Science.gov

Sample records for ett massabruks sodapanna

  1. EttA regulates translation by binding to the ribosomal E site and restricting ribosome-tRNA dynamics

    PubMed Central

    Chen, Bo; Boël, Grégory; Hashem, Yaser; Ning, Wei; Fei, Jingyi; Wang, Chi; Gonzalez, Ruben L.; Hunt, John F.; Frank, Joachim

    2014-01-01

    Cells express many ribosome-interacting factors whose functions and molecular mechanisms remain unknown. Here, we elucidate the mechanism of a newly characterized regulatory translation factor, Energy-dependent Translational Throttle A (EttA), which is an Escherichia coli representative of the ATP-binding cassette F (ABC-F) protein family. Using cryo-EM, we demonstrate that the ATP-bound form of EttA binds to the ribosomal tRNA exit (E) site, where it forms bridging interactions between the ribosomal L1 stalk and the tRNA bound in the peptidyl-tRNA binding (P) site. Using single-molecule fluorescence resonance energy transfer (smFRET), we show that the ATP-bound form of EttA restricts ribosome and tRNA dynamics required for protein synthesis. This work represents the first example, to our knowledge, where the detailed molecular mechanism of any ABC-F family protein has been determined and establishes a framework for elucidating the mechanisms of other regulatory translation factors. PMID:24389465

  2. Transition from two to one integument in Prunus species: expression pattern of INNER NO OUTER (INO), ABERRANT TESTA SHAPE (ATS) and ETTIN (ETT).

    PubMed

    Lora, Jorge; Hormaza, José I; Herrero, Maria

    2015-10-01

    While gymnosperm ovules have one integument, in most angiosperms two integuments surround the ovules. Unitegmic ovules have arisen independently several times during the evolution of angiosperms, but the ultimate genetic cause of the presence of a single integument remains elusive. We compared species of the genus Prunus that have different numbers of integuments: bitegmic species, such as Prunus armeniaca (apricot) and Prunus persica (peach), and unitegmic species, such as Prunus incisa, analyzing the expression pattern of genes that are involved in integument development in Arabidopsis thaliana: INNER NO OUTER (INO), ABERRANT TESTA SHAPE (ATS) and ETTIN (ETT). Bitegmic and unitegmic species showed similar INO expression patterns, indicative of the conservation of an outer integument. However, expression of ETT, which occurs in the boundary of the outer and inner integuments, was altered in unitegmic ovules, which showed lack of ETT expression. These results strongly suggest that the presence of a single integument could be attributable to the amalgamation of two integuments and support the role of ETT in the fusion of the outer and inner integuments in unitegmic ovules, a situation that could be widespread in other unitegmic species of angiosperms.

  3. Distributed Denial of Service Attack Source Detection Using Efficient Traceback Technique (ETT) in Cloud-Assisted Healthcare Environment.

    PubMed

    Latif, Rabia; Abbas, Haider; Latif, Seemab; Masood, Ashraf

    2016-07-01

    Security and privacy are the first and foremost concerns that should be given special attention when dealing with Wireless Body Area Networks (WBANs). As WBAN sensors operate in an unattended environment and carry critical patient health information, Distributed Denial of Service (DDoS) attack is one of the major attacks in WBAN environment that not only exhausts the available resources but also influence the reliability of information being transmitted. This research work is an extension of our previous work in which a machine learning based attack detection algorithm is proposed to detect DDoS attack in WBAN environment. However, in order to avoid complexity, no consideration was given to the traceback mechanism. During traceback, the challenge lies in reconstructing the attack path leading to identify the attack source. Among existing traceback techniques, Probabilistic Packet Marking (PPM) approach is the most commonly used technique in conventional IP- based networks. However, since marking probability assignment has significant effect on both the convergence time and performance of a scheme, it is not directly applicable in WBAN environment due to high convergence time and overhead on intermediate nodes. Therefore, in this paper we have proposed a new scheme called Efficient Traceback Technique (ETT) based on Dynamic Probability Packet Marking (DPPM) approach and uses MAC header in place of IP header. Instead of using fixed marking probability, the proposed scheme uses variable marking probability based on the number of hops travelled by a packet to reach the target node. Finally, path reconstruction algorithms are proposed to traceback an attacker. Evaluation and simulation results indicate that the proposed solution outperforms fixed PPM in terms of convergence time and computational overhead on nodes.

  4. Meta-analyses of microarrays of Arabidopsis asymmetric leaves1 (as1), as2 and their modifying mutants reveal a critical role for the ETT pathway in stabilization of adaxial-abaxial patterning and cell division during leaf development.

    PubMed

    Takahashi, Hiro; Iwakawa, Hidekazu; Ishibashi, Nanako; Kojima, Shoko; Matsumura, Yoko; Prananingrum, Pratiwi; Iwasaki, Mayumi; Takahashi, Anna; Ikezaki, Masaya; Luo, Lilan; Kobayashi, Takeshi; Machida, Yasunori; Machida, Chiyoko

    2013-03-01

    It is necessary to use algorithms to analyze gene expression data from DNA microarrays, such as in clustering and machine learning. Previously, we developed the knowledge-based fuzzy adaptive resonance theory (KB-FuzzyART), a clustering algorithm suitable for analyzing gene expression data, to find clues for identifying gene networks. Leaf primordia form around the shoot apical meristem (SAM), which consists of indeterminate stem cells. Upon initiation of leaf development, adaxial-abaxial patterning is crucial for lateral expansion, via cellular proliferation, and the formation of flat symmetric leaves. Many regulatory genes that specify such patterning have been identified. Analysis by the KB-FuzzyART and subsequent molecular and genetic analyses previously showed that ASYMMETRIC LEAVES1 (AS1) and AS2 repress the expression of some abaxial-determinant genes, such as AUXIN RESPONSE FACTOR3 (ARF3)/ETTIN (ETT) and ARF4, which are responsible for defects in leaf adaxial-abaxial polarity in as1 and as2. In the present study, genetic analysis revealed that ARF3/ETT and ARF4 were regulated by modifier genes, BOBBER1 (BOB1) and ELONGATA3 (ELO3), together with AS1-AS2. We analyzed expression arrays with as2 elo3 and as2 bob1, and extracted genes downstream of ARF3/ETT by using KB-FuzzyART and molecular analyses. The results showed that expression of Kip-related protein (KRP) (for inhibitors of cyclin-dependent protein kinases) and Isopentenyltransferase (IPT) (for biosynthesis of cytokinin) genes were controlled by AS1-AS2 through ARF3/ETT and ARF4 functions, which suggests that the AS1-AS2-ETT pathway plays a critical role in controlling the cell division cycle and the biosynthesis of cytokinin around SAM to stabilize leaf development in Arabidopsis thaliana.

  5. Propulsion Velocity and ETT on Biomagnetic Assessment of the Human Esophagus

    SciTech Connect

    Cordova-Fraga, T.; Cano, E.; Bravo-Miranda, C.; De la Roca-Chiapas, J. M.; Bernal, J. J.; Sosa, M.; Huerta, R.

    2008-08-11

    Esophagus transit time measurement is a common clinical practical. Biomagnetic techniques and modern instrumentation can perform non invasive and functional assessments of the gastrointestinal tract. This study presents the evaluation of the esophagus transit time and propulsion velocity of a magnetic marker from the mouth to stomach using water vs. a swallow easy substance recently patented. A group of ten healthy subjects from 45 to 55 years, were evaluated in identical conditions for two times, they ingested randomly a magnetic marker in an anatomical body position of 45 deg., one times with water and the other one with a patented substance developed in order to help the subjects to swallow pills. The esophagus transit time was shorter when the subjects ingested the magnetic marker with the swallow easy substance than they ingested the magnetic marker with same quantity of water.

  6. Propulsion Velocity and ETT on Biomagnetic Assessment of the Human Esophagus

    NASA Astrophysics Data System (ADS)

    Cordova-Fraga, T.; Cano, E.; Bravo-Miranda, C.; Huerta, R.; De la Roca-Chiapas, J. M.; Bernal, J. J.; Sosa, M.

    2008-08-01

    Esophagus transit time measurement is a common clinical practical. Biomagnetic techniques and modern instrumentation can perform non invasive and functional assessments of the gastrointestinal tract. This study presents the evaluation of the esophagus transit time and propulsion velocity of a magnetic marker from the mouth to stomach using water vs. a swallow easy substance recently patented. A group of ten healthy subjects from 45 to 55 years, were evaluated in identical conditions for two times, they ingested randomly a magnetic marker in an anatomical body position of 45°, one times with water and the other one with a patented substance developed in order to help the subjects to swallow pills. The esophagus transit time was shorter when the subjects ingested the magnetic marker with the swallow easy substance than they ingested the magnetic marker with same quantity of water

  7. Greenhouse Gas-ette Fall 1988, Spring, Fall 1989, Winter, Spring, Fall 1990.

    ERIC Educational Resources Information Center

    Greenhouse Gas-ette, 1990

    1990-01-01

    This newsletter is for educators interested in developing lessons related to global climate change. The newsletter contains sample lessons, news items involving global climate change on an international scale, and background information on issues related to global climate change. (CW)

  8. Description and modelling of the solar-hydrogen-biogas-fuel cell system in GlashusEtt

    NASA Astrophysics Data System (ADS)

    Hedström, L.; Wallmark, C.; Alvfors, P.; Rissanen, M.; Stridh, B.; Ekman, J.

    The need to reduce pollutant emissions and utilise the world's available energy resources more efficiently has led to increased attention towards e.g. fuel cells, but also to other alternative energy solutions. In order to further understand and evaluate the prerequisites for sustainable and energy-saving systems, ABB and Fortum have equipped an environmental information centre, located in Hammarby Sjöstad, Stockholm, Sweden, with an alternative energy system. The system is being used to demonstrate and evaluate how a system based on fuel cells and solar cells can function as a complement to existing electricity and heat production. The stationary energy system is situated on the top level of a three-floor glass building and is open to the public. The alternative energy system consists of a fuel cell system, a photovoltaic (PV) cell array, an electrolyser, hydrogen storage tanks, a biogas burner, dc/ac inverters, heat exchangers and an accumulator tank. The fuel cell system includes a reformer and a polymer electrolyte fuel cell (PEFC) with a maximum rated electrical output of 4 kW el and a maximum thermal output of 6.5 kW th. The fuel cell stack can be operated with reformed biogas, or directly using hydrogen produced by the electrolyser. The cell stack in the electrolyser consists of proton exchange membrane (PEM) cells. To evaluate different automatic control strategies for the system, a simplified dynamic model has been developed in MATLAB Simulink. The model based on measurement data taken from the actual system. The evaluation is based on demand curves, investment costs, electricity prices and irradiation. Evaluation criteria included in the model are electrical and total efficiencies as well as economic parameters.

  9. Enlisted Personnel Individualized Career System (EPICS) Design, Development, and Implementation

    DTIC Science & Technology

    1984-01-01

    I 0 TV CI.MPICAIWSO 6P.S PM (Mme Due ae* SEPICS features use of 3PAs, deferred formal training, and an individualized career... advancement...3.0 Use of Simpson 260-5P multimeter ETT 4.0 Variational analysis of DC series circuits ErT 5.0 Parallel DC circuits ETT 6.0 Combination DC circuits ETT...7.0 Special DC circuits ETT 8.0 Introduction to AC test equipment4 ETT 9.0 Introduction to inductors ETT 10.0 Transformer identification and

  10. Micropatterned Endotracheal Tubes Reduce Secretion-Related Lumen Occlusion.

    PubMed

    Mann, Ethan E; Magin, Chelsea M; Mettetal, M Ryan; May, Rhea M; Henry, MiKayla M; DeLoid, Heather; Prater, Justin; Sullivan, Lauren; Thomas, John G; Twite, Mark D; Parker, Albert E; Brennan, Anthony B; Reddy, Shravanthi T

    2016-12-01

    Tracheal intubation disrupts physiological homeostasis of secretion production and clearance, resulting in secretion accumulation within endotracheal tubes (ETTs). Novel in vitro and in vivo models were developed to specifically recapitulate the clinical manifestations of ETT occlusion. The novel Sharklet™ micropatterned ETT was evaluated, using these models, for the ability to reduce the accumulation of both bacterial biofilm and airway mucus compared to a standard care ETT. Novel ETTs with micropattern on the inner and outer surfaces were placed adjacent to standard care ETTs in in vitro biofilm and airway patency (AP) models. The primary outcome for the biofilm model was to compare commercially-available ETTs (standard care and silver-coated) to micropatterned for quantity of biofilm accumulation. The AP model's primary outcome was to evaluate accumulation of artificial airway mucus. A 24-h ovine mechanical ventilation model evaluated the primary outcome of relative quantity of airway secretion accumulation in the ETTs tested. The secondary outcome was measuring the effect of secretion accumulation in the ETTs on airway resistance. Micropatterned ETTs significantly reduced biofilm by 71% (p = 0.016) compared to smooth ETTs. Moreover, micropatterned ETTs reduced lumen occlusion, in the AP model, as measured by cross-sectional area, in distal (85%, p = 0.005), middle (84%, p = 0.001) and proximal (81%, p = 0.002) sections compared to standard care ETTs. Micropatterned ETTs reduced the volume of secretion accumulation in a sheep model of occlusion by 61% (p < 0.001) after 24 h of mechanical ventilation. Importantly, micropatterned ETTs reduced the rise in ventilation peak inspiratory pressures over time by as much as 49% (p = 0.005) compared to standard care ETTs. Micropatterned ETTs, demonstrated here to reduce bacterial contamination and mucus occlusion, will have the capacity to limit complications occurring during mechanical ventilation and

  11. Insights on the role of antimicrobial cuffed endotracheal tubes in preventing transtracheal transmission of VAP pathogens from an in vitro model of microaspiration and microbial proliferation.

    PubMed

    Rosenblatt, Joel; Reitzel, Ruth; Jiang, Ying; Hachem, Ray; Raad, Issam

    2014-01-01

    We developed an in vitro model to evaluate the effect of different cuffed endotracheal tubes (ETTs) on transtracheal transmission of ventilator-associated pneumonia (VAP) pathogens along external surfaces of ETTs. The model independently assessed the relative contributions of microbial proliferation to the distal tip and microaspiration of contaminated secretions past the cuff by testing in three modes: microaspiration only, microbial proliferation only, and simultaneous microaspiration and microbial proliferation. We evaluated transmission of methicillin resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa (PA) in the presence of a standard ETT; a soft, tapered cuff ETT with subglottic suctioning; and a novel antimicrobial gendine (combination of gentian violet and chlorhexidine) ETT in the model. In the microaspiration only mode, when leakage past the cuff occurred quickly, no ETT prevented transmission. When microaspiration was delayed, the gendine ETT was able to completely disinfect the fluid above the cuff and thereby prevent transmission of pathogens. In microbial proliferation only mode, the gendine ETT was the sole ETT that prevented transmission. With both mechanisms simultaneously available, transmission was dependent on how long microaspiration was delayed. Potent antimicrobial ETTs, such as a gendine ETT, can make unique contributions to prevent VAP when microaspiration is gradual.

  12. Ultrasonography for endotracheal tube position in infants and children.

    PubMed

    Jaeel, Pooja; Sheth, Mansi; Nguyen, Jimmy

    2017-03-01

    Ultrasonography (US) has been shown to be effective for verifying endotracheal tube (ETT) position in adults but has been less studied in infants and children. We review the literature regarding US for ETT positioning in the pediatric population. A literature search was conducted using the Ovid and MEDLINE databases with search terms regarding US relating to ETT intubation and positioning in infants and children. Most studies in neonates and infants used the midsagittal suprasternal view. Studies reported >80% visualization of the ETT tip by US, and US interpretation of the ETT position correlated with the XR position in 73-100% of cases. Studies of older children used the suprasternal views, substernal views, and mid-axillary intercostal views. US appears comparable to XR and capnography in determining ETT position in this population.

  13. Computer-aided detection of malpositioned endotracheal tubes in portable chest radiographs

    NASA Astrophysics Data System (ADS)

    Huo, Zhimin; Mao, Hongda; Zhang, Jane; Sykes, Anne-Marie; Munn, Samson; Wandtke, John

    2014-03-01

    Portable chest radiographic images play a critical role in examining and monitoring the condition and progress of critically ill patients in intensive care units (ICUs). For example, portable chest images are acquired to ensure that tubes inserted into the patients are properly positioned for effective treatment. In this paper, we present a system that automatically detects the position of an endotracheal tube (ETT), which is inserted into the trachea to assist patients who have difficulty breathing. The computer detection includes the detections of the lung field, spine line, and aortic arch. These detections lead to the identification of regions of interest (ROIs) used for the subsequent detection of the ETT and carina. The detection of the ETT and carina is performed within the ROIs. Our ETT and carina detection methods were trained and tested on a large number of images. The locations of the ETT and carina were confirmed by an experienced radiologist for the purpose of performance evaluation. Our ETT detection achieved an average sensitivity of 85% at less than 0.1 false-positive detections per image. The carina approach correctly identified the carina location within a 10 mm distance from the truth location for 81% of the 217 testing images. We expect our system will assist ICU clinicians to detect malpositioned ETTs and reposition malpositioned ETTs more effectively and efficiently.

  14. Ventilator associated pneumonia and endotracheal tube repositioning: an underrated risk factor.

    PubMed

    McGovern Murphy, F; Raymond, M; Menard, P-A; Bejar-Ardiles, K-R; Carignan, A; Lesur, O

    2014-12-01

    Aspiration of secretions toward lower airways potentially occurs during endotracheal tube (ETT) repositioning in mechanically ventilated patients in the intensive care unit and may be a risk factor for developing ventilator-associated pneumonia (VAP). This case-control study confirms that repositioning of the ETT is an independent risk factor for VAP.

  15. Decreased Staphylococcus aureus biofilm formation on nanomodified endotracheal tubes: a dynamic airway model.

    PubMed

    Machado, Mary C; Tarquinio, Keiko M; Webster, Thomas J

    2012-01-01

    Ventilator-associated pneumonia (VAP) is a serious and costly clinical problem. Specifically, receiving mechanical ventilation for over 24 hours increases the risk of VAP and is associated with high morbidity, mortality, and medical costs. Cost-effective endotracheal tubes (ETTs) that are resistant to bacterial infections could help prevent this problem. The objective of this study was to determine differences in the growth of Staphylococcus aureus on nanomodified and unmodified polyvinyl chloride (PVC) ETTs under dynamic airway conditions simulating a ventilated patient. PVC ETTs were modified to have nanometer surface features by soaking them in Rhizopus arrhisus, a fungal lipase. Twenty-four-hour experiments (supported by computational models) showed that airflow conditions within the ETT influenced both the location and the concentration of bacterial growth on the ETTs, especially within areas of tube curvature. More importantly, experiments revealed a 1.5 log reduction in the total number of S. aureus on the novel nanomodified ETTs compared with the conventional ETTs after 24 hours of airflow. This dynamic study showed that lipase etching can create nanorough surface features on PVC ETTs that suppress S. aureus growth, and thus may provide clinicians with an effective and inexpensive tool to combat VAP.

  16. Decreased Staphylococcus aureus biofilm formation on nanomodified endotracheal tubes: a dynamic airway model

    PubMed Central

    Machado, Mary C; Tarquinio, Keiko M; Webster, Thomas J

    2012-01-01

    Ventilator-associated pneumonia (VAP) is a serious and costly clinical problem. Specifically, receiving mechanical ventilation for over 24 hours increases the risk of VAP and is associated with high morbidity, mortality, and medical costs. Cost-effective endotracheal tubes (ETTs) that are resistant to bacterial infections could help prevent this problem. The objective of this study was to determine differences in the growth of Staphylococcus aureus on nanomodified and unmodified polyvinyl chloride (PVC) ETTs under dynamic airway conditions simulating a ventilated patient. PVC ETTs were modified to have nanometer surface features by soaking them in Rhizopus arrhisus, a fungal lipase. Twenty-four-hour experiments (supported by computational models) showed that airflow conditions within the ETT influenced both the location and the concentration of bacterial growth on the ETTs, especially within areas of tube curvature. More importantly, experiments revealed a 1.5 log reduction in the total number of S. aureus on the novel nanomodified ETTs compared with the conventional ETTs after 24 hours of airflow. This dynamic study showed that lipase etching can create nanorough surface features on PVC ETTs that suppress S. aureus growth, and thus may provide clinicians with an effective and inexpensive tool to combat VAP. PMID:22904622

  17. Effective Teaching Training. Program Evaluation.

    ERIC Educational Resources Information Center

    Vanderburg, Arne S.; Shainline, Michael

    Workshops for teachers given under the Effective Teaching Training (ETT) program of the Albuquerque (New Mexico) Public Schools were evaluated. Based on the Upland Model of Effective Teaching, ETT will be extended to all teachers and administrators in the district by the end of the 1988-89 school year. Interviews, workshop ratings, and…

  18. [Final report for DOE contract FG03-88ER13882

    SciTech Connect

    1999-04-30

    The female reproductive organ, the gynoecium, is the most complex structure that plants produce. The molecular mechanisms that coordinate its development are unknown, but can be dissected by molecular genetics. The ettin (ett) mutation provides a remarkable window for viewing gynoecium development. ett induced alterations result from misinterpretation of positional information along longitudinal and transverse gynoecial axes. Molecular cloning revealed the ETT encoded amino acid sequence is homologous to transcriptional factors involved in signaling by the plant hormone auxin. Early ETT gene expression marks the site of the future outgrowth of the gynoecium. The primary gene sequence and pattern of expression of ETT fits with a role in hormone mediated signaling for regional development in the female organ.

  19. Studenters fritids--och motionsvanor i Umea och Madison. Ett bidrag till forstaelsen av Pierre Bourdieus vetenskapliga metodologi. Akademiska avhanlingar, Pedagogiska institutionen Nr. 58 (Leisure and Exercise Habits among Students in Umea and Madison. A Contribution to the Understanding of Pierre Bourdieu's Scientific Methodology. Academic Dissertation, Faculty of Social Sciences No. 58).

    ERIC Educational Resources Information Center

    Lofgren, Kent

    This study, presented in Swedish with an English summary, analyzed differences between student groups at Umea University, Sweden, and the University of Wisconsin-Madison in terms of study situations, experiences of the university environment, exercise and sports activities, and the connections between study and leisure time activities. The study…

  20. Prevalence, diagnosis and management of ectopic thyroid glands.

    PubMed

    Santangelo, Giuseppe; Pellino, Gianluca; De Falco, Nadia; Colella, Giuseppe; D'Amato, Salvatore; Maglione, M Grazia; De Luca, Roberto; Canonico, Silvestro; De Falco, Massimo

    2016-04-01

    Ectopic thyroid tissue (ETT) is an uncommon entity that may be found anywhere along the line of the obliterated thyroglossal duct, usually from the tongue to the diaphragm. We performed a retrospective analysis of patients undergoing surgical treatment for thyroid disease between January 2000 and December 2013, seeking for ETT All patients with prior neck surgery or trauma were excluded. The clinic-pathologic features, prevalence and diagnosis of the lesions were collected and analyzed. Out of 3092 included patients, 28 ETT were identified (0.9%). The anatomical site of ETT was as follows: lateral cervical in 6 (21.4%), along the thyroglossal duct in 6 (21.4%), mediastinal in 5 (17.9%), lingual in 5 (17.9%), sublingual in 3 (10.7%), and submandibular in 3 (10.7%). Histopathology revealed 27 benign lesions and 1 (3.6%) papillary carcinoma. ETT is found in less than 1% of patients receiving thyroid surgery. Diagnosis of ETT requires clinical imaging. Surgery is a prudent choice due to the potential of malignant evolution of ETT.

