High resolution pipette

DOEpatents

Beroz, Justin Douglas; Hart, Anastasios John

2016-06-07

A pipette includes a movable piston and a diaphragm that at least partly defines a fluid chamber enclosing a volume of working fluid. The piston displaces a volumetric amount of the working fluid in the chamber when moved. In response, the diaphragm displaces a smaller volumetric amount of fluid outside the chamber. A deamplification ratio is defined by the ratio of the volume displaced by the diaphragm to the volume displaced by the piston. The deamplification ratio is adjustable by adjusting or changing the diaphragm and/or by adjusting the size of the fluid chamber. The deamplifying pipette enables measuring and dispensing of very small volumes of liquid and is easily adapted to commercially available pipette components. Pipette components such as a pipette tip or adaptor may include a diaphragm to enable deamplification of the nominal volume capacity of a given pipette device.

Initial fluid resuscitation following adjusted body weight dosing is associated with improved mortality in obese patients with suspected septic shock.

PubMed

Taylor, Stephanie Parks; Karvetski, Colleen H; Templin, Megan A; Heffner, Alan C; Taylor, Brice T

2018-02-01

The optimal initial fluid resuscitation strategy for obese patients with septic shock is unknown. We evaluated fluid resuscitation strategies across BMI groups. Retrospective analysis of 4157 patients in a multicenter activation pathway for treatment of septic shock between 2014 and 2016. 1293 (31.3%) patients were obese (BMI≥30). Overall, higher BMI was associated with lower mortality, however this survival advantage was eliminated in adjusted analyses. Patients with higher BMI received significantly less fluid per kilogram at 3h than did patients with lower BMI (p≤0.001). In obese patients, fluid given at 3h mimicked a dosing strategy based on actual body weight (ABW) in 780 (72.2%), adjusted body weight (AdjBW) in 95 (8.8%), and ideal body weight (IBW) in 205 (19.0%). After adjusting for condition- and treatment-related variables, dosing based on AdjBW was associated with improved mortality compared to ABW (OR 0.45; 95% CI [0.19, 1.07]) and IBW (OR 0.29; 95% CI [0.11,0.74]). Using AdjBW to calculate initial fluid resuscitation volume for obese patients with suspected shock may improve outcomes compared to other weight-based dosing strategies. The optimal fluid dosing strategy for obese patients should be a focus of future prospective research. Copyright © 2017 Elsevier Inc. All rights reserved.

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

PubMed

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

2014-12-01

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

Prolonged fasting with fluid therapy is related to poorer outcomes in medical patients.

PubMed

Kyriakos, Georgios; Calleja-Fernández, Alicia; Ávila-Turcios, Dalia; Cano-Rodríguez, Isidoro; Ballesteros Pomar, María D; Vidal-Casariego, Alfonso

2013-01-01

An inadequate fluid therapy can worsen the outcomes of surgical patients, but there are no data in medical patients. The aim of this study was to determine the adequacy of fluid therapy in hospitalised patients of medical wards, and its influence on outcomes. Cross-sectional study including nil-per-os patients admitted in medical wards of the Complejo Asistencial Universitario de León. The administered fluid therapy was compared with the standardised requirements. Nutritional status was evaluated with Subjective Global Assessment. Fasting was considered inappropriate if it lasted > 7 days in well-nourished, and >5 days in malnourished patients if nutritional support had not been provided. Fluid therapy lasted 4 (IQR = 2) days, and fasting was inadequately maintained in 27% of patients. Fluid requirements were correctly fulfilled, but patients received an excess of sodium (+58.4%) and chloride (+62.2%), and potassium administration was insufficient (-35.1%). Glucose supply was 68.8 (29.2) g/d, and 99% received < 130 g/d. Patients with an inadequate duration of fasting had a longer hospital stay after adjusting for sex, age, nutritional status, infused volume, electrolytes, glucose and diseases. Only malnutrition predicted mortality during hospitalisation (OR 10.5; 95%CI 1.3 to 83.2), when multivariate analysis was performed. Fasting medical patients receive an inadequate supply of glucose and electrolytes. Prolonged fluid therapy and malnutrition may worsen the outcomes of these patients, independently of other conditions like age or diseases. Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.

Ad libitum fluid consumption via self- or external administration.

PubMed

Yeargin, Susan W; Finn, Megan E; Eberman, Lindsey E; Gage, Matthew J; McDermott, Brendon P; Niemann, Andrew

2015-01-01

During team athletic events, athletic trainers commonly provide fluids with water bottles. When a limited number of water bottles exist, various techniques are used to deliver fluids. To determine whether fluid delivered via water-bottle administration influenced fluid consumption and hydration status. Crossover study. Outdoor field (22.2°C ± 3.5°C). Nineteen participants (14 men, 5 women, age = 30 ± 10 years, height = 176 ± 8 cm, mass = 72.5 ± 10 kg) were recruited from the university and local running clubs. The independent variable was fluid delivery with 3 levels: self-administration with mouth-to-bottle direct contact (SA-DC), self-administration with no contact between mouth and bottle (SA-NC), and external administration with no contact between the mouth and the bottle (EA-NC). Participants warmed up for 10 minutes before completing 5 exercise stations, after which an ad libitum fluid break was given, for a total of 6 breaks. We measured the fluid variables of total volume consumed, total number of squirts, and average volume per squirt. Hydration status via urine osmolality and body-mass loss, and perceptual variables for thirst and fullness were recorded. We calculated repeated-measures analyses of variance to assess hydration status, fluid variables, and perceptual measures to analyze conditions across time. The total volume consumed for EA-NC was lower than for SA-DC (P = .001) and SA-NC (P = .001). The total number of squirts for SA-DC was lower than for SA-NC (P = .009). The average volume per squirt for EA-NC was lower than for SA-DC (P = .020) and SA-NC (P = .009). Participants arrived (601.0 ± 21.3 mOsm/L) and remained (622.3 ± 38.3 mOsm/L) hydrated, with no difference between conditions (P = .544); however, the EA-NC condition lost more body mass than did the SA-DC condition (P = .001). There was no main effect for condition on thirst (P = .147) or fullness (P = .475). External administration of fluid decreased total volume consumed via a decreased average volume per squirt. The SA-DC method requires fewer squirts within a specific time frame. Fluid breaks every 15 minutes resulted in maintenance of euhydration; however, loss of body mass was influenced by fluid administration. Athletic trainers should avoid external administration to promote positive hydration behaviors. When fluid is self-administered, individual bottles may be the best clinical practice because more volume can be consumed per squirt.

Effect of External Pressure and Catheter Gauge on Flow Rate, Kinetic Energy, and Endothelial Injury During Intravenous Fluid Administration in a Rabbit Model.

PubMed

Hu, Mei-Hua; Chan, Wei-Hung; Chen, Yao-Chang; Cherng, Chen-Hwan; Lin, Chih-Kung; Tsai, Chien-Sung; Chou, Yu-Ching; Huang, Go-Shine

2016-01-01

The effects of intravenous (IV) catheter gauge and pressurization of IV fluid (IVF) bags on fluid flow rate have been studied. However, the pressure needed to achieve a flow rate equivalent to that of a 16 gauge (G) catheter through smaller G catheters and the potential for endothelial damage from the increased kinetic energy produced by higher pressurization are unclear. Constant pressure on an IVF bag was maintained by an automatic adjustable pneumatic pressure regulator of our own design. Fluids running through 16 G, 18 G, 20 G, and 22 G catheters were assessed while using IV bag pressurization to achieve the flow rate equivalent to that of a 16 G catheter. We assessed flow rates, kinetic energy, and flow injury to rabbit inferior vena cava endothelium. By applying sufficient external constant pressure to an IVF bag, all fluids could be run through smaller (G) catheters at the flow rate in a 16 G catheter. However, the kinetic energy increased significantly as the catheter G increased. Damage to the venous endothelium was negligible or minimal/patchy cell loss. We designed a new rapid infusion system, which provides a constant pressure that compresses the fluid volume until it is free from visible residual fluid. When large-bore venous access cannot be obtained, multiple smaller catheters, external pressure, or both should be considered. However, caution should be exercised when fluid pressurized to reach a flow rate equivalent to that in a 16 G catheter is run through a smaller G catheter because of the profound increase in kinetic energy that can lead to venous endothelium injury.

Prosthetic occlusive device for an internal passageway

NASA Technical Reports Server (NTRS)

Tenney, J. B., Jr. (Inventor)

1983-01-01

An occlusive device is disclosed for surgical implant to occlude the lumen of an internal organ. The device includes a cuff having a backing collar and two isolated cuff chambers. The fluid pressure of one chamber is regulated by a pump/valve reservoir unit. The other chamber is unregulated in pressure but its fluid volume is adjusted by removing or adding fluid to a septum/reservoir by means of a hypodermic needle. Pressure changes are transmitted between the two cuff chambers via faying surfaces which are sufficiently large in contact area and thin as to transmit pressure generally without attenuation. By adjusting the fluid volume of the septum, the operating pressure of the device may be adjusted to accommodate tubular organs of different diameter sizes as well as to compensate for changes in the organ following implant without reoperation.

Socially cued seminal fluid gene expression mediates responses in ejaculate quality to sperm competition risk.

PubMed

Simmons, Leigh W; Lovegrove, Maxine

2017-08-30

There is considerable evidence that males will increase the number of sperm ejaculated in response to sperm competition risk. However, whether they have the capacity to adjust seminal fluid components of the ejaculate has received less attention. Male crickets ( Teleogryllus oceanicus ) have been shown to adjust the viability of sperm in their ejaculate in response to sperm competition risk. Here we show that socially mediated plasticity in sperm viability is probably due, at least in part, to male adjustments in the protein composition of the seminal fluid. Seven seminal fluid protein genes were found to have an increased expression in males exposed to rival calls. Increased expression of these genes was correlated with increased sperm viability in whole ejaculates, and gene knockdown confirmed that at least one of these proteins promotes sperm viability. Our results lend support for recent theoretical models that predict complex responses in male allocation to seminal fluid composition in response to sperm competition risk. © 2017 The Author(s).

Method and apparatus for controlling fluid flow

DOEpatents

Miller, J.R.

1980-06-27

A method and apparatus for precisely controlling the rate (and hence amount) of fluid flow are given. The controlled flow rate is finely adjustable, can be extremely small (on the order of microliter-atmospheres per second), can be adjusted to zero (flow stopped), and is stable to better than 1% with time. The dead volume of the valve can be made arbitrarily small, in fact essentially zero. The valve employs no wearing mechanical parts (including springs, stems, or seals). The valve is finely adjustable, has a flow rate dynamic range of many decades, can be made compatible with any fluid, and is suitable for incorporation into an open or closed loop servo-control system.

A pragmatic multi-centre randomised controlled trial of fluid loading in high-risk surgical patients undergoing major elective surgery--the FOCCUS study.

PubMed

Cuthbertson, Brian H; Campbell, Marion K; Stott, Stephen A; Elders, Andrew; Hernández, Rodolfo; Boyers, Dwayne; Norrie, John; Kinsella, John; Brittenden, Julie; Cook, Jonathan; Rae, Daniela; Cotton, Seonaidh C; Alcorn, David; Addison, Jennifer; Grant, Adrian

2011-01-01

Fluid strategies may impact on patient outcomes in major elective surgery. We aimed to study the effectiveness and cost-effectiveness of pre-operative fluid loading in high-risk surgical patients undergoing major elective surgery. This was a pragmatic, non-blinded, multi-centre, randomised, controlled trial. We sought to recruit 128 consecutive high-risk surgical patients undergoing major abdominal surgery. The patients underwent pre-operative fluid loading with 25 ml/kg of Ringer's solution in the six hours before surgery. The control group had no pre-operative fluid loading. The primary outcome was the number of hospital days after surgery with cost-effectiveness as a secondary outcome. A total of 111 patients were recruited within the study time frame in agreement with the funder. The median pre-operative fluid loading volume was 1,875 ml (IQR 1,375 to 2,025) in the fluid group compared to 0 (IQR 0 to 0) in controls with days in hospital after surgery 12.2 (SD 11.5) days compared to 17.4 (SD 20.0) and an adjusted mean difference of 5.5 days (median 2.2 days; 95% CI -0.44 to 11.44; P = 0.07). There was a reduction in adverse events in the fluid intervention group (P = 0.048) and no increase in fluid based complications. The intervention was less costly and more effective (adjusted average cost saving: £2,047; adjusted average gain in benefit: 0.0431 quality adjusted life year (QALY)) and has a high probability of being cost-effective. Pre-operative intravenous fluid loading leads to a non-significant reduction in hospital length of stay after high-risk major surgery and is likely to be cost-effective. Confirmatory work is required to determine whether these effects are reproducible, and to confirm whether this simple intervention could allow more cost-effective delivery of care. Prospective Clinical Trials, ISRCTN32188676.

A pragmatic multi-centre randomised controlled trial of fluid loading in high-risk surgical patients undergoing major elective surgery - the FOCCUS study

PubMed Central

2011-01-01

Introduction Fluid strategies may impact on patient outcomes in major elective surgery. We aimed to study the effectiveness and cost-effectiveness of pre-operative fluid loading in high-risk surgical patients undergoing major elective surgery. Methods This was a pragmatic, non-blinded, multi-centre, randomised, controlled trial. We sought to recruit 128 consecutive high-risk surgical patients undergoing major abdominal surgery. The patients underwent pre-operative fluid loading with 25 ml/kg of Ringer's solution in the six hours before surgery. The control group had no pre-operative fluid loading. The primary outcome was the number of hospital days after surgery with cost-effectiveness as a secondary outcome. Results A total of 111 patients were recruited within the study time frame in agreement with the funder. The median pre-operative fluid loading volume was 1,875 ml (IQR 1,375 to 2,025) in the fluid group compared to 0 (IQR 0 to 0) in controls with days in hospital after surgery 12.2 (SD 11.5) days compared to 17.4 (SD 20.0) and an adjusted mean difference of 5.5 days (median 2.2 days; 95% CI -0.44 to 11.44; P = 0.07). There was a reduction in adverse events in the fluid intervention group (P = 0.048) and no increase in fluid based complications. The intervention was less costly and more effective (adjusted average cost saving: £2,047; adjusted average gain in benefit: 0.0431 quality adjusted life year (QALY)) and has a high probability of being cost-effective. Conclusions Pre-operative intravenous fluid loading leads to a non-significant reduction in hospital length of stay after high-risk major surgery and is likely to be cost-effective. Confirmatory work is required to determine whether these effects are reproducible, and to confirm whether this simple intervention could allow more cost-effective delivery of care. Trial registration Prospective Clinical Trials, ISRCTN32188676 PMID:22177541

Force characteristics of a modular squeeze mode magneto-rheological element

NASA Astrophysics Data System (ADS)

Craft, Michael J.; Ahmadian, Mehdi; Farjoud, Alireza; Burke, William C. T.; Nagode, Clement

2010-04-01

While few publications exist on the behavior of Magneto-Rheological (MR) fluid in squeeze mode, devices using squeeze mode may take advantage of the very large range of adjustment that squeeze mode offers. Based on results obtained through modeling and testing MR fluid in a squeeze mode rheometer, a novel compression-adjustable element has been fabricated and tested, which utilizes MR fluid in squeeze mode. While shear and valve modes have been used exclusively for MR fluid damping applications, recent modeling and testing with MR fluid has revealed that much larger adjustment ranges are achievable in squeeze mode. Utilizing squeeze mode, a compression element, or MR Pouch, was developed consisting of a flexible cylindrical membrane with each end fastened to a steel endplate (pole plates). The silicone rubber pouch material was molded in the required shape for use in the squeeze mode rheometer. This flexible membrane allows for the complete self-containment of MR fluid and because the pouch compensates for volume changes, there is no need for dynamic seals and associated surface finish treatments on the steel components. An electromagnet incorporated in the rheometer passes an adjustable magnetic field axially through the pole plates and MR fluid. Test results show the device was capable of varying the compression force from less than 8lbs to greater than 1000lbs when the pole plates were 0.050" apart. Simulations were compared against test data with good correlation. Possible applications of this technology include primary suspension components, auxiliary suspension bump stops, and other vibration isolation components, as MR Pouches are scalable depending on the application and force requirements.

Principles of fluid management and stewardship in septic shock: it is time to consider the four D's and the four phases of fluid therapy.

PubMed

Malbrain, Manu L N G; Van Regenmortel, Niels; Saugel, Bernd; De Tavernier, Brecht; Van Gaal, Pieter-Jan; Joannes-Boyau, Olivier; Teboul, Jean-Louis; Rice, Todd W; Mythen, Monty; Monnet, Xavier

2018-05-22

In patients with septic shock, the administration of fluids during initial hemodynamic resuscitation remains a major therapeutic challenge. We are faced with many open questions regarding the type, dose and timing of intravenous fluid administration. There are only four major indications for intravenous fluid administration: aside from resuscitation, intravenous fluids have many other uses including maintenance and replacement of total body water and electrolytes, as carriers for medications and for parenteral nutrition. In this paradigm-shifting review, we discuss different fluid management strategies including early adequate goal-directed fluid management, late conservative fluid management and late goal-directed fluid removal. In addition, we expand on the concept of the "four D's" of fluid therapy, namely drug, dosing, duration and de-escalation. During the treatment of patients with septic shock, four phases of fluid therapy should be considered in order to provide answers to four basic questions. These four phases are the resuscitation phase, the optimization phase, the stabilization phase and the evacuation phase. The four questions are "When to start intravenous fluids?", "When to stop intravenous fluids?", "When to start de-resuscitation or active fluid removal?" and finally "When to stop de-resuscitation?" In analogy to the way we handle antibiotics in critically ill patients, it is time for fluid stewardship.

43 CFR 38.3 - Administration of adjusted rates of pay.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Administration of adjusted rates of pay. 38.3 Section 38.3 Public Lands: Interior Office of the Secretary of the Interior PAY OF U.S. PARK POLICE-INTERIM GEOGRAPHIC ADJUSTMENTS § 38.3 Administration of adjusted rates of pay. (a) An employee is...

Electrostatically frequency tunable micro-beam-based piezoelectric fluid flow energy harvester

NASA Astrophysics Data System (ADS)

Rezaee, Mousa; Sharafkhani, Naser

2017-07-01

This research investigates the dynamic behavior of a sandwich micro-beam based piezoelectric energy harvester with electrostatically adjustable resonance frequency. The system consists of a cantilever micro-beam immersed in a fluid domain and is subjected to the simultaneous action of cross fluid flow and nonlinear electrostatic force. Two parallel piezoelectric laminates are extended along the length of the micro-beam and connected to an external electric circuit which generates an output power as a result of the micro-beam oscillations. The fluid-coupled structure is modeled using Euler-Bernoulli beam theory and the equivalent force terms for the fluid flow. Fluid induced forces comprise the added inertia force which is evaluated using equivalent added mass and the drag and lift forces which are evaluated using relative velocity and Van der Pol equation. In addition to flow velocity and fluid density, the influence of several design parameters such as external electrical resistance, piezo layer position, and dc voltage on the generated power are investigated by using Galerkin and step by step linearization method. It is shown that for given flowing fluid parameters, i.e., density and velocity, one can adjust the applied dc voltage to tune resonance frequency so that the lock-in phenomenon with steady large amplitude oscillations happens, also by adjusting the harvester parameters including the mechanical and electrical ones, the maximal output power of the harvester becomes possible.

76 FR 43349 - Employment and Training Administration Investigations Regarding Certifications of Eligibility To...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-20

... DEPARTMENT OF LABOR Employment and Training Administration Investigations Regarding Certifications of Eligibility To Apply for Worker Adjustment Assistance and Alternative Trade Adjustment Assistance... Director of the Office of Trade Adjustment Assistance, Employment and Training Administration, has...

Fluid-filled bomb-disrupting apparatus and method

DOEpatents

Cherry, Christopher R.

2001-01-01

An apparatus and method for disarming improvised bombs are disclosed. The apparatus comprises a fluid-filled bottle or container made of plastic or another soft material which contains a fixed or adjustable, preferably sheet explosive. The charge is fired centrally at its apex and can be adjusted to propel a fluid projectile that is broad or narrow, depending upon how it is set up. In one embodiment, the sheet explosive is adjustable so as to correlate the performance of the fluid projectile to the disarming needs for the improvised explosive device (IED). Common materials such as plastic water bottles or larger containers can be used, with the sheet explosive or other explosive material configured in a general chevron-shape to target the projectile toward the target. In another embodiment, a thin disk of metal is conformably mounted with the exterior of the container and radially aligned with the direction of fire of the fluid projectile. Depending on the configuration and the amount of explosive and fluid used, a projectile is fired at the target that has sufficient energy to penetrate rigid enclosures from fairly long stand-off and yet is focused enough to be targeted to specific portions of the IED for disablement.

An alternative for rapid administration of medication and fluids in the emergency setting using a novel device.

PubMed

Lyons, Neal; Nejak, Daniel; Lomotan, Nadine; Mokszycki, Robert; Jamieson, Stephen; McDowell, Marc; Kulstad, Erik

2015-08-01

Routes of administration for medications and fluids in the acute care setting have primarily focused on oral, intravenous, or intraosseous routes, but, in many patients, none of these routes is optimal. A novel device (Macy Catheter; Hospi Corp) that offers an easy route for administration of medications or fluids via rectal mucosal absorption (proctoclysis) has recently become available in the palliative care market; we describe here the first known uses of this device in the emergency setting. Three patients presenting to the hospital with conditions limiting more typical routes of medication or fluid administration were treated with this new device; patients were administered water for hydration, lorazepam for treatment of alcohol withdrawal, ondansetron for nausea, acetaminophen for fever, aspirin for antiplatelet effect, and methimazole for hyperthyroidism. Placement of the device was straightforward, absorption of administered medications (judged by immediacy of effects, where observable) was rapid, and use of the device was well tolerated by patients, suggesting that this device may be an appealing alternative route to medication and fluid administration for a variety of indications in acute and critical care settings.

PAROTID FLUID CORTISOL AND CORTISONE.

DTIC Science & Technology

Concentrations of parotid fluid cortisol and cortisone, and of plasma dialyzable cortisol, were measured in normal men before and 2 hours after...of 8.5 to 17.7 micrograms/100 ml. after ACTH treatment, and to 39.4 micrograms/100 ml. after administration of the estrogen. However, parotid fluid...the increase in total plasma cortisol (which was over twice as high after administration of estrogen as of ACTH). Thus parotid fluid corticosteroids

Errors in fluid therapy in medical wards.

PubMed

Mousavi, Maryam; Khalili, Hossein; Dashti-Khavidaki, Simin

2012-04-01

Intravenous fluid therapy remains an essential part of patients' care during hospitalization. There are only few studies that focused on fluid therapy in the hospitalized patients, and there is not any consensus statement about fluid therapy in patients who are hospitalized in medical wards. The aim of the present study was to assess intravenous fluid therapy status and related errors in the patients during the course of hospitalization in the infectious diseases wards of a referral teaching hospital. This study was conducted in the infectious diseases wards of Imam Khomeini Complex Hospital, Tehran, Iran. During a retrospective study, data related to intravenous fluid therapy were collected by two clinical pharmacists of infectious diseases from 2008 to 2010. Intravenous fluid therapy information including indication, type, volume and rate of fluid administration was recorded for each patient. An internal protocol for intravenous fluid therapy was designed based on literature review and available recommendations. The data related to patients' fluid therapy were compared with this protocol. The fluid therapy was considered appropriate if it was compatible with the protocol regarding indication of intravenous fluid therapy, type, electrolyte content and rate of fluid administration. Any mistake in the selection of fluid type, content, volume and rate of administration was considered as intravenous fluid therapy errors. Five hundred and ninety-six of medication errors were detected during the study period in the patients. Overall rate of fluid therapy errors was 1.3 numbers per patient during hospitalization. Errors in the rate of fluid administration (29.8%), incorrect fluid volume calculation (26.5%) and incorrect type of fluid selection (24.6%) were the most common types of errors. The patients' male sex, old age, baseline renal diseases, diabetes co-morbidity, and hospitalization due to endocarditis, HIV infection and sepsis are predisposing factors for the occurrence of fluid therapy errors in the patients. Our result showed that intravenous fluid therapy errors occurred commonly in the hospitalized patients especially in the medical wards. Improvement in knowledge and attention of health-care workers about these errors are essential for preventing of medication errors in aspect of fluid therapy.

Reference Manual: Navy Message Words and Word Frequencies.

DTIC Science & Technology

1981-12-29

ADJUDGED 8 ADJUST 14 ADJUSTED 7 ADJUSTMENT 3 ADJUSTMENTS 7 ADM 4 ADMIN 2 ADMINISTER 4 ADMINISTERED 4 ADMINISTRATION 3 ADMINISTRATIVE 2 ADMINISTRATIVELY ...I ADMINISTRATORS I ADMINSUPU 25 ADMIRAL I ADMIT 13 ADMITTED I ADMITTING 5 ADMSG 2 ADOLF 1 ADOLPH 4 ADOPT 1 ADOPTION 2 ADP 2 ADRESSE (Fr.) 4 ADRIAN 2...HEADWAITER 6 HEALTH 3 HEAR 3 HEARD 9 HEARING I HEART 2 HEAT 4 HEATH 3 HEATHROW 4 HEAVILY 9 HEAVY 2 HEAZLITT 1 HEBRIDES 7 HED 2 HEE 3 HEF 2 HEFFRON 2

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

PubMed Central

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

2017-01-01

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

Fluid Therapy for Pediatric Patients.

PubMed

Lee, Justine A; Cohn, Leah A

2017-03-01

Young puppies and kittens have unique physiologic needs in regards to fluid therapy, which must address hydration, vascular fluid volume, electrolyte disturbances, or hypoglycemia. Pediatric patients have a higher fluid requirement compared with adults and can rapidly progress from mild dehydration to hypovolemia. Simultaneously, their small size makes overhydration a real possibility. Patient size complicates fluid administration because catheters used in larger pets may be difficult to place. Routes of fluid administration used in the neonate or pediatric patient include oral, subcutaneous, intraperitoneal, intraosseous, and intravenous. Clinicians should be aware of the pros and cons of each route. Copyright © 2016 Elsevier Inc. All rights reserved.

FREE 17-HYDROXYCORTICOSTERIOD CONCENTRATION OF PAROTID FLUID FOLLOWING INTRAVENOUS ADMINISTRATION OF CORTISOL,

DTIC Science & Technology

In an attempt to determine the time required for adrenocortical steroids to pass from the bloodstream to parotid fluid, twenty subjects were given...intravenous injections of cortisol and parotid fluid was collected continuously for 120 minutes after injection. Additional studies were carried out...with intramuscular injections and oral administration of cortisol. The parotid fluid free 17-OHCS mean rose from 3.51 (S.D. = 1.57) to 21.34 (S.D

28 CFR 11.7 - Salary adjustments.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Salary adjustments. 11.7 Section 11.7 Judicial Administration DEPARTMENT OF JUSTICE DEBT COLLECTION Administration of Debt Collection § 11.7 Salary adjustments. The following debts shall not be subject to the salary offset procedures of § 11.8...

Prevalence of adherence to fluid restriction in kidney patients in haemodialysis: objective indicator and perceived compliance.

PubMed

Iborra-Moltó, Carmelo; López-Roig, Sofía; Pastor-Mira, M de Los Ángeles

2012-07-17

Studies of adherence to fluid restriction show high variability in prevalence data, as different methods of measuring IWG (interdialysis weight gain) and cut-off criteria are used. To describe the prevalence of adherence to fluid restriction using daily IWG (criterion: ≤1 Kg) and daily IWG adjusted for dry weight (DW) (cut-off point adjusted criterion: DW<70 kg, IWG=1 kg/day; DW>70 kg and ≤80 kg, IWG=1.1 kg/day; DW>80 kg and ≤90 kg, IWG=1.2 kg/day; DW>90 kg, IWG=1.3 kg/day) and to study the association between this objective indicator and adherence behaviour as reported by patient. Our study included a total of 146 patients with a mean age of 66 years (SD: 13.6 years; range: 25-88 years), 66% of which were male. Ours was a longitudinal study with one month of follow-up. We collected both sociodemographic and clinical variables and mean daily IWG. Patient-reported adherence behaviour was assessed through an interview by a trained staff member from outside the department who asked the following question: "In order to avoid complications between haemodialysis sessions: during the last month, how many days did you ingest less than 1 litre of fluid per day?" (0= no days; 10= every day). A score ≤5 led to categorisation of patients as compliant with treatment. Statistical analysis included descriptive analysis, correlation test, chi-square and Crosstabs, ROC curve and logistic regression procedures. Prevalence of "objective" adherence to fluid restriction was 61% (mean daily IWG≤1kg) and 73% (mean daily IWG adjusted for dry weight). Reported adherence (prevalence: 56.2%) was associated with IWG adjusted for weight (chi-square =31.34; P=.000). In patients with objective adherence adjusted for weight, the prevalence of reported adherence was 1.65 times that of non-adherence (PR=1.65; 95% CI: 1.29-2.11). The final model for estimating the association between reported adherence behaviour and daily adjusted IWG included: age (higher), dry weight (lower), potassium (lower), time on haemodialysis treatment (less) and its interaction with reported behaviour (F=50.70; P=.000; R2=44%). The sensitivity of reported adherence behaviour for detecting objective adherence adjusted for dry weight was 89%; specificity was 58%, and the overall classification power was 85% (AUC=.85; 95% CI: 0.78-0.92). The probability of objective adherence adjusted for weight in patients who claimed proper adherence was 9 times higher than in non-compliant patients in patients who had been on HD for 2.3 years (PORp25=9.16; 95% CI: 2.58-32.51); 6 times higher in patients on HD for 4.7 years (PORP50=6.16; 95% CI: 2.1217.92); and 3 times higher in those on HD for 8.2 years (PORp75=3.44; 95% CI: 1.32-8.96). Prevalence of adherence to fluid restriction was 73% and 16% depending on daily IWG adjusted/not adjusted for dry weight, respectively. Absolute daily IWG adjusted for weight seems a good indicator of adherence, as it allows for a personalised fluid restriction regimen. Significant association between this objective indicator and reported adherence behaviour supports a combination of patient approach and objective data, which can help with the adjustment of the individual cut-off for daily IWG. This also provides useful information for designing intervention strategies to maintain and increase adherence.

Actively controlling coolant-cooled cold plate configuration

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

Chainer, Timothy J.; Parida, Pritish R.

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

Variable flexure-based fluid filter

DOEpatents

Brown, Steve B.; Colston, Jr., Billy W.; Marshall, Graham; Wolcott, Duane

2007-03-13

An apparatus and method for filtering particles from a fluid comprises a fluid inlet, a fluid outlet, a variable size passage between the fluid inlet and the fluid outlet, and means for adjusting the size of the variable size passage for filtering the particles from the fluid. An inlet fluid flow stream is introduced to a fixture with a variable size passage. The size of the variable size passage is set so that the fluid passes through the variable size passage but the particles do not pass through the variable size passage.

In children requiring intravenous fluid for hydration maintenance, which out of hypotonic saline and isotonic saline is less likely to result in the development of hyponatraemia?

PubMed

Tran, Michael Ma; Tantsis, Esther M; Ging, Joanne M

2017-03-01

The administration of intravenous fluids remains a common intervention for hospitalised children. Commonly used hypotonic fluids administered at maintenance rates provide 2-4 mmol/kg/day of sodium. Being hypotonic, the development of hyponatraemia remains a risk. The consequences of hyponatraemia are not insignificant, with possibilities of irreversible neurological morbidity and mortality. There is currently no clear consensus on the optimal composition of fluids to be used for intravenous rehydration. A review of the available literature suggests that children who receive isotonic fluid have a lower risk of developing hyponatraemia, regardless of the rate of administration. This result is most applicable in the first 24 h of administration in a wide age group of paediatric patients with varying severities of illness. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Simultaneous Multiple-Location Separation Control

NASA Technical Reports Server (NTRS)

Greenblatt, David (Inventor)

2009-01-01

A method of controlling a shear layer for a fluid dynamic body introduces first periodic disturbances into the fluid medium at a first flow separation location. Simultaneously, second periodic disturbances are introduced into the fluid medium at a second flow separation location. A phase difference between the first and second periodic disturbances is adjusted to control flow separation of the shear layer as the fluid medium moves over the fluid dynamic body.

A Novel Pharmacologic Activity of Ketorolac for Therapeutic Benefit in Ovarian Cancer Patients.

PubMed

Guo, Yuna; Kenney, S Ray; Cook, Linda; Adams, Sarah F; Rutledge, Teresa; Romero, Elsa; Oprea, Tudor I; Sklar, Larry A; Bedrick, Edward; Wiggins, Charles L; Kang, Huining; Lomo, Lesley; Muller, Carolyn Y; Wandinger-Ness, Angela; Hudson, Laurie G

2015-11-15

We previously identified the R-enantiomer of ketorolac as an inhibitor of the Rho-family GTPases Rac1 and Cdc42. Rac1 and Cdc42 regulate cancer-relevant functions, including cytoskeleton remodeling necessary for tumor cell adhesion and migration. This study investigated whether administration of racemic (R,S) ketorolac after ovarian cancer surgery leads to peritoneal distribution of R-ketorolac, target GTPase inhibition in cells retrieved from the peritoneal cavity, and measureable impact on patient outcomes. Eligible patients had suspected advanced-stage ovarian, fallopian tube or primary peritoneal cancer. Secondary eligibility was met when ovarian cancer was confirmed and optimally debulked, an intraperitoneal port was placed, and there were no contraindications for ketorolac administration. R- and S-ketorolac were measured in serum and peritoneal fluid, and GTPase activity was measured in peritoneal cells. A retrospective study correlated perioperative ketorolac and ovarian cancer-specific survival in ovarian cancer cases. Elevated expression and activity of Rac1 and Cdc42 was detected in ovarian cancer patient tissues, confirming target relevance. Ketorolac in peritoneal fluids was enriched in the R-enantiomer and peritoneal cell GTPase activity was inhibited after ketorolac administration when R-ketorolac was at peak levels. After adjusting for age, AJCC stage, completion of chemotherapy, and neoadjuvant therapy, women given perioperative ketorolac had a lower hazard of death (HR, 0.30; 95% confidence interval, 0.11-0.88). Ketorolac has a novel pharmacologic activity conferred by the R-enantiomer and R-ketorolac achieves sufficient levels in the peritoneal cavity to inhibit Rac1 and Cdc42, potentially contributing to the observed survival benefit in women who received ketorolac. ©2015 American Association for Cancer Research.

A novel pharmacologic activity of ketorolac for therapeutic benefit in ovarian cancer patients

PubMed Central

Guo, Yuna; Kenney, S. Ray; Cook, Linda; Adams, Sarah F.; Rutledge, Teresa; Romero, Elsa; Oprea, Tudor I.; Sklar, Larry A.; Bedrick, Edward; Wiggins, Charles L.; Kang, Huining; Lomo, Lesley; Muller, Carolyn Y.; Wandinger-Ness, Angela; Hudson, Laurie G.

2015-01-01

PURPOSE We previously identified the R-enantiomer of ketorolac as an inhibitor of the Rho-family GTPases Rac1 and Cdc42. Rac1 and Cdc42 regulate cancer-relevant functions including cytoskeleton remodeling necessary for tumor cell adhesion and migration. This study investigated whether administration of racemic (R,S) ketorolac after ovarian cancer surgery leads to peritoneal distribution of R-ketorolac, target GTPase inhibition in cells retrieved from the peritoneal cavity, and measureable impact on patient outcomes. EXPERIMENTAL DESIGN Eligible patients had suspected advanced stage ovarian, fallopian tube or primary peritoneal cancer. Secondary eligibility was met when ovarian cancer was confirmed and optimally debulked, an intraperitoneal port was placed, and there were no contraindications for ketorolac administration. R- and S-ketorolac were measured in serum and peritoneal fluid, and GTPase activity was measured in peritoneal cells. A retrospective study correlated peri-operative ketorolac and ovarian cancer-specific survival in ovarian cancer cases. RESULTS Elevated expression and activity of Rac1 and Cdc42 was detected in ovarian cancer patient tissues, confirming target relevance. Ketorolac in peritoneal fluids was enriched in the R-enantiomer and peritoneal cell GTPase activity was inhibited after ketorolac administration when R-ketorolac was at peak levels. After adjusting for age, AJCC stage, completion of chemotherapy, and neo-adjuvant therapy, women given peri-operative ketorolac had a lower hazard of death (Hazard Ratio=0.30 [95%CI 0.11–0.88]). CONCLUSION Ketorolac has a novel pharmacologic activity conferred by the R-enantiomer and R-ketorolac achieves sufficient levels in the peritoneal cavity to inhibit Rac1 and Cdc42, potentially contributing to the observed survival benefit in women who received ketorolac. PMID:26071482

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

PubMed

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

2001-05-01

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

7 CFR 1000.77 - Adjustment of accounts.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Payments for Milk § 1000.77 Adjustment of accounts. Whenever audit by the market administrator of any... due the market administrator from a handler, or due a handler from the market administrator, or due a producer or cooperative association from a handler, the market administrator shall promptly notify such...

7 CFR 1000.77 - Adjustment of accounts.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Payments for Milk § 1000.77 Adjustment of accounts. Whenever audit by the market administrator of any... due the market administrator from a handler, or due a handler from the market administrator, or due a producer or cooperative association from a handler, the market administrator shall promptly notify such...

7 CFR 1000.77 - Adjustment of accounts.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Payments for Milk § 1000.77 Adjustment of accounts. Whenever audit by the market administrator of any... due the market administrator from a handler, or due a handler from the market administrator, or due a producer or cooperative association from a handler, the market administrator shall promptly notify such...

7 CFR 1000.77 - Adjustment of accounts.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Payments for Milk § 1000.77 Adjustment of accounts. Whenever audit by the market administrator of any... due the market administrator from a handler, or due a handler from the market administrator, or due a producer or cooperative association from a handler, the market administrator shall promptly notify such...

7 CFR 1000.77 - Adjustment of accounts.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Payments for Milk § 1000.77 Adjustment of accounts. Whenever audit by the market administrator of any... due the market administrator from a handler, or due a handler from the market administrator, or due a producer or cooperative association from a handler, the market administrator shall promptly notify such...

2013 AAHA/AAFP fluid therapy guidelines for dogs and cats.

PubMed

Davis, Harold; Jensen, Tracey; Johnson, Anthony; Knowles, Pamela; Meyer, Robert; Rucinsky, Renee; Shafford, Heidi

2013-01-01

Fluid therapy is important for many medical conditions in veterinary patients. The assessment of patient history, chief complaint, physical exam findings, and indicated additional testing will determine the need for fluid therapy. Fluid selection is dictated by the patient's needs, including volume, rate, fluid composition required, and location the fluid is needed (e.g., interstitial versus intravascular). Therapy must be individualized, tailored to each patient, and constantly re-evaluated and reformulated according to changes in status. Needs may vary according to the existence of either acute or chronic conditions, patient pathology (e.g., acid-base, oncotic, electrolyte abnormalities), and comorbid conditions. All patients should be assessed for three types of fluid disturbances: changes in volume, changes in content, and/or changes in distribution. The goals of these guidelines are to assist the clinician in prioritizing goals, selecting appropriate fluids and rates of administration, and assessing patient response to therapy. These guidelines provide recommendations for fluid administration for anesthetized patients and patients with fluid disturbances.

Monitoring nicotine intake from e-cigarettes: measurement of parent drug and metabolites in oral fluid and plasma.

PubMed

Papaseit, Esther; Farré, Magí; Graziano, Silvia; Pacifici, Roberta; Pérez-Mañá, Clara; García-Algar, Oscar; Pichini, Simona

2017-03-01

Electronic cigarettes (e-cig) known as electronic nicotine devices recently gained popularity among smokers. Despite many studies investigating their safety and toxicity, few examined the delivery of e-cig-derived nicotine and its metabolites in alternative biological fluids. We performed a randomized, crossover, and controlled clinical trial in nine healthy smokers. Nicotine (NIC), cotinine (COT), and trans-3'-hydroxycotinine (3-HCOT) were measured in plasma and oral fluid by liquid chromatography-tandem mass spectrometry after consumption of two consecutive e-cig administrations or two consecutive tobacco cigarettes. NIC and its metabolites were detected both in oral fluid and plasma following both administration conditions. Concentrations in oral fluid resulted various orders of magnitude higher than those observed in plasma. Oral fluid concentration of tobacco cigarette and e-cig-derived NIC peaked at 15 min after each administration and ranged between 1.0 and 1396 μg/L and from 0.3 to 860 μg/L; those of COT between 52.8 and 110 μg/L and from 33.8 to 94.7 μg/L; and those of 3-HCOT between 12.4 and 23.5 μg/L and from 8.5 to 24.4 μg/L. The oral fluid to plasma concentration ratio of both e-cig- and tobacco cigarette-derived NIC peaked at 15 min after both administrations and correlated with oral fluid NIC concentration. The obtained results support the measurement of NIC and metabolites in oral fluid in the assessment of intake after e-cig use and appear to be a suitable alternative to plasma when monitoring nicotine delivery from e-cig for clinical and toxicological studies.

[Perioperative fluid therapy in perforated ulcers].

PubMed

Bjerre, Catherine Collin; Holte, Kathrine

2009-04-27

Surgery for perforated ulcers is one of the most common emergency surgical procedures. Approximately 400 procedures are performed each year in Denmark and mortality is high, reaching close to 30% at 30 days postoperatively. The importance of perioperative fluid administration during the perioperative course remains unclear. The purpose of this study is to describe the perioperative fluid management in these patients in order to identify problem areas (if any) and to create a basis on which future trials on fluid management in this patient group may be designed. Retrospective survey of 45 consecutive patients operated for perforated ulcers over a 3-year period between 1 January 2003 and 31 December 2005 in the surgical department of a university hospital. Data that would permit rational fluid therapy are not being collected on a regular basis. Fluid balance charts were kept for 42 patients on the day of operation (89%), for 29 patients on the first post-operative day (61%), for 17 patients on the second post-operative day (36%) and for 12 patients (25%) on the third post-operative day. No patients were weighed for assessment of fluid status. Perioperative fluid administration varied extensively, with fluid balance on the day of surgery ranging from -45 to 8,030 ml (median 2688 ml) and a cumulated fluid balance of 7,2 litres (1,875-14,565 ml) three days postoperatively. Generally, patients had no fluid administered prior to surgery (median 0 ml, applying to 41 patients (87%) range 0-4,500 ml). Both the preoperative fluid management and the postoperative monitoring of the fluid balance are suboptimal and should be optimized. Individualized (goal-directed) fluid administration aiming at optimizing the oxygen supply to the peripheral tissues is warranted and is recommended to high-risk emergency surgery patients.

[Fluid therapy in acute pancreatitis].

PubMed

de-Madaria, Enrique

2013-12-01

Severe acute pancreatitis (AP) is associated with an increased need for fluids due to fluid sequestration and, in the most severe cases, with decreased peripheral vascular tone. For several decades, clinical practice guidelines have recommended aggressive fluid therapy to improve the prognosis of AP. This recommendation is based on theoretical models, animal studies, and retrospective studies in humans. Recent studies suggest that aggressive fluid administration in all patients with AP could have a neutral or harmful effect. Fluid therapy based on Ringer's lactate could improve the course of the disease, although further studies are needed to confirm this possibility. Most patients with AP do not require invasive monitoring of hemodynamic parameters to guide fluid therapy administration. Moreover, the ability of these parameters to improve prognosis has not been demonstrated. Copyright © 2013 Elsevier España, S.L. and AEEH y AEG. All rights reserved.

78 FR 8491 - Proposed Information Collection; Comment Request; Trade Adjustment Assistance for Firms

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-06

... DEPARTMENT OF COMMERCE Economic Development Administration Proposed Information Collection; Comment Request; Trade Adjustment Assistance for Firms AGENCY: Economic Development Administration (EDA... Assistance Division, Room 71028, Economic Development Administration, Washington, DC 20230, telephone (202...

Review article: closed-loop systems in anesthesia: is there a potential for closed-loop fluid management and hemodynamic optimization?

PubMed

Rinehart, Joseph; Liu, Ngai; Alexander, Brenton; Cannesson, Maxime

2012-01-01

Closed-loop (automated) controllers are encountered in all aspects of modern life in applications ranging from air-conditioning to spaceflight. Although these systems are virtually ubiquitous, they are infrequently used in anesthesiology because of the complexity of physiologic systems and the difficulty in obtaining reliable and valid feedback data from the patient. Despite these challenges, closed-loop systems are being increasingly studied and improved for medical use. Two recent developments have made fluid administration a candidate for closed-loop control. First, the further description and development of dynamic predictors of fluid responsiveness provides a strong parameter for use as a control variable to guide fluid administration. Second, rapid advances in noninvasive monitoring of cardiac output and other hemodynamic variables make goal-directed therapy applicable for a wide range of patients in a variety of clinical care settings. In this article, we review the history of closed-loop controllers in clinical care, discuss the current understanding and limitations of the dynamic predictors of fluid responsiveness, and examine how these variables might be incorporated into a closed-loop fluid administration system.

Treatment of hypernatremia in an acidotic neonatal calf.

PubMed

Angelos, S M; Smith, B P; George, L W; House, J K; Van Metre, D C; Fecteau, G; Thacker, V C; Angelos, J A

1999-05-01

A 7-day-old Jersey calf was evaluated because of diarrhea and pneumonia. The calf was hypernatremic, hypoproteinemic, and acidemic, and was treated initially with i.v. administration of fluids with sodium concentration (175 mEq/L) similar to the calf's serum sodium concentration. Sodium concentration of the administered fluids was gradually decreased over the following days, but the calf's serum sodium concentration decreased too rapidly, and the calf developed neurologic signs attributed to cerebral edema. Treatment with mannitol and i.v. administration of fluids with a higher concentration of sodium resulted in abatement of clinical signs. In calves, hypernatremia may develop over several days. Prescribing traditional isotonic or hypotonic fluids in such cases will be harmful, because during chronic hypernatremia, the brain's adaptive mechanisms involve accumulation of organic osmoles that may take several days to equilibrate across cell membranes, and cerebral edema may result. Administration of fluids containing sodium concentration approximately equal to the patient's measured serum sodium concentration is required to decrease serum sodium concentration more slowly than is possible with traditional isotonic fluids.

Malone-brayton cycle engine/heat pump

NASA Astrophysics Data System (ADS)

Gilmour, Thomas A.

1994-07-01

A machine, such as a heat pump, and having an all liquid heat exchange fluid, operates over a more nearly ideal thermodynamic cycle by adjustment of the proportionality of the volumetric capacities of a compressor and an expander to approximate the proportionality of the densities of the liquid heat exchange fluid at the chosen working pressures. Preferred forms of a unit including both the compressor and the expander on a common shaft employs difference in axial lengths of rotary pumps of the gear or vane type to achieve the adjustment of volumetric capacity. Adjustment of the heat pump system for differing heat sink conditions preferably employs variable compression ratio pumps.

A prospective study of adjustment to hemodialysis.

PubMed

Lev, E L; Owen, S V

1998-10-01

To examine (a) changes in subjects' self-care self-efficacy over time and (b) the relationship of subjects' self-care self-efficacy with adjustment to hemodialysis. A longitudinal design was used to study changes in self-care self-efficacy and associations between self-care self-efficacy and measures of adjustment: health status, mood distress, symptom distress, dialysis stress, and perceived adherence to fluid restriction. Subjects were recruited from 8 settings in the Northeast where outpatient hemodialysis treatment was administered. Sixty-four subjects were recruited to the study. Twenty-eight subjects completed 3 occasions of data collection. Data were collected on three occasions: (a) baseline-within 100 days of beginning treatment; (b) 4 months after beginning treatment; and (c) 8 months after beginning treatment. Eta-squared, a measure of practical significance, is reported for four factors of the self-care self-efficacy measure on each of the three occasions. Associations between self-care self-efficacy and measures of adjustment were examined by means of Pearson correlations. Eta-squared estimates showed generally positive changes occurring over time in subjects' self-care self-efficacy, health status, mood distress, symptom distress, dialysis stress, and perceived adherence to fluid restriction. Changes were more positive at 4-months than at 8-months after enrollment. Significant correlations (p < .05) occurred between self-care self-efficacy and mood states, health status, symptom distress, and perceived adherence to fluid restrictions. Correlations occurred more frequently between self-care self-efficacy and mood states than between self-care self-efficacy and other measures of adjustment. The study provided pilot data suggesting that hemodialysis patients' self-care self-efficacy and measures of adjustment change over time. Patients who had increased confidence in self-care strategies (self-efficacy) were associated with having more positive mood states, health status, and perceived adherence to fluid restrictions and less symptom distress. Interventions designed to increase patients' self-care self-efficacy may yield positive results. Nurses are in an excellent position to give efficacy enhancing feedback that may promote patients' adjustment.

Immunogenicity testing of therapeutic antibodies in ocular fluids after intravitreal injection.

