[Analysis of clinical use of Danhong injection based on hospital information system].

PubMed

Chen, Qian; Yi, Danhui; Xie, Yanming; Yang, Wei; Yang, Wei; Zhuang, Yan; Du, Jing

2011-10-01

To know how Danhong injection is used in clinical practice and to provide a reference for guiding clinical use of Danhong Injection. Extract Danhong injection's post-marketing re-evaluation data from the Hospital Information System of ten three grade III-A General Hospitals in Beijing, use basic statistical analysis methods to analyze Danhong injection's indications, usage and dosage, days of treatment etc. in clinical practice. In patients using Danhong injection, there were more than 60 percent patients were prescribed based on main-diagnosis, first-visit and other diagnosis, which were also coincided with Danhong injection's instruction. In clinical practice, 95.5 percent of Danhong injection's administration routes conformed to the instruction and more than 90 percent of Danhong injection's dosage were within the limits prescribed by the instruction. Danhong injection was used less than 20 days successively. Danhong injection was used in combination with drugs with the action of removing blood stasis, antianginal drug, antiplatelet drug, drugs for cerebrovascular disease and so on. Danhong injection has been used according to instruction in practice almostly.

Cognitive Behavioral Theories Used to Explain Injection Risk Behavior among Injection Drug Users: A Review and Suggestions for the Integration of Cognitive and Environmental Models

ERIC Educational Resources Information Center

Wagner, Karla Dawn; Unger, Jennifer B.; Bluthenthal, Ricky N.; Andreeva, Valentina A.; Pentz, Mary Ann

2010-01-01

Injection drug users (IDUs) are at risk for HIV and viral hepatitis, and risky injection behavior persists despite decades of intervention. Cognitive behavioral theories (CBTs) are commonly used to help understand risky injection behavior. The authors review findings from CBT-based studies of injection risk behavior among IDUs. An extensive…

[Clinical outcomes research of use of Shenfu injection based on hospital information system].

PubMed

Yang, Jing; Zhao, Ruo-Qi; Xie, Yan-Ming; Yang, Hu; Li, Lin; Zhuang, Yan

2012-09-01

To know how Shenfu injection is used in clinical practice and to provide a reference for guiding clinical use of Shenfu injection. Extract Shenfu injection's post-marketing re-evaluation data from the hospital information system (HIS) of 20 national grade III-A General Hospitals, use basic statistical analysis methods to analyze Shenfu injection's indications, usage and dosage, treatment course etc. in clinical practice. In patients using Shenfu injection, the average age was 62. 15, and patients mainly concentrated in cardiovascular medicine. In clinical practice, Shenfu injection was used mainly for treatment of coronary heart disease (diagnosed as chest obstruction in traditional Chinese medicine). The treatment course mainly ranged from 3 to 7 days, and the dosage was within the limits prescribed by the instruction. Shenfu injection was mainly used for elderly patients, and has been used according to instruction in practice almostly.

Women's injection drug practices in their own words: a qualitative study.

PubMed

Tuchman, Ellen

2015-03-07

There are significant gender differences in injection drug practices and relative risks involved for women who inject drug compared with men. This qualitative study aims to explore the social, contextual, and behavioral dimensions of injecting practices among women who inject drugs. Participants were selected by purposive venue-based sampling from a syringe exchange program in 2012-2013. In-depth interviews were conducted with 26 women to elicit detailed perspectives regarding injection drug use practices and women-focused decision-making. All interviews were transcribed verbatim and analyzed with Atlas.ti. Participant's mean age was 43.2 years, 48% Caucasian, 36% African American, and 16% Latina, poorly educated, mostly single, and heroin self-injectors. Three themes emerged; a) transitioning from non-injection to injection drug use; b) patterns and variations of initiation to injecting; and c) shifting toward autonomy or reliance on others. Women were predominantly influenced to transition to injection drug use by other women with their claims that injecting was a way to curtail their daily drug expenditure. More than half the women received their first injection from another woman in their social network rather than a male sexual partner. Self-injecting women exhibited agency around the circumstances of injection safety and potential risks. Other women revealed that their inability to inject themselves could and did make them dependent on others for unsafe injection practices. The finding that many women were influenced to transition to injection drug use and receive the first injection from a woman is contrary to literature claims that male sexual partners introduce and initiate women to injection drug use. Self-injecting women possessed capacity to act in a way that produced the results they wanted, not sharing prepared drugs or injecting equipment. In stark contrast, women assisted with injections could and did make them vulnerable to unsafe injecting. Findings support early prevention strategies that discourage women's transition from non-injection to injection and development of female peer-driven experiential interventions to dispel myths for non-injection women and to increase personal capability to self-inject for women who require assistance with injecting, to reduce injection-related harm.

Prompt Recovery and Enhancement of the Earth's Outer Radiation Belt due to Relativistic Electron Injections

NASA Astrophysics Data System (ADS)

Tang, C. L.; Zhang, J.; Reeves, G. D.; Baker, D. N.; Spence, H. E.; Funsten, H. O.; Blake, J. B.

2015-12-01

We present multipoint observations (RBSP, GEOS and THEMIS) of the substorm electron injections during the substorm event on 16 August 2013. RBSP-A detected the MeV electron phase space density increased by an order of magnitude in about one hour at L* > 5.0. At L* = 4.4, the injected MeV electrons were also detected. It is suggested that the magnetic field dipolarization associated with the substorm injections alone can explain that the prompt recovery and enhancements of the relativistic electron (~ MeV) fluxes in the outer radiation belt. The observations of THEMIS-A also first presented that the near-Earth magnetotail at substorm onset is important in the MeV electron injection event: the enhanced fluxes of ~200 keV electrons are the source population and intense electromagnetic pulses are the driving source of MeV injected electrons. The pulse model is used to explain the dispersionless MeV injected electrons in the outer radiation belt observed by GEOS-13 and RBSP-A.

Strategies to avoid opiate withdrawal: implications for HCV and HIV risks.

PubMed

Mateu-Gelabert, Pedro; Sandoval, Milagros; Meylakhs, Peter; Wendel, Travis; Friedman, Samuel R

2010-05-01

Research on heroin withdrawal has primarily been done clinically, thus focussing on symptom severity, physiological manifestations, and how withdrawal impairs normal functioning. However, there is little scientific knowledge on how heroin withdrawal affects injection behaviour. This paper explores how withdrawal episodes heighten unsafe injection practices and how some long-term injectors manage such risks. We interviewed 32 injection drug users in New York City who had been injecting drugs for 8-15 years (21 HIV and HCV uninfected; 3 HIV and HCV infected; and 8 singly infected with HCV). We used in-depth life history interviews to inquire about IDUs' life history, injection practices and drug use behaviour over time. Analysis used grounded theory techniques. Withdrawal can enhance risk by undermining IDUs' willingness to inject safely; increasing the likelihood of attending risky settings; raising the number of injection partners; and seeking ad hoc partners for drug or needle sharing. Some IDUs have developed practices to cope with withdrawal and avoid risky practices (examples include carrying clean needles to shooting galleries and sniffing rather than injecting). Strategies to avoid withdrawal include back up methods, resorting to credit, collaborating with others, regimenting drug intake, balancing drug intake with money available, and/or resorting to treatment. Withdrawal periods can heighten risky injection practices. Some IDUs have applied strategies to avoid withdrawal or used practices to cope without engaging in risky practices. These behaviours might in turn help IDUs prevent an infection with hepatitis C or HIV. Copyright 2009 Elsevier B.V. All rights reserved.

Assessment of the safety of injection practices and injection-related procedures in family health units and centers in Alexandria.

PubMed

Elhoseeny, Taghareed A; Mourad, Juidan K

2014-08-01

The Safe Injection Global Network (SIGN) developed an intervention strategy for reducing overuse of injections and promoting the administration of safe injections. Tool C--Revised is designed to assess the safety of the most common procedures that puncture the skin within health services. The aim of the study was to assess injection safety within the primary healthcare facilities in Alexandria using Tool C--Revised. A total of 45 family health units and centers in Alexandria were selected by proportional allocation from the eight regions of Alexandria. The Tool C--Revised of the WHO was used for observation of the entire facility, injection practices and injection-related procedures, and sterilization practices. Interview of different health providers and immediate supervisor of injections was carried out. Indicators that reflect risk included: deficiency of alcohol-based hand rub for cleansing hands (13.3%), compliance with hand wash before preparing a procedure (56.9% before injection practices, 61.3% before phlebotomy, and 67.6% before lancet puncture), and wearing a new pair of gloves before new procedures (48.6% before injection practices, 9.7% for phlebotomy, 11.8% for lancet puncture, and 80% for both intravenous injections and infusions). Enough disposable equipment in all facilities for at least 2 weeks dependent on the statement of the average numbers of procedures per week was shown. Only 38% of the providers had received training regarding injection safety in the last 2 years and 62.5% had completed their three doses of hepatitis B vaccine. Only 42.2% of staffs who handled healthcare waste had access to heavy gloves. Indicators related to injection and injection-related practices that reflect risk to patients include deficiency of alcohol-based hand rub tools, nonadherence to hand hygiene before preparing an injection, and inadequate adherence to using a clean barrier when opening a glass ampule and use of gloves. Indicators that may reflect risk to patients and providers include inadequate injection safety training and incomplete hepatitis B vaccination of healthcare providers. Indicators that may reflect risk to providers include nonadherence to safety precautions related to injection practices, such as inadequate access to heavy gloves by staff handling healthcare waste.

Enduring consequences from the War on Drugs: How policing practices impact HIV risk among people who inject drugs in Baltimore City

PubMed Central

Flath, Natalie; Tobin, Karin; King, Kelly; Lee, Alexandra; Latkin, Carl

2017-01-01

Background Neighborhood-level characteristics, including police activity, are associated with HIV and Hepatitis C injection risk-behaviors among people who inject drugs (PWID). However, the pathways through which these neighborhood perceptions shape individual-level HIV risk behaviors are unclear. This study helps to explain perceived behaviors between perceived neighborhood police activity and HIV injection risk behavior (i.e., injection syringe/tool sharing in the previous six months). Methods A sample of (n=366) PWIDs who self-reported recent use were recruited using community-based outreach methods in Baltimore, Maryland. Neighborhood police perceptions were assessed by asking participants whether they would (1) be more likely to ask others to share injection tools in the context of heightened police activity; and (2) be less likely to carry syringes with them due to fear of arrest. Poisson regression with robust variance was used to identify statistical relationships. Recent police encounters, frequency of heroin injection, and socio-demographic characteristics were controlled for in the model. Results Neighborhood police perceptions shaped injection-risk behavior. Half of the sample (49%) reported an aversion of carrying personal syringes, due to fear of arrest. Those who agreed they would be more likely to ask others to share injection equipment in the context of heightened police activity were more likely to share syringes (21% versus 3%, p<0.01). Adjusted models showed that syringe sharing was independently associated with asking to borrow equipment in neighborhoods with perceived heightened police activity (aPR 2.22 95% CI 1.7, 3.0). Conclusion This study sheds light on how police perceptions may influence injection risk behavior. While these relationships require further elucidation, this study suggests that public health interventions aiming to reduce HIV risk would benefit from improving community- police relationships. PMID:28318343

Injection practices in a metropolis of North India: perceptions, determinants and issues of safety.

PubMed

Kotwal, A; Priya, R; Thakur, R; Gupta, V; Kotwal, J; Seth, T

2004-08-01

At least 50 percent of the injections administered each year are unsafe, more particularly in developing countries, posing serious health risks. An initial assessment to describe injection practices; their determinants and adverse effects can prevent injection-associated transmission of blood borne pathogens by reducing injection frequency and adoption of safe injection practices. To assess the injection practices in a large metropolitan city encompassing varied socio-cultural scenarios. STUDY SETTING AND DESIGN: Field based cross sectional survey covering urban non-slum, slum and peri-urban areas of a large metropolitan city. Injection prescribers, providers and community members selected by random sampling from the study areas. Pre tested questionnaires assessed knowledge and perceptions of study subjects towards injections and their possible complications. Observation of the process of injection and prescription audit also carried out. MS Access for database and SPSS ver 11 for analysis. Point estimates, 95% confidence intervals, Chi Square, t test, one-way ANOVA. The per capita injection rate was 5.1 per year and ratio of therapeutic to immunization injections was 4.4:1. Only 22.5%of injections were administered with a sterile syringe and needle. The level of knowledge about HIV and HBV transmission by unsafe injections was satisfactory amongst prescribers and community, but inadequate amongst providers. HCV was known to a very few in all the groups. The annual incidence of needle stick injuries among providers was quite high. A locally relevant safe injection policy based on multi disciplinary approach is required to reduce number of injections, unsafe injections and their attendant complications.

Physiological and biochemical changes after boldenone injection in adult rabbits.

PubMed

Tousson, Ehab; El-Moghazy, Mostafa; Massoud, Ahmed; El-Atrash, Afaf; Sweef, Osama; Akel, Amani

2016-01-01

Boldenone (BOL) is an androgenic steroid that improves the growth and food conversion in food-producing animals. In most countries worldwide, this anabolic steroid is forbidden for human uses and meat production as it was developed for veterinary use. Recently, BOL is used by bodybuilders in both off season and pre-contest, where it is well known for increasing vascularity while preparing for a bodybuilding contest. The present study was designed to investigate the physiological and biochemical changes in rabbits after injection with the growth promoter BOL. A total of 32 adult New Zealand rabbits were divided into four groups, where the control group includes animals that were injected intramuscularly with olive oil and dissected after 3 weeks. The remaining three experimental groups included animals that received one, two and three intramuscular injections of 5 mg/kg body weight BOL, respectively, and were dissected after 3, 6 and 9 weeks, respectively. The animals from practice appeared healthy and did not show clinical signs of disease and none of the rabbits died during the experimental period. Serum total protein, globulin, alanine aminotransferase, asparate aminotransferase, urea, creatinine, testosterone, luteinizing hormone and follicle-stimulating hormone levels were significantly increased while serum direct bilirubin, albumin and albumin/globulin ratio were significantly decreased (p < 0.05) after one, two and three intramuscular injections of BOL as compared to their relative values in the control group. These findings explain the common phenomena in athletes and bodybuilders who suffer from infertility, renal and hepatic alterations following injection with some drugs as steroids (BOL) to build muscles. © The Author(s) 2013.

Intramuscular injection technique: an evidence-based approach.

PubMed

Ogston-Tuck, Sherri

2014-09-30

Intramuscular injections require a thorough and meticulous approach to patient assessment and injection technique. This article, the second in a series of two, reviews the evidence base to inform safer practice and to consider the evidence for nursing practice in this area. A framework for safe practice is included, identifying important points for safe technique, patient care and clinical decision making. It also highlights the ongoing debate in selection of intramuscular injection sites, predominately the ventrogluteal and dorsogluteal muscles.

Rituals in nursing: intramuscular injections.

PubMed

Greenway, Kathleen

2014-12-01

To consider to what extent intramuscular injection technique can be described to remain entrenched in ritualistic practice and how evidence-based practice should be considered and applied to the nursing practice of this essential skill. The notion of rituals within nursing and the value or futile impact they afford to this essential nursing skill will be critically reviewed. Discursive paper. Literature review from 2002-2013 to review the current position of intramuscular injection injections. Within the literature review, it became clear that there are several actions within the administration of an intramuscular injection that could be perceived as ritualistic and require consideration for contemporary nursing practice. The essential nursing skill of intramuscular injection often appears to fit into the description of a ritualised practice. By providing evidence-based care, nurses will find themselves empowered to make informed decisions based on clinical need and using their clinical judgement. For key learning, it will outline with rationale how site selection, needle selection, insertion technique and aspiration can be cited as examples of routinised or ritualistic practice and why these should be rejected in favour of an evidence-based approach. The effect on some student nurses of experiencing differing practices between what is taught at university and what is often seen in clinical practice will also be discussed. © 2014 John Wiley & Sons Ltd.

APIC position paper: safe injection, infusion, and medication vial practices in health care.

PubMed

Dolan, Susan A; Felizardo, Gwenda; Barnes, Sue; Cox, Tracy R; Patrick, Marcia; Ward, Katherine S; Arias, Kathleen Meehan

2010-04-01

Outbreaks involving the transmission of bloodborne pathogens or other microbial pathogens to patients in various types of health care settings due to unsafe injection, infusion, and medication vial practices are unacceptable. Each of the outbreaks could have been prevented by the use of proper aseptic technique in conjunction with basic infection prevention practices for handling parenteral medications, administration of injections, and procurement and sampling of blood. This document provides practice guidance for health care facilities on essential safe injection, infusion, and vial practices that should be consistently implemented in such settings. 2010 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Forum for Injection Technique (FIT), India: The Indian recommendations 2.0, for best practice in Insulin Injection Technique, 2015

PubMed Central

Tandon, Nikhil; Kalra, Sanjay; Balhara, Yatan Pal Singh; Baruah, Manash P.; Chadha, Manoj; Chandalia, Hemraj B.; Chowdhury, Subhankar; Jothydev, Kesavadev; Kumar, Prasanna K. M.; V., Madhu S.; Mithal, Ambrish; Modi, Sonal; Pitale, Shailesh; Sahay, Rakesh; Shukla, Rishi; Sundaram, Annamalai; Unnikrishnan, Ambika G.; Wangnoo, Subhash K.

2015-01-01

As injectable therapies such as human insulin, insulin analogs, and glucagon-like peptide-1 receptor agonists are used to manage diabetes, correct injection technique is vital for the achievement of glycemic control. The forum for injection technique India acknowledged this need for the first time in India and worked to develop evidence-based recommendations on insulin injection technique, to assist healthcare practitioners in their clinical practice. PMID:25932385

Romiplostim Injection

MedlinePlus

... treated or have not been helped by other treatments, including other medications or surgery to remove the ... given written information that explains the risks of treatment with romiplostim injection and you will need to ...

"The first shot": the context of first injection of illicit drugs, ongoing injecting practices, and hepatitis C infection in Rio de Janeiro, Brazil.

PubMed

Oliveira, Maria de Lourdes Aguiar; Hacker, Mariana A; Oliveira, Sabrina Alberti Nóbrega de; Telles, Paulo Roberto; O, Kycia Maria Rodrigues do; Yoshida, Clara Fumiko Tachibana; Bastos, Francisco I

2006-04-01

The context of first drug injection and its association with ongoing injecting practices and HCV (hepatitis C virus) infection were investigated. Injection drug users (IDUs) (N = 606) were recruited in "drug scenes" (public places, bars) in Rio de Janeiro, Brazil, interviewed, and tested for HCV. Sharing of needles/syringes was more prevalent at the first injection (51.3%) than at the baseline interview (36.8%). Those who shared syringes/needles at first injection were more likely to be currently engaged in direct/indirect sharing practices. Among young injectors (< 30 years), those reporting sharing of needles/ syringes at the first injection were about four times more likely to have been infected by HCV. Hepatitis C virus prevalence among active IDUs (n = 272) was 11%. Prison history and longer duration of drug injection were identified as independent predictors of HCV infection. To effectively curb HCV transmission among IDUs and minimize harms associated with risk behaviors, preventive strategies should target individuals initiating drug injection beginning with their very first injection and discourage the transition from non-injecting use to the self-injection of illicit drugs.

Safe injection practices for administration of propofol.

PubMed

King, Cecil A; Ogg, Mary

2012-03-01

Sepsis and postoperative infection can occur as a result of unsafe practices in the administration of propofol and other injectable medications. Investigations of infection outbreaks have revealed the causes to be related to bacterial growth in or contamination of propofol and unsafe medication practices, including reuse of syringes on multiple patients, use of single-use medication vials for multiple patients, and failure to practice aseptic technique and adhere to infection control practices. Surveys conducted by AORN and other researchers have provided additional information on perioperative practices related to injectable medications. In 2009, the US Food and Drug Administration and the Centers for Disease Control and Prevention convened a group of clinicians to gain a better understanding of the issues related to infection outbreaks and injectable medications. The meeting participants proposed collecting data to persuade clinicians to adopt new practices, developing guiding principles for propofol use, and describing propofol-specific, site-specific, and practitioner-specific injection techniques. AORN provides resources to help perioperative nurses reduce the incidence of postoperative infection related to medication administration. Copyright © 2012 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Self-reported injection practices among people who use drugs in French prisons: Public health implications (ANRS-Coquelicot survey 2011-2013).

PubMed

Michel, Laurent; Trouiller, Philippe; Chollet, Aude; Molinier, Marie; Duchesne, Lucie; Jauffret-Roustide, Marie

2018-04-01

The aims of this study were to describe the prevalences of injection practices and needle/syringe sharing in people who use drugs in French prisons, and to investigate associated factors. Using the ANRS-Coquelicot survey (2011-2013), a random sample of 1718 people who used drugs in free society was included. Information regarding a history of incarceration, drug-injection practices inside prison and needle/syringe sharing was collected during interviews. In our sample, 65.5% reported a history of injection and 57.4% had been incarcerated at least once. Among those who reported both of these conditions, 14% reported injection practices inside prison, 40.5% of whom had shared needles/syringes. In the multivariable model, the following variables were associated with injection practices inside prison: being a Russian-speaking detainee, having spent more time in prison, and having started to inject before 1996 and especially before 1987. Being Russian speaking was also associated with needle/syringe sharing in prison. The prevalences of injection practices and needle/syringe sharing in prisons are alarmingly high. Effective interventions to prevent the transmission of infectious diseases among people who use drugs in the prison setting are essential. The implementation of international recommendations on the principle of equivalence between prisons and the community is still very limited in most countries, and should be complemented with tailored interventions for the most vulnerable prison populations, especially Russian-speaking detainees. © 2017 Australasian Professional Society on Alcohol and other Drugs.

Study of status of safe injection practice and knowledge regarding injection safety among primary health care workers in Baglung district, western Nepal.

PubMed

Gyawali, Sudesh; Rathore, Devendra S; Kc, Bhuvan; Shankar, P Ravi

2013-01-03

Unsafe injection practices and injection overuse are widespread in developing countries harming the patient and inviting risks to the health care workers. In Nepal, there is a dearth of documented information about injection practices so the present study was carried out: a) to determine whether the selected government health facilities satisfy the conditions for safe injections in terms of staff training, availability of sterile injectable equipment and their proper disposal after use and b) to assess knowledge and attitudes of healthcare workers in these health care facilities with regard to injection safety. A descriptive cross-sectional mixed type (qualitative and quantitative) survey was carried out from 18th May to 16th June 2012. In-depth interviews with the in-charges were conducted using a semi-structured questionnaire. Observation of the health facilities using a structured observation tool was done. The data were analysed manually by summarizing, tabulating and presenting in various formats. The in-charges (eight males, two females) who participated in the study ranged in age from 30 to 50 years with a mean age of 37.8 years. Severe infection followed by pain was the most important cause for injection use with injection Gentamicin being most commonly prescribed. New single use (disposable) injections and auto-disable syringes were used to inject curative drugs and vaccines respectively. Sufficient safety boxes were also supplied to dispose the used syringe. All health care workers had received full course of Hepatitis B vaccine and were knowledgeable about at least one pathogen transmitted through unsafe injection practices. Injection safety management policy and waste disposal guideline was not available for viewing in any of the facilities. The office staff who disposed the bio-medical wastes did so without taking any safety measures. Moreover, none of these staff had received any formal training in waste management. Certain safe injection practices were noticed in the studied health care facilities but there remain a number of grey areas where unsafe practices still persists placing patient and health workers at risk of associated hazards. Training concentrating on injection safety, guidelines to dispose biomedical waste and monitoring of the activity is needed.

Study of status of safe injection practice and knowledge regarding injection safety among primary health care workers in Baglung district, western Nepal

PubMed Central

2013-01-01

Background Unsafe injection practices and injection overuse are widespread in developing countries harming the patient and inviting risks to the health care workers. In Nepal, there is a dearth of documented information about injection practices so the present study was carried out: a) to determine whether the selected government health facilities satisfy the conditions for safe injections in terms of staff training, availability of sterile injectable equipment and their proper disposal after use and b) to assess knowledge and attitudes of healthcare workers in these health care facilities with regard to injection safety. Methodology A descriptive cross-sectional mixed type (qualitative and quantitative) survey was carried out from 18th May to 16th June 2012. In-depth interviews with the in-charges were conducted using a semi-structured questionnaire. Observation of the health facilities using a structured observation tool was done. The data were analysed manually by summarizing, tabulating and presenting in various formats. Results The in-charges (eight males, two females) who participated in the study ranged in age from 30 to 50 years with a mean age of 37.8 years. Severe infection followed by pain was the most important cause for injection use with injection Gentamicin being most commonly prescribed. New single use (disposable) injections and auto-disable syringes were used to inject curative drugs and vaccines respectively. Sufficient safety boxes were also supplied to dispose the used syringe. All health care workers had received full course of Hepatitis B vaccine and were knowledgeable about at least one pathogen transmitted through unsafe injection practices. Injection safety management policy and waste disposal guideline was not available for viewing in any of the facilities. The office staff who disposed the bio-medical wastes did so without taking any safety measures. Moreover, none of these staff had received any formal training in waste management. Conclusions Certain safe injection practices were noticed in the studied health care facilities but there remain a number of grey areas where unsafe practices still persists placing patient and health workers at risk of associated hazards. Training concentrating on injection safety, guidelines to dispose biomedical waste and monitoring of the activity is needed. PMID:23286907

Patient's Compliance on the Use of Extended Low Molecular Weight Heparin Post Major Pelvic Surgeries in Cancer Patients at King Hussein Cancer Center.

PubMed

Baba, M; Al-Masri, M; Salhab, M; El-Ghanem, M

2015-01-01

Effective Venous Thrombo-Embolism (VTE) prophylaxis is used in less than 50% of oncology patients despite its wide availability. Low molecular weight heparin (LMWH) as a daily injection is an essential tool for effective prophylaxis against deep vein thrombosis (DVT). Daily outpatient self-injection by the patients or their family members is common practice. The effectiveness of this measure depends on patient compliance. The purpose of this study is to determine the degree of compliance and the factors that affect compliance to the extended out-patient use of prophylactic LMWH for 1 month after major abdominal/pelvic surgeries in cancer patients at King Hussein Cancer Center (KHCC). Following major abdominal/pelvic surgeries, data on 160 cancer patients at KHCC from January 2007 until July 2012 were collected concerning knowledge of DVT and compliance with prophylactic self-injections by answering a questionnaire. We have achieved a high compliance rate, this was explained by the medical team's role in educating the patients about the risk of VTE and the importance of thromboprophylaxis. The compliance with self-injections was directly associated with younger age, employment and higher degree of education. The high compliance rate outside clinical trials can be achieved through comprehensive patient education by a well-qualified medical team, clarification of the importance of DVT prophylaxis and patients' support.

Assessment of injection safety in Ha Dong General Hospital, Hanoi, in 2012.

PubMed

Van Tuong, Phan; Phuong, Tran Thi Minh; Anh, Bui Thi My; Nguyen, Trang Huyen Thi

2017-01-01

Background : Injection is one of the most frequently used medical methods to introduce drugs or other substances into the body for purposes of treatment or prevention. Unsafe injection can cause adverse outcomes, such as abscess and anaphylactic shock, and increases the risk of blood-borne transmission of viruses to patients and health care workers, as well as the community. Recognizing the importance of injection safety, in 2000 the Vietnamese Ministry of Health (MOH) collaborated with the Vietnam Nurses Association to launch the "Safe injection" program throughout the country, including Hanoi. Methods : This cross-sectional study, combining quantitative and qualitative analysis, was conducted from February to August 2012 in Ha Dong General Hospital using a structured questionnaire and observation checklist. The target population of the study was 109 nurses working in clinical departments and 436 injections were observed. Results : The percentage of nurses who are familiar with injection safety standards was found to be 82.6%. The proportion of practical injections that met the 23 standards of injection safety set by the MOH amounted to 22.2%. The factors related to safe injection practice of nurses who were younger age group (OR=3.1; p<0.05) and fewer number of years working as a nurse (OR=2.8; p<0.05). Conclusions : While nurses have high level of knowledge about safe injections but a small proportion actually practiced. Experience may not always guarantee safe practices.  Injection safety training should be regularly imparted upon all categories of nurses.

Combined Case of Blood-Injury-Injection Phobia and Social Phobia: Behavior Therapy Management and Effectiveness through Tilt Test

PubMed Central

Ferenidou, Fotini; Chalimourdas, Theodoros; Antonakis, Velissarios; Vaidakis, Nikolaos; Papadimitriou, Georgios

2012-01-01

The efficacy of behavior therapy based mainly on real-life exposure situations as well as applied tension was examined for a combined case of blood-injury-injection (BII) phobia and social anxiety disorder. Treatment involved 28 behavior therapy sessions, while applied tension technique was also described and practiced. The specific contribution of social skills techniques, fantasy, and real-life situations exposure was examined in a single case design. The subject was a 39-year-old male with anxiety symptoms when confronting an audience, as well as symptoms of the autonomic nervous system (bradycardia and syncope), which were better explained by BII. All self-report measures regarding fear, social phobia, and anxiety were reduced after behavior therapy and remained maintained at followup, while BII decreased further after applied tension techniques. The contribution of behavior therapy to the overall outcome of the case is considered significant for many reasons that are discussed in the pape. PMID:23304602

Safe Injection Practices in Primary Health Care Settings of Naxalbari Block, Darjeeling District, West Bengal.

PubMed

Chaudhuri, Sudip Banik; Ray, Kuntala

2016-01-01

Unsafe injection can transmit many diseases to patients, injection providers and healthy people of community. To find out critical steps whether executed according to recommended best practice methods, availability of equipments in health facilities for safe injection practices and some important steps of waste disposal methods. This facility-based cross-sectional observational study was conducted among 30 Auxiliary nurse midwives (ANM) & 27 nursing staffs (NS) to assess certain aspects of their practice while administrating injection and disposal of the disposables. Health facilities were also observed to asses necessary equipments of safe injection and waste disposal methods. Among the health workers 93.3% ANM and 100% NS took sterile syringe from sterile unopened packet, all of the study subjects washed hand before giving injection, 13.3% of ANMs and 8% of NS are fully vaccinated against Hep B, 53.3% of ANM and all NS are practices non recapping. Only 13.33% sub centres along with PHC & BPHC had at least one puncture resistant leak proof container, 86.7% sub centres, PHC are free from loose needles. Transport for off side treatment is the method of waste disposal in case of 73.3% cases sub centres, PHC & BPHC. There is need to educate, train and motivate service providers in proper methods of giving injection along with improve the adequacy of supply of required equipments.

Injection safety practices in a main referral hospital in Northeastern Nigeria.

PubMed

Gadzama, G B; Bawa, S B; Ajinoma, Z; Saidu, M M; Umar, A S

2014-01-01

No adherence of safe injection policies remains a major challenge, and, worldwide, annually, it leads to 21 million new hepatitis B cases and 260,000 HIV infection cases. This descriptive observational survey was conducted to determine the level of adherence to universal precaution for safe injection practices in the hospital. The study units were selected using a simple random sampling of injection services provider/phlebotomist in 27 units/wards of the hospital. The study instruments were observation checklist and interviewer administered questionnaires. EPI info (version 3.5.2) software was used for data entry and generation of descriptive statistics was done with units of analysis (units/wards) on injection safety practices of health workers, availability of logistics and supplies, and disposal methods. Only 33.3% of the units (95% CI, 16-54) had non-sharps infectious healthcare waste of any type inside containers specific for non-sharps infectious waste and 17 (77.3%) of the observed therapeutic injections were prepared on a clean, dedicated table or tray, where contamination of the equipment with blood, body fluids, or dirty swabs was unlikely. Absence of recapping of needles was observed in 11 (50.0%) units giving therapeutic injections. Only 7.4% of units surveyed had separate waste containers for infectious non-sharps. This study depicts poor knowledge and a practice of injection safety, inadequate injection safety supplies, and non-compliance to injection safety policy and guidelines.

Assessment of injection safety in Ha Dong General Hospital, Hanoi, in 2012

PubMed Central

Van Tuong, Phan; Phuong, Tran Thi Minh; Anh, Bui Thi My; Nguyen, Trang Huyen Thi

2017-01-01

Background: Injection is one of the most frequently used medical methods to introduce drugs or other substances into the body for purposes of treatment or prevention. Unsafe injection can cause adverse outcomes, such as abscess and anaphylactic shock, and increases the risk of blood-borne transmission of viruses to patients and health care workers, as well as the community. Recognizing the importance of injection safety, in 2000 the Vietnamese Ministry of Health (MOH) collaborated with the Vietnam Nurses Association to launch the “Safe injection” program throughout the country, including Hanoi. Methods: This cross-sectional study, combining quantitative and qualitative analysis, was conducted from February to August 2012 in Ha Dong General Hospital using a structured questionnaire and observation checklist. The target population of the study was 109 nurses working in clinical departments and 436 injections were observed. Results: The percentage of nurses who are familiar with injection safety standards was found to be 82.6%. The proportion of practical injections that met the 23 standards of injection safety set by the MOH amounted to 22.2%. The factors related to safe injection practice of nurses who were younger age group (OR=3.1; p<0.05) and fewer number of years working as a nurse (OR=2.8; p<0.05). Conclusions: While nurses have high level of knowledge about safe injections but a small proportion actually practiced. Experience may not always guarantee safe practices.  Injection safety training should be regularly imparted upon all categories of nurses. PMID:29188014

“People Knew They Could Come Here to Get Help”: An Ethnographic Study of Assisted Injection Practices at a Peer-Run ‘Unsanctioned’ Supervised Drug Consumption Room in a Canadian Setting

PubMed Central

McNeil, Ryan; Small, Will; Lampkin, Hugh; Shannon, Kate; Kerr, Thomas

2013-01-01

People who require help injecting are disproportionately vulnerable to drug-related harm, including HIV transmission. North America’s only sanctioned SIF operates in Vancouver, Canada under an exemption to federal drug laws, which imposes operating regulations prohibiting assisted injections. In response, the Vancouver Area Network of Drug Users (VANDU) launched a peer-run unsanctioned SIF in which trained peer volunteers provide assisted injections to increase the coverage of supervised injection services and minimize drug-related harm. We undertook qualitative interviews (n=23) and ethnographic observation (50 hours) to explore how this facility shaped assisted injection practices. Findings indicated that VANDU reshaped the social, structural, and spatial contexts of assisted injection practices in a manner that minimized HIV and other health risks, while allowing people who require help injecting to escape drug scene violence. Findings underscore the need for changes to regulatory frameworks governing SIFs to ensure that they accommodate people who require help injecting. PMID:23797831

Partner Relationships and Injection Sharing Practices among Rural Appalachian Women.

PubMed

Staton, Michele; Strickland, Justin C; Tillson, Martha; Leukefeld, Carl; Webster, J Matthew; Oser, Carrie B

The role of relationships in initiating and maintaining women's risk behaviors has been established. However, understanding factors that may underlie partner relationships and women's risky drug use, particularly in rural contexts, is limited. This study is the first to examine the association between injecting partners and women's risky injection practices as a function of relationship power perception. Female participants were recruited from three rural jails in the Appalachian region. Women were selected randomly, provided informed consent, and screened for study eligibility criteria. This cross-sectional analysis focuses on women who inject drugs during the year before entering jail (n = 199). Approximately three-quarters (76%) reported having a recent main male sexual partner with a history of injection drug use. Although having a risky partner independently increased the likelihood of women reporting shared injection practices, perceptions of relationship power significantly moderated the effect on shared needle (adjusted odds ratio, 0.02; 95% CI, 0.003-0.23; p = .001) and shared works (adjusted odds ratio, 0.17; 95% CI, 0.03-0.95; p = .04) use. This interaction indicated that, for women who inject drugs with a recent injecting male partner, greater perception of relationship power was associated with a decreased likelihood of shared injection practices. Implications for clinical assessment and intervention are discussed. Copyright © 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Injecting buprenorphine-naloxone film: Findings from an explorative qualitative study.

PubMed

White, Nancy; Flaherty, Ian; Higgs, Peter; Larance, Briony; Nielsen, Suzanne; Degenhardt, Louisa; Ali, Robert; Lintzeris, Nicholas

2015-11-01

Experiences of buprenorphine-naloxone (BNX) sublingual film injection are not well documented or understood. We examined how people who inject BNX film seek and share information about this practice, document the methods used to prepare BNX film for injection, and report participants' experiences of this practice. Interviews were (n = 16) conducted with people who indicated that they had injected BNX film since its introduction onto the Australian market. Semistructured interviews were recorded and transcribed. NVivo10 program (QSR International) was used to analyse the data using qualitative description methodology. Participants largely reported similar BNX film preparation techniques, although the texture of BNX film during preparation to inject was reported to be unusual (gluggy), and there were many varied accounts associated with the amount of water used. Physical harms reported as associated with injecting BNX film were described (including local and systemic issues); participants reported injecting the film to enhance its immediate effects, yet generally reported that sublingual administration provided longer-lasting effects. Understanding knowledge acquisition about injecting new formulations of opioid substitution therapy is crucial in developing more effective harm-reduction strategies. Dissemination by peer networks to those who are currently or planning to inject BNX film regarding the 'gelatine like' texture when mixing, using only cold water and double filtering is important to ensure safer injecting practices. Findings from this study highlight the importance of peer networks for the dissemination of harm-reduction information. Introduction of new formulations internationally requires more qualitative studies to inform safer practices. © 2015 Australasian Professional Society on Alcohol and other Drugs.

Iatrogenic Hepatitis C Virus Transmission and Safe Injection Practices.

PubMed

Defendorf, Charles M; Paul, Sindy; Scott, George J

2018-05-01

Hepatitis C virus (HCV) infection poses significant adverse health effects. Improper use of vials, needles, syringes, intravenous bags, tubing, and connectors for injections and infusions is a current preventable cause of iatrogenic HCV transmission. Numerous cases have demonstrated the need for continued vigilance and the widespread nature of this iatrogenic infection risk across a variety of medical practice settings in the United States. Failure to implement the evidence-based Centers for Disease Control and Prevention (CDC) infection prevention guidelines exposes patients to preventable harm. The guidelines establish the requirement to notify patients in cases of suspected virus transmission, as well as to screen those patients who would not otherwise have been at risk for HCV seroconversion and other bloodborne pathogens. Legal and regulatory ramifications, including state, criminal, and tort laws, hold physicians and other health care professionals accountable to use safe injection practices. This article reviews the major health risks of HCV infection, significant effects of iatrogenic infection transmission, CDC guidelines for safe injection practices, and legal regulations and ramifications designed to promote safe injection practices.

Are nursing students safe when choosing gluteal intramuscular injection locations?

PubMed

Cornwall, J

2011-01-01

Nurses are required to perform gluteal intramuscular (IM) injections in practice. There are dangers associated with erroneous performance of this task, particularly with dorsogluteal injections. Knowledge regarding safe injection practice is therefore vital for nursing students. Fifty-eight second year students at a New Zealand Nursing School were given schematic drawings of the posterior and lateral aspects of the gluteal region. They were asked to mark and justify the safest location for gluteal IM injections. Fifty-seven students marked the dorsal schematic and one the lateral, with 38 (66.7%) marking in the upper outer quadrant (UOQ). Twenty indicating the UOQ (52.6%) wrote 'sciatic' or 'nerve' in justifying their location. Nineteen (33.3%) marked a location outside the UOQ; nine (47.4%) of these mentioned 'sciatic' or 'nerve' as reasons for injection safety. Overall, 50% of students mentioned 'sciatic' or 'nerve' in justifying the safety of their chosen injection location. Results suggest some second year nursing students do not understand safe gluteal IM injection locations and rationale. Current teaching practices and IM injection techniques could be revisited to prepare students more effectively; this may help prevent pathologies arising from this procedure.

Low knowledge and perceived Hepatitis C risk despite high risk behaviour among injection drug users in Kathmandu, Nepal.

PubMed

Loewinger, Gabriel; Sharma, Bishnu; Karki, Deepak Kumar; Khatiwoda, Prasana; Kainee, Sher; Poudel, Krishna C

2016-07-01

In Nepal, prevalence of Hepatitis C (HCV) among injecting drug users (IDUs) has been measured at 50% and knowledge of the virus is low. Rehabilitation and harm reduction attendees constitute populations to whom health care providers can deliver services. As such, characterizing their drug use and risk profiles is important for developing targeted service delivery. We measured drug use and risk patterns of IDUs participating in residential rehabilitation as well as those contacted through needle exchanges to identify correlates of drug use frequency, risky injection practices as well as HCV testing, knowledge and perceived risk. We collected cross-sectional data from one-on-one structured interviews of IDUs contacted through needle-exchange outreach workers (n=202) and those attending rehabilitation centres (behaviour immediately prior to joining rehabilitation) (n=167). Roughly half of participants reported injecting at least 30 times in the past 30 days and individuals with previous residential rehabilitation experience reported frequent injection far more than those without it. About one in fourteen respondents reported past week risky injection practices. Participants were over three times as likely to report risky injection if they consumed alcohol daily (17.2%) than if they did not (5.0%) (p=0.002). Those who reported injecting daily reported risky injection practices (11.9%) significantly more than non-daily injectors (1.8%) (p<0.001). Respondents reported high HCV infection rates, low perceived risk, testing history and knowledge. HCV knowledge was not associated with differences in risky injecting. Treatment centres should highlight the link between heavy drinking, frequent injection and risky injecting practices. The link between rehabilitation attendance and frequent injection may suggest IDUs with more severe use patterns are more likely to attend rehabilitation. Rehabilitation centres and needle exchanges should provide testing and education for HCV. Education alone may not be sufficient to initiate change since knowledge did not predict lower risk. Copyright © 2016 Elsevier B.V. All rights reserved.

Needle and Syringe Cleaning Practices among Injection Drug Users.

ERIC Educational Resources Information Center

Fisher, Dennis G.; Harbke, Colin R.; Canty, John R.; Reynolds, Grace L.

2002-01-01

Evaluates the effect of needle exchange on the bleach-mediated disinfection (BMD) practices of 176 needle and syringe sharing injection drug users (IDUs). Results reveal that IDUs who traded sex for money or drugs were less likely to practice BMD, and IDUs who reported a reduced number of sex partners were more likely to practice BMD. (Contains 36…

APIC position paper: Safe injection, infusion, and medication vial practices in health care.

PubMed

Dolan, Susan A; Arias, Kathleen Meehan; Felizardo, Gwen; Barnes, Sue; Kraska, Susan; Patrick, Marcia; Bumsted, Amelia

2016-07-01

The transmission of bloodborne viruses and other microbial pathogens to patients during routine health care procedures continues to occur because of the use of improper injection, infusion, medication vial, and point-of-care testing practices by health care personnel. These unsafe practices occur in various clinical settings and result in unacceptable and devastating events for patients. This document updates the Association for Professionals in Infection Control and Epidemiology 2010 position paper on safe injection, infusion, and medication vial practices in health care. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

The adsorption of 99Tcm dimercaptosuccinic acid onto injection vials.

PubMed

Millar, A M

1984-04-01

It is common practice to dispense radiopharmaceuticals into empty sterile vials for dispatch to the departments where they are to be administered. It has been noted that on withdrawal of technetium-99m dimercaptosuccinic acid injections (99Tcm-DMSA) which have been dispensed into such vials, the activities obtained are lower than expected. To explain this phenomenon, the adsorption of 99Tcm-DMSA onto commercially available, empty, sterile vials has been investigated. The 99Tcm-DMSA solutions were prepared using kits from two manufacturers and were tested in vials from two manufacturers and the original kit vials. Adsorption of 99Tcm in one DMSA/vial combination after storage for 4 h was 49.6% (+/- 4.5% S.E.M.), but typically, adsorption was approximately 12% after 4 h. Although rate of adsorption was found to vary with storage conditions, no conditions satisfactorily overcame the effect. In vials from one manufacturer, the 99Tcm adsorption was predominantly on the glass, while in vials from the other, it was predominantly on the rubber stopper. It is concluded that the compatibility between vials and radiopharmaceuticals must be investigated in the hospital radiopharmacy.

Injection practice in Kaski district, Western Nepal: a community perspective.

PubMed

Gyawali, Sudesh; Rathore, Devendra Singh; Shankar, Pathiyil Ravi; Kumar, Vikash K C; Maskey, Manisha; Jha, Nisha

2015-04-29

Previous studies have shown that unsafe injection practice is a major public health problem in Nepal but did not quantify the problem. The present community-based study was planned to: 1) quantify injection usage, 2) identify injection providers, 3) explore differences, if any, in injection usage and injection providers, and 4) study and compare people's knowledge and perception about injections between the urban and rural areas of Kaski district. A descriptive, cross-sectional mixed-methods study was conducted from July to November 2012, using a questionnaire based survey and focus group discussions (FGDs). A semi-structured questionnaire advocated by the World Health Organization was modified and administered to household heads and injection receivers in selected households and the FGDs were conducted using a topic guide. The district was divided into urban and rural areas and 300 households from each area were selected. Twenty FGDs were held. In 218 households (36.33%) [99 in urban and 119 in rural] one or more members received at least one injection. During the three month recall period, 258 subjects (10.44%) reported receiving injection(s) with a median of two injections. The average number of injections per person per year was calculated to be 2.37. Health care workers (34.8%), staff of medical dispensaries (37.7%), physicians (25.2%), and traditional healers (2.3%) were consulted by the respondents for their basic health care needs and for injections. Compared to urban respondents, more rural respondents preferred injections for fever (p < 0.001). People preferred injections due to injections being perceived by them as being powerful, fast-acting, and longer lasting than oral pills. More than 82% of respondents were aware of, and named, at least one disease transmitted by using unsterile syringes during injection administration or when syringes are shared between people. Less preference for injections and high awareness about the association between injections and injection-borne infections among the general population is encouraging for safe injection practice. However, respondents were not aware of the importance of having qualified injection providers for safe injections and were receiving injections from unqualified personnel.