  1. Effects of anatomical position on esophageal transit time: A biomagnetic diagnostic technique

    PubMed Central

    Cordova-Fraga, Teodoro; Sosa, Modesto; Wiechers, Carlos; la Roca-Chiapas, Jose Maria De; Moreles, Alejandro Maldonado; Bernal-Alvarado, Jesus; Huerta-Franco, Raquel

    2008-01-01

    AIM: To study the esophageal transit time (ETT) and compare its mean value among three anatomical inclinations of the body; and to analyze the correlation of ETT to body mass index (BMI). METHODS: A biomagnetic technique was implemented to perform this study: (1) The transit time of a magnetic marker (MM) through the esophagus was measured using two fluxgate sensors placed over the chest of 14 healthy subjects; (2) the ETT was assessed in three anatomical positions (at upright, fowler, and supine positions; 90º, 45º and 0º, respectively). RESULTS: ANOVA and Tuckey post-hoc tests demonstrated significant differences between ETT mean of the different positions. The ETT means were 5.2 ± 1.1 s, 6.1 ± 1.5 s, and 23.6 ± 9.2 s for 90º, 45º and 0º, respectively. Pearson correlation results were r = -0.716 and P < 0.001 by subjects’ anatomical position, and r = -0.024 and P > 0.05 according the subject’s BMI. CONCLUSION: We demonstrated that using this biomagnetic technique, it is possible to measure the ETT and the effects of the anatomical position on the ETT. PMID:18837088

  2. Comparison of the cuff pressure of a TaperGuard endotracheal tube and a cylindrical endotracheal tube after lateral rotation of head during middle ear surgery

    PubMed Central

    Choi, Eunkyung; Park, Yongmin; Jeon, Younghoon

    2017-01-01

    Abstract Background: Positional change affects the cuff pressure of an endotracheal tube (ETT) in treacheally intubated patients. We compared the cuff pressure of a TaperGuard ETT and a cylindrical ETT after lateral rotation of head during middle ear surgery. Methods: Fifty-two patients aged 18–70 years underwent a tympanomastoidectomy under general anesthesia were randomly allocated to receive endotracheal intubation with cylindrical (group C, n = 26) or TaperGuard ETTs (group T, n = 26). After endotracheal intubation, the ETT cuff pressure was set at 22 cmH2O in the neutral position of head. After lateral rotation of head, the cuff pressure was measured again and readjusted to 22 cmH2O. In addition, the change of distance from the carina to the tip of the ETT was measured before and after the positional change. The incidence of cough, sore throat, and hoarseness was assessed at 30 minutes, 6 hours, and 24 hours after surgery. Results: There was no difference in demographic data between groups. After lateral rotation of head, the cuff pressure significantly increased in group T (11.9 ± 2.3 cmH2O) compared with group C (6.0 ± 1.9 cmH2O) (P < 0.001). The incidence of a cuff pressure >30 cmH2O was higher in group T (96.2%) than in group C (30.8%) (P < 0.001). In addition, the degree of displacement of an ETT was greater in group T (11.0 ± 1.7 mm) than in group C (7.2 ± 2.6 mm) (P < 0.001). The overall incidences of postoperative sore throat, hoarseness, and cough at 30 minutes, 6 hours, and 24 hours after surgery were comparable between two groups. Conclusion: The cuff pressure was higher in the TaperGuard ETT than in the cylindrical ETT after positional change of head from neutral to lateral rotation. In addition, after a positional change, the extent of displacement of ETT was greater in the TaperGuard ETT than in the cylindrical ETT. PMID:28272230

  3. Respiratory mechanics during high-frequency oscillatory ventilation: a physical model and preterm infant study.

    PubMed

    Singh, Rachana; Courtney, Sherry E; Weisner, Michael D; Habib, Robert H

    2012-04-01

    Accurate mechanics measurements during high-frequency oscillatory ventilation (HFOV) facilitate optimizing ventilator support settings. Yet, these are influenced substantially by endotracheal tube (ETT) contributions, which may dominate when leaks around uncuffed ETT are present. We hypothesized that 1) the effective removal of ETT leaks may be confirmed via direct comparison of measured vs. model-predicted mean intratracheal pressure [mPtr (meas) vs. mPtr (pred)], and 2) reproducible respiratory system resistance (Rrs) and compliance (Crs) may be derived from no-leak oscillatory Ptr and proximal flow. With the use of ETT test-lung models, proximal airway opening (Pao) and distal (Ptr) pressures and flows were measured during slow-cuff inflations until leaks are removed. These were repeated for combinations of HFOV settings [frequency, mean airway pressure (Paw), oscillation amplitudes (ΔP), and inspiratory time (%t(I))] and varying test-lung Crs. Results showed that leaks around the ETT will 1) systematically reduce the effective distending pressures and lung-delivered oscillatory volumes, and 2) derived mechanical properties are increasingly nonphysiologic as leaks worsen. Mean pressures were systematically reduced along the ventilator circuit and ETT (Paw > Pao > Ptr), even for no-leak conditions. ETT size-specific regression models were then derived for predicting mPtr based on mean Pao (mPao), ΔP, %t(I), and frequency. Next, in 10 of 11 studied preterm infants (0.77 ± 0.24 kg), no-to-minimal leak was confirmed based on excellent agreement between mPtr (meas) and mPtr (pred), and consequently, their oscillatory respiratory mechanics were evaluated. Infant resistance at the proximal ETT (R(ETT); resistance airway opening = R(ETT) + Rrs; P < 0.001) and ETT inertance (P = 0.014) increased significantly with increasing ΔP (50%, 100%, and 150% baseline), whereas Rrs showed a modest, nonsignificant increase (P = 0.14), and Crs was essentially unchanged (P = 0

  4. Influence of Low Peak Respiratory Exchange Ratio on Cardiac Rehabilitation in Patients With Coronary Artery Disease

    PubMed Central

    2016-01-01

    Objective To compare and analyze the effects of cardiac rehabilitation (CR) in two groups based on the peak respiratory exchange ratio (RERpeak) 1.1 values using the exercise tolerance test (ETT) results, and to investigate the reasons for early termination of ETT. Methods Patients with acute coronary syndrome who participated in CR exercise training were selected and all subjects underwent 6 weeks of CR exercise training. ETT was performed on a treadmill using a Modified Bruce Protocol before and after CR exercise training. According to the result of the first ETT, the subjects were divided into two groups: those with an RERpeak≥1.1 (n=33) and those with an RERpeak<1.1 (n=22). We investigated the reasons for ETT termination and compared the effect of CR between the groups. Results The reasons for the early termination of the first ETT in the RERpeak<1.1 group were subjective dyspnea, abnormal cardiovascular responses, leg fatigue and other problems. After a 6-week CR, the peak oxygen consumption (VO2peak) and ETT time increased, and the rate of perceived exertion (RPE) and RPP (rate pressure product) at stage 3 decreased in both the RERpeak<1.1 and RERpeak≥1.1 groups. Conclusion CR exercise training improved exercise capacity, not only in the RERpeak≥1.1 group, but also in the RERpeak<1.1 group. This means that patients with a lower exercise tolerance could also benefit from the effects of CR. Thoughtful consideration to identify the direct and indirect causes for the early termination of ETT would be necessary to improve the efficiency of CR. PMID:28119843

  5. ProSeal Laryngeal Mask Airway as an Alternative to Standard Endotracheal Tube in Securing Upper Airway in the Patients Undergoing Beating-heart Coronary Artery Bypass Grafting

    PubMed Central

    Shah, Kalpana

    2017-01-01

    Background: ProSeal laryngeal mask airways (PLMAs) are routinely used after failed tracheal intubation as airway rescue, facilitating tracheal intubation by acting as a conduit and to secure airway during emergencies. In long duration surgeries, use of endotracheal tube (ETT) is associated with various hemodynamic complications, which are minimally affected during PLMA use. However, except for few studies, there are no significant data available that promote the use of laryngeal mask during cardiac surgery. This prospective study was conducted with the objective of demonstrating the advantages of PLMA over ETT in the patients undergoing beating-heart coronary artery bypass graft (CABG). Methodology: This prospective, interventional study was carried out in 200 patients who underwent beating-heart CABG. Patients were randomized in equal numbers to either ETT group or PLMA group, and various hemodynamic and respiratory parameters were observed at different time points. Results: Patients in PLMA group had mean systolic blood pressure 126.10 ± 5.31 mmHg compared to the patients of ETT group 143.75 ± 6.02 mmHg. Pulse rate in the PLMA group was less (74.52 ± 10.79 per min) (P < 0.05) compared to ETT group (81.72 ± 9.8). Thus, hemodynamic changes were significantly lower (P < 0.05) in PLMA than in ETT group. Respiratory parameters such as oxygen saturation, pressure CO2 (pCO2), peak airway pressure, and lung compliance were similar to ETT group at all evaluation times. The incidence of adverse events was also lower in PLMA group. Conclusion: In experience hand, PLMA offers advantages over the ETT in airway management in the patients undergoing beating-heart CABG. PMID:28074798

  6. Predicting endotracheal tube size by length in newborns.

    PubMed

    Luten, Robert; Kahn, Nagma; Wears, Robert; Kissoon, Niranjan

    2007-05-01

    The objective of this study was to determine the relationship of length to endotracheal tube (ETT) size in newborns and to use this relationship to develop a tool for predicting ETT size. The study, a prospective derivation, and validation of a predictive model, took place in the neonatal intensive care units (NICUs) in two urban teaching hospitals. Subjects included: ETT derivation set - 39 intubated neonates admitted to the NICU; Validation set - 69 intubated newborns from the same NICU. Leak percentages were measured in intubated neonates where the actual ETT size did not correlate with the tape-determined ETT size. Interventions were length, weight, and leak measurements. A prototype tape was developed using the derivation set and published anthropometric studies. The accuracy of the tape was validated on a separate set of newborns. The average relative difference between tape-predicted weight and actual weight was 9.5% (confidence interval [CI] = 8.3-10.6%) and was evenly distributed throughout all the weight groups. The tape predicted actual ETT size in 96% of cases (CI 86.3-99.5%) and was correct within 1 tube size (1/2 mm) in 100% (CI 94.8-100%). The only error in prediction of ETT size was in underestimation. Length-based weight estimations were tested on 100 subjects and predicted actual weight within 20% in 94% of cases. We concluded that length is an accurate predictor of ETT size and weight in term and preterm newborns and may be useful in situations in which weights are unobtainable, such as emergency resuscitation.

  7. Decreased Pseudomonas aeruginosa biofilm formation on nanomodified endotracheal tubes: a dynamic lung model

    PubMed Central

    Machado, Mary C; Webster, Thomas J

    2016-01-01

    Ventilator-associated pneumonia (VAP) is a serious complication of mechanical ventilation that has been shown to be associated with increased mortality rates and medical costs in the pediatric intensive care unit. Currently, there is no cost-effective solution to the problems posed by VAP. Endotracheal tubes (ETTs) that are resistant to bacterial colonization and that inhibit biofilm formation could provide a novel solution to the problems posed by VAP. The objective of this in vitro study was to evaluate differences in the growth of Pseudomonas aeruginosa on unmodified polyvinyl chloride (PVC) ETTs and on ETTs etched with a fungal lipase, Rhizopus arrhizus, to create nanoscale surface features. These differences were evaluated using an in vitro model of the pediatric airway to simulate a ventilated patient in the pediatric intensive care unit. Each experiment was run for 24 hours and was supported by computational models of the ETT. Dynamic conditions within the ETT had an impact on the location of bacterial growth within the tube. These conditions also quantitatively affected bacterial growth especially within the areas of tube curvature. Most importantly, experiments in the in vitro model revealed a 2.7 log reduction in the number (colony forming units/mL) of P. aeruginosa on the nanoroughened ETTs compared to the untreated PVC ETTs after 24 hours. This reduction in total colony forming units/mL along the x-axis of the tube was similar to previous studies completed for Staphylococcus aureus. Thus, this dynamic study showed that lipase etching can create surface features of nanoscale roughness on PVC ETTs that decrease bacterial attachment of P. aeruginosa without the use of antibiotics and may provide clinicians with an effective and inexpensive tool to combat VAP. PMID:27563242

  8. Heart Rate Variability, Catecholamine and Hemodynamic Responses During Rest and Stress in Coronary Artery Disease Patients: The PIMI Study

    DTIC Science & Technology

    2007-01-31

    Chierchia, S. L. (1997). Angina pectoris and the personality factor: the relevance of psychosocial factors in myocardial ischaemia. Eur Heart J, 18(6), 892...25 ischemic events were asymptomatic (no angina ) and the decreases in HRV (HF and LF) were correlated with high levels of...angioplasty (PTCA) within 6 months of qualifying ETT, cardiac surgery requiring thoracotomy, unstable angina within 4 weeks of qualifying ETT

  9. Parallel structural evolution of auxin response factors in the angiosperms.

    PubMed

    Finet, Cédric; Fourquin, Chloé; Vinauger, Marion; Berne-Dedieu, Annick; Chambrier, Pierre; Paindavoine, Sandrine; Scutt, Charles P

    2010-09-01

    Here we analyze the structural evolution of the paralogous transcription factors ETTIN (ETT/ARF3) and AUXIN RESPONSE FACTOR 4 (ARF4), which control the development of floral organs and leaves in the model angiosperm Arabidopsis. ETT is truncated at its C terminus, and consequently lacks two regulatory domains present in most other ARFs, including ARF4. Our analysis indicates ETT and ARF4 to have been generated by the duplication of a non-truncated ARF gene prior to the radiation of the extant angiosperms. We furthermore show that either ETT or ARF4 orthologs have become modified to encode truncated ARF proteins, lacking C-terminal regulatory domains, in representatives of three groups that separated early in angiosperm evolution: Amborellales, Nymphaeales and the remaining angiosperm clade. Interestingly, the production of truncated ARF4 transcripts in Amborellales occurs through an alternative splicing mechanism, rather than through a permanent truncation, as in the other groups studied. To gain insight into the potential functional significance of truncations to ETT and ARF4, we tested the capacity of native, truncated and chimeric coding sequences of these genes to restore a wild-type phenotype to Arabidopsis ett mutants. We discuss the results of this analysis in the context of the structural evolution of ARF genes in the angiosperms.

  10. Extrauterine epithelioid trophoblastic tumor in hysterectomized woman

    PubMed Central

    Kim, Ji-Hye; Lee, Sun Kyung; Hwang, Soo Hyun; Kim, Jung-Sun; Yoon, Gun; Lee, Yoo-Young; Kim, Tae-Joong; Choi, Chel Hun; Kim, Byoung-Gie; Bae, Duk-Soo

    2017-01-01

    Epithelioid trophoblastic tumor (ETT) is a very rare variant of gestational trophoblastic disease (GTD) which arises in reproductive age women with prior gestational history. Although abnormal vaginal bleeding is the most common symptom of ETT, there are no reported pathognomonic symptoms of ETT because of its rarity. ETT is similar to placental site trophoblastic tumor in terms of its slow growing characteristic and microscopic findings. Therefore, it could be misdiagnosed as placental site trophoblastic tumor or other types of GTD. Unlike other types of GTD, primary treatment of ETT is surgical resection because of its chemo-resistant nature. Accordingly, immunohistochemical staining is essential for accurate diagnosis and appropriate treatment. Here, we report a case of a 42-year-old hysterectomized woman with pelvic masses who suffered from abdominal pain. Through laparotomy, tumors were resected completely and they were diagnosed as ETT through immunohistochemical stain. This report provides more evidence about its clinical features, diagnosis, and treatment including a brief review of the literature. PMID:28217684

  11. Comparison of prophylactic effects of polyurethane cylindrical or tapered cuff and polyvinyl chloride cuff endotracheal tubes on ventilator-associated pneumonia.

    PubMed

    Mahmoodpoor, Ata; Peyrovi-far, Ali; Hamishehkar, Hadi; Bakhtyiari, Zhaleh; Mirinezhad, Mir Mousa; Hamidi, Masoud; Golzari, Samad Eslam Jamal

    2013-08-07

    Because microaspiration of contaminated supraglottic secretions past the endotracheal tube cuff is considered to be central in the pathogenesis of pneumonia, improved design of tracheal tubes with new cuff material and shape have reduced the size and number of folds, which together with the addition of suction ports above the cuff to drain pooled subglottic secretions leads to reduced aspiration of oropharyngeal secretions. So we conducted a study to compare the prophylactic effects of polyurethane-cylindrical or tapered cuff and polyvinyl chloride cuff endotracheal tubes (ETT) on ventilator-associated pneumonia. This randomized clinical trial was carried out in a 12 bed surgical intensive care unit. 96 patients expected to require mechanical ventilation more than 96 hours were randomly allocated to one of three following groups: Polyvinyl chloride cuff (PCV) ETT, Polyurethane (PU) cylindrical Sealguard ETT and PU Taperguard ETT. Cuff pressure monitored every three hours 3 days in all patients. Mean cuff pressure didn't have significant difference between three groups during 72 hours. Pneumonia was seen in 11 patients (34%) in group PVC, 8 (25%) in Sealguard and 7 (21%) in Taperguard group. Changes in mean cuff pressure between Sealguard and PVC tubes and also between Taperguard and PVC tubes did not show any significant difference. There was no significant difference in overinflation between three groups. The use of ETT with PU material results in reducing ventilator-associated pneumonia compared to ETT with PVC cuff. In PU tubes Taperguard has less incidence of ventilator-associated pneumonia compared to Sealguard tubes.

  12. Fructose-enhanced reduction of bacterial growth on nanorough surfaces.

    PubMed

    Durmus, Naside Gozde; Taylor, Erik N; Inci, Fatih; Kummer, Kim M; Tarquinio, Keiko M; Webster, Thomas J

    2012-01-01

    Patients on mechanical ventilators for extended periods of time often face the risk of developing ventilator-associated pneumonia. During the ventilation process, patients incapable of breathing are intubated with polyvinyl chloride (PVC) endotracheal tubes (ETTs). PVC ETTs provide surfaces where bacteria can attach and proliferate from the contaminated oropharyngeal space to the sterile bronchoalveolar area. To overcome this problem, ETTs can be coated with antimicrobial agents. However, such coatings may easily delaminate during use. Recently, it has been shown that changes in material topography at the nanometer level can provide antibacterial properties. In addition, some metabolites, such as fructose, have been found to increase the efficiency of antibiotics used to treat Staphylococcus aureus (S. aureus) infections. In this study, we combined the antibacterial effect of nanorough ETT topographies with sugar metabolites to decrease bacterial growth and biofilm formation on ETTs. We present for the first time that the presence of fructose on the nanorough surfaces decreases the number of planktonic S. aureus bacteria in the solution and biofilm formation on the surface after 24 hours. We thus envision that this method has the potential to impact the future of surface engineering of biomaterials leading to more successful clinical outcomes in terms of longer ETT lifetimes, minimized infections, and decreased antibiotic usage; all of which can decrease the presence of antibiotic resistant bacteria in the clinical setting.

  13. Ultrasonographic Measurement of Subglottic Diameter for Paediatric Cuffed Endotracheal Tube Size Selection: Feasibility Report

    PubMed Central

    Altun, Demet; Sungur, Mukadder Orhan; Ali, Achmet; Bingül, Emre Sertaç; Seyhan, Tülay Özkan; Çamcı, Emre

    2016-01-01

    Objective The aim of this feasibility study was to investigate the first attempt success of ultrasonography (USG) in paediatric patients in predicting an appropriate cuffed endotracheal tube (ETT) size. Methods Fifty children who were 1–10 years of age and who received general anaesthesia with endotracheal intubation for adenoidectomy or adenotonsillectomy were enrolled in the study. In all participants, the transverse diameter of the subglottic airway was measured with USG at the cricoid level without ventilation. The outer diameter (OD) of the maximum allowable ETT was chosen according to the measured subglottic airway diameter. In the presence of resistance to passage of the tube into the trachea or in the absence of an audible leak at airway pressure of >25 cm H2O, the ETT was replaced with a tube whose internal diameter (ID) was 0.5 mm smaller. If a leak was audible at airway pressures of <10 cm H2O, if a seal could not be achieved with a cuff pressure of >25 cm H2O or if a peak airway pressure of >25 cm H2O was observed during ventilation, the tube was changed to a tube one size larger. The OD of the best-fit ETT was converted to the ID. The best-fit ID, the requirement for ETT replacement, the duration of airway diameter measurement by USG and the peak airway pressure were recorded. Results The success rate of the first attempt with USG was 86%; the ETT was replaced in five patients with a tube one size larger and in two patients with a tube one size smaller. Conclusion Our findings show the subglottic diameter measured by USG to be a reliable predictor in estimating the appropriate paediatric ETT size. PMID:28058141

  14. I-gel as an alternative to endotracheal tube in adult laparoscopic surgeries: A comparative study

    PubMed Central

    Badheka, Jigisha Prahladrai; Jadliwala, Rashida Mohammedi; Chhaya, Vrajeshchandra Amrishbhi; Parmar, Vandana Surendrabhai; Vasani, Amit; Rajyaguru, Ajay Maganlal

    2015-01-01

    BACKGROUND: The tracheal tube is always considered to be the gold standard for laparoscopic surgeries. As conventional laryngoscopy guided endotracheal intubation evokes significant hypertension and tachycardia, we have used I-gel, second generation extraglottic airway device, in an attempt to overcome these drawbacks. We conducted this study to compare haemodynamic changes during insertion, efficacy of ventilation, and complications with the use of I-gel when compared with endotracheal tube (ETT) in laparoscopic surgeries. MATERIALS AND METHODS: A total of 60 American Society of Anaesthesiologists physical status I and II adult patients undergoing elective laparoscopic surgeries were randomly allocated to one of the two groups of 30 patients each: Group-A (I-gel) in which patients airway was secured with appropriate sized I-gel, and Group-B (ETT) in which patients airway was secured with laryngoscopy - guided endotracheal intubation. Ease, attempts and time for insertion of airway device, haemodynamic and ventilatory parameters at different time intervals, and attempts for gastric tube insertion, and perioperative complications were recorded. RESULTS: There was significant rise in pulse rate and mean blood pressure during insertion with use of ETT when compared to I-gel. Furthermore, time required for I-gel insertion was significantly less when compared with ETT. However ease and attempts for airway device insertion, attempts for gastric tube insertion and efficacy of ventilation were comparable between two groups. CONCLUSION: We concluded that I-gel requires less time for insertion with minimal haemodynamic changes when compared to ETT. I-gel also provides adequate positive-pressure ventilation, comparable with ETT. Hence I-gel can be a safe and suitable alternative to ETT for laparoscopic surgeries. PMID:26622115

  15. A multifaceted quality improvement program improves endotracheal tube confirmation documentation in the emergency department.

    PubMed

    Phelan, Michael P; Hustey, Fredric M; Glauser, Jonathan M; Bena, James

    2015-01-01

    Confirmation of endotracheal tube (ETT) position is an essential part of emergency department (ED) airway care. The study team evaluated the effect of a multifaceted quality improvement initiative on improving confirmation documentation rates. Rates of documentation of appropriate methods of ETT position confirmation were better for patients undergoing ETT placement in the study site ED than for those arriving already intubated (103/127 [81.1%] vs 19/71 [26.8%]; relative risk [RR] = 3.03; 95% confidence interval [CI] = 2.04 to 4.49). Overall rates of documentation of appropriate methods of ETT position confirmation were higher after the intervention (557/758 [73.5%] vs 122/198 [61.6%]; RR = 1.19; 95% CI = 1.06 to 1.34), with a greater increase among the group presenting to the ED with an ETT already placed (116/259 [44.8%] vs 19/71 [26.8%]; RR = 1.67; 95% CI = 1.11 to 2.51) compared with those intubated in the study site ED (103/127 [81.1%] vs 441/499 [88.4%]; RR = 0.92; 95% CI = 0.8389 to 1.0039).

  16. Ventilator-associated pneumonia or endotracheal tube-associated pneumonia? An approach to the pathogenesis and preventive strategies emphasizing the importance of endotracheal tube.

    PubMed

    Pneumatikos, Ioannis A; Dragoumanis, Christos K; Bouros, Demosthenes E

    2009-03-01

    Ventilator-associated pneumonia is the most common nosocomial infection in the intensive care unit, and it is associated with prolonged hospitalization, increased health care costs, and high attributable mortality. During the past several decades, numerous studies focused on the crucial role of the endotracheal tube (ETT) in the pathogenesis of ventilator-associated pneumonia. Tracheal intubation thwarts the cough reflex, compromises mucocilliary clearance, injures the tracheal epithelial surface, provides a direct conduit for rapid access of bacteria from upper into the lower respiratory tract, and allows the formation of biofilm on the ETT surface. The combination of these factors puts the mechanically ventilated patient at great jeopardy of developing ventilator-associated pneumonia. Many preventive strategies have arisen from this understanding: control of intracuff pressure, aspiration of subglottic secretions, decontamination of subglottic area, use of antiseptic impregnated ETTs, and elimination or prevention of the ETT biofilm formation. The authors review the role of ETT management for the prevention of the ventilator-associated pneumonia.

  17. A semi-Dirac point and an electromagnetic topological transition in a dielectric photonic crystal.

    PubMed

    Wu, Ying

    2014-01-27

    Accidental degeneracy in a photonic crystal consisting of a square array of elliptical dielectric cylinders leads to both a semi-Dirac point at the center of the Brillouin zone and an electromagnetic topological transition (ETT). A perturbation method is deduced to affirm the peculiar linear-parabolic dispersion near the semi-Dirac point. An effective medium theory is developed to explain the simultaneous semi-Dirac point and ETT and to show that the photonic crystal is either a zero-refractive-index material or an epsilon-near-zero material at the semi-Dirac point. Drastic changes in the wave manipulation properties at the semi-Dirac point, resulting from ETT, are described.

  18. Intonation and expressivity: a single case study of classical western singing.

    PubMed

    Sundberg, Johan; Lã, Filipa M B; Himonides, Evangelos

    2013-05-01

    Previous studies have shown that singers tend to sharpen phrase-peak tones as compared with equally tempered tuning (ETT). Here we test the hypothesis that this can serve the purpose of musical expressivity. Data were drawn from earlier recordings, where a professional baritone sang excerpts as void of musical expression as he could (Neutral) and as expressive as in a concert (Concert). Fundamental frequency averaged over tones was examined and compared with ETT. Phrase-peak tones were sharper in excited examples, particularly in the Concert versions. These tones were flattened to ETT using the Melodyne software. The manipulated and original versions were presented pairwise to a musician panel that was asked to choose the more expressive version. By and large, the original versions were perceived as more expressive, thus supporting the common claim that intonation is a means for adding expressivity to a performance.

  19. Perioperative and anesthetic management of complete tracheal rupture in one dog and one cat.

    PubMed

    Morath, Ute; Gendron, Karine; Revés, Nuria Vizcaíno; Adami, Chiara

    2015-01-01

    The authors describe two animals (one dog and one cat) that were presented with severe respiratory distress after trauma. Computerized tomographic imaging under general anesthesia revealed, in both cases, complete tracheal transection. Hypoxic episodes during anesthesia were relieved by keeping the endotracheal tube (ETT) positioned in the cranial part of the transected trachea and by allowing spontaneous breathing. Surgical preparation was performed quickly, and patients were kept in a sternal position to improve ventilation and oxygenation, and were only turned into dorsal recumbency shortly before surgical incision. A sterile ETT was guided into the distal part of the transected trachea by the surgeon, at which point mechanical ventilation was started. Both animals were successfully discharged from hospital a few days after surgery. Rapid and well-coordinated teamwork seemed to contribute to the good outcome. Precise planning and communication between anesthetists, surgeons, and technicians, as well as a quick course of action prior to correct ETT positioning helped to overcome critical phases.

  20. Nitrous oxide pollution in the operating room. A comparison of two modes of ventilation.

    PubMed

    Noorddin, Y; Raha, A R; Jaafar, M Z; Rozaidi, S H W; Muraly, S; Marlizan, M Y

    2007-06-01

    The use of laryngeal mask airway (LMA) as an alternative to the endotracheal tube (ETT) is becoming more popular in the practice of anesthesia. It is undeniable that this device has numerous advantages over endotracheal tube, however it does not provide an airtight seal between the airway and atmospheric gases. This may lead to pollution of the operating room environment with nitrous oxide. One hundreds adult patients undergoing general anaesthesia were divided into two groups. The airway in Group I was maintained with LMA with spontaneous ventilation and ETT with intermittent positive pressure ventilation (IPPV) was used for Group II. The result demonstrated that the ETT group recorded concentrations of nitrous oxide that were well above the NIOSH recommended eight hour time weighted average of 25ppm throughout the duration of surgery when compared to patients using LMA.

  1. Discordance of exercise thallium testing with coronary arteriography in patients with atypical presentations

    NASA Technical Reports Server (NTRS)

    Bungo, M. W.; Leland, O. S., Jr.

    1983-01-01

    Eighty-one patients with diagnostically difficult clinical presentations suggesting coronary artery disease underwent symptom-limited maximal-exercise treadmill testing (ETT) and exercise radionuclide scanning with thallium-201 followed by coronary angiography. Results showed that in nearly half of the patients (47%) these tests were in agreement, while either exercise thallium or ETT was positive in 94% of patients with coronary artery disease. It was found that agreement between exercise thallium and ETT tests predicted disease in 92% of the instances or excluded disease in 82% of the instances. It is concluded that despite frequent discord between these two tests in 53% of the cases, a significant gain in exclusive diagnostic capability is realized when applied to a patient population anticipated to have a disease prevalence equal to the 67% encountered in this study.