PubMed

Wessels, Uwe; Zadak, Markus; Reiser, Astrid; Brockhaus, Janis; Ritter, Mirko; Abdolzade-Bavil, Afsaneh; Heinrich, Julia; Stubenrauch, Kay

2018-04-11

High drug concentrations in ocular fluids after intravitreal administration preclude the use of drug-sensitive immunoassays. A drug-tolerant immunoassay is therefore desirable for immunogenicity testing in ophthalmology. Immune complex (IC) antidrug antibody (ADA) assays were established for two species. The assays were compared with the bridging assay in ocular and plasma samples from two preclinical studies. The IC assays showed high drug tolerance, which enabled a reliable ADA detection in ocular fluids after intravitreal administration. The IC assays were superior to the bridging assay in the analysis of ocular fluids with high drug concentrations. The IC assay allows a reliable ADA detection in matrices with high drug concentrations, such as ocular fluids.

Fluid management in acute kidney injury.

PubMed

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

2017-06-01

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

5 CFR 9701.345 - Developmental pay adjustments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Developmental pay adjustments. 9701.345 Section 9701.345 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT... HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Performance-Based Pay § 9701.345...

Perioperative intravenous fluid prescribing: a multi-centre audit.

PubMed

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

2015-01-01

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

45 CFR 153.310 - Risk adjustment administration.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 1 2012-10-01 2012-10-01 false Risk adjustment administration. 153.310 Section 153.310 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE...

45 CFR 153.310 - Risk adjustment administration.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Risk adjustment administration. 153.310 Section 153.310 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE...

45 CFR 153.310 - Risk adjustment administration.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Risk adjustment administration. 153.310 Section 153.310 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS STANDARDS RELATED TO REINSURANCE, RISK CORRIDORS, AND RISK ADJUSTMENT UNDER THE AFFORDABLE CARE...

5 CFR 534.504 - Annual adjustment in pay.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Annual adjustment in pay. 534.504 Section 534.504 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay for Senior-Level and Scientific and Professional Positions § 534.504 Annual adjustment...

5 CFR 9901.333 - Setting and adjusting local market supplements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... factors. The Secretary may determine the effective date of newly set or adjusted targeted local market... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Setting and adjusting local market... DEFENSE NATIONAL SECURITY PERSONNEL SYSTEM (NSPS) Pay and Pay Administration Local Market Supplements...

Protocol for the administration of haemofiltration fluids and using patient group electrolytes direction.

PubMed

Kingston, Diana; Sykes, Siobhan; Raper, Sarah

2002-01-01

A patient group direction (PGD) is a specific written instruction for the supply or administration of named medicines in an identified clinical situation The introduction of a PGD must demonstrate a benefit for patients Haemofiltration is widely accepted as the treatment of choice when caring for critically ill patients in acute renal failure on an intensive care unit The haemofiltration PGD improves patient care by providing standardisation in administration of fluids and electrolytes and enabling nurses to respond rapidly to changes in biochemistry during haemofiltration This paper describes the development and implementation of a protocol to enable nurses to administer haemofiltration fluids and electrolytes under a patient group direction.

[Cerebral water and electrolytes during changes in the osmolarity and volume of the extracellular fluid].

PubMed

Pinegin, L E; Tibekina, L M; Shakhmatova, E I; Natochin, Iu

1979-01-01

The increase of osmolarity in the blood serum after administration of polyethylenglycol-400 (PEG) as well as the sharp increase of the renal loss of fluid under the influence of furosemide insignificantly affected the water contents in the white and grey brain substance. A slight dehydration of the grey substance occured on combination of osmotic gradient effect and the renal loss of fluid. Preservation of initial hydration of the brain within the skull on administration of PEG and furosemide is due to redistribution of the fluid phases: dehydration of cells is followed by an increase in the volume of sodium-containing tissue fluid where upon the amount of sodium and calcium in the tissue practically does not change.

Effect of ovine hydatid cyst fluid on the cardiovascular and respiratory systems in sheep.

PubMed

Tabatabai, M; Ismaili, M H; Sami, M; Fardin, R; Kadivar, R

1975-01-01

Rupture of the hydatid cyst in man brings about mild to severe toxic reactions including death. The present study was undertaken to investigate some of the responses resulting from administration of the ovine hydatid fluid to the sheep, which, like man, is an intermediate host of the Echinococcus granulosus. In 50 sodium pentobarbital-anesthetized sheep, the arterial blood pressure (A.B.P.), central venous pressure (C.V.P.), respiration and electrocardiogram were recorded. Intraveonus administration of 5-10 ml hydatid fluid brought about moderate to severe fall in A.B.P. and rapid respiration with or without transient apnea or permanent repiratory cessation in 80 percent of the animals. Fifty percent of the sheep died of circulatory and respiratory failure after the first injection of the hydatid fluid. Boiled hydatid fluid did not lose its potency to evoke the above responses. Pretreatment of the aminals with atropine sulfate, 0,5 mg/kg subcutaneously, did not block the reactions. Administration of the antihistamine chlorpheniramine, 4 mg/kg intravenously, caused partial prevention of the reactions in 6 out of 10 responsive sheep. The cardiovascular and respiratory responses to ovine hydatid fluid may be due to antigen-antibody reactions or some toxic component of the fluid.

Fluid Balance, Diuretic Use, and Mortality in Acute Kidney Injury

PubMed Central

Estrella, Michelle M.; Coresh, Josef; Brower, Roy G.; Liu, Kathleen D.

2011-01-01

Summary Background and objectives Management of volume status in patients with acute kidney injury (AKI) is complex, and the role of diuretics is controversial. The primary objective was to elucidate the association between fluid balance, diuretic use, and short-term mortality after AKI in critically ill patients. Design, setting, participants, & measurements Using data from the Fluid and Catheter Treatment Trial (FACTT), a multicenter, randomized controlled trial evaluating a conservative versus liberal fluid-management strategy in 1000 patients with acute lung injury (ALI), we evaluated the association of post-renal injury fluid balance and diuretic use with 60-day mortality in patients who developed AKI, as defined by the AKI Network criteria. Results 306 patients developed AKI in the first 2 study days and were included in our analysis. There were 137 in the fluid-liberal arm and 169 in the fluid-conservative arm (P = 0.04). Baseline characteristics were similar between groups. Post-AKI fluid balance was significantly associated with mortality in both crude and adjusted analysis. Higher post-AKI furosemide doses had a protective effect on mortality but no significant effect after adjustment for post-AKI fluid balance. There was no threshold dose of furosemide above which mortality increased. Conclusions A positive fluid balance after AKI was strongly associated with mortality. Post-AKI diuretic therapy was associated with 60-day patient survival in FACTT patients with ALI; this effect may be mediated by fluid balance. PMID:21393482

5 CFR 880.207 - Adjustment of accounts after finding of death.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Adjustment of accounts after finding of death. 880.207 Section 880.207 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL... Procedures § 880.207 Adjustment of accounts after finding of death. After a missing annuitant is determined...

5 CFR 880.207 - Adjustment of accounts after finding of death.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Adjustment of accounts after finding of death. 880.207 Section 880.207 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL... Procedures § 880.207 Adjustment of accounts after finding of death. After a missing annuitant is determined...

5 CFR 880.207 - Adjustment of accounts after finding of death.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Adjustment of accounts after finding of death. 880.207 Section 880.207 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL... Procedures § 880.207 Adjustment of accounts after finding of death. After a missing annuitant is determined...

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

PubMed

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

2013-03-01

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

14 CFR 125.123 - Propeller deicing fluid.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Propeller deicing fluid. 125.123 Section 125.123 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED... Requirements § 125.123 Propeller deicing fluid. If combustible fluid is used for propeller deicing, the...

14 CFR 125.123 - Propeller deicing fluid.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Propeller deicing fluid. 125.123 Section 125.123 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED... Requirements § 125.123 Propeller deicing fluid. If combustible fluid is used for propeller deicing, the...

14 CFR 121.225 - Propeller deicing fluid.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Propeller deicing fluid. 121.225 Section 121.225 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED... Propeller deicing fluid. If combustible fluid is used for propeller deicing, the certificate holder must...

14 CFR 121.225 - Propeller deicing fluid.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Propeller deicing fluid. 121.225 Section 121.225 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED... Propeller deicing fluid. If combustible fluid is used for propeller deicing, the certificate holder must...

14 CFR 121.225 - Propeller deicing fluid.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Propeller deicing fluid. 121.225 Section 121.225 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED... Propeller deicing fluid. If combustible fluid is used for propeller deicing, the certificate holder must...

14 CFR 125.123 - Propeller deicing fluid.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Propeller deicing fluid. 125.123 Section 125.123 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED... Requirements § 125.123 Propeller deicing fluid. If combustible fluid is used for propeller deicing, the...

14 CFR 121.225 - Propeller deicing fluid.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Propeller deicing fluid. 121.225 Section 121.225 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED... Propeller deicing fluid. If combustible fluid is used for propeller deicing, the certificate holder must...

14 CFR 125.123 - Propeller deicing fluid.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Propeller deicing fluid. 125.123 Section 125.123 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED... Requirements § 125.123 Propeller deicing fluid. If combustible fluid is used for propeller deicing, the...

14 CFR 125.123 - Propeller deicing fluid.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Propeller deicing fluid. 125.123 Section 125.123 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED... Requirements § 125.123 Propeller deicing fluid. If combustible fluid is used for propeller deicing, the...

14 CFR 121.225 - Propeller deicing fluid.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Propeller deicing fluid. 121.225 Section 121.225 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED... Propeller deicing fluid. If combustible fluid is used for propeller deicing, the certificate holder must...

Fluid Therapy: Double-Edged Sword during Critical Care?

PubMed Central

Benes, Jan; Kirov, Mikhail; Kuzkov, Vsevolod; Lainscak, Mitja; Molnar, Zsolt; Voga, Gorazd; Monnet, Xavier

2015-01-01

Fluid therapy is still the mainstay of acute care in patients with shock or cardiovascular compromise. However, our understanding of the critically ill pathophysiology has evolved significantly in recent years. The revelation of the glycocalyx layer and subsequent research has redefined the basics of fluids behavior in the circulation. Using less invasive hemodynamic monitoring tools enables us to assess the cardiovascular function in a dynamic perspective. This allows pinpointing even distinct changes induced by treatment, by postural changes, or by interorgan interactions in real time and enables individualized patient management. Regarding fluids as drugs of any other kind led to the need for precise indication, way of administration, and also assessment of side effects. We possess now the evidence that patient centered outcomes may be altered when incorrect time, dose, or type of fluids are administered. In this review, three major features of fluid therapy are discussed: the prediction of fluid responsiveness, potential harms induced by overzealous fluid administration, and finally the problem of protocol-led treatments and their timing. PMID:26798642

Fluid Therapy: Double-Edged Sword during Critical Care?

PubMed

Benes, Jan; Kirov, Mikhail; Kuzkov, Vsevolod; Lainscak, Mitja; Molnar, Zsolt; Voga, Gorazd; Monnet, Xavier

2015-01-01

Fluid therapy is still the mainstay of acute care in patients with shock or cardiovascular compromise. However, our understanding of the critically ill pathophysiology has evolved significantly in recent years. The revelation of the glycocalyx layer and subsequent research has redefined the basics of fluids behavior in the circulation. Using less invasive hemodynamic monitoring tools enables us to assess the cardiovascular function in a dynamic perspective. This allows pinpointing even distinct changes induced by treatment, by postural changes, or by interorgan interactions in real time and enables individualized patient management. Regarding fluids as drugs of any other kind led to the need for precise indication, way of administration, and also assessment of side effects. We possess now the evidence that patient centered outcomes may be altered when incorrect time, dose, or type of fluids are administered. In this review, three major features of fluid therapy are discussed: the prediction of fluid responsiveness, potential harms induced by overzealous fluid administration, and finally the problem of protocol-led treatments and their timing.

Analysis, approximation, and computation of a coupled solid/fluid temperature control problem

NASA Technical Reports Server (NTRS)

Gunzburger, Max D.; Lee, Hyung C.

1993-01-01

An optimization problem is formulated motivated by the desire to remove temperature peaks, i.e., 'hot spots', along the bounding surfaces of containers of fluid flows. The heat equation of the solid container is coupled to the energy equations for the fluid. Heat sources can be located in the solid body, the fluid, or both. Control is effected by adjustments to the temperature of the fluid at the inflow boundary. Both mathematical analyses and computational experiments are given.

Sharp Injury and Exposure to Blood and Body Fluids among Health Care Workers in Health Care Centers of Eastern Ethiopia.

PubMed

Alemayehu, T; Worku, A; Assefa, N

2016-07-01

Health care workers are facing certain occupational hazards because of sharp injury and exposure to human blood and body fluids as a result of handling wastes. Though much attention is paid for the protection of these workers, the number of exposures and injuries do not show a sign of decline from time to time. To examine the occurrence of sharp injury and exposure to blood and body fluids in health care workers in health care centers in Ethiopia. In a case-control study, a randomly selected sample of 65 health facilities with 391 cases and 429 controls were studied. Data were collected through a self-administered questionnaire. Detailed analysis of exposure among the health care workers was done by logistic regression analysis with generalized estimating equations model to control correlation effects of responses within the cluster of health facilities. The number of health care workers who got sharp injury was 217 (26.5%). 296 (36.1%) had exposure to blood and body fluids. Working at Harari region (adjusted OR 0.44, 95% CI 0.26 to 0.75) and East Hararghea (adjusted OR 0.61, 95% CI 0.40 to 0.94), being male (adjusted OR 0.56, 95% CI 0.44 to 0.91), and a being nurse (adjusted OR 0.188, 95% CI 0.06 to 0.63) were independent risk factors of the exposure. Regardless of the anticipated low self-reporting for exposure status, the number of health care workers reported having sharp injury and exposure to blood and body fluids was high. Such high exposures indicate that health care workers are at high risk of acquiring blood-borne viral infections such as hepatitis B, hepatitis C, and HIV.

Greater fluid overload and lower interdialytic weight gain are independently associated with mortality in a large international hemodialysis population.

PubMed

Hecking, Manfred; Moissl, Ulrich; Genser, Bernd; Rayner, Hugh; Dasgupta, Indranil; Stuard, Stefano; Stopper, Andrea; Chazot, Charles; Maddux, Franklin W; Canaud, Bernard; Port, Friedrich K; Zoccali, Carmine; Wabel, Peter

2018-04-20

Fluid overload and interdialytic weight gain (IDWG) are discrete components of the dynamic fluid balance in haemodialysis patients. We aimed to disentangle their relationship, and the prognostic importance of two clinically distinct, bioimpedance spectroscopy (BIS)-derived measures, pre-dialysis and post-dialysis fluid overload (FOpre and FOpost) versus IDWG. We conducted a retrospective cohort study on 38 614 incident patients with one or more BIS measurement within 90 days of haemodialysis initiation (1 October 2010 through 28 February 2015). We used fractional polynomial regression to determine the association pattern between FOpre, FOpost and IDWG, and multivariate adjusted Cox models with FO and/or IDWG as longitudinal and time-varying predictors to determine all-cause mortality risk. In analyses using 1-month averages, patients in quartiles 3 and 4 (Q3 and Q4) of FO had an incrementally higher adjusted mortality risk compared with reference Q2, and patients in Q1 of IDWG had higher adjusted mortality compared with Q2. The highest adjusted mortality risk was observed for patients in Q4 of FOpre combined with Q1 of IDWG [hazard ratio (HR) = 2.66 (95% confidence interval 2.21-3.20), compared with FOpre-Q2/IDWG-Q2 (reference)]. Using longitudinal means of FO and IDWG only slightly altered all HRs. IDWG associated positively with FOpre, but negatively with FOpost, suggesting a link with post-dialysis extracellular volume depletion. FOpre and FOpost were consistently positive risk factors for mortality. Low IDWG was associated with short-term mortality, suggesting perhaps an effect of protein-energy wasting. FOpost reflected the volume status without IDWG, which implies that this fluid marker is clinically most intuitive and may be best suited to guide volume management in haemodialysis patients.

HIV quality report cards: impact of case-mix adjustment and statistical methods.

PubMed

Ohl, Michael E; Richardson, Kelly K; Goto, Michihiko; Vaughan-Sarrazin, Mary; Schweizer, Marin L; Perencevich, Eli N

2014-10-15

There will be increasing pressure to publicly report and rank the performance of healthcare systems on human immunodeficiency virus (HIV) quality measures. To inform discussion of public reporting, we evaluated the influence of case-mix adjustment when ranking individual care systems on the viral control quality measure. We used data from the Veterans Health Administration (VHA) HIV Clinical Case Registry and administrative databases to estimate case-mix adjusted viral control for 91 local systems caring for 12 368 patients. We compared results using 2 adjustment methods, the observed-to-expected estimator and the risk-standardized ratio. Overall, 10 913 patients (88.2%) achieved viral control (viral load ≤400 copies/mL). Prior to case-mix adjustment, system-level viral control ranged from 51% to 100%. Seventeen (19%) systems were labeled as low outliers (performance significantly below the overall mean) and 11 (12%) as high outliers. Adjustment for case mix (patient demographics, comorbidity, CD4 nadir, time on therapy, and income from VHA administrative databases) reduced the number of low outliers by approximately one-third, but results differed by method. The adjustment model had moderate discrimination (c statistic = 0.66), suggesting potential for unadjusted risk when using administrative data to measure case mix. Case-mix adjustment affects rankings of care systems on the viral control quality measure. Given the sensitivity of rankings to selection of case-mix adjustment methods-and potential for unadjusted risk when using variables limited to current administrative databases-the HIV care community should explore optimal methods for case-mix adjustment before moving forward with public reporting. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Management of Gastric Obstruction Caused by Adjustable Gastric Band.

PubMed

Czeiger, David; Abu-Swis, Shadi; Shaked, Gad; Ovnat, Amnon; Sebbag, Gilbert

2016-12-01

Optimal adjustment of the filling volume of laparoscopic adjustable gastric banding is challenging and commonly performed empirically. Patients with band over-inflation and gastric obstruction arrive at the emergency department complaining of recurrent vomiting. In cases of gastric obstruction, intra-band pressure measurement may assist in determining the amount of fluid that should be removed from the band; however, our investigations have determined that intra-band pressure assessment need not play a role in the treatment of gastric band obstruction. In patients coming to the emergency department with gastric band obstruction, we measured intra-band pressure at arrival and following stepped removal of fluid, comparing the initial pressure with post-deflation pressure and measuring the volume of fluid removed. Forty-eight patients participated in the study. Forty-five patients had a low-pressure/high-volume band. Their mean baseline pressure was 54.6 ± 22.3 mmHg. The mean volume of fluid removed from the band was 1.3 ± 0.8 ml. The mean post-deflation pressure was 22.5 ± 16.3 mmHg. Nearly 30 % of patients required as little as 0.5 ml of fluid removal, and 60 % of them were free of symptoms with removal of 1 ml. Our results indicate that intra-band pressure measurement is of little value for determining the amount of fluid that should be removed for treatment of band obstruction. We suggest the removal of fluid in volumes of 0.5 ml until symptoms are relieved. Only in complicated cases, such as in patients having recurrent obstructions, should additional modalities be employed for further management guidance.

Use of standard hypodermic needles for accessing laparoscopic adjustable gastric band ports.

PubMed

Bewsher, Samuel Mark; Azzi, Anthony; Wright, Timothy

2010-06-01

Laparoscopic adjustable gastric banding is a common and successful method of surgically treating morbid obesity. A recipient will have to attend their surgeon's rooms a number of times to optimally adjust the amount of fluid in the band and hence the amount of restriction. Manufacturers suggest that the ports should be accessed with special non-coring needles that may not always be available in regional or remote centers, and this could create a safety risk in cases where urgent band deflation is required. Ports of two different brands were repeatedly accessed over 100 times in the same location while containing fluid under pressure, using a standard beveled 21 g hypodermic needle (SN) and a 20 g Huber tipped non-coring needle (NCN). The path the needles types took through the port septum was also examined. There was no leakage of fluid from any of the ports tested. Neither SN nor NCN passed through the port septum down their axis, but rather in a direction closer to that of their beveled surface. There is no more risk of "coring" the septum with a SN than with a NCN. SN can be used safely and routinely to access laparoscopic adjustable gastric band ports.

Real-time adjustment of ventricular restraint therapy in heart failure.

PubMed

Ghanta, Ravi K; Lee, Lawrence S; Umakanthan, Ramanan; Laurence, Rita G; Fox, John A; Bolman, Ralph Morton; Cohn, Lawrence H; Chen, Frederick Y

2008-12-01

Current ventricular restraint devices do not allow for either the measurement or adjustment of ventricular restraint level. Periodic adjustment of restraint level post-device implantation may improve therapeutic efficacy. We evaluated the feasibility of an adjustable quantitative ventricular restraint (QVR) technique utilizing a fluid-filled polyurethane epicardial balloon to measure and adjust restraint level post-implantation guided by physiologic parameters. QVR balloons were implanted in nine ovine with post-infarction dilated heart failure. Restraint level was defined by the maximum restraint pressure applied by the balloon to the epicardium at end-diastole. An access line connected the balloon lumen to a subcutaneous portacath to allow percutaneous access. Restraint level was adjusted while left ventricular (LV) end-diastolic volume (EDV) and cardiac output was assessed with simultaneous transthoracic echocardiography. All nine ovine successfully underwent QVR balloon implantation. Post-implantation, restraint level could be measured percutaneously in real-time and dynamically adjusted by instillation and withdrawal of fluid from the balloon lumen. Using simultaneous echocardiography, restraint level could be adjusted based on LV EDV and cardiac output. After QVR therapy for 21 days, LV EDV decreased from 133+/-15 ml to 113+/-17 ml (p<0.05). QVR permits real-time measurement and physiologic adjustment of ventricular restraint therapy after device implantation.

78 FR 47580 - Fisheries of the Northeastern United States; Scup Fishery; Adjustment to the 2013 Winter II Quota

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-06

... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration 50 CFR Part 648 [Docket No. 121009528-2729-02] RIN 0648-XC749 Fisheries of the Northeastern United States; Scup Fishery; Adjustment to... Atmospheric Administration (NOAA), Commerce. ACTION: Temporary rule; inseason adjustment. SUMMARY: NMFS...

5 CFR 9901.312 - Maximum rates of base salary and adjusted salary.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Maximum rates of base salary and adjusted salary. 9901.312 Section 9901.312 Administrative Personnel DEPARTMENT OF DEFENSE HUMAN RESOURCES....312 Maximum rates of base salary and adjusted salary. (a) Subject to § 9901.105, the Secretary may...

Excess intraoperative fluid volume administration is associated with pancreatic fistula after pancreaticoduodenectomy

PubMed Central

Han, In Woong; Kim, Hongbeom; Heo, JinSeok; Oh, Min Gu; Choi, Yoo Shin; Lee, Seung Eun; Lim, Chang-Sup

2017-01-01

Abstract Recent studies on perioperative fluid administration in patients undergoing pancreaticoduodenectomy (PD) have suggested that increased fluid loads are associated with worse perioperative outcomes. The purpose of this study was to investigate the relationship between intraoperative fluid (IOF) administration and postoperative pancreatic fistula (POPF), and to determine additional risk factors affecting pancreatic fistula in patients undergoing PD. From 2005 to 2014, a total of 182 patients with various periampullary diseases after PD were reviewed retrospectively at Dongguk University Ilsan Hospital, Chung-Ang University Hospital, and Dongnam Institute of Radiological and Medical Sciences. Patients were assigned to high or low IOF groups based on more or less fluid administration for supplementation of estimated blood loss and maintenance volume (12.5 mL/kg/h) than planned, respectively. The associations between IOF administration, pancreatic fistula development, and perioperative outcomes were evaluated. A total of 98 patients were assigned to the high-IOF group, and 84 to the low-IOF group. Risk factors for pancreatic fistula after univariate analysis were assignment to the high-IOF group, higher preoperative serum hemoglobin level, ampullary or bile duct cancer, pylorus preserving PD, small pancreatic duct, duct-to-mucosa pancreatojejunostomy, use of a stent, and mesh application to pancreatojejunal anastomosis. Among these, assignment to the high-IOF group (hazard ratio [HR] = 5.501, 95% CI 1.624–18.632, P = .006) and a small (<4 mm) pancreatic duct (HR = 4.129, 95% CI 1.569–14.658, P = .035) were identified as independent risk factors for the development of pancreatic fistula after multivariate analysis. However, long-term survival rate did not differ according to IOF group or duct size. Excessive IOF volume administration is associated with an increased incidence of pancreatic fistula after pancreaticoduodenectomy. PMID:28562540

A C-terminal cyclic 8-13 neurotensin fragment analog appears less exposed to neprilysin when it crosses the blood-brain barrier than the cerebrospinal fluid-brain barrier in mice.

PubMed

Van Kemmel, F M; Dubuc, I; Bourdel, E; Fehrentz, J A; Martinez, J; Costentin, J

1996-10-11

A C-terminal cyclic 8-13 neurotensin fragment analog. JMV 1193, a direct agonist of central neurotensin receptors, is able to cross both the cerebrospinal fluid-brain barrier and the blood-brain barrier. When administered intracerebroventricularly (i.c.v.), its hypothermic effect was potentiated by the enkephalinase inhibition induced either by thiorphan (simultaneous intracerebroventricular administration of 10 micrograms) or by the thiorphan prodrug. acetorphan (intravenous (i.v.) administration of 10 mg/kg). Such a potentiation was not observed when both JMV 1193 and acetorphan were administered intravenously. Therefore it appears that the sensitivity of JMV 1193 to enkephalinase depends on its route of administration. It is exposed to this peptidase after i.c.v. injection (when crossing the cerebrospinal fluid-brain barrier), while it is not after i.v. administration (when crossing the blood-brain barrier).

21 CFR 880.2500 - Spinal fluid manometer.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Spinal fluid manometer. 880.2500 Section 880.2500 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... Devices § 880.2500 Spinal fluid manometer. (a) Identification. A spinal fluid manometer is a device used...

21 CFR 880.2500 - Spinal fluid manometer.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Spinal fluid manometer. 880.2500 Section 880.2500 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... column fluid space, to connect the spinal fluid to a graduated column so that the pressure can be...

Clinical outcomes and mortality before and after implementation of a pediatric sepsis protocol in a limited resource setting: A retrospective cohort study in Bangladesh.

PubMed

Kortz, Teresa Bleakly; Axelrod, David M; Chisti, Mohammod J; Kache, Saraswati

2017-01-01

Pediatric sepsis has a high mortality rate in limited resource settings. Sepsis protocols have been shown to be a cost-effective strategy to improve morbidity and mortality in a variety of populations and settings. At Dhaka Hospital in Bangladesh, mortality from pediatric sepsis in high-risk children previously approached 60%, which prompted the implementation of an evidenced-based protocol in 2010. The clinical effectiveness of this protocol had not been measured. We hypothesized that implementation of a pediatric sepsis protocol improved clinical outcomes, including reducing mortality and length of hospital stay. This was a retrospective cohort study of children 1-59 months old with a diagnosis of sepsis, severe sepsis or septic shock admitted to Dhaka Hospital from 10/25/2009-10/25/2011. The primary outcome was inpatient mortality pre- and post-protocol implementation. Secondary outcomes included fluid overload, heart failure, respiratory insufficiency, length of hospital stay, and protocol compliance, as measured by antibiotic and fluid bolus administration within 60 minutes of hospital presentation. 404 patients were identified by a key-word search of the electronic medical record; 328 patients with a primary diagnosis of sepsis, severe sepsis, or septic shock were included (143 pre- and185 post-protocol) in the analysis. Pre- and post-protocol mortality were similar and not statistically significant (32.17% vs. 34.59%, p = 0.72). The adjusted odds ratio (AOR) for post-protocol mortality was 1.55 (95% CI, 0.88-2.71). The odds for developing fluid overload were significantly higher post-protocol (AOR 3.45, 95% CI, 2.04-5.85), as were the odds of developing heart failure (AOR 4.52, 95% CI, 1.43-14.29) and having a longer median length of stay (AOR 1.81, 95% CI 1.10-2.96). There was no statistically significant difference in respiratory insufficiency (pre- 65.7% vs. post- 70.3%, p = 0.4) or antibiotic administration between the cohorts (pre- 16.08% vs. post- 12.43%, p = 0.42). Implementation of a pediatric sepsis protocol did not improve all-cause mortality or length of stay and may have been associated with increased fluid overload and heart failure during the study period in a large, non-governmental hospital in Bangladesh. Similar rates of early antibiotic administration may indicate poor protocol compliance. Though evidenced-based protocols are a potential cost-effective strategy to improve outcomes, future studies should focus on optimal implementation of context-relevant sepsis protocols in limited resource settings.

URINARY AND AMNIOTIC FLUID LEVELS OF PHTHALATE MONOESTERS IN RATS AFTER THE ORAL ADMINISTRATION OF DI(2-ETHYLHEXYL) PHTHALATE AND DI-N-BUTYL PHTHALATE

EPA Science Inventory

Two studies were designed to examine amniotic fluid and maternal urine concentrations of the di(2-ethylhexyl) phthalate (DEHP) metabolite mono(2-ethylhexyl) phthalate (MEHP) and the di-n-butyl phthalate (DBP) metabolite monobutyl phthalate (MBP) after administration of DEHP and D...

Circulating Biologically Active Adrenomedullin (bio-ADM) Predicts Hemodynamic Support Requirement and Mortality During Sepsis.

PubMed

Caironi, Pietro; Latini, Roberto; Struck, Joachim; Hartmann, Oliver; Bergmann, Andreas; Maggio, Giuseppe; Cavana, Marco; Tognoni, Gianni; Pesenti, Antonio; Gattinoni, Luciano; Masson, Serge

2017-08-01

The biological role of adrenomedullin (ADM), a hormone involved in hemodynamic homeostasis, is controversial in sepsis because administration of either the peptide or an antibody against it may be beneficial. Plasma biologically active ADM (bio-ADM) was assessed on days 1, 2, and 7 after randomization of 956 patients with sepsis or septic shock to albumin or crystalloids for fluid resuscitation in the multicenter Albumin Italian Outcome Sepsis trial. We tested the association of bio-ADM and its time-dependent variation with fluid therapy, vasopressor administration, organ failures, and mortality. Plasma bio-ADM on day 1 (median [Q1-Q3], 110 [59-198] pg/mL) was higher in patients with septic shock, associated with 90-day mortality, multiple organ failures and the average extent of hemodynamic support therapy (fluids and vasopressors), and serum lactate time course over the first week. Moreover, it predicted incident cardiovascular dysfunction in patients without shock at enrollment (OR [95% CI], 1.9 [1.4-2.5]; P < .0001, for an increase of 1 interquartile range of bio-ADM concentration). bio-ADM trajectory during the first week of treatment clearly predicted 90-day mortality after adjustment for clinically relevant covariates (hazard ratio [95% CI], 1.3 [1.2-1.4]; P < .0001), and its reduction below 110 pg/mL at day 7 was associated with a marked reduction in 90-day mortality. Changes over the first 7 days of bio-ADM concentrations were not dependent on albumin treatment. In patients with sepsis, the circulating, biologically active form of ADM may help individualizing hemodynamic support therapy, while avoiding harmful effects. Its possible pathophysiologic role makes bio-ADM a potential candidate for future targeted therapies. ClinicalTrials.gov; No.: NCT00707122. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Comparison of Active Drug Concentrations in the Pulmonary Epithelial Lining Fluid and Interstitial Fluid of Calves Injected with Enrofloxacin, Florfenicol, Ceftiofur, or Tulathromycin

PubMed Central

Foster, Derek M.; Martin, Luke G.; Papich, Mark G.

2016-01-01

Bacterial pneumonia is the most common reason for parenteral antimicrobial administration to beef cattle in the United States. Yet there is little information describing the antimicrobial concentrations at the site of action. The objective of this study was to compare the active drug concentrations in the pulmonary epithelial lining fluid and interstitial fluid of four antimicrobials commonly used in cattle. After injection, plasma, interstitial fluid, and pulmonary epithelial lining fluid concentrations and protein binding were measured to determine the plasma pharmacokinetics of each drug. A cross-over design with six calves per drug was used. Following sample collection and drug analysis, pharmacokinetic calculations were performed. For enrofloxacin and metabolite ciprofloxacin, the interstitial fluid concentration was 52% and 78% of the plasma concentration, while pulmonary fluid concentrations was 24% and 40% of the plasma concentration, respectively. The pulmonary concentrations (enrofloxacin + ciprofloxacin combined) exceeded the MIC90 of 0.06 μg/mL at 48 hours after administration. For florfenicol, the interstitial fluid concentration was almost 98% of the plasma concentration, and the pulmonary concentrations were over 200% of the plasma concentrations, exceeding the breakpoint (≤ 2 μg/mL), and the MIC90 for Mannheimia haemolytica (1.0 μg/mL) for the duration of the study. For ceftiofur, penetration to the interstitial fluid was only 5% of the plasma concentration. Pulmonary epithelial lining fluid concentration represented 40% of the plasma concentration. Airway concentrations exceeded the MIC breakpoint for susceptible respiratory pathogens (≤ 2 μg/mL) for a short time at 48 hours after administration. The plasma and interstitial fluid concentrations of tulathromcyin were lower than the concentrations in pulmonary fluid throughout the study. The bronchial concentrations were higher than the plasma or interstitial concentrations, with over 900% penetration to the airways. Despite high diffusion into the bronchi, the tulathromycin concentrations achieved were lower than the MIC of susceptible bacteria at most time points. PMID:26872361

Fluid Therapy: Options and Rational Selection.

PubMed

Byers, Christopher G

2017-03-01

Administration of appropriate types and volumes of parenteral fluids is of paramount importance when treating sick and debilitated patients, especially those fighting critical illness. Fluid selection and accurate calculations must be performed logically and accurately to maximize positive outcomes. Knowledge of fluid types, as well as the complex relationship of the body's fluid compartments, helps clinicians develop rational fluid therapy plans for their patients. Copyright © 2016 Elsevier Inc. All rights reserved.

20 CFR 416.555 - Waiver of adjustment or recovery-impede administration.

Code of Federal Regulations, 2010 CFR

2010-04-01

... INCOME FOR THE AGED, BLIND, AND DISABLED Payment of Benefits, Overpayments, and Underpayments § 416.555... the current average administrative cost of handling such overpayment case through such adjustment or...

Upflow bioreactor having a septum and an auger and drive assembly

DOEpatents

Hansen, Carl S.; Hansen, Conly L.

2007-11-06

An upflow bioreactor includes a vessel having an inlet and an outlet configured for upflow operation. A septum is positioned within the vessel and defines a lower chamber and an upper chamber. The septum includes an aperture that provides fluid communication between the upper chamber and lower chamber. The bioreactor also includes an auger positioned in the aperture of the septum. The vessel includes an opening in the top for receiving the auger. The auger extends from a drive housing, which is position over the opening and provides a seal around the opening. The drive housing is adjustable relative to the vessel. The position of the auger in the aperture can be adjusted by adjusting the drive housing relative to the vessel. The auger adjustment mechanism allows the auger to be accurately positioned within the aperture. The drive housing can also include a fluid to provide an additional seal around the shaft of the auger.

Actively controlling coolant-cooled cold plate configuration

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

Chainer, Timothy J.; Parida, Pritish R.

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

Physicochemical characterisation of fluids and soft foods frequently mixed with oral drug formulations prior to administration to children.

PubMed

Kersten, E; Barry, A; Klein, S

2016-03-01

Oral drug administration to children poses specific pharmaceutical challenges that are often not seen to the same extent in adults, and whose occurrence may also be age dependent. When an age-appropriate dosage form is not available, manipulation of adult dosage forms (e.g., splitting and crushing of tablets or opening of capsules) has been reported as a means to facilitate administration to children. To enhance swallowability and/or mask an unpleasant taste of the dosage form to be administered, crushed/split tablets or the contents of capsules are often mixed with food or drinks or suspended in a vehicle prior to administration. However, it seems that the risks and benefits of an approach whereby the dosage form is modified prior to administration in this manner are everything but clear. The aim of the present study was to gain an overview of the physicochemical properties of a number of fluids, soft foods and suspension vehicles that are commonly reported to be mixed with oral medications before administration to children to improve patient acceptability. For this purpose, physicochemical parameters of 15 different fluids, soft foods and suspension vehicles were measured. These included pH, buffer capacity, osmolality, surface tension and viscosity. Results of the study clearly show the differences in physicochemical properties of the test candidates. It is thus obvious that the type of fluid/food mixed with a drug product before administration may have a significant impact on bioavailability of the drug administered. Therefore, a risk-based assessment of such practices considering API properties, formulation features and physicochemical properties of the fluids and foods intended to be co-administered with the dosage form, in conjunction with the anatomical and physiological maturity of the gastro-intestinal tract in the intended paediatric population, should be an essential part of paediatric oral formulation development.

Combinatorial effects of quercetin and sex-steroids on fluid and electrolytes’ (Na+, Cl-, HCO3-) secretory mechanisms in the uterus of ovariectomised female Sprague-Dawley rats

PubMed Central

Shahzad, Huma; Giribabu, Nelli; Karim, Kamarulzaman; Kassim, Normadiah M.; Muniandy, Sekaran

2017-01-01

Dysregulation of uterine fluid environment could impair successful reproduction and this could be due to the effect of environmental estrogens. Therefore, in this study, effect of quercetin, an environmental estrogen on uterine fluid and electrolytes concentrations were investigated under sex-steroid influence. Ovariectomised adult female Sprague-Dawley rats were given 10, 50 or 100mg/kg/day quercetin subcutaneously with 17-β estradiol (E) for seven days or three days E, then three days E plus progesterone (P) (E+P) treatment. Uterine fluid secretion rate, Na+, Cl- and HCO3- concentrations were determined by in-vivo perfusion. Following sacrifice, uteri were harvested and levels of the proteins of interest were identified by Western blotting and Realtime PCR. Distribution of these proteins in the uterus was observed by immunofluorescence. Levels of uterine cAMP were measured by enzyme-linked immunoassay (EIA). Administration of quercetin at increasing doses increased uterine fluid secretion rate, Na+, Cl- and HCO3- concentrations, but to the levels lesser than that of E. In concordant, levels of CFTR, SLC4A4, ENaC (α, β and γ), Na+/K+-ATPase, GPα/β, AC and cAMP in the uterus increased following increased in the doses of quercetin. Co-administration of quercetin with E caused uterine fluid secretion rate, Na+, Cl- and HCO3- concentrations to decrease. In concordant, uterine CFTR, SLC26A6, SLC4A4, ENaC (α, β and γ), Na+/K+-ATPase, GPα/β, AC and cAMP decreased. Greatest effects were observed following co-administration of 10mg/kg/day quercetin with E. Co-administration of quercetin with E+P caused uterine fluid Na+ and HCO3- concentrations to increase but no changes in fluid secretion rate and Cl- concentration were observed. Co-administration of high dose quercetin (100 mg/kg/day) with E+P caused uterine CFTR, SLC26A6, AC, GPα/β and ENaC (α, β and γ) to increase. Quercetin-induced changes in the uterine fluid secretion rate and electrolytes concentrations could potentially affect the uterine reproductive functions under female sex-steroid influence. PMID:28253299

Subretinal fluid levels of topical, oral, and combined administered ciprofloxacin in humans

PubMed Central

Cekic, O.; Batman, C.; Yasar, U.; Basci, N.; Zilelioglu, O.; Bozkurt, A.

2000-01-01

AIMS—To investigate the subretinal fluid (SRF) penetration of ciprofloxacin following topical, oral, and combined administration.
METHODS—34 patients undergoing conventional retinal reattachment surgery were randomly assigned to three groups. Twelve patients received topical ciprofloxacin, 11 patients received oral ciprofloxacin, and the other 11 patients received combined drug administration. SRF drug level was measured by using high performance liquid chromatography method.
RESULTS—The highest drug concentrations of all tested modes were attained following combined administration and lowest following topical administration (p <0.001). The SRF drug concentration following oral administration was also significantly higher than that of topical administration (p <0.001). Concentrations after oral and combined administration did not differ significantly (p = 0.217).
CONCLUSIONS—Topical ciprofloxacin can penetrate SRF. Ocular bioavailability of ciprofloxacin in SRF after oral and combined administration is equivalent.

 PMID:10966968

Supplemental Intravenous Crystalloid Administration Does Not Reduce the Risk of Surgical Wound Infection

PubMed Central

Kabon, Barbara; Akça, Ozan; Taguchi, Akiko; Nagele, Angelika; Jebadurai, Ratnaraj; Arkilic, Cem F.; Sharma, Neeru; Ahluwalia, Arundhathi; Galandiuk, Susan; Fleshman, James; Sessler, Daniel I.; Kurz, Andrea

2005-01-01

Wound perfusion and oxygenation are important determinants of the development of postoperative wound infections. Supplemental fluid administration significantly increases tissue oxygenation in surrogate wounds in the subcutaneous tissue of the upper arm in perioperative surgical patients. We tested the hypothesis that supplemental fluid administration during and after elective colon resections decreases the incidence of postoperative wound infections. Patients undergoing open colon resection were randomly assigned to small (n=124, 8 mL·kg-1·h-1) or large volume (n=129, 16-18 mL·kg-1·h-1) fluid management. Our major outcomes were two distinct criteria for diagnosis of surgical wound infections: 1) purulent exudate combined with a culture positive for pathogenic bacteria and 2) Center for Disease Control criteria for diagnosis of surgical wound infections. All wound infections diagnosed using either criterion by a blinded observer in the 15 days following surgery were considered in the analysis. Wound healing was evaluated with the ASEPSIS scoring system. Of the patients given small fluid administration, 14 had surgical wound infections; 11 given large fluid therapy had infections, P=0.46. ASEPSIS wound healing scores were similar in both groups: 7±16 (small volume) vs. 8±14 (large volume), P=0.70. Our results suggest that supplemental hydration in the range tested does not impact wound infection rate. PMID:16244030

Study on fracturing flowback fluid treatment technology for shale gas in Yangzhou

NASA Astrophysics Data System (ADS)

Shi, Shengwei; Du, Jiajia; Kang, Dingyu; Chen, Xinjian; Qu, Chengtun; Yu, Tao

2018-02-01

Shale gas fracturing flowback fluid has the characteristics of high viscosity, large displacement, complex components and difficult to deal with. Therefore, it is of great significance for environmental protection to treat and reuse it. In this paper, Yangzhou shale gas is taken as an object to study the treatment of shale gas fracturing flowback fluid. The results shown that the viscosity of the fracturing flowback fluid before treatment was 16.75mPa·s, and when the pH was adjusted to 3.5, with Cerium(III) sulfate and ferrous sulfate as catalyst and the dosage were 60mg/L and 120 mg/L respectively, and hydrogen peroxide dosage was 0.5%, the viscosity of fracturing folwback fluid was reduced from 16.75mPa·s to 1.97mPa·s After the oxidation treatment, adjusting pH to 7.5, and treating it with inorganic flocculant and organic flocculant, the water quality met the reinjection requirement of the average air permeability of less than or equal to 0.01 μm2.

Influence of occlusal loading on peri-implant clinical parameters. A pilot study

PubMed Central

Pellicer-Chover, Hilario; Viña-Almunia, José; Romero-Millán, Javier; Peñarrocha-Oltra, David; Peñarrocha-Diago, María

2014-01-01

Objectives: To investigate the relation between occlusal loading and peri-implant clinical parameters (probing depth, bleeding on probing, gingival retraction, width of keratinized mucosa, and crevicular fluid volume) in patients with implant-supported complete fixed prostheses in both arches. Material and Methods: This clinical study took place at the University of Valencia (Spain) dental clinic. It included patients attending the clinic for regular check-ups during at least 12 months after rehabilitation of both arches with implant-supported complete fixed ceramo-metallic prostheses. One study implant and one control implant were established for each patient using the T-Scan®III computerized system (Tesco, South Boston, USA). The maxillary implant closest to the point of maximum occlusal loading was taken as the study implant and the farthest (with least loading) as the control. Occlusal forces were registered with the T-Scan® III and then occlusal adjustment was performed to distribute occlusal forces correctly. Peri-implant clinical parameters were analyzed in both implants before and two and twelve months after occlusal adjustment. Results: Before occlusal adjustment, study group implants presented a higher mean volume of crevicular fluid (51.3±7.4 UP) than the control group (25.8±5.5 UP), with statistically significant difference. Two months after occlusal adjustment, there were no significant differences between groups (24.6±3.8 UP and 26±4.5 UP respectively) (p=0.977). After twelve months, no significant differences were found between groups (24.4±11.1 UP and 22.5±8.9 UP respectively) (p=0.323). For the other clinical parameters, no significant differences were identified between study and control implants at any of the study times (p>0.05). Conclusions: Study group implants receiving higher occlusal loading presented significantly higher volumes of crevicular fluid than control implants. Crevicular fluid volumes were similar in both groups two and twelve months after occlusal adjustment. Key words:Occlusal loading, crevicular fluid, peri-implant clinical parameters, T-Scan®. PMID:24316708

A randomised single blinded study of the administration of pre-warmed fluid vs active fluid warming on the incidence of peri-operative hypothermia in short surgical procedures.

PubMed

Andrzejowski, J C; Turnbull, D; Nandakumar, A; Gowthaman, S; Eapen, G

2010-09-01

We compared the effect of delivering fluid warmed using two methods in 76 adult patients having short duration surgery. All patients received a litre of crystalloid delivered either at room temperature, warmed using an in-line warming device or pre-warmed in a warming cabinet for at least 8 h. The tympanic temperature of those receiving fluid at room temperature was 0.4 °C lower on arrival in recovery when compared with those receiving fluid from a warming cabinet (p = 0.008). Core temperature was below the hypothermic threshold of 36.0 °C in seven (14%) patients receiving either type of warm fluid, compared to eight (32%) patients receiving fluid at room temperature (p = 0.03). The administration of 1 l warmed fluid to patients having short duration general anaesthesia results in higher postoperative temperatures. Pre-warmed fluid, administered within 30 min of its removal from a warming cabinet, is as efficient at preventing peri-operative hypothermia as that delivered through an in-line warming system. © 2010 The Authors. Journal compilation © 2010 The Association of Anaesthetists of Great Britain and Ireland.

Prevention of duodenal ileus reveals functional differences in the duodenal response to luminal hypertonicity in Sprague-Dawley and Dark Agouti rats.

PubMed

Sedin, J; Sjöblom, M; Nylander, O

2014-03-01

The mechanism by which the duodenum adjusts the luminal osmolality remains unclear. The aim was to compare the duodenal osmoregulation in response to different hyperosmolar solutions in Sprague-Dawley and Dark Agouti rats and to elucidate whether cyclooxygenase-2 inhibition affects these responses. The duodenum was perfused in situ with a 700-milliosmolar solution (NaCl alone, D-glucose ± NaCl, D-mannitol ± NaCl or orange juice), and the effects on the duodenal motility, mucosal permeability, luminal alkalinization, fluid flux and osmoregulation were assessed in anaesthetized rats. The change in net fluid flux and luminal osmolality, in response to a given hyperosmolar solution, was almost identical in control rats of both strains. In control rats, hypertonic D-glucose-NaCl induced fluid secretion only in the presence of phlorizin, an inhibitor of SGLT1. Cyclooxygenase-2 inhibition potentiated the hypertonicity-induced fluid secretion and increased the osmolality-adjusting capability in both strains, but the responses were greater in Dark Agouti rats. While cyclooxygenase-2-inhibited Dark Agouti rats responded to the hyperosmolar solutions with depression of motility and increased mucosal permeability, these effects were absent or smaller in the Sprague-Dawley strain. In contrast, orange juice induced the same duodenal responses in cyclooxygenase-2-inhibited Dark Agouti and Sprague-Dawley rats. The duodenum possesses the ability to absorb fluid despite a very high luminal osmolality. Inhibition of cyclooxygenase-2 markedly enhanced the capability of the duodenum to secrete fluid and to decrease luminal osmolality, irrespective of the hyperosmolar solution or the rat strain used, and revealed notable differences between the two strains with regard to their osmolality-adjusting capability. © 2013 Scandinavian Physiological Society. Published by John Wiley & Sons Ltd.

Albumin administration is associated with acute kidney injury in cardiac surgery: a propensity score analysis.

PubMed

Frenette, Anne Julie; Bouchard, Josée; Bernier, Pascaline; Charbonneau, Annie; Nguyen, Long Thanh; Rioux, Jean-Philippe; Troyanov, Stéphan; Williamson, David R

2014-11-14

The risk of acute kidney injury (AKI) with the use of albumin-containing fluids compared to starches in the surgical intensive care setting remains uncertain. We evaluated the adjusted risk of AKI associated with colloids following cardiac surgery. We performed a retrospective cohort study of patients undergoing on-pump cardiac surgery in a tertiary care center from 2008 to 2010. We assessed crystalloid and colloid administration until 36 hours after surgery. AKI was defined by the RIFLE (risk, injury, failure, loss and end-stage kidney disease) risk and Acute Kidney Injury Network (AKIN) stage 1 serum creatinine criterion within 96 hours after surgery. Our cohort included 984 patients with a baseline glomerular filtration rate of 72 ± 19 ml/min/1.73 m(2). Twenty-three percent had a reduced left ventricular ejection fraction (LVEF), thirty-one percent were diabetics and twenty-three percent underwent heart valve surgery. The incidence of AKI was 5.3% based on RIFLE risk and 12.0% based on the AKIN criterion. AKI was associated with a reduced LVEF, diuretic use, anemia, heart valve surgery, duration of extracorporeal circulation, hemodynamic instability and the use of albumin, pentastarch 10% and transfusions. There was an important dose-dependent AKI risk associated with the administration of albumin, which also paralleled a higher prevalence of concomitant risk factors for AKI. To address any indication bias, we derived a propensity score predicting the likelihood to receive albumin and matched 141 cases to 141 controls with a similar risk profile. In this analysis, albumin was associated with an increased AKI risk (RIFLE risk: 12% versus 5%, P = 0.03; AKIN stage 1: 28% versus 13%, P = 0.002). We repeated this methodology in patients without postoperative hemodynamic instability and still identified an association between the use of albumin and AKI. Albumin administration was associated with a dose-dependent risk of AKI and remained significant using a propensity score methodology. Future studies should address the safety of albumin-containing fluids on kidney function in patients undergoing cardiac surgery.

