operational monitoring of carbon and water fluxes.

Making sense of all the conflict: a theoretical review and critique of conflict-related ERPs.

PubMed

Larson, Michael J; Clayson, Peter E; Clawson, Ann

2014-09-01

Cognitive control theory suggests that goal-directed behavior is governed by a dynamic interplay between areas of the prefrontal cortex. Critical to cognitive control is the detection and resolution of competing stimulus or response representations (i.e., conflict). Event-related potential (ERP) research provides a window into the nature and precise temporal sequence of conflict monitoring. We critically review the research on conflict-related ERPs, including the error-related negativity (ERN), Flanker N2, Stroop N450 and conflict slow potential (conflict SP or negative slow wave [NSW]), and provide an analysis of how these ERPs inform conflict monitoring theory. Overall, there is considerable evidence that amplitude of the ERN is sensitive to the degree of response conflict, consistent with a role in conflict monitoring. It remains unclear, however, to what degree contextual, individual, affective, and motivational factors influence ERN amplitudes and how ERN amplitudes are related to regulative changes in behavior. The Flanker N2, Stroop N450, and conflict SP ERPs represent distinct conflict-monitoring processes that reflect conflict detection (N2, N450) and conflict adjustment or resolution processes (N2, conflict SP). The investigation of conflict adaptation effects (i.e., sequence or sequential trial effects) shows that the N2 and conflict SP reflect post-conflict adjustments in cognitive control, but the N450 generally does not. Conflict-related ERP research provides a promising avenue for understanding the effects of individual differences on cognitive control processes in healthy, neurologic and psychiatric populations. Comparisons between the major conflict-related ERPs and suggestions for future studies to clarify the nature of conflict-related neural processes are provided. Copyright © 2014 Elsevier B.V. All rights reserved.

Osmotic adjustment in five tree species under elevated CO sub 2 and water stress. [Platanus occidentalis L. ; Liquidambar styraciflua L. ; Quercus rubra L. ; Acer saccharum Marsh; Liriodendron tulipifera L

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

Tschaplinski, T.J.; Hanson, P.J.; Norby, R.J.

1991-05-01

Since osmotic adjustment to water stress requires carbon assimilation during stress, the stimulation of photosynthesis by elevated CO{sub 2} may enhance osmotic adjustment. Osmotic adjustment of American sycamore (Platanus occidentalis L.), sweetgum (Liquidambar styraciflua L.), sugar maple (Acer saccharum Marsh.), yellow-poplar (Liriodendron tulipifera L.), and northern red oak (Quercus rubra L.) to water stress was assessed under ambient and elevated CO{sub 2} (ambient +300 {mu}L L{sup {minus}1}), with seedlings grown in 8-L pots in four open-top chambers, fitted with rain exclusion canopies. Trees were subjected to repeated water stress cycles over a six-week period. Well-watered trees were watered daily tomore » maintain a soil matric potential > {minus}0.3 MPa, whereas stressed trees were watered when soil matric potential declined to < {minus}0.9 MPa. Gas exchange and water relations were monitored at the depth of stress and after rewatering. All species displayed an increase in leaf-level water-use efficiency (net photosynthesis/transpiration). Leaves of sycamore and sweetgum displayed an adjustment in osmotic potential at saturation (pressure-volume analysis) of 0.3 MPa and 0.6 MPa, respectively. Elevated CO{sub 2} did not enhance osmotic adjustment in leaves of any of the species studied. Studies to characterize organic solute concentrations in roots are ongoing to determine if osmotic adjustment occurred in the roots.« less

Platelet indices and glucose control in type 1 and type 2 diabetes mellitus: A case-control study.

PubMed

Zaccardi, F; Rocca, B; Rizzi, A; Ciminello, A; Teofili, L; Ghirlanda, G; De Stefano, V; Pitocco, D

2017-10-01

The relationship between platelet indices and glucose control may differ in type 1 (T1DM) and type 2 (T2DM) diabetes. We aimed to investigate differences in mean platelet volume (MPV), platelet count, and platelet mass between patients with T1DM, T2DM, and healthy controls and to explore associations between these platelet indices and glucose control. A total of 691 T1DM and 459 T2DM patients and 943 control subjects (blood donors) were included. HbA1c was measured in all subjects with diabetes and 36 T1DM patients further underwent 24 h-continuous glucose monitoring to estimate short-term glucose control (glucose mean and standard deviation). Adjusting for age and sex, platelet count was higher and MPV lower in both T1DM and T2DM patients vs control subjects, while platelet mass (MPV × platelet count) resulted higher only in T2DM. Upon further adjustment for HbA1c, differences in platelet count and mass were respectively 19.5 × 10 9 /L (95%CI: 9.8-29.3; p < 0.001) and 101 fL/nL (12-191; p = 0.027) comparing T2DM vs T1DM patients. MPV and platelet count were significantly and differently related in T2DM patients vs both T1DM and control subjects; this difference was maintained also accounting for HbA1c, age, and sex. Platelet mass and the volume-count relationship were significantly related to HbA1c only in T1DM patients. No associations were found between platelet indices and short-term glucose control. By accounting for confounders and glucose control, our data evidenced higher platelet mass and different volume-count kinetics in subjects with T2DM vs T1DM. Long-term glucose control seemed to influence platelet mass and the volume-count relationship only in T1DM subjects. These findings suggest different mechanisms behind platelet formation in T1DM and T2DM patients with long-term glycaemic control being more relevant in T1DM than T2DM. Copyright © 2017 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Emerging markets for satellite data communications in the public service

NASA Technical Reports Server (NTRS)

Potter, J. G.

1978-01-01

The paper discusses some of the current and potential markets for satellite data communications as projected by the Public Service Satellite Consortium (PSSC). Organizations in the public service sector are divided into three categories, depending on their expected benefits and organizational changes due to increased satellite telecommunications use: A - modest institutional adjustments are necessary and significant productivity gains are likely; B - institutional requirements picture is promising, but more information is needed to assess benefits and risk; and C - major institutional adjustments are needed, risks are high but possible benefits are high. These criteria are applied to the U.S. health care system, continuing education, equipment maintenance, libraries, environmental monitoring, and other potential markets. The potential revenues are seen to be significant, but what is needed is a cooperative effort by common carriers and major public service institutions to aggregate the market.

40 CFR Appendix C to Part 75 - Missing Data Estimation Procedures

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 17 2013-07-01 2013-07-01 false Missing Data Estimation Procedures C... (CONTINUED) CONTINUOUS EMISSION MONITORING Pt. 75, App. C Appendix C to Part 75—Missing Data Estimation Procedures 1. Parametric Monitoring Procedure for Missing SO2 Concentration or NOX Emission Rate Data 1...

40 CFR Appendix C to Part 75 - Missing Data Estimation Procedures

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 17 2014-07-01 2014-07-01 false Missing Data Estimation Procedures C... (CONTINUED) CONTINUOUS EMISSION MONITORING Pt. 75, App. C Appendix C to Part 75—Missing Data Estimation Procedures 1. Parametric Monitoring Procedure for Missing SO2 Concentration or NOX Emission Rate Data 1...

40 CFR Appendix C to Part 75 - Missing Data Estimation Procedures

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 17 2012-07-01 2012-07-01 false Missing Data Estimation Procedures C... (CONTINUED) CONTINUOUS EMISSION MONITORING Pt. 75, App. C Appendix C to Part 75—Missing Data Estimation Procedures 1. Parametric Monitoring Procedure for Missing SO2 Concentration or NOX Emission Rate Data 1...

40 CFR Appendix C to Part 75 - Missing Data Estimation Procedures

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 16 2011-07-01 2011-07-01 false Missing Data Estimation Procedures C... (CONTINUED) CONTINUOUS EMISSION MONITORING Pt. 75, App. C Appendix C to Part 75—Missing Data Estimation Procedures 1. Parametric Monitoring Procedure for Missing SO2 Concentration or NOX Emission Rate Data 1...

Cosmological implications of a large complete quasar sample.

PubMed

Segal, I E; Nicoll, J F

1998-04-28

Objective and reproducible determinations of the probabilistic significance levels of the deviations between theoretical cosmological prediction and direct model-independent observation are made for the Large Bright Quasar Sample [Foltz, C., Chaffee, F. H., Hewett, P. C., MacAlpine, G. M., Turnshek, D. A., et al. (1987) Astron. J. 94, 1423-1460]. The Expanding Universe model as represented by the Friedman-Lemaitre cosmology with parameters qo = 0, Lambda = 0 denoted as C1 and chronometric cosmology (no relevant adjustable parameters) denoted as C2 are the cosmologies considered. The mean and the dispersion of the apparent magnitudes and the slope of the apparent magnitude-redshift relation are the directly observed statistics predicted. The C1 predictions of these cosmology-independent quantities are deviant by as much as 11sigma from direct observation; none of the C2 predictions deviate by >2sigma. The C1 deviations may be reconciled with theory by the hypothesis of quasar "evolution," which, however, appears incapable of being substantiated through direct observation. The excellent quantitative agreement of the C1 deviations with those predicted by C2 without adjustable parameters for the results of analysis predicated on C1 indicates that the evolution hypothesis may well be a theoretical artifact.

Glycemic excursions are positively associated with HbA1c reduction from baseline after treatment with acarbose in patients with type 2 diabetes on metformin monotherapy.

PubMed

Wang, Jun-Sing; Lee, I-Te; Lee, Wen-Jane; Lin, Shi-Dou; Su, Shih-Li; Tu, Shih-Te; Tseng, Yao-Hsien; Lin, Shih-Yi; Sheu, Wayne Huey-Herng

2017-03-01

The aim of the present study was to examine the association between glycemic excursions before treatment and HbA1c reduction after treatment intensification with acarbose or glibenclamide in patients with type 2 diabetes (T2D). Patients receiving single or dual oral antidiabetic drug treatment with an HbA1c of 7.0-11.0 % (53-97 mmol/mol) were switched to metformin monotherapy (500 mg, t.i.d.) for 8 weeks, followed by randomization to either acarbose (100 mg, t.i.d.) or glibenclamide (5 mg, t.i.d.) as add-on treatment for 16 weeks. Glycemic excursions were assessed as mean amplitude of glycemic excursions (MAGE) with 72-h ambulatory continuous glucose monitoring. Treatment efficacy was evaluated as relative HbA1c reduction (%), calculated as (baseline HbA1c - post-treatment HbA1c)/baseline HbA1c × 100. Fifty patients (mean [±SD] age 53.5 ± 8.2 years, 48 % men, mean baseline HbA1c 8.4 ± 1.2 %) were analyzed. Baseline MAGE was positively correlated with relative HbA1c reduction from baseline in patients treated with acarbose (r = 0.421, P = 0.029) but not glibenclamide (r = 0.052, P = 0.813). Linear regression analysis revealed that the association between baseline MAGE and relative HbA1c reduction from baseline (β = 0.125, P = 0.029) in patients treated with acarbose remained significant after adjustment for several confounders (P < 0.05 for all models). In patients with T2D on metformin monotherapy, baseline MAGE was positively correlated with relative HbA1c reduction from baseline after treatment with acarbose, but not glibenclamide. These findings highlight the importance of glycemic excursions in individualized treatment for patients with T2D. © 2016 Ruijin Hospital, Shanghai JiaoTong University School of Medicine (SJTU), Chinese Society of Endocrinology and Chinese Endocrinologist Association and John Wiley & Sons Australia, Ltd.

Short article: Anger and quality of life in patients co-infected with HIV and hepatitis C virus: a cross-sectional study (ANRS CO13-HEPAVIH).

PubMed

Marcellin, Fabienne; Protopopescu, Camelia; Esterle, Laure; Wittkop, Linda; Piroth, Lionel; Aumaitre, Hugues; Bouchaud, Olivier; Goujard, Cécile; Vittecoq, Daniel; Dabis, François; Salmon-Ceron, Dominique; Spire, Bruno; Roux, Perrine; Carrieri, Maria P

2017-07-01

The aim of this study is to document the relationship between anger dimensions (state, trait, expression, and control) and quality of life (QoL) in patients co-infected with HIV and hepatitis C virus (HCV). This is a cross-sectional study nested in the ANRS CO13-HEPAVIH French national cohort. Anger and QoL were assessed using self-administered questionnaires in 536 HIV-HCV-co-infected patients. Correlations between anger scores (STAXI-2 scale) and QoL scores (WHOQOL-HIV BREF scale) were assessed using Spearman's coefficients. Multiple linear regression models were then used to test the relationship between the different dimensions of anger and QoL after adjustment for statistically significant psychosocial, sociobehavioral, and clinical characteristics. Patients with excessive alcohol use or history of injecting drug use had higher levels of anger. All dimensions of anger were significantly correlated with impaired QoL for all six dimensions of the WHOQOL-HIV BREF scale. Greater internal experience of anger and impaired anger control were confirmed as independent correlates of impaired QoL related to psychological health, social relationships, and patients' beliefs after adjustment for depressive symptoms, functional impact of fatigue, socioeconomic status, and HIV-related characteristics. Anger issues need close monitoring in HIV-HCV-co-infected patients, especially in patients with addictive behaviors. Screening for problems in anger management and implementing individualized psychotherapeutic strategies may help improve QoL in this population.

Distribution, genetic and cardiovascular determinants of FVIII:c - Data from the population-based Gutenberg Health Study.

PubMed

Hermanns, M Iris; Grossmann, Vera; Spronk, Henri M H; Schulz, Andreas; Jünger, Claus; Laubert-Reh, Dagmar; Mazur, Johanna; Gori, Tommaso; Zeller, Tanja; Pfeiffer, Norbert; Beutel, Manfred; Blankenberg, Stefan; Münzel, Thomas; Lackner, Karl J; Ten Cate-Hoek, Arina J; Ten Cate, Hugo; Wild, Philipp S

2015-01-01

Elevated levels of c are associated with risk for both venous and arterial thromboembolism. However, no population-based study on the sex-specific distribution and reference ranges of plasma c and its cardiovascular determinants is available. c was analyzed in a randomly selected sample of 2533 males and 2440 females from the Gutenberg Health Study in Germany. Multivariable regression analyses for c were performed under adjustment for genetic determinants, cardiovascular risk factors and cardiovascular disease. Females (126.6% (95% CI: 125.2/128)) showed higher c levels than males (121.2% (119.8/122.7)). c levels increased with age in both sexes (ß per decade: 5.67% (4.22/7.13) male, 6.15% (4.72/7.57) female; p<0.001). Sex-specific reference limits and categories indicating the grade of deviation from the reference were calculated, and nomograms for c were created. c was approximately 25% higher in individuals with non-O blood type. Adjusted for sex and age, ABO-blood group accounted for 18.3% of c variation. In multivariable analysis, c was notably positively associated with diabetes mellitus, obesity, hypertension and dyslipidemia and negatively with current smoking. In a fully adjusted multivariable model, the strongest associations observed were of elevated c with diabetes and peripheral artery disease in both sexes and with obesity in males. Effects of SNPs in the vWF, STAB2 and SCARA5 gene were stronger in females than in males. The use of nomograms for valuation of c might be useful to identify high-risk cohorts for thromboembolism. Additionally, the prospective evaluation of c as a risk predictor becomes feasible. Copyright © 2015. Published by Elsevier Ireland Ltd.

The Cost-Effectiveness of Real-Time Continuous Glucose Monitoring (RT-CGM) in Type 2 Diabetes.

PubMed

Fonda, Stephanie J; Graham, Claudia; Munakata, Julie; Powers, Julia M; Price, David; Vigersky, Robert A

2016-07-01

This analysis models the cost-effectiveness of real-time continuous glucose monitoring (RT-CGM) using evidence from a randomized controlled trial (RCT) that demonstrated RT-CGM reduced A1C, for up to 9 months after using the technology, among patients with type 2 diabetes not on prandial insulin. RT-CGM was offered short-term and intermittently as a self-care tool to inform patients' behavior. The analyses projected lifetime clinical and economic outcomes for RT-CGM versus self-monitoring of blood glucose by fingerstick only. The base-case analysis was consistent with the RCT (RT-CGM for 2 weeks on/1 week off over 3 months). A scenario analysis simulated outcomes of an RT-CGM "refresher" after the active intervention of the RCT. Analyses used the IMS CORE Diabetes Model and were conducted from a US third-party payer perspective, including direct costs obtained from published sources and inflated to 2011 US dollars. Costs and health outcomes were discounted at 3% per annum. Life expectancy (LE) and quality-adjusted life expectancy (QALE) from RT-CGM were 0.10 and 0.07, with a cost of $653/patient over a lifetime. Incremental LE and QALE from a "refresher" were 0.14 and 0.10, with a cost of $1312/patient over a lifetime, and incremental cost-effectiveness ratios were $9319 and $13 030 per LY and QALY gained. RT-CGM, as a self-care tool, is a cost-effective disease management option in the US for people with type 2 diabetes not on prandial insulin. Repeated use of RT-CGM may result in additional cost-effectiveness. © 2016 Diabetes Technology Society.

Effect of long-term glycemic variability on estimated glomerular filtration rate decline among patients with type 2 diabetes mellitus: Insights from the Diabetic Nephropathy Cohort in Singapore.

PubMed

Low, Serena; Lim, Su C; Yeoh, Lee Y; Liu, Yan L; Liu, Jian J; Fun, Sharon; Su, Chang; Zhang, Xiao; Subramaniam, Tavintharan; Sum, Chee F

2017-10-01

In the present study, we examined the association between HbA1c variability and renal disease progression based on estimated glomerular filtration rate (eGFR) decline in patients with type 2 diabetes mellitus (T2DM) in Singapore. Glycemic burden and renal function were retrospectively assessed in 1628 patients in 2002-2014. Multivariable logistic regression was used to assess the relationships between HbA1c variability (expressed as HbA1c coefficient of variation [HbA1c-CV] in quartiles), HbA1c intrapersonal mean (HbA1c-IM), and eGFR decline, adjusted for baseline covariates. Among patients with relatively good glycemic control (i.e. HbA1c-IM below the median cohort value [8.0%]), HbA1c-CV Quartile 4 was associated with eGFR decline (odds ratio [OR] 1.88; 95% confidence interval [CI] 1.10-3.25). The OR for HbA1c-CV Quartile 4 was 2.20 (95% CI 1.24-3.89) after additional adjustment for HbA1c-IM. Where HbA1c-IM was above the median cohort value, HbA1c-CV Quartiles 3 and 4 were associated with eGFR decline, with ORs of 2.60 (95% CI 1.48-4.55) and 3.29 (95% CI 1.89-5.76) respectively. After further adjusting for HbA1c-IM, the ORs for Quartiles 3 and 4 were 2.69 (95% CI 1.53-4.74) and 3.51 (95% CI 1.98-6.21), respectively. Variability in HbA1c is strongly and independently associated with eGFR decline in patients with T2DM independent of mean HbA1c. The findings may highlight the importance of sustained stable glycemic control in management of diabetes mellitus. © 2016 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

In situ spectroscopic ellipsometry study of low-temperature epitaxial silicon growth

NASA Astrophysics Data System (ADS)

Halagačka, L.; Foldyna, M.; Leal, R.; Roca i Cabarrocas, P.

2018-07-01

Low-temperature growth of doped epitaxial silicon layers is a promising way to reduce the cost of p-n junction formation in c-Si solar cells. In this work, we study process of highly doped epitaxial silicon layer growth using in situ spectroscopic ellipsometry. The film was deposited by plasma-enhanced chemical vapor deposition (PECVD) on a crystalline silicon substrate at a low substrate temperature of 200 °C. In the deposition process, SiF4 was used as a precursor, B2H6 as doping gas, and a hydrogen/argon mixture as carrier gas. A spectroscopic ellipsometer with a wide spectral range was used for in situ spectroscopic measurements. Since the temperature during process is 200 °C, the optical functions of silicon differ from these at room temperature and have to be adjusted. Thickness of the epitaxial silicon layer was fitted on in situ ellipsometric data. As a result we were able to determine the dynamics of epitaxial layer growth, namely initial layer formation time and epitaxial growth rate. This study opens new perspectives in understanding and monitoring the epitaxial silicon deposition processes as the model fitting can be applied directly during the growth.

Adjustment of activity coefficients as a function of changes in temperature, using the specific interaction theory

NASA Astrophysics Data System (ADS)

Giffaut, Eric; Vitorge, Pierre; Capdevila, Helene

1994-10-01

The aim of this work is to propose and to check approximations to calculate from only a few experimental measurements, ionic strength I and temperature T, influences on Gibbs' energy G, formal redox potential E and standard equilibrium constant K. Series expansions vs. T are first used: S and C(sub p)/2T (sup o) are typically the first- and second-order terms in -G. In the same way, -Delta H and T(exp 2) Delta C(sub p)/2 are the first- and second-order terms ofR ln K expansions vs. 1/T. This type of approximation is discussed for E of the M(4+)/M(3+), MO2(2+)/MO2(+) and MO2(CO3)3(4+)/MO2(CO3)3(4-)/MO2(CO3)3(4-) couples (M equivalent to U or Pu) measured from 5 to 70 C, for the standard Delta G of some solid U compounds, calculated from 17 to 117 C, and for Delta C(sub p), Delta G and log K of the CO2(aq)/HCO3(-) equilibrium from 0 to 150 C. Excess functions X(sup ex) are then calculated from activity coefficients gamma: enthalpy H or heat capacity C(sub p) adjustment as a function of I changes is needed only when the gamma adjustment as a function of T changes is needed. The variations in the specific interaction theory coefficient epsilon with T are small and roughly linear for the above redox equilibria and for the mean gamma of chloride electrolytes: first-order expansion seems enough to deduce epsilon, and then the excess functions G(sup ex), S(sup ex) and H(sup ex), in this T range; but second-order expansion is more consistent for estimation of C(sub p)(sup ex).

CO2 exchange in the Hudson Bay lowlands: Community characteristics and multispectral reflectance properties

NASA Technical Reports Server (NTRS)

Whiting, Gary J.

1994-01-01

Net ecosystem CO2 exchange was measured during the 1990 growing season (June to August) along a transect starting 10 km inland from James Bay and extending 100 km interior to Kinosheo Lake, Ontario. Sites were chosen in three distinct areas: a coastal fen, an interior fen, and a bog. For the most productive sites in the bog, net daily uptake rates reached a maximum of 2.5 g C-CO2 m(exp -2)/d with an area-weighted exchange of 0.3 g C-CO2 m(exp -2)/d near midsummer. This site was estimated to be a net carbon source of 9 g C-CO2 m(exp -2) to the atmosphere over a 153-day growing season. The interior fen was less productive on a daily basis with a net maximum uptake of 0.5 g C-CO2 m(exp -2)/d and with corresponding area-weighted uptake of 0.1 g C-CO2 m(exp -2)/d during midsummer. Early and late season release of carbon to the atmosphere resulted in a net loss of 21 g C-CO2 m(exp -2) over the growing season from this site. The coastal fen was the most productive site with uptake rates peaking near 1.7 g C-CO2 m(exp -2)/d which corresponded to an area-weighted uptake of 0.8 g C-CO2 m(exp -2)/d during midsummer and an estimated net uptake of 6 g C-CO2 m(exp -2) for the growing season. Associated with net CO2 exchange measurements, multispectral reflectance properties of the sites were measured over the growing season using portable radiometers. These properties were related to exchange rates with the goal of examining the potential for satellite remote sensing to monitor biosphere/atmosphere CO2 exchange in this biome. The normalized difference vegetation index (NDVI) computed from surface reflectance was correlated with net CO2 exchange for all sites with the exception of areas with large proportions of Sphagnum moss cover. These mosses have greater near-infrared reflectance than typical surrounding vegetation and may require special adjustment for regional exchange/remote sensing applications.

Cognitive Processing and the Functional Matching Effect in Persuasion: The Mediating Role of Subjective Perceptions of Message Quality

PubMed

Lavine; Snyder

1996-11-01

In two experiments, we examined the hypothesis that subjective perceptions of message quality mediate the functional matching effect in persuasion. In Experiment 1, participants whose attitudes and behaviors serve primarily a value-expressive function (i.e., low self-monitors) or a social-adjustive function (i.e., high self-monitors) were exposed to persuasive messages that contained value-expressive, social-adjustive, or both types of arguments in favor of voting. Functionally-relevant messages (i.e., the social-adjustive message for high self-monitors and the value-expressive message for low self-monitors) produced enhanced perceptions of message quality and persuasiveness, more positive attitudes, and more message-related behavior than functionally nonrelevant messages. Functionally mixed messages were generally more effective than messages containing only functionally nonrelevant arguments, but less effective than messages containing only functionally relevant arguments. Path analyses indicated that the influence of functional relevance on attitudes and behavior was significantly mediated by subjective perceptions of the quality of the message. In Experiment 2, we exposed participants to a functionally relevant or nonrelevant voting appeal five days before a presidential election. Results replicated those of Experiment 1; functionally relevant messages produced more favorable attitudes, and this effect was mediated by enhanced perceptions of message quality. Finally, postmessage attitudes exerted a significant influence on whether participants voted in the election, and this effect was mediated by voting intentions. Discussion focuses on the subjective nature of message evaluation and on the cognitive processes underlying the functional matching effect in persuasion.

40 CFR 75.5 - Prohibitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... (c) No owner or operator of an affected unit shall use any alternative monitoring system, alternative... be discharged, emissions of SO2, NOX or CO2 to the atmosphere without accounting for all such... approved emission monitoring method, and thereby avoid monitoring and recording SO2, NOX, or CO2 emissions...

Reconstructions of the 1900-2015 Greenland ice sheet surface mass balance using the regional climate MAR model

NASA Astrophysics Data System (ADS)

Fettweis, Xavier; Box, Jason E.; Agosta, Cécile; Amory, Charles; Kittel, Christoph; Lang, Charlotte; van As, Dirk; Machguth, Horst; Gallée, Hubert

2017-04-01

With the aim of studying the recent Greenland ice sheet (GrIS) surface mass balance (SMB) decrease relative to the last century, we have forced the regional climate MAR (Modèle Atmosphérique Régional; version 3.5.2) model with the ERA-Interim (ECMWF Interim Re-Analysis; 1979-2015), ERA-40 (1958-2001), NCEP-NCARv1 (National Centers for Environmental Prediction-National Center for Atmospheric Research Reanalysis version 1; 1948-2015), NCEP-NCARv2 (1979-2015), JRA-55 (Japanese 55-year Reanalysis; 1958-2014), 20CRv2(c) (Twentieth Century Reanalysis version 2; 1900-2014) and ERA-20C (1900-2010) reanalyses. While all these forcing products are reanalyses that are assumed to represent the same climate, they produce significant differences in the MAR-simulated SMB over their common period. A temperature adjustment of +1 °C (respectively -1 °C) was, for example, needed at the MAR boundaries with ERA-20C (20CRv2) reanalysis, given that ERA-20C (20CRv2) is ˜ 1 °C colder (warmer) than ERA-Interim over Greenland during the period 1980-2010. Comparisons with daily PROMICE (Programme for Monitoring of the Greenland Ice Sheet) near-surface observations support these adjustments. Comparisons with SMB measurements, ice cores and satellite-derived melt extent reveal the most accurate forcing datasets for the simulation of the GrIS SMB to be ERA-Interim and NCEP-NCARv1. However, some biases remain in MAR, suggesting that some improvements are still needed in its cloudiness and radiative schemes as well as in the representation of the bare ice albedo. Results from all MAR simulations indicate that (i) the period 1961-1990, commonly chosen as a stable reference period for Greenland SMB and ice dynamics, is actually a period of anomalously positive SMB (˜ +40 Gt yr-1) compared to 1900-2010; (ii) SMB has decreased significantly after this reference period due to increasing and unprecedented melt reaching the highest rates in the 120-year common period; (iii) before 1960, both ERA-20C and 20CRv2-forced MAR simulations suggest a significant precipitation increase over 1900-1950, but this increase could be the result of an artefact in the reanalyses that are not well-enough constrained by observations during this period and (iv) since the 1980s, snowfall is quite stable after having reached a maximum in the 1970s. These MAR-based SMB and accumulation reconstructions are, however, quite similar to those from Box (2013) after 1930 and confirm that SMB was quite stable from the 1940s to the 1990s. Finally, only the ERA-20C-forced simulation suggests that SMB during the 1920-1930 warm period over Greenland was comparable to the SMB of the 2000s, due to both higher melt and lower precipitation than normal.

Rapid Improvement of Glycemic Control in Type 2 Diabetes Using Weekly Intensive Multifactorial Interventions: Structured Glucose Monitoring, Patient Education, and Adjustment of Therapy—A Randomized Controlled Trial

PubMed Central

Rodbard, David; Zanella, Maria Teresa

2011-01-01

Abstract Background We evaluated intensive intervention in poorly controlled patients with type 2 diabetes mellitus involving weekly clinic visits and adjustment of therapy with analysis of three seven-point glucose profiles and intervention from an interdisciplinary staff. Methods Sixty-three patients were randomized to an intensive treatment group that obtained self-monitoring of blood glucose (SMBG) profiles (six or seven values per day, 3 days/week) and were seen in the clinic at Weeks 1–6 and 12. SMBG results were downloaded, analyzed using Accu-Chek® 360° software (Roche Diagnostics, Indianapolis, IN), and used to adjust therapy. Control group subjects obtained glucose profiles and had clinic visits only at Weeks 0, 6, and 12. Results There were highly statistically significant improvements in the intensive treatment group compared with the control group between Weeks 0 and 6 with greater reductions in weekly mean glycemia (WMG) (−76.7±8.9 mg/dL vs. −20.5±8.1 mg/dL), glycemic variability (SD) (−16.3±3.1 mg/dL vs. −5.0±3.1 mg/dL), and glycated hemoglobin (−1.82±0.16% vs. −0.66±0.22%) without significant changes in frequency of hypoglycemia or weight. Improvements were sustained in the intensive treatment group through Week 12. A minimal but statistically significant degree of improvement was seen in the control group at Week 12. Conclusions This short-term pilot study of an intensive monitoring, educational, and pharmacological interventions program resulted in dramatic improvement of glycemic control within 6 weeks, and these effects are sustained through Week 12. SMBG glucose profiles, calculation of WMG and SD, and graphical displays of glucose data can improve the effectiveness of adjustment of therapy at weekly clinic visits when combined with intensive support from a multidisciplinary team. PMID:21751888

Ex vivo evaluation of various instrumentation techniques and irrigants in reducing E. faecalis within root canals.

PubMed

Basmaci, F; Oztan, M D; Kiyan, M

2013-09-01

To evaluate ex vivo the effectiveness of single-file instrumentation techniques compared with serial Ni-Ti rotary instrumentation with several irrigation regimens in reducing E. faecalis within root canals. A total of 81 extracted human mandibular premolar teeth with a single root canal were infected with E. faecalis before and after canal preparation. Samples were divided randomly into 9 groups, as follows: group 1-A: sterile phosphate-buffered saline + Self-adjusting file, group 1-B: 5% sodium hypochlorite + 15% EDTA + Self-adjusting file, group 1-C: 5% sodium hypochlorite + 7% maleic acid + Self-adjusting file, group 2-A: sterile phosphate-buffered saline + Reciproc (R25), group 2-B: 5% sodium hypochlorite + 15% EDTA + Reciproc (R25), group 2-C: 5% sodium hypochlorite + 7% maleic acid + Reciproc (R25), group 3-A: sterile phosphate-buffered saline + ProTaper, group 3-B: 5% sodium hypochlorite + 15% EDTA + ProTaper, group 3-C: 5% sodium hypochlorite + 7% maleic acid + ProTaper. anova was used to analyse statistically the differences in terms of reduction in colony counts between the groups, and Dunn's post hoc test was used for multiple comparisons. All techniques and irrigation regimens significantly reduced the number of bacterial cells in the root canal (P < 0.001). Comparisons amongst the groups revealed significant differences between group 1A (sterile phosphate-buffered saline + Self-adjusting file)/group 1B (5% sodium hypochlorite + 15% EDTA + Self-adjusting file) (P = 0.031), group 1A (sterile phosphate-buffered saline + Self-adjusting file)/group 2C (5% sodium hypochlorite + 7% maleic acid + Reciproc) (P = 0.003), group 2A (sterile phosphate-buffered saline + Reciproc)/group 3B (5% sodium hypochlorite + 15% EDTA + ProTaper) (P = 0.036), group 3B (5% sodium hypochlorite + 15% EDTA + ProTaper)/group 1A (sterile phosphate-buffered saline + Self-adjusting file) (P < 0.001), and group 3C (5% sodium hypochlorite + 7% maleic acid + ProTaper)/group 1A (sterile phosphate-buffered saline + Self-adjusting file) (P = 0.033). No significant differences in terms of reduction in microbial counts were observed between single-file techniques (SAF and Reciproc) and serial Ni-Ti instrumentation technique (ProTaper) in combination with irrigants. © 2013 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Predicting cost of care using self-reported health status data.

PubMed

Boscardin, Christy K; Gonzales, Ralph; Bradley, Kent L; Raven, Maria C

2015-09-23

We examined whether self-reported employee health status data can improve the performance of administrative data-based models for predicting future high health costs, and develop a predictive model for predicting new high cost individuals. This retrospective cohort study used data from 8,917 Safeway employees self-insured by Safeway during 2008 and 2009. We created models using step-wise multivariable logistic regression starting with health services use data, then socio-demographic data, and finally adding the self-reported health status data to the model. Adding self-reported health data to the baseline model that included only administrative data (health services use and demographic variables; c-statistic = 0.63) increased the model" predictive power (c-statistic = 0.70). Risk factors associated with being a new high cost individual in 2009 were: 1) had one or more ED visits in 2008 (adjusted OR: 1.87, 95 % CI: 1.52, 2.30), 2) had one or more hospitalizations in 2008 (adjusted OR: 1.95, 95 % CI: 1.38, 2.77), 3) being female (adjusted OR: 1.34, 95 % CI: 1.16, 1.55), 4) increasing age (compared with age 18-35, adjusted OR for 36-49 years: 1.28; 95 % CI: 1.03, 1.60; adjusted OR for 50-64 years: 1.92, 95 % CI: 1.55, 2.39; adjusted OR for 65+ years: 3.75, 95 % CI: 2.67, 2.23), 5) the presence of self-reported depression (adjusted OR: 1.53, 95 % CI: 1.29, 1.81), 6) chronic pain (adjusted OR: 2.22, 95 % CI: 1.81, 2.72), 7) diabetes (adjusted OR: 1.73, 95 % CI: 1.35, 2.23), 8) high blood pressure (adjusted OR: 1.42, 95 % CI: 1.21, 1.67), and 9) above average BMI (adjusted OR: 1.20, 95 % CI: 1.04, 1.38). The comparison of the models between the full sample and the sample without theprevious high cost members indicated significant differences in the predictors. This has importantimplications for models using only the health service use (administrative data) given that the past high costis significantly correlated with future high cost and often drive the predictive models. Self-reported health data improved the ability of our model to identify individuals at risk for being high cost beyond what was possible with administrative data alone.

Building Automation Systems.

ERIC Educational Resources Information Center

Honeywell, Inc., Minneapolis, Minn.

A number of different automation systems for use in monitoring and controlling building equipment are described in this brochure. The system functions include--(1) collection of information, (2) processing and display of data at a central panel, and (3) taking corrective action by sounding alarms, making adjustments, or automatically starting and…

High-sensitivity C-reactive protein predicts mortality but not stroke

PubMed Central

Elkind, M S.V.; Luna, J M.; Moon, Y P.; Liu, K M.; Spitalnik, S L.; Paik, M C.; Sacco, R L.

2009-01-01

Objective: To determine whether high-sensitivity C-reactive protein (hsCRP) and serum amyloid A (SAA) predict stroke, vascular events, and mortality in a prospective cohort study. Background: Markers of inflammation have been associated with risk of myocardial infarction (MI). Their association with stroke is controversial. Methods: The Northern Manhattan Study includes a stroke-free community-based cohort study in participants aged ≥40 years (median follow-up 7.9 years). hsCRP and SAA were measured using nephelometry. Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the association of markers with risk of ischemic stroke and other outcomes after adjusting for demographics and risk factors. Results: hsCRP measurements were available in 2,240 participants (mean age 68.9 ± 10.1 years; 64.2% women; 18.8% white, 23.5% black, and 55.1% Hispanic). The median hsCRP was 2.5 mg/L. Compared with those with hsCRP <1 mg/L, those with hsCRP >3 mg/L were at increased risk of ischemic stroke in a model adjusted for demographics (HR = 1.60, 95% CI 1.06–2.41), but the effect was attenuated after adjusting for other risk factors (adjusted HR = 1.20, 95% CI 0.78–1.86). hsCRP >3 mg/L was associated with risk of MI (adjusted HR = 1.70, 95% CI 1.04–2.77) and death (adjusted HR = 1.55, 95% CI 1.23–1.96). SAA was not associated with stroke risk. Conclusion: In this multiethnic cohort, high-sensitivity C-reactive protein (hsCRP) was not associated with ischemic stroke, but was modestly associated with myocardial infarction and mortality. The value of hsCRP and serum amyloid A may depend on population characteristics such as age and other risk factors. GLOSSARY AHA = American Heart Association; BP = blood pressure; CDC = Centers for Disease Control and Prevention; CI = confidence interval; CRP = C-reactive protein; CUMC = Columbia University Medical Center; HR = hazard ratio; hsCRP = high-sensitivity C-reactive protein; IQR = interquartile range; JUPITER = Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin; MI = myocardial infarction; NOMAS = Northern Manhattan Study; SAA = serum amyloid A. PMID:19841382

26 CFR 301.6222(a)-2 - Application of consistent reporting and notification rules to indirect partners.

Code of Federal Regulations, 2012 CFR

2012-04-01

... accordance with § 301.6222(c)-1, shall not be subject to a computational adjustment to conform the treatment....6222(b)-1, is subject to a computational adjustment to conform the treatment of that item to the... computational adjustment to conform to the treatment of that item on the return of the source partnership. (d...