  2. Are specialized endotracheal tubes and heat-and-moisture exchangers cost-effective in preventing ventilator associated pneumonia?

    PubMed

    Gentile, Michael A; Siobal, Mark S

    2010-02-01

    Ventilator-associated pneumonia (VAP) is a common and serious complication of mechanical ventilation via an artificial airway. As with all nosocomial infections, VAP increases costs, morbidity, and mortality in the intensive care unit (ICU). VAP prevention is a multifaceted priority of the intensive care team, and can include the use of specialized artificial airways and heat-and-moisture exchangers (HME). Substantial evidence supports the use of endotracheal tubes (ETTs) that allow subglottic suctioning; silver-coated and antiseptic-impregnated ETTs; ETTs with thin-walled polyurethane cuffs; and HMEs, but these devices also can have adverse effects. Controversy still exists regarding the evidence, cost-effectiveness, and disadvantages and risks of these devices.

  3. Is I-gel airway a better option to endotracheal tube airway for sevoflurane-fentanyl anesthesia during cardiac surgery?

    PubMed Central

    Elgebaly, Ahmed Said; Eldabaa, Ahmed Ali

    2014-01-01

    Background: Anesthetists used lower doses of fentanyl, successfully with hemodynamic control by titrating volatile anesthetic agents or vasodilators for fast-tracking in cardiac surgery. Hypothesis: Lower total doses of anesthetics and fentanyl could be required with hemodynamic control by use of supraglottic devices than endotracheal tube (ETT) and helps in fast-tracking. Design: A prospective randomized observational clinical trial study. Aims: The authors compared the utility of I-gel airway with a conventional ETT during the induction and maintenance of anesthesia with sevoflurane and fentanyl in adults undergoing cardiac surgery. Patients and Methods: A total of 49 adult patients underwent cardiac surgery were randomized into two groups according to the airway management: I-gel group (n = 23) and ETT group (n = 26). Doses of fentanyl and hemodynamic parameters (heart rate [HR], mean arterial pressure [MAP] central venous pressure [CVP], pulmonary artery pressure [PAP], and pulmonary capillary wedge pressure [PCWP]) were recorded preoperative, 5 min following tracheal intubation or I-gel airway insertion, after skin incision, after stenotomy, and after weaning off bypass. Results: None of the patients in the I-gel group required additional doses of fentanyl during the I-gel insertion, compared with 74% of the patients during laryngoscopy and endotracheal insertion in the ETT group, for an average total dose of 22.6 ± 0.6 μg/kg. The MAP and HR did not significantly differ from the baseline values at any point of measurement in either group. Furthermore, CVP, PAP, and PCWP measured during the procedure were significantly lower in I-gel group than ETT group. Extubation required more amount of time in ETT than I- gel group. Conclusion: The I-gel airway is well-tolerated by adult patients undergoing cardiac surgery, and requires lower total doses of anesthetics than endotracheal intubation with hemodynamic control and helps in fast-tracking. PMID:25886229

  4. The Prevalence of Oral Flora in the Biofilm Microbiota of the Endotracheal Tube.

    PubMed

    Bardes, James M; Waters, Christopher; Motlagh, Hamed; Wilson, Alison

    2016-05-01

    The endotracheal tube (ETT) is recognized as an independent factor for infection in intubated patients. The presence of biofilm contributes to the development of pneumonia. Standard culturing techniques are inadequate to detect many of the bacteria present in a biofilm. Delineation of the microbiota in the ETT is needed to further understand infections in ventilated patients. A prospective, observational study was performed at a university, Level I trauma center. Twenty ETT were collected at extubation. Bioluminal accretions were removed and quantified. DNA was extracted and 16S ribosomal RNA gene analysis performed using the Human Oral Microbe Identification Microarray. Twenty ETT were evaluated. Mean age was 47.5 years (19-82). Five were smokers. Mean ventilator days was 3.6 ± 3.1. Mean intensive care unit days was 7.8 ± 6.3. In those ETT, 87 different bacterial species were identified. Mean number of bacterial species identified was 16 ± 9 (3-35). There was no relationship between duration of intubation and number of species (P = 0.5). Nonsmokers had a greater variety of bacteria than smokers (P = 0.03). Patients with pneumonia did not have a greater variety of bacteria (P = 0.14). Parvimonas micra presence was associated with reintubation (P = 0.01). The most common species in smokers were different from nonsmokers. There is a wide variety of bacteria present in an ETT, many of which cannot be cultured by standard means. Variation is not correlated to duration of intubation or accretion volume. Studies to evaluate these bacteria and their interaction with the biofilm may further delineate factors in development of infections.

  5. Detection of endobronchial intubation by monitoring the CO2 level above the endotracheal cuff.

    PubMed

    Efrati, Shai; Deutsch, Israel; Weksler, Nathan; Gurman, Gabriel M

    2015-02-01

    Early detection of accidental endobronchial intubation (EBI) is still an unsolved problem in anesthesia and critical care daily practice. The aim of this study was to evaluate the ability of monitoring above cuff CO2 to detect EBI (the working hypothesis was that the origin of CO2 is from the unventilated, but still perfused, lung). Six goats were intubated under general anesthesia and the ETT positioning was verified by a flexible bronchoscope. The AnapnoGuard system, already successfully used to detect air leak around the ETT cuff, was used for continuous monitoring of above-the-cuff CO2 level. When the ETT distal tip was located in the trachea, with an average cuff pressure of 15 mmHg, absence of CO2 above the cuff was observed. The ETT was then deliberately advanced into one of the main bronchi under flexible bronchoscopic vision. In all six cases the immediate presence of CO2 above the cuff was identified. Further automatic inflation of the cuff, up to a level of 27 mmHg, did not affect the above-the-cuff measured CO2 level. Withdrawal of the ETT and repositioning of its distal tip in mid-trachea caused the disappearance of CO2 above the cuff in a maximum of 3 min, confirming the absence of air leak and the correct positioning of the ETT. Our results suggest that measurement of the above-the-cuff CO2 level could offer a reliable, on-line solution for early identification of accidental EBI. Further studies are planned to validate the efficacy of the method in a clinical setup.

  6. Measurement of endotracheal tube cuff pressure: Instrumental versus conventional method

    PubMed Central

    Khan, Mueen Ullah; Khokar, Rashid; Qureshi, Sadia; Al Zahrani, Tariq; Aqil, Mansoor; Shiraz, Motasim

    2016-01-01

    Objective: To evaluate the conventional practice of endotracheal tube (ETT) cuff inflation and pressure measurement as compared to the instrumental method. Study Design: Prospective observational study. Place and Duration of Study: Department of Anaesthesia, King Saud University Hospital, Riyadh, Saudi Arabia (June 2014–July 2014). Methods: A total of 100 adult patients were observed according to the syringe size used Group-1 (10 ml) and Group-2 (20 ml) for ETT cuff inflation in general anesthesia. Patients with anticipated difficult intubation, risk for aspiration, known anatomical laryngotracheal abnormalities, and emergency cases were excluded. Trachea was intubated with size 8 or 8.5 mm and 7.0 or 7.5 mm ETT in male and female patients respectively. The ETT cuff was inflated with air by one of the anesthesia technician. Cuff pressures were measured using aneroid manometer. ETT cuff pressure of 20–30 cm of water was considered as standard. Results: In 69% of the patients, the cuff pressure measurements were above the standard. Age (P = 0.806), weight (P = 0.527), height (P = 0.850), and gender (P = 1.00) were comparable in both groups. The mean cuff pressure in Group-1 and Group-2 was 32.52 ± 6.39 and 38.90 ± 6.60 cm of water (P = 0.001). The cuff inflation with 20 ml syringe resulted in higher cuff pressure as compared to 10cc syringe 37.73 ± 4.23 versus 40.74 ± 5.01 (86% vs. 52%, P = 0.013). Conclusion: The conventional method for ETT cuff inflation and pressure measuring is unreliable. As a routine instrumental cuff pressure, monitoring is suggested. PMID:27833487

  7. Endotracheal Tube Cuff Management at Altitude

    DTIC Science & Technology

    2014-02-05

    adults Fixed wing/3,000 Cuff pressure 45 cm H2O at 3,000 ft Mann [11] ETTs LMA Air filled Diameter Bench top Rotor wing/10,000 Cuff diameter...increased by 4.5 mm at 10,000 ft Wilson [12] LMA Air filled Pressure Adult & infant mannequin Fixed wing/6,000 Rotor wing/2,200 Cuff pressure...120 cm H2O at 5,000 ft Miyashiro [13] ETTs LMA Air filled Pressure Tracheal model Ground ascent/ 7,874 Cuff pressure > 80 cm H2O at 8,000

  8. Endotracheal Tube Cuff Pressures in Patients Intubated Prior to Helicopter EMS Transport

    PubMed Central

    Tennyson, Joseph; Ford-Webb, Tucker; Weisberg, Stacy; LeBlanc, Donald

    2016-01-01

    Introduction Endotracheal intubation is a common intervention in critical care patients undergoing helicopter emergency medical services (HEMS) transportation. Measurement of endotracheal tube (ETT) cuff pressures is not common practice in patients referred to our service. Animal studies have demonstrated an association between the pressure of the ETT cuff on the tracheal mucosa and decreased blood flow leading to mucosal ischemia and scarring. Cuff pressures greater than 30 cmH2O impede mucosal capillary blood flow. Multiple prior studies have recommended 30 cmH2O as the maximum safe cuff inflation pressure. This study sought to evaluate the inflation pressures in ETT cuffs of patients presenting to HEMS. Methods We enrolled a convenience sample of patients presenting to UMass Memorial LifeFlight who were intubated by the sending facility or emergency medical services (EMS) agency. Flight crews measured the ETT cuff pressures using a commercially available device. Those patients intubated by the flight crew were excluded from this analysis as the cuff was inflated with the manometer to a standardized pressure. Crews logged the results on a research form, and we analyzed the data using Microsoft Excel and an online statistical analysis tool. Results We analyzed data for 55 patients. There was a mean age of 57 years (range 18–90). The mean ETT cuff pressure was 70 (95% CI= [61–80]) cmH2O. The mean lies 40 cmH2O above the maximum accepted value of 30 cmH2O (p<0.0001). Eighty-four percent (84%) of patients encountered had pressures above the recommended maximum. The most frequently recorded pressure was >120 cmH2O, the maximum pressure on the analog gauge. Conclusion Patients presenting to HEMS after intubation by the referral agency (EMS or hospital) have ETT cuffs inflated to pressures that are, on average, more than double the recommended maximum. These patients are at risk for tracheal mucosal injury and scarring from decreased mucosal capillary blood flow

  9. 2011 North Plains research field 12-200 limited irrigation corn production study

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The North Plains Water Conservation District started a water conservation project in 2010 on corn irrigation aimed at using just 12 inches of irrigation and producing 200 bu/ac of corn. This report is for 2011, the second year of the study, conducted at the North Plains Research Field (NPRF) in Ett...

  10. Physiological Responses During the Lower Body Positive Pressure Supported Treadmill Test

    PubMed Central

    2016-01-01

    Objective To quantify changes in cardiopulmonary function using a lower body positive pressure supported (LBPPS) treadmill during the exercise tolerance test (ETT) in healthy subjects before applying the LBPPS treadmill in patients with gait problems. Methods We evaluated 30 healthy subjects who were able to walk independently. The ETT was performed using the Modified Bruce Protocol (stages 1–5) at four levels (0%, 40%, 60%, and 80%) of LBPPS. The time interval at each level of the LBPPS treadmill test was 20 minutes to recover to baseline status. We measured systolic blood pressure, diastolic blood pressure, peak heart rate (PHR), rating of perceived exertion (RPE), metabolic equivalents (METs), and oxygen consumption rate (VO2) during each LBPPS condition. Results Systolic blood pressure increased as the LBPPS level was increased (40% to 80%). PHR, RPE, METs, and VO2 were negatively associated with the LBPPS condition, although they were not always significant different among the LBPPS levels. The equation from a random effect linear regression model was as follows: VO2 (mL/kg/min)=(2.75×stage)+(–0.14×LBPPS level)+11.9 (r2=0.69). Conclusion Detection of the changes in physiological parameters during a submaximal ETT using the LBPPS system may be helpful for applying the LBPPS treadmill in patients who cannot perform the ETT due to gait problems, even at submaximal intensity. PMID:27847722

  11. Algorithm Development for the Multi-Fluid Plasma Model

    DTIC Science & Technology

    2011-05-30

    to preserve the diver- gence constraint relations. Figure 2 shows the results for the GEM challenge ( Geospace Environmental Modeling Magnetic...Bhattacharjee, A. Otto, and P. L. Pritch- ett. Geospace Environmental Modeling (GEM) Magnetic Reconnection Challenge. Journal of Geophysical Research, 106

  12. Ease of intubation with the Parker Flex-Tip or a standard Mallinckrodt endotracheal tube using a video laryngoscope (GlideScope).

    PubMed

    Radesic, Brian P; Winkelman, Chris; Einsporn, Richard; Kless, Jack

    2012-10-01

    Two endotracheal tubes (ETTs) are available for use in operative suites for intubation: the Parker Flex-Tip (PFT, Parker Medical) and the standard Mallinckrodt (Covidien). To the authors' knowledge, no study has compared these 2 ETTs with each other when the anesthesia provider uses the GlideScope video laryngoscope (Verathon) for intubation. The purpose of the study was to determine if there are differences related to ease of intubation reported by anesthesia providers who use the PFT tube compared with the standard tube while using the GlideScope. The study was a randomized block intervention design. The sample consisted of 58 observed intubations in an operating room setting. Data analysis was completed with a 2-factor analysis of covariance using 2 covariates. The PFT tube in suboptimal conditions demonstrated a significantly greater ease of intubation, as measured by decreased time for ETT insertion and greater ease of ETT insertion score. The number of redirections at the glottis to intubate the trachea once the glottis was visualized was not statistically different. Based on the findings from this study, anesthesia providers may want to consider the use of the PFT tube when using the GlideScope to promote ease of intubation.

  13. Endotracheal Tube Cuff Pressure Following Intubation

    DTIC Science & Technology

    2005-09-08

    inflated ETT cuff. This method may lead to erroneous cuff pressures. Fernandez, Blanch, Mancebo, Bonsoms, and Artigas studied the accuracy of...Laryngologica, 345, suppl: 1-71. 10. Fernandez, R., Blanch, L., Mancebo, J., Bonsoms, N., Artigas , A. (1990). Endotracheal tube cuff pressure assessment

  14. The endotracheal tube microbiome associated with Pseudomonas aeruginosa or Staphylococcus epidermidis

    PubMed Central

    Hotterbeekx, An; Xavier, Basil B.; Bielen, Kenny; Lammens, Christine; Moons, Pieter; Schepens, Tom; Ieven, Margareta; Jorens, Philippe G; Goossens, Herman; Kumar-Singh, Samir; Malhotra-Kumar, Surbhi

    2016-01-01

    Ventilator-associated pneumonia (VAP) is one of the commonest hospital-acquired infections associated with high mortality. VAP pathogenesis is closely linked to organisms colonizing the endotracheal tube (ETT) such as Staphylococcus epidermidis and Pseudomonas aeruginosa, the former a common commensal with pathogenic potential and the latter a known VAP pathogen. However, recent gut microbiome studies show that pathogens rarely function alone. Hence, we determined the ETT microbial consortium co-colonizing with S. epidermidis or P. aeruginosa to understand its importance in the development of VAP and for patient prognosis. Using bacterial 16S rRNA and fungal ITS-II sequencing on ETT biomass showing presence of P. aeruginosa and/or S. epidermidis on culture, we found that presence of P. aeruginosa correlated inversely with patient survival and with bacterial species diversity. A decision tree, using 16S rRNA and patient parameters, to predict patient survival was generated. Patients with a relative abundance of Pseudomonadaceae <4.6% and of Staphylococcaceae <70.8% had the highest chance of survival. When Pseudomonadaceae were >4.6%, age of patient <66.5 years was the most important predictor of patient survival. These data indicate that the composition of the ETT microbiome correlates with patient prognosis, and presence of P. aeruginosa is an important predictor of patient outcome. PMID:27812037

  15. Technologic advances in endotracheal tubes for prevention of ventilator-associated pneumonia.

    PubMed

    Fernandez, Juan F; Levine, Stephanie M; Restrepo, Marcos I

    2012-07-01

    Ventilator-associated pneumonia (VAP) is associated with high morbidity, mortality, and costs. Interventions to prevent VAP are a high priority in the care of critically ill patients requiring mechanical ventilation (MV). Multiple interventions are recommended by evidence-based practice guidelines to prevent VAP, but there is a growing interest in those related to the endotracheal tube (ETT) as the main target linked to VAP. Microaspiration and biofilm formation are the two most important mechanisms implicated in the colonization of the tracheal bronchial tree and the development of VAP. Microaspiration occurs when there is distal migration of microorganisms present in the secretions accumulated above the ETT cuff. Biofilm formation has been described as the development of a network of secretions and attached microorganisms that migrate along the ETT cuff polymer and inside the lumen, facilitating the transfer to the sterile bronchial tree. Therefore, our objective was to review the literature related to recent advances in ETT technologies regarding their impact on the control of microaspiration and biofilm formation in patients on MV, and the subsequent impact on VAP.

  16. Strategic Requirements for the Army to the Year 2000. Volume II. The World Environment to the Year 2000.

    DTIC Science & Technology

    1982-11-01

    masses to sur- vive Khomeini’s death. Nevertheless, the problems facing the post-Khomeini leadership will be monumental. A significant and vocal ...the next two decades. Saud Ar1big A n tbh ett " oesf lba now e Gu.l Saudi Arabia is increasingly assuming a leadership role in the area. After the Iran

  17. European Training Thesaurus: A Multilingual Synopsis

    ERIC Educational Resources Information Center

    Cedefop - European Centre for the Development of Vocational Training, 2012

    2012-01-01

    Education and training issues are similar across Europe, but how can we ensure we mean the same things with the same terms? The new format of the European training thesaurus (ETT) is a multilingual synopsis. It is an online tool enabling those working in education, training and employment to have a common understanding of terms. It helps…

  18. Measurements of endotracheal tube cuff contact pressure using fibre Bragg gratings

    NASA Astrophysics Data System (ADS)

    Hernandez, F. U.; Correia, R.; Korposh, S.; Morgan, S. P.; Hayes-Gill, B. R.; James, S. W.; Evans, D.; Norris, A.

    2015-09-01

    An optical fibre Bragg grating (FBG) was used to measure local strain (due to contact pressure) at the interface of a cuffed endotracheal tube (ETT) tested in a tracheal model. The tracheal model consisted of a corrugated tube. Two FBG sensors written in a single optical fibre were attached to the outside wall of the cuff of the ETT. Intracuff endotracheal pressure was measured using a digital manometer, while the contact pressure between the model trachea and the ETT was measured using Flexiforce sensors. Changes in the Bragg wavelengths in response to the inflation of the cuff of the ETT, and concomitant pressure increase, were observed to be dependent on the location of the FBGs at the corrugations, i.e., the annular peaks and troughs of the corrugated tube. The performance of both contact pressure sensors FBG and Flexiforce suggests that FBG technology is better suited to this application as it allows the measurement of contact pressures on non-uniform surfaces such as in the tracheal model.

  19. Protective effect of an aphrodisiac herb Tribulus terrestris Linn on cadmium-induced testicular damage

    PubMed Central

    Rajendar, B.; Bharavi, K.; Rao, G. S.; Kishore, P.V.S; Kumar, P. Ravi; Kumar, C.S.V Satish; Patel, T. Pankaj

    2011-01-01

    Aim: The aim of the present study was to investigate whether Tribulus terrestris Linn (TT) could protect the cadmium (Cd)-induced testicular tissue peroxidation in rats and to explore the underlying mechanism of the same. Materials and Methods: In vitro and in vivo studies were conducted to know the protective effect of ethanolic extract of TT (eTT) in Cd toxicity. In in vitro studies, total antioxidant and ferrous metal ion chelating activity of TT was studied. In vivo studies were conducted in rats. A total of 40 Wistar strain adult male rats were divided into four groups. Group 1 served as control, while group 2 to 4 received CdCl2 (3 mg/kg b. wt. s/c once a week). In addition to Cd, group 3 and 4 rats also received eTT (5 mg/kg b.wt. daily as oral gavage) and α-tocopherol (75 mg/kg daily by oral gavage), respectively. At the end of 6th week, all the rats were sacrificed and the separated testes were weighted and processed for estimation of tissue peroxidation markers, antioxidant markers, functional markers, and Cd concentration. The testes were also subjected to histopathological screening. Results: In in vitro studies, the percentage of metal ion chelating activity of 50 μg/ml of eTT and α-tocopherol were 2.76 and 9.39, respectively, and the antioxidant capacity of eTT was equivalent to 0.063 μg of α-tocopherol/μg of eTT. In in vivo studies, administration of Cd significantly reduced the absolute and relative testicular weight, antioxidant markers such as superoxide dismutase and glutathione, and functional markers such as LDH and ALP, along with significant increase in peroxidation markers such as malondialdehyde and protein carbonyls in testicular tissue. Testes of Cd only-treated group showed histological insults like necrotic changes in seminiferous tubules and interstitium, shrunken tubules with desquamated basal lamina, vacuolization and destruction of sertoli cells, and degenerating Leydig cells. This group also had higher Cd levels in testicular

  20. Evaluating Risk Factors for Pediatric Post-extubation Upper Airway Obstruction Using a Physiology-based Tool

    PubMed Central

    Hotz, Justin; Morzov, Rica; Flink, Rutger; Kamerkar, Asavari; Ross, Patrick A.; Newth, Christopher J. L.

    2016-01-01

    Rationale: Subglottic edema is the most common cause of pediatric extubation failure, but few studies have confirmed risk factors or prevention strategies. This may be due to subjective assessment of stridor or inability to differentiate supraglottic from subglottic disease. Objectives: Objective 1 was to assess the utility of calibrated respiratory inductance plethysmography (RIP) and esophageal manometry to identify clinically significant post-extubation upper airway obstruction (UAO) and differentiate subglottic from supraglottic UAO. Objective 2 was to identify risk factors for subglottic UAO, stratified by cuffed versus uncuffed endotracheal tubes (ETTs). Methods: We conducted a single-center prospective study of children receiving mechanical ventilation. UAO was defined by inspiratory flow limitation (measured by RIP and esophageal manometry) and classified as subglottic or supraglottic based on airway maneuver response. Clinicians performed simultaneous blinded clinical UAO assessment at the bedside. Measurements and Main Results: A total of 409 children were included, 98 of whom had post-extubation UAO and 49 (12%) of whom were subglottic. The reintubation rate was 34 (8.3%) of 409, with 14 (41%) of these 34 attributable to subglottic UAO. Five minutes after extubation, RIP and esophageal manometry better identified patients who subsequently received UAO treatment than clinical UAO assessment (P < 0.006). Risk factors independently associated with subglottic UAO included low cuff leak volume or high preextubation leak pressure, poor sedation, and preexisting UAO (P < 0.04) for cuffed ETTs; and age (range, 1 mo to 5 yr) for uncuffed ETTs (P < 0.04). For uncuffed ETTs, the presence or absence of preextubation leak was not associated with subglottic UAO. Conclusions: RIP and esophageal manometry can objectively identify subglottic UAO after extubation. Using this technique, preextubation leak pressures or cuff leak volumes predict subglottic UAO in

  1. [A new bite block also serving as an endotracheal tube holder for infants].

    PubMed

    Kitamura, S; Fukumitsu, K; Taniguchi, A; Kinouchi, K; Tamai, H

    1999-08-01

    We developed a new type of bite block with a combined function as an endotracheal tube (ETT) holder for infants and small children to prevent airway troubles caused by tube kinking, dislodging, extubation and oral membrane trauma. One mm thick plastic plate sized 3.5 x 2 cm was curved to make an open roll. The outer surface of the roll was covered and glued with soft plastic tube (5.0 mm ID endotracheal tube), cut in 3.5 cm length to give an elastic outer surface for the patient's comfort. The rolled ends were diagonally cut to make an oblique slit of 3 mm width. A t-shaped flange made of soft vinyl plate was fixed at a third of the length of the roll to maintain the block's position relative to the lips and to make the fixation of the tube easier. In practical use, after endotracheal intubation is performed as usual, this bite block is put into the mouth and positioned at the oral angle with the flange on the patient's skin. The ETT is fit into the slit of the roll. The skin-facing surface of the flange is pasted to the skin with the double stick material usually used for colostomy stoma. The ETT and the bite block are fixed en bloc with fixing tapes around the mouth. Our bite block has following advantages over other types of bite blocks and tube holders especially for children; 1) the volume of foreign bodies (ETT and bite block) occupying the oral cavity can be reduced and this attenuates the patient's discomfort, 2) good holding of the ETT can prevent its dislodging and decrease the incidence of accidental extubation and 3) suctioning is easier because of wide oral space. The four sizes of the bite block suitable for 4.0, 4.5, 5.0, 5.5 and 6.0 mm ID ETTs are manufactured. We applied this device to several ICU patients and found its use practical and safe.