Injection practices in Nepal: health policymakers’ perceptions

PubMed Central

2014-01-01

Background The unnecessary and unsafe use of injections is common in developing countries like Nepal. Policymakers have an important role in promoting rational and safe injection use. Hence, the present study was carried out to explore the perception of health policymakers regarding safe injection practice in Nepal. Methods An exploratory qualitative study design was used in this study. Key policymakers from both the central and regional level were selected using purposive sampling. A semi-structured questionnaire advocated by the World Health Organization (WHO) was used after modifying the context. Interviews were conducted to clarify doubts and obtain additional information. The data was analyzed manually using deductive content analysis technique. Results In total, eleven policymakers participated. All unanimously agreed that injection safety is a problem and seven participants reported that injections are overused. They shared the opinion that injections are administered by various providers, including formal and informal health providers, and also quacks. Almost half the respondents reported that the National Drug Policy discourages injection overuse, while others reported that the policy contains no provisions regarding injection overuse. Most policymakers stated that only single-use disposable injection equipment is used to provide injection, while others thought that sterilizable glass syringe is also used. More than half of the participants believed that the quality of injection equipment available in the Nepalese market is not regulated by any government institution. Almost two-third of the policymakers stated that syringes and needles are not reused, while the rest thought syringes might be reused without sterilization in some parts of the country. Almost half of the respondents stated that illegal commercialization of used syringes exists in Nepal. Almost all respondents thought that health care institutions have a waste management plan, while more than half of them opined that such plans are limited to tertiary care hospitals located in the capital. Conclusions The result of this study revealed a divergence of views among policymakers, even among those in the same ministry. Though there has been some effort from the government to increase the safety of injection practices, greater efforts are required, especially with regard to standardization of policies and procedures related to injection practice. PMID:24957575

Injection practices in Nepal: health policymakers' perceptions.

PubMed

Gyawali, Sudesh; Rathore, Devendra Singh; Shankar, Pathiyil Ravi; Maskey, Manisha; Vikash, Kumar K C

2014-06-24

The unnecessary and unsafe use of injections is common in developing countries like Nepal. Policymakers have an important role in promoting rational and safe injection use. Hence, the present study was carried out to explore the perception of health policymakers regarding safe injection practice in Nepal. An exploratory qualitative study design was used in this study. Key policymakers from both the central and regional level were selected using purposive sampling. A semi-structured questionnaire advocated by the World Health Organization (WHO) was used after modifying the context. Interviews were conducted to clarify doubts and obtain additional information. The data was analyzed manually using deductive content analysis technique. In total, eleven policymakers participated. All unanimously agreed that injection safety is a problem and seven participants reported that injections are overused. They shared the opinion that injections are administered by various providers, including formal and informal health providers, and also quacks. Almost half the respondents reported that the National Drug Policy discourages injection overuse, while others reported that the policy contains no provisions regarding injection overuse. Most policymakers stated that only single-use disposable injection equipment is used to provide injection, while others thought that sterilizable glass syringe is also used. More than half of the participants believed that the quality of injection equipment available in the Nepalese market is not regulated by any government institution. Almost two-third of the policymakers stated that syringes and needles are not reused, while the rest thought syringes might be reused without sterilization in some parts of the country. Almost half of the respondents stated that illegal commercialization of used syringes exists in Nepal. Almost all respondents thought that health care institutions have a waste management plan, while more than half of them opined that such plans are limited to tertiary care hospitals located in the capital. The result of this study revealed a divergence of views among policymakers, even among those in the same ministry. Though there has been some effort from the government to increase the safety of injection practices, greater efforts are required, especially with regard to standardization of policies and procedures related to injection practice.

A comprehensive situation assessment of injection practices in primary health care hospitals in Bangladesh

PubMed Central

2011-01-01

Background Understanding injection practices is crucial for evidence-based development of intervention initiatives. This study explored the extent of injection use and injection safety practices in primary care hospitals in Bangladesh. Methods The study employed both quantitative and qualitative research methods. The methods used were - a retrospective audit of prescriptions (n = 4320), focus group discussions (six with 43 participants), in-depth interviews (n = 38) with a range service providers, and systematic observation of the activities of injection providers (n = 120), waste handlers (n = 48) and hospital facilities (n = 24). Quantitative and qualitative data were assessed with statistical and thematic analysis, respectively, and then combined. Results As many as 78% of our study sample (n = 4230) received an injection. The most commonly prescribed injections (n = 3354) including antibiotics (78.3%), IV fluids (38.6%), analgesics/pain killers (29.4%), vitamins (26.7%), and anti-histamines (18.5%). Further, 43.7% (n = 1145) of the prescribed antibiotics (n = 2626) were given to treat diarrhea and 42.3% (n = 600) of IV fluids (n = 1295) were used to manage general weakness conditions. Nearly one-third (29.8%; n = 36/120) of injection providers reported needle-stick injuries in the last 6 months with highest incidences in Rajshahi division followed by Dhaka division. Disposal of injection needles, syringes and other materials was not done properly in 83.5% (n = 20/24) of the facilities. Health providers' safety concerns were not addressed properly; only 23% (n = 28/120) of the health providers and 4.2% (n = 2/48) of the waste handlers were fully immunized against Hepatitis B virus. Moreover, 73% (n = 87/120) of the injection providers and 90% (n = 43/48) of the waste handlers were not trained in injection safety practices and infection prevention. Qualitative data further confirmed that both providers and patients preferred injections, believing that they provide quick relief. The doctors' perceived injection use as their prescribing norm that enabled them to prove their professional credibility and to remain popular in a competitive health care market. Additionally, persistent pressure from hospital administration to use up injections before their expiry dates also influenced doctors to prescribe injections regardless of actual indications. Conclusions As far as the patients and providers' safety is concerned, this study demonstrated a need for further research exploring the dynamics of injection use and safety in Bangladesh. In a context where a high level of injection use and unsafe practices were reported, immediate prevention initiatives need to be operated through continued intervention efforts and health providers' training in primary care hospitals in Bangladesh. PMID:21985397

Substorm injection boundaries. [magnetospheric electric field model

NASA Technical Reports Server (NTRS)

Mcilwain, C. E.

1974-01-01

An improved magnetospheric electric field model is used to compute the initial locations of particles injected by several substorms. Trajectories are traced from the time of their encounter with the ATS-5 satellite backwards to the onset time given by ground-based magnetometers. A spiral shaped inner boundary of injection is found which is quite similar to that found by a statistical analysis. This injection boundary is shown to move in an energy dependent fashion which can explain the soft energy spectra observed at the inner edge of the electrons plasma sheet.

Crack Cocaine Injection Practices and HIV Risk: Findings From New York and Bridgeport

PubMed Central

Lankenau, Stephen E.; Clatts, Michael C.; Goldsamt, Lloyd A.; Welle, Dorinda L.

2007-01-01

This article examines the behavioral practices and health risks associated with preparing crack cocaine for injection. Using an ethno-epidemiological approach, injection drug users (n=38) were recruited between 1999 and 2000 from public settings in New York City and Bridgeport, Connecticut and responded to a semistructured interview focusing on crack injection initiation and their most recent crack injection. Study findings indicate that methods of preparing crack for injection were impacted by a transforming agent, heat applied to the “cooker,” heroin use, age of the injector, and geographic location of the injector. The findings suggest that crack injectors use a variety of methods to prepare crack, which may carry different risks for the transmission of bloodborne pathogens. In particular, crack injection may be an important factor in the current HIV epidemic. PMID:18079990

Effect of neonatal injection of sodium glutamate and diethylnitrosamine on hepatocarcinogenesis, reproductive and adrenocortical systems of male mice.

PubMed

Kuznetsova, E G; Amstislavskaya, T G; Bulygina, V V; Il'nitskaya, S I

2005-06-01

Neonatal injection of sodium glutamate before injection of diethylnitrosamine decreased the number of tumor nodes in the liver of male mice, decreased the weight of the testes and adrenals and blood level of testosterone (but increased blood level of corticosterone), impaired recovery of diethylnitrosamine-disturbed sexual motivation in half of males. Anticarcinogenic effect of sodium glutamate is explained by feminization of males under its effect.

Rethinking risk: Gender and injection drug-related HIV risk among female sex workers and their non-commercial partners along the Mexico-U.S. border

PubMed Central

Syvertsen, Jennifer L.; Robertson, Angela M.; Strathdee, Steffanie A; Martinez, Gustavo; Rangel, M. Gudelia; Wagner, Karla D

2014-01-01

Background Studies of injection drug-using couples suggest a gendered performance of risk in which men exert greater control over drug use and render their female partners vulnerable to HIV infection and other negative health outcomes. This study assesses gender roles in injection drug use as practiced among female sex workers and their intimate male partners within a risk environment marked by rapid socioeconomic changes. Methods We draw on quantitative surveys, semi-structured interviews, and ethnographic fieldwork conducted as part of cohort study of HIV/STI risk among female sex workers and their intimate, non-commercial partners along the Mexico-U.S. border. This study employed descriptive statistics and inductive analyses of transcripts and field notes to examine practices related to drug procurement, syringe sharing, and injection assistance among couples in which both partners reported injecting drugs in the past six months. Results Among 156 couples in which both partners injected drugs (n=312), our analyses revealed that women’s roles in drug use were active and multidimensional, and both partners’ injection risk practices represented embodied forms of cooperation and compassion. Women often earned money to purchase drugs and procured drugs to protect their partners from the police. Sharing drugs and syringes and seeking injection assistance were common among couples due to drug market characteristics (e.g., the use of “black tar” heroin that clogs syringes and damages veins). Both women and men provided and received injection assistance, which was typically framed as caring for the partner in need of help. Conclusion Our mixed methods study suggests that in certain risk environments, women are more active participants in injection-related practices than has often been revealed. This participation is shaped by dynamic relationship and structural factors. Our suggestion to consider gendered injection risk as a nuanced and relational process has direct implications for future research and interventions. PMID:24641906

Rethinking risk: gender and injection drug-related HIV risk among female sex workers and their non-commercial partners along the Mexico-U.S. border.

PubMed

Syvertsen, Jennifer L; Robertson, Angela M; Strathdee, Steffanie A; Martinez, Gustavo; Rangel, M Gudelia; Wagner, Karla D

2014-09-01

Studies of injection drug-using couples suggest a gendered performance of risk in which men exert greater control over drug use and render their female partners vulnerable to HIV infection and other negative health outcomes. This study assesses gender roles in injection drug use as practiced among female sex workers and their intimate male partners within a risk environment marked by rapid socioeconomic changes. We draw on quantitative surveys, semi-structured interviews, and ethnographic fieldwork conducted as part of cohort study of HIV/STI risk among female sex workers and their intimate, non-commercial partners along the Mexico-U.S. border. This study employed descriptive statistics and inductive analyses of transcripts and field notes to examine practices related to drug procurement, syringe sharing, and injection assistance among couples in which both partners reported injecting drugs in the past 6 months. Among 156 couples in which both partners injected drugs (n=312), our analyses revealed that women's roles in drug use were active and multidimensional, and both partners' injection risk practices represented embodied forms of cooperation and compassion. Women often earned money to purchase drugs and procured drugs to protect their partners from the police. Sharing drugs and syringes and seeking injection assistance were common among couples due to drug market characteristics (e.g., the use of "black tar" heroin that clogs syringes and damages veins). Both women and men provided and received injection assistance, which was typically framed as caring for the partner in need of help. Our mixed methods study suggests that in certain risk environments, women are more active participants in injection-related practices than has often been revealed. This participation is shaped by dynamic relationship and structural factors. Our suggestion to consider gendered injection risk as a nuanced and relational process has direct implications for future research and interventions. Copyright © 2014 Elsevier B.V. All rights reserved.

Progress on Botulinum Toxin Type A-Induced Pain Relief in the Field of Plastics.

PubMed

Lu, Xiaona; Chen, Guocheng; Ren, Pengjie; Yang, Yan; Fan, Fei

2017-11-01

To retrospectively evaluate the effectiveness of Botulinum Toxin Type A (BTX-A) injections relieve pain in the field of plastic surgery and postoperative rehabilitation, and discuss the analgesic mechanism of BTX- A in plastics and related research progress. From appearance to September 1, 2016, PUBMED, EMBASE, and Web of Science were searched, using the key words related to "Botulinum Toxin Type A" and "Pain." Furtherly, nonplastic surgery-related literature was excluded by manual screening. Eleven literatures met the inclusion criteria, including 6 prospective controlled cohorts, 4 patient series, and 1 retrospective cohort. These studies involved Lower Limb, Breast, Hallux, Amputees, and Temporomandibular joint disk disfigurement and enrolled 402 patients. Among the patients, 360 received intraoperative BTX-A injection at the time of the main surgical procedure, 16 injected postoperatively and 26 did not undergo surgery. And 85.32% reported pain alleviation and 69.96% got favorable side effects and no one occurred major adverse effects. But 1.83% accepted injections more than once. Mechanism analysis explained these studies' results and demonstrated the analgesic effectiveness of BTX-A in plastics with nociceptive pain, inflammatory pain, and neuropathic pain. The results suggest that BTX-A may induce postoperative pain associated with plastic surgeries relief. But the available data of outcome assessment involved in this review are inconsistent and failed to meet methodological rigor. And pain alleviations are influenced by many factors. So further randomized controlled clinical trials with large sample sizes are needed to support this practice, determine standard usage methods, and establish corresponding specification systems.

Drug preparation, injection, and sharing practices in Tajikistan: a qualitative study in Kulob and Khorog.

PubMed

Otiashvili, David; Latypov, Alisher; Kirtadze, Irma; Ibragimov, Umedjon; Zule, William

2016-06-02

Sharing injection equipment remains an important rout of transmission of HIV and HCV infections in the region of Eastern Europe and Central Asia. Tajikistan is one of the most affected countries with high rates of injection drug use and related epidemics.The aim of this qualitative study was to describe drug use practices and related behaviors in two Tajik cities - Kulob and Khorog. Twelve focus group discussions (6 per city) with 100 people who inject drugs recruited through needle and syringe program (NSP) outreach in May 2014. Topics covered included specific drugs injected, drug prices and purity, access to sterile equipment, safe injection practices and types of syringes and needles used. Qualitative thematic analysis was performed using NVivo 10 software. All participants were male and ranged in age from 20 to 78 years. Thematic analysis showed that cheap Afghan heroin, often adulterated by dealers with other admixtures, was the only drug injected. Drug injectors often added Dimedrol (Diphenhydramine) to increase the potency of "low quality" heroin. NSPs were a major source of sterile equipment. Very few participants report direct sharing of needles and syringes. Conversely, many participants reported preparing drugs jointly and sharing injection paraphernalia. Using drugs in an outdoor setting and experiencing withdrawal were major contributors to sharing equipment, using non-sterile water, not boiling and not filtering the drug solution. Qualitative research can provide insights into risk behaviors that may be missed in quantitative studies. These finding have important implications for planning risk reduction interventions in Tajikistan. Prevention should specifically focus on indirect sharing practices.

Safe injection practice among health-care workers in Gharbiya Governorate, Egypt.

PubMed

Ismail, N A; Aboul Ftouh, A M; El-Shoubary, W H; Mahaba, H

2007-01-01

We assessed safe injection practices among 1100 health-care workers in 25 health-care facilities in Gharbiya Governorate. Questionnaires were used to collect information and 278 injections were observed using a standardized checklist. There was a lack of infection control policies in all the facilities and a lack of many supplies needed for safe injection. Proper needle manipulation before disposal was observed in only 41% of injections, safe needle disposal in 47.5% and safe syringe disposal in 0%. Reuse of used syringes and needles was reported by 13.2% of the health-care workers and 66.2% had experienced a needle-stick injury. Only 11.3% had received a full course of hepatitis B vaccination.

The push for increased coal injection rates -- Blast furnace experience at AK Steel Corporation

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

Dibert, W.A.; Duncan, J.H.; Keaton, D.E.

1994-12-31

An effort has been undertaken to increase the coal injection rate on Amanda blast furnace at AK Steel Corporation`s Ashland Works in Ashland, Kentucky to decrease fuel costs and reduce coke demand. Operating practices have been implemented to achieve a sustained coal injection rate of 140 kg/MT, increased from 100--110 kg/MT. In order to operate successfully at the 140 kg/MT injection rate; changes were implemented to the furnace charging practice, coal rate control methodology, orientation of the injection point, and the manner of distribution of coal to the multiple injection points. Additionally, changes were implemented in the coal processing facilitymore » to accommodate the higher demand of pulverized coal; grinding 29 tonnes per hour, increased from 25 tonnes per hour. Further increases in injection rate will require a supplemental supply of fuel.« less

Impact de l'utilisation des strategies d'injection multiple et de biodiesel sur un moteur diesel a rampe commune d'injection

NASA Astrophysics Data System (ADS)

Plamondon, Etienne

Using biodiesel/diesel fuel blends and multiple injection strategies in diesel engines have shown promising results in improving the trade-off relationship between nitrous oxides and particulate matters, but their effects are still not completely understood. In this context, this thesis focuses on the characterization of the multiple injection strategies and biodiesel impacts on pollutant emissions, performances and injection system behavior. To reach this goal, an experimental campaign on a diesel engine was performed and a model simulating the injection process was developed. The engine tests at low load with pilot injection allowed the reduction of NOx emissions up to 27% and those of PM up to 22.3% compared to single injection, provided that a precise tuning of the injection parameters was previously realized. This simultaneous reduction is explained by the reduction of the premixed combustion phase and injected fuel quantity during principal injection when a pilot injection is used. With triple injection for the tested engine load, the post-injection did not result in PM reduction since it contributes by itself to the PM production while the preinjection occurred too soon to burn conveniently and caused perturbations in the injection system as well. Using B20 blend in single injection caused a PM increase and a NOx reduction which might be explained by the poorer fuel atomization. However, pilot injection with B20 allowed to get a simultaneous reduction of NOx and PM, as observed with diesel. An injection simulation model was also developed and experimentally validated for different injection pressures as well as different energizing times and dwell times. When comparing the use of biodiesel with diesel, simulation showed that there was a critical energizing time for which both fuels yielded the same injection duration. For shorter energizing times, the biodiesel injection duration was shorter than for diesel, while longer energizing times presented the opposite behavior. The injection duration for the different blends falls between the pure-fuel situations. The use of constant properties (density, viscosity) and constant discharge coefficient showed no major loss in the precision of the flow-rate estimation, but revealed a great gain in calculus time. The use of pressure dependent bulk modulus and fluctuating injection pressure proved to be essential in order to have no drastic changes in the final predictions. Finally, the proposed model relevance in a case of engine testing was demonstrated with multiple injection strategies as well as with biodiesel since it allows a precise adjustment of the injection parameters while considering the dynamic effects caused by the injection. Keywords : Diesel engine, multiple injection, biodiesel, pollutant emission, heat release, mathematical model, injection simulation.

Injecting drug users' experiences of policing practices in two Mexican-U.S. border cities: public health perspectives.

PubMed

Miller, Cari L; Firestone, Michelle; Ramos, Rebeca; Burris, Scott; Ramos, Maria Elena; Case, Patricia; Brouwer, Kimberly C; Fraga, Miguel Angel; Strathdee, Steffanie A

2008-08-01

Previous research has identified the impact of law enforcement practices on the behaviours and health of injection drug users (IDUs). We undertook a qualitative study of IDUs' experiences of policing practices in two Mexican cities on the U.S. border. In 2004, two teams of Mexican interviewers conducted in-depth interviews with IDUs residing in Tijuana and Ciudad Juarez (Cd. Juarez), Mexico, who had injected drugs at least once in the prior month. Topics included types of drug used, injection settings, access to sterile needles and experiences with police. Field notes and transcribed interviews were analysed to identify emergent themes. Amongst the 43 participants, most reported that it is common for IDUs to be arrested and detained for 36h for carrying sterile or used syringes. Most reported that they or someone they knew had been beaten by police. Interviews suggested five key themes relating to police influence on the risk environment: (1) impact of policing practices on accessibility of sterile syringes, (2) influence of police on choice of places to inject drugs (e.g., shooting galleries), (3) police violence, (4) police corruption and (5) perceived changes in policing practices. Findings suggest that some behaviour of police officers in Tijuana and Cd. Juarez is inconsistent with legal norms and may be negatively influencing the risk of acquiring blood-borne infections amongst IDUs. Implementing a comprehensive and successful HIV prevention programme amongst IDUs requires interventions to influence the knowledge, attitudes and practices of law enforcement officers.

Administering Multiple Injectable Vaccines During a Single Visit-Summary of Findings From the Accelerated Introduction of Inactivated Polio Vaccine Globally.

PubMed

Dolan, Samantha B; Patel, Manish; Hampton, Lee M; Burnett, Eleanor; Ehlman, Daniel C; Garon, Julie; Cloessner, Emily; Chmielewski, Elizabeth; Hyde, Terri B; Mantel, Carsten; Wallace, Aaron S

2017-07-01

In 2013, the World Health Organization's (WHO's) Strategic Advisory Group of Experts (SAGE) recommended that all 126 countries using only oral polio vaccine (OPV) introduce at least 1 dose of inactivated polio vaccine (IPV) into their routine immunization schedules by the end of 2015. In many countries, the addition of IPV would necessitate delivery of multiple injectable vaccines (hereafter, "multiple injections") during a single visit, with infants receiving IPV alongside pentavalent vaccine (which covers diphtheria, tetanus, and whole-cell pertussis; hepatitis B; and Haemophilus influenzae type b) and pneumococcal vaccine. Unanticipated concerns emerged from countries over acceptability of multiple injections, sites of administration, and safety. We contextualized the issues surrounding multiple injections by documenting concerns associated with administration of ≥3 injections, existing evidence in the published literature, and findings of a systematic review on administration practices and techniques. Concerns associated with multiple-injection visits were documented from meetings and personal communications with immunization program managers. Published literature on the acceptability of multiple injections by providers and caregivers was summarized, and a systematic review of the literature on administration practices was completed on the following topics: spacing between injection sites (ie, vaccine spacing), site of injection, route of injection, and procedural preparedness. WHO and United Nations Children's Fund data from 2013-2015 were used to assess multiple-injection visits included in national immunization schedules. Healthcare provider and caregiver attitudes and practices indicated concerns about infant pain, potential adverse effects, and uncertainty about vaccine effectiveness with multiple-injection visits. Published literature reinforced the record of safety and acceptance of the recommended schedule of IPV by the SAGE, but the evidence was largely from developed countries. Parental acceptance of multiple injections was associated with a positive provider recommendation to the caregiver. Findings of the systematic review identified that the intramuscular route is preferred over the subcutaneous route for vaccine administration and that the vastus lateralis muscle is preferred over the deltoid muscle for intramuscular injections. Recommendations on vaccine spacing and procedural preparedness were based on practical necessities, but comparative evidence was not identified. During 2013-2015, 85 countries added IPV to their immunization schedules, 46 (55%) of which adopted a schedule resulting in 3 injectable vaccines being administered in a single visit. The multiple-injection experience identified gaps in guidance for future vaccine introductions. Global partner organizations quickly mobilized to assess, document, and communicate the existing global experience on multiple-injection visits. This evidence-based approach provided reassurance to opinion leaders, health workers, and professional societies, thus encouraging uptake of IPV as a second or third injection in an accelerated manner globally. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Treatment of Lipoma by Injection Lipolysis

PubMed Central

Nanda, Soni

2011-01-01

Injection lipolysis or lipodissolve is the practice of injecting phosphatidyl choline/ sodium deoxycholate (PDC/DC) compounds in the subcutaneous fat. Though this practice is being used extensively for nonsurgical contouring of body and dissolving localized collections of excess fat, it's use as a treatment modality for lipomas needs further evaluation. We present a case where this technique was used for treating a lipoma, with no recurrence after 9 months of follow up. Injection lipolysis as a treatment modality for lipomas needs to be evaluated for safety and efficacy in trials on larger population. This could prove to be a very valuable adjunct to the current practice of excision, if done by a trained person in a properly selected patient. Also the side effects and the controversies regarding this procedure have been discussed in detail in the present paper. PMID:21976907

Corticosteroid and platelet-rich plasma injection therapy in tennis elbow (lateral epicondylalgia): a survey of current U.K. specialist practice and a call for clinical guidelines.

PubMed

Titchener, Andrew G; Booker, Simon J; Bhamber, Nivraj S; Tambe, Amol A; Clark, David I

2015-11-01

Tennis elbow is a common condition with a variety of treatment options, but little is known about which of these options specialists choose most commonly. Corticosteroid injections in tennis elbow may reduce pain in the short-term but delay long-term recovery. We have undertaken a UK-wide survey of upper limb specialists to assess current practice. Cross-sectional electronic survey of current members of the British Elbow and Shoulder Society (BESS) and the British Society for Surgery of the Hand (BSSH). 271 of 1047 eligible members responded (25.9%); consultant surgeons constituted the largest group (232/271, 85%). 131 respondents (48%) use corticosteroid injections as their first-line treatment for tennis elbow. 206 respondents (77%) believed that corticosteroid injections are not potentially harmful in the treatment of tennis elbow, while 31 (11%) did not use them in their current practice. In light of recent evidence of the potential harmful effects of corticosteroid therapy, 136 (50%) had not changed their practice while 108 (40.1%) had reduced or discontinued their use. 43 respondents (16%) reported having used platelet-rich plasma injections. Recent high-quality evidence that corticosteroids may delay recovery in tennis elbow appears to have had a limited effect on current practice. Treatment is not uniform among specialists and a proportion of them use platelet-rich plasma injections. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

[Talc-induced pulmonary granulomas in drug addicts].

PubMed

Latartseva, L N; Kryvenko, O N

2013-01-01

Among the diseases accompanied by granuloma formation in the lung, there is so-called granulomatosis developing in injection drug users who have been long injecting suspensions of oral medications containing talc and other water insoluble fillers. 102 deaths of chronic intravenous drug users were examined; 12 of whom showed pulmonary talc-induced granulomatosis. Their morphology was studied using polarized light microscopy. The main mechanisms of thanatogenesis in lethal cases within the first hours after intravenous injection of talc-containing oral medication suspensions are explained.

Evidence-based medicine: Dupuytren contracture.

PubMed

Eaton, Charles

2014-05-01

After studying this article, the participant should be able to: (1) Describe features and clinical importance of Dupuytren diathesis. (2) Explain the difference between the new definition of recurrence used in collagenase studies compared with prior definitions of recurrence. (3) Compare and list the main advantage/main disadvantage of fasciectomy versus minimally invasive treatment (collagenase injection or needle aponeurotomy) of Dupuytren contracture. The large body of existing literature on Dupuytren disease is spread across many journals in many specialties. It is thus a daunting task for practitioners to follow trends and practice recommendations. It is also a testimony to the lack of an acceptable solution to this common problem. Recent publications provide evidence to highlight controversies and challenge some traditional teachings. Literature from 2010 to 2012 was reviewed with the intent of clarifying some of these issues.

The Curious Connection Between Insects and Dreams.

PubMed

Klein, Barrett A

2011-12-21

A majority of humans spend their waking hours surrounded by insects, so it should be no surprise that insects also appear in humans' dreams as we sleep. Dreaming about insects has a peculiar history, marked by our desire to explain a dream's significance and by the tactic of evoking emotions by injecting insects in dream-related works of art, film, music, and literature. I surveyed a scattered literature for examples of insects in dreams, first from the practices of dream interpretation, psychiatry, and scientific study, then from fictional writings and popular culture, and finally in the etymology of entomology by highlighting insects with dream-inspired Latinate names. A wealth of insects in dreams, as documented clinically and culturally, attests to the perceived relevance of dreams and to the ubiquity of insects in our lives.

Administering Multiple Injectable Vaccines During a Single Visit—Summary of Findings From the Accelerated Introduction of Inactivated Polio Vaccine Globally

PubMed Central

Patel, Manish; Hampton, Lee M.; Burnett, Eleanor; Ehlman, Daniel C.; Garon, Julie; Cloessner, Emily; Chmielewski, Elizabeth; Hyde, Terri B.; Mantel, Carsten; Wallace, Aaron S.

2017-01-01

Abstract Background. In 2013, the World Health Organization’s (WHO’s) Strategic Advisory Group of Experts (SAGE) recommended that all 126 countries using only oral polio vaccine (OPV) introduce at least 1 dose of inactivated polio vaccine (IPV) into their routine immunization schedules by the end of 2015. In many countries, the addition of IPV would necessitate delivery of multiple injectable vaccines (hereafter, “multiple injections”) during a single visit, with infants receiving IPV alongside pentavalent vaccine (which covers diphtheria, tetanus, and whole-cell pertussis; hepatitis B; and Haemophilus influenzae type b) and pneumococcal vaccine. Unanticipated concerns emerged from countries over acceptability of multiple injections, sites of administration, and safety. We contextualized the issues surrounding multiple injections by documenting concerns associated with administration of ≥3 injections, existing evidence in the published literature, and findings of a systematic review on administration practices and techniques. Methods. Concerns associated with multiple-injection visits were documented from meetings and personal communications with immunization program managers. Published literature on the acceptability of multiple injections by providers and caregivers was summarized, and a systematic review of the literature on administration practices was completed on the following topics: spacing between injection sites (ie, vaccine spacing), site of injection, route of injection, and procedural preparedness. WHO and United Nations Children’s Fund data from 2013–2015 were used to assess multiple-injection visits included in national immunization schedules. Results. Healthcare provider and caregiver attitudes and practices indicated concerns about infant pain, potential adverse effects, and uncertainty about vaccine effectiveness with multiple-injection visits. Published literature reinforced the record of safety and acceptance of the recommended schedule of IPV by the SAGE, but the evidence was largely from developed countries. Parental acceptance of multiple injections was associated with a positive provider recommendation to the caregiver. Findings of the systematic review identified that the intramuscular route is preferred over the subcutaneous route for vaccine administration and that the vastus lateralis muscle is preferred over the deltoid muscle for intramuscular injections. Recommendations on vaccine spacing and procedural preparedness were based on practical necessities, but comparative evidence was not identified. During 2013–2015, 85 countries added IPV to their immunization schedules, 46 (55%) of which adopted a schedule resulting in 3 injectable vaccines being administered in a single visit. Conclusion. The multiple-injection experience identified gaps in guidance for future vaccine introductions. Global partner organizations quickly mobilized to assess, document, and communicate the existing global experience on multiple-injection visits. This evidence-based approach provided reassurance to opinion leaders, health workers, and professional societies, thus encouraging uptake of IPV as a second or third injection in an accelerated manner globally. PMID:28838188

Safe injections and waste management among healthcare workers at a regional hospital in northern Tanzania.

PubMed

Nilsson, Josefine; Pembe, Andrea B; Urasa, Miriam; Darj, Elisabeth

2013-01-01

Unsafe injections and substandard waste management are public health issues exposing healthcare workers and the community to the risk of infections. The objective of this study was to assess the knowledge and practice of safe injections and health care waste management among healthcare workers at a regional hospital in northern Tanzania. This cross sectional descriptive study was conducted in a regional hospital in northern Tanzania. Data was collected through a self-administered questionnaire with additional observations of the incinerator, injections, waste practices, and the availability of medical supplies. Data was analysed in SPSS descriptive statistics and chi-square tests were performed. A total of 223 of 305 (73%) healthcare workers from different cadres were included in the study. The majority of healthcare workers had adequate knowledge and practice of safe injections, but inadequate knowledge about waste management. The majority of the staff reported knowledge of HIV as a risk factor, however, had less knowledge about other blood-borne infections. Guidelines and posters on post exposure prophylaxes and waste management -were present at the hospital, however, the incinerator had no fence or temperature gauge. In conclusion, healthcare workers reported good knowledge and practice of injections, and high knowledge of HIV transmission routes. However, the hospital is in need of a well functioning incinerator and healthcare workers require sufficient medical supplies. There was a need for continual training about health care waste management and avoidance of blood-borne pathogens that may be transmitted through unsafe injections or poor health care waste management.

The social context of hormone and silicone injection among Puerto Rican transwomen.

PubMed

Padilla, Mark B; Rodríguez-Madera, Sheilla; Ramos Pibernus, Alixida G; Varas-Díaz, Nelson; Neilands, Torsten B

2018-05-01

This paper draws on ethnographic, qualitative and survey data with transwomen in Puerto Rico to examine the social and political-economic context of lay injection with hormone and silicone - common practices within this community. We describe specific practices of hormone and silicone injection, the actors that govern them, the market for the sale and distribution of syringes and the networks of lay specialists who provide services to a population that is neglected by and largely excluded from biomedical settings. Our data derive from ethnographic observations, sociodemographic questionnaires, surveys and semi-structured interviews conducted with a diverse group of transwomen in metropolitan San Juan, Puerto Rico. Our analysis focuses on four overlapping social domains or processes that shape the practices of lay silicone and hormone injection among transwomen: (1) the circulation of gender transitioning technologies within local and global markets; (2) the tension between the social exclusion of transwomen and their resilient sub-cultural responses; (3) the cultural meanings that shape transwomen's attitudes about injection; and (4) the perceived consequences of injection. We conclude with a discussion of the kinds of intervention and policy changes that would respond to the factors that most endanger transwomen's health.

Subcutaneous injections: preventing needlestick injuries in the community.

PubMed

Aziz, Ann-Marie

2012-06-01

Community nurses provide care to patients in a variety of settings, for example health centres, community hospitals, patients' homes, residential and nursing homes. Administering subcutaneous injections to patients in the community is an everyday activity for many nurses in clinical practice. Many problems related to being 'sharps safe' are common to both community nurses and hospital staff. The majority of subcutaneous injections administered in the community are for patients with diabetes. Reducing needlestick injuries after the administration of subcutaneous injections in the community remains paramount to all NHS staff. This article provides information on what national standards to employ when administrating subcutaneous injections and what safety practices should be undertaken for good sharps management. Staff administering subcutaneous injections in the community need to ensure that they are updated on the latest developments in safety needle devices in order to prevent needlestick injuries and provide safe, effective and individualised care for their patients.

Reducing needlestick injuries: a review of a community service.

PubMed

Aziz, Ann-Marie

Community nurses provide care to patients in a variety of settings; for example, health centres, community hospitals, patients' homes, and residential and nursing homes. Administering intramuscular (IM)injections to patients in the community is an everyday activity for many nurses in clinical practice. A great deal of problems related to being 'sharps safe' are common to both community nurses and hospital staff. There had been a reported six needlestick injuries (NSIs) from community clinics administering depot IM injections, which required a review. An audit of practice was undertaken in clinics administering depot injections. The audit was undertaken to monitor compliance in sharps management and investigated how community nurses were administering IM injections. The review highlighted a lack of resources, gaps in knowledge and training deficits. The infection prevention and control nurses worked hard to improve practices and procedures. After a year, there had been a significant reduction in NSIs.

INJECTING DRUG USERS’ EXPERIENCES OF POLICING PRACTICES IN TWO MEXICAN-U.S. BORDER CITIES: PUBLIC HEALTH PERSPECTIVES

PubMed Central

Miller, Cari L.; Firestone, Michelle; Ramos, Rebeca; Burris, Scott; Ramos, Maria Elena; Case, Patricia; Brouwer, Kimberly C.; Fraga, Miguel Angel; Strathdee, Steffanie A.

2008-01-01

Background Previous research has identified the impact of law enforcement practices on the behaviors and health of injection drug users (IDUs). We undertook a qualitative study of IDUs’ experiences of policing practices in two Mexican cities on the U.S. border. Methods In 2004, two teams of Mexican interviewers conducted in-depth interviews with IDUs residing in Tijuana and Ciudad Juarez (Cd. Juarez), Mexico who had injected drugs at least once in the prior month. Topics included types of drug used, injection settings, access to sterile needles and experiences with police. Field notes and transcribed interviews were analyzed to identify emergent themes. Results Among the 43 participants, most reported that it is common for IDUs to be arrested and detained for 36 hours for carrying sterile or used syringes. Most reported that they or someone they knew had been beaten by police. Interviews suggested 5 key themes relating to police influence on the risk environment: 1) impact of policing practices on accessibility of sterile syringes, 2) influence of police on choice of places to inject drugs (e.g., shooting galleries), 3) police violence, 4) police corruption, and 5) perceived changes in policing practices. Conclusion Findings suggest that some behavior of police officers in Tijuana and Cd. Juarez is inconsistent with legal norms and may be negatively influencing the risk of acquiring blood-borne infections among IDUs. Implementing a comprehensive and successful HIV prevention program among IDUs requires interventions to influence the knowledge, attitudes and practices of law enforcement officers. PMID:17997089

Effectiveness of long-acting antipsychotics in clinical practice : 1. A retrospective, 18-month follow up and comparison between paliperidone palmitate, risperidone long-acting injection and zuclopenthixol decanoate

PubMed Central

Cordiner, Matthew; Shajahan, Polash; McAvoy, Sarah; Bashir, Muhammad; Taylor, Mark

2016-01-01

Objectives: In the UK, nine different compounds are available as long-acting antipsychotic injections (LAIs). There are few clinical guidelines for determining which LAIs are most effective in specific patient groups. To measure the clinical effectiveness of LAIs we aimed to determine the now-established concept of antipsychotic discontinuation rates and measure Clinical Global Impression (CGI) outcomes. Method: The population (n was approximately 560,000) was a secondary care NHS adult mental health service in Lanarkshire, Scotland, UK. This was a retrospective, electronic case note search of LAI-naïve patients commenced on paliperidone palmitate (n = 31), risperidone long-acting injection (RLAI) (n = 102) or zuclopenthixol decanoate (n = 105), with an 18-month follow up. Kaplan–Meier survival statistics for discontinuation rates and hospital admission were calculated. CGI severity and improvement scores were retrospectively assigned by the investigating team. Results: Paliperidone palmitate performed less favourably than risperidone long-acting injection (RLAI) or zuclopenthixol decanoate. Paliperidone palmitate had higher discontinuation rates due to any cause, inefficacy and increased hospitalization risk. Paliperidone palmitate had the smallest proportion of patients assigned a clinically desirable CGI-I score of 1 (very much improved) or 2 (much improved). Conclusions: Paliperidone palmitate had less favourable discontinuation and CGI outcomes compared with RLAI and zuclopenthixol decanoate. This could not be adequately explained by patients in the paliperidone group being more chronically or severely unwell, nor by the presence of comorbidities such as alcohol or substance misuse, or by the use of lower mean dosages compared with RLAI or zuclopenthixol decanoate. We considered that prescribers are familiarizing themselves with paliperidone and outcomes may improve over time. PMID:26913175

‘On the same level’: facilitators’ experiences running a drug user-led safer injecting education campaign

PubMed Central

2013-01-01

Background Unsafe injection practices play a major role in elevated rates of morbidity and mortality among people who inject drugs (IDU). There is growing interest in the direct involvement of IDU in interventions that seek to address unsafe injecting. This study describes a drug user-led safer injecting education campaign, and explores facilitators’ experiences delivering educational workshops. Methods We conducted semi-structured qualitative interviews with 8 members of the Injection Support (IS) Team who developed and facilitated a series of safer injecting education workshops. Interviews explored facilitator’s perceptions of the workshops, experiences being a facilitator, and perspectives on the educational campaign. Interviews were transcribed verbatim and a thematic analysis was conducted. Results IS Team facilitators described how the workshop’s structure and content enabled effective communication of information about safer injecting practices, while targeting the unsafe practices of workshop participants. Facilitators’ identity as IDU enhanced their ability to relate to workshop participants and communicate educational messages in language accessible to workshop participants. Facilitators reported gaining knowledge and skills from their involvement in the campaign, as well as positive feelings about themselves from the realization that they were helping people to protect their health. Overall, facilitators felt that this campaign provided IDU with valuable information, although facilitators also critiqued the campaign and suggested improvements for future efforts. Conclusions This study demonstrates the feasibility of involving IDU in educational initiatives targeting unsafe injecting. Findings illustrate how IDU involvement in prevention activities improves relevance and cultural appropriateness of interventions while providing individual, social, and professional benefits to those IDU delivering education. PMID:23497293

Fluorescent blue lights, injecting drug use and related health risk in public conveniences: findings from a qualitative study of micro-injecting environments.

PubMed

Parkin, Stephen; Coomber, Ross

2010-07-01

This paper presents findings relating to injecting drug users' experiences and opinions of public toilets illuminated with fluorescent blue lights and presents an empirical assessment of the intended deterrent effect of such installations. Data analysis identified that blue lights deterred less than half the sample interviewed. Furthermore over half (18/31) of the sample were prepared to inject in conditions specifically designed to deter injecting practice. Of these, 11 respondents were completely undeterred and 7 individuals were only partially deterred by blue light environments. These findings are discussed within the interpretative frameworks of Pierre Bourdieu's theory of habitus and symbolic violence. The authors conclude that fluorescent blue lights contribute towards the development of situated resistance by injecting drug users within a public injecting habitus; a resistance that produces and reproduces drug-related harm and is a behaviour that opposes the symbolic violence of harm reduction intervention. The paper concludes with suggestions for theory-driven practical intervention that may seek to disrupt the harmful elements of the public injecting habitus. 2010 Elsevier Ltd. All rights reserved.

Uptake of wheel-filtration among clients of a supervised injecting facility: Can structured education work?

PubMed

Steele, Maureen; Silins, Edmund; Flaherty, Ian; Hiley, Sarah; van Breda, Nick; Jauncey, Marianne

2018-01-01

Wheel-filtration of pharmaceutical opioid tablets is a recognised harm reduction strategy, but uptake of the practice among people who inject drugs is low. The study aimed to: (i) examine perceptions of filtration practices; (ii) provide structured education on wheel-filtration; and (iii) assess uptake of the practice. Frequent opioid tablet injectors (n = 30) attending a supervised injecting facility in Sydney, Australia, received hands-on instruction on wheel-filtration based on recommended practice. Pre-education, post-education and follow-up questionnaires were administered. Wheel-filtration was generally regarded as better than cotton-filtration (the typical method) in terms of perceived effects on health, ease of use and overall drug effect. Sixty-eight percent of those who said they would try wheel-filtration after the education had actually done so. Of those who usually used cotton-filtration, over half (60%) had used wheel-filtration two weeks later. Uptake of safer preparation methods for pharmaceutical opioid tablets increases after structured education in wheel-filtration. Findings suggest that SIFs are an effective site for this kind of education. Supervised injecting facility workers are uniquely positioned to provide harm reduction education at the time of injection. [Steele M, Silins E, Flaherty I, Hiley S, van Breda N, Jauncey M. Uptake of wheel-filtration among clients of a supervised injecting facility: Can structured education work? Drug Alcohol Rev 2018;37:116-120]. © 2017 Australasian Professional Society on Alcohol and other Drugs.

Impact of injection therapy on retinal patients with diabetic macular edema or retinal vein occlusion.

PubMed

Sivaprasad, Sobha; Oyetunde, Sesan

2016-01-01

An important factor in the choice of therapy is the impact it has on the patient's quality of life. This survey aimed to understand treatment burden, treatment-related anxiety and worry, and practical issues such as appointment attendance and work absence in patients receiving injection therapy for diabetic macular edema (DME) or retinal vein occlusion (RVO). A European sample of 131 retinal patients completed a detailed questionnaire to elucidate the impact of injection therapy on individuals with DME or RVO. RVO and DME greatly impact a patient's quality of life. An intensive injection regimen and the requirements for multiple hospital visits place a large practical burden on the patient. Each intravitreal injection appointment (including travel time) was reported to take an average of 4.5 hours, with a total appointment burden over 6 months of 13.5 hours and 20 hours for RVO and DME patients, respectively. This creates a significant burden on patient time and may make appointment attendance difficult. Indeed, 53% of working patients needed to take at least 1 day off work per appointment and 71% of patients required a carer's assistance at the time of the injection appointment, ~6.3 hours per injection. In addition to practical issues, three-quarters of patients reported experiencing anxiety about their most recent injection treatment, with 54% of patients reporting that they were anxious for at least 2 days prior to the injection. Patients' most desired improvement to their treatment regimen was to have fewer injections and to require fewer appointments, to achieve the same visual results. Patients' quality of life is clearly very affected by having to manage an intensive intravitreal injection regimen, with a considerable treatment burden having a large negative effect. Reducing the appointment burden to achieve the same visual outcomes and the provision of additional support for patients to attend appointments would greatly benefit those receiving intravitreal injection therapies for DME and RVO.

Hyaluronidase: Understanding Its Properties and Clinical Application for Cosmetic Injection Adverse Events.