Withholding the artificial administration of fluids and food from elderly patients with dementia: ethnographic study

PubMed Central

The, Anne-Mei; Pasman, Roeline; Onwuteaka-Philipsen, Bregje; Ribbe, Miel; van der Wal, Gerrit

2002-01-01

Objective To clarify the practice of withholding the artificial administration of fluids and food from elderly patients with dementia in nursing homes. Design Qualitative, ethnographic study in two phases. Setting 10 wards in two nursing homes in the Netherlands. Participants 35 patients with dementia, eight doctors, 43 nurses, and 32 families. Results The clinical course of dementia was considered normal and was rarely reason to begin the artificial administration of fluids and food in advanced disease. Fluids and food seemed to be given mainly when there was an acute illness or a condition that needed medical treatment and which required hydration to be effective. The medical condition of the patient, the wishes of the family, and the interpretations of the patients' quality of life by their care providers were considered more important than living wills and policy agreements. Conclusions Doctors' decisions about withholding the artificial administration of fluids and food from elderly patients with dementia are influenced more by the clinical course of the illness, the presumed quality of life of the patient, and the patient's medical condition than they are by advanced planning of care. In an attempt to understand the wishes of the patient doctors try to create the broadest possible basis for the decision making process and its outcome, mainly by involving the family. What is already known on this topicDebate has focused on whether it is beneficial to withhold the artificial administration of fluids and food from patients with advanced dementiaWhat this study addsThe course of dementia, the patient's quality of life, and the patient's current medical condition influence doctors' decision making more than advanced planning of careDoctors try to create the broadest possible basis for the decision making process and its outcome, mainly by involving the family PMID:12468479

Impact of late fluid balance on clinical outcomes in the critically ill surgical and trauma population.

PubMed

Elofson, Kathryn A; Eiferman, Daniel S; Porter, Kyle; Murphy, Claire V

2015-12-01

Management of fluid status in critically ill patients poses a significant challenge due to limited literature. This study aimed to determine the impact of late fluid balance management after initial adequate fluid resuscitation on in-hospital mortality for critically ill surgical and trauma patients. This single-center retrospective cohort study included 197 patients who underwent surgical procedure within 24 hours of surgical intensive care unit admission. Patients with high fluid balance on postoperative day 7 (>5 L) were compared with those with a low fluid balance (≤5 L) with a primary end point of in-hospital mortality. Subgroup analyses were performed based on diuretic administration, diuretic response, and type of surgery. High fluid balance was associated with significantly higher in-hospital mortality (30.2 vs 3%, P<.001) compared with low fluid balance; this relationship remained after multivariable regression analysis. High fluid balance was associated with increased mortality, independent of diuretic administration, diuretic response, and type of surgery. Consistent with previous literature, high fluid balance on postoperative day 7 was associated with increased in-hospital mortality. Patients who received and responded to diuretic therapy did not demonstrate improved clinical outcomes, which questions their use in the postoperative period. Copyright © 2015 Elsevier Inc. All rights reserved.

Adjustable Pitot Probe

NASA Technical Reports Server (NTRS)

Ashby, George C., Jr.; Robbins, W. Eugene; Horsley, Lewis A.

1991-01-01

Probe readily positionable in core of uniform flow in hypersonic wind tunnel. Formed of pair of mating cylindrical housings: transducer housing and pitot-tube housing. Pitot tube supported by adjustable wedge fairing attached to top of pitot-tube housing with semicircular foot. Probe adjusted both radially and circumferentially. In addition, pressure-sensing transducer cooled internally by water or other cooling fluid passing through annulus of cooling system.

5 CFR 9701.336 - Treatment of employees whose pay does not fall below the minimum adjusted rate of their band.

Code of Federal Regulations, 2012 CFR

2012-01-01

... fall below the minimum adjusted rate of their band. 9701.336 Section 9701.336 Administrative Personnel... Administration Locality and Special Rate Supplements § 9701.336 Treatment of employees whose pay does not fall... or special rate supplement) does not fall below the minimum adjusted rate of his or her band as a...

5 CFR 9701.337 - Treatment of employees whose rate of pay falls below the minimum adjusted rate of their band.

Code of Federal Regulations, 2011 CFR

2011-01-01

... falls below the minimum adjusted rate of their band. 9701.337 Section 9701.337 Administrative Personnel... Administration Locality and Special Rate Supplements § 9701.337 Treatment of employees whose rate of pay falls... (including a locality or special rate supplement) falls below the minimum adjusted rate of his or her band as...

5 CFR 9701.336 - Treatment of employees whose pay does not fall below the minimum adjusted rate of their band.

Code of Federal Regulations, 2013 CFR

2013-01-01

... fall below the minimum adjusted rate of their band. 9701.336 Section 9701.336 Administrative Personnel... Administration Locality and Special Rate Supplements § 9701.336 Treatment of employees whose pay does not fall... or special rate supplement) does not fall below the minimum adjusted rate of his or her band as a...

5 CFR 9701.337 - Treatment of employees whose rate of pay falls below the minimum adjusted rate of their band.

Code of Federal Regulations, 2012 CFR

2012-01-01

... falls below the minimum adjusted rate of their band. 9701.337 Section 9701.337 Administrative Personnel... Administration Locality and Special Rate Supplements § 9701.337 Treatment of employees whose rate of pay falls... (including a locality or special rate supplement) falls below the minimum adjusted rate of his or her band as...

5 CFR 9701.337 - Treatment of employees whose rate of pay falls below the minimum adjusted rate of their band.

Code of Federal Regulations, 2014 CFR

2014-01-01

... falls below the minimum adjusted rate of their band. 9701.337 Section 9701.337 Administrative Personnel... Administration Locality and Special Rate Supplements § 9701.337 Treatment of employees whose rate of pay falls... (including a locality or special rate supplement) falls below the minimum adjusted rate of his or her band as...

5 CFR 9701.337 - Treatment of employees whose rate of pay falls below the minimum adjusted rate of their band.

Code of Federal Regulations, 2013 CFR

2013-01-01

... falls below the minimum adjusted rate of their band. 9701.337 Section 9701.337 Administrative Personnel... Administration Locality and Special Rate Supplements § 9701.337 Treatment of employees whose rate of pay falls... (including a locality or special rate supplement) falls below the minimum adjusted rate of his or her band as...

5 CFR 9701.336 - Treatment of employees whose pay does not fall below the minimum adjusted rate of their band.

Code of Federal Regulations, 2014 CFR

2014-01-01

... fall below the minimum adjusted rate of their band. 9701.336 Section 9701.336 Administrative Personnel... Administration Locality and Special Rate Supplements § 9701.336 Treatment of employees whose pay does not fall... or special rate supplement) does not fall below the minimum adjusted rate of his or her band as a...

5 CFR 9701.336 - Treatment of employees whose pay does not fall below the minimum adjusted rate of their band.

Code of Federal Regulations, 2011 CFR

2011-01-01

... fall below the minimum adjusted rate of their band. 9701.336 Section 9701.336 Administrative Personnel... Administration Locality and Special Rate Supplements § 9701.336 Treatment of employees whose pay does not fall... or special rate supplement) does not fall below the minimum adjusted rate of his or her band as a...

Fluid therapy and the hypovolemic microcirculation.

PubMed

Gruartmoner, G; Mesquida, J; Ince, Can

2015-08-01

In shock states, optimizing intravascular volume is crucial to promote an adequate oxygen delivery to the tissues. Our current practice in fluid management pivots on the Frank-Starling law of the heart, and the effects of fluids are measured according to the induced changes on stroke volume. The purpose of this review is to evaluate the boundaries of current macrohemodynamic approach to fluid administration, and to introduce the microcirculatory integration as a fundamental part of tissue perfusion monitoring. Macrocirculatory changes induced by volume expansion are not always coupled to proportional changes in microcirculatory perfusion. Loss of hemodynamic coherence limits the value of guiding fluid therapy according to macrohemodynamics, and highlights the importance of evaluating the ultimate target of volume administration, the microcirculation. Current approach to intravascular volume optimization is made from a macrohemodynamic perspective. However, several situations wherein macrocirculatory and microcirculatory coherence is lost have been described. Future clinical trials should explore the usefulness of integrating the microcirculatory evaluation in fluid optimization.

Penetration of topical, oral, and combined administered ofloxacin into the subretinal fluid

PubMed Central

Cekic, O.; Batman, C.; Yasar, U.; Totan, Y.; Basci, N.; Bozkurt, A.; Zilelioglu, O.; Kayaalp, S

1999-01-01

AIMS—To assess the subretinal fluid (SRF) levels of ofloxacin following topical, oral or combined administration.
METHODS—31 patients undergoing conventional retinal reattachment surgery were randomly assigned to three groups. Nine patients received topical ofloxacin, 11 patients received oral ofloxacin, and the other 11 patients received combined administration. Collected SRF samples were analysed for drug level by using high performance liquid chromatography.
RESULTS—SRF drug levels after oral and combined administration were significantly higher than that after topical administration (p=0.0002 and p=0.0002, respectively) while there was no significant difference between oral and combined administration (p=0.0844).
CONCLUSIONS—Ocular bioavailability of ofloxacin in SRF after oral and combined administration is equivalent. The addition of oral ofloxacin to topical therapy increased drug SRF penetration sixfold.

 PMID:10502583

Modifying the baricity of local anesthetics for spinal anesthesia by temperature adjustment: model calculations.

PubMed

Heller, Axel R; Zimmermann, Katrin; Seele, Kristin; Rössel, Thomas; Koch, Thea; Litz, Rainer J

2006-08-01

Although local anesthetics (LAs) are hyperbaric at room temperature, density drops within minutes after administration into the subarachnoid space. LAs become hypobaric and therefore may cranially ascend during spinal anesthesia in an uncontrolled manner. The authors hypothesized that temperature and density of LA solutions have a nonlinear relation that may be described by a polynomial equation, and that conversion of this equation may provide the temperature at which individual LAs are isobaric. Density of cerebrospinal fluid was measured using a vibrating tube densitometer. Temperature-dependent density data were obtained from all LAs commonly used for spinal anesthesia, at least in triplicate at 5 degrees, 20 degrees, 30 degrees, and 37 degrees C. The hypothesis was tested by fitting the obtained data into polynomial mathematical models allowing calculations of substance-specific isobaric temperatures. Cerebrospinal fluid at 37 degrees C had a density of 1.000646 +/- 0.000086 g/ml. Three groups of local anesthetics with similar temperature (T, degrees C)-dependent density (rho) characteristics were identified: articaine and mepivacaine, rho1(T) = 1.008-5.36 E-06 T2 (heavy LAs, isobaric at body temperature); L-bupivacaine, rho2(T) = 1.007-5.46 E-06 T2 (intermediate LA, less hypobaric than saline); bupivacaine, ropivacaine, prilocaine, and lidocaine, rho3(T) = 1.0063-5.0 E-06 T (light LAs, more hypobaric than saline). Isobaric temperatures (degrees C) were as follows: 5 mg/ml bupivacaine, 35.1; 5 mg/ml L-bupivacaine, 37.0; 5 mg/ml ropivacaine, 35.1; 20 mg/ml articaine, 39.4. Sophisticated measurements and mathematic models now allow calculation of the ideal injection temperature of LAs and, thus, even better control of LA distribution within the cerebrospinal fluid. The given formulae allow the adaptation on subpopulations with varying cerebrospinal fluid density.

Dietary sodium intake is associated with total fluid and sugar-sweetened beverage consumption in US children and adolescents aged 2–18 y: NHANES 2005–2008123

PubMed Central

Grimes, Carley A; Wright, Jacqueline D; Liu, Kiang; Nowson, Caryl A

2013-01-01

Background: Increasing dietary sodium drives the thirst response. Because sugar-sweetened beverages (SSBs) are frequently consumed by children, sodium intake may drive greater consumption of SSBs and contribute to obesity risk. Objective: We examined the association between dietary sodium, total fluid, and SSB consumption in a nationally representative sample of US children and adolescents aged 2–18 y. Design: We analyzed cross-sectional data from NHANES 2005–2008. Dietary sodium, fluid, and SSB intakes were assessed with a 24-h dietary recall. Multiple regression analysis was used to assess associations between sodium, fluid, and SSBs adjusted for age, sex, race-ethnic group, body mass index (BMI), socioeconomic status (SES), and energy intake. Results: Of 6400 participants, 51.3% (n = 3230) were males, and the average (±SEM) age was 10.1 ± 0.1 y. The average sodium intake was 3056 ± 48 mg/d (equivalent to 7.8 ± 0.1 g salt/d). Dietary sodium intake was positively associated with fluid consumption (r = 0.42, P < 0.001). After adjustment for age, sex, race-ethnic group, SES, and BMI, each additional 390 mg Na/d (1 g salt/d) was associated with a 74-g/d greater intake of fluid (P < 0.001). In consumers of SSBs (n = 4443; 64%), each additional 390 mg Na/d (1 g salt/d) was associated with a 32-g/d higher intake of SSBs (P < 0.001) adjusted for age, sex, race-ethnic group, SES, and energy intake. Conclusions: Dietary sodium is positively associated with fluid consumption and predicted SSB consumption in consumers of SSBs. The high dietary sodium intake of US children and adolescents may contribute to a greater consumption of SSBs, identifying a possible link between dietary sodium intake and excess energy intake. PMID:23676421

Dietary sodium intake is associated with total fluid and sugar-sweetened beverage consumption in US children and adolescents aged 2-18 y: NHANES 2005-2008.

PubMed

Grimes, Carley A; Wright, Jacqueline D; Liu, Kiang; Nowson, Caryl A; Loria, Catherine M

2013-07-01

Increasing dietary sodium drives the thirst response. Because sugar-sweetened beverages (SSBs) are frequently consumed by children, sodium intake may drive greater consumption of SSBs and contribute to obesity risk. We examined the association between dietary sodium, total fluid, and SSB consumption in a nationally representative sample of US children and adolescents aged 2-18 y. We analyzed cross-sectional data from NHANES 2005-2008. Dietary sodium, fluid, and SSB intakes were assessed with a 24-h dietary recall. Multiple regression analysis was used to assess associations between sodium, fluid, and SSBs adjusted for age, sex, race-ethnic group, body mass index (BMI), socioeconomic status (SES), and energy intake. Of 6400 participants, 51.3% (n = 3230) were males, and the average (±SEM) age was 10.1 ± 0.1 y. The average sodium intake was 3056 ± 48 mg/d (equivalent to 7.8 ± 0.1 g salt/d). Dietary sodium intake was positively associated with fluid consumption (r = 0.42, P < 0.001). After adjustment for age, sex, race-ethnic group, SES, and BMI, each additional 390 mg Na/d (1 g salt/d) was associated with a 74-g/d greater intake of fluid (P < 0.001). In consumers of SSBs (n = 4443; 64%), each additional 390 mg Na/d (1 g salt/d) was associated with a 32-g/d higher intake of SSBs (P < 0.001) adjusted for age, sex, race-ethnic group, SES, and energy intake. Dietary sodium is positively associated with fluid consumption and predicted SSB consumption in consumers of SSBs. The high dietary sodium intake of US children and adolescents may contribute to a greater consumption of SSBs, identifying a possible link between dietary sodium intake and excess energy intake.

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

PubMed

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

2013-12-01

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

21 CFR 872.1500 - Gingival fluid measurer.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Gingival fluid measurer. 872.1500 Section 872.1500 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Diagnostic Devices § 872.1500 Gingival fluid measurer. (a) Identification...

21 CFR 872.1500 - Gingival fluid measurer.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Gingival fluid measurer. 872.1500 Section 872.1500 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Diagnostic Devices § 872.1500 Gingival fluid measurer. (a) Identification...

20 CFR 435.72 - Subsequent adjustments and continuing responsibilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Subsequent adjustments and continuing responsibilities. 435.72 Section 435.72 Employees' Benefits SOCIAL SECURITY ADMINISTRATION UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS AND AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, OTHER NON-PROFIT...

76 FR 2720 - Trade Adjustment Assistance Program; Designation of Certifying Officers

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-14

... DEPARTMENT OF LABOR Employment and Training Administration Trade Adjustment Assistance Program; Designation of Certifying Officers AGENCY: Employment and Training Administration, Labor. ACTION: Notice... workers and firms in the service sector; made benefits available to workers whose jobs have been off...

[Perioperative management of the pancreaticoduoden-ectomy: fluid administration and nutritional support based on complication prevention and treatment].

PubMed

Peng, Jun-sheng; Chen, Shi

2013-11-01

Pancreaticoduodenectomy(PD) has been widely accepted as one of the most complicated operation in abdominal surgery. The patients who receive PD operation always have other concurrent conditions, such as jaundice, diabetes, liver dysfunction, and malnutrition. Pancreatic fistula, biliary fistula and gastrointestinal dysfunction are common complications after PD. Proper perioperative management and fluid administration can reduce postoperative complications and the mortality.

Rationale and design of the Aquapheresis Versus Intravenous Diuretics and Hospitalization for Heart Failure (AVOID-HF) trial.

PubMed

Costanzo, Maria Rosa; Negoianu, Daniel; Fonarow, Gregg C; Jaski, Brian E; Bart, Bradley A; Heywood, J Thomas; Nabut, Jose L; Schollmeyer, Michael P

2015-09-01

In patients hospitalized with acutely decompensated heart failure, unresolved signs and symptoms of fluid overload have been consistently associated with poor outcomes. Regardless of dosing and type of administration, intravenous loop diuretics have not reduced heart failure events or mortality in patients with acutely decompensated heart failure. The results of trials comparing intravenous loop diuretics to mechanical fluid removal by isolated venovenous ultrafiltration have yielded conflicting results. Studies evaluating early decongestive strategies have shown that ultrafiltration removed more fluid and was associated with fewer heart failure-related rehospitalization than intravenous loop diuretics. In contrast, when used in the setting of worsening renal function, ultrafiltration was associated with poorer renal outcomes and no reduction in heart failure events. The AVOID-HF trial seeks to determine if an early strategy of ultrafiltration in patients with acutely decompensated heart failure is associated with fewer heart failure events at 90 days compared with a strategy based on intravenous loop diuretics. Study subjects from 40 highly experienced institutions are randomized to either early ultrafiltration or intravenous loop diuretics. In both treatment arms, fluid removal therapies are adjusted according to the patients' hemodynamic condition and renal function. The study was unilaterally terminated by the sponsor in the absence of futility and safety concerns after the enrollment of 221 subjects, or 27% of the originally planned sample size of 810 patients. The AVOID-HF trial's principal aim is to compare the safety and efficacy of ultrafiltration vs that of intravenous loop diuretics in patients hospitalized with acutely decompensated heart failure. Because stepped treatment approaches are applied in both ultrafiltration and intravenous loop diuretics groups and the primary end point is time to first heart failure event within 90 days, it is hoped that the AVOID-HF trial, despite its untimely termination by the sponsor, will provide further insight on how to optimally decongest patients with fluid-overloaded heart failure. Copyright © 2015. Published by Elsevier Inc.

Reduction of the viscosity of solutions viscosified with xanthan gum polymers

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

Bridges, K.L.; Kalinski, K.L.

1991-10-08

This patent describes a process for reducing the viscosity of a drilling fluid containing Xanthan gum polymer solution. It comprises: contacting the drilling fluid with hydrogen peroxide and adjusting the pH of the solution to a level of at least about between 8 and 10.

Development of an Urban Search and Rescue Robot

DTIC Science & Technology

2003-01-01

is a magnetorheological (MR) fluids shock absorber. The nature of this fluid is such that its compliance can be electronically adjusted thousands...simulators. First, ODE is still a work in progress. The user manual is far from finished and modifications to the coded library come out quite frequently...

7 CFR 1032.30 - Reports of receipts and utilization.

Code of Federal Regulations, 2013 CFR

2013-01-01

... the following information: (1) Product pounds, pounds of butterfat, pounds of protein, pounds of solids-not-fat other than protein (other solids), and the value of the somatic cell adjustment pursuant... of fluid milk products and bulk fluid cream products; (3) The utilization or disposition of all milk...

7 CFR 1033.30 - Reports of receipts and utilization.

Code of Federal Regulations, 2014 CFR

2014-01-01

... the following information: (1) Product pounds, pounds of butterfat, pounds of protein, pounds of solids-not-fat other than protein (other solids), and the value of the somatic cell adjustment pursuant... of fluid milk products and bulk fluid cream products; (3) The utilization or disposition of all milk...

7 CFR 1032.30 - Reports of receipts and utilization.

Code of Federal Regulations, 2011 CFR

2011-01-01

... the following information: (1) Product pounds, pounds of butterfat, pounds of protein, pounds of solids-not-fat other than protein (other solids), and the value of the somatic cell adjustment pursuant... of fluid milk products and bulk fluid cream products; (3) The utilization or disposition of all milk...

7 CFR 1033.30 - Reports of receipts and utilization.

Code of Federal Regulations, 2012 CFR

2012-01-01

... the following information: (1) Product pounds, pounds of butterfat, pounds of protein, pounds of solids-not-fat other than protein (other solids), and the value of the somatic cell adjustment pursuant... of fluid milk products and bulk fluid cream products; (3) The utilization or disposition of all milk...

7 CFR 1032.30 - Reports of receipts and utilization.

Code of Federal Regulations, 2014 CFR

2014-01-01

... the following information: (1) Product pounds, pounds of butterfat, pounds of protein, pounds of solids-not-fat other than protein (other solids), and the value of the somatic cell adjustment pursuant... of fluid milk products and bulk fluid cream products; (3) The utilization or disposition of all milk...

7 CFR 1033.30 - Reports of receipts and utilization.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the following information: (1) Product pounds, pounds of butterfat, pounds of protein, pounds of solids-not-fat other than protein (other solids), and the value of the somatic cell adjustment pursuant... of fluid milk products and bulk fluid cream products; (3) The utilization or disposition of all milk...

7 CFR 1032.30 - Reports of receipts and utilization.

Code of Federal Regulations, 2012 CFR

2012-01-01

... the following information: (1) Product pounds, pounds of butterfat, pounds of protein, pounds of solids-not-fat other than protein (other solids), and the value of the somatic cell adjustment pursuant... of fluid milk products and bulk fluid cream products; (3) The utilization or disposition of all milk...

7 CFR 1032.30 - Reports of receipts and utilization.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the following information: (1) Product pounds, pounds of butterfat, pounds of protein, pounds of solids-not-fat other than protein (other solids), and the value of the somatic cell adjustment pursuant... of fluid milk products and bulk fluid cream products; (3) The utilization or disposition of all milk...

7 CFR 1033.30 - Reports of receipts and utilization.

Code of Federal Regulations, 2013 CFR

2013-01-01

... the following information: (1) Product pounds, pounds of butterfat, pounds of protein, pounds of solids-not-fat other than protein (other solids), and the value of the somatic cell adjustment pursuant... of fluid milk products and bulk fluid cream products; (3) The utilization or disposition of all milk...

7 CFR 1033.30 - Reports of receipts and utilization.

Code of Federal Regulations, 2011 CFR

2011-01-01

... the following information: (1) Product pounds, pounds of butterfat, pounds of protein, pounds of solids-not-fat other than protein (other solids), and the value of the somatic cell adjustment pursuant... of fluid milk products and bulk fluid cream products; (3) The utilization or disposition of all milk...

75 FR 55628 - National Highway Traffic Safety Administration Reports, Forms and Record Keeping Requirements...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-13

... vehicle brake fluid or hydraulic system mineral oil is permanently attached, clearly states the contents... motor vehicle brake fluid and hydraulic mineral oil containers as specified in FMVSS No. 116, Motor..., specifies performance and design requirements for motor vehicle brake fluids and hydraulic system mineral...

40 CFR 61.247 - Reporting requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... the fluid at the equipment. (iv) Process fluid state at the equipment (gas/vapor or liquid). (v... with dual mechanical seals”). (b) A report shall be submitted to the Administrator semiannually...

Sensitivity, specificity, and efficiency in detecting opiates in oral fluid with the Cozart Opiate Microplate EIA and GC-MS following controlled codeine administration.

PubMed

Barnes, Allan J; Kim, Insook; Schepers, Raf; Moolchan, Eric T; Wilson, Lisa; Cooper, Gail; Reid, Claire; Hand, Chris; Huestis, Marilyn A

2003-10-01

Oral fluid specimens (N = 1406) were collected from 19 subjects prior to and up to 72 h following controlled administration of oral codeine. Volunteers provided informed consent to participate in this National Institute on Drug Abuse Institutional Review Board-approved protocol. A modification of Cozart Microplate Opiate EIA Oral Fluid Kit (Opiate ELISA), employing codeine calibrators, was used for semiquantitative analysis of opiates, followed by gas chromatography-mass spectrometry (GC-MS) for the confirmation and quantitation of codeine, norcodeine, morphine, and normorphine in oral fluid. GC-MS limits of detection and quantitation were 2.5 microg/L for all analytes. The Substance Abuse and Mental Health Services Administration (SAMHSA) has proposed a 40-microg/L opiate screening and a 40-microg/L morphine or codeine confirmation cutoff for the detection of opiate use. Oral fluid opiate screening and confirmation cutoffs of 30 micro g/L are in use in the U.K. Utilizing 2.5-, 20-, 30-, and 40-microg/L GC-MS cutoffs, 26%, 20%, 19%, and 18% of the oral fluid specimens were positive for codeine or one of its metabolites. Six Opiate ELISA/confirmation cutoff criteria (2.5/2.5, 10/2.5, 20/20, 30/20, 30/30, and 40/40 microg/L) were evaluated. Calculations for Opiate ELISA sensitivity, specificity, and efficiency were determined from the number of true-positive, true-negative, false-positive, and false-negative results at each screening/confirmation cutoff. Sensitivity, specificity, and efficiency for the lowest cutoff were 91.5%, 88.6%, and 89.3%. Application of the cutoff currently used in the U.K. yielded sensitivity, specificity, and efficiency results of 79.7%, 99.0%, and 95.4% and similar results of 76.7%, 99.1%, and 95.1% when applying the SAMHSA criteria. These data indicate that the Opiate ELISA efficiently detects oral codeine use. In addition, the data, collected following controlled oral codeine administration, may aid in the interpretation of opiate oral fluid test results and in the selection of appropriate oral fluid screening and confirmation cutoffs.

28 CFR 85.1 - In general.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false In general. 85.1 Section 85.1 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CIVIL MONETARY PENALTIES INFLATION ADJUSTMENT § 85.1 In general. (a) In accordance with the requirements of the Federal Civil Penalties Inflation Adjustment Act of...

5 CFR 531.207 - Applying annual pay adjustments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Applying annual pay adjustments. 531.207 Section 531.207 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER THE GENERAL SCHEDULE Determining Rate of Basic Pay General Provisions § 531.207 Applying annual...

Clinical outcomes and mortality before and after implementation of a pediatric sepsis protocol in a limited resource setting: A retrospective cohort study in Bangladesh

PubMed Central

Axelrod, David M.; Chisti, Mohammod J.; Kache, Saraswati

2017-01-01

Background Pediatric sepsis has a high mortality rate in limited resource settings. Sepsis protocols have been shown to be a cost-effective strategy to improve morbidity and mortality in a variety of populations and settings. At Dhaka Hospital in Bangladesh, mortality from pediatric sepsis in high-risk children previously approached 60%, which prompted the implementation of an evidenced-based protocol in 2010. The clinical effectiveness of this protocol had not been measured. We hypothesized that implementation of a pediatric sepsis protocol improved clinical outcomes, including reducing mortality and length of hospital stay. Materials and methods This was a retrospective cohort study of children 1–59 months old with a diagnosis of sepsis, severe sepsis or septic shock admitted to Dhaka Hospital from 10/25/2009-10/25/2011. The primary outcome was inpatient mortality pre- and post-protocol implementation. Secondary outcomes included fluid overload, heart failure, respiratory insufficiency, length of hospital stay, and protocol compliance, as measured by antibiotic and fluid bolus administration within 60 minutes of hospital presentation. Results 404 patients were identified by a key-word search of the electronic medical record; 328 patients with a primary diagnosis of sepsis, severe sepsis, or septic shock were included (143 pre- and185 post-protocol) in the analysis. Pre- and post-protocol mortality were similar and not statistically significant (32.17% vs. 34.59%, p = 0.72). The adjusted odds ratio (AOR) for post-protocol mortality was 1.55 (95% CI, 0.88–2.71). The odds for developing fluid overload were significantly higher post-protocol (AOR 3.45, 95% CI, 2.04–5.85), as were the odds of developing heart failure (AOR 4.52, 95% CI, 1.43–14.29) and having a longer median length of stay (AOR 1.81, 95% CI 1.10–2.96). There was no statistically significant difference in respiratory insufficiency (pre- 65.7% vs. post- 70.3%, p = 0.4) or antibiotic administration between the cohorts (pre- 16.08% vs. post- 12.43%, p = 0.42). Conclusions Implementation of a pediatric sepsis protocol did not improve all-cause mortality or length of stay and may have been associated with increased fluid overload and heart failure during the study period in a large, non-governmental hospital in Bangladesh. Similar rates of early antibiotic administration may indicate poor protocol compliance. Though evidenced-based protocols are a potential cost-effective strategy to improve outcomes, future studies should focus on optimal implementation of context-relevant sepsis protocols in limited resource settings. PMID:28753618

Prevention of Contrast-Induced Nephropathy by Central Venous Pressure-Guided Fluid Administration in Chronic Kidney Disease and Congestive Heart Failure Patients.

PubMed

Qian, Geng; Fu, Zhenhong; Guo, Jun; Cao, Feng; Chen, Yundai

2016-01-11

This study aimed to explore the hemodynamic index-guided hydration method for patients with congestive heart failure (CHF) and chronic kidney disease (CKD) to reduce the risk of contrast-induced nephropathy (CIN) and at the same time to avoid the acute heart failure. Patients at moderate or high risk for CIN should receive sufficient hydration before contrast application. This prospective, randomized, double-blind, comparative clinical trial enrolled 264 consecutive patients with CKD and CHF undergoing coronary procedures. These patients were randomly assigned to either central venous pressure (CVP)-guided hydration group (n = 132) or the standard hydration group (n = 132). In the CVP-guided group, the hydration infusion rate was dynamically adjusted according to CVP level every hour. CIN was defined as an absolute increase in serum creatinine (SCr) >0.5 mg/dl (44.2 μmol/l) or a relative increase >25% compared with baseline SCr. Baseline characteristics were well-matched between the 2 groups. The total mean volume of isotonic saline administered in the CVP-guided hydration group was significantly higher than the control group (1,827 ± 497 ml vs. 1,202 ± 247 ml; p < 0.001). CIN occurred less frequently in CVP-guided hydration group than the control group (15.9% vs. 29.5%; p = 0.006). The incidences of acute heart failure during the hydration did not differ between the 2 groups (3.8% vs. 3.0%; p = 0.500). CVP-guided fluid administration can safely and effectively reduce the risk of CIN in patients with CKD and CHF. (Central Venous Pressure Guided Hydration Prevention for Contrast-Induced Nephropathy; NCT02405377). Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Shaft seal assembly and method

NASA Technical Reports Server (NTRS)

Keba, John E. (Inventor)

2007-01-01

A pressure-actuated shaft seal assembly and associated method for controlling the flow of fluid adjacent a rotatable shaft are provided. The seal assembly includes one or more seal members that can be adjusted between open and closed positions, for example, according to the rotational speed of the shaft. For example, the seal member can be configured to be adjusted according to a radial pressure differential in a fluid that varies with the rotational speed of the shaft. In addition, in the closed position, each seal member can contact a rotatable member connected to the shaft to form a seal with the rotatable member and prevent fluid from flowing through the assembly. Thus, the seal can be closed at low speeds of operation and opened at high speeds of operation, thereby reducing the heat and wear in the seal assembly while maintaining a sufficient seal during all speeds of operation.

21 CFR 880.5430 - Nonelectrically powered fluid injector.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nonelectrically powered fluid injector. 880.5430 Section 880.5430 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... hypodermic injection by means of a narrow, high velocity jet of fluid which can penetrate the surface of the...

EFFECTS OF PREDNISOLONE AND TRIAMCINOLONE ON CORTICOSTEROID LEVELS IN PAROTID FLUID, SERUM, AND URINE.

DTIC Science & Technology

A simultaneous determination was made of 17-OHCS in serum, urine, and parotid fluid, by the Porter-Silber reaction, after the oral administration of...prednisolone, triamcinolone, or placebo to 240 normal human subjects. The data clearly demonstrate the homology of serum and parotid fluid 17-OHCS

21 CFR 880.5430 - Nonelectrically powered fluid injector.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Nonelectrically powered fluid injector. 880.5430 Section 880.5430 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... skin and deliver the fluid to the body. It may be used for mass inoculations. (b) Classification. Class...

21 CFR 500.45 - Use of polychlorinated biphenyls (PCB's) in the production, handling, and storage of animal feed.

Code of Federal Regulations, 2011 CFR

2011-04-01

... highly stable, heat resistant, and nonflammable chemicals. Industrial uses of PCB's include, or did include in the past, their use as electrical transformer and capacitor fluids, heat transfer fluids... Food and Drug Administration have revealed that heat exchange fluids for certain pasteurization...

Chloride toxicity in critically ill patients: What's the evidence?

PubMed

Soussi, Sabri; Ferry, Axelle; Chaussard, Maité; Legrand, Matthieu

2017-04-01

Crystalloids have become the fluid of choice in critically ill patients and in the operating room both for fluid resuscitation and fluid maintenance. Among crystalloids, NaCl 0.9% has been the most widely used fluid. However, emerging evidence suggests that administration of 0.9% saline could be harmful mainly through high chloride content and that the use of fluid with low chloride content may be preferable in major surgery and intensive care patients. Administration of NaCl 0.9% is the leading cause of metabolic hyperchloraemic acidosis in critically ill patients and side effects might target coagulation, renal function, and ultimately increase mortality. More balanced solutions therefore may be used especially when large amount of fluids are administered in high-risk patients. In this review, we discuss physiological background favouring the use of balanced solutions as well as the most recent clinical data regarding the use of crystalloid solutions in critically ill patients and patients undergoing major surgery. Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

75 FR 78690 - Fiscal Year (FY) 2012-2013 Proposed Transmission Rate Adjustments Public Hearing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-16

... DEPARTMENT OF ENERGY Bonneville Power Administration [BPA File No.: BP-12] Fiscal Year (FY) 2012... Comment AGENCY: Bonneville Power Administration (BPA), Department of Energy (DOE). ACTION: Notice of FY 2012-2013 proposed transmission rate adjustments. SUMMARY: BPA is holding a consolidated rate...

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

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-13

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

46 CFR 309.6 - Adjustments for condition, equipment, and other considerations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... of $50,000, an amount estimated by the Maritime Administration as the fair and reasonable value of... considerations. 309.6 Section 309.6 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS VALUES FOR WAR RISK INSURANCE § 309.6 Adjustments for condition, equipment, and other...

Preliminary buprenorphine sublingual tablet pharmacokinetic data in plasma, oral fluid and sweat during treatment of opioid-dependent pregnant women

PubMed Central

Concheiro, Marta; Jones, Hendreé E.; Johnson, Rolley E.; Choo, Robin; Huestis, Marilyn A.

2011-01-01

Background Buprenorphine is currently under investigation as a pharmacotherapy to treat pregnant women for opioid dependence. This research evaluates buprenorphine (BUP), norbuprenophine (NBUP), buprenorphine-glucuronide (BUP-Gluc) and norbuprenorphine-glucuronide (NBUP-Gluc) pharmacokinetics after high dose (14–20 mg) BUP sublingual tablet administration in three opioid-dependent pregnant women. Methods Oral fluid and sweat specimens were collected in addition to plasma specimens for 24 h during gestation weeks 28 or 29 and 34, and 2 months after delivery. Tmax was not affected by pregnancy; however, BUP and NBUP Cmax and AUC0–24h tended to be lower during pregnancy compared to postpartum levels. Results Statistically significant but weak positive correlations were found for BUP plasma and OF concentrations, and BUP/NBUP ratios in plasma and OF. Conclusion Statistically significant negative correlations were observed for times of specimen collection and BUP and NBUP OF/plasma ratios. BUP-Gluc and NBUP-Gluc were detected in only 5% of OF specimens. In sweat, BUP and NBUP were detected in only 4 of 25 (12 or 24 h) specimens in low concentrations (<2.4 ng/patch). These preliminary data describe BUP and metabolite pharmacokinetics in pregnant women and suggest that, like methadone, upward dose adjustments may be needed with advancing gestation. PMID:21860340

Control system for fluid heated steam generator

DOEpatents

Boland, J.F.; Koenig, J.F.

1984-05-29

A control system for controlling the location of the nucleate-boiling region in a fluid heated steam generator comprises means for measuring the temperature gradient (change in temperature per unit length) of the heating fluid along the steam generator; means for determining a control variable in accordance with a predetermined function of temperature gradients and for generating a control signal in response thereto; and means for adjusting the feedwater flow rate in accordance with the control signal.

Control system for fluid heated steam generator

DOEpatents

Boland, James F.; Koenig, John F.

1985-01-01

A control system for controlling the location of the nucleate-boiling region in a fluid heated steam generator comprises means for measuring the temperature gradient (change in temperature per unit length) of the heating fluid along the steam generator; means for determining a control variable in accordance with a predetermined function of temperature gradients and for generating a control signal in response thereto; and means for adjusting the feedwater flow rate in accordance with the control signal.

28 CFR 85.2 - Calculation of adjustment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 85.2 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CIVIL MONETARY PENALTIES INFLATION ADJUSTMENT § 85.2 Calculation of adjustment. (a) The inflation adjustments described in § 85.3 were... Inflation Adjustment Act of 1990, Pub. L. 101-410. Any increase so determined was rounded to the nearest— (1...

Fatty Acid Composition of Human Follicular Fluid Phospholipids and Fertilization Rate in Assisted Reproductive Techniques

PubMed Central

Shaaker, Maghsod; Rahimipour, Ali; Nouri, Mohammad; Khanaki, Korosh; Darabi, Masoud; Farzadi, Laya; Shahnazi, Vahideh; Mehdizadeh, Amir

2012-01-01

Background: Fatty acids are known to be critically important in multiple biological functions. Phospholipid fatty acids of follicular fluid, an important microenvironment for the development of oocytes, may contribute to the women’s fertility and the efficacy of assisted reproduction techniques. The aim of this study was to investigate the effect of fatty acid composition of follicular fluid phospholipids on women undergoing assisted reproductive techniques. Methods: Follicular fluid samples were obtained from 100 patients, referred to Tabriz Alzahra Hospital. Seventy-nine subjects underwent in vitro fertilization (IVF) and the remaining 21 underwent intracytoplasmic sperm injection (ICSI). Total lipid of follicular fluid was extracted and fatty acids were analyzed by gas-liquid chromatography. Results: Saturated fatty acids (SFA, P = 0.002) and the ratio of SFA to polyunsaturated fatty acids (P = 0.001) were correlated negatively with a number of mature oocytes after age adjustment. Linoleic acid (P = 0.006) was positively correlated, while the level of arachidonic acid was negatively correlated with fertility percentage after adjustment for body mass index, sperm count, sperm motility. Conclusion: Since phospholipids are one of the major components of lipid metabolism, the results of this study highlight the importance of this component in follicular fluid lipid metabolism. Consequently, it is proposed as an index in determination of the rate of success in assisted reproductive techniques such as IVF/ICSI. PMID:23023218

Risk-adjusted impact of administrative costs on the distribution of terminal wealth for long-term investment.

PubMed

Guillén, Montserrat; Jarner, Søren Fiig; Nielsen, Jens Perch; Pérez-Marín, Ana M

2014-01-01

The impact of administrative costs on the distribution of terminal wealth is approximated using a simple formula applicable to many investment situations. We show that the reduction in median returns attributable to administrative fees is usually at least twice the amount of the administrative costs charged for most investment funds, when considering a risk-adjustment correction over a reasonably long-term time horizon. The example we present covers a number of standard cases and can be applied to passive investments, mutual funds, and hedge funds. Our results show investors the potential losses they face in performance due to administrative costs.

Risk-Adjusted Impact of Administrative Costs on the Distribution of Terminal Wealth for Long-Term Investment

PubMed Central

Guillén, Montserrat; Jarner, Søren Fiig; Pérez-Marín, Ana M.

2014-01-01

The impact of administrative costs on the distribution of terminal wealth is approximated using a simple formula applicable to many investment situations. We show that the reduction in median returns attributable to administrative fees is usually at least twice the amount of the administrative costs charged for most investment funds, when considering a risk-adjustment correction over a reasonably long-term time horizon. The example we present covers a number of standard cases and can be applied to passive investments, mutual funds, and hedge funds. Our results show investors the potential losses they face in performance due to administrative costs. PMID:25180200

Appropriate fluid regimens to prevent bronchopulmonary dysplasia.

PubMed

Tammela, O K

1995-01-01

Pulmonary oedema is an important problem in premature neonates with surfactant deficiency because of fluid accumulation in the lung interstitium and reduced urine output. Some retrospective reports suggest that excessive early hydration might increase the risk of bronchopulmonary dysplasia (BPD). Only three prospective studies evaluating low or conventional fluid administration regimens to very low birth weight infants have been published. According to their results no significant differences in the incidence of BPD have been shown. However, fluid restriction seems to improve the outcome of the infants because of decreased incidence of haemodynamically significant patent ductus arteriosus, necrotizing enterocolitis, pulmonary air leaks and decreased mortality. The appropriate amount of sodium in the intravenous fluids during the first days of life needs further evaluation. In tiny infants with birth weights from 500 to 800g intensive monitoring of fluid balance is essential to control the extremely high fluid losses due to evaporation. Undernutrition is a risk factor of BPD and therefore it is important to start parenteral nutrition early. The benefit of the use of colloids as volume expanders is controversial. According to some retrospective reports there might be an association with increased use of colloidal fluids during the first days of life and the development of BPD. Early excessive fluid administration might constitute a potential risk for low birth weight infants with hyaline membrane disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Psychosocial and cognitive factors associated with adherence to dietary and fluid restriction regimens by people on chronic haemodialysis.

PubMed

Sensky, T; Leger, C; Gilmour, S

1996-01-01

Failure by people on chronic haemodialysis to adhere adequately to dietary and fluid restrictions can have serious medical consequences. Numerous psychosocial factors possibly associated with adherence have been investigated in previous research. However, most previous studies have examined one or a few variables in isolation, and have tended to focus on sociodemographic variables not easily amenable to intervention. Much previous work has tended to ignore potential differences in adherence between male and female dialysands. Sociodemographic and psychosocial factors associated with adherence to dietary and fluid restrictions were investigated in 45 people on haemodialysis attending one renal unit, excluding those with a residual urine volume > 500 ml/day. Multiple regression analyses were used to estimate the contribution to adherence of a range of variables, including gender, age, duration of dialysis, affective disturbance, past psychiatric history, health locus of control, social adjustment and social supports. Adherence to diet (measured by predialysis serum potassium) and to fluid restriction (interdialysis weight gain) were not linked, and had different psychosocial correlates. Regression models of four different aspects of adherence revealed very distinct psychosocial correlates, with contributions to adherence from complex interactions between psychosocial and cognitive variables, notably gender, age, social adjustment, health locus of control, and depression. The findings cast doubt on the results of many previous studies which have used simple models of adherence. Adherence is likely to be influenced in a complex manner by multiple factors including age, gender, locus of control, social adjustment, and past psychiatric history.

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

PubMed

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

2017-09-01

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

Contemporary Approaches to Perioperative IV Fluid Therapy.

PubMed

Myles, Paul S; Andrews, Sam; Nicholson, Jonathan; Lobo, Dileep N; Mythen, Monty

2017-10-01

Intravenous fluid therapy is required for most surgical patients, but inappropriate regimens are commonly prescribed. The aim of this narrative review was to provide evidence-based guidance on appropriate perioperative fluid management. We did a systematic literature search of the literature to identify relevant studies and meta-analyses to develop recommendations. Of 275 retrieved articles, we identified 25 articles to inform this review. "Normal" saline (0.9% sodium chloride) is not physiological and can result in sodium overload and hyperchloremic acidosis. Starch colloid solutions are not recommended in surgical patients at-risk of sepsis or renal failure. Most surgical patients can have clear fluids and/or administration of carbohydrate-rich drinks up to 2 h before surgery. An intraoperative goal-directed fluid strategy may reduce postoperative complications and reduce hospital length of stay. Regular postoperative assessment of the patient's fluid status and requirements should include looking for physical signs of dehydration or hypovolemia, or fluid overload. Both hypovolemia and salt and water overload lead to adverse events, complications and prolonged hospital stay. Urine output can be an unreliable indicator of hydration status in the postoperative surgical patient. Excess fluid administration has been linked to acute kidney injury, gastrointestinal dysfunction, and cardiac and pulmonary complications. There is good evidence supporting the avoidance of unnecessary fasting and the value of an individualized perioperative IV fluid regimen, with transition to oral fluids as soon as possible, to help patients recover from major surgery.

21 CFR 500.45 - Use of polychlorinated biphenyls (PCB's) in the production, handling, and storage of animal feed.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Food and Drug Administration have revealed that heat exchange fluids for certain pasteurization equipment used in processing animal feed contain PCB's. Although heat exchange fluids in such equipment are... animal feed shall: (i) Have the heat exchange fluid used in existing equipment or machinery for handling...

21 CFR 500.45 - Use of polychlorinated biphenyls (PCB's) in the production, handling, and storage of animal feed.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Food and Drug Administration have revealed that heat exchange fluids for certain pasteurization equipment used in processing animal feed contain PCB's. Although heat exchange fluids in such equipment are... animal feed shall: (i) Have the heat exchange fluid used in existing equipment or machinery for handling...

75 FR 70744 - Fiscal Year (FY) 2012-2013 Proposed Power Rate Adjustments Public Hearing and Opportunities for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-18

... DEPARTMENT OF ENERGY Bonneville Power Administration [BPA File No.: BP-12] Fiscal Year (FY) 2012... AGENCY: Bonneville Power Administration (BPA), Department of Energy (DOE). ACTIONS: Notice of FY 2012-2013 Proposed Power Rate Adjustments. SUMMARY: BPA is holding a consolidated rate proceeding, Docket No...

Outcomes for youth residential treatment programs using administrative data from the child welfare system: a risk-adjustment application.

PubMed

McMillen, J Curtis; Lee, Bethany R; Jonson-Reid, Melissa

2008-05-01

This study assessed whether administrative data from the public child welfare system could be used to develop risk-adjusted performance reports for residential mental health programs for adolescents. Regression methods were used with 3,759 residential treatment spells for 2,784 children and youth to determine which outcomes could be adequately risk adjusted for case mix. Expected outcomes were created for each residential program given its case mix; then, expected and achieved outcomes were compared. For most programs, achieved results did not differ significantly from expected results for individual outcomes. Overall, outcomes achieved were not impressive. Only one quarter of spells resulted in a youth being maintained in a single less restrictive setting in the year following discharge. Methodological implications of this study suggest further refinements are needed for child welfare administrative data in order to develop risk-adjusted report cards of program performance.

Therapeutic management of botulism in dairy cattle.

PubMed

Pandian, S Jegaveera; Subramanian, M; Vijayakumar, G; Balasubramaniam, G A; Sukumar, K

2015-11-01

To report the successful recovery of few dairy cattle from botulism in response to a modified therapeutic strategy. Seventy four naturally-occurring clinical cases of bovine botulism encountered during the period of 2012-2014 which were confirmed by mouse lethality test became material for this study. Affected animals were made into three groups based on the treatment modifications made during the course of study. With the modified therapeutic regimen, 17 animals recovered after 7-10 days of treatment. Clinical recovery took 2-30 days. Animals which were not given intravenous fluid and calcium recovered uneventfully. Cattle which were already treated with intravenous fluids, calcium borogluconate, and antibiotics did not recover. They were either died or slaughtered for salvage. In cattle with botulism, administration of Vitamin AD3E and activated charcoal aid the clinical recovery. Besides, strictly avoiding anti-clostridial antibiotics, fluid therapy, and calcium therapy may facilitate the clinical recovery. Upon fluid administration, the pulmonary congestion existed in the ailing cattle might have worsened the anoxia. Administration of antibiotics like penicillin, aminoglycosides, and tetracyclines further worsen the neuronal paralysis by increasing the availability of botulinum neurotoxin. Cattle in early botulism have fair chances of recovery with the modified therapy.

Intravenous maintenance fluid therapy in children.