  2. Clinical value and severity of myocardial perfusion defects in asymptomatic diabetic patients with negative or weakly positive exercise treadmill test

    PubMed Central

    Zakavi, Seyed Rasoul; Taherpour, Mehdi; Moossavi, Zohreh; Sadeghi, Ramin; Kakhki, Vahidreza Dabbagh; Rokni, Haleh

    2013-01-01

    Objective: Although coronary artery disease (CAD) is the leading cause of death in type 2 diabetic patients, it is frequently asymptomatic. Myocardial perfusion imaging (MPI) is reported to show ischemia in a significant number of asymptomatic diabetic patients. We studied the prevalence and severity of myocardial perfusion defects in asymptomatic diabetic patients and its clinical impact. Methods and patients: One hundred thirty consecutive asymptomatic patients, aged 35-65 years with type 2 diabetes mellitus and with no history of CAD and no cardiac symptoms were recruited in the study. Echocardiography, electrocardiography (ECG), routine laboratory tests and exercise treadmill test (ETT) were performed and patients with weakly positive or negative ETT underwent Dipyridamole MPI. Patients with positive ETT were referred to coronary angiography. Patients were followed for at least 17 months (mean 21.7 months) and any cardiac event was recorded. Results: We studied 81 female and 49 male patients with mean age of 51.8 years. Negative, weakly positive and positive ETT result was noted in 74.3%, 15% and 10.7% respectively. 75% of patients with positive ETT had coronary artery disease in angiography. Gated myocardial perfusion SPECT was done in 106 patients. MPI showed reversible defect in 26.9% of the patients with a mean summed stress score of 3.3±1.8. Follow up completed in 112 patients and only one patient with abnormal MPI underwent coronary angiography followed by PTCA. No cardiac death, MI, UA or hospital admission occurred among our patients during follow up (17-26 months). Mean stress end diastolic volume (EDV) was significantly higher in patients with reversible defect compared to patients without reversible defect based on MPI findings (62.0±31.6 Vs 48.5±18.4 ml, P=0.04). Blood glucose and HbA1c were significantly higher in patients with ischemia compared to patients without ischemia (P<0.05). Meanwhile the ratio of TG to HDL was 6.06±3.2 in ischemic

  3. Airway Complications during and after General Anesthesia: A Comparison, Systematic Review and Meta-Analysis of Using Flexible Laryngeal Mask Airways and Endotracheal Tubes

    PubMed Central

    Xu, Rui; Lian, Ying; Li, Wen Xian

    2016-01-01

    Objective Flexible laryngeal mask airways (FLMAs) have been widely used in thyroidectomy as well as cleft palate, nasal, upper chest, head and neck oncoplastic surgeries. This systematic review aims to compare the incidence of airway complications that occur during and after general anesthesia when using the FLMA and endotracheal intubation (ETT). We performed a quantitative meta-analysis of the results of randomized trials. Methods A comprehensive search of the PubMed, Embase and Cochrane Library databases was conducted using the key words "flexible laryngeal mask airway" and "endotracheal intubation". Only prospective randomized controlled trials (RCTs) that compared the FLMA and ETT were included. The relative risks (RRs) and the corresponding 95% confidence intervals (95% CIs) were calculated using a quality effects model in MetaXL 1.3 software to analyze the outcome data. Results Ten RCTs were included in this meta-analysis. There were no significant differences between the FLMA and ETT groups in the incidence of difficulty in positioning the airway [RR = 1.75, 95% CI = (0.70–4.40)]; the occurrence of sore throat at one hour and 24 hours postoperative [RR = 0.90, 95% CI = (0.13–6.18) and RR = 0.95, 95% CI = (0.81–1.13), respectively]; laryngospasms [RR = 0.58, 95% CI = (0.27–1.23)]; airway displacement [RR = 2.88, 95% CI = (0.58–14.33)]; aspiration [RR = 0.76, 95% CI = (0.06–8.88)]; or laryngotracheal soiling [RR = 0.34, 95% CI = (0.10–1.06)]. Patients treated with the FLMA had a lower incidence of hoarseness [RR = 0.31, 95% CI = (0.15–0.62)]; coughing [RR = 0.28, 95% CI = (0.15–0.51)] during recovery in the postanesthesia care unit (PACU); and oxygen desaturation [RR = 0.43, 95% CI = (0.26–0.72)] than did patients treated with ETT. However, the incidence of partial upper airway obstruction in FLMA patients was significantly greater than it was for ETT patients [RR = 4.01, 95% CI = (1.44–11.18)]. Conclusion This systematic review showed

  4. Survival time of endodontically treated teeth: a 7-year retrospective clinical study

    NASA Astrophysics Data System (ADS)

    Baldea, Bogdan; Canjau, Silvana; Popescu, Dragos; Tudor, Anca; Todea, Carmen

    2014-01-01

    The aim of this retrospective clinical study was to examine the survival time of endodontically treated teeth (ETT) and the factors that may influence the failure risk, over a period of up to 7 years. The files of 67 patients that received metal free post and core restorations using a standardized technique were analyzed. The survival probability was assessed using Kaplan-Meyer analysis and Log Rank (Matel-Cox). Cox regression was used to assess the risk of failure and to identify possible covariates. The average survival time of the ETT was 6.6 Years. The cumulative failure rate was 5.82% for all type of the restored endodontically treated teeth. The main failure type was encountered in the cervical area of the teeth, and due to the extensive hard tissue loss, the teeth were extracted.

  5. Laryngeal mask airways in ear, nose, and throat procedures.

    PubMed

    Mandel, Jeff E

    2010-09-01

    The use of laryngeal mask airway (LMA) and its variants in ear, nose, and throat procedures have been extensively described in case reports, retrospective reviews, and randomized clinical trials. The LMA has developed a considerable following because of its lack of tracheal stimulation, which can be a considerable advantage in ear, nose, and throat (ENT) procedures. The incidence of coughing on emergence has been shown to be lower with the LMA than with the endotracheal tube (ETT). Although other approaches to smooth emergence have been described, few would argue that it is as easy to achieve a smooth emergence with an ETT as with an LMA. Although patients certainly exist for whom the LMA is contraindicated, many will experience better results with the LMA because of the features delineated in this article.

  6. Smoking and Soldier Performance: A Literature Review

    DTIC Science & Technology

    1986-06-01

    components in cigarette smoke such as benzopyrene and polonium , have been implicated in develop- ient of lung cancer (Clee and Clark 1982), nicotine...the decreased ability of smokers to clear dust particles from their lungs as a 152 possible factor in increased cancer among asbestos and uranium...Behavioral pharmacology of cigar- ette smoking. Advances in Behavioral Pharmacology. 4:131- 210 . Henningfield, J. E., Chait, L. D., anO Griffiths, R. R

  7. Approaches to Inflight Ear Oximetry.

    DTIC Science & Technology

    1980-10-01

    of arterial oxygen saturation. For centri- fuge experiments the floe,! ett-Packard ear oximeter, Model 47201A, has been successfully used both at...These difficulties are perhaps even more significant with respect to inflight experimental use. The difficulties are: 1. The bloodless ear is not truly...available (9), and a number of papers on both the clini- cal use (10-17) and the experimental use (1, 2, 18) of this equipment have been published since its

  8. Choices and Challenges: A Guide for the Battalion Commander’s Wife

    DTIC Science & Technology

    1991-05-28

    tradition you establish. 10 Take dance lessons; brush up nn your speaking skills; collect recipes for yroup gatherings; get ready for your first round of...8217 functions? Ideas? d. Annual dinner dance ? What rank? e. Hail and farewell ideas? f. Holiday parties: Christmas, Easter? g. As a group interested in...ettes! We wanted to tell you how excited we arc about our upcomi.; 19-91st Battalion Spring Dance on 10 June 1991 at the Embers and also to give you

  9. A prospective randomised comparison of the LMA ProSeal™ versus endotracheal tube on the severity of postoperative pain following gynaecological laparoscopy.

    PubMed

    Griffiths, J D; Nguyen, M; Lau, H; Grant, S; Williams, D I

    2013-01-01

    Pain and postoperative nausea and vomiting (PONV) are common problems after gynaecologic laparoscopy. Two recent studies have shown that morphine requirements and PONV are lower when an LMA ProSeal™ is used, rather than an endotracheal tube (ETT), for female patients undergoing breast and gynaecological surgery. We conducted a patient and observer-blinded randomised controlled trial, recruiting non-obese women without gastro-oesophageal reflux undergoing laparoscopic gynaecological surgery. Patients received a standardised relaxant general anaesthetic and then were randomised to receive either an LMA ProSeal or an endotracheal tube. Patients were assessed at two and 24 hours post-anaesthesia. The primary outcome was postoperative pain score and secondary endpoints included morphine consumption, postoperative emesis and adverse upper airway symptoms. We recruited 116 patients to the study, 57 patients in the ETT group and 59 patients in the LMA ProSeal group. The patients were similar in demographic and surgical characteristics. At two hours, the ETT group was similar to the LMA ProSeal group in regards to pain scores (Visual Analogue Scale 3.0 vs 3.5, P=0.86), morphine consumption (7.2 vs 7.4 mg, P=0.56) and PONV (47.4 vs 47.5%, P=0.99). After 24 hours, pain scores and PONV rates were also similar. No significant difference in rates of sore throat or dysphagia was observed between the ETT and LMA ProSeal groups. No significant complications were attributable to either airway device. The LMA ProSeal did not decrease pain or PONV in patients undergoing gynaecological laparoscopy when compared to endotracheal intubation.

  10. Friendly Extensible Transfer Tool Beta Version

    SciTech Connect

    Collins, William P.; Gutierrez, Kenneth M.; McRee, Susan R.; Sands, Daniel N.; Yaklin, Allan C.

    2016-04-15

    Often data transfer software is designed to meet specific requirements or apply to specific environments. Frequently, this requires source code integration for added functionality. An extensible data transfer framework is needed to more easily incorporate new capabilities, in modular fashion. Using FrETT framework, functionality may be incorporated (in many cases without need of source code) to handle new platform capabilities: I/O methods (e.g., platform specific data access), network transport methods, data processing (e.g., data compression.).

  11. Visual Search in the Detection of Retinal Injury: A Feasibility Study

    DTIC Science & Technology

    2013-04-01

    D, Heyes A. et al. Mobility of people with retinitis pigmentosa as a function of vision and psychological variables. Optometry and Vision Science...AFRL-RH-FS-TR-2013-0019 Visual Search in the Detection of Retinal Injury: A Feasibility Study Thomas Kuyk TASC, Inc. Lei Liu The...Detection of Retinal Injury: A Feasibility Study" 2013 0019 LEON N. McLIN, JR., DR-III, DAF Work Unit Manager 711 HPW/ RHDO POLHAMUS.GARR ETT.D

  12. Alternative approaches to ventilator-associated pneumonia prevention.

    PubMed

    Berra, L; Sampson, J; Fumagalli, J; Panigada, M; Kolobow, T

    2011-03-01

    Ventilator-associated pneumonia (VAP), which develops in patients receiving mechanical ventilation, is the most common nosocomial infection in patients with acute respiratory failure. The major mechanism of lower respiratory tract colonization is aspiration of bacteria-colonized secretions from the oropharynx into the lower airways. The hydrostatic pressure of the secretions that collect in the subglottic space, which is the area above the endotracheal tube (ETT) cuff, or aerosolization of bacteria from the secretions collected within the respiratory tubing may facilitate the leakage into the lower airways. Ideally, the elimination of the mechanisms responsible for aspiration would decrease the incidence of VAP. Several preventive measures have been tested in clinical trials with little success.Here we present the results of our efforts to develop novel approaches for the prevention of VAP. Specifically, we found that keeping ventilated patients in a lateral position, which eliminates gravitational forces, is feasible and possibly advantageous. Additionally, several novel medical devices have been recently developed to prevent bacterial biofilm formation from the ETT and breathing tubing. These devices include coated ETTs, mucus shavers and mucus slurpers. Prevention of ETT bacterial colonization showed decreased bacterial colonization of the respiratory circuit and of the lower respiratory tract in laboratory studies and clinical trials. Future large studies should be designed to test the hypothesis that VAP can be prevented with these novel strategies. While there is a current focus on the use of respiratory devices to prevent biofilm formation and microaspiration, it is important to remember that lower respiratory tract colonization is multifactorial. Prevention of VAP cannot be achieved solely by eliminating bacterial biofilm on respiratory devices, and more comprehensive care of the intubated patient needs to be implemented.

  13. Ultrasonography of Extravaginal Testicular Torsion in Neonates

    PubMed Central

    Bombiński, Przemysław; Warchoł, Stanisław; Brzewski, Michał; Majkowska, Zofia; Dudek-Warchoł, Teresa; Żerańska, Maria; Panek, Małgorzata; Drop, Magdalena

    2016-01-01

    Summary Background Extravaginal testicular torsion (ETT), also called prenatal or perinatal, occurs prenatally and is present at birth or appears within the first month of life. It has different etiology than intravaginal torsion, which appears later in life. Testicular torsion must be taken into consideration in differential diagnosis of acute scrotum and should be confirmed or ruled out at first diagnostic step. Ultrasonography is a basic imaging modality, however diagnostic pitfalls are still possible. There is still wide discussion concerning management of ETT, which varies from immediate orchiectomy to conservative treatment resulting in testicle atrophy. Material/Methods In this article we present ultrasonographic spectrum of ETT in neonates, which were diagnosed and treated in our hospital during the last 8 years (2008–2015), in correlation with clinical and intraoperative findings. Results Thirteen neonates with ETT were enrolled in the study – 11 patients with a single testicle affected and 2 patients with bilateral testicular torsion. Most common signs on clinical examination were: hardened and enlarged testicle and discoloration of the scrotum. Most common ultrasonographic signs were: abnormal size or echostructure of the affected testicle and absence of the blood flow in Doppler ultrasonography. In 3 patients ultrasound elastography was performed, which appeared very useful in testicle structure assessment. Conclusions Testicular torsion may concern boys even in the perinatal period. Ultrasonographic picture of acute scrotum in young boys may be confused. Coexistence of the abnormal size or echostructure of the torsed testicle with absence of the blood flow in Doppler ultrasonography appear as very specific but late ultrasonographic sings. Ultrasound elastography may be a very useful tool for visualisation of a very common clinical sign – hardening of the necrotic testicle. PMID:27757176

  14. Prototype Concept Design for U.S. Army Type IIIA Air Traffic Control Tower (ATCT).

    DTIC Science & Technology

    1984-10-01

    Insulated cores will be provided in all exterior doors and in all interior doors at the tower support module level that lead into the kitchen- ette area... assembled in box modules, they would create shear walls that would provide lateral load resistance. The module’s major disadvantage is its weight, which...be eliminated by the "H" option illustrated in Figure 12. The module now becomes one floor/ceiling assembly with columns positioned to end at half

  15. I Will Never Forget: An Analysis of the POW/MIA (Prisoners of War/Missing in Action) Episode in the War in Southeast Asia.

    DTIC Science & Technology

    1982-05-01

    Purcell, Benjamin H., Col Ett: ueiler, Harry L., SSgL Rander, Donald J., SFC . Flora, Carroll E. Jr., SFC Ray, Johnnie L., Capt Frank, ::artin 3.. SS...Jr., Lt Col Elander, William J., Jr., Maj Brenneman, Richard C., Capt Ellis, Jeffrey T., Capt Bridger, Barry B., Capt Ellis, Leon F., Capt Brodak...j * Guy, Theodore W.., Col Logn, c.., t Hall, George R., It Col Lollar. . Hall, Keith I., 1.:aj Luna , jose I., Capz *: Hanson, Gregg 0., 2t

  16. Knowledge, Attitudes and Practice of Restoring Endodontically Treated Teeth by Dentists in North of Saudi Arabia

    PubMed Central

    Akbar, Iftikhar

    2015-01-01

    Objectives The aim of this study was to determine the knowledge, current approaches, techniques and practices for the restoration of endodontically treated teeth (ETT) among general dental practitioners and specialists in north of Saudi Arabia. Methodology A standard questionnaire based survey containing 16 multiple choice questions about techniques and treatment methods, frequency of post, type of post, choice of luting cement, core material, reason of failure of endodontic treatment was distributed by hand and through email among 255 general dentists and specialists. The data were processed by using SPSS statistical software. Results The majority of clinicians (54%) believed that post reinforces the remaining tooth structure and reduces fracture probability. The ferrule effect was considered an important factor in increasing fracture resistance of the ETT (72%). The preferred technique for restoring ETT was core material along with 1–2 mm of ferule (41%) followed by prefabricated post and core build up (25%). On the basis of post material, the most common was metal (43%) followed by fiber post (41%). 2/3rd length of the root canal for the post length (67%), 4–5mm apical seal of gutta percha after post placement (47%) and for the post diameter, 1/3rd of root diameter (51%) was agreed by most of the participants. Composite resin (61%) was the most popular material for core foundation followed by amalgam (23%). Conclusion The surveyed practitioners had a sound knowledge of the techniques and materials for restoring ETT with the exception that post reinforces the remaining tooth structure and reduces fracture probability. PMID:25901132

  17. Effects of aerobic conditioning in lupus fatigue: a pilot study.

    PubMed

    Robb-Nicholson, L C; Daltroy, L; Eaton, H; Gall, V; Wright, E; Hartley, L H; Schur, P H; Liang, M H

    1989-12-01

    Fatigue, a complex symptom, significantly affects the quality of life in many patients with systemic lupus erythematosus (SLE). To understand this phenomenon, 23 patients with SLE and fatigue were studied. Standardized tests of depression (NIMH), fatigue, exercise tolerance (ETT) on a bicycle ergometer, and SLE activity were obtained. At baseline, SLE patients had significantly lower maximum oxygen consumption (VO2 max) than normals (p less than 0.005). Adjusted for age and sex, SLE patients perform at 54% of their expected maximum VO2, which is similar to published data from patients with rheumatoid arthritis. Depression by NIMH was not correlated with VO2 max or length of time on ETT. Fatigue measured by Profile of Mood States (POMS) was correlated with ETT time (r = 0.476, p less than 0.025) and with VO2 max (r = -0.402, p less than 0.07). After an 8-week aerobic conditioning programme the experimental group increased their aerobic capacity by 19% in contrast to 8% in controls. This change correlated with decreased fatigue as measured by visual analogue scales. Exercise did not exacerbate disease, and only two of 16 experimental subjects experienced transient joint symptoms during exercise.

  18. Comparison of quantification methods illustrates reduced Pseudomonas aeruginosa activity on nanorough polyvinyl chloride.

    PubMed

    Seil, Justin T; Rubien, Nathan M; Webster, Thomas J; Tarquinio, Keiko M

    2011-07-01

    Patients on mechanical ventilators for extended periods of time are faced with a high probability of developing ventilator associated pneumonia. Although this has been mostly addressed through the re-engineering of endotracheal tubes (ETTs) with antimicrobial materials, such material coatings may easily delaminate during use. However, the potential exists to apply nanotechnology to the ETT to avoid delamination but implement antibacterial properties. Selecting a protocol to evaluate in vitro material for anti-infection is difficult, partially due to the existence of conflicting reported methods of analysis. In this study, the susceptibility of conventional and nanorough polymeric materials to bacterial biofilm growth were evaluated. After creating nanorough polyvinyl chloride (PVC) ETTs, Pseudomonas aeruginosa biofilms were then grown on sample surfaces during a 24-h culture. Biofilms were then removed and assayed from sample surfaces using a variety of techniques. Comparisons between the different techniques used for biofilm removal indicated that vortexing provided adequate removal of the biofilm from sample surfaces. Most importantly, a protocol following the vortexing method of biofilm and bacteria removal provided an ∼40% lower yield of colony forming units from nanorough PVC compared to conventional PVC. This suggests that Pseudomonas aeruginosa are less adherent on nanorough PVC than conventional PVC.

  19. Heart Rate Variability Correlates to Functional Aerobic Impairment in Hemodialysis Patients

    PubMed Central

    Carreira, Maria Angela Magalhães de Queiroz; Nogueira, André Barros; Pena, Felipe Montes; Kiuchi, Marcio Galindo; Rodrigues, Ronaldo Campos; Rodrigues, Rodrigo da Rocha; de Matos, Jorge Paulo Strogoff; Lugon, Jocemir Ronaldo

    2015-01-01

    Background Autonomic dysfunction (AD) is highly prevalent in hemodialysis (HD) patients and has been implicated in their increased risk of cardiovascular mortality. Objective To correlate heart rate variability (HRV) during exercise treadmill test (ETT) with the values obtained when measuring functional aerobic impairment (FAI) in HD patients and controls. Methods Cross-sectional study involving HD patients and a control group. Clinical examination, blood sampling, transthoracic echocardiogram, 24-hour Holter, and ETT were performed. A symptom-limited ramp treadmill protocol with active recovery was employed. Heart rate variability was evaluated in time domain at exercise and recovery periods. Results Forty-one HD patients and 41 controls concluded the study. HD patients had higher FAI and lower HRV than controls (p<0.001 for both). A correlation was found between exercise HRV (SDNN) and FAI in both groups. This association was independent of age, sex, smoking, body mass index, diabetes, and clonidine or beta-blocker use, but not of hemoglobin levels. Conclusion No association was found between FAI and HRV on 24-hour Holter or at the recovery period of ETT. Of note, exercise HRV was inversely correlated with FAI in HD patients and controls. PMID:26131705

  20. Strain induced Z{sub 2} topological insulating state of β-As{sub 2}Te{sub 3}

    SciTech Connect

    Pal, Koushik; Waghmare, Umesh V.

    2014-08-11

    Topological insulators are non-trivial quantum states of matter which exhibit a gap in the electronic structure of their bulk form, but a gapless metallic electronic spectrum at the surface. Here, we predict a uniaxial strain induced electronic topological transition (ETT) from a band to topological insulating state in the rhombohedral phase (space group: R3{sup ¯}m) of As{sub 2}Te{sub 3} (β-As{sub 2}Te{sub 3}) through first-principles calculations including spin-orbit coupling within density functional theory. The ETT in β-As{sub 2}Te{sub 3} is shown to occur at the uniaxial strain ϵ{sub zz} = −0.05 (σ{sub zz} = 1.77 GPa), passing through a Weyl metallic state with a single Dirac cone in its electronic structure at the Γ point. We demonstrate the ETT through band inversion and reversal of parity of the top of the valence and bottom of the conduction bands leading to change in the ℤ{sub 2} topological invariant ν{sub 0} from 0 to 1 across the transition. Based on its electronic structure and phonon dispersion, we propose ultra-thin films of As{sub 2}Te{sub 3} to be promising for use in ultra-thin stress sensors, charge pumps, and thermoelectrics.

  1. Lipase degradation of plasticized polyvinyl chloride endotracheal tube surfaces to create nanoscale features

    PubMed Central

    Machado, Mary C; Webster, Thomas J

    2017-01-01

    Polyvinyl chloride (PVC) endotracheal tubes (ETTs) nanoetched with a fungal lipase have been shown to reduce bacterial growth and biofilm formation and could be an inexpensive solution to the complex problem of ventilator-associated pneumonia (VAP). Although bacterial growth and colonization on these nanoetched materials have been well characterized, little is known about the mechanism by which the fungal lipase degrades the PVC and, thus, alters its properties to minimize bacteria functions. This study used X-ray photoelectron spectroscopy (XPS) and attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR) to better describe the surface chemistry of both unetched and lipase nanoetched PVC ETT. ATR-FTIR analysis of the unetched and treated surfaces showed a similar presence of a plasticizer. This was confirmed by XPS analysis, which showed an increase of carbon and the presence of oxygen on both unetched and nanoetched surfaces. A quantitative comparison of the FTIR spectra revealed significant correlations (Pearson’s correlation, R=0.997 [R2=0.994, P<0.001]) between the unetched and nanomodified PVC ETT spectra, demonstrating similar surface chemistry. This analysis showed no shifting or widening of the bands in the spectra and no significant changes in the intensity of the infrared peaks due to the degradation of the plasticizer by the fungal lipase. In contrast, results from this study did demonstrate significantly increased nanoscale surface features on the lipase etched compared to non-etched PVC ETTs. This led to a change in surface energetics, which altered ion adsorption to the ETTs. Thus, these results showed that PVC surfaces nanoetched with a 0.1% lipase solution for 48 hours have no significant change on surface chemistry but do significantly increase nanoscale surface roughness and alters ion adsorption, which suggests that the unique properties of these materials, including their previously reported ability to decrease

  2. Independent Review of Elemental Phosphorus Remediation at the Eastern Michaud Flats FMC Operable Unit near Pocatello, Idaho

    SciTech Connect

    Martino, L. E.; Jerden, J. J.; Kimmell, T. A.; Quinn, J.

    2016-01-01

    If, despite risks to workers and these potential impacts, stakeholders decide that P4 wastes need to be excavated and treated, the Review Team determined that a number of the ETTs examined warrant further consideration for the treatment of P4 waste that has been characterized (for example, P4 waste present in the historical ponds). Nevertheless, concerns about the health and safety of site investigation workers using then-available investigation approaches prevented the collection of subsurface samples containing P4 from large areas of the site (e.g., the railroad swale, the vadose zone beneath the Furnace Building, and the abandoned railcars), As a result, the contaminant CSM in those particular areas was not refined enough to allow the Review Team to draw conclusions about using some of the ETTs to treat P4 waste in those areas. The readiness of an ETT for implementation varies depending on many factors, including stakeholder input, permitting, and remedial action construction requirements. Technologies that could be ready for use in the near term (within 1 year) include the following: mechanical excavation, containment technologies, off-site incineration, and drying and mechanical mixing under a tent structure. Technologies that could be ready for use in the mid-term (1 to 2 years) include cutter suction dredging, thermal-hydraulic dredging, and underground pipeline cleaning technologies. Technologies requiring a longer lead time (2 to 5 years) include on-site incineration, a land disposal restriction waste treatment system, an Albright & Wilson batch mud still, post-treatment on-site disposal, and post-treatment off-site disposal.

  3. Lifshitz topological transitions, induced by doping and deformation in single-crystal bismuth wires

    NASA Astrophysics Data System (ADS)

    Nikolaeva, A. A.; Konopko, L. A.; Huber, T. E.; Kobylianskaya, A. K.; Para, Gh. I.

    2017-02-01

    The features associated with the manifestation of Lifshitz electron topological transitions (ETT) in glass-insulated bismuth wires upon qualitative changes to the topology of the Fermi surface are investigated. The variation of the energy spectrum parameters was implemented by doping Bi with an acceptor impurity Sn and using elastic strain of up to 2%, relative to the elongation in the weakly-doped p-type Bi wires. Pure and doped glass-insulated single-crystal bismuth with different diameters and (1011) orientations along the axis were prepared by the Ulitovsky liquid phase casting method. For the first time, ETT-induced anomalies are observed along the temperature dependences of the thermoemf α(T) as triple-changes of the α sign (given heavy doping of Bi wires with an acceptor impurity Sn). The concentration and energy position of the Σ-band given a high degree of bismuth doping with Sn was assessed using the Shubnikov-de Haas effect oscillations, which were detected both from L-electrons and from T-holes in magnetic fields of up to 14 T. It is shown that the Lifshitz electron-topological transitions with elastic deformation of weakly-doped p-type Bi wires are accompanied by anomalies along the deformation dependences of the thermoemf at low temperatures. The effect is interpreted in terms of the formation of a selective scattering channel of L-carriers into the T-band with a high density of states, which is in good agreement with existing theoretical ETT models.