PubMed

Harrison, Jeanine; Rhodes, Oriol

The recent global consensus on the management of cosmetic aesthetic injectable complications from hyaluronic acid (HA) has increased the focus on the use of hyaluronidase more than ever before (M. Signorini et al., 2016). A comprehensive knowledge of facial anatomy, including structural positioning of facial arteries and veins, and an extensive knowledge of HA products available for injection procedures, combined with best practice protocols, will assist to prevent adverse events. Despite the growing number of patients using cosmetic fillers for facial restoration, the incidents incidence of adverse events remains low. Indeed, the avoidance of complications through safe and effective injection practice remains the key to preventing the need to use hyaluronidase.

Seismic and aseismic fault slip in response to fluid injection observed during field experiments at meter scale

NASA Astrophysics Data System (ADS)

Cappa, F.; Guglielmi, Y.; De Barros, L.; Wynants-Morel, N.; Duboeuf, L.

2017-12-01

During fluid injection, the observations of an enlarging cloud of seismicity are generally explained by a direct response to the pore pressure diffusion in a permeable fractured rock. However, fluid injection can also induce large aseismic deformations which provide an alternative mechanism for triggering and driving seismicity. Despite the importance of these two mechanisms during fluid injection, there are few studies on the effects of fluid pressure on the partitioning between seismic and aseismic motions under controlled field experiments. Here, we describe in-situ meter-scale experiments measuring synchronously the fluid pressure, the fault motions and the seismicity directly in a fault zone stimulated by controlled fluid injection at 280 m depth in carbonate rocks. The experiments were conducted in a gallery of an underground laboratory in south of France (LSBB, http://lsbb.eu). Thanks to the proximal monitoring at high-frequency, our data show that the fluid overpressure mainly induces a dilatant aseismic slip (several tens of microns up to a millimeter) at the injection. A sparse seismicity (-4 < Mw < -3) is observed several meters away from the injection, in a part of the fault zone where the fluid overpressure is null or very low. Using hydromechanical modeling with friction laws, we simulated an experiment and investigated the relative contribution of the fluid pressure diffusion and stress transfer on the seismic and aseismic fault behavior. The model reproduces the hydromechanical data measured at injection, and show that the aseismic slip induced by fluid injection propagates outside the pressurized zone where accumulated shear stress develops, and potentially triggers seismicity. Our models also show that the permeability enhancement and friction evolution are essential to explain the fault slip behavior. Our experimental results are consistent with large-scale observations of fault motions at geothermal sites (Wei et al., 2015; Cornet, 2016), and suggest that controlled field experiments at meter-scale are important for better assessing the role of fluid pressure in natural and human-induced earthquakes.

The myth of the 90 degrees-angle intramuscular injection.

PubMed

Katsma, D L; Katsma, R

2000-01-01

This article shows that the textbook 90 degrees-angle requirement for intramuscular injections is unrealistic. Trigonometry demonstrates that an injection given at 72 degrees reaches 95% of the depth of an injection given at 90 degrees. This relation between needle angle and needle depth, previous research into the kinematics of hand motion during an intramuscular injection, and other practical considerations support the proposal for a new, relaxed standard: Intramuscular injections administered at a comfortable angle between 72 degrees and 90 degrees.

[Guidelines for practical usage of botulinum toxin type A (BoNTA) for refractory idiopathic overactive bladder management].

PubMed

Hermieu, J-F; Ballanger, P; Amarenco, G; Chartier-Kastler, E; Cosson, M; Costa, P; Fatton, B; Deffieux, X; Denys, P; Gamé, X; Haab, F; Karsenty, G; Le Normand, L; Ruffion, A; Saussine, C

2013-12-01

Provide guidelines for practical usage of botulinum toxin type A (BoNTA) for refractory idiopathic Overactive Bladder management. Guidelines using formalized consensus guidelines method. These guidelines have been validated by a group of 13 experts quoting proposals, subsequently reviewed by an independent group of experts. In the case of patients with urinary tract infection, it must be treated and injection postponed. Before proposing an injection, it is recommended to ensure the feasibility and acceptability of self-catheterisation by patient. The injection can be performed after local anesthesia of the bladder and urethra (lidocaine), supplemented where necessary by nitrous oxide inhalation and sometimes under general anesthesia. Injection is performed in the operating room or endoscopy suite. The bladder should not be too filled (increased risk of perforation). Treatment should be applied in 10 to 20 injections of 0.5 to 1mL homogeneously distributed in the bladder at a distance from the urethral orifices. It is not recommended to leave a urinary catheter in place except in cases of severe hematuria. The patient should be monitored until resumption of micturition. After the first injection, an appointment must be scheduled within 3 months (micturition diary, uroflowmetry, measurement of residual urine and urine culture). Performance of self-catheterisation should be questioned in the case of a symptomatic post-void residual and/or a residue>200mL. A new injection may be considered when the clinical benefit of the previous injection diminishes (between 6 and 9 months). A period of three months must elapse between each injection. Implementation of these guidelines may promote best practice usage of BoNTA with optimal risk/benefit ratio. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Guidelines for practical usage of botulinum toxin type A (BoNTA) for refractory idiopathic overactive bladder management: Translation of French recommendations.

PubMed

Hermieu, J-F; Ballanger, P; Amarenco, G; Chartier-Kastler, É; Cosson, M; Costa, P; Fatton, B; Saussine, C; Denys, P; Gamé, X; Haab, F; Karsenty, G; Le Normand, L; Ruffion, A; Deffieux, X

2014-09-01

Provide guidelines for practical usage of botulinum toxin type A (BoNTA) for refractory idiopathic overactive bladder management. Guidelines using formalized consensus guidelines method. These guidelines have been validated by a group of 13 experts quoting proposals, subsequently reviewed by an independent group of experts. In the case of patients with urinary tract infection, it must be treated and injection postponed. Before proposing an injection, it is recommended to ensure the feasibility and acceptability of self-catheterisation by patient. The injection can be performed after local anesthesia of the bladder and urethra (lidocaine), supplemented where necessary by nitrous oxide inhalation and sometimes under general anesthesia. Injection is performed in the operating room or endoscopy suite. The bladder should not be too filled (increased risk of perforation). Treatment should be applied in 10 to 20 injections of 0.5 to 1 mL homogeneously distributed in the bladder at a distance from the urethral orifices. It is not recommended to leave a urinary catheter in place except in cases of severe hematuria. The patient should be monitored until resumption of micturition. After the first injection, an appointment must be scheduled within 3 months (micturition diary, uroflowmetry, measurement of residual urine and urine culture). Performance of self-catheterisation should be questioned in the case of a symptomatic post-void residual and/or a residue>200 mL. A new injection may be considered when the clinical benefit of the previous injection diminishes (between 6 and 9 months). A period of three months must elapse between each injection. Implementation of these guidelines may promote best practice usage of BoNTA with optimal risk/benefit ratio. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Evaluation of economic efficiencies in clinical retina practice: activity-based cost analysis and modeling to determine impacts of changes in patient management

PubMed Central

Murray, Timothy G; Tornambe, Paul; Dugel, Pravin; Tong, Kuo Bianchini

2011-01-01

Background The purpose of this study is to report the use of activity-based cost analysis to identify areas of practice efficiencies and inefficiencies within a large academic retinal center and a small single-specialty group. This analysis establishes a framework for evaluating rapidly shifting clinical practices (anti-vascular endothelial growth factor therapy, microincisional vitrectomy surgery) and incorporating changing reimbursements for care delivery (intravitreal injections, optical coherence tomography [OCT]) to determine the impact on practice profitability. Pro forma modeling targeted the impact of declining reimbursement for OCT imaging and intravitreal injection using a strategy that incorporates activity-based cost analysis into a direct evaluation schema for clinical operations management. Methods Activity-based costing analyses were performed at two different types of retinal practices in the US, ie, a small single-specialty group practice and an academic hospital-based practice (Bascom Palmer Eye Institute). Retrospective claims data were utilized to identify all procedures performed and billed, submitted charges, allowed charges, and net collections from each of these two practices for the calendar years 2005–2006 and 2007–2008. A pro forma analysis utilizing current reimbursement profiles was performed to determine the impact of altered reimbursement on practice profitability. All analyses were performed by a third party consulting firm. Results The small single-specialty group practice outperformed the academic hospital-based practice on almost all markers of efficiency. In the academic hospital-based practice, only four service lines were profitable, ie, nonlaser surgery, laser surgery, non-OCT diagnostics, and injections. Profit margin varied from 62% for nonlaser surgery to 1% for intravitreal injections. Largest negative profit contributions were associated with office visits and OCT imaging. Conclusion Activity-based cost analysis is a powerful tool to evaluate retinal practice efficiencies. These two distinct practices were able to provide significant increases in clinical care (office visits, ophthalmic imaging, and patient procedures) through maintaining efficiencies of care. Pro forma analysis of 2011 data noted that OCT payments to facilities and physicians continue to decrease dramatically and that this payment decrease further reduced the profitability for the two largest aspects of these retinal practices, ie, intravitreal injections and OCT retinal imaging. Ultimately, all retinal practices are at risk for significant shifts in financial health related to rapidly evolving changes in patterns of care and reimbursement associated with providing outstanding clinical care. PMID:21792278

On the connection between the 3HE-enrichment and spectral index of solar energetic particles

NASA Technical Reports Server (NTRS)

Kocharov, L. G.; Dvoryanchikov, Y. V.

1985-01-01

A model is presented which explains the observed tendency of events with large 3He/4He ratios to have steeper spectra. In this model preferential injection of 3He, acceleration by Alfven waves and Coulomb deceleration of ions are considered simultaneously. The observed tendency may be obtained as a result of competition between injection and acceleration processes.

The Curious Connection Between Insects and Dreams

PubMed Central

Klein, Barrett A.

2011-01-01

A majority of humans spend their waking hours surrounded by insects, so it should be no surprise that insects also appear in humans’ dreams as we sleep. Dreaming about insects has a peculiar history, marked by our desire to explain a dream’s significance and by the tactic of evoking emotions by injecting insects in dream-related works of art, film, music, and literature. I surveyed a scattered literature for examples of insects in dreams, first from the practices of dream interpretation, psychiatry, and scientific study, then from fictional writings and popular culture, and finally in the etymology of entomology by highlighting insects with dream-inspired Latinate names. A wealth of insects in dreams, as documented clinically and culturally, attests to the perceived relevance of dreams and to the ubiquity of insects in our lives. PMID:26467945

A concealed observational study of infection control and safe injection practices in Jordanian governmental hospitals.

PubMed

Al-Rawajfah, Omar M; Tubaishat, Ahmad

2017-10-01

The recognized international organizations on infection prevention recommend using an observational method as the gold standard procedure for assessing health care professional's compliance with standard infection control practices. However, observational studies are rarely used in Jordanian infection control studies. This study aimed to evaluate injection practices among nurses working in Jordanian governmental hospitals. A cross-sectional concealed observational design is used for this study. A convenience sampling technique was used to recruit a sample of nurses working in governmental hospitals in Jordan. Participants were unaware of the time and observer during the observation episode. A total of 384 nurses from 9 different hospitals participated in the study. A total of 835 injections events were observed, of which 73.9% were performed without handwashing, 64.5% without gloving, and 27.5% were followed by needle recapping. Handwashing rate was the lowest (18.9%) when injections were performed by beginner nurses. Subcutaneous injections were associated with the lowest rate (26.7%) of postinjection handwashing compared with other routes. This study demonstrates the need for focused and effective infection control educational programs in Jordanian hospitals. Future studies should consider exploring the whole infection control practices related to waste disposal and the roles of the infection control nurse in this process in Jordanian hospitals. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Charge injection from gate electrode by simultaneous stress of optical and electrical biases in HfInZnO amorphous oxide thin film transistor

NASA Astrophysics Data System (ADS)

Kwon, Dae Woong; Kim, Jang Hyun; Chang, Ji Soo; Kim, Sang Wan; Sun, Min-Chul; Kim, Garam; Kim, Hyun Woo; Park, Jae Chul; Song, Ihun; Kim, Chang Jung; Jung, U. In; Park, Byung-Gook

2010-11-01

A comprehensive study is done regarding stabilities under simultaneous stress of light and dc-bias in amorphous hafnium-indium-zinc-oxide thin film transistors. The positive threshold voltage (Vth) shift is observed after negative gate bias and light stress, and it is completely different from widely accepted phenomenon which explains that negative-bias stress results in Vth shift in the left direction by bias-induced hole-trapping. Gate current measurement is performed to explain the unusual positive Vth shift under simultaneous application of light and negative gate bias. As a result, it is clearly found that the positive Vth shift is derived from electron injection from gate electrode to gate insulator.

Correlates of lending needles/syringes among HIV-seropositive injection drug users.

PubMed

Metsch, Lisa R; Pereyra, Margaret; Purcell, David W; Latkin, Carl A; Malow, Robert; Gómez, Cynthia A; Latka, Mary H

2007-11-01

Among HIV-positive injection drug users (IDUs), we examined the correlates of lending needles/syringes with HIV-negative and unknown status injection partners. HIV-positive IDUs (N=738) from 4 cities in the United States who reported injection drug use with other IDUs in the past 3 months participated in an audio computer-assisted self-administered interview. Eighteen percent of study participants self-reported having lent their needles to HIV-negative or unknown status injection partners. Multivariate analyses showed that 6 variables were significantly associated with this high-risk injecting practice. Older IDUs, high school graduates, and those reporting more supportive peer norms for safer drug use were less likely to lend needles/syringes. Admission to a hospital for drug treatment in the past 6 months, having injected with >1 person in the past 3 months, and having more psychiatric symptoms were all associated with more risk. These findings underscore the need for a continued prevention focus on HIV-positive IDUs that recognizes the combination of drug use, mental health factors, and social factors that might affect this high-risk injecting practice, which could be associated with HIV and hepatitis C transmission.

Differential experiences of Mexican policing by people who inject drugs residing in Tijuana and San Diego.

PubMed

Wood, Emily F; Werb, Dan; Beletsky, Leo; Rangel, Gudelia; Cuevas Mota, Jazmine; Garfein, Richard S; Strathdee, Steffanie A; Wagner, Karla D

2017-03-01

Research among people who inject drugs (PWIDs) in the USA and Mexico has identified a range of adverse health impacts associated with policing of PWIDs. We employed a mixed methods design to investigate how PWIDs from San Diego and Mexico experienced policing in Tijuana, and how these interactions affect PWIDs behavior, stratifying by country of origin. In 2012-2014, 575 PWIDs in San Diego, 102 of whom had used drugs in Mexico in the past six months, were enrolled in the STAHR-II study, with qualitative interviews conducted with a subsample of 20 who had recently injected drugs in Mexico. During this period, 735 PWIDs in Tijuana were also enrolled in the El Cuete-IV study, with qualitative interviews conducted with a subsample of 20 recently stopped by police. We calculated descriptive statistics for quantitative variables and conducted thematic analysis of qualitative transcripts. Integration of these data involved comparing frequencies across cohorts and using qualitative themes to explain and explore findings. Sixty-one percent of San Diego-based participants had been recently stopped by law enforcement officers (LEOs) in Mexico; 53% reported it was somewhat or very likely that they would be arrested while in Mexico because they look like a drug user. Ninety percent of Tijuana-based participants had been recently stopped by LEOs; 84% reported it was somewhat or very likely they could get arrested because they look like a drug user. Participants in both cohorts described bribery and targeting by LEOs in Mexico. However, most San Diego-based participants described compliance with bribery as a safeguard against arrest and detention, with mistreatment being rare. Tijuana-based participants described being routinely targeted by LEOs, were frequently detained, and reported instances of sexual and physical violence. Tijuana-based participants described modifying how, where, and with whom they injected drugs in response; and experienced feelings of stress, anxiety, and powerlessness. This was less common among San Diego-based participants, who mostly attempted to avoid contact with LEOs in Mexico while engaging in risky injection behavior. Experiences of discrimination and stigma were reported by a larger proportion of PWIDs living in Mexico, suggesting that they may be subject to greater health harms related to policing practices compared with those residing in the USA. Our findings reinforce the importance of efforts to curb abuse and align policing practices with public health goals in both the US and Mexico. Copyright © 2016 Elsevier B.V. All rights reserved.

Differential experiences of Mexican policing by people who inject drugs residing in Tijuana and San Diego

PubMed Central

Wood, Emily F.; Werb, Dan; Beletsky, Leo; Rangel, Gudelia; Mota, Jazmine Cuevas; Garfein, Richard S.; Strathdee, Steffanie A.; Wagner, Karla D.

2017-01-01

Background Research among people who inject drugs (PWIDs) in the USA and Mexico has identified a range of adverse health impacts associated with policing of PWIDs. We employed a mixed methods design to investigate how PWIDs from San Diego and Mexico experienced policing in Tijuana, and how these interactions affect PWIDs behavior, stratifying by country of origin. Methods In 2012–2014, 575 PWIDs in San Diego, 102 of whom had used drugs in Mexico in the past six months, were enrolled in the STAHR-II study, with qualitative interviews conducted with a subsample of 20 who had recently injected drugs in Mexico. During this period, 735 PWIDs in Tijuana were also enrolled in the El Cuete-IV study, with qualitative interviews conducted with a subsample of 20 recently stopped by police. We calculated descriptive statistics for quantitative variables and conducted thematic analysis of qualitative transcripts. Integration of these data involved comparing frequencies across cohorts and using qualitative themes to explain and explore findings. Results Sixty-one percent of San Diego-based participants had been recently stopped by law enforcement officers (LEOs) in Mexico; 53% reported it was somewhat or very likely that they would be arrested while in Mexico because they look like a drug user. Ninety percent of Tijuana-based participants had been recently stopped by LEOs; 84% reported it was somewhat or very likely they could get arrested because they look like a drug user. Participants in both cohorts described bribery and targeting by LEOs in Mexico. However, most San Diego-based participants described compliance with bribery as a safeguard against arrest and detention, with mistreatment being rare. Tijuana-based participants described being routinely targeted by LEOs, were frequently detained, and reported instances of sexual and physical violence. Tijuana-based participants described modifying how, where, and with whom they injected drugs in response; and experienced feelings of stress, anxiety, and powerlessness. This was less common among San Diego-based participants, who mostly attempted to avoid contact with LEOs in Mexico while engaging in risky injection behavior. Conclusion Experiences of discrimination and stigma were reported by a larger proportion of PWIDs living in Mexico, suggesting that they may be subject to greater health harms related to policing practices compared with those residing in the USA. Our findings reinforce the importance of efforts to curb abuse and align policing practices with public health goals in both the US and Mexico. PMID:28111221

Pharmacy practice and injection use in community pharmacies in Pokhara city, Western Nepal.

PubMed

Gyawali, Sudesh; Rathore, Devendra Singh; Adhikari, Kishor; Shankar, Pathiyil Ravi; K C, Vikash Kumar; Basnet, Suyog

2014-04-28

Community pharmacies in Nepal serve as the first point of contact for the public with the health care system and provide many services, including administering injections. However, there is a general lack of documented information on pharmacy practice and injection use in these pharmacies. This study aims to provide information about pharmacy practice in terms of service and drug information sources, and injection use, including the disposal of used injection equipment. A mixed method, cross-sectional study was conducted in 54 community pharmacies in Pokhara city. Data was collected using a pre-tested, semi-structured questionnaire, and also by the direct observation of pharmacy premises. Interviews with pharmacy supervisors (proprietors) were also conducted to obtain additional information about certain points. Interviews were carried out with 54 pharmacy supervisors/proprietors (47 males and 7 females) with a mean age and experience of 35.54 and 11.73 years, respectively. Approximately a half of the studied premises were operated by legally recognized pharmaceutical personnel, while the remainder was run by people who did not have the legal authority to operate pharmacies independently. About a quarter of pharmacies were providing services such as the administration of injections, wound dressing, and laboratory and consultation services in addition to medicine dispensing and counseling services. The 'Current Index of Medical Specialties' was the most commonly used source for drug information. Almost two-thirds of patients visiting the pharmacies were dispensed medicines without a prescription. Tetanus Toxoid, Depot-Medroxy Progesterone Acetate, and Diclofenac were the most commonly-used/administered injections. Most of the generated waste (including sharps) was disposed of in a municipal dump without adhering to the proper procedures for the disposal of hazardous waste. Community pharmacies in Pokhara offer a wide range of services including, but not limited to, drug dispensing, counseling, dressing of wounds, and administering injections. However, the lack of qualified staff and adequate infrastructure may be compromising the quality of the services offered. Therefore, the health authorities should take the necessary measures to upgrade the qualifications of the personnel and to improve the infrastructure for the sake of good pharmacy practice and the safer use of injections.

Safety of immunization injections in Africa: not simply a problem of logistics.

PubMed Central

Dicko, M.; Oni, A. Q.; Ganivet, S.; Kone, S.; Pierre, L.; Jacquet, B.

2000-01-01

In 1995, the WHO Regional Office for Africa launched a logistics project to address the four main areas of immunization logistics: the cold chain, transport, vaccine supply and quality, and the safety of injections in the countries of the region. The impact of this logistic approach on immunization injection safety was evaluated through surveys of injection procedures and an analysis of the injection materials (e.g. sterilizable or disposable syringes) chosen by the Expanded Programme on Immunization (EPI) and those actually seen to be used. Re-use of injection materials without sterilization, accidental needle-stick injuries among health care workers, and injection-related abscesses in patients were common in countries in the WHO African Region. Few health centres used time-steam saturation-temperature (TST) indicators to check the quality of sterilization and, in many centres, the injection equipment was boiled instead of being steam sterilized. Facilities for the proper disposal of used materials were rarely present. Although the official EPI choice was to use sterilizable equipment, use of a combination of sterilizable and disposable equipment was observed in the field. Unsafe injection practices in these countries were generally due to a failure to integrate nursing practices and public awareness with injection safety issues, and an absence of the influence of EPI managers on health care service delivery. Holistic rather than logistic approaches should be adopted to achieve safe injections in immunization, in the broader context of promoting safe vaccines and safety of all injections. PMID:10743280

Effect of post injections on mixture preparation and unburned hydrocarbon emissions in a heavy-duty diesel engine

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

O'Connor, Jacqueline; Musculus, Mark P. B.; Pickett, Lyle M.

This work explores the mechanisms by which a post injection can reduce unburned hydrocarbon (UHC) emissions in heavy-duty diesel engines operating at low-temperature combustion conditions. Post injections, small, close-coupled injections of fuel after the main injection, have been shown to reduce UHC in the authors’ previous work. In this work, we analyze optical data from laser-induced fluorescence of both CH 2O and OH and use chemical reactor modeling to better understand the mechanism by which post injections reduce UHC emissions. The results indicate that post-injection efficacy, or the extent to which a post injection reduces UHC emissions, is a strongmore » function of the cylinder pressure variation during the post injection. However, the data and analysis indicate that the pressure and temperature rise from the post injection combustion cannot solely explain the UHC reduction measured by both engine-out and optical diagnostics. In conclusion, the fluid-mechanic, thermal, and chemical interaction of the post injection with the main-injection mixture is a key part of UHC reduction; the starting action of the post jet and the subsequent entrainment of surrounding gases are likely both important processes in reducing UHC with a post injection.« less

Effect of post injections on mixture preparation and unburned hydrocarbon emissions in a heavy-duty diesel engine

DOE PAGES

O'Connor, Jacqueline; Musculus, Mark P. B.; Pickett, Lyle M.

2016-05-30

This work explores the mechanisms by which a post injection can reduce unburned hydrocarbon (UHC) emissions in heavy-duty diesel engines operating at low-temperature combustion conditions. Post injections, small, close-coupled injections of fuel after the main injection, have been shown to reduce UHC in the authors’ previous work. In this work, we analyze optical data from laser-induced fluorescence of both CH 2O and OH and use chemical reactor modeling to better understand the mechanism by which post injections reduce UHC emissions. The results indicate that post-injection efficacy, or the extent to which a post injection reduces UHC emissions, is a strongmore » function of the cylinder pressure variation during the post injection. However, the data and analysis indicate that the pressure and temperature rise from the post injection combustion cannot solely explain the UHC reduction measured by both engine-out and optical diagnostics. In conclusion, the fluid-mechanic, thermal, and chemical interaction of the post injection with the main-injection mixture is a key part of UHC reduction; the starting action of the post jet and the subsequent entrainment of surrounding gases are likely both important processes in reducing UHC with a post injection.« less

Intracerebral Injections and Ultrastructural Analysis of High-Pressure Frozen Brain Tissue.

PubMed

Weil, Marie-Theres; Ruhwedel, Torben; Möbius, Wiebke; Simons, Mikael

2017-01-03

Intracerebral injections are an invasive method to bypass the blood brain barrier and are widely used to study molecular and cellular mechanisms of the central nervous system. The administered substances are injected directly at the site of interest, executing their effect locally. By combining injections in the rat brain with state-of-the-art electron microscopy, subtle changes in ultrastructure of the nervous tissue can be detected prior to overt damage or disease. The protocol presented here involves stereotactic injection into the corpus callosum of Lewis rats and the cryopreparation of freshly dissected tissue for electron microscopy. The localization of the injection site in tissue sections during the sample preparation for transmission electron microscopy is explained and possible artifacts of the method are indicated. With the help of this powerful combination of injections and electron microscopy, subtle effects of the applied substances on the biology of neural cells can be identified and monitored over time. © 2017 by John Wiley & Sons, Inc. Copyright © 2017 John Wiley & Sons, Inc.

Triggering processes of microseismic events associated with water injection in Okuaizu Geothermal Field, Japan

NASA Astrophysics Data System (ADS)

Okamoto, Kyosuke; Yi, Li; Asanuma, Hiroshi; Okabe, Takashi; Abe, Yasuyuki; Tsuzuki, Masatoshi

2018-02-01

A continuous water injection test was conducted to halt the reduction in steam production in the Okuaizu Geothermal Field, Japan. Understanding the factors triggering microseismicity associated with water injection is essential to ensuring effective steam production. We identified possible triggering processes by applying methods based on microseismic monitoring, including a new method to determine the presence of water in local fractures using scattered P-waves. We found that the evolving microseismicity near the injection point could be explained by a diffusion process and/or water migration. We also found that local microseismicity on a remote fault was likely activated by stress fluctuations resulting from changes in the injection rate. A mediator of this fluctuation might be water remaining in the fracture zone. After the injection was terminated, microseismicity possibly associated with the phase transition of the liquid was found. We conclude that a variety of triggering processes associated with water injection may exist.[Figure not available: see fulltext.

Understanding and meeting injection device needs in multiple sclerosis: a survey of patient attitudes and practices

PubMed Central

Verdun di Cantogno, Elisabetta; Russell, Susan; Snow, Tom

2011-01-01

Background: All established disease-modifying drugs for multiple sclerosis require parenteral administration, which can cause difficulties for some patients, sometimes leading to suboptimal adherence. A new electronic autoinjection device has been designed to address these issues. Methods: Patients with relapsing multiple sclerosis currently receiving subcutaneous or intramuscular interferon beta-1a, interferon beta-1b, or glatiramer acetate completed an online questionnaire (July 4–25, 2008) that surveyed current injection practices, experiences with current injection methods, and impressions and appeal of the new device. Results: In total, 422 patients completed the survey, of whom 44% used autoinjectors, 43% prefilled syringes, and 13% syringes and vials; overall, 66% currently self-injected. Physical and psychological barriers to self-injection included difficulty with injections, needle phobia, and concerns over correct injection technique. Only 40% of respondents were “very satisfied” with their current injection method. The new electronic autoinjector was rated as “very appealing” by 65% of patients. The benefits of the new device included the ability to customize injection settings and to review dosing history. Conclusion: New technologies may help patients overcome physical and psychological barriers to self-injection. The combination of a reliable and flexible autoinjection device with dose-monitoring technology may improve communication between health care professionals and patients, and improve treatment adherence. PMID:21573048

Safer injections following a new national medicine policy in the public sector, Burkina Faso 1995 – 2000

PubMed Central

Logez, Sophie; Hutin, Yvan; Somda, Paul; Thuault, Jérôme; Holloway, Kathleen

2005-01-01

Background The common failure of health systems to ensure adequate and sufficient supplies of injection devices may have a negative impact on injection safety. We conducted an assessment in April 2001 to determine to which extent an increase in safe injection practices between 1995 and 2000 was related to the increased access to injection devices because of a new essential medicine policy in Burkina Faso. Methods We reviewed outcomes of the new medicine policy implemented in1995. In April 2001, a retrospective programme review assessed the situation between 1995 and 2000. We visited 52 health care facilities where injections had been observed during a 2000 injection safety assessment and their adjacent operational public pharmaceutical depots. Data collection included structured observations of available injection devices and an estimation of the proportion of prescriptions including at least one injection. We interviewed wholesaler managers at national and regional levels on supply of injection devices to public health facilities. Results Fifty of 52 (96%) health care facilities were equipped with a pharmaceutical depot selling syringes and needles, 37 (74%) of which had been established between 1995 and 2000. Of 50 pharmaceutical depots, 96% had single-use 5 ml syringes available. At all facilities, patients were buying syringes and needles out of the depot for their injections prescribed at the dispensary. While injection devices were available in greater quantities, the proportion of prescriptions including at least one injection remained stable between 1995 (26.5 %) and 2000 (23.8 %). Conclusion The implementation of pharmaceutical depots next to public health care facilities increased geographical access to essential medicines and basic supplies, among which syringes and needles, contributing substantially to safer injection practices in the absence of increased use of therapeutic injections. PMID:16364178

Survey of Botulinum Toxin Injections in Anticoagulated Patients: Korean Physiatrists' Preference in Controlling Anticoagulation Profile Prior to Intramuscular Injection.

PubMed

Jang, Yongjun; Park, Geun-Young; Park, Jihye; Choi, Asayeon; Kim, Soo Yeon; Boulias, Chris; Phadke, Chetan P; Ismail, Farooq; Im, Sun

2016-04-01

To evaluate Korean physiatrists' practice of performing intramuscular botulinum toxin injection in anticoagulated patients and to assess their preference in controlling the bleeding risk before injection. As part of an international collaboration survey study, a questionnaire survey was administered to 100 Korean physiatrists. Physiatrists were asked about their level of experience with botulinum toxin injection, the safe international normalized ratio range in anticoagulated patients undergoing injection, their tendency for injecting into deep muscles, and their experience of bleeding complications. International normalized ratio <2.0 was perceived as an ideal range for performing Botulinum toxin injection by 41% of the respondents. Thirty-six respondents replied that the international normalized ratio should be lowered to sub-therapeutic levels before injection, and 18% of the respondents reported that anticoagulants should be intentionally withheld and discontinued prior to injection. In addition, 20%-30% of the respondents answered that they were uncertain whether they should perform the injection regardless of the international normalized ratio values. About 69% of the respondents replied that they did have any standardized protocols for performing botulinum toxin injection in patients using anticoagulants. Only 1 physiatrist replied that he had encountered a case of compartment syndrome. In accordance with the lack of consensus in performing intramuscular botulinum toxin injection in anticoagulated patients, our survey shows a wide range of practices among many Korean physiatrists; they tend to avoid botulinum toxin injection in anticoagulated patients and are uncertain about how to approach these patients. The results of this study emphasize the need for formulating a proper international consensus on botulinum toxin injection management in anticoagulated patients.

'It's Fast, It's Quick, It Stops Me Being Sick': How to influence preparation of opioid tablets for injection.

PubMed

Lafferty, Lise; Treloar, Carla; van Breda, Nick; Steele, Maureen; Hiley, Sarah; Flaherty, Ian; Salmon, Allison

2017-09-01

Injection of pharmaceutical opioids (PO) among people who inject drugs has increased in many countries. The common method for preparing PO tablets for injection uses heat, resulting in greater particulate matter and therefore increased risk of local infection risk and damage to veins and organs. A cold preparation process has fewer risks, but this preparation method is not commonly used. This study seeks to explore how people who inject PO learn to prepare injections and how health promotion efforts could influence practice. Between March and December 2013, qualitative interviews were undertaken with 33 clients of Sydney's Medically Supervised Injecting Centre who inject PO tablets regarding sources of knowledge and current preparation methods for injection of POs. Overwhelmingly, the most commonly reported source of knowledge around injection of tablets was others who inject. Most participants reported heating the solution as the quickest way to administer the drug. Attitudes to the use of wheel filters varied, with some participants reporting that they would use the filters if they were shown how, while others reported a number of barriers to using filters, including complexity of use. Harnessing the power of social connections may provide avenues for education about safer injecting of tablets, including the use of wheel filters. Further work is required to debunk myths about the relative potencies of cold versus hot drug solution. Collaborations between harm reduction workers and peer workers would assist in knowledge dissemination regarding safer injecting practices. © 2017 Australasian Professional Society on Alcohol and other Drugs.

Induced and triggered earthquakes at The Geysers geothermal reservoir

NASA Astrophysics Data System (ADS)

Johnson, Lane R.; Majer, Ernest L.

2017-05-01

The Geysers geothermal reservoir in northern California is the site of numerous studies of both seismicity induced by injection of fluids and seismicity triggered by other earthquakes. Data from a controlled experiment in the northwest part of The Geysers in the time period 2011 to 2015 are used to study these induced and triggered earthquakes and possible differences between them. Causal solutions to the elastic equations for a porous medium show how fluid injection generates fast elastic and diffusion waves followed by a much slower diffusive wake. Calculations of fluid increment, fluid pressure and elastic stress are used to investigate both when and why seismic failure takes place. Taking into account stress concentrations caused by material heterogeneity leads to the conclusion that fluid injection by itself can cause seismic activity with no need for tectonic forces. Induced events that occur at early times are best explained by changes in stress rate, while those that occur at later times are best explained by changes in stress. While some of the seismic activity is clearly induced by injection of fluids, also present is triggered seismicity that includes aftershock sequences, swarms of seismicity triggered by other earthquakes at The Geysers and clusters of multiple earthquakes. No basic differences are found between the source mechanisms of these different types of earthquakes.

Correlates of risky injection practices among past-year injection drug users among the US general population.

PubMed

Ropelewski, Lauren R; Mancha, Brent E; Hulbert, Alicia; Rudolph, Abby E; Martins, Silvia S

2011-07-01

With an estimated 1 million active injection drug users (IDUs), injection drug use continues to be a public health concern in the United States. Risky injection practices have been associated with the transmission of HIV, Hepatitis B and C, as well as other skin and soft tissue infections. We used data from 463 respondents, aged 18 and older, who were past-year IDUs in the 2005-2008 National Survey of Drug Use and Health (NSDUH). We investigated correlates of risky injection behavior among these recent IDUs. Older age (≥ 35 versus 18-25) was associated with reusing one's own needle at last injection (aOR=1.80 [1.02-3.17], as were past year heroin (aOR=2.59 [1.18-5.66]) and cocaine injection (aOR=2.17 [1.13-4.15]). Past year crack cocaine use was positively associated with not cleaning needles with bleach (aOR=2.18 [1.10-4.33]). Past year cocaine injection was associated with obtaining needles in a risky manner (aOR=2.29 [1.23-4.25]). Methamphetamine injection was associated with obtaining needles in less risky ways (aOR=0.41 [0.20-0.84]). Our findings indicate that some IDUs are continuing to engage in high risk injection behaviors. The identification of potential at-risk populations of IDUs may have implications for harm reduction interventions and HIV prevention programs. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Evaluating the functional outcomes of ultrasound-guided botulinum toxin type A injections using the Euro-musculus approach for upper limb spasticity treatment in post-stroke patients; an observational study.

PubMed

Buyukavci, Raikan; Akturk, Semra; Ersoy, Yüksel

2018-02-07

Ultrasound-guided botulinum toxin type A injection is an effective treatment for spasticity. Euro-musculus spasticity approach is a new method for administering injections to the correct point of the correct muscle. The clinical outcomes of this practical approach is not yet available in the literature. The purpose of this study was to evaluate the effects on spasticity and the functional outcomes of ultrasound guided botulinum toxin type A injections via the Euro-musculus spasticity approach to treat upper limb spasticity in post-stroke patients. An observational study. Inpatient post-stroke patients. Twenty five post-stroke patients with post-stroke upper limb spasticity were recruited. The ultrasound-guided botulinum toxin type A injections were administered into the spastic target muscles using the Euro-musculus spasticity approach, and all of the patients were enrolled in rehabilitation programmes after the injections. This research included the innervation zone and injection site figures and ultrasound images of each muscle in the upper limb. The degree of spasticity was assessed via the Modified Ashworth Scale and the upper limb motor function via the Fugl Meyer Upper Extremity Scale at the baseline and 4 and 12 weeks after the botulinum toxin type A injection. Significant decreases in the Modified Ashworth Scale scores of the upper limb flexor muscle tone measured 4 and 12 weeks after the botulinum toxin type A injection were found when compared to the baseline scores (p<0.025). When compared with the baseline Fugl Meyer Upper Extremity subgroup scores, the sitting position, wrist and total scores at 4 and 12 weeks were significantly improved (p<0.025). However, only the Fugl Meyer Upper Extremity hand scores were significantly improved 12 weeks after the injection (p<0.025). Ultrasound-guided botulinum toxin type A injection via the Euro- musculus spasticity approach is a practical and effective method for administering injections to the correct point of the correct muscle. Ultrasound-guided botulinum toxin type A injections combined with rehabilitation programmes decrease spasticity and improve the upper extremity motor functions in stroke patients. This new approach for ultrasound- guided botulinum toxin type A injection is very practical and effective method for upper extremity spasticity.

Illicit Cosmetic Silicone Injection: A Recent Reiteration of History.

PubMed

Leonardi, Nicholas R; Compoginis, John M; Luce, Edward A

2016-10-01

The injection of liquid silicone for cosmetic augmentation has a history of both legal as well as illicit practice in the United States and worldwide. Recently, the American Society of Plastic Surgeons has launched a public awareness campaign through patient stories and various statements in response to the rise in deaths related to this illicit practice. A articular segment of the population that has become a target is the transgender patient group. A brief review is provided of the history of industrial liquid silicone injection, including the pathophysiology to fully describe and review silicone injection injury. Three cases of soft tissue cellulitis and wound necrosis treated at our institution are summarized and a treatment algorithm proposed based on literature review of treatment options and our own experience.

A Randomized Intervention Trial to Reduce the Lending of Used Injection Equipment Among Injection Drug Users Infected With Hepatitis C

PubMed Central

Latka, Mary H.; Hagan, Holly; Kapadia, Farzana; Golub, Elizabeth T.; Bonner, Sebastian; Campbell, Jennifer V.; Coady, Micaela H.; Garfein, Richard S.; Pu, Minya; Thomas, Dave L.; Thiel, Thelma K.; Strathdee, Steffanie A.

2008-01-01

Objectives. We evaluated the efficacy of a peer-mentoring behavioral intervention designed to reduce risky distributive injection practices (e.g., syringe lending, unsafe drug preparation) among injection drug users with hepatitis C virus (HCV) infection. Methods. A randomized trial with a time-equivalent attention-control group was conducted among 418 HCV-positive injection drug users aged 18 to 35 years in 3 US cities. Participants reported their injection-related behaviors at baseline and at 3- and 6-month follow-ups. Results. Compared with the control group, intervention-group participants were less likely to report distributive risk behaviors at 3 months (odds ratio [OR]=0.46; 95% confidence interval [CI]=0.27, 0.79) and 6 months (OR=0.51; 95% CI=0.31, 0.83), a 26% relative risk reduction, but were no more likely to cite their HCV-positive status as a reason for refraining from syringe lending. Effects were strongest among intervention-group participants who had known their HCV-positive status for at least 6 months. Peer mentoring and self-efficacy were significantly increased among intervention-group participants, and intervention effects were mediated through improved self-efficacy. Conclusions. This behavioral intervention reduced unsafe injection practices that may propagate HCV among injection drug users. PMID:18382005

A randomized intervention trial to reduce the lending of used injection equipment among injection drug users infected with hepatitis C.

PubMed

Latka, Mary H; Hagan, Holly; Kapadia, Farzana; Golub, Elizabeth T; Bonner, Sebastian; Campbell, Jennifer V; Coady, Micaela H; Garfein, Richard S; Pu, Minya; Thomas, Dave L; Thiel, Thelma K; Strathdee, Steffanie A

2008-05-01

We evaluated the efficacy of a peer-mentoring behavioral intervention designed to reduce risky distributive injection practices (e.g., syringe lending, unsafe drug preparation) among injection drug users with hepatitis C virus (HCV) infection. A randomized trial with a time-equivalent attention-control group was conducted among 418 HCV-positive injection drug users aged 18 to 35 years in 3 US cities. Participants reported their injection-related behaviors at baseline and at 3- and 6-month follow-ups. Compared with the control group, intervention-group participants were less likely to report distributive risk behaviors at 3 months (odds ratio [OR]=0.46; 95% confidence interval [CI]=0.27, 0.79) and 6 months (OR=0.51; 95% CI=0.31, 0.83), a 26% relative risk reduction, but were no more likely to cite their HCV-positive status as a reason for refraining from syringe lending. Effects were strongest among intervention-group participants who had known their HCV-positive status for at least 6 months. Peer mentoring and self-efficacy were significantly increased among intervention-group participants, and intervention effects were mediated through improved self-efficacy. This behavioral intervention reduced unsafe injection practices that may propagate HCV among injection drug users.

40 CFR Table 9 to Subpart Wwww of... - Initial Compliance With Work Practice Standards

Code of Federal Regulations, 2014 CFR

2014-07-01

... compression/injection molding uncover, unwrap or expose only one charge per mold cycle per compression/injection molding machine. For machines with multiple molds, one charge means sufficient material to fill... cycle per compression/injection molding machine, or prior to the loader, hoppers are closed except when...

Experimental Investigation of Diffuser Hub Injection to Improve Centrifugal Compressor Stability

NASA Technical Reports Server (NTRS)

Skoch, Gary J.

2004-01-01

Results from a series of experiments to investigate whether centrifugal compressor stability could be improved by injecting air through the diffuser hub surface are reported. The research was conducted in a 4:1 pressure ratio centrifugal compressor configured with a vane-island diffuser. Injector nozzles were located just upstream of the leading edge of the diffuser vanes. Nozzle orientations were set to produce injected streams angled at 8, 0 and +8 degrees relative to the vane mean camber line. Several injection flow rates were tested using both an external air supply and recirculation from the diffuser exit. Compressor flow range did not improve at any injection flow rate that was tested. Compressor flow range did improve slightly at zero injection due to the flow resistance created by injector openings on the hub surface. Leading edge loading and semi-vaneless space diffusion showed trends similar to those reported earlier from shroud surface experiments that did improve compressor flow range. Opposite trends are seen for hub injection cases where compressor flow range decreased. The hub injection data further explain the range improvement provided by shroud-side injection and suggest that different hub-side techniques may produce range improvement in centrifugal compressors.

Practice patterns of ophthalmologists administering intravitreal injections in Europe: a longitudinal survey.

PubMed

Huang, Kui; Sultan, Marla B; Zhou, Duo; Tressler, Charles S; Mo, Jingping

2016-01-01

This study was performed to understand the practice patterns of ophthalmologists administering intravitreal (IVT) injections in Europe after the procedure became routine. As part of a prospective, multinational, non-interventional cohort study in 13 countries in Europe between 2006 and 2012, ophthalmologists completed the Baseline Questionnaire and the Follow-up Questionnaire 1 year after baseline. Of the 125 ophthalmologists who participated in the study, 113 (90.4%) completed the Baseline Questionnaire. Most of these ophthalmologists were medical retina specialists (43.0%). The median number of IVT injections that the ophthalmologists performed per month during the year prior to completing the Baseline Questionnaire was 20.0. The majority of the ophthalmologists had performed their last IVT injection prior to completing the questionnaire in an operating room or theater (68.4%). When performing IVT injections, a majority of the ophthalmologists reported applying povidone-iodine (90.4%) before IVT injections and topical antibiotics right after IVT injections (89.5%). In addition, 81.6% of the ophthalmologists reported using a sterile adhesive eye drape and 80.7% reported using an eyelid speculum. In all, 95 ophthalmologists (76%) completed the Follow-up Questionnaire. The median number of IVT injections performed per month during the year prior to completing the Follow-up Questionnaire by these ophthalmologists was increased to 35. The results of the Follow-up Questionnaire on administering IVT injections were similar to those of the Baseline Questionnaire. A majority of the ophthalmologists reported applying povidone-iodine (87.4%) before IVT injections, topical antibiotics right after IVT injections (89.5%), and an eyelid speculum (85.3%). The results of this study indicated a good adherence to all aspects of the guidelines on IVT injections. It seemed that ophthalmologists were more experienced in IVT injections after they became a routine treatment procedure.

Can local corticosteroid injection in the retrocalcaneal bursa lead to rupture of the Achilles tendon and the medial head of the gastrocnemius muscle?

PubMed

Turmo-Garuz, A; Rodas, G; Balius, R; Til, L; Miguel-Perez, M; Pedret, C; Del Buono, A; Maffulli, N

2014-08-01

The purpose of the study is to explain the cause-effect relationship in three patients who reported combined ruptures of the Achilles tendon and the gastrosoleus complex 6 months after they had received corticosteroids injections for the management of retrocalcaneal bursitis. Three cryopreserved cadavers (three men, three left legs) were examined to assess the anatomic connection between the retrocalcaneal bursa and the Achilles tendon (distal and anterior fibers). Blue triptan medium contrast was injected. An unexpected connection between the retrocalcaneal bursa and the anterior fibers of the Achilles tendon was found in all instances. Local corticosteroid injection of the retrocalcaneal bursa may help the symptoms of retrocalcanear bursitis, but pose a risk of Achilles tendon rupture. This risk-benefit has to be taken into account when corticosteroid injections are prescribed to professional and high-level athletes.