26 CFR 301.6222(a)-2 - Application of consistent reporting and notification rules to indirect partners.

Code of Federal Regulations, 2011 CFR

2011-04-01

... accordance with § 301.6222(c)-1, shall not be subject to a computational adjustment to conform the treatment....6222(b)-1, is subject to a computational adjustment to conform the treatment of that item to the... computational adjustment to conform to the treatment of that item on the return of the source partnership. (d...

26 CFR 301.6222(a)-2 - Application of consistent reporting and notification rules to indirect partners.

Code of Federal Regulations, 2013 CFR

2013-04-01

... accordance with § 301.6222(c)-1, shall not be subject to a computational adjustment to conform the treatment....6222(b)-1, is subject to a computational adjustment to conform the treatment of that item to the... computational adjustment to conform to the treatment of that item on the return of the source partnership. (d...

26 CFR 301.6222(a)-2 - Application of consistent reporting and notification rules to indirect partners.

Code of Federal Regulations, 2014 CFR

2014-04-01

... accordance with § 301.6222(c)-1, shall not be subject to a computational adjustment to conform the treatment....6222(b)-1, is subject to a computational adjustment to conform the treatment of that item to the... computational adjustment to conform to the treatment of that item on the return of the source partnership. (d...

26 CFR 301.6222(a)-2 - Application of consistent reporting and notification rules to indirect partners.

Code of Federal Regulations, 2010 CFR

2010-04-01

... accordance with § 301.6222(c)-1, shall not be subject to a computational adjustment to conform the treatment....6222(b)-1, is subject to a computational adjustment to conform the treatment of that item to the... computational adjustment to conform to the treatment of that item on the return of the source partnership. (d...

20 CFR 404.401 - Deduction, reduction, and nonpayment of monthly benefits or lump-sum death payments.

Code of Federal Regulations, 2014 CFR

2014-04-01

... work (see §§ 404.415 and 404.417); (2) Failure of certain beneficiaries receiving wife's or mother's...). (c) Adjustments. We may adjust your benefits to correct errors in payments under title II of the Act. We may also adjust your benefits if you received more than the correct amount due under titles VIII...

20 CFR 404.401 - Deduction, reduction, and nonpayment of monthly benefits or lump-sum death payments.

Code of Federal Regulations, 2012 CFR

2012-04-01

... work (see §§ 404.415 and 404.417); (2) Failure of certain beneficiaries receiving wife's or mother's...). (c) Adjustments. We may adjust your benefits to correct errors in payments under title II of the Act. We may also adjust your benefits if you received more than the correct amount due under titles VIII...

20 CFR 404.401 - Deduction, reduction, and nonpayment of monthly benefits or lump-sum death payments.

Code of Federal Regulations, 2011 CFR

2011-04-01

... work (see §§ 404.415 and 404.417); (2) Failure of certain beneficiaries receiving wife's or mother's...). (c) Adjustments. We may adjust your benefits to correct errors in payments under title II of the Act. We may also adjust your benefits if you received more than the correct amount due under titles VIII...

20 CFR 404.401 - Deduction, reduction, and nonpayment of monthly benefits or lump-sum death payments.

Code of Federal Regulations, 2013 CFR

2013-04-01

... work (see §§ 404.415 and 404.417); (2) Failure of certain beneficiaries receiving wife's or mother's...). (c) Adjustments. We may adjust your benefits to correct errors in payments under title II of the Act. We may also adjust your benefits if you received more than the correct amount due under titles VIII...

Morbidity study of extruder personnel with potential exposure to brominated dioxins and furans. I. Results of blood monitoring and immunological tests.

PubMed Central

Zober, M A; Ott, M G; Päpke, O; Senft, K; Germann, C

1992-01-01

The potential for exposure of employees to polybrominated dibenzofurans (PBDFs) and dibenzo-p-dioxins (PBDDs) during extrusion blending of resins containing decabromodiphenyl ether was established through previous air monitoring (area samples) and biomonitoring studies. The findings presented herein are further biomonitoring results for 42 employees and immunological tests for exposed and referent employees. Among potentially exposed men, 2,3,7,8-TBDF and 2,3,7,8-TBDD concentrations in blood lipid ranged from non-detectable to 112 parts per trillion (ppt) and from non-detectable to 478 ppt respectively. Biomonitoring results correlated well with assignments in the extruder work area when adjusted for process changes and engineering improvements and provided biological half life estimates of between 1.1 and 1.9 years for 2,3,7,8-TBDF and between 2.9 and 10.8 years for 2,3,7,8-TBDD. Results for 16 measures of the immune system were examined in relation to exposure (exposed v referent group) and in relation to the biomonitoring data. Some individual trends in immunological parameters with exposure and covariates such as age and cigarette smoking were found (for example, an increase in complement C4 with increasing concentrations of PBDFs and PBDDs, increased lymphocyte subpopulation counts with cigarette smoking); however, the overall clinical assessment was that the immune system of exposed employees was not adversely impacted at these burdens of PBDFs and PBDDs. PMID:1515345

Morbidity study of extruder personnel with potential exposure to brominated dioxins and furans. I. Results of blood monitoring and immunological tests.

PubMed

Zober, M A; Ott, M G; Päpke, O; Senft, K; Germann, C

1992-08-01

The potential for exposure of employees to polybrominated dibenzofurans (PBDFs) and dibenzo-p-dioxins (PBDDs) during extrusion blending of resins containing decabromodiphenyl ether was established through previous air monitoring (area samples) and biomonitoring studies. The findings presented herein are further biomonitoring results for 42 employees and immunological tests for exposed and referent employees. Among potentially exposed men, 2,3,7,8-TBDF and 2,3,7,8-TBDD concentrations in blood lipid ranged from non-detectable to 112 parts per trillion (ppt) and from non-detectable to 478 ppt respectively. Biomonitoring results correlated well with assignments in the extruder work area when adjusted for process changes and engineering improvements and provided biological half life estimates of between 1.1 and 1.9 years for 2,3,7,8-TBDF and between 2.9 and 10.8 years for 2,3,7,8-TBDD. Results for 16 measures of the immune system were examined in relation to exposure (exposed v referent group) and in relation to the biomonitoring data. Some individual trends in immunological parameters with exposure and covariates such as age and cigarette smoking were found (for example, an increase in complement C4 with increasing concentrations of PBDFs and PBDDs, increased lymphocyte subpopulation counts with cigarette smoking); however, the overall clinical assessment was that the immune system of exposed employees was not adversely impacted at these burdens of PBDFs and PBDDs.

Whey protein gel composites in the diet of goats increased the omega-3 and omega-6 content of milk fat.

PubMed

Weinstein, J A; Taylor, S J; Rosenberg, M; DePeters, E J

2016-08-01

Previously, feeding whey protein gels containing polyunsaturated fatty acids (PUFA) reduced their rumen biohydrogenation and increased their concentration in milk fat of Holstein cows. Our objective was to test the efficacy of whey protein isolate (WPI) gels produced in a steam tunnel as a method to alter the fatty acid (FA) composition of the milk lipids. Four primiparous Lamancha goats in midlactation were fed three diets in a 3 × 4 Latin square design. The WPI gels were added to a basal concentrate mix that contained one of three lipid sources: (i) 100% soya bean oil (S) to create (WPI/S), (ii) a 1:1 (wt/wt) mixture of S and linseed (L) oil to create (WPI/SL), or (iii) 100% L to create (WPI/L). Periods were 22 days with the first 10 days used as an adjustment phase followed by a 12-day experimental phase. During the adjustment phase, all goats received a rumen available source of lipid, yellow grease, to provide a baseline for milk FA composition. During the experimental phase, each goat received its assigned WPI. Milk FA concentration of C18:2 n-6 and C18:3 n-3 reached 9.3 and 1.64 g/100 g FA, respectively, when goats were fed WPI/S. Feeding WPI/SL increased the C18:2 n-6 and C18:3 n-3 concentration to 6.22 and 4.36 g/100 g FA, and WPI/L increased C18:2 n-6 and C18:3 n-3 to 3.96 and 6.13 g/100 g FA respectively. The adjusted transfer efficiency (%) of C18:3 n-3 to milk FA decreased significantly as dietary C18:3 n-3 intake increased. Adjusted transfer efficiency for C18:2 n-6 did not change with increasing intake of C18:2 n-6. The WPI gels were effective at reducing rumen biohydrogenation of PUFA; however, we observed a change in the proportion increase of C18:3 n-3 in milk FA suggesting possible regulation of n-3 FA to the lactating caprine mammary gland. Journal of Animal Physiology and Animal Nutrition © 2015 Blackwell Verlag GmbH.

Rate of warming affects temperature sensitivity of anaerobic peat decomposition and greenhouse gas production.

PubMed

Sihi, Debjani; Inglett, Patrick W; Gerber, Stefan; Inglett, Kanika S

2018-01-01

Temperature sensitivity of anaerobic carbon mineralization in wetlands remains poorly represented in most climate models and is especially unconstrained for warmer subtropical and tropical systems which account for a large proportion of global methane emissions. Several studies of experimental warming have documented thermal acclimation of soil respiration involving adjustments in microbial physiology or carbon use efficiency (CUE), with an initial decline in CUE with warming followed by a partial recovery in CUE at a later stage. The variable CUE implies that the rate of warming may impact microbial acclimation and the rate of carbon-dioxide (CO 2 ) and methane (CH 4 ) production. Here, we assessed the effects of warming rate on the decomposition of subtropical peats, by applying either a large single-step (10°C within a day) or a slow ramping (0.1°C/day for 100 days) temperature increase. The extent of thermal acclimation was tested by monitoring CO 2 and CH 4 production, CUE, and microbial biomass. Total gaseous C loss, CUE, and MBC were greater in the slow (ramp) warming treatment. However, greater values of CH 4 -C:CO 2 -C ratios lead to a greater global warming potential in the fast (step) warming treatment. The effect of gradual warming on decomposition was more pronounced in recalcitrant and nutrient-limited soils. Stable carbon isotopes of CH 4 and CO 2 further indicated the possibility of different carbon processing pathways under the contrasting warming rates. Different responses in fast vs. slow warming treatment combined with different endpoints may indicate alternate pathways with long-term consequences. Incorporations of experimental results into organic matter decomposition models suggest that parameter uncertainties in CUE and CH 4 -C:CO 2 -C ratios have a larger impact on long-term soil organic carbon and global warming potential than uncertainty in model structure, and shows that particular rates of warming are central to understand the response of wetland soils to global climate change. © 2017 John Wiley & Sons Ltd.

Factors Other than GFR Affecting Serum Cystatin C Levels

PubMed Central

Stevens, Lesley A; Schmid, Christopher H.; Greene, Tom; Li, Liang; Beck, Gerald J; Joffe, Marshall; Froissart, Marc; Kusek, John; Zhang, Yaping (Lucy); Coresh, Josef; Levey, Andrew S

2015-01-01

Cystatin C is gaining acceptance as an endogenous filtration marker. Factors other than glomerular filtration rate (GFR) that affect the serum level have not been carefully studied. In a cross-sectional analysis of a pooled dataset of participants from clinical trials and a clinical population with chronic kidney disease (N=3418), we related serum levels of cystatin C and creatinine to clinical and biochemical variables after adjustment for GFR using errors-in-variables models to account for GFR measurement error. GFR was measured as urinary clearance of 125I-iothalamate and 15Cr-EDTA. Cystatin C was assayed at a single laboratory and creatinine was standardized to reference methods. Mean (SD) creatinine and cystatin C were 2.1 (1.1) mg/dL and 1.8 (0.8) mg/L, respectively. After adjustment for GFR, cystatin C was 4.3% lower for every 20 years of age, 9.2% lower for female sex but only 1.9% lower in blacks. Diabetes was associated with 8.5% higher levels of cystatin C and 3.9% lower levels of creatinine. Higher C-reactive protein and white blood cell count and lower serum albumin were associated with higher levels of cystatin C and lower levels of creatinine. Adjustment for age, sex and race had a greater effect on association of factors with creatinine than cystatin C. In conclusion, cystatin C is affected by factors other than GFR. Clinicians should consider these factors when interpreting the serum levels or GFR estimates from cystatin C. PMID:19119287

Experimental investigation of a general real-time 3D target localization method using sequential kV imaging combined with respiratory monitoring.

PubMed

Cho, Byungchul; Poulsen, Per; Ruan, Dan; Sawant, Amit; Keall, Paul J

2012-11-21

The goal of this work was to experimentally quantify the geometric accuracy of a novel real-time 3D target localization method using sequential kV imaging combined with respiratory monitoring for clinically realistic arc and static field treatment delivery and target motion conditions. A general method for real-time target localization using kV imaging and respiratory monitoring was developed. Each dimension of internal target motion T(x, y, z; t) was estimated from the external respiratory signal R(t) through the correlation between R(t(i)) and the projected marker positions p(x(p), y(p); t(i)) on kV images by a state-augmented linear model: T(x, y, z; t) = aR(t) + bR(t - τ) + c. The model parameters, a, b, c, were determined by minimizing the squared fitting error ∑‖p(x(p), y(p); t(i)) - P(θ(i)) · (aR(t(i)) + bR(t(i) - τ) + c)‖(2) with the projection operator P(θ(i)). The model parameters were first initialized based on acquired kV arc images prior to MV beam delivery. This method was implemented on a trilogy linear accelerator consisting of an OBI x-ray imager (operating at 1 Hz) and real-time position monitoring (RPM) system (30 Hz). Arc and static field plans were delivered to a moving phantom programmed with measured lung tumour motion from ten patients. During delivery, the localization method determined the target position and the beam was adjusted in real time via dynamic multileaf collimator (DMLC) adaptation. The beam-target alignment error was quantified by segmenting the beam aperture and a phantom-embedded fiducial marker on MV images and analysing their relative position. With the localization method, the root-mean-squared errors of the ten lung tumour traces ranged from 0.7-1.3 mm and 0.8-1.4 mm during the single arc and five-field static beam delivery, respectively. Without the localization method, these errors ranged from 3.1-7.3 mm. In summary, a general method for real-time target localization using kV imaging and respiratory monitoring has been experimentally investigated for arc and static field delivery. The average beam-target error was 1 mm.

Experimental investigation of a general real-time 3D target localization method using sequential kV imaging combined with respiratory monitoring

NASA Astrophysics Data System (ADS)

Cho, Byungchul; Poulsen, Per; Ruan, Dan; Sawant, Amit; Keall, Paul J.

2012-11-01

The goal of this work was to experimentally quantify the geometric accuracy of a novel real-time 3D target localization method using sequential kV imaging combined with respiratory monitoring for clinically realistic arc and static field treatment delivery and target motion conditions. A general method for real-time target localization using kV imaging and respiratory monitoring was developed. Each dimension of internal target motion T(x, y, z; t) was estimated from the external respiratory signal R(t) through the correlation between R(ti) and the projected marker positions p(xp, yp; ti) on kV images by a state-augmented linear model: T(x, y, z; t) = aR(t) + bR(t - τ) + c. The model parameters, a, b, c, were determined by minimizing the squared fitting error ∑‖p(xp, yp; ti) - P(θi) · (aR(ti) + bR(ti - τ) + c)‖2 with the projection operator P(θi). The model parameters were first initialized based on acquired kV arc images prior to MV beam delivery. This method was implemented on a trilogy linear accelerator consisting of an OBI x-ray imager (operating at 1 Hz) and real-time position monitoring (RPM) system (30 Hz). Arc and static field plans were delivered to a moving phantom programmed with measured lung tumour motion from ten patients. During delivery, the localization method determined the target position and the beam was adjusted in real time via dynamic multileaf collimator (DMLC) adaptation. The beam-target alignment error was quantified by segmenting the beam aperture and a phantom-embedded fiducial marker on MV images and analysing their relative position. With the localization method, the root-mean-squared errors of the ten lung tumour traces ranged from 0.7-1.3 mm and 0.8-1.4 mm during the single arc and five-field static beam delivery, respectively. Without the localization method, these errors ranged from 3.1-7.3 mm. In summary, a general method for real-time target localization using kV imaging and respiratory monitoring has been experimentally investigated for arc and static field delivery. The average beam-target error was 1 mm.

Short-Term Trajectories of Use of a Caloric-Monitoring Mobile Phone App Among Patients With Type 2 Diabetes Mellitus in a Primary Care Setting

PubMed Central

Goh, Glenn; Tan, Ngiap Chuan; Malhotra, Rahul; Padmanabhan, Uma; Barbier, Sylvaine; Allen Jr, John Carson

2015-01-01

Background Self-management plays an important role in maintaining good control of diabetes mellitus, and mobile phone interventions have been shown to improve such self-management. The Health Promotion Board of Singapore has created a caloric-monitoring mobile health app, the “interactive Diet and Activity Tracker” (iDAT). Objective The objective was to identify and describe short-term (8-week) trajectories of use of the iDAT app among patients with type 2 diabetes mellitus in a primary care setting in Singapore, and identify patient characteristics associated with each trajectory. Methods A total of 84 patients with type 2 diabetes mellitus from a public primary care clinic in Singapore who had not previously used the iDAT app were enrolled. The app was demonstrated and patients’ weekly use of the app was monitored over 8 weeks. Weekly use was defined as any record in terms of food entry or exercise workout entry in that week. Information on demographics, diet and exercise motivation, diabetes self-efficacy (Diabetes Empowerment Scale-Short Form), and clinical variables (body mass index, blood pressure, and glycosylated hemoglobin/HbA1c) were collected at baseline. iDAT app use trajectories were delineated using latent-class growth modeling (LCGM). Association of patient characteristics with the trajectories was ascertained using logistic regression analysis. Results Three iDAT app use trajectories were observed: Minimal Users (66 out of 84 patients, 78.6%, with either no iDAT use at all or use only in the first 2 weeks), Intermittent-Waning Users (10 out of 84 patients, 11.9%, with occasional weekly use mainly in the first 4 weeks), and Consistent Users (8 out of 84 patients, 9.5%, with weekly use throughout all or most of the 8 weeks). The adjusted odds ratio of being a Consistent User, relative to a Minimal User, was significantly higher for females (OR 19.55, 95% CI 1.78-215.42) and for those with higher exercise motivation scores at baseline (OR 4.89, 95% CI 1.80-13.28). The adjusted odds ratio of being an Intermittent-Waning User relative to a Minimal User was also significantly higher for those with higher exercise motivation scores at baseline (OR 1.82, 95% CI 1.00-3.32). Conclusions This study provides insight into the nature and extent of usage of a caloric-monitoring app among patients with type 2 diabetes and managed in primary care. The application of LCGM provides a useful framework for evaluating future app use in other patient populations. PMID:25648130

Rainfall estimation for real time flood monitoring using geostationary meteorological satellite data

NASA Astrophysics Data System (ADS)

Veerakachen, Watcharee; Raksapatcharawong, Mongkol

2015-09-01

Rainfall estimation by geostationary meteorological satellite data provides good spatial and temporal resolutions. This is advantageous for real time flood monitoring and warning systems. However, a rainfall estimation algorithm developed in one region needs to be adjusted for another climatic region. This work proposes computationally-efficient rainfall estimation algorithms based on an Infrared Threshold Rainfall (ITR) method calibrated with regional ground truth. Hourly rain gauge data collected from 70 stations around the Chao-Phraya river basin were used for calibration and validation of the algorithms. The algorithm inputs were derived from FY-2E satellite observations consisting of infrared and water vapor imagery. The results were compared with the Global Satellite Mapping of Precipitation (GSMaP) near real time product (GSMaP_NRT) using the probability of detection (POD), root mean square error (RMSE) and linear correlation coefficient (CC) as performance indices. Comparison with the GSMaP_NRT product for real time monitoring purpose shows that hourly rain estimates from the proposed algorithm with the error adjustment technique (ITR_EA) offers higher POD and approximately the same RMSE and CC with less data latency.

Effect of gender on psychosocial adjustment of colorectal cancer survivors with ostomy

PubMed Central

Poudel, Anju

2016-01-01

Background Stoma can pose extensive challenges for colorectal cancer survivors. Identifying the psychological and social adjustment among them and how it differs by gender will aid in identifying those particularly at risk of having poor adjustment and in planning programs to improve their adjustment. The purpose of this study was to determine the effect of gender on psychosocial adjustment of colorectal cancer survivors with ostomy. Methods A descriptive cross sectional study was carried out in the stoma clinic of B.P. Koirala Memorial Cancer Hospital, Bharatpur, Nepal. A purposive sample of 122 patients with ostomy was taken from the above mentioned setting. Selection criteria included colorectal cancer survivors having ostomy for at least 6 months. Data on socio-demographic and clinical variables were collected. Psychosocial adjustment was measured using Ostomy Adjustment Inventory-23 (OAI-23). Results A total of 122 patients were included in the study. Mean time since ostomy surgery was 2.53 and 1.98 years for men and women respectively. Both men and women had significant impairment in the psychosocial adjustment, however, men had significantly lower psychosocial adjustment score (37.68±12.96 vs. 43.45±12.81, t=−2.47, P=0.015) at 95% CI as compared to women and they reported more negative emotions. Furthermore, men significantly predicted low acceptance {β=−3.078, P=0.023, ΔR2=0.036, F [4,117] =7.90, P<0.001} and social engagement score {β=−2.501, P<0.001, ΔR2=0.098, F [4,117] =6.03, P<0.001}. Conclusions Colorectal cancer survivors with ostomy should be monitored for psychosocial concerns in regular basis and health care providers should tailor care based on their need. Approaches of survivorship care and psychosocial interventions in colorectal cancer survivors with ostomy should take into account gender specific concerns and requirements to aid adjustment. PMID:28078117

Effect of gender on psychosocial adjustment of colorectal cancer survivors with ostomy.

PubMed

Gautam, Sital; Poudel, Anju

2016-12-01

Stoma can pose extensive challenges for colorectal cancer survivors. Identifying the psychological and social adjustment among them and how it differs by gender will aid in identifying those particularly at risk of having poor adjustment and in planning programs to improve their adjustment. The purpose of this study was to determine the effect of gender on psychosocial adjustment of colorectal cancer survivors with ostomy. A descriptive cross sectional study was carried out in the stoma clinic of B.P. Koirala Memorial Cancer Hospital, Bharatpur, Nepal. A purposive sample of 122 patients with ostomy was taken from the above mentioned setting. Selection criteria included colorectal cancer survivors having ostomy for at least 6 months. Data on socio-demographic and clinical variables were collected. Psychosocial adjustment was measured using Ostomy Adjustment Inventory-23 (OAI-23). A total of 122 patients were included in the study. Mean time since ostomy surgery was 2.53 and 1.98 years for men and women respectively. Both men and women had significant impairment in the psychosocial adjustment, however, men had significantly lower psychosocial adjustment score (37.68±12.96 vs . 43.45±12.81, t=-2.47, P=0.015) at 95% CI as compared to women and they reported more negative emotions. Furthermore, men significantly predicted low acceptance {β=-3.078, P=0.023, ΔR 2 =0.036, F [4,117] =7.90, P<0.001} and social engagement score {β=-2.501, P<0.001, ΔR 2 =0.098, F [4,117] =6.03, P<0.001}. Colorectal cancer survivors with ostomy should be monitored for psychosocial concerns in regular basis and health care providers should tailor care based on their need. Approaches of survivorship care and psychosocial interventions in colorectal cancer survivors with ostomy should take into account gender specific concerns and requirements to aid adjustment.

Improvement of Toluene Selectivity via the Application of an Ethanol Oxidizing Catalytic Cell Upstream of a YSZ-Based Sensor for Air Monitoring Applications

PubMed Central

Sato, Tomoaki; Breedon, Michael; Miura, Norio

2012-01-01

The sensing characteristics of a yttria-stabilized zirconia (YSZ)-based sensor utilizing a NiO sensing-electrode (SE) towards toluene (C7H8) and interfering gases (C3H6, H2, CO, NO2 and C2H5OH) were evaluated with a view to selective C7H8 monitoring in indoor atmospheres. The fabricated YSZ-based sensor showed preferential responses toward 480 ppb C2H5OH, rather than the target 50 ppb C7H8 at an operational temperature of 450 °C under humid conditions (RH ≃ 32%). To overcome this limitation, the catalytic activity of Cr2O3, SnO2, Fe2O3 and NiO powders were evaluated for their selective ethanol oxidation ability. Among these oxides, SnO2 was found to selectively oxidize C2H5OH, thus improving C7H8 selectivity. An inline pre-catalytic cell loaded with SnO2 powder was installed upstream of the YSZ-based sensor utilizing NiO-SE, which enabled the following excellent abilities by selectively catalyzing common interfering gases; sensitive ppb level detection of C7H8 lower than the established Japanese Guideline value; low interferences from 50 ppb C3H6, 500 ppb H2, 100 ppb CO, 40 ppb NO2, as well as 480 ppb C2H5OH. These operational characteristics are all indicative that the developed sensor may be suitable for real-time C7H8 concentration monitoring in indoor environments. PMID:22666053

Design and package of a {sup 14}CO{sub 2} field analyzer The Global Monitor Platform (GMP)

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

Bright, Michelle; Marino, Bruno D.V.; Gronniger, Glen

2011-08-01

Carbon Capture and Sequestration (CCS) is widely accepted as a means to reduce and eliminate the fossil fuel CO{sub 2} (ff- CO{sub 2}) emissions from coal fired power plants. Success of CCS depends on near zero leakage rates over decadal time scales. Currently no commercial methods to determine leakage of ff-CO{sub 2} are available. The Global Monitor Platform (GMP) field analyzer provides high precision analysis of CO{sub 2} isotopes [12C (99%), 13C (<1%), 14C (1.2x10-10 %)] that can differentiate between fossil and biogenic CO{sub 2} emissions. Fossil fuels contain no {sup 14}C; their combustion should lower atmospheric amounts on localmore » to global scales. There is a clear mandate for monitoring, verification and accounting (MVA) of CCS systems nationally and globally to verify CCS integrity, treaty verification (Kyoto Protocol) and to characterize the nuclear fuel cycle. Planetary Emissions Management (PEM), working with the National Secure Manufacturing Center (NSMC), has the goal of designing, ruggedizing and packaging the GMP for field deployment. The system will conduct atmosphere monitoring then adapt the system to monitor water and soil evaluations. Measuring {sup 14}CO{sub 2} in real time will provide quantitative concentration data for ff-CO{sub 2} in the atmosphere and CCS leakage detection. Initial results will be discussed along with design changes for improved detection sensitivity and manufacturability.« less

Cost-effectiveness and Budget Impact of Routine Use of Fractional Exhaled Nitric Oxide Monitoring for the Management of Adult Asthma Patients in Spain.

PubMed

Sabatelli, L; Seppälä, U; Sastre, J; Crater, G

Fractional exhaled nitric oxide (FeNO) is a marker for type 2 airway inflammation. The objective of this study was to evaluate the cost-effectiveness and budget impact of FeNO monitoring for management of adult asthma in Spain. A cost-effectiveness analysis model was used to evaluate the effect on costs of adding FeNO monitoring to asthma management. Over a 1-year period, the model estimated the incremental cost per quality-adjusted life year and incremental number of exacerbations avoided when FeNO monitoring was added to standard guideline-driven asthma care compared with standard care alone. Univariate and multivariate sensitivity analyses were applied to explore uncertainty in the model. A budget impact model was used to examine the impact of FeNO monitoring on primary care costs across the Spanish health system. The results showed that adding FeNO to standard asthma care saved €62.53 per patient-year in the adult population and improved quality-adjusted life years by 0.026 per patient-year. The budget impact analysis revealed a potential net yearly saving of €129 million if FeNO monitoring had been used in primary care settings in Spain. The present economic model shows that adding FeNO to the treatment algorithm can considerably reduce costs and improve quality of life when used to manage asthma in combination with current treatment guidelines.

Troponin T as a Predictor of End-Stage Renal Disease and All-Cause Death in African Americans and Whites From Hypertensive Families.

PubMed

Hickson, LaTonya J; Rule, Andrew D; Butler, Kenneth R; Schwartz, Gary L; Jaffe, Allan S; Bartley, Adam C; Mosley, Thomas H; Turner, Stephen T

2015-11-01

To evaluate cardiac troponin T (cTnT) as a predictor of end-stage renal disease (ESRD) and death in a cohort of African American and white community-dwelling adults with hypertensive families. A total of 3050 participants (whites from Rochester, Minnesota; African Americans from Jackson, Mississippi) of the Genetic Epidemiology Network of Arteriopathy study were followed from baseline examination (June 1, 1996, through August 31, 2000) through January 22, 2010. Cox proportional hazards regression models were used to examine the association of cTnT with ESRD and death after adjusting for traditional risk factors. Cohort demographic characteristics and measurements included 1395 whites (45.7%), 2174 hypertensive (71.3%), 992 estimated glomerular filtration rate of less than 60 mL/min per 1.73 m(2) (32.5%), 1574 high-sensitivity C-reactive protein level of greater than 3 mg/L (51.6%), and 66 abnormal cTnT level of 0.01 ng/mL or higher (2.2%). The estimated cumulative incidence of ESRD at 10 years was 27.4% among those with abnormal cTnT levels compared with 1.3% for those with normal levels. Similarly, the estimated cumulative incidence of death at 10 years was 47% among those with abnormal cTnT compared with 7.3% among those with normal cTnT. Abnormal cTnT levels were strongly associated with ESRD and death. This effect was attenuated but was still highly significant after adjustment for demographic characteristics, estimated glomerular filtration rate, and traditional risk factors for ESRD (unadjusted hazard ratio [HR], 23.91; 95% CI, 12.9-44.2; adjusted HR, 2.81; 95% CI, 1.3-5.9) and death (unadjusted HR, 8.43; 95% CI, 6.0-11.9; adjusted HR, 3.46; 95% CI, 2.3-5.1). Cardiac troponin T makes an independent contribution to the prediction of ESRD and all-cause death in community-dwelling individuals beyond traditional risk markers. Further studies may be needed to determine whether cTnT screening in individuals with hypertension or in a subset of hypertensive individuals would help identify those at risk of ESRD and all-cause death. Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Elucidation of taste- and odor-producing bacteria and toxigenic cyanobacteria in a Midwestern drinking water supply reservoir by shotgun metagenomics analysis

USGS Publications Warehouse

Otten, Timothy; Graham, Jennifer L.; Harris, Theodore D.; Dreher, Theo

2016-01-01

While commonplace in clinical settings, DNA-based assays for identification or enumeration of drinking water pathogens and other biological contaminants remain widely unadopted by the monitoring community. In this study, shotgun metagenomics was used to identify taste-and-odor producers and toxin-producing cyanobacteria over a 2-year period in a drinking water reservoir. The sequencing data implicated several cyanobacteria, including Anabaena spp.,Microcystis spp., and an unresolved member of the order Oscillatoriales as the likely principal producers of geosmin, microcystin, and 2-methylisoborneol (MIB), respectively. To further demonstrate this, quantitative PCR (qPCR) assays targeting geosmin-producing Anabaena and microcystin-producing Microcystis were utilized, and these data were fitted using generalized linear models and compared with routine monitoring data, including microscopic cell counts, sonde-based physicochemical analyses, and assays of all inorganic and organic nitrogen and phosphorus forms and fractions. The qPCR assays explained the greatest variation in observed geosmin (adjusted R2 = 0.71) and microcystin (adjusted R2 = 0.84) concentrations over the study period, highlighting their potential for routine monitoring applications. The origin of the monoterpene cyclase required for MIB biosynthesis was putatively linked to a periphytic cyanobacterial mat attached to the concrete drinking water inflow structure. We conclude that shotgun metagenomics can be used to identify microbial agents involved in water quality deterioration and to guide PCR assay selection or design for routine monitoring purposes. Finally, we offer estimates of microbial diversity and metagenomic coverage of our data sets for reference to others wishing to apply shotgun metagenomics to other lacustrine systems.

Crude versus case-mix-adjusted control charts for safety monitoring in thyroid surgery.

PubMed

Duclos, Antoine; Voirin, Nicolas; Touzet, Sandrine; Soardo, Pietro; Schott, Anne-Marie; Colin, Cyrille; Peix, Jean-Louis; Lifante, Jean-Christophe

2010-12-01

Patient-safety monitoring based on health-outcome indicators can lead to misinterpretation of changes in case mix. This study aimed to compare the detection of indicator variations between crude and case-mix-adjusted control charts using data from thyroid surgeries. The study population included each patient who underwent thyroid surgery in a teaching hospital from January 2006 to May 2008. Patient safety was monitored according to two indicators, which are immediately recognisable postoperative complications: recurrent laryngeal nerve palsy and hypocalcaemia. Each indicator was plotted monthly on a p-control chart using exact limits. The weighted κ statistic was calculated to measure the agreement between crude and case-mix-adjusted control charts. We evaluated the outcomes of 1405 thyroidectomies. The overall proportions of immediate recurrent laryngeal nerve palsy and hypocalcaemia were 7.4% and 20.5%, respectively. The proportion of agreement in the detection of indicator variations between the crude and case-mix-adjusted p-charts was 95% (95% CI 85% to 99%). The strength of the agreement was κ = 0.76 (95% CI 0.54 to 0.98). The single special cause of variation that occurred was only detected by the case-mix-adjusted p-chart. There was good agreement in the detection of indicator variations between crude and case-mix-adjusted p-charts. The joint use of crude and adjusted charts seems to be a reasonable approach to increase the accuracy of interpretation of variations in outcome indicators.

The influence of body mass index and age on C-peptide at the diagnosis of type 1 diabetes in children who participated in the diabetes prevention trial-type 1.

PubMed

Sosenko, Jay M; Geyer, Susan; Skyler, Jay S; Rafkin, Lisa E; Ismail, Heba M; Libman, Ingrid M; Liu, Yuk-Fun; DiMeglio, Linda A; Evans-Molina, Carmella; Palmer, Jerry P

2018-05-01

The extent of influence of BMI and age on C-peptide at the diagnosis of type 1 diabetes (T1D) is unknown. We thus studied the impact of body mass index Z-scores (BMIZ) and age on C-peptide measures at and soon after the diagnosis of T1D. Data from Diabetes Prevention Trial-Type 1 (DPT-1) participants <18.0 years at diagnosis was analyzed. Analyses examined associations of C-peptide measures with BMIZ and age in 2 cohorts: oral glucose tolerance tests (OGTTs) at diagnosis (n = 99) and mixed meal tolerance tests (MMTTs) <6 months after diagnosis (n = 80). Multivariable linear regression was utilized. Fasting and area under the curve (AUC) C-peptide from OGTTs (n = 99) at diagnosis and MMTTs (n = 80) after diagnosis were positively associated with BMIZ and age (P < .001 for all). Associations persisted when BMIZ and age were included as independent variables in regression models (P < .001 for all). BMIZ and age explained 31%-47% of the variance of C-peptide measures. In an example, 2 individuals with identical AUC C-peptide values had an approximate 5-fold difference in values after adjustments for BMIZ and age. The association between fasting glucose and C-peptide decreased markedly when fasting C-peptide values were adjusted (r = 0.30, P < .01 to r = 0.07, n.s.). C-peptide measures are strongly and independently related to BMIZ and age at and soon after the diagnosis of T1D. Adjustments for BMIZ and age cause substantial changes in C-peptide values, and impact the association between glycemia and C-peptide. Such adjustments can improve assessments of β-cell impairment at diagnosis. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

40 CFR 75.24 - Out-of-control periods and adjustment for system bias.

Code of Federal Regulations, 2012 CFR

2012-07-01

... subsequent tests: (1) Apply the procedures for missing data substitution to emissions from affected unit(s... monitor or continuous emission monitoring system is out-of-control, any data recorded by the monitor or monitoring system are not quality-assured and shall not be used in calculating monitor data availabilities...

40 CFR 75.24 - Out-of-control periods and adjustment for system bias.

Code of Federal Regulations, 2011 CFR

2011-07-01

... subsequent tests: (1) Apply the procedures for missing data substitution to emissions from affected unit(s... monitor or continuous emission monitoring system is out-of-control, any data recorded by the monitor or monitoring system are not quality-assured and shall not be used in calculating monitor data availabilities...

40 CFR 75.24 - Out-of-control periods and adjustment for system bias.

Code of Federal Regulations, 2014 CFR

2014-07-01

... subsequent tests: (1) Apply the procedures for missing data substitution to emissions from affected unit(s... monitor or continuous emission monitoring system is out-of-control, any data recorded by the monitor or monitoring system are not quality-assured and shall not be used in calculating monitor data availabilities...

40 CFR 75.24 - Out-of-control periods and adjustment for system bias.

Code of Federal Regulations, 2010 CFR

2010-07-01

... subsequent tests: (1) Apply the procedures for missing data substitution to emissions from affected unit(s... monitor or continuous emission monitoring system is out-of-control, any data recorded by the monitor or monitoring system are not quality-assured and shall not be used in calculating monitor data availabilities...