  4. Neuro-otological findings in psychiatric patients with nystagmus.

    PubMed

    Kiyomizu, Kensuke; Matsuda, Keiji; Torihara, Koji; Nakayama, Meiho; Ishida, Yasushi; Yoshida, Kensei; Tono, Tetsuya

    2011-12-01

    To evaluate whether neuro-otological tests have clinical significance in psychiatric patients with nystagmus who have inner ear and/or brain dysfunction, we performed neuro-otological tests on 56 psychiatric patients with nystagmus (38 men, 18 women) (age range 40-97; mean age ± SD 61.6 ± 10.5 years). Patients were classified according to the underlying diseases: schizophrenia (25 cases), organic psychiatric disorders (14 cases), alcoholism (16 cases) and excited mental retardation (1 case). Caloric test results showed a normal response in 30 (75%) cases, right canal paresis (CP) in 4 (10%), left CP in 4 (10%) and bilateral CP in 2 (5%). Therefore, 10 (25%) cases had CP. The results of the eye tracking tests (ETT) were sorted into five categories: 4 (8.2%) cases smooth (normal), 8 (16.3%) slightly saccadic, 28 (57.1%) saccadic, 8 (16.3%) ataxic, and 1 (2%) no tracking ability. Therefore, 45 (91.8%) cases had abnormal ETT results. Pure tone audiometry showed normal hearing in 24 (47.1%) cases, right hearing loss (HL) in 3 (5.8%), left HL in 3 (5.8%) and bilateral HL in 21 (41.2%). Therefore, 27 (52.9%) cases had HL. The patients were classified as organic or functional groups. In ETT there was a significant difference between these two groups. These results indicate that neuro-otological tests with video-oculography are very important not only for neurological or neuro-otological patients with nystagmus, but also for psychiatric patients with nystagmus.

  5. Retrospective analysis of vocal cord-to-suprasternal notch distance

    PubMed Central

    Kim, Hyerim; Chang, Jee-Eun; Ryu, Jung-Hee; Jung, Haesun; Min, Seong-Won; Lee, Jung-Man; Hwang, Jin-Young

    2017-01-01

    Abstract Endotracheal tube (ETT) positioning using the cuff ballottement test, which confirms that the inflated cuff is positioned at the suprasternal notch with squeezing or inflating a pilot balloon, has been reported to be a simple and reliable method of preventing endobronchial intubation. However, in patients with a short vocal cord-to-suprasternal notch, ETT placement using the cuff ballottement test can cause vocal cord injury. In the present study, we assessed the distance from a point 15 mm below the vocal cord to the suprasternal notch (VSD-15), the safe position for ETT cuff placement above the suprasternal notch, and investigated variables for predicting VSD-15. We retrospectively examined neck computed tomography in 427 adult patients and measured VSD-15 and the distance from the thyroid notch to the suprasternal notch (TSD). Patient height, weight, sex, and age were also recorded. In total, 47 patients (11.0%) showed a VSD-15 shorter than 45 mm. VSD-15 significantly correlated with TSD (r = 0.778, P < 0.001) and height (r = 0.312, P < 0.001), and inversely correlated with age (r = −0.321, P < 0.001). In multiple linear regression models, a formula was obtained for VSD-15 (VSD-15 [mm] = −6.220 + 0.744 × TSD [mm] + 0.092 × height [cm] − 0.065 × age [years], R2 = 0.621). The cuff ballottement test should be used cautiously in patients with a predicted short VSD-15. VSD-15 can be predicted from TSD, height, and age. PMID:28207550

  6. Rescue Ventilation Through a Small-Bore Transtracheal Cannula in Severe Hypoxic Pigs Using Expiratory Ventilation Assistance

    PubMed Central

    Hamaekers, Ankie E.; van der Beek, Tim; Theunissen, Maurice

    2015-01-01

    BACKGROUND: Suction-generated expiratory ventilation assistance (EVA) has been proposed as a way to facilitate bidirectional ventilation through a small-bore transtracheal cannula (TC). In this study, we investigated the efficiency of ventilation with EVA for restoring oxygenation and ventilation in a pig model of acute hypoxia. METHODS: Six pigs (61–76 kg) were anesthetized and ventilated (intermittent positive pressure ventilation) via a cuffed endotracheal tube (ETT). Monitoring lines were placed, and a 75-mm long, 2-mm inner diameter TC was inserted. After the baseline recordings, the ventilator was disconnected. After 2 minutes of apnea, reoxygenation with EVA was initiated through the TC and continued for 15 minutes with the ETT occluded. In the second part of the study, the experiment was repeated with the ETT either partially obstructed or left open. Airway pressures and hemodynamic data were recorded, and arterial blood gases were measured. Descriptive statistical analysis was performed. RESULTS: With a completely or partially obstructed upper airway, ventilation with EVA restored oxygenation to baseline levels in all animals within 20 seconds. In a completely obstructed airway, Paco2 remained stable for 15 minutes. At lesser degrees of airway obstruction, the time to reoxygenation was delayed. Efficacy probably was limited when the airway was completely unobstructed, with 2 of 6 animals having a Pao2 <85 mm Hg even after 15 minutes of ventilation with EVA and a mean Paco2 increased up to 90 mm Hg. CONCLUSIONS: In severe hypoxic pigs, ventilation with EVA restored oxygenation quickly in case of a completely or partially obstructed upper airway. Reoxygenation and ventilation were less efficient when the upper airway was completely unobstructed. PMID:25565319

  7. Frequency and distribution of early tooth loss and endodontic treatment needs of permanent first molars in a Turkish pediatric population

    PubMed Central

    Demirbuga, Sezer; Tuncay, Oznur; Cantekin, Kenan; Cayabatmaz, Muhammed; Dincer, Asiye Nur; Kilinc, Halil İbrahim; Sekerci, Ahmet Ercan

    2013-01-01

    Objectives: The objective of this study is to evaluate the frequency and distribution of early tooth loss and endodontic treatment needs of permanent first molars in a Turkish pediatric population. Materials and Methods: A total of 7,895 panoramic radiographs taken for routine dental examination at the Department of Oral Maxillofacial Radiology between 2008 and 2012 years were investigated. Two independent specialists evaluated early tooth loss and endodontic treatment needs of permanent first molars using panoramic radiography and patient anamnesis forms. The teeth were classified according to the following data: (a) Missing teeth, (b) teeth requiring extraction, (c) endodontically treated teeth (ETT), (d) teeth requiring endodontic therapy. The data also classified according to four factors: Age group (6-12 and 13-16), gender (boy and girl), jaw (mandible and maxilla) and side (right and left). A Chi-square test was used for statistical analyses. Results: A total of 19,488 and 12,092 teeth were evaluated in the child group and adolescent group respectively. All data were higher in adolescents than children (P < 0.001). For gender factor, only ETT was higher in girls than it was in boys (P < 0.001). For the jaw factor, all data were higher (P < 0.001) in mandible than in the maxilla. For the side factor, no statistical difference existed between right and left. Conclusions: Early tooth loss and endodontic treatment needs of permanent first molars showed variability according to age groups and jaws. When the results were compared according to the side and gender factors, no statistical difference was found (P > 0.05) except with the data of ETT in gender groups. PMID:24966738

  8. Autoinducer-2 of Streptococcus mitis as a Target Molecule to Inhibit Pathogenic Multi-Species Biofilm Formation In Vitro and in an Endotracheal Intubation Rat Model

    PubMed Central

    Wang, Zhengli; Xiang, Qingqing; Yang, Ting; Li, Luquan; Yang, Jingli; Li, Hongong; He, Yu; Zhang, Yunhui; Lu, Qi; Yu, Jialin

    2016-01-01

    Streptococcus mitis (S. mitis) and Pseudomonas aeruginosa (P. aeruginosa) are typically found in the upper respiratory tract of infants. We previously found that P. aeruginosa and S. mitis were two of the most common bacteria in biofilms on newborns’ endotracheal tubes (ETTs) and in their sputa and that S. mitis was able to produce autoinducer-2 (AI-2), whereas P. aeruginosa was not. Recently, we also found that exogenous AI-2 and S. mitis could influence the behaviors of P. aeruginosa. We hypothesized that S. mitis contributes to this interspecies interaction and that inhibition of AI-2 could result in inhibition of these effects. To test this hypothesis, we selected PAO1 as a representative model strain of P. aeruginosa and evaluated the effect of S. mitis as well as an AI-2 analog (D-ribose) on mono- and co-culture biofilms in both in vitro and in vivo models. In this context, S. mitis promoted PAO1 biofilm formation and pathogenicity. Dual-species (PAO1 and S. mitis) biofilms exhibited higher expression of quorum sensing genes than single-species (PAO1) biofilms did. Additionally, ETTs covered in dual-species biofilms increased the mortality rate and aggravated lung infection compared with ETTs covered in mono-species biofilms in an endotracheal intubation rat model, all of which was inhibited by D-ribose. Our results demonstrated that S. mitis AI-2 plays an important role in interspecies interactions with PAO1 and may be a target for inhibition of biofilm formation and infection in ventilator-associated pneumonia. PMID:26903968

  9. Do physical examination and CT-scan measures of femoral neck anteversion and tibial torsion relate to each other?

    PubMed

    Sangeux, Morgan; Mahy, Jessica; Graham, H Kerr

    2014-01-01

    Informed clinical decision making for femoral and/or tibial de-rotation osteotomies requires accurate measurement of patient function through gait analysis and anatomy through physical examination of bony torsions. Validity of gait analysis has been extensively studied; however, controversy remains regarding the accuracy of physical examination measurements of femoral and tibial torsion. Comparison between CT-scans and physical examination measurements of femoral neck anteversion (FNA) and external tibial torsion (ETT) were retrospectively obtained for 98 (FNA) and 64 (ETT) patients who attended a tertiary hospital for instrumented gait analysis between 2007 and 2010. The physical examination methods studied for femoral neck anteversion were the trochanteric prominence angle test (TPAT) and the maximum hip rotation arc midpoint (Arc midpoint) and for external tibial torsion the transmalleolar axis (TMA). Results showed that all physical examination measurements statistically differed to the CT-scans (bias(standard deviation): -2(14) for TPAT, -10(12) for Arc midpoint and -16(9) for TMA). Bland and Altman plots showed that method disagreements increased with increasing bony torsions in all cases but notably for TPAT. Regression analysis showed that only TMA and CT-scan measurement of external tibial torsion demonstrated good (R(2)=57%) correlation. Correlations for both TPAT (R(2)=14%) and Arc midpoint (R(2)=39%) with CT-scan measurements of FNA were limited. We conclude that physical examination should be considered as screening techniques rather than definitive measurement methods for FNA and ETT. Further research is required to develop more accurate measurement methods to accompany instrumented gait analysis.

  10. The Art and Science of Psychological Operations: Case Studies of Military Application. Volume Two

    DTIC Science & Technology

    1976-04-01

    dividends to be drawn from such investments. It would be surprising if Britain rv ere not concerned in this form of peaceful competition for: If it is...Stalin’s lifetime some essential enements of the strategy w!,ich has paid considerable political dividends to Khrushchev were worked out at least in...the Afro-Asian Jiunst-- Conference, Conakry. October 15-22, 1962 "L’Emigration et le travail forc6," "La Situation politique ," "Paruis politiques ett

  11. Nuclear Techniques for Plasma Diagnostics.

    DTIC Science & Technology

    1979-04-23

    ers ar e ’ usually u’~ett t o s ep ar a t e ’ t h e n eu t cons and x rays . In e x p e r i r n ’n t s w her e I ic x — r a \\ pu iso is Sn I S ic...DAViS EGSG , INC. ALBU QUER QUE D IV IS ION P.O. BOX 10218 ALBUQUERQUE, NM 87114 1 CV ATTN: TECHNICAL LIBRARY FORD AEROSPACE & COMMUNICATIONS CORP

  12. Sugar Creek Basin North Carolina and South Carolina, Feasibility Report and Environmental Impact Statement for Water Resources Development.

    DTIC Science & Technology

    1982-10-01

    are featured in the larger parks. Three swimming pools, 15 corimunity centern , a iolf couirse, Park Center arena, and *f Mern i St !i uv’ ar, -fl 1...ietion of Strate ies. Efforts during Stage I centered on the idintificat ion of problems and needs in the stu dy art-a, ssabisent of broad- planninq...cultura9 3:i ccc: 1 ooortuni ties, and other factors. LNVIRQN-’’ErJAL- . rETT,1JC-: AND ’IATURAL PESOURCES The SJugar I Ee asin lies within the Central

  13. Developing Tactical Commanders at CGSOC for the Future AirLand Battlefield

    DTIC Science & Technology

    1991-01-04

    and history. Airland BaLtLe Futr (ALB-F), sentor Army leaders and cu|rrent an thors ettIIaI sizL’ w LI tIpo rta|ce of these same c’ommniland cotlpoilets...high and the margin for error will grow smaller .... At a time when technology and electronic devices appear to offer an easy path to overcome the...learn by doing himself. In this case, he normally learns by trial and error (on the job training). The painter can also learn from someone else he

  14. Complete Obstruction of Endotracheal Tube in an Infant with a Retropharyngeal and Anterior Mediastinal Abscess

    PubMed Central

    Greene, Nathaniel H.

    2017-01-01

    Intraoperative ventilatory failure is not an uncommon complication; however, acute endotracheal obstruction by a foreign body or blood clot can be difficult to quickly discriminate from other causes. Once the diagnosis is made, quick action is needed to restore ventilation. The ultimate solution is to exchange the endotracheal tube; however, there can be other ways of resolving this in situations where reintubation would be difficult or unsafe. This case report discusses such an event in an infant with multiple airway challenges including a retropharyngeal and anterior mediastinal abscess. We have also formulated a pathway based on various case reports involving complete ETT obstruction. PMID:28299222

  15. Factor analysis of laboratory and clinical measurements of dyspnea in patients with chronic obstructive pulmonary disease.

    PubMed

    Nguyen, Huong Q; Altinger, Julie; Carrieri-Kohlman, Virginia; Gormley, Jenny M; Stulbarg, Michael S

    2003-02-01

    The primary purpose of this study was to determine if there are three distinct factors representing ratings of dyspnea during laboratory exercise, clinical ratings of dyspnea, and pulmonary function in patients with moderate to severe chronic obstructive pulmonary disease (COPD) (n = 92) using factor analysis. Subjects (mean age 66 +/- 7 yrs; FEV1% predicted 44.7 +/- 14.0) were randomly assigned to one of three treatment groups to test the effects of three education and exercise training programs. Outcomes were evaluated at baseline and at 2 months after the intervention. Dyspnea ratings with laboratory exercise (SOB) were measured during incremental (ITT) and endurance (ETT) treadmill tests, and a six-minute walk (6MW) using the modified Borg scale. Clinical measures of dyspnea were measured with the Baseline and Transitional Dyspnea Index (BDI/TDI), UCSD Shortness of Breath Questionnaire (SOBQ), Medical Research Council Dyspnea Scale (MRC), Dyspnea subscale of the Chronic Respiratory Questionnaire (CRQ-D), and a global dyspnea question. Pulmonary function parameters included FEV1% predicted, FEV1/FVC, and RV/TLC. The factor analysis yielded three factors that accounted for 58.7% of the total variance in the data: Factor 1, "Dyspnea with Laboratory Exercise" comprised ETT SOB end, ETT SOB isotime, ITTSOB end, ITT SOB isotime, ITT SOB/Time and ETT SOB/Time. Factor 2, "Clinical Dyspnea," comprised 6MW SOB, 6MW SOB/Feet, BDI, SOBQ, MRC, Global SOB, CRQ-D. Measures of airway resistance (FEV1% predicted, FEV1/FVC) and hyperinflation (RV/TLC) loaded on a third factor, "Pulmonary Function." An additional post hoc factor analysis with post-intervention data provided similar results. The Global SOB question and ITT SOB isostage variables were relatively more sensitive to change compared to the other outcome variables. We conclude that pulmonary function, clinical ratings of dyspnea, and laboratory ratings of dyspnea are three separate and independent factors and should be

  16. Micro-patterned surfaces reduce bacterial colonization and biofilm formation in vitro: Potential for enhancing endotracheal tube designs

    PubMed Central

    2014-01-01

    Background Ventilator-associated pneumonia (VAP) is a leading hospital acquired infection in intensive care units despite improved patient care practices and advancements in endotracheal tube (ETT) designs. The ETT provides a conduit for bacterial access to the lower respiratory tract and a substratum for biofilm formation, both of which lead to VAP. A novel microscopic ordered surface topography, the Sharklet micro-pattern, has been shown to decrease surface attachment of numerous microorganisms, and may provide an alternative strategy for VAP prevention if included on the surface of an ETT. To evaluate the feasibility of this micro-pattern for this application, the microbial range of performance was investigated in addition to biofilm studies with and without a mucin-rich medium to simulate the tracheal environment in vitro. Methods The top five pathogens associated with ETT-related pneumonia, Methicillin-Resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Klebsiella pneumonia, Acinetobacter baumannii, and Escherichia coli, were evaluated for attachment to micro-patterned and un-patterned silicone surfaces in a short-term colonization assay. Two key pathogens, MRSA and Pseudomonas aeruginosa, were evaluated for biofilm formation in a nutrient rich broth for four days and minimal media for 24 hours, respectively, on each surface type. P. aeruginosa was further evaluated for biofilm formation on each surface type in a mucin-modified medium mimicking tracheal mucosal secretions. Results are reported as percent reductions and significance is based on t-tests and ANOVA models of log reductions. All experiments were replicated at least three times. Results Micro-patterned surfaces demonstrated reductions in microbial colonization for a broad range of species, with up to 99.9% (p < 0.05) reduction compared to un-patterned controls. Biofilm formation was also reduced, with 67% (p = 0.12) and 52% (p = 0.05) reductions in MRSA and P. aeruginosa

  17. Vehicle Mobility Assessment for Project Wheels Study Group

    DTIC Science & Technology

    1972-07-01

    for obtaining the reliable on-time information needed. 2 I 2. AMC-71 GROUND MOBILITY HODEL 2.1 Purpose The AMC-71 Ground Mobility Model is designed ...printed, refiled, ett., by an output routine designed to meet the needs of the particular study. 5 The basic output of AMC-71 is vehicle speed in each of a...road inflation pressures. The M52OE1 8-ton, 4xJ cargo truck is equipped with earthmover tires designed to operato at approximately 25 percent

  18. Wanat: Combat Action in Afghanistan, 2008

    DTIC Science & Technology

    2010-01-01

    events of that day through the eyes of the leaders and Soldiers of Task Force Rock . It is meant to provide context to the chaos and complexity of...Battalion, 503d Infantry (“The Rock ”), as well as members of the 62d Engineer Battalion, USMC ETT 5-3, and the staffs of the 173d Airborne Brigade...Operation ROCK MOVE ........... 53 Chapter 2. The Establishment of COP Kahler, 8-12 July 2008 ........ 69 ROCK MOVE—The Plan

  19. Robust Optimization and Sensitivity Analysis with Multi-Objective Genetic Algorithms: Single- and Multi-Disciplinary Applications

    DTIC Science & Technology

    2007-01-01

    WCCSR Ru radius of uncertainty from the approximation model t target variables tij corresponding target variables for coupling variables yij...of the variance 2σ̂ for Eq. (2.5) is given by o T n/)ˆ()ˆ(ˆ 12 ββσ vuvu −−= −R (2.9) The Mean Squared Error (MSE) s2...ttg ttg .ttg -ttg L-g tttt t w ttEttEtE b ttcttctcwL L f µ µ (3.13) In Eq. (3.13), the notations (ρ1, ρ2, ρ3

  20. Effect of nebulized eucalyptus on contamination of microbial plaque of endotracheal tube in ventilated patients

    PubMed Central

    Amini, Nazanin; Rezaei, Korosh; Yazdannik, Ahmadreza

    2016-01-01

    Background: Formation of biofilm and bacterial colonization within the endotracheal tube (ETT) are significant sources of airway contamination and play a role in the development of ventilator-associated pneumonia (VAP). This study was conducted to examine the effect of nebulized eucalyptus (NE) on bacterial colonization of ETT biofilm. Materials and Methods: We performed a randomized clinical trial in three intensive care units (ICUs) of an educational hospital. Seventy intubated patients were selected and randomly divided into intervention (n = 35) and control (n = 35) groups. The intervention group received 4 ml (5%) of eucalyptus in 6 ml normal saline every 8 h. The placebo group received only 10 ml of normal saline in the same way. On extubation, the interior of the tube was immediately sampled using a sterile swab for standard microbiological analysis. Chi-square and Fisher's exact tests were used for statistical analysis in SPSS. P values less than 0.05 were considered statistically significant. Results: In both samples, Klebsiella pneumoniae and Acinetobacter baumannii were the most frequently isolated bacteria. In the control group, heavy colonization was greater than in the intervention group (P = 0.002). The frequency of isolation of K. pneumoniae in the intervention group was lower than in the control group (P < 0.001). However, there was no difference between the two groups in other isolated bacteria. Conclusions: NE can reduce microbial contamination of the endotracheal tube biofilm in ventilated patients. Moreover, K. pneumoniae was the most sensitive to NE. PMID:27095990

  1. Classifying movement behaviour in relation to environmental conditions using hidden Markov models.

    PubMed

    Patterson, Toby A; Basson, Marinelle; Bravington, Mark V; Gunn, John S

    2009-11-01

    1. Linking the movement and behaviour of animals to their environment is a central problem in ecology. Through the use of electronic tagging and tracking (ETT), collection of in situ data from free-roaming animals is now commonplace, yet statistical approaches enabling direct relation of movement observations to environmental conditions are still in development. 2. In this study, we examine the hidden Markov model (HMM) for behavioural analysis of tracking data. HMMs allow for prediction of latent behavioural states while directly accounting for the serial dependence prevalent in ETT data. Updating the probability of behavioural switches with tag or remote-sensing data provides a statistical method that links environmental data to behaviour in a direct and integrated manner. 3. It is important to assess the reliability of state categorization over the range of time-series lengths typically collected from field instruments and when movement behaviours are similar between movement states. Simulation with varying lengths of times series data and contrast between average movements within each state was used to test the HMMs ability to estimate movement parameters. 4. To demonstrate the methods in a realistic setting, the HMMs were used to categorize resident and migratory phases and the relationship between movement behaviour and ocean temperature using electronic tagging data from southern bluefin tuna (Thunnus maccoyii). Diagnostic tools to evaluate the suitability of different models and inferential methods for investigating differences in behaviour between individuals are also demonstrated.

  2. Exaggerated blood pressure response during the exercise treadmill test as a risk factor for hypertension

    PubMed Central

    Lima, S.G.; Albuquerque, M.F.P.M.; Oliveira, J.R.M.; Ayres, C.F.J.; Cunha, J.E.G.; Oliveira, D.F.; Lemos, R.R.; Souza, M.B.R.; Silva, O. Barbosa e

    2013-01-01

    Exaggerated blood pressure response (EBPR) during the exercise treadmill test (ETT) has been considered to be a risk factor for hypertension. The relationship of polymorphisms of the renin-angiotensin system gene with hypertension has not been established. Our objective was to evaluate whether EBPR during exercise is a clinical marker for hypertension. The study concerned a historical cohort of normotensive individuals. The exposed individuals were those who presented EBPR. At the end of the observation period (41.7 months = 3.5 years), the development of hypertension was analyzed within the two groups. Genetic polymorphisms and blood pressure behavior were assessed as independent variables, together with the classical risk factors for hypertension. The I/D gene polymorphism of the angiotensin-converting enzyme and M235T of angiotensinogen were ruled out as risk factors for hypertension. EBPR during ETT is not an independent influence on the chances of developing hypertension. No differences were observed between the hypertensive and normotensive individuals regarding gender (P = 0.655), skin color (P = 0.636), family history of hypertension (P = 0.225), diabetes mellitus (P = 0.285), or hypertriglyceridemia (P = 0.734). The risk of developing hypertension increased with increasing body mass index (BMI) and advancing age. The risk factors, which independently influenced the development of hypertension, were age and BMI. EBPR did not constitute an independent risk factor for hypertension and is probably a preclinical phase in the spectrum of normotension and hypertension. PMID:23598646

  3. A genetic link between epigenetic repressor AS1-AS2 and a putative small subunit processome in leaf polarity establishment of Arabidopsis

    PubMed Central

    Matsumura, Yoko; Ohbayashi, Iwai; Takahashi, Hiro; Kojima, Shoko; Ishibashi, Nanako; Keta, Sumie; Nakagawa, Ayami; Hayashi, Rika; Saéz-Vásquez, Julio; Echeverria, Manuel; Sugiyama, Munetaka; Nakamura, Kenzo; Machida, Chiyoko

    2016-01-01

    ABSTRACT Although the DEAD-box RNA helicase family is ubiquitous in eukaryotes, its developmental role remains unelucidated. Here, we report that cooperative action between the Arabidopsis nucleolar protein RH10, an ortholog of human DEAD-box RNA helicase DDX47, and the epigenetic repressor complex of ASYMMETRIC-LEAVES1 (AS1) and AS2 (AS1-AS2) is critical to repress abaxial (ventral) genes ETT/ARF3 and ARF4, which leads to adaxial (dorsal) development in leaf primordia at shoot apices. Double mutations of rh10-1 and as2 (or as1) synergistically up-regulated the abaxial genes, which generated abaxialized filamentous leaves with loss of the adaxial domain. DDX47 is part of the small subunit processome (SSUP) that mediates rRNA biogenesis. In rh10-1 we found various defects in SSUP-related events, such as: accumulation of 35S/33S rRNA precursors; reduction in the 18S/25S ratio; and nucleolar hypertrophy. Double mutants of as2 with mutations of genes that encode other candidate SSUP-related components such as nucleolin and putative rRNA methyltransferase exhibited similar synergistic defects caused by up-regulation of ETT/ARF3 and ARF4. These results suggest a tight link between putative SSUP and AS1-AS2 in repression of the abaxial-determining genes for cell fate decisions for adaxial development. PMID:27334696

  4. Who gets admitted to the Chest Pain Unit (CPU) and how do we manage them? Improving the use of the CPU in Waikato DHB, New Zealand.

    PubMed

    Jade, Judith; Huggan, Paul; Stephenson, Douglas

    2015-01-01

    Chest pain is a commonly encountered presentation in the emergency department (ED). The chest pain unit at Waikato DHB is designed for patients with likely stable angina, who are at low risk of acute coronary syndrome (ACS), with a normal ECG and Troponin T, who have a history which is highly suggestive of coronary artery disease (CAD). Two issues were identified with patient care on the unit (1) the number of inappropriate admissions and (2) the number of inappropriate exercise tolerance tests. A baseline study showed that 73% of admissions did not fulfil the criteria and the majority of patients (72%) had an exercise tolerance test (ETT) irrespective of clinical picture. We delivered educational presentations to key stakeholders and the implementation of a new fast track chest pain pathway for discharging patients directly from the ED. There was an improvement in the number of patients inappropriately admitted, which fell to 61%. However, the number of inappropriate ETTs did not decrease, and were still performed on 76.9% of patients.