Pattern of Drug Use and Associated Behaviors Among Female Injecting Drug Users From Northeast India: A Multi-Centric, Cross-Sectional, Comparative Study.

PubMed

Ambekar, Atul; Rao, Ravindra; Agrawal, Alok; Goyal, Shrigopal; Mishra, Ashwani; Kishore, Kunal; Mukherjee, Debashis; Albertin, Cristina

2015-01-01

Studies from developed countries document the presence of injecting drug use among females and significantly higher vulnerabilities and risks as compared with male injecting drug users (IDUs). Studies comparing vulnerabilities and drug use patterns between female and male IDUs are not available for developing countries. The aim of the study was to assess the drug use pattern and related HIV vulnerabilities among female IDUs and compare these findings with those from male IDUs from four states of Northeast India. The study used data collected as part of a nationwide study of drug use pattern and related HIV vulnerabilities among IDUs. Ninety-eight female and 202 male IDUs accessing services from harm reduction sites across the four states of Northeast region of India were chosen through random sampling methodology. Drug use pattern, injecting practices, and knowledge of HIV were assessed using a structured questionnaire. Significantly higher proportion of female IDUs was uneducated, unemployed, reported their occupation as sex workers, and switched to injecting drug use faster as compared with male IDUs. Female IDUs practicing sex work differed significantly from those who did not with respect to frequency of daily injections, choice of drugs injected, and concomitant use of non-injecting drugs. More than half of female IDUs initiated sharing within the first month of injecting. The study demonstrates that female IDUs differ from male IDUs in their drug use pattern, initiation into injection as well as injecting behavior, which would be an important consideration during designing of female-specific interventions.

Pharmacy practice and injection use in community pharmacies in Pokhara city, Western Nepal

PubMed Central

2014-01-01

Background Community pharmacies in Nepal serve as the first point of contact for the public with the health care system and provide many services, including administering injections. However, there is a general lack of documented information on pharmacy practice and injection use in these pharmacies. This study aims to provide information about pharmacy practice in terms of service and drug information sources, and injection use, including the disposal of used injection equipment. Methods A mixed method, cross-sectional study was conducted in 54 community pharmacies in Pokhara city. Data was collected using a pre-tested, semi-structured questionnaire, and also by the direct observation of pharmacy premises. Interviews with pharmacy supervisors (proprietors) were also conducted to obtain additional information about certain points. Results Interviews were carried out with 54 pharmacy supervisors/proprietors (47 males and 7 females) with a mean age and experience of 35.54 and 11.73 years, respectively. Approximately a half of the studied premises were operated by legally recognized pharmaceutical personnel, while the remainder was run by people who did not have the legal authority to operate pharmacies independently. About a quarter of pharmacies were providing services such as the administration of injections, wound dressing, and laboratory and consultation services in addition to medicine dispensing and counseling services. The ‘Current Index of Medical Specialties’ was the most commonly used source for drug information. Almost two-thirds of patients visiting the pharmacies were dispensed medicines without a prescription. Tetanus Toxoid, Depot-Medroxy Progesterone Acetate, and Diclofenac were the most commonly-used/administered injections. Most of the generated waste (including sharps) was disposed of in a municipal dump without adhering to the proper procedures for the disposal of hazardous waste. Conclusions Community pharmacies in Pokhara offer a wide range of services including, but not limited to, drug dispensing, counseling, dressing of wounds, and administering injections. However, the lack of qualified staff and adequate infrastructure may be compromising the quality of the services offered. Therefore, the health authorities should take the necessary measures to upgrade the qualifications of the personnel and to improve the infrastructure for the sake of good pharmacy practice and the safer use of injections. PMID:24774195

Explainers' development of science-learner identities through participation in a community of practice

NASA Astrophysics Data System (ADS)

Richardson, Anne E.

The urgent environmental issues of today require science-literate adults to engage in business and political decisions to create solutions. Despite the need, few adults have the knowledge and skills of science literacy. This doctoral dissertation is an analytical case study examining the science-learner identity development of Exploratorium Field Trip Explainers. Located in San Francisco, CA, the Exploratorium is a museum of science, art, and human perception dedicated to nurturing curiosity and exploration. Data collected included semi-structured interviews with sixteen former Field Trip Explainers, participant observation of the current Field Trip Explainer Program, and review of relevant documentation. Data analysis employed constant comparative analysis, guided by the communities of practice theoretical framework (Wenger, 1998) and the National Research Council's (2009) Six Strands of Science Learning. Findings of this research indicate that Exploratorium Field Trip Explainers participate in a community of practice made up of a diverse group of people that values curiosity and openness to multiple ways of learning. Many participants entered the Field Trip Explainer Program with an understanding of science learning as a rigid process reserved for a select group of people; through participation in the Field Trip Explainer community of practice, participants developed an understanding of science learning as accessible and a part of everyday life. The findings of this case study have implications for research, theory, and practice in informal adult science learning, access of non-dominant groups to science learning, and adult workplace learning in communities of practice.

Large decline in injecting drug use in Amsterdam, 1986-1998: explanatory mechanisms and determinants of injecting transitions.

PubMed

van Ameijden, E J; Coutinho, R A

2001-05-01

To study community wide trends in injecting prevalence and trends in injecting transitions, and determinants. Open cohort study with follow up every four months (Amsterdam Cohort Study). Generalised estimating equations were used for statistical analysis. Amsterdam has adopted a harm reduction approach as drug policy. 996 drug users who were recruited from 1986 to 1998, mainly at methadone programmes, who paid 13620 cohort visits. The prevalence of injecting decreased exponentially (66% to 36% in four to six monthly periods). Selective mortality and migration could maximally explain 33% of this decline. Instead, injecting initiation linearly decreased (4.1% to 0.7% per visit), cessation exponentially increased (10.0% to 17.1%), and relapse linearly decreased (21.3% to 11.8%). Non-injecting cocaine use (mainly pre-cooked, comparable to crack) and heroin use strongly increased. Trends were not attributable to changes in the study sample. Harm reduction, including large scale needle exchange programmes, does not lead to an increase in injecting drug use. The injecting decline seems mainly attributable to ecological factors (for example, drug culture and market). Prevention of injecting is possible and peer-based interventions may be effective. The consequences of the recent upsurge in crack use requires further study.

Over-injection and self-oscillations in an electron vacuum diode

NASA Astrophysics Data System (ADS)

Leopold, J. G.; Siman-Tov, M.; Goldman, A.; Krasik, Ya. E.

2017-07-01

We demonstrate a practical means by which one can inject more than the space-charge limiting current into a vacuum diode. This over-injection causes self-oscillations of the space-charge resulting in an electron beam current modulation at a fixed frequency, a reaction of the system to the Coulomb repulsive forces due to charge accumulation.

[Prevalence of indirect sharing of drug-injecting paraphernalia in Galicia, Madrid, Seville and Valencia [Spain

PubMed

Bravo, María J; Royuela, Luis; Barrio, Gregorio; Rodríguez-Arenas, María A; de la Fuente, Luis

2004-01-01

To study drug-injecting practices, particularly indirect sharing of injecting paraphernalia (ISIP), and sexual risk behavior. We performed a cross-sectional study of 1638 users of needle exchange programs (NEPs). Different types of ISIP were studied: taking diluted drugs in a syringe used by others, placing the needle in a recipient with other used needles, and reusing cleaning liquid previously used by others. The prevalence of injecting with syringes already used by others was 16% in Galicia, 4.7% in Madrid, 17.6% in Seville and 13.2% in Valencia (p < 0.001). With geographical variations, other types of ISIP (Galicia: 32.4%; Madrid: 28.5%; Seville: 42.6%; Valencia: 27.4% -p < 0.001-) were more frequent than injecting with syringes already used by others (Galicia: 32.4%; Madrid: 28.5%; Seville: 42.6%; Valencia: 27.4% -p < 0.001-). The percentage not injecting with syringes used by others but performing ISIP was 21.7%, 25.3%, 28.2% and 18.1% (p < 0.01) respectively. In all geographical areas, sexual risk practices were more prevalent with steady sex partners (68.6%, 72.0%, 77.8%, 72.8% [NS]) than with casual partners (36.6%, 40.9%, 37.9%, 23.9% [NS]). Among injectors with a stable partner, 81.3% in Galicia, 75.9% in Madrid, 86.1% in Seville and 79.7% in Valencia reported that his/her serological status was negative for HIV or was unknown (p < 0.001). ISIP is more prevalent than injection with syringes already used by others. For a substantial percentage of injectors, ISIP is the only risk practice. ISIP and the low use of condoms, particularly with steady partners, could be a contributory factor to the spread of HIV, hepatitis C virus, and hepatitis B virus infection.

Steam injection pilot study in a contaminated fractured limestone (Maine, USA): Modeling and analysis of borehole radar reflection data

USGS Publications Warehouse

Gregoire, C.; Lane, J.W.; Joesten, P.K.

2005-01-01

Steam-enhanced remediation (SER) has been successfully used to remove DNAPL and LNAPL contaminants in porous media. Between August and November 2002, SER was tested in fractured limestone at the former Loring Air Force Base, in Maine, USA. During the SER investigation, the U.S. Geological Survey conducted a series of borehole radar surveys to evaluate the effectiveness of radar methods for monitoring the movement of steam and heat through the fractured limestone. The data were collected before steam injection, 10 days after the beginning of injection, and at the end of injection. In this paper, reflection-mode borehole radar data from wells JBW-7816 and JBW-7817A are presented and discussed. Theoretical modeling was performed to predict the variation of fracture reflectivity owed to heating, to show displacement of water and to assess the effect of SER at the site. Analysis of the radar profile data indicates some variations resulting from heating (increase of continuity of reflectors, attenuation of deeper reflections) but no substantial variation of traveltimes. Spectral content analysis of several individual reflections surrounding the boreholes was used to investigate the replacement of water by steam in the fractures. Observed decrease in radar reflectivity was too small to be explained by a replacement of water by steam, except for two high-amplitude reflectors, which disappeared near the end of the injection; moreover, no change of polarity, consistent with steam replacing water, was observed. The decrease of amplitude was greater for reflectors near well JBW-7817A and is explained by a greater heating around this well.

Probabilistic 3-D time-lapse inversion of magnetotelluric data: application to an enhanced geothermal system

NASA Astrophysics Data System (ADS)

Rosas-Carbajal, M.; Linde, N.; Peacock, J.; Zyserman, F. I.; Kalscheuer, T.; Thiel, S.

2015-12-01

Surface-based monitoring of mass transfer caused by injections and extractions in deep boreholes is crucial to maximize oil, gas and geothermal production. Inductive electromagnetic methods, such as magnetotellurics, are appealing for these applications due to their large penetration depths and sensitivity to changes in fluid conductivity and fracture connectivity. In this work, we propose a 3-D Markov chain Monte Carlo inversion of time-lapse magnetotelluric data to image mass transfer following a saline fluid injection. The inversion estimates the posterior probability density function of the resulting plume, and thereby quantifies model uncertainty. To decrease computation times, we base the parametrization on a reduced Legendre moment decomposition of the plume. A synthetic test shows that our methodology is effective when the electrical resistivity structure prior to the injection is well known. The centre of mass and spread of the plume are well retrieved. We then apply our inversion strategy to an injection experiment in an enhanced geothermal system at Paralana, South Australia, and compare it to a 3-D deterministic time-lapse inversion. The latter retrieves resistivity changes that are more shallow than the actual injection interval, whereas the probabilistic inversion retrieves plumes that are located at the correct depths and oriented in a preferential north-south direction. To explain the time-lapse data, the inversion requires unrealistically large resistivity changes with respect to the base model. We suggest that this is partly explained by unaccounted subsurface heterogeneities in the base model from which time-lapse changes are inferred.

Probabilistic 3-D time-lapse inversion of magnetotelluric data: Application to an enhanced geothermal system

USGS Publications Warehouse

Rosas-Carbajal, Marina; Linde, Nicolas; Peacock, Jared R.; Zyserman, F. I.; Kalscheuer, Thomas; Thiel, Stephan

2015-01-01

Surface-based monitoring of mass transfer caused by injections and extractions in deep boreholes is crucial to maximize oil, gas and geothermal production. Inductive electromagnetic methods, such as magnetotellurics, are appealing for these applications due to their large penetration depths and sensitivity to changes in fluid conductivity and fracture connectivity. In this work, we propose a 3-D Markov chain Monte Carlo inversion of time-lapse magnetotelluric data to image mass transfer following a saline fluid injection. The inversion estimates the posterior probability density function of the resulting plume, and thereby quantifies model uncertainty. To decrease computation times, we base the parametrization on a reduced Legendre moment decomposition of the plume. A synthetic test shows that our methodology is effective when the electrical resistivity structure prior to the injection is well known. The centre of mass and spread of the plume are well retrieved.We then apply our inversion strategy to an injection experiment in an enhanced geothermal system at Paralana, South Australia, and compare it to a 3-D deterministic time-lapse inversion. The latter retrieves resistivity changes that are more shallow than the actual injection interval, whereas the probabilistic inversion retrieves plumes that are located at the correct depths and oriented in a preferential north-south direction. To explain the time-lapse data, the inversion requires unrealistically large resistivity changes with respect to the base model. We suggest that this is partly explained by unaccounted subsurface heterogeneities in the base model from which time-lapse changes are inferred.

Drug injecting and HIV risk among injecting drug users in Hai Phong, Vietnam: a qualitative analysis.

PubMed

Ahmed, Tanvir; Long, Thanh Nguyen; Huong, Phan Thi; Stewart, Donald Edwin

2015-01-29

Hai Phong, located in northern Vietnam, has become a high HIV prevalence province among Injecting Drug Users (IDUs) since the infection shifted from the southern to the northern region of the country. Previous research indicates high levels of drug and sex related risk behaviour especially among younger IDUs. Our recent qualitative research provides a deeper understanding of HIV risk behaviour and highlights views and experiences of IDUs relating to drug injecting and sharing practices. Fifteen IDUs participated in semi-structured interviews conducted in September-October, 2012. Eligible participants were selected from those recruited in a larger scale behavioural research project and identified through screening questions. Interviews were conducted by two local interviewers in Vietnamese and were audiotaped. Ethical procedures, including informed consent and participants' understanding of their right to skip and withdraw, were applied. Transcripts were translated and double checked. The data were categorised and coded according to themes. Thematic analysis was conducted and a qualitative data analysis thematic framework was used. Qualitative analysis highlighted situational circumstances associated with HIV risks among IDUs in Hai Phong and revealed three primary themes: (i) places for injecting, (ii) injecting drugs in small groups, and (iii) sharing practices. Our results showed that shared use of jointly purchased drugs and group injecting were widespread among IDUs without adequate recognition of these as HIV risk behaviours. Frequent police raids generated a constant fear of arrest. As a consequence, the majority preferred either rail lines or isolated public places for injection, while some injected in their own or a friend's home. Price, a heroin crisis, and strong group norms encouraged collective preparation and group injecting. Risk practices were enhanced by a number of factors: the difficulty in getting new syringes, quick withdrawal management, punitive attitudes, fear of arrest/imprisonment, lack of resources, incorrect self-assessment, and risk denial. Some of the IDU participants emphasised self-care attitudes which should be encouraged to minimise HIV transmission risk. The IDUs' experiences in Hai Phong identified through our data broaden our qualitative understanding about the HIV transmission risk among IDUs and emphasize the need to strengthen harm reduction services in Vietnam.

Mycobacterium abscessus post-injection abscesses from extrinsic contamination of multiple-dose bottles of normal saline in a rural clinic.

PubMed

Yuan, Jun; Liu, Yufei; Yang, Zhicong; Cai, Yanshan; Deng, Zhiai; Qin, Pengzhe; Li, Tiegang; Dong, Zhiqiang; Yan, Ziqiang; Zhou, Duanhua; Luo, Huiming; Ma, Huilai; Pang, Xinglin; Fontaine, Robert E

2009-09-01

We investigated an outbreak of gluteal abscesses following intramuscular (IM) injections given at a clinic in rural China to identify the causative agent, source, and method of exposure. We defined a case as an abscess that appeared at the site of an injection given since June 1, 2006. We compared case rates by injection route, medication, and diluents. We reviewed injection practices, and cultured abscesses and environmental sites for mycobacteria. From October through December 2006, 5.8% (n=35) of 604 persons who had received injections at the clinic developed a case. All 35 cases occurred in 184 patients (attack rate=19.0%) who had received IM injections with various drugs that had been mixed with normal saline (NS); risk ratio=infinity; p<0.0001. No cases occurred in the absence of NS exposure. We identified Mycobacterium abscessus from eight abscesses and from the clinic water supply, and observed the inappropriate reuse of a 16-gauge needle left in the rubber septum of 100 ml multiple-dose bottles of NS in the clinic. Fourteen percent (n=527) of the 3887 registered residents of this village had been treated with IM drugs over a three-month period, often for minor illnesses. This outbreak of M. abscessus occurred from exposure to extrinsically contaminated NS through improper injection practices. Frequent treatment of minor illnesses with IM injections of antibiotics was likely an important contributing factor to the size of this outbreak.

Survey of intravitreal injection techniques among retina specialists in Israel

PubMed Central

Segal, Ori; Segal-Trivitz, Yael; Nemet, Arie Y; Geffen, Noa; Nesher, Ronit; Mimouni, Michael

2016-01-01

Purpose The purpose of this study was to describe antivascular endothelial growth factor intravitreal injection techniques of retinal specialists in order to establish a cornerstone for future practice guidelines. Methods All members of the Israeli Retina Society were contacted by email to complete an anonymous, 19-question, Internet-based survey regarding their intravitreal injection techniques. Results Overall, 66% (52/79) completed the survey. Most (98%) do not instruct patients to discontinue anticoagulant therapy and 92% prescribe treatment for patients in the waiting room. Three quarters wear sterile gloves and prepare the patient in the supine position. A majority (71%) use sterile surgical draping. All respondents apply topical analgesics and a majority (69%) measure the distance from the limbus to the injection site. A minority (21%) displace the conjunctiva prior to injection. A majority of the survey participants use a 30-gauge needle and the most common quadrant for injection is superotemporal (33%). Less than half routinely assess postinjection optic nerve perfusion (44%). A majority (92%) apply prophylactic antibiotics immediately after the injection. Conclusion The majority of retina specialists perform intravitreal injections similarly. However, a relatively large minority performs this procedure differently. Due to the extremely low percentage of complications, it seems as though such differences do not increase the risk. However, more evidence-based medicine, a cornerstone for practice guidelines, is required in order to identify the intravitreal injection techniques that combine safety and efficacy while causing as little discomfort to the patients as possible. PMID:27366050

Avoiding errors when administering injectable phenytoin to a child in status epilepticus.

PubMed

Douglass, Callum

2018-02-07

Errors often occur in the prescribing, preparing, administering and monitoring of intravenous phenytoin ( NHS Improvement 2016 ). Following two fatal incidents involving injectable phenytoin, with contributing factors such as wrong weight estimation, a disregard for existing phenytoin prescriptions and confusion about the final concentration, an alert was issued by NHS Improvement in 2016. This article explores research into the use of injectable phenytoin and why adverse events occur when it is used. The article will inform nurses and doctors who work with children in acute settings about the risks associated with using injectable phenytoin and implications for practice on how to negate these risks. Applying this knowledge to nursing practice can result in reduced adverse events, and a safer and more effective care environment. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

[Reasonable and safe application of Shuxuetong injection and intravenous medication's combined application in acute cerebral infarction's therapy].

PubMed

Li, Ming-Quan; Xie, Yan-Ming; Zhao, Jian-Jun

2012-09-01

Shuxuetong injection is a kind of compound injection which is made from traditional Chinese medicine Hirudo and Pheretime, which has a clear anticoagulant, fibrinolytic promoting, blood rheology improving, blood lipids regulating and cell protecting effect, and the injection has been widely used in clinical. Especially, the injection has often been combined with other Chinese and modern medicine in the treatment of cerebral infarction disease. However, there are still many non-standard and irrational aspects in clinical practice so as to make a more reasonable and safer use of Shuxuetong injection. In order to avoid the occurrence of adverse reactions to provide a reference for regulating the use of the injection,the paper systematically expounds the Shuxuetong injection's main clinical problems and the reasonable combination.

Optical microwave interactions in semiconductor devices

NASA Astrophysics Data System (ADS)

Figueroa, L.; Slayman, C. W.; Yen, H. W.

1980-11-01

The results of an extensive characterization of high speed analog modulation of (GaAl)As injection lasers, high speed optical detectors, and mode locking of (GaAl)As injection lasers are presented. Commercial injection lasers were successfully modulated up to 5 GHz. The 5 GHz value represents a practical upper limit to the modulation bandwith of existing commercial lasers. The laser equivalent circuit was characterized and the parasitics were found to play a significant role in the high speed modulation of the injection laser.

When the dragon's awake: a needs assessment of people injecting drugs in a small urban centre.

PubMed

Gustafson, Diana L; Goodyear, Lesley; Keough, Fran

2008-06-01

St. John's, Newfoundland and Labrador is one of the smallest Canadian provincial capitals. Like other Canadian coastal communities, St. John's has been affected by dramatic economic and institutional restructuring that negatively impacted community health. Marginalized populations including people who inject drugs are more negatively affected by the gap between health needs and available services. A mixed methods needs assessment began with a survey and key informant and focus group interviews to determine attitudes, knowledge, and practices of people with current or previous experience injecting drugs. An environmental scan of programmes and services was conducted followed by a community consultation with key stakeholders, community agencies, study participants, the media, and members of the public to share and validate findings, solicit feedback, and gather data about future knowledge transfer activities. This paper examines two of the five barriers to health and health services for people injecting drugs: First, there was a discrepancy amongst people injecting drugs between awareness and use of safer practices, and second, there was a limited formalized network of health and social programmes and services. Accurate and timely information about safer practices, whilst an essential component of a harm reduction approach, is insufficient to reduce the risk of negative health outcomes for people injecting drugs. Funding new programmes and services, although desirable, is not always feasible in small urban centres with limited human and material resources. Recommendations for promoting health, reducing harm, and building local capacity must consider these limitations. Registered nurses are well positioned to provide leadership through collaborative community-based research, education and advocacy.

Viral Tracer Studies Indicate Contamination of Marine Waters by Sewage Disposal Practices in Key Largo, Florida

PubMed Central

Paul, J. H.; Rose, J. B.; Brown, J.; Shinn, E. A.; Miller, S.; Farrah, S. R.

1995-01-01

Domestic wastewater disposal practices in the Florida Keys are primarily limited to on-site disposal systems such as septic tanks, injection wells, and illegal cesspits. Poorly treated sewage is thus released into the highly porous subsurface Key Largo limestone matrix. To investigate the fate and transport of sewage in the subsurface environment and the potential for contamination of marine surface waters, we employed bacteriophages as tracers in a domestic septic system and a simulated injection well in Key Largo, Florida. Transport of bacteriophage (Phi)HSIC-1 from the septic tank to adjacent surface canal waters and outstanding marine waters occurred in as little as 11 and 23 h, respectively. Transport of the Salmonella phage PRD1 from the simulated injection well to a canal adjacent to the injection site occurred in 11.2 h. Estimated rates of migration of viral tracers ranged from 0.57 to 24.2 m/h, over 500-fold greater than flow rates measured previously by subsurface flow meters in similar environments. These results suggest that current on-site disposal practices can lead to contamination of the subsurface and surface marine waters in the Keys. PMID:16535046

FILLERS-Q: an instrument for assessing patient experiences after treatment with facial injectable soft tissue fillers.

PubMed

Sclafani, Anthony P; Pizzi, Laura; Jutkowitz, Eric; Mueller, Nancy; Jung, Matthew

2010-08-01

Patient-reported outcomes data are limited after injectable soft tissue filler treatment. Patient-reported outcome measures (PROMs) are becoming integral to medical practices in other specialties and will become so as well in facial plastic surgery. The obvious differences in types of disorders treated and the outcomes of primary importance seen between general medical/surgical and facial plastic surgery practices make institution of standard outcomes studies difficult in facial plastic surgery. However, understanding the patient's experience and satisfaction with treatment is essential to continue to provide excellent care to facial aesthetic patients. This article describes use of a new survey instrument, Facial Injectables: Longevity, Late and Early Reactions and Satisfaction Questionnaire (FILLERS-Q), in assessing patient response to facial injections of soft tissue fillers. FILLERS-Q is a 43-item questionnaire that captures patient demographics (4 items), patient satisfaction with treatment (10 items), procedure-related events (3 to 7 items), impact on relationships (9 to 15 items), and economic considerations related to dermal filler treatment (3 to 7 items). The results provide a "snapshot" of patients treated in an individual surgeon's practice. (c) Thieme Medical Publishers.

Viral tracer studies indicate contamination of marine waters by sewage disposal practices in key largo, Florida.

PubMed

Paul, J H; Rose, J B; Brown, J; Shinn, E A; Miller, S; Farrah, S R

1995-06-01

Domestic wastewater disposal practices in the Florida Keys are primarily limited to on-site disposal systems such as septic tanks, injection wells, and illegal cesspits. Poorly treated sewage is thus released into the highly porous subsurface Key Largo limestone matrix. To investigate the fate and transport of sewage in the subsurface environment and the potential for contamination of marine surface waters, we employed bacteriophages as tracers in a domestic septic system and a simulated injection well in Key Largo, Florida. Transport of bacteriophage (Phi)HSIC-1 from the septic tank to adjacent surface canal waters and outstanding marine waters occurred in as little as 11 and 23 h, respectively. Transport of the Salmonella phage PRD1 from the simulated injection well to a canal adjacent to the injection site occurred in 11.2 h. Estimated rates of migration of viral tracers ranged from 0.57 to 24.2 m/h, over 500-fold greater than flow rates measured previously by subsurface flow meters in similar environments. These results suggest that current on-site disposal practices can lead to contamination of the subsurface and surface marine waters in the Keys.

Association between Pregnancy and Active Injection Drug Use and Sex Work among Women Injection Drug Users in Saint Petersburg, Russia.

PubMed

Girchenko, P; Ompad, D C; Bikmukhametov, D; Gensburg, L

2015-06-01

Widespread use of unsafe sexual practices among women injecting drugs both practicing and not practicing sex work leads to high levels of unplanned pregnancies in this population. The goal of this study was to investigate the association between pregnancy and active drug use and sex work. Data were collected using a convenience sample of 500 women in Saint Petersburg, Russia, in 2013. All women had recent experience of drug use, of which 200 were pregnant at the time of the study. The study consisted of a structured interview followed by a rapid HIV test. Pregnancy was protective against both active drug use and sex work. For HIV-positive women, these associations were stronger than for HIV-negative women: drug use prevalence ratio (PR) was 0.59 vs 0.85; for sex work, the PRs were 0.36 vs 0.64. Higher levels of education were associated with a lower prevalence ratio for active drug use and sex work in all models. Having children was not associated with active drug use or sex work. Pregnancy might be an optimal time for conducting interventions aimed at cessation of drug use and sex work among women injecting drugs.

Patterns of Use of Peripheral Nerve Blocks and Trigger Point Injections for Pediatric Headache: Results of a survey of the American Headache Society Pediatric & Adolescent Section

PubMed Central

Szperka, Christina L.; Gelfand, Amy A.; Hershey, Andrew D.

2016-01-01

Objective To describe current patterns of use of nerve blocks and trigger point injections for treatment of pediatric headache. Background Peripheral nerve blocks are often used to treat headaches in adults and children, but the available studies and practice data from adult headache specialists have shown wide variability in diagnostic indications, sites injected, and medication(s) used. The purpose of this study was to describe current practice patterns in the use of nerve blocks and trigger point injections for pediatric headache disorders. Methods A survey was created in REDCap, and sent via email to the 82 members of the Pediatric & Adolescent Section of the American Headache Society in June 2015. The survey queried about current practice and use of nerve blocks, as well as respondents’ opinions regarding gaps in the evidence for use of nerve blocks in this patient population. Results Forty-one complete, 5 incomplete, and 3 duplicate responses were submitted (response rate complete 50%). Seventy-eight percent of the respondents identified their primary specialty as Child Neurology, and 51% were certified in headache medicine. Twenty-six (63%) respondents perform nerve blocks themselves, and 7 (17%) refer patients to another provider for nerve blocks. Chronic migraine with status migrainosus was the most common indication for nerve blocks (82%), though occipital neuralgia (79%), status migrainosus (73%), chronic migraine without flare (70%), post-traumatic headache (70%), and new daily persistent headache (67%) were also common indications. The most commonly selected clinically meaningful response for status migrainosus was ≥50% reduction in severity, while for chronic migraine this was a ≥50% decrease in frequency at 4 weeks. Respondents inject the following locations: 100% inject the greater occipital nerve, 69% lesser occipital nerve, 50% supraorbital, 46% trigger point injections, 42% auriculotemporal, and 34% supratrochlear. All respondents used local anesthetic, while 12 (46%) also use corticosteroid (8 bupivacaine only, 4 each lidocaine + bupivacaine, lidocaine + corticosteroid, bupivacaine + corticosteroid, lidocaine + bupivacaine + corticosteroid, and 2 lidocaine only). Conclusion Despite limited evidence, nerve blocks are commonly used by pediatric headache specialists. There is considerable variability among clinicians as to injection site(s) and medication selection, indicating a substantial gap in the literature to guide practice, and supporting the need for further research in this area. PMID:27731894

Cavitation Inside High-Pressure Optically Transparent Fuel Injector Nozzles

NASA Astrophysics Data System (ADS)

Falgout, Z.; Linne, M.

2015-12-01

Nozzle-orifice flow and cavitation have an important effect on primary breakup of sprays. For this reason, a number of studies in recent years have used injectors with optically transparent nozzles so that orifice flow cavitation can be examined directly. Many of these studies use injection pressures scaled down from realistic injection pressures used in modern fuel injectors, and so the geometry must be scaled up so that the Reynolds number can be matched with the industrial applications of interest. A relatively small number of studies have shown results at or near the injection pressures used in real systems. Unfortunately, neither the specifics of the design of the optical nozzle nor the design methodology used is explained in detail in these papers. Here, a methodology demonstrating how to prevent failure of a finished design made from commonly used optically transparent materials will be explained in detail, and a description of a new design for transparent nozzles which minimizes size and cost will be shown. The design methodology combines Finite Element Analysis with relevant materials science to evaluate the potential for failure of the finished assembly. Finally, test results imaging a cavitating flow at elevated pressures are presented.

Novel design for transparent high-pressure fuel injector nozzles.

PubMed

Falgout, Z; Linne, M

2016-08-01

The efficiency and emissions of internal combustion (IC) engines are closely tied to the formation of the combustible air-fuel mixture. Direct-injection engines have become more common due to their increased practical flexibility and efficiency, and sprays dominate mixture formation in these engines. Spray formation, or rather the transition from a cylindrical liquid jet to a field of isolated droplets, is not completely understood. However, it is known that nozzle orifice flow and cavitation have an important effect on the formation of fuel injector sprays, even if the exact details of this effect remain unknown. A number of studies in recent years have used injectors with optically transparent nozzles (OTN) to allow observation of the nozzle orifice flow. Our goal in this work is to design various OTN concepts that mimic the flow inside commercial injector nozzles, at realistic fuel pressures, and yet still allow access to the very near nozzle region of the spray so that interior flow structure can be correlated with primary breakup dynamics. This goal has not been achieved until now because interior structures can be very complex, and the most appropriate optical materials are brittle and easily fractured by realistic fuel pressures. An OTN design that achieves realistic injection pressures and grants visual access to the interior flow and spray formation will be explained in detail. The design uses an acrylic nozzle, which is ideal for imaging the interior flow. This nozzle is supported from the outside with sapphire clamps, which reduces tensile stresses in the nozzle and increases the nozzle's injection pressure capacity. An ensemble of nozzles were mechanically tested to prove this design concept.

Comparing risk environments for HIV among people who inject drugs from three cities in Northern Mexico.

PubMed

Ospina-Escobar, Angelica; Magis-Rodríguez, Carlos; Juárez, Fatima; Werb, Dan; Bautista Arredondo, Sergio; Carreón, Rubén; Ramos, María Elena; Strathdee, Steffanie

2018-05-18

A large body of research has investigated the rise of injection drug use and HIV transmission in Tijuana and Ciudad Juarez (CJ). However, little is known about the dynamics of injecting in Hermosillo. This study compares drug-related behaviors and risk environment for HIV of people who inject drugs (PWID) across Tijuana, CJ, and Hermosillo to identify factors that could explain differences in HIV prevalence. Data from Tijuana belong to a prospective study (El Cuete IV). Data from Hermosillo and Ciudad Juarez belong to a cross-sectional study. Both studies collected data in places where PWID spend time. All participants completed quantitative behavioral and serological testing for HIV. Datasets were merged using only comparable variables. Descriptive statistics tests were used to compare sociodemographic and behavioral characteristics of people who inject drugs PWID sampled in each city. A logistic regression model was built to identify factors independently associated with the likelihood of reporting receptive syringe sharing in the past 6 months. A total of 1494 PWID provided data between March 2011 and May 2012. HIV prevalence differed significantly between participants in Tijuana (4.2%), CJ (7.7%), and Hermosillo (5.2%; p < 0.05). PWID from Hermosillo reported better living conditions, less frequency of drug injection, and lower prevalence of syringe sharing (p < 0.01). PWID from CJ reported a higher prevalence of syringe sharing and confiscation by police (p < 0.01). In a multivariable logistic regression model, living in Hermosillo compared to Tijuana (adjusted odds ratio [AOR] = 0.42, 95% confidence interval [CI] 0.29-0.61) and being female (AOR = 0.61, 95% CI 0.45-0.83) were protective against syringe sharing. Having used crystal meth (AOR = 1.62, 95% CI 1.24-2.13, p = 0.001), having experienced syringe confiscation by police in the last 6 months (AOR = 1.78, 95% CI 1.34-2.40), and lower perception of syringe availability (AOR = 2.15, 95% CI 1.59-2.91) were significantly associated with syringe sharing (p < 0.05). Differences in HIV prevalence across cities reflect mainly differences in risk environments experienced by PWID, shaped by police practices, access to injection equipment, and dynamics of drug markets. Findings highlight the importance of ensuring sterile syringe availability through harm reduction services and a human rights approach to drug harms in northern Mexico and to generate better understanding of local dynamics and contexts of drug use for designing proper harm reduction programs.

Effect of aminophylline on tryptophan and other aromatic amino acids in plasma, brain and other tissues and on brain 5-hydroxytryptamine metabolism.

PubMed

Curzon, G; Fernando, J C

1976-12-01

1 Aminophylline and other methylxanthines increase brain tryptophan and hence 5-hydroxytryptamine turnover. The mechanism of this effect of aminophylline was investigated. 2 At lower doses (greater than 100 mg/kg i.p.) the brain tryptophan increase could be explained by the lipolytic action of the drug, i.e. increased plasma unesterified fatty acid freeing plasma tryptophan from protein binding so that it became available to the brain. 3 Plasma unesterified fatty acid did not increase when aminophylline (109 mg/kg i.p.) was given to nicotinamide-treated rats but as both plasma total and free tryptophan rose, a tryptophan increase in the brain still occurred. 4 The rise in brain tryptophan concentration following the injection of a higher dose of the drug (150 mg/kg i.p.) could no longer be explained by a rise of plasma free tryptophan as the ratio of brain tryptophan to plasma free tryptophan rose considerably. Plasma total tryptophan fell and the plasma insulin concentration rose. 5 The increase of brain tryptophan concentration after injection of 150 mg/kg aminophylline appeared specific for this amino acid as brain tyrosine and phenyllanine did not increase. However as their plasma concentrations fell the brain/plasma ratio for all three amino acids rose. 6 The higher dose of aminophylline increased the muscle concentration of tryptophan but that of tyrosine fell and that of phenylalanine remained unaltered. The liver concentrations were not affected. 7 The aminophylline-induced increase of the ratio of brain tryptophan of plasma free tryptophan no longer occurred when the drug was given to animals injected with the beta-adrenoreceptor blocking agent propranolol or the diabetogenic agent streptozotocin. 8 The changes in brain tryptophan upon aminophylline injection may be explained by (a) increased availability of plasma tryptophan to the brain due to increased lipolysis and (b) increased effectiveness of uptake of tryptophan by the brain due to increased insulin secretion.

The celebrated écorchés of honoré Fragonard, part 2: The details of the technique used by Fragonard.

PubMed

Degueurce, Christophe; vo Duy, Sung; Bleton, Jean; Hugon, Paulette; Cadot, Laure; Tchapla, Alain; Adds, Philip

2010-04-01

It is remarkable that the famous écorchés of Honoré Fragonard have survived the centuries to reach us today. Studies carried out by several teams have established details of the technique used by Fragonard that help to explain their longevity. The injection of the vessels was achieved by means of a mixture of mutton tallow and pine resin diluted in essence of turpentine and essential oils. This gave Fragonard a very high success rate. Above all, he did not add pigments to his mixture while injecting the veins, and this facilitated the procedure. The vessels were painted after preservation to give them the vivid colors that we can still see today. Another detail that explains their exceptional conservation is that the varnish used by Fragonard was composed of Venice turpentine, made from larch resin and known to repel insects. 2010 Wiley-Liss, Inc.

Hepatitis C infection and other drug-related harms among inpatients who injected drugs in Turkey.

PubMed

Alaei, A; Alaei, K; Waye, K; Tracy, M; Nalbandyan, M; Mutlu, E; Cetin, M K

2017-06-01

Hepatitis C virus (HCV) is easily spread among those who share drug injection equipment. Due to the ease of contraction and growing prevalence of HCV in Eastern Europe, the aims of this study focused on describing risky injection practices as well as the prevalence of HCV, HIV and hepatitis B virus (HBV) among people who inject drugs (PWID) who were admitted to public and private drug treatment centres in Turkey from 2012 to 2013. Other aims included identifying correlates of needle sharing and HCV infection. Of the 4694 inpatients who ever injected drugs and the 3914 who injected in the past 30 days, nearly all (98%) reported heroin as their drug of choice, the vast majority reported ever sharing a needle (73.4% and 79.3%), and the mean age at first injection was 23 years. Of current PWID, 51.9% were HCV-positive, 5.9% were HBV-positive and only 0.34% of lifetime PWID were HIV-positive. Predictors of increased needle sharing include younger age, being unemployed, having lesser education and reporting heroin as a drug of choice. Significant predictors of HCV infection included being 40 years or older, receiving treatment in the Mediterranean region of Turkey, reporting heroin as a primary substance, a longer duration of drug use and sharing needles. With this information, it is essential to improve access to clean injection equipment in Turkey, to focus on improving education on clean injection practices and to enhance efforts in testing and treating HCV-positive PWID. © 2016 John Wiley & Sons Ltd.

Radiesse: Advanced Techniques and Applications for a Unique and Versatile Implant.

PubMed

Eviatar, Joseph; Lo, Christopher; Kirszrot, James

2015-11-01

Radiesse is a well-tolerated facial injectable with unique filling and lifting capabilities. Although initially approved for facial volumizing in HIV-related lipodystrophy patients, it quickly gained wide acceptance for aesthetic facial rejuvenation. In the USA, the Food and Drug Administration has approved several new indications for its use. This synopsis presents the experience and injection techniques currently favored by the primary author after many years of use in thousands of patients. The anecdotal practice of an experienced injector is presented along with the current Food and Drug Administration-approved standards of Radiesse injection. Radiesse has many on- and off-label applications that can be thoughtfully incorporated into clinical practice. Its unique chemical composition allows for immediate lifting and filling with long-term collagen stimulation. The product can be reconstituted to increase its versatility and minimize adverse events. Injections can be performed in the supraperiosteal space and the subcutaneous layer and are best administered in small, calculated doses to prevent nodules or vascular occlusion. Various techniques for Radiesse injection in specific areas are discussed in detail. Radiesse is a versatile injectable implant and a valuable tool for short- and long-term cosmetic and reconstructive treatments. In addition to various off-label uses, this injectable is often used in conjunction with botox, other injectables, collagen stimulators and tightening devices. A customized reconstitution of product increases its versatility for natural appearing and long lasting results that are both economical and effective for full facial rejuvenation.

The Role of Injectables in Aesthetic Surgery: Financial Implications.

PubMed

Richards, Bryson G; Schleicher, William F; D'Souza, Gehaan F; Isakov, Raymond; Zins, James E

2017-10-01

The plastic surgeon competes with both core and noncore physicians and surgeons for traditional cosmetic procedures. In 2007, the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) joined efforts to form a Cosmetic Medicine Task Force to further analyze this trend. Our objective is to document and quantify the patient capture and total collections generated in a single surgeon's practice exclusive from Botulinum Toxin A and filler injections over a 10-year period. We subsequently identified the effect and importance that fillers and Botulinum Toxin A have on an active cosmetic practice. A retrospective chart review of all male and female patients who received Botulinum Toxin A or soft tissue filler injections (noninvasive aesthetic treatment) in a single surgeons practice from January 2004 to December 2013 was undertaken. Only those patients new to the practice and who were exclusively seeking out Botulinum Toxin A or fillers were included in the study. Chart review then identified which of these selected patients ultimately underwent invasive aesthetic surgery during this 10-year period. Noninvasive and invasive aesthetic surgery total collections were calculated using billing records. From January 2004 to December 2013, 375 patients entered the senior surgeon's practice specifically requesting and receiving noninvasive aesthetic treatments. Of these 375 patients, 59 patients (15.7%) subsequently underwent an aesthetic surgery procedure at an average of 19 months following initial noninvasive aesthetic treatment. Of these 375 patients, 369 were female and 6 were male. The most common initial invasive aesthetic procedure performed after injectable treatment included 22 facelifts (18.5%), 21 upper eyelid blepharoplasties (17.6%), and 15 endoscopic brow lifts (12.6%). Total collections from noninvasive aesthetic sessions and invasive surgery combined represented US$762,470 over this 10-year span. This represented US$524,771 and US$396,166 in total collections for injectables and surgery respectively. Noninvasive aesthetic surgery is a critical part of a plastic surgery practice. A measurable and significant number of patients who sought out a single plastic surgeon exclusively for noninvasive treatment ultimately underwent traditional invasive cosmetic surgical procedures. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

Neutralization of beam-emitting spacecraft by plasma injection

NASA Technical Reports Server (NTRS)

Sasaki, S.; Kawashima, N.; Kuriki, K.; Yanagisawa, M.; Obayashi, T.; Roberts, W. T.; Reasoner, D. L.; Taylor, W. W. L.

1987-01-01

An impulsive plasma injection has been used to study charge neutralization of the Space Shuttle Orbiter while it was emitting an electron beam into space. This investigation was performed by Space Experiments with Particle Accelerators on Spacelab-1. A plasma consisting of 10 to the 19th argon ion-electron pairs was injected into space for 1 ms while an electron beam was also being emitted into space. The electron beam energy and current were as high as 5 keV and 300 mA. While the orbiter potential was positive before the plasma injection and began to decrease during the plasma injection, it was near zero for 6 to 20 ms after the plasma injection. The recovery time to the initial level of charging varied from 10 to 100 ms. In a laboratory test in a large space chamber using the same flight hardware, the neutralization time was 8-17 ms and the recovery time was 11-20 ms. The long duration of the neutralization effect in space can be explained by a model of diffusion of the cold plasma which is produced near the Orbiter by charge exchange between the neutral argon atoms and the energetic argon ions during plasma injection.

The influence of the perceived consequences of refusing to share injection equipment among injection drug users: Balancing competing risks

PubMed Central

Wagner, Karla D.; Lankenau, Stephen E.; Palinkas, Lawrence A.; Richardson, Jean L.; Chou, Chih-Ping; Unger, Jennifer B.

2011-01-01

Injection drug users (IDUs) are at risk for HIV and other bloodborne pathogens through receptive syringe sharing (RSS) and receptive paraphernalia sharing (RPS). Research into the influence of the perceived risk of HIV infection on injection risk behavior has yielded mixed findings. One explanation may be that consequences other than HIV infection are considered when IDUs are faced with decisions about whether or not to share equipment. We investigated the perceived consequences of refusing to share injection equipment among 187 IDUs recruited from a large syringe exchange program in Los Angeles, California, assessed their influence on RSS and RPS, and evaluated gender differences. Two sub-scales of perceived consequences were identified: structural/external consequences and social/internal consequences. In multiple linear regression, the perceived social/internal consequences of refusing to share were associated with both RSS and RPS, after controlling for other psychosocial constructs and demographic variables. Few statistically significant gender differences emerged. Assessing the consequences of refusing to share injection equipment may help explain persistent injection risk behavior, and may provide promising targets for comprehensive intervention efforts designed to address both individual and structural risk factors. PMID:21498004

Asymmetric injection and distribution of space charges in propylene carbonate under impulse voltage

NASA Astrophysics Data System (ADS)

Sima, Wenxia; Chen, Qiulin; Sun, Potao; Yang, Ming; Guo, Hongda; Ye, Lian

2018-05-01

Space charge can distort the electric field in high voltage stressed liquid dielectrics and lead to breakdown. Observing the evolution of space charge in real time and determining the influencing factors are of considerable significance. The spatio-temporal evolution of space charge in propylene carbonate, which is very complex under impulse voltage, was measured in this study through the time-continuous Kerr electro-optic field mapping measurement. We found that the injection charge from a brass electrode displayed an asymmetric effect; that is, the negative charge injection near the cathode lags behind the positive charge injection near the anode. Physical mechanisms, including charge generation and drift, are analyzed, and a voltage-dependent saturated drift rectification model was established to explain the interesting phenomena. Mutual validation of models and our measurement data indicated that a barrier layer, which is similar to metal-semiconductor contact, was formed in the contact interface between the electrode and propylene carbonate and played an important role in the space charge injection.