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

K. L. Davis; J. L. Rempe; D. L. Knudson

Silicon carbide (SiC) temperature monitors 05R4-02-A KG1403 (300 LO) and 05R4-01-A KG1415 (400 LO B) were evaluated at the High Temperature Test Lab (HTTL) to determine their peak irradiation temperatures. HTTL measurements indicate that the peak irradiation temperature for the 300 LO monitor was 295 {+-} 20 C and the peak irradiation temperature for the 400 LO B monitor was 294 {+-} 25 C. Two silicon carbide (SiC) temperature monitors irradiated in the Advanced Test Reactor (ATR) were evaluated at the High Temperature Test Lab (HTTL) to determine their peak temperature during irradiation. These monitors were irradiated as part ofmore » the University of Wisconsin Pilot Project with a target dose of 3 dpa. Temperature monitors were fabricated from high density (3.203 g/cm3) SiC manufactured by Rohm Haas with a nominal size of 12.5 mm x 1.0 mm x 0.75 mm (see Attachment A). Table 1 provides identification for each monitor with an expected peak irradiation temperature range based on preliminary thermal analysis (see Attachment B). Post irradiation calculations are planned to reduce uncertainties in these calculated temperatures. Since the early 1960s, SiC has been used as a post-irradiation temperature monitor. As noted in Reference 2, several researchers have observed that neutron irradiation induced lattice expansion of SiC annealed out when the post-irradiation annealing temperature exceeds the peak irradiation temperature. As noted in Reference 3, INL uses resistivity measurements to infer peak irradiation temperature from SiC monitors. Figure 1 depicts the equipment at the HTTL used to evaluate the SiC monitors. The SiC monitors are heated in the annealing furnace using isochronal temperature steps that, depending on customer needs, can range from 50 to 800 C. This furnace is located under a ventilation hood within the stainless steel enclosure. The ventilation system is activated during heating so that any released vapors are vented through this system. Annealing temperatures are recorded using a National Institute of Standards and Technology (NIST) traceable thermocouple inserted into an alumina tube in the furnace. After each isochronal annealing, the specimens are placed in a specialized fixture located in the constant temperature chamber (maintained at 30 C) for a minimum of 30 minutes. After the 30 minute wait time, each specimen's resistance is measured using the specialized fixture and a calibrated DC power analyzer. This report discusses the evaluation of the SiC monitors and presents the results. Testing was conducted in accordance with Reference 3. Sections 2 and 3 present the data collected for each monitor and provide interpretation of the data. Section 4 presents the evaluated temperature results.« less

Monitoring of Deformation in Ground Before and After Tunnel Excavation

NASA Astrophysics Data System (ADS)

Eren, Mehmet; Hilmi Erkoç, Muharrem

2017-04-01

As population increase in metropolitan city, we need transportation and transmission tunnel. In this context, the engineers and administors attach impotance to building and planning underground-tunnel. Moreover, we must at regular intervals monitoring to deformation in underground-tunnel for quality and safety. Firstly, a deformation monitoring network is designed as perpendicular to the tunnel main axis. Secondly, the prescribed number of deformation measurements must be made. Finally, the deformation analysis is evaluated and its results is interpreted. This study investigates how deformation in monitoring network during and after tunnel excavate change.For this purpose, a deformation monitoring network of 18 object point and 4 reference point was established. Object points networks was designed steeply to the tunnel main axis as 3 cross section. Each cross section consisted of 3 point left, 2 point right and 1 point at the flowing line. Initial conditional measurement was made before tunnel excavation. Then the deformation measurement was made 5 period (1 period measured after tunnel excavate). All data sets were adjusted according to free adjustment method. The results from the investigation considering the tunnel line, a symmetrical subsidence was observed. The following day of tunnel excavation, we were observed %68 per of the total deformation. At the end of the last period measurements, %99 per of the total deformation was detected. Keywords: Tunnel, Deformation, Subsidence, Excavation

Defining hazards of supplemental oxygen therapy in neonatology using the FMEA tool.

PubMed

van der Eijk, Anne Catherine; Rook, Denise; Dankelman, Jenny; Smit, Bert Johan

2013-01-01

To prospectively evaluate hazards in the process of supplemental oxygen therapy in very preterm infants hospitalized in a Dutch NICU. A Failure Mode and Effects Analysis (FMEA) was conducted by a multidisciplinary team. This team identified, evaluated, and prioritized hazards of supplemental oxygen therapy in preterm infants. After accrediting "hazard scores" for each step in this process, recommendations were formulated for the main hazards. Performing the FMEA took seven meetings of 2 hours. The top 10 hazards could all be categorized into three main topics: incorrect adjustment of the fraction of inspired oxygen (FiO2), incorrect alarm limits for SpO2, and incorrect pulse-oximetry alarm limits on patient monitors for temporary use. The FMEA culminated in recommendations in both educational and technical directions. These included suggestions for (changes in) protocols on alarm limits and manual FiO2 adjustments, education of NICU staff on hazards of supplemental oxygen, and technical improvements in respiratory devices and patient monitors. The FMEA prioritized flaws in the process of supplemental oxygen therapy in very preterm infants. Thanks to the structured approach of the analysis by a multidisciplinary team, several recommendations were made. These recommendations are currently implemented in the study's center.

Carotid femoral pulse wave velocity in type 2 diabetes and hypertension: capturing arterial health effects of step counts

PubMed Central

Dasgupta, Kaberi; Rosenberg, Ellen; Joseph, Lawrence; Trudeau, Luc; Garfield, Natasha; Chan, Deborah; Sherman, Mark; Rabasa-Lhoret, Rémi; Daskalopoulou, Stella S.

2017-01-01

Objective: Optimal medication use obscures the impact of physical activity on traditional cardiometabolic risk factors. We evaluated the relationship between step counts and carotid-femoral pulse wave velocity (cfPWV), a summative risk indicator, in patients with type 2 diabetes and/or hypertension. Research design and methods: Three hundred and sixty-nine participants were recruited (outpatient clinics; Montreal, Quebec; 2011–2015). Physical activity (pedometer/accelerometer), cfPWV (applanation tonometry), and risk factors (A1C, Homeostatic Model Assessment–Insulin Resistance, blood pressure, lipid profiles) were evaluated. Linear regression models were constructed to quantify the relationship of steps/day with cfPWV. Results: The study population comprised 191 patients with type 2 diabetes and hypertension, 39 with type 2 diabetes, and 139 with hypertension (mean ± SD: age 59.6 ± 11.2 years; BMI 31.3 ± 4.8 kg/m2; 54.2% women). Blood pressure (125/77 ± 15/9 mmHg), A1C (diabetes: 7.7 ± 1.3%; 61 mmol/mol), and low-density lipoprotein cholesterol (diabetes: 2.19 ± 0.8 mmol/l; without diabetes: 3.13 ± 1.1mmol/l) were close to target. Participants averaged 5125 ± 2722 steps/day. Mean cfPWV was 9.8 ± 2.2 m/s. Steps correlated with cfPWV, but not with other risk factors. A 1000 steps/day increment was associated with a 0.1 m/s cfPWV decrement across adjusted models and in subgroup analysis by diabetes status. In a model adjusted for age, sex, BMI, ethnicity, immigrant status, employment, education, diabetes, hypertension, medication classes, the mean cfPWV decrement was 0.11 m/s (95% confidence interval −0.2, −0.02). Conclusions: cfPWV is responsive to step counts in patients who are well controlled on cardioprotective medications. This ability to capture the ‘added value’ of physical activity supports the emerging role of cfPWV in arterial health monitoring. PMID:28129250

Response of consumer and research grade indoor air quality monitors to residential sources of fine particles.

PubMed

Singer, B C; Delp, W W

2018-04-23

The ability to inexpensively monitor PM 2.5 to identify sources and enable controls would advance residential indoor air quality (IAQ) management. Consumer IAQ monitors incorporating low-cost optical particle sensors and connections with smart home platforms could provide this service if they reliably detect PM 2.5 in homes. In this study, particles from typical residential sources were generated in a 120 m 3 laboratory and time-concentration profiles were measured with 7 consumer monitors (2-3 units each), 2 research monitors (Thermo pDR-1500, MetOne BT-645), a Grimm Mini Wide-Range Aerosol Spectrometer (GRM), and a Tapered Element Oscillating Microbalance with Filter Dynamic Measurement System (FDMS), a Federal Equivalent Method for PM 2.5 . Sources included recreational combustion (candles, cigarettes, incense), cooking activities, an unfiltered ultrasonic humidifier, and dust. FDMS measurements, filter samples, and known densities were used to adjust the GRM to obtain time-resolved mass concentrations. Data from the research monitors and 4 of the consumer monitors-AirBeam, AirVisual, Foobot, Purple Air-were time correlated and within a factor of 2 of the estimated mass concentrations for most sources. All 7 of the consumer and both research monitors substantially under-reported or missed events for which the emitted mass was comprised of particles smaller than 0.3 μm diameter. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Age-Adjusted Percentage of Adults Aged 18 Years or Older with Diagnosed Diabetes Performing Daily Self-Monitoring of ...

MedlinePlus

... Share Compartir Age-Adjusted Percentage of Adults Aged 18 Years or Older with Diagnosed Diabetes Performing Daily ... 2010, the age-adjusted percentage of adults aged 18 years or older with diagnosed diabetes performing daily ...

Harmonized Landsat/Sentinel-2 Reflectance Products for Land Monitoring (Invited)

NASA Technical Reports Server (NTRS)

Masek, Jeffrey G.; Dungan, Jennifer L.; Ju, Junchang; Roger, Jean-Claude; Claverie, Martin P.; Skakun, Sergii; Vermote, Eric; Justice, Christopher Owen

2017-01-01

Many land applications require more frequent observations than can be obtained from a single 'Landsat class'� sensor. Agricultural monitoring, inland water quality assessment, stand-scale phenology, and numerous other applications all require near-daily imagery at better than 1ha resolution. Thus the land science community has begun expressing a desire for a '30-meter MODIS' global monitoring capability. One cost-effective way to achieve this goal is via merging data from multiple, international observatories into a single virtual constellation. The Harmonized Landsat/Sentinel-2 (HLS) project has been working to generate a seamless surface reflectance product by combining observations from USGS/NASA Landsat-8 and ESA Sentinel-2. Harmonization in this context requires a series of radiometric and geometric transforms to create a single surface reflectance time series agnostic to sensor origin. Radiometric corrections include a common atmospheric correction using the Landsat-8 LaSRC/6S approach, a simple BRDF adjustment to constant solar and nadir view angle, and spectral bandpass adjustments to fit the Landsat-8 OLI reference. Data are then resampled to a consistent 30m UTM grid, using the Sentinel-2 global tile system. Cloud and shadow masking are also implemented. Quality assurance (QA) involves comparison of the output 30m HLS products with near-simultaneous MODIS nadir-adjusted observations. Prototoype HLS products have been processed for approximately 7% of the global land area using the NASA Earth Exchange (NEX) compute environment at NASA Ames, and can be downloaded from the HLS web site (https://hls.gsfc.nasa.gov). A wall-to-wall North America data set is being prepared for 2018. This talk will review the objectives and status of the HLS project, and illustrate applications of high-density optical time series data for agriculture and ecology. We also discuss lessons learned from HLS in the general context of implementing virtual constellations.

Harmonized Landsat/Sentinel-2 Reflectance Products for Land Monitoring

NASA Astrophysics Data System (ADS)

Masek, J. G.; Ju, J.; Claverie, M.; Vermote, E.; Dungan, J. L.; Roger, J. C.; Skakun, S.; Justice, C. O.

2017-12-01

Many land applications require more frequent observations than can be obtained from a single "Landsat class" sensor. Agricultural monitoring, inland water quality assessment, stand-scale phenology, and numerous other applications all require near-daily imagery at better than 1ha resolution. Thus the land science community has begun expressing a desire for a "30-meter MODIS" global monitoring capability. One cost-effective way to achieve this goal is via merging data from multiple, international observatories into a single virtual constellation. The Harmonized Landsat/Sentinel-2 (HLS) project has been working to generate a seamless surface reflectance product by combining observations from USGS/NASA Landsat-8 and ESA Sentinel-2. Harmonization in this context requires a series of radiometric and geometric transforms to create a single surface reflectance time series agnostic to sensor origin. Radiometric corrections include a common atmospheric correction using the Landsat-8 LaSRC/6S approach, a simple BRDF adjustment to constant solar and nadir view angle, and spectral bandpass adjustments to fit the Landsat-8 OLI reference. Data are then resampled to a consistent 30m UTM grid, using the Sentinel-2 global tile system. Cloud and shadow masking are also implemented. Quality assurance (QA) involves comparison of the output 30m HLS products with near-simultaneous MODIS nadir-adjusted observations. Prototoype HLS products have been processed for 7% of the global land area using the NASA Earth Exchange (NEX) compute environment at NASA Ames, and can be downloaded from the HLS web site (https://hls.gsfc.nasa.gov). A wall-to-wall North America data set is being prepared for 2018.This talk will review the objectives and status of the HLS project, and illustrate applications of high-density optical time series data for agriculture and ecology. We also discuss lessons learned from HLS in the general context of implementing virtual constellations.

Growth and Nutritional Biomarkers of Preterm Infants Fed a New Powdered Human Milk Fortifier: A Randomized Trial.

PubMed

Rigo, Jacques; Hascoët, Jean-Michel; Billeaud, Claude; Picaud, Jean-Charles; Mosca, Fabio; Rubio, Amandine; Saliba, Elie; Radkë, Michaël; Simeoni, Umberto; Guillois, Bernard; de Halleux, Virginie; Jaeger, Jonathan; Ameye, Laurent; Hays, Nicholas P; Spalinger, Johannes

2017-10-01

The aim of this study was to assess growth and nutritional biomarkers of preterm infants fed human milk (HM) supplemented with a new powdered HM fortifier (nHMF) or a control HM fortifier (cHMF). The nHMF provides similar energy content, 16% more protein (partially hydrolyzed whey), and higher micronutrient levels than the cHMF, along with medium-chain triglycerides and docosahexaenoic acid. In this controlled, multicenter, double-blind study, a sample of preterm infants ≤32 weeks or ≤1500 g were randomized to receive nHMF (n = 77) or cHMF (n = 76) for a minimum of 21 days. Weight gain was evaluated for noninferiority (margin = -1 g/day) and superiority (margin = 0 g/day). Nutritional status and gut inflammation were assessed by blood, urine, and fecal biochemistries. Adverse events were monitored. Adjusted mean weight gain (analysis of covariance) was 2.3 g/day greater in nHMF versus cHMF; the lower limit of the 95% CI (0.4 g/day) exceeded both noninferiority (P < 0.001) and superiority margins (P = 0.01). Weight gain rate (unadjusted) was 18.3 (nHMF) and 16.8 g · kg · day (cHMF) between study days 1 and 21 (D1-D21). Length and head circumference (HC) gains between D1 and D21 were not different. Adjusted weight-for-age z score at D21 and HC-for-age z score at week 40 corrected age were greater in nHMF versus cHMF (P = 0.013, P = 0.003 respectively). nHMF had higher serum blood urea nitrogen, pre-albumin, alkaline phosphatase, and calcium (all within normal ranges; all P ≤ 0.019) at D21 versus cHMF. Both HMFs were well tolerated with similar incidence of gastrointestinal adverse events. nHMF providing more protein and fat compared to a control fortifier is safe, well-tolerated, and improves the weight gain of preterm infants.

47 CFR 95.221 - (R/C Rule 21) How do I have my R/C transmitter serviced?

Code of Federal Regulations, 2010 CFR

2010-10-01

... FCC certificated R/C transmitter (see R/C Rule 9) must be made in accord with the Technical... in order to: (1) Adjust a transmitter to an antenna; (2) Detect or measure radiation of energy other...

Effect of cell size and shear stress on bacterium growth rate

NASA Astrophysics Data System (ADS)

Fadlallah, Hadi; Jarrahi, Mojtaba; Herbert, Éric; Peerhossaini, Hassan; PEF Team

2015-11-01

Effect of shear stress on the growth rate of Synechocystis and Chlamydomonas cells is studied. An experimental setup was prepared to monitor the growth rate of the microorganisms versus the shear rate inside a clean room, under atmospheric pressure and 20 °C temperature. Digital magnetic agitators are placed inside a closed chamber provided with airflow, under a continuous uniform light intensity over 4 weeks. In order to study the effect of shear stress on the growth rate, different frequencies of agitation are tested, 2 vessels filled with 150 ml of each specie were placed on different agitating system at the desired frequency. The growth rate is monitored daily by measuring the optical density and then correlate it to the cellular concentration. The PH was adjusted to 7 in order to maintain the photosynthetic activity. Furthermore, to measure the shear stress distribution, the flow velocity field was measured using PIV. Zones of high and low shear stress were identified. Results show that the growth rate is independent of the shear stress magnitude, mostly for Synechocystis, and with lower independency for Chlamydomonas depending on the cell size for each species.

Reactive Tracer Techniques to Quantitatively Monitor Carbon Dioxide Storage in Geologic Formations

NASA Astrophysics Data System (ADS)

Matter, J. M.; Carson, C.; Stute, M.; Broecker, W. S.

2012-12-01

Injection of CO2 into geologic storage reservoirs induces fluid-rock reactions that may lead to the mineralization of the injected CO2. The long-term safety of geologic CO2 storage is, therefore, determined by in situ CO2-fluid-rock reactions. Currently existing monitoring and verification techniques for CO2 storage are insufficient to characterize the solubility and reactivity of the injected CO2, and to establish a mass balance of the stored CO2. Dissolved and chemically transformed CO2 thus avoid detection. We developed and are testing a new reactive tracer technique for quantitative monitoring and detection of dissolved and chemically transformed CO2 in geologic storage reservoirs. The technique involves tagging the injected carbon with radiocarbon (14C). Carbon-14 is a naturally occurring radioisotope produced by cosmic radiation and made artificially by 14N neutron capture. The ambient concentration is very low with a 14C/12C ratio of 10-12. The concentration of 14C in deep geologic formations and fossil fuels is at least two orders of magnitude lower. This makes 14C an ideal quantitative tracer for tagging underground injections of anthropogenic CO2. We are testing the feasibility of this tracer technique at the CarbFix pilot injection site in Iceland, where approximately 2,000 tons of CO2 dissolved in water are currently injected into a deep basalt aquifer. The injected CO2 is tagged with 14C by dynamically adding calibrated amounts of H14CO3 solution to the injection stream. The target concentration is 12 Bq/kg of injected water, which results in a 14C activity that is 5 times enriched compared to the 1850 background. In addition to 14C as a reactive tracer, trifluormethylsulphur pentafluoride (SF5CF3) and sulfurhexafluoride (SF6) are used as conservative tracers to monitor the transport of the injected CO2 in the subsurface. Fluid samples are collected for tracer analysis from the injection and monitoring wells on a regular basis. Results show a fast reaction of the injected CO2 with the ambient reservoir fluid and rocks. Mixing and in situ CO2-water-rock reactions are detected by changes in the different tracer ratios. The feasibility of 14C as a reactive tracer for geologic CO2 storage also depends on the analytical technique used to measure 14C activities. Currently, 14C is analyzed using Accelerator Mass Spectrometery (AMS), which is expensive and requires centralized facilities. To enable real time online monitoring and verification, we are developing an alternative detection method for radiocarbon. The IntraCavity OptoGalvanic Spectroscopy (ICOGS) system is using a CO2 laser to detect carbon isotope ratios at environmental levels. Results from our prototype of this bench-top technology demonstrate that an ICOGS system can be used in a continuous mode with analysis times of the order of minutes, and can deliver data of similar quality as AMS.

15 CFR 6.4 - Adjustments to penalties.

Code of Federal Regulations, 2014 CFR

2014-01-01

... $130,000. (f) National Oceanic and Atmospheric Administration. (1) 51 U.S.C. 60123(a)(3), Land Remote Sensing Policy Act of 2010; new penalty $10,000. (2) 51 U.S.C. 60148(c), Land Remote Sensing Policy Act of...

15 CFR 6.4 - Adjustments to penalties.

Code of Federal Regulations, 2013 CFR

2013-01-01

... $130,000. (f) National Oceanic and Atmospheric Administration. (1) 51 U.S.C. 60123(a)(3), Land Remote Sensing Policy Act of 2010; new penalty $10,000. (2) 51 U.S.C. 60148(c), Land Remote Sensing Policy Act of...

Relationship Between Frequency and Intensity of Cigarette Smoking and TTFC/C Among Students of the GYTS in Select Countries, 2007-2009

PubMed Central

Lam, Eugene; Giovino, Gary A.; Shin, Mikyong; Lee, Kyung A.; Rolle, Italia; Asma, Samira

2015-01-01

BACKGROUND This study assessed the construct validity of a measure of nicotine dependence that was used in the Global Youth Tobacco Survey (GYTS). METHODS Using 2007-2009 data from the GYTS, subjects from 6 countries were used to assess current smokers’ odds of reporting time to first cigarette or craving positive (TTFC/C+) by the number of cigarette smoking days per month (DPM) and the number of cigarettes smoked per day (CPD). RESULTS The percentage of GYTS smokers who reported TTFC/C+ ranged from 58.0% to 69.7%. Compared with students who smoked on 1-2 DPM, those who smoked on 3-9 DPM had 3 times the adjusted odds of reporting TTFC/C+. The adjusted odds of reporting TTFC/C+ were 3 to 7 times higher among those who smoked 10-29 DPM and 6 to 20 times higher among daily smokers. Similarly, the adjusted odds of TTFC/C+ were 3-6 times higher among those who smoked 2-5 CPD and 6 to 20 times higher among those who smoked >6 CPD, compared to those who smoked <1 CPD. CONCLUSION Associations of TTFC/C+ prevalence with both frequency and intensity of cigarette smoking provide a construct validation of the GYTS question used to assess respondents’ TTFC/C status. PMID:25117888

Relationship between frequency and intensity of cigarette smoking and TTFC/C among students of the GYTS in select countries, 2007-2009.

PubMed

Lam, Eugene; Giovino, Gary A; Shin, Mikyong; Lee, Kyung A; Rolle, Italia; Asma, Samira

2014-09-01

This study assessed the construct validity of a measure of nicotine dependence that was used in the Global Youth Tobacco Survey (GYTS). Using 2007-2009 data from the GYTS, subjects from 6 countries were used to assess current smokers' odds of reporting time to first cigarette or craving positive (TTFC/C+) by the number of cigarette smoking days per month (DPM) and the number of cigarettes smoked per day (CPD). The percentage of GYTS smokers who reported TTFC/C+ ranged from 58.0% to 69.7%. Compared with students who smoked on 1-2 DPM, those who smoked on 3-9 DPM had 3 times the adjusted odds of reporting TTFC/C+. The adjusted odds of reporting TTFC/C+ were 3 to 7 times higher among those who smoked 10-29 DPM and 6 to 20 times higher among daily smokers. Similarly, the adjusted odds of TTFC/C+ were 3-6 times higher among those who smoked 2-5 CPD and 6 to 20 times higher among those who smoked >6 CPD, compared to those who smoked <1 CPD. Associations of TTFC/C+ prevalence with both frequency and intensity of cigarette smoking provide a construct validation of the GYTS question used to assess respondents' TTFC/C status. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

Cardiorespiratory fitness and components of the metabolic syndrome in sedentary men.

PubMed

Riou, Marie-Eve; Pigeon, Etienne; St-Onge, Josée; Tremblay, Angelo; Marette, André; Weisnagel, John; Joanisse, Denis R

2009-01-01

To investigate the relationships between fitness and components of the metabolic syndrome in sedentary men. 39 subjects (34-53 years) were evaluated for fitness (VO(2max)) and anthropometric, metabolic, and skeletal muscle phenotypes. VO(2max) was assessed on a bicycle ergometer whereas other variables were obtained from an oral glucose tolerance test (OGTT), hydrostatic weighing, and a muscle biopsy. Pearson and partial correlations adjusted for fat mass (FM), waist circumference (WC), muscle enzyme activities (citrate synthase (CS), cytochrome c oxidase (COX)), and capillary density were used to investigate the independent relationships be tween variables. Negative correlations between VO(2max) and WC as well as blood pressure and OGTT test were observed. When adjusted for FM, correlations remained between VO(2max) and WC (r = -0.46, p < 0.01) and systolic blood pressure (r = -0.35, p < 0.05). When adjusted for WC and CS activity, all correlations were lost except for high-sensitivity C-reactive protein (hs-CRP) (r = -0.34, p < 0.05) which remained when adjusted for CS activity. Adjustment for COX activity failed to remove correlations with hs-CRP (r = -0.36, p < 0.05), age (r = 0.34, p < 0.05), WC (r = -0.35, p < 0.05), and blood pressure. Negative correlations persisted when fitness was adjusted for the mean number of capillaries. The effects of fitness on components of the metabolic syndrome in sedentary men are explained by abdominal obesity and muscle phenotypes.

In-situ sensing using mass spectrometry and its use for run-to-run control on a W-CVD cluster tool

NASA Astrophysics Data System (ADS)

Gougousi, T.; Sreenivasan, R.; Xu, Y.; Henn-Lecordier, L.; Rubloff, G. W.; Kidder, , J. N.; Zafiriou, E.

2001-01-01

A 300 amu closed-ion-source RGA (Leybold-Inficon Transpector 2) sampling gases directly from the reactor of an ULVAC ERA-1000 cluster tool has been used for real time process monitoring of a W CVD process. The process involves H2 reduction of WF6 at a total pressure of 67 Pa (0.5 torr) to produce W films on Si wafers heated at temperatures around 350 °C. The normalized RGA signals for the H2 reagent depletion and the HF product generation were correlated with the W film weight as measured post-process with an electronic microbalance for the establishment of thin-film weight (thickness) metrology. The metrology uncertainty (about 7% for the HF product) was limited primarily by the very low conversion efficiency of the W CVD process (around 2-3%). The HF metrology was then used to drive a robust run-to-run control algorithm, with the deposition time selected as the manipulated (or controlled) variable. For that purpose, during a 10 wafer run, a systematic process drift was introduced as a -5 °C processing temperature change for each successive wafer, in an otherwise unchanged process recipe. Without adjustment of the deposition time the W film weight (thickness) would have declined by about 50% by the 10th wafer. With the aid of the process control algorithm, an adjusted deposition time was computed so as to maintain constant HF sensing signal, resulting in weight (thickness) control comparable to the accuracy of the thickness metrology. These results suggest that in-situ chemical sensing, and particularly mass spectrometry, provide the basis for wafer state metrology as needed to achieve run-to-run control. Furthermore, since the control accuracy was consistent with the metrology accuracy, we anticipate significant improvements for processes as used in manufacturing, where conversion rates are much higher (40-50%) and corresponding signals for metrology will be much larger.

Acute health impacts of airborne particles estimated from satellite remote sensing.

PubMed

Wang, Zhaoxi; Liu, Yang; Hu, Mu; Pan, Xiaochuan; Shi, Jing; Chen, Feng; He, Kebin; Koutrakis, Petros; Christiani, David C

2013-01-01

Satellite-based remote sensing provides a unique opportunity to monitor air quality from space at global, continental, national and regional scales. Most current research focused on developing empirical models using ground measurements of the ambient particulate. However, the application of satellite-based exposure assessment in environmental health is still limited, especially for acute effects, because the development of satellite PM(2.5) model depends on the availability of ground measurements. We tested the hypothesis that MODIS AOD (aerosol optical depth) exposure estimates, obtained from NASA satellites, are directly associated with daily health outcomes. Three independent healthcare databases were used: unscheduled outpatient visits, hospital admissions, and mortality collected in Beijing metropolitan area, China during 2006. We use generalized linear models to compare the short-term effects of air pollution assessed by ground monitoring (PM(10)) with adjustment of absolute humidity (AH) and AH-calibrated AOD. Across all databases we found that both AH-calibrated AOD and PM(10) (adjusted by AH) were consistently associated with elevated daily events on the current day and/or lag days for cardiovascular diseases, ischemic heart diseases, and COPD. The relative risks estimated by AH-calibrated AOD and PM(10) (adjusted by AH) were similar. Additionally, compared to ground PM(10), we found that AH-calibrated AOD had narrower confidence intervals for all models and was more robust in estimating the current day and lag day effects. Our preliminary findings suggested that, with proper adjustment of meteorological factors, satellite AOD can be used directly to estimate the acute health impacts of ambient particles without prior calibrating to the sparse ground monitoring networks. Copyright © 2012 Elsevier Ltd. All rights reserved.

Consequences of implementing a cardiac troponin assay with improved sensitivity at Swedish coronary care units: an analysis from the SWEDEHEART registry.

PubMed

Eggers, Kai M; Lindahl, Bertil; Melki, Dina; Jernberg, Tomas

2016-08-07

Cardiac troponin (cTn) assays with improved sensitivity are increasingly utilized for the assessment of patients admitted because of suspected acute coronary syndrome (ACS). However, data on the clinical consequences of the implementation of such assays are limited. In a retrospective register-based study (37 710 coronary care unit admissions; SWEDEHEART registry), we compared the case mix, the use of diagnostic procedures, treatments, and 1-year all-cause mortality 1 year before the implementation of a cTn assay with improved sensitivity (study period 1) and 1 year thereafter (study period 2). During study period 2, more at-risk patients were admitted and more patients had cTn levels above the myocardial infarction cut-off (ACS patients +13.1%; non-ACS patients +160.1%). cTn levels above this cut-off exhibited stronger associations with mortality risk in study period 2 (adjusted HR 4.45 [95% confidence interval, CI, 3.36-5.89]) compared with period 1 (adjusted HR 2.43 [95% CI 2.11-2.80]), similar as for the cTn ratio relative to the respective 99th percentile. While there was no multivariable-adjusted increase in the use of diagnostic procedures, significant trends towards more differentiated treatment depending on the cause of cTn elevation, i.e. ACS or non-ACS, were noted. The implementation of a cTn assay with improved sensitivity was associated with an increase in the number of patients who due to their cTn-status were identified as suitable for beneficial therapies. There was no inappropriate increase in hospital resource utilization. As such, cTn assays with improved sensitivity provide an opportunity to improve the clinical management of patients with suspected ACS. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

Elevated serum complement C3 levels are related to the development of prediabetes in an adult population: the Tianjin Chronic Low-Grade Systematic Inflammation and Health Cohort Study.

PubMed

Bao, X; Xia, Y; Zhang, Q; Wu, H M; Du, H M; Liu, L; Wang, C J; Shi, H B; Guo, X Y; Liu, X; Li, C L; Su, Q; Meng, G; Yu, B; Sun, S M; Wang, X; Zhou, M; Jia, Q Y; Song, K; Niu, K J

2016-04-01

To investigate whether serum complement C3 is related to the prevalence and incidence of prediabetes in an adult population. A cross-sectional (n = 10 206) and prospective cohort study (n = 3333), with a mean (range; 95% CI) follow-up of 2.63 (1-6; 2.58-2.68) years, was conducted in people recruited from the Health Management Centre of Tianjin Medical University General Hospital in Tianjin, China. Measurement of serum C3 concentration, blood fasting glucose, oral glucose tolerance, HbA1c and other potential confounding factors was performed at baseline and each year during the follow-up. Prediabetes was defined according to the criteria of the American Diabetes Association. Adjusted logistic and Cox proportional hazards regression models were used to assess the relationships between C3 quintiles and prediabetes. The prevalence and incidence of prediabetes were 38.5% and 119 per 1000 person-years, respectively. In cross-sectional analysis, after adjustment for potential confounders, the odds ratios of prediabetes for increasing quintiles of C3 were 1.00 (reference), 1.32 (95% CI 1.14-1.53), 1.37 (95% CI 1.18-1.59), 1.75 (95% CI 1.51-2.03), 2.25 (95% CI 1.93-2.62; P for trend < 0.0001). In the cohort analysis, the multiple-adjusted hazard ratio of prediabetes in the highest quintile of baseline C3 was 1.43 (95% CI 1.15, 1.78; P for trend < 0.001), when compared with the lowest quintile. These findings indicate that elevated serum C3 levels are significantly related to an increased risk of developing prediabetes in an adult population, suggesting that C3 can be used as a biomarker in high-risk individuals to improve primary prevention of prediabetes and diabetes. © 2015 Diabetes UK.

Distribution, variability, and predictors of urinary bisphenol A levels in 50 North Carolina adults over a six-week monitoring period.

PubMed

Morgan, Marsha K; Nash, Maliha; Barr, Dana Boyd; Starr, James M; Scott Clifton, M; Sobus, Jon R

2018-03-01

Bisphenol A (BPA) is commonly manufactured to make polycarbonate plastics and epoxy resins for use in consumer products and packaged goods. BPA has been found in several different types of environmental media (e.g., food, dust, and air). Many cross-sectional studies have frequently detected BPA concentrations in adult urine samples. However, limited data are available on the temporal variability and important predictors of urinary BPA concentrations in adults. In this work, the major objectives were to: 1) quantify BPA levels in duplicate-diet solid food, drinking water, hard floor surface wipe, and urine samples (first-morning void [FMV], bedtime, and 24-h) collected from adults over a six-week monitoring period; 2) determine the temporal variability of urinary BPA levels using concentration, specific gravity (SG) adjusted, creatinine (CR) adjusted, and excretion rate values, and; 3) examine associations between available study factors and urinary BPA concentrations. In 2009-2011, a convenience sample of 50 adults was recruited from residential settings in North Carolina. The participants completed diaries and collected samples during weeks 1, 2, and/or 6 of a six-week monitoring period. BPA was detected in 38%, 4%, and 99% of the solid food (n=775), drinking water (n=50), and surface wipe samples (n=138), respectively. Total BPA (free plus conjugated) was detected in 98% of the 2477 urine samples. Median urinary BPA levels were 2.07ng/mL, 2.20ng/mL-SG, 2.29ng/mg, and 2.31ng/min for concentration, SG-adjusted, CR-adjusted, and excretion rate values, respectively. The intraclass correlation coefficient (ICC) estimates for BPA showed poor reproducibility (≤0.35) for all urine sample types and methods over a day, week, and six weeks. CR-adjusted bedtime voids collected over six-weeks required the fewest, realistic number of samples (n=11) to obtain a reliable biomarker estimate (ICC=0.80). Results of linear mixed-effects models showed that sex, race, season, and CR-level were all significant predictors (p<0.05) of the adults' urinary BPA concentrations. BPA levels in the solid food and surface wipe samples did not contribute significantly to the participants' urinary BPA concentrations. However, a significant positive relationship was observed between solid food intake and urine-based estimates of BPA dose, when aggregated over 24-h periods. Ingestion of BPA via solid food explained only about 20% of the total dose (at the median of the dose distribution), suggesting that these adults were likely exposed to other major unknown (non-dietary) sources of BPA in their everyday environments. Published by Elsevier Ltd.

43 CFR 2885.24 - If I hold a grant or TUP, what monitoring fees must I pay?

Code of Federal Regulations, 2011 CFR

2011-10-01

... of work hours necessary to monitor your grant or TUP. Category 1 through 4 monitoring fees are one-time fees and are not refundable. The work hours and fees for 2005 are as follows: 2005 Monitoring Fee Schedule Monitoring category Federal work hours involved Monitoring fee as of June 21, 2005. To be adjusted...

The Influence of Meteorological Factors and Atmospheric Pollutants on the Risk of Preterm Birth.

PubMed

Giorgis-Allemand, Lise; Pedersen, Marie; Bernard, Claire; Aguilera, Inmaculada; Beelen, Rob M J; Chatzi, Leda; Cirach, Marta; Danileviciute, Asta; Dedele, Audrius; van Eijsden, Manon; Estarlich, Marisa; Fernández-Somoano, Ana; Fernández, Mariana F; Forastiere, Francesco; Gehring, Ulrike; Grazuleviciene, Regina; Gruzieva, Olena; Heude, Barbara; Hoek, Gerard; de Hoogh, Kees; van den Hooven, Edith H; Håberg, Siri E; Iñiguez, Carmen; Jaddoe, Vincent W V; Korek, Michal; Lertxundi, Aitana; Lepeule, Johanna; Nafstad, Per; Nystad, Wenche; Patelarou, Evridiki; Porta, Daniela; Postma, Dirkje; Raaschou-Nielsen, Ole; Rudnai, Peter; Siroux, Valérie; Sunyer, Jordi; Stephanou, Euripides; Sørensen, Mette; Eriksen, Kirsten Thorup; Tuffnell, Derek; Varró, Mihály J; Vrijkotte, Tanja G M; Wijga, Alet; Wright, John; Nieuwenhuijsen, Mark J; Pershagen, Göran; Brunekreef, Bert; Kogevinas, Manolis; Slama, Rémy

2017-02-15

Atmospheric pollutants and meteorological conditions are suspected to be causes of preterm birth. We aimed to characterize their possible association with the risk of preterm birth (defined as birth occurring before 37 completed gestational weeks). We pooled individual data from 13 birth cohorts in 11 European countries (71,493 births from the period 1994-2011, European Study of Cohorts for Air Pollution Effects (ESCAPE)). City-specific meteorological data from routine monitors were averaged over time windows spanning from 1 week to the whole pregnancy. Atmospheric pollution measurements (nitrogen oxides and particulate matter) were combined with data from permanent monitors and land-use data into seasonally adjusted land-use regression models. Preterm birth risks associated with air pollution and meteorological factors were estimated using adjusted discrete-time Cox models. The frequency of preterm birth was 5.0%. Preterm birth risk tended to increase with first-trimester average atmospheric pressure (odds ratio per 5-mbar increase = 1.06, 95% confidence interval: 1.01, 1.11), which could not be distinguished from altitude. There was also some evidence of an increase in preterm birth risk with first-trimester average temperature in the -5°C to 15°C range, with a plateau afterwards (spline coding, P = 0.08). No evidence of adverse association with atmospheric pollutants was observed. Our study lends support for an increase in preterm birth risk with atmospheric pressure. © The Author 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Exercise Therapy for Management of Type 2 Diabetes Mellitus: Superior Efficacy of Activity Monitors over Pedometers.

PubMed

Miyauchi, Masaaki; Toyoda, Masao; Kaneyama, Noriko; Miyatake, Han; Tanaka, Eitaro; Kimura, Moritsugu; Umezono, Tomoya; Fukagawa, Masafumi

2016-01-01

We compared the efficacy of activity monitor (which displays exercise intensity and number of steps) versus that of pedometer in exercise therapy for patients with type 2 diabetes. The study subjects were divided into the activity monitor group ( n = 92) and pedometer group ( n = 95). The primary goal was improvement in hemoglobin A1c (HbA1c). The exercise target was set at 8,000 steps/day and 20 minutes of moderate-intensity exercise (≥3.5 metabolic equivalents). The activity monitor is equipped with a triple-axis accelerometer sensor capable of measuring medium-intensity walking duration, number of steps, walking distance, calorie consumption, and total calorie consumption. The pedometer counts the number of steps. Blood samples for laboratory tests were obtained during the visits. The first examination was conducted at the start of the study and repeated at 2 and 6 months. A significant difference in the decrease in HbA1c level was observed between the two groups at 2 months. The results suggest that the use of activity level monitor that displays information on exercise intensity, in addition to the number of steps, is useful in exercise therapy as it enhances the concept of exercise therapy and promotes lowering of HbA1c in diabetic patients.