  5. Prediction of the mid-tracheal level using surface anatomical landmarks in adults

    PubMed Central

    Jang, Young-Eun; Kim, Eun-Hee; Song, In-Kyung; Lee, Ji-Hyun; Ryu, Ho-Geoul; Kim, Hee-Soo; Kim, Jin-Tae

    2017-01-01

    Abstract Endotracheal tube (ETT) should be placed at the optimal level to avoid single lung ventilation or accidental extubation. This study was performed to estimate the mid-tracheal level by using surface anatomical landmarks in adult patients. Neck computed tomography images of 329 adult patients between the ages of 16 and 79 years were reviewed. In the midline sagittal plane, the levels corresponding to the vocal cords, cricoid cartilage, suprasternal notch, manubriosternal junction, and carina were identified. The surface distances from the cricoid cartilage to the suprasternal notch (extCC-SSN) and that from the suprasternal notch to the manubriosternal junction (extSSN-MSJ) were measured. The relationship between mid-tracheal level and the surface distances was analyzed using Bland–Altman plot. The difference between the extCC-SSN and the mid-tracheal level was −6.6 (12.5) mm, and the difference between the extSSN-MSJ and the mid-tracheal level was −19.2 (6.1) mm. The difference between the extCC-SSN and the mid-tracheal level was smaller in females compared with males [−1.7 (11.7) mm vs −12.8 (10.7) mm; P < 0.001]. The mid-tracheal level, which is helpful in planning the insertion depth of an ETT, can be predicted by the surface distance between the cricoid cartilage and suprasternal notch in adults, especially in females. PMID:28328810

  6. Fiberoptic intubation through laryngeal mask airway for management of difficult airway in a child with Klippel-Feil syndrome.

    PubMed

    Bhat, Ravi; Mane, Rajesh S; Patil, Manjunath C; Suresh, S N

    2014-07-01

    The ideal airway management modality in pediatric patients with syndromes like Klippel-Feil syndrome is a great challenge and is technically difficult for an anesthesiologist. Half of the patients present with the classic triad of short neck, low hairline, and fusion of cervical vertebra. Numerous associated anomalies like scoliosis or kyphosis, cleft palate, respiratory problems, deafness, genitourinary abnormalities, Sprengel's deformity (wherein the scapulae ride high on the back), synkinesia, cervical ribs, and congenital heart diseases may further add to the difficulty. Fiberoptic bronchoscopy alone can be technically difficult and patient cooperation also becomes very important, which is difficult in pediatric patients. Fiberoptic bronchoscopy with the aid of supraglottic airway devices is a viable alternative in the management of difficult airway in children. We report a case of Klippel-Feil syndrome in an 18-month-old girl posted for cleft palate surgery. Imaging of spine revealed complete fusion of the cervical vertebrae with hypoplastic C3 and C6 vertebrae and thoracic kyphosis. We successfully managed airway in this patient by fiberoptic intubation through classic laryngeal mask airway (LMA). After intubation, we used second smaller endotracheal tube (ETT) to stabilize and elongate the first ETT while removing the LMA.

  7. Endoscopic Appearance of Oropharyngeal and Upper GI Kaposi's Sarcoma in an Immunocompromised Patient.

    PubMed

    Darr, Umar; Renno, Anas; Khan, Zubair; Alkully, Turki; Moslim, Maitham A; Kamal, Sehrish; Nawras, Ali

    2017-01-01

    Introduction. Kaposi's sarcoma (KS) usually manifests as a cutaneous disease but GI manifestation is often rare. It is associated with human herpes virus-8 (HHV-8) and seen in immunocompromised patients. In the USA, use of highly active antiretroviral therapy (HAART) has drastically reduced incidence of KS in HIV patients. Case Presentation. A 65-year-old male with human immunodeficiency virus (HIV) was admitted to the intensive care unit (ICU) with cardiopulmonary arrest secondary to hyperkalemia of 7.5 meq/L. Following placement of orogastric and endotracheal tube (ETT), a significant amount of blood was noticed in the ETT. Hemoglobin trended down from 9.6 mg/dL to 6.7 mg/dL over five days. Stool guaiac was positive. Esophagogastroduodenoscopy (EGD) was performed and revealed multiple large hypervascularized violaceous submucosal nodular lesions with stigmata of bleeding seen on the soft palate and pharynx and within the cricopharyngeal area close to the vocal cords. Biopsy of the soft palate lesions showed proliferation of neoplastic spindle shaped cells arranged in bundles with slit-like capillary spaces containing erythrocytes consistent with Kaposi's sarcoma. Biopsy was positive for HHV-8. Colonoscopy was unremarkable. There were no cutaneous manifestations of the disease. Conclusion. GI involvement of Kaposi's sarcoma must be considered in immunocompromised patients and can be confirmed by endoscopic methods.

  8. Numerical investigation of pulmonary drug delivery under mechanical ventilation conditions

    NASA Astrophysics Data System (ADS)

    Banerjee, Arindam; van Rhein, Timothy

    2012-11-01

    The effects of mechanical ventilation waveform on fluid flow and particle deposition were studied in a computer model of the human airways. The frequency with which aerosolized drugs are delivered to mechanically ventilated patients demonstrates the importance of understanding the effects of ventilation parameters. This study focuses specifically on the effects of mechanical ventilation waveforms using a computer model of the airways of patient undergoing mechanical ventilation treatment from the endotracheal tube to generation G7. Waveforms were modeled as those commonly used by commercial mechanical ventilators. Turbulence was modeled with LES. User defined particle force models were used to model the drag force with the Cunningham correction factor, the Saffman lift force, and Brownian motion force. The endotracheal tube (ETT) was found to be an important geometric feature, causing a fluid jet towards the right main bronchus, increased turbulence, and a recirculation zone in the right main bronchus. In addition to the enhanced deposition seen at the carinas of the airway bifurcations, enhanced deposition was also seen in the right main bronchus due to impaction and turbulent dispersion resulting from the fluid structures created by the ETT. Authors acknowledge financial support through University of Missouri Research Board Award.

  9. CO2 Absorption Using Fluorine Functionalized Ionic Liquids: Interplay of Hydrogen and σ-Hole Interactions.

    PubMed

    Rao, Soniya S; Gejji, Shridhar P

    2016-03-03

    Use of ionic liquids (ILs) for CO2 capture offers certain advantages over currently used methodologies and is of growing interest. With this perspective, ILs composed of S-ethyl-N,N,N',N'-tetramethylthiouronium ([ETT]) and 1-hexyl-3-methylimidazolium ([Hmim]) cations and tris(pentafluoroethyl)trifluorophosphate ([FEP]) anion have been investigated. The present work unravels the noncovalent interactions accompanying CO2 capture by these ILs. Electronic structure of ion pairs and their CO2 absorbed [ETT][FEP]·n(CO2) and [Hmim][FEP]·n(CO2) (n up to 30) complexes are derived. The anisotropy in molecular electrostatic potential dictates the binding of CO2 through the interplay of (i) halogen bonding (O···F) between electron deficient σ-holes on fluorines, (ii) electrostatic C···F interactions between electron deficient carbons of CO2 and the electron-rich fluorine atoms, and the (iii) hydrogen bonding (O···H) interactions from the cation. The manifestations of these interactions on binding energies, polarizabilities, and vibrational spectra of CO2 absorbed complexes are presented. Consequent "frequency shift" accompanying hydrogen and halogen bonding exhibit complementary characteristics in the infrared spectra of CO2 absorbed complexes. Correlation of binding energies to absorbed CO2 molecules further demonstrate that [Hmim] based ILs are more efficient for CO2 capture applications.

  10. Endoscopic Appearance of Oropharyngeal and Upper GI Kaposi's Sarcoma in an Immunocompromised Patient

    PubMed Central

    Renno, Anas; Khan, Zubair; Alkully, Turki; Kamal, Sehrish; Nawras, Ali

    2017-01-01

    Introduction. Kaposi's sarcoma (KS) usually manifests as a cutaneous disease but GI manifestation is often rare. It is associated with human herpes virus-8 (HHV-8) and seen in immunocompromised patients. In the USA, use of highly active antiretroviral therapy (HAART) has drastically reduced incidence of KS in HIV patients. Case Presentation. A 65-year-old male with human immunodeficiency virus (HIV) was admitted to the intensive care unit (ICU) with cardiopulmonary arrest secondary to hyperkalemia of 7.5 meq/L. Following placement of orogastric and endotracheal tube (ETT), a significant amount of blood was noticed in the ETT. Hemoglobin trended down from 9.6 mg/dL to 6.7 mg/dL over five days. Stool guaiac was positive. Esophagogastroduodenoscopy (EGD) was performed and revealed multiple large hypervascularized violaceous submucosal nodular lesions with stigmata of bleeding seen on the soft palate and pharynx and within the cricopharyngeal area close to the vocal cords. Biopsy of the soft palate lesions showed proliferation of neoplastic spindle shaped cells arranged in bundles with slit-like capillary spaces containing erythrocytes consistent with Kaposi's sarcoma. Biopsy was positive for HHV-8. Colonoscopy was unremarkable. There were no cutaneous manifestations of the disease. Conclusion. GI involvement of Kaposi's sarcoma must be considered in immunocompromised patients and can be confirmed by endoscopic methods. PMID:28261507

  11. Implementing a perpetual anesthesia setup standardized for the trauma room in a level I trauma center.

    PubMed

    Faircloth, Amanda C; Ford, Mary B

    2013-02-01

    The trauma room in a level I trauma center is a dynamic environment that provides little room for error. Significant variability can exist if anesthesia providers set up the room differently. Standardization provides a system that is consistent, reliable, and cost-effective. This study examines the process of creating and implementing a standardized anesthesia setup in the trauma room of a level I trauma center. As a result of this study, the medication cart and airway setups have been standardized. Providers are encouraged to only draw up medications that will be immediately used and to ensure that prefilled syringes have been incorporated into the pharmacy formulary. Using the EZ Endo prestyleted endotracheal tube (ETT) vs a regular ETT with stylet has yielded an annual cost savings of $2,673. Ensuring that items such as an esophageal temperature probe, humidifier, and nasogastric tube are available but unopened has provided a savings of $1,989.25 per year. The reservoir bag has been changed to a latex-free bag, and 3 central line kits including an arterial line kit are routinely stocked. An ultrasound machine dedicated for central line access, GlideScope, rapid fluid infuser, and Airtraq laryngoscope have all been incorporated into the permanent setup in the trauma room.

  12. Effects of Glutamine and Omega-3 Fatty Acids on Erythrocyte Deformability and Oxidative Damage in Rat Model of Enterocolitis

    PubMed Central

    Cehreli, Ruksan; Akpinar, Hale; Artmann, Aysegul Temiz; Sagol, Ozgul

    2015-01-01

    Background The aim of the study was to investigate preventive effects of glutamine (Gln), omega-3 fatty acids (FA) on erythrocyte deformability (EDEF) in rat model of indomethacin-induced enterocolitis. Methods Nineteen Wistar albino male rats were divided into three groups: control group, colitis induced by indomethacin and were fed with a standard laboratory diet (group 1), and colitis induced by indomethacin and were also fed with Gln, omega-3 FA (group 2). An investigation was performed in a rat model of experimental colitis induced by subcutaneous injections of 2 mL intdomethacine solution applied at 24 and 48 hours intervals to male Wistar rats for 14 days. Gln and omega-3 FA were added to the daily standard diets of the animals during 14 days of injections. During the study, changes in body weight were evaluated. The intestines were examined, and colitis was macroscopic and histologically scored. The circulating tumor necrosis factor alpha (TNF-α) and interleukine-1β (IL-1β), erythrocyte transit time (ETT) and thiobarbituric acid reactive substances (TBARS) levels were determined in addition to calculation of EDEF indices in all groups. Results No significant differences in body weight changes could be determined between the standard diet and special diet groups at the end of the experiment. After macroscopic and microscopic scoring, in all of the groups that colitis was found induced, the lowest microscopic score was observed in the group 2. But Gln and omega-3 FA supplemented diet did not change the mean macroscopic and histological scores in all rats. The proliferating cell nuclear antigen (PCNA) levels were significantly higher in group 1 and group 2 compared to the control group. Effects of the diet on circulating TNF-α and IL-1β levels were found correlated with inflammation but statistically significant differences were not found in the group 1 and group 2 (P < 0.05). The ETT and TBARS levels in standard and special diet groups were significantly

  13. First Report on Determination of Possible Movement of Corps and Division Artillery Utilizing C-47, B-17, and B-24 Air Planes, and First Report on Ordnance Program No. 6077

    DTIC Science & Technology

    1944-02-12

    parallol with the longitudinal axis of tho Plano ~. Additional boxes were placed in the center Tith the 1long axis transverse to the longitudinal axis of...crv-:-,ette ro~ur-cls T;:. fo lrai_ 2! - 1 .ý Pie for. nl oad inZ - *7 -harý V.ok. adltitional .1"M .,lm ca =i’,c c-mrried - 2. -4 a8a to~* z I, 2...61 under wneels. b. ~ pie es f p ari in ~ 2" 6" x 6 ’ for block i . C. Threa pleces off llu-btzr I" x 6" 36 urder doll., d.IYo blocks 6,1 x 6- x.Ld

  14. Technology Insertion (TI)/Industrial Process Improvement (IPI) Task Order Number 1. Data Base Documentation Book for SA-ALC/MATPSS (Assembly and Test GTE’s)

    DTIC Science & Technology

    1989-08-14

    8217 -- - AD-A237 070 JMENTATION PAGE _ N tt t *. 0 ’t o0t o f im lt0 e o mn’t0 tfverage Itott I ( flh t Ett 9 ain q ’ tc "I"? O" 3t W turce* i i...technology Insertion (TI)/Industrial Process Improvement (IPI).D(taas%V’ocumentatioh ,ook Folume-; f or SA-ALC/MATPSS (Assembl’V & Test GTE’s X . this...ffo6A Fir W~ r-uFL sTAgTFR &FEs) 13e r14 JET FUE STRT~ER (jFS) c! ?6O7A ,F15 (&/FI-RAL 6-iARt9,-; X k/6rR )27I2A F/ ACcfKS~tQR VR,]F (,FARBcX (At&-) Od

  15. Humidification on Ventilated Patients: Heated Humidifications or Heat and Moisture Exchangers?

    PubMed

    Cerpa, F; Cáceres, D; Romero-Dapueto, C; Giugliano-Jaramillo, C; Pérez, R; Budini, H; Hidalgo, V; Gutiérrez, T; Molina, J; Keymer, J

    2015-01-01

    The normal physiology of conditioning of inspired gases is altered when the patient requires an artificial airway access and an invasive mechanical ventilation (IMV). The endotracheal tube (ETT) removes the natural mechanisms of filtration, humidification and warming of inspired air. Despite the noninvasive ventilation (NIMV) in the upper airways, humidification of inspired gas may not be optimal mainly due to the high flow that is being created by the leakage compensation, among other aspects. Any moisture and heating deficit is compensated by the large airways of the tracheobronchial tree, these are poorly suited for this task, which alters mucociliary function, quality of secretions, and homeostasis gas exchange system. To avoid the occurrence of these events, external devices that provide humidification, heating and filtration have been developed, with different degrees of evidence that support their use.

  16. Humidification on Ventilated Patients: Heated Humidifications or Heat and Moisture Exchangers?

    PubMed Central

    Cerpa, F; Cáceres, D; Romero-Dapueto, C; Giugliano-Jaramillo, C; Pérez, R; Budini, H; Hidalgo, V; Gutiérrez, T; Molina, J; Keymer, J

    2015-01-01

    The normal physiology of conditioning of inspired gases is altered when the patient requires an artificial airway access and an invasive mechanical ventilation (IMV). The endotracheal tube (ETT) removes the natural mechanisms of filtration, humidification and warming of inspired air. Despite the noninvasive ventilation (NIMV) in the upper airways, humidification of inspired gas may not be optimal mainly due to the high flow that is being created by the leakage compensation, among other aspects. Any moisture and heating deficit is compensated by the large airways of the tracheobronchial tree, these are poorly suited for this task, which alters mucociliary function, quality of secretions, and homeostasis gas exchange system. To avoid the occurrence of these events, external devices that provide humidification, heating and filtration have been developed, with different degrees of evidence that support their use. PMID:26312102

  17. Catalogue of UBVRI photometry of T Tauri stars and analysis of the causes of their variability

    NASA Technical Reports Server (NTRS)

    Herbst, William; Herbst, Debra K.; Grossman, Elan J.; Weinstein, Daryl

    1994-01-01

    A computer-based catalogue of UBVRI photoelectric photometry of T Tauri stars and their earlier type analogs has been compiled. It presently includes over 10 000 entries on 80 stars and will be updated on a regular basis; it is available on Internet. The catalogue is used to analyze the sometimes bizarre light variations of pre-main-sequence stars on time scales of days to months in an attempt to illuminate the nature and causes of the phenomenon. It is useful in discussing their light variations to divide the stars into three groups according to their spectra. These are: weak T Tauri stars (WTTS; spectral class later than K0 and W(sub H-alpha less than 10 A), classical T Tauri stars (CTTS; spectral class later than K0 and W(sub H-alpha) greater than 10 A), and early type T Tauri stars (ETTS; spectral class of K0 or earlier). Three distinct types of variability are displayed by stars in the catalogue. Type I variations are periodic in VRI and undoubtedly caused by rotational modulation of a star with an asymmetric distribution of cool spots on its surface. Irregular flare activity is sometimes seen on such stars in U and B. Type I variations are easiest to see on WTTS but are clearly present on CTTS and ETTS as well. Type II variations are caused by hot 'spots' or zones and, it is argued, result from changes in the excess or 'veiling' continuum commonly attributed to an accretion boundary layer or impact zone of a magnetically channeled accretion flow. This type of variation is seen predominantly or solely in CTTS. A subcategory, designated Type IIp, consists of stars which display periodic variations caused by hot spots. Whereas cool spots may last for hundreds or thousands of rotations, hot spots appear to come and go on a much shorter time scale. This suggests that both unsteady accretion and rotation of the star contribute to Type II variations. It is shown that a third type of variation exists among ETTS, including stars as early as A type. UX Ori is a typical

  18. Numerical Methods for Singularly Perturbed Differential Equations with Applications

    DTIC Science & Technology

    1993-03-31

    e e on . :nOrmaton Send comments r t e@aradg tt •rden estimate :ir an, nher t p ( of At,$ -tr :C "Id~tn t-to" He&aQa .Jtters Ser vces. Directorate ror...no,) at ton Do~ers I.ors snap gr-c),rs 󈧝 .ette’i.D -e a _2 2 4 r to 4 S e )f management -no 8..aqet. Paer .s0r RC~edu ci P ’,ect 0C,04-0’S .󈨜...refinement and coarsening (h-refinement, order variation ( p -refinement), and occasionally, mesh motion (r-refinement), we addressed problems in

  19. DMSP Special Sensor Microwave/Imager Calibration/Validation

    DTIC Science & Technology

    1991-05-20

    DMAX. When D > 1, the ice concentration will be more than 90% -And old ice is arcsent in the fleid of view. 1 1A. I LTL)I 9-f(seoson) 1, TA37 -1(u"os4)I...N I>NID 1yF-cs NI ___ T___ 37:tr7J=3)j -I- Mc OGE r1LTER RIOR AThm(spt4fRE.- - -- 1 tIS/T37>NI2 N "-OX2 O>CMIN2 ~-y Ofi>N14)c A * N T937-I V37. TA37 §T...n N rTA37-$(T837) TO ~ TUS,-rC- TA37 ) - I C7ET-T7U Fi&r 1OA. -cniu 40 lOA-9 The data points for which D < DmAx and D > Dm are given a second test. This

  20. An Interactive Computer Session to Initiate Physical Activity in Sedentary Cardiac Patients: Randomized Controlled Trial

    PubMed Central

    Smith-Ray, Renae L; Dzewaltowski, David A; Glasgow, Russell E; Lee, Rebecca E; Thomas, Deborah SK; Xu, Stanley; Estabrooks, Paul A

    2015-01-01

    Background Physical activity (PA) improves many facets of health. Despite this, the majority of American adults are insufficiently active. Adults who visit a physician complaining of chest pain and related cardiovascular symptoms are often referred for further testing. However, when this testing does not reveal an underlying disease or pathology, patients typically receive no additional standard care services. A PA intervention delivered within the clinic setting may be an effective strategy for improving the health of this population at a time when they may be motivated to take preventive action. Objective Our aim was to determine the effectiveness of a tailored, computer-based, interactive personal action planning session to initiate PA among a group of sedentary cardiac patients following exercise treadmill testing (ETT). Methods This study was part of a larger 2x2 randomized controlled trial to determine the impact of environmental and social-cognitive intervention approaches on the initiation and maintenance of weekly PA for patients post ETT. Participants who were referred to an ETT center but had a negative-test (ie, stress tests results indicated no apparent cardiac issues) were randomized to one of four treatment arms: (1) increased environmental accessibility to PA resources via the provision of a free voucher to a fitness facility in close proximity to their home or workplace (ENV), (2) a tailored social cognitive intervention (SC) using a “5 As”-based (ask, advise, assess, assist, and arrange) personal action planning tool, (3) combined intervention of both ENV and SC approaches (COMBO), or (4) a matched contact nutrition control (CON). Each intervention was delivered using a computer-based interactive session. A general linear model for repeated measures was conducted with change in PA behavior from baseline to 1-month post interactive computer session as the primary outcome. Results Sedentary participants (n=452; 34.7% participation rate) without

  1. Summary of the Northeast Artificial Intelligence Consortium (NAIC)

    DTIC Science & Technology

    1991-09-01

    rwwmg ranjac , s ,ct vm V w- ta so’l-e- gattwrig anl r %w-,"g Tor d"n reec " ,T rr wid rmwmV tlcdeax, of rformrou Serd cTrrts r wdeg u- s b’u-d e,te cr m...y Orw aspec c: ’ded=of iormr ru.dig & ux for redc"- & ,ase to WastVcn Hoec e*tts S wuvc DcIaraoe for forz Operg us a iRepl . 12s 5 .-e-i-c D Nis HkwW... S l* 1204. Arkxpcr VA 202432, n to &is Office of Mwvgrr rt and BLcxg Ppwwork Reducr1 Prj ;t (0704-010 ). WsagwigtoR OC 205C3 . AGENCY USE ONLY

  2. Bias/Variance Analysis for Relational Domains

    DTIC Science & Technology

    2007-08-15

    EDtr ,Dte,t[L(t, y)] = EDtr ,Dte,t[(t − y)2] = Et[(t − E[t])2] + EDtr ,Dte...y − E[t])2] = NT (x) + EDtr ,Dte[(y − EDtr ,Dte[y] + EDtr ,Dte[y]− E[t])2] = NT (x) + EDtr ,Dte[(y − EDtr ,Dte[y])2 + ( EDtr ,Dte[y]− E[t])2 + 2(y − EDtr ,Dte...y]) · ( EDtr ,Dte[y]− E[t])] = NT (x) + EDtr ,Dte[(y − EDtr ,Dte[y])2] + ( EDtr ,Dte[y]− E[t])2 = NT (x) + VT (x) + BT (x) In this decomposition the

  3. Endotracheal Suctioning in Preterm Infants Using Four-Handed versus Routine Care

    PubMed Central

    Cone, Sharon; Pickler, Rita H.; Grap, Mary Jo; McGrath, Jacqueline; Wiley, Paul M.

    2013-01-01

    Objective To evaluate the effect of four-handed care on preterm infants’ physiologic and behavioral responses to and recovery from endotracheal suctioning versus routine endotracheal (ETT) suctioning. Design Randomized crossover design with infants as their own controls. Setting Single-family-room newborn intensive care unit in an academic health center. Participants Ten intubated infants on conventional ventilation with inline suctioning who were fewer than 37 weeks gestation at birth, and less than one week of age. Methods Each infant was observed twice on a single day. One observation involved routine ETT suctioning and one involved four-handed care. Physiologic and behavioral response data were collected. Results No differences were noted when comparing baseline heart rate (HR) or oxygen saturation (SpO2) data to those obtained during and after suctioning while in the routine care condition. In the four-handed care condition, mean SpO2 increased from preobservation 95.49 to during observation saturation 97.75 (p = .001). Salivary cortisol levels did not differ between groups at baseline or postsuctioning. No significant difference in behavior state was observed between the two conditions. More stress and defense behaviors occurred postsuctioning when infants received routine care as opposed to four-handed care (p = .001) and more self-regulatory behaviors were exhibited by infants during (p = .019) and after suctioning (p = .016) when receiving four-handed care. No statistical difference was found in the number of monitor call-backs postsuctioning. Conclusions Four-handed care during suctioning was associated with a decrease in stress and defense behaviors and an increase in self-regulatory behaviors. PMID:23316894

  4. The effect of mouth prop on endotracheal tube intracuff pressure in children during dental rehabilitation under general anaesthesia.

    PubMed

    Canpolat, Dilek Günay; Cantekin, Kenan; Bayram, Adnan; Yıldırım, Mustafa Denizhan

    2017-01-20

    Although the endotracheal tube (ETT) cuff may be associated with tracheal morbidity, cuffed tubes may reduce the aspiration risk in oral procedures. Dentists must use a mouth prop to facilitate oral visualization and to protect the oral soft tissues during dental rehabilitation under general anaesthesia (DRGA). The aim of this study was to evaluate the effect of mouth prop on endotracheal tube intracuff pressure in children during DRGA. Two-hundred and three ASA I-II patients, <18 years of age (mean: 5.3 ± 2.4 years) were included in the prospective observational study whose comprehensive dental treatment was performed under general anaesthesia. Following the induction of general anaesthesia, placement of a cuffed endotracheal tube which was an appropriate size for children was fixed. The intracuff pressure was measured intermittently after the intubation (baseline) (T0), immediately after the mouth prop (T1), 30 min after the mouth prop (T2), after taking out the mouth prop (T3) and just before extubation (T4). The mean intracuff pressure was 28.3 ± 2.01 cm H2O at T0. The mean intracuff pressure significantly increased at T1 (30.8 ± 2.7) and T2 (29.6 ± 3.7) compared to T0 (P < 0.001). No significant differences were observed between the duration of the procedure and intracuff pressure or postoperative complications (P > 0.05). Cough, sore throat and nausea were observed in 4, 1 and 5 patients, respectively. Because a mouth prop may increase the intracuff pressure of ETT, strict measurement and readjustment of cuff pressures should be employed when used in children during DRGA.