Kerr electro-optic field mapping study of the effect of charge injection on the impulse breakdown strength of transformer oil

NASA Astrophysics Data System (ADS)

Zhang, X.; Zahn, M.

2013-10-01

The smart use of charge injection to improve breakdown strength in transformer oil is demonstrated in this paper. Hypothetically, bipolar homo-charge injection with reduced electric field at both electrodes may allow higher voltage operation without insulation failure, since electrical breakdown usually initiates at the electrode-dielectric interfaces. To find experimental evidence, the applicability and limitation of the hypothesis is first analyzed. Impulse breakdown tests and Kerr electro-optic field mapping measurements are then conducted with different combinations of parallel-plate aluminum and brass electrodes stressed by millisecond duration impulse. It is found that the breakdown voltage of brass anode and aluminum cathode is ˜50% higher than that of aluminum anode and brass cathode. This can be explained by charge injection patterns from Kerr measurements under a lower voltage, where aluminum and brass electrodes inject negative and positive charges, respectively. This work provides a feasible approach to investigating the effect of electrode material on breakdown strength.

A pore-scale numerical method for simulating low-salinity waterflooding in porous media

NASA Astrophysics Data System (ADS)

Jiang, F.; Yang, J.; Tsuji, T.

2017-12-01

Low-salinity (LS)water injection has been attracting attention as a practical oil recovery technique because of its low cost and high efficiency in recent years. Many researchers conducted laboratory and observed its significant benefits compared to conventional high-salinity (HS) waterflooding. However, the fundamental mechanisms remain poorly understood. Different mechanisms such as fine migration, wettability alteration have been proposed to explain this low-salinity effect. Here, we aim to focus on investigating the effect of wettability alteration on the recovery efficiency. For this purpose, we proposed a pore scale numerical method to quantitatively evaluate the impact of salinity concentration on the sweep efficiency. We first developed the pore scale model by coupling the convection-diffusion model for tracking the concentration change and the lattice Boltzmann model for two-phase flow behavior, and assuming that a reduction of water salinity leads to localised wettability alteration. The model is then validated by simulating the contact angle change of an oil droplet attached to a clay substrate. Finally, the method was applied on a real rock geometry extracted from the micro-CT images of Berea sandstone. The results indicate that the initial wettability state of the system and the extent of wettability alteration are important in predicting the improvement of oil recovery due to LS brine injection. This work was supported by JSPS KAKENHI Grant Numbers 16K18331.

Human and bovine spinal disc mechanics subsequent to trypsin injection.

PubMed

Alsup, Jeremy; Bishop, Timothy; Eggett, Dennis; Bowden, Anton E

2017-10-01

To investigate the biomechanical effects of injections of a protease on the characteristics of bovine coccygeal and human lumbar disc motion segments. Mechanics of treated tissues were measured immediately after injection and 3 h after injection. Motion segments underwent axial rotation and flexion-extension loading. Stiffness and neutral zone parameters experienced significant changes over time, with bovine tissues more strongly affected than human cadaver tissues. This was true in both axial rotation and flexion-extension. The treatment type significantly affected the neutral zone measurements in axial rotation. Hysteresis parameters were impacted by control injections. The extrapolation of bovine coccygeal motion testing results to human lumbar disc mechanics is not yet practical. The injected treatment may have a smaller impact on disc mechanics than time in testing. Viscoelasticity of human lumbar discs may be impacted by any damage to the annulus fibrosis induced by needlestick. Preclinical testing of novel spinal devices is essential to the design validation and regulatory processes, but current testing techniques rely on cadaveric testing of primarily older spines with essentially random amounts of disc degeneration. The present work investigates the viability of using trypsin injections to create a more uniform preclinical model of disc degeneration from a mechanics perspective, for the purpose of testing spinal devices. Such a model would facilitate translation of new spinal technologies to clinical practice.

Spatial and temporal distribution of trunk-injected imidacloprid in apple tree canopies.

PubMed

Aćimović, Srđan G; VanWoerkom, Anthony H; Reeb, Pablo D; Vandervoort, Christine; Garavaglia, Thomas; Cregg, Bert M; Wise, John C

2014-11-01

Pesticide use in orchards creates drift-driven pesticide losses which contaminate the environment. Trunk injection of pesticides as a target-precise delivery system could greatly reduce pesticide losses. However, pesticide efficiency after trunk injection is associated with the underinvestigated spatial and temporal distribution of the pesticide within the tree crown. This study quantified the spatial and temporal distribution of trunk-injected imidacloprid within apple crowns after trunk injection using one, two, four or eight injection ports per tree. The spatial uniformity of imidacloprid distribution in apple crowns significantly increased with more injection ports. Four ports allowed uniform spatial distribution of imidacloprid in the crown. Uniform and non-uniform spatial distributions were established early and lasted throughout the experiment. The temporal distribution of imidacloprid was significantly non-uniform. Upper and lower crown positions did not significantly differ in compound concentration. Crown concentration patterns indicated that imidacloprid transport in the trunk occurred through radial diffusion and vertical uptake with a spiral pattern. By showing where and when a trunk-injected compound is distributed in the apple tree canopy, this study addresses a key knowledge gap in terms of explaining the efficiency of the compound in the crown. These findings allow the improvement of target-precise pesticide delivery for more sustainable tree-based agriculture. © 2014 Society of Chemical Industry.

Injecting drug use: Gendered risk.

PubMed

Zahnow, Renee; Winstock, Adam R; Maier, Larissa J; Levy, Jay; Ferris, Jason

2018-06-01

Research demonstrates gender related differences in drug-use practices and risk behaviours. Females' structural vulnerability stemming from traditional gender roles and gender-power relations may enhance their propensity to experience injecting related risk. In this paper we explore gender differences in injection practices at the initiation event, during the first year of injecting and in the most recent 12-month period, to inform more effective harm reduction strategies. Data used in this study were drawn from the Global Drug Survey 2015. The study employs chi-square and logistic regression to assess gender differences in injection behaviours in a sample of current injectors residing in six global regions: North-West Europe; Southern Eastern Europe; North America. South America and Oceania. Females were more likely than males to report being injected by an intimate partner at initiation (OR = 4.4, 95%CI: 2.2-8.8), during the first year of injecting (OR = 4.8, 95% CI: 2.4-9.3) and in the most recent 12-month period (OR = 2.5, 95%CI: 1.0-6.2). Females reported greater difficulties accessing sterile equipment (X 2 (2,N = 453) = 8.2, p = 0.02) and were more likely to share injecting equipment than males (X 2 (1,N = 463) = 3.9, p = 0.05). Our findings highlight females' continued dependence on their intimate partner to administer the injection into the first year of their injecting career. Females remained more likely than males to rely on intimate partners for injection during the most recent 12-month period. Females report greater difficulties in sourcing sterile equipment and are more likely to share injecting equipment. We suggest that these findings reflect the broader social structure in which females are disempowered through traditional gender roles and the lack of gender appropriate harm reduction services. Copyright © 2018 Elsevier B.V. All rights reserved.

Dispersion-convolution model for simulating peaks in a flow injection system.

PubMed

Pai, Su-Cheng; Lai, Yee-Hwong; Chiao, Ling-Yun; Yu, Tiing

2007-01-12

A dispersion-convolution model is proposed for simulating peak shapes in a single-line flow injection system. It is based on the assumption that an injected sample plug is expanded due to a "bulk" dispersion mechanism along the length coordinate, and that after traveling over a distance or a period of time, the sample zone will develop into a Gaussian-like distribution. This spatial pattern is further transformed to a temporal coordinate by a convolution process, and finally a temporal peak image is generated. The feasibility of the proposed model has been examined by experiments with various coil lengths, sample sizes and pumping rates. An empirical dispersion coefficient (D*) can be estimated by using the observed peak position, height and area (tp*, h* and At*) from a recorder. An empirical temporal shift (Phi*) can be further approximated by Phi*=D*/u2, which becomes an important parameter in the restoration of experimental peaks. Also, the dispersion coefficient can be expressed as a second-order polynomial function of the pumping rate Q, for which D*(Q)=delta0+delta1Q+delta2Q2. The optimal dispersion occurs at a pumping rate of Qopt=sqrt[delta0/delta2]. This explains the interesting "Nike-swoosh" relationship between the peak height and pumping rate. The excellent coherence of theoretical and experimental peak shapes confirms that the temporal distortion effect is the dominating reason to explain the peak asymmetry in flow injection analysis.

Syringe disposal among injection drug users in Harlem and the Bronx during the New York State Expanded Syringe Access Demonstration Program.

PubMed

Cleland, Charles M; Deren, Sherry; Fuller, Crystal M; Blaney, Shannon; McMahon, James M; Tortu, Stephanie; Des Jarlais, Don C; Vlahov, David

2007-04-01

Effective January 1, 2001, New York State enacted the Expanded Syringe Access Demonstration Program (ESAP), allowing syringes to be sold in pharmacies without a prescription or dispensed through doctors, hospitals, and clinics to adults. A concern in the assessment of ESAP is its effects on syringe disposal practices. Syringe use data regarding the last injection episode were combined from three projects (N = 1,030) recruiting injection drug users. Disposal of syringes by methods known to be safe decreased significantly over time after the implementation of ESAP. Syringes obtained either from syringe exchange programs or ESAP sources were more likely to be disposed of safely than syringes obtained from other sources. Efforts to enlist pharmacists and others involved in ESAP implementation to encourage safe disposal are needed. More detailed information on disposal practices is needed to capture the continuum from least to most safe practices and variation within individuals.

Trans-Corneal Subretinal Injection in Mice and Its Effect on the Function and Morphology of the Retina

PubMed Central

He, Ying; Zhang, Yangyang; Han, Juanjuan; Zhu, Ping; Zhang, Yuxin; Zheng, Qinxiang; Li, Xia; Zhao, Chen; Pang, Jijing

2015-01-01

Purpose To introduce a practical method of subretinal injection in mice and evaluate injection-induced retinal detachment (RD) and damage using a dynamic imaging system, electrophysiology, and histology. Methods After full dilation of a 2-month-old C57BL/6J mouse pupil, the cornea near the limbus was punctured with a 30 ½-gague disposable beveled needle. A 33 ½-gauge blunt needle was inserted through the corneal perforation into the anterior chamber, avoiding the lens before going deeper into the vitreous cavity, and penetrating the inner retina to reach the subretinal space. The mice were divided into four groups: in group 1, about 80–100% of the retina was filled with subretinally injected solution; in group 2, approximately 50–70% of the retina was filled with injected solution; in group 3, the procedures were stopped before solution injection; and non-injected eyes were used as the negative control in group 4. An optical coherence tomography (OCT) imaging system was used to monitor retinal reattachment during the first three days following the injections. Histological and functional changes were examined by light microscopy and electroretinography (ERG) at five weeks post-injection. Results After a short-term training, a 70% success rate with 50% or more coverage (i.e., retinal blebs occupied 50% or more retinal area and filled with the injected solution) with minimal injection-related damages can be achieved. Bleb formation was associated with retinal detachment (RD) between the neuroretina and the retinal pigment epithelium (RPE) layer. Partial RD could be observed at post-injection day 1, and by day 2 most of the retina had reattached. At 5 weeks post-injection, compared to uninjected control group 4, the b-wave amplitudes of ERG decreased 22% in group 1, 16% in group 2, and 7% in group 3; the b-wave amplitudes were statistically different between the uninjected group and the groups with either 50–70% or 80–100% coverage. The subretinal injection-induced RD reattached and became stable at five weeks post-injection, although some photoreceptor damage could still be observed in and around the injection sites, especially in 80–100% coverage group. Conclusions Trans-corneal subretinal injection is effective and practical, although subretinal injection-related damages can cause some morphological and functional loss. PMID:26317758

Editorial Commentary: Big Data Suggest That Because of a Significant Increased Risk of Postoperative Infection, Steroid Injection Is Not Recommended After Ankle Arthroscopy.

PubMed

Brand, Jefferson C

2016-02-01

A recent study addressing infection rate after intra-articular steroid injection during ankle arthroscopy gives pause to this practice, with an odds ratio of 2.2 in the entire population that was injected with a steroid simultaneously with ankle arthroscopy compared with patients who did not receive an ankle injection. Big data, used in the study upon which the Editor comments here, suggest that because of a significant increased risk of postoperative infection, steroid injection is not recommended after ankle arthroscopy. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Acoustic emission of rock mass under the constant-rate fluid injection

NASA Astrophysics Data System (ADS)

Shadrin Klishin, AV, VI

2018-03-01

The authors study acoustic emission in coal bed and difficult-to-cave roof under injection of fluid by pumps at a constant rate. The functional connection between the roof hydrofracture length and the total number of AE pulses is validated, it is also found that the coal bed hydroloosening time, injection rate and time behavior of acoustic emission activity depend on the fluid injection volume required until the fluid breakout in a roadway through growing fractures. In the formulas offered for the practical application, integral parameters that characterize permeability and porosity of rock mass and process parameters of the technology are found during test injection.

Design and Checking Analysis of Injection Mold for a Plastic Cup

NASA Astrophysics Data System (ADS)

Li, Xuebing

2018-03-01

A special injection mold was designed for the structural characteristics of a plastic cup part. The mold was simulated by Moldflow software and verified by calculating the stripping force, the pulling force and the clamping force of the mold so that to determine the appropriate injection parameters. It has been proved that the injection mold is effective and practical in the actual producing and can meet the quality requirements during the course of using it, which solved some problems for injection molding of this kind of parts and can provide some reference for the production of other products in the same industry.

Injection Drug Users' Perceived Barriers to Using Self-Initiated Harm Reduction Strategies.

PubMed

Bonar, Erin E; Rosenberg, Harold

2014-08-01

Increasing the frequency with which injecting drug users (IDUs) engage in self-initiated harm reduction strategies could improve their health, but few investigations have examined IDUs' perceived barriers to engaging in these behaviors. We interviewed 90 IDUs recruited from needle exchanges to assess: a) perceived obstacles to their use of two specific harm reduction strategies (i.e., test shots and pre-injection skin cleaning) designed to reduce two unhealthy outcomes (i.e., overdose and bacterial infections, respectively) and b) their use of other risk-reduction practices. The most frequently cited barrier for both test shots and skin cleaning was being in a rush to inject one's drugs. Other, less commonly cited barriers were strategy-specific (e.g., buying drugs from a known dealer as a reason not to do a test shot; not having access to cleaning supplies as a reason not to clean skin). Regarding other risk reduction practices, participants' most frequently reported using new or clean injecting supplies and avoiding sharing needles and injecting supplies. Some, but not all, of the barriers generated by participants in our study were similar to those frequently reported in other investigations, perhaps due to differences in the type of sample recruited or in the harm reduction behaviors investigated.

Injection Drug Users’ Perceived Barriers to Using Self-Initiated Harm Reduction Strategies

PubMed Central

Rosenberg, Harold

2014-01-01

Introduction and Aims Increasing the frequency with which injecting drug users (IDUs) engage in self-initiated harm reduction strategies could improve their health, but few investigations have examined IDUs’ perceived barriers to engaging in these behaviors. Method We interviewed 90 IDUs recruited from needle exchanges to assess: a) perceived obstacles to their use of two specific harm reduction strategies (i.e., test shots and pre-injection skin cleaning) designed to reduce two unhealthy outcomes (i.e., overdose and bacterial infections, respectively) and b) their use of other risk-reduction practices. Results The most frequently cited barrier for both test shots and skin cleaning was being in a rush to inject one’s drugs. Other, less commonly cited barriers were strategy-specific (e.g., buying drugs from a known dealer as a reason not to do a test shot; not having access to cleaning supplies as a reason not to clean skin). Regarding other risk reduction practices, participants’ most frequently reported using new or clean injecting supplies and avoiding sharing needles and injecting supplies. Discussion and Conclusions Some, but not all, of the barriers generated by participants in our study were similar to those frequently reported in other investigations, perhaps due to differences in the type of sample recruited or in the harm reduction behaviors investigated. PMID:25419201

Public reporting as a prescriptions quality improvement measure in primary care settings in China: variations in effects associated with diagnoses

PubMed Central

Tang, Yuqing; Liu, Chaojie; Zhang, Xinping

2016-01-01

The overprovision and irrational use of antibiotics and injections are a major public health concern. Public reporting has been adopted as a strategy to encourage good prescribing practices. This study evaluated the effects of public reporting on antibiotic and injection prescriptions in urban and rural primary care settings in Hubei province, China. A randomized control trial was conducted, with 10 primary care institutions being subject to public reporting and another 10 serving as controls. Prescription indicators were publicly reported monthly over a one-year period. Prescriptions for bronchitis, gastritis and hypertension before and after the intervention were collected. Difference-in-difference tests were performed to estimate the effect size of the intervention on five prescription indicators: percentage of prescriptions containing antibiotics; percentage of prescriptions containing two or more antibiotics; percentage of prescriptions containing injections; percentage of prescriptions containing antibiotic injections; and average prescription cost. Public reporting had varied effects on prescriptions for different diagnoses. It reduced antibiotic prescribing for gastritis. Prescriptions containing injections, especially antibiotic injections, also declined, but only for gastritis. A reduction of prescription costs was noted for bronchitis and gastritis. Public reporting has the potential to encourage good prescribing practices. Its effects vary with different disease conditions. PMID:27996026

Prescribing injectable and oral methadone to opiate addicts: results from the 1995 national postal survey of community pharmacies in England and Wales.

PubMed Central

Strang, J.; Sheridan, J.; Barber, N.

1996-01-01

OBJECTIVE--To establish the extent of prescribing injectable and oral methadone to opiate addicts and the practice characteristics and dispensing arrangements attached to these prescriptions. DESIGN--National survey of 25% random sample of community (high street) pharmacies through postal questionnaire, with four mailings. SETTING--England and Wales. SUBJECTS--1 in 4 sample of all 10,616 community pharmacies, stratified by family health services authority. MAIN OUTCOME MEASURES--Data were collected on each prescription for controlled drugs currently being dispensed by pharmacies to misusers, describing the drug, form, dose, source (general practice or hospital; and NHS or private), and numbers of dispensing pick ups a week. RESULTS--Methadone was the opiate most commonly dispensed to misusers (96.0% of 3846 opiate prescriptions). 79.6% of methadone prescriptions were for the oral liquid form, 11.0% for tablet, and 9.3% for injectable ampoules. More than one third of all methadone prescriptions were for weekly or fortnightly pick up, with a further third being for daily pick up. Tablets and ampoules were even less likely to be dispensed on a daily basis. Private prescriptions were significantly more likely than NHS ones to be for tablets or ampoules, to be for substantially higher daily doses, and to be collected on a weekly or fortnightly basis. CONCLUSIONS--The distinctively British practice of prescribing injectable methadone was found to be widespread and, contrary to guidance, to be as prevalent in non-specialist as specialist settings. In view of the frequent crushing and injecting of methadone tablets, clearer more authoritative guidance is needed on the contexts in which injectable methadone (tablets as well as ampoules) should be prescribed and on the responsibilities for monitoring and supervision which should be attached. PMID:8704540

The Story of Schooling: Critical Race Theory and the Educational Racial Contract

ERIC Educational Resources Information Center

Leonardo, Zeus

2013-01-01

This article is an engagement of methodology as an ideologico-racial practice through Critical Race Theory's practice of storytelling. It is a conceptual extension of this practice as explained through Charles Mills' use of the "racial contract (RC) as methodology" in order to explain the Herrenvolk Education--one standard for…

Simulation of radial expansion of an electron beam injected into a background plasma

NASA Technical Reports Server (NTRS)

Koga, J.; Lin, C. S.

1989-01-01

A 2-D electrostatic particle code was used to study the beam radial expansion of a nonrelativistic electron beam injected from an isolated equipotential conductor into a background plasma. The simulations indicate that the beam radius is generally proportional to the beam electron gyroradius when the conductor is charged to a large potential. The simulations also suggest that the charge buildup at the beam stagnation point causes the beam radial expansion. From a survey of the simulation results, it is found that the ratio of the beam radius to the beam electron gyroradius increases with the square root of beam density and decreases inversely with beam injection velocity. This dependence is explained in terms of the ratio of the beam electron Debye length to the ambient electron Debye length. These results are most applicable to the SEPAC electron beam injection experiments from Spacelab 1, where high charging potential was observed.

Characterization of sleep-pattern and neuro-immune-endocrine markers at 24 hour post-injection of a single low dose of lipopolysaccharide in male Wistar rats.

PubMed

Nachón-García, Francisco; Hurtado-Alvarado, Gabriela; Acosta-Hernández, Mario E; Peña-Escudero, Carolina; Priego-Fernández, Sergio; Alvarez-Herrera, Samantha; Becerril-Villanueva, Enrique; Pérez-Sánchez, Gilberto; Pavón, Lenin; García-García, Fabio

2018-07-15

The long-term effect of immune system activation by a low dose of lipopolysaccharide on neuro-immune-endocrine regulation is unclear. Sleep, neurotransmitter concentrations, TNF-α, and corticosterone levels were evaluated in male Wistar rats implanted with conventional sleep recordings. In this work, we found that REM sleep was reduced in the first 4 h post-injection, without affecting the total sleep time, while adrenaline concentration was reduced in the hippocampus at 24 h post-injection of LPS. Our results demonstrated that, although the acute immune response was not evident 24 h after the injection of LPS, it was able to promote the reduction of AD in the hippocampus, which may explain in part the depressive behavior reported in rodents following LPS administration. Copyright © 2018 Elsevier B.V. All rights reserved.

Dynamical injections as the source of near geostationary quiet time particle spatial boundaries

NASA Technical Reports Server (NTRS)

Mauk, B. H.; Meng, C. I.

1983-01-01

The question whether the noon-dusk feature is a manifestation of the spatial structures that should arise from quasi-stationary convection is examined. The key consideration here is whether the energy dispersion of the feature can be explained. It is shown that the observed energy dispersion cannot be attributed to the standard stationary convection configurations, either perturbed or unperturbed. It is also demonstrated, using a detailed computer simulation, that the nighttime, double-spiral-shaped injection boundary (used previously to reproduce the fast changing nighttime features) is successful at reproducing the noon-dusk feature by allowing the particles to evolve for periods of 12 to 36 hours after the injection. It is stressed that the portion of the injection boundary responsible for the feature looks very different from the standard convection boundaries configuration. Conclusions are offered concerning the importance of quasi-stationary convection as the mechanism by which the near geostationary regions are populated.

Contrasting dynamics of electrons and protons in the near-Earth plasma sheet during dipolarization

NASA Astrophysics Data System (ADS)

Malykhin, Andrey Y.; Grigorenko, Elena E.; Kronberg, Elena A.; Koleva, Rositza; Ganushkina, Natalia Y.; Kozak, Ludmila; Daly, Patrick W.

2018-05-01

The fortunate location of Cluster and the THEMIS P3 probe in the near-Earth plasma sheet (PS) (at X ˜ -7-9 RE) allowed for the multipoint analysis of properties and spectra of electron and proton injections. The injections were observed during dipolarization and substorm current wedge formation associated with braking of multiple bursty bulk flows (BBFs). In the course of dipolarization, a gradual growth of the BZ magnetic field lasted ˜ 13 min and it was comprised of several BZ pulses or dipolarization fronts (DFs) with duration ≤ 1 min. Multipoint observations have shown that the beginning of the increase in suprathermal ( > 50 keV) electron fluxes - the injection boundary - was observed in the PS simultaneously with the dipolarization onset and it propagated dawnward along with the onset-related DF. The subsequent dynamics of the energetic electron flux was similar to the dynamics of the magnetic field during the dipolarization. Namely, a gradual linear growth of the electron flux occurred simultaneously with the gradual growth of the BZ field, and it was comprised of multiple short ( ˜ few minutes) electron injections associated with the BZ pulses. This behavior can be explained by the combined action of local betatron acceleration at the BZ pulses and subsequent gradient drifts of electrons in the flux pile up region through the numerous braking and diverting DFs. The nonadiabatic features occasionally observed in the electron spectra during the injections can be due to the electron interactions with high-frequency electromagnetic or electrostatic fluctuations transiently observed in the course of dipolarization. On the contrary, proton injections were detected only in the vicinity of the strongest BZ pulses. The front thickness of these pulses was less than a gyroradius of thermal protons that ensured the nonadiabatic acceleration of protons. Indeed, during the injections in the energy spectra of protons the pronounced bulge was clearly observed in a finite energy range ˜ 70-90 keV. This feature can be explained by the nonadiabatic resonant acceleration of protons by the bursts of the dawn-dusk electric field associated with the BZ pulses.

In vivo long-term kinetics of radiolabeled n,n-dimethyltryptamine and tryptamine.

PubMed

Vitale, Arturo A; Pomilio, Alicia B; Cañellas, Carlos O; Vitale, Martín G; Putz, Eva Maria; Ciprian-Ollivier, Jorge

2011-06-01

N,N-dimethyltryptamine (DMT), a strong psychodysleptic drug, has been found in higher plants, shamanic hallucinogenic beverages, and the urine of schizophrenic patients. The aim of this work was to gain better knowledge on the relationship between this drug and hallucinogenic processes by studying DMT behavior in comparison with tryptamine. (131)I-labeled DMT and tryptamine were injected into rabbits. γ-Camera and biodistribution studies were performed. Brain uptake, plasma clearance, and renal excretion were assessed for each indolealkylamine. DMT and tryptamine showed different behavior when brain uptake, residence time, and excretion were compared. Labeled DMT entered the brain 10 s after injection, crossed the blood-brain barrier, and bound to receptors; then it was partially renally excreted. It was detected in urine within 24 h after injection and remained in the brain, even after urine excretion ceased; up to 0.1% of the injected dose was detected at 7 d after injection in the olfactory bulb. In contrast, tryptamine was rapidly taken up in the brain and fully excreted 10 min after injection. To our knowledge, this is the first demonstration that exogenous DMT remains in the brain for at least 7 d after injection. Although labeled DMT and tryptamine behave as agonists for at least 5-hydroxytryptamine 2A receptor, 5-hydroxytryptamine 2C receptor, trace amine-associated receptor, and σ-1 putative receptor targets, binding to the latter can explain the different behavior of labeled DMT and tryptamine in the brain. The persistence in the brain can be further explained on the basis that DMT and other N,N-dialkyltryptamines are transporter substrates for both the plasma membrane serotonin transporter and the vesicle monoamine transporter 2. Furthermore, storage in vesicles prevents DMT degradation by monoamine oxidase. At high concentrations, DMT is taken up by the serotonin transporter and further stored in vesicles by the vesicle monoamine transporter 2, to be released under appropriate stimuli. Moreover, the (131)I-labeling proved to be a useful tool to perform long-term in vivo studies.

Bioengineering of injectable encapsulated aggregates of pluripotent stem cells for therapy of myocardial infarction

NASA Astrophysics Data System (ADS)

Zhao, Shuting; Xu, Zhaobin; Wang, Hai; Reese, Benjamin E.; Gushchina, Liubov V.; Jiang, Meng; Agarwal, Pranay; Xu, Jiangsheng; Zhang, Mingjun; Shen, Rulong; Liu, Zhenguo; Weisleder, Noah; He, Xiaoming

2016-10-01

It is difficult to achieve minimally invasive injectable cell delivery while maintaining high cell retention and animal survival for in vivo stem cell therapy of myocardial infarction. Here we show that pluripotent stem cell aggregates pre-differentiated into the early cardiac lineage and encapsulated in a biocompatible and biodegradable micromatrix, are suitable for injectable delivery. This method significantly improves the survival of the injected cells by more than six-fold compared with the conventional practice of injecting single cells, and effectively prevents teratoma formation. Moreover, this method significantly enhances cardiac function and survival of animals after myocardial infarction, as a result of a localized immunosuppression effect of the micromatrix and the in situ cardiac regeneration by the injected cells.

MEASUREMENT OF FUGITIVE EMISSIONS AT A LANDFILL PRACTICING LEACHATE RECIRCULATION AND AIR INJECTION

EPA Science Inventory

Recently research has begun on operating bioreactor landfills. The bioreactor process involves the injection of liquid into the waste mass to accelerate waste degradation. Arcadis and EPA conducted a fugitive emissions characterization study at the Three Rivers Solid Waste Techno...

A randomized trial to evaluate the efficacy of a computer-tailored intervention to promote safer injection practices among drug users.

PubMed

Gagnon, Hélène; Godin, Gaston; Alary, Michel; Bruneau, Julie; Otis, Joanne

2010-06-01

The aim of this study was to evaluate the efficacy of a theory-based intervention to increase the use of a new syringe for each injection among injection drug users (IDUs). Users of two needle exchange programs (NEPs) were involved. At both sites, participants were assigned at random to either the experimental or the control group. Once a week for four weeks, users reported to the NEPs where they logged onto a computer and received an audiovisual message. A total of 260 IDUs were recruited. At baseline, 52.3% of participants reported that they had not always used new syringes in the previous week. The results indicate that it is possible for IDUs to adopt safer injection practices. One month after the intervention began, participants in the experimental group were using fewer dirty syringes compared to the control group (RR: 0.47 CI(95%) 0.28-0.79; P = .004). This short-term effect was no longer present 3 months later.

[Practical advices in choosing local anesthesia tools in dentistry. Management of carpule's quality in local anesthesia in dentistry].

PubMed

Kuzin, A V

2014-01-01

The equipment for local anesthesia is described in this article. Practical recommendations for the selection of the injection needle length, size, bevel type is given. Using dental needle for local anesthesia should be guided by the "one injection - one needle" rule, as a needle tends to deform by even the slightest contact with jawbone. Some of the shortcomings of carpule quality may be detected before use: signs of cup corrosion, the presence of sediment, air bubbles, rubber plunger disposition. In the case of such defects being identified all the package should not be used. The use of such carpule in clinical practice is unsafe.

Effectiveness of Needleless Vial Adaptors and Blunt Cannulas for Drug Administration in a Microgravity Environment

NASA Technical Reports Server (NTRS)

Hailey, M.; Bayuse, T.

2010-01-01

Fluid Isolation in the medication vial: Air/ fluid isolation maneuvers were used to move the medication to the septum end of vial. This isolation may be achieved in multiple ways based on the experience of the astronaut with fluid management in microgravity. If vial adaptors/blunt cannula or syringe assembly is inserted into the to vial before fluid isolation commences, the stability of this assembly should be considered in an effort to limit the risk of "slinging off" of the vial during isolation. Alternatively, fluid isolation can be performed prior to attaching the syringe/vial adaptor assembly. Terrestrial practices for medication withdrawal from a nonvented vial require injection of an equivalent amount of air as the expected medication volume prior to withdrawing liquid. In microgravity, this action is still valid, however the injection of additional air into the vial creates a multitude of micro bubbles and increases the volume of medication mixed with air that then must be withdrawn to achieve the desired drug volume in syringe. This practice is more likely to be required when using vials >30ml in size and injection volumes >10mL. It is felt that based on the microgravity flight, the practice of air injection is more of a hindrance than help.

Reduction of plasma density in the Helicity Injected Torus with Steady Inductance experiment by using a helicon pre-ionization source.

PubMed

Hossack, Aaron C; Firman, Taylor; Jarboe, Thomas R; Prager, James R; Victor, Brian S; Wrobel, Jonathan S; Ziemba, Timothy

2013-10-01

A helicon based pre-ionization source has been developed and installed on the Helicity Injected Torus with Steady Inductance (HIT-SI) spheromak. The source initiates plasma breakdown by injecting impurity-free, unmagnetized plasma into the HIT-SI confinement volume. Typical helium spheromaks have electron density reduced from (2-3) × 10(19) m(-3) to 1 × 10(19) m(-3). Deuterium spheromak formation is possible with density as low as 2 × 10(18) m(-3). The source also enables HIT-SI to be operated with only one helicity injector at injector frequencies above 14.5 kHz. A theory explaining the physical mechanism driving the reduction of breakdown density is presented.

The micro-social risk environment for injection drug use: An event specific analysis of dyadic, situational, and network predictors of injection risk behavior.

PubMed

Janulis, Patrick

2016-01-01

This study explores the risk environment for drug use by examining injection risk behavior during specific injection episodes. By leveraging multiple observations of injection episodes of participants, the study attempts to move beyond global assessment of environmental variables to simultaneously model within (i.e., event level) as well as between (i.e., individual level) predictors of injection risk. Furthermore, gender is also explored as a potential moderator of the relationship between the association of specific partner characteristics (e.g., having an injection partner who is also a sexual partner) and injection risk behavior. Data is used from the Sexual Acquisition of Transmission of HIV Cooperative Agreement Study (SATHCAP). Multilevel structural equation modeling is utilized to predict within and between variations in underlying injection risk behavior as measured using four indicators of injection risk. Results indicated that a number of partner level characteristics (i.e., being emotionally close with the partner, sexual partnership, being a first time partner) and one social situational (i.e., the number of non-injectors present at the injection episode) characteristic predicted event level injection risk behavior. However, the impact of partner characteristics also appears to be moderated by gender of the participants. More specifically, sharing a sexual partnership with an injection partner was more strongly associated with injection risk among females as compared to males and females indicated higher levels of risk when injecting with other females while the partner's gender showed no significant association with risk for male injectors. These results suggest that people who inject drug do report varying levels of risk during different injection episodes and this variation can be explained by partner and situational characteristics. Improved understanding of the social processes surrounding injection episodes is required to further refine harm reduction approaches. Copyright © 2015 Elsevier B.V. All rights reserved.

On Practical Charge Injection at the Metal/Organic Semiconductor Interface

PubMed Central

Kumatani, Akichika; Li, Yun; Darmawan, Peter; Minari, Takeo; Tsukagoshi, Kazuhito

2013-01-01

We have revealed practical charge injection at metal and organic semiconductor interface in organic field effect transistor configurations. We have developed a facile interface structure that consisted of double-layer electrodes in order to investigate the efficiency through contact metal dependence. The metal interlayer with few nanometers thickness between electrode and organic semiconductor drastically reduces the contact resistance at the interface. The improvement has clearly obtained when the interlayer is a metal with lower standard electrode potential of contact metals than large work function of the contact metals. The electrode potential also implies that the most dominant effect on the mechanism at the contact interface is induced by charge transfer. This mechanism represents a step forward towards understanding the fundamental physics of intrinsic charge injection in all organic devices. PMID:23293741

Palatal Injection for the Removal of Maxillary Teeth: Current Practice Among Oral and Maxillofacial Surgeons.

PubMed

Badenoch-Jones, Emma K; David, Michael; Lincoln, Trent

2017-07-01

Conventional teaching regarding palatal injection for the removal of maxillary teeth dictates the administration of buccal and palatal injections. Recently, some investigators have questioned the necessity of the palatal injection, suggesting that contemporary local anesthetics might diffuse sufficiently across the buccopalatal cortical bone distance. It has been suggested that because the buccopalatal cortical bone distance increases anteriorly to posteriorly in the maxilla, the success of maxillary extractions with buccal injection only might be related to the anteroposterior position of the tooth. Evidence from clinical trials has only recently become available. Since 2006, 15 clinical trials that examined outcomes of maxillary tooth extractions performed with buccal injection of local anesthetic only have been published. However, there are limited data available on the clinical practice of surgeons. An online survey was sent to 276 full members of the Canadian Association of Oral and Maxillofacial Surgeons. Respondents were asked about their use of palatal injection for the removal of maxillary teeth under local anesthesia, including how often they administer a palatal injection for maxillary extractions in each region of the maxilla. Ninety-two responses were received (33%). Most practitioners deliver a palatal injection for every maxillary tooth extraction under local anesthesia. However, there is a substantial number who do not always administer a palatal injection (ie, they give it "most of the time," "occasionally," or "never"). This number decreased in a linear fashion anteriorly to posteriorly in the maxilla (incisors, 17 of 89; canines, 16 of 88; premolars, 13 of 88; first and second molars, 10 of 89; third molars, 10 of 88). Some surgeons who do not always administer a palatal injection for extraction of maxillary teeth under local anesthesia. The number is larger for anterior compared with posterior teeth. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Home medication injection among Latina women in Los Angeles: implications for health education and prevention.

PubMed

Flaskerud, J H; Nyamathi, A M

1996-02-01

Reuse of needles and syringes after home injection of medications and vitamins may be a risk for transmission of HIV. An exploratory study was done to determine (1) how commonly injectable medications were used in the home; (2) whether needles and syringes were reused; and (3) common practices for cleaning needles and syringes. A survey was conducted of low income Latina women (n = 216) who were attending a Public Health Foundation nutrition programme for women, infants and children (WIC) in Los Angeles. To clarify and expand on the survey findings, focus group interviews were done with an additional 55 women attending WIC. Quantitative data were analysed using descriptive and comparative statistics. Qualitative data were subjected to content analysis. The use of injectable medications purchased in Mexico was fairly common (43.5%); reuse of disposable needles and syringes (48%) and sharing (36%) among injectors were also common. Methods of cleaning needles and syringes were inadequate to CDC recommended guidelines. Injectors and non-injectors differed significantly in ethnicity, religion, and marital status. The only significant predictor of medication injection was educational level. Analysis of qualitative data revealed the reasons that Latina subjects were injecting medication; how they were transporting medicines from Mexico; and how they were cleaning their equipment. The practical implications for health education and prevention programmes should include an awareness that home use and reuse of needles for injection of medications may be common in some social groups and that knowledge of the potential dangers in reuse and sharing of needles may not extend to home medication injection.

Overcoming the Practical Barriers to Spinal Cord Cell Transplantation for ALS

DTIC Science & Technology

2012-10-01

ABSTRACT: This grant will provide critical data on tolerance and toxicity of cell dosing and numbers of permissible spinal cord injections. Rigorous...Surgical Technique) will provide critical data on tolerance and toxicity of cell dosing and numbers of permissible spinal cord injections. Aim 2 (Graft...connected to a rigid needle of the same gauge as the floating cannula one – Figure 7) using the maximum volume/number of injections could result in

Spectral distortions of the cosmic microwave background

NASA Technical Reports Server (NTRS)

Adams, Fred C.; Mcdowell, Jonathan C.; Freese, Katherine; Levin, Janna

1989-01-01

Recent experiments indicate that the spectrum of the cosmic microwave background deviates from a pure blackbody; here, spectral distortions produced by cosmic dust are considered. The main result is that cosmic dust in conjunction with an injected radiation field (perhaps produced by an early generation of very massive stars) can explain the observed spectral distortions without violating existing cosmological constraints. In addition, it is shown that Compton y-distortions can also explain the observed spectral shape, but the energetic requirements are more severe.

Too many crying babies: a systematic review of pain management practices during immunizations on YouTube

PubMed Central

2014-01-01

Background Early childhood immunizations, although vital for preventative health, are painful and too often lead to fear of needles. Effective pain management strategies during infant immunizations include breastfeeding, sweet solutions, and upright front-to-front holding. However, it is unknown how often these strategies are used in clinical practice. We aimed to review the content of YouTube videos showing infants being immunized to ascertain parents’ and health care professionals’ use of pain management strategies, as well as to assess infants’ pain and distress. Methods A systematic review of YouTube videos showing intramuscular injections in infants less than 12 months was completed using the search terms "baby injection" and "baby vaccine" to assess (1) the use of pain management strategies and (2) infant pain and distress. Pain was assessed by crying duration and pain scores using the FLACC (Face, Legs, Activity, Cry, Consolability) tool. Results A total of 142 videos were included and coded by two trained individual viewers. Most infants received one injection (range of one to six). Almost all (94%) infants cried before or during the injections for a median of 33 seconds (IQR = 39), up to 146 seconds. FLACC scores during the immunizations were high, with a median of 10 (IQR = 3). No videos showed breastfeeding or the use of sucrose/sweet solutions during the injection(s), and only four (3%) videos showed the infants being held in a front-to-front position during the injections. Distraction using talking or singing was the most commonly used (66%) pain management strategy. Conclusions YouTube videos of infants being immunized showed that infants were highly distressed during the procedures. There was no use of breastfeeding or sweet solutions and limited use of upright or front-to-front holding during the injections. This systematic review will be used as a baseline to evaluate the impact of future knowledge translation interventions using YouTube to improve pain management practices for infant immunizations. PMID:24885559

Injection of coal by screw feed

NASA Technical Reports Server (NTRS)

Fisher, R.

1977-01-01

The use of the screw feeder for injecting solids through a 20 to 30 psi barrier is common practice in the cement making industry. An analytical extrapolation of that design, accounting for pressure holding characteristics of a column of solids, shows that coal can be fed to zones at several hundred psi with minimal or no loss of gas. A series of curves showing the calculated pressure gradient through a moving column of solids is presented. Mean particle size, solids velocity, and column length are parameters. Further study of this system to evaluate practicality is recommended.

Mechanics of the injected pulsejet into gelatin gel and evaluation of the effect by puncture and crack generation and growth

NASA Astrophysics Data System (ADS)

Kato, T.; Arafune, T.; Washio, T.; Nakagawa, A.; Ogawa, Y.; Tominaga, T.; Sakuma, I.; Kobayashi, E.

2014-08-01

Recently, fluid jets have become widely used in medical devices and have been created and evaluated in clinical environments. Such devices are classified into two broad groups; those adopting continuous jets and those adopting discrete (or pulsed) jets. We developed a discrete jet device for brain cancer treatment, called a laser-induced liquid jet (LILJ) system. Although several studies have evaluated the availability and described the treatment mechanisms of fluid jet devices, the mechanisms of the fluid and injected material remain under-investigated. In this paper, we report the mechanism of frequent pulsejet injections into a viscoelastic biological material; namely, simulated gelatin brain tissue. The mechanism is evaluated by the injection depth, an easily measured parameter. To explain the injection mechanism, we propose that the pulsejet is pressured by forces introduced by resistance on the side surface of the hole and the reaction force proportionate to the injection depth. The pulsejet generated and propagated cracks in the gelatin, and the resistance eventually fractured the side surface of the hole. We evaluated the proposed model by measuring the behavior of pulsejets injected into gelatin by the LILJ. From the results, the following conclusions were obtained. First, the proposed model accurately describes the behavior of the injected pulsejet. Second, whether the hole or crack growth largely increases the final injection depth can be evaluated from differences in the decay constant. Finally, crack growth increases the final injection depth when the number of the injected pulsejets is greater than the inverse of the decay constant.

Hypotensive Effect and Accumulation of Dinitrosyl Iron Complexes in Blood and Tissues after Intravenous and Subcutaneous Injection.

PubMed

Timoshin, A A; Lakomkin, V L; Abramov, A A; Ruuge, E K; Vanin, A F

2016-12-01

Subcutaneous injection of Oxacom with glutathione-bound dinitrosyl iron complex as the active principle produced a slower drop of mean BP and longer accumulation of protein-bound dinitrosyl iron complexes in whole blood and tissues than intravenous injection of this drug, while durations of hypotensive effect in both cases were practically identical. In contrast to intravenous injection of the drug, its subcutaneous administration was not characterized by a high concentration of protein-bound dinitrosyl iron complexes in the blood at the onset of experiment; in addition, accumulation of these NO forms in the lungs was more pronounced after subcutaneous injection than after intravenous one.

What are the necessary practice competencies for two providers: dermal fillers and botulinum toxin type A injections?

PubMed

Spear, Marcia

2010-01-01

There has been a steady increase in the number of individuals who undergo dermal fillers and botulinum toxin Type A injections. The majority of these procedures are performed by nurse providers. The purpose of this study was to collect national data on the current practice among nursing providers within the American Society of Plastic Surgical Nurses (ASPSN). The goal was to utilize the national data and develop a document of the necessary competencies to guide the practice of providers of dermal fillers and botulinum toxin Type A injections. A survey tool was developed and validated for content by expert nursing providers among the membership of the ASPSN and disseminated via e-mail to the membership of the ASPSN. In addition, data from investigator training, mentoring, and evidence from a review of the literature were also incorporated into the competency document utilizing the Competency Outcomes and Performance Assessment (COPA) model. Common core issues became apparent that included contraindications for the use of botulinum toxin Type A and dermal fillers, postprocedure complications as well as strategies in terms of managing complications. The data also revealed that there is no common method providers are taught to assess the aesthetic patient and a lack of a collaborative relationship in current practice. Overwhelmingly, the respondents supported the need for defined practice competencies. A competency document to guide the practice of providers of dermal fillers and botulinum toxin Type A has been developed for completion of this DNP project.