CD4 cell count response to first-line combination ART in HIV-2+ patients compared with HIV-1+ patients: a multinational, multicohort European study.

PubMed

Wittkop, Linda; Arsandaux, Julie; Trevino, Ana; Schim van der Loeff, Maarten; Anderson, Jane; van Sighem, Ard; Böni, Jürg; Brun-Vezinet, Françoise; Soriano, Vicente; Boufassa, Faroudy; Brockmeyer, Norbert; Calmy, Alexandra; Dabis, François; Jarrin, Inma; Dorrucci, Maria; Duque, Vitor; Fätkenheuer, Gerd; Zangerle, Robert; Ferrer, Elena; Porter, Kholoud; Judd, Ali; Sipsas, Nikolaos V; Lambotte, Olivier; Shepherd, Leah; Leport, Catherine; Morrison, Charles; Mussini, Cristina; Obel, Niels; Ruelle, Jean; Schwarze-Zander, Carolyne; Sonnerborg, Anders; Teira, Ramon; Torti, Carlo; Valadas, Emilia; Colin, Celine; Friis-Møller, Nina; Costagliola, Dominique; Thiebaut, Rodolphe; Chene, Geneviève; Matheron, Sophie

2017-10-01

CD4 cell recovery following first-line combination ART (cART) is poorer in HIV-2+ than in HIV-1+ patients. Only large comparisons may allow adjustments for demographic and pretreatment plasma viral load (pVL). ART-naive HIV+ adults from two European multicohort collaborations, COHERE (HIV-1 alone) and ACHIeV2e (HIV-2 alone), were included, if they started first-line cART (without NNRTIs or fusion inhibitors) between 1997 and 2011. Patients without at least one CD4 cell count before start of cART, without a pretreatment pVL and with missing a priori-defined covariables were excluded. Evolution of CD4 cell count was studied using adjusted linear mixed models. We included 185 HIV-2+ and 30321 HIV-1+ patients with median age of 46 years (IQR 36-52) and 37 years (IQR 31-44), respectively. Median observed pretreatment CD4 cell counts/mm3 were 203 (95% CI 100-290) in HIV-2+ patients and 223 (95% CI 100-353) in HIV-1+ patients. Mean observed CD4 cell count changes from start of cART to 12 months were +105 (95% CI 77-134) in HIV-2+ patients and +202 (95% CI 199-205) in HIV-1+ patients, an observed difference of 97 cells/mm3 in 1 year. In adjusted analysis, the mean CD4 cell increase was overall 25 CD4 cells/mm3/year lower (95% CI 5-44; P = 0.0127) in HIV-2+ patients compared with HIV-1+ patients. A poorer CD4 cell increase during first-line cART was observed in HIV-2+ patients, even after adjusting for pretreatment pVL and other potential confounders. Our results underline the need to identify more potent therapeutic regimens or strategies against HIV-2. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Accounting for interim safety monitoring of an adverse event upon termination of a clinical trial.

PubMed

Dallas, Michael J

2008-01-01

Upon termination of a clinical trial that uses interim evaluations to determine whether the trial can be stopped, a proper statistical analysis must account for the interim evaluations. For example, in a group-sequential design where the efficacy of a treatment regimen is evaluated at interim stages, and the opportunity to stop the trial based on positive efficacy findings exists, the terminal p-value, point estimate, and confidence limits of the outcome of interest must be adjusted to eliminate bias. While it is standard practice to adjust terminal statistical analyses due to opportunities to stop for "positive" findings, adjusting due to opportunities to stop for "negative" findings is also important. Stopping rules for negative findings are particularly useful when monitoring a specific rare serious adverse event in trials designed to show safety with respect to the event. In these settings, establishing conservative stopping rules are appropriate, and therefore accounting for the interim monitoring can have a substantial effect on the final results. Here I present a method to account for interim safety monitoring and illustrate its usefulness. The method is demonstrated to have advantages over methodology that does not account for interim monitoring.

30 CFR 27.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... MINING PRODUCTS METHANE-MONITORING SYSTEMS General Provisions § 27.2 Definitions. As used in this part... designs, manufactures, or assembles and that seeks certification or preliminary testing of a methane-monitoring system or component. (c) Methane-monitoring system means a complete assembly of one or more...

Decreased levels of serum complement C3 and natural killer cells add to the predictive value of total immunoglobulin G for severe infection in heart transplant recipients.

PubMed

Sarmiento, E; del Pozo, N; Gallego, A; Fernández-Yañez, J; Palomo, J; Villa, A; Ruiz, M; Muñoz, P; Rodríguez, C; Rodríguez-Molina, J; Navarro, J; Kotsch, K; Fernandez-Cruz, E; Carbone, J

2012-10-01

Infection remains a source of mortality in heart recipients. We previously reported that post-transplant immunoglobulin G (IgG) quantification can help identify the risk for infection. We assessed whether other standardized parameters of humoral and cellular immunity could prove useful when identifying patients at risk of infection. We prospectively studied 133 heart recipients over a 12-month period. Forty-eight patients had at least one episode of severe infection. An event was defined as an infection requiring intravenous antimicrobial therapy. Cox regression analysis revealed an association between the risk of developing infection and the following: lower IgG2 subclass levels (day 7: relative hazard [RH] 1.71; day 30: RH 1.76), lower IgA levels (day 7: RH 1.61; day 30: RH 1.91), lower complement C3 values (day 7: RH 1.25), lower CD3 absolute counts (day 30: RH 1.10), lower absolute natural killer [NK] cell count (day 7: RH 1.24), and lower IgG concentrations (day 7: RH 1.31; day 30: RH 1.36). Cox regression bivariate analysis revealed that lower day 7 C3 levels, IgG2 concentration, and absolute NK cell count remained significant after adjustment for total IgG levels. Data suggest that early immune monitoring including C3, IgG2, and NK cell testing in addition to IgG concentrations is useful when attempting to identify the risk of infection in heart transplant recipients. © 2012 John Wiley & Sons A/S.

Use of Normothermic Default Humidifier Settings Causes Excessive Humidification of Respiratory Gases During Therapeutic Hypothermia.

PubMed

Tanaka, Shoichiro; Iwata, Sachiko; Kinoshita, Masahiro; Tsuda, Kennosuke; Sakai, Sayaka; Saikusa, Mamoru; Shindo, Ryota; Harada, Eimei; Okada, Junichiro; Hisano, Tadashi; Kanda, Hiroshi; Maeno, Yasuki; Araki, Yuko; Ushijima, Kazuo; Sakamoto, Teruo; Yamashita, Yushiro; Iwata, Osuke

2016-12-01

Adult patients frequently suffer from serious respiratory complications during therapeutic hypothermia. During therapeutic hypothermia, respiratory gases are humidified close to saturated vapor at 37°C (44 mg/L) despite that saturated vapor reduces considerably depending on temperature reduction. Condensation may cause serious adverse events, such as bronchial edema, mucosal dysfunction, and ventilator-associated pneumonia during cooling. To determine clinical variables associated with inadequate humidification of respiratory gases during cooling, humidity of inspiratory gases was measured in 42 cumulative newborn infants who underwent therapeutic hypothermia. Three humidifier settings of 37-default (chamber outlet, 37°C; distal circuit, 40°C), 33.5-theoretical (chamber outlet, 33.5°C; distal circuit, 36.5°C), and 33.5-adjusted (optimized setting to achieve 36.6 mg/L using feedback from a hygrometer) were tested to identify independent variables of excessively high humidity >40.7 mg/L and low humidity <32.9 mg/L. The mean (SD) humidity at the Y-piece was 39.2 (5.2), 33.3 (4.1), and 36.7 (1.2) mg/L for 37-default, 33.5-theoretical, and 33.5-adjusted, respectively. The incidence of excessive high humidity was 10.3% (37-default, 31.0%; 33.5-theoretical, 0.0%; 33.5-adjusted, 0.0%), which was positively associated with the use of a counter-flow humidifier (p < 0.001), 37-default (compared with 33.5-theoretical and 33.5-adjusted, both p < 0.001) and higher fraction of inspired oxygen (p = 0.003). The incidence of excessively low humidity was 17.5% (37-default, 7.1%; 33.5-theoretical, 45.2%; 33.5-adjusted, 0.0%), which was positively associated with the use of a pass-over humidifier and 33.5-theoretical (both p < 0.001). All patients who used a counter-flow humidifier achieved the target gas humidity at the Y-piece (36.6 ± 0.5 mg/L) required for 33.5-adjusted with 33.5-theoretical. During cooling, 37-default is associated with excessively high humidity, whereas 33.5-theoretical leads to excessively low humidity. Future studies are needed to assess whether a new regimen with optimized Y-piece temperature and humidity control reduces serious respiratory adverse events during cooling.

Influence of uridine diphosphate glucuronosyltransferase 2B7 -161C>T polymorphism on the concentration of valproic acid in pediatric epilepsy patients.

PubMed

Inoue, Kazuyuki; Suzuki, Eri; Yazawa, Rei; Yamamoto, Yoshiaki; Takahashi, Toshiki; Takahashi, Yukitoshi; Imai, Katsumi; Koyama, Seiichi; Inoue, Yushi; Tsuji, Daiki; Hayashi, Hideki; Itoh, Kunihiko

2014-06-01

Valproic acid (VPA) is widely used to treat various types of epilepsy. Interindividual variability in VPA pharmacokinetics may arise from genetic polymorphisms of VPA-metabolizing enzymes. This study aimed to examine the relationships between plasma VPA concentrations and the -161C>T single nucleotide polymorphism in uridine diphosphate glucuronosyltransferase (UGT) 2B7 genes in pediatric epilepsy patients. This study included 78 pediatric epilepsy patients carrying the cytochrome P450 (CYP) 2C9*1/*1 genotype and who were not treated with the enzyme inducers (phenytoin, phenobarbital, and carbamazepine), lamotrigine, and/or topiramate. CYP2C9*3 and UGT2B7 -161C>T polymorphisms were identified using methods based on polymerase chain reaction-restriction fragment length polymorphism. Blood samples were drawn from each patient under steady-state conditions, and plasma VPA concentrations were measured. Significant differences in adjusted plasma VPA concentrations were observed between carriers of CC, CT, and TT genotypes in the UGT2B7 -161C>T polymorphism (P = 0.039). Patients with the CC genotype had lower adjusted plasma VPA concentrations than those with CT or TT genotype (P = 0.028). These data suggest that the UGT2B7 -161C>T polymorphism in pediatric epilepsy patients carrying the CYP2C9*1/*1 genotype affects VPA concentration.

Cosmological implications of a large complete quasar sample

PubMed Central

Segal, I. E.; Nicoll, J. F.

1998-01-01

Objective and reproducible determinations of the probabilistic significance levels of the deviations between theoretical cosmological prediction and direct model-independent observation are made for the Large Bright Quasar Sample [Foltz, C., Chaffee, F. H., Hewett, P. C., MacAlpine, G. M., Turnshek, D. A., et al. (1987) Astron. J. 94, 1423–1460]. The Expanding Universe model as represented by the Friedman–Lemaitre cosmology with parameters qo = 0, Λ = 0 denoted as C1 and chronometric cosmology (no relevant adjustable parameters) denoted as C2 are the cosmologies considered. The mean and the dispersion of the apparent magnitudes and the slope of the apparent magnitude–redshift relation are the directly observed statistics predicted. The C1 predictions of these cosmology-independent quantities are deviant by as much as 11σ from direct observation; none of the C2 predictions deviate by >2σ. The C1 deviations may be reconciled with theory by the hypothesis of quasar “evolution,” which, however, appears incapable of being substantiated through direct observation. The excellent quantitative agreement of the C1 deviations with those predicted by C2 without adjustable parameters for the results of analysis predicated on C1 indicates that the evolution hypothesis may well be a theoretical artifact. PMID:9560182

Continuous electroencephalography predicts delayed cerebral ischemia after subarachnoid hemorrhage: A prospective study of diagnostic accuracy.

PubMed

Rosenthal, Eric S; Biswal, Siddharth; Zafar, Sahar F; O'Connor, Kathryn L; Bechek, Sophia; Shenoy, Apeksha V; Boyle, Emily J; Shafi, Mouhsin M; Gilmore, Emily J; Foreman, Brandon P; Gaspard, Nicolas; Leslie-Mazwi, Thabele M; Rosand, Jonathan; Hoch, Daniel B; Ayata, Cenk; Cash, Sydney S; Cole, Andrew J; Patel, Aman B; Westover, M Brandon

2018-04-16

Delayed cerebral ischemia (DCI) is a common, disabling complication of subarachnoid hemorrhage (SAH). Preventing DCI is a key focus of neurocritical care, but interventions carry risk and cannot be applied indiscriminately. Although retrospective studies have identified continuous electroencephalographic (cEEG) measures associated with DCI, no study has characterized the accuracy of cEEG with sufficient rigor to justify using it to triage patients to interventions or clinical trials. We therefore prospectively assessed the accuracy of cEEG for predicting DCI, following the Standards for Reporting Diagnostic Accuracy Studies. We prospectively performed cEEG in nontraumatic, high-grade SAH patients at a single institution. The index test consisted of clinical neurophysiologists prospectively reporting prespecified EEG alarms: (1) decreasing relative alpha variability, (2) decreasing alpha-delta ratio, (3) worsening focal slowing, or (4) late appearing epileptiform abnormalities. The diagnostic reference standard was DCI determined by blinded, adjudicated review. Primary outcome measures were sensitivity and specificity of cEEG for subsequent DCI, determined by multistate survival analysis, adjusted for baseline risk. One hundred three of 227 consecutive patients were eligible and underwent cEEG monitoring (7.7-day mean duration). EEG alarms occurred in 96.2% of patients with and 19.6% without subsequent DCI (1.9-day median latency, interquartile range = 0.9-4.1). Among alarm subtypes, late onset epileptiform abnormalities had the highest predictive value. Prespecified EEG findings predicted DCI among patients with low (91% sensitivity, 83% specificity) and high (95% sensitivity, 77% specificity) baseline risk. cEEG accurately predicts DCI following SAH and may help target therapies to patients at highest risk of secondary brain injury. Ann Neurol 2018. © 2018 American Neurological Association.

Hepatitis C co-infection is associated with an increased risk of incident chronic kidney disease in HIV-infected patients initiating combination antiretroviral therapy.

PubMed

Rossi, Carmine; Raboud, Janet; Walmsley, Sharon; Cooper, Curtis; Antoniou, Tony; Burchell, Ann N; Hull, Mark; Chia, Jason; Hogg, Robert S; Moodie, Erica E M; Klein, Marina B

2017-04-04

Combination antiretroviral therapy (cART) has reduced mortality from AIDS-related illnesses and chronic comorbidities have become prevalent among HIV-infected patients. We examined the association between hepatitis C virus (HCV) co-infection and chronic kidney disease (CKD) among patients initiating modern antiretroviral therapy. Data were obtained from the Canadian HIV Observational Cohort for individuals initiating cART from 2000 to 2012. Incident CKD was defined as two consecutive serum creatinine-based estimated glomerular filtration (eGFR) measurements <60 mL/min/1.73m 2 obtained ≥3 months apart. CKD incidence rates after cART initiation were compared between HCV co-infected and HIV mono-infected patients. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox regression. We included 2595 HIV-infected patients with eGFR >60 mL/min/1.73m 2 at cART initiation, of which 19% were HCV co-infected. One hundred and fifty patients developed CKD during 10,903 person-years of follow-up (PYFU). The CKD incidence rate was higher among co-infected than HIV mono-infected patients (26.0 per 1000 PYFU vs. 10.7 per 1000 PYFU). After adjusting for demographics, virologic parameters and traditional CKD risk factors, HCV co-infection was associated with a significantly shorter time to incident CKD (HR 1.97; 95% CI: 1.33, 2.90). Additional factors associated with incident CKD were female sex, increasing age after 40 years, lower baseline eGFR below 100 mL/min/1.73m 2 , increasing HIV viral load and cumulative exposure to tenofovir and lopinavir. HCV co-infection was associated with an increased risk of incident CKD among HIV-infected patients initiating cART. HCV-HIV co-infected patients should be monitored for kidney disease and may benefit from available HCV treatments.

40 CFR 60.2735 - Is there a minimum amount of monitoring data I must obtain?

Code of Federal Regulations, 2014 CFR

2014-07-01

... activities including, as applicable, calibration checks and required zero and span adjustments. A monitoring... monitoring system quality assurance or control activities in calculations used to report emissions or...-control periods, and required monitoring system quality assurance or quality control activities including...

40 CFR 60.2735 - Is there a minimum amount of monitoring data I must obtain?

Code of Federal Regulations, 2013 CFR

2013-07-01

... activities including, as applicable, calibration checks and required zero and span adjustments. A monitoring... monitoring system quality assurance or control activities in calculations used to report emissions or...-control periods, and required monitoring system quality assurance or quality control activities including...

78 FR 11643 - Agency Information Collection Activities; Submission to OMB for Review and Approval; Comment...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-19

... monitoring, accumulated refuse, surface methane monitoring, and collection and control system exceedances... included a burden item for Agency review of surface methane monitoring reports. Respondents, however, are... adjusted the calculations to exclude any Agency burden associated with surface methane monitoring. We have...

15 CFR 6.4 - Adjustments to penalties.

Code of Federal Regulations, 2012 CFR

2012-01-01

... $130,000. (e) National Oceanic and Atmospheric Administration. (1) 15 U.S.C. 5623(a)(3), Land Remote Sensing Policy Act of 1992, from $11,000 to $11,000. (2) 15 U.S.C. 5658(c), Land Remote Sensing Policy Act...

15 CFR 6.4 - Adjustments to penalties.

Code of Federal Regulations, 2011 CFR

2011-01-01

... $130,000. (e) National Oceanic and Atmospheric Administration. (1) 15 U.S.C. 5623(a)(3), Land Remote Sensing Policy Act of 1992, from $11,000 to $11,000. (2) 15 U.S.C. 5658(c), Land Remote Sensing Policy Act...

Cost-effectiveness of point-of-care viral load monitoring of antiretroviral therapy in resource-limited settings: mathematical modelling study.

PubMed

Estill, Janne; Egger, Matthias; Blaser, Nello; Vizcaya, Luisa Salazar; Garone, Daniela; Wood, Robin; Campbell, Jennifer; Hallett, Timothy B; Keiser, Olivia

2013-06-01

Monitoring of HIV viral load in patients on combination antiretroviral therapy (ART) is not generally available in resource-limited settings. We examined the cost-effectiveness of qualitative point-of-care viral load tests (POC-VL) in sub-Saharan Africa. Mathematical model based on longitudinal data from the Gugulethu and Khayelitsha township ART programmes in Cape Town, South Africa. Cohorts of patients on ART monitored by POC-VL, CD4 cell count or clinically were simulated. Scenario A considered the more accurate detection of treatment failure with POC-VL only, and scenario B also considered the effect on HIV transmission. Scenario C further assumed that the risk of virologic failure is halved with POC-VL due to improved adherence. We estimated the change in costs per quality-adjusted life-year gained (incremental cost-effectiveness ratios, ICERs) of POC-VL compared with CD4 and clinical monitoring. POC-VL tests with detection limits less than 1000 copies/ml increased costs due to unnecessary switches to second-line ART, without improving survival. Assuming POC-VL unit costs between US$5 and US$20 and detection limits between 1000 and 10,000 copies/ml, the ICER of POC-VL was US$4010-US$9230 compared with clinical and US$5960-US$25540 compared with CD4 cell count monitoring. In Scenario B, the corresponding ICERs were US$2450-US$5830 and US$2230-US$10380. In Scenario C, the ICER ranged between US$960 and US$2500 compared with clinical monitoring and between cost-saving and US$2460 compared with CD4 monitoring. The cost-effectiveness of POC-VL for monitoring ART is improved by a higher detection limit, by taking the reduction in new HIV infections into account and assuming that failure of first-line ART is reduced due to targeted adherence counselling.

Development of a microbial time/temperature indicator prototype for monitoring the microbiological quality of chilled foods.

PubMed

Vaikousi, Hariklia; Biliaderis, Costas G; Koutsoumanis, Konstantinos P

2008-05-01

A time/temperature indicator (TTI) system based on the growth and metabolic activity of a Lactobacillus sakei strain was developed for monitoring food quality throughout the chilled-food chain. In the designed system, an irreversible color change of a chemical chromatic indicator (from red to yellow) progressively occurs due to the pH decline that results from microbial growth and metabolism in a selected medium. The relation of the TTI response (color change) to the growth and metabolic activity (glucose consumption, lactic acid production, pH decrease) of L. sakei was studied. In addition, the temperature dependence of the TTI kinetics was investigated isothermally in the range of 0 to 16 degrees C and modeled with a system of differential equations. At all temperatures tested, the pH and color changes of the TTI system followed closely the growth of L. sakei, with the endpoint (the time at which a distinct visual color change to the final yellow was observed) of the TTI coinciding with a population level of 10(7) to 10(8) CFU/ml. The endpoint decreased from 27 days at 0 degrees C to 2.5 days at 16 degrees C, yielding an activation energy of 97.7 kJ/mol, which was very close to the activation energy of the L. sakei growth rate in the TTI substrate (103.2 kJ/mol). Furthermore, experiments conducted on the effect of the inoculum level showed a negative linear relationship between the level of L. sakei inoculated in the system medium and the endpoint of the TTI. For example, the endpoint at 8 degrees C ranged from 6 to 2 days for inoculum levels of 10(1) and 10(6) CFU/ml, respectively. This relationship allows the easy adjustment of the TTI endpoint at a certain temperature according to the shelf life of the food product of concern by using an appropriate inoculum level of L. sakei. The microbial TTI prototype developed in the present study could be used as an effective tool for monitoring shelf life during the distribution and storage of food products that are spoiled primarily by lactic acid bacteria or other bacteria exhibiting similar kinetic responses and spoilage potentials. Apart from the low cost, the main advantage of the proposed TTI is that its response closely matches the loss of the quality of a food product by simulating the microbial spoilage process in particular environments.

Development of a Microbial Time/Temperature Indicator Prototype for Monitoring the Microbiological Quality of Chilled Foods▿

PubMed Central

Vaikousi, Hariklia; Biliaderis, Costas G.; Koutsoumanis, Konstantinos P.

2008-01-01

A time/temperature indicator (TTI) system based on the growth and metabolic activity of a Lactobacillus sakei strain was developed for monitoring food quality throughout the chilled-food chain. In the designed system, an irreversible color change of a chemical chromatic indicator (from red to yellow) progressively occurs due to the pH decline that results from microbial growth and metabolism in a selected medium. The relation of the TTI response (color change) to the growth and metabolic activity (glucose consumption, lactic acid production, pH decrease) of L. sakei was studied. In addition, the temperature dependence of the TTI kinetics was investigated isothermally in the range of 0 to 16°C and modeled with a system of differential equations. At all temperatures tested, the pH and color changes of the TTI system followed closely the growth of L. sakei, with the endpoint (the time at which a distinct visual color change to the final yellow was observed) of the TTI coinciding with a population level of 107 to 108 CFU/ml. The endpoint decreased from 27 days at 0°C to 2.5 days at 16°C, yielding an activation energy of 97.7 kJ/mol, which was very close to the activation energy of the L. sakei growth rate in the TTI substrate (103.2 kJ/mol). Furthermore, experiments conducted on the effect of the inoculum level showed a negative linear relationship between the level of L. sakei inoculated in the system medium and the endpoint of the TTI. For example, the endpoint at 8°C ranged from 6 to 2 days for inoculum levels of 101 and 106 CFU/ml, respectively. This relationship allows the easy adjustment of the TTI endpoint at a certain temperature according to the shelf life of the food product of concern by using an appropriate inoculum level of L. sakei. The microbial TTI prototype developed in the present study could be used as an effective tool for monitoring shelf life during the distribution and storage of food products that are spoiled primarily by lactic acid bacteria or other bacteria exhibiting similar kinetic responses and spoilage potentials. Apart from the low cost, the main advantage of the proposed TTI is that its response closely matches the loss of the quality of a food product by simulating the microbial spoilage process in particular environments. PMID:18326676

Monitoring the refinement of crystal structures with {sup 15}N solid-state NMR shift tensor data

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

Kalakewich, Keyton; Eloranta, Harriet; Harper, James K.

The {sup 15}N chemical shift tensor is shown to be extremely sensitive to lattice structure and a powerful metric for monitoring density functional theory refinements of crystal structures. These refinements include lattice effects and are applied here to five crystal structures. All structures improve based on a better agreement between experimental and calculated {sup 15}N tensors, with an average improvement of 47.0 ppm. Structural improvement is further indicated by a decrease in forces on the atoms by 2–3 orders of magnitude and a greater similarity in atom positions to neutron diffraction structures. These refinements change bond lengths by more thanmore » the diffraction errors including adjustments to X–Y and X–H bonds (X, Y = C, N, and O) of 0.028 ± 0.002 Å and 0.144 ± 0.036 Å, respectively. The acquisition of {sup 15}N tensors at natural abundance is challenging and this limitation is overcome by improved {sup 1}H decoupling in the FIREMAT method. This decoupling dramatically narrows linewidths, improves signal-to-noise by up to 317%, and significantly improves the accuracy of measured tensors. A total of 39 tensors are measured with shifts distributed over a range of more than 400 ppm. Overall, experimental {sup 15}N tensors are at least 5 times more sensitive to crystal structure than {sup 13}C tensors due to nitrogen’s greater polarizability and larger range of chemical shifts.« less

A risk-adjusted O-E CUSUM with monitoring bands for monitoring medical outcomes.

PubMed

Sun, Rena Jie; Kalbfleisch, John D

2013-03-01

In order to monitor a medical center's survival outcomes using simple plots, we introduce a risk-adjusted Observed-Expected (O-E) Cumulative SUM (CUSUM) along with monitoring bands as decision criterion.The proposed monitoring bands can be used in place of a more traditional but complicated V-shaped mask or the simultaneous use of two one-sided CUSUMs. The resulting plot is designed to simultaneously monitor for failure time outcomes that are "worse than expected" or "better than expected." The slopes of the O-E CUSUM provide direct estimates of the relative risk (as compared to a standard or expected failure rate) for the data being monitored. Appropriate rejection regions are obtained by controlling the false alarm rate (type I error) over a period of given length. Simulation studies are conducted to illustrate the performance of the proposed method. A case study is carried out for 58 liver transplant centers. The use of CUSUM methods for quality improvement is stressed. Copyright © 2013, The International Biometric Society.

Development of the U.S. Army Railroad Track Maintenance Management System (RAILER).

DTIC Science & Technology

1986-05-01

availability is both feasible and desirable. Section 5 of this study discusses measurement and analysis equipment. .5 *- Sample Deduct Value Calculations... Sample of Five Groups of 50 Ties From Same Mile on Track 72 C2 Bad Tie Count Adjustment Factors 80 C3 Adjusted Badtie Count Factors Under Conservative...economic analysis developed as part of the PAVER system 3 can be used for RAILER; however, guidelines for providing track information inputs to the

Patient-level predictors of achieving early glycaemic control in Type 2 diabetes mellitus: a population-based study.

PubMed

Svensson, E; Baggesen, L M; Thomsen, R W; Lyngaa, T; Pedersen, L; Nørrelund, H; Buhl, E S; Haase, C L; Johnsen, S P

2016-11-01

To identify individual predictors of early glycaemic control in people with Type 2 diabetes mellitus after initiation of first glucose-lowering drug treatment in everyday clinical practice. Using medical registries, we identified a population-based cohort of people with a first-time glucose-lowering drug prescription in Northern Denmark in the period 2000-2012. We used Poisson regression analysis to examine patient-level predictors of success in reaching early glycaemic control [HbA 1c target of < 53 mmol/mol (7%)] < 6 months after treatment start. Among the 38 418 people (median age 63 years), 27 545 (72%) achieved early glycaemic control. The strongest predictor of achieving early control was pre-treatment HbA 1c level; compared with a pre-treatment HbA 1c level of ≤ 58 mmol/mol (7.5%), the adjusted relative risks of attaining early control were 0.63 (95% CI 0.61-0.64) for baseline HbA 1c levels of > 58 and ≤ 75 mmol/mol (> 7.5 and ≤ 9%), and 0.58 (95% CI 0.57-0.59) for a baseline HbA 1c level of > 9% (> 75 mmol/mol). All other examined predictors were only weakly associated with the chance of achieving early control. After adjustment, the only characteristics that remained independently associated with early control (in addition to high baseline HbA 1c ) were being widowed (adjusted relative risk 0.95; 95% CI 0.93-0.97) and having a high Charlson comorbidity index score (score ≥ 3; adjusted relative risk 0.94; 95% CI 0.90-0.97). In a real-world clinical setting, people with Type 2 diabetes mellitus initiating glucose-lowering medication had a similar likelihood of achieving glycaemic control, regardless of sex, age, comorbidities and other individual factors; the only strong and potentially modifiable predictor was HbA 1c before therapy start. © 2016 Diabetes UK.

28 CFR 85.3 - Adjustments to penalties.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., falsification or failure to file required reports: from $10,000 to $11,000. (4) 5 U.S.C. App. 4 105(c)(2..., Recovery, and Enforcement Act of 1989, violation: from $1,000,000 to $1,100,000. (7) 12 U.S.C. 1833a(b)(2), Financial Institutions Reform, Recovery, and Enforcement Act of 1989, continuing violations (per day...

Decrement of postprandial insulin secretion determines the progressive nature of type-2 diabetes.

PubMed

Shim, Wan Sub; Kim, Soo Kyung; Kim, Hae Jin; Kang, Eun Seok; Ahn, Chul Woo; Lim, Sung Kil; Lee, Hyun Chul; Cha, Bong Soo

2006-10-01

Type-2 diabetes is a progressive disease. However, little is known about whether decreased fasting or postprandial pancreatic beta-cell responsiveness is more prominent with increased duration of diabetes. The aim of this study was to evaluate the relationship between insulin secretion both during fasting and 2 h postprandial, and the duration of diabetes in type-2 diabetic patients. Cross-sectional clinical investigation. We conducted a meal tolerance test in 1466 type-2 diabetic patients and calculated fasting (M0) and postprandial (M1) beta-cell responsiveness. The fasting C-peptide, postprandial C-peptide, M0, and M1 values were lower, but HbA1c values were higher, in patients with diabetes duration > 10 years than those in other groups. There was no difference in the HbA1c levels according to the tertiles of their fasting C-peptide level. However, in a group of patients with highest postprandial C-peptide tertile, the HbA1c values were significantly lower than those in other groups. After adjustment of age, sex, and body mass index (BMI), the duration of diabetes was found to be negatively correlated with fasting C-peptide (gamma = -0.102), postprandial C-peptide (gamma = -0.356), M0 (gamma = -0.263), and M1 (gamma = -0.315; P < 0.01 respectively). After adjustment of age, sex, and BMI, HbA1c was found to be negatively correlated with postprandial C-peptide (gamma = -0.264), M(0) (gamma = -0.379), and M1 (gamma = -0.522), however, positively correlated with fasting C-peptide (gamma = 0.105; P < 0.01 respectively). In stepwise multiple regression analysis, M0, M1, and homeostasis model assessment for insulin resistance (HOMA-IR) emerged as predictors of HbAlc after adjustment for age, sex, and BMI (R2 = 0.272, 0.080, and 0.056 respectively). With increasing duration of diabetes, the decrease of postprandial insulin secretion is becoming more prominent, and postprandial beta-cell responsiveness may be a more important determinant for glycemic control than fasting beta-cell responsiveness.

A Harmonized Landsat-Sentinel-2 Surface Reflectance product: a resource for Agricultural Monitoring

NASA Astrophysics Data System (ADS)

Masek, J. G.; Claverie, M.; Ju, J.; Vermote, E.; Justice, C. O.

2015-12-01

The combination of Landsat and Sentinel-2 data offers a unique opportunity to observe globally the land every 2-3 days at medium (<30m) spatial resolution. The Harmonized Landsat-Sentinel-2 (HLS) project is a NASA initiative aiming to produce surface reflectance data from Landsat and Sentinel-2 missions and to deliver them to the community in a combined, seamless form. The HLS will be beneficial for global agricultural monitoring applications that require medium spatial resolution and weekly or more frequent observations. In particular, the provided opportunity to track crop phenology at the scale of individual fields will support detailed mapping of crop type and type-specific vegetation conditions. To create a compatible set of radiometric measurements, the HLS product relies on rigorous pre- and post-launch cross-calibration (Landsat-8 OLI and Sentinel-2 MSI) activities. The processing chain includes the following components: atmospheric correction, cloud/shadow masking, nadir BRDF-adjustment, spectral-adjustment, regridding, and temporal composite. The atmospheric correction and cloud masking is based on the OLI atmospheric correction developed at NASA-GSFC and has been adapted to the MSI data. The BRDF-adjustment is based on a disaggregation technique using MODIS-based BRDF coefficients. The technique has been evaluated using the multi-angular acquisition from the SPOT 4 and 5 (Take5) experiments. The spectral-adjustment relies on a linear regression that has been calibrated and evaluated using synthetic data and surface reflectance processed from a large number of hyperspectral EO-1 Hyperion scenes. Finally, significant effort is placed on product validation and evaluation. The delivered data set will include surface reflectance products at different levels: Using the native gridding, i.e. UTM, 30m for Landsat-8, and UTM, 10-20m for Sentinel-2 Using a common global gridding (Sinusoidal, 30m) Temporal composite (Sinusoidal, 30m, 5-day) During the first year of operation of Sentinel-2A, the HLS will be prototyped over a selection of 30 sites that includes some of the JECAM sites, Aeronet sites and Cal/Val sites. Then, the HLS spatial coverage will be increased as more Sentinel-2A data become available.

Cure of tuberculosis despite serum concentrations of antituberculosis drugs below published reference ranges.

PubMed

Meloni, Monica; Corti, Natascia; Müller, Daniel; Henning, Lars; Gutteck, Ursula; von Braun, Amrei; Weber, Rainer; Fehr, Jan

2015-01-01

Therapeutic target serum concentrations of first-line antituberculosis drugs have not been well defined in clinical studies in tuberculosis (TB) patients. We retrospectively investigated the estimated maximum serum concentrations (eC max) of antituberculosis drugs and clinical outcome of TB patients with therapeutic drug monitoring performed between 2010-2012 at our institution, and follow-up until March 2014. The eC max was defined as the highest serum concentration during a sampling period (2, 4 and 6 hours after drug ingestion). We compared the results with published eC max values, and categorised them as either "within reference range", "low eC max", or "very low eC max".Low/very low eC max-levels were defined as follows: isoniazid 2-3/<2 mg/l, rifampicin 4-8/<4 mg/l, rifabutin 0.2-0.3/<0.2 mg/l, ethambutol 1-2/<0.1 mg/l and pyrazinamide <20 mg/l. Concentrations of antituberculosis drugs in 175 serum samples of 17 patients with TB were analysed. In 12 (71%) patients, multiple therapeutic drug monitoring samples were collected over time, in 5 (29%) patients only one sample was available for therapeutic drug monitoring. Overall, 94% of all patients had at least one low antituberculosis drug concentration. Overall, 64% of all eC max levels were classified as "low" or "very low". The eC max was below the relevant reference range in 80% of isoniazid, 95% of rifampicin, 30% of pyrazinamide, and 30% of ethambutol measurements. All but one patient were cured of tuberculosis. Although many antituberculosis drug serum concentrations were below the widely used reference ranges, 16 of 17 patients were cured of tuberculosis. These results challenge the use of the published reference ranges for therapeutic drug monitoring.

Geochemistry, radiocarbon ages, and paleorecharge conditions along a transect in the central High Plains aquifer, southwestern Kansas, USA

USGS Publications Warehouse

McMahon, P.B.; Böhlke, J.K.; Christenson, S.C.

2004-01-01

Water samples from short-screen monitoring wells installed along a 90-km transect in southwestern Kansas were analyzed for major ions, trace elements, isotopes (H, B, C, N, O, S, Sr), and dissolved gases (He, Ne, N2, Ar, O2, CH4) to evaluate the geochemistry, radiocarbon ages, and paleorecharge conditions in the unconfined central High Plains aquifer. The primary reactions controlling water chemistry were dedolomitization, cation exchange, feldspar weathering, and O2 reduction and denitrification. Radiocarbon ages adjusted for C mass transfers ranged from <2.6 ka (14C) B.P. near the water table to 12.8 ± 0.9 ka (14C) B.P. at the base of the aquifer, indicating the unconfined central High Plains aquifer contained a stratified sequence of ground water spanning Holocene time. A cross-sectional model of steady-state ground-water flow, calibrated using radiocarbon ages, is consistent with recharge rates ranging from 0.8 mm/a in areas overlain by loess to 8 mm/a in areas overlain by dune sand. Paleorecharge temperatures ranged from an average of 15.2 ± 0.7 °C for the most recently recharged waters to 11.6 ± 0.4 °C for the oldest waters. The temperature difference between Early and Late Holocene recharge was estimated to be 2.4 ± 0.7 °C, after taking into account variable recharge elevations. Nitrogen isotope data indicate NO3 in paleorecharge (average concentration=193 μM) was derived from a relatively uniform source such as soil N, whereas NO3 in recent recharge (average concentration=885 μM) contained N from varying proportions of fertilizer, manure, and soil N. Deep water samples contained components of N2 derived from atmospheric, denitrification, and deep natural gas sources. Denitrification rates in the aquifer were slow (5 ± 2× 10−3 μmol N L−1 a−1), indicating this process would require >10 ka to reduce the average NO3 concentration in recent recharge to the Holocene background concentration.