PubMed

McNab, Sarah

2016-02-01

Intravenous fluids are frequently used in paediatrics but have been associated with significant adverse outcomes. Understanding the composition of fluid prescribed and administering an appropriate rate is essential for safe fluid administration, along with regular monitoring. Recent evidence has shown that using an isotonic fluid with a sodium concentration similar to plasma can decrease the risk of hyponatraemia without an increase in adverse effects. This should lead to a change in guidelines: isotonic fluid should now be used as the primary maintenance intravenous fluid given to the majority of children. © 2016 The Author Journal of Paediatrics and Child Health © 2016 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Liberal Versus Restrictive Intravenous Fluid Therapy for Early Septic Shock: Rationale for a Randomized Trial.

PubMed

Self, Wesley H; Semler, Matthew W; Bellomo, Rinaldo; Brown, Samuel M; deBoisblanc, Bennett P; Exline, Matthew C; Ginde, Adit A; Grissom, Colin K; Janz, David R; Jones, Alan E; Liu, Kathleen D; Macdonald, Stephen P J; Miller, Chadwick D; Park, Pauline K; Reineck, Lora A; Rice, Todd W; Steingrub, Jay S; Talmor, Daniel; Yealy, Donald M; Douglas, Ivor S; Shapiro, Nathan I

2018-05-09

Prompt intravenous fluid therapy is a fundamental treatment for patients with septic shock. However, the optimal approach for administering intravenous fluid in septic shock resuscitation is unknown. Two competing strategies are emerging: a liberal fluids approach, consisting of a larger volume of initial fluid (50 to 75 mL/kg [4 to 6 L in an 80-kg adult] during the first 6 hours) and later use of vasopressors, versus a restrictive fluids approach, consisting of a smaller volume of initial fluid (≤30 mL/kg [≤2 to 3 L]), with earlier reliance on vasopressor infusions to maintain blood pressure and perfusion. Early fluid therapy may enhance or maintain tissue perfusion by increasing venous return and cardiac output. However, fluid administration may also have deleterious effects by causing edema within vital organs, leading to organ dysfunction and impairment of oxygen delivery. Conversely, a restrictive fluids approach primarily relies on vasopressors to reverse hypotension and maintain perfusion while limiting the administration of fluid. Both strategies have some evidence to support their use but lack robust data to confirm the benefit of one strategy over the other, creating clinical and scientific equipoise. As part of the National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Network, we designed a randomized clinical trial to compare the liberal and restrictive fluids strategies, the Crystalloid Liberal or Vasopressor Early Resuscitation in Sepsis trial. The purpose of this article is to review the current literature on approaches to early fluid resuscitation in adults with septic shock and outline the rationale for the upcoming trial. Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Evaporative Cooling Membrane Device

NASA Technical Reports Server (NTRS)

Lomax, Curtis (Inventor); Moskito, John (Inventor)

1999-01-01

An evaporative cooling membrane device is disclosed having a flat or pleated plate housing with an enclosed bottom and an exposed top that is covered with at least one sheet of hydrophobic porous material having a thin thickness so as to serve as a membrane. The hydrophobic porous material has pores with predetermined dimensions so as to resist any fluid in its liquid state from passing therethrough but to allow passage of the fluid in its vapor state, thereby, causing the evaporation of the fluid and the cooling of the remaining fluid. The fluid has a predetermined flow rate. The evaporative cooling membrane device has a channel which is sized in cooperation with the predetermined flow rate of the fluid so as to produce laminar flow therein. The evaporative cooling membrane device provides for the convenient control of the evaporation rates of the circulating fluid by adjusting the flow rates of the laminar flowing fluid.

Flight Engineer Donald R. Pettit making a valve adjustment to the FCPA

NASA Image and Video Library

2003-03-17

ISS006-E-39401 (17 March 2003) --- Astronaut Donald R. Pettit, Expedition Six NASA ISS science officer, makes a valve adjustment to the Fluid Control Pump Assembly (FCPA), which is a part of the Internal Thermal Control System (ITCS) in the Destiny laboratory on the International Space Station (ISS).

Flight Engineer Donald R. Pettit making a valve adjustment to the FCPA

NASA Image and Video Library

2003-03-17

ISS006-E-39400 (17 March 2003) --- Astronaut Donald R. Pettit, Expedition Six NASA ISS science officer, makes a valve adjustment to the Fluid Control Pump Assembly (FCPA), which is a part of the Internal Thermal Control System (ITCS) in the Destiny laboratory on the International Space Station (ISS).

7 CFR 1580.303 - Adjustment assistance payments.

Code of Federal Regulations, 2012 CFR

2012-01-01

.... (a) If the Administrator (FAS) determines that insufficient appropriated fiscal year funds are... transportation and substance payments and administrative and technical assistance costs, the Administrator (FAS...

7 CFR 1580.303 - Adjustment assistance payments.

Code of Federal Regulations, 2014 CFR

2014-01-01

.... (a) If the Administrator (FAS) determines that insufficient appropriated fiscal year funds are... transportation and substance payments and administrative and technical assistance costs, the Administrator (FAS...

7 CFR 1580.303 - Adjustment assistance payments.

Code of Federal Regulations, 2013 CFR

2013-01-01

.... (a) If the Administrator (FAS) determines that insufficient appropriated fiscal year funds are... transportation and substance payments and administrative and technical assistance costs, the Administrator (FAS...

Personalised fluid resuscitation in the ICU: still a fluid concept?

PubMed

van Haren, Frank

2017-12-28

The administration of intravenous fluid to critically ill patients is one of the most common, but also one of the most fiercely debated, interventions in intensive care medicine. Even though many thousands of patients have been enrolled in large trials of alternative fluid strategies, consensus remains elusive and practice is widely variable. Critically ill patients are significantly heterogeneous, making a one size fits all approach unlikely to be successful.New data from basic, animal, and clinical research suggest that fluid resuscitation could be associated with significant harm. There are several important limitations and concerns regarding fluid bolus therapy as it is currently being used in clinical practice. These include, but are not limited to: the lack of an agreed definition; limited and short-lived physiological effects; no evidence of an effect on relevant patient outcomes; and the potential to contribute to fluid overload, specifically when fluid responsiveness is not assessed and when targets and safety limits are not used.Fluid administration in critically ill patients requires clinicians to integrate abnormal physiological parameters into a clinical decision-making model that also incorporates the likely diagnosis and the likely risk or benefit in the specific patient's context. Personalised fluid resuscitation requires careful attention to the mnemonic CIT TAIT: context, indication, targets, timing, amount of fluid, infusion strategy, and type of fluid.The research agenda should focus on experimental and clinical studies to: improve our understanding of the physiological effects of fluid infusion, e.g. on the glycocalyx; evaluate new types of fluids; evaluate novel fluid minimisation protocols; study the effects of a no-fluid strategy for selected patients and scenarios; and compare fluid therapy with other interventions. The adaptive platform trial design may provide us with the tools to evaluate these types of interventions in the intrinsically heterogeneous intensive care unit population, accounting for the explicit assumption that treatment effects may be heterogeneous.

In vivo effects of meloxicam and aspirin on blood, gastric mucosal, and synovial fluid prostanoid synthesis in dogs.

PubMed

Jones, Christopher J; Streppa, Heather K; Harmon, Barry G; Budsberg, Steven C

2002-11-01

To evaluate in vivo activity in dogs of meloxicam or aspirin, previously shown in vitro to be a selective cyclooxygenase-2 (COX-2) inhibitor (COX-1 sparing drug), or a nonselective COX inhibitor, respectively. 12 male dogs with unilateral osteoarthritis of the stifle joint. Each dog was treated in a crossover design with aspirin or meloxicam for 21 days. Prostaglandin E2 (PGE2) concentrations were measured at days 0 (baseline), 7, and 21 of each treatment period in lipopolysaccharide (LPS)-stimulated blood, synovial fluid collected by arthrocentesis, and endoscopic gastric mucosal biopsy specimens. Thromboxane B2 (TXB2) was evaluated in blood on days 0, 7, and 21 of each treatment period. Aspirin administration significantly suppressed PGE2 concentrations in blood, gastric mucosa, synovial fluid, and suppressed TXB2 concentration in blood at days 7 and 21. Meloxicam administration significantly suppressed PGE2 concentrations in blood and synovial fluid at days 7 and 21, but had no effect on concentrations of TXB2 in blood or PGE2 in gastric mucosa. Suppression of LPS-stimulated PGE2 concentrations in blood and synovial fluid by aspirin and meloxicam administration is consistent with activity against the COX-2 isoenzyme. Suppression of concentrations of PGE2 in the gastric mucosa and TXB2 in blood by aspirin administration is consistent with activity against COX-1. Meloxicam, in contrast, had a minimal effect on functions mediated by COX-1. Meloxicam acts in vivo in dogs as a COX-1 sparing drug on target tissues by sparing gastric PGE2 synthesis while retaining antiprostaglandin effects within inflamed joints.

Segment-specific resistivity improves body fluid volume estimates from bioimpedance spectroscopy in hemodialysis patients.

PubMed

Zhu, F; Kuhlmann, M K; Kaysen, G A; Sarkar, S; Kaitwatcharachai, C; Khilnani, R; Stevens, L; Leonard, E F; Wang, J; Heymsfield, S; Levin, N W

2006-02-01

Discrepancies in body fluid estimates between segmental bioimpedance spectroscopy (SBIS) and gold-standard methods may be due to the use of a uniform value of tissue resistivity to compute extracellular fluid volume (ECV) and intracellular fluid volume (ICV). Discrepancies may also arise from the exclusion of fluid volumes of hands, feet, neck, and head from measurements due to electrode positions. The aim of this study was to define the specific resistivity of various body segments and to use those values for computation of ECV and ICV along with a correction for unmeasured fluid volumes. Twenty-nine maintenance hemodialysis patients (16 men) underwent body composition analysis including whole body MRI, whole body potassium (40K) content, deuterium, and sodium bromide dilution, and segmental and wrist-to-ankle bioimpedance spectroscopy, all performed on the same day before a hemodialysis. Segment-specific resistivity was determined from segmental fat-free mass (FFM; by MRI), hydration status of FFM (by deuterium and sodium bromide), tissue resistance (by SBIS), and segment length. Segmental FFM was higher and extracellular hydration of FFM was lower in men compared with women. Segment-specific resistivity values for arm, trunk, and leg all differed from the uniform resistivity used in traditional SBIS algorithms. Estimates for whole body ECV, ICV, and total body water from SBIS using segmental instead of uniform resistivity values and after adjustment for unmeasured fluid volumes of the body did not differ significantly from gold-standard measures. The uniform tissue resistivity values used in traditional SBIS algorithms result in underestimation of ECV, ICV, and total body water. Use of segmental resistivity values combined with adjustment for body volumes that are neglected by traditional SBIS technique significantly improves estimations of body fluid volume in hemodialysis patients.

One-step method for the production of nanofluids

DOEpatents

Kostic, Milivoje [Chicago, IL; Golubovic, Mihajlo [Chicago, IL; Hull, John R [Downers Grove, IL; Choi, Stephen U. S. [Napersville, IL

2010-05-18

A one step method and system for producing nanofluids by a particle-source evaporation and deposition of the evaporant into a base fluid. The base fluid such (i.e. ethylene glycol) is placed in a rotating cylindrical drum having an adjustable heater-boat-evaporator and heat exchanger-cooler apparatus. As the drum rotates, a thin liquid layer is formed on the inside surface of the drum. A heater-boat-evaporator having an evaporant material (particle-source) placed within its boat evaporator is adjustably positioned near a portion of the rotating thin liquid layer, the evaporant material being heated thereby evaporating a portion of the evaporant material, the evaporated material absorbed by the liquid film to form nanofluid.

Separator

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

Ashbrook, C.L.

1970-09-22

A separator consists of a housing having an upper fluid inlet and a lower fluid outlet in the sides of the housing. An inverted conical tube is disposed internally of the housing and is in fluid communication with the fluid inlet. The upper fluid inlet tangentially intersects the inverted conical tube so as to create a rotating vortex upon introduction of the mixture. Axially disposed within the vortex tube at the upper end is a withdrawal tube for removing lighter mixture components that are drawn toward the center of the tube. At the lower end of the vortex tube ismore » an adjustable impact plate for transmitting a concussion wave through the vortexed body, so as to cause cavitation. Heavier mixture components gravitate toward the lower fluid outlet and are withdrawn through it. (7 claims)« less

The iodide space in rabbit brain

PubMed Central

Ahmed, Nawal; Van Harreveld, A.

1969-01-01

1. The iodide space in rabbit brain varies greatly depending on the conditions under which it is determined. 2. When 131I- only is used the iodide space 4 hr after administration of the marker is of the order of 2%. The iodide content of the cerebrospinal fluid (c.s.f.) is about 1% of that of the serum. 3. Depression of the active iodide transport by perchlorate increases the space to 8·2% and the iodide content of the c.s.f. to 26% of that of the serum. 4. The active iodide transport can also be depressed by saturation with unlabelled iodide. Up to a serum iodide concentration of 5 mM the space determined after 5 hr remained constant at 2·7%. The iodide space grew when the serum iodide content was enhanced from 5 to 20 mM, to become constant at a value of 10·6% on further increase of the serum iodide (up to 50 mM). The iodide content of the c.s.f. increased in a similar manner as the space with the iodide concentration of the serum to about 1/3 of the serum concentration. The iodide space of the muscle was independent of the plasma iodide content. 5. From 4 to 8 hr after administration of 131I- alone or with unlabelled iodide (to a serum concentration of 15 mM) the iodide space remained relatively constant. 6. When 131I- was administered in the fluid with which the ventricles were perfused an iodide space of about 7% was attained after about 5 hr. 7. In experiments in which 131I- was administered intravenously and the sink action of the c.s.f. was eliminated by perfusion of the ventricles with a perfusate containing as much 131I- as the plasma, the iodide space was 10·2%. When in addition active iodide transport was depressed by perchlorate the space increased to 16·8%. 8. Intravenous administration of labelled and unlabelled iodide (to a serum concentration of 20-40 mM) and ventricle perfusion with the same concentration of 131I- and unlabelled iodide as in the plasma yielded an iodide space of 20·8%. In similar experiments the iodide concentration of the perfusate was so adjusted that after 5 hr perfusion its iodide content hardly changed during the passage through the ventricles. Under these conditions the iodide concentration of the extracellular and perfusion fluids can be considered to be near equal. The iodide space computed on the basis of the iodide content of the outflowing fluid was 22·5%. 9. The large iodide space could be equated with the extracellular space if the iodide remained extracellular. This seems to be the case in the muscle where the iodide space is similar to the inulin space. 10. The large effects on the iodide space of perchlorate and saturation with unlabelled iodide in experiments in which the marker was administered intravenously and in the perfusate (7 and 8) suggests the presence of an active iodide transport from the brain extracellular fluid into the blood over the blood—brain barrier. PMID:4310942

Perioperative Fluid Therapy.

PubMed

Fantoni, Denise; Shih, Andre C

2017-03-01

Anesthesia can lead to pathophysiologic changes that dramatically alter the fluid balance of the body compartments and the intravascular space. Fluid administration can be monitored and evaluated using static and dynamic indexes. Guidelines for fluid rates during anesthesia begin with 3 mL/kg/h in cats and 5 mL/kg/h in dogs. If at all possible, patients should be stabilized and electrolyte disturbances should be corrected before general anesthesia. Copyright © 2016 Elsevier Inc. All rights reserved.

Perioperative fluid management: comparison of high, medium and low fluid volume on tissue oxygen pressure in the small bowel and colon.

PubMed

Hiltebrand, L B; Pestel, G; Hager, H; Ratnaraj, J; Sigurdsson, G H; Kurz, A

2007-11-01

Insufficient blood flow and oxygenation in the intestinal tract is associated with increased incidence of postoperative complications after bowel surgery. High fluid volume administration may prevent occult regional hypoperfusion and intestinal tissue hypoxia. We tested the hypothesis that high intraoperative fluid volume administration increases intestinal wall tissue oxygen pressure during laparotomy. In all, 27 pigs were anaesthetized, ventilated and randomly assigned to one of the three treatment groups (n = 9 in each) receiving low (3 mL kg-1 h-1), medium (7 mL kg-1 h-1) or high (20 mL kg-1 h-1) fluid volume treatment with lactated Ringer's solution. All animals received 30% and 100% inspired oxygen in random order. Cardiac index was measured with thermodilution and tissue oxygen pressure with a micro-oximetry system in the jejunum and colon wall and subcutaneous tissue. Groups receiving low and medium fluid volume treatment had similar systemic haemodynamics. The high fluid volume group had significantly higher mean arterial pressure, cardiac index and subcutaneous tissue oxygenation. Tissue oxygen pressures in the jejunum and colon were comparable in all three groups. The three different fluid volume regimens tested did not affect tissue oxygen pressure in the jejunum and colon, suggesting efficient autoregulation of intestinal blood flow in healthy subjects undergoing uncomplicated abdominal surgery.

5 CFR 591.227 - What adjustment factors does OPM add to the price indexes?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false What adjustment factors does OPM add to the price indexes? 591.227 Section 591.227 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS ALLOWANCES AND DIFFERENTIALS Cost-of-Living Allowance and Post Differential-Nonforeign Areas Cost-Of-Living Allowances §...

18 CFR 382.201 - Annual charges under Parts II and III of the Federal Power Act and related statutes.

Code of Federal Regulations, 2010 CFR

2010-04-01

... annual charges to be assessed to power marketing agencies. The adjusted costs of administration of the... Act and related statutes. (a) Determination of costs to be assessed to public utilities. The adjusted costs of administration of the electric regulatory program, excluding the costs of regulating the Power...

78 FR 70531 - Notice of Petitions by Firms for Determination of Eligibility To Apply for Trade Adjustment...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-26

... DEPARTMENT OF COMMERCE Economic Development Administration Notice of Petitions by Firms for Determination of Eligibility To Apply for Trade Adjustment Assistance AGENCY: Economic Development Administration, Department of Commerce. ACTION: Notice and opportunity for public comment. Pursuant to Section 251 of the Trade Act 1974, as amended (19...

78 FR 77648 - Notice of Petitions by Firms for Determination of Eligibility To Apply for Trade Adjustment...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-24

... DEPARTMENT OF COMMERCE Economic Development Administration Notice of Petitions by Firms for Determination of Eligibility To Apply for Trade Adjustment Assistance AGENCY: Economic Development Administration, Department of Commerce ACTION: Notice and Opportunity for Public Comment Pursuant to Section 251 of the Trade Act 1974, as amended (19 U.S.C...

78 FR 68025 - Notice of Petitions by Firms for Determination of Eligibility To Apply for Trade Adjustment...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-13

... DEPARTMENT OF COMMERCE Economic Development Administration Notice of Petitions by Firms for Determination of Eligibility To Apply for Trade Adjustment Assistance AGENCY: Economic Development Administration, Department of Commerce. ACTION: Notice and opportunity for public comment. Pursuant to Section 251 of the Trade Act 1974, as amended (19...

78 FR 75330 - Notice of Petitions by Firms for Determination of Eligibility To Apply for Trade Adjustment...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-11

... DEPARTMENT OF COMMERCE Economic Development Administration Notice of Petitions by Firms for Determination of Eligibility To Apply for Trade Adjustment Assistance AGENCY: Economic Development Administration, Department of Commerce. ACTION: Notice and opportunity for public comment. Pursuant to Section 251 of the Trade Act 1974, as amended (19...

78 FR 57257 - Medicare Determinations and Income-Related Monthly Adjustment Amounts to Medicare Part B Premiums...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-18

...; Conforming Changes to Regulations AGENCY: Social Security Administration. ACTION: Interim final rule with... monthly adjustment amounts (IRMAA) in order to conform to changes made to the Social Security Act (Act) by... SOCIAL SECURITY ADMINISTRATION 20 CFR Parts 404 and 418 [Docket No. SSA-2012-0011] RIN 0960-AH47...

A population health approach to reducing observational intensity bias in health risk adjustment: cross sectional analysis of insurance claims.

PubMed

Wennberg, David E; Sharp, Sandra M; Bevan, Gwyn; Skinner, Jonathan S; Gottlieb, Daniel J; Wennberg, John E

2014-04-10

To compare the performance of two new approaches to risk adjustment that are free of the influence of observational intensity with methods that depend on diagnoses listed in administrative databases. Administrative data from the US Medicare program for services provided in 2007 among 306 US hospital referral regions. Cross sectional analysis. 20% sample of fee for service Medicare beneficiaries residing in one of 306 hospital referral regions in the United States in 2007 (n = 5,153,877). The effect of health risk adjustment on age, sex, and race adjusted mortality and spending rates among hospital referral regions using four indices: the standard Centers for Medicare and Medicaid Services--Hierarchical Condition Categories (HCC) index used by the US Medicare program (calculated from diagnoses listed in Medicare's administrative database); a visit corrected HCC index (to reduce the effects of observational intensity on frequency of diagnoses); a poverty index (based on US census); and a population health index (calculated using data on incidence of hip fractures and strokes, and responses from a population based annual survey of health from the Centers for Disease Control and Prevention). Estimated variation in age, sex, and race adjusted mortality rates across hospital referral regions was reduced using the indices based on population health, poverty, and visit corrected HCC, but increased using the standard HCC index. Most of the residual variation in age, sex, and race adjusted mortality was explained (in terms of weighted R2) by the population health index: R2=0.65. The other indices explained less: R2=0.20 for the visit corrected HCC index; 0.19 for the poverty index, and 0.02 for the standard HCC index. The residual variation in age, sex, race, and price adjusted spending per capita across the 306 hospital referral regions explained by the indices (in terms of weighted R2) were 0.50 for the standard HCC index, 0.21 for the population health index, 0.12 for the poverty index, and 0.07 for the visit corrected HCC index, implying that only a modest amount of the variation in spending can be explained by factors most closely related to mortality. Further, once the HCC index is visit corrected it accounts for almost none of the residual variation in age, sex, and race adjusted spending. Health risk adjustment using either the poverty index or the population health index performed substantially better in terms of explaining actual mortality than the indices that relied on diagnoses from administrative databases; the population health index explained the majority of residual variation in age, sex, and race adjusted mortality. Owing to the influence of observational intensity on diagnoses from administrative databases, the standard HCC index over-adjusts for regional differences in spending. Research to improve health risk adjustment methods should focus on developing measures of risk that do not depend on observation influenced diagnoses recorded in administrative databases.

A protocol guided by transpulmonary thermodilution and lactate levels for resuscitation of patients with severe burns.

PubMed

Berger, Mette M; Que, Yok Ai

2013-11-11

Over-resuscitation is deleterious in many critically ill conditions, including major burns. For more than 15 years, several strategies to reduce fluid administration in burns during the initial resuscitation phase have been proposed, but no single or simple parameter has shown superiority. Fluid administration guided by invasive hemodynamic parameters usually resulted in over-resuscitation. As reported in the previous issue of Critical Care, Sánchez-Sánchez and colleagues analyzed the performance of a 'permissive hypovolemia' protocol guided by invasive hemodynamic parameters (PiCCO, Pulsion Medical Systems, Munich, Germany) and vital signs in a prospective cohort over a 3-year period. The authors' results confirm that resuscitation can be achieved with below-normal levels of preload but at the price of a fluid administration greater than predicted by the Parkland formula (2 to 4 mL/kg per% burn). The classic approach based on an adapted Parkland equation may still be the simplest until further studies identify the optimal bundle of resuscitation goals.

A comparison of administrative and physiologic predictive models in determining risk adjusted mortality rates in critically ill patients.

PubMed

Enfield, Kyle B; Schafer, Katherine; Zlupko, Mike; Herasevich, Vitaly; Novicoff, Wendy M; Gajic, Ognjen; Hoke, Tracey R; Truwit, Jonathon D

2012-01-01

Hospitals are increasingly compared based on clinical outcomes adjusted for severity of illness. Multiple methods exist to adjust for differences between patients. The challenge for consumers of this information, both the public and healthcare providers, is interpreting differences in risk adjustment models particularly when models differ in their use of administrative and physiologic data. We set to examine how administrative and physiologic models compare to each when applied to critically ill patients. We prospectively abstracted variables for a physiologic and administrative model of mortality from two intensive care units in the United States. Predicted mortality was compared through the Pearsons Product coefficient and Bland-Altman analysis. A subgroup of patients admitted directly from the emergency department was analyzed to remove potential confounding changes in condition prior to ICU admission. We included 556 patients from two academic medical centers in this analysis. The administrative model and physiologic models predicted mortalities for the combined cohort were 15.3% (95% CI 13.7%, 16.8%) and 24.6% (95% CI 22.7%, 26.5%) (t-test p-value<0.001). The r(2) for these models was 0.297. The Bland-Atlman plot suggests that at low predicted mortality there was good agreement; however, as mortality increased the models diverged. Similar results were found when analyzing a subgroup of patients admitted directly from the emergency department. When comparing the two hospitals, there was a statistical difference when using the administrative model but not the physiologic model. Unexplained mortality, defined as those patients who died who had a predicted mortality less than 10%, was a rare event by either model. In conclusion, while it has been shown that administrative models provide estimates of mortality that are similar to physiologic models in non-critically ill patients with pneumonia, our results suggest this finding can not be applied globally to patients admitted to intensive care units. As patients and providers increasingly use publicly reported information in making health care decisions and referrals, it is critical that the provided information be understood. Our results suggest that severity of illness may influence the mortality index in administrative models. We suggest that when interpreting "report cards" or metrics, health care providers determine how the risk adjustment was made and compares to other risk adjustment models.

Sleep Apnea and Circadian Extracellular Fluid Change as Independent Factors for Nocturnal Polyuria.

PubMed

Niimi, Aya; Suzuki, Motofumi; Yamaguchi, Yasuhiro; Ishii, Masaki; Fujimura, Tetsuya; Nakagawa, Tohru; Fukuhara, Hiroshi; Kume, Haruki; Igawa, Yasuhiko; Akishita, Masahiro; Homma, Yukio

2016-10-01

We investigated the relationships among nocturnal polyuria, sleep apnea and body fluid volume to elucidate the pathophysiology of nocturia in sleep apnea syndrome. We enrolled 104 consecutive patients who underwent polysomnography for suspected sleep apnea syndrome. Self-assessed symptom questionnaires were administered to evaluate sleep disorder and lower urinary tract symptoms, including nocturia. Voiding frequency and voided volume were recorded using a 24-hour frequency-volume chart. Body fluid composition was estimated in the morning and at night using bioelectric impedance analysis. Frequency-volume chart data were analyzed in 22 patients after continuous positive airway pressure therapy. Patients with nocturnal polyuria showed a higher apnea-hypopnea index (33.9 vs 24.2, p = 0.03) and a larger circadian change in extracellular fluid adjusted to lean body mass (0.22 vs -0.19, p = 0.019) than those without nocturnal polyuria. These relations were more evident in patients 65 years old or older than in those 64 years or younger. A multivariate linear regression model showed an independent relationship of nocturnal polyuria with the apnea-hypopnea index and the circadian change in extracellular fluid adjusted to lean body mass (p = 0.0012 and 0.022, respectively). Continuous positive airway pressure therapy significantly improved nocturnal polyuria and nocturia only in patients with nocturnal polyuria. This study identified sleep apnea and the circadian change in extracellular fluid as independent factors for nocturnal polyuria. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Enhanced oral bioavailability of paclitaxel by solid dispersion granulation.

PubMed

Shanmugam, Srinivasan; Im, Ho Taek; Sohn, Young Taek; Kim, Yong-Il; Park, Jae-Hyun; Park, Eun-Seok; Woo, Jong Soo

2015-01-01

The main objective of this study was to develop novel orally administrable tablets containing solid dispersion granules (SDG) of amorphous paclitaxel (PTX) prepared by fluid bed technology, and to evaluate its in vitro dissolution and in vivo pharmacokinetics (PK) in beagle dogs. The SDG were prepared using optimized composition by fluid bed technology, and characterized for solid-state properties. The release study of SDG tablet (SDG-T) in simulated gastric fluid showed a rapid release of PTX, reaching maximum dissolution within 20 min. Finally, the PK profile of SDG-T and a reference formulation Oraxol™ (oral solution formulation used in Phase I clinical study) at a dose of 60 mg orally with co-administration of P-gp inhibitor HM38101, and Taxol® at a dose of 10 mg intravenously (i.v.) was investigated in beagle dogs. The mean absolute BA% of PTX following SDG-T and Oraxol™ solution was 8.23 and 6.22% in comparison to i.v. administration of Taxol®. The relative BA% of PTX from SDG-T in comparison to Oraxol™ solution was 132.25% at a dose of 60 mg following oral administration. In conclusion, we have successfully prepared PTX tablets with solid dispersion granules (SDG) of amorphous PTX using fluid bed technology that could provide plasma PTX concentration in the range of 10-150 ng/mL for a period of 24 h following oral administration in dogs with a P-gp inhibitor. Hence, this could be a promising formulation for PTX oral delivery and could be used in our intended clinical studies following pre-clinical efficacy studies.

Anti-tau antibody administration increases plasma tau in transgenic mice and patients with tauopathy

PubMed Central

Yanamandra, Kiran; Patel, Tirth K.; Jiang, Hong; Schindler, Suzanne; Ulrich, Jason D.; Boxer, Adam L.; Miller, Bruce L.; Kerwin, Diana R.; Gallardo, Gilbert; Stewart, Floy; Finn, Mary Beth; Cairns, Nigel J.; Verghese, Philip B.; Fogelman, Ilana; West, Tim; Braunstein, Joel; Robinson, Grace; Keyser, Jennifer; Roh, Joseph; Knapik, Stephanie S.; Hu, Yan; Holtzman, David M.

2017-01-01

Tauopathies are a group of disorders in which the cytosolic protein tau aggregates and accumulates in cells within the brain, resulting in neurodegeneration. A promising treatment being explored for tauopathies is passive immunization with anti-tau antibodies. We previously found that administration of an anti-tau antibody to human tau transgenic mice increased the concentration of plasma tau. We further explored the effects of administering an anti-tau antibody on plasma tau. After peripheral administration of an anti-tau antibody to human patients with tauopathy and to mice expressing human tau in the central nervous system, there was a dose-dependent increase in plasma tau. In mouse plasma, we found that tau had a short half-life of 8 min that increased to more than 3 hours after administration of anti-tau antibody. As tau transgenic mice accumulated insoluble tau in the brain, brain soluble and interstitial fluid tau decreased. Administration of anti-tau antibody to tau transgenic mice that had decreased brain soluble tau and interstitial fluid tau resulted in an increase in plasma tau, but this increase was less than that observed in tau transgenic mice without these brain changes. Tau transgenic mice subjected to acute neuronal injury using 3-nitropropionic acid showed increased interstitial fluid tau and plasma tau. These data suggest that peripheral administration of an anti-tau antibody results in increased plasma tau, which correlates with the concentration of extracellular and soluble tau in the brain. PMID:28424326

48 CFR 43.204 - Administration.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 1 2013-10-01 2013-10-01 false Administration. 43.204... CONTRACT MODIFICATIONS Change Orders 43.204 Administration. (a) Change order documentation. When change... adjusting the contract delivery schedule. (3) Contracting offices and contract administration offices, as...

48 CFR 43.204 - Administration.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 1 2012-10-01 2012-10-01 false Administration. 43.204... CONTRACT MODIFICATIONS Change Orders 43.204 Administration. (a) Change order documentation. When change... adjusting the contract delivery schedule. (3) Contracting offices and contract administration offices, as...

48 CFR 43.204 - Administration.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Administration. 43.204... CONTRACT MODIFICATIONS Change Orders 43.204 Administration. (a) Change order documentation. When change... adjusting the contract delivery schedule. (3) Contracting offices and contract administration offices, as...

Calcium-Mediated Adhesion of Nanomaterials in Reservoir Fluids.

PubMed

Eichmann, Shannon L; Burnham, Nancy A

2017-09-14

Globally, a small percentage of oil is recovered from reservoirs using primary and secondary recovery mechanisms, and thus a major focus of the oil industry is toward developing new technologies to increase recovery. Many new technologies utilize surfactants, macromolecules, and even nanoparticles, which are difficult to deploy in harsh reservoir conditions and where failures cause material aggregation and sticking to rock surfaces. To combat these issues, typically material properties are adjusted, but recent studies show that adjusting the dispersing fluid chemistry could have significant impact on material survivability. Herein, the effect of injection fluid salinity and composition on nanomaterial fate is explored using atomic force microscopy (AFM). The results show that the calcium content in reservoir fluids affects the interactions of an AFM tip with a calcite surface, as surrogates for nanomaterials interacting with carbonate reservoir rock. The extreme force sensitivity of AFM provides the ability to elucidate small differences in adhesion at the pico-Newton (pN) level and provides direct information about material survivability. Increasing the calcium content mitigates adhesion at the pN-scale, a possible means to increase nanomaterial survivability in oil reservoirs or to control nanomaterial fate in other aqueous environments.

14 CFR 25.1727 - Flammable fluid shutoff means: EWIS.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Flammable fluid shutoff means: EWIS. 25.1727 Section 25.1727 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Electrical Wiring Interconnection...

14 CFR 25.1723 - Flammable fluid fire protection: EWIS.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Flammable fluid fire protection: EWIS. 25.1723 Section 25.1723 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES Electrical Wiring Interconnection...

Growth and Morphology of Supercritical Fluids Studied in Microgravity on Mir

NASA Technical Reports Server (NTRS)

Wilkinson, R. Allen

2000-01-01

The Growth and Morphology of Supercritical Fluids (GMSF) is an international experiment facilitated by the NASA Glenn Research Center at Lewis Field and under the guidance of U.S. principal investigator Professor John Hegseth of the University of New Orleans and three French coinvestigators Daniel Beysens, Yves Garrabos, and Carole Chabot. In early 1999, GMSF experiments were operated for 20 days on the Russian Space Station Mir. Mir astronauts performed experiments One through Seven, which spanned the three science themes of near-critical phase separation rates, interface dynamics in near-critical boiling, and measurement of the spectrum of density fluctuation length scales very close to the critical point. The fluids used were pure CO2 or SF6. Three of the five thermostats used could adjust the sample volume with the scheduled crew time. Such a volume adjustment enabled variable sample densities around the critical density as well as pressure steps (as distinct from the usual temperature steps) to be applied to the sample.

76 FR 10500 - Nationally Recognized Testing Laboratories Fees

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-25

... Administration (OSHA), Labor. ACTION: Final rule. SUMMARY: The Occupational Safety and Health Administration... Signature I. Introduction The Occupational Safety and Health Administration (OSHA) is adjusting the approach... DEPARTMENT OF LABOR Occupational Safety and Health Administration 29 CFR Part 1910 [Docket No...

Mechanism of gastrointestinal abnormal motor activity induced by cisplatin in conscious dogs.

PubMed

Ando, Hiroyuki; Mochiki, Erito; Ohno, Tetsuro; Yanai, Mitsuhiro; Toyomasu, Yoshitaka; Ogata, Kyoichi; Tabe, Yuichi; Aihara, Ryuusuke; Nakabayashi, Toshihiro; Asao, Takayuki; Kuwano, Hiroyuki

2014-11-14

To investigate whether 5-hydroxytryptamine (serotonin; 5-HT) is involved in mediating abnormal motor activity in dogs after cisplatin administration. After the dogs had been given a 2-wk recovery period, all of them were administered cisplatin, and the motor activity was recorded using strain gauge force transducers. Blood and intestinal fluid samples were collected to measure 5-HT for 24 h. To determine whether 5-HT in plasma or that in intestinal fluids is more closely related to abnormal motor activity we injected 5-HT into the bloodstream and the intestinal tract of the dogs. Cisplatin given intravenously produced abnormal motor activity that lasted up to 5 h. From 3 to 4 h after cisplatin administration, normal intact dogs exhibited retropropagation of motor activity accompanied by emesis. The concentration of 5-HT in plasma reached the peak at 4 h, and that in intestinal fluids reached the peak at 3 h. In normal intact dogs with resection of the vagus nerve that were administered kytril, cisplatin given intravenously did not produce abnormal motor activity. Intestinal serotonin administration did not produce abnormal motor activity, but intravenous serotonin administration did. After the intravenous administration of cisplatin, abnormal motor activity was produced in the involved vagus nerve and in the involved serotonergic neurons via another pathway. This study was the first to determine the relationship between 5-HT and emesis-induced motor activity.

One-step formation of multiple emulsions in microfluidics.

PubMed

Abate, Adam R; Thiele, Julian; Weitz, David A

2011-01-21

We present a robust way to create multiple emulsions with controllable shell thicknesses that can vary over a wide range. We use a microfluidic device to create a coaxial jet of immiscible fluids; using a dripping instability, we break the jet into multiple emulsions. By controlling the thickness of each layer of the jet, we adjust the thicknesses of the shells of the multiple emulsions. The same method is also effective in creating monodisperse emulsions from fluids that cannot otherwise be controllably emulsified, such as, for example, viscoelastic fluids.

Feasibility of using a personal digital assistant to self-monitor diet and fluid intake: a pilot study.

PubMed

Welch, Janet; Dowell, Shannon; Johnson, Cynthia S

2007-01-01

The feasibility of using an electronic device to self-monitor diet and fluid intake was assessed using the treatment implementation model. The three patients on hemodialysis who participated in this pilot study were asked to self-monitor diet and fluid intake for 12 weeks with a personal digital assistant. The intervention was delivered as intended; however, participants reported problems with usability, and compliance to self-monitoring was lower than desirable. Further adjustments to the intervention will be made before testing efficacy.

75 FR 23225 - Trade Adjustment Assistance for Farmers

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-03

... DEPARTMENT OF AGRICULTURE Foreign Agricultural Service Trade Adjustment Assistance for Farmers AGENCY: Foreign Agricultural Service, USDA. ACTION: Notice. The Administrator, Foreign Agricultural... program information can be obtained at the Web site for the Trade Adjustment Assistance for Farmers...

75 FR 16987 - Trade Adjustment Assistance; Merit Staffing of State Administration and Allocation of Training...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-02

...The Employment and Training Administration (ETA) of the Department of Labor (Department) issues this final rule to implement changes to the regulations for the Trade Adjustment Assistance for Workers (TAA) program under the Trade Act of 1974, as amended (Trade Act). This rule requires that personnel engaged in TAA-funded functions undertaken to carry out the worker adjustment assistance provisions must be State employees covered by a merit system of personnel administration. This rule also prescribes the system for allocating training funds to the States, as required by amendments to the Trade Act contained in the American Recovery and Reinvestment Act of 2009, commonly called the Recovery Act. The Recovery Act included provisions which reauthorized and significantly amended the TAA program.

Therapeutic management of botulism in dairy cattle

PubMed Central

Pandian, S. Jegaveera; Subramanian, M.; Vijayakumar, G.; Balasubramaniam, G. A.; Sukumar, K.

2015-01-01

Aim: To report the successful recovery of few dairy cattle from botulism in response to a modified therapeutic strategy. Materials and Methods: Seventy four naturally-occurring clinical cases of bovine botulism encountered during the period of 2012-2014 which were confirmed by mouse lethality test became material for this study. Affected animals were made into three groups based on the treatment modifications made during the course of study. Results and Discussion: With the modified therapeutic regimen, 17 animals recovered after 7-10 days of treatment. Clinical recovery took 2-30 days. Animals which were not given intravenous fluid and calcium recovered uneventfully. Cattle which were already treated with intravenous fluids, calcium borogluconate, and antibiotics did not recover. They were either died or slaughtered for salvage. Conclusion: In cattle with botulism, administration of Vitamin AD3E and activated charcoal aid the clinical recovery. Besides, strictly avoiding anti-clostridial antibiotics, fluid therapy, and calcium therapy may facilitate the clinical recovery. Upon fluid administration, the pulmonary congestion existed in the ailing cattle might have worsened the anoxia. Administration of antibiotics like penicillin, aminoglycosides, and tetracyclines further worsen the neuronal paralysis by increasing the availability of botulinum neurotoxin. Cattle in early botulism have fair chances of recovery with the modified therapy. PMID:27047034

5 CFR 591.228 - How does OPM convert the price index plus adjustment factor to a COLA rate?

Code of Federal Regulations, 2013 CFR

2013-01-01

... adjustment factor to a COLA rate? 591.228 Section 591.228 Administrative Personnel OFFICE OF PERSONNEL... adjustment factor to a COLA rate? (a) OPM converts the price index plus the adjustment factor to a COLA rate as shown in the following table: Price index plus adjustment factor COLA rate subject to paragraph (b...

5 CFR 591.228 - How does OPM convert the price index plus adjustment factor to a COLA rate?

Code of Federal Regulations, 2012 CFR

2012-01-01

... adjustment factor to a COLA rate? 591.228 Section 591.228 Administrative Personnel OFFICE OF PERSONNEL... adjustment factor to a COLA rate? (a) OPM converts the price index plus the adjustment factor to a COLA rate as shown in the following table: Price index plus adjustment factor COLA rate subject to paragraph (b...

5 CFR 591.228 - How does OPM convert the price index plus adjustment factor to a COLA rate?

Code of Federal Regulations, 2011 CFR

2011-01-01

... adjustment factor to a COLA rate? 591.228 Section 591.228 Administrative Personnel OFFICE OF PERSONNEL... adjustment factor to a COLA rate? (a) OPM converts the price index plus the adjustment factor to a COLA rate as shown in the following table: Price index plus adjustment factor COLA rate subject to paragraph (b...

5 CFR 591.228 - How does OPM convert the price index plus adjustment factor to a COLA rate?

Code of Federal Regulations, 2014 CFR

2014-01-01

... adjustment factor to a COLA rate? 591.228 Section 591.228 Administrative Personnel OFFICE OF PERSONNEL... adjustment factor to a COLA rate? (a) OPM converts the price index plus the adjustment factor to a COLA rate as shown in the following table: Price index plus adjustment factor COLA rate subject to paragraph (b...

[Volume assessment in the acute heart and renal failure].

PubMed

Vujicić, Bozidar; Ruzić, Alen; Zaputović, Luka; Racki, Sanjin

2012-10-01

Acute kidney injury (AKI) is an important clinical issue, especially in the setting of critical care. It has been shown in multiple studies to be a key independent risk factor for mortality, even after adjustment for demographics and severity of illness. There is wide agreement that a generally applicable classification system is required for AKI which helps to standardize estimation of severity of renal disfunction and to predict outcome associated with this condition. That's how RIFLE (Risk-Injury-Failure-Loss-End-stage renal disease), and AKIN (Acute Kidney Injury Network) classifications for AKI were found in 2004 and 2007, respectively. In the clinical setting of heart failure, a positive fluid balance (often expressed in the literature as weight gain) is used by disease management programs as a marker of heart failure decompensation. Oliguria is defined as urine output less than 0,3 ml/kg/h for at least 24 h. Since any delay in treatment can lead to a dangerous progression of the AKI, early recognition of oliguria appears to be crucial. Critically ill patients with oliguric AKI are at increased risk for fluid imbalance due to widespread systemic inflammation, reduced plasma oncotic pressure and increased capillary leak. These patients are particulary at risk of fluid overload and therefore restrictive strategy of fluid administration should be used. Objective, rapid and accurate volume assessment is important in undiagnosed patients presenting with critical illness, as errors may result in interventions with fatal outcomes. The historical tools such as physical exam, and chest radiography suffer from significant limitations. As gold standard, radioisolopic measurement of volume is impractical in the acute care enviroment. Newer technologies offer the promise of both rapid and accurate bedside estimation of volume status with the potential to improve clinical outcomes. Blood assessment with bioimpendance vector analysis, and bedside ultrasound seem to be promising technologies for this need.

One-step method for the production of nanofluids

DOEpatents

Kostic, Milivoje [Sycamore, IL; Golubovic, Mihajlo [Chicago, IL; Hull, John [Downers Grove, IL; Choi, Stephen U. S. [Naperville, IL

2011-08-16

A one step method and system for producing nanofluids by a nanoparticle-source evaporation and deposition of the evaporant into a base fluid. The base fluid such oil or ethylene glycol is placed in a rotating cylindrical drum having an adjustable heater-boat-evaporator and heat exchanger-cooler apparatus. As the drum rotates, a thin liquid layer is formed on the inside surface of the drum. An insulated heater-boat-evaporator having an evaporant material (nanoparticle-source) placed within its boat evaporator is adjustably positioned near a portion of the rotating thin liquid layer, the evaporant material being heated thereby evaporating a portion of the evaporant material and forming nanoparticles, the nanoparticles absorbed by the liquid film to form nanofluid.

Effects of oral administration of tilmicosin on pulmonary inflammation in piglets experimentally infected with Actinobacillus pleuropneumoniae.

PubMed

Nerland, Erin M; LeBlanc, Justin M; Fedwick, Jason P; Morck, Douglas W; Merrill, John K; Dick, Paul; Paradis, Marie-Anne; Buret, Andre G

2005-01-01

To determine the effects of oral administration of tilmicosin in piglets experimentally infected with Actinobacillus pleuropneumoniae. Forty 3-week-old specific-pathogen free piglets. Piglets were assigned to 1 of 4 groups as follows: 1) uninfected sham-treated control piglets; 2) infected untreated piglets that were intratracheally inoculated with 10(7) CFUs of A pleuropneumoniae; 3) infected treated piglets that were intratracheally inoculated with A pleuropneumoniae and received tilmicosin in feed (400 ppm [microg/g]) for 7 days prior to inoculation; or 4) infected treated piglets that were intratracheally inoculated with A pleuropneumoniae and received chlortetracycline (CTC) in feed (1100 ppm [microg/gl) for 7 days prior to inoculation. Bronchoalveolar lavage (BAL) fluid and lung tissue specimens of piglets for each group were evaluated at 3 or 24 hours after inoculation. For each time point, 4 to 6 piglets/group were studied. Feeding of CTC and tilmicosin decreased bacterial load in lungs of infected piglets. Tilmicosin delivered in feed, but not CTC, enhanced apoptosis in porcine BAL fluid leukocytes. This was associated with a decrease in LTB4 concentrations in BAL fluid of tilmicosin-treated piglets, compared with untreated and CTC-treated piglets, and also with a significant decrease in the number of pulmonary lesions. Tilmicosin inhibited infection-induced increases in rectal temperatures, as measured in untreated and CTC-treated piglets. Pulmonary neutrophil infiltration and prostaglandin E2 concentrations in the BAL fluid were not significantly different among groups at any time. Oral administration of tilmicosin to infected piglets induces apoptosis in BAL fluid leukocytes and decreases BAL fluid LTB4 concentrations and inflammatory lung lesions.

Safety and effectiveness evaluation of a domestic peritoneal dialysis fluid packed in non-PVC bags: study protocol for a randomized controlled trial.

PubMed

Zhou, Jianhui; Cao, Xueying; Lin, Hongli; Ni, Zhaohui; He, Yani; Chen, Menghua; Zheng, Hongguang; Chen, Xiangmei

2015-12-29

Peritoneal dialysis is an important type of renal replacement therapy for uremic patients. In peritoneal dialysis, fluids fill in and flow out of the abdominal cavity three to five times per day. Usually, the fluid is packed in a polyvinyl chloride (PVC) bag. Safety concerns have arisen over di-(2-ethylhexyl) phthalate, which is essential in the formation of PVC materials. In 2011, the National Development and Reform Commission of China released a catalog of industrial structural adjustments, mandating the elimination of PVC bags for intravenous infusion and food containers. Although bags for peritoneal dialysis fluid were not included in the elimination list, several manufacturers began to develop new materials for fluid bags. HUAREN peritoneal dialysis fluid consists of the same electrolytes and buffer agent as in Baxter fluid, but is packed in bags that do not contain PVC. This multicenter randomized controlled trial was designed to compare peritoneal dialysis fluid packed in non-PVC-containing and PVC-containing bags. Further, the study sought to determine the proper dose of peritoneal dialysis fluid and the actual survival rates of Chinese patients undergoing peritoneal dialysis. The study participants are adults undergoing continuous ambulatory peritoneal dialysis for 30 days to 6 months. All eligible patients are randomized (1:1) to peritoneal dialysis with Baxter and HUAREN dialysis fluids (initial dose, 6 l/day), with dosages adjusted according to a unified protocol. The primary outcomes are the 1-, 2-, 3-, 4-, and 5-year overall survival rates. Secondary outcome measures include technique survival rates, reductions in estimated glomerular filtration rate, nutritional status, quality of life, cardiovascular events, medical costs and drop-out rates. Safety outcome measures include adverse events, changes in vital signs and laboratory parameters, peritonitis, allergies, and quality of products. This study is the first to evaluate the long-term safety and effectiveness of a non-PVC packed peritoneal dialysis fluid. The effects of plasticizer on patient long-term survival will be determined. The characteristics of Chinese patients undergoing peritoneal dialysis will be determined, including proper dose, technique survival rates, patient survival rates, and medical costs. Clinicaltrials.gov NCT01779557 .