  5. Electronic Topological Transition in Ag2Te at High-pressure

    PubMed Central

    Zhang, Yuhang; Li, Yan; Ma, Yanmei; Li, Yuwei; Li, Guanghui; Shao, Xuecheng; Wang, Hui; Cui, Tian; Wang, Xin; Zhu, Pinwen

    2015-01-01

    Recently, Ag2Te was experimentally confirmed to be a 3D topological insulator (TI) at ambient pressure. However, the high-pressure behaviors and properties of Ag2Te were rarely reported. Here, a pressure-induced electronic topological transition (ETT) is firstly found in Ag2Te at 1.8 GPa. Before ETT, the positive pressure coefficient of bulk band-gap, which is firstly found in TIs family, is found by both first-principle calculations and in situ high-pressure resistivity measurements. The electrical resistivity obtained at room temperature shows a maximum at 1.8 GPa, which is nearly 3.3 times to that at ambient pressure. This result indicates that the best bulk insulating character and topological nature in Ag2Te can be obtained at this pressure. Furthermore, the high-pressure structural behavior of Ag2Te has been investigated by in situ high-pressure synchrotron powder X-ray diffraction technique up to 33.0 GPa. The accurate pressure-induced phase transition sequence is firstly determined as P21/c → Cmca → Pnma. It is worth noting that the reported isostructural P21/c phase is not existed, and the reported structure of Cmca phase is corrected by CALYPSO methodology. The second high-pressure structure, a long puzzle to previous reports, is determined as Pnma phase. A pressure-induced metallization in Ag2Te is confirmed by the results of temperature-dependent resistivity measurements. PMID:26419707

  6. A New Lifshitz Transition and the Equation of State of Osmium

    SciTech Connect

    Occelli, F; Aracne, C M; Teter, D M; Hanfland, M; Canny, B; Couzinet, B; Chervin, J; Badro, J; Farber, D L

    2003-11-05

    We have measured the equation of state (EoS) of osmium to 75 GPa under hydrostatic conditions at room temperature using angle dispersive x-ray diffraction. A least-squares fit of the data using a third order Birch-Murnaghan EoS yields K{sub 0} = 411 {+-} 6 GPa and K'{sub 0} = 4.0 {+-} 0.2, showing osmium is in fact more compressible than diamond. Most importantly, we have documented an anomaly in the compressibility at 20.3 GPa associated with a large discontinuity in the first pressure derivative of the c/a ratio. This discontinuity likely arises from the collapse of the small hole-ellipsoid in the Fermi surface near the L point. There has been much interest in the possibility of a Lifshitz [1] or electronic topological transition (ETT) in zinc at high-pressure near 10 GPa. Interestingly, while the experimental data remain somewhat ambiguous [2-5], most simulations suggest the ETT exists in this pressure range [6-8]. Recently, Steinle-Neumann et al. [8] have shown that the transition arises from changes in the band structure near the high-symmetry point K where three bands cross the Fermi surface upon compression. Thus one might expect that other hcp metals should exhibit similar phenomena. The hcp 4d and 5d transition elements Re, Os and Ru are known to be among the densest and stiffest metals [9,10] suggesting that these might in fact be poor candidates in which to look for such effects. In osmium however, experimental and theoretical results [11,12] have shown the existence of small local maxima in the band structure just above the Fermi energy near the high-symmetry point L on the zone boundary [11]. These structures might potentially fall below the Fermi energy upon compression and give rise to an ETT. Osmium is of further interest as recent EoS measurements by Cynn et al. [13] have suggested that Os (K{sub 0} = 462 GPa and K'{sub 0} = 2.4) has the lowest known compressibility, lower even than diamond (K{sub 0} = 446 GPa and K'{sub 0} = 3) [14]. This

  7. Evidence of long-lived founder virus in mother-to-child HIV transmission.

    PubMed

    Danaviah, Sivapragashini; de Oliveira, Tulio; Bland, Ruth; Viljoen, Johannes; Pillay, Sureshnee; Tuaillon, Edouard; Van de Perre, Philippe; Newell, Marie-Louise

    2015-01-01

    Exposure of the infant's gut to cell-associated and cell-free HIV-1 trafficking in breast milk (BM) remains a primary cause of mother-to-child transmission (MTCT). The mammary gland represents a unique environment for HIV-1 replication and host-virus interplay. We aimed to explore the origin of the virus transmitted during breastfeeding, and the link with quasi-species found in acellular and cellular fractions of breast-milk (BM) and in maternal plasma. The C2-V5 region of the env gene was amplified, cloned and sequenced from the RNA and DNA of BM, the RNA from the mother's plasma (PLA) and the DNA from infant's dried blood spot (DBS) in 11 post-natal mother-infant pairs. Sequences were assembled in Geneious, aligned in ClustalX, manually edited in SeAL and phylogenetic reconstruction was undertaken in PhyML and MrBayes. We estimated the timing of transmission (ETT) and reconstructed the time for the most recent common ancestor (TMRCA) of the infant in BEAST. Transmission of single quasi-species was observed in 9 of 11 cases. Phylogenetic analysis illustrated a BM transmission event by cell-free virus in 4 cases, and by cell-associated virus in 2 cases but could not be identified in the remaining 5 cases. Molecular clock estimates, of the infant ETT and TMRCA, corresponded well with the timing of transmission estimated by sequential infant DNA PCR in 10 of 11 children. The TMRCA of BM variants were estimated to emerge during gestation in 8 cases. We hypothesize that in the remaining cases, the breast was seeded with a long-lived lineage latently infecting resting T-cells. Our analysis illustrated the role of DNA and RNA virus in MTCT. We postulate that DNA archived viruses stem from latently infected quiescent T-cells within breast tissue and MTCT can be expected to continue, albeit at low levels, should interventions not effectively target these cells.

  8. Methods For Collecting , Culturing And Performing Toxicity Tests With Daphnia ambigua

    SciTech Connect

    Specht, Winona L.

    2005-07-01

    Toxicity tests conducted on water collected from impacted locations in SRS streams often failed chronic toxicity tests and sometimes failed acute toxicity tests (Specht 1995). These findings prompted SRS to determine the cause of the failures. Some SRS NPDES outfalls were also failing chronic toxicity tests, even though no toxicant could be identified and when TIEs were performed, none of the TIE treatments removed the toxicity. Ultimately, it was determined that the failures were due to the low hardness of SRS surface waters, rather than to the presence of a toxicant. The species of cladoceran that the EPA recommends for toxicity testing, Ceriodaphnia dubia, is stressed by the very low hardness of SRS waters. SRS developed an alternate species toxicity test that is similar to the EPA test, but uses an indigenous cladoceran, Daphnia ambigua (Specht and Harmon, 1997; Harmon et al., 2003). In 2001, SCDHEC approved the use of D. ambigua for toxicity testing at SRS, contingent upon approval by EPA Region 4. In 2002, EPA Region 4 approved the use of this species for compliance toxicity testing at SRS. Ultimately, the use of this species demonstrated that SRS effluents were not toxic, and most toxicity testing requirements were removed from the NPDES permit that was issued in December 2003, with the exception of one round of chronic definitive testing on outfalls A-01, A-11, and G-10 just before the next NPDES permit application is submitted to SCDHEC. Although the alternate species test was developed at SRS (1996-1998), the culture was transferred to a contract toxicity testing lab (ETT Environmental) located in Greer, SC in 1998. ETT Environmental became certified by SCDHEC to perform toxicity tests using D. ambigua in 2002, and at this time is the only laboratory certified by SCDHEC to perform tests with this species. Because of the expense associated with maintaining the D. ambigua culture for several years when no toxicity testing is required, SRS decided to suspend

  9. SMQIE: The shower max QIE chip

    SciTech Connect

    James R. Hoff

    1999-06-02

    A QIE-like full-custom chip has been designed by members of the Fermilab PPD/ETT/ES Group as well as members of the CDF/Shower Max Group. This chip contains two channels each with an eight range QIE front end capable of handling charges from roughly 12 fC to roughly 100 pC. Each channel also contains a five-bit flash A-to-D converter, a 38 stage deep FIFO for level 1 trigger delay and storage for holding selected time slices. It communicates with the outside world via LVDS-like differential signals. This chip utilizes a 1.2mm double-metal, double-polysilicon process with a vertical NPN transistor option. It has been prototyped using ORBIT Semiconductor�s Foresight program. As of this writing, it has been submitted to Super Tex (new owner of the ORBIT fabrication facility) for fabrication. However, it has not yet returned from fabrication.

  10. OCTN1 is a high-affinity carrier of nucleoside analogs.

    PubMed

    Drenberg, Christina; Gibson, Alice A; Pounds, Stanley; Shi, Lei; Rhinehart, Dena; Li, Lie; Hu, Shuiying; Du, Guoqing; Nies, Anne T; Schwab, Matthias; Pabla, Navjotsingh; Blum, William; Gruber, Tanja A; Baker, Sharyn D; Sparreboom, Alex

    2017-02-16

    Resistance to xenobiotic nucleosides used to treat acute myeloid leukemia (AML) and other cancers remains a major obstacle to clinical management. One process suggested to participate in resistance is reduced uptake into tumor cells via nucleoside transporters, although precise mechanisms are not understood. Through transcriptomic profiling, we determined that low expression of the ergothioneine transporter OCTN1 (SLC22A4; ETT) strongly predicts poor event-free survival and overall survival in multiple cohorts of AML patients receiving treatment with the cytidine nucleoside analog cytarabine. Cell biological studies confirmed OCTN1-mediated transport of cytarabine and various structurally-related cytidine analogs, such as 2'deoxycytidine and gemcitabine, occurs through a saturable process that is highly sensitive to inhibition by the classic nucleoside transporter inhibitors dipyridamole and nitrobenzylmercaptopurine ribonucleoside (NBMPR). Our findings have immediate clinical implications given the potential of the identified transport system to help refine strategies that could improve patient survival across multiple cancer types where nucleoside analogs are used in cancer treatment.

  11. AICA syndrome with facial palsy following vertigo and acute sensorineural hearing loss.

    PubMed

    Ikegami-Takada, Tomoko; Izumikawa, Masahiko; Doi, Tadashi; Takada, Yohei; Tomoda, Koichi

    2012-04-01

    We report a case of infarction of the anterior inferior cerebellar artery (AICA) with peripheral facial palsy following vertigo and acute sensorineural hearing loss. A 39-year-old female presented with vertigo and sudden hearing loss, tinnitus, and aural fullness of the right ear. An audiogram revealed a severe hearing loss at all tested frequencies in the right ear. Spontaneous nystagmus toward the left side was also observed. Otoneurological examinations showed sensorineural hearing loss of the right ear and horizontal and rotatory gaze nystagmus toward the left side, and a caloric reflex test demonstrated canal paresis. Initially, we diagnosed the patient for sudden deafness with vertigo. However, right peripheral facial palsy appeared 2 days later. An eye tracking test (ETT) and optokinetic pattern test (OKP) showed centralis abnormality. The patient's brain was examined by magnetic resonance imaging (MRI) and magnetic resonance angioglaphy (MRA) and showed an infarction localized in the pons and cerebellum. MRI and MRA revealed infarction of the right cerebellar hemisphere indicating occlusion of the AICA. Consequently, the patient was diagnosed with AICA syndrome but demonstrated regression following steroid and edaravone treatment. We suggest that performing MRI and MRA in the early stage of AICA syndrome is important for distinguishing cerebellar infarction resulting from vestibular disease.

  12. Gestational Trophoblastic Disorders: An Update in 2015

    PubMed Central

    Stevens, F. T.; Katzorke, N.; Tempfer, C.; Kreimer, U.; Bizjak, G. I.; Fleisch, M. C.; Fehm, T. N.

    2015-01-01

    Gestational trophoblastic diseases (GTD) are a group of pregnancy-related disorders representing rare human tumours. They encompass premalignant disorders including complete (CHM), partial hydatidiform mole (PHM), exaggerated placental site (EPS), and placental-site nodule (PSN) as well as malignant disorders (also known as “gestational trophoblastic neoplasia [GTN]”) including invasive mole, choriocarcinoma (CC), placenta-site trophoblastic tumour (PSTT), and epitheloid trophoblastic tumours (ETT) (Fig. 1). Originally, GTD develop from abnormal proliferation of trophoblastic tissue and form botryoid arranged vesicles. Premalignant moles are usually treated by suction curettage while persistent and recurrent moles and malignant forms require systemic therapy with methotrexate or combination chemotherapy consisting of etoposide, actimomycin D, methotrexate, vincristine, and cyclophosphamide (EMA-CO). β-human chorion gonadotropin (β-hCG) plays a crucial role in diagnosis and monitoring therapeutic effects. Since the definitive diagnosis cannot be obtained by histology in most cases, persistent or recurrent disease is diagnosed by elevated or persistent serum levels of β-hCG. While curing rates are described to be as high as 98 %, GTD may initially present, recur, or end up as a metastasising systemic disease. This underlines the importance of a regular and consistent follow-up after treatment. PMID:26556906

  13. Pathophysiological Basis of Acute Respiratory Failure on Non-Invasive Mechanical Ventilation.

    PubMed

    Romero-Dapueto, C; Budini, H; Cerpa, F; Caceres, D; Hidalgo, V; Gutiérrez, T; Keymer, J; Pérez, R; Molina, J; Giugliano-Jaramillo, C

    2015-01-01

    Noninvasive mechanical ventilation (NIMV) was created for patients who needed noninvasive ventilator support, this procedure decreases the complications associated with the use of endotracheal intubation (ETT). The application of NIMV has acquired major relevance in the last few years in the management of acute respiratory failure (ARF), in patients with hypoxemic and hypercapnic failure. The main advantage of NIMV as compared to invasive mechanical ventilation (IMV) is that it can be used earlier outside intensive care units (ICUs). The evidence strongly supports its use in patients with COPD exacerbation, support in weaning process in chronic obstructive pulmonary disease (COPD) patients, patients with acute cardiogenic pulmonary edema (ACPE), and Immunosuppressed patients. On the other hand, there is poor evidence that supports the use of NIMV in other pathologies such as pneumonia, acute respiratory distress syndrome (ARDS), and during procedures as bronchoscopy, where its use is still controversial because the results of these studies are inconclusive against the decrease in the rate of intubation or mortality.

  14. Mars Global Surveyor Ka-Band Frequency Data Analysis

    NASA Astrophysics Data System (ADS)

    Morabito, D.; Butman, S.; Shambayati, S.

    2000-01-01

    for the feed and electronics equipment. A dichroic plate is used to reflect the X-band energy and pass the Ka-band energy to another mirror. The RF energy for each band is then focused onto a feed horn and low-noise amplifier package. After amplification and RF/IF downconversion, the IF signals are sent to the Experimental Tone Tracker (ETT), a digital phase-lock-loop receiver, which simultaneously tracks both X-band and Ka-band carrier signals. Once a signal is detected, the ETT outputs estimates of the SNR in a I -Hz bandwidth (Pc/No), baseband phase and frequency of the signals every I -sec. Between December 1996 and December 1998, the Ka-band and X-band signals from MGS were tracked on a regular basis using the ETT. The Ka-band downlink frequencies described here were referenced to the spacecraft's on-board USO which was also the X-band frequency reference (fka= 3.8 fx). The ETT estimates of baseband phase at I -second sampled time tags were converted to sky frequency estimates. Frequency residuals were then generated for each band by removing a model frequency from each observable frequency at each time tag. The model included Doppler and other effects derived from spacecraft trajectory files obtained from the MGS Navigation Team. A simple troposphere correction was applied to the data. In addition to residuals, the USO frequencies emitted by the spacecraft were estimated. For several passes, the USO frequencies were determined from X-band data and from Ka-band data (referred to X-band by dividing by 3.8) and were found to be in good agreement. In addition, X-band USO frequency estimates from MGS Radio Science data acquired from operational DSN stations were available for comparison and were found to agree within the I Hz level. The remaining sub-Hertz differences were attributed to the different models and software algorithms used by MGS Radio Science and KaBLE-11. A summary of the results of a linear fit of the USO frequency versus time (day of year) is

  15. Mars Global Surveyor Ka-Band Frequency Data Analysis

    NASA Technical Reports Server (NTRS)

    Morabito, D.; Butman, S.; Shambayati, S.

    2000-01-01

    environment for the feed and electronics equipment. A dichroic plate is used to reflect the X-band energy and pass the Ka-band energy to another mirror. The RF energy for each band is then focused onto a feed horn and low-noise amplifier package. After amplification and RF/IF downconversion, the IF signals are sent to the Experimental Tone Tracker (ETT), a digital phase-lock-loop receiver, which simultaneously tracks both X-band and Ka-band carrier signals. Once a signal is detected, the ETT outputs estimates of the SNR in a I -Hz bandwidth (Pc/No), baseband phase and frequency of the signals every I -sec. Between December 1996 and December 1998, the Ka-band and X-band signals from MGS were tracked on a regular basis using the ETT. The Ka-band downlink frequencies described here were referenced to the spacecraft's on-board USO which was also the X-band frequency reference (f(sub ka)= 3.8 f(sub x)). The ETT estimates of baseband phase at I -second sampled time tags were converted to sky frequency estimates. Frequency residuals were then generated for each band by removing a model frequency from each observable frequency at each time tag. The model included Doppler and other effects derived from spacecraft trajectory files obtained from the MGS Navigation Team. A simple troposphere correction was applied to the data. In addition to residuals, the USO frequencies emitted by the spacecraft were estimated. For several passes, the USO frequencies were determined from X-band data and from Ka-band data (referred to X-band by dividing by 3.8) and were found to be in good agreement. In addition, X-band USO frequency estimates from MGS Radio Science data acquired from operational DSN stations were available for comparison and were found to agree within the I Hz level. The remaining sub-Hertz differences were attributed to the different models and software algorithms used by MGS Radio Science and KaBLE-11. A summary of the results of a linear fit of the USO frequency versus time (day of

  16. The Different Effects of BMI and WC on Organ Damage in Patients from a Cardiac Rehabilitation Program after Acute Coronary Syndrome

    PubMed Central

    Xu, Lin; Zhao, Hui; Qiu, Jian; Zhu, Wei; Lei, Hongqiang; Cai, Zekun; Lin, Wan-Hua; Huang, Wenhua; Zhang, Heye; Zhang, Yuan-Ting

    2015-01-01

    One of the purposes of cardiac rehabilitation (CR) after acute coronary syndrome (ACS) is to monitor and control weight of the patient. Our study is to compare the different obesity indexes, body mass index (BMI), and waist circumference (WC), through one well-designed CR program (CRP) with ACS in Guangzhou city of Guangdong Province, China, in order to identify different effects of BMI and WC on organ damage. In our work, sixty-one patients between October 2013 and January 2014 fulfilled our study. We collected the vital signs by medical records, the clinical variables of body-metabolic status by fasting blood test, and the organ damage variables by submaximal exercise treadmill test (ETT) and ultrasonic cardiogram (UCG) both on our inpatient and four-to-five weeks of outpatient part of CRP after ACS. We mainly used two-tailed Pearson's test and liner regression to evaluate the relationship of BMI/WC and organ damage. Our results confirmed that WC could be more accurate than BMI to evaluate the cardiac function through the changes of left ventricular structure on the CRP after ACS cases. It makes sense of early diagnosis, valid evaluation, and proper adjustment to ACS in CRP of the obesity individuals in the future. PMID:26247035

  17. Preoperative Anxiety in Patients With Myasthenia Gravis and Risk for Myasthenic Crisis After Extended Transsternal Thymectomy: A CONSORT Study.

    PubMed

    Zou, Jianyong; Su, Chunhua; Lun, Xueping; Liu, Weibing; Yang, Weiling; Zhong, Beilong; Zhu, Haoshuai; Lei, Yiyan; Luo, Honghe; Chen, Zhenguang

    2016-03-01

    A thymectomy can ameliorate the symptoms of myasthenia gravis (MG) and prevent the progression of ocular MG (OMG) to generalized MG (GMG). However, postoperative myasthenic crisis (POMC) is a serious post-thymectomy complication. Preoperative anxiety (POA) is common but typically neglected in MG patients. The association of POA with POMC has not yet been examined.From June 2007 to December 2013, 541 cases of MG were admitted to the First Affiliated Hospital of Sun Yat-sen University (Guangzhou, China). All cases underwent extended transsternal thymectomy (ETT). The clinical and pathological characteristics of these patients, including POA and POMC, were analyzed.A total of 179 patients experienced POA and 67 patients experienced POMC. Patients with POA were more likely to have POMC, a thymoma, and an ectopic thymus. Univariate analysis showed that POMC correlated with POA, presence of an ectopic thymus, dose of pyridostigmine bromide (PYR), presence of a thymoma, MGFA stage, preoperative myasthenic crisis, and postoperative pneumonia. Multivariate logistic regression analysis showed that the independent risk factors for POMC were POA, preoperative myasthenic crisis, higher dose of PYR, and postoperative pneumonia.Our results suggest that clinicians should consider the risk factors for POMC-especially preoperative anxiety-before performing a thymectomy in patients with MG.

  18. Transition state analogs of 5'-methylthioadenosine nucleosidase disrupt quorum sensing.

    SciTech Connect

    Gutierrez, J.; Crowder, T; Rinaldo-Matthis, A; Ho, M; Almo, S; Schramm, V

    2009-01-01

    5'-Methylthioadenosine/S-adenosylhomocysteine nucleosidase (MTAN) is a bacterial enzyme involved in S-adenosylmethionine-related quorum sensing pathways that induce bacterial pathogenesis factors. Transition state analogs MT-DADMe-Immucillin-A, EtT-DADMe-Immucillin-A and BuT-DADMe-Immucillin-A are slow-onset, tight-binding inhibitors of Vibrio cholerae MTAN (VcMTAN), with equilibrium dissociation constants of 73, 70 and 208 pM, respectively. Structural analysis of VcMTAN with BuT-DADMe-Immucillin-A revealed interactions contributing to the high affinity. We found that in V. cholerae cells, these compounds are potent MTAN inhibitors with IC50 values of 27, 31 and 6 nM for MT-, EtT- and BuT-DADMe-Immucillin-A, respectively; the compounds disrupt autoinducer production in a dose-dependent manner without affecting growth. MT- and BuT-DADMe-Immucillin-A also inhibited autoinducer-2 production in enterohemorrhagic Escherichia coli O157:H7 with IC{sub 50} values of 600 and 125 nM, respectively. BuT-DADMe-Immucillin-A inhibition of autoinducer-2 production in both strains persisted for several generations and caused reduction in biofilm formation. These results support MTAN's role in quorum sensing and its potential as a target for bacterial anti-infective drug design.

  19. Pathophysiological Basis of Acute Respiratory Failure on Non-Invasive Mechanical Ventilation

    PubMed Central

    Romero-Dapueto, C; Budini, H; Cerpa, F; Caceres, D; Hidalgo, V; Gutiérrez, T; Keymer, J; Pérez, R; Molina, J; Giugliano-Jaramillo, C

    2015-01-01

    Noninvasive mechanical ventilation (NIMV) was created for patients who needed noninvasive ventilator support, this procedure decreases the complications associated with the use of endotracheal intubation (ETT). The application of NIMV has acquired major relevance in the last few years in the management of acute respiratory failure (ARF), in patients with hypoxemic and hypercapnic failure. The main advantage of NIMV as compared to invasive mechanical ventilation (IMV) is that it can be used earlier outside intensive care units (ICUs). The evidence strongly supports its use in patients with COPD exacerbation, support in weaning process in chronic obstructive pulmonary disease (COPD) patients, patients with acute cardiogenic pulmonary edema (ACPE), and Immunosuppressed patients. On the other hand, there is poor evidence that supports the use of NIMV in other pathologies such as pneumonia, acute respiratory distress syndrome (ARDS), and during procedures as bronchoscopy, where its use is still controversial because the results of these studies are inconclusive against the decrease in the rate of intubation or mortality. PMID:26312101

  20. The Type Three Secretion System 2-Encoded Regulator EtrB Modulates Enterohemorrhagic Escherichia coli Virulence Gene Expression

    PubMed Central

    Luzader, Deborah H.; Willsey, Graham G.; Wargo, Matthew J.

    2016-01-01

    Enterohemorrhagic Escherichia coli O157:H7 (EHEC) is a foodborne pathogen that causes bloody diarrhea and hemolytic uremic syndrome throughout the world. A defining feature of EHEC pathogenesis is the formation of attaching and effacing (AE) lesions on colonic epithelial cells. Most of the genes that code for AE lesion formation, including a type three secretion system (T3SS) and effectors, are carried within a chromosomal pathogenicity island called the locus of enterocyte effacement (LEE). In this study, we report that a putative regulator, which is encoded in the cryptic E. coli type three secretion system 2 (ETT2) locus and herein renamed EtrB, plays an important role in EHEC pathogenesis. The etrB gene is expressed as a monocistronic transcript, and EtrB autoregulates expression. We provide evidence that EtrB directly interacts with the ler regulatory region to activate LEE expression and promote AE lesion formation. Additionally, we mapped the EtrB regulatory circuit in EHEC to determine a global role for EtrB. EtrB is regulated by the transcription factor QseA, suggesting that these proteins comprise a regulatory circuit important for EHEC colonization of the gastrointestinal tract. PMID:27324484

  1. Use of laryngeal mask airway for non-endotracheal intubated anesthesia for patients with pectus excavatum undergoing thoracoscopic Nuss procedure

    PubMed Central

    Du, Xiaojun; Mao, Songsong; Cui, Jianxiu; Ma, Jue; Zhang, Guangyan; Zheng, Yong; Zhou, Haiyu; Xie, Liang; Zhang, Dongkun; Shi, Ruiqing

    2016-01-01

    Background The aim of the present study was to determine the safety and feasibility of the use of laryngeal mask airway (LMA) for non-endotracheal intubated anesthesia for patients with pectus excavatum (PE) undergoing thoracoscopic Nuss procedure. Methods Between July 2015 and December 2015, 30 selected patients with PE were planned to undergo a thoracoscopic Nuss procedure using LMA for non-endotracheal intubated anesthesia in the Guangdong General Hospital. The clinical data were analyzed to evaluate the safety and feasibility of this technique. Results Of the 30 selected patients, two were female, the mean age was 16.04±5.09 years and the average Haller index was 3.37±0.88. A total of 27 cases (90%) succeeded at the first attempt, one patient required conversion to an endotracheal tube (ETT) because of continuous air leak. The peripheral O2 saturation (SpO2), end-tidal carbon dioxide (EtCO2) values, heart rate (HR), and mean arterial blood pressure (MAP) remained stable throughout the procedure in all cases. All of the 30 patients were successfully corrected without requiring conversion to an open surgery. Two patients experienced postoperative nausea and one reported a sore throat. Neither gastro-esophageal reflux nor in-hospital mortality occurred. Conclusions The use of LMA for non-endotracheal intubated anesthesia for selected patients with PE undergoing thoracoscopic Nuss procedure is clinically safe and technically feasible. PMID:27621860

  2. Effect of Pressure Controlled Waveforms on Flow Transport and Gas mixing in a Patient Specific Lung Model during Invasive High Frequency Oscillatory Ventilation

    NASA Astrophysics Data System (ADS)

    Alzahrany, Mohammed; Banerjee, Arindam

    2012-11-01

    A computational fluid dynamic study is carried out to investigate gas transport in patient specific human lung models (based on CT scans) during high frequency oscillatory ventilation (HFOV). Different pressure-controlled waveforms and various ventilator frequencies are studied to understand the effect of flow transport and gas mixing during these processes. Three different pressure waveforms are created by solving the equation of motion subjected to constant lung wall compliance and flow resistance. Sinusoidal, exponential and constant waveforms shapes are considered with three different frequencies 6, 10 and 15 Hz and constant tidal volume 50 ml. The velocities are calculated from the obtained flow rate and imposed as inlet flow conditions to represent the mechanical ventilation waveforms. An endotracheal tube ETT is joined to the model to account for the effect of the invasive management device with the peak Reynolds number (Re) for all the cases ranging from 6960 to 24694. All simulations are performed using high order LES turbulent model. The gas transport near the flow reversal will be discussed at different cycle phases for all the cases and a comparison of the secondary flow structures between different cases will be presented.