An Audit of Insulin Usage and Insulin Injection Practices in a Large Indian Cohort

PubMed Central

Baruah, Manash P.; Kalra, Sanjay; Bose, Saptarshi; Deka, Jumi

2017-01-01

Introduction: Insulin remains the cornerstone of therapy in a substantial number of patients with type 2 diabetes mellitus (T2DM). Inadequate knowledge regarding insulin usage is likely to influence its acceptance and adherence, and outcome of therapy, underscoring great need to investigate knowledge, attitude, and practice of insulin usage in patients with T2DM. Methodology: A cross-sectional registry-based retrospective study analyzed data collected from 748 respondents (male: 466, female: 282), mostly from high or middle economic status, who were enrolled as outpatient in a referral clinic during last 10 years (2006–2016), to assess the general characteristics of patients with type 2 diabetes and their baseline knowledge, attitude, and practice of insulin usage and injection practices. Results: Mean ± standard deviation (SD) of duration of diabetes was 12.24 ± 7.60 years and mean ± SD duration of insulin therapy was 3.42 ± 4.18 years, which was initiated after a mean ± SD diabetes duration of 8.80 ± 6.42 years. Mean insulin dose per kilogram of body weight/day was 0.51 ± 0.27 units. Total daily dose of insulin was 33.36 ± 18.44 units and number of injections/day (mean ± SD) was 2.06 ± 0.73. Among the respondents, 58.96% were on human insulin and 35.70% were on analog insulin. Pen devices were used by 66.08% of the population whereas 31.76% used insulin syringes. The prevalence of lipohypertrophy (LH) was 12.57%, which was significantly (P < 0.001) associated with wrong technique with regard to injection angle (10.45% vs. 23.02%), site of injection (7.00% vs. 30.51%), rotation of site of injection (0.88% vs. 17.66%), and reuse of needle (5.77% vs. 15.19%). LH was also significantly (P < 0.05) associated with the use of human (14.74%) compared to analog insulin (8.24%). Conclusion: The current study highlights the unique patterns of insulin usage and associated high prevalence of LH among insulin users in India. PMID:28553603

Long-acting injectable hormonal dosage forms for contraception.

PubMed

Wu, Linfeng; Janagam, Dileep R; Mandrell, Timothy D; Johnson, James R; Lowe, Tao L

2015-07-01

Although great efforts have been made to develop long-acting injectable hormonal contraceptives for more than four decades, few long-acting injectable contraceptives have reached the pharmaceutical market or even entered clinical trials. On the other hand, in clinical practice there is an urgent need for injectable long-acting reversible contraceptives which can provide contraceptive protection for more than 3 months after one single injection. Availability of such products will offer great flexibility to women and resolve certain continuation issues currently occurring in clinics. Herein, we reviewed the strategies exploited in the past to develop injectable hormonal contraceptive dosages including drug microcrystal suspensions, drug-loaded microsphere suspensions and in situ forming depot systems for long-term contraception and discussed the potential solutions for remaining issues met in the previous development.

Advocacy for Gender Affirming Care: Learning from the Injectable Estrogen Shortage.

PubMed

Geffen, Sophia; Horn, Tim; Smith, Kimberleigh Joy; Cahill, Sean

2018-01-01

Hormone therapy is medically necessary for many transgender individuals. The U.S. Food and Drug Administration (FDA) and pharmaceutical companies' failure to guarantee a supply of injectable estrogen in 2016 and 2017 for transgender individuals is a violation of their right to comprehensive medical treatment, free of discrimination. A series of advocacy actions eventually led to all formulations of injectable estrogen being restored to market; however, long-term solutions to supply interruptions of injectable estrogen are needed. Long-term solutions should address the lack of federally funded research and, consequently, evidence-based practice on hormone therapy for gender affirmation.

Botulinum Toxin Injections Reduce Associative Plasticity in Patients with Primary Dystonia

PubMed Central

Kojovic, Maja; Caronni, Antonio; Bologna, Matteo; Rothwell, John C.; Bhatia, Kailash P.; Edwards, Mark J.

2014-01-01

Botulinum toxin injections ameliorate dystonic symptoms by blocking the neuromuscular junction and weakening dystonic contractions. We asked if botulinum toxin injections in dystonia patients might also affect the integrity of sensorimotor cortical plasticity, one of the key pathophysiological features of dystonia. We applied a paired associative stimulation protocol, known to induce long-term potentiation–like changes in the primary motor cortex hand area to 12 patients with cervical dystonia before and 1 and 3 months after botulinum toxin injections to the neck muscles. Primary motor cortex excitability was probed by measuring transcranial magnetic stimulation-evoked motor evoked potentials before and after paired associative stimulation. We also measured the input–output curve, short-interval intracortical inhibition, intracortical facilitation, short afferent inhibition, and long afferent inhibition in hand muscles and the clinical severity of dystonia. Before botulinum toxin injections, paired associative stimulation significantly facilitated motor evoked potentials in hand muscles. One month after injections, this effect was abolished, with partial recovery after 3 months. There were significant positive correlations between the facilitation produced by paired associative stimulation and (1) the time elapsed since botulinum toxin injections and (2) the clinical dystonia score. One effect of botulinum toxin injection treatment is to modulate afferent input from the neck. We propose that subsequent reorganization of the motor cortex representation of hand muscles may explain the effect of botulinum toxin on motor cortical plasticity. PMID:21469207

Characterisation of acoustic energy content in an experimental combustion chamber with and without external forcing

NASA Astrophysics Data System (ADS)

Webster, S.; Hardi, J.; Oschwald, M.

2015-03-01

The influence of injection conditions on rocket engine combustion stability is investigated for a sub-scale combustion chamber with shear coaxial injection elements and the propellant combination hydrogen-oxygen. The experimental results presented are from a series of tests conducted at subcritical and supercritical pressures for oxygen and for both ambient and cryogenic temperature hydrogen. The stability of the system is characterised by the root mean squared amplitude of dynamic combustion chamber pressure in the upper part of the acoustic spectrum relevant for high frequency combustion instabilities. Results are presented for both unforced and externally forced combustion chamber configurations. It was found that, for both the unforced and externally forced configurations, the injection velocity had the strongest influence on combustion chamber stability. Through the use of multivariate linear regression the influence of hydrogen injection temperature and hydrogen injection mass flow rate were best able to explain the variance in stability for dependence on injection velocity ratio. For unforced tests turbulent jet noise from injection was found to dominate the energy content of the signal. For the externally forced configuration a non-linear regression model was better able to predict the variance, suggesting the influence of non-linear behaviour. The response of the system to variation of injection conditions was found to be small; suggesting that the combustion chamber investigated in the experiment is highly stable.

Pregnancy and Sexual Health among Homeless Young Injection Drug Users

ERIC Educational Resources Information Center

Hathazi, Dodi; Lankenau, Stephen E.; Sanders, Bill; Bloom, Jennifer Jackson

2009-01-01

Research on pregnancy and sexual health among homeless youth is limited. In this study, qualitative interviews were conducted with 41 homeless young injection drug users (IDUs) in Los Angeles with a history of pregnancy. The relationship between recent pregnancy outcomes, contraception practices, housing status, substance use, utilization of…

40 CFR 146.6 - Area of review.

Code of Federal Regulations, 2010 CFR

2010-07-01

... operators of injection wells within the State as to which method is most appropriate for each geographic... injection well or pattern. The following modified Theis equation illustrates one form which the mathematical... dependence; and historical practices in the area. (c) If the area of review is determined by a mathematical...

An evidence-based approach to the management of low back pain and sciatica: how the evidence is applied in clinical cases.

PubMed

Goh, L; Bawendi, A; Samanta, J; Samanta, A

2003-09-01

Low back pain and sciatica are common complaints that affect a major proportion of the population at some time in their lives. The treatment and management of this condition may vary widely. The present paper aims to provide an evidence-based approach to the management of low back pain and sciatica, and demonstrates how to search for the evidence and how to apply it practically in individual patients. The principles underlying evidence-based medicine are explained. The practice of evidence-based medicine requires initial formulation of the appropriate clinical question, followed by searching databases for relevant evidence. Finally evidence needs to be applied on a patient-specific basis. Best Evidence, the Cochrane Library, Embase and Medline were searched to obtain quality controlled information regarding the management of low back pain and sciatica. Current evidence shows that an active exercise programme promotes early recovery. This may allow patients to resume an active and sportive lifestyle. Epidural corticosteroid injections may help to resolve additional troublesome symptoms of sciatica. Two clinical cases are used to show how evidence-based medicine can be individualized to specific patients. A patient-focused strategy combining best evidence and clinical expertise is suggested as the mainstay for the management of low back pain.

Prevalence of injections and knowledge of safe injections among rural residents in Central China.

PubMed

Yan, Y W; Yan, J; Zhang, G P; Gao, Z L; Jian, H X

2007-08-01

Abuse of the injection services, namely unnecessary injections and unsafe injections, exists extensively in developing countries. Unsafe injection practices contribute to the transmission of blood-borne pathogens. The aims of this study were to survey the prevalence of injections and knowledge of injection safety among the rural residents in Jingzhou district, Hubei, China and to provide scientific data for developing a health educational programme. A retrospective cross-sectional study was conducted in 12 villages, which were selected from the Jingzhou district by the random sampling method. 50 rural residents were interviewed per village using a questionnaire. Among the 595 residents studied, 192 had received at least one injection in the past three months, with an injection prevalence of 32.3 percent and an average of 0.93 injections. 90.3 percent of the rural residents knew that unsafe injections could transmit the following blood-borne pathogens: human immunodeficiency virus (74.4 percent), hepatitis B virus (55.8 percent) and hepatitis C virus (22.9 percent). Logistic regression analysis showed that the residents' age, educational level and residential area were important factors in influencing their knowledge about injection safety. The results indicated that the injection prevalence was high among rural residents in the study area, and their knowledge regarding injection safety should be further improved.

Microphysics and dynamics of the gamma-ray burst 121024A

NASA Astrophysics Data System (ADS)

Varela, K.; van Eerten, H.; Greiner, J.; Schady, P.; Elliott, J.; Sudilovsky, V.; Krühler, T.; van der Horst, A. J.; Bolmer, J.; Knust, F.; Agurto, C.; Azagra, F.; Belloche, A.; Bertoldi, F.; De Breuck, C.; Delvaux, C.; Filgas, R.; Graham, J. F.; Kann, D. A.; Klose, S.; Menten, K. M.; Nicuesa Guelbenzu, A.; Rau, A.; Rossi, A.; Schmidl, S.; Schuller, F.; Schweyer, T.; Tanga, M.; Weiss, A.; Wiseman, P.; Wyrowski, F.

2016-05-01

Aims: The aim of the study is to constrain the physics of gamma-ray bursts (GRBs) by analysing the multi-wavelength afterglow data set of GRB 121024A that covers the full range from radio to X-rays. Methods: Using multi-epoch broad-band observations of the GRB 121024A afterglow, we measured the three characteristic break frequencies of the synchrotron spectrum. We used six epochs of combined XRT and GROND data to constrain the temporal slopes, the dust extinction, the X-ray absorption, and the spectral slope with high accuracy. Two more epochs of combined data from XRT, GROND, APEX, CARMA, and EVLA were used to set constraints on the break frequencies and therefore on the micro-physical and dynamical parameters. Results: The XRT and GROND light curves show a simultaneous and achromatic break at around 49 ks. As a result, the crossing of the synchrotron cooling break is no suitable explanation for the break in the light curve. The multi-wavelength data allow us to test two plausible scenarios explaining the break: a jet break, and the end of energy injection. The jet-break scenario requires a hard electron spectrum, a very low cooling break frequency, and a non-spreading jet. The energy injection avoids these problems, but requires ɛe > 1 (k = 2), spherical outflow, and ɛB < 10-9. Conclusions: In light of the extreme microphysical parameters required by the energy-injection model, we favour a jet-break scenario where νm < νsa to explain the observations. This scenario gives physically meaningful microphysical parameters, and it also naturally explains the reported detection of linear and circular polarisation.

Heavy-Duty Low-Temperature and Diesel Combustion & Heavy-Duty Combustion Modeling

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

Musculus, Mark P.

Regulatory drivers and market demands for lower pollutant emissions, lower carbon dioxide emissions, and lower fuel consumption motivate the development of clean and fuel-efficient engine operating strategies. Most current production engines use a combination of both in-cylinder and exhaust emissions-control strategies to achieve these goals. The emissions and efficiency performance of in-cylinder strategies depend strongly on flow and mixing processes associated with fuel injection. Various diesel engine manufacturers have adopted close-coupled post-injection combustion strategies to both reduce pollutant emissions and to increase engine efficiency for heavy-duty applications, as well as for light- and medium-duty applications. Close-coupled post-injections are typically shortmore » injections that follow a larger main injection in the same cycle after a short dwell, such that the energy conversion efficiency of the post-injection is typical of diesel combustion. Of the various post-injection schedules that have been reported in the literature, effects on exhaust soot vary by roughly an order of magnitude in either direction of increasing or decreasing emissions relative to single injections (O’Connor et al., 2015). While several hypotheses have been offered in the literature to help explain these observations, no clear consensus has been established. For new engines to take full advantage of the benefits that post-injections can offer, the in-cylinder mechanisms that affect emissions and efficiency must be identified and described to provide guidance for engine design.« less

A bio-inspired microstructure induced by slow injection moulding of cylindrical block copolymers.

PubMed

Stasiak, Joanna; Brubert, Jacob; Serrani, Marta; Nair, Sukumaran; de Gaetano, Francesco; Costantino, Maria Laura; Moggridge, Geoff D

2014-08-28

It is well known that block copolymers with cylindrical morphology show alignment with shear, resulting in anisotropic mechanical properties. Here we show that well-ordered bi-directional orientation can be achieved in such materials by slow injection moulding. This results in a microstructure, and anisotropic mechanical properties, similar to many natural tissues, making this method attractive for engineering prosthetic fibrous tissues. An application of particular interest to us is prosthetic polymeric heart valve leaflets, mimicking the shape, microstructure and hence performance of the native valve. Anisotropic layers have been observed for cylinder-forming block copolymers centrally injected into thin circular discs. The skin layers exhibit orientation parallel to the flow direction, whilst the core layer shows perpendicularly oriented domains; the balance of skin to core layers can be controlled by processing parameters such as temperature and injection rate. Heart valve leaflets with a similar layered structure have been prepared by injection moulding. Numerical modelling demonstrates that such complex orientation can be explained and predicted by the balance of shear and extensional flow.

Severe visual loss and cerebral infarction after injection of hyaluronic acid gel.

PubMed

Kim, Eung Gyu; Eom, Tae Kyung; Kang, Seok Joo

2014-01-01

We report a case of a 23-year-old man with cerebral infarction and permanent visual loss after injection of a hyaluronic acid gel filler for augmentation rhinoplasty. The patient was admitted to the hospital with complaints of loss of vision in the right eye, facial paralysis on the right side, and paralysis of the left limbs with severe pain during augmentation rhinoplasty with filler injection. Brain magnetic resonance imaging and computed tomography showed ophthalmic artery obstruction and right middle cerebral artery infarction. Acute thrombolysis was performed to treat the infarction; however, the patient's condition did not improve. Intracerebral hemorrhage in the right temporal/frontal/occipital/parietal lobe, subarachnoid hemorrhage, and midline shifting were observed on brain computed tomography after 24 hours after thrombolysis. Emergency decompressive craniectomy was performed. After the surgery, the patient continued to experience drowsiness, with no improvement in visual loss and motor weakness. Three months later, he could walk with cane. This case indicates that surgeons who administer filler injections should be familiar with the possibility of accidental intravascular injection and should explain the adverse effects of fillers to patients before surgery.

Therapeutic efficacy of melanoma-reactive TIL injected in stage III melanoma patients.

PubMed

Labarrière, Nathalie; Pandolfino, Marie-Christine; Gervois, Nadine; Khammari, Amir; Tessier, Marie-Hélène; Dréno, Brigitte; Jotereau, Francine

2002-11-01

Adoptive therapy for cancer using tumor-infiltrating lymphocytes (TIL) has mainly been investigated in cancer patients with advanced stage disease. The limited clinical success has not been encouraging, although this might be explained by poor TIL specificity and/or high tumor burden. To re-evaluate the effectiveness of adoptive therapy, we analyzed the capacity of tumor-reactive TIL injection in preventing the further development of disease in stage III melanoma patients after complete tumor resection. A phase II/III randomized trial was performed on 88 melanoma patients, who received autologous TIL plus interleukin-2 (IL-2) or IL-2 only. The duration of relapse-free survival was analyzed, taking into account the immunological specificity of injected TIL and the number of metastatic lymph nodes removed before treatment. Kaplan-Meyer analysis revealed that the injection of tumor-reactive TIL was statistically correlated with prolonged relapse-free survival in patients with only one metastatic lymph node. Therefore, improved clinical outcome could be obtained after adoptive therapy by selecting appropriate groups of patients and monitoring the specificity of the injected TIL populations.

Imaging the photoinduced charge injection in CdS/TiO2 nanoparticles by the sequential fluorescence mapping method

NASA Astrophysics Data System (ADS)

Frederice, Rafael; Lencione, Diego; Gehlen, Marcelo H.

2017-03-01

The combination of a sensitizer and TiO2 nanoparticles forming a photocatalytic material is a central issue in many fields of applied photochemistry. The charge injection of emissive sensitizers into the conduction band of the semiconductor TiO2 may form a photoactive region that becomes dark, or it has a very low emission signal due to the generation of sensitizer radicals. However, by sequential coupling of a selected photoredox dye, such as resazurin, the dark region may become fluorescent at the interfaces where the charge injection has taken place due to the concomitant formation of fluorescent resorufin by cascade electron transfer. Using this strategy and a total internal reflection fluorescence microscopy (TIRFM) image, the charge injection in TiO2/CdS and SiO2/TiO2/CdS nanoparticles is investigated The method allows the charge injection efficiency of the excited CdS into TiO2 to be evaluated qualitatively, explaining the differences observed for these photocatalytic materials in H2 generation.

Imaging the photoinduced charge injection in CdS/TiO2 nanoparticles by the sequential fluorescence mapping method.

PubMed

Frederice, Rafael; Lencione, Diego; Gehlen, Marcelo H

2017-02-10

The combination of a sensitizer and TiO 2 nanoparticles forming a photocatalytic material is a central issue in many fields of applied photochemistry. The charge injection of emissive sensitizers into the conduction band of the semiconductor TiO 2 may form a photoactive region that becomes dark, or it has a very low emission signal due to the generation of sensitizer radicals. However, by sequential coupling of a selected photoredox dye, such as resazurin, the dark region may become fluorescent at the interfaces where the charge injection has taken place due to the concomitant formation of fluorescent resorufin by cascade electron transfer. Using this strategy and a total internal reflection fluorescence microscopy (TIRFM) image, the charge injection in TiO 2 /CdS and SiO 2 /TiO 2 /CdS nanoparticles is investigated The method allows the charge injection efficiency of the excited CdS into TiO 2 to be evaluated qualitatively, explaining the differences observed for these photocatalytic materials in H 2 generation.

Diabetes-Related Goals, Practices, and Beliefs of Practicing Pediatricians.

ERIC Educational Resources Information Center

Lorenz, Rodney A.; Pichert, James W.

1982-01-01

Practicing pediatricians were surveyed to assess their need for diabetes education programs. Pediatricians generally have fewer than five diabetic patients, see them less than every four months, prescribe single daily insulin injections, and do not include diatetic services in the treatment program. No adequate rationale for continuing education…

Subsurface waste disposal by means of wells - A selective annotated bibliography

USGS Publications Warehouse

Rima, Donald Robert; Chase, Edith B.; Myers, Beverly M.

1971-01-01

Subsurface waste disposal by means of wells is the practice of using drilled wells to inject unwanted substances into underground rock formations. The use of wells for this purpose is not a new idea. As long ago as the end of the last century, it was common practice to drill wells for the express purpose of draining swamps and small lakes to reclaim the land for agricultural purposes. A few decades later in the 1920's and 1930's many oil companies began using injection wells to dispose of oil-field brines and to repressurize oil reservoirs. During World War II, the Atomic Energy Commission began using injection wells to dispose of certain types of radioactive wastes. More recently, injection wells have been drilled to dispose of a variety of byproducts of industrial processes. The number of such wells has increased rapidly since Congress passed the Clean Streams Act of 1966, which restricted the discharge of waste into surface waters.Many scientists and public officials question the propriety of using the term "disposal" when referring to the underground injection of wastes. Their reasons are that underground injection is not, as many advocates claim, "a complete and final answer" to the waste-disposal problem. Rather, it is merely a process wherein the injected wastes are committed to the subsurface with uncertainty as to their ultimate fate or limits of confinement. In effect, the wastes, undiminished and unchanged, are removed from the custody of man and placed in the custody of nature.Although the concept of waste-injection wells is relatively simple, the effects of waste injection can be very complex, particularly when dealing with the exotic and complex components of some industrial wastes. Besides the physical forces of injection, there are many varied interactions between the injected wastes and the materials within the injection zone. Because these changes occur out of sight in the subsurface, they are difficult to assess and not generally understood. In addition, the various aspects of the problem involve a wide spectrum of science and engineering. Hence, articles published on the subject are widely dispersed in the technical and scientific literature. 

Geothermal Reservoir Well Stimulation Program: technology transfer

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

Not Available

1980-05-01

Each of the following types of well stimulation techniques are summarized and explained: hydraulic fracturing; thermal; mechanical, jetting, and drainhole drilling; explosive and implosive; and injection methods. Current stimulation techniques, stimulation techniques for geothermal wells, areas of needed investigation, and engineering calculations for various techniques. (MHR)

HIV and hepatitis B and C co-infection among people who inject drugs in Zanzibar.

PubMed

Khatib, Ahmed; Matiko, Eva; Khalid, Farhat; Welty, Susie; Ali, Ameir; Othman, Asha; Haji, Shaaban; Dahoma, Mohammed; Rutherford, George

2017-11-28

People who inject drugs are at high risk of acquiring hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) due to risky injection and sexual practices. The objective of this study is to investigate the epidemiology of HIV, hepatitis B, and hepatitis C, and co-infection of these viruses among people who inject drugs in Zanzibar, Tanzania. We used respondent-driven sampling to identify 408 participants, from whom we collected demographic data, information on sexual behaviours and injection drug practices, and blood samples for biological testing. Prevalence of hepatitis B surface antigenaemia, HCV, and HIV infection were 5.9, 25.4, and 11.3%, respectively. Of the participants who were hepatitis B surface antigen (HBsAg) positive, 33.5% were infected with HCV and 18.8% were infected with HIV. Of the HCV-infected participants, 29.3% were infected with HIV. Of the participants who were infected with HIV, 9.0% were HBsAg positive, 66.6% had HCV and 8.5% had both. None of the potential risk factors we measured were associated with HBsAg positivity. In contrast, older age and longer duration of injection drug use were independently associated with HCV infection. HCV infection among people who inject drugs is lower in Zanzibar than in other countries, but could rise without proper interventions. These findings underscore the importance of screening people who inject drugs for HIV, HBsAg, and HCV; providing HBV vaccination to those who are eligible; initiating antiretroviral therapy for those who are co-infected with HIV/HBV and HIV/HCV; and introducing interventions that have high impact on reducing needle sharing.

Practical considerations in clinical strategy to support the development of injectable drug-device combination products for biologics.

PubMed

Li, Zhaoyang; Easton, Rachael

2018-01-01

The development of an injectable drug-device combination (DDC) product for biologics is an intricate and evolving process that requires substantial investments of time and money. Consequently, the commercial dosage form(s) or presentation(s) are often not ready when pivotal trials commence, and it is common to have drug product changes (manufacturing process or presentation) during clinical development. A scientifically sound and robust bridging strategy is required in order to introduce these changes into the clinic safely. There is currently no single developmental paradigm, but a risk-based hierarchical approach has been well accepted. The rigor required of a bridging package depends on the level of risk associated with the changes. Clinical pharmacokinetic/pharmacodynamic comparability or outcome studies are only required when important changes occur at a late stage. Moreover, an injectable DDC needs to be user-centric, and usability assessment in real-world clinical settings may be required to support the approval of a DDC. In this review, we discuss the common issues during the manufacturing process and presentation development of an injectable DDC and practical considerations in establishing a clinical strategy to address these issues, including key elements of clinical studies. We also analyze the current practice in the industry and review relevant and status of regulatory guidance in the DDC field.

Practical considerations in clinical strategy to support the development of injectable drug-device combination products for biologics

PubMed Central

Easton, Rachael

2018-01-01

ABSTRACT The development of an injectable drug-device combination (DDC) product for biologics is an intricate and evolving process that requires substantial investments of time and money. Consequently, the commercial dosage form(s) or presentation(s) are often not ready when pivotal trials commence, and it is common to have drug product changes (manufacturing process or presentation) during clinical development. A scientifically sound and robust bridging strategy is required in order to introduce these changes into the clinic safely. There is currently no single developmental paradigm, but a risk-based hierarchical approach has been well accepted. The rigor required of a bridging package depends on the level of risk associated with the changes. Clinical pharmacokinetic/pharmacodynamic comparability or outcome studies are only required when important changes occur at a late stage. Moreover, an injectable DDC needs to be user-centric, and usability assessment in real-world clinical settings may be required to support the approval of a DDC. In this review, we discuss the common issues during the manufacturing process and presentation development of an injectable DDC and practical considerations in establishing a clinical strategy to address these issues, including key elements of clinical studies. We also analyze the current practice in the industry and review relevant and status of regulatory guidance in the DDC field. PMID:29035675

Evidence Based Medicine in Pediatric Practice: Brief Review

PubMed Central

Kianifar, Hamid-Reza; Akhondian, Javad; Najafi-Sani, Mehri; Sadeghi, Ramin

2010-01-01

Practicing medicine according to the best evidence is gaining popularity in the medical societies. Although this concept, which is usually called Evidence Based Medicine (EBM) has been explained in many resources, it has not been addressed enough in pediatrics. In this review, we briefly explained Evidence Based Medicine approach and its applications in pediatrics in order to help the pediatricians to efficiently integrate EBM into their daily practice. PMID:23056715

Large enhancement in photocurrent by Mn doping in CdSe/ZTO quantum dot sensitized solar cells.

PubMed

Pimachev, Artem; Poudyal, Uma; Proshchenko, Vitaly; Wang, Wenyong; Dahnovsky, Yuri

2016-09-29

We find a large enhancement in the efficiency of CdSe quantum dot sensitized solar cells by doping with manganese. In the presence of Mn impurities in relatively small concentrations (2.3%) the photoelectric current increases by up to 190%. The average photocurrent enhancement is about 160%. This effect cannot be explained by a light absorption mechanism because the experimental and theoretical absorption spectra demonstrate that there is no change in the absorption coefficient in the presence of the Mn impurities. To explain such a large increase in the injection current we propose a tunneling mechanism of electron injection from the quantum dot LUMO state to the Zn 2 SnO 4 (ZTO) semiconductor photoanode. The calculated enhancement is approximately equal to 150% which is very close to the experimental average value of 160%. The relative discrepancy between the calculated and experimentally measured ratios of the IPCE currents is only 6.25%. For other mechanisms (such as electron trapping, etc.) the remaining 6.25% cannot explain the large change in the experimental IPCE. Thus we have indirectly proved that electron tunneling is the major mechanism of photocurrent enhancement. This work proposes a new approach for a significant improvement in the efficiency of quantum dot sensitized solar cells.

Self injection of foreign materials into the penis.

PubMed

Ahmed, U; Freeman, A; Kirkham, A; Ralph, D J; Minhas, S; Muneer, A

2017-02-01

Injection of the subcutaneous tissues of the penis for enlargement of penile girth has been practised for many years by laypeople and medical practitioners alike. However, with recognition of the complications, the practice has died out. We report a series of five patients who presented having injected foreign materials into the subcutaneous tissues of their penises, including paraffin and mineral oils. Our patients had a variable time course of presentation ranging from 1 day following injection to over 26 years. Self-injection of the subcutaneous tissues of the penis is an unusual presentation for a penile mass but should be considered as a differential diagnosis in patients with a long latent period to presentation or with characteristic magnetic resonance imaging and histological appearances.

Self injection of foreign materials into the penis

PubMed Central

Freeman, A; Kirkham, A; Ralph, DJ; Minhas, S; Muneer, A

2017-01-01

Injection of the subcutaneous tissues of the penis for enlargement of penile girth has been practised for many years by laypeople and medical practitioners alike. However, with recognition of complications, the practice has died out. We report a series of five patients who presented having injected foreign materials into the subcutaneous tissues of their penises, including paraffin and mineral oils. Our patients had a variable time course of presentation ranging from 1 day following injection to over 26 years. Self-injection of the subcutaneous tissues of the penis is an unusual presentation for a penile mass but should be considered as a differential diagnosis in patients with a long latent period to presentation or with characteristic magnetic resonance imaging and histological appearances. PMID:27869491

Pain reduction and improvement of function following ultrasound-guided intra-articular injections of triamcinolone hexacetonide and hyaluronic acid in hip osteoarthritis.

PubMed

Araújo, J P; Silva, L; Andrade, R; Paços, M; Moreira, H; Migueis, N; Pereira, R; Sarmento, A; Pereira, H; Loureiro, N; Espregueira-Mendes, J

2016-01-01

The scientific literature has shown positive results regarding intra-articular injections of hyaluronic acid in osteoarthritic joints. When injecting in the hip joint, the guidance of ultrasound can provide higher injection accuracy and repeatability. However, due to the methodological limitations in the current available literature, its recommendation in the current practice is still controversial. This study shows that ultrasound-guided intra-articular injections of triamcinolone hexacetonide and hyaluronic acid can improve pain, function and quality of life in patients with symptomatic and radiographic hip osteoarthritis. In addition, the administration of triamcinolone hexacetonide and hyaluronic acid to the hip joint in these patients can delay the need for interventional surgery.

Numerical Simulation of Atomization in Nozzle Injection Flow

NASA Astrophysics Data System (ADS)

Fan, Qinyin; Guo, Chenhai; Takagi, Tosimi; Narumiya, Kikuo; Hattori, Hiroshi

At the initial stage of injection, the injection flow has not yet broken up and in a range of small atmosphere pressure (16˜500KPa), the tip of the injection flow always forms a shape of mushroom. [1] [2] Moreover, the umbrella of the mushroom is always very big and its root is always very thin, especially when the atmosphere pressure is relatively low (88KPa, or 100mmHg). These phenomena are not known popularly and the reason of mushroom formation is not clear. In this paper, with the MARS method for simulating free surface, analysis of injection flow is practiced. The phenomena are reproduced and the reason is cleared that the formation of the mushroom is induced by the momentum exchange between the injection fuel flow with very high speed and the very complex flow of the air.

Numerical study of rotating detonation engine with an array of injection holes

NASA Astrophysics Data System (ADS)

Yao, S.; Han, X.; Liu, Y.; Wang, J.

2017-05-01

This paper aims to adopt the method of injection via an array of holes in three-dimensional numerical simulations of a rotating detonation engine (RDE). The calculation is based on the Euler equations coupled with a one-step Arrhenius chemistry model. A pre-mixed stoichiometric hydrogen-air mixture is used. The present study uses a more practical fuel injection method in RDE simulations, injection via an array of holes, which is different from the previous conventional simulations where a relatively simple full injection method is usually adopted. The computational results capture some important experimental observations and a transient period after initiation. These phenomena are usually absent in conventional RDE simulations due to the use of an idealistic injection approximation. The results are compared with those obtained from other numerical studies and experiments with RDEs.

Incorporating geographic settings into a social network analysis of injection drug use and bloodborne pathogen prevalence.

PubMed

Wylie, John L; Shah, Lena; Jolly, Ann

2007-09-01

Using social network analysis, we investigated how communal meeting places can link injection drug user (IDU) populations and create opportunities for the transmission of bloodborne pathogens. In our locale, specific hotels played a key role in the injection drug scene. Within this hotel network some IDU injected at only one hotel while others injected at multiple hotels; this latter group potentially acted as spatial bridges linking relatively distinct hotel networks. Pathogen prevalence showed a gradation with the highest prevalence occurring at the centre of the network. Consistent with pathogen prevalence, people most central to the network were more likely to engage in risky injection practices. Incorporating geographic place into analyses involving IDU can contribute to an understanding of pathogen transmission patterns in an area and assist public health efforts to develop targeted intervention programs.

Resolving bulimia nervosa using an innovative neural therapy approach: two case reports.

PubMed

Gurevich, Michael I; Chung, Myung Kyu; LaRiccia, Patrick J

2018-02-01

Conventional treatment of Bulimia Nervosa is long term, expensive, and often ineffective. Neural therapy holds promise for treating Bulimia Nervosa in a shorter term, lower cost, and more effective manner. Much of neural therapy involves the superficial injection of local anesthetic injections. Implementation into current practice would be feasible.

Chemical Facial Cellulitis Due to Inadvertent Injection of Formalin into Oral Tissue Space

PubMed Central

Virk, Pawandeep Sandhu; Arakeri, Gururaj

2015-01-01

This paper reports the accidental injection of formalin into oral tissue space, in an 8-year old child resulting in chemical facial necrotizing cellulitis and its management. The common practice of keeping formalin in local anesthesia vials should be avoided by dental clinics, to prevent such unfortunate incidents. PMID:26918101

Chemical Facial Cellulitis Due to Inadvertent Injection of Formalin into Oral Tissue Space.

PubMed

Bector, Aditi; Virk, Pawandeep Sandhu; Arakeri, Gururaj

2015-11-05

This paper reports the accidental injection of formalin into oral tissue space, in an 8-year old child resulting in chemical facial necrotizing cellulitis and its management. The common practice of keeping formalin in local anesthesia vials should be avoided by dental clinics, to prevent such unfortunate incidents.

Influence of gonadotropin-releasing hormone and timing of insemination relative to estrus on pregnancy rates of dairy cattle at first service.

PubMed

Mee, M O; Stevenson, J S; Scoby, R K; Folman, Y

1990-06-01

The objective was to determine the influence of gonadotropin-releasing hormone on pregnancy rates of dairy cattle at first services, when both the timing of hormone injection and insemination were altered relative to the onset of estrus. Cows (n = 325) were assigned randomly to six groups making up a 2 X 2 X 2 incomplete factorial experiment; dose of GnRH (100 micrograms versus saline), timing [1 h (early) or 12 to 16 h (late) after first detected estrus] of AI, and timing of hormone injection (early versus late) were the three main effects. Cows were observed for estrus 4 times daily. Treatments and resulting pregnancy rates were: 1) hormone injection early plus AI early (35%), 2) hormone injection late plus AI early (34%), 3) saline injection early plus AI early (30%), 4) hormone injection late plus AI late (30%), 5) hormone injection early plus AI late (46%), and 6) saline injection late plus AI late (43%). Pregnancy rate in the first four groups (32%) was less than that in the latter two groups (44%). Concentrations of LH in serum were greater for cows given hormone or saline injections in early estrus than for cows injected with either hormone of saline during late estrus. Concentrations of LH in serum 2 h after GnRH were elevated above those of controls, whether GnRH was injected during early or late estrus. Neither concentrations of LH during estrus nor concentrations of progesterone 8 to 14 d after estrus explained the possible antifertility effect of GnRH given during late estrus.(ABSTRACT TRUNCATED AT 250 WORDS)

Sensitivity of mouse bioassay in clinical wound botulism.

PubMed

Wheeler, Charlotte; Inami, Gregory; Mohle-Boetani, Janet; Vugia, Duc

2009-06-15

California has an ongoing epidemic of wound botulism (WB) among injection drug users (IDUs). We retrospectively studied a cohort of patients with WB and determined the sensitivity of the mouse bioassay-the gold standard laboratory test for confirmation of botulism-in verifying WB. We defined a clinical case of WB as an acute, bilateral, descending, flaccid paralysis starting with 1 cranial nerve palsies in an IDU with no other explainable diagnosis. We calculated the sensitivity of the mouse bioassay as the proportion of clinical WB cases that had positive serum toxin test results by mouse bioassay. We compared serum toxin-positive with serum toxin-negative patients. Of 73 patients with WB, 50 tested serum toxin positive, yielding a sensitivity of 68%. Serum toxin-positive patients did not differ significantly from serum toxin-negative patients with respect to demographic characteristics or injection drug use practices or in days from patient symptom onset to collection of specimens for testing. Patients did not differ significantly by clinical characteristics, except that serum toxin-positive patients were more likely than serum toxin-negative patients to have required mechanical ventilation during their hospital courses (74% vs. 43%; P = .01). In this study, the mouse bioassay failed to detect botulinum toxin in the serum samples of nearly one-third of IDUs with characteristic WB. Such patients should be considered to have probable WB. Physicians should be aware of the test's limitations and base their final diagnosis of suspected WB on clinical criteria when the mouse bioassay produces negative results.

BLOOD PLASMA PROTEIN GIVEN BY VEIN UTILIZED IN BODY METABOLISM

PubMed Central

Holman, Russell L.; Mahoney, Earle B.; Whipple, George H.

1934-01-01

Large amounts of normal blood plasma can be given intravenously to normal dogs over several weeks without causing any significant escape by way of the urine. There appears to be no renal threshold for plasma protein even with high plasma protein concentration (9.7 per cent). Dogs receiving sugar by mouth and plasma by vein can be kept practically in nitrogen equilibrium and it would seem that the injected protein must be utilized by the body. If this can happen in this emergency we may suspect that normally there is a certain amount of "give and take" between body protein and plasma protein. Plasma protein fed by mouth under identical conditions shows the same general reaction as noted with plasma by vein but the urinary nitrogen is a little higher and suggests that the injected protein is utilized a little more completely to form new protein. The difference may be explained as due to deaminization in the case of protein by mouth. During fasting periods the blood plasma proteins are used up and the total circulating protein may even decrease to one-half the normal level. The plasma protein concentration changes but little and the significant change is a shrinkage of plasma volume. All these facts point to a dynamic equilibrium between tissue protein and plasma protein depending upon the physiological needs of the moment. In the absence of food protein the body can use material coming from one body protein to fabricate badly needed protein material of different character. PMID:19870245

Prevalence and correlates of neck injection among people who inject drugs in Tijuana, Mexico.

PubMed

Rafful, Claudia; Wagner, Karla D; Werb, Dan; González-Zúñiga, Patricia E; Verdugo, Silvia; Rangel, Gudelia; Strathdee, Steffanie A

2015-11-01

Injecting drugs in the neck has been related to adverse health conditions such as jugular vein thrombosis, deep neck infections, aneurysm, haematomas, airway obstruction, vocal cord paralysis and wound botulism, among others. We identified prevalence and correlates of neck injection among people who inject drugs (PWID) in Tijuana, Mexico. Beginning in 2011, PWID aged ≥18 years who injected drugs within the last month were recruited into a prospective cohort. At baseline and semi-annually, PWID completed interviewer-administered surveys soliciting data on drug-injecting practices. Logistic regression was used to identify predictors of injecting in the neck as the most frequent injection site at a single visit. Of 380 PWID, 35.3% injected in the neck at least once in the past 6 months, among whom 71.6% reported it as their most common injection site, the most common injecting site after the arms (47%). Controlling for age, years injecting and injecting frequency, injecting heroin and methamphetamine two or more times per day and having sought injection assistance were associated with injecting in the neck [adjusted odds ratios (AOR): 2.12; 95% confidence intervals (CI): 1.27-3.53 and AOR: 2.65; 95% CI: 1.52-4.53 respectively]. Injecting in the neck was very common among PWID in Tijuana and was associated with polydrug use and seeking injection assistance. Tailoring harm reduction education interventions for individuals who provide injection assistance ('hit doctors') may allow for the dissemination of safe injecting knowledge to reduce injection-related morbidity and mortality. © 2015 Australasian Professional Society on Alcohol and other Drugs.

Do procedural skills workshops during family practice residency work?

PubMed

MacKenzie, Mark S; Berkowitz, Jonathan

2010-08-01

To determine if participation in a procedural skills workshop during family practice residency affects future use of these skills in postgraduate clinical practice. Survey involving self-assessment of procedural skills experience and competence. British Columbia. Former University of British Columbia family practice residents who trained in Vancouver, BC, including residents who participated in a procedural skills workshop in 2001 or 2003 and residents graduating in 2000 and 2002 who did not participate in the procedural skills workshop. Self-assessed experience and competence in the 6 office-based procedural skills that were taught during the procedural skills workshops in 2001 and 2003. Participation in a procedural skills workshop had no positive effect on future use of these skills in clinical practice. Participation in the workshop was associated with less reported experience (P = .091) in injection of lateral epicondylitis. As with previous Canadian studies, more women than men reported experience and competence in gynecologic procedures. More women than men reported experience (P = .001) and competence (P = .004) in intrauterine device insertion and experience (P = .091) in endometrial aspiration biopsy. More men than women reported competence (P = .052) in injection of trochanteric bursae. A third year of emergency training was correlated with an increase in reported experience (P = .021) in shoulder injection. Participation in a procedural skills workshop during family practice residency did not produce a significant increase in the performance of these skills on the part of participants once they were in clinical practice. The benefit of a skills workshop might be lost when there is no opportunity to practise and perfect these skills. Sex bias in the case of some procedures might represent a needs-based acquisition of skills on the part of practising physicians. Short procedural skills workshops might be better suited to graduated physicians with more clinical experience.

Advocacy for Gender Affirming Care: Learning from the Injectable Estrogen Shortage

PubMed Central

Geffen, Sophia; Horn, Tim; Smith, Kimberleigh Joy; Cahill, Sean

2018-01-01

Abstract Hormone therapy is medically necessary for many transgender individuals. The U.S. Food and Drug Administration (FDA) and pharmaceutical companies' failure to guarantee a supply of injectable estrogen in 2016 and 2017 for transgender individuals is a violation of their right to comprehensive medical treatment, free of discrimination. A series of advocacy actions eventually led to all formulations of injectable estrogen being restored to market; however, long-term solutions to supply interruptions of injectable estrogen are needed. Long-term solutions should address the lack of federally funded research and, consequently, evidence-based practice on hormone therapy for gender affirmation. PMID:29682613

Overestimation of low cardiac output measured by thermodilution.

PubMed

Tournadre, J P; Chassard, D; Muchada, R

1997-10-01

We have investigated the influence of a cold water bolus (CWB) injection on overestimation of cardiac output (CO) in low CO states in anaesthetized dogs. CO was measured using three methods: (1) thermodilution (TD), (2) electromagnetic (EM) flow meter placed on the pulmonary artery and (3) transoesophageal echo-Doppler (OD) placed on the descending aorta. Measurements of CO were obtained before (steady state) and after induction of a low CO state with thiopentone 5 mg kg-1 i.v. After CWB injection, mean CO measured by EM and OD increased by 26% and 27%, respectively (P < 0.05) during steady state, and by 85% and 75% (P < 0.05) during the low CO state. This transient increase was produced by an increase in stroke volume, while heart rate did not change. Frank Starling's law may explain this variation by a sudden increase in preload produced by CWB injection. These results indicate that thermodilution overestimated CO during low CO states when CWB injection was used.

Usage of Practices Promoted by School Improvement Grants. NCEE 2015-4019

ERIC Educational Resources Information Center

Dragoset, Lisa; James-Burdumy, Susanne; Hallgren, Kristin; Perez-Johnson, Irma; Herrmann, Mariesa; Tuttle, Christina; Angus, Megan Hague; Herman, Rebecca; Murray, Matthew; Tanenbaum, Courtney; Graczewski, Cheryl

2015-01-01

The American Recovery and Reinvestment Act of 2009 injected $7 billion into two of the Obama administration's signature competitive education grant programs: Race to the Top (RTT) and School Improvement Grants (SIG). While RTT focused on state policies and SIG focused on school practices, both programs promoted related policies and practices,…

Demonstration of self-truncated ionization injection for GeV electron beams

PubMed Central

Mirzaie, M.; Li, S.; Zeng, M.; Hafz, N. A. M.; Chen, M.; Li, G. Y.; Zhu, Q. J.; Liao, H.; Sokollik, T.; Liu, F.; Ma, Y. Y.; Chen, L.M.; Sheng, Z. M.; Zhang, J.

2015-01-01

Ionization-induced injection mechanism was introduced in 2010 to reduce the laser intensity threshold for controllable electron trapping in laser wakefield accelerators (LWFA). However, usually it generates electron beams with continuous energy spectra. Subsequently, a dual-stage target separating the injection and acceleration processes was regarded as essential to achieve narrow energy-spread electron beams by ionization injection. Recently, we numerically proposed a self-truncation scenario of the ionization injection process based upon overshooting of the laser-focusing in plasma which can reduce the electron injection length down to a few hundred micrometers, leading to accelerated beams with extremely low energy-spread in a single-stage. Here, using 100 TW-class laser pulses we report experimental observations of this injection scenario in centimeter-long plasma leading to the generation of narrow energy-spread GeV electron beams, demonstrating its robustness and scalability. Compared with the self-injection and dual-stage schemes, the self-truncated ionization injection generates higher-quality electron beams at lower intensities and densities, and is therefore promising for practical applications. PMID:26423136

Addressing the “Risk Environment” for Injection Drug Users: The Mysterious Case of the Missing Cop

PubMed Central

Burris, Scott; Blankenship, Kim M; Donoghoe, Martin; Sherman, Susan; Vernick, Jon S; Case, Patricia; Lazzarini, Zita; Koester, Stephen

2004-01-01

Ecological models of the determinants of health and the consequent importance of structural interventions have been widely accepted, but using these models in research and practice has been challenging. Examining the role of criminal law enforcement in the “risk environment” of injection drug users (IDUs) provides an opportunity to apply structural thinking to the health problems associated with drug use. This article reviews international evidence that laws and law enforcement practices influence IDU risk. It argues that more research is needed at four levels—laws; management of law enforcement agencies; knowledge, attitudes, beliefs, and practices of frontline officers; and attitudes and experiences of IDUs—and that such research can be the basis of interventions within law enforcement to enhance IDU health. PMID:15016246

Top-down Controls on Bacterial Transport in Oxic and Suboxic Subsurface Environments

NASA Astrophysics Data System (ADS)

Choi, K.; Dobbs, F. C.