Association of Fluid Accumulation with Clinical Outcomes in Critically Ill Children with Severe Sepsis

PubMed Central

Chen, Jiao; Li, Xiaozhong; Bai, Zhenjiang; Fang, Fang; Hua, Jun; Li, Ying; Pan, Jian; Wang, Jian; Feng, Xing; Li, Yanhong

2016-01-01

Objective To evaluate whether early and acquired daily fluid overload (FO), as well as fluctuations in fluid accumulation, were associated with adverse outcomes in critically ill children with severe sepsis. Methods This study enrolled 202 children in a pediatric intensive care unit (PICU) with severe sepsis. Early fluid overload was defined as ≥5% fluid accumulation occurring in the first 24 hours of PICU admission. The maximum daily fluid accumulation ≥5% occurring during the next 6 days in patients with at least 48 hours of PICU stay was defined as PICU-acquired daily fluid overload. The fluctuation in fluid accumulation was calculated as the difference between the maximum and the minimum daily fluid accumulation obtained during the first 7 days after admission. Results Of the 202 patients, 61 (30.2%) died during PICU stay. Among all patients, 41 (20.3%) experienced early fluid overload, including 9 with a FO ≥10%. Among patients with at least 48 hours of PICU stay (n = 154), 36 (23.4%) developed PICU-acquired daily fluid overload, including 2 with a FO ≥10%. Both early fluid overload (AOR = 1.20; 95% CI 1.08–1.33; P = 0.001; n = 202) and PICU-acquired daily fluid overload (AOR = 5.47 per log increase; 95% CI 1.15–25.96; P = 0.032; n = 154) were independent risk factors associated with mortality after adjusting for age, illness severity, etc. However, fluctuations in fluid accumulation were not associated with mortality after adjustment. Length of PICU stay increased with greater fluctuations in fluid accumulation in all patients with at least 48 hours of PICU stay (FO <5%, 5%-10% vs. ≥10%: 4 [3–8], 7 [4–11] vs. 10 [6–16] days; P <0.001; n = 154) and in survivors (4 [3–8], 7 [5–11] vs. 10 [5–15] days; P <0.001; n = 121). Early fluid overload achieved an area under-the-receiver-operating-characteristic curve of 0.74 (95% CI 0.65–0.82; P <0.001; n = 202) for predicting mortality in patients with severe sepsis, with a sensitivity of 67.2% and a specificity of 80.1% at the optimal cut-off value of 2.65%. Conclusions Both early and acquired daily fluid overload were independently associated with PICU mortality in children with severe sepsis. PMID:27467522

10 CFR 903.17 - Informal public meetings for minor rate adjustments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Informal public meetings for minor rate adjustments. 903..., Southwestern, and Western Area Power Administrations § 903.17 Informal public meetings for minor rate adjustments. In lieu of public information or comment forums in conjunction with a minor rate adjustment...

10 CFR 903.17 - Informal public meetings for minor rate adjustments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Informal public meetings for minor rate adjustments. 903..., Southwestern, and Western Area Power Administrations § 903.17 Informal public meetings for minor rate adjustments. In lieu of public information or comment forums in conjunction with a minor rate adjustment...

5 CFR 838.622 - Cost-of-living and salary adjustments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Cost-of-living and salary adjustments....622 Cost-of-living and salary adjustments. (a)(1) A court order that awards adjustments to a former... such as “salary adjustments” or “pay adjustments” occurring after the date of the decree provides...

Guiding principles of fluid and volume therapy.

PubMed

Aditianingsih, Dita; George, Yohanes W H

2014-09-01

Fluid therapy is a core concept in the management of perioperative and critically ill patients for maintenance of intravascular volume and organ perfusion. Recent evidence regarding the vascular barrier and its role in terms of vascular leakage has led to a new concept for fluid administration. The choice of fluid used should be based on the fluid composition and the underlying pathophysiology of the patient. Avoidance of both hypo- and hypervolaemia is essential when treating circulatory failure. In daily practice, the assessment of individual thresholds in order to optimize cardiac preload and avoid hypovolaemia or deleterious fluid overload remains a challenge. Liberal versus restrictive fluid management has been challenged by recent evidence, and the ideal approach appears to be goal-directed fluid therapy. Copyright © 2014 Elsevier Ltd. All rights reserved.

A population health approach to reducing observational intensity bias in health risk adjustment: cross sectional analysis of insurance claims

PubMed Central

Sharp, Sandra M; Bevan, Gwyn; Skinner, Jonathan S; Gottlieb, Daniel J

2014-01-01

Objective To compare the performance of two new approaches to risk adjustment that are free of the influence of observational intensity with methods that depend on diagnoses listed in administrative databases. Setting Administrative data from the US Medicare program for services provided in 2007 among 306 US hospital referral regions. Design Cross sectional analysis. Participants 20% sample of fee for service Medicare beneficiaries residing in one of 306 hospital referral regions in the United States in 2007 (n=5 153 877). Main outcome measures The effect of health risk adjustment on age, sex, and race adjusted mortality and spending rates among hospital referral regions using four indices: the standard Centers for Medicare and Medicaid Services—Hierarchical Condition Categories (HCC) index used by the US Medicare program (calculated from diagnoses listed in Medicare’s administrative database); a visit corrected HCC index (to reduce the effects of observational intensity on frequency of diagnoses); a poverty index (based on US census); and a population health index (calculated using data on incidence of hip fractures and strokes, and responses from a population based annual survey of health from the Centers for Disease Control and Prevention). Results Estimated variation in age, sex, and race adjusted mortality rates across hospital referral regions was reduced using the indices based on population health, poverty, and visit corrected HCC, but increased using the standard HCC index. Most of the residual variation in age, sex, and race adjusted mortality was explained (in terms of weighted R2) by the population health index: R2=0.65. The other indices explained less: R2=0.20 for the visit corrected HCC index; 0.19 for the poverty index, and 0.02 for the standard HCC index. The residual variation in age, sex, race, and price adjusted spending per capita across the 306 hospital referral regions explained by the indices (in terms of weighted R2) were 0.50 for the standard HCC index, 0.21 for the population health index, 0.12 for the poverty index, and 0.07 for the visit corrected HCC index, implying that only a modest amount of the variation in spending can be explained by factors most closely related to mortality. Further, once the HCC index is visit corrected it accounts for almost none of the residual variation in age, sex, and race adjusted spending. Conclusion Health risk adjustment using either the poverty index or the population health index performed substantially better in terms of explaining actual mortality than the indices that relied on diagnoses from administrative databases; the population health index explained the majority of residual variation in age, sex, and race adjusted mortality. Owing to the influence of observational intensity on diagnoses from administrative databases, the standard HCC index over-adjusts for regional differences in spending. Research to improve health risk adjustment methods should focus on developing measures of risk that do not depend on observation influenced diagnoses recorded in administrative databases. PMID:24721838

75 FR 41432 - Trade Adjustment Assistance for Farmers

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-16

... DEPARTMENT OF AGRICULTURE Foreign Agricultural Service Trade Adjustment Assistance for Farmers AGENCY: Foreign Agricultural Service, USDA. ACTION: Notice. The Administrator of the Foreign Agricultural Service (FAS) has denied a petition (No. 2010002) for trade adjustment assistance (TAA) for U.S. lobster...

Coupled Data Assimilation in Navy ESPC

NASA Astrophysics Data System (ADS)

Barron, C. N.; Spence, P. L.; Frolov, S.; Rowley, C. D.; Bishop, C. H.; Wei, M.; Ruston, B.; Smedstad, O. M.

2017-12-01

Data assimilation under global coupled Earth System Prediction Capability (ESPC) presents significantly greater challenges than data assimilation in forecast models of a single earth system like the ocean and atmosphere. In forecasts of a single component, data assimilation has broad flexibility in adjusting boundary conditions to reduce forecast errors; coupled ESPC requires consistent simultaneous adjustment of multiple components within the earth system: air, ocean, ice, and others. Data assimilation uses error covariances to express how to consistently adjust model conditions in response to differences between forecasts and observations; in coupled ESPC, these covariances must extend from air to ice to ocean such that changes within one fluid are appropriately balanced with corresponding adjustments in the other components. We show several algorithmic solutions that allow us to resolve these challenges. Specifically, we introduce the interface solver method that augments existing stand-alone systems for ocean and atmosphere by allowing them to be influenced by relevant measurements from the coupled fluid. Plans are outlined for implementing coupled data assimilation within ESPC for the Navy's global coupled model. Preliminary results show the impact of assimilating SST-sensitive radiances in the atmospheric model and first results of hybrid DA in a 1/12 degree model of the global ocean.

The HYSLAR trial: a prospective randomized controlled trial of the use of a restrictive fluid regimen with 3% hypertonic saline versus lactated Ringers in patients undergoing pancreaticoduodenectomy.

PubMed

Lavu, Harish; Sell, Naomi M; Carter, Timothy I; Winter, Jordan M; Maguire, David P; Gratch, David M; Berman, Richard A; Feil, Marian G; Grunwald, Zvi; Leiby, Benjamin E; Pequignot, Edward C; Rosato, Ernest L; Yeo, Charles J

2014-09-01

This study was designed to determine whether the volume and type of fluid administered for pancreaticoduodenectomy impacts postoperative outcomes. Three percent hypertonic saline (HYS) has been suggested as a means of reducing the volume of fluid required to sustain tissue perfusion in the perioperative period. Between May 2011 and November 2013, patients undergoing pancreaticoduodenectomy were enrolled in an institutional review board-approved, single-center, prospective, parallel, randomized controlled trial (NCT 01428050), comparing lactated Ringers (LAR) (15 mL/kg/hr LAR intraoperation, 2 mL/kg/hr LAR postoperation) with HYS (9 mL/kg/hr LAR and 1 mL/kg/hr HYS intraoperation, 1 mL/kg/hr HYS postoperation). A total of 264 patients were randomized. Demographic variables between groups were similar. The HYS patients had a significantly reduced net fluid balance (65 vs 91 mL/kg, P = 0.02). The overall complication rate was reduced in the HYS group (43% vs 54%), with a relative risk of 0.79 [95% confidence interval (CI), 0.62-1.02; P = 0.073], factoring stratification for pancreas texture. After adjustment for age and weight, the relative risk was 0.75 [95% CI (0.58-0.96); P = 0.023]. The total number of complications was significantly reduced in the HYS group (93 vs 123), with an incidence rate ratio of 0.74 [95% CI (0.56-0.97); P = 0.027]. After adjustment for age and weight, the incidence rate ratio was 0.69 [95% CI (0.52-0.90); P = 0.0068]. Reoperations, length of stay, readmissions, and 90-day mortality were similar between groups. A moderately restrictive fluid regimen with HYS resulted in a statistically significant 25% reduction in complications when adjusted for age, weight, and pancreatic texture.

Bronchopulmonary dysplasia: clinical practices in five Portuguese neonatal intensive care units.

PubMed

Guimarães, H; Rocha, G; Vasconcellos, G; Proença, E; Carreira, M L; Sossai, M R; Morais, B; Martins, I; Rodrigues, T; Severo, M

2010-01-01

With the advent of surfactant, prenatal corticosteroids (PNC) and advances in technology, the survival rate of extremely low birth weight (ELBW) infants has improved dramatically. Rates of bronchopulmonary dysplasia (BPD) vary widely among neonatal intensive care units (NICUs) and many studies using multiple interventions have shown some improvement in BPD rates. Implementing potentially better practices to reduce BPD has been an effort made over the last few decades. To compare five Portuguese NICUs in terms of clinical practices in very low birth weight (VLBW) infants, in order to develop better practices to prevent BPD. 256 preterm neonates, gestational age (GA) <30 weeks and/or birthweight (BW) <1250g admitted to five Portuguese NICUs (centers 1 to 5) between 1st January 2004 and 31st December 2006, were studied. VLBW infants with major malformations, grade IV intraventricular haemorrhage in the first week of life and metabolic or neuromuscular disease were excluded. BPD was defined as oxygen dependency at 36 weeks of postconceptional age. We considered a practice to be improved as clinically significant whenever a decrease greater than 10% in the prevalence of BPD adjusted for the practice, GA and BW was achieved compared to BPD prevalence adjusted only for GA and BW. The overall prevalence of BPD was 12.9%. Our results revealed that PNC use should be improved in centers 4 and 5; fluid policy in center 4; oxygen therapy and sepsis prevention in centers 1 and 2. Patent ductus arteriosus (PDA) treatment should be improved in center 2. The implementation of potentially better practices to reduce lung injury in neonates in Portuguese NICUs, according to each NICU, must be addressed to increase the prescription of PNC, to use a lower FiO2, to be careful with fluid administration in the first weeks of life and to prevent PDA and sepsis. It is necessary to follow guidelines, recommendations or protocols to improve quality in the prevention of BPD.

Magnetic heat pump flow director

NASA Technical Reports Server (NTRS)

Howard, Frank S. (Inventor)

1995-01-01

A fluid flow director is disclosed. The director comprises a handle body and combed-teeth extending from one side of the body. The body can be formed of a clear plastic such as acrylic. The director can be used with heat exchangers such as a magnetic heat pump and can minimize the undesired mixing of fluid flows. The types of heat exchangers can encompass both heat pumps and refrigerators. The director can adjust the fluid flow of liquid or gas along desired flow directions. A method of applying the flow director within a magnetic heat pump application is also disclosed where the comb-teeth portions of the director are inserted into the fluid flow paths of the heat pump.

Polyurethane foam pica in a patient with excessive interdialytic weight gain

PubMed Central

Iyasere, Osasuyi; Allington, Ying; Cafferkey, Michele

2010-01-01

Maintaining fluid balance in haemodialysis patients is important because of the adverse effects of excessive interdialytic weight gain. This often requires fluid restriction that patients often struggle with. We report a case of a 31-year-old female diabetic patient on haemodialysis with repeated excessive interdialytic weight gains despite fluid restriction and dry weight adjustment. It was subsequently discovered that she devised an unusual, albeit unsuccessful, strategy of eating the polyurethane foam from her dialysis chair while increasing her fluid intake hoping that it would absorb excess water in the gut! This under-diagnosed phenomenon known as pica has been reported in renal patients with substances such as ice, clay and baking soda. PMID:22767521

Association Between Fluid Balance and Outcomes in Critically Ill Children: A Systematic Review and Meta-analysis.

PubMed

Alobaidi, Rashid; Morgan, Catherine; Basu, Rajit K; Stenson, Erin; Featherstone, Robin; Majumdar, Sumit R; Bagshaw, Sean M

2018-03-01

After initial resuscitation, critically ill children may accumulate fluid and develop fluid overload. Accruing evidence suggests that fluid overload contributes to greater complexity of care and worse outcomes. To describe the methods to measure fluid balance, define fluid overload, and evaluate the association between fluid balance and outcomes in critically ill children. Systematic search of MEDLINE, EMBASE, Cochrane Library, trial registries, and selected gray literature from inception to March 2017. Studies of children admitted to pediatric intensive care units that described fluid balance or fluid overload and reported outcomes of interest were included. No language restrictions were applied. All stages were conducted independently by 2 reviewers. Data extracted included study characteristics, population, fluid metrics, and outcomes. Risk of bias was assessed using the Newcastle-Ottawa Scale. Narrative description of fluid assessment methods and fluid overload definitions was done. When feasible, pooled analyses were performed using random-effects models. Mortality was the primary outcome. Secondary outcomes included treatment intensity, organ failure, and resource use. A total of 44 studies (7507 children) were included in this systematic review and meta-analysis. Of those, 27 (61%) were retrospective cohort studies, 13 (30%) were prospective cohort studies, 3 (7%) were case-control studies, and 1 study (2%) was a secondary analysis of a randomized trial. The proportion of children with fluid overload varied by case mix and fluid overload definition (median, 33%; range, 10%-83%). Fluid overload, however defined, was associated with increased in-hospital mortality (17 studies [n = 2853]; odds ratio [OR], 4.34 [95% CI, 3.01-6.26]; I2 = 61%). Survivors had lower percentage fluid overload than nonsurvivors (22 studies [n = 2848]; mean difference, -5.62 [95% CI, -7.28 to -3.97]; I2 = 76%). After adjustment for illness severity, there was a 6% increase in odds of mortality for every 1% increase in percentage fluid overload (11 studies [n = 3200]; adjusted OR, 1.06 [95% CI, 1.03-1.10]; I2 = 66%). Fluid overload was associated with increased risk for prolonged mechanical ventilation (>48 hours) (3 studies [n = 631]; OR, 2.14 [95% CI, 1.25-3.66]; I2 = 0%) and acute kidney injury (7 studies [n = 1833]; OR, 2.36 [95% CI, 1.27-4.38]; I2 = 78%). Fluid overload is common and is associated with substantial morbidity and mortality in critically ill children. Additional research should now ideally focus on interventions aimed to mitigate the potential for harm associated with fluid overload.

Disposition of isoflupredone acetate in plasma, urine and synovial fluid following intra-articular administration to exercised Thoroughbred horses.

PubMed

Knych, Heather K; Harrison, Linda M; White, Alexandria; McKemie, Daniel S

2016-01-01

The use of isoflupredone acetate in performance horses and the scarcity of published pharmacokinetic data necessitate further study. The objective of the current study was to describe the plasma pharmacokinetics of isoflupredone acetate as well as time-related urine and synovial fluid concentrations following intra-articular administration to horses. Twelve racing-fit adult Thoroughbred horses received a single intra-articular administration (8 mg) of isoflupredone acetate into the right antebrachiocarpal joint. Blood, urine and synovial fluid samples were collected prior to and at various times up to 28 days post drug administration. All samples were analyzed using liquid chromatography-Mass Spectrometry. Plasma data were analyzed using a population pharmacokinetic compartmental model. Maximum measured plasma isoflupredone concentrations were 1.76 ± 0.526 ng/mL at 4.0 ± 1.31 h and 1.63 ± 0.243 ng/mL at 4.75 ± 0.5 h, respectively, for horses that had synovial fluid collected and for those that did not. The plasma beta half-life was 24.2 h. Isoflupredone concentrations were below the limit of detection in all horses by 48 h and 7 days in plasma and urine, respectively. Isoflupredone was detected in the right antebrachiocarpal and middle carpal joints for 8.38 ± 5.21 and 2.38 ± 0.52 days, respectively. Results of this study provide information that can be used to regulate the use of intra-articular isoflupredone in the horse. Copyright © 2015 John Wiley & Sons, Ltd.

Intrapulmonary concentration of enrofloxacin in healthy calves

PubMed Central

OTOMARU, Konosuke; HIRATA, Masaya; IKEDO, Tomonobu; HORINOUCHI, Chie; NOGUCHI, Michiko; ISHIKAWA, Shingo; NAGATA, Shun-ichi; HOBO, Seiji

2015-01-01

To determine the intrapulmonary concentration of enrofloxacin (ERFX) in calves, plasma, bronchoalveolar lavage fluid (BALF) and alveolar cells samples were obtained from clinically healthy calves. Four clinically healthy calves were administered a single dose of ERFX (5 mg/kg) by subcutaneous injection. Samples of plasma were obtained for each subjects at 0 (before administration), 1 and 2 hr after administration of ERFX. Samples of BALF were obtained from each subject at 0, 1 and 2 hr after administration of ERFX. This examination was conducted two times, one week apart. The mean EFRX concentrations in plasma at 1 and 2 hr after administration were l.23 and 1.29 µg/ml, respectively. The mean EFRX concentrations in pulmonary epithelial lining fluid (ELF) at 1 and 2 hr after administration 8.53 µg/ml and 9.42 µg/ml, respectively. The mean ERFX concentrations of alveolar cells in BALF at 1 and 2 hr after administration were 4.04 µg/ml and 5.19 µg/ml, respectively. These results suggest that the ERFX concentrations in ELF and alveolar cells concentrations in BALF at 1 and 2 hr after administration were higher than the plasma concentrations. PMID:26668174

Decreased levels of sRAGE in follicular fluid from patients with PCOS.

PubMed

Wang, BiJun; Li, Jing; Yang, QingLing; Zhang, FuLi; Hao, MengMeng; Guo, YiHong

2017-03-01

This study aimed to explore the association between soluble receptor for advanced glycation end products (sRAGE) levels in follicular fluid and the number of oocytes retrieved and to evaluate the effect of sRAGE on vascular endothelial growth factor (VEGF) in granulosa cells in patients with polycystic ovarian syndrome (PCOS). Two sets of experiments were performed in this study. In part one, sRAGE and VEGF protein levels in follicular fluid samples from 39 patients with PCOS and 35 non-PCOS patients were measured by ELISA. In part two, ovarian granulosa cells were isolated from an additional 10 patients with PCOS and cultured. VEGF and SP1 mRNA and protein levels, as well as pAKT levels, were detected by real-time PCR and Western blotting after cultured cells were treated with different concentrations of sRAGE. Compared with the non-PCOS patients, patients with PCOS had lower sRAGE levels in follicular fluid. Multi-adjusted regression analysis showed that high sRAGE levels in follicular fluid predicted a lower Gn dose, more oocytes retrieved, and a better IVF outcome in the non-PCOS group. Logistic regression analysis showed that higher sRAGE levels predicted favorably IVF outcomes in the non-PCOS group. Multi-adjusted regression analysis also showed that high sRAGE levels in follicular fluid predicted a lower Gn dose in the PCOS group. Treating granulosa cells isolated from patients with PCOS with recombinant sRAGE decreased VEGF and SP1 mRNA and protein expression and pAKT levels in a dose-dependent manner. © 2017 Society for Reproduction and Fertility.

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

PubMed

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

2015-09-23

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

49 CFR 630.11 - Data adjustments.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 7 2012-10-01 2012-10-01 false Data adjustments. 630.11 Section 630.11 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL TRANSIT ADMINISTRATION, DEPARTMENT OF TRANSPORTATION NATIONAL TRANSIT DATABASE § 630.11 Data adjustments. Errors in the data used in...

49 CFR 630.11 - Data adjustments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false Data adjustments. 630.11 Section 630.11 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL TRANSIT ADMINISTRATION, DEPARTMENT OF TRANSPORTATION NATIONAL TRANSIT DATABASE § 630.11 Data adjustments. Errors in the data used in...

49 CFR 630.11 - Data adjustments.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 7 2011-10-01 2011-10-01 false Data adjustments. 630.11 Section 630.11 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL TRANSIT ADMINISTRATION, DEPARTMENT OF TRANSPORTATION NATIONAL TRANSIT DATABASE § 630.11 Data adjustments. Errors in the data used in...

49 CFR 630.11 - Data adjustments.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 7 2014-10-01 2014-10-01 false Data adjustments. 630.11 Section 630.11 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL TRANSIT ADMINISTRATION, DEPARTMENT OF TRANSPORTATION NATIONAL TRANSIT DATABASE § 630.11 Data adjustments. Errors in the data used in...

49 CFR 630.11 - Data adjustments.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 7 2013-10-01 2013-10-01 false Data adjustments. 630.11 Section 630.11 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL TRANSIT ADMINISTRATION, DEPARTMENT OF TRANSPORTATION NATIONAL TRANSIT DATABASE § 630.11 Data adjustments. Errors in the data used in...

Amniotic fluid index predicts the relief of variable decelerations after amnioinfusion bolus.

PubMed

Spong, C Y; McKindsey, F; Ross, M G

1996-10-01

Our purpose was to determine whether intrapartum amniotic fluid index before amnioinfusion can be used to predict response to therapeutic amnioinfusion. Intrapartum patients (n = 85) with repetitive variable decelerations in fetal heart rate that necessitated amnioinfusion (10 ml/min for 60 minutes) underwent determination of amniotic fluid index before and after bolus amnioinfusion. The fetal heart tracing was scored (scorer blinded to amniotic fluid index values) for number and characteristics of variable decelerations before and 1 hour after initiation of amnioinfusion. The amnioinfusion was considered successful if it resulted in a decrease of > or = 50% in total number of variable decelerations or a decrease of > or = 50% in the rate of atypical or severe variable decelerations after administration of the bolus. Spontaneous vaginal births before completion of administration of the bolus (n = 18) were excluded from analysis. The probability of success of amnioinfusion in relation to amniotic fluid index was analyzed with the chi(2) test for progressive sequence. The mean amniotic fluid index before amnioinfusion was 6.2 +/- 3.3 cm. An amniotic fluid index of < or = 5 cm was present in 40% of patients (27/67), and an amniotic fluid index of < or = 8 cm was present in 72% of patients (48/67). The probability of success of amnioinfusion decreased with increasing amniotic fluid index before amnioinfusion (76% [16/21] when initial amniotic fluid index was 0 to 4 cm, 63% [17/27] when initial amniotic fluid index was 4 to 8 cm, 44% [7/16] when initial amniotic fluid index was 8 to 12 cm, and 33% [1/3] when initial amniotic fluid index was > 12 cm, p = 0.03). The incidence of nuchal cords or true umbilical cord knots increased in relation to amniotic fluid index before amnioinfusion. Amniotic fluid index before amnioinfusion can be used to predict the success of amnioinfusion for relief of variable decelerations in fetal heart rate. Failure of amnioinfusion at a high amniotic fluid index before amnioinfusion may be explained by the increased prevalence of nuchal cords or true knots in the umbilical cord.

A protocol guided by transpulmonary thermodilution and lactate levels for resuscitation of patients with severe burns

PubMed Central

2013-01-01

Over-resuscitation is deleterious in many critically ill conditions, including major burns. For more than 15 years, several strategies to reduce fluid administration in burns during the initial resuscitation phase have been proposed, but no single or simple parameter has shown superiority. Fluid administration guided by invasive hemodynamic parameters usually resulted in over-resuscitation. As reported in the previous issue of Critical Care, Sánchez-Sánchez and colleagues analyzed the performance of a ‘permissive hypovolemia’ protocol guided by invasive hemodynamic parameters (PiCCO, Pulsion Medical Systems, Munich, Germany) and vital signs in a prospective cohort over a 3-year period. The authors’ results confirm that resuscitation can be achieved with below-normal levels of preload but at the price of a fluid administration greater than predicted by the Parkland formula (2 to 4 mL/kg per% burn). The classic approach based on an adapted Parkland equation may still be the simplest until further studies identify the optimal bundle of resuscitation goals. PMID:24229466

Extreme pressure fluid sample transfer pump

DOEpatents

Halverson, Justin E.; Bowman, Wilfred W.

1990-01-01

A transfer pump for samples of fluids at very low or very high pressures comprising a cylinder having a piston sealed with an O-ring, the piston defining forward and back chambers, an inlet and exit port and valve arrangement for the fluid to enter and leave the forward chamber, and a port and valve arrangement in the back chamber for adjusting the pressure across the piston so that the pressure differential across the piston is essentially zero and approximately equal to the pressure of the fluid so that the O-ring seals against leakage of the fluid and the piston can be easily moved, regardless of the pressure of the fluid. The piston may be actuated by a means external to the cylinder with a piston rod extending through a hole in the cylinder sealed with a bellows attached to the piston head and the interior of the back chamber.

Feedback regulated induction heater for a flowing fluid

DOEpatents

Migliori, Albert; Swift, Gregory W.

1985-01-01

A regulated induction heater for heating a stream of flowing fluid to a predetermined desired temperature. The heater includes a radiofrequency induction coil which surrounds a glass tube through which the fluid flows. A heating element consisting of a bundle of approximately 200 stainless steel capillary tubes located within the glass tube couples the output of the induction coil to the fluid. The temperature of the fluid downstream from the heating element is sensed with a platinum resistance thermometer, the output of which is applied to an adjustable proportional and integral feedback control circuit which regulates the power applied to the induction coil. The heater regulates the fluid temperature to within 0.005.degree. C. at a flow rate of 50 cm.sup.3 /second with a response time of less than 0.1 second, and can accommodate changes in heat load up to 1500 watts.

Feedback regulated induction heater for a flowing fluid

DOEpatents

Migliori, A.; Swift, G.W.

1984-06-13

A regulated induction heater for heating a stream of flowing fluid to a predetermined desired temperature. The heater includes a radiofrequency induction coil which surrounds a glass tube through which the fluid flows. A heating element consisting of a bundle of approximately 200 stainless steel capillary tubes located within the glass tube couples the output of the induction coil to the fluid. The temperature of the fluid downstream from the heating element is sensed with a platinum resistance thermometer, the output of which is applied to an adjustable porportional and integral feedback control circuit which regulates the power applied to the induction coil. The heater regulates the fluid temperature to within 0.005/sup 0/C at a flow rate of 50 cm/sup 3//sec with a response time of less than 0.1 second, and can accommodate changes in heat load up to 1500 watts.

EFFECT OF URICOSURIC DRUG ADMINISTRATION ON URIC ACID LEVELS IN UNSTIMULATED PAROTID FLUID.

DTIC Science & Technology

Parotid fluid was collected twice daily without exogenous stimulation from 6 healthy young adult males, both before and during a 5-day period of...was found in parotid fluid uric acid concentration and uric acid secretion rate. The mean for serum uric acid decreased from 5.40 to 2.06 mg./100 ml...and parotid fluid uric acid concentration fell from 10.16 to 4.23 mg./100 ml. (morning samples) and 7.29 to 3.90 mg./100 ml. (afternoon samples). (Author)

5 CFR 536.305 - Adjusting an employee's retained rate when a pay schedule is adjusted.

Code of Federal Regulations, 2010 CFR

2010-01-01

... conversion under § 536.303(b) or any other simultaneous pay action. The retained rate adjustment under... new retained rate must be determined under the geographic conversion rule in § 536.303(b). (4... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Adjusting an employee's retained rate...

Effect of intraoperative transesophageal Doppler-guided fluid therapy versus central venous pressure-guided fluid therapy on renal allograft outcome in patients undergoing living donor renal transplant surgery: a comparative study.

PubMed

Srivastava, Divya; Sahu, Sandeep; Chandra, Abhilash; Tiwari, Tanmay; Kumar, Sanjay; Singh, P K

2015-12-01

Transesophageal Doppler (TED)-guided intraoperative fluid therapy has shown to noninvasively optimize intravascular volume and reduce postoperative morbidity. The aim of this study was to compare the effects of Doppler-guided intraoperative fluid administration and central venous pressure (CVP)-guided fluid therapy on renal allograft outcome and postoperative complications. A prospective nonrandomized active controlled study was conducted on end-stage renal disease patients scheduled for living donor renal transplant surgery. 110 patients received intraoperative fluid guided by corrected flow time (FTc) and variation in stroke volume values obtained by continuous TED monitoring. Data of 104 patients in whom intraoperative fluid administration was guided by CVP values were retrospectively obtained for a control. The amount of intraoperative fluid given in the study group (12.20 ± 4.24 ml/kg/h) was significantly lower than in the controls (22.21 ± 4.67 ml/kg/h). The amount of colloid used was also significantly less and fewer recipients were seen to require colloid (69 vs 85%). The mean arterial pressures were comparable throughout. CVP reached was 7.18 ± 3.17 mmHg in the study group. It was significantly higher in the controls (13.42 ± 3.12 mmHg). The postoperative graft function and rate of dysfunction were comparable. Side-effects like postoperative dyspnoea (4.8 vs 0%) and tissue edema (9.6 vs 2.7%) were higher in the controls. FTc-guided intraoperative fluid therapy achieved the same rate of immediate graft function as CVP-guided fluid therapy but used a significantly less amount of fluid. The incidence of postoperative complications related to fluid overload was also reduced. The use of TED may replace invasive central line insertions in the future.

Systemic complications of fluid resuscitation.

PubMed

Weinstein, P D; Doerfler, M E

1992-04-01

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

13 CFR 307.6 - Economic Adjustment Assistance post-approval requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Economic Adjustment Assistance post-approval requirements. 307.6 Section 307.6 Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT OF COMMERCE ECONOMIC ADJUSTMENT ASSISTANCE INVESTMENTS General § 307.6 Economic...

14 CFR 35.34 - Inspections, adjustments and repairs.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Inspections, adjustments and repairs. 35.34 Section 35.34 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: PROPELLERS Tests and Inspections § 35.34 Inspections, adjustments and repairs. (a...

14 CFR 35.34 - Inspections, adjustments and repairs.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Inspections, adjustments and repairs. 35.34 Section 35.34 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: PROPELLERS Tests and Inspections § 35.34 Inspections, adjustments and repairs. (a...

14 CFR 35.34 - Inspections, adjustments and repairs.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Inspections, adjustments and repairs. 35.34 Section 35.34 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: PROPELLERS Tests and Inspections § 35.34 Inspections, adjustments and repairs. (a...

14 CFR 35.34 - Inspections, adjustments and repairs.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Inspections, adjustments and repairs. 35.34 Section 35.34 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: PROPELLERS Tests and Inspections § 35.34 Inspections, adjustments and repairs. (a...

14 CFR 35.34 - Inspections, adjustments and repairs.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Inspections, adjustments and repairs. 35.34 Section 35.34 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION AIRCRAFT AIRWORTHINESS STANDARDS: PROPELLERS Tests and Inspections § 35.34 Inspections, adjustments and repairs. (a...

13 CFR 307.6 - Economic Adjustment Assistance post-approval requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false Economic Adjustment Assistance post-approval requirements. 307.6 Section 307.6 Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT OF COMMERCE ECONOMIC ADJUSTMENT ASSISTANCE INVESTMENTS General § 307.6 Economic...

13 CFR 307.6 - Economic Adjustment Assistance post-approval requirements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 13 Business Credit and Assistance 1 2012-01-01 2012-01-01 false Economic Adjustment Assistance post-approval requirements. 307.6 Section 307.6 Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT OF COMMERCE ECONOMIC ADJUSTMENT ASSISTANCE INVESTMENTS General § 307.6 Economic...

13 CFR 307.6 - Economic Adjustment Assistance post-approval requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 13 Business Credit and Assistance 1 2014-01-01 2014-01-01 false Economic Adjustment Assistance post-approval requirements. 307.6 Section 307.6 Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT OF COMMERCE ECONOMIC ADJUSTMENT ASSISTANCE INVESTMENTS General § 307.6 Economic...

13 CFR 307.6 - Economic Adjustment Assistance post-approval requirements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 13 Business Credit and Assistance 1 2013-01-01 2013-01-01 false Economic Adjustment Assistance post-approval requirements. 307.6 Section 307.6 Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT OF COMMERCE ECONOMIC ADJUSTMENT ASSISTANCE INVESTMENTS General § 307.6 Economic...

75 FR 59682 - Trade Adjustment Assistance for Farmers

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-28

... Service (FAS) has denied petitions (No.'s 2011006-2011011, 2011028) for trade adjustment assistance for..., Farm Service Agency, Agricultural Marketing Service, and FAS. After a review, the Administrator... Adjustment Assistance for Farmers Program Staff, Office of Trade Programs, FAS, USDA; or by phone at (202...

75 FR 62759 - Trade Adjustment Assistance for Farmers

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-13

... Service (FAS), denied a petition (No. 2011019) for trade adjustment assistance (TAA) for Tilapia filed..., and FAS. After a review, the Administrator determined that the petition was unable to demonstrate the... INFORMATION CONTACT: Trade Adjustment Assistance for Farmers Program Staff, Office of Trade Programs, FAS...

5 CFR 9701.322 - Setting and adjusting rate ranges.

Code of Federal Regulations, 2010 CFR

2010-01-01

... MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Setting and Adjusting Rate Ranges... operational reasons, these adjustments will become effective on or about the date of the annual General...

Mechanism of gastrointestinal abnormal motor activity induced by cisplatin in conscious dogs

PubMed Central

Ando, Hiroyuki; Mochiki, Erito; Ohno, Tetsuro; Yanai, Mitsuhiro; Toyomasu, Yoshitaka; Ogata, Kyoichi; Tabe, Yuichi; Aihara, Ryuusuke; Nakabayashi, Toshihiro; Asao, Takayuki; Kuwano, Hiroyuki

2014-01-01

AIM: To investigate whether 5-hydroxytryptamine (serotonin; 5-HT) is involved in mediating abnormal motor activity in dogs after cisplatin administration. METHODS: After the dogs had been given a 2-wk recovery period, all of them were administered cisplatin, and the motor activity was recorded using strain gauge force transducers. Blood and intestinal fluid samples were collected to measure 5-HT for 24 h. To determine whether 5-HT in plasma or that in intestinal fluids is more closely related to abnormal motor activity we injected 5-HT into the bloodstream and the intestinal tract of the dogs. RESULTS: Cisplatin given intravenously produced abnormal motor activity that lasted up to 5 h. From 3 to 4 h after cisplatin administration, normal intact dogs exhibited retropropagation of motor activity accompanied by emesis. The concentration of 5-HT in plasma reached the peak at 4 h, and that in intestinal fluids reached the peak at 3 h. In normal intact dogs with resection of the vagus nerve that were administered kytril, cisplatin given intravenously did not produce abnormal motor activity. Intestinal serotonin administration did not produce abnormal motor activity, but intravenous serotonin administration did. CONCLUSION: After the intravenous administration of cisplatin, abnormal motor activity was produced in the involved vagus nerve and in the involved serotonergic neurons via another pathway. This study was the first to determine the relationship between 5-HT and emesis-induced motor activity. PMID:25400453

Adjustable steam producing flexible orifice independent of fluid pressure

NASA Technical Reports Server (NTRS)

Morrison, Andrew D. (Inventor)

1992-01-01

A self-adjusting choke for a fluids nozzle includes a membrane constructed of a single piece of flexible or elastic material. This flexible material is shaped to fit into the outlet of a nozzle. The body of the membrane has at least two flow channels, from one face to the other, which directs two streams of water to cross at the opening of the nozzle or at some point beyond. The elasticity and thickness of the membrane is selected to match the range of expected pressures and fluid velocities. The choke may have more than two flow channels, as long as they are aligned adjacent to one another and directed towards each other at the exit face. In a three orifice embodiment, one is directed upward, one is directed downward, and the one in the middle is directed forward. In this embodiment all three fluid streams intersect at some point past the nozzle opening. Under increased pressure the membrane will deform causing the orifices to realign in a more forward direction, causing the streams to intersect at a smaller angle. This reduces the force with which the separate streams impact each other, still allowing the separate streams to unify into a single stable spiralling stream in spite of the increased pressure.

5 CFR 304.106 - Pay and leave administration.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Pay and leave administration. 304.106... AND CONSULTANT APPOINTMENTS § 304.106 Pay and leave administration. (a) The employing agency has the authority to adjust the pay of experts and consultants after initial appointment and to establish...

March 2016 Memo: Planning for Removal and Remedial Activities at Hardrock Mining and Mineral Processing Sites with Fluid Hazards

EPA Pesticide Factsheets

Memo from EPA Assistant Administrator Mathy Stanislaus, regarding planning for removal and remedial activities at hardrock mining and mineral processing sites with fluid hazards, and to share the Agency’s expectations for the work that is done at these sit

Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma (EPR CAT)

DTIC Science & Technology

2016-12-01

Preservation and Resuscitation (EPR) was developed to rapidly preserve the organism during ischemia, using hypothermia, drugs , and fluids, to “ buy time...Device Exemption (IDE) from the Food and Drug Administration (FDA). Our trial is complicated by the fact that both fluids and equipment are to be used

Induction voidmeter

DOEpatents

Anderson, Thomas T.; Roop, Conard J.; Schmidt, Kenneth J.; Brewer, John

1986-01-01

An induction voidmeter for detecting voids in a conductive fluid may comprise: a four arm bridge circuit having two adjustable circuit elements connected as opposite arms of said bridge circuit, an input branch, and an output branch; two induction coils, bifilarly wound together, connected as the remaining two opposing arms of said bridge circuit and positioned such that the conductive fluid passes through said coils; applying an AC excitation signal to said input branch; and detecting the output signal generated in response to said excitation signal across said output branch. The induction coils may be located outside or inside a non-magnetic pipe containing the conductive fluid.

Haemodynamic-guided fluid administration for the prevention of contrast-induced acute kidney injury: the POSEIDON randomised controlled trial.

PubMed

Brar, Somjot S; Aharonian, Vicken; Mansukhani, Prakash; Moore, Naing; Shen, Albert Y-J; Jorgensen, Michael; Dua, Aman; Short, Lindsay; Kane, Kevin

2014-05-24

The administration of intravenous fluid remains the cornerstone treatment for the prevention of contrast-induced acute kidney injury. However, no well-defined protocols exist to guide fluid administration in this treatment. We aimed to establish the efficacy of a new fluid protocol to prevent contrast-induced acute kidney injury. In this randomised, parallel-group, comparator-controlled, single-blind phase 3 trial, we assessed the efficacy of a new fluid protocol based on the left ventricular end-diastolic pressure for the prevention of contrast-induced acute kidney injury in patients undergoing cardiac catheterisation. The primary outcome was the occurrence of contrast-induced acute kidney injury, which was defined as a greater than 25% or greater than 0·5 mg/dL increase in serum creatinine concentration. Between Oct 10, 2010, and July 17, 2012, 396 patients aged 18 years or older undergoing cardiac catheterisation with an estimated glomerular filtration rate of 60 mL/min per 1·73 m(2) or less and one or more of several risk factors (diabetes mellitus, history of congestive heart failure, hypertension, or age older than 75 years) were randomly allocated in a 1:1 ratio to left ventricular end-diastolic pressure-guided volume expansion (n=196) or the control group (n=200) who received a standard fluid administration protocol. Four computer-generated concealed randomisation schedules, each with permuted block sizes of 4, were used for randomisation, and participants were allocated to the next sequential randomisation number by sealed opaque envelopes. Patients and laboratory personnel were masked to treatment assignment, but the physicians who did the procedures were not masked. Both groups received intravenous 0·9% sodium chloride at 3 mL/kg for 1 h before cardiac catheterisation. Analyses were by intention to treat. Adverse events were assessed at 30 days and 6 months and all such events were classified by staff who were masked to treatment assignment. This trial is registered with ClinicalTrials.gov, number NCT01218828. Contrast-induced acute kidney injury occurred less frequently in patients in the left ventricular end-diastolic pressure-guided group (6·7% [12/178]) than in the control group (16·3% [28/172]; relative risk 0·41, 95% CI 0·22-0·79; p=0·005). Hydration treatment was terminated prematurely because of shortness of breath in three patients in each group. Left ventricular end-diastolic pressure-guided fluid administration seems to be safe and effective in preventing contrast-induced acute kidney injury in patients undergoing cardiac catheterisation. Kaiser Permanente Southern California regional research committee grant. Copyright © 2014 Elsevier Ltd. All rights reserved.

40 CFR 86.1604 - Conditions for disapproval.

Code of Federal Regulations, 2011 CFR

2011-07-01

... adjustment control in use and provides appropriate instruction as part of the high-altitude performance... Altitude Performance Adjustments for New and In-Use Motor Vehicles and Engines § 86.1604 Conditions for disapproval. (a) The Administrator shall not approve altitude performance adjustments that will: (1) Cause any...

46 CFR 506.1 - Scope and purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... MARITIME COMMISSION GENERAL AND ADMINISTRATIVE PROVISIONS CIVIL MONETARY PENALTY INFLATION ADJUSTMENT § 506... for inflation of civil monetary penalties and to adjust such penalties in conformity with the Federal Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. 2461 note), as amended by the Debt...

13 CFR 307.3 - Use of Economic Adjustment Assistance Investments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Use of Economic Adjustment Assistance Investments. 307.3 Section 307.3 Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT OF COMMERCE ECONOMIC ADJUSTMENT ASSISTANCE INVESTMENTS General § 307.3 Use of Economic...

13 CFR 307.2 - Criteria for Economic Adjustment Assistance Investments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Criteria for Economic Adjustment Assistance Investments. 307.2 Section 307.2 Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT OF COMMERCE ECONOMIC ADJUSTMENT ASSISTANCE INVESTMENTS General § 307.2 Criteria for...

13 CFR 307.2 - Criteria for Economic Adjustment Assistance Investments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 13 Business Credit and Assistance 1 2014-01-01 2014-01-01 false Criteria for Economic Adjustment Assistance Investments. 307.2 Section 307.2 Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT OF COMMERCE ECONOMIC ADJUSTMENT ASSISTANCE INVESTMENTS General § 307.2 Criteria for...

13 CFR 307.2 - Criteria for Economic Adjustment Assistance Investments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 13 Business Credit and Assistance 1 2012-01-01 2012-01-01 false Criteria for Economic Adjustment Assistance Investments. 307.2 Section 307.2 Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT OF COMMERCE ECONOMIC ADJUSTMENT ASSISTANCE INVESTMENTS General § 307.2 Criteria for...

13 CFR 307.2 - Criteria for Economic Adjustment Assistance Investments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 13 Business Credit and Assistance 1 2013-01-01 2013-01-01 false Criteria for Economic Adjustment Assistance Investments. 307.2 Section 307.2 Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT OF COMMERCE ECONOMIC ADJUSTMENT ASSISTANCE INVESTMENTS General § 307.2 Criteria for...

13 CFR 307.3 - Use of Economic Adjustment Assistance Investments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 13 Business Credit and Assistance 1 2012-01-01 2012-01-01 false Use of Economic Adjustment Assistance Investments. 307.3 Section 307.3 Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT OF COMMERCE ECONOMIC ADJUSTMENT ASSISTANCE INVESTMENTS General § 307.3 Use of Economic...

13 CFR 307.3 - Use of Economic Adjustment Assistance Investments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false Use of Economic Adjustment Assistance Investments. 307.3 Section 307.3 Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT OF COMMERCE ECONOMIC ADJUSTMENT ASSISTANCE INVESTMENTS General § 307.3 Use of Economic...

13 CFR 307.3 - Use of Economic Adjustment Assistance Investments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 13 Business Credit and Assistance 1 2013-01-01 2013-01-01 false Use of Economic Adjustment Assistance Investments. 307.3 Section 307.3 Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT OF COMMERCE ECONOMIC ADJUSTMENT ASSISTANCE INVESTMENTS General § 307.3 Use of Economic...

13 CFR 307.3 - Use of Economic Adjustment Assistance Investments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 13 Business Credit and Assistance 1 2014-01-01 2014-01-01 false Use of Economic Adjustment Assistance Investments. 307.3 Section 307.3 Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT OF COMMERCE ECONOMIC ADJUSTMENT ASSISTANCE INVESTMENTS General § 307.3 Use of Economic...

13 CFR 307.2 - Criteria for Economic Adjustment Assistance Investments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false Criteria for Economic Adjustment Assistance Investments. 307.2 Section 307.2 Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT OF COMMERCE ECONOMIC ADJUSTMENT ASSISTANCE INVESTMENTS General § 307.2 Criteria for...

75 FR 23226 - Trade Adjustment Assistance for Farmers

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-03

... DEPARTMENT OF AGRICULTURE Foreign Agricultural Service Trade Adjustment Assistance for Farmers AGENCY: Foreign Agricultural Service, USDA. ACTION: Notice. The Administrator, Foreign Agricultural Service (FAS), today accepted a petition, and began a review of a petition, for trade adjustment assistance by the National Asparagus Council on behalf...

75 FR 59682 - Trade Adjustment Assistance for Farmers

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-28

... Service (FAS) has denied petitions (Nos. 2011023-2011027) for trade adjustment assistance for wool filed... Economist, Farm Service Agency, Agricultural Marketing Service, and FAS. After a review, the Administrator... Adjustment Assistance for Farmers Program Staff, Office of Trade Programs, FAS, USDA; or by phone at (202...

50 CFR 648.25 - Atlantic Mackerel, squid, and butterfish framework adjustments to management measures.

Code of Federal Regulations, 2012 CFR

2012-10-01

... framework adjustments to management measures. 648.25 Section 648.25 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE FISHERIES... Butterfish Fisheries § 648.25 Atlantic Mackerel, squid, and butterfish framework adjustments to management...

50 CFR 648.25 - Atlantic Mackerel, squid, and butterfish framework adjustments to management measures.

Code of Federal Regulations, 2014 CFR

2014-10-01

... framework adjustments to management measures. 648.25 Section 648.25 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE FISHERIES... Butterfish Fisheries § 648.25 Atlantic Mackerel, squid, and butterfish framework adjustments to management...

50 CFR 648.25 - Atlantic Mackerel, squid, and butterfish framework adjustments to management measures.

Code of Federal Regulations, 2013 CFR

2013-10-01

... framework adjustments to management measures. 648.25 Section 648.25 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE FISHERIES... Butterfish Fisheries § 648.25 Atlantic Mackerel, squid, and butterfish framework adjustments to management...

14 CFR 13.305 - Cost of living adjustments of civil monetary penalties.

Code of Federal Regulations, 2011 CFR

2011-01-01

... monetary penalties. 13.305 Section 13.305 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES INVESTIGATIVE AND ENFORCEMENT PROCEDURES Civil Monetary Penalty Inflation Adjustment § 13.305 Cost of living adjustments of civil monetary penalties. (a) Except for the...

14 CFR 13.305 - Cost of living adjustments of civil monetary penalties.

Code of Federal Regulations, 2013 CFR

2013-01-01

... monetary penalties. 13.305 Section 13.305 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES INVESTIGATIVE AND ENFORCEMENT PROCEDURES Civil Monetary Penalty Inflation Adjustment § 13.305 Cost of living adjustments of civil monetary penalties. (a) Except for the...

14 CFR 13.305 - Cost of living adjustments of civil monetary penalties.

Code of Federal Regulations, 2012 CFR

2012-01-01

... monetary penalties. 13.305 Section 13.305 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES INVESTIGATIVE AND ENFORCEMENT PROCEDURES Civil Monetary Penalty Inflation Adjustment § 13.305 Cost of living adjustments of civil monetary penalties. (a) Except for the...

14 CFR 13.305 - Cost of living adjustments of civil monetary penalties.

Code of Federal Regulations, 2014 CFR

2014-01-01

... monetary penalties. 13.305 Section 13.305 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES INVESTIGATIVE AND ENFORCEMENT PROCEDURES Civil Monetary Penalty Inflation Adjustment § 13.305 Cost of living adjustments of civil monetary penalties. (a) Except for the...