  3. Assessment of v-gel supraglottic airway device placement in cats performed by inexperienced veterinary students.

    PubMed

    Barletta, M; Kleine, S A; Quandt, J E

    2015-11-21

    Endotracheal intubation has been associated with several complications in cats. The v-gel supraglottic airway device (SGAD) has been developed to adapt to the unique oropharynx of the cat and to overcome these complications. Thirty-three cats were randomly assigned to receive an endotracheal tube (ETT group) or a v-gel SGAD (v-gel group) after induction of general anaesthesia. Third year veterinary students without previous clinical experience placed these devices under direct supervision of an anaesthesiologist. Amount of propofol, number of attempts, time required to secure the airway, leakage around the device, signs of upper airway discomfort and food consumption were compared between the two groups. The v-gel group required less propofol (P=0.03), less time (P<0.01) and fewer attempts (P<0.01) to secure the cats' airway. The incidence of leakage was lower for the v-gel group immediately after placement of the device (P<0.01) and 60 minutes after induction of general anaesthesia (P=0.04). Cats that received the v-gel SGAD presented a lower incidence of upper airway discomfort immediately after the device was removed (P=0.03) and recorded a higher food consumption score (P=0.03). The v-gel SGAD is a feasible way to secure the airway of healthy cats when performed by inexperienced personnel.

  4. Gestational trophoblastic diseases - clinical guidelines for diagnosis, treatment, follow-up, and counselling.

    PubMed

    Niemann, Isa; Vejerslev, Lars O; Frøding, Ligita; Blaakær, Jan; Maroun, Lisa Leth; Hansen, Estrid Stæhr; Grove, Anni; Lund, Helle; Havsteen, Hanne; Sunde, Lone

    2015-11-01

    , either orally every third week or IV every week (B). In MTX-resistant PTD, IV act D is added (or replaces the MTX) (B). Third line chemotherapy is BEP or EP, alternatively EMA-CO (B). Choriocarcinoma is primarily treated with chemotherapy. Hysterectomy and/or resection of metastases are possible treatments (A). Placental site trophoblastic tumour (PSTT) and epithelioid trophoblastic tumour (ETT) are primarily treated with hysterectomy. In the case of disseminated disease, chemotherapy is considered (A). The risk of reoccurrence after trophoblastic disease treated with chemotherapy is approximately 3%. Most reoccurrences are seen within 12 months, and for this reason monitoring of hCG is recommended for one year, the first third months once or twice a month, thereafter every second to third month. Patients with PSTT and ETT are monitored with measurement of hCG throughout their lifetimes (C). In genetically verified twin pregnancy with hydatidiform mole and a living foetus, the pregnancy can continue if serum hCG is monitored and ultrasound scans regularly performed, and possible obstetric complications dealt with (C). In the case of recurrent hydatidiform mole and/or familial hydatidiform mole, patients should be referred to genetic workup and counselling (C). Women with a hereditary disposition to hydatidiform mole because of a mutation in NLRP7 should be informed of the possibility of becoming pregnant via egg donation (C).

  5. Polymicrobial Ventilator-Associated Pneumonia: Fighting In Vitro Candida albicans-Pseudomonas aeruginosa Biofilms with Antifungal-Antibacterial Combination Therapy.

    PubMed

    Rodrigues, Maria E; Lopes, Susana P; Pereira, Cláudia R; Azevedo, Nuno F; Lourenço, Anália; Henriques, Mariana; Pereira, Maria O

    2017-01-01

    The polymicrobial nature of ventilator-associated pneumonia (VAP) is now evident, with mixed bacterial-fungal biofilms colonizing the VAP endotracheal tube (ETT) surface. The microbial interplay within this infection may contribute for enhanced pathogenesis and exert impact towards antimicrobial therapy. Consequently, the high mortality/morbidity rates associated to VAP and the worldwide increase in antibiotic resistance has promoted the search for novel therapeutic strategies to fight VAP polymicrobial infections. Under this scope, this work aimed to assess the activity of mono- vs combinational antimicrobial therapy using one antibiotic (Polymyxin B; PolyB) and one antifungal (Amphotericin B; AmB) agent against polymicrobial biofilms of Pseudomonas aeruginosa and Candida albicans. The action of isolated antimicrobials was firstly evaluated in single- and polymicrobial cultures, with AmB being more effective against C. albicans and PolyB against P. aeruginosa. Mixed planktonic cultures required equal or higher antimicrobial concentrations. In biofilms, only PolyB at relatively high concentrations could reduce P. aeruginosa in both monospecies and polymicrobial populations, with C. albicans displaying only punctual disturbances. PolyB and AmB exhibited a synergistic effect against P. aeruginosa and C. albicans mixed planktonic cultures, but only high doses (256 mg L-1) of PolyB were able to eradicate polymicrobial biofilms, with P. aeruginosa showing loss of cultivability (but not viability) at 2 h post-treatment, whilst C. albicans only started to be inhibited after 14 h. In conclusion, combination therapy involving an antibiotic and an antifungal agent holds an attractive therapeutic option to treat severe bacterial-fungal polymicrobial infections. Nevertheless, optimization of antimicrobial doses and further clinical pharmacokinetics/pharmacodynamics and toxicodynamics studies underpinning the optimal use of these drugs are urgently required to improve therapy

  6. Superconductivity on the verge of electronic topological transition in Fe based superconductors

    NASA Astrophysics Data System (ADS)

    Ghosh, Haranath; Sen, Smritijit

    2017-04-01

    A comprehensive first principles study on the electronic topological transition in a number of 122 family of Fe based superconductors is presented. Doping as well as temperature driven Lifshitz transitions are predicted from ab-initio simulations in a variety of Fe based superconductors that are consistent with experimental findings. In all the studied compounds the Lifshitz transitions are consistently found to take place at a doping concentration just around where superconductivity is known to acquire the highest Tc and magnetism disappears. This indicates the intriguing heed to the inter-relationship between superconductivity and Lifshitz transition in Fe-based 122 materials. Systematically, the Lifshitz transition occurs (above certain threshold doping) in some of the electronic Fermi surfaces for hole doped 122 compounds, whereas in hole Fermi surfaces for electron as well as iso-electronic doped 122 compounds. Temperature driven Lifshitz transition is found to occur in the iso-electronic Ru-doped BaFe2As2 compounds. A systematic study of Fermi surface area e.g., variations of (i) areas of each individual Fermi surfaces, (ii) sum total areas of all the electron Fermi Surfaces, (iii) sum total areas of all the hole Fermi Surfaces, (iv) sum total areas of all the five Fermi Surfaces, (v) difference of all hole and all electron Fermi surface areas as a function of doping is a rare wealth of information that can be verified by the de Haas-van Alphen and allied effects (i.e. , Shubnikov-de Haas effect) are presented. Fermi surface area are found to carry sensitivity of topological modifications more acutely than the band structures and can be used as a better experimental tool to identify ETT/LT.

  7. Polymicrobial Ventilator-Associated Pneumonia: Fighting In Vitro Candida albicans-Pseudomonas aeruginosa Biofilms with Antifungal-Antibacterial Combination Therapy

    PubMed Central

    Pereira, Cláudia R.; Azevedo, Nuno F.; Lourenço, Anália; Henriques, Mariana; Pereira, Maria O.

    2017-01-01

    The polymicrobial nature of ventilator-associated pneumonia (VAP) is now evident, with mixed bacterial-fungal biofilms colonizing the VAP endotracheal tube (ETT) surface. The microbial interplay within this infection may contribute for enhanced pathogenesis and exert impact towards antimicrobial therapy. Consequently, the high mortality/morbidity rates associated to VAP and the worldwide increase in antibiotic resistance has promoted the search for novel therapeutic strategies to fight VAP polymicrobial infections. Under this scope, this work aimed to assess the activity of mono- vs combinational antimicrobial therapy using one antibiotic (Polymyxin B; PolyB) and one antifungal (Amphotericin B; AmB) agent against polymicrobial biofilms of Pseudomonas aeruginosa and Candida albicans. The action of isolated antimicrobials was firstly evaluated in single- and polymicrobial cultures, with AmB being more effective against C. albicans and PolyB against P. aeruginosa. Mixed planktonic cultures required equal or higher antimicrobial concentrations. In biofilms, only PolyB at relatively high concentrations could reduce P. aeruginosa in both monospecies and polymicrobial populations, with C. albicans displaying only punctual disturbances. PolyB and AmB exhibited a synergistic effect against P. aeruginosa and C. albicans mixed planktonic cultures, but only high doses (256 mg L-1) of PolyB were able to eradicate polymicrobial biofilms, with P. aeruginosa showing loss of cultivability (but not viability) at 2 h post-treatment, whilst C. albicans only started to be inhibited after 14 h. In conclusion, combination therapy involving an antibiotic and an antifungal agent holds an attractive therapeutic option to treat severe bacterial-fungal polymicrobial infections. Nevertheless, optimization of antimicrobial doses and further clinical pharmacokinetics/pharmacodynamics and toxicodynamics studies underpinning the optimal use of these drugs are urgently required to improve therapy

  8. Partitioning Evapotranspiration in Semiarid Grassland and Shrubland Ecosystems Using Diurnal Surface Temperature Variation

    NASA Technical Reports Server (NTRS)

    Moran, M. Susan; Scott, Russell L.; Keefer, Timothy O.; Paige, Ginger B.; Emmerich, William E.; Cosh, Michael H.; O'Neill, Peggy E.

    2007-01-01

    The encroachment of woody plants in grasslands across the Western U.S. will affect soil water availability by altering the contributions of evaporation (E) and transpiration (T) to total evapotranspiration (ET). To study this phenomenon, a network of flux stations is in place to measure ET in grass- and shrub-dominated ecosystems throughout the Western U.S. A method is described and tested here to partition the daily measurements of ET into E and T based on diurnal surface temperature variations of the soil and standard energy balance theory. The difference between the mid-afternoon and pre-dawn soil surface temperature, termed Apparent Thermal Inertia (I(sub A)), was used to identify days when E was negligible, and thus, ET=T. For other days, a three-step procedure based on energy balance equations was used to estimate Qe contributions of daily E and T to total daily ET. The method was tested at Walnut Gulch Experimental Watershed in southeast Arizona based on Bowen ratio estimates of ET and continuous measurements of surface temperature with an infrared thermometer (IRT) from 2004- 2005, and a second dataset of Bowen ratio, IRT and stem-flow gage measurements in 2003. Results showed that reasonable estimates of daily T were obtained for a multi-year period with ease of operation and minimal cost. With known season-long daily T, E and ET, it is possible to determine the soil water availability associated with grass- and shrub-dominated sites and better understand the hydrologic impact of regional woody plant encroachment.

  9. Comparison of suction above cuff and standard endotracheal tubes in neurological patients for the incidence of ventilator-associated pneumonia and in-hospital outcome: A randomized controlled pilot study

    PubMed Central

    Jena, Sritam; Kamath, Sriganesh; Masapu, Dheeraj; Veenakumari, H. B.; Ramesh, Venkatapura J.; Bhadrinarayan, Varadarajan; Ravikumar, R.

    2016-01-01

    Background: Ventilator-associated pneumonia (VAP) is a common complication with endotracheal intubation. The occurrence of VAP results in significant mortality and morbidity. Earlier studies have shown reduction in the incidence of VAP with subglottic secretion drainage. The incidence of VAP in neurologically injured patients is higher and can impact the neurological outcome. This study aimed to compare the incidence of VAP with standard endotracheal tube (SETT) and suction above cuff endotracheal tube (SACETT) in neurologically ill patients and its impact on clinical outcome. Methods: Fifty-four patients with neurological illnesses aged ≥18 years and requiring intubation and/or ventilation and anticipated to remain on ETT for ≥48 h were randomized to receive either SETT or SACETT. All the VAP preventive measures were similar between two groups except for the difference in type of tube. Results: The data of 50 patients were analyzed. The incidence of clinical VAP was 20% in SETT group and 12% in SACETT group; (P = 0.70). The incidence of microbiological VAP was higher in the SETT group (52%) as compared to SACETT group (44%) but not statistically significant; (P = 0.78). There was no difference between the two groups for measured outcomes such as duration of intubation, mechanical ventilation, and Intensive Care Unit stay. Conclusions: In this pilot study in neurological population, a there was no significant difference in incidence of clinical and microbiological VAP was seen between SETT and SACETT, when other strategies for VAP prevention were similar. Other outcomes were similar with use of either tube for intubation. PMID:27275073

  10. Six months of multiwavelength follow-up of the tidal disruption candidate ASASSN-14li and implied TDE rates from ASAS-SN

    NASA Astrophysics Data System (ADS)

    Holoien, T. W.-S.; Kochanek, C. S.; Prieto, J. L.; Stanek, K. Z.; Dong, Subo; Shappee, B. J.; Grupe, D.; Brown, J. S.; Basu, U.; Beacom, J. F.; Bersier, D.; Brimacombe, J.; Danilet, A. B.; Falco, E.; Guo, Z.; Jose, J.; Herczeg, G. J.; Long, F.; Pojmanski, G.; Simonian, G. V.; Szczygieł, D. M.; Thompson, T. A.; Thorstensen, J. R.; Wagner, R. M.; Woźniak, P. R.

    2016-01-01

    We present ground-based and Swift photometric and spectroscopic observations of the candidate tidal disruption event (TDE) ASASSN-14li, found at the centre of PGC 043234 (d ≃ 90 Mpc) by the All-Sky Automated Survey for SuperNovae (ASAS-SN). The source had a peak bolometric luminosity of L ≃ 1044 erg s-1 and a total integrated energy of E ≃ 7 × 1050 erg radiated over the ˜6 months of observations presented. The UV/optical emission of the source is well fitted by a blackbody with roughly constant temperature of T ˜ 35 000 K, while the luminosity declines by roughly a factor of 16 over this time. The optical/UV luminosity decline is broadly consistent with an exponential decline, L∝ e^{-t/t_0}, with t0 ≃ 60 d. ASASSN-14li also exhibits soft X-ray emission comparable in luminosity to the optical and UV emission but declining at a slower rate, and the X-ray emission now dominates. Spectra of the source show broad Balmer and helium lines in emission as well as strong blue continuum emission at all epochs. We use the discoveries of ASASSN-14li and ASASSN-14ae to estimate the TDE rate implied by ASAS-SN, finding an average rate of r ≃ 4.1 × 10-5 yr-1 per galaxy with a 90 per cent confidence interval of (2.2-17.0) × 10-5 yr-1 per galaxy. ASAS-SN found roughly 1 TDE for every 70 Type Ia supernovae in 2014, a rate that is much higher than that of other surveys.

  11. ASASSN-15oi: a rapidly evolving, luminous tidal disruption event at 216 Mpc

    NASA Astrophysics Data System (ADS)

    Holoien, T. W.-S.; Kochanek, C. S.; Prieto, J. L.; Grupe, D.; Chen, Ping; Godoy-Rivera, D.; Stanek, K. Z.; Shappee, B. J.; Dong, Subo; Brown, J. S.; Basu, U.; Beacom, J. F.; Bersier, D.; Brimacombe, J.; Carlson, E. K.; Falco, E.; Johnston, E.; Madore, B. F.; Pojmanski, G.; Seibert, M.

    2016-12-01

    We present ground-based and Swift photometric and spectroscopic observations of the tidal disruption event (TDE) ASASSN-15oi, discovered at the centre of 2MASX J20390918-3045201 (d ≃ 216 Mpc) by the All-Sky Automated Survey for SuperNovae. The source peaked at a bolometric luminosity of L ≃ 1.3 × 1044 erg s-1 and radiated a total energy of E ≃ 6.6 × 1050 erg over the first ˜3.5 months of observations. The early optical/UV emission of the source can be fit by a blackbody with temperature increasing from T ˜ 2 × 104 K to T ˜ 4 × 104 K while the luminosity declines from L ≃ 1.3 × 1044 erg s-1 to L ≃ 2.3 × 1043 erg s-1, requiring the photosphere to be shrinking rapidly. The optical/UV luminosity decline during this period is most consistent with an exponential decline, L∝ e^{-(t-t_0)/τ}, with τ ≃ 46.5 d for t0 ≃ 57241.6 (MJD), while a power-law decline of L ∝ (t - t0)-α with t0 ≃ 57 212.3 and α = 1.62 provides a moderately worse fit. ASASSN-15oi also exhibits roughly constant soft X-ray emission that is significantly weaker than the optical/UV emission. Spectra of the source show broad helium emission lines and strong blue continuum emission in early epochs, although these features fade rapidly and are not present ˜3 months after discovery. The early spectroscopic features and colour evolution of ASASSN-15oi are consistent with a TDE, but the rapid spectral evolution is unique among optically selected TDEs.

  12. Likelihood of Myocardial Infarction during Stroke Rehabilitation Preceded by Cardiovascular Screening and an Exercise Tolerance Test: The LEAPS Experience

    PubMed Central

    Nadeau, Stephen E.; Rose, Dorian K.; Dobkin, Bruce; Wu, Samuel S.; Dai, Yunfeng E.; Schofield, Richard; Duncan, Pamela W

    2014-01-01

    Background Coronary artery disease is highly prevalent in patients with stroke but, because revascularization does not improve major clinical outcomes in patients with stable coronary artery disease relative to intensive medical therapy, routine evaluation for this disease is not warranted in stroke patients. However, it might be warranted in patients destined to undergo vigorous physical therapy. The Locomotor Experience Applied Post-Stroke (LEAPS) study, a randomized controlled trial of 408 participants that tested the relative efficacy of two rehabilitation techniques on functional walking level, provided the opportunity to address this question. Aim Test the efficacy of screening for cardiovascular disease and an exercise tolerance test in assuring safety among patients undergoing vigorous rehabilitation for gait impairment. Methods All participants were screened for serious cardiovascular and pulmonary conditions. At 6-weeks post-stroke, they also completed a cardiovascular screening inventory and underwent an exercise tolerance test involving bicycle ergometry. Participants received 36 90-minute sessions of a prescribed physical therapy (3/week), initiated at either 2 months or 6 months post-stroke. Results 29 participants were excluded on the basis of the cardiac screening questionnaire and 15 failed the exercise tolerance test for cardiovascular reasons. No participant experienced a cardiac event during a treatment session. Two participants experienced myocardial infarctions but continued in the trial. In 3 additional participants, myocardial infarctions caused or contributed to death. Conclusions The combination of a negative cardiac screen and the absence of ETT failure appeared to have a high negative predictive value for cardiac events during treatment, despite the likelihood of a high prevalence of coronary artery disease in our population. PMID:25156340

  13. High Incidence of Virulence Factors Among Clinical Enterococcus faecalis Isolates in Southwestern Iran

    PubMed Central

    Heidari, Hamid; Hasanpour, Somayeh; Ebrahim-Saraie, Hadi Sedigh

    2017-01-01

    Background Over the past two decades, enterococci have emerged as an important agent responsible for hospital acquired infection. Several virulence factors contribute to the adherence, colonization, evasion of the host immune response, and pathogenicity and severity of the infection. Enterococcus faecalis is the most common and virulent species causing infections in hospitalized patients. The aim of the present study was to examine the prevalence of genes encoding virulence factors and antimicrobial resistance patterns of E. faecalis strains isolated from hospitalized patients in Shiraz, south west of Iran. Materials and Methods A total of 51 E. faecalis isolates from the urine, blood, pleural fluid, peritoneal fluid, eye discharge, endotracheal tube (ETT) and transjugular intrahepatic portosystemic shunt (TIPS) specimens of patients were identified by phenotypic and genotypic methods. Antimicrobial sensitivity tests and detection of virulence factors were performed using standard methods. Results The efa and asa1 were the most frequently detected gene (100%) among the isolates, followed by esp (94.1%), ace (90.2%), gelE (80.4%), cylA (64.7%), and hyl (51%). More than half of the isolates (52.9%) were high level gentamicin resistant (HLGR). Vancomycin resistance was observed among 23 (45.1%) isolates. The lowest antimicrobial activity was related to erythromycin (3.9%), tetracycline (5.9%) and ciprofloxacin (9.8%). No isolate was found resistant to fosfomycin and linezolid. Conclusion Our data indicated a high incidence of virulence factors among E. faecalis strains isolated from clinical samples. Colonization of drug resistant virulent isolates in hospital environment may lead to life threatening infection in hospitalized patients. Therefore, infection control procedures should be performed. PMID:28332345

  14. Calcifications valvulaires chez l'hémodialysé au Maroc

    PubMed Central

    Noto-Kadou-Kaza, Béfa; Abouamrane, Lalla Meryam; Mtiou, Naoufal; El Khaya, Selma; Zamd, Mohamed; Medkouri, Ghislaine; Bengahanem, Mohamed Gharbi; Ramdani, Benyounes

    2016-01-01

    Introduction Les calcifications valvulaires constituent une des complications cardiovasculaires majeures de l'hémodialysé de par sa prévalence et son caractère prédictif de morbidité et de mortalité. De nombreux facteurs de risque sont à l'origine de ces calcifications. Le but de notre étude est d’évaluer à la fois la prévalence des calcifications valvulaires chez nos patients hémodialysés ainsi que leurs facteurs de risque. Méthodes Il s'agissait d'une étude transversale monocentrique, descriptive et analytique, ayant inclus 111 patients adultes hémodialysés depuis plus de 6 mois au centre d'hémodialyse du CHU Ibn Rochd de Casablanca et qui ont eu à bénéficier d'une ETT durant l'année 2013. Résultats L’âge moyen de nos patients était de 44 ± 14 ans. L'ancienneté moyenne en hémodialyse était de 146 ± 80 mois. La pression artérielle moyenne était de 123 ± 23 mmHg pour la systolique et de 72 ± 13 mmHg pour la diastolique, la PTHi moyenne de 529±460 pg/ml, la calcémie moyenne de 86±10 mg/l et la phosphatémie moyenne de 40±15 mg/l. La CRP moyenne était de 11±19,8 mg/L. Sur le plan thérapeutique, 96% des patients étaient sous carbonate de calcium, 11% sous 25 OH vitamine D, 55,5% sous 1 hydroxy-vitamine D3. La prévalence des calcifications valvulaires était de 15% avec une localisation valvulaire aortique dans 41,2% et valvulaire mitrale dans 41,2%. En analyse univariée, seule la durée d'hémodialyse semble être associée à la survenue des calcifications avec p = 0,09 proche du seuil de significativité. Conclusion La prévalence des calcifications valvulaires chez nos patients hémodialysés reste élevée même si elle parait relativement moindre comparée aux données de la littérature. Aucun facteur de risque connu n'est apparu significativement associé à ces calcifications. PMID:27642453

  15. Atteinte cardiaque au cours de la dystrophie myotonique de Steinert: expérience marocaine, à propos de 18 cas

    PubMed Central

    Saghi, Ghita; Bouhouch, Rachida; Salaheddine, Loubna; Birouk, Nezha; Nadifi, Salama; Fellat, Ibtissam; Cherti, Mohamed

    2015-01-01

    La maladie de Steinert ou dystrophie myotonique de type 1 (DM1) est une maladie génétique à transmission autosomique dominante caractérisée par une myotonie et une atteinte de plusieurs organes dont le cœur. L'atteinte cardiaque est la plus grave des atteintes systémiques puisqu'elle conditionne le pronostic vital. Ce travail a pour but de déterminer les anomalies cardiaques rencontrées au cours de la DM1 et de mettre en exergue l'intérêt d'un examen cardiaque rigoureux et régulier, indépendamment de la sévérité de l'atteinte neuromusculaire, ainsi que l'apport des examens cardiaques complémentaires et notamment l'exploration électrophysiologique. 18 patients atteints de DM1 ont bénéficiés d'une exploration cardiaque systématique. Il s'agit de 9 hommes et de 9 femmes, d’âge moyen de 41,8 +/- 16,2 ans. 66 p.100 des patients sont symptomatiques sur le plan cardiovasculaire. Les anomalies électrocardiographiques sont dominées par un trouble de la conduction intra-ventriculaire dans 16 p.100 des cas et un BAV de 1er degré dans 16 p.100 des cas. L'Holter ECG objective une hyperexcitabilité à l’étage atrial et/ou ventriculaire dans 50p.100 des cas. L'ETT est normale chez 95 p.100 des patients. L'exploration électrophysiologique, réalisée chez 4 patients symptomatiques, a objectivé un bloc tronculaire dans un cas ayant conduit à l'implantation d'un PM double chambre. Un seul patient est décédé suite à une détresse respiratoire. Enfin, on n'a pas noté de corrélation entre l'atteinte cardiaque et neuromusculaire. Une exploration cardiaque est indispensable chez tout patient atteint de DM1, en dépit de l'absence de symptômes, et un bilan annuel minimal s'impose pour guetter un éventuel trouble rythmique et/ou conductif, fatal en l'absence de traitement adéquat. PMID:26097635