2001-12-01

The purpose of this investigation was to assess the impact of top-down processes (protistan grazing and viral infection) on bacterial transport through a shallow, unconfined, sandy aquifer at the Department of Energy study site in Oyster, Virginia. A cultured, adhesion-deficient, viably stained, indigenous bacterial strain (DA001) was injected during a field experiment performed at an oxic site in October 1999, while DA001 and an iron-reducing bacterial strain (OY107) were co-injected at a nearby suboxic site in July 2001. Groundwater samples were collected before and after injection and abundance of protists and virus-like particles (the latter at the oxic site only) was determined. Three major groups of protists (flagellates, amoebae, and ciliates) were found at both sites during the experiments, with flagellate abundance greatly dominating the others. Following bacterial injections, concentrations up to 5000 and 3000 protists per ml were observed at the oxic and suboxic sites, respectively. However, removal of bacteria in groundwater by predation, estimated with a mass balance approach, was apparently minimal. Elevated hydraulic gradients during the injections may explain the estimated low impact of predation. The abundance of virus-like particles increased as much as six-fold in the month following injection of DA001 at the oxic site, yet plaque assays revealed no evidence supporting lytic infection of the injected bacteria.

Prompt enhancement of the Earth's outer radiation belt due to substorm electron injections

DOE PAGES

Tang, C. L.; Zhang, J. -C.; Reeves, G. D.; ...

2016-12-17

Here, we present multipoint simultaneous observations of the near-Earth magnetotail and outer radiation belt during the substorm electron injection event on 16 August 2013. Time History of Events and Macroscale Interactions during Substorms A in the near-Earth magnetotail observed flux-enhanced electrons of 300 keV during the magnetic field dipolarization. Geosynchronous orbit satellites also observed the intensive electron injections. Located in the outer radiation belt, RBSP-A observed enhancements of MeV electrons accompanied by substorm dipolarization. The phase space density (PSD) of MeV electrons at L* ~5.4 increased by 1 order of magnitude in 1 h, resulting in a local PSD peakmore » of MeV electrons, which was caused by the direct effect of substorm injections. We also detected an enhanced MeV electrons in the heart of the outer radiation belt within 2 h, which may be associated with intensive substorm electron injections and subsequent local acceleration by chorus waves. Multipoint observations have shown that substorm electron injections not only can be the external source of MeV electrons at the outer edge of the outer radiation belt (L* ~5.4) but also can provide the intensive seed populations in the outer radiation belt. These initial higher-energy electrons from injection can reach relativistic energy much faster. Furthermore, these observations also provide evidence that enhanced substorm electron injections can explain rapid enhancements of MeV electrons in the outer radiation belt.« less

Prompt enhancement of the Earth's outer radiation belt due to substorm electron injections

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

Tang, C. L.; Zhang, J. -C.; Reeves, G. D.

Here, we present multipoint simultaneous observations of the near-Earth magnetotail and outer radiation belt during the substorm electron injection event on 16 August 2013. Time History of Events and Macroscale Interactions during Substorms A in the near-Earth magnetotail observed flux-enhanced electrons of 300 keV during the magnetic field dipolarization. Geosynchronous orbit satellites also observed the intensive electron injections. Located in the outer radiation belt, RBSP-A observed enhancements of MeV electrons accompanied by substorm dipolarization. The phase space density (PSD) of MeV electrons at L* ~5.4 increased by 1 order of magnitude in 1 h, resulting in a local PSD peakmore » of MeV electrons, which was caused by the direct effect of substorm injections. We also detected an enhanced MeV electrons in the heart of the outer radiation belt within 2 h, which may be associated with intensive substorm electron injections and subsequent local acceleration by chorus waves. Multipoint observations have shown that substorm electron injections not only can be the external source of MeV electrons at the outer edge of the outer radiation belt (L* ~5.4) but also can provide the intensive seed populations in the outer radiation belt. These initial higher-energy electrons from injection can reach relativistic energy much faster. Furthermore, these observations also provide evidence that enhanced substorm electron injections can explain rapid enhancements of MeV electrons in the outer radiation belt.« less

NURSES INFECTION PREVENTION PRACTICES IN HANDLING INJECTIONS: A CASE OF RIFT VALLEY PROVINCIAL HOSPITAL IN KENYA.

PubMed

Chemoiwa, R K; Mukthar, V K; Maranga, A K; Kulei, S J

2014-10-01

To analyse the infection prevention practices in handling of injections by nurses in Rift Valley Provincial Hospital in Kenya. A cross-sectional observational study. Rift Valley Provincial hospital which is a level five health facility situated in Nakuru County, Kenya. A sample of 386 injection procedures attributed to the nurses in Rift Valley Provincial Hospital was considered for this study. The study established that among all the injections administered in this study, 43.7% (386) adhered to aseptic techniques. Over seventy five percent (76.9%, n = 386) of the observed injections procedures did not involve the hand-washing, 53.4% (n = 206) did not involve swabbing of a vial rubber cap with alcohol swabs and 95.1%(n = 263) involved using of multidose drug in more than one designated patient. Over ninety five percent (95.6%, n = 364) of the observed procedures involved use of sterile the syringe bit of the devices only while the rest used either clean or contaminated syringes. Around forty percent (42.2%, n = 316) of the injections preparation was done elsewhere (not at the patient bedside) before administration. Slightly over thirty five percent (36.6%, n = 386) of the injections were administered immediately upon reconstitution(at the right time). The study also established the use of aseptic techniques to reconstitute and administer was significantly related to the number of nurses to patients ratio per shift (X2(1) = 3.5: p = 0.04). The findings of this study indicate that patient safety in public hospital is still relatively low. The adherence to basic infection prevention procedures/aseptic techniques in handling of injections by health workers is still a concern. The adherence to aseptic techniques in handling injections is significantly associated with the nurses to patients ratios. Therefore, it is imperative to improve nurse to patient ratio in public health facilities in Kenya.

Cluster of HIV Infections Attributed to Unsafe Injection Practices--Cambodia, December 1, 2014-February 28, 2015.

PubMed

Vun, Mean Chhi; Galang, Romeo R; Fujita, Masami; Killam, William; Gokhale, Runa; Pitman, John; Selenic, Dejana; Mam, Sovatha; Mom, Chandara; Fontenille, Didier; Rouet, Francois; Vonthanak, Saphonn

2016-02-19

In December 2014, local health authorities in Battambang province in northwest Cambodia reported 30 cases of human immunodeficiency virus (HIV) infection in a rural commune (district subdivision) where only four cases had been reported during the preceding year. The majority of cases occurred in residents of Roka commune. The Cambodian National Center for HIV/AIDS (acquired immunodeficiency syndrome), Dermatology and Sexually Transmitted Diseases (NCHADS) investigated the outbreak in collaboration with the University of Health Sciences in Phnom Penh and members of the Roka Cluster Investigation Team. By February 28, 2015, NCHADS had confirmed 242 cases of HIV infection among the 8,893 commune residents, an infection rate of 2.7%. Molecular investigation of the HIV strains present in this outbreak indicated that the majority of cases were linked to a single HIV strain that spread quickly within this community. An NCHADS case-control study identified medical injections and infusions as the most likely modes of transmission. In response to this outbreak, the Government of Cambodia has taken measures to encourage safe injection practices by licensed medical professionals, ban unlicensed medical practitioners, increase local capacity for HIV testing and counseling, and expand access to HIV treatment in Battambang province. Measures to reduce the demand for unnecessary medical injections and the provision of unsafe injections are needed. Estimates of national HIV incidence and prevalence might need to be adjusted to account for unsafe injection as a risk exposure.

Penile paraffinoma after subcutaneous injection of paraffin. Treatment with a two step cutaneous plasty of the penile shaft with scrotal skin.

PubMed

Oñate Celdrán, Julián; Sanchez Rodríguez, Carlos; Tomás Ros, Mariano; González Valverde, Francisco Miguel; Morga Egea, Juan Pedro; Ruiz Marín, Miguel; Valdelvira Nadal, Pedro; Jiménez López, José Miguel; Fontana Compiano, Luis Oscar

2012-06-01

To report a rare case of penile paraffinoma caused by the subcutaneous or intra-urethral injection of foreign substances containing long-chain saturated hydrocarbons. These were injected in order to increase the penis size which generated a chronic granulomatous inflammatory reaction. This is a rare practice in the western world. We present the case of a 32-year-old Bulgarian male who presented with a two-year history of elastic, slightly painful penis swelling after subcutaneous liquid paraffin injection. The proposed treatment was excision of the affected tissue and penile reconstruction in a two-stage procedure. The operative procedure was successful and the patient had good aesthetic and functional results. Paraffin and other materials injected into the penis can produce many complications. Foreign body granuloma, skin necrosis, penile deformity, chronic and unhealed ulcer, painful erection, and the inability to achieve a satisfactory sexual relationship are some of the resulting complications. Intralesional or systemic steroids have been used in primary sclerosing lipogranuloma resulting in the disappearance of the granuloma, but in our opinion the treatment of choice should be radical excision, and, if necessary, secondary reconstruction of the penis. The injection of foreign substances to enhance penis size is currently an unjustifiable practice. However, it is still carried out, especially in Eastern Europe and Asia. In most cases surgical treatment is needed to treat the complications and the best modality seems to be radical excision together with follow-up.

Facilitating treatment entry among out-of-treatment injection drug users.

PubMed Central

Booth, R E; Kwiatkowski, C; Iguchi, M Y; Pinto, F; John, D

1998-01-01

OBJECTIVE: High risk injection practices are common among injecting drug users (IDUs), even following intervention efforts. Moreover, relapse to risk behaviors has been reported among those who initiate risk reduction. Substance abuse treatment offers the potential to reduce or eliminate injecting risk behaviors through drug cessation. We report on the effectiveness of two intervention strategies in facilitating treatment entry among out-of-treatment IDUs: motivational interviewing (MI), and intervention developed to help individuals resolve their ambivalence about behavior change, and free treatment for 90 days. These conditions were compared with an intervention focusing on a hierarchy of safer injecting practice, referred to here as risk reduction (RR), and no free treatment. METHODS: Nearly 200 out-of-treatment IDUs were randomly assigned to one of four experimental conditions: MI/free treatment, MI/no free treatment, RR/free treatment, and RR/no free treatment. Regardless of assignment, we assisted anyone desiring treatment by calling to schedule the appointment, providing transportation, and waiving the intake fee. RESULTS: Overall, 42% of study participants entered treatment. No significant differences were found between MI and RR; however, 52% of those assigned free treatment entered compare with 32% for those who had to pay. Other predictors of treatment entry included prior treatment experiences, perceived chance of contracting acquired immunodeficiency syndrome (AIDS) greater than 50%, "determination" stage of change, greater frequency of heroin injecting, and fewer drug-using friends. CONCLUSIONS: These findings support the importance of removing barriers to treatment entry. PMID:9722817

Rationale and design of a prospective study: Cervical Dystonia Patient Registry for Observation of OnaBotulinumtoxinA Efficacy (CD PROBE)

PubMed Central

2011-01-01

Background A registry of patients with cervical dystonia (Cervical Dystonia Patient Registry for Observation of onaBotulinumtoxinA Efficacy [CD PROBE]) was initiated to capture data regarding physician practices and patient outcomes with onabotulinumtoxinA (BOTOX®, Allergan, Inc., Irvine, CA, USA). Methods and baseline demographics from an interim analysis are provided. Methods/Design This is a prospective, multicenter, clinical registry in the United States enrolling subjects with cervical dystonia (CD) who are toxin naïve and/or new to the physicians' practices, or who had been in a clinical trial but received their last injection ≥ 16 weeks prior to enrollment. Subjects are followed over 3 injection cycles of onabotulinumtoxinA, with assessments at time of injection and 4-6 weeks later. Information on physician's practice, patient demographics, CD disease history, duration of treatment intervals and neurotoxin dose, dilution, use of electromyography, and muscles injected are collected. Outcomes are assessed by physicians and subjects using various questionnaires. Discussion This ongoing registry includes 609 subjects with the following baseline data: 75.9% female, 93.6% Caucasian, mean age 57.6 ± 14.3, age at symptom onset 48.3 ± 16.2, and time to diagnosis 5.4 ± 8.6 years, with an additional 1.0 ± 3.5 years before treatment. Of those employed at the time of diagnosis, 36.6% stopped working as a result of CD. CD PROBE, the largest clinical registry of CD treatment, will provide useful data on current treatment practices with onabotulinumtoxinA, potentially leading to refinements for optimization of outcomes. Trial registration NCT00836017 PMID:22054223

Spatiotemporal changes of seismic attenuation caused by injected CO2 at the Frio-II pilot site, Dayton, TX, USA

NASA Astrophysics Data System (ADS)

Zhu, Tieyuan; Ajo-Franklin, Jonathan B.; Daley, Thomas M.

2017-09-01

A continuous active source seismic monitoring data set was collected with crosswell geometry during CO2 injection at the Frio-II brine pilot, near Liberty, TX. Previous studies have shown that spatiotemporal changes in the P wave first arrival time reveal the movement of the injected CO2 plume in the storage zone. To further constrain the CO2 saturation, particularly at higher saturation levels, we investigate spatial-temporal changes in the seismic attenuation of the first arrivals. The attenuation changes over the injection period are estimated by the amount of the centroid frequency shift computed by local time-frequency analysis. We observe that (1) at receivers above the injection zone seismic attenuation does not change in a physical trend; (2) at receivers in the injection zone attenuation sharply increases following injection and peaks at specific points varying with distributed receivers, which is consistent with observations from time delays of first arrivals; then, (3) attenuation decreases over the injection time. The attenuation change exhibits a bell-shaped pattern during CO2 injection. Under Frio-II field reservoir conditions, White's patchy saturation model can quantitatively explain both the P wave velocity and attenuation response observed. We have combined the velocity and attenuation change data in a crossplot format that is useful for model-data comparison and determining patch size. Our analysis suggests that spatial-temporal attenuation change is not only an indicator of the movement and saturation of CO2 plumes, even at large saturations, but also can quantitatively constrain CO2 plume saturation when used jointly with seismic velocity.

Two-year survey comparing earthquake activity and injection-well locations in the Barnett Shale, Texas

PubMed Central

Frohlich, Cliff

2012-01-01

Between November 2009 and September 2011, temporary seismographs deployed under the EarthScope USArray program were situated on a 70-km grid covering the Barnett Shale in Texas, recording data that allowed sensing and locating regional earthquakes with magnitudes 1.5 and larger. I analyzed these data and located 67 earthquakes, more than eight times as many as reported by the National Earthquake Information Center. All 24 of the most reliably located epicenters occurred in eight groups within 3.2 km of one or more injection wells. These included wells near Dallas–Fort Worth and Cleburne, Texas, where earthquakes near injection wells were reported by the media in 2008 and 2009, as well as wells in six other locations, including several where no earthquakes have been reported previously. This suggests injection-triggered earthquakes are more common than is generally recognized. All the wells nearest to the earthquake groups reported maximum monthly injection rates exceeding 150,000 barrels of water per month (24,000 m3/mo) since October 2006. However, while 9 of 27 such wells in Johnson County were near earthquakes, elsewhere no earthquakes occurred near wells with similar injection rates. A plausible hypothesis to explain these observations is that injection only triggers earthquakes if injected fluids reach and relieve friction on a suitably oriented, nearby fault that is experiencing regional tectonic stress. Testing this hypothesis would require identifying geographic regions where there is interpreted subsurface structure information available to determine whether there are faults near seismically active and seismically quiescent injection wells. PMID:22869701

Formation and dissipation of runaway current by MGI on J-TEXT

NASA Astrophysics Data System (ADS)

Wei, Yunong; Chen, Zhongyong; Huang, Duwei; Tong, Ruihai; Zhang, Xiaolong

2017-10-01

Plasma disruptions are one of the major concern for ITER. A large fraction of runaway current may be formed due to the avalanche generation of runaway electrons (REs) during disruptions and ruin the device structure. Experiments of runaway current formation and dissipation have been done on J-TEXT. Two massive gas injection (MGI) valves are used to form and dissipate the runaway current. Hot tail RE generation caused by the fast thermal quench leads to an abnormal formation of runaway current when the pre-TQ electron density increases in a range of 0.5-2-10 19m-3. 1020-22 quantities of He, Ne, Ar or Kr impurities are injected by MGI2 to dissipate the runaway current. He injection shows no obvious effect on runaway current dissipation in the experiments and Kr injection shows the best. The kinetic energy of REs and the magnetic energy of RE beam will affect the dissipation efficiency to a certain extent. Runaway current decay rate is found increasing quickly with the increase of the gas injection when the quantity is moderate, and then reaches to a saturation value with large quantity injection. A possible reason to explain the saturation of dissipation effect is the saturation of gas assimilation efficiency.

Review of palliative sedation and its distinction from euthanasia and lethal injection.

PubMed

Hahn, Michael P

2012-01-01

Palliative sedation evolved from within the practice of palliative medicine and has become adopted by other areas of medicine, such as within intensive care practice. Clinician's usually come across this practice for dying patients who are foregoing or having life support terminated. A number of intolerable and intractable symptom burdens can occur during the end of life period that may require the use of palliative sedation. Furthermore, when patients receive palliative sedation, the continued use of hydration and nutrition becomes an issue of consideration and there are contentious bioethical issues involved in using or withholding these life-sustaining provisions. A general understanding of biomedical ethics helps prevent abuse in the practice of palliative sedation. Various sedative drugs can be employed in the provision of palliative sedation that can produce any desired effect, from light sedation to complete unconsciousness. Although there are some similarities in the pharmacotherapy of palliative sedation, euthanasia, physician-assisted suicide, and lethal injection, there is a difference in how the drugs are administered with each practice. There are some published guidelines about how palliative sedation should be practiced, but currently there is not any universally accepted standard of practice.

Dependences of contraction/expansion of stacking faults on temperature and current density in 4H-SiC p–i–n diodes

NASA Astrophysics Data System (ADS)

Okada, Aoi; Nishio, Johji; Iijima, Ryosuke; Ota, Chiharu; Goryu, Akihiro; Miyazato, Masaki; Ryo, Mina; Shinohe, Takashi; Miyajima, Masaaki; Kato, Tomohisa; Yonezawa, Yoshiyuki; Okumura, Hajime

2018-06-01

To investigate the mechanism of contraction/expansion behavior of Shockley stacking faults (SSFs) in 4H-SiC p–i–n diodes, the dependences of the SSF behavior on temperature and injection current density were investigated by electroluminescence image observation. We investigated the dependences of both triangle- and bar-shaped SSFs on the injection current density at four temperature levels. All SSFs in this study show similar temperature and injection current density dependences. We found that the expansion of SSFs at a high current density was converted to contraction at a certain value as the current decreased and that the value is temperature-dependent. It has been confirmed that SSF behavior, which was considered complex or peculiar, might be explained mainly by the energy change caused by SSFs.

Reduction of plasma density in the Helicity Injected Torus with Steady Inductance experiment by using a helicon pre-ionization source

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

Hossack, Aaron C.; Jarboe, Thomas R.; Victor, Brian S.

2013-10-15

A helicon based pre-ionization source has been developed and installed on the Helicity Injected Torus with Steady Inductance (HIT-SI) spheromak. The source initiates plasma breakdown by injecting impurity-free, unmagnetized plasma into the HIT-SI confinement volume. Typical helium spheromaks have electron density reduced from (2–3) × 10{sup 19} m{sup −3} to 1 × 10{sup 19} m{sup −3}. Deuterium spheromak formation is possible with density as low as 2 × 10{sup 18} m{sup −3}. The source also enables HIT-SI to be operated with only one helicity injector at injector frequencies above 14.5 kHz. A theory explaining the physical mechanism driving the reductionmore » of breakdown density is presented.« less

Rapid quantitative detection of glucose content in glucose injection by reaction headspace gas chromatography.

PubMed

Xie, Wei-Qi; Gong, Yi-Xian; Yu, Kong-Xian

2017-10-20

This work investigates an automated technique for rapid detecting the glucose content in glucose injection by reaction headspace gas chromatography (HS-GC). This method is based on the oxidation reaction of glucose in glucose injection with potassium dichromate. The carbon dioxide (CO 2 ) formed from the oxidation reaction can be quantitatively detected by GC. The results show that the relative standard deviation (RSD) of the present method was within 2.91%, and the measured glucose contents in glucose injection closely match those quantified by the reference method (relative differences <6.45%). The new HS-GC technique is rapid, practical and can be used to the batch detection of the glucose content in glucose injection related applications. Copyright © 2017 Elsevier B.V. All rights reserved.

Prevalence and correlates of neck injection among people who inject drugs in Tijuana, Mexico

PubMed Central

RAFFUL, CLAUDIA; WAGNER, KARLA D.; WERB, DAN; GONZÁLEZ-ZÚÑIGA, PATRICIA E.; VERDUGO, SILVIA; RANGEL, GUDELIA; STRATHDEE, STEFFANIE A.

2016-01-01

Introduction and Aims Injecting drugs in the neck has been related to adverse health conditions such as jugular vein thrombosis, deep neck infections, aneurysm, haematomas, airway obstruction, vocal cord paralysis and wound botulism, among others. We identified prevalence and correlates of neck injection among people who inject drugs (PWID) in Tijuana, Mexico. Design and Methods Beginning in 2011, PWID aged ≥18 years who injected drugs within the last month were recruited into a prospective cohort. At baseline and semi-annually, PWID completed interviewer-administered surveys soliciting data on drug-injecting practices. Logistic regression was used to identify predictors of injecting in the neck as the most frequent injection site at a single visit. Results Of 380 PWID, 35.3% injected in the neck at least once in the past 6 months, among whom 71.6% reported it as their most common injection site, the most common injecting site after the arms (47%). Controlling for age, years injecting and injecting frequency, injecting heroin and methamphetamine two or more times per day and having sought injection assistance were associated with injecting in the neck [adjusted odds ratios (AOR): 2.12; 95% confidence intervals (CI): 1.27–3.53 and AOR: 2.65; 95% CI: 1.52–4.53 respectively]. Discussion and Conclusions Injecting in the neck was very common among PWID in Tijuana and was associated with polydrug use and seeking injection assistance. Tailoring harm reduction education interventions for individuals who provide injection assistance (‘hit doctors’) may allow for the dissemination of safe injecting knowledge to reduce injection-related morbidity and mortality. PMID:25867795

SEPAC data analysis in support of the environmental interaction program

NASA Technical Reports Server (NTRS)

Lin, Chin S.

1990-01-01

Injections of nonrelativistic electron beams from an isolated equipotential conductor into a uniform background of plasma and neutral gas were simulated using a two dimensional electrostatic particle code. The ionization effects of spacecraft charging are examined by including interactions of electrons with neutral gas. The simulations show that the conductor charging potential decreases with increasing neutral background density due to the production of secondary electrons near the conductor surface. In the spacecraft wake, the background electrons accelerated towards the charged space craft produced an enhancement of secondary electrons and ions. Simulations run for longer times indicate that the spacecraft potential is further reduced and short wavelength beam-plasma oscillations appear. The results are applied to explain the space craft charging potential measured during the SEPAC experiments from Spacelab 1. A second paper is presented in which a two dimensional electrostatic particle code was used to study the beam radial expansion of a nonrelativistic electron beam injected from an isolated equipotential conductor into a background plasma. The simulations indicate that the beam radius is generally proportional to the beam electron gyroradius when the conductor is charged to a large potential. The simulations also suggest that the charge buildup at the beam stagnation point causes the beam radial expansion. From a survey of the simulation results, it is found that the ratio of the beam radius to the beam electron gyroradius increases with the square root of beam density and decreases inversely with beam injection velocity. This dependence is explained in terms of the ratio of the beam electron Debye length to the ambient electron Debye length. These results are most applicable to the SEPAC electron beam injection experiments from Spacelab 1, where high charging potential was observed.

Induced seismicity constraints on subsurface geological structure, Paradox Valley, Colorado

NASA Astrophysics Data System (ADS)

Block, Lisa V.; Wood, Christopher K.; Yeck, William L.; King, Vanessa M.

2015-02-01

Precise relative hypocentres of seismic events induced by long-term fluid injection at the Paradox Valley Unit (PVU) brine disposal well provide constraints on the subsurface geological structure and compliment information available from deep seismic reflection and well data. We use the 3-D spatial distribution of the hypocentres to refine the locations, strikes, and throws of subsurface faults interpre­ted previously from geophysical surveys and to infer the existence of previously unidentified subsurface faults. From distinct epicentre lineations and focal mechanism trends, we identify a set of conjugate fracture orientations consistent with shear-slip reactivation of late-Palaeozoic fractures over a widespread area, as well as an additional fracture orientation present only near the injection well. We propose simple Mohr-Coulomb fracture models to explain these observations. The observation that induced seismicity preferentially occurs along one of the identified conjugate fracture orientations can be explained by a rotation in the direction of the regional maximum compressive stress from the time when the fractures were formed to the present. Shear slip along the third fracture orientation observed near the injection well is inconsistent with the current regional stress field and suggests a local rotation of the horizontal stresses. The detailed subsurface model produced by this analysis provides important insights for anticipating spatial patterns of future induced seismicity and for evaluation of possible additional injection well sites that are likely to be seismically and hydrologically isolated from the current well. In addition, the interpreted fault patterns provide constraints for estimating the maximum magnitude earthquake that may be induced, and for building geomechanical models to simulate pore pressure diffusion, stress changes and earthquake triggering.

Usage of Policies and Practices Promoted by Race to the Top. NCEE 2015-4018

ERIC Educational Resources Information Center

Dragoset, Lisa; James-Burdumy, Susanne; Hallgren, Kristin; Perez-Johnson, Irma; Herrmann, Mariesa; Tuttle, Christina; Angus, Megan Hague; Herman, Rebecca; Murray, Matthew; Tanenbaum, Courtney; Graczewski, Cheryl

2015-01-01

The American Recovery and Reinvestment Act of 2009 injected $7 billion into two of the Obama administration's signature competitive education grant programs: Race to the Top (RTT) and School Improvement Grants (SIG). While RTT focused on state policies and SIG focused on school practices, both programs promoted related policies and practices,…

Ambiguity in measuring matrix diffusion with single-well injection/recovery tracer tests

USGS Publications Warehouse

Lessoff, S.C.; Konikow, Leonard F.

1997-01-01

Single-well injection/recovery tracer tests are considered for use in characterizing and quantifying matrix diffusion in dual-porosity aquifers. Numerical modeling indicates that neither regional drift in homogeneous aquifers, nor heterogeneity in aquifers having no regional drift, nor hydrodynamic dispersion significantly affects these tests. However, when drift is coupled simultaneously with heterogeneity, they can have significant confounding effects on tracer return. This synergistic effect of drift and heterogeneity may help explain irreversible flow and inconsistent results sometimes encountered in previous single-well injection/recovery tracer tests. Numerical results indicate that in a hypothetical single-well injection/recovery tracer test designed to demonstrate and measure dual-porosity characteristics in a fractured dolomite, the simultaneous effects of drift and heterogeneity sometimes yields responses similar to those anticipated in a homogeneous dual-porosity formation. In these cases, tracer recovery could provide a false indication of the occurrence of matrix diffusion. Shortening the shut-in period between injection and recovery periods may make the test less sensitive to drift. Using multiple tracers having different diffusion characteristics, multiple tests having different pumping schedules, and testing the formation at more than one location would decrease the ambiguity in the interpretation of test data.

Cost and Performance Assessment of In-situ Chemical Oxidation for Intermittent and Continuous Oxidant Injection

NASA Astrophysics Data System (ADS)

Kim, U.; Parker, J.; Borden, R. C.

2015-12-01

In situ chemical oxidation (ISCO) is a popular remediation technology that involves injection of chemical oxidant into groundwater to destroy dissolved and non-aqueous liquid phase contaminants. Depending on site conditions, oxidant can be injected into the contaminated subsurface periodically (intermittently) or continuously. A common approach is to intermittently inject oxidant into a network of wells over a period long enough to emplace oxidant over a target treatment volume (referred to ISCO-int). The injection phase is followed by a passive phase when the oxidant is allowed to react with contaminants and natural oxygen demand (NOD) and to migrate under natural hydraulic gradients. This process may be repeated multiple times until termination criteria are met. Recently, some practitioners have adopted an alternative approach in which oxidant is injected continuously with extraction wells recovering unreacted oxidant to recycle with additional makeup oxidant to maintain its constant concentration (referred to ISCO-cont). Each method has certain advantages and disadvantages. This study numerically evaluates those two ISCO practices in terms of remediation costs and performance based on multiple equi-probable parameter sets. Stochastic cost optimization toolbox (SCOToolkit) is used for this purpose. SCOToolkit is an integrated semi-analytical model for contaminant transport and remediation (e.g., thermal source treatment, ISCO, electron donor injections, permeable reactive barriers) enabling inverse solution and Monte Carlo simulations. Four different aquifer settings, slow and fast Darcy velocities combined with low and high NOD conditions, are used for the evaluation. Preliminary results showed that ISCO-cont is effective for a full scale application without large investment while ISCO-int is more efficient to utilize oxidant in well-characterized sites. Pros and cons of each approach are discussed for the practical use of ISCO for various site conditions.

Adipose-Derived Mesenchymal Stem Cell Administration Does Not Improve Corneal Graft Survival Outcome

PubMed Central

Fuentes-Julián, Sherezade; Arnalich-Montiel, Francisco; Jaumandreu, Laia; Leal, Marina; Casado, Alfonso; García-Tuñon, Ignacio; Hernández-Jiménez, Enrique; López-Collazo, Eduardo; De Miguel, Maria P.

2015-01-01

The effect of local and systemic injections of mesenchymal stem cells derived from adipose tissue (AD-MSC) into rabbit models of corneal allograft rejection with either normal-risk or high-risk vascularized corneal beds was investigated. The models we present in this study are more similar to human corneal transplants than previously reported murine models. Our aim was to prevent transplant rejection and increase the length of graft survival. In the normal-risk transplant model, in contrast to our expectations, the injection of AD-MSC into the graft junction during surgery resulted in the induction of increased signs of inflammation such as corneal edema with increased thickness, and a higher level of infiltration of leukocytes. This process led to a lower survival of the graft compared with the sham-treated corneal transplants. In the high-risk transplant model, in which immune ocular privilege was undermined by the induction of neovascularization prior to graft surgery, we found the use of systemic rabbit AD-MSCs prior to surgery, during surgery, and at various time points after surgery resulted in a shorter survival of the graft compared with the non-treated corneal grafts. Based on our results, local or systemic treatment with AD-MSCs to prevent corneal rejection in rabbit corneal models at normal or high risk of rejection does not increase survival but rather can increase inflammation and neovascularization and break the innate ocular immune privilege. This result can be partially explained by the immunomarkers, lack of immunosuppressive ability and immunophenotypical secretion molecules characterization of AD-MSC used in this study. Parameters including the risk of rejection, the inflammatory/vascularization environment, the cell source, the time of injection, the immunosuppression, the number of cells, and the mode of delivery must be established before translating the possible benefits of the use of MSCs in corneal transplants to clinical practice. PMID:25730319

Syringe Disposal Among Injection Drug Users in San Francisco

PubMed Central

Martinez, Alexis N.; Carpenter, Lisa; Geckeler, Dara; Colfax, Grant; Kral, Alex H.

2011-01-01

To assess the prevalence of improperly discarded syringes and to examine syringe disposal practices of injection drug users (IDUs) in San Francisco, we visually inspected 1000 random city blocks and conducted a survey of 602 IDUs. We found 20 syringes on the streets we inspected. IDUs reported disposing of 13% of syringes improperly. In multivariate analysis, obtaining syringes from syringe exchange programs was found to be protective against improper disposal, and injecting in public places was predictive of improper disposal. Few syringes posed a public health threat. PMID:20466956

Technical tips for collagenase injection treatment for Dupuytren contracture.

PubMed

Meals, Roy A; Hentz, Vincent R

2014-06-01

We describe technical tips for injecting collagenase into Dupuytren cords based on experience acquired during the prerelease Food and Drug Administration clinical trials and with subsequent clinical practice. These tips include techniques for extracting the reconstituted enzyme efficiently from the vial, injecting the cord(s) with increased safety to the tendons, and anesthetizing the hand before manipulation. The tips are intended to supplement but by no means replace the manufacturer's prescribing information and training video. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

The staying safe intervention: training people who inject drugs in strategies to avoid injection-related HCV and HIV infection.

PubMed

Mateu-Gelabert, Pedro; Gwadz, Marya Viorst; Guarino, Honoria; Sandoval, Milagros; Cleland, Charles M; Jordan, Ashly; Hagan, Holly; Lune, Howard; Friedman, Samuel R

2014-04-01

This pilot study explores the feasibility and preliminary efficacy of the Staying Safe Intervention, an innovative, strengths-based program to facilitate prevention of infection with the human immunodeficiency virus and with the hepatitis C virus among people who inject drugs (PWID). The authors explored changes in the intervention's two primary endpoints: (a) frequency and amount of drug intake, and (b) frequency of risky injection practices. We also explored changes in hypothesized mediators of intervention efficacy: planning skills, motivation/self-efficacy to inject safely, skills to avoid PWID-associated stigma, social support, drug-related withdrawal symptoms, and injection network size and risk norms. A 1-week, five-session intervention (10 hours total) was evaluated using a pre- versus 3-month posttest design. Fifty-one participants completed pre- and posttest assessments. Participants reported significant reductions in drug intake and injection-related risk behavior. Participants also reported significant increases in planning skills, motivation/self-efficacy, and stigma management strategies, while reducing their exposure to drug withdrawal episodes and risky injection networks.

THE STAYING SAFE INTERVENTION: TRAINING PEOPLE WHO INJECT DRUGS IN STRATEGIES TO AVOID INJECTION-RELATED HCV AND HIV INFECTION

PubMed Central

Mateu-Gelabert, Pedro; Gwadz, Marya Viorst; Guarino, Honoria; Sandoval, Milagros; Cleland, Charles M.; Jordan, Ashly; Hagan, Holly; Lune, Howard; Friedman, Samuel R.

2014-01-01

This pilot study explores the feasibility and preliminary efficacy of the Staying Safe Intervention, an innovative, strengths-based program to facilitate prevention of infection with the human immunodeficiency virus and with the hepatitis C virus among people who inject drugs (PWID). The authors explored changes in the intervention's two primary endpoints: (a) frequency and amount of drug intake, and (b) frequency of risky injection practices. We also explored changes in hypothesized mediators of intervention efficacy: planning skills, motivation/self-efficacy to inject safely, skills to avoid PWID-associated stigma, social support, drug-related withdrawal symptoms, and injection network size and risk norms. A 1-week, five-session intervention (10 hours total) was evaluated using a pre- versus 3-month posttest design. Fifty-one participants completed pre- and posttest assessments. Participants reported significant reductions in drug intake and injection-related risk behavior. Participants also reported significant increases in planning skills, motivation/self-efficacy, and stigma management strategies, while reducing their exposure to drug withdrawal episodes and risky injection networks. PMID:24694328

Energy optimization aspects by injection process technology

NASA Astrophysics Data System (ADS)

Tulbure, A.; Ciortea, M.; Hutanu, C.; Farcas, V.

2016-08-01

In the proposed paper, the authors examine the energy aspects related to the injection moulding process technology in the automotive industry. Theoretical considerations have been validated by experimental measurements on the manufacturing process, for two types of injections moulding machines, hydraulic and electric. Practical measurements have been taken with professional equipment separately on each technological operation: lamination, compression, injection and expansion. For results traceability, the following parameters were, whenever possible, maintained: cycle time, product weight and the relative time. The aim of the investigations was to carry out a professional energy audit with accurate losses identification. Base on technological diagram for each production cycle, at the end of this contribution, some measure to reduce the energy consumption were proposed.

Respiratory response to microinjections of GABA and penicillin into various parts of the ventral respiratory group.

PubMed

Vedyasova, O A; Kovalyov, A M

2012-06-01

Experiments on rats showed that local injection of GABA (10(-4) M) into the rostral and caudal compartments of the ventral respiratory groups decreased the respiratory rhythm, but increased lung ventilation (especially injection into the rostral part). Penicillin (10(-7) M) injected into the rostral division increased the tidal volume and practically did not change the respiratory rate, but its injection into the caudal part reduced the tidal volume and increased respiratory rate. These results indicate that GABAergic mechanisms including GABA(A) sites play an ambiguous role in the regulation of respiration at the level of the rostral and caudal parts of the ventral respiratory group.

Patient's Satisfaction with Health Care: a Questionnaire Study of Different Aspects of Care.

PubMed

Spasojevic, Nada; Hrabac, Boris; Huseinagic, Senad

2015-08-01

To determine the influence of sociodemographic factors on patients´ satisfaction with health care system. In a cross-sectional study, 1,995 patients from 12 municipalities of Zenica-Doboj Canton were interviewed after a visit to the practice. Individual interviews were conducted and the questionnaire was made on the basis of EUROPEP (European Task Force on Patient Evaluations of General Practice Care) standardized questionnaire. Out of the total number patients, 47.1% were females, 47.9% were from urban population and median of age was 42.0 years (IQR = 30.0 to 53.0 years). The rural population was more likely to buy drugs for medical treatment (p < 0.001) and parenteral injections in primary care practice (p < 0.001). Patients with lower level of education were more likely: to be ordered for physical examination (p = 0.001), to buy drugs for medical treatment (p = 0.001), to buy parenteral injections in primary care practice (p < 0.001); to pay unofficially to someone from medical staff (p < 0.001); to feel that they could be better treated (p = 0.032) and they had longer waiting for health service in primary care practice (p < 0.001). Older population had better assessment of secondary (p = 0.040) and tertiary health care practices (p = 0.034); needed more time is needed to reach health facilities (p = 0.016), longer waiting for health service in primary care practice (p < 0.001); more likely to have health problems in the past 12 months but they did not request medical treatment (p = 0.008); more likely to be ordered for physical examination (p < 0.001); more likely to buy drugs for medical treatment (p = 0.004); more likely to buy parenteral injections in primary care practice (p < 0.001). The following variables: gender, age, overall perception of health status and financial status appear to be predictors of patients´ satisfaction.

Teachers' Use of Curriculum to Support Students in Writing Scientific Arguments to Explain Phenomena

ERIC Educational Resources Information Center

McNeill, Katherine L.

2009-01-01

The role of the teacher is essential for students' successful engagement in scientific inquiry practices. This study focuses on teachers' use of an 8-week chemistry curriculum that explicitly supports students in one particular inquiry practice, the construction of scientific arguments to explain phenomena in which students justify their claims…

Modelling Framework and Assistive Device for Peripheral Intravenous Injections

NASA Astrophysics Data System (ADS)

Kam, Kin F.; Robinson, Martin P.; Gilbert, Mathew A.; Pelah, Adar

2016-02-01

Intravenous access for blood sampling or drug administration that requires peripheral venepuncture is perhaps the most common invasive procedure practiced in hospitals, clinics and general practice surgeries.We describe an idealised mathematical framework for modelling the dynamics of the peripheral venepuncture process. Basic assumptions of the model are confirmed through motion analysis of needle trajectories during venepuncture, taken from video recordings of a skilled practitioner injecting into a practice kit. The framework is also applied to the design and construction of a proposed device for accurate needle guidance during venepuncture administration, assessed as consistent and repeatable in application and does not lead to over puncture. The study provides insights into the ubiquitous peripheral venepuncture process and may contribute to applications in training and in the design of new devices, including for use in robotic automation.

Evaluation of AllergiSense Smartphone Tools for Adrenaline Injection Training.

PubMed

Hernandez-Munoz, Luis U; Woolley, Sandra I; Luyt, David; Stiefel, Gary; Kirk, Kerrie; Makwana, Nick; Melchior, Cathryn; Dawson, Tom C; Wong, Gabriel; Collins, Tim; Diwakar, Lavanya

2017-01-01

Anaphylaxis is an increasingly prevalent life-threatening allergic condition that requires people with anaphylaxis and their caregivers to be trained in the avoidance of allergen triggers and in the administration of adrenaline autoinjectors. The prompt and correct administration of autoinjectors in the event of an anaphylactic reaction is a significant challenge in the management of anaphylaxis. Unfortunately, many people do not know how to use autoinjectors and either fail to use them or fail to use them correctly. This is due in part to deficiencies in training and also to the lack of a system encouraging continuous practice with feedback. Assistive smartphone healthcare technologies have demonstrated potential to support the management of chronic conditions such as diabetes and cardiovascular disease, but there have been deficiencies in their evaluation and there has been a lack of application to anaphylaxis. This paper describes AllergiSense, a smartphone app and sensing system for anaphylaxis management, and presents the results of a randomized, controlled, prepost evaluation of AllergiSense injection training and feedback tools with healthy participants. Participants whose training was supplemented with AllergiSense injection feedback achieved significantly better practiced injections with 90.5% performing correct injections compared to only 28.6% in the paper-only control group. In addition, the results provide insights into possible self-efficacy failings in traditional training and the benefits of embedding self-efficacy theory into the technology design process.

Rapid in vivo testing of drug response in multiple myeloma made possible by xenograft to turkey embryos

PubMed Central

Farnoushi, Y; Cipok, M; Kay, S; Jan, H; Ohana, A; Naparstek, E; Goldstein, R S; Deutsch, V R

2011-01-01

Background: The best current xenograft model of multiple myeloma (MM) in immune-deficient non-obese diabetic/severe-combined immunodeficient mice is costly, animal maintenance is complex and several weeks are required to establish engraftment and study drug efficacy. More practical in vivo models may reduce time and drug development cost. We recently described a rapid low-cost xenograft model of human blood malignancies in pre-immune turkey. Here, we report application of this system for studying MM growth and the preclinical assessment of anticancer therapies. Methods: Cell lines and MM patient cells were injected intravenously into embryonic veins on embryonic day 11 (E11). Engraftment of human cells in haematopoietic organs was detected by quantitative real-time polymerase chain reaction, immunohistochemistry, flow cytometry and circulating free light chain. Results: Engraftment was detected after 1 week in all embryos injected with cell lines and in 50% of those injected with patient cells. Injection of bortezomib or lenalinomide 48 h after cell injection at therapeutic levels that were not toxic to the bone marrow dramatically reduced MM engraftment. Conclusion: The turkey embryo provides a practical, xenograft system to study MM and demonstrates the utility of this model for rapid and affordable testing therapeutics in vivo. With further development, this model may enable rapid, inexpensive personalised drug screening. PMID:22045188

Survey of Intraocular Antibiotics Prophylaxis Practice after Open Globe Injury in China.

PubMed

Lou, Bingsheng; Lin, Lixia; Tan, Junlian; Yang, Yao; Yuan, Zhaohui; Lin, Xiaofeng

2016-01-01

To elucidate the Chinese practice of intraocular antibiotics administration for prophylaxis after open globe injury. A cross-sectional questionnaire survey was performed online by scanning a Quickmark (QR) code with smartphones at the 20th Chinese National Conference of Ocular Trauma in November 2014. A total of 153 (30.6%) of all participators at the conference responded. Of the respondents, 20.9% were routinely administered with prophylactic intraocular injection of antibiotics at the conclusion of the primary eye repair, and 56.9% were used only in cases with high risk of endophthalmitis development. The intraocular route of delivery was mainly included with intracameral injection (47.9%) and intravitreal injection (42.0%). Cephalosporins (53.8%) and vancomycin (42.0%) were the main choices of antibiotic agents, followed by fluoroquinolones (24.3%), and aminoglycosides (13.4%). Only 21.9% preferred a combination of two or more two drugs routinely. In addition, significantly more respondents from the referral eye hospital (92.7%) replied using intraocular antibiotics injection for prophylaxis compared to those respondents from the primary hospital (69.4%) (p = 0.001, Fisher's exact test). Intraocular antibiotics injection for post-traumatic endophthalmitis prophylaxis is widely used in China. However, the choice of antibiotic agents and the intraocular route of delivery vary. A well-designed clinical trial is needed to establish a standardized protocol of intraocular antibiotics administration for post-traumatic endophthalmitis prophylaxis.

Principles and Practices of Enhanced Anaerobic Bioremediation of Chlorinated Solvents

DTIC Science & Technology

2004-09-01

high - fructose corn syrup (HFCS), whey, bark mulch and compost, chitin, and gaseous hydrogen. Table 1.2...Benzoate Injection wells or circulation systems Dissolved in water Continuous to monthly Molasses, High Fructose Corn Syrup Injection wells...to 0.35 High (> 100) Refined Sugars ( high fructose corn syrup ) 0.25 to 0.30 Moderate (> 20) Soluble substrates may be used for source

Exploring motivations to stop injecting in English prisons: qualitative research with former male prisoners.