Skin Collagen Glycation, Glycoxidation, and Crosslinking Are Lower in Subjects With Long-Term Intensive Versus Conventional Therapy of Type 1 Diabetes

PubMed Central

Monnier, Vincent M.; Bautista, Oliver; Kenny, David; Sell, David R.; Fogarty, John; Dahms, William; Cleary, Patricia A.; Lachin, John; Genuth, Saul

2010-01-01

The relationships between long-term intensive control of glycemia and indicators of skin collagen glycation (furosine), glycoxidation (pentosidine and N∊-[carboxymethyl]-lysine [CML]), and crosslinking (acid and pepsin solubility) were examined in 216 patients with type 1 diabetes from the primary prevention and secondary intervention cohorts of the Diabetes Control and Complications Trial. By comparison with conventional treatment, 5 years of intensive treatment was associated with 30–32% lower furosine, 9% lower pentosidine, 9–13% lower CML, 24% higher acid-soluble collagen, and 50% higher pepsin-soluble collagen. All of these differences were statistically significant in the subjects of the primary prevention cohort (P < 0 .006–0.001) and also of the secondary intervention cohort (P < 0.015–0.001) with the exception of CML and acid-soluble collagen. Age- and duration-adjusted collagen variables were significantly associated with the HbA1c value nearest the biopsy and with cumulative prior HbA1c values. Multiple logistic regression analyses with six nonredundant collagen parameters as independent variables and various expressions of retinopathy, nephropathy, and neuropathy outcomes as dependent variables showed that the complications were significantly associated with the full set of collagen variables. Surprisingly, the percentage of total variance (R2) in complications explained by the collagen variables ranged from 19 to 36% with the intensive treatment and from 14 to 51% with conventional treatment. These associations generally remained significant even after adjustment for HbA1c, and, most unexpectedly, in conventionally treated subjects, glycated collagen was the parameter most consistently associated with diabetic complications. Continued monitoring of these subjects may determine whether glycation products in the skin, and especially the early Amadori product (furosine), have the potential to be predictors of the future risk of developing complications, and perhaps be even better predictors than glycated hemoglobin (HbA1c). PMID:10102706

Interface of the general fitting tool GENFIT2 in PandaRoot

NASA Astrophysics Data System (ADS)

Prencipe, Elisabetta; Spataro, Stefano; Stockmanns, Tobias; PANDA Collaboration

2017-10-01

\\bar{{{P}}}ANDA is a planned experiment at FAIR (Darmstadt) with a cooled antiproton beam in a range [1.5; 15] GeV/c, allowing a wide physics program in nuclear and particle physics. It is the only experiment worldwide, which combines a solenoid field (B=2T) and a dipole field (B=2Tm) in a spectrometer with a fixed target topology, in that energy regime. The tracking system of \\bar{{{P}}}ANDA involves the presence of a high performance silicon vertex detector, a GEM detector, a straw-tubes central tracker, a forward tracking system, and a luminosity monitor. The offline tracking algorithm is developed within the PandaRoot framework, which is a part of the FairRoot project. The tool here presented is based on algorithms containing the Kalman Filter equations and a deterministic annealing filter. This general fitting tool (GENFIT2) offers to users also a Runge-Kutta track representation, and interfaces with Millepede II (useful for alignment) and RAVE (vertex finder). It is independent on the detector geometry and the magnetic field map, and written in C++ object-oriented modular code. Several fitting algorithms are available with GENFIT2, with user-adjustable parameters; therefore the tool is of friendly usage. A check on the fit convergence is done by GENFIT2 as well. The Kalman-Filter-based algorithms have a wide range of applications; among those in particle physics they can perform extrapolations of track parameters and covariance matrices. The adoptions of the PandaRoot framework to connect to Genfit2 are described, and the impact of GENFIT2 on the physics simulations of \\bar{{{P}}}ANDA are shown: significant improvement is reported for those channels where a good low momentum tracking is required (pT < 400 MeV/c).

Indian Island Mooring Project. Phase II. Completion Report.

DTIC Science & Technology

1984-03-01

32151 B 4299 31859 B 3327 31317 C 4460 31138 C 4266 31414 BUOY #2 394572 1532350 BUOY # 5 393784 1532410 ANCHOR A 4987 32457 ANCHOR A 4044 32990 B 4279...WASHINGTON, D. C. 20374 ;- -:r- -.. :;.\\:.,;:.:- ,- ---- :..-.- -.:-:::.:-:". 5 --.:.-..".- ".".--, .S .’---. : ..-. - ... V-.. .... :.. BLOCK 19 (Con’t...NUMBER 5 . MONITORING ORGANIZATION REPORT # FPO-1-84(2) 6a. NAME OF PERFORM. ORG. 6b. OFFICE SYM 7a. NAME OF MONITORING ORGANIZATION Robert Taggart

Long- and Short-Term Exposure To Air Pollution and Inflammatory/Hemostatic Markers in Midlife Women

PubMed Central

Green, Rochelle; Broadwin, Rachel; Malig, Brian; Basu, Rupa; Gold, Ellen B.; Qi, Lihong; Sternfeld, Barbara; Bromberger, Joyce T.; Greendale, Gail A.; Kravitz, Howard M.; Tomey, Kristin; Matthews, Karen; Derby, Carol; Jackson, Elizabeth A.; Green, Robin; Ostro, Bart

2016-01-01

Background Studies have reported associations between long-term air pollution exposures and cardiovascular mortality. The biological mechanisms connecting them remain uncertain. Methods We examined associations of fine particles (PM2.5) and ozone with serum markers of cardiovascular disease risk in a cohort of midlife women. We obtained information from women enrolled at six sites in the multi-ethnic, longitudinal Study of Women's Health Across the Nation, including repeated measurements of high-sensitivity C-reactive protein (hs-CRP), fibrinogen, tissue-type plasminogen activator antigen (tPA-ag), plasminogen activator inhibitor Type 1 (PAI-1), and Factor VIIc (Factor VII coagulant activity). We obtained residence-proximate PM2.5 and ozone monitoring data for a maximum five annual visits, calculating prior year, six-month, one-month, and one-day exposures and their relations to serum markers using longitudinal mixed models. Results For the 2,086 women studied from 1999 through 2004, PM2.5 exposures were associated with all blood markers except Factor VIIc after adjusting for age, race/ethnicity, education, site, body mass index, smoking, and recent alcohol use. Adjusted associations were of the strongest for prior year exposures for hs-CRP (21% increase per 10 μg/m3 PM2.5, 95% CI: 6.6, 37), tPA-ag (8.6%, 95% CI: 1.8, 16), and PAI-1 (35%, 95% CI: 19, 53). An association was also observed between year prior ozone exposure and Factor VIIc (5.7% increase per 10 ppb ozone, 95% CI: 2.9, 8.5). Conclusions Our findings suggest that prior year exposures to PM2.5 and ozone are associated with adverse effects on inflammatory and hemostatic pathways for cardiovascular outcomes in midlife women. PMID:26600256

GRACE score predicts heart failure admission following acute coronary syndrome.

PubMed

McAllister, David A; Halbesma, Nynke; Carruthers, Kathryn; Denvir, Martin; Fox, Keith A

2015-04-01

Congestive heart failure (CHF) is a common and preventable complication of acute coronary syndrome (ACS). Nevertheless, ACS risk scores have not been shown to predict CHF risk. We investigated whether the at-discharge Global Registry of Acute Coronary Events (GRACE) score predicts heart failure admission following ACS. Five-year mortality and hospitalization data were obtained for patients admitted with ACS from June 1999 to September 2009 to a single centre of the GRACE registry. CHF was defined as any admission assigned WHO International Classification of Diseases 10 diagnostic code I50. The hazard ratio (HR) for CHF according to GRACE score was estimated in Cox models adjusting for age, gender and the presence of CHF on index admission. Among 1,956 patients, CHF was recorded on index admission in 141 patients (7%), and 243 (12%) were admitted with CHF over 3.8 median years of follow-up. Compared to the lowest quintile, patients in the highest GRACE score quintile had more CHF admissions (116 vs 17) and a shorter time to first admission (1.2 vs 2.0 years, HR 9.87, 95% CI 5.93-16.43). Per standard deviation increment in GRACE score, the instantaneous risk was more than two-fold higher (HR 2.28; 95% CI 2.02-2.57), including after adjustment for CHF on index admission, age and gender (HR 2.49; 95% CI 2.06-3.02). The C-statistic for CHF admission at 1-year was 0.74 (95% CI 0.70-0.79). The GRACE score predicts CHF admission, and may therefore be used to target ACS patients at high risk of CHF with clinical monitoring and therapies. © The European Society of Cardiology 2014.

Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial.

PubMed

McManus, Richard J; Mant, Jonathan; Franssen, Marloes; Nickless, Alecia; Schwartz, Claire; Hodgkinson, James; Bradburn, Peter; Farmer, Andrew; Grant, Sabrina; Greenfield, Sheila M; Heneghan, Carl; Jowett, Susan; Martin, Una; Milner, Siobhan; Monahan, Mark; Mort, Sam; Ogburn, Emma; Perera-Salazar, Rafael; Shah, Syed Ahmar; Yu, Ly-Mee; Tarassenko, Lionel; Hobbs, F D Richard

2018-03-10

Studies evaluating titration of antihypertensive medication using self-monitoring give contradictory findings and the precise place of telemonitoring over self-monitoring alone is unclear. The TASMINH4 trial aimed to assess the efficacy of self-monitored blood pressure, with or without telemonitoring, for antihypertensive titration in primary care, compared with usual care. This study was a parallel randomised controlled trial done in 142 general practices in the UK, and included hypertensive patients older than 35 years, with blood pressure higher than 140/90 mm Hg, who were willing to self-monitor their blood pressure. Patients were randomly assigned (1:1:1) to self-monitoring blood pressure (self-montoring group), to self-monitoring blood pressure with telemonitoring (telemonitoring group), or to usual care (clinic blood pressure; usual care group). Randomisation was by a secure web-based system. Neither participants nor investigators were masked to group assignment. The primary outcome was clinic measured systolic blood pressure at 12 months from randomisation. Primary analysis was of available cases. The trial is registered with ISRCTN, number ISRCTN 83571366. 1182 participants were randomly assigned to the self-monitoring group (n=395), the telemonitoring group (n=393), or the usual care group (n=394), of whom 1003 (85%) were included in the primary analysis. After 12 months, systolic blood pressure was lower in both intervention groups compared with usual care (self-monitoring, 137·0 [SD 16·7] mm Hg and telemonitoring, 136·0 [16·1] mm Hg vs usual care, 140·4 [16·5]; adjusted mean differences vs usual care: self-monitoring alone, -3·5 mm Hg [95% CI -5·8 to -1·2]; telemonitoring, -4·7 mm Hg [-7·0 to -2·4]). No difference between the self-monitoring and telemonitoring groups was recorded (adjusted mean difference -1·2 mm Hg [95% CI -3·5 to 1·2]). Results were similar in sensitivity analyses including multiple imputation. Adverse events were similar between all three groups. Self-monitoring, with or without telemonitoring, when used by general practitioners to titrate antihypertensive medication in individuals with poorly controlled blood pressure, leads to significantly lower blood pressure than titration guided by clinic readings. With most general practitioners and many patients using self-monitoring, it could become the cornerstone of hypertension management in primary care. National Institute for Health Research via Programme Grant for Applied Health Research (RP-PG-1209-10051), Professorship to RJM (NIHR-RP-R2-12-015), Oxford Collaboration for Leadership in Applied Health Research and Care, and Omron Healthcare UK. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Impact of extended monitoring-guided intensive care on outcome after severe traumatic brain injury: A prospective multicentre cohort study (PariS-TBI study).

PubMed

Mateo, Joaquim; Payen, Didier; Ghout, Idir; Vallée, Fabrice; Lescot, Thomas; Welschbillig, Stephane; Tazarourte, Karim; Azouvi, Philippe; Weiss, Jean-Jacques; Aegerter, Philippe; Vigué, Bernard

2017-01-01

We evaluated whether an integrated monitoring with systemic and specific monitoring affect mortality and disability in adults with severe traumatic brain injury (sTBI). Adults with severeTBI (Glasgow Coma Scale [GCS] ≤ 8) admitted alive in intensive care units (ICUs) were prospectively included. Primary endpoints were in-hospital 30-day mortality and extended Glasgow outcome score (GOSE) at 3 years. Association with the intensity of monitoring and outcome was studied by comparing a high level of monitoring (HLM) (systemic and ≥3 specific monitoring) and low level of monitoring (LLM) (systemic and 0-2 specific monitoring) and using inverse probability weighting procedure. 476 patients were included and IPW was used to improve the balance between the two groups of treatments (HLM/LMM). Overall hospital mortality (at 30 days) was 43%, being significantly lower in HLM than LLM group (27% vs. 53%: RR, 1.63: 95% CI: 1.23-2.15). The 14-day hospital mortality was also lower in the HLM group than expected, based upon the CRASH prediction model (35%). At 3 years, disability was not significantly different between the monitoring groups. After adjustment, HLM group improved short-term mortality but did not show any improvement in the 3-year outcome compared with LLM.

Comparative assessment of a real-time particle monitor against the reference gravimetric method for PM10 and PM2.5 in indoor air

NASA Astrophysics Data System (ADS)

Tasić, Viša; Jovašević-Stojanović, Milena; Vardoulakis, Sotiris; Milošević, Novica; Kovačević, Renata; Petrović, Jelena

2012-07-01

Accurate monitoring of indoor mass concentrations of particulate matter is very important for health risk assessment as people in developed countries spend approximately 90% of their time indoors. The direct reading, aerosol monitoring device, Turnkey, OSIRIS Particle Monitor (Model 2315) and the European reference low volume sampler, LVS3 (Sven/Leckel LVS3) with size-selective inlets for PM10 and PM2.5 fractions were used to assess the comparability of available optical and gravimetric methods for particulate matter characterization in indoor air. Simultaneous 24-hour samples were collected in an indoor environment for 60 sampling periods in the town of Bor, Serbia. The 24-hour mean PM10 levels from the OSIRIS monitor were well correlated with the LVS3 levels (R2 = 0.87) and did not show statistically significant bias. The 24-hour mean PM2.5 levels from the OSIRIS monitor were moderately correlated with the LVS3 levels (R2 = 0.71), but show statistically significant bias. The results suggest that the OSIRIS monitor provides sufficiently accurate measurements for PM10. The OSIRIS monitor underestimated the indoor PM10 concentrations by approximately 12%, relative to the reference LVS3 sampler. The accuracy of PM10 measurements could be further improved through empirical adjustment. For the fine fraction of particulate matter, PM2.5, it was found that the OSIRIS monitor underestimated indoor concentrations by approximately 63%, relative to the reference LVS3 sampler. This could lead to exposure misclassification in health effects studies relying on PM2.5 measurements collected with this instrument in indoor environments.

Substantial improvement in HbA1c following a treatment and teaching programme for people with type 2 diabetes on conventional insulin therapy in an in- and outpatient setting.

PubMed

Kuniss, Nadine; Müller, Ulrich A; Kloos, Christof; Müller, Regina; Starrach, Gerd; Jörgens, Viktor; Kramer, Guido

2018-02-01

The aim of the study was to assess the efficacy of a patient education programme (DTTP) for the optimisation of conventional insulin therapy in patients with type 2 diabetes in an in- and outpatient setting. The study was designed as a prospective, longitudinal trial. Thirty-three people with diabetes (females 54.5%, age 61.0 years, diabetes duration 12.7 years, HbA1c 9.3%) from ten general practices in Thuringia (outpatient group) participated in a DTTP for conventional insulin therapy. Thirty-three individuals-matched pairs-(female 72.7%, age 63.2 years, diabetes duration 13.6 years, HbA1c 9.7%) who were hospitalised for the optimisation of conventional insulin therapy participated in the same DTTP during their hospitalisation. All individuals were invited to participate in an outpatient follow-up visit 12 months after participation in the DTTP. All participants were re-examined after 1.0 ± 0.2 years. HbA1c improved in both groups equally by 1.2% in the outpatient group and 1.3% in the inpatient group. Insulin dosage increased marginally within the outpatient group (+ 0.09 units/kg/day, p = 0.023) and remained stable within the inpatients. Blood glucose self-monitoring increased significantly in both groups without inter-group difference (+ 7.9 vs. + 6.4 tests per week). Participation in an out- or inpatient DTTP improved substantially HbA1c levels in people with type 2 diabetes on conventional insulin treatment. Probably, the improved adjustment of the eating behaviour to the insulin therapy was the reason for improved metabolic control. Guidelines should recommend "refresher" programmes when metabolic control deteriorates before an intensification of blood glucose-lowering treatment.

Accuracy of Zero-Heat-Flux Cutaneous Temperature in Intensive Care Adults.

PubMed

Dahyot-Fizelier, Claire; Lamarche, Solène; Kerforne, Thomas; Bénard, Thierry; Giraud, Benoit; Bellier, Rémy; Carise, Elsa; Frasca, Denis; Mimoz, Olivier

2017-07-01

To compare accuracy of a continuous noninvasive cutaneous temperature using zero-heat-flux method to esophageal temperature and arterial temperature. Prospective study. ICU and NeuroICU, University Hospital. Fifty-two ICU patients over a 4-month period who required continuous temperature monitoring were included in the study, after informed consent. All patients had esophageal temperature probe and a noninvasive cutaneous device to monitor their core temperature continuously. In seven patients who required cardiac output monitoring, continuous iliac arterial temperature was collected. Simultaneous core temperatures were recorded from 1 to 5 days. Comparison to the esophageal temperature, considered as the reference in this study, used the Bland and Altman method with adjustment for multiple measurements per patient. The esophageal temperature ranged from 33°C to 39.7°C, 61,298 pairs of temperature using zero-heat-flux and esophageal temperature were collected and 1,850 triple of temperature using zero-heat-flux, esophageal temperature, and arterial temperature. Bias and limits of agreement for temperature using zero-heat-flux were 0.19°C ± 0.53°C compared with esophageal temperature with an absolute difference of temperature pairs equal to or lower than 0.5°C of 92.6% (95% CI, 91.9-93.4%) of cases and equal to or lower than 1°C for 99.9% (95% CI, 99.7-100.0%) of cases. Compared with arterial temperature, bias and limits of agreement were -0.00°C ± 0.36°C with an absolute difference of temperature pairs equal to or lower than 0.5°C of 99.8% (95% CI, 95.3-100%) of cases. All absolute difference of temperature pairs between temperature using zero-heat-flux and arterial temperature and between arterial temperature and esophageal temperature were equal to or lower than 1°C. No local or systemic serious complication was observed. These results suggest a comparable reliability of the cutaneous sensor using the zero-heat-flux method compared with esophageal or iliac arterial temperatures measurements.

The effect of temperature correction of blood gas values on the accuracy of end-tidal carbon dioxide monitoring in children after cardiac surgery.

PubMed

Suominen, Pertti K; Stayer, Stephen; Wang, Wei; Chang, Anthony C

2007-01-01

We evaluated accuracy of end-tidal carbon dioxide tension (PETco2) monitoring and measured the effect of temperature correction of blood gas values in children after cardiac surgery. Data from 49 consecutive mechanically ventilated children after cardiac surgery in the cardiac intensive care unit were prospectively collected. One patient was excluded from the study. Four arterial-end-tidal CO2 pairs in each patient were obtained. Both the arterial carbon dioxide tension (Paco2) values determined at a temperature of 37 degrees C and values corrected to body temperature (Patcco2) were compared with the PETco2 values. After the surgical correction 28 patients had biventricular, acyanotic (mean age 2.7 +/- 4.8 years) and 20 patients had a cyanotic lesion (mean age 1.0 +/- 1.7 years). The body temperature ranged from 35.2 degrees C to 38.9 degrees C. The Pa-PETco2 discrepancy was affected both by the type of cardiac lesion and by the temperature correction of Paco2 values. Correlation slopes of the Pa-PETco2 and Patc-PETco2 discrepancies were significantly different (p = 0.040) when the body temperature was higher or lower than 37 degrees C. In children, after cardiac surgery, end-tidal CO2 monitoring provided a clinically acceptable estimate of arterial CO2 value, which remained stabile in repeated measurements. End-tidal CO2 monitoring more accurately reflects temperature-corrected blood gas values.

Relationships between air pollution and preterm birth in California.

PubMed

Huynh, Mary; Woodruff, Tracey J; Parker, Jennifer D; Schoendorf, Kenneth C

2006-11-01

Air pollution from vehicular emissions and other combustion sources is related to cardiovascular and respiratory outcomes. However, few studies have investigated the relationship between air pollution and preterm birth, a primary cause of infant mortality and morbidity. This analysis examined the effect of fine particulate matter (PM(2.5)) and carbon monoxide (CO) on preterm birth in a matched case-control study. PM(2.5) and CO monitoring data from the California Air Resources Board were linked to California birth certificate data for singletons born in 1999-2000. Each birth was mapped to the closest PM monitor within 5 miles of the home address. County-level CO measures were utilised to increase sample size and maintain a representative population. After exclusion of implausible birthweight-gestation combinations, preterm birth was defined as birth occurring between 24 and 36 weeks' gestation. Each of the 10 673 preterm cases was matched to three controls of term (39-44 weeks) gestation with a similar date of last menstrual period. Based on the case's gestational age, CO and PM(2.5) exposures were calculated for total pregnancy, first month of pregnancy, and last 2 weeks of pregnancy. Exposures were divided into quartiles; the lowest quartile was the reference. Because of the matched design, conditional logistic regression was used to adjust for maternal race/ethnicity, age, parity, marital status and education. High total pregnancy PM(2.5) exposure was associated with a small effect on preterm birth, after adjustment for maternal factors (adjusted odds ratio [AOR] = 1.15, [95% CI 1.07, 1.24]). The odds ratio did not change after adjustment for CO. Results were similar for PM(2.5) exposure during the first month of pregnancy (AOR = 1.21, 95% CI [1.12, 1.30]) and the last 2 weeks of pregnancy (AOR = 1.17, 95% CI [1.09, 1.27]). Conversely, CO exposure at any time during pregnancy was not associated with preterm birth (AORs from 0.95 to 1.00). Maternal exposure to PM(2.5), but not CO, is associated with preterm birth. This analysis did not show differences by timing of exposure, although more detailed examination may be needed.

40 CFR 63.7535 - How do I monitor and collect data to demonstrate continuous compliance?

Code of Federal Regulations, 2012 CFR

2012-07-01

... activities, including, as applicable, calibration checks and required zero and span adjustments. A monitoring...-control periods, or required monitoring system quality assurance or control activities in data averages... data according to this section and the site-specific monitoring plan required by § 63.7505(d). (b) You...

40 CFR 63.7535 - How do I monitor and collect data to demonstrate continuous compliance?

Code of Federal Regulations, 2011 CFR

2011-07-01

... activities, including, as applicable, calibration checks and required zero and span adjustments. A monitoring...-control periods, or required monitoring system quality assurance or control activities in data averages... data according to this section and the site-specific monitoring plan required by § 63.7505(d). (b) You...

40 CFR 1033.320 - Calculation and reporting of test results.

Code of Federal Regulations, 2010 CFR

2010-07-01

... applicable non-deterioration adjustments such as a Green Engine Factor or regeneration adjustment factor... following are true: (1) The catalyst was in a green condition when tested initially. (2) The locomotive met... locomotive, including: (A) Configuration and engine family identification. (B) Year, make, and build date. (C...

50 CFR 648.55 - Framework adjustments to management measures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... establish OFL, ABC, ACL, ACT, DAS allocations, rotational area management programs, percentage allocations... measures will be adjusted. (c) OFL, ABC, ACL, ACT, and AMs. The Council shall specify OFL, ABC, ACL, ACT... derive specifications for ABC, ACL, and ACT, as specified in paragraphs (a)(2) through (5) of this...

Serum low-density lipoprotein cholesterol level is strong risk factor for acquired color vision impairment in young to middle-aged Japanese men: the Okubo Color Study Report 2.

PubMed

Shoji, Takuhei; Sakurai, Yutaka; Sato, Hiroki; Chihara, Etsuo; Ishida, Masahiro; Omae, Kazuyuki

2010-06-01

To investigate associations between blood low-density lipoprotein cholesterol (LDL-C) levels and the prevalence of acquired color vision impairment (ACVI) in middle-aged Japanese men. Participants in this cross-sectional study underwent color vision testing, ophthalmic examination, a standardized interview and examination of venous blood samples. Ishihara plates, a Lanthony 15-hue desaturated panel, and Standard pseudoisochromatic Plates part 2 were used to examine color vision ability. The Farnsworth-Munsell 100-hue test was performed to define ACVI. Smoking status and alcohol intake were recorded during the interview. We performed logistic regression analysis adjusted for age, LDL-C level, systemic hypertension, diabetes, cataract, glaucoma, overweight, smoking status, and alcohol intake. Adjusted odds ratios for four LDL-C levels were calculated. A total of 1042 men were enrolled, 872 participants were eligible for the study, and 31 subjects were diagnosed with ACVI. As compared to the lowest LDL-C category level (<100 mg/dl), the crude OR of ACVI was 3.85 (95% confidence interval [CI], 1.24-11.00) for the 2nd highest category (130-159 mg/dl), and 4.84 (95% CI, 1.42-16.43) for the highest level (>or=160 mg/dl). The multiple-adjusted ORs were 2.91 (95% CI, 0.87-9.70) for the 2nd highest category and 3.81 (95% CI, 1.03-14.05) for the highest level. Tests for trend were significant (P<0.05) in both analyses. These findings suggested that the prevalence of ACVI is higher among middle-aged Japanese men with elevated LDL-C levels. These changes might be related to deteriorated neurologic function associated with lipid metabolite abnormalities. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

An information and communication technology-based centralized clinical trial to determine the efficacy and safety of insulin dose adjustment education based on a smartphone personal health record application: a randomized controlled trial.

PubMed

Kim, Gyuri; Bae, Ji Cheol; Yi, Byoung Kee; Hur, Kyu Yeon; Chang, Dong Kyung; Lee, Moon-Kyu; Kim, Jae Hyeon; Jin, Sang-Man

2017-07-18

A Personal Health Record (PHR) is an online application that allows patients to access, manage, and share their health data. PHRs not only enhance shared decision making with healthcare providers, but also enable remote monitoring and at-home-collection of detailed data. The benefits of PHRs can be maximized in insulin dose adjustment for patients starting or intensifying insulin regimens, as frequent self-monitoring of glucose, self-adjustment of insulin dose, and precise at-home data collection during the visit-to-visit period are important for glycemic control. The aim of this study is to examine the efficacy and safety of insulin dose adjustment based on a smartphone PHR application in patients with diabetes mellitus (DM) and to confirm the validity and stability of an information and communication technology (ICT)-based centralized clinical trial monitoring system. This is a 24-week, open-label, randomized, multi-center trial. There are three follow-up measures: baseline, post-intervention at week 12, and at week 24. Subjects diagnosed with type 1 DM, type 2 DM, and/or post-transplant DM who initiate basal insulin or intensify their insulin regimen to a basal-bolus regimen are included. After education on insulin dose titration and prevention for hypoglycemia and a 1-week acclimation period, subjects are randomized in a 1:1 ratio to either an ICT-based intervention group or a conventional intervention group. Subjects in the conventional intervention group will save and send their health information to the server via a PHR application, whereas those in ICT-based intervention group will receive additional algorithm-based feedback messages. The health information includes level of blood glucose, insulin dose, details on hypoglycemia, food diary, and step count. The primary outcome will be the proportion of patients who reach an optimal insulin dose within 12 weeks of study enrollment, without severe hypoglycemia or unscheduled clinic visits. This clinical trial will reveal whether insulin dose adjustment based on a smartphone PHR application can facilitate the optimization of insulin doses in patients with DM. In addition, the process evaluation will provide information about the validity and stability of the ICT-based centralized clinical trial monitoring system in this research field. Clinicaltrials.gov NCT 03112343 . Registered on 12 April 2017.

Effect of Depth and Duration of Cooling on Death or Disability at Age 18 Months Among Neonates With Hypoxic-Ischemic Encephalopathy: A Randomized Clinical Trial.

PubMed

Shankaran, Seetha; Laptook, Abbot R; Pappas, Athina; McDonald, Scott A; Das, Abhik; Tyson, Jon E; Poindexter, Brenda B; Schibler, Kurt; Bell, Edward F; Heyne, Roy J; Pedroza, Claudia; Bara, Rebecca; Van Meurs, Krisa P; Huitema, Carolyn M Petrie; Grisby, Cathy; Devaskar, Uday; Ehrenkranz, Richard A; Harmon, Heidi M; Chalak, Lina F; DeMauro, Sara B; Garg, Meena; Hartley-McAndrew, Michelle E; Khan, Amir M; Walsh, Michele C; Ambalavanan, Namasivayam; Brumbaugh, Jane E; Watterberg, Kristi L; Shepherd, Edward G; Hamrick, Shannon E G; Barks, John; Cotten, C Michael; Kilbride, Howard W; Higgins, Rosemary D

2017-07-04

Hypothermia for 72 hours at 33.5°C for neonatal hypoxic-ischemic encephalopathy reduces death or disability, but rates continue to be high. To determine if cooling for 120 hours or to a temperature of 32.0°C reduces death or disability at age 18 months in infants with hypoxic-ischemic encephalopathy. Randomized 2 × 2 factorial clinical trial in neonates (≥36 weeks' gestation) with hypoxic-ischemic encephalopathy at 18 US centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network between October 2010 and January 2016. A total of 364 neonates were randomly assigned to 4 hypothermia groups: 33.5°C for 72 hours (n = 95), 32.0°C for 72 hours (n = 90), 33.5°C for 120 hours (n = 96), or 32.0°C for 120 hours (n = 83). The primary outcome was death or moderate or severe disability at 18 to 22 months of age adjusted for center and level of encephalopathy. Severe disability included any of Bayley Scales of Infant Development III cognitive score less than 70, Gross Motor Function Classification System (GMFCS) level of 3 to 5, or blindness or hearing loss despite amplification. Moderate disability was defined as a cognitive score of 70 to 84 and either GMFCS level 2, active seizures, or hearing with amplification. The trial was stopped for safety and futility in November 2013 after 364 of the planned 726 infants were enrolled. Among 347 infants (95%) with primary outcome data (mean age at follow-up, 20.7 [SD, 3.5] months; 42% female), death or disability occurred in 56 of 176 (31.8%) cooled for 72 hours and 54 of 171 (31.6%) cooled for 120 hours (adjusted risk ratio, 0.92 [95% CI, 0.68-1.25]; adjusted absolute risk difference, -1.0% [95% CI, -10.2% to 8.1%]) and in 59 of 185 (31.9%) cooled to 33.5°C and 51 of 162 (31.5%) cooled to 32.0°C (adjusted risk ratio, 0.92 [95% CI, 0.68-1.26]; adjusted absolute risk difference, -3.1% [95% CI, -12.3% to 6.1%]). A significant interaction between longer and deeper cooling was observed (P = .048), with primary outcome rates of 29.3% at 33.5°C for 72 hours, 34.5% at 32.0°C for 72 hours, 34.4% at 33.5°C for 120 hours, and 28.2% at 32.0°C for 120 hours. Among term neonates with moderate or severe hypoxic-ischemic encephalopathy, cooling for longer than 72 hours, cooling to lower than 33.5°C, or both did not reduce death or moderate or severe disability at 18 months of age. However, the trial may be underpowered, and an interaction was found between longer and deeper cooling. These results support the current regimen of cooling for 72 hours at 33.5°C. clinicaltrials.gov Identifier: NCT01192776.

Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS

PubMed Central

Shokati, Touraj; Bodenberger, Nicholas; Gadpaille, Holly; Schniedewind, Björn; Vinks, Alexander A.; Jiang, Wenlei; Alloway, Rita R.; Christians, Uwe

2015-01-01

The calcineurin inhibitor tacrolimus is the cornerstone of most immunosuppressive treatment protocols after solid organ transplantation in the United States. Tacrolimus is a narrow therapeutic index drug and as such requires therapeutic drug monitoring and dose adjustment based on its whole blood trough concentrations. To facilitate home therapeutic drug and adherence monitoring, the collection of dried blood spots is an attractive concept. After a finger stick, the patient collects a blood drop on filter paper at home. After the blood is dried, it is mailed to the analytical laboratory where tacrolimus is quantified using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) in combination with a simple manual protein precipitation step and online column extraction. For tacrolimus analysis, a 6-mm disc is punched from the saturated center of the blood spot. The blood spot is homogenized using a bullet blender and then proteins are precipitated with methanol/0.2 M ZnSO4 containing the internal standard D2,13C-tacrolimus. After vortexing and centrifugation, 100 µl of supernatant is injected into an online extraction column and washed with 5 ml/min of 0.1 formic acid/acetonitrile (7:3, v:v) for 1 min. Hereafter, the switching valve is activated and the analytes are back-flushed onto the analytical column (and separated using a 0.1% formic acid/acetonitrile gradient). Tacrolimus is quantified in the positive multi reaction mode (MRM) using a tandem mass spectrometer. The assay is linear from 1 to 50 ng/ml. Inter-assay variability (3.6%-6.1%) and accuracy (91.7%-101.6%) as assessed over 20 days meet acceptance criteria. Average extraction recovery is 95.5%. There are no relevant carry-over, matrix interferences and matrix effects. Tacrolimus is stable in dried blood spots at RT and at +4 °C for 1 week. Extracted samples in the autosampler are stable at +4 °C for at least 72 hr. PMID:26575262

Patient-led versus physician-led titration of insulin glargine in patients with uncontrolled type 2 diabetes: a randomized multinational ATLAS study.

PubMed

Garg, Satish K; Admane, Karim; Freemantle, Nick; Odawara, Masato; Pan, Chang-Yu; Misra, Anoop; Jarek-Martynowa, Iwona R; Abbas-Raza, Syed; Mirasol, Roberto C; Perfetti, Riccardo

2015-02-01

Self-adjustment of insulin dose is commonly practiced in Western patients with type 2 diabetes but is usually not performed in Asian patients. This multinational, 24-week, randomized study compared patient-led with physician-led titration of once-daily insulin glargine in Asian patients with uncontrolled type 2 diabetes who were on 2 oral glucose-lowering agents. Patient-led (n = 275) or physician-led (n = 277) subjects followed the same dose-titration algorithm guided by self-monitored fasting blood glucose (FBG; target, 110 mg/dL [6.1 mmol/L]). The primary endpoint was change in mean glycated hemoglobin (HbA1c) at week 24 in the patient-led versus physician-led titration groups. Patient-led titration resulted in a significantly higher drop in HbA1c value at 24 weeks when compared with physician-led titration (-1.40% vs. -1.25%; mean difference, -0.15; 95% confidence interval, -0.29 to 0.00; P = .043). Mean decrease in FBG was greatest in the patient-led group (-2.85 mmol/L vs. -2.48 mmol/L; P = .001). The improvements in HbA1c and FBG were consistent across countries, with similar improvements in treatment satisfaction in both groups. Mean daily insulin dose was higher in the patient-led group (28.9 units vs. 22.2 units; P<.001). Target HbA1c of <7.0% without severe hypoglycemia was achieved in 40.0% and 32.9% in the patient-led and physician-led groups, respectively (P = .086). Severe hypoglycemia was not different in the 2 groups (0.7%), with an increase in nocturnal and symptomatic hypoglycemia in the patient-led arm. Patient-led insulin glargine titration achieved near-target blood glucose levels in Asian patients with uncontrolled type 2 diabetes who were on 2 oral glucose-lowering drugs, demonstrating that Asian patients can self-uptitrate insulin dose effectively when guided.

Novel protein glycan side-chain biomarker and risk of incident type 2 diabetes mellitus.

PubMed

Akinkuolie, Akintunde O; Pradhan, Aruna D; Buring, Julie E; Ridker, Paul M; Mora, Samia

2015-06-01

Enzymatically glycosylated proteins partake in multiple biological processes, including glucose transport and inflammation. We hypothesized that a novel biomarker (GlycA) of N-acetyl methyl groups originating mainly from N-acetylglucosamine moieties of acute-phase glycoproteins is related to incident type 2 diabetes mellitus and compared it with high-sensitivity C-reactive protein. In 26,508 initially healthy women free of diabetes mellitus, baseline GlycA and high-sensitivity C-reactive protein were quantified by nuclear magnetic resonance spectroscopy and immunoturbidimetry, respectively. During median follow-up of 17.2 years, 2087 type 2 diabetes mellitus cases occurred. In Cox models with adjustment for age, race, smoking, alcohol, activity, menopausal status, hormone use, family history, and body mass index, quartile 4 versus 1 hazard ratios and 95% confidence intervals were 2.67 (2.26-3.14) for GlycA and 3.93 (3.24-4.77) for high-sensitivity C-reactive protein; both P trend <0.0001. Associations for GlycA and high-sensitivity C-reactive protein were attenuated after additionally adjusting for lipids: 1.65 (1.39-1.95) and 2.83 (2.32-3.44), respectively, both P trend <0.0001, and after mutual adjustment: 1.11 (0.93-1.33; P trend=0.10) and 2.57 (2.09-3.16; P trend<0.0001), respectively. Our finding of an association between a consensus glycan sequence common to a host of acute-phase reactants and incident type 2 diabetes mellitus provides further support for inflammation in the development of type 2 diabetes mellitus. Additional studies exploring the role of enzymatic glycosylation in the prevention of type 2 diabetes mellitus are warranted. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000479. © 2015 American Heart Association, Inc.

40 CFR 464.36 - Pretreatment standards for new sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 0.0257 0.00838 Oil and Grease (for alternate monitoring) 1.43 0.476 (2) Applicable to plants that... Oil and Grease (for alternate monitoring) 1.43 0.476 (c) Dust Collection Scrubber Operations. (1... TTO 2.04 0.664 Oil and Grease (for alternate monitoring) 22.5 7.51 (2) Applicable to plants that are...

40 CFR 464.36 - Pretreatment standards for new sources.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 0.0257 0.00838 Oil and Grease (for alternate monitoring) 1.43 0.476 (2) Applicable to plants that... Oil and Grease (for alternate monitoring) 1.43 0.476 (c) Dust Collection Scrubber Operations. (1... TTO 2.04 0.664 Oil and Grease (for alternate monitoring) 22.5 7.51 (2) Applicable to plants that are...

Intra-operative adjustment of standard planes in C-arm CT image data.