14 CFR 13.305 - Cost of living adjustments of civil monetary penalties.

Code of Federal Regulations, 2010 CFR

2010-01-01

... monetary penalties. 13.305 Section 13.305 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES INVESTIGATIVE AND ENFORCEMENT PROCEDURES Civil Monetary Penalty Inflation Adjustment § 13.305 Cost of living adjustments of civil monetary penalties. (a) Except for the...

50 CFR 648.261 - Framework adjustment process.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE FISHERIES OF THE NORTHEASTERN UNITED STATES Management Measures for the Atlantic Deep-Sea Red Crab Fishery § 648.261 Framework adjustment process. (a) To...

Liberal or restricted fluid administration: are we ready for a proposal of a restricted intraoperative approach?

PubMed

Della Rocca, Giorgio; Vetrugno, Luigi; Tripi, Gabriella; Deana, Cristian; Barbariol, Federico; Pompei, Livia

2014-01-01

Fluid management in the perioperative period has been extensively studied but, despite that, "the right amount" still remains uncertain. The purpose of this paper is to summarize the state of the art of intraoperative fluid approach today. In the current medical literature there are only heterogeneous viewpoints that gives the idea of how confusing the situation is. The approach to the intraoperative fluid management is complex and it should be based on human physiology and the current evidence. An intraoperative restrictive fluid approach in major surgery may be beneficial while Goal-directed Therapy should be superior to the liberal fluid strategy. Finally, we propose a rational approach currently used at our institution.

Surface sampling concentration and reaction probe with controller to adjust sampling position

DOEpatents

Van Berkel, Gary J.; ElNaggar, Mariam S.

2016-07-19

A method of analyzing a chemical composition of a specimen is described. The method can include providing a probe comprising an outer capillary tube and an inner capillary tube disposed co-axially within the outer capillary tube, where the inner and outer capillary tubes define a solvent capillary and a sampling capillary in fluid communication with one another at a distal end of the probe; contacting a target site on a surface of a specimen with a solvent in fluid communication with the probe; maintaining a plug volume proximate a solvent-specimen interface, wherein the plug volume is in fluid communication with the probe; draining plug sampling fluid from the plug volume through the sampling capillary; and analyzing a chemical composition of the plug sampling fluid with an analytical instrument. A system for performing the method is also described.

Wetting-induced formation of controllable monodisperse multiple emulsions in microfluidics.

PubMed

Deng, Nan-Nan; Wang, Wei; Ju, Xiao-Jie; Xie, Rui; Weitz, David A; Chu, Liang-Yin

2013-10-21

Multiple emulsions, which are widely applied in a myriad of fields because of their unique ability to encapsulate and protect active ingredients, are typically produced by sequential drop-formations and drop-encapsulations using shear-induced emulsification. Here we report a qualitatively novel method of creating highly controlled multiple emulsions from lower-order emulsions. By carefully controlling the interfacial energies, we adjust the spreading coefficients between different phases to cause drops of one fluid to completely engulf other drops of immiscible fluids; as a result multiple emulsions are directly formed by simply putting preformed lower-order emulsion drops together. Our approach has highly controllable flexibility. We demonstrate this in preparation of both double and triple emulsions with a controlled number of inner drops and precisely adjusted shell thicknesses including ultra-thin shells. Moreover, this controllable drop-engulfing-drop approach has a high potential in further investigations and applications of microfluidics. Importantly, this innovative approach opens a window to exploit new phenomena occurring in fluids at the microscale level, which is of great significance for developing novel microfluidics.

7 CFR 1580.501 - Administration.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 10 2011-01-01 2011-01-01 false Administration. 1580.501 Section 1580.501 Agriculture Regulations of the Department of Agriculture (Continued) FOREIGN AGRICULTURAL SERVICE, DEPARTMENT OF AGRICULTURE TRADE ADJUSTMENT ASSISTANCE FOR FARMERS § 1580.501 Administration. (a) The petition process will...

7 CFR 1580.501 - Administration.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Administration. 1580.501 Section 1580.501 Agriculture Regulations of the Department of Agriculture (Continued) FOREIGN AGRICULTURAL SERVICE, DEPARTMENT OF AGRICULTURE TRADE ADJUSTMENT ASSISTANCE FOR FARMERS § 1580.501 Administration. (a) The application process...

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

PubMed Central

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

2014-01-01

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

Sensing of fluid viscoelasticity from piezoelectric actuation of cantilever flexural vibration

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

Park, Jeongwon; Jeong, Seongbin; Kim, Seung Joon

2015-01-15

An experimental method is proposed to measure the rheological properties of fluids. The effects of fluids on the vibration actuated by piezoelectric patches were analyzed and used in measuring viscoelastic properties. Fluid-structure interactions induced changes in the beam vibration properties and frequency-dependent variations of the complex wavenumber of the beam structure were used in monitoring these changes. To account for the effects of fluid-structure interaction, fluids were modelled as a simple viscoelastic support at one end of the beam. The measured properties were the fluid’s dynamic shear modulus and loss tangent. Using the proposed method, the rheological properties of variousmore » non-Newtonian fluids were measured. The frequency range for which reliable viscoelasticity results could be obtained was 10–400 Hz. Viscosity standard fluids were tested to verify the accuracy of the proposed method, and the results agreed well with the manufacturer’s reported values. The simple proposed laboratory setup for measurements was flexible so that the frequency ranges of data acquisition were adjustable by changing the beam’s mechanical properties.« less

Development of a Mechatronic Syringe Pump to Control Fluid Flow in a Microfluidic Device Based on Polyimide Film

NASA Astrophysics Data System (ADS)

Sek Tee, Kian; Sharil Saripan, Muhammad; Yap, Hiung Yin; Fhong Soon, Chin

2017-08-01

With the advancement in microfluidic technology, fluid flow control for syringe pump is always essential. In this paper, a mechatronic syringe pump will be developed and customized to control the fluid flow in a poly-dimethylsiloxane (PDMS) microfluidic device based on a polyimide laminating film. The syringe pump is designed to drive fluid with flow rates of 100 and 1000 μl/min which intended to drive continuous fluid in a polyimide based microfluidic device. The electronic system consists of an Arduino microcontroller board and a uni-polar stepper motor. In the system, the uni-polar stepper motor was coupled to a linear slider attached to the plunger of a syringe pump. As the motor rotates, the plunger pumps the liquid out of the syringe. The accuracy of the fluid flow rate was determined by adjusting the number of micro-step/revolution to drive the stepper motor to infuse fluid into the microfluidic device. With the precise control of the electronic system, the syringe pump could accurately inject fluid volume at 100 and 1000 μl/min into a microfluidic device.

21 CFR 880.5100 - AC-powered adjustable hospital bed.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false AC-powered adjustable hospital bed. 880.5100 Section 880.5100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Therapeutic Devices § 880.5100 AC-powered adjustable hospital bed. (a) Identification. An AC-powered...

20 CFR 416.405 - Cost-of-living adjustments in benefits.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Cost-of-living adjustments in benefits. 416.405 Section 416.405 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Amount of Benefits § 416.405 Cost-of-living adjustments in benefits...

20 CFR 416.405 - Cost-of-living adjustments in benefits.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Cost-of-living adjustments in benefits. 416.405 Section 416.405 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Amount of Benefits § 416.405 Cost-of-living adjustments in benefits...

20 CFR 416.405 - Cost-of-living adjustments in benefits.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Cost-of-living adjustments in benefits. 416.405 Section 416.405 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Amount of Benefits § 416.405 Cost-of-living adjustments in benefits...

5 CFR 831.702 - Adjustment of annuities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Adjustment of annuities. 831.702 Section... (CONTINUED) RETIREMENT Computation of Annuities § 831.702 Adjustment of annuities. (a)(1) An annuity which... benefit shall require a corresponding deduction in the civil service annuity. (3) Any cost-of-living...

75 FR 59685 - Trade Adjustment Assistance for Farmers

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-28

... Service (FAS) has denied petitions (Nos. 2011024, 2011025) for trade adjustment assistance for lamb filed under the fiscal year (FY) 2011 program by lamb producers from Ohio. The petitions were accepted for... Administrator was not able to certify them, making lamb producers in Ohio ineligible for trade adjustment...

20 CFR 416.405 - Cost-of-living adjustments in benefits.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Cost-of-living adjustments in benefits. 416.405 Section 416.405 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Amount of Benefits § 416.405 Cost-of-living adjustments in benefits...

Risk-adjusted antibiotic consumption in 34 public acute hospitals in Ireland, 2006 to 2014

PubMed Central

Oza, Ajay; Donohue, Fionnuala; Johnson, Howard; Cunney, Robert

2016-01-01

As antibiotic consumption rates between hospitals can vary depending on the characteristics of the patients treated, risk-adjustment that compensates for the patient-based variation is required to assess the impact of any stewardship measures. The aim of this study was to investigate the usefulness of patient-based administrative data variables for adjusting aggregate hospital antibiotic consumption rates. Data on total inpatient antibiotics and six broad subclasses were sourced from 34 acute hospitals from 2006 to 2014. Aggregate annual patient administration data were divided into explanatory variables, including major diagnostic categories, for each hospital. Multivariable regression models were used to identify factors affecting antibiotic consumption. Coefficient of variation of the root mean squared errors (CV-RMSE) for the total antibiotic usage model was very good (11%), however, the value for two of the models was poor (> 30%). The overall inpatient antibiotic consumption increased from 82.5 defined daily doses (DDD)/100 bed-days used in 2006 to 89.2 DDD/100 bed-days used in 2014; the increase was not significant after risk-adjustment. During the same period, consumption of carbapenems increased significantly, while usage of fluoroquinolones decreased. In conclusion, patient-based administrative data variables are useful for adjusting hospital antibiotic consumption rates, although additional variables should also be employed. PMID:27541730

Metabolic consequences of fluid shifts induced by microgravity

NASA Technical Reports Server (NTRS)

Cintron, N. M.; Lane, H. W.; Leach, C. S.

1990-01-01

The effects of fluid redistribution induced by weightlessness on the fluid and electrolyte regulation, the maintenance of optimum nutritional status, and on pharmacodynamics (i.e., the absorption, distribution, and elimination of pharmacologic agents) are examined on the basis of published data on flights aboard Skylab and Space Shuttle. Data are presented on changes in plasma osmolarity and the content of antinuclear factor, serum glucose, and the salivary scopolamine concentrations after oral administration before and during space flights.

Pharmacokinetics of single-dose oral ciprofloxacin in patients undergoing chronic ambulatory peritoneal dialysis.

PubMed Central

Shalit, I; Greenwood, R B; Marks, M I; Pederson, J A; Frederick, D L

1986-01-01

The prevention and treatment of peritonitis in patients undergoing peritoneal dialysis is often complicated by several factors, including nephrotoxicity, requirement for hospitalization, parenteral antibiotic therapy, and infection caused by resistant microorganisms. Ciprofloxacin, a new carboxyquinolone derivative, may offer the advantages of oral administration, a broad spectrum of antibacterial activity, and safety for the management of these patients. The pharmacokinetics of ciprofloxacin in serum and peritoneal fluid of eight adult patients undergoing chronic ambulatory peritoneal dialysis (CAPD) were investigated. Each patient ingested a single 750-mg dose of ciprofloxacin, and drug concentrations were measured by high-pressure liquid chromatography in serum and peritoneal fluid for 48 h after the dose. Serum concentrations reached a mean peak of 3.6 micrograms/ml 1 to 2 h after the oral dose. The mean terminal serum half-life was 16.8 h, and the mean peritoneal fluid/serum concentration ratio was 0.64. The mean peak ciprofloxacin concentration in peritoneal fluid was 1.3 micrograms/ml, and the bioactivity of the drug in peritoneal fluid was confirmed. These data indicated that therapeutic concentrations of ciprofloxacin against bacterial pathogens commonly associated with peritonitis in CAPD patients may be achievable in the peritoneal fluid after oral administration to patients undergoing CAPD. In addition, the pharmacokinetic data provide guidelines for further clinical studies of oral ciprofloxacin in CAPD patients. PMID:2944477

Goal-Directed Fluid Therapy on Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients.

PubMed

Muñoz, José Luis; Gabaldón, Tanya; Miranda, Elena; Berrio, Diana Lorena; Ruiz-Tovar, Jaime; Ronda, José María; Esteve, Nuria; Arroyo, Antonio; Pérez, Ana

2016-11-01

In bariatric surgery, there are no guidelines available for intraoperative fluid administration. Goal-directed fluid therapy (GDFT) is a new concept of perioperative fluid management that has been shown to improve the prognosis of patients undergoing abdominal surgery. The aim of our study is to assess the impact of the implementation of a GDFT protocol in morbidly obese patients who underwent laparoscopic sleeve gastrectomy (LSG). A before-after intervention study, in morbidly obese patients who underwent LSG, was conducted at the Obesity Unit of the General University Hospital Elche. Data from the GDFT implementation group (January 2014 to December 2015) were prospectively collected and compared with a preimplementation group (January 2012 to December 2013). Baseline demographic and comorbidity data between the two groups of patients were similar. The length of stay in the hospital was significantly shortened in GDFT group from 4.5 to 3.44 days (p < 0.001). Intraoperative fluid administration was significantly lower in the GDFT group (1002.4 vs 1687.2 ml in preimplementation group, p < 0.001). In the postoperative period, there was a statistically significant reduction in postoperative nausea and vomiting (PONV) after GDFT implementation (48 to 14.3 %, p < 0.001). Implementation of GDFT protocols can prevent intraoperative fluid overload in patients undergoing bariatric surgery. It could improve outcomes, for example decreasing PONV or even hospital stay.

7 CFR 1580.203 - Determination of eligibility and certification by the Administrator (FAS).

Code of Federal Regulations, 2012 CFR

2012-01-01

... Administrator (FAS). 1580.203 Section 1580.203 Agriculture Regulations of the Department of Agriculture... § 1580.203 Determination of eligibility and certification by the Administrator (FAS). (a) As soon as... Administrator (FAS) shall certify a group of producers as eligible to apply for adjustment assistance under this...

7 CFR 1580.203 - Determination of eligibility and certification by the Administrator (FAS).

Code of Federal Regulations, 2014 CFR

2014-01-01

... Administrator (FAS). 1580.203 Section 1580.203 Agriculture Regulations of the Department of Agriculture... § 1580.203 Determination of eligibility and certification by the Administrator (FAS). (a) As soon as... Administrator (FAS) shall certify a group of producers as eligible to apply for adjustment assistance under this...

7 CFR 1580.203 - Determination of eligibility and certification by the Administrator (FAS).

Code of Federal Regulations, 2013 CFR

2013-01-01

... Administrator (FAS). 1580.203 Section 1580.203 Agriculture Regulations of the Department of Agriculture... § 1580.203 Determination of eligibility and certification by the Administrator (FAS). (a) As soon as... Administrator (FAS) shall certify a group of producers as eligible to apply for adjustment assistance under this...

Fluid loss, venous congestion, and worsening renal function in acute decompensated heart failure.

PubMed

Aronson, Doron; Abassi, Zaid; Allon, Eyal; Burger, Andrew J

2013-06-01

To investigate the relationship between decongestion, central venous pressure, and risk of worsening renal function (WRF) in patients with acute decompensated heart failure (ADHF). We studied 475 patients with ADHF, of whom 238 underwent right heart catheterization. Right atrial pressure (RAP) was measured at baseline and at 24 h. Net fluid loss was recorded in the first 24 h. WRF was defined as a >0.3 mg/dL increase in serum creatinine above baseline. WRF occurred in 84 catheterized patients (35.3%). There was a weak correlation between baseline RAP and baseline estimated glomerular filtration rate (r = -0.17, P = 0.009). The amount of fluid removed during the first 24 h did not correlate with the magnitude of RAP reduction (r = 0.06, P = 0.35). No association was observed between WRF and baseline RAP [odds ratio (OR) 1.06, 95% confidence interval (CI) 0.80-1.41, P = 0.68 per 6.6 mmHg] or the decrease in RAP (adjusted OR 1.13, 95% CI 0.85-1.49, P = 0.40 per 5.3 mmHg reduction in RAP). In contrast, smaller net fluid loss was strongly associated with increased WRF risk. Compared with the first net fluid loss tertile, the adjusted OR was 1.85 (95% CI 0.90-3.80, P = 0.10) and 2.58 (95% CI 1.27-5.25; P = 0.009) for the second and third tertile, respectively (P for trend <0.0001). Smaller early net fluid loss is associated with increased risk for WRF. RAP is not a reliable surrogate of the magnitude of decongestion and risk of WRF. Future research is necessary to determine if targeting congestion may help prevent WRF.

Automatic temperature adjustment apparatus

DOEpatents

Chaplin, James E.

1985-01-01

An apparatus for increasing the efficiency of a conventional central space heating system is disclosed. The temperature of a fluid heating medium is adjusted based on a measurement of the external temperature, and a system parameter. The system parameter is periodically modified based on a closed loop process that monitors the operation of the heating system. This closed loop process provides a heating medium temperature value that is very near the optimum for energy efficiency.

5 CFR 550.1001 - Coverage.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Coverage. 550.1001 Section 550.1001 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Adjustment of Work Schedules for Religious Observances § 550.1001 Coverage. This subpart applies to each...

5 CFR 550.1001 - Coverage.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Coverage. 550.1001 Section 550.1001 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Adjustment of Work Schedules for Religious Observances § 550.1001 Coverage. This subpart applies to each...

5 CFR 550.1001 - Coverage.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Coverage. 550.1001 Section 550.1001 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Adjustment of Work Schedules for Religious Observances § 550.1001 Coverage. This subpart applies to each...

5 CFR 550.1001 - Coverage.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Coverage. 550.1001 Section 550.1001 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Adjustment of Work Schedules for Religious Observances § 550.1001 Coverage. This subpart applies to each...

5 CFR 550.1001 - Coverage.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Coverage. 550.1001 Section 550.1001 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Adjustment of Work Schedules for Religious Observances § 550.1001 Coverage. This subpart applies to each...

21 CFR 866.5800 - Seminal fluid (sperm) immunological test system.

Code of Federal Regulations, 2011 CFR

2011-04-01

... differentiate animal and human semen. The test results may be used as court evidence in alleged instances of... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Seminal fluid (sperm) immunological test system. 866.5800 Section 866.5800 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN...

Total volume and composition of fluid intake and mortality in older women: a cohort study.

PubMed

Lim, Wai H; Wong, Germaine; Lewis, Joshua R; Lok, Charmaine E; Polkinghorne, Kevan R; Hodgson, Jonathan; Lim, Ee M; Prince, Richard L

2017-03-24

The health benefits of 'drinking at least 8 glasses of water a day" in healthy individuals are largely unproven. We aimed to examine the relationship between total fluid and the sources of fluid consumption, risk of rapid renal decline, cardiovascular disease (CVD) mortality and all-cause mortality in elderly women. We conducted a longitudinal analysis of a population-based cohort study of 1055 women aged ≥70 years residing in Australia. The associations between total daily fluid intake (defined as total volume of beverage excluding alcohol and milk) and the types of fluid (water, black tea, coffee, milk and other fluids) measured as cups per day and rapid renal decline, CVD and all-cause mortality were assessed using adjusted logistic and Cox regression analyses. Over a follow-up period of 10 years, 70 (6.6%) experienced rapid renal decline and 362 (34.4%) died, of which 142 (13.5%) deaths were attributed to CVD. The median (IQR) intake of total fluid was 10.4 (8.5-12.5) cups per day, with water (median (IQR) 4 (2-6) cups per day) and black tea (median (IQR) 3 (1-4) cups per day) being the most frequent type of fluid consumed. Every cup per day higher intake of black tea was associated with adjusted HRs of 0.90 (95% CI 0.81 to 0.99) and 0.92 (95% CI 0.86 to 0.98) for CVD mortality and all-cause mortality, respectively. There were no associations between black tea intake and rapid renal decline, or between the quantity or type of other fluids, including water intake, and any clinical outcomes. Habitual higher intake of black tea may potentially improve long-term health outcomes, independent of treating traditional CVD risk factors, but validation of our study findings is essential. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Fluid flow characteristics during polymer flooding

NASA Astrophysics Data System (ADS)

Yao, S. L.; Dou, H. E.; Wu, M.; Zhang, H. J.

2018-05-01

At present the main problems of polymer flooding is the high injection pressure which could not guarantee the later injection. In this paper the analyses of polymer’s physical properties and its solution’s variable movement characteristics in porous media reveal the inevitable trend of decrease in injection capacity and liquid production due to the increase of fluid viscosity and flow rate with more flow resistance. The injection rate makes the primary contribution to the active viscosity of the polymer solution in porous media. The higher injection rate, the greater shearing degradation and the more the viscosity loss. Besides the quantitative variation, the rate also changes qualitatively as that the injection rate demonstrates composite change of injection intensity and density. Due to the different adjustment function of the polymer solution on its injection profile, there should be different adjustment model of rates in such stages. Here in combination of the on-site recognitions, several conclusions and recommendations are made based on the study of the injection pattern adjustment during polymer flooding to improve the pressure distribution system, which would be a meaningful reference for extensive polymer flooding in the petroleum industry.

Operation Brain Trauma Therapy Extended Studies

DTIC Science & Technology

2015-05-01

peaks in the TBI models. It is also possible that the use of a craniotomy in all 3 models results in an under- estimation of the potential benefit of...traditional strategies, namely, osmolar therapy (mannitol or hypertonic saline administration), CSF drainage , craniectomy, limitation of fluid administration

Administrative Practices of Accredited Adventure Programs.

ERIC Educational Resources Information Center

Gass, Michael, Ed.

In response to the growth and diversification of adventure programming, the Association for Experiential Education developed an accreditation process that addresses both the fluid nature of adventure programming and the need for specificity in standards. This book describes exemplary administrative practices and policies of accredited adventure…

Associations of maternal iodine status and thyroid function with adverse pregnancy outcomes in Henan Province of China.

PubMed

Yang, Jin; Liu, Yang; Liu, Hongjie; Zheng, Heming; Li, Xiaofeng; Zhu, Lin; Wang, Zhe

2018-05-01

The study aimed to explore the effects of maternal iodine status and thyroid diseases on adverse pregnancy outcomes. A prospective study was conducted on 2347 pregnant women, who provided 2347 urinary samples tested for iodine, 1082 serum samples tested for thyroid function, and 2347 questionnaires about demographic information. Their pregnancy outcomes were recorded and compared between different urinary iodine concentration (UIC) and thyroid function groups. Pregnant women with UIC between 150 and 249 μg/L had lower incidences of preeclampsia (adjusted odds ratio (OR) 0.12, 95% CI: 0.01-0.87), placenta previa (adjusted OR 0.06, 95% CI: 0.01-0.69) and fetal distress (adjusted OR 0.10, 95% CI: 0.02-0.64) than the reference group (UIC < 50 μg/L). Women with UIC between 100 and 149 μg/L had lower risks of abnormal amniotic fluid (adjusted OR 0.32, 95% CI: 0.12-0.87) and fetal distress (adjusted OR 0.08, 95% CI: 0.01-0.82). Women with UIC above 249 μg/L had a significant higher rate of abnormal amniotic fluid (adjusted OR 0.38, 95% CI: 0.16-0.89). Clinical and subclinical hypothyroidism during pregnancy increased the risk of preterm delivery by 4.4 times (P = 0.009) and 3.0 times (P =  0.014), respectively. Isolated hypothyroxinemia had increased odds of having macrosomia (adjusted OR 2.22, 95% CI: 1.13-4.85). Clinical hyperthyroidism was significantly associated with miscarriage (adjusted OR 2.12, 95% CI: 1.92-96.67) and fetal distress (adjusted OR 9.53, 95% CI: 1.05--81.81). Subclinical hyperthyroidism had a significant association with umbilical cord entanglement (adjusted OR 3.82, 95% CI: 1.38-10.58). Isolated hyperthyroxinemia was associated with preterm delivery (adjusted OR 4.73, 95% CI: 1.49-15.05). Maternal iodine status and thyroid diseases during pregnancy were associated with adverse pregnancy outcomes. Copyright © 2018 Elsevier GmbH. All rights reserved.

75 FR 59684 - Trade Adjustment Assistance for Farmers

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-28

... Service (FAS) has denied a petition (No. 2011017) for trade adjustment assistance for apples filed under...' criterion, the Administrator was not able to certify the petition, making apple producers in Maine...

20 CFR 418.1140 - What will happen if the modified adjusted gross income information from IRS is different from the...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false What will happen if the modified adjusted gross income information from IRS is different from the modified adjusted gross income information we used to determine your income-related monthly adjustment amount? 418.1140 Section 418.1140 Employees' Benefits SOCIAL SECURITY ADMINISTRATION MEDICARE...

Use of the Fluid Challenge in Critically Ill Adult Patients: A Systematic Review.

PubMed

Messina, Antonio; Longhini, Federico; Coppo, Corinne; Pagni, Aline; Lungu, Ramona; Ronco, Chiara; Cattaneo, Marco Ambrogio; Dore, Simone; Sotgiu, Giovanni; Navalesi, Paolo

2017-11-01

The fluid challenge (FC) aims at identifying patients in whom fluid administration improves hemodynamics. Although the FC has been extensively studied, the implementation and definition of improvement are not standardized. This systematic review of studies published between January 1, 1994 and December 31, 2014 characterizes these key components of the FC for critically ill adult patients, as described in the medical literature in the last 20 years. A literature search was performed using MEDLINE, Embase, and Cochrane. For each study, data were collected on study design, study size, study setting, patient population, and how the FC was administered. Eligibility criteria for FC were (1) the infusion of a definite quantity of fluid, (2) of a specific type, (3) in a fixed time period (expressed as either span or infusion rate), (4) with a defined hemodynamic variable as the target, and (5) for a predetermined threshold. One hundred fifty-seven full-text manuscripts were extracted from 870 potentially relevant studies. The inclusion criteria were met by 71 studies including 3617 patients. Sixty-six studies were from a single center and 45 were prospective observational in format. The most common amount infused was 500 cc, used by 55 (77.5%) studies. The most commonly infused fluids were colloids (62.0%). In 43 (60.5%) studies, the FC was administered between 20 and 30 minutes. A positive response to fluid administration was defined as an increase ≥15% of cardiac index or cardiac output in 44 (62.6%) studies. Static or dynamic physiologic indices were utilized in a minority of studies (16.9%) and safety limits for interrupting the FC are adopted in 4 (5.6%) studies only. This systematic review indicates that the FC most commonly consists in infusing 500 mL of crystalloids or colloids in 20-30 minutes, and considered an increase in cardiac index ≥15% as a positive response. However, definite standards for FC administration and evaluation remain undefined.

Renal effects of carprofen and etodolac in euvolemic and volume-depleted dogs.

PubMed

Surdyk, Kathryn K; Sloan, Dawn L; Brown, Scott A

2012-09-01

To determine the effects of carprofen and etodolac on renal function in euvolemic dogs and dogs with extracellular fluid volume depletion induced via administration of furosemide. 12 female Beagles. Dogs received a placebo, furosemide, carprofen, etodolac, furosemide and carprofen, and furosemide and etodolac. The order in which dogs received treatments was determined via a randomization procedure. Values of urine specific gravity, various plasma biochemical variables, glomerular filtration rate (GFR [urinary clearance of creatinine]), and renal plasma flow (urinary clearance of para-aminohippuric acid) were determined before and after 8 days of drug administration. A washout time of approximately 12 days was allowed between treatment periods. Administration of furosemide, furosemide and carprofen, and furosemide and etodolac caused changes in urine specific gravity and values of plasma biochemical variables. Administration of carprofen or etodolac alone did not have a significant effect on renal plasma flow or GFR. Concurrent administration of furosemide and carprofen or furosemide and etodolac caused a significant decrease in GFR. After 12-day washout periods, mean values of GFR were similar to values before drug administration for all treatments. Results indicated GFR decreased after 8 days of concurrent administration of furosemide and carprofen or furosemide and etodolac to dogs. Administration of preferential cyclooxygenase-2 inhibitors to dogs with extracellular fluid volume depletion or to dogs treated with diuretics may transiently impair renal function.

Split radiator design for heat rejection optimization for a waste heat recovery system

DOEpatents

Ernst, Timothy C.; Nelson, Christopher R.

2016-10-18

A cooling system provides improved heat recovery by providing a split core radiator for both engine cooling and condenser cooling for a Rankine cycle (RC). The cooling system includes a radiator having a first cooling core portion and a second cooling core portion. An engine cooling loop is fluidly connected the second cooling core portion. A condenser of an RC has a cooling loop fluidly connected to the first cooling core portion. A valve is provided between the engine cooling loop and the condenser cooling loop adjustably control the flow of coolant in the condenser cooling loop into the engine cooling loop. The cooling system includes a controller communicatively coupled to the valve and adapted to determine a load requirement for the internal combustion engine and adjust the valve in accordance with the engine load requirement.

75 FR 59681 - Trade Adjustment Assistance for Farmers

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-28

... Service (FAS) has denied a petition (No. 2011029) for trade adjustment assistance for lamb filed under the..., the Administrator was not able to certify the petition, making lamb producers in Montana ineligible...

75 FR 21365 - Investigations Regarding Certifications of Eligibility To Apply for Worker Adjustment Assistance

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-23

... DEPARTMENT OF LABOR Employment and Training Administration Investigations Regarding Certifications... Assistance, Employment and Training Administration, has instituted investigations pursuant to section 221(a... Training Administration, U.S. Department of Labor, Room N-5428, 200 Constitution Avenue, NW., Washington...

76 FR 49763 - Bonneville Power Administration; Notice of Filing

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-11

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. EF11-8-000] Bonneville Power Administration; Notice of Filing Take notice that on August 1, 2011, the Bonneville Power Administration submitted its Proposed 2012 Wholesale Power and Transmission Rates Rate Adjustment, for confirmation and...

77 FR 46124 - Investigations Regarding Eligibility To Apply for Worker Adjustment Assistance

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-02

... DEPARTMENT OF LABOR Employment and Training Administration Investigations Regarding Eligibility To... and Training Administration, has instituted investigations pursuant to Section 221(a) of the Act. The... and Training Administration, U.S. Department of Labor, Room N-5428, 200 Constitution Avenue NW...

75 FR 10324 - Investigations Regarding Certifications of Eligibility To Apply for Worker Adjustment Assistance

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-05

... DEPARTMENT OF LABOR Employment and Training Administration Investigations Regarding Certifications... Assistance, Employment and Training Administration, has instituted investigations pursuant to Section 221(a..., Employment and Training Administration, U.S. Department of Labor, Room N-5428, 200 Constitution Avenue, NW...

System and method for confining an object to a region of fluid flow having a stagnation point

NASA Technical Reports Server (NTRS)

Schroeder, Charles M. (Inventor); Babcock, Hazen P. (Inventor); Shaqfeh, Eric S. G. (Inventor); Chu, Steven (Inventor)

2006-01-01

A device for confining an object to a region proximate to a fluid flow stagnation point includes one or more inlets for carrying the fluid into the region, one or more outlets for carrying the fluid out of the region, and a controller, in fluidic communication with the inlets and outlets, for adjusting the motion of the fluid to produce a stagnation point in the region, thereby confining the object to the region. Applications include, for example, prolonged observation of the object, manipulation of the object, etc. The device optionally may employ a feedback control mechanism, a sensing apparatus (e.g., for imaging), and a storage medium for storing, and a computer for analyzing and manipulating, data acquired from observing the object. The invention further provides methods of using such a device and system in a number of fields, including biology, chemistry, physics, material science, and medical science.

Adjustable Autonomy Testbed

NASA Technical Reports Server (NTRS)

Malin, Jane T.; Schrenkenghost, Debra K.

2001-01-01

The Adjustable Autonomy Testbed (AAT) is a simulation-based testbed located in the Intelligent Systems Laboratory in the Automation, Robotics and Simulation Division at NASA Johnson Space Center. The purpose of the testbed is to support evaluation and validation of prototypes of adjustable autonomous agent software for control and fault management for complex systems. The AA T project has developed prototype adjustable autonomous agent software and human interfaces for cooperative fault management. This software builds on current autonomous agent technology by altering the architecture, components and interfaces for effective teamwork between autonomous systems and human experts. Autonomous agents include a planner, flexible executive, low level control and deductive model-based fault isolation. Adjustable autonomy is intended to increase the flexibility and effectiveness of fault management with an autonomous system. The test domain for this work is control of advanced life support systems for habitats for planetary exploration. The CONFIG hybrid discrete event simulation environment provides flexible and dynamically reconfigurable models of the behavior of components and fluids in the life support systems. Both discrete event and continuous (discrete time) simulation are supported, and flows and pressures are computed globally. This provides fast dynamic simulations of interacting hardware systems in closed loops that can be reconfigured during operations scenarios, producing complex cascading effects of operations and failures. Current object-oriented model libraries support modeling of fluid systems, and models have been developed of physico-chemical and biological subsystems for processing advanced life support gases. In FY01, water recovery system models will be developed.

Distribution of electrolytes in a flow battery

DOEpatents

Darling, Robert Mason; Smeltz, Andrew; Junker, Sven Tobias; Perry, Michael L.

2017-12-26

A method of determining a distribution of electrolytes in a flow battery includes providing a flow battery with a fixed amount of fluid electrolyte having a common electrochemically active specie, a portion of the fluid electrolyte serving as an anolyte and a remainder of the fluid electrolyte serving as a catholyte. An average oxidation state of the common electrochemically active specie is determined in the anolyte and the catholyte and, responsive to the determined average oxidation state, a molar ratio of the common electrochemically active specie between the anolyte and the catholyte is adjusted to increase an energy discharge capacity of the flow battery for the determined average oxidation state.

Induction voidmeter

DOEpatents

Anderson, T.T.; Roop, C.J.; Schmidt, K.J.; Brewer, J.

1983-12-21

An induction voidmeter for detecting voids in a conductive fluid may comprise: a four arm bridge circuit having two adjustable circuit elements connected as opposite arms of said bridge, an input branch, and an output branch; two induction coils, bifilarly wound together, connected as the remaining two opposing arms of said bridge circuit and positioned such that the conductive fluid passes through said coils; means for applying an AC excitation signal to said input branch; and means for detecting the output signal generated in response to said excitation signal across said output branch. The induction coils may be located outside or inside a non-magnetic pipe containing the conductive fluid.

5 CFR 534.404 - Setting and adjusting pay for senior executives.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Setting and adjusting pay for senior... REGULATIONS PAY UNDER OTHER SYSTEMS Pay and Performance Awards Under the Senior Executive Service § 534.404 Setting and adjusting pay for senior executives. (a) Setting pay upon initial appointment to the SES. An...

How to Implement Differentiated Instruction? Adjust, Adjust, Adjust: North Carolina Project Begins with Encouragement from Administrators

ERIC Educational Resources Information Center

Lewis, Sylvia G.; Batts, Kelly

2005-01-01

To help teachers meet the diverse needs of individual students, North Topsail Elementary School in North Carolina developed a differentiated instruction program. North Topsail began its change with staff focusing on the principles of Accelerated Schools, including differentiation. Teachers reflected, developed a vision, and set priorities for…

50 CFR 648.261 - Framework adjustment process.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Measures for the Atlantic Deep-Sea Red Crab Fishery § 648.261 Framework adjustment process. (a) To implement a framework adjustment for the Red Crab FMP, the Council shall develop and analyze proposed... Administrator. (1) In response to an annual review of the status of the fishery or the resource by the Red Crab...

21 CFR 1315.13 - Adjustments of the assessment of annual needs.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 9 2014-04-01 2014-04-01 false Adjustments of the assessment of annual needs... Needs § 1315.13 Adjustments of the assessment of annual needs. (a) The Administrator may at any time increase or reduce the assessment of annual needs for ephedrine, pseudoephedrine, or phenylpropanolamine...

21 CFR 1315.13 - Adjustments of the assessment of annual needs.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 9 2012-04-01 2012-04-01 false Adjustments of the assessment of annual needs... Needs § 1315.13 Adjustments of the assessment of annual needs. (a) The Administrator may at any time increase or reduce the assessment of annual needs for ephedrine, pseudoephedrine, or phenylpropanolamine...

21 CFR 1315.13 - Adjustments of the assessment of annual needs.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 9 2013-04-01 2013-04-01 false Adjustments of the assessment of annual needs... Needs § 1315.13 Adjustments of the assessment of annual needs. (a) The Administrator may at any time increase or reduce the assessment of annual needs for ephedrine, pseudoephedrine, or phenylpropanolamine...

21 CFR 1315.13 - Adjustments of the assessment of annual needs.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 9 2011-04-01 2011-04-01 false Adjustments of the assessment of annual needs... Needs § 1315.13 Adjustments of the assessment of annual needs. (a) The Administrator may at any time increase or reduce the assessment of annual needs for ephedrine, pseudoephedrine, or phenylpropanolamine...

5 CFR 530.307 - OPM review and adjustment of special rate schedules.

Code of Federal Regulations, 2010 CFR

2010-01-01

.... 5305(d), special rate schedule adjustments made by OPM have the force and effect of statute. (d)(1) For... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false OPM review and adjustment of special rate... REGULATIONS PAY RATES AND SYSTEMS (GENERAL) Special Rate Schedules for Recruitment and Retention General...

A discontinuous finite element approach to cracking in coupled poro-elastic fluid flow models

NASA Astrophysics Data System (ADS)

Wilson, C. R.; Spiegelman, M. W.; Evans, O.; Ulven, O. I.; Sun, W.

2016-12-01

Reaction-driven cracking is a coupled process whereby fluid-induced reactions drive large volume changes in the host rock which produce stresses leading to crack propagation and failure. This in turn generates new surface area and fluid-flow pathways for subsequent reaction in a potentially self-sustaining system. This mechanism has has been proposed for the pervasive serpentinization and carbonation of peridotite, as well as applications to mineral carbon sequestration and hydrocarbon extraction. The key computational issue in this problem is implementing algorithms that adequately model the formation of discrete fractures. Here we present models using a discontinuous finite element method for modeling fracture formation (Radovitsky et al., 2011). Cracks are introduced along facets of the mesh by the relaxation of penalty parameters once a failure criterion is met. It is fully described in the weak form of the equations, requiring no modification of the underlying mesh structure and allowing fluid properties to be easily adjusted along cracked facets. To develop and test the method, we start by implementing the algorithm for the simplified Biot equations for poro-elasticity using the finite element model assembler TerraFERMA. We consider hydro-fracking around a borehole (Grassl et al., 2015), where elevated fluid pressure in the poro-elastic solid causes it to fail radially in tension. We investigate the effects of varying the Biot coefficient and adjusting the fluid transport properties in the vicinity of the crack and compare our results to related dual-graph models (Ulven & Sun, submitted). We discuss issues arising from this method, including the formation of null spaces and appropriate preconditioning and solution strategies. Initial results suggest that this method provides a promising way to incorporate cracking into our reactive fluid flow models and future work aims to integrate the mechanical and chemical aspects of this process.

Pharmacokinetic Profile of Oral Cannabis in Humans: Blood and Oral Fluid Disposition and Relation to Pharmacodynamic Outcomes

PubMed Central

Vandrey, Ryan; Herrmann, Evan S.; Mitchell, John M.; Bigelow, George E.; Flegel, Ronald; LoDico, Charles; Cone, Edward J.

2017-01-01

Abstract Most research on cannabis pharmacokinetics has evaluated inhaled cannabis, but oral (“edible”) preparations comprise an increasing segment of the cannabis market. To assess oral cannabis pharmacokinetics and pharmacodynamics, healthy adults (N = 6 per dose) were administered cannabis brownies containing 10, 25 or 50 mg 9-tetrahydrocannabinol (THC). Whole blood and oral fluid specimens were obtained at baseline and then for 9 days post-exposure; 6 days in a residential research setting and 3 days as outpatients. Measures of subjective, cardiovascular and performance effects were obtained at baseline and for 8 h post-ingestion. The mean Cmax for THC in whole blood was 1, 3.5 and 3.3 ng/mL for the 10, 25 and 50 mg THC doses, respectively. The mean maximum concentration (Cmax) and mean time to maximum concentration (Tmax) of 11-OH-THC in whole blood were similar to THC. Cmax blood concentrations of THCCOOH were generally higher than THC and had longer Tmax values. The mean Tmax for THC in oral fluid occurred immediately following oral dose administration, and appear to reflect local topical residue rather than systemic bioavailbility. Mean Cmax oral fluid concentrations of THCCOOH were lower than THC, erratic over time and mean Tmax occurred at longer times than THC. The window of THC detection ranged from 0 to 22 h for whole blood (limit of quantitation (LOQ) = 0.5 ng/mL) and 1.9 to 22 h for oral fluid (LOQ = 1.0 ng/mL). Subjective drug and cognitive performance effects were generally dose dependent, peaked at 1.5–3 h post-administration, and lasted 6–8 h. Whole blood cannabinoid concentrations were significantly correlated with subjective drug effects. Correlations between blood cannabinoids and cognitive performance measures, and between oral fluid and all pharmacodynamic outcomes were either non-significant or not orderly by dose. Quantitative levels of cannabinoids in whole blood and oral fluid were low compared with levels observed following inhalation of cannabis. The route of administration is important for interpretation of cannabinoid toxicology. PMID:28158482

Fluid therapy and perfusional considerations during resuscitation in critically ill patients with intra-abdominal hypertension.

PubMed

Regli, Adrian; De Keulenaer, Bart; De Laet, Inneke; Roberts, Derek; Dabrowski, Wojciech; Malbrain, Manu L N G

2015-01-01

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are consistently associated with morbidity and mortality among the critically ill or injured. Thus, avoiding or potentially treating these conditions may improve patient outcomes. With the aim of improving the outcomes for patients with IAH/ACS, the World Society of the Abdominal Compartment Syndrome recently updated its clinical practice guidelines. In this article, we review the association between a positive fluid balance and outcomes among patients with IAH/ACS and how optimisation of fluid administration and systemic/regional perfusion may potentially lead to improved outcomes among this patient population.Evidence consistently associates secondary IAH with a positive fluid balance. However, despite increased research in the area of non-surgical management of patients with IAH and ACS, evidence supporting this approach is limited. Some evidence exists to support implementing goal-directed resuscitation protocols and restrictive fluid therapy protocols in shocked and recovering critically ill patients with IAH. Data from animal experiments and clinical trials has shown that the early use of vasopressors and inotropic agents is likely to be safe and may help reduce excessive fluid administration, especially in patients with IAH. Studies using furosemide and/or renal replacement therapy to achieve a negative fluid balance in patients with IAH are encouraging. The type of fluid to be administered in patients with IAH remains far from resolved. There is currently insufficient evidence to recommend the use of abdominal perfusion pressure as a resuscitation endpoint in patients with IAH. However, it is important to recognise that IAH either abolishes or increases threshold values for pulse pressure variation and stroke volume variation to predict fluid responsiveness, while the presence of IAH may also result in a false negative passive leg raising test.Correct fluid therapy and perfusional support during resuscitation form the cornerstone of medical management in patients with abdominal hypertension. Controlled studies determining whether the above medical interventions may improve outcomes among those with IAH/ACS are urgently required.

Theoretical and experimental analysis of MR valve

NASA Astrophysics Data System (ADS)

Leicht, Z.; Urreta, H.; Sanchez, A.; Agirre, A.; Kuzhir, P.; Magnac, G.

2009-02-01

The properties of magnetorheological (MR) fluid can be rapidly varied by the application of a magnetic field. This behaviour allows the designer to construct a machine that's quality can be changed in action, according to the variation of the surround and to the expectations. The commercial use of MR fluid is already not limited in dampers and breaks. Thanks to the advantageous quality - that requires low voltage - is on the increase. Using the MR fluid in a valve, the pressure drop can be adjusted by the intensity of the magnetic field, without moving parts. In this work a MR valve has been designed, that can supply a hydrostatic bearing lubricated with magnetic fluid. Its behaviour has been simulated with three models. The analytical model based on the Bingham law of the magnetic fluid flow, the Buckingham model (Bingham modified) and the dimensional model suggested by Lord Corporation, the manufacturer of used MR fluid, MRF 122 2EG. The results of the simulations are compared with the experimental data.

Intravenous fluids for reducing the duration of labour in low risk nulliparous women.

PubMed

Dawood, Feroza; Dowswell, Therese; Quenby, Siobhan

2013-06-18

Several factors may influence the progression of normal labour. It has been postulated that the routine administration of intravenous fluids to keep women adequately hydrated during labour may reduce the period of contraction and relaxation of the uterine muscle, and may ultimately reduce the duration of the labour. It has also been suggested that intravenous fluids may reduce caesarean sections (CS) for prolonged labour. However, the routine administration of intravenous fluids to labouring women has not been adequately elucidated although it is a widely-adopted policy, and there is no consensus on the type or volume of fluids that are required, or indeed, whether intravenous fluids are at all necessary. Women may be able to adequately hydrate themselves if they were allowed oral fluids during labour.Furthermore, excessive volumes of intravenous fluids may pose risks to both the mother and her newborn and different fluids are associated with different risks. To evaluate whether the routine administration of intravenous fluids to low-risk nulliparous labouring women reduces the duration of labour and to evaluate the safety of intravenous fluids on maternal and neonatal health. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 February 2013). Randomised controlled trials of intravenous fluid administration to spontaneously labouring low-risk nulliparous women. The review authors independently assessed trials for inclusion, trial quality and extracted data. We included nine randomised trials with 1781 women. Three trials had more than two treatment arms and were included in more than one comparison.Two trials compared women randomised to receive up to 250 mL/hour of Ringer's lactate solution as well as oral intake versus oral intake only. For women delivering vaginally, there was a reduction in the duration of labour in the Ringer's lactate group (mean difference (MD) -28.86 minutes, 95% confidence interval (CI) -47.41 to -10.30). There was no statistical reduction in the number of CS in the Ringer's lactate group (risk ratio (RR), 0.73 95% CI 0.49 to 1.08).Three trials compared women who received 125 mL/hour versus 250 mL/hour of intravenous fluids with free oral fluids in both groups. Women receiving a greater hourly volume of intravenous fluids (250 mL) had shorter labours than those receiving 125 mL (MD 23.87 minutes, 95% CI 3.72 to 44.02, 256 women). There was no statistically significant reduction in the number of CS in the 250 mL intravenous fluid group (average RR 1.00, 95% CI 0.54 to1.87, three studies, 334 women). In one study the number of assisted vaginal deliveries was lower in the group receiving 125 mL/hour (RR 0.47, 95% CI 0.27 to 0.81).Four trials compared rates of intravenous fluids in women where oral intake was restricted (125 mL/hour versus 250 mL/hour). There was a reduction in the duration of labour in women who received the higher infusion rate (MD 105.61 minutes, 95% CI 53.19 to 158.02); P < 0.0001, however, findings must be interpreted with caution as there was high heterogeneity amongst trials (I(2) = 53%). There was a significant reduction in CS in women receiving the higher rate of intravenous fluid infusion (RR 1.56, 95% CI 1.10 to 2.21; P = 0.01). There was no difference identified in the assisted delivery rate (RR 0.78, 95% CI 0.44 to 1.40). There was no clear difference between groups in the number of babies admitted to the NICU (RR 0.48, 95% CI 0.07 to 3.17).Two trials compared normal saline versus 5% dextrose. Only one reported the mean duration of labour, and there was no strong evidence of a difference between groups (MD -12.00, 95% CI -30.09 to 6.09). A trial reporting the median suggested that the duration was reduced in the dextrose group. There was no significant difference in CS or assisted deliveries (RR 0.77, 95% CI 0.41 to 1.43, two studies, 284 women) and (RR 0.59, 95% CI 0.21 to 1.63, one study, 93 women) respectively. Only one trial reported on maternal hyponatraemia (serum sodium levels < 135 mmol/L ). For neonatal complications, there was no difference in the admission to NICU) or in low Apgar scores, however 33.3% of babies developed hyponatraemia in the dextrose group compared to 13.3 % in the normal saline group (RR 0.40, 95% CI 0.17 to 0.93) (P = 0.03). One trial reported a higher incidence of neonatal hyperbilirubinaemia in the dextrose group of babies. There was no difference in neonatal hypoglycaemic episodes between groups. Although the administration of intravenous fluids compared with oral intake alone demonstrated a reduction in the duration of labour, this finding emerged from only two trials. The findings of other trials suggest that if a policy of no oral intake is applied, then the duration of labour in nulliparous women may be shortened by the administration of intravenous fluids at a rate of 250 mL/hour rather than 125 mL/hour. However, it may be possible for women to simply increase their oral intake rather than being attached to a drip and we have to consider whether it is justifiable to persist with a policy of 'nil by mouth'. One trial raised concerns about the safety of dextrose and this needs further exploration.None of the trials reported on the evaluation of maternal views of being attached to a drip during their entire labour. Furthermore, there was no objective assessment of dehydration. The evidence from this review does not provide robust evidence to recommend routine administration of intravenous fluids. Interpreting the results from trials was hampered by the low number of trials contributing data and by variation between trials. In trials where oral fluids were not restricted there was considerable variation in the amount of oral fluid consumed by women in different arms of the same trial, and between different trials. In addition, results from trials were not consistent and risk of bias varied. Some important research questions were addressed by single trials only, and important outcomes relating to maternal and infant morbidity were frequently not reported.

Application of a renormalization-group treatment to the statistical associating fluid theory for potentials of variable range (SAFT-VR).

PubMed

Forte, Esther; Llovell, Felix; Vega, Lourdes F; Trusler, J P Martin; Galindo, Amparo

2011-04-21

An accurate prediction of phase behavior at conditions far and close to criticality cannot be accomplished by mean-field based theories that do not incorporate long-range density fluctuations. A treatment based on renormalization-group (RG) theory as developed by White and co-workers has proven to be very successful in improving the predictions of the critical region with different equations of state. The basis of the method is an iterative procedure to account for contributions to the free energy of density fluctuations of increasing wavelengths. The RG method has been combined with a number of versions of the statistical associating fluid theory (SAFT), by implementing White's earliest ideas with the improvements of Prausnitz and co-workers. Typically, this treatment involves two adjustable parameters: a cutoff wavelength L for density fluctuations and an average gradient of the wavelet function Φ. In this work, the SAFT-VR (variable range) equation of state is extended with a similar crossover treatment which, however, follows closely the most recent improvements introduced by White. The interpretation of White's latter developments allows us to establish a straightforward method which enables Φ to be evaluated; only the cutoff wavelength L then needs to be adjusted. The approach used here begins with an initial free energy incorporating only contributions from short-wavelength fluctuations, which are treated locally. The contribution from long-wavelength fluctuations is incorporated through an iterative procedure based on attractive interactions which incorporate the structure of the fluid following the ideas of perturbation theories and using a mapping that allows integration of the radial distribution function. Good agreement close and far from the critical region is obtained using a unique fitted parameter L that can be easily related to the range of the potential. In this way the thermodynamic properties of a square-well (SW) fluid are given by the same number of independent intermolecular model parameters as in the classical equation. Far from the critical region the approach provides the correct limiting behavior reducing to the classical equation (SAFT-VR). In the critical region the β critical exponent is calculated and is found to take values close to the universal value. In SAFT-VR the free energy of an associating chain fluid is obtained following the thermodynamic perturbation theory of Wertheim from the knowledge of the free energy and radial distribution function of a reference monomer fluid. By determining L for SW fluids of varying well width a unique equation of state is obtained for chain and associating systems without further adjustment of critical parameters. We use computer simulation data of the phase behavior of chain and associating SW fluids to test the accuracy of the new equation.

Home blood sodium monitoring, sliding-scale fluid prescription and subcutaneous DDAVP for infantile diabetes insipidus with impaired thirst mechanism.

PubMed

Hameed, Shihab; Mendoza-Cruz, Abel C; Neville, Kristen A; Woodhead, Helen J; Walker, Jan L; Verge, Charles F

2012-06-09

Infants with diabetes insipidus (DI), especially those with impaired thirst mechanism or hypothalamic hyperphagia, are prone to severe sodium fluctuations, often requiring hospitalization. We aimed to avoid dangerous fluctuations in serum sodium and improve parental independence. A 16-month old girl with central DI, absent thirst mechanism and hyperphagia following surgery for hypothalamic astrocytoma had erratic absorption of oral DDAVP during chemotherapy cycles. She required prolonged hospitalizations for hypernatremia and hyponatremic seizure. Intensive monitoring of fluid balance, weight and clinical assessment of hydration were not helpful in predicting serum sodium. Discharge home was deemed unsafe. Oral DDAVP was switched to subcutaneous (twice-daily injections, starting with 0.01mcg/dose, increasing to 0.024mcg/dose). The parents adjusted daily fluid allocation by sliding-scale, according to the blood sodium level (measured by handheld i-STAT analyser, Abbott). We adjusted the DDAVP dose if fluid allocation differed from maintenance requirements for 3 consecutive days. After 2.5 months, sodium was better controlled, with 84% of levels within reference range (135-145 mmol/L) vs. only 51% on the old regimen (p = 0.0001). The sodium ranged from 132-154 mmol/L, compared to 120-156 on the old regimen. She was discharged home. This practical regimen improved sodium control, parental independence, and allowed discharge home.

Home blood sodium monitoring, sliding-scale fluid prescription and subcutaneous DDAVP for infantile diabetes insipidus with impaired thirst mechanism

PubMed Central

2012-01-01

Background/Aims Infants with diabetes insipidus (DI), especially those with impaired thirst mechanism or hypothalamic hyperphagia, are prone to severe sodium fluctuations, often requiring hospitalization. We aimed to avoid dangerous fluctuations in serum sodium and improve parental independence. Methods A 16-month old girl with central DI, absent thirst mechanism and hyperphagia following surgery for hypothalamic astrocytoma had erratic absorption of oral DDAVP during chemotherapy cycles. She required prolonged hospitalizations for hypernatremia and hyponatremic seizure. Intensive monitoring of fluid balance, weight and clinical assessment of hydration were not helpful in predicting serum sodium. Discharge home was deemed unsafe. Oral DDAVP was switched to subcutaneous (twice-daily injections, starting with 0.01mcg/dose, increasing to 0.024mcg/dose). The parents adjusted daily fluid allocation by sliding-scale, according to the blood sodium level (measured by handheld i-STAT analyser, Abbott). We adjusted the DDAVP dose if fluid allocation differed from maintenance requirements for 3 consecutive days. Results After 2.5 months, sodium was better controlled, with 84% of levels within reference range (135-145 mmol/L) vs. only 51% on the old regimen (p = 0.0001). The sodium ranged from 132-154 mmol/L, compared to 120–156 on the old regimen. She was discharged home. Conclusion This practical regimen improved sodium control, parental independence, and allowed discharge home. PMID:22682315

Improved fluid dynamics similarity, analysis and verification. Part 5: Analytical and experimental studies of thermal stratification phenomena

NASA Technical Reports Server (NTRS)

Winter, E. R. F.; Schoenhals, R. J.; Haug, R. I.; Libby, T. L.; Nelson, R. N.; Stevenson, W. H.

1968-01-01

The stratification behavior of a contained fluid subjected to transient free convection heat transfer was studied. A rectangular vessel was employed with heat transfer from two opposite walls of the vessel to the fluid. The wall temperature was increased suddenly to initiate the process and was then maintained constant throughout the transient stratification period. Thermocouples were positioned on a post at the center of the vessel. They were adjusted so that temperatures could be measured at the fluid surface and at specific depths beneath the surface. The predicted values of the surface temperature and the stratified layer thickness were found to agree reasonably well with the experimental measurements. The experiments also provided information on the transient centerline temperature distribution and the transient flow distribution.

Ultrasonic cleaning of interior surfaces

DOEpatents

MacKenzie, D.; Odell, C.

1994-03-01

An ultrasonic cleaning apparatus is described for cleaning the interior surfaces of tubes. The apparatus includes an ultrasonic generator and reflector each coupled to opposing ends of the open-ended, fluid-filled tube. Fluid-tight couplings seal the reflector and generator to the tube, preventing leakage of fluid from the interior of the tube. The reflector and generator are operatively connected to actuators, whereby the distance between them can be varied. When the distance is changed, the frequency of the sound waves is simultaneously adjusted to maintain the resonant frequency of the tube so that a standing wave is formed in the tube, the nodes of which are moved axially to cause cavitation along the length of the tube. Cavitation maximizes mechanical disruption and agitation of the fluid, dislodging foreign material from the interior surface. 3 figures.

Ultrasonic cleaning of interior surfaces

DOEpatents

Odell, D. MacKenzie C.

1996-01-01

An ultrasonic cleaning method for cleaning the interior surfaces of tubes. The method uses an ultrasonic generator and reflector each coupled to opposing ends of the open-ended, fluid-filled tube. Fluid-tight couplings seal the reflector and generator to the tube, preventing leakage of fluid from the interior of the tube. The reflector and generator are operatively connected to actuators, whereby the distance between them can be varied. When the distance is changed, the frequency of the sound waves is simultaneously adjusted to maintain the resonant frequency of the tube so that a standing wave is formed in the tube, the nodes of which are moved axially to cause cavitation along the length of the tube. Cavitation maximizes mechanical disruption and agitation of the fluid, dislodging foreign material from the interior surface.

Ultrasonic cleaning of interior surfaces

DOEpatents

Odell, D. MacKenzie C.

1994-01-01

An ultrasonic cleaning apparatus for cleaning the interior surfaces of tubes. The apparatus includes an ultrasonic generator and reflector each coupled to opposing ends of the open-ended, fluid-filled tube. Fluid-tight couplings seal the reflector and generator to the tube, preventing leakage of fluid from the interior of the tube. The reflector and generator are operatively connected to actuators, whereby the distance between them can be varied. When the distance is changed, the frequency of the sound waves is simultaneously adjusted to maintain the resonant frequency of the tube so that a standing wave is formed in the tube, the nodes of which are moved axially to cause cavitation along the length of the tube. Cavitation maximizes mechanical disruption and agitation of the fluid, dislodging foreign material from the interior surface.

Power tong torque control

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

Buck, D.A.; James, R.N.

1987-10-20

Torque controlled powered pipe tongs, are described the apparatus comprises: (a) a power tong powered by a fluid motor; (b) a fluid power source connected to the motor; (c) a force conducting element attached to the power tong, situated to oppose reaction torque from the tongs when torque is applied to pipe; (d) force sensing means operatively associated with the force conducting element situated to sense at least part of the force experienced by the force conducting element, arranged to produce a pressure signal proportional to force sensed; and (e) a fluid by-pass valve, adjustably biased toward a closed position,more » responsive to the signal to tend to move toward an open position, the by-pass valve connected between the fluid power source and the motor.« less

Micro-fluid exchange coupling apparatus

NASA Technical Reports Server (NTRS)

Johnson, J. E., Jr.; Swartz, P. F. (Inventor)

1980-01-01

In a macro-fluid exchange, a hollow needle, such as a syringe needle, is provided for penetrating the fluid conduit of the animal. The syringe needle is coupled to a plenum chamber having an inlet and outlet port. The plenum chamber is coupled to the syringe needle via the intermediary of a standard quick disconnect coupling fitting. The plenum chamber is carried at the end of a drive rod which is coupled to a micrometer drive head. The micrometer drive head is slidably and pivotably coupled to a pedestal for adjusting the height and angle of inclination of the needle relative to a reference base support. The needle is positioned adjacent to the incised trachea or a blood vessel of a small animal and the micrometer drive head is operated for penetrating the fluid conduit of the animal.

Purinergic and cholinergic components of bladder contractility and flow.

PubMed

Theobald, R J

1995-01-01

The role of ATP as a neurotransmitter/neuromodulator in the urinary tract has been the subject of much study, particularly whether ATP has a functional role in producing urine flow. Recent studies suggested significant species variation, specifically a variation between cat and other species. This study was performed to determine the in vivo response of cat urinary bladder to pelvic nerve stimulation (PNS) and to the exogenous administration of cholinergic and purinergic agents. In anesthetized cats, bladder contractions and fluid expulsion was measured in response to PNS and to the exogenous administration of cholinergic and purinergic agents. Fluid was instilled into the bladder and any fluid expelled by bladder contractions induced by PNS or exogenous agents was collected in a beaker. The volume was measured in a graduated cylinder and recorded. PNS, carbachol and APPCP produced sustained contractions with significant expulsion of fluid. ATP, ACh and hypogastric nerve stimulation did not produce any significant expulsion of fluid. Atropine, a cholinergic antagonist, inhibited PNS contractions and fluid expulsion with no effect on purinergic actions. There was a significant relationship between the magnitude of the contraction, duration of the contractions and volume of fluid expelled. The data and information from other studies, strongly suggests a functional role for ATP as a cotransmitter in the lower urinary tract different from ACh's role. ATP stimulation of a specific purinergic receptor plays a role in initiation of bladder contractions and perhaps in the initiation of urine flow from the bladder. ACh's role is functionally different and appears to be more involved in maintenance of contractile activity and flow.

Study of Fluid Cooling Loop System in Chinese Manned Spacecraft

NASA Astrophysics Data System (ADS)

Jiang, Jun; Xu, Jiwan; Fan, Hanlin; Huang, Jiarong

2002-01-01

change. To solve the questions, a fluid cooling loop system must be applied to Chinese manned spacecraft besides other conventional thermal control methods, such as thermal control coatings, multiplayer insulation blankets, heat pipes, electro-heating adjustment temperature devices, and so on. The paper will introduce the thermal design of inner and outer fluid loop including their constitution and fundamental, etc. The capability of heat transportation and the accuracy of control temperature for the fluid loop will be evaluated and analyzed. To insure the air temperature of sealed cabins within 21+/-4, the inlet liquid temperature of condensing heat exchanger needs to be controlled within 9+/-2. To insure this, the inlet liquid temperature of middle heat exchanger needs to be controlled within 8+/-1.8. The inlet temperature point is controlled by a subsidiary loop adjusting: when the computer receives feedbacks of the deviation and the variety rate of deviation from the controlled temperature point. It drives the temperature control valve to adjust the flow flux distribution between the main loop through radiator and the subsidiary loop which isn't through radiator to control the temperature of the mixed fluid within 8+/-1.8. The paper will also introduce thermal designs of key parts in the cooling loop, such as space radiators, heat exchangers and cooling plates. Thermal simulated tests on the ground and flight tests have been performed to verify correctness of thermal designs. rational and the loop system works order. It realizes the circulation of absorbing heat dissipation to the loop and transferring it to radiator then radiating it to space. (2) loop control system controls inlet temperature of middle heat exchanger within 8+/-1.8 under various thermal cases. Thermal design of the middle heat exchanger insures inlet temperature of condensing heat within 9+/-2. Thereby, the air temperature of sealed cabins is controlled within about 21+/-4 accurately. (3) The thermal designs of the key heat exchanging parts (such as radiator, heat exchangers and cooling plates) in the cooling loop are rational and effective, they meet the requirements of heat exchanging and assure the entire system work order.

77 FR 39265 - Notice of Determinations Regarding Eligibility To Apply for Worker Adjustment Assistance

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-02

... DEPARTMENT OF LABOR Employment and Training Administration Notice of Determinations Regarding Eligibility To Apply for Worker Adjustment Assistance In accordance with Section 223 of the Trade Act of 1974...

21 CFR 880.2460 - Electrically powered spinal fluid pressure monitor.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Electrically powered spinal fluid pressure monitor. 880.2460 Section 880.2460 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal Use Monitoring Devices § 880.2460...

Maintenance Fluid Therapy: Isotonic Versus Hypotonic Solutions.

PubMed

Hansen, Bernie; Vigani, Alessio

2017-03-01

The goal of maintenance fluid therapy in small animals is to replace normal ongoing losses of water and salts when oral intake is withheld. Hospitalized dogs and cats may have multiple stimuli for antidiuretic hormone release that disrupt normal osmoregulation and predispose to water retention. Severe illness promotes retention of both sodium and water as edema. Commercially available fluids have electrolyte concentrations that are very different from dietary maintenance requirements, and potential consequences include development of hypoosmolality, edema, or both when excesses of water or sodium are administered. Suggestions for tailoring fluid administration toward specific goals are provided. Copyright © 2016 Elsevier Inc. All rights reserved.

National survey of fluid therapy in acute pancreatitis: current practice lacks a sound evidence base.

PubMed

Haydock, Matthew D; Mittal, Anubhav; van den Heever, Marc; Rossaak, Jeremy I; Connor, Saxon; Rodgers, Michael; Petrov, Maxim S; Windsor, John A

2013-10-01

Fluid therapy (FT) is a critical intervention in managing acute pancreatitis (AP). There is a paucity of evidence to guide FT and virtually no data on current prescribing practice. This survey aims to characterize current practice and opinion with regard to FT in AP throughout New Zealand. Information was collected on fluid selection, administration, and goal-directed FT. The survey was distributed online and in print to all doctors employed in General Surgery Departments in New Zealand on 1 May 2012. Monthly email reminders were sent for 6 months. The overall response rate was 47 % (n = 190/408). Crystalloids were the preferred initial fluid for all categories of severity; however, colloid use increased with severity (p < 0.001). Fluid volume also increased with severity (p = 0.001), with 74 % of respondents prescribing >4 L for AP with organ failure (OF). Clinicians treating 26-50 patients per year with AP were less likely to prescribe colloid for AP with OF (8 vs 43 %) (p = 0.001). Rate of fluid administration in AP with OF varied according to physicians' seniority (p = 0.004); consultants prescribed >4 L more than other groups (83 vs 68 %). Only 17 % of respondents reported the use of guidelines. This survey reveals significant variation in prescription of FT for AP, and aggressive FT is commonly prescribed for AP with OF. There is little adherence to published guidelines or best available evidence.

77 FR 23291 - Investigations Regarding Certifications of Eligibility To Apply for Worker Adjustment Assistance

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-18

.... Credentialing Administration (Company). [FR Doc. 2012-9247 Filed 4-17-12; 8:45 am] BILLING CODE 4510-FN-P ... DEPARTMENT OF LABOR Employment and Training Administration Investigations Regarding Certifications... Assistance, Employment and Training Administration, has instituted investigations pursuant to Section 221 (a...

Observational intensity bias associated with illness adjustment: cross sectional analysis of insurance claims

PubMed Central

Staiger, Douglas O; Sharp, Sandra M; Gottlieb, Daniel J; Bevan, Gwyn; McPherson, Klim; Welch, H Gilbert

2013-01-01

Objective To determine the bias associated with frequency of visits by physicians in adjusting for illness, using diagnoses recorded in administrative databases. Setting Claims data from the US Medicare program for services provided in 2007 among 306 US hospital referral regions. Design Cross sectional analysis. Participants 20% sample of fee for service Medicare beneficiaries residing in the United States in 2007 (n=5 153 877). Main outcome measures The effect of illness adjustment on regional mortality and spending rates using standard and visit corrected illness methods for adjustment. The standard method adjusts using comorbidity measures based on diagnoses listed in administrative databases; the modified method corrects these measures for the frequency of visits by physicians. Three conventions for measuring comorbidity are used: the Charlson comorbidity index, Iezzoni chronic conditions, and hierarchical condition categories risk scores. Results The visit corrected Charlson comorbidity index explained more of the variation in age, sex, and race mortality across the 306 hospital referral regions than did the standard index (R2=0.21 v 0.11, P<0.001) and, compared with sex and race adjusted mortality, reduced regional variation, whereas adjustment using the standard Charlson comorbidity index increased it. Although visit corrected and age, sex, and race adjusted mortality rates were similar in hospital referral regions with the highest and lowest fifths of visits, adjustment using the standard index resulted in a rate that was 18% lower in the highest fifth (46.4 v 56.3 deaths per 1000, P<0.001). Age, sex, and race adjusted spending as well as visit corrected spending was more than 30% greater in the highest fifth of visits than in the lowest fifth, but only 12% greater after adjustment using the standard index. Similar results were obtained using the Iezzoni and the hierarchical condition categories conventions for measuring comorbidity. Conclusion The rates of visits by physicians introduce substantial bias when regional mortality and spending rates are adjusted for illness using comorbidity measures based on the observed number of diagnoses recorded in Medicare’s administrative database. Adjusting without correction for regional variation in visit rates tends to make regions with high rates of visits seem to have lower mortality and lower costs, and vice versa. Visit corrected comorbidity measures better explain variation in age, sex, and race mortality than observed measures, and reduce observational intensity bias. PMID:23430282

Effects of neurobehavioral assessment on feeding and weight gain in preterm neonates.

PubMed

Senn, Theresa E; Espy, Kimberly Andrews

2003-04-01

Neonatal intensive care unit personnel and parents often are concerned that developmental assessment will tire preterm neonates and impair their feeding ability and subsequent weight gain. Therefore, the amount of fluid consumed by 108 preterm neonates (

5 CFR 838.923 - Cost-of-living adjustment before the death of a retiree.

Code of Federal Regulations, 2010 CFR

2010-01-01

... before the death of a retiree (in the same manner as these adjustments are applied to the survivor rate... death of a retiree. 838.923 Section 838.923 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT...-living adjustment before the death of a retiree. A court order that awards a former spouse survivor...

5 CFR 838.923 - Cost-of-living adjustment before the death of a retiree.

Code of Federal Regulations, 2014 CFR

2014-01-01

... before the death of a retiree (in the same manner as these adjustments are applied to the survivor rate... death of a retiree. 838.923 Section 838.923 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT...-living adjustment before the death of a retiree. A court order that awards a former spouse survivor...

5 CFR 838.923 - Cost-of-living adjustment before the death of a retiree.

Code of Federal Regulations, 2012 CFR

2012-01-01

... before the death of a retiree (in the same manner as these adjustments are applied to the survivor rate... death of a retiree. 838.923 Section 838.923 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT...-living adjustment before the death of a retiree. A court order that awards a former spouse survivor...

5 CFR 838.923 - Cost-of-living adjustment before the death of a retiree.

Code of Federal Regulations, 2011 CFR

2011-01-01

... before the death of a retiree (in the same manner as these adjustments are applied to the survivor rate... death of a retiree. 838.923 Section 838.923 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT...-living adjustment before the death of a retiree. A court order that awards a former spouse survivor...

5 CFR 838.923 - Cost-of-living adjustment before the death of a retiree.

Code of Federal Regulations, 2013 CFR

2013-01-01

... before the death of a retiree (in the same manner as these adjustments are applied to the survivor rate... death of a retiree. 838.923 Section 838.923 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT...-living adjustment before the death of a retiree. A court order that awards a former spouse survivor...

77 FR 26703 - Inflation Adjustment of the Aggravated Maximum Civil Monetary Penalty for a Violation of a...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-07

.... FRA-2004-17529; Notice No. 9] RIN 2130-AB94 Inflation Adjustment of the Aggravated Maximum Civil Monetary Penalty for a Violation of a Federal Railroad Safety Law or Federal Railroad Administration Safety... rule, pursuant to the Federal Civil Penalties Inflation Adjustment Act of 1990, which increased the...

20 CFR 408.922 - When will we adjust your SVB payments to recover an overpayment?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false When will we adjust your SVB payments to recover an overpayment? 408.922 Section 408.922 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS Underpayments and Overpayments Adjustment of Svb § 408.922 When...

20 CFR 408.922 - When will we adjust your SVB payments to recover an overpayment?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false When will we adjust your SVB payments to recover an overpayment? 408.922 Section 408.922 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS Underpayments and Overpayments Adjustment of Svb § 408.922 When...

20 CFR 408.922 - When will we adjust your SVB payments to recover an overpayment?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false When will we adjust your SVB payments to recover an overpayment? 408.922 Section 408.922 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS Underpayments and Overpayments Adjustment of Svb § 408.922 When...

20 CFR 408.922 - When will we adjust your SVB payments to recover an overpayment?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false When will we adjust your SVB payments to recover an overpayment? 408.922 Section 408.922 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS Underpayments and Overpayments Adjustment of Svb § 408.922 When...

20 CFR 408.922 - When will we adjust your SVB payments to recover an overpayment?

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false When will we adjust your SVB payments to recover an overpayment? 408.922 Section 408.922 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SPECIAL BENEFITS FOR CERTAIN WORLD WAR II VETERANS Underpayments and Overpayments Adjustment of Svb § 408.922 When...

5 CFR 177.106 - Authority to adjust, determine, compromise, and settle.

Code of Federal Regulations, 2010 CFR

2010-01-01

... SERVICE REGULATIONS ADMINISTRATIVE CLAIMS UNDER THE FEDERAL TORT CLAIMS ACT § 177.106 Authority to adjust... alleged negligence or wrongful act or omission of an OPM employee, with the exception of claims involving...

13 CFR 307.1 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT OF COMMERCE ECONOMIC ADJUSTMENT ASSISTANCE INVESTMENTS General § 307.1 Purpose. The purpose of Economic Adjustment Assistance Investments is to address the needs of communities experiencing adverse economic changes that may occur...

20 CFR 617.1 - Scope.

Code of Federal Regulations, 2010 CFR

2010-04-01

... other allowances such as allowances while in training, job search and relocation allowances; and (c...' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR TRADE ADJUSTMENT ASSISTANCE FOR...) Adjustment assistance, such as counseling, testing, training, placement, and other supportive services for...

Cost-Effective Adjustments to Nursing Home Staffing to Improve Quality.

PubMed

Bowblis, John R; Roberts, Amy Restorick

2018-06-01

Health care providers face fixed reimbursement rates from government sources and need to carefully adjust staffing to achieve the highest quality within a given cost structure. With data from the Certification and Survey Provider Enhanced Reports (1999-2015), this study holistically examined how staffing levels affect two publicly reported measures of quality in the nursing home industry, the number of deficiency citations and the deficiency score. While higher staffing consistently yielded better quality, the largest quality improvements resulted from increasing administrative registered nurses and social service staffing. After adjusting for wages, the most cost-effective investment for improving overall deficiency outcomes was increasing social services. Deficiencies related to quality of care were improved most by increasing administrative nursing and social service staff. Quality of life deficiencies were improved most by increasing social service and activities staff. Approaches to improve quality through staffing adjustments should target specific types of staff to maximize return on investment.

Haemodynamic coherence - The relevance of fluid therapy.

PubMed

Arnemann, Philip; Seidel, Laura; Ertmer, Christian

2016-12-01

The ultimate goal of fluid therapy is to improve the oxygenation of cells by improving the cardiac output, thus improving microcirculation by optimizing macrocirculation. This haemodynamic coherence is often altered in patients with haemorrhagic shock and sepsis. The loss of haemodynamic coherence is associated with adverse outcomes. It may be influenced by the mechanisms of the underlying disease and properties of different fluids used for resuscitation in these critically ill patients. Monitoring microcirculation and haemodynamic coherence may be an additional tool to predict the response to fluid administration. In addition, microcirculatory analysis may support the clinician in his decision to not administer fluids when microcirculatory blood flow is preserved. In future, the indication, guidance and termination of fluid therapy may be assessed by bedside microvascular analysis in combination with standard haemodynamic monitoring. Copyright © 2016 Elsevier Ltd. All rights reserved.

Pediatric Diabetic Ketoacidosis, Fluid Therapy and Cerebral Injury: The Design of a Factorial Randomized Controlled Trial

PubMed Central

Glaser, Nicole S.; Ghetti, Simona; Casper, T. Charles; Dean, J. Michael; Kuppermann, Nathan

2013-01-01

Treatment protocols for pediatric diabetic ketoacidosis (DKA) vary considerably among centers in the United States and worldwide. The optimal protocol for intravenous fluid administration is an area of particular controversy, mainly in regard to possible associations between rates of intravenous fluid infusion and the development of cerebral edema, the most common and most feared complication of DKA in children. Theoretical concerns about associations between osmotic fluid shifts and cerebral edema have prompted recommendations for conservative fluid infusion during DKA. However, recent data suggest that cerebral hypoperfusion may play a role in cerebral injury associated with DKA. Currently there are no existing data from prospective clinical trials to determine the optimal fluid treatment protocol for pediatric DKA. The Pediatric Emergency Care Applied Research Network FLUID (Fluid Therapies Under Investigation in DKA) Study is the first prospective randomized trial to evaluate fluid regimens for pediatric DKA. This 13-center nationwide factorial-design study will evaluate the effects of rehydration rate and fluid sodium content on neurological status during DKA treatment, the frequency of clinically-overt CE, and long-term neurocognitive outcomes following DKA. PMID:23490311

Intravenous fluid prescription practices among pediatric residents in Korea.

PubMed

Lee, Jiwon M; Jung, Younghwa; Lee, Se Eun; Lee, Jun Ho; Kim, Kee Hyuck; Koo, Ja Wook; Park, Young Seo; Cheong, Hae Il; Ha, Il-Soo; Choi, Yong; Kang, Hee Gyung

2013-07-01

Recent studies have established the association between hypotonic fluids administration and hospital-acquired hyponatremia in children. The present paper investigated the pattern of current practice in intravenous fluid prescription among Korean pediatric residents, to underscore the need for updated education. A survey-based analysis was carried out. Pediatric residents at six university hospitals in Korea completed a survey consisting of four questions. Each question proposed a unique scenario in which the respondents had to prescribe either a hypotonic or an isotonic fluid for the patient. Ninety-one responses were collected and analyzed. In three of the four scenarios, a significant majority prescribed the hypotonic fluids (98.9%, 85.7%, and 69.2%, respectively). Notably, 69.2% of the respondents selected the hypotonic fluids for postoperative management. Almost all (96.7%) selected the isotonic fluids for hydration therapy. In the given scenarios, the majority of Korean pediatric residents would prescribe a hypotonic fluid, except for initial hydration. The current state of pediatric fluid management, notably, heightens the risk of hospital-acquired hyponatremia. Updated clinical practice education on intravenous fluid prescription, therefore, is urgently required.

Associations between lifestyle and air pollution exposure: Potential for confounding in large administrative data cohorts.

PubMed

Strak, Maciej; Janssen, Nicole; Beelen, Rob; Schmitz, Oliver; Karssenberg, Derek; Houthuijs, Danny; van den Brink, Carolien; Dijst, Martin; Brunekreef, Bert; Hoek, Gerard

2017-07-01

Cohorts based on administrative data have size advantages over individual cohorts in investigating air pollution risks, but often lack in-depth information on individual risk factors related to lifestyle. If there is a correlation between lifestyle and air pollution, omitted lifestyle variables may result in biased air pollution risk estimates. Correlations between lifestyle and air pollution can be induced by socio-economic status affecting both lifestyle and air pollution exposure. Our overall aim was to assess potential confounding by missing lifestyle factors on air pollution mortality risk estimates. The first aim was to assess associations between long-term exposure to several air pollutants and lifestyle factors. The second aim was to assess whether these associations were sensitive to adjustment for individual and area-level socioeconomic status (SES), and whether they differed between subgroups of the population. Using the obtained air pollution-lifestyle associations and indirect adjustment methods, our third aim was to investigate the potential bias due to missing lifestyle information on air pollution mortality risk estimates in administrative cohorts. We used a recent Dutch national health survey of 387,195 adults to investigate the associations of PM 10 , PM 2.5 , PM 2.5-10 , PM 2.5 absorbance, OP DTT, OP ESR and NO 2 annual average concentrations at the residential address from land use regression models with individual smoking habits, alcohol consumption, physical activity and body mass index. We assessed the associations with and without adjustment for neighborhood and individual SES characteristics typically available in administrative data cohorts. We illustrated the effect of including lifestyle information on the air pollution mortality risk estimates in administrative cohort studies using a published indirect adjustment method. Current smoking and alcohol consumption were generally positively associated with air pollution. Physical activity and overweight were negatively associated with air pollution. The effect estimates were small (mostly <5% of the air pollutant standard deviations). Direction and magnitude of the associations depended on the pollutant, use of continuous vs. categorical scale of the lifestyle variable, and level of adjustment for individual and area-level SES. Associations further differed between subgroups (age, sex) in the population. Despite the small associations between air pollution and smoking intensity, indirect adjustment resulted in considerable changes of air pollution risk estimates for cardiovascular and especially lung cancer mortality. Individual lifestyle-related risk factors were weakly associated with long-term exposure to air pollution in the Netherlands. Indirect adjustment for missing lifestyle factors in administrative data cohort studies may substantially affect air pollution mortality risk estimates. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Variable-pulse switching circuit accurately controls solenoid-valve actuations

NASA Technical Reports Server (NTRS)

Gillett, J. D.

1967-01-01

Solid state circuit generating adjustable square wave pulses of sufficient power operates a 28 volt dc solenoid valve at precise time intervals. This circuit is used for precise time control of fluid flow in combustion experiments.

Application study of fluid pressure energy recycling of decarbonisation process by C4H6O3 in ammonia synthesis systems by hydraulic turbochargers

NASA Astrophysics Data System (ADS)

Ji, Yunguang; Xu, Yangyang; Li, Hongtao; Oklejas, Michael; Xue, Shuqi

2018-01-01

A new type of hydraulic turbocharger energy recovery system was designed and applied in the decarbonisation process by propylene carbonate of a 100k tons ammonia synthesis system firstly in China. Compared with existing energy recovery devices, hydraulic turbocharger energy recovery system runs more smoothly, has lower failure rate, longer service life and greater comprehensive benefits due to its unique structure, simpler adjustment process and better adaptability to fluid fluctuation.

Melatonin concentrations in the sudden infant death syndrome

NASA Technical Reports Server (NTRS)

Sturner, W. Q.; Lynch, H. J.; Deng, M. H.; Gleason, R. E.; Wurtman, R. J.

1990-01-01

The melatonin levels in various body fluids of the sudden infant death syndrome (SIDS) infants are compared with those of infants of comparable age who died of other causes to examine a possible relationship between pineal function and SIDS. After adjusting for age differences, cerebrospinal fluid melatonin levels are found to be significantly lower in the SIDS infants. It is suggested that diminished melatonin production may be characteristic of SIDS and could represent an impairment in the maturation of physiologic circadian organization.

Extracorporeal Ultrafiltration for Fluid Overload in Heart Failure

PubMed Central

Costanzo, Maria Rosa; Ronco, Claudio; Abraham, William T.; Agostoni, Piergiuseppe; Barasch, Jonathan; Fonarow, Gregg C.; Gottlieb, Stephen S.; Jaski, Brian E.; Kazory, Amir; Levin, Allison P.; Levin, Howard R.; Marenzi, Giancarlo; Mullens, Wilfried; Negoianu, Dan; Redfield, Margaret M.; Tang, W.H. Wilson; Testani, Jeffrey M.; Voors, Adriaan A.

2017-01-01

More than 1 million heart failure hospitalizations occur annually, and congestion is the predominant cause. Rehospitalizations for recurrent congestion portend poor outcomes independently of age and renal function. Persistent congestion trumps serum creatinine increases in predicting adverse heart failure outcomes. No decongestive pharmacological therapy has reduced these harmful consequences. Simplified ultrafiltration devices permit fluid removal in lower-acuity hospital settings, but with conflicting results regarding safety and efficacy. Ultrafiltration performed at fixed rates after onset of therapy-induced increased serum creatinine was not superior to standard care and resulted in more complications. In contrast, compared with diuretic agents, some data suggest that adjustment of ultrafiltration rates to patients’ vital signs and renal function may be associated with more effective decongestion and fewer heart failure events. Essential aspects of ultrafiltration remain poorly defined. Further research is urgently needed, given the burden of congestion and data suggesting sustained benefits of early and adjustable ultrafiltration. PMID:28494980

Volume Overload: Prevalence, Risk Factors, and Functional Outcome in Survivors of Septic Shock

PubMed Central

Carlbom, David; Caldwell, Ellen; Himmelfarb, Jonathan; Hough, Catherine L.

2015-01-01

Rationale: Survivors of septic shock have impaired functional status. Volume overload is associated with poor outcomes in patients with septic shock, but the impact of volume overload on functional outcome and discharge destination of survivors is unknown. Objectives: This study describes patterns of fluid management both during and after septic shock. We examined factors associated with volume overload upon intensive care unit (ICU) discharge. We then examined associations between volume overload upon ICU discharge, mobility limitation, and discharge to a healthcare facility in septic shock survivors, with the hypothesis that volume overload is associated with increased odds of these outcomes. Methods: We retrospectively reviewed the medical records of 247 patients admitted with septic shock to an academic county hospital between June 2009 and April 2012 who survived to ICU discharge. We defined volume overload as a fluid balance expected to increase the subject’s admission weight by 10%. Statistical methods included unadjusted analyses and multivariable logistic regression. Measurements and Main Results: Eighty-six percent of patients had a positive fluid balance, and 35% had volume overload upon ICU discharge. Factors associated with volume overload in unadjusted analyses included more severe illness, cirrhosis, blood transfusion during shock, and higher volumes of fluid administration both during and after shock. Blood transfusion during shock was independently associated with increased odds of volume overload (odds ratio [OR], 2.65; 95% confidence interval [CI], 1.33–5.27; P = 0.01) after adjusting for preexisting conditions and severity of illness. Only 42% of patients received at least one dose of a diuretic during their hospitalization. Volume overload upon ICU discharge was independently associated with inability to ambulate upon hospital discharge (OR, 2.29; 95% CI, 1.24–4.25; P = 0.01) and, in patients admitted from home, upon discharge to a healthcare facility (OR, 2.34; 95% CI, 1.1–4.98; P = 0.03). Conclusions: Volume overload is independently associated with impaired mobility and discharge to a healthcare facility in survivors of septic shock. Prevention and treatment of volume overload in patients with septic shock warrants further investigation. PMID:26394090

18 CFR 301.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... OF ENERGY REGULATIONS FOR FEDERAL POWER MARKETING ADMINISTRATIONS AVERAGE SYSTEM COST METHODOLOGY FOR... the adjusted historical load for each customer proportionately scaled to Tier 1 System Resources and adjusted for conservation achieved. The CHWM is specified in each eligible customer's CHWM Contract...

How do sock ply changes affect residual-limb fluid volume in people with transtibial amputation?

PubMed

Sanders, Joan E; Harrison, Daniel S; Allyn, Katheryn J; Myers, Timothy R; Ciol, Marcia A; Tsai, Elaine C

2012-01-01

The purpose of this research was to investigate the influence of sock addition and removal on residual-limb fluid volume in people using prosthetic limbs. We used bioimpedance analysis to measure residual-limb extracellular fluid volume on 28 transtibial amputee subjects during 30 min test sessions. Upon addition of a one-ply polyester sock, residual-limb fluid volume changes ranged from -4.0% to 0.8% (mean -0.9 +/- 1.3%) of the initial limb fluid volume. Changes for sock removal ranged from -1.2% to 2.8% (mean 0.5 +/- 0.8%). Subjects who reduced in fluid volume with both addition and removal of a sock and subjects with high positive ratios between the fluid-volume loss upon sock addition and gain upon sock removal (high add/remove [AR] ratios) tended to have arterial disease, were obese, and were smokers. Subjects with low positive AR ratios, subjects who increased in fluid volume both with sock addition and removal, and a single subject who increased in fluid volume with sock addition and decreased with sock removal tended to be nonsmokers and either individuals in good health without complications or individuals without arterial problems. Results are relevant for the anticipation of limb volume changes during prosthetic fitting and toward the design of adjustable-socket technologies.

Constipation and the preached trio: diet, fluid intake, exercise.

PubMed

Annells, Merilyn; Koch, Tina

2003-11-01

A survey of 90 older community-dwelling people's constipation experience is reported in part. The focus is the participants' efforts to use diet, fluid intake and exercise as preventive strategies. Most feel that they have been preached to in this regard. However, constraints may prevent full adherence to the trio and although some have gained from diet adjustment, the majority is disillusioned about these strategies. Nurses should be aware that scientific and medical literature is discussing evidence that dietary fibre intake preventing constipation is not proven, that fluid intake does not necessarily determine stool bulk or speed colon transit time, and that there is no proven link between exercise levels and chronic constipation.

Variable delivery, fixed displacement pump

DOEpatents

Sommars, Mark F.

2001-01-01

A variable delivery, fixed displacement pump comprises a plurality of pistons reciprocated within corresponding cylinders in a cylinder block. The pistons are reciprocated by rotation of a fixed angle swash plate connected to the pistons. The pistons and cylinders cooperate to define a plurality of fluid compression chambers each have a delivery outlet. A vent port is provided from each fluid compression chamber to vent fluid therefrom during at least a portion of the reciprocal stroke of the piston. Each piston and cylinder combination cooperates to close the associated vent port during another portion of the reciprocal stroke so that fluid is then pumped through the associated delivery outlet. The delivery rate of the pump is varied by adjusting the axial position of the swash plate relative to the cylinder block, which varies the duration of the piston stroke during which the vent port is closed.

Independent information from cerebrospinal fluid amyloid-β and florbetapir imaging in Alzheimer's disease.

PubMed

Mattsson, Niklas; Insel, Philip S; Donohue, Michael; Landau, Susan; Jagust, William J; Shaw, Leslie M; Trojanowski, John Q; Zetterberg, Henrik; Blennow, Kaj; Weiner, Michael W

2015-03-01

Reduced cerebrospinal fluid amyloid-β42 and increased retention of florbetapir positron emission tomography are biomarkers reflecting cortical amyloid load in Alzheimer's disease. However, these measurements do not always agree and may represent partly different aspects of the underlying Alzheimer's disease pathology. The goal of this study was therefore to test if cerebrospinal fluid and positron emission tomography amyloid-β biomarkers are independently related to other Alzheimer's disease markers, and to examine individuals who are discordantly classified by these two biomarker modalities. Cerebrospinal fluid and positron emission tomography amyloid-β were measured at baseline in 769 persons [161 healthy controls, 68 subjective memory complaints, 419 mild cognitive impairment and 121 Alzheimer's disease dementia, mean age 72 years (standard deviation 7 years), 47% females] and used to predict diagnosis, APOE ε4 carriage status, cerebral blood flow, cerebrospinal fluid total-tau and phosphorylated-tau levels (cross-sectionally); and hippocampal volume, fluorodeoxyglucose positron emission tomography results and Alzheimer's Disease Assessment Scale-cognitive subscale scores (longitudinally). Cerebrospinal fluid and positron emission tomography amyloid-β were highly correlated, but adjusting one of these predictors for the other revealed that they both provided partially independent information when predicting diagnosis, APOE ε4, hippocampal volume, metabolism, cognition, total-tau and phosphorylated-tau (the 95% confidence intervals of the adjusted effects did not include zero). Cerebrospinal fluid amyloid-β was more strongly related to APOE ε4 whereas positron emission tomography amyloid-β was more strongly related to tau levels (P < 0.05). Discordance (mainly isolated cerebrospinal fluid amyloid-β positivity) differed by diagnostic group (P < 0.001) and was seen in 21% of cognitively healthy people but only 6% in dementia patients. The finding that cerebrospinal fluid and positron emission tomography amyloid-β provide partially independent information about a wide range of Alzheimer's measures supports the theory that these modalities represent partly different aspects of Alzheimer's pathology. The fact that mismatch, with positive cerebrospinal fluid amyloid-β but normal positron emission tomography amyloid-β, is relatively common in cognitively healthy people may be considered when using these biomarkers to identify early stage Alzheimer's disease. Reduced cerebrospinal fluid amyloid-β may be more strongly related to early stage Alzheimer's disease, whereas increased positron emission tomography amyloid-β may be more strongly related to disease progression. © The Author (2014). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A prototype space flight intravenous injection system

NASA Technical Reports Server (NTRS)

Colombo, G. V.

1985-01-01

Medical emergencies, especially those resulting from accidents, frequently require the administration of intravenous fluids to replace lost body liquids. The development of a prototype space flight intravenous injection system is presented. The definition of requirements, injectable concentrates development, water polisher, reconstitution hardware development, administration hardware development, and prototype fabrication and testing are discussed.

Who Do They Think They Are? The Changing Identities of Professional Administrators and Managers in UK Higher Education

ERIC Educational Resources Information Center

Whitchurch, Celia

2006-01-01

Contemporary universities, serving mass higher education markets, find themselves delivering complex, broadly based projects such as student support and welfare, human resource development, and business enterprise. Established concepts of academic administration and devolved management have been overlaid by more fluid institutional structures and…

The diffusion of innovation in nursing regulatory policy: removing a barrier to medication administration training for child care providers.

PubMed

Torre, Carolyn T; Crowley, Angela A

2011-08-01

Safe medication administration is an essential component of high-quality child care. Its achievement in New Jersey was impeded by a controversy over whether teaching child care providers medication administration involves registered nurses in the process of nursing delegation. Through the theoretical framework of the Diffusion of Innovation, this paper examines how the interpretation of regulatory policy related to nursing practice in New Jersey was adjusted by the Board of Nursing following a similar interpretation of regulatory policy by the Board of Nursing in Connecticut. This adjustment enabled New Jersey nurses to continue medication administration training for child care providers. National data supporting the need for training child care providers in medication administration is presented, the Diffusion of Innovation paradigm is described; the Connecticut case and the New Jersey dilemma are discussed; the diffusion process between the two states is analyzed and an assessment of the need for further change is made.

7 CFR 1580.201 - Petitions for trade adjustment assistance.

Code of Federal Regulations, 2014 CFR

2014-01-01

... for by the Administrator (FAS), and submitted to FAS no later than the last day of the filing period... previous 3 marketing years, and identify the source of the data. In such cases the Administrator (FAS... previous 3 marketing years, and identification of the data source. (iii) The Administrator (FAS) may...

7 CFR 1580.201 - Petitions for trade adjustment assistance.

Code of Federal Regulations, 2012 CFR

2012-01-01

... for by the Administrator (FAS), and submitted to FAS no later than the last day of the filing period... previous 3 marketing years, and identify the source of the data. In such cases the Administrator (FAS... previous 3 marketing years, and identification of the data source. (iii) The Administrator (FAS) may...

7 CFR 1580.201 - Petitions for trade adjustment assistance.

Code of Federal Regulations, 2013 CFR

2013-01-01

... for by the Administrator (FAS), and submitted to FAS no later than the last day of the filing period... previous 3 marketing years, and identify the source of the data. In such cases the Administrator (FAS... previous 3 marketing years, and identification of the data source. (iii) The Administrator (FAS) may...

Adjusting for Year to Year Rater Variation in IRT Linking--An Empirical Evaluation

ERIC Educational Resources Information Center

Yen, Shu Jing; Ochieng, Charles; Michaels, Hillary; Friedman, Greg

2005-01-01

The main purpose of this study was to illustrate a polytomous IRT-based linking procedure that adjusts for rater variations. Test scores from two administrations of a statewide reading assessment were used. An anchor set of Year 1 students' constructed responses were rescored by Year 2 raters. To adjust for year-to-year rater variation in IRT…

20 CFR 418.2240 - Should you notify us if the information you gave us about your modified adjusted gross income for...

Code of Federal Regulations, 2011 CFR

2011-04-01

... gave us about your modified adjusted gross income for the more recent tax year changes? 418.2240 Section 418.2240 Employees' Benefits SOCIAL SECURITY ADMINISTRATION MEDICARE SUBSIDIES Income-Related... about your modified adjusted gross income for the more recent tax year changes? We will follow the rules...

20 CFR 418.2265 - What kind of evidence of a significant modified adjusted gross income reduction will you need to...

Code of Federal Regulations, 2011 CFR

2011-04-01

... modified adjusted gross income reduction will you need to support your request? 418.2265 Section 418.2265 Employees' Benefits SOCIAL SECURITY ADMINISTRATION MEDICARE SUBSIDIES Income-Related Monthly Adjustments to... reduction will you need to support your request? We will follow the rules in § 418.1265, except that any...

20 CFR 418.1245 - What will happen if you notify us that your modified adjusted gross income for the more recent...

Code of Federal Regulations, 2010 CFR

2010-04-01

... modified adjusted gross income for the more recent tax year changes? 418.1245 Section 418.1245 Employees' Benefits SOCIAL SECURITY ADMINISTRATION MEDICARE SUBSIDIES Medicare Part B Income-Related Monthly... changes? (a) If you notify us that your modified adjusted gross income for the more recent tax year has...

The use of cardiac output monitoring to guide the administration of intravenous fluid during hyperthermic intraperitoneal chemotherapy.

PubMed

Thanigaimani, K; Mohamed, F; Cecil, T; Moran, B J; Bell, J

2013-12-01

The optimal strategy for intravenous (IV) fluid management during administration of hyperthermic intraperitoneal chemotherapy (HIPEC) is unclear. In this prospective study we describe the use of a LiDCOrapid™ (LiDCO, Cambridge, UK) cardiac output monitor to guide IV fluid management during cytoreductive surgery (CRS) with HIPEC. The aim of this study was to determine whether cardiac output monitoring will allow close maintenance of physiological parameters during the HIPEC phase. Twenty-five patients who underwent CRS combined with HIPEC were included in the study. Intra-operative IV fluid boluses were titrated using parameters measured by the LiDCOrapid™ monitor. Stroke volume variation was maintained below 10% with fluid boluses and mean arterial pressure was maintained within 20% of the baseline figure with vasopressors. There was no significant change in heart rate and cardiac output. The systemic vascular resistance dropped from an average of 966 dyn.s/cm-5 to 797 dyn s/cm(5) at 60 min during the HIPEC phase (P = 0.62) despite an increase in the dose of phenylepherine. The average total volume of fluid given was 748 ml in the first 30 min and 630 ml in the second 30 min with an average urine output of 307 and 445 ml, respectively. The change in lactate levels was not statistically or clinically significant. LiDCOrapid™ is an effective noninvasive tool for guiding fluid management in this population. It allows the anaesthesiologist to maintain tight control of essential physiological parameters during a phase of the procedure in which there is a risk of renal injury. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

Screening and Confirmatory Analyses of Flunixin in Tissues and Bodily Fluids after Intravenous or Intramuscular Administration to Cull Dairy Cows with or without Lipopolysaccharide Challenge.

PubMed

Shelver, Weilin L; Smith, David J; Tell, Lisa A; Baynes, Ronald E; Schroeder, J W; Riviere, Jim E

2016-01-13

Twenty cull dairy cows (645 ± 83 kg) were treated with 2.2 mg/kg bw flunixin by intravenous (IV) or intramuscular (IM) administration with, or without, exposure to lipopolysaccharide in a two factor balanced design. The usefulness of screening assays to identify violative flunixin levels in a variety of easily accessible ante-mortem fluids in cattle was explored. Two animals with violative flunixin liver residue and/or violative 5-hydroxy flunixin milk residues were correctly identified by a flunixin liver ELISA screen. Oral fluid did not produce anticipated flunixin concentration profiles using ELISA determination. One cow that had liver and milk violative residues, and one cow that had a milk violation at the prescribed withdrawal period were correctly identified by flunixin milk lateral flow analyses. The ratio of urinary flunixin and 5-hydroxy flunixin may be useful for predicting disruption of metabolism caused by disease or other factors potentially leading to violative liver flunixin residues.