PubMed

Brehler, Michael; Görres, Joseph; Franke, Jochen; Barth, Karl; Vetter, Sven Y; Grützner, Paul A; Meinzer, Hans-Peter; Wolf, Ivo; Nabers, Diana

2016-03-01

With the help of an intra-operative mobile C-arm CT, medical interventions can be verified and corrected, avoiding the need for a post-operative CT and a second intervention. An exact adjustment of standard plane positions is necessary for the best possible assessment of the anatomical regions of interest but the mobility of the C-arm causes the need for a time-consuming manual adjustment. In this article, we present an automatic plane adjustment at the example of calcaneal fractures. We developed two feature detection methods (2D and pseudo-3D) based on SURF key points and also transferred the SURF approach to 3D. Combined with an atlas-based registration, our algorithm adjusts the standard planes of the calcaneal C-arm images automatically. The robustness of the algorithms is evaluated using a clinical data set. Additionally, we tested the algorithm's performance for two registration approaches, two resolutions of C-arm images and two methods for metal artifact reduction. For the feature extraction, the novel 3D-SURF approach performs best. As expected, a higher resolution ([Formula: see text] voxel) leads also to more robust feature points and is therefore slightly better than the [Formula: see text] voxel images (standard setting of device). Our comparison of two different artifact reduction methods and the complete removal of metal in the images shows that our approach is highly robust against artifacts and the number and position of metal implants. By introducing our fast algorithmic processing pipeline, we developed the first steps for a fully automatic assistance system for the assessment of C-arm CT images.

Phasic valence and arousal do not influence post-conflict adjustments in the Simon task.

PubMed

Dignath, David; Janczyk, Markus; Eder, Andreas B

2017-03-01

According to theoretical accounts of cognitive control, conflict between competing responses is monitored and triggers post conflict behavioural adjustments. Some models proposed that conflict is detected as an affective signal. While the conflict monitoring theory assumed that conflict is registered as a negative valence signal, the adaptation by binding model hypothesized that conflict provides a high arousal signal. The present research induced phasic affect in a Simon task with presentations of pleasant and unpleasant pictures that were high or low in arousal. If conflict is registered as an affective signal, the presentation of a corresponding affective signal should potentiate post conflict adjustments. Results did not support the hypothesis, and Bayesian analyses corroborated the conclusion that phasic affects do not influence post conflict behavioural adjustments in the Simon task. Copyright © 2017 Elsevier B.V. All rights reserved.

Improved nurse-parent communication in neonatal intensive care unit: evaluation and adjustment of an implementation strategy.

PubMed

Weis, Janne; Zoffmann, Vibeke; Egerod, Ingrid

2014-12-01

To evaluate and adjust systematic implementation of guided family-centred care in a neonatal intensive care unit. Family-centred care is valued in neonatal intensive care units internationally, but innovative strategies are needed to realise the principles. Guided family-centred care was developed to facilitate person-centred communication by bridging the gap between theory and practice in family-centred care. Main mechanisms of guided family-centred care are structured dialogue, reflection and person-centred communication. Qualitative and quantitative data were used to monitor participatory implementation of a systematic approach to training and certification of nurses delivering guided family-centred care. Systematic implementation of guided family-centred care included workshops, supervised delivery and certification. Evaluation and adjustment of nurse adherence to guided family-centred care was conducted by monitoring (1) knowledge, (2) delivery, (3) practice uptake and (4) certification. Implementation was improved by the development of a strategic framework and by adjusting the framework according to the real-life context of a busy neonatal care unit. Promoting practice uptake was initially underestimated, but nurse guided family-centred care training was improved by increasing the visibility of the study in the unit, demonstrating intervention progress to the nurses and assuring a sense of ownership among nurse leaders and nonguided-family-centred-care-trained nurses. An adjusted framework for guided family-centred care implementation was successful in overcoming barriers and promoting facilitators. Insights gained from our pioneering work might help nurses in a similar context to reach their goals of improving family-centred care. © 2014 John Wiley & Sons Ltd.

Oxygen sensor for monitoring gas mixtures containing hydrocarbons

DOEpatents

Ruka, Roswell J.; Basel, Richard A.

1996-01-01

A gas sensor measures O.sub.2 content of a reformable monitored gas containing hydrocarbons H.sub.2 O and/or CO.sub.2, preferably in association with an electrochemical power generation system. The gas sensor has a housing communicating with the monitored gas environment and carries the monitored gas through an integral catalytic hydrocarbon reforming chamber containing a reforming catalyst, and over a solid electrolyte electrochemical cell used for sensing purposes. The electrochemical cell includes a solid electrolyte between a sensor electrode that is exposed to the monitored gas, and a reference electrode that is isolated in the housing from the monitored gas and is exposed to a reference gas environment. A heating element is also provided in heat transfer communication with the gas sensor. A circuit that can include controls operable to adjust operations via valves or the like is connected between the sensor electrode and the reference electrode to process the electrical signal developed by the electrochemical cell. The electrical signal varies as a measure of the equilibrium oxygen partial pressure of the monitored gas. Signal noise is effectively reduced by maintaining a constant temperature in the area of the electrochemical cell and providing a monitored gas at chemical equilibria when contacting the electrochemical cell. The output gas from the electrochemical cell of the sensor is fed back into the conduits of the power generating system.

Oxygen sensor for monitoring gas mixtures containing hydrocarbons

DOEpatents

Ruka, R.J.; Basel, R.A.

1996-03-12

A gas sensor measures O{sub 2} content of a reformable monitored gas containing hydrocarbons, H{sub 2}O and/or CO{sub 2}, preferably in association with an electrochemical power generation system. The gas sensor has a housing communicating with the monitored gas environment and carries the monitored gas through an integral catalytic hydrocarbon reforming chamber containing a reforming catalyst, and over a solid electrolyte electrochemical cell used for sensing purposes. The electrochemical cell includes a solid electrolyte between a sensor electrode that is exposed to the monitored gas, and a reference electrode that is isolated in the housing from the monitored gas and is exposed to a reference gas environment. A heating element is also provided in heat transfer communication with the gas sensor. A circuit that can include controls operable to adjust operations via valves or the like is connected between the sensor electrode and the reference electrode to process the electrical signal developed by the electrochemical cell. The electrical signal varies as a measure of the equilibrium oxygen partial pressure of the monitored gas. Signal noise is effectively reduced by maintaining a constant temperature in the area of the electrochemical cell and providing a monitored gas at chemical equilibria when contacting the electrochemical cell. The output gas from the electrochemical cell of the sensor is fed back into the conduits of the power generating system. 4 figs.

Association of Peak Changes in Plasma Cystatin C and Creatinine with Mortality post Cardiac Surgery

PubMed Central

Park, Meyeon; Shlipak, Michael G.; Thiessen-Philbrook, Heather; Garg, Amit X.; Koyner, Jay L.; Coca, Steven G.; Parikh, Chirag R.

2015-01-01

Background Acute kidney injury is a risk factor for mortality in cardiac surgery patients. Plasma cystatin C and creatinine have different temporal profiles in the post-operative setting, but the associations of simultaneous changes in both filtration markers as compared to change in only one marker with prognosis following hospital discharge are not well described. Methods This is a longitudinal study of 1199 high-risk adult cardiac surgery patients in the TRIBE-AKI (Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury) Consortium who survived hospitalization. We examined in-hospital peak changes of cystatin C and creatinine in the 3 days following cardiac surgery. We evaluated associations of these filtration markers with mortality, adjusting for demographics, operative characteristics, medical comorbidities, pre-operative estimated glomerular filtration rate, pre-operative urinary albumin to creatinine ratio, and site. Results During the first 3 days of hospitalization, nearly twice as many patients had a ≥ 25% rise in creatinine (30%) compared to a ≥ 25% peak rise in cystatin C (15%). Those with elevations in either cystatin C or creatinine had higher mortality risk (adjusted hazard ratio cystatin C 1.83 (95% CI 1.4–2.37) and creatinine 1.90 (95% CI 1.32–2.72)) compared with persons who experienced a post-operative decrease in either filtration marker, respectively. Patients who had simultaneous elevations of ≥ 25% in both cystatin C and creatinine were at similar adjusted risk for 3 year mortality (HR 1.79, 95% CI 1.03–3.1) as those with ≥ 25% increase in cystatin C alone (HR 2.2, 95% CI 1.09–4.47). Conclusions Elevations in creatinine post-operatively are more common than elevations in cystatin C. However, elevations in cystatin C appeared to be associated with higher risk of mortality after hospital discharge. PMID:26921980

Inhalable Ipratropium Bromide Particle Engineering with Multicriteria Optimization.

PubMed

Vinjamuri, Bhavani Prasad; Haware, Rahul V; Stagner, William C

2017-08-01

Spray-dried ipratropium bromide (IPB) microspheres for oral inhalation were engineered using Quality by Design. The interrogation of material properties, process parameters, and critical product quality attributes interplay enabled rational product design. A 2 7-3 screening design exhibited the Maillard reaction between L-leucine (LL) and lactose at studied outlet temperatures (OT) >130°C. A response surface custom design was used in conjunction with multicriteria optimization to determine the operating design space to achieve inhalable microparticles. Statistically significant predictive models were developed for volume median diameter (p = 0.0001, adjusted R 2   = 0.9938), span (p = 0.0278, adjusted R 2   = 0.7912), yield (p = 0.0020, adjusted R 2   = 0.9320), and OT (p = 0.0082, adjusted R 2   = 0.8768). An independent verification batch confirmed the model's predictive capability. The prediction and actual values were in good agreement. Particle size and span were 3.32 ± 0.09 μm and 1.71 ± 0.18, which were 4.7 and 5.3% higher than the predicted values. The process yield was 50.3%, compared to the predicted value of 65.3%. The OT was 100°C versus the predicted value of 105°C. The label strength of IPB microparticles was 99.0 to 105.9% w/w suggesting that enrichment occurred during the spray-drying process. The present study can be utilized to initiate the design of the first commercial IPB dry powder inhaler.

Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges.

PubMed

Bajorek, Beata; Lemay, Kate S; Magin, Parker; Roberts, Christopher; Krass, Ines; Armour, Carol L

2016-01-01

Suboptimal utilisation of pharmacotherapy, non-adherence to prescribed treatment, and a lack of monitoring all contribute to poor blood (BP) pressure control in patients with hypertension. The objective of this study was to evaluate the implementation of a pharmacist-led hypertension management service in terms of processes, outcomes, and methodological challenges. A prospective, controlled study was undertaken within the Australian primary care setting. Community pharmacists were recruited to one of three study groups: Group A (Control - usual care), Group B (Intervention), or Group C (Short Intervention). Pharmacists in Groups B and C delivered a service comprising screening and monitoring of BP, as well as addressing poor BP control through therapeutic adjustment and adherence strategies. Pharmacists in Group C delivered the shortened version of the service. Significant changes to key outcome measures were observed in Group C: reduction in systolic and diastolic BPs at the 3-month visit (P<0.01 and P<0.01, respectively), improvement in medication adherence scores (P=0.01), and a slight improvement in quality of life (EQ-5D-3L Index) scores (P=0.91). There were no significant changes in Group B (the full intervention), and no differences in comparison to Group A (usual care). Pharmacists fed-back that patient recruitment was a key barrier to service implementation, highlighting the methodological implications of screening. A collaborative, pharmacist-led hypertension management service can help monitor BP, improve medication adherence, and optimise therapy in a step-wise approach. However, blood pressure screening can effect behaviour change in patients, presenting methodological challenges in the evaluation of services in this context.

Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges

PubMed Central

2016-01-01

Background: Suboptimal utilisation of pharmacotherapy, non-adherence to prescribed treatment, and a lack of monitoring all contribute to poor blood (BP) pressure control in patients with hypertension. Objective: The objective of this study was to evaluate the implementation of a pharmacist-led hypertension management service in terms of processes, outcomes, and methodological challenges. Method: A prospective, controlled study was undertaken within the Australian primary care setting. Community pharmacists were recruited to one of three study groups: Group A (Control – usual care), Group B (Intervention), or Group C (Short Intervention). Pharmacists in Groups B and C delivered a service comprising screening and monitoring of BP, as well as addressing poor BP control through therapeutic adjustment and adherence strategies. Pharmacists in Group C delivered the shortened version of the service. Results: Significant changes to key outcome measures were observed in Group C: reduction in systolic and diastolic BPs at the 3-month visit (P<0.01 and P<0.01, respectively), improvement in medication adherence scores (P=0.01), and a slight improvement in quality of life (EQ-5D-3L Index) scores (P=0.91). There were no significant changes in Group B (the full intervention), and no differences in comparison to Group A (usual care). Pharmacists fed-back that patient recruitment was a key barrier to service implementation, highlighting the methodological implications of screening. Conclusion: A collaborative, pharmacist-led hypertension management service can help monitor BP, improve medication adherence, and optimise therapy in a step-wise approach. However, blood pressure screening can effect behaviour change in patients, presenting methodological challenges in the evaluation of services in this context. PMID:27382427

The use and efficacy of continuous glucose monitoring in type 1 diabetes treated with insulin pump therapy: a randomised controlled trial.

PubMed

Battelino, T; Conget, I; Olsen, B; Schütz-Fuhrmann, I; Hommel, E; Hoogma, R; Schierloh, U; Sulli, N; Bolinder, J

2012-12-01

The aim of this multicentre, randomised, controlled crossover study was to determine the efficacy of adding continuous glucose monitoring (CGM) to insulin pump therapy (CSII) in type 1 diabetes. Children and adults (n = 153) on CSII with HbA(1c) 7.5-9.5% (58.5-80.3 mmol/mol) were randomised to (CGM) a Sensor On or Sensor Off arm for 6 months. After 4 months' washout, participants crossed over to the other arm for 6 months. Paediatric and adult participants were separately electronically randomised through the case report form according to a predefined randomisation sequence in eight secondary and tertiary centres. The primary outcome was the difference in HbA(1c) levels between arms after 6 months. Seventy-seven participants were randomised to the On/Off sequence and 76 to the Off/On sequence; all were included in the primary analysis. The mean difference in HbA(1c) was -0.43% (-4.74 mmol/mol) in favour of the Sensor On arm (8.04% [64.34 mmol/mol] vs 8.47% [69.08 mmol/mol]; 95% CI -0.32%, -0.55% [-3.50, -6.01 mmol/mol]; p < 0.001). Following cessation of glucose sensing, HbA(1c) reverted to baseline levels. Less time was spent with sensor glucose <3.9 mmol/l during the Sensor On arm than in the Sensor Off arm (19 vs 31 min/day; p = 0.009). The mean number of daily boluses increased in the Sensor On arm (6.8 ± 2.5 vs 5.8 ± 1.9, p < 0.0001), together with the frequency of use of the temporary basal rate (0.75 ± 1.11 vs 0.26 ± 0.47, p < 0.0001) and manual insulin suspend (0.91 ± 1.25 vs 0.70 ± 0.75, p < 0.018) functions. Four vs two events of severe hypoglycaemia occurred in the Sensor On and Sensor Off arm, respectively (p = 0.40). Continuous glucose monitoring was associated with decreased HbA(1c) levels and time spent in hypoglycaemia in individuals with type 1 diabetes using CSII. More frequent self-adjustments of insulin therapy may have contributed to these effects.

Deficient dietary iron intakes among women and children in Russia: evidence from the Russian Longitudinal Monitoring Survey.

PubMed Central

Kohlmeier, L; Mendez, M; Shalnova, S; Martinchik, A; Chakraborty, H; Kohlmeier, M

1998-01-01

OBJECTIVES: This study evaluated the iron sufficiency of the Russian diet. METHODS: Data were obtained from 24-hour dietary recalls conducted in 4 rounds (1992 through 1994) of a nationally representative longitudinal survey of 10,548 women and children. Iron bioavailability was estimated via algorithms adjusting for enhancers (heme, vitamin C) and inhibitors (tannins in tea, phytates in grains) consumed at the same meal. RESULTS: Dietary iron intakes were deficient in the most vulnerable groups: young children and women of reproductive age. Poverty status was strongly associated with deficiency. After adjustment for enhancers and inhibitors, estimated bioavailable iron intakes at 3% to 4% of total iron were inadequate in all women and children. CONCLUSIONS: These dietary data suggest that Russian women and children are at high risk of iron deficiency. Grain products rich in phytates, which inhibit absorption, were the major food source of iron in Russia. High intakes of tea and low consumption of vitamin C also inhibited iron bioavailability. Since changes in eating behavior could potentially double iron bioavailability, educational programs should be explored as a strategy for improving iron nutriture. PMID:9550997

Education, glucose control, and mortality risks among U.S. older adults with diabetes.

PubMed

Dupre, Matthew E; Silberberg, Mina; Willis, Janese M; Feinglos, Mark N

2015-03-01

Studies have shown that diabetes mellitus disproportionately afflicts persons of low socioeconomic status and that the burden of disease is greatest among the disadvantaged. However, our understanding of educational differences in the control of diabetes and its impact on survival is limited. This study investigated the associations among education, hemoglobin A1c (HbA1c), and subsequent mortality in adults with diabetes. Prospective cohort data from the 2006, 2008, and 2010 Health and Retirement Study were linked with biomarker data for U.S. older adults with diabetes (n=3312). Weighted distributions were estimated for all subjects at baseline and by the American Diabetes Association's general guidelines for HbA1c control (<7.0% [53 mmol/mol] vs. ≥7.0% [53 mmol/mol]). Proportional hazard models were used to estimate educational differences in all-cause mortality by HbA1c level with sequential adjustments for contributing risk factors. Mortality risks associated with HbA1c≥7.0% [53 mmol/mol] were significantly greater in lower-educated adults than higher-educated adults (P<0.001). We found that the hazard ratios (HR) associated with HbA1c ≥7.0% [53 mmol/mol] were highest among low-educated adults (HR=2.18, 95% CI: 1.62, 2.94) and that a combination of socioeconomic, psychosocial, and behavioral factors accounted for most, but not all, of the associations. Educational differences in HbA1c control have significant implications for mortality and efforts to reduce these disparities should involve more vigilant screening and monitoring of lower-educated adults with diabetes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Monitoring Microbial Mineralization Using Reverse Stable Isotope Labeling Analysis by Mid-Infrared Laser Spectroscopy

PubMed Central

2017-01-01

Assessing the biodegradation of organic compounds is a frequent question in environmental science. Here, we present a sensitive, inexpensive, and simple approach to monitor microbial mineralization using reverse stable isotope labeling analysis (RIL) of dissolved inorganic carbon (DIC). The medium for the biodegradation assay contains regular organic compounds and 13C-labeled DIC with 13C atom fractions (x(13C)DIC) higher than natural abundance (typically 2–50%). The produced CO2 (x(13C) ≈ 1.11%) gradually dilutes the initial x(13C)DIC allowing to quantify microbial mineralization using mass-balance calculations. For 13C-enriched CO2 samples, a newly developed isotope ratio mid-infrared spectrometer was introduced with a precision of x(13C) < 0.006%. As an example for extremely difficult and slowly degradable compounds, CO2 production was close to the theoretical stoichiometry for anaerobic naphthalene degradation by a sulfate-reducing enrichment culture. Furthermore, we could measure the aerobic degradation of dissolved organic carbon (DOC) adsorbed to granular activated carbon in a drinking water production plant, which cannot be labeled with 13C. Thus, the RIL approach can be applied to sensitively monitor biodegradation of various organic compounds under anoxic or oxic conditions. PMID:28903553

Construction of a General Purpose Command Language for Use in Computer Dialog.

DTIC Science & Technology

1980-09-01

Page 1 Skeletal Command Action File...............35 2 Sample from Cyber Action File.................36 3 Program MONITOR Structure Chart...return indicates subroutine call and no return Fig 3. Program MONITOR Structure Chart 48 IV. Validation The general purpose command language was...executive control of these functions, in C addition to its role as interpreter. C C The structure , concept, design, and implementation of program C

Hydrothermal Oxidation of Fecal Sludge: Experimental Investigations and Kinetic Modeling.

PubMed

Hübner, Tobias; Roth, Markus; Vogel, Frédéric

2016-11-23

Hydrothermal oxidation (HTO) provides an efficient technique to completely destroy wet organic wastes. In this study, HTO was applied to treat fecal sludge at well-defined experimental conditions. Four different kinetic models were adjusted to the obtained data. Among others, a distributed activation energy model (DAEM) was applied. A total of 33 experiments were carried out in an unstirred batch reactor with pressurized air as the oxidant at temperatures of <470 °C, oxygen-to-fuel equivalence ratios between 0 and 1.9, feed concentrations between 3.9 and 9.8 mol TOC L -1 (TOC = total organic carbon), and reaction times between 86 and 1572 s. Decomposition of the fecal sludge was monitored by means of the conversion of TOC to CO 2 and CO. In the presence of oxygen, ignition of the reaction was observed around 300 °C, followed by further rapid decomposition of the organic material. The TOC was completely decomposed to CO 2 within 25 min at 470 °C and an oxygen-to-fuel equivalence ratio of 1.2. CO was formed as an intermediate product, and no other combustible products were found in the gas. At certain reaction conditions, the formation of unwanted coke and tarlike products occurred. The reaction temperature and oxygen-to-fuel equivalence ratio showed a significant influence on TOC conversion, while the initial TOC concentration did not. Conversion of TOC to CO 2 could be well described with a first-order rate law and an activation energy of 39 kJ mol -1 .

Hydrothermal Oxidation of Fecal Sludge: Experimental Investigations and Kinetic Modeling

PubMed Central

2016-01-01

Hydrothermal oxidation (HTO) provides an efficient technique to completely destroy wet organic wastes. In this study, HTO was applied to treat fecal sludge at well-defined experimental conditions. Four different kinetic models were adjusted to the obtained data. Among others, a distributed activation energy model (DAEM) was applied. A total of 33 experiments were carried out in an unstirred batch reactor with pressurized air as the oxidant at temperatures of <470 °C, oxygen-to-fuel equivalence ratios between 0 and 1.9, feed concentrations between 3.9 and 9.8 molTOC L–1 (TOC = total organic carbon), and reaction times between 86 and 1572 s. Decomposition of the fecal sludge was monitored by means of the conversion of TOC to CO2 and CO. In the presence of oxygen, ignition of the reaction was observed around 300 °C, followed by further rapid decomposition of the organic material. The TOC was completely decomposed to CO2 within 25 min at 470 °C and an oxygen-to-fuel equivalence ratio of 1.2. CO was formed as an intermediate product, and no other combustible products were found in the gas. At certain reaction conditions, the formation of unwanted coke and tarlike products occurred. The reaction temperature and oxygen-to-fuel equivalence ratio showed a significant influence on TOC conversion, while the initial TOC concentration did not. Conversion of TOC to CO2 could be well described with a first-order rate law and an activation energy of 39 kJ mol–1. PMID:28539700

The heat is on: room temperature affects laboratory equipment--an observational study.

PubMed

Butler, Julia M; Johnson, Jane E; Boone, William R

2013-10-01

To evaluate the effect of ambient room temperature on equipment typically used in in vitro fertilization (IVF). We set the control temperature of the room to 20 °C (+/-0.3) and used CIMScan probes to record temperatures of the following equipment: six microscope heating stages, four incubators, five slide warmers and three heating blocks. We then increased the room temperature to 26 °C (+/-0.3) or decreased it to 17 °C (+/-0.3) and monitored the same equipment again. We wanted to determine what role, if any, changing room temperature has on equipment temperature fluctuation. There was a direct relationship between room temperature and equipment temperature stability. When room temperature increased or decreased, equipment temperature reacted in a corresponding manner. Statistical differences between equipment were found when the room temperature changed. What is also noteworthy is that temperature of equipment responded within 5 min to a change in room temperature. Clearly, it is necessary to be aware of the affect of room temperature on equipment when performing assisted reproductive procedures. Room and equipment temperatures should be monitored faithfully and adjusted as frequently as needed, so that consistent culture conditions can be maintained. If more stringent temperature control can be achieved, human assisted reproduction success rates may improve.

Multiplex Liquid Chromatography-Tandem Mass Spectrometry Assay for Simultaneous Therapeutic Drug Monitoring of Ribavirin, Boceprevir, and Telaprevir

PubMed Central

Aouri, Manel; Moradpour, Darius; Cavassini, Matthias; Mercier, Thomas; Buclin, Thierry; Csajka, Chantal; Telenti, Amalio; Rauch, Andri

2013-01-01

New directly acting antivirals (DAAs) that inhibit hepatitis C virus (HCV) replication are increasingly used for the treatment of chronic hepatitis C. A marked pharmacokinetic variability and a high potential for drug-drug interactions between DAAs and numerous drug classes have been identified. In addition, ribavirin (RBV), commonly associated with hemolytic anemia, often requires dose adjustment, advocating for therapeutic drug monitoring (TDM) in patients under combined antiviral therapy. However, an assay for the simultaneous analysis of RBV and DAAs constitutes an analytical challenge because of the large differences in polarity among these drugs, ranging from hydrophilic (RBV) to highly lipophilic (telaprevir [TVR]). Moreover, TVR is characterized by erratic behavior on standard octadecyl-based reversed-phase column chromatography and must be separated from VRT-127394, its inactive C-21 epimer metabolite. We have developed a convenient assay employing simple plasma protein precipitation, followed by high-performance liquid chromatography coupled to tandem mass spectrometry (HPLC-MS/MS) for the simultaneous determination of levels of RBV, boceprevir, and TVR, as well as its metabolite VRT-127394, in plasma. This new, simple, rapid, and robust HPLC-MS/MS assay offers an efficient method of real-time TDM aimed at maximizing efficacy while minimizing the toxicity of antiviral therapy. PMID:23629707

F-Area Acid/Caustic Basin groundwater monitoring report: Third quarter 1994

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

Not Available

1994-12-01

During third quarter 1994, samples from the FAC monitoring wells at the F-Area Acid/Caustic Basin were collected and analyzed for herbicides/pesticides, indicator parameters, metals, nitrate, radionuclide indicators, volatile organic compounds, and other constituents. Piezometer FAC 5P and monitoring well FAC 6 were dry and could not be sampled. New monitoring wells FAC 9C, 10C, 11C, and 12C were sampled for the first time during third quarter. Analytical results that exceeded final Primary Drinking Water Standards (PDWS), other Savannah River Site (SRS) Flag 2 criteria, or the SRS turbidity standard of 50 NTU during the quarter were as follows: gross alphamore » exceeded the final PDWS and aluminum, iron, manganese, and total alpha-emitting radium exceeded the SRS Flag 2 criteria in one or more of the FAC wells. Turbidity exceeded the SRS standard in wells FAC 3 and 10C. Groundwater flow direction and rate in the water table beneath the F-Area Acid/Caustic Basin were similar to past quarters.« less

Associations of anthropometric markers with serum metabolites using a targeted metabolomics approach: results of the EPIC-potsdam study

PubMed Central

Bachlechner, U; Floegel, A; Steffen, A; Prehn, C; Adamski, J; Pischon, T; Boeing, H

2016-01-01

Background/Objectives: The metabolic consequences of type of body shape need further exploration. Whereas accumulation of body mass in the abdominal area is a well-established metabolic risk factor, accumulation in the gluteofemoral area is controversially debated. We evaluated the associations of anthropometric markers of overall body mass and body shape with 127 serum metabolites within a sub-sample of the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam cohort. Subjects/Methods: The cross-sectional analysis was conducted in 2270 participants, randomly drawn from the EPIC-Potsdam cohort. Metabolites were measured by targeted metabolomics. To select metabolites related with both waist circumference (WC) (abdominal subcutaneous and visceral fat) and hip circumference (HC) (gluteofemoral fat, muscles and bone structure) correlations (r) with body mass index (BMI) as aggregating marker of body mass (lean and fat mass) were calculated. Relations with body shape were assessed by median metabolite concentrations across tertiles of WC and HC, mutually adjusted to each other. Results: Correlations revealed 23 metabolites related to BMI (r⩾I0.20 I). Metabolites showing relations with BMI were showing similar relations with HC adjusted WC (WCHC). In contrast, relations with WC adjusted HC (HCWC) were less concordant with relations of BMI and WCHC. In both sexes, metabolites with concordant relations regarding WCHC and HCWC included tyrosine, diacyl-phosphatidylcholine C38:3, C38:4, lyso-phosphatidylcholine C18:1, C18:2 and sphingomyelin C18:1; metabolites with opposite relations included isoleucine, diacyl-phosphatidylcholine C42:0, acyl–alkyl-phosphatidylcholine C34:3, C42:4, C42:5, C44:4 and C44:6. Metabolites specifically related to HCWC included acyl–alkyl-phosphatidylcholine C34:2, C36:2, C38:2 and C40:4, and were solely observed in men. Other metabolites were related to WCHC only. Conclusions: The study revealed specific metabolic profiles for HCWC as marker of gluteofemoral body mass differing from those for BMI and WCHC as markers of overall body mass and abdominal fat, respectively. Thus, the study suggests that gluteofemoral mass may have less-adverse metabolic implications than abdominal fat. PMID:27348203

Association of hemoglobin A1c and glycated albumin with carotid atherosclerosis in community-dwelling Japanese subjects: the Hisayama Study.

PubMed

Mukai, Naoko; Ninomiya, Toshiharu; Hata, Jun; Hirakawa, Yoichiro; Ikeda, Fumie; Fukuhara, Masayo; Hotta, Taeko; Koga, Masafumi; Nakamura, Udai; Kang, Dongchon; Kitazono, Takanari; Kiyohara, Yutaka

2015-06-24

It is not clear which glucose measure is more useful in the assessment of atherosclerosis. We investigated the associations of hemoglobin A1c (HbA1c), glycated albumin (GA), 1,5-anhydroglucitol (1,5-AG), fasting plasma glucose (FPG), and 2-hour postload glucose (PG) with carotid intima-media thickness (IMT) in community-dwelling Japanese subjects. A total of 2702 subjects aged 40-79 years underwent a 75-g oral glucose tolerance test and measurements of HbA1c, GA, 1,5-AG, and carotid IMT by ultrasonography in 2007-2008. Carotid wall thickening was defined as a maximum IMT of >1.0 mm. The crude and multivariable-adjusted linear and logistic regression models were used to analyze cross-sectional associations between levels of glycemic measures and carotid IMT. The crude average of the maximum IMT increased significantly with rising quartiles of HbA1c, GA, FPG, and 2-hour PG levels in subjects with and without glucose intolerance (GI), while no clear association was observed for 1,5-AG. After adjustment for other confounding factors, positive trends for HbA1c, GA, and FPG (all p for trend < 0.05), but not 2-hour PG (p = 0.07) remained robust in subjects with GI, but no such associations were found in those without GI. When estimating multivariable-adjusted β values for the associations of 1 SD change in glycemic measures with the maximum IMT in subjects with GI, the magnitude of the influence of HbA1c (β = 0.021), GA (β = 0.024), and FPG (β = 0.024) was larger than that of 2-hour PG (β = 0.014) and 1,5-AG (β = 0.003). The multivariable-adjusted odds ratios for the presence of carotid wall thickening increased significantly with elevating HbA1c, GA, and FPG levels only in subjects with GI (all p for trend < 0.001). Among subjects with GI, the area under the receiver operating characteristic curve significantly increased by adding HbA1c (p = 0.04) or GA (p = 0.04), but not 1,5-AG, FPG, or 2-hour PG, to the model including other cardiovascular risk factors. In community-dwelling Japanese subjects with GI, elevated HbA1c, GA, and FPG levels were significantly associated with increased carotid IMT, and HbA1c and GA provided superior discrimination for carotid wall thickening compared to 1,5-AG, FPG, and 2-hour PG, suggesting that HbA1c and GA are useful for assessing carotid atherosclerosis.

Polymorphisms of the FOXF1 and MHC locus genes in individuals undergoing esophageal acid reflux assessments.

PubMed

Lam, C; Liu, W F; Bel, R D; Chan, K; Miller, L; Brown, M C; Chen, Z; Cheng, D; Patel, D; Xu, W; Darling, G E; Liu, G

2017-02-01

Gastroesophageal reflux disease (GERD) may lead to Barrett's esophagus (BE). Previously, a large genome-wide association study found two germline markers to be associated with BE, FOXF1 rs9936833 (C allele) and MHC rs9257809 (A allele). This study evaluated whether these two polymorphisms are associated with gastroesphageal acid reflux as measured by 24-hour pH testing. Patients with acid reflux symptoms referred for esophageal manometry and 24-hour pH monitoring at University Health Network (Toronto, ON) were enrolled. DNA extracted from blood was genotyped using a Taqman Polymerase Chain Reaction (PCR) assay. DeMeester scores of ≥14.7 or prior evidence of reflux esophagitis on endoscopy defined individuals with esophageal acid reflux. Logistic regression analysis, adjusted for clinical risk factors, was used to calculate odds ratios with 95% confidence intervals for each polymorphism in relation to the presence of acid reflux. Of 182 patients, the median age was 50 years and 62% were female; 95 (52%) met the definition of GERD. In the multivariable analysis, both FOXF1 rs9936833 (OR = 1.82; 95%CI: 1.12-2.96; P = 0.02) and MHC rs9257809 (OR = 9.36; 95%CI: 2.92-29.99; P < 0.001) remained significantly associated with presence of acid reflux. When both polymorphisms were placed in the same model, the adjusted ORs were 2.10 (95%CI: 1.24-3.53; P = 0.005) and 10.95 (95%CI: 3.32-36.09; P < 0.001), respectively. The association for risk allele C in FOXF1 rs9936833 and risk allele A in MHC rs9257809 with the presence of acid reflux suggests a potential pathophysiologic mechanism for the role of genetic influences in BE development. © 2016 International Society for Diseases of the Esophagus.

Intimate Partner Violence, Small for Gestational Age Birth and Cigarette Smoking in the Pregnancy Risk Assessment Monitoring System.

PubMed

Alhusen, Jeanne L; Geller, Ruth; Jellig, Jerry; Budhathoki, Chakra; Decker, Michele

2018-04-01

Exposure to intimate partner violence (IPV) in the perinatal period is associated with obstetric complications, poor maternal mental health, neonatal complications, and increased risk of infant mortality and morbidity. Less is known about how IPV may influence small for gestational age (SGA) birth. Data were obtained for 231,081 United States mothers who delivered neonates from 2004 to 2011 and completed the Pregnancy Risk Assessment Monitoring System survey 2-9 months after delivery. Weighted descriptive statistics and multivariate logistic regression models were used. IPV in the year before or during pregnancy was related to SGA bivariately (odds ratio 1.39, 95% confidence interval [CI] 1.28, 1.51), and after adjustment for demographic and obstetric factors, this association attenuated after further adjustment for perinatal smoking patterns, (adjusted odds ratio [aOR] 1.06, 95% CI 0.97, 1.15). Compared with nonabused women, women experiencing perinatal IPV were more than twice as likely to smoke before pregnancy (aOR 2.34, 95% CI 2.19, 2.49), and nearly 1.5 times as likely to report sustained smoking into the last 3 months of pregnancy (aOR 1.45, 95% CI 1.32, 1.59). In turn, among prepregnancy smokers, sustained smoking was associated with delivery of a SGA neonate (aOR 1.87, 95% CI 1.72, 2.03), fully attenuating the association of perinatal IPV with SGA. Women who experienced perinatal IPV were significantly more likely to smoke prepregnancy and sustain smoking into the last 3 months of pregnancy. Through behavioral and physiological pathways, smoking cessation may be uniquely challenging for women experiencing IPV, yet critical to address clinically to mitigate risk for SGA.

40 CFR Appendix B to Part 434 - Baseline Determination and Compliance Monitoring for Pre-existing Discharges at Remining Operations

Code of Federal Regulations, 2012 CFR

2012-07-01

.... Rather than assign one a rank of 2 and the other a rank of 3, the average of 2 and 3 (i.e., 2.5) is given... baseline and monitoring (i.e., n = 12 and m = 12), the critical value C is 99. (f) Compare C to Sn. If Sn... Discharges at Remining Operations I. General Procedure Requirements a. This appendix presents the procedures...

40 CFR Appendix B to Part 434 - Baseline Determination and Compliance Monitoring for Pre-existing Discharges at Remining Operations

Code of Federal Regulations, 2013 CFR

2013-07-01

.... Rather than assign one a rank of 2 and the other a rank of 3, the average of 2 and 3 (i.e., 2.5) is given... baseline and monitoring (i.e., n = 12 and m = 12), the critical value C is 99. (f) Compare C to Sn. If Sn... Discharges at Remining Operations I. General Procedure Requirements a. This appendix presents the procedures...

Prognostic Significance of Blood Pressure Variability on Beat-to-Beat Monitoring After Transient Ischemic Attack and Stroke.

PubMed

Webb, Alastair J S; Mazzucco, Sara; Li, Linxin; Rothwell, Peter M

2018-01-01

Visit-to-visit and day-to-day blood pressure (BP) variability (BPV) predict an increased risk of cardiovascular events but only reflect 1 form of BPV. Beat-to-beat BPV can be rapidly assessed and might also be predictive. In consecutive patients within 6 weeks of transient ischemic attack or nondisabling stroke (Oxford Vascular Study), BPV (coefficient of variation) was measured beat-to-beat for 5 minutes (Finometer), day-to-day for 1 week on home monitoring (3 readings, 3× daily), and on awake ambulatory BP monitoring. BPV after 1-month standard treatment was related (Cox proportional hazards) to recurrent stroke and cardiovascular events for 2 to 5 years, adjusted for mean systolic BP. Among 520 patients, 26 had inadequate beat-to-beat recordings, and 22 patients were in atrial fibrillation. Four hundred five patients had all forms of monitoring. Beat-to-beat BPV predicted recurrent stroke and cardiovascular events independently of mean systolic BP (hazard ratio per group SD, stroke: 1.47 [1.12-1.91]; P =0.005; cardiovascular events: 1.41 [1.08-1.83]; P =0.01), including after adjustment for age and sex (stroke: 1.47 [1.12-1.92]; P =0.005) and all risk factors (1.40 [1.00-1.94]; P =0.047). Day-to-day BPV was less strongly associated with stroke (adjusted hazard ratio, 1.29 [0.97-1.71]; P =0.08) but similarly with cardiovascular events (1.41 [1.09-1.83]; P =0.009). BPV on awake ambulatory BP monitoring was nonpredictive (stroke: 0.89 [0.59-1.35]; P =0.59; cardiovascular events: 1.08 [0.77-1.52]; P =0.65). Despite a weak correlation ( r =0.119; P =0.02), beat-to-beat BPV was associated with risk of recurrent stroke independently of day-to-day BPV (1.41 [1.05-1.90]; P =0.02). Beat-to-beat BPV predicted recurrent stroke and cardiovascular events, independently of mean systolic BP and risk factors but short-term BPV on ambulatory BP monitoring did not. Beat-to-beat BPV may be a useful additional marker of cardiovascular risk. © 2017 The Authors.