[Postmortem distribution of tetrodotoxin in tissues and body fluids of guinea pigs].

PubMed

Liu, Wei; Da, Qing; Shen, Min

2012-06-01

To investigate the postmortem distribution of tetrodotoxin in tissues and body fluids of guinea pig, and to provide method and evidence for forensic identification and clinical diagnosis and treatment. Guinea pigs were intragastric administrated with 100, 50, 15 microg/kg tetrodotoxin, respectively. The poisoning symptoms were observed. The samples of heart, liver, spleen, lung, kidney, brain, stomach, intestines, bile, heart blood and urine were collected. The concentrations of tetrodotoxin in tissues and body fluids were measured with liquid chromatography-tandem mass spectrometry (LC-MS/MS). After administrated with tetrodotoxin, all guinea pigs came out poisoning signs including tachypnea, weary and dead finally. Tetrodotoxin concentrations in lung, stomach, intestines and urine were higher, followed by blood, heart and brain. The concentration in bile was the lowest. Postmortem distribution of tetrodotoxin in guinea pig is uneven. The concentration in the lung, stomach, intestines, urine and heart blood are higher, those tissues could be used for diagnosis of tetrodotoxin poisoning.

Interpretation of Oral Fluid Tests for Drugs of Abuse

PubMed Central

CONE, EDWARD J.; HUESTIS, MARILYN A.

2009-01-01

Oral fluid testing for drugs of abuse offers significant advantages over urine as a test matrix. Collection can be performed under direct observation with reduced risk of adulteration and substitution. Drugs generally appear in oral fluid by passive diffusion from blood, but also may be deposited in the oral cavity during oral, smoked, and intranasal administration. Drug metabolites also can be detected in oral fluid. Unlike urine testing, there may be a close correspondence between drug and metabolite concentrations in oral fluid and in blood. Interpretation of oral fluid results for drugs of abuse should be an iterative process whereby one considers the test results in the context of program requirements and a broad scientific knowledge of the many factors involved in determining test outcome. This review delineates many of the chemical and metabolic processes involved in the disposition of drugs and metabolites in oral fluid that are important to the appropriate interpretation of oral fluid tests. Chemical, metabolic, kinetic, and analytic parameters are summarized for selected drugs of abuse, and general guidelines are offered for understanding the significance of oral fluid tests. PMID:17332074

Preoperative oral carbohydrate administration to ASA III-IV patients undergoing elective cardiac surgery.

PubMed

Breuer, Jan-P; von Dossow, Vera; von Heymann, Christian; Griesbach, Markus; von Schickfus, Michael; Mackh, Elise; Hacker, Cornelia; Elgeti, Ulrike; Konertz, Wolfgang; Wernecke, Klaus-D; Spies, Claudia D

2006-11-01

In this study we investigated the effects of preoperative oral carbohydrate administration on postoperative insulin resistance (PIR), gastric fluid volume, preoperative discomfort, and variables of organ dysfunction in ASA physical status III-IV patients undergoing elective cardiac surgery, including those with noninsulin-dependent Type-2 diabetes mellitus. Before surgery, 188 patients were randomized to receive a clear 12.5% carbohydrate drink (CHO), flavored water (placebo), or to fast overnight (control). CHO and placebo were treated in double-blind format and received 800 mL of the corresponding beverage in the evening and 400 mL 2 h before surgery. Patients were monitored from induction of general anesthesia until 24 h postoperatively. Exogenous insulin requirements to control blood glucose levels

Administration costs of intravenous biologic drugs for rheumatoid arthritis.

PubMed

Soini, Erkki J; Leussu, Miina; Hallinen, Taru

2013-01-01

Cost-effectiveness studies explicitly reporting infusion times, drug-specific administration costs for infusions or real-payer intravenous drug cost are few in number. Yet, administration costs for infusions are needed in the health economic evaluations assessing intravenously-administered drugs. To estimate the drug-specific administration and total cost of biologic intravenous rheumatoid arthritis (RA) drugs in the adult population and to compare the obtained costs with published cost estimates. Cost price data for the infusions and drugs were systematically collected from the 2011 Finnish price lists. All Finnish hospitals with available price lists were included. Drug administration and total costs (administration cost + drug price) per infusion were analysed separately from the public health care payer's perspective. Further adjustments for drug brand, dose, and hospital type were done using regression methods in order to improve the comparability between drugs. Annual expected drug administration and total costs were estimated. A literature search not limited to RA was performed to obtain the per infusion administration cost estimates used in publications. The published costs were converted to Finnish values using base-year purchasing power parities and indexing to the year 2011. Information from 19 (95%) health districts was obtained (107 analysable prices out of 176 observations). The average drug administration cost for infliximab, rituximab, abatacept, and tocilizumab infusion in RA were €355.91; €561.21; €334.00; and €293.96, respectively. The regression-adjusted (dose, hospital type; using semi-log ordinary least squares) mean administration costs for infliximab and rituximab infusions in RA were €289.12 (95% CI €222.61-375.48) and €542.28 (95% CI €307.23-957.09). The respective expected annual drug administration costs were €2312.96 for infliximab during the first year, €1879.28 for infliximab during the forthcoming years, and €1843.75 for rituximab. The obtained average administration costs per infusion were higher (1.8-3.3 times depending on the drug) than the previously published purchasing power adjusted and indexed average administration costs for infusions in RA. The administration costs of RA infusions vary between drugs, and more effort should be made to find realistic drug-specific estimates for cost-effectiveness evaluations. The frequent assumption of intravenous drug administration costs equalling outpatient visit cost can underestimate the costs.

29 CFR 541.203 - Administrative exemption examples.

Code of Federal Regulations, 2012 CFR

2012-07-01

... or safety, building or construction, health or sanitation, environmental or soils specialists and... claims adjusters generally meet the duties requirements for the administrative exemption, whether they... prepare damage estimates; evaluating and making recommendations regarding coverage of claims; determining...

29 CFR 541.203 - Administrative exemption examples.

Code of Federal Regulations, 2013 CFR

2013-07-01

... or safety, building or construction, health or sanitation, environmental or soils specialists and... claims adjusters generally meet the duties requirements for the administrative exemption, whether they... prepare damage estimates; evaluating and making recommendations regarding coverage of claims; determining...

The effect of tooth brushing, irrigation, and topical tetracycline administration on the reduction of oral bacteria in mechanically ventilated patients: a preliminary study.

PubMed

Hayashida, Saki; Funahara, Madoka; Sekino, Motohiro; Yamaguchi, Noriko; Kosai, Kosuke; Yanamoto, Souichi; Yanagihara, Katsunori; Umeda, Masahiro

2016-06-07

One of the main causes of ventilator-associated pneumonia (VAP) is thought to be aspiration of oropharyngeal fluid containing pathogenic microorganisms. The aim of this study was to examine the effects of various oral care methods on the reduction of oral bacteria during intubation. First, the effect of mechanical oral cleaning was investigated. The bacterial count on the tongue and in the oropharyngeal fluid was measured after tooth brushing, irrigation, and three hours after irrigation in mechanically ventilated patients at the intensive care unit (ICU). Next, the efficacy of topical administration of tetracycline and povidone iodine on the inhibition of bacterial growth on the tongue and in the oropharyngeal fluid was examined in oral cancer patients during neck dissection. The number of bacteria in the oropharyngeal fluid was approximately 10(5)-10(6) cfu/mL before surgery, but increased to 10(8) cfu/mL after intubation. Oral care with tooth brushing and mucosal cleaning did not reduce oral bacteria, while irrigation of the oral cavity and oropharynx significantly decreased it to a level of 10(5) cfu/mL (p < 0.001). However, oral bacteria increased again to almost 10(8) cfu/mL within three hours of irrigation. Oral bacteria did not decrease by topical povidone iodine application. In contrast, 30 min after topical administration of tetracycline, the number of oral bacteria decreased to 10(5) cfu/mL, and remained under 10(6) cfu/mL throughout the entire experimental period of 150 min. While the present studies are only preliminary, these results indicate that irrigation of the oral cavity and oropharynx followed by topical antibiotic administration may reduce oral bacteria in mechanically ventilated patients. UMIN000018318 , 1 August 2015.

Anaesthesia for 1131 patients undergoing proximal femoral fracture repair: a retrospective, observational study of effects on blood pressure, fluid administration and perioperative anaemia.

PubMed

Wood, R J; White, S M

2011-11-01

Intra-operative hypotension is a frequent occurrence during anaesthesia for hip fracture surgery in older patients with co-morbidities. We analysed retrospective data from the Brighton Hip Fracture Database to determine the intra-operative fall in systolic blood pressure, and the incidence of absolute (lowest systolic blood pressure < 90 mmHg) and relative (> 20% fall in systolic blood pressure from baseline) hypotension during general or spinal anaesthesia among 1131 non-consecutive patients with hip fracture. General anaesthesia for 489 patients (43.2%) produced a greater mean (SD) fall in systolic blood pressure than spinal anaesthesia for 578 patients (51.1%): 34.2% (13.0%) vs 29.7% (10.8%), respectively (p < 0.0001), mean difference 4.5% (95% CI 3.1-5.9%), and was associated with greater mean (SD) intra-operative fluid administration (1555 (801) ml vs 1375 (621) ml, respectively, p < 0.0001). We observed a correlation between the volume of subarachnoid hyperbaric bupivacaine 0.5% and fall in systolic blood pressure (p = 0.004): compared with patients receiving > 1.5 ml (n = 463), fewer patients receiving ≤ 1.5 ml bupivacaine 0.5% (n = 97) experienced episodes of absolute (31.1% vs 11.3%, p < 0.0001) or relative (83.9% vs 26.8%, p < 0.0001) hypotension. Both mean (SD) intravenous fluid administration (1097 ml (439) vs 1431 ml (638), p < 0.0001) and mean peri-operative fall in haemoglobin concentration (2.1 (1.8) g.dl(-1) vs 2.6 (1.7) g.dl(-1), p = 0.009) were lower in the low-dose spinal group. If these data are confirmed by other researchers, intra-operative hypotension (and consequent haemodilution secondary to reactive fluid administration) in this patient group may be reduced by the simple expedient of administering more cautious general anaesthesia, or reduced volumes of subarachnoid local anaesthetic. © 2011 The Authors. Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland.

Matching refractive indices of two fluids and finding interfacial tension for the purpose of fuel spray imaging

NASA Astrophysics Data System (ADS)

Liang, Y. H.

2017-06-01

This study attempts to prepare a fluid pair for use in spray dynamics investigations. Better understanding the behavior of fuel sprays is one of the things that can help improve the efficiency of internal combustion engines. To address the scattering issue in current imaging methods, the refractive index difference between the injected fluid and the medium that it is injected into is eliminated. Two immiscible fluids (sucrose solution and silicone oil) with the same refractive index was identified, their surface tension to build a model fluid engine system injection was also studied. At the same time, Weber number is found to help correct the difference. Results show that 63.7% mass sucrose solution has the same refractive index as silicone oil, and the sucrose solution/silicone oil interface has a surface tension of 0.08941 N/m, which is roughly four times larger than that of ethanol/air. This means using the sucrose/silicone oil fluid pair to model fuel spray will involve some adjustments to be accurate.

A review of adjustable lenses for head mounted displays

NASA Astrophysics Data System (ADS)

Stevens, Robert E.; Jacoby, Thomas N. L.; Aricescu, Ilinca Å.ž.; Rhodes, Daniel P.

2017-06-01

Adjustable lens technology has the potential to improve Head Mounted Displays (HMDs) through style and comfort by providing optical prescription correction and focussing mechanisms integrated within the HMD. It can also reduce simulator sickness and user experience of 3D through resolution of Vergence Accommodation Conflict, and age-related user problems (presbyopia). We review the available technology and the design constraints to show how a fluid filled lens may be appropriate for AR and MR, and an Alvarez lens may be appropriate for VR.

Modeling of Aircraft Deicing Fluid Induced Biochemical Oxygen Demand in Subsurface-Flow Constructed Treatment Wetlands

DTIC Science & Technology

2009-03-01

meters. The input and output control structures are modeled as sharp crested , rectangular weirs one meter in width. The elevation of the input weir is...manipulated by adjusting the width of both the input and output weirs and the crest height of the output weir . All of these adjustments were found to be...reduction of the weir crest height had an effect on the amount of storm water retained during low precipitation conditions, but not on the crest

A modified fluid percussion device.

PubMed

Yamaki, T; Murakami, N; Iwamoto, Y; Yoshino, E; Nakagawa, Y; Ueda, S; Horikawa, J; Tsujii, T

1994-10-01

This report examines a modified fluid percussion device with specific improvements made to address deficiencies found in previously reported devices. These improvements include the use of a cylindrical saline reservoir made of stainless steel, placement of the reservoir in a 15-degree head-up position for the easy release of air bubbles, placement of the fluid flushing outlet and the pressure transducer close to the piston on the same plane, with both perpendicular to the direction of the piston, and adjustable reservoir volume to vary the waveform of the pressure pulse, and a metallic central injury screw secured to the animal's skull over the exposed dura. Using this device, midline fluid percussion (MFP) and lateral fluid percussion (LFP) injuries were performed in 70 rats. Histopathologic findings included diffuse axonal injury in the MFP model and cortical contusion in the LFP model. Survival rate was 41.4% in MFP animals and 100% in LFM animals when the device settings were 178 mm3 of the cylindrical reservoir and 50 degrees-60 degrees in height of the pendulum. Our results suggest that this modified fluid percussion device may offer significant improvements over previously reported fluid percussion models for use in experimental head injury.

Pharmacokinetic Profile of Oral Cannabis in Humans: Blood and Oral Fluid Disposition and Relation to Pharmacodynamic Outcomes.

PubMed

Vandrey, Ryan; Herrmann, Evan S; Mitchell, John M; Bigelow, George E; Flegel, Ronald; LoDico, Charles; Cone, Edward J

2017-03-01

Most research on cannabis pharmacokinetics has evaluated inhaled cannabis, but oral ("edible") preparations comprise an increasing segment of the cannabis market. To assess oral cannabis pharmacokinetics and pharmacodynamics, healthy adults (N = 6 per dose) were administered cannabis brownies containing 10, 25 or 50 mg 9-tetrahydrocannabinol (THC). Whole blood and oral fluid specimens were obtained at baseline and then for 9 days post-exposure; 6 days in a residential research setting and 3 days as outpatients. Measures of subjective, cardiovascular and performance effects were obtained at baseline and for 8 h post-ingestion. The mean Cmax for THC in whole blood was 1, 3.5 and 3.3 ng/mL for the 10, 25 and 50 mg THC doses, respectively. The mean maximum concentration (Cmax) and mean time to maximum concentration (Tmax) of 11-OH-THC in whole blood were similar to THC. Cmax blood concentrations of THCCOOH were generally higher than THC and had longer Tmax values. The mean Tmax for THC in oral fluid occurred immediately following oral dose administration, and appear to reflect local topical residue rather than systemic bioavailbility. Mean Cmax oral fluid concentrations of THCCOOH were lower than THC, erratic over time and mean Tmax occurred at longer times than THC. The window of THC detection ranged from 0 to 22 h for whole blood (limit of quantitation (LOQ) = 0.5 ng/mL) and 1.9 to 22 h for oral fluid (LOQ = 1.0 ng/mL). Subjective drug and cognitive performance effects were generally dose dependent, peaked at 1.5-3 h post-administration, and lasted 6-8 h. Whole blood cannabinoid concentrations were significantly correlated with subjective drug effects. Correlations between blood cannabinoids and cognitive performance measures, and between oral fluid and all pharmacodynamic outcomes were either non-significant or not orderly by dose. Quantitative levels of cannabinoids in whole blood and oral fluid were low compared with levels observed following inhalation of cannabis. The route of administration is important for interpretation of cannabinoid toxicology. Published by Oxford University Press 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

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

PubMed Central

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

2016-01-01

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

Incremental Cost Study.

ERIC Educational Resources Information Center

Shymoniak, Leonard; McIntyre, Chuck

Administrative and empirical factors affecting the relationship between changing workloads and concomitant budget adjustments are examined in this analysis of the funding structure by which state aid to each California community college is adjusted for increases or decreases in average daily attendance (ADA). The report first describes current…

7 CFR 3016.51 - Later disallowances and adjustments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Later disallowances and adjustments. 3016.51 Section 3016.51 Agriculture Regulations of the Department of Agriculture (Continued) OFFICE OF THE CHIEF FINANCIAL OFFICER, DEPARTMENT OF AGRICULTURE UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS AND COOPERATIVE...

50 CFR 679.25 - Inseason adjustments.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 50 Wildlife and Fisheries 11 2011-10-01 2011-10-01 false Inseason adjustments. 679.25 Section 679.25 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE (CONTINUED) FISHERIES OF THE EXCLUSIVE ECONOMIC ZONE OFF ALASKA Management...

50 CFR 679.25 - Inseason adjustments.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 50 Wildlife and Fisheries 13 2013-10-01 2013-10-01 false Inseason adjustments. 679.25 Section 679.25 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE (CONTINUED) FISHERIES OF THE EXCLUSIVE ECONOMIC ZONE OFF ALASKA Management...

50 CFR 679.25 - Inseason adjustments.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 50 Wildlife and Fisheries 13 2014-10-01 2014-10-01 false Inseason adjustments. 679.25 Section 679.25 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE (CONTINUED) FISHERIES OF THE EXCLUSIVE ECONOMIC ZONE OFF ALASKA Management...

50 CFR 679.25 - Inseason adjustments.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 50 Wildlife and Fisheries 13 2012-10-01 2012-10-01 false Inseason adjustments. 679.25 Section 679.25 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE (CONTINUED) FISHERIES OF THE EXCLUSIVE ECONOMIC ZONE OFF ALASKA Management...

14 CFR 1209.300 - Scope.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 5 2012-01-01 2012-01-01 false Scope. 1209.300 Section 1209.300 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION BOARDS AND COMMITTEES Contract Adjustment Board § 1209.300 Scope. This subpart continues in effect the Contract Adjustment Board (hereinafter...

Success through Inattention in School Administration and Elsewhere.

ERIC Educational Resources Information Center

Lindblom, Charles E.

1994-01-01

Examines two ways of achieving social coordination: unilateral/hierarchical controls and multilateral controls. Discusses advantages of using mutual adjustment as an alternative to central coordination. Mutual adjustment occurs variously through language creation, moral codes, biological self-selection, market systems, and politics. Although…

20 CFR 356.1 - Introduction.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Introduction. 356.1 Section 356.1 Employees' Benefits RAILROAD RETIREMENT BOARD ADMINISTRATIVE REMEDIES FOR FRAUDULENT CLAIMS OR STATEMENTS CIVIL... Adjustment Act requires that civil monetary penalties be adjusted by the percentage by which the Consumer...

19 CFR 351.409 - Differences in quantities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Customs Duties INTERNATIONAL TRADE ADMINISTRATION, DEPARTMENT OF COMMERCE ANTIDUMPING AND COUNTERVAILING... the line of trade and market under consideration, the exporter or producer demonstrates that it has adhered to its price list. (e) Relationship to level of trade adjustment. If adjustments are claimed for...

5 CFR 9701.345 - Developmental pay adjustments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Section 9701.345 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Performance-Based Pay § 9701.345...

5 CFR 9701.345 - Developmental pay adjustments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Section 9701.345 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Performance-Based Pay § 9701.345...

5 CFR 9701.345 - Developmental pay adjustments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Section 9701.345 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Performance-Based Pay § 9701.345...

5 CFR 9701.345 - Developmental pay adjustments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Section 9701.345 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Performance-Based Pay § 9701.345...

20 CFR 437.51 - Later disallowances and adjustments.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Section 437.51 Employees' Benefits SOCIAL SECURITY ADMINISTRATION UNIFORM ADMINISTRATIVE REQUIREMENTS FOR... disallow costs and recover funds on the basis of a later audit or other review; (b) The grantee's...; and (e) Audit requirements in § 437.26. ...

20 CFR 437.51 - Later disallowances and adjustments.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Section 437.51 Employees' Benefits SOCIAL SECURITY ADMINISTRATION UNIFORM ADMINISTRATIVE REQUIREMENTS FOR... disallow costs and recover funds on the basis of a later audit or other review; (b) The grantee's...; and (e) Audit requirements in § 437.26. ...

5 CFR 9701.321 - Structure of bands.

Code of Federal Regulations, 2010 CFR

2010-01-01

....321 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Setting and Adjusting Rate Ranges § 9701.321...

20 CFR 418.1005 - Purpose and administration.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 418.1005 Employees' Benefits SOCIAL SECURITY ADMINISTRATION MEDICARE SUBSIDIES Medicare Part B Income... also change income-related monthly adjustment amount determinations using information provided by a beneficiary under certain circumstances. In addition, we notify beneficiaries when the social security benefit...

Impact of Accumulated Error on Item Response Theory Pre-Equating with Mixed Format Tests

ERIC Educational Resources Information Center

Keller, Lisa A.; Keller, Robert; Cook, Robert J.; Colvin, Kimberly F.

2016-01-01

The equating of tests is an essential process in high-stakes, large-scale testing conducted over multiple forms or administrations. By adjusting for differences in difficulty and placing scores from different administrations of a test on a common scale, equating allows scores from these different forms and administrations to be directly compared…

Pediatric diabetic ketoacidosis, fluid therapy, and cerebral injury: the design of a factorial randomized controlled trial.

PubMed

Glaser, Nicole S; Ghetti, Simona; Casper, T Charles; Dean, J Michael; Kuppermann, Nathan

2013-09-01

Treatment protocols for pediatric diabetic ketoacidosis (DKA) vary considerably among centers in the USA and worldwide. The optimal protocol for intravenous (IV) fluid administration is an area of particular controversy, mainly in regard to possible associations between rates of IV fluid infusion and the development of cerebral edema (CE), the most common and the most feared complication of DKA in children. Theoretical concerns about associations between osmotic fluid shifts and CE have prompted recommendations for conservative fluid infusion during DKA. However, recent data suggest that cerebral hypoperfusion may play a role in cerebral injury associated with DKA. Currently, there are no existing data from prospective clinical trials to determine the optimal fluid treatment protocol for pediatric DKA. The Pediatric Emergency Care Applied Research Network FLUID (FLuid therapies Under Investigation in DKA) study is the first prospective randomized trial to evaluate fluid regimens for pediatric DKA. This 13-center nationwide factorial design study will evaluate the effects of rehydration rate and fluid sodium content on neurological status during DKA treatment, the frequency of clinically overt CE and long-term neurocognitive outcomes following DKA. © 2013 John Wiley & Sons A/S.

Economics of fluid therapy in critically ill patients.

PubMed

Lyu, Peter F; Murphy, David J

2014-08-01

Fluid therapy practices are an ongoing debate in critical care as evidence continues to emerge on the clinical effectiveness of different fluids and regimens. Although fluid therapy is a frequent and often costly treatment in the ICU, cost considerations have been largely absent from these studies. To facilitate a more structured approach to understanding fluid therapy costs and their role in clinical practice, we summarize currently available options and describe a framework for identifying and organizing relevant costs. Fluid therapy is a complex area of care that has been rarely studied from a cost-effectiveness perspective. We identify seven cost areas that capture fluid therapy-related costs during preutilization, point-of-utilization, and postutilization periods. These costs are driven by decisions on the type of fluid and administration strategy. Although estimates for some cost areas could be informed by medical literature, other cost areas remain unclear and require further investigation. Given the growing emphasis on the value of care, providers must recognize the important cost consequences of clinical decisions in fluid therapy. Future research into fluid therapy costs is needed and can be guided by this framework. Developing a complete cost picture is an initial and necessary step for improving values for patients, hospitals, and healthcare systems.

The Effects of Post-Mating Administration of Anti-IL-10 and Anti-TGFß on Conception Rates in Mice

PubMed Central

Risvanli, Ali; Godekmerdan, Ahmet

2015-01-01

Background In fertility studies, it has been shown that transforming growth factor β (TGFβ) and interlukin 10 (IL-10) play very important roles in implantation, maternal immune tolerance, placentation and fetal development, and the release beginning of release for fetal and postnatal death. The present study aims to determine the effects of the postmating administration of neutralizing antibodies against IL-10 and TGFβ, which significantly impact pregnancy in females and the conception rates in mice via assessments of blood serum and uterine fluid concentrations of IL-2, IL-4, IL-6, IL-10, IL-17, interferon γ (IFNγ), Tumor necrosis factor α (TNFα), and TGFβ. Materials and Methods In this experimental study, 21 BALB/c strain female mice were mated and randomly divided into three groups. The mice in the first group were selected as the control group. The second group of animals was injected with 0.5 mg of anti-IL-10 after mating, while those in the third group were intraperitoneally injected with 0.5 mg of anti-TGFβ. The animals in all groups were decapitated on the 13thday after mating and their blood samples were taken. The uteri were removed to determine pregnancy. The mice’s uterine irrigation fluids were also obtained. We used the multiplex immunoassay technique to determine the cytokine concentrations in uterine fluid and blood serum of the mice. Results We observed no intergroup difference with respect to conception rates. A comparison of the cytokine concentrations in the uterine fluids of pregnant mice revealed higher TGFβ concentrations (p<0.01) in the second group injected with the anti-IL-10 antibody compared with the other groups. There was no difference detected in pregnant animals with regards to both uterine fluid and blood serum concentrations of the other cytokines. Conclusion Post-mating administration of anti-IL-10 and anti-TGFβ antibodies in mice may not have any effect on conception rates. PMID:25918594

Harborview Burns – 1974 to 2009

PubMed Central

Engrav, Loren H.; Heimbach, David M.; Rivara, Frederick P.; Kerr, Kathleen F.; Osler, Turner; Pham, Tam N.; Sharar, Sam R.; Esselman, Peter C.; Bulger, Eileen M.; Carrougher, Gretchen J.; Honari, Shari; Gibran, Nicole S.

2012-01-01

Background Burn demographics, prevention and care have changed considerably since the 1970s. The objectives were to 1) identify new and confirm previously described changes, 2) make comparisons to the American Burn Association National Burn Repository, 3) determine when the administration of fluids in excess of the Baxter formula began and to identify potential causes, and 4) model mortality over time, during a 36-year period (1974–2009) at the Harborview Burn Center in Seattle, WA, USA. Methods and Findings 14,266 consecutive admissions were analyzed in five-year periods and many parameters compared to the National Burn Repository. Fluid resuscitation was compared in five-year periods from 1974 to 2009. Mortality was modeled with the rBaux model. Many changes are highlighted at the end of the manuscript including 1) the large increase in numbers of total and short-stay admissions, 2) the decline in numbers of large burn injuries, 3) that unadjusted case fatality declined to the mid-1980s but has changed little during the past two decades, 4) that race/ethnicity and payer status disparity exists, and 5) that the trajectory to death changed with fewer deaths occurring after seven days post-injury. Administration of fluids in excess of the Baxter formula during resuscitation of uncomplicated injuries was evident at least by the early 1990s and has continued to the present; the cause is likely multifactorial but pre-hospital fluids, prophylactic tracheal intubation and opioids may be involved. Conclusions 1) The dramatic changes include the rise in short-stay admissions; as a result, the model of burn care practiced since the 1970s is still required but is no longer sufficient. 2) Fluid administration in excess of the Baxter formula with uncomplicated injuries began at least two decades ago. 3) Unadjusted case fatality declined to ∼6% in the mid-1980s and changed little since then. The rBaux mortality model is quite accurate. PMID:22792216

Fluid accumulation during acute kidney injury in the intensive care unit.

PubMed

Berthelsen, R E; Perner, A; Jensen, A K; Jensen, J-U; Bestle, M H

2018-07-01

Fluid therapy is a ubiquitous intervention in patients admitted to the intensive care unit, but positive fluid balance may be associated with poor outcomes and particular in patients with acute kidney injury. Studies describing this have defined fluid overload either at specific time points or considered patients with a positive mean daily fluid balance as fluid overloaded. We wished to detail this further and performed joint model analyses of the association between daily fluid balance and outcome represented by mortality and renal recovery in patients admitted with acute kidney injury. We did a retrospective cohort study of patients admitted to the intensive care unit with acute kidney injury during a 2-year observation period. We used serum creatinine measurements to identify patients with acute kidney injury and collected sequential daily fluid balance during the first 5 days of admission to the intensive care unit. We used joint modelling techniques to correlate the development of fluid overload with survival and renal recovery adjusted for age, gender and disease severity. The cohort contained 863 patients with acute kidney injury of whom 460 (53%) and 254 (29%) developed 5% and 10% fluid overload, respectively. We found that both 5% and 10% fluid overload was correlated with reduced survival and renal recovery. Joint model analyses of fluid accumulation in patients admitted to the intensive care unit with acute kidney injury confirm that even a modest degree of fluid overload (5%) may be negatively associated with both survival and renal recovery. © 2018 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Monitoring and blunting styles in fluid restriction consultation.

PubMed

Lindberg, Magnus

2012-04-01

Excessive fluid overload is common in hemodialysis patients. Understanding fluid intake behavior in relation to used cognitive coping style would serve the fluid restriction consultation. The aim of this study was to explore whether hemodialysis patients' fluid intake behavior differs as a function of used coping style. Secondary analysis of data from 51 hemodialysis patients regarding cognitive coping style (assessed by the Threatening Medical Situations Inventory) and fluid intake behavior were used. The participants' mean age was 62.9 years (range 27-84), they had received dialysis treatment for 3.9 years on average (range 0-22), 63% were male and they had gained 3.6% (±1.3) of their dry body weight during the interdialytic period. There was a significant difference in fluid intake behavior between coping groups (F = 3.899, d.f. 2, P = 0.027). The difference (P = 0.028) was isolated between patients with cognitive blunting style and patients with neutral coping style. Identification of hemodialysis patients using cognitive avoidance strategies can be advantageous in renal care. Fluid advice provided may have to be adjusted to the used coping style, especially for patients with a blunting coping style. However, the findings need to be confirmed, and the effect of individualized counseling needs to be evaluated in forthcoming studies.

Reexamination of Total Fluid Intake and Bladder Cancer in the Health Professionals Follow-Up Study Cohort

PubMed Central

Zhou, Jiachen; Smith, Scott; Giovannucci, Edward; Michaud, Dominique S.

2012-01-01

It has been hypothesized that high fluid intake may reduce contact time between carcinogens and bladder epithelium and consequently reduce carcinogenesis. Epidemiologic studies examining fluid intake and bladder cancer have been extremely inconsistent, ranging from strong inverse to strong positive associations. The authors reevaluated the association between fluid intake and bladder cancer among 47,909 participants in the prospective Health Professionals Follow-up Study over a period of 22 years. During follow-up (1986–2008), 823 incident bladder cancer cases were diagnosed. Information on fluid intake was collected by using the food frequency questionnaire at baseline and every 4 years thereafter. Cox proportional hazard regression analysis was used to adjust for risk factors for bladder cancer. Total fluid intake was inversely associated with bladder cancer when the analysis was based on the baseline diet (relative risk = 0.76, 95% confidence interval: 0.60, 0.97), comparing the highest total daily fluid intake quintile (>2,531 mL/day) with the lowest quintile (<1,290 mL/day) (Ptrend = 0.01). However, no association was detected when the analysis was based on recent diet or cumulative updated diet. The updated analysis for total fluid intake and bladder cancer was attenuated compared with the original findings from the first 10-year follow-up period. PMID:22355034

Early resuscitation intensity as a surrogate for bleeding severity and early mortality in the PRospective, Observational, Multicenter, Major Trauma Transfusion (PROMMTT) Study

PubMed Central

Rahbar, Elaheh; Fox, Erin E.; del Junco, Deborah J.; Harvin, John A.; Holcomb, John B.; Wade, Charles E.; Schreiber, Martin A.; Rahbar, Mohammad H.; Bulger, Eileen M.; Phelan, Herb A.; Brasel, Karen J.; Alarcon, Louis H.; Myers, John G.; Cohen, Mitchell J.; Muskat, Peter; Cotton, Bryan A.

2013-01-01

Background The classic definition of MT, ≥10 units red blood cells (RBCs) in 24 hours, has never been demonstrated as a valid surrogate for severe hemorrhage and can introduce survival bias. In addition, the definition fails to capture other products that the clinician may have immediately available during the initial resuscitation. Assuming that units of resuscitative fluids reflect patient illness, our objective was to identify a rate of resuscitation intensity (RI) that could serve as an early surrogate of sickness for patients with substantial bleeding post-injury. Methods Adult patients surviving at least 30 minutes post-admission and receiving ≥1 RBC within 6 hours of admission from ten US Level 1 trauma centers were enrolled in the PRospective Observational Multicenter Major Trauma Transfusion study. Total fluid units were calculated as the sum of the number of crystalloid units (1 L=1 unit), colloids (0.5 L=1 unit) and blood products (1 RBC=1 unit, 1 plasma=1 unit, 6 pack platelets=1 unit). Univariable and multivariable logistic regressions were used to evaluate associations between RI and 6-hour mortality, adjusting for age, center, penetrating injury, weighted Revised Trauma Score, and Injury Severity Score. Results 1096 eligible patients received resuscitative fluids within 30 minutes, including 620 transfused with blood products. Despite varying products utilized, the total fluid RI was similar across all sites (3.2±2.5 units). Patients who received ≥4 units of any resuscitative fluid had a 6-hour mortality rate of 14.4% vs. 4.5% in patients who received <4 units. The adjusted odds ratio of 6-hour mortality for patients receiving ≥4 units within 30 minutes was 2.1 (95% Confidence Interval: 1.2–3.5). Conclusions Resuscitation with ≥4 units of any fluid was significantly associated with 6-hour mortality. This study suggests that early RI regardless of fluid type can be used as a surrogate for sickness and mortality in severely bleeding patients. Level of Evidence PROMMTT is a prospective observational study, Level II. PMID:23778506

Growth and Morphology of Supercritical Fluids, a Fluid Physics Experiment Conducted on Mir, Complete

NASA Technical Reports Server (NTRS)

Wilkinson, R. Allen

2001-01-01

The Growth and Morphology of Supercritical Fluids (GMSF) is an international experiment facilitated by the NASA Glenn Research Center and under the guidance of U.S. principal investor Professor Hegseth of the University of New Orleans and three French coinvestigators: Daniel Beysens, Yves Garrabos, and Carole Chabot. The GMSF experiments were concluded in early 1999 on the Russian space station Mir. The experiments spanned the three science themes of near-critical phase separation rates, interface dynamics in near-critical boiling, and measurement of the spectrum of density fluctuation length scales very close to the critical point. The fluids used were pure CO2 or SF6. Three of the five thermostats used could adjust the sample volume with the scheduled crew time. Such a volume adjustment enabled variable sample densities around the critical density as well as pressure steps (as distinct from the usual temperature steps) applied to the sample. The French-built ALICE II facility was used for these experiments. It allows tightly thermostated (left photograph) samples (right photograph) to be controlled and viewed/measured. Its diagnostics include interferometry, shadowgraph, high-speed pressure measurements, and microscopy. Data were logged on DAT tapes, and PCMCIA cards and were returned to Earth only after the mission was over. The ground-breaking near critical boiling experiment has yielded the most results with a paper published in Physical Review Letters (ref. 1). The boiling work also received press in Science Magazine (ref. 2). This work showed that, in very compressible near-critical two-phase pure fluids, a vapor bubble was induced to temporarily overheat during a rapid heating of the sample wall. The temperature rise in the vapor was 23-percent higher than the rise in the driving container wall. The effect is due to adiabatic compression of the vapor bubble by the rapid expansion of fluid near the boundary during heatup. Thermal diffusivity is low near the critical point, so getting heat out of the compressed bubble is observably slow. This gives the appearance of a backward heat flow, or heat flow from a cold surface to a warm fluid.

Dialysis staff encouragement and fluid control adherence in patients on hemodialysis.

PubMed

Yokoyama, Yoko; Suzukamo, Yoshimi; Hotta, Osamu; Yamazaki, Shin; Kawaguchi, Takehiko; Hasegawa, Takeshi; Chiba, Shigemi; Moriya, Toshiko; Abe, Emi; Sasaki, Satoshi; Haga, Megumi; Fukuhara, Shunichi

2009-01-01

Fluid control in patients on dialysis is an important predictor of outcome but is a difficult restriction to achieve. The authors examined the association between dialysis staff encouragement and fluid control adherence in patients on hemodialysis. This cross-sectional study used the dialysis staff encouragement subscale (DSE). The outcome measure was intradialytic weight loss (IWL) of dry weight (DW), with nonadherence defined as IWL/DW greater than 5.7%. Predictors of nonadherence were identified using logistic regression. Odds ratio (OR) was for the occurrence of nonadherence as it correlated with a one standard deviation (SD) decrease in scale score. Seventy-two patients on hemodialysis participated, 45 men (62.5%) and 27 women. The crude OR in DSE score was 1.75 (95% confidence interval [CI]: 1.02 to 3.0) and adjusted odds ratio was 2.51 (95% CI: 0.99 to 6.34). Dialysis staff encouragement is important in improving fluid control adherence.

Application of microturbines to control emissions from associated gas

DOEpatents

Schmidt, Darren D.

2013-04-16

A system for controlling the emission of associated gas produced from a reservoir. In an embodiment, the system comprises a gas compressor including a gas inlet in fluid communication with an associated gas source and a gas outlet. The gas compressor adjusts the pressure of the associated gas to produce a pressure-regulated associated gas. In addition, the system comprises a gas cleaner including a gas inlet in fluid communication with the outlet of the gas compressor, a fuel gas outlet, and a waste product outlet. The gas cleaner separates at least a portion of the sulfur and the water from the associated gas to produce a fuel gas. Further, the system comprises a gas turbine including a fuel gas inlet in fluid communication with the fuel gas outlet of the gas cleaner and an air inlet. Still further, the system comprises a choke in fluid communication with the air inlet.

Heating and cooling system for an on-board gas adsorbent storage vessel

DOEpatents

Tamburello, David A.; Anton, Donald L.; Hardy, Bruce J.; Corgnale, Claudio

2017-06-20

In one aspect, a system for controlling the temperature within a gas adsorbent storage vessel of a vehicle may include an air conditioning system forming a continuous flow loop of heat exchange fluid that is cycled between a heated flow and a cooled flow. The system may also include at least one fluid by-pass line extending at least partially within the gas adsorbent storage vessel. The fluid by-pass line(s) may be configured to receive a by-pass flow including at least a portion of the heated flow or the cooled flow of the heat exchange fluid at one or more input locations and expel the by-pass flow back into the continuous flow loop at one or more output locations, wherein the by-pass flow is directed through the gas adsorbent storage vessel via the by-pass line(s) so as to adjust an internal temperature within the gas adsorbent storage vessel.

Pressurized fluid extraction of essential oil from Lavandula hybrida using a modified supercritical fluid extractor and a central composite design for optimization.

PubMed

Kamali, Hossein; Jalilvand, Mohammad Reza; Aminimoghadamfarouj, Noushin

2012-06-01

Essential oil components were extracted from lavandin (Lavandula hybrida) flowers using pressurized fluid extraction. A central composite design was used to optimize the effective extraction variables. The chemical composition of extracted samples was analyzed by a gas chromatograph-flame ionization detector column. For achieving 100% extraction yield, the temperature, pressure, extraction time, and the solvent flow rate were adjusted at 90.6°C, 63 bar, 30.4 min, and 0.2 mL/min, respectively. The results showed that pressurized fluid extraction is a practical technique for separation of constituents such as 1,8-cineole (8.1%), linalool (34.1%), linalyl acetate (30.5%), and camphor (7.3%) from lavandin to be applied in the food, fragrance, pharmaceutical, and natural biocides industries. © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Population Pharmacokinetics of Colistin Methanesulfonate in Rats: Achieving Sustained Lung Concentrations of Colistin for Targeting Respiratory Infections

PubMed Central

W. S. Yapa, Shalini; Li, Jian; Porter, Christopher J. H.; Nation, Roger L.

2013-01-01

Colistin methanesulfonate (CMS), the inactive prodrug of colistin, is administered by inhalation for the management of respiratory infections. However, limited pharmacokinetic data are available for CMS and colistin following pulmonary delivery. This study investigates the pharmacokinetics of CMS and colistin following intravenous (i.v.) and intratracheal (i.t.) administration in rats and determines the targeting advantage after direct delivery into the lungs. In addition to plasma, bronchoalveolar lavage (BAL) fluid was collected to quantify drug concentrations in lung epithelial lining fluid (ELF). The resulting data were analyzed using a population modeling approach in S-ADAPT. A three-compartment model described the disposition of both compounds in plasma following i.v. administration. The estimated mean clearance from the central compartment was 0.122 liters/h for CMS and 0.0657 liters/h for colistin. Conversion of CMS to colistin from all three compartments was required to fit the plasma data. The fraction of the i.v. dose converted to colistin in the systemic circulation was 0.0255. Two BAL fluid compartments were required to reflect drug kinetics in the ELF after i.t. dosing. A slow conversion of CMS (mean conversion time [MCTCMS] = 3.48 h) in the lungs contributed to high and sustained concentrations of colistin in ELF. The fraction of the CMS dose converted to colistin in ELF (fm,ELF = 0.226) was higher than the corresponding fractional conversion in plasma after i.v. administration. In conclusion, pulmonary administration of CMS achieves high and sustained exposures of colistin in lungs for targeting respiratory infections. PMID:23917323

50 CFR 622.412 - Adjustment of management measures.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 50 Wildlife and Fisheries 12 2014-10-01 2014-10-01 false Adjustment of management measures. 622.412 Section 622.412 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE FISHERIES OF THE CARIBBEAN, GULF OF MEXICO, AND SOUTH...

50 CFR 622.389 - Adjustment of management measures.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 50 Wildlife and Fisheries 12 2014-10-01 2014-10-01 false Adjustment of management measures. 622.389 Section 622.389 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE FISHERIES OF THE CARIBBEAN, GULF OF MEXICO, AND SOUTH...

50 CFR 622.42 - Adjustment of management measures.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 50 Wildlife and Fisheries 12 2014-10-01 2014-10-01 false Adjustment of management measures. 622.42 Section 622.42 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE FISHERIES OF THE CARIBBEAN, GULF OF MEXICO, AND SOUTH...

50 CFR 622.412 - Adjustment of management measures.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 50 Wildlife and Fisheries 12 2013-10-01 2013-10-01 false Adjustment of management measures. 622.412 Section 622.412 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE FISHERIES OF THE CARIBBEAN, GULF OF MEXICO, AND SOUTH...

50 CFR 622.93 - Adjustment of management measures.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 50 Wildlife and Fisheries 12 2014-10-01 2014-10-01 false Adjustment of management measures. 622.93 Section 622.93 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE FISHERIES OF THE CARIBBEAN, GULF OF MEXICO, AND SOUTH...

50 CFR 648.127 - Framework adjustments to management measures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 50 Wildlife and Fisheries 10 2011-10-01 2011-10-01 false Framework adjustments to management measures. 648.127 Section 648.127 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE FISHERIES OF THE NORTHEASTERN UNITED STATES...

20 CFR 639.1 - Purpose and scope.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR WORKER ADJUSTMENT AND RETRAINING NOTIFICATION § 639.1 Purpose and scope. (a) Purpose of WARN. The Worker Adjustment and Retraining Notification Act (WARN or the Act) provides protection to workers, their families and communities by requiring...

40 CFR 31.51 - Later disallowances and adjustments.

Code of Federal Regulations, 2010 CFR

2010-07-01

....51 Section 31.51 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL ASSISTANCE UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS AND COOPERATIVE AGREEMENTS TO STATE AND LOCAL GOVERNMENTS After-the-Grant Requirements § 31.51 Later disallowances and adjustments. The closeout of a grant...

50 CFR 635.34 - Adjustment of management measures.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 50 Wildlife and Fisheries 12 2013-10-01 2013-10-01 false Adjustment of management measures. 635.34 Section 635.34 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE ATLANTIC HIGHLY MIGRATORY SPECIES Management Measures § 635...

13 CFR 107.1540 - Distributions by Licensee-Prioritized Payments and Adjustments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Distributions by Licensee-Prioritized Payments and Adjustments. 107.1540 Section 107.1540 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION SMALL BUSINESS INVESTMENT COMPANIES SBA Financial Assistance for Licensees (Leverage...

Metabolic pathways and pharmacokinetics of natural medicines with low permeability.

PubMed

Zeng, Mei; Yang, Lan; He, Dan; Li, Yao; Shi, Mingxin; Zhang, Jingqing

2017-11-01

Drug metabolism plays an important role in the drug disposal process. Differences in pharmacokinetics among individuals are the basis for personalized medicine. Natural medicines, formed by long-term evolution of nature, prioritize the action of a target protein with a drug. Natural medicines are valued for structural diversity, low toxicity, low cost, and definite biological activities. Metabolic pathway and pharmacokinetic research of natural medicines is highly beneficial for clinical dose adjustment and the development of personalized medicine. This review was performed using a systematic search of all available literature. It provides an overview and discussion of metabolic pathways and the pharmacokinetics of natural medicines with low permeability. The related enzymes and factors affecting them are analyzed. The series of metabolic reactions, including phase I reactions(oxidation hydrolysis, and reduction reactions) and phase II reactions (binding reactions), catalyzed by intracellular metabolic enzymes (such as CYP450, esterase, SULT, and UGT enzymes) in tissues (such as liver and gastro-intestinal tract) or in the body fluid environment were examined. The administration route, drug dose, and delivery system had a large influence on absorption, metabolism, and pharmacokinetics. Natural medicines with low permeability had distinctive metabolisms and pharmacokinetics. The metabolic and in vivo kinetic properties were favorably modified by choosing suitable drug delivery systems, administration routes and drug doses, among other variables. This study provides valuable information for clinicians and pharmacists to guide patients safe, effective, and rational drug use. The research of metabolism and pharmacokinetics is significant in guiding personalized clinical medicine.

75 FR 52992 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-30

... NATIONAL ARCHIVES AND RECORDS ADMINISTRATION Agency Information Collection Activities: Proposed Collection; Comment Request AGENCY: National Archives and Records Administration (NARA). ACTION: Notice... records matter. The information will support adjustments in this offering that will improve the overall...

Automated Fluid Management for Treatment of Rhabdomyolysis

PubMed Central

Beilstein, Christian M.; Prowle, John R.

2016-01-01

Purpose. Fluid therapy aimed at increasing urine output is a commonly employed strategy to prevent acute kidney injury (AKI) in critically ill patients with rhabdomyolysis. Automated fluid management has the potential to optimise urine output while avoiding fluid accumulation in rhabdomyolysis patients. Methods. In a single centre clinical service evaluation we compared a convenience sample of critically ill adults with rhabdomyolysis treated with automated fluid management using the RenalGuard® device to patients managed with manual fluid adjustment following our standard rhabdomyolysis protocol. Primary outcome was number of hours with urine output >2 mL/kg during first 48 h of therapy. Results. Eight patients treated with RenalGuard were compared to 28 patients treated with manual fluid management. Number of hours of target urine output was greater in the RenalGuard versus the Standard group (176/312 (56.4%) versus 534/1305 (40.9%); p < 0.01). Urine output was significantly higher in the first 24 h in the RenalGuard group (median (IQR) 4033 mL (3682–7363) versus 2913 mL (2263–4188 mL); p < 0.01). Fluid balance, electrolyte, diuretics, and bicarbonate use were comparable between groups. Conclusions. Automated fluid management resulted in a higher urine output more quickly in the treatment of rhabdomyolysis. Further research is needed to analyse the effect of diuresis-matched hydration for the prevention of AKI in rhabdomyolysis. PMID:28003911

Automated Fluid Management for Treatment of Rhabdomyolysis.

PubMed

Beilstein, Christian M; Prowle, John R; Kirwan, Christopher J

2016-01-01

Purpose . Fluid therapy aimed at increasing urine output is a commonly employed strategy to prevent acute kidney injury (AKI) in critically ill patients with rhabdomyolysis. Automated fluid management has the potential to optimise urine output while avoiding fluid accumulation in rhabdomyolysis patients. Methods . In a single centre clinical service evaluation we compared a convenience sample of critically ill adults with rhabdomyolysis treated with automated fluid management using the RenalGuard® device to patients managed with manual fluid adjustment following our standard rhabdomyolysis protocol. Primary outcome was number of hours with urine output >2 mL/kg during first 48 h of therapy. Results . Eight patients treated with RenalGuard were compared to 28 patients treated with manual fluid management. Number of hours of target urine output was greater in the RenalGuard versus the Standard group (176/312 (56.4%) versus 534/1305 (40.9%); p < 0.01). Urine output was significantly higher in the first 24 h in the RenalGuard group (median (IQR) 4033 mL (3682-7363) versus 2913 mL (2263-4188 mL); p < 0.01). Fluid balance, electrolyte, diuretics, and bicarbonate use were comparable between groups. Conclusions . Automated fluid management resulted in a higher urine output more quickly in the treatment of rhabdomyolysis. Further research is needed to analyse the effect of diuresis-matched hydration for the prevention of AKI in rhabdomyolysis.