31 CFR 576.701 - Penalties.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Penalties § 576.701 Penalties. (a) Attention is directed to section 206 of the International Emergency... of 1990 (Pub. L. 101-410, as amended, 28 U.S.C. 2461 note). (2) The criminal penalties provided in IEEPA are subject to adjustment pursuant to 18 U.S.C. 3571. (c) Attention is also directed to 18 U.S.C...

12 CFR 263.65 - Civil penalty inflation adjustments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... tier—$7,500. (ii) Second tier—$37,500. (iii) Third tier—$1,375,000. (3) 12 U.S.C. 1820(k)(6)(A)(ii...) 12 U.S.C. 1467a(i)(3)-$32,500. (12) 12 U.S.C. 1467a(r): (i) 12 U.S.C. 1467a(r)(1)-$ 2,200. (ii) 12 U.S.C. 1467a(r)(2)-$32,500. (iii) 12 U.S.C. 1467a(r)(3)-$1,375,000. [73 FR 58032, Oct. 6, 2008, as...

Arabidopsis pdr2 reveals a phosphate-sensitive checkpoint in root development.

PubMed

Ticconi, Carla A; Delatorre, Carla A; Lahner, Brett; Salt, David E; Abel, Steffen

2004-03-01

Plants have evolved complex strategies to maintain phosphate (Pi) homeostasis and to maximize Pi acquisition when the macronutrient is limiting. Adjustment of root system architecture via changes in meristem initiation and activity is integral to the acclimation process. However, the mechanisms that monitor external Pi status and interpret the nutritional signal remain to be elucidated. Here, we present evidence that the Pi deficiency response, pdr2, mutation disrupts local Pi sensing. The sensitivity and amplitude of metabolic Pi-starvation responses, such as Pi-responsive gene expression or accumulation of anthocyanins and starch, are enhanced in pdr2 seedlings. However, the most conspicuous alteration of pdr2 is a conditional short-root phenotype that is specific for Pi deficiency and caused by selective inhibition of root cell division followed by cell death below a threshold concentration of about 0.1 mm external Pi. Measurements of general Pi uptake and of total phosphorus (P) in root tips exclude a defect in high-affinity Pi acquisition. Rescue of root meristem activity in Pi-starved pdr2 by phosphite (Phi), a non-metabolizable Pi analog, and divided-root experiments suggest that pdr2 disrupts sensing of low external Pi availability. Thus, PDR2 is proposed to function at a Pi-sensitive checkpoint in root development, which monitors environmental Pi status, maintains and fine-tunes meristematic activity, and finally adjusts root system architecture to maximize Pi acquisition.

Modeling and predicting the biofilm formation of Salmonella Virchow with respect to temperature and pH.

PubMed

Ariafar, M Nima; Buzrul, Sencer; Akçelik, Nefise

2016-03-01

Biofilm formation of Salmonella Virchow was monitored with respect to time at three different temperature (20, 25 and 27.5 °C) and pH (5.2, 5.9 and 6.6) values. As the temperature increased at a constant pH level, biofilm formation decreased while as the pH level increased at a constant temperature, biofilm formation increased. Modified Gompertz equation with high adjusted determination coefficient (Radj(2)) and low mean square error (MSE) values produced reasonable fits for the biofilm formation under all conditions. Parameters of the modified Gompertz equation could be described in terms of temperature and pH by use of a second order polynomial function. In general, as temperature increased maximum biofilm quantity, maximum biofilm formation rate and time of acceleration of biofilm formation decreased; whereas, as pH increased; maximum biofilm quantity, maximum biofilm formation rate and time of acceleration of biofilm formation increased. Two temperature (23 and 26 °C) and pH (5.3 and 6.3) values were used up to 24 h to predict the biofilm formation of S. Virchow. Although the predictions did not perfectly match with the data, reasonable estimates were obtained. In principle, modeling and predicting the biofilm formation of different microorganisms on different surfaces under various conditions could be possible.

Lung Quality and Utilization in Controlled Donation after Circulatory Determination of Death Donors within the United States

PubMed Central

Mooney, Joshua J; Hedlin, Haley; Mohabir, Paul K; Vazquez, Rodrigo; Nguyen, John; Ha, Richard; Chiu, Peter; Patel, Kapilkumar; Zamora, Martin R.; Weill, David; Nicolls, Mark R; Dhillon, Gundeep S

2016-01-01

While controlled donation after circulatory determination of death (cDCDD) donors could increase the supply of donor lungs within the United States, the yield of lungs from cDCDD donors remain low compared to donation after neurologic determination of death (DNDD) donors. To explore the reason for low lung yield from cDCDD donors, Scientific Registry of Transplant Recipient data were used to assess the impact of donor lung quality on cDCDD lung utilization by fitting a logistic regression model. The relationship between center volume and cDCDD use was assessed and distance between center and donor hospital was calculated by cDCDD status. Recipient survival was compared using a multivariable Cox regression model. Lung utilization was 2.1% for cDCDD donors and 21.4% for DNDD donors. Being a cDCDD donor decreased lung donation (adjusted OR 0.101, CI 0.085–0.120). A minority of centers have performed cDCDD transplant with higher volume centers generally performing more cDCDD transplants. There was no difference in center to donor distance or recipient survival (adjusted HR 1.03, CI 0.78–1.37) between cDCDD and DNDD transplants. cDCDD lungs are underutilized compared to DNDD lungs after adjusting for lung quality. Increasing transplant center expertise and commitment to cDCDD lung procurement is needed to improve utilization. PMID:26844673

Cost-effectiveness of home telemedical cardiotocography compared with traditional outpatient monitoring.

PubMed

Tõrõk, M; Kovács, F; Doszpod, J

2000-01-01

We compared the cost of passive sensor telemedical non-stress cardiotocography performed at home and the same test performed by traditional equipment in an outpatient clinic in the Budapest area. The costs were calculated using two years' registered budget data from the home monitoring service in Budapest and the outpatient clinic of the department of obstetrics and gynaecology at the Haynal Imre University of Health Sciences. The traditional test at the university outpatient clinic cost 3652 forint for the health-care and 1000 forint in additional expenses for the patient (travel and time off work). This means that the total cost for each test in the clinic was 4652 forint. The cost of home telemedical cardiotocography was 1500 forint per test, but each test took 2.1 times as long. For a more realistic comparison between the two methods, we adjusted the cost to take account of the extra length of time that home monitoring required. The adjusted cost for home care was 3150 forint, some 32% lower than in the clinic. Passive sensor telemedical non-stress cardiotocography at home was therefore less expensive than the same test performed in the traditional way in an outpatient clinic.

Serum cystatin C in youth with diabetes: The SEARCH for diabetes in youth study.

PubMed

Kanakatti Shankar, Roopa; Dolan, Lawrence M; Isom, Scott; Saydah, Sharon; Maahs, David M; Dabelea, Dana; Reynolds, Kristi; Hirsch, Irl B; Rodriguez, Beatriz L; Mayer-Davis, Elizabeth J; Marcovina, Santica; D'Agostino, Ralph; Mauer, Michael; Mottl, Amy K

2017-08-01

We compared cystatin C in youth with versus without diabetes and determined factors associated with cystatin C in youth with type 1 diabetes (T1D) and type 2 diabetes (T2D). Youth (ages 12-19years) without diabetes (N=544) were ascertained from the NHANES Study 2000-2002 and those with T1D (N=977) and T2D (N=168) from the SEARCH for Diabetes in Youth Study. Adjusted means of cystatin C concentrations were compared amongst the 3 groups. Next, we performed multivariable analyses within the T1D and T2D SEARCH samples to determine the association between cystatin C and race, sex, age, diabetes duration, HbA1c, fasting glucose, and BMI. Adjusted cystatin C concentrations were statistically higher in NHANES (0.85mg/L) than in either the T1D (0.75mg/L) or T2D (0.70mg/L) SEARCH groups (P<0.0001). Fasting glucose was inversely related to cystatin C only in T1D (P<0.001) and BMI positively associated only in T2D (P<0.01) while HbA1c was inversely associated in both groups. Cystatin C concentrations are statistically higher in youth without diabetes compared to T1D or T2D, however the clinical relevance of this difference is quite small, especially in T1D. In youth with diabetes, cystatin C varies with BMI and acute and chronic glycemic control, however their effects may be different according to diabetes type. Copyright © 2017 Elsevier B.V. All rights reserved.

Monitoring water quality in a hypereutrophic reservoir using Landsat ETM+ and OLI sensors: how transferable are the water quality algorithms?

PubMed

Deutsch, Eliza S; Alameddine, Ibrahim; El-Fadel, Mutasem

2018-02-15

The launch of the Landsat 8 in February 2013 extended the life of the Landsat program to over 40 years, increasing the value of using Landsat to monitor long-term changes in the water quality of small lakes and reservoirs, particularly in poorly monitored freshwater systems. Landsat-based water quality hindcasting often incorporate several Landsat sensors in an effort to increase the temporal range of observations; yet the transferability of water quality algorithms across sensors remains poorly examined. In this study, several empirical algorithms were developed to quantify chlorophyll-a, total suspended matter (TSM), and Secchi disk depth (SDD) from surface reflectance measured by Landsat 7 ETM+ and Landsat 8 OLI sensors. Sensor-specific multiple linear regression models were developed by correlating in situ water quality measurements collected from a semi-arid eutrophic reservoir with band ratios from Landsat ETM+ and OLI sensors, along with ancillary data (water temperature and seasonality) representing ecological patterns in algae growth. Overall, ETM+-based models outperformed (adjusted R 2 chlorophyll-a = 0.70, TSM = 0.81, SDD = 0.81) their OLI counterparts (adjusted R 2 chlorophyll-a = 0.50, TSM = 0.58, SDD = 0.63). Inter-sensor differences were most apparent for algorithms utilizing the Blue spectral band. The inclusion of water temperature and seasonality improved the power of TSM and SDD models.

Validation of [(11) C]ORM-13070 as a PET tracer for alpha2c -adrenoceptors in the human brain.

PubMed

Lehto, Jussi; Hirvonen, Mika M; Johansson, Jarkko; Kemppainen, Jukka; Luoto, Pauliina; Naukkarinen, Tarja; Oikonen, Vesa; Arponen, Eveliina; Rouru, Juha; Sallinen, Jukka; Scheinin, Harry; Vuorilehto, Lauri; Finnema, Sjoerd J; Halldin, Christer; Rinne, Juha O; Scheinin, Mika

2015-03-01

This study explored the use of the α2C -adrenoceptor PET tracer [(11) C]ORM-13070 to monitor α2C -AR occupancy in the human brain. The subtype-nonselective α2 -AR antagonist atipamezole was administered to eight healthy volunteer subjects to determine its efficacy and potency (Emax and EC50 ) at inhibiting tracer uptake. We also explored whether the tracer could reveal changes in the synaptic concentrations of endogenous noradrenaline in the brain, in response to several pharmacological and sensory challenge conditions. We assessed occupancy from the bound-to-free ratio measured during 5-30 min post injection. Based on extrapolation of one-site binding, the maximal extent of inhibition of striatal [(11) C]ORM-13070 uptake (Emax ) achievable by atipamezole was 78% (95% CI 69-87%) in the caudate nucleus and 65% (53-77%) in the putamen. The EC50 estimates of atipamezole (1.6 and 2.5 ng/ml, respectively) were in agreement with the drug's affinity to α2C -ARs. These findings represent clear support for the use of [(11) C]ORM-13070 for monitoring drug occupancy of α2C -ARs in the living human brain. Three of the employed noradrenaline challenges were associated with small, approximately 10-16% average reductions in tracer uptake in the dorsal striatum (atomoxetine, ketamine, and the cold pressor test; P < 0.05 for all), but insulin-induced hypoglycemia did not affect tracer uptake. The tracer is suitable for studying central nervous system receptor occupancy by α2C -AR ligands in human subjects. [(11) C]ORM-13070 also holds potential as a tool for in vivo monitoring of synaptic concentrations of noradrenaline, but this remains to be further evaluated in future studies. © 2014 Wiley Periodicals, Inc.

Family variables as moderators between beliefs towards medicines and adherence to self-care behaviors and medication in type 2 diabetes.

PubMed

Pereira, M Graça; Pedras, Susana; Machado, José Cunha

2014-06-01

This study analyzed whether family variables such as marital adjustment, partner support, family coping, and family stress moderated the relationship between negative beliefs about medicines and adherence to self-care behaviors (diet, glucose monitoring, exercise, foot care, and medication), in Type 2 diabetes patients. The sample was composed of 387 individuals with Type 2 diabetes, diagnosed in the past 12 months. Patients were assessed on self-care behaviors in diabetes, medication adherence, beliefs about medicines, family coping, family stress, marital adjustment, and partner support. The results showed marital adjustment, family coping, partner support, and family stress as moderators in the relationship between negative beliefs and adherence. Patients with negative beliefs regarding medicines, but who reported good marital adjustment and family coping were more likely to test their blood glucose; and if they reported low support from their partners were less likely to adhere to their prescribed diet. Finally, patients with negative beliefs about medicines, but who reported high family stress, were less likely to take their medication. The results emphasize the importance of family variables on adherence to self-care behaviors and medication. This study revealed the importance of including partners on interventions regarding Type 2 diabetes because they seem to play an important role in patient's adherence.

Accuracy of continuous noninvasive hemoglobin monitoring for the prediction of blood transfusions in trauma patients.

PubMed

Galvagno, Samuel M; Hu, Peter; Yang, Shiming; Gao, Cheng; Hanna, David; Shackelford, Stacy; Mackenzie, Colin

2015-12-01

Early detection of hemorrhagic shock is required to facilitate prompt coordination of blood component therapy delivery to the bedside and to expedite performance of lifesaving interventions. Standard physical findings and vital signs are difficult to measure during the acute resuscitation stage, and these measures are often inaccurate until patients deteriorate to a state of decompensated shock. The aim of this study is to examine a severely injured trauma patient population to determine whether a noninvasive SpHb monitor can predict the need for urgent blood transfusion (universal donor or additional urgent blood transfusion) during the first 12 h of trauma patient resuscitation. We hypothesize that trends in continuous SpHb, combined with easily derived patient-specific factors, can identify the immediate need for transfusion in trauma patients. Subjects were enrolled if directly admitted to the trauma center, >17 years of age, and with a shock index (heart rate/systolic blood pressure) >0.62. Upon admission, a Masimo Radical-7 co-oximeter sensor (Masimo Corporation, Irvine, CA) was applied, providing measurement of continuous non-invasive hemoglobin (SpHb) levels. Blood was drawn and hemoglobin concentration analyzed and conventional pulse oximetry photopletysmograph signals were continuously recorded. Demographic information and both prehospital and admission vital signs were collected. The primary outcome was transfusion of at least one unit of packed red blood cells within 24 h of admission. Eight regression models (C1-C8) were evaluated for the prediction of blood use by comparing area under receiver operating curve (AUROC) at different time intervals after admission. 711 subjects had continuous vital signs waveforms available, to include heart rate (HR), SpHb and SpO2 trends. When SpHb was monitored for 15 min, SpHb did not increase AUROC for prediction of transfusion. The highest ROC was recorded for model C8 (age, sex, prehospital shock index, admission HR, SpHb and SpO2) for the prediction of blood products within the first 3 h of admission. When data from 15 min of continuous monitoring were analyzed, significant improvement in AUROC occurred as more variables were added to the model; however, the addition of SpHb to any of the models did not improve AUROC significantly for prediction of blood use within the first 3 h of admission in comparison to analysis of conventional oximetry features. The results demonstrate that SpHb monitoring, accompanied by continuous vital signs data and adjusted for age and sex, has good accuracy for the prediction of need for transfusion; however, as an independent variable, SpHb did not enhance predictive models in comparison to use of features extracted from conventional pulse oximetry. Nor was shock index better than conventional oximetry at discriminating hemorrhaging and prediction of casualties receiving blood. In this population of trauma patients, noninvasive SpHb monitoring, including both trends and absolute values, did not enhance the ability to predict the need for blood transfusion.

CATS EYES Adjustment Procedures

DTIC Science & Technology

1993-04-01

AL-TR-1 993-0025 AD-A264 069 CATS EYES ADJUSTMENT PROCEDURES A R M Joseph C. Antonio DTIC S ELECTET University of Dayton Research Institute MAY 13...Final November 1992 - January 1993 4. TITLE AND SUBTITLE S. FUNDING NUMBERS C F33615-90-C-0005 CATS EYES Adjustment Procedures PE - 62205F 6. AUTHOR(S) PR...the loss of NVG performance resulting from improper goggle adjustments. This report describes correct adjustment procedures for the CATS EYES NVG system

An Autonomous System for Experimental Evolution of Microbial Cultures: Test Results Using Ultraviolet-C Radiation and Escherichia Coli.

NASA Technical Reports Server (NTRS)

Ouandji, Cynthia; Wang, Jonathan; Arismendi, Dillon; Lee, Alonzo; Blaich, Justin; Gentry, Diana

2017-01-01

At its core, the field of microbial experimental evolution seeks to elucidate the natural laws governing the history of microbial life by understanding its underlying driving mechanisms. However, observing evolution in nature is complex, as environmental conditions are difficult to control. Laboratory-based experiments for observing population evolution provide more control, but manually culturing and studying multiple generations of microorganisms can be time consuming, labor intensive, and prone to inconsistency. We have constructed a prototype, closed system device that automates the process of directed evolution experiments in microorganisms. It is compatible with any liquid microbial culture, including polycultures and field samples, provides flow control and adjustable agitation, continuously monitors optical density (OD), and can dynamically control environmental pressures such as ultraviolet-C (UV-C) radiation and temperature. Here, the results of the prototype are compared to iterative exposure and survival assays conducted using a traditional hood, UV-C lamp, and shutter system.

A Model of Parental Distress and Factors that Mediate its Link with Parental Monitoring of Youth Diabetes Care, Adherence, and Glycemic Control

PubMed Central

Robinson, Elizabeth M.; Weaver, Patrick; Chen, Rusan; Streisand, Randi; Holmes, Clarissa S.

2016-01-01

Objective Parental monitoring of adolescents’ diabetes self-care is associated with better adherence and glycemic control (A1c). A number of parent-level factors are associated with higher levels of parental monitoring, including lower levels of parental distress (depressive symptoms, stress, anxiety), as well as higher levels of parental self-efficacy for diabetes management and authoritative parenting. Often studied in isolation, these factors may be best considered simultaneously as they are interrelated and are associated with parental monitoring and youth adherence. Methods Structural equation modeling with a cross-sectional sample of 257 parent/youth (aged 11-14) dyads: 1) examined a broad model of parental factors (i.e., parental distress, parental diabetes self-efficacy, authoritative parenting) and 2) assessed their relation to parental monitoring, youth adherence, and A1c. Post-hoc ANOVAs evaluated clinical implications of daily parental monitoring. Results Parental distress was not related directly to parental monitoring. Instead less distress related indirectly to more monitoring via higher parental self-efficacy and more authoritative parenting which in turn related to better adherence and A1c. Higher parental self-efficacy also related directly to better youth adherence and then to better A1c. Clinically, more parental monitoring related to more daily blood glucose checks and to better A1c (8.48% v. 9.17%). Conclusions A broad model of parent-level factors revealed more parental distress was linked only indirectly to less monitoring via lower parental self-efficacy and less authoritative parenting. Behaviorally, more parental monitoring related to better adherence and to clinically better A1c in adolescents. Further study of parent-level factors that relate to parental distress and monitoring of adherence appears warranted. PMID:27513476

Measuring NO, NO2, CO2 and O3 with low-cost sensors

NASA Astrophysics Data System (ADS)

Müller, Michael; Graf, Peter; Hüglin, Christoph

2017-04-01

Inexpensive sensors measuring ambient gas concentrations can be integrated in sensor units forming dense sensor networks. The utilized sensors have to be sufficiently accurate as the value of such networks directly depends on the information they provide. Thus, thorough testing of sensors before bringing them into service and the application of effective strategies for performance monitoring and adjustments during service are key elements for operating the low-cost sensors that are currently available on the market. We integrated several types of low-cost sensors into sensor units (Alphasense NO2 B4/B42F/B43F, Alphasense NO B4, SensAir CO2 LP8, Aeroqual O3 SM50), run them in the field next to instruments of air quality monitoring stations and performed tests in the laboratory. The poster summarizes our findings regarding the achieved sensor accuracy, methods to improve sensor performance as well as strategies to monitor the current state of the sensor (drifts, sensitivity) within a sensor network.

A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in patients with uncontrolled type 2 diabetes.

PubMed

Safren, Steven A; Gonzalez, Jeffrey S; Wexler, Deborah J; Psaros, Christina; Delahanty, Linda M; Blashill, Aaron J; Margolina, Aleksandra I; Cagliero, Enrico

2014-01-01

To test cognitive behavioral therapy for adherence and depression (CBT-AD) in type 2 diabetes. We hypothesized that CBT-AD would improve adherence; depression; and, secondarily, hemoglobin A1c (A1C). Eighty-seven adults with unipolar depression and uncontrolled type 2 diabetes received enhanced treatment as usual (ETAU), including medication adherence, self-monitoring of blood glucose (SMBG), and lifestyle counseling; a provider letter documented psychiatric diagnoses. Those randomized to the intervention arm also received 9-11 sessions of CBT-AD. Immediately after acute treatment (4 months), adjusting for baseline, CBT-AD had 20.7 percentage points greater oral medication adherence on electronic pill cap (95% CI -31.14 to -10.22, P = 0.000); 30.2 percentage points greater SMBG adherence through glucometer downloads (95% CI -42.95 to -17.37, P = 0.000); 6.44 points lower depression scores on the Montgomery-Asberg Depression Rating Scale (95% CI 2.33-10.56, P = 0.002); 0.74 points lower on the Clinical Global Impression (95% CI 0.16-1.32, P = 0.01); and 0.72 units lower A1C (95% CI 0.29-1.15, P = 0.001) relative to ETAU. Analyses of 4-, 8-, and 12-month follow-up time points indicated that CBT-AD maintained 24.3 percentage points higher medication adherence (95% CI -38.2 to -10.3, P = 0.001); 16.9 percentage points greater SMBG adherence (95% CI -33.3 to -0.5, P = 0.043); and 0.63 units lower A1C (95% CI 0.06-1.2, P = 0.03) after acute treatment ended. For depression, there was some evidence of continued improvement posttreatment, but no between-group differences. CBT-AD is an effective intervention for adherence, depression, and glycemic control, with enduring and clinically meaningful benefits for diabetes self-management and glycemic control in adults with type 2 diabetes and depression.

Quality of pancreatic transplant program assessment using a risk-adjusted cumulative sum chart: experience from a single, small center.

PubMed

Grochowiecki, T; Jakimowicz, T; Grabowska-Derlatka, L; Szmidt, J

2014-10-01

The high rate of complication after pancreas transplantation not only had an impact on recipient quality of life and survival but also had significant financial implications. Thus, monitoring transplant center performance was crucial to indentifying changes in clinical practice that result in quality deterioration. To evaluate retrospectively the quality of the single, small pancreatic transplant program and to establish prospective monitoring of the center using risk-adjusted cumulative sum (CUSUM). From 1988 to 2014, 119 simultaneous pancreas and the kidney transplantations (SPKTx) were performed. The program was divided into 3 eras, based on surgical technique and immunosuppression. Analyses of the 15 fatal outcomes due to complication from pancreatic graft were performed. The risk model was developed using multivariable logistic regression analysis based on retrospective data of 112 SPKTx recipients. The risk-adjusted 1-sided CUSUM chart was plotted for retrospective and prospective events. The upper control limit was set to 2. There were 2 main causes of death: multiorgan failure (73.3%; 11/15) and septic hemorrhage (26.7%; 4/15). Quality analysis using the CUSUM chart revealed that the process was not homogeneous; however, no significant signal of program deterioration was obtained and the performance of the whole program was within the settled control limit. For a single pancreatic transplant center. The risk-adjusted CUSUM chart was a useful tool for quality program assessment. It could support decision making during traditional surgical morbidity and mortality conferences. For small transplant centers, increasing the sensitivity of the CUSUM method by lowering the upper control limit should be considered. However, an individual assessment approach of the for particular centers is recommended.

Dynamic probability control limits for risk-adjusted CUSUM charts based on multiresponses.

PubMed

Zhang, Xiang; Loda, Justin B; Woodall, William H

2017-07-20

For a patient who has survived a surgery, there could be several levels of recovery. Thus, it is reasonable to consider more than two outcomes when monitoring surgical outcome quality. The risk-adjusted cumulative sum (CUSUM) chart based on multiresponses has been developed for monitoring a surgical process with three or more outcomes. However, there is a significant effect of varying risk distributions on the in-control performance of the chart when constant control limits are applied. To overcome this disadvantage, we apply the dynamic probability control limits to the risk-adjusted CUSUM charts for multiresponses. The simulation results demonstrate that the in-control performance of the charts with dynamic probability control limits can be controlled for different patient populations because these limits are determined for each specific sequence of patients. Thus, the use of dynamic probability control limits for risk-adjusted CUSUM charts based on multiresponses allows each chart to be designed for the corresponding patient sequence of a surgeon or a hospital and therefore does not require estimating or monitoring the patients' risk distribution. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Skin autofluorescence predicts cardiovascular mortality in patients on chronic hemodialysis.

PubMed

Kimura, Hiroshi; Tanaka, Kenichi; Kanno, Makoto; Watanabe, Kimio; Hayashi, Yoshimitsu; Asahi, Koichi; Suzuki, Hodaka; Sato, Keiji; Sakaue, Michiaki; Terawaki, Hiroyuki; Nakayama, Masaaki; Miyata, Toshio; Watanabe, Tsuyoshi

2014-10-01

Tissue accumulation of advanced glycation end products (AGE) is thought to contribute to the progression of cardiovascular disease (CVD). Skin autofluorescence, a non-invasive measure of AGE accumulation using autofluorescence of the skin under ultraviolet light, has been reported to be an independent predictor of mortality associated with CVD in Caucasian patients on chronic hemodialysis. The aim of this study was to assess the predictive value of skin autofluorescence on all-cause and cardiovascular mortality in non-Caucasian (Japanese) patients on chronic hemodialysis. Baseline skin autofluorescence was measured with an autofluorescence reader in 128 non-Caucasian (Japanese) patients on chronic hemodialysis. All-cause and cardiovascular mortality was monitored prospectively during a period of 6 years. During the follow-up period, 42 of the 128 patients died; 19 of those patients died of CVD. Skin autofluorescence did not have a significant effect on all-cause mortality. However, age, carotid artery intima-media thickness (IMT), serum albumin, high-sensitivity C-reactive protein (hsCRP), skin autofluorescence and pre-existing CVD were significantly correlated with cardiovascular mortality. Multivariate Cox regression analysis showed skin autofluorescence (adjusted hazard ratio [HR] 3.97; 95% confidence interval [CI]1.67-9.43), serum albumin (adjusted HR 0.05; 95% CI 0.01-0.32), and hsCRP (adjusted HR 1.55; 95% CI 1.18-2.05) to be independent predictors of cardiovascular mortality. The present study suggests that skin autofluorescence is an independent predictor of cardiovascular mortality in non-Caucasian (Japanese) patients on chronic hemodialysis. © 2014 The Authors. Therapeutic Apheresis and Dialysis © 2014 International Society for Apheresis.

Prevalence of Celiac Disease in 52,721 Youth With Type 1 Diabetes: International Comparison Across Three Continents.

PubMed

Craig, Maria E; Prinz, Nicole; Boyle, Claire T; Campbell, Fiona M; Jones, Timothy W; Hofer, Sabine E; Simmons, Jill H; Holman, Naomi; Tham, Elaine; Fröhlich-Reiterer, Elke; DuBose, Stephanie; Thornton, Helen; King, Bruce; Maahs, David M; Holl, Reinhard W; Warner, Justin T

2017-08-01

Celiac disease (CD) has a recognized association with type 1 diabetes. We examined international differences in CD prevalence and clinical characteristics of youth with coexisting type 1 diabetes and CD versus type 1 diabetes only. Data sources were as follows: the Prospective Diabetes Follow-up Registry (DPV) (Germany/Austria); the T1D Exchange Clinic Network (T1DX) (U.S.); the National Paediatric Diabetes Audit (NPDA) (U.K. [England/Wales]); and the Australasian Diabetes Data Network (ADDN) (Australia). The analysis included 52,721 youths <18 years of age with a clinic visit between April 2013 and March 2014. Multivariable linear and logistic regression models were constructed to analyze the relationship between outcomes (HbA 1c , height SD score [SDS], overweight/obesity) and type 1 diabetes/CD versus type 1 diabetes, adjusting for sex, age, and diabetes duration. Biopsy-confirmed CD was present in 1,835 youths (3.5%) and was diagnosed at a median age of 8.1 years (interquartile range 5.3-11.2 years). Diabetes duration at CD diagnosis was <1 year in 37% of youths, >1-2 years in 18% of youths, >3-5 years in 23% of youths, and >5 years in 17% of youths. CD prevalence ranged from 1.9% in the T1DX to 7.7% in the ADDN and was higher in girls than boys (4.3% vs. 2.7%, P < 0.001). Children with coexisting CD were younger at diabetes diagnosis compared with those with type 1 diabetes only (5.4 vs. 7.0 years of age, P < 0.001) and fewer were nonwhite (15 vs. 18%, P < 0.001). Height SDS was lower in those with CD (0.36 vs. 0.48, adjusted P < 0.001) and fewer were overweight/obese (34 vs. 37%, adjusted P < 0.001), whereas mean HbA 1c values were comparable: 8.3 ± 1.5% (67 ± 17 mmol/mol) versus 8.4 ± 1.6% (68 ± 17 mmol/mol). CD is a common comorbidity in youth with type 1 diabetes. Differences in CD prevalence may reflect international variation in screening and diagnostic practices, and/or CD risk. Although glycemic control was not different, the lower height SDS supports close monitoring of growth and nutrition in this population. © 2017 by the American Diabetes Association.

Increased Risk for Other Cancers in Addition to Breast Cancer for CHEK2*1100delC Heterozygotes Estimated From the Copenhagen General Population Study.

PubMed

Näslund-Koch, Charlotte; Nordestgaard, Børge G; Bojesen, Stig E

2016-04-10

CHEK2 is a cell cycle checkpoint regulator, and the CHEK2*1100delC germline mutation leads to loss of function and increased breast cancer risk. It seems plausible that this mutation could also predispose to other cancers. Therefore, we tested the hypothesis that CHEK2*1100delC heterozygosity is associated with increased risk for other cancers in addition to breast cancer in the general population. We examined 86,975 individuals from the Copenhagen General Population Study, recruited from 2003 through 2010. The participants completed a questionnaire on health and lifestyle, were examined physically, had blood drawn for DNA extraction, were tested for presence of CHEK2*1100delC using Taqman assays and sequencing, and were linked over 1943 through 2011 to the Danish Cancer Registry. Incidences and risks of individual cancer types, including breast cancer, were calculated using Kaplan-Meier estimates, Fine and Gray competing-risks regressions, and stratified analyses with interaction tests. Among 86,975 individuals, 670 (0.8%) were CHEK2*1100delC heterozygous, 2,442 developed breast cancer, and 6,635 developed other cancers. The age- and sex-adjusted hazard ratio for CHEK2*1100delC heterozygotes compared with noncarriers was 2.08 (95% CI, 1.51 to 2.85) for breast cancer and 1.45 (95% CI, 1.15 to 1.82) for other cancers. When stratifying for sex, the age-adjusted hazard ratios for other cancers were 1.54 (95% CI, 1.08 to 2.18) for women and 1.37 (95% CI, 1.01 to 1.85) for men (sex difference: P = .63). For CHEK2*1100delC heterozygotes compared with noncarriers, the age- and sex-adjusted hazard ratios were 5.76 (95% CI, 2.12 to 15.6) for stomach cancer, 3.61 (95% CI, 1.33 to 9.79) for kidney cancer, 3.45 (95% CI, 1.09 to 10.9) for sarcoma, and 1.60 (95% CI, 1.00 to 2.56) for prostate cancer. CHEK2*1100delC heterozygosity is associated with 15% to 82% increased risk for at least some cancers in addition to breast cancer. This information may be useful in clinical counseling of patients with this loss-of-function mutation. © 2016 by American Society of Clinical Oncology.

48 CFR 52.216-3 - Economic Price Adjustment-Semistandard Supplies.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Economic Price Adjustment... Clauses 52.216-3 Economic Price Adjustment—Semistandard Supplies. As prescribed in 16.203-4(b), insert the... specified in subparagraph (c)(1), upon approval by the chief of the contracting office. Economic Price...

48 CFR 52.216-3 - Economic Price Adjustment-Semistandard Supplies.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 2 2012-10-01 2012-10-01 false Economic Price Adjustment... Clauses 52.216-3 Economic Price Adjustment—Semistandard Supplies. As prescribed in 16.203-4(b), insert the... specified in subparagraph (c)(1), upon approval by the chief of the contracting office. Economic Price...

48 CFR 52.216-3 - Economic Price Adjustment-Semistandard Supplies.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 2 2014-10-01 2014-10-01 false Economic Price Adjustment... Clauses 52.216-3 Economic Price Adjustment—Semistandard Supplies. As prescribed in 16.203-4(b), insert the... specified in subparagraph (c)(1), upon approval by the chief of the contracting office. Economic Price...

48 CFR 52.216-3 - Economic Price Adjustment-Semistandard Supplies.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 2 2011-10-01 2011-10-01 false Economic Price Adjustment... Clauses 52.216-3 Economic Price Adjustment—Semistandard Supplies. As prescribed in 16.203-4(b), insert the... specified in subparagraph (c)(1), upon approval by the chief of the contracting office. Economic Price...

48 CFR 52.216-3 - Economic Price Adjustment-Semistandard Supplies.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 2 2013-10-01 2013-10-01 false Economic Price Adjustment... Clauses 52.216-3 Economic Price Adjustment—Semistandard Supplies. As prescribed in 16.203-4(b), insert the... specified in subparagraph (c)(1), upon approval by the chief of the contracting office. Economic Price...

JPRS Report, China.

DTIC Science & Technology

1991-04-16

mice , color monitors, image Industrial Production Rises Over 6 Percent First 2 scanners, key-boards and drawing cards in 1990. Months The center...Adjusting Industrial Structure, Suggestions 32 Experts Forecast 1991 Market Trends [ZHONGGUO TONGJI XIAOXI BAO 11 Feb] ................. 35 Price Index of...Policies Regarding Industrial Structure in Hunan [HUNAN RIBAO 5 Feb] ........................... 45 Bank Official Views 1991 Monetary Policies [JINRONG

Parenting and Peer Relationships: Reinvigorating Research on Family-Peer Linkages in Adolescence

ERIC Educational Resources Information Center

Brown, B. Bradford; Bakken, Jeremy P.

2011-01-01

Drawing energy from a debate about the efficacy of parental monitoring, research over the first decade of the 21st century has traced numerous ways in which parenting practices and parent-child relationship features affect adolescents' peer interactions, and how these 2 factors interact to affect adolescent adjustment. In reviewing this research,…

Epitaxial graphene/SiC Schottky ultraviolet photodiode with orders of magnitude adjustability in responsivity and response speed

NASA Astrophysics Data System (ADS)

Yang, Junwei; Guo, Liwei; Guo, Yunlong; Hu, Weijie; Zhang, Zesheng

2018-03-01

A simple optical-electronic device that possesses widescale adjustability in its performance is specially required for realizing multifunctional applications as in optical communication and weak signal detectors. Here, we demonstrate an epitaxial graphene (EG)/n-type SiC Schottky ultraviolet (UV) photodiode with extremely widescale adjustability in its responsivity and response speed. It is found that the response speed of the device can be modulated over seven orders of magnitude from tens of nanoseconds to milliseconds by changing its working bias from 0 to -5 V, while its responsivity can be varied by three orders of magnitude. A 2.18 A/W responsivity is observed at -5 V when a 325 nm laser is irradiated on, corresponding to an external quantum efficiency over 800% ascribed to the trap induced internal gain mechanism. These performances of the EG/SiC Schottky photodiode are far superior to those based on traditional metal/SiC and indicate that the EG/n-type SiC Schottky diode is a good candidate for application in UV photodetection.

Factors influencing naproxen metabolite interference in total bilirubin assays.

PubMed

Saifee, Nabiha Huq; Ranjitkar, Pratistha; Greene, Dina N

2016-04-01

The factors influencing naproxen metabolite O-desmethylnaproxen (ODMN) positive interference in diazo-based Jendrassik and Grof (JG) total bilirubin (Tbil) assays and lack of interference in direct bilirubin (Dbil) assays have not been resolved. The objective of this study was to understand the conditions causing this interference pattern. Pooled normal and ultra-filtered plasma samples spiked with ODMN and naproxen were measured on the Beckman Coulter DxC and AU instruments. Absorbance spectra were obtained for ODMN mixed with Dbil reagent at original and adjusted pH. Absorbance spectra were also obtained for ODMN and bilirubin samples mixed with Tbil assay reagents. ODMN produces a positive interference in the DxC JG Tbil assays, but not the AU Tbil or Dbil assays or the DxC Dbil assay. Neutralizing the acidic pH of AU and DxC Dbil reagents allows ODMN to react with diazo salts. ODMN samples mixed with DxC and AU Tbil reagents produce broad peaks from 450 to 560nm and 400 to 540nm, respectively. The DxC JG Tbil assay monitors a change in absorbance at 520nm close to peak absorbance wavelength of diazo-reacted ODMN, whereas the AU Tbil assay monitors a change in absorbance at 570/660nm, beyond the peak absorbance wavelengths of diazo-reacted ODMN. The acidic pH of diazo-based Dbil assay reagents inhibits the reaction of ODMN with diazo salts. The AU JG Tbil assay is a reliable method to measure Tbil in the setting of naproxen overdose. Copyright © 2015 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Autonomous magnetic float zone microgravity crystal growth application to TiC and GaAs

NASA Astrophysics Data System (ADS)

Chan, Tony Y.-T.; Choi, Sang-Keun

1992-10-01

The floating zone process is ideal for high temperature (greater than 3000 K) growth of titanium carbide because it is containerless. However, float zoning requires small melt volumes in order to maintain a stable melt configuration. The short melt columns make it difficult to achieve a controlled thermal profile, a necessity for producing crystals of high quality. Thus, an automated control strategy based upon continuous monitoring of the growth process with processing parameters adjusted to values based upon the physical transport processes of the growth process is very desirable for maintaining stability and reproducibility of the process. The present work developed a Float-zone Acquisition and Control Technology (FACT) system which uses relations derived by combining empirical relations with a knowledge data base deduced from detailed numerical analysis of fluid mechanics and thermal transport of the growth process. The FACT system was assembled, tested and employed to grow two TiC ingots. One of the ingots was characterized by x-ray diffraction at different axial locations. The x-ray rocking curves showed consistent characteristics of a manually grown ingot. It was also found that with the FACT system, the process conditions can be operated closer to the stability limits, due to fast response time and repetitive amounts of adjustment from the FACT system. The FACT system shows a major potential in growing quality TiC crystals in a cost-effective manner.

Canine parvovirus in vaccinated dogs: a field study.

PubMed

Miranda, C; Thompson, G

2016-04-16

The authors report a field study that investigated the canine parvovirus (CPV) strains present in dogs that developed the disease after being vaccinated. Faecal samples of 78 dogs that have been vaccinated against CPV and later presented with clinical signs suspected of parvovirus infection were used. Fifty (64.1 per cent) samples tested positive by PCR for CPV. No CPV vaccine type was detected. The disease by CPV-2b occurred in older and female dogs when compared with that by CPV-2c. The clinical signs presented by infected dogs were similar when any of both variants were involved. In most cases of disease, the resulting infection by field variants occurred shortly after CPV vaccination. Two dogs that had been subjected to a complete vaccination schedule and presented with clinical signs after 10 days of vaccination, had the CPV-2c variant associated. The phylogenetic studies showed a close relationship of the isolates in vaccinated dogs to European field strains. Despite the limited sample size in this study, the findings point to the significance of the continuous molecular typing of the virus as a tool to monitor the prevalent circulating CPV strains and access the efficacy of current vaccines. Adjustments on the vaccine types to be used may have to be evaluated again according to each epidemiological situation in order to achieve the dog's optimal immune protection against CPV.

Respiratory health and lung function in Chinese restaurant kitchen workers.

PubMed

Wong, Tze Wai; Wong, Andromeda H S; Lee, Frank S C; Qiu, Hong

2011-10-01

To measure air pollutant concentrations in Chinese restaurant kitchens using different stove types and assess their influence on workers' respiratory health. 393 kitchen workers from 53 Chinese restaurants were surveyed over 16 months: 115 workers from 21 restaurants using only electric stoves and 278 workers from 32 restaurants using only gas stoves. Workers were interviewed about their respiratory symptoms and had their lung function tested. Concentrations of nitric oxide (NO), nitrogen dioxide (NO(2)), carbon monoxide (CO), carbon dioxide (CO(2)), methane (CH(4)), non-methane hydrocarbons (NMHC), total volatile organic compounds (TVOC) and fine particulate matter (PM(2.5)) were measured using portable monitors and air-bag sampling. Temperature and noise levels were assessed. Median concentrations of NO, NO(2) and CO were 7.4, 1.5 and 1.6 times higher in gas-fuelled kitchens than in electric ones and average concentrations of PM(2.5) and TVOC were 81% and 78% higher, respectively. Differences were smaller for CH(4) and NMHC. Electricity-run kitchens were 4.5°C cooler and 9 dBA less noisy than gas-fuelled ones. Workers using electric cookers had significantly better lung function than their gas-using counterparts and their mean FEV(1) and FVC values were 5.4% and 3.8% higher, respectively, after adjustment for confounders. Wheeze, phlegm, cough and sore throat were more prevalent in workers using gas. The adjusted OR for having phlegm regularly was significantly higher. The poorer lung function and higher prevalence of respiratory symptoms among workers in gas-fuelled kitchens compared to those in electricity-powered kitchens may be associated with exposure to higher concentrations of toxic air pollutants generated during gas cooking.

32 CFR 269.4 - Cost of living adjustments of civil monetary penalties.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Statement 5,000 5,500 33 U.S.C. 1319(g)(2)(A) § 404Permit Condition Violation, Class I (per violation amount) 10,000 11,000 33 U.S.C. 1319(g)(2)(A) § 404Permit Condition Violation, Class I (maximum amount) 25,000 27,500 33 U.S.C. 1319(g)(2)(B) § 404Permit Condition Violation, Class II (per day amount) 10,000...

Facilitating Children's Adjustment to Orthotic and Prosthetic Appliances.

ERIC Educational Resources Information Center

Fredrick, Jeff; Fletcher, Donna

1985-01-01

Guidelines are offered to help teachers understand the nature and use of orthotic and prosthetic appliances for disabled students. Classroom behavior observations are noted so that teachers can help monitor the child's adjustment to the appliance. (CL)

33 CFR 27.3 - Penalty Adjustment Table.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Manufacture 8,000 33 U.S.C. 1608(a) International Navigation Rules; Operator 8,000 33 U.S.C. 1608(b) International Navigation Rules; Vessel 8,000 33 U.S.C. 1908(b)(1) Pollution from Ships; General 40,000 33 U.S.C... (Judicial Assessment subsequent offense) 100,000 46 U.S.C. App 1505(a)(2) Safe Containers for International...

An approach for using AVHRR data to monitor U.S. great plains grasslands

USGS Publications Warehouse

Reed, B.C.; Loveland, Thomas R.; Tieszen, L.L.

1996-01-01

Environmental monitoring requires regular observations regarding the status of the landscape- The concept behind most monitoring efforts using satellite data involve deriving normalized difference vegetation index (NDVI) values or accumulating the NDVI over a specified time period. These efforts attempt to estimate the continuous growth of green biomass by using continuous additions of NDVI as a surrogate measure. To build upon this concept, this study proposes three refinements; 1) use an objective definition of the current growing season to adjust the time window during which the NDVI is accumulated, 2) accumulate only the NDVI values which are affected by green vegetation, and 3) base monitoring units upon land cover type. These refinements improve the sensitivity of detecting interannual vegetation variability, reduce the need for extensive and detailed knowledge of ground conditions and crop calendars, provide a framework in which several types of monitoring can take place over diverse land cover types, and provide an objective time frame during which monitoring takes place.

Predicting thermally stressful events in rivers with a strategy to evaluate management alternatives

USGS Publications Warehouse

Maloney, K.O.; Cole, J.C.; Schmid, M.

2016-01-01

Water temperature is an important factor in river ecology. Numerous models have been developed to predict river temperature. However, many were not designed to predict thermally stressful periods. Because such events are rare, traditionally applied analyses are inappropriate. Here, we developed two logistic regression models to predict thermally stressful events in the Delaware River at the US Geological Survey gage near Lordville, New York. One model predicted the probability of an event >20.0 °C, and a second predicted an event >22.2 °C. Both models were strong (independent test data sensitivity 0.94 and 1.00, specificity 0.96 and 0.96) predicting 63 of 67 events in the >20.0 °C model and all 15 events in the >22.2 °C model. Both showed negative relationships with released volume from the upstream Cannonsville Reservoir and positive relationships with difference between air temperature and previous day's water temperature at Lordville. We further predicted how increasing release volumes from Cannonsville Reservoir affected the probabilities of correctly predicted events. For the >20.0 °C model, an increase of 0.5 to a proportionally adjusted release (that accounts for other sources) resulted in 35.9% of events in the training data falling below cutoffs; increasing this adjustment by 1.0 resulted in 81.7% falling below cutoffs. For the >22.2 °C these adjustments resulted in 71.1% and 100.0% of events falling below cutoffs. Results from these analyses can help managers make informed decisions on alternative release scenarios.

Association of CYP2D6*10 (c.100C>T) polymorphisms with clinical outcome of breast cancer after tamoxifen adjuvant endocrine therapy in Chinese population.

PubMed

Lei, Lei; Wang, Xian; Wu, Xiao-Dan; Wang, Zeng; Chen, Zhan-Hong; Zheng, Ya-Bin; Wang, Xiao-Jia

2016-01-01

Tamoxifen is the most widely used adjuvant endocrine therapy for breast cancer. However, the pharmacogenetic effect of CYP2D6 on its efficacy remains unclear. Therefore, this study aimed to evaluate the association of CYP2D6*10 (c.100C>T) polymorphisms with clinical outcome in Chinese breast cancer patients. A total of 72 tamoxifen-treated early breast cancer patients were included in this study. CYP2D6*10 (c.100C>T) polymorphisms (C/C: wild type; T/T: homozygous mutant genotype T; C/T: heterozygote genotype C) were detected by pyrosequencing. The plasma concentrations of tamoxifen and its two major active metabolites were determined by liquid chromatography tandem mass spectrometry (LC-MS). Disease-free survival (DFS) and overall survival (OS) were assessed by Kaplan-Meier analysis, while the Cox proportional hazards model was used in multivariate tests for prognostic significance. We found that T/T carrier showed the lowest serum concentration of endoxifen as compared to C/C and C/T carriers (p<0.01). In the subgroup of patients below 40 years of age, T/T carriers appeared to have the shortest DFS and OS as compared to other genotype carriers (p<0.01). When genotypes (C/C, C/T and T/T carriers) and other clinical characteristics were adjusted, tumor size (>2 cm) and grades were independent prognostic factors for DFS but not OS (tumor size >2 cm: HR: 3.870, 95% CI: 1.045-14.330, P = 0.043; tumor grades: HR: 2.230, 95% CI: 1.090-4.562, P = 0.028). In conclusion, the T/T genotype is a negative prognostic factor in young breast cancer patients using tamoxifen. Tumor size (>2 cm) and grades are independent prognostic factors for DFS, when genotype of CYP2D6*10 (c.100C>T) is adjusted.

One-to-one teaching with pictures--flashcard health education for British Asians with diabetes.

PubMed Central

Hawthorne, K; Tomlinson, S

1997-01-01

BACKGROUND: Type 2 diabetes is up to four times more common in British Asians, but they know little about its management and complications. AIM: To design and evaluate a structured pictorial teaching programme for Pakistani Moslem patients in Manchester with type 2 diabetes. METHOD: A randomized controlled trial of pictorial flashcard one-to-one education in 201 patients attending a hospital outpatient clinic or diabetic clinics in ten general practices in Manchester. Patients' knowledge, self-caring skills and attitudes to diabetes were measured on four topics before the structured teaching, and compared with results six months later. RESULTS: All parameters of knowledge were increased in the study group; for example, percentage scores for correctly identifying different food values increased from 57% to 71% (Analysis of Variance (ANOVA) adjusted difference +11.8%) and knowledge of one diabetic complication from 18% to 78%. Self-caring behaviour improved, with 92% of patients doing regular glucose tests at six months compared with 63% at the start. Attitudinal views were more resistant to change, with patients still finding it hard to choose suitable foods at social occasions. Haemoglobin A1c control improved by 0.34% over six months (ANOVA adjusted difference, 95% CI -0.8% to +0.1%). CONCLUSION: It is concluded that this health education programme can empower Asian diabetics to take control of their diets, learn to monitor and interpret glucose results, and understand the implications of poor glycaemic control for diabetic complications. PMID:9219407

Association between -1082G/A, -819C/T, and -592C/A genetic polymorphisms in IL-10 and risk of type 2 diabetes mellitus in a Chinese population.

PubMed

Dong, Q Y; Liu, X M; Liang, C G; Du, W H; Wang, Y L; Li, W X; Gao, G Q

2016-08-29

Type 2 diabetes mellitus is the most common form of endocrine disease in humans; genetic factors are known to contribute to the development of this disease. In this case-control study, we investigated the relationship between the -1082G/A, -819C/T, and -592C/A polymorphisms in interleukin 10 (IL-10) and the pathogenesis of type 2 diabetes mellitus in a Chinese population. Patients with type 2 diabetes mellitus (N = 228) and control subjects (N = 240) were recruited from the Department of Endocrinology at the People's Hospital of Linyi City, between September 2013 and April 2015. The IL-10 -1082G/A, -819C/T, and -592C/A polymorphisms were genotyped by polymerase chain reaction-restriction fragment length polymorphism. Multivariate logistic regression analyses revealed that patients carrying the AA genotype of IL-10 -592C/A were at a higher risk of developing type 2 diabetes mellitus compared to those carrying the CC genotype [adjusted odds ratio (OR) = 1.74; 95% confidence interval (CI) = 1.03-2.95]. In addition, individuals carrying the A allele of IL-10 -592C/A showed a 1.34-fold higher risk of developing type 2 diabetes mellitus compared to those carrying the C allele (adjusted OR = 1.34; 95%CI = 1.03- 1.75). There was no significant correlation between the IL-10 -1082G/ A and -819C/T polymorphisms and risk of type 2 diabetes mellitus. In conclusion, this study shows that the -1082G/A polymorphism of IL-10 contributes to the onset of type 2 diabetes mellitus, and may be considered a biomarker for early screening of type 2 diabetes mellitus in the Chinese population studied here.

Design of the intelligent smoke alarm system based on photoelectric smoke

NASA Astrophysics Data System (ADS)

Ma, Jiangfei; Yang, Xiufang; Wang, Peipei

2017-02-01

This paper designed a kind of intelligent smoke alarm system based on photoelectric smoke detector and temperature, The system takes AT89C51 MCU as the core of hardware control and Labview as the host computer monitoring center.The sensor system acquires temperature signals and smoke signals, the MCU control A/D by Sampling and converting the output analog signals , and then the two signals will be uploaded to the host computer through the serial communication. To achieve real-time monitoring of smoke and temperature in the environment, LabVIEW monitoring platform need to hold, process, analysis and display these samping signals. The intelligent smoke alarm system is suitable for large scale shopping malls and other public places, which can greatly reduce the false alarm rate of fire, The experimental results show that the system runs well and can alarm when the setting threshold is reached,and the threshold parameters can be adjusted according to the actual conditions of the field. The system is easy to operate, simple in structure, intelligent, low cost, and with strong practical value.

Effects of meal preparation training on body weight, glycemia, and blood pressure: results of a phase 2 trial in type 2 diabetes.

PubMed

Dasgupta, Kaberi; Hajna, Samantha; Joseph, Lawrence; Da Costa, Deborah; Christopoulos, Stavroula; Gougeon, Rejeanne

2012-10-17

Modest reductions in weight and small increases in step- related activity (e.g., walking) can improve glycemic and blood pressure control in type 2 diabetes mellitus (DM2). We examined changes in these parameters following training in time- efficient preparation of balanced, low- energy meals combined with pedometer- based step count monitoring. Seventy- two adults with DM2 were enrolled in a 24- week program (i.e., 15 three- hour group sessions). They prepared meals under a chef's supervision, and discussed eating behaviours/nutrition with a registered dietitian. They maintained a record of pedometer- assessed step counts. We evaluated changes from baseline to 24 weeks in terms of weight, step counts, hemoglobin A1c (HbA1c, glycemic control), blood pressure, and eating control ability (Weight Efficacy Lifestyle WEL Questionnaire). 53 participants (73.6%) completed assessments. There were improvements in eating control (11.2 point WEL score change, 95% CI 4.7 to 17.8), step counts (mean change 869 steps/day, 95% CI 198 to 1,540), weight (mean change -2.2%; 95% CI -3.6 to -0.8), and HbA1c (mean change -0.3% HbA1c, 95% CI -0.6 to -0.1), as well as suggestion of systolic blood pressure reduction (mean change -3.5 mm Hg, 95% CI -7.8 to 0.9). Findings were not attributable to medication changes. In linear regression models (adjusted for age, sex, ethnicity, insulin use, season), a -2.5% weight change was associated with a -0.3% HbA1c change (95% CI -0.4 to -0.2) and a -3.5% systolic blood pressure change (95% CI -5.5 to -1.4). In this 'proof of concept' study, persistence with the program led to improvements in eating and physical activity habits, glycemia reductions, and suggestion of blood pressure lowering effects. The strategy thus merits further study and development to expand the range of options for vascular risk reduction in DM2.

12 CFR 263.65 - Civil penalty inflation adjustments.

Code of Federal Regulations, 2014 CFR

2014-01-01

...) First tier—$7,500. (ii) Second tier—$37,500. (iii) Third tier—$1,425,000. (3) 12 U.S.C. 1820(k)(6)(A)(ii...) 12 U.S.C. 1467a(i)(2)—$32,500. (ii) 12 U.S.C. 1467a(i)(3)—$32,500. (12) 12 U.S.C. 1467a(r): (i) 12 U.S.C. 1467a(r)(1)—$3,200. (ii) 12 U.S.C. 1467a(r)(2)—$32,500. (iii) 12 U.S.C. 1467a(r)(3)—$1,425,000...

12 CFR 263.65 - Civil penalty inflation adjustments.

Code of Federal Regulations, 2013 CFR

2013-01-01

...) First tier—$7,500. (ii) Second tier—$37,500. (iii) Third tier—$1,425,000. (3) 12 U.S.C. 1820(k)(6)(A)(ii...) 12 U.S.C. 1467a(i)(2)—$32,500. (ii) 12 U.S.C. 1467a(i)(3)—$32,500. (12) 12 U.S.C. 1467a(r): (i) 12 U.S.C. 1467a(r)(1)—$3,200. (ii) 12 U.S.C. 1467a(r)(2)—$32,500. (iii) 12 U.S.C. 1467a(r)(3)—$1,425,000...

Diabetes Mellitus Care Provided by Nurse Practitioners vs Primary Care Physicians.

PubMed

Kuo, Yong-Fang; Goodwin, James S; Chen, Nai-Wei; Lwin, Kyaw K; Baillargeon, Jacques; Raji, Mukaila A

2015-10-01

To compare processes and cost of care of older adults with diabetes mellitus cared for by nurse practitioners (NPs) with processes and cost of those cared for by primary care physicians (PCPs). Retrospective cohort study. Primary care in communities. Individuals with a diagnosis of diabetes mellitus in 2009 who received all their primary care from NPs or PCPs were selected from a national sample of Medicare beneficiaries (N = 64,354). Propensity score matching within each state was used to compare these two cohorts with regard to rate of eye examinations, low-density lipoprotein cholesterol (LDL-C) and glycosylated hemoglobin (HbA1C) testing, nephropathy monitoring, specialist consultation, and Medicare costs. The two groups were also compared regarding medication adherence and use of statins, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (for individuals with a diagnosis of hypertension), and potentially inappropriate medications (PIMs). Nurse practitioners and PCPs had similar rates of LDL-C testing (odds ratio (OR) = 1.01, 95% confidence interval (CI) = 0.94-1.09) and nephropathy monitoring (OR = 1.05, 95% CI = 0.98-1.03), but NPs had lower rates of eye examinations (OR = 0.89, 95% CI = 0.84-0.93) and HbA1C testing (OR = 0.88, 95% CI = 0.79-0.98). NPs were more likely to have consulted cardiologists (OR = 1.29, 95% CI = 1.21-1.37), endocrinologists (OR = 1.64, 95% CI = 1.48-1.82), and nephrologists (OR = 1.90, 95% CI = 1.67-2.17) and more likely to have prescribed PIMs (OR = 1.07, 95% CI = 1.01-1.12). There was no statistically significant difference in adjusted Medicare spending between the two groups (P = .56). Nurse practitioners were similar to PCPs or slightly lower in their rates of diabetes mellitus guideline-concordant care. NPs used specialist consultations more often but had similar overall costs of care to PCPs. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Pregnancies After the Diagnosis of Mild Gestational Diabetes Mellitus and Risk of Cardiometabolic Disorders.

PubMed

Varner, Michael W; Rice, Madeline Murguia; Landon, Mark B; Casey, Brian M; Reddy, Uma M; Wapner, Ronald J; Rouse, Dwight J; Tita, Alan T N; Thorp, John M; Chien, Edward K; Saade, George R; Peaceman, Alan M; Blackwell, Sean C; Vandorsten, J Peter

2017-02-01

To assess the association of subsequent pregnancy with subsequent metabolic syndrome and type II diabetes mellitus after a pregnancy complicated by mild gestational diabetes mellitus (GDM). We conducted a prospective observational follow-up study of women with mild GDM randomized from 2002 to 2007 to usual care or dietary intervention and glucose self-monitoring. Women were evaluated 5-10 years after the parent study. Participants were grouped according to the number of subsequent pregnancies (group A, none [reference]; group B, one; group C, two or greater). Serum triglycerides, glucose tolerance, high-density lipoprotein cholesterol, blood pressure, and waist circumference were assessed. Metabolic syndrome was diagnosed by American Heart Association and National Heart Lung and Blood Institute criteria. Multivariable regression was used to estimate adjusted relative risks (RRs) and 95% confidence intervals (CIs). Of 905 eligible women from the original trial, 483 agreed to participate, 426 of whom were included in this analysis. Groups A, B, and C consisted of 212, 143, and 71 women, respectively. Of women with subsequent pregnancies, 32% (69/214) had another pregnancy complicated with GDM. No difference between groups was observed for metabolic syndrome (group A, 34%; group B, 33%; group C, 30%). Subsequent pregnancies were associated with diabetes mellitus outside of pregnancy (group A, 5.2%; group B, 10.5%, RR 2.62, 95% CI 1.16-5.91; group C, 11.3%, RR 2.83, 95% CI 1.06-7.59), and if complicated with GDM (no subsequent GDM pregnancy, RR 1.99, 95% CI 0.82-4.84; subsequent GDM pregnancy, RR 3.75, 95% CI 1.60-8.82). In women with prior mild GDM, subsequent pregnancies did not increase the frequency of metabolic syndrome, but subsequent pregnancies with GDM increased the risk of diabetes mellitus outside of pregnancy.

Short-Term Exposure to Ambient Air Pollution and Biomarkers of Systemic Inflammation: The Framingham Heart Study.

PubMed

Li, Wenyuan; Dorans, Kirsten S; Wilker, Elissa H; Rice, Mary B; Ljungman, Petter L; Schwartz, Joel D; Coull, Brent A; Koutrakis, Petros; Gold, Diane R; Keaney, John F; Vasan, Ramachandran S; Benjamin, Emelia J; Mittleman, Murray A

2017-09-01

The objective of this study is to examine associations between short-term exposure to ambient air pollution and circulating biomarkers of systemic inflammation in participants from the Framingham Offspring and Third Generation cohorts in the greater Boston area. We included 3996 noncurrent smoking participants (mean age, 53.6 years; 54% women) who lived within 50 km from a central air pollution monitoring site in Boston, MA, and calculated the 1- to 7-day moving averages of fine particulate matter (diameter<2.5 µm), black carbon, sulfate, nitrogen oxides, and ozone before the examination visits. We used linear mixed effects models for C-reactive protein and tumor necrosis factor receptor 2, which were measured up to twice for each participant; we used linear regression models for interleukin-6, fibrinogen, and tumor necrosis factor α, which were measured once. We adjusted for demographics, socioeconomic position, lifestyle, time, and weather. The 3- to 7-day moving averages of fine particulate matter (diameter<2.5 µm) and sulfate were positively associated with C-reactive protein concentrations. A 5 µg/m 3 higher 5-day moving average fine particulate matter (diameter<2.5 µm) was associated with 4.2% (95% confidence interval: 0.8, 7.6) higher circulating C-reactive protein. Positive associations were also observed for nitrogen oxides with interleukin-6 and for black carbon, sulfate, and ozone with tumor necrosis factor receptor 2. However, black carbon, sulfate, and nitrogen oxides were negatively associated with fibrinogen, and sulfate was negatively associated with tumor necrosis factor α. Higher short-term exposure to relatively low levels of ambient air pollution was associated with higher levels of C-reactive protein, interleukin-6, and tumor necrosis factor receptor 2 but not fibrinogen or tumor necrosis factor α in individuals residing in the greater Boston area. © 2017 American Heart Association, Inc.

Blood circulatory system for noninvasive diagnostics

NASA Astrophysics Data System (ADS)

Fricke, D.; Kraitl, J.; Ewald, H.

2013-02-01

Based on the human circulatory system, an artificial blood circulatory system was developed to allow the controlled variation of the following blood parameters: total hemoglobin concentration (ctHb), oxyhemoglobin (O2Hb) methemoglobin (MetHb) and carboxyhemoglobin (COHb). The optical properties of the blood were observed by online spectrometer measurements. The purpose of this was to observe and quantify the absorption, transmission and scattering properties of human whole blood in the wavelength range of 400 to 1700 nm. All the non-invasive measurements of the whole blood transmission-spectra were compared with sample results obtained by a Blood Gas Analyzer (BGA) to validate the results. For all measurements, donor erythrocyte concentrates were used. The concentration of hemoglobin was changed by adding fixed amounts of blood plasma to the erythrocyte concentrate. Oxygen saturation and COHb were adjusted by a continuous flow of N2, N2-CO and compressed air through a hollow fibre membrane oxygenator. Different methemoglobin concentrations were adjusted by using natrium nitrite. The blood temperature was kept constant at 37 °C via a tube heating mechanism, with a separate circulation of water passing through the membrane Oxygenator. The Temperature and pressure of the system were automatically controlled and monitored. The model was also used to test new non-invasive measurement systems, and for this reason special cuvettes were designed to imitate human tissue and generate plethysmographical signals. In the future, the blood circulatory system has the potential to be used for testing, validating and also to calibrate newly developed optical prototype devices. It can also be used to further investigate blood components of interest.

Cavity beam position monitor system for the Accelerator Test Facility 2

NASA Astrophysics Data System (ADS)

Kim, Y. I.; Ainsworth, R.; Aryshev, A.; Boogert, S. T.; Boorman, G.; Frisch, J.; Heo, A.; Honda, Y.; Hwang, W. H.; Huang, J. Y.; Kim, E.-S.; Kim, S. H.; Lyapin, A.; Naito, T.; May, J.; McCormick, D.; Mellor, R. E.; Molloy, S.; Nelson, J.; Park, S. J.; Park, Y. J.; Ross, M.; Shin, S.; Swinson, C.; Smith, T.; Terunuma, N.; Tauchi, T.; Urakawa, J.; White, G. R.

2012-04-01

The Accelerator Test Facility 2 (ATF2) is a scaled demonstrator system for final focus beam lines of linear high energy colliders. This paper describes the high resolution cavity beam position monitor (BPM) system, which is a part of the ATF2 diagnostics. Two types of cavity BPMs are used, C-band operating at 6.423 GHz, and S-band at 2.888 GHz with an increased beam aperture. The cavities, electronics, and digital processing are described. The resolution of the C-band system with attenuators was determined to be approximately 250 nm and 1μm for the S-band system. Without attenuation the best recorded C-band cavity resolution was 27 nm.

40 CFR 19.4 - Penalty adjustment and table.

Code of Federal Regulations, 2010 CFR

2010-07-01

...,000/4,300 140,000/4,300 33 U.S.C. 1415(a) MARINE PROTECTION, RESEARCH, AND SANCTUARIES ACT (MPRSA) 50.... 300j-4(c) SDWA 25,000 27,500 32,500 37,500 42 U.S.C. 300j-6(b)(2) SDWA 25,000 25,000 27,500 32,500 42 U.... 6928(g) RCRA 25,000 27,500 32,500 37,500 42 U.S.C. 6928(h)(2) RCRA 25,000 27,500 32,500 37,500 42 U.S.C...

40 CFR 19.4 - Penalty adjustment and table.

Code of Federal Regulations, 2011 CFR

2011-07-01

...,000/4,300 140,000/4,300 33 U.S.C. 1415(a) MARINE PROTECTION, RESEARCH, AND SANCTUARIES ACT (MPRSA) 50.... 300j-4(c) SDWA 25,000 27,500 32,500 37,500 42 U.S.C. 300j-6(b)(2) SDWA 25,000 25,000 27,500 32,500 42 U.... 6928(g) RCRA 25,000 27,500 32,500 37,500 42 U.S.C. 6928(h)(2) RCRA 25,000 27,500 32,500 37,500 42 U.S.C...

40 CFR 63.7832 - How do I monitor and collect data to demonstrate continuous compliance?

Code of Federal Regulations, 2011 CFR

2011-07-01

... and collect data to demonstrate continuous compliance? (a) Except for monitoring malfunctions, out-of... control activities (including as applicable, calibration checks and required zero and span adjustments... source is operating. (b) You may not use data recorded during monitoring malfunctions, associated repairs...

40 CFR 63.7832 - How do I monitor and collect data to demonstrate continuous compliance?

Code of Federal Regulations, 2013 CFR

2013-07-01

... and collect data to demonstrate continuous compliance? (a) Except for monitoring malfunctions, out-of... control activities (including as applicable, calibration checks and required zero and span adjustments... source is operating. (b) You may not use data recorded during monitoring malfunctions, associated repairs...

40 CFR 63.7832 - How do I monitor and collect data to demonstrate continuous compliance?

Code of Federal Regulations, 2014 CFR

2014-07-01

... and collect data to demonstrate continuous compliance? (a) Except for monitoring malfunctions, out-of... control activities (including as applicable, calibration checks and required zero and span adjustments... source is operating. (b) You may not use data recorded during monitoring malfunctions, associated repairs...

40 CFR 63.2270 - How do I monitor and collect data to demonstrate continuous compliance?

Code of Federal Regulations, 2014 CFR

2014-07-01

... control activities (including, as applicable, calibration checks and required zero and span adjustments), you must conduct all monitoring in continuous operation at all times that the process unit is operating. For purposes of calculating data averages, you must not use data recorded during monitoring...

40 CFR 63.7832 - How do I monitor and collect data to demonstrate continuous compliance?

Code of Federal Regulations, 2010 CFR

2010-07-01

... and collect data to demonstrate continuous compliance? (a) Except for monitoring malfunctions, out-of... control activities (including as applicable, calibration checks and required zero and span adjustments... source is operating. (b) You may not use data recorded during monitoring malfunctions, associated repairs...

40 CFR 63.2270 - How do I monitor and collect data to demonstrate continuous compliance?

Code of Federal Regulations, 2013 CFR

2013-07-01

... control activities (including, as applicable, calibration checks and required zero and span adjustments), you must conduct all monitoring in continuous operation at all times that the process unit is operating. For purposes of calculating data averages, you must not use data recorded during monitoring...

40 CFR 63.7832 - How do I monitor and collect data to demonstrate continuous compliance?

Code of Federal Regulations, 2012 CFR

2012-07-01

... and collect data to demonstrate continuous compliance? (a) Except for monitoring malfunctions, out-of... control activities (including as applicable, calibration checks and required zero and span adjustments... source is operating. (b) You may not use data recorded during monitoring malfunctions, associated repairs...

40 CFR 60.54 - Test methods and procedures.

Code of Federal Regulations, 2014 CFR

2014-07-01

.... (c) The owner or operator may use either of the following procedures to determine the adjusted CO2... owner or operator shall use as reference methods and procedures the test methods in appendix A of this... follows: (1) The concentration (c12) of particulate matter, corrected to 12 percent CO2, shall be computed...

Vascular compliance in women with polycystic ovary syndrome and healthy women.

PubMed

Muneyyirci-Delale, Ozgul; Winer, Nathaniel; Oklander, Vita; Joulak, Ibrahim; Dalloul, Nezar; Nacharaju, Vijaya; Dham, Shefali; von Gizycki, Hans

2007-01-01

Polycystic ovary syndrome (PCOS), one of the most common endocrine disorders in women of reproductive age, has been associated with the cardiometabolic syndrome and increased risk for cardiovascular diseases. Large (C1) and small (C2) vessel compliance and fasting lipids were measured in 45 healthy women and 36 women with PCOS. There were no differences in vacular compliance (C1, C2) between the 2 groups. Systolic blood pressure (116.8 vs 124.3 mm Hg; P=.01), mean arterial pressure (82.5 vs 87 mm Hg; P=.03), and low-density lipoprotein cholesterol (98.1 vs 119 mg/dL; P=.001) were significantly higher in the PCOS group. This difference was not significant after adjusting for age and body mass index. High-density lipoprotein levels in subjects with PCOS were significantly lower than in healthy women (60.2 vs 48.9 mg/dL, P=.02) even after adjusting for age and body mass index. The study indicates that obesity and low high-density lipoprotein are the major contributing factors to cardiovascular changes in PCOS.

Serum calcium changes and risk of type 2 diabetes mellitus in Asian population.

PubMed

Suh, Sunghwan; Bae, Ji Cheol; Jin, Sang-Man; Jee, Jae Hwan; Park, Mi Kyoung; Kim, Duk Kyu; Kim, Jae Hyeon

2017-11-01

We examined the association between changes in serum calcium levels with the incidence of type 2 diabetes mellitus (T2DM) in apparently healthy South Korean subjects. A retrospective longitudinal analysis was conducted with subjects who had participated in comprehensive health check-ups at least four times over a 7-year period (between 2006 and 2012). In total, 23,121 subjects were categorized into tertiles based on changes in their albumin-adjusted serum calcium levels. Multivariate Cox regression models were fitted to assess the association between changes in serum calcium levels during follow-up and the relative risk of diabetes incidence. After a median follow-up of 57.4months, 1,929 (8.3%) new cases of T2DM occurred. Simple linear regression analysis showed serum calcium level changes correlated positively with changes in HbA1c and fasting plasma glucose (FPG) levels (B=5.72, p<0.001 for FPG; B=0.13, p<0.001 for HbA1c). An increase in albumin-adjusted serum calcium levels during follow-up was related to an increased risk of T2DM. After adjustment for potential confounders, the risk of T2DM was 1.6 times greater for subjects whose albumin-adjusted serum calcium levels were in the highest change tertile during follow-up than for subjects whose levels were in the lowest tertile (HR 1.65, 95% CI 1.44-1.88, P<0.001). The elevation of albumin-adjusted serum calcium levels was associated with an increased risk of T2DM, independent of baseline glycemic status. Copyright © 2017 Elsevier B.V. All rights reserved.

Clinical and Pharmacogenetic Predictors of Circulating Atorvastatin and Rosuvastatin Concentration in Routine Clinical Care

PubMed Central

DeGorter, Marianne K.; Tirona, Rommel G.; Schwarz, Ute I.; Choi, Yun-Hee; Dresser, George K.; Suskin, Neville; Myers, Kathryn; Zou, GuangYong; Iwuchukwu, Otito; Wei, Wei-Qi; Wilke, Russell A.; Hegele, Robert A.; Kim, Richard B.

2014-01-01

Background A barrier to statin therapy is myopathy associated with elevated systemic drug exposure. Our objective was to examine the association between clinical and pharmacogenetic variables and statin concentrations in patients. Methods and Results In total, 299 patients taking atorvastatin or rosuvastatin were prospectively recruited at an outpatient referral center. The contribution of clinical variables and transporter gene polymorphisms to statin concentration was assessed using multiple linear regression. We observed 45-fold variation in statin concentration among patients taking the same dose. After adjustment for gender, age, body mass index, ethnicity, dose, and time from last dose, SLCO1B1 c.521T>C (p < 0.001) and ABCG2 c.421C>A (p < 0.01) were important to rosuvastatin concentration (adjusted R2 = 0.56 for the final model). Atorvastatin concentration was associated with SLCO1B1 c.388A>G (p < 0.01) and c.521T>C (p < 0.05), and 4β-hydroxycholesterol, a CYP3A activity marker (adjusted R2 = 0.47). A second cohort of 579 patients from primary and specialty care databases were retrospectively genotyped. In this cohort, genotypes associated with statin concentration were not differently distributed among dosing groups, implying providers had not yet optimized each patient's risk-benefit ratio. Nearly 50% of patients in routine practice taking the highest doses were predicted to have statin concentrations greater than the 90th percentile. Conclusions Interindividual variability in statin exposure in patients is associated with uptake and efflux transporter polymorphisms. An algorithm incorporating genomic and clinical variables to avoid high atorvastatin and rosuvastatin levels is described; further study will determine if this approach reduces incidence of statin-myopathy. PMID:23876492

Architectures and Evaluation for Adjustable Control Autonomy for Space-Based Life Support Systems

NASA Technical Reports Server (NTRS)

Malin, Jane T.; Schreckenghost, Debra K.

2001-01-01

In the past five years, a number of automation applications for control of crew life support systems have been developed and evaluated in the Adjustable Autonomy Testbed at NASA's Johnson Space Center. This paper surveys progress on an adjustable autonomous control architecture for situations where software and human operators work together to manage anomalies and other system problems. When problems occur, the level of control autonomy can be adjusted, so that operators and software agents can work together on diagnosis and recovery. In 1997 adjustable autonomy software was developed to manage gas transfer and storage in a closed life support test. Four crewmembers lived and worked in a chamber for 91 days, with both air and water recycling. CO2 was converted to O2 by gas processing systems and wheat crops. With the automation software, significantly fewer hours were spent monitoring operations. System-level validation testing of the software by interactive hybrid simulation revealed problems both in software requirements and implementation. Since that time, we have been developing multi-agent approaches for automation software and human operators, to cooperatively control systems and manage problems. Each new capability has been tested and demonstrated in realistic dynamic anomaly scenarios, using the hybrid simulation tool.