PubMed

Tompkins, Charlotte N E

2013-01-01

This paper aims to explore the cessation of injecting amongst male drug users when in prison in England and uncovers what influenced this behaviour and why. Qualitative interviews were conducted with 30 male drug users on release from prison to explore what happened to their injecting drug use in prison. The research was conducted from a pragmatic harm reduction approach using grounded theory. Not injecting in prison was identified as a pertinent finding and nine overarching themes accounted for this decline. The themes often overlapped with one another, highlighting how the decision not to inject when last in prison was multi-factorial. Running throughout the themes were participants' concerns regarding the health and social risks attributed to injecting in prison, alongside an appreciation of some of the rehabilitative measures and opportunities offered to injecting drug users when in prison. This qualitative research offers an updated perspective on illicit drug injecting in prison in England from the view of drug users since health and prison policy changes in prescribing and practice. It contributes to evidence suggesting that prisons can be used as a time of reprieve and recovery from injecting drug use.

Is groin injecting an ethical boundary for harm reduction?

PubMed

Miller, Peter G; Lintzeris, Nick; Forzisi, Luciana

2008-12-01

Femoral vein (or groin) injecting by street drug users is an emerging public health issue in the UK. It has been proposed that groin injecting is becoming normalised among UK injecting drug users (IDUs), yet harm reduction strategies are currently piecemeal and some may be crossing the boundary of responsible provision of information. This paper discusses the interventions available to service providers dealing with groin injecting and explores the utility of ethical frameworks for informing service provider decisions. Methods analysis of possible service provider responses using White and Popovits' ethical decision-making framework. The use of ethical frameworks suggest that different types of groin injectors should receive different interventions. Injectors for whom the groin is a site of 'last resort' should be given information about how to inject there less dangerously, whereas 'convenience' groin injectors should be actively encouraged to inject elsewhere. Groin injecting is a behaviour which represents a boundary for some harm reduction practices (such as providing 'how to' booklets to all injectors) as well as being an argument for more complex and environmentally appropriate harm reduction responses such as drug consumption rooms and training IDUs to maintain healthier injecting sites.

Knowledge Growth of Mathematics Teachers during Professional Activity Based on the Task of Lesson Explaining

ERIC Educational Resources Information Center

Peng, Aihui

2007-01-01

"Lesson explaining" has been developed in China from an evaluative resource to an effective form of teacher professional development with the value of emphasizing teacher reflective practice. This paper begins with a general description of lesson explaining. Then an example of "explaining" a mathematics lesson for teaching…

He-3-rich flares - A possible explanation

NASA Technical Reports Server (NTRS)

Fisk, L. A.

1978-01-01

A plasma mechanism is proposed to explain the dramatic enhancements in He-3 observed in He-3-rich flares. It is shown that a common current instability in the corona may heat ambient He-3(2+) over any other ion and thus may preferentially inject He-3 into the flare acceleration process. This mechanism operates when the abundance of He-4 and heavier elements is larger than normal in the coronal plasma. It may also preferentially heat and thus inject certain ions of iron. The mechanism thus provides a possible explanation for the observed correlation between He-3 and heavy enhancements in He-3-rich flares.

Metal injection molding of titanium for medical and aerospace applications

NASA Astrophysics Data System (ADS)

Scharvogel, Matthias; Winkelmueller, Wendelin

2011-02-01

Mixing of titanium powder and thermoplastic binders creates a feedstock that is injection molded similar to plastic, has a chemical and thermal debinding process, and then is sintered to form a net-shape or near-net shape part. TiJet Medizintechnik GmbH (TiJet) developed and uses its own feedstock and powder processing technology to achieve desired mechanical properties. This paper explains the theory of the process and the possibilities that result from the development of this new powder processing technology, such as new alloys, design possibilities, etc. Discussed will be the microstructure, chemical composition, and mechanical properties of the manufactured parts.

[Experimental intervention study of safe injection in basic-level hospitals in Hunan by medical staff].

PubMed

Li, Li; Li, Yinglan; Long, Yanfang; Zhou, Yang; Lu, Jingmei; Wu, Ying

2013-07-01

To experimentally intervene safe injection by medical staff in basic-level hospitals and observe the recent and long-term effect after the intervention and to provide practical measures to improve safe injection. We used random sampling methods to set up groups in county hospitals and township hospitals of Hunan Province, and offered lectures, delivered safe injection guide, brochure and on-site guidance in the experimental group. We surveyed the 2 groups after the intervention at 1 month and 6 months to compare the effect of unsafe injection behaviors and safe injection behaviors. One month after the intervention, the unsafe injection rate in the experimental group decreased from 27.8% to 21.7%, while in the control group injection the unsafe injection rate rose from 26.0% to 27.9%, with significant difference (P<0.01). Six months after the intervention, the unsafe injection rate in the experimental group declined to 18.4% while the unsafe injection rate in the control group also dropped to 22.4%, with significant difference (P<0.01). Unsafe injection rate was decreased in the experimental group at different intervention points, with significant difference (P<0.01). The safe injection behavior scores in the experimental group were higher than those in the control group after the intervention of 1 month and 6 month intervention (P<0.01); the experimental group got higher scores after the intervention (P<0.01). Training of safe injection, distribution of safe injection guide, and comprehensive intervention model can significantly change the primary care practitioners' behaviors in unsafe injections and it is worth promoting.

Predictors of response to intra-articular steroid injection in psoriatic arthritis.

PubMed

Eder, Lihi; Chandran, Vinod; Ueng, Joanna; Bhella, Sita; Lee, Ker-Ai; Rahman, Proton; Pope, Angela; Cook, Richard J; Gladman, Dafna D

2010-07-01

To assess the effectiveness of IA corticosteroid (IAS) injections in PsA and to determine the association between macrophage migration inhibition factor (MIF) gene polymorphism and response to IAS injections. A cohort analysis of PsA patients who were followed prospectively was performed. Clinical response was defined as no tenderness or effusion in the injected joint at 3 months. Relapse was defined as re-occurrence of joint pain or effusion. MIF 173C > G genotyping (rs755622) was performed. Two hundred and twenty patients with 245 IAS injections were included in the study. The probability of responding at 3 months was 41.6%. Within 12 months, 25.5% of the joints relapsed. Clinical factors that were associated with response included duration of psoriasis [Odds ratio (OR) 1.03] and the use of MTX or anti-TNF agents at the time of injection (OR 2.68). Factors that were associated with relapse included injection into large joints (OR 4.58) and elevated sedimentation rate (OR 15.0), whereas absence of clinical and/or radiographic damage (OR 0.23) and duration of PsA (OR 0.92) reduced risk of relapse. MIF polymorphism was not associated with clinical response, but was associated with relapse (OR 3.2). On multivariate analysis including clinical covariates, the association between MIF polymorphism and relapse was lost. IAS injections are effective in PsA. MIF gene polymorphism is associated with relapse. However, this effect is explained by clinical variables that reflect disease activity, suggesting that MIF gene polymorphism influences inflammatory activity.

Effects of Nursing Students' Practices Using Smartphone Videos on Fundamental Nursing Skills, Self-Efficacy, and Learning Satisfaction in South Korea

ERIC Educational Resources Information Center

Jeong, HyeSun

2017-01-01

This is a quasi-experimental study with a non-equivalent group pre-test and post-test designed to investigate the effects of learning with smartphone video recordings in fundamental nursing practice. General "intramuscular injection" practice for sophomore nursing students was given to the experimental and control groups for two weeks.…

Listen to Us: Teacher Views and Voices

ERIC Educational Resources Information Center

Rentner, Diane Stark; Kober, Nancy; Frizzell, Matthew; Ferguson, Maria

2016-01-01

Education policymakers and leaders often say that the opinions and observations of teachers are among the most important information to help explain and understand what is happening in schools. Teachers' voices can inject a sense of classroom and school-level realism into those discussions and add clarity and credibility to issues that are often…

Seasonal Variations of the James Webb Space Telescope Orbital Dynamics

NASA Technical Reports Server (NTRS)

Brown, Jonathan; Peterson, Jeremy; Villac, Benjamin; Yu, Wayne

2015-01-01

LV separation state is fixed ECEF, so inertial states vary with hourly, daily, monthly, and yearly frequencies The net effect of all frequencies leads to significant variations in orbit geometry Injection states can be matched with invariant manifolds of periodic orbits in the CR3BP to explain observed final orbit.

Crushed and Injected Buprenorphine Tablets: Characteristics of Princeps and Generic Solutions

PubMed Central

Bouquié, Régis; Wainstein, Laura; Pilet, Paul; Mussini, Jean-Marie; Deslandes, Guillaume; Clouet, Johann; Dailly, Eric; Jolliet, Pascale; Victorri-Vigneau, Caroline

2014-01-01

Self-injection of high-dose buprenorphine is responsible for well-described complications. In 2011, we have been alerted by unusual but serious cutaneous complication among injection buprenorphine users. A prospective data collection identified 30 cases of necrotic cutaneous lesions after injection of filtered buprenorphine solution, among which 25 cases occurred following injection of buprenorphine generics. The main goal of our study was to put forward particularities that could explain the cutaneous complications, by qualitatively and quantitatively confronting particles present in Subutex and generics solutions. We used the same protocol that injected-buprenorphine users: generic or subutex tablets were crushed in sterile water and filtered through 2 filters commonly used (cotton-pad and sterifilt). Solutions were analyzed by laser granulometry, flow cytometry and scanning electron microscopy. We have highlighted the wide variation of the quantity and the size of the particles present in solution between the two drugs after cotton-pad filtration. The proportion of particles <10 µm is systematically higher in the generic solutions than with Subutex. All of the insoluble particles found in generic solutions contain silica, whereas non- organic element was to be identified in the insoluble particles of Subutex. One skin biopsy obtained from one patient who developed a necrotic lesion after intravenous injection of filtrated solution of buprenorphine generic, shows non-organic elements. Identification of particles in situ enables us to confirm the presence of silica in the biopsy. Actually the monitoring of patient receiving generic of buprenorphine must be strengthened. PMID:25474108

Gas injection may have triggered earthquakes in the Cogdell oil field, Texas

PubMed Central

Gan, Wei; Frohlich, Cliff

2013-01-01

Between 1957 and 1982, water flooding was conducted to improve petroleum production in the Cogdell oil field north of Snyder, TX, and a contemporary analysis concluded this induced earthquakes that occurred between 1975 and 1982. The National Earthquake Information Center detected no further activity between 1983 and 2005, but between 2006 and 2011 reported 18 earthquakes having magnitudes 3 and greater. To investigate these earthquakes, we analyzed data recorded by six temporary seismograph stations deployed by the USArray program, and identified 93 well-recorded earthquakes occurring between March 2009 and December 2010. Relocation with a double-difference method shows that most earthquakes occurred within several northeast–southwest-trending linear clusters, with trends corresponding to nodal planes of regional focal mechanisms, possibly indicating the presence of previously unidentified faults. We have evaluated data concerning injection and extraction of oil, water, and gas in the Cogdell field. Water injection cannot explain the 2006–2011 earthquakes, especially as net volumes (injection minus extraction) are significantly less than in the 1957–1982 period. However, since 2004 significant volumes of gases including supercritical CO2 have been injected into the Cogdell field. The timing of gas injection suggests it may have contributed to triggering the recent seismic activity. If so, this represents an instance where gas injection has triggered earthquakes having magnitudes 3 and larger. Further modeling studies may help evaluate recent assertions suggesting significant risks accompany large-scale carbon capture and storage as a strategy for managing climate change. PMID:24191019

Gas injection may have triggered earthquakes in the Cogdell oil field, Texas.

PubMed

Gan, Wei; Frohlich, Cliff

2013-11-19

Between 1957 and 1982, water flooding was conducted to improve petroleum production in the Cogdell oil field north of Snyder, TX, and a contemporary analysis concluded this induced earthquakes that occurred between 1975 and 1982. The National Earthquake Information Center detected no further activity between 1983 and 2005, but between 2006 and 2011 reported 18 earthquakes having magnitudes 3 and greater. To investigate these earthquakes, we analyzed data recorded by six temporary seismograph stations deployed by the USArray program, and identified 93 well-recorded earthquakes occurring between March 2009 and December 2010. Relocation with a double-difference method shows that most earthquakes occurred within several northeast-southwest-trending linear clusters, with trends corresponding to nodal planes of regional focal mechanisms, possibly indicating the presence of previously unidentified faults. We have evaluated data concerning injection and extraction of oil, water, and gas in the Cogdell field. Water injection cannot explain the 2006-2011 earthquakes, especially as net volumes (injection minus extraction) are significantly less than in the 1957-1982 period. However, since 2004 significant volumes of gases including supercritical CO2 have been injected into the Cogdell field. The timing of gas injection suggests it may have contributed to triggering the recent seismic activity. If so, this represents an instance where gas injection has triggered earthquakes having magnitudes 3 and larger. Further modeling studies may help evaluate recent assertions suggesting significant risks accompany large-scale carbon capture and storage as a strategy for managing climate change.

Towards safe injection practices for prevention of hepatitis C transmission in South Asia: Challenges and progress.

PubMed

Janjua, Naveed Zafar; Butt, Zahid Ahmad; Mahmood, Bushra; Altaf, Arshad

2016-07-07

To summarize the available information about injection use and its determinants in the South Asian region. We searched published and unpublished literature on injection safety in South Asia published during 1995-2016 using the keywords "injection" "unsafe injection" and "immunization injection" and combined these with each of the countries and/or their respective states or provinces in South Asia. We used a standardized questionnaire to abstract the following data from the articles: the annual number of injections per capita, the proportion of injections administered with a reused syringe or needle, the distribution of injections with respect to prescribers and providers and determinants of injection use. Although information is very limited for certain countries (i.e., Bhutan, Maldives and Sri Lanka), healthcare injection use is very common across South Asia, with cross-country rates ranging from 2.4 to 13.6 injections/person/year. Furthermore, recent studies show that 5% to 50% of these injections are provided with reused syringes, thus creating potential to transmission of blood-borne pathogens. Qualified and unqualified practitioners, especially in the private sector, are the major drivers behind injection use, but patients also prefer injections, especially among the rural, poor or uneducated in certain countries. According to available data, Pakistan and India have recently taken steps towards achieving safe injection. Potential interventions include the introduction of reuse prevention devices, and patient-, community- and patient/community and provider-centered interventions to change population and practitioner behavior. Injection use is common in South Asian countries. Multilevel interventions aiming at patients, providers and the healthcare system are needed to reduce injection use and reuse.

[Viral retinitis following intravitreal triamcinolone injection].

PubMed

Zghal, I; Malek, I; Amel, C; Soumaya, O; Bouguila, H; Nacef, L

2013-09-01

Necrotizing viral retinitis is associated with infection by the Herpes family of viruses, especially herpes simplex virus (HSV), varicella zoster virus (VZV) and occasionally cytomegalovirus (CMV). When the diagnosis is suspected clinically, antiviral therapy must be instituted immediately. We report the case of a patient presenting with necrotizing viral retinitis 3 months following intravitreal injection of triamcinolone acetonide for diabetic macular edema. Fluorescein angiography demonstrated a superior temporal occlusive vasculitis. A diagnostic anterior chamber paracentesis was performed to obtain deoxyribo-nucleic acid (DNA) for a polymerase chain reaction (PCR) test for viral retinitis. PCR was positive for CMV. The patient was placed on intravenous ganciclovir. CMV retinitis is exceedingly rare in immunocompetent patients; however, it remains the most common cause of posterior uveitis in immunocompromised patients. The incidence of this entity remains unknown. Local immunosuppression, the dose and the frequency of injections may explain the occurrence of this severe retinitis. Copyright © 2013. Published by Elsevier Masson SAS.

The γ-ray emission produced by protons that escape from supernova remnant G349.7+0.2

NASA Astrophysics Data System (ADS)

Zhang, Xiao; Li, Hui; Chen, Yang

2016-10-01

G349.7+0.2 is an interacting supernova remnant (SNR) expanding in a dense medium. Recently, a very strong γ-ray source coincident with this SNR has been revealed by Fermi-LAT and H.E.S.S. observations which shows a broken power-law-like spectrum. An escaping-diffusion model, including the power-law and δ-function injection, is applied to this source which can naturally explain the spectral feature in both the GeV and TeV regime. We use the Markov Chain Monte Carlo method to constrain the model parameters and find that the correction factor of slow diffusion around this SNR, χ ˜ 0.01 for power-law injection and χ ˜ 0.1 for δ-function injection, can fit the data best with reasonable molecular cloud mass. This slow diffusion is also consistent with previous results from both phenomenological models and theoretical predication.

Plasma irregularities caused by cycloid bunching of the CRRES G-2 barium release

NASA Technical Reports Server (NTRS)

Bernhardt, P. A.; Huba, J. D.; Pongratz, M. B.; Simons, D. J.; Wolcott, J. H.

1993-01-01

The Combined Release and Radiation Effects Satellite (CRRES) spacecraft carried a number of barium thermite canisters for release into the upper atmosphere. The barium release labeled G-2 showed evidence of curved irregularities not aligned with the ambient magnetic field B. The newly discovered curved structures can be explained by a process called cycloid bunching. Cycloid bunching occurs when plasma is created by photoionization of a neutral cloud injected at high velocity perpendicular to B. If the injection velocity is much larger than the expansion speed of the cloud, the ion trail will form a cycloid that has irregularities spaced by the product of the perpendicular injection speed and the ion gyroperiod, Images of the solar-illuminated barium ions are compared with the results of a three-dimensional kinetic simulation. Cycloid bunching is shown to be responsible for the rapid generation of both curved and field-aligned irregularities in the CRRES G-2 experiment.

Growth and optical characteristics of InAs quantum dot structures with tunnel injection quantum wells for 1.55 μ m high-speed lasers

NASA Astrophysics Data System (ADS)

Bauer, Sven; Sichkovskyi, Vitalii; Reithmaier, Johann Peter

2018-06-01

InP based lattice matched tunnel injection structures consisting of a InGaAs quantum well, InAlGaAs barrier and InAs quantum dots designed to emit at 1.55 μ m were grown by molecular beam epitaxy and investigated by photoluminescence spectroscopy and atomic force microscopy. The strong influence of quantum well and barrier thicknesses on the samples emission properties at low and room temperatures was investigated. The phenomenon of a decreased photoluminescence linewidth of tunnel injection structures compared to a reference InAs quantum dots sample could be explained by the selection of the emitting dots through the tunneling process. Morphological investigations have not revealed any effect of the injector well on the dot formation and their size distribution. The optimum TI structure design could be defined.

Surgical Interventions and the Use of Device-Aided Therapy for the Treatment of Fecal Incontinence and Defecatory Disorders.

PubMed

Bharucha, Adil E; Rao, Satish S C; Shin, Andrea S

2017-12-01

The purpose of this clinical practice update expert review is to describe the key principles in the use of surgical interventions and device-aided therapy for managing fecal incontinence (FI) and defecatory disorders. The best practices outlined in this review are based on relevant publications, including systematic reviews and expert opinion (when applicable). Best Practice Advice 1: A stepwise approach should be followed for management of FI. Conservative therapies (diet, fluids, techniques to improve evacuation, a bowel training program, management of diarrhea and constipation with diet and medications if necessary) will benefit approximately 25% of patients and should be tried first. Best Practice Advice 2: Pelvic floor retraining with biofeedback therapy is recommended for patients with FI who do not respond to the conservative measures indicated above. Best Practice Advice 3: Perianal bulking agents such as intra-anal injection of dextranomer may be considered when conservative measures and biofeedback therapy fail. Best Practice Advice 4: Sacral nerve stimulation should be considered for patients with moderate or severe FI in whom symptoms have not responded after a 3-month or longer trial of conservative measures and biofeedback therapy and who do not have contraindications to these procedures. Best Practice Advice 5: Until further evidence is available, percutaneous tibial nerve stimulation should not be used for managing FI in clinical practice. Best Practice Advice 6: Barrier devices should be offered to patients who have failed conservative or surgical therapy, or in those who have failed conservative therapy who do not want or are not eligible for more invasive interventions. Best Practice Advice 7: Anal sphincter repair (sphincteroplasty) should be considered in postpartum women with FI and in patients with recent sphincter injuries. In patients who present later with symptoms of FI unresponsive to conservative and biofeedback therapy and evidence of sphincter damage, sphincteroplasty may be considered when perianal bulking injection and sacral nerve stimulation are not available or have proven unsuccessful. Best Practice Advice 8: The artificial anal sphincter, dynamic graciloplasty, may be considered for patients with medically refractory severe FI who have failed treatment or are not candidates for barrier devices, sacral nerve stimulation, perianal bulking injection, sphincteroplasty and a colostomy. Best Practice Advice 9: Major anatomic defects (eg, rectovaginal fistula, full-thickness rectal prolapse, fistula in ano, or cloaca-like deformity) should be rectified with surgery. Best Practice Advice 10: A colostomy should be considered in patients with severe FI who have failed conservative treatment and have failed or are not candidates for barrier devices, minimally invasive surgical interventions, and sphincteroplasty. Best Practice Advice 11: A magnetic anal sphincter device may be considered for patients with medically refractory severe FI who have failed or are not candidates for barrier devices, perianal bulking injection, sacral nerve stimulation, sphincteroplasty, or a colostomy. Data regarding efficacy are limited and 40% of patients had moderate or severe complications. Best Practice Advice 12: For defecatory disorders, biofeedback therapy is the treatment of choice. Best Practice Advice 13: Based on limited evidence, sacral nerve stimulation should not be used for managing defecatory disorders in clinical practice. Best Practice Advice 14: Anterograde colonic enemas are not effective in the long term for management of defecatory disorders. Best Practice Advice 15: The stapled transanal rectal resection and related procedures should not be routinely performed for correction of structural abnormalities in patients with defecatory disorders. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Ventrogluteal versus dorsogluteal site selection: A cross-sectional study of muscle and subcutaneous fat thicknesses and an algorithm incorporating demographic and anthropometric data to predict injection outcome.

PubMed

Larkin, Theresa A; Ashcroft, Elfriede; Elgellaie, Asmahan; Hickey, Blake A

2017-06-01

The dorsogluteal and ventrogluteal intramuscular injection sites both have their use in clinical practice; however, it has not been established in whom one or the other should be preferentially targeted or avoided. There is a need for an evidence-based approach towards site selection for a successful intramuscular injection outcome and to avoid unwanted injection outcomes of inadvertent subcutaneous injection or bone contact. Injection outcome is dependent on injection site subcutaneous fat thickness and muscle thickness; these are likely influenced by gender and anthropometry. To determine whether subcutaneous fat, muscle, and total tissue thicknesses differ between the dorsogluteal and ventrogluteal sites, and whether theoretical injection outcome (intramuscular, subcutaneous, or bone contact) can be predicted by demographic and anthropometric data and described by an algorithm. Cross-sectional study design. University in Australia. 145 volunteers (57% female) of at least 18 years of age recruited through the university community. Anthropometric data was collected and subcutaneous fat and muscle thicknesses were quantified by ultrasonography. Anthropometric differences between theoretical injection outcome groups (bone contact versus intramuscular versus subcutaneous at the ventrogluteal and dorsogluteal sites) was determined for each gender (ANOVA). Multiple regression analysis was conducted to determine the influence of demographic and anthropometric data on theoretical intramuscular injection outcome. An algorithm to guide site selection was developed for each gender, based on the anthropometric measures that best discriminated between injection outcomes. Subcutaneous fat, muscle and total tissue were significantly thicker at the dorsogluteal site than the ventrogluteal site, and subcutaneous fat was significantly thicker in females than males at both sites (all p<0.001); there was no gender difference for muscle or total tissue thickness at either site. Female gender, and waist and hip circumference were significant predictors of subcutaneous fat thickness at both sites; male gender was a significant predictor of dorsogluteal site muscle thickness (all p<0.05). In the algorithm developed for site selection based on theoretical injection outcome, the best discriminators were: weight, BMI and waist circumference for females, and weight and distance between the iliac tubercle and anterior superior iliac spine for males. The algorithm describes when each of the ventrogluteal and dorsogluteal sites is appropriate or should be avoided, based on easily obtained anthropometric data. This has direct relevance in clinical practice in evidence-based site selection for gluteal intramuscular injections for optimal medication and health outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

Synergy between Teacher Practices and Curricular Scaffolds to Support Students in Using Domain-Specific and Domain-General Knowledge in Writing Arguments to Explain Phenomena

ERIC Educational Resources Information Center

McNeill, Katherine L.; Krajcik, Joseph

2009-01-01

We investigated how 2 different curricular scaffolds (context-specific vs. generic), teacher instructional practices, and the interaction between these 2 types of support influenced students' learning of science content and their ability to write scientific arguments to explain phenomena. The context-specific scaffolds provided students with hints…

Why does it run in families? Explaining family similarity in help-seeking behaviour by shared circumstances, socialisation and selection.

PubMed

Cardol, Mieke; Groenewegen, Peter P; Spreeuwenberg, Peter; Van Dijk, Liset; Van Den Bosch, Wil J H M; De Bakker, Dinny H

2006-08-01

Why do contact frequencies with general practice of family members resemble each other? Many aspects related to the clustering of health-care utilisation within families have been studied, but the underlying mechanisms have not been addressed. This article considers whether family similarity in contact frequency with general practice can be explained as (a) a result of shared circumstances, (b) through socialisation, and (c) through homogeneity of background characteristics. Data from the second Dutch national survey of general practice were used to test these mechanisms empirically. This survey recorded all consultations in 2001 for 104 general practices in the Netherlands, serving 385,461 patients. Information about socio-demographic characteristics was collected by means of a patient survey. In a random sample, an extended health interview took place (n=12,699). Overall, we were able to show that having determinants in common through socialisation and shared circumstances can explain similarity in contact frequencies within families, but not all hypotheses could be confirmed. In specific terms, this study shows that resemblances in contact frequencies within families can be best explained by spending more time together (socialisation) and parents and children consulting a general practitioner simultaneously (circumstances of the moment). For general practitioners, the mechanisms identified can serve as a framework for a family case history. The importance of the mechanism of socialisation in explaining similarities in help-seeking behaviour between family members points to the significance of knowledge and health beliefs underlying consultation behaviour. An integrated framework including these aspects can help to better explain health behaviour.

Seismogenic response to fluid injection operations in Oklahoma and California: Implications for crustal stresses

NASA Astrophysics Data System (ADS)

Goebel, T.; Aminzadeh, F.

2015-12-01

The seismogenic response to induced pressure changes provides insight into the proximity to failure of faults close to injection sites. Here, we examine possible seismicity rate changes in response to wastewater disposal and enhanced oil recovery operations in hydrocarbon basins in California and Oklahoma. We test whether a statistically significant rate increase exists within these areas and determine the corresponding timing and location based on nonparametric modeling of background seismicity rates. Annual injection volumes increased monotonically since ~2001 in California and ~1998 in Oklahoma. While OK experienced a recent surge in seismic activity which exceeded the 95% confidence limit of a stationary Poisson process in ~2010, seismicity in CA showed no increase in background rates between 1980 and 2014. A systematic analysis of frequency-magnitude-distributions (FMDs) of likely induced earthquakes in OK indicates that FMDs are depleted in large-magnitude events. Seismicity in CA hydrocarbon basins, on the other hand, shows Gutenberg-Richter type FMDs and b~1. Moreover, the earthquakes and injection operations occur preferably in distinct areas in CA whereas in OK earthquakes occur closer to injection wells than expected from a random uniform process. To test whether injection operations may be responsible for the strongly different seismicity characteristics in CA and OK, we compare overall well density, wellhead pressures, peak and cumulative rates as well as injection depths. We find that average injection rates, pressures and volumes are comparable between CA and OK and that injection occurs on average 0.5 km deeper in CA than in OK. Thus, the here tested operational parameters can not easily explain the vastly different seismogenic response to injection operations in CA and OK, and may only be of secondary importance for the resulting earthquake activity. The potential to induce earthquakes by fluid injection operations is likely controlled by the specific geologic setting and stress state on nearby faults.

Worsening of myasthenia gravis after administration of injectable long-acting risperidone for treatment of schizophrenia; first case report and a call for caution.

PubMed

Al-Hashel, Jasem Y; Ismail, Ismail Ibrahim; John, John K; Ibrahim, Mohammed; Ali, Mahmoud

2016-01-01

Myasthenia gravis is an autoimmune disease characterized by muscle weakness due to autoantibodies affecting the neuromuscular junction. Co-occurrence of myasthenia gravis and schizophrenia is very rare and raises a challenge in management of both diseases. Antipsychotic drugs exhibit anticholinergic side effects and have the potentials of worsening myasthenia. Long-acting risperidone is an injectable atypical antipsychotic drug that has not been previously reported to worsen myasthenia gravis in literature. We report the first case report of worsening of myasthenia after receiving long-acting risperidone injection for schizophrenia in a 29-year-old female with both diseases. She started to have worsening 2 weeks following the first injection and her symptoms persisted despite receiving plasma exchange. This could be explained by the pharmacokinetics of the drug. We recommend that long-acting risperidone should be used with caution in patients with myasthenia gravis, and clinicians must be aware of the potential risks of this therapy. Copyright © 2016 Elsevier B.V. All rights reserved.

Evaluation of the specificity and sensitivity of ferritin as an MRI reporter gene in the mouse brain using lentiviral and adeno-associated viral vectors.

PubMed

Vande Velde, G; Rangarajan, J R; Toelen, J; Dresselaers, T; Ibrahimi, A; Krylychkina, O; Vreys, R; Van der Linden, A; Maes, F; Debyser, Z; Himmelreich, U; Baekelandt, V

2011-06-01

The development of in vivo imaging protocols to reliably track transplanted cells or to report on gene expression is critical for treatment monitoring in (pre)clinical cell and gene therapy protocols. Therefore, we evaluated the potential of lentiviral vectors (LVs) and adeno-associated viral vectors (AAVs) to express the magnetic resonance imaging (MRI) reporter gene ferritin in the rodent brain. First, we compared the induction of background MRI contrast for both vector systems in immune-deficient and immune-competent mice. LV injection resulted in hypointense (that is, dark) changes of T(2)/T(2)(*) (spin-spin relaxation time)-weighted MRI contrast at the injection site, which can be partially explained by an inflammatory response against the vector injection. In contrast to LVs, AAV injection resulted in reduced background contrast. Moreover, AAV-mediated ferritin overexpression resulted in significantly enhanced contrast to background on T(2)(*)-weighted MRI. Although sensitivity associated with the ferritin reporter remains modest, AAVs seem to be the most promising vector system for in vivo MRI reporter gene imaging.

Preferential acceleration and magnetic field enhancement in plasmas with e{sup +}/e{sup −} beam injection

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

Huynh, Cong Tuan; Ryu, Chang-Mo, E-mail: ryu201@postech.ac.kr

A theoretical model of current filaments predicting preferential acceleration/deceleration and magnetic field enhancement in a plasma with e{sup +}/e{sup −} beam injection is presented. When the e{sup +}/e{sup −} beams are injected into a plasma, current filaments are formed. The beam particles are accelerated or decelerated depending on the types of current filaments in which they are trapped. It is found that in the electron/ion ambient plasma, the e{sup +} beam particles are preferentially accelerated, while the e{sup −} beam particles are preferentially decelerated. The preferential particle acceleration/deceleration is absent when the ambient plasma is the e{sup +}/e{sup −} plasma.more » We also find that the particle momentum decrease can explain the magnetic field increase during the development of Weibel/filamentation instability. Supporting simulation results of particle acceleration/deceleration and magnetic field enhancement are presented. Our findings can be applied to a wide range of astrophysical plasmas with the e{sup +}/e{sup −} beam injection.« less

Impact of charge carrier injection on single-chain photophysics of conjugated polymers

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

Hofmann, Felix J.; Vogelsang, Jan, E-mail: jan.vogelsang@physik.uni-regensburg.de; Lupton, John M.

Charges in conjugated polymer materials have a strong impact on the photophysics and their interaction with the primary excited state species has to be taken into account in understanding device properties. Here, we employ single-molecule spectroscopy to unravel the influence of charges on several photoluminescence (PL) observables. The charges are injected either stochastically by a photochemical process or deterministically in a hole-injection sandwich device configuration. We find that upon charge injection, besides a blue-shift of the PL emission and a shortening of the PL lifetime due to quenching and blocking of the lowest-energy chromophores, the non-classical photon arrival time distributionmore » of the multichromophoric chain is modified towards a more classical distribution. Surprisingly, the fidelity of photon antibunching deteriorates upon charging, whereas one would actually expect the opposite: the number of chromophores to be reduced. A qualitative model is presented to explain the observed PL changes. The results are of interest to developing a microscopic understanding of the intrinsic charge-exciton quenching interaction in devices.« less

Does metabosensitive afferent fibers activity differ from slow- and fast-twitch muscles?

PubMed

Caron, Guillaume; Decherchi, Patrick; Marqueste, Tanguy

2015-09-01

This study was designed to investigate the metabosensitive afferent response evoked by electrically induced fatigue (EIF), lactic acid (LA) and potassium chloride (KCl) in three muscle types. We recorded the activity of groups III-IV afferents originating from soleus, gastrocnemius and tibialis anterior muscles. Our data showed a same pattern of response in the three muscles after chemical injections, i.e., a bell curve with maximal discharge rate at 1 mM for LA injections and a linear relationship between KCl concentrations and the afferent discharge rate. Furthermore, a stronger response was recorded after EIF in the gastrocnemius muscle compared to the two other muscles. The change in afferent discharge after 1 mM LA injection was higher for the gastrocnemius muscle compared to the response obtained with the corresponding concentration applied in the two other muscles, whereas changes to KCl injections did not dramatically differ between the three muscles. We conclude that anatomical (mass, phenotype, vascularization, receptor and afferent density…) and functional (flexor vs. extensor) differences between muscles could explain the amplitude of these responses.

Rabies: changing prophylaxis and new insights in pathophysiology.

PubMed

Ugolini, Gabriella; Hemachudha, Thiravat

2018-02-01

Despite great progress in decoding disease mechanisms, rabies remains one of the leading causes of human death worldwide. Towards the elimination of human rabies deaths by 2030, feasible and affordable post (PEP) and pre-exposure prophylaxis (PrEP) must be available with expansion to rural areas in rabies endemic countries. Vaccination and population control of dogs, principal reservoirs and transmitters, must be done in concert. Advances in the understanding of rabies neuropathogenesis and pathophysiology are reviewed, including recent experimental findings on host- and virus-specific mechanisms mediating neuronal survival and explaining clinical differences in furious and paralytic rabies. The forthcoming World Health Organization guide on rabies based on pathogenesis and immunization mechanisms data with support by clinical evidence provide new accelerated 1 week intradermal PrEP and PEP schedules. Rabies immunoglobulin injected into the wound only is endorsed at amounts not exceeding the dose interfering with active immunization. Potential therapeutics as designed in accord with rabies neuro-pathophysiology are plausible. Clinical practice and rabies awareness can be leveraged by transboundary collaboration among different areas. Advancement in prophylaxis and perspectives on animal control offer a new path to conquer rabies by 2030.

Evolution of the global use of unsafe medical injections, 2000-2010.

PubMed

Pépin, Jacques; Abou Chakra, Claire Nour; Pépin, Eric; Nault, Vincent

2013-01-01

Since 1999, substantial efforts have been made by the international community to reduce the risks associated with unsafe injections, through ministries of health, international donors, the World Health Organization and the Safe Injection Global Network. The present study attempted to measure the progress, or lack thereof, made over the 2000-2010 decade in reducing unsafe injections in ten regions of the world corresponding to developing and transitional economies. Data about the number of injections per person per year and the proportion of re-use of syringes and needles were obtained for 2010, mainly from population surveys, and compared with previous estimates for 2000 which had used various sources of information including injection safety assessments, population surveys and published studies on injection practices. From 2000 to 2010, in developing countries and transitional economies, the average number of injections per person per year decreased from 3.40 to 2.88, while the proportion of re-use of injection devices dropped from 39.8% to 5.5%. Combining both factors the number of unsafe injections per person per year decreased from 1.35 to 0.16. Even if substantial progress has been made, the Eastern Mediterranean region remains problematic, with 0.57 unsafe injections per person per year. In sub-Saharan Africa and Latin America, people now receive on average only 0.04-0.05 unsafe injections per year. Substantial progress has been made in reducing the number of unsafe injections in developing countries and transitional economies, essentially through a reduction in the re-use of injection devices. In some regions, elimination of unsafe injections might become a reasonable goal.

The effectiveness of repeat lumbar transforaminal epidural steroid injections.

PubMed

Murthy, Naveen S; Geske, Jennifer R; Shelerud, Randy A; Wald, John T; Diehn, Felix E; Thielen, Kent R; Kaufmann, Timothy J; Morris, Jonathan M; Lehman, Vance T; Amrami, Kimberly K; Carter, Rickey E; Maus, Timothy P

2014-10-01

The aim of this study was to determine 1) if repeat lumbar transforaminal epidural steroid injections (TFESIs) resulted in recovery of pain relief, which has waned since an index injection, and 2) if cumulative benefit could be achieved by repeat injections within 3 months of the index injection. Retrospective observational study with statistical modeling of the response to repeat TFESI. Academic radiology practice. Two thousand eighty-seven single-level TFESIs were performed for radicular pain on 933 subjects. Subjects received repeat TFESIs >2 weeks and <1 year from the index injection. Hierarchical linear modeling was performed to evaluate changes in continuous and categorical pain relief outcomes after repeat TFESI. Subgroup analyses were performed on patients with <3 months duration of pain (acute pain), patients receiving repeat injections within 3 months (clustered injections), and in patients with both acute pain and clustered injections. Repeat TFESIs achieved pain relief in both continuous and categorical outcomes. Relative to the index injection, there was a minimal but statistically significant decrease in pain relief in modeled continuous outcome measures with subsequent injections. Acute pain patients recovered all prior benefit with a statistically significant cumulative benefit. Patients receiving clustered injections achieved statistically significant cumulative benefit, of greater magnitude in acute pain patients. Repeat TFESI may be performed for recurrence of radicular pain with the expectation of recovery of most or all previously achieved benefit; acute pain patients will likely recover all prior benefit. Repeat TFESIs within 3 months of the index injection can provide cumulative benefit. Wiley Periodicals, Inc.

Policing behaviors, safe injection self-efficacy, and intervening on injection risks: Moderated mediation results from a randomized trial.

PubMed

Pitpitan, Eileen V; Patterson, Thomas L; Abramovitz, Daniela; Vera, Alicia; Martinez, Gustavo; Staines, Hugo; Strathdee, Steffanie A

2016-01-01

We aim to use conditional or moderated mediation to simultaneously test how and for whom an injection risk intervention was efficacious at reducing receptive needle sharing among female sex workers who inject drugs (FSWs-IDUs) in Mexico. Secondary analysis of data from a randomized trial. A total of 300 FSW-IDUs participated in Mujer Mas Segura in Ciudad Juarez, Mexico, and were randomized to an interactive injection risk intervention or a didactic injection risk intervention. We measured safe injection self-efficacy as the hypothesized mediator and policing behaviors (being arrested and syringe confiscation) as hypothesized moderators. In total, 213 women provided complete data for the current analyses. Conditional (moderated) mediation showed that the intervention affected receptive needle sharing through safe injection self-efficacy among women who experienced syringe confiscation. On average, police syringe confiscation was associated with lower safe injection self-efficacy (p = .04). Among those who experienced syringe confiscation, those who received the interactive (vs. didactic) intervention reported higher self-efficacy, which in turn predicted lower receptive needle sharing (p = .04). Whereas syringe confiscation by the police negatively affected safe injection self-efficacy and ultimately injection risk behavior, our interactive intervention helped to "buffer" this negative impact of police behavior on risky injection practices. The theory-based, active skills building elements included in the interactive condition, which were absent from the didactic condition, helped participants' self-efficacy for safer injection in the face of syringe confiscation. (c) 2015 APA, all rights reserved).

Policing Behaviors, Safe Injection Self-Efficacy, and Intervening on Injection Risks: Moderated Mediation Results from a Randomized Trial

PubMed Central

Pitpitan, Eileen V.; Patterson, Thomas L.; Abramovitz, Daniela; Vera, Alicia; Martinez, Gustavo; Staines, Hugo; Strathdee, Steffanie A.

2015-01-01

Objective We aim to use conditional, or moderated mediation to simultaneously test how and for whom an injection risk intervention was efficacious at reducing receptive needle sharing among female sex workers who inject drugs (FSWs-IDUs) in Mexico. Methods Secondary analysis of data from a randomized trial. A total of 300 FSW-IDUs participated in Mujer Mas Segura in Ciudad Juarez, Mexico and were randomized to an interactive injection risk intervention or a didactic injection risk intervention. We measured safe injection self-efficacy as the hypothesized mediator, and policing behaviors (being arrested and syringe confiscation) as hypothesized moderators. 213 women provided complete data for the current analyses. Results Conditional (moderated) mediation showed that the intervention affected receptive needle sharing through safe injection self-efficacy among women who experienced syringe confiscation. On average, police syringe confiscation was associated with lower safe injection self-efficacy (p = 0.04). Among those who experienced syringe confiscation, those who received the interactive (vs. didactic) intervention reported higher self-efficacy, which in turn predicted lower receptive needle sharing (p = 0.04). Conclusions Whereas syringe confiscation by the police negatively impacted safe injection self-efficacy and ultimately injection risk behavior, our interactive intervention helped to “buffer” this negative impact of police behavior on risky injection practices. The theory-based, active skills building elements included in the interactive condition, which were absent from the didactic condition, helped participants’ self-efficacy for safer injection in the face of syringe confiscation. PMID:26120851

Localization of 14C-labeled 2% lidocaine hydrochloride after intraosseous anesthesia in the rabbit.

PubMed

Goto, Takashi; Mamiya, Hideki; Ichinohe, Tatsuya; Kaneko, Yuzuru

2011-10-01

The purpose of this study was to investigate the tissue distribution of lidocaine hydrochloride in mandibular bone marrow after intraosseous anesthesia (IOA) in rabbits. We used macroautoradiography to examine the tissue distribution of a (14)C-labeled 2% lidocaine hydrochloride solution containing 1:80,000 epinephrine ((14)C-lidocaine). Under general anesthesia, (14)C-lidocaine was injected intraosseously or paraperiosteally. After IOA, animals were divided into three groups and observed at 1 (IOA-1), 5 (IOA-5), and 10 minutes (IOA-10) after injection. After infiltration anesthesia (IA), animals were observed at 1 minute after injection. The accumulation of (14)C-lidocaine was observed around the injection site in both the IA and the IOA groups. Paraperiosteally injected (14)C-lidocaine diffused to the surrounding tissues such as the lip, whereas IOA showed concentrated accumulation around the root apex throughout the experiment. The distribution area was significantly smaller in the IOA-1 group than in the IA group. The distribution area in the IOA-5 group was larger than those in the IOA-1 and IOA-10 groups. The accumulation of (14)C-lidocaine injected by IOA in rabbits was concentrated around the root apex. These results may explain the rapid onset time of IOA. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

[Registration study on analysis of adaptation syndromes and medication characteristics of tanreqing injection].

PubMed

Xie, Peng-Yang; Xie, Yan-Ming; Wang, Lian-Xin; Chang, Yan-Peng; You, Li; Zhang, Xiao-Li

2014-09-01

Tanreqing injection is suitable for early pneumonia, acute bronchitis, acute exacerbations of chronic, and upper respiratory tract infection which are classified with phlegm-heat obstructing lung syndrome of traditional Chinese medicine. To understand the clinical adaptation syndromes and medication characteristics of the post-market Tanreqing injection, the research team of the paper monitored the patients who are used with Tanreqing injection from September 2012 to October 2013 in four leader hospitals based on the method--prospective, multi-center, large sample, registration-type hospital centralized monitoring,and analyzes the general information, diagnostic information and medication characteristics of patients, in order to produce evidence for clinical practice and medication decisions and to establish the foundation of rational drug use.

Alternative practices of achieving anaesthesia for dental procedures: a review.

PubMed

Angelo, Zavattini; Polyvios, Charalambous

2018-04-01

Managing pain and anxiety in patients has always been an essential part of dentistry. To prevent pain, dentists administer local anaesthesia (LA) via a needle injection. Unfortunately, anxiety and fear that arise prior to and/or during injection remains a barrier for many children and adults from receiving dental treatment. There is a constant search for techniques to alleviate the invasive and painful nature of the needle injection. In recent years, researchers have developed alternative methods which enable dental anaesthesia to be less invasive and more patient-friendly. The aim of this review is to highlight the procedures and devices available which may replace the conventional needle-administered local anaesthesia. The most known alternative methods in providing anaesthesia in dentistry are: topical anaesthesia, electronic dental anaesthesia, jet-injectors, iontophoresis, and computerized control local anaesthesia delivery systems. Even though these procedures are well accepted by patients to date, it is the authors' opinion that the effectiveness practicality of such techniques in general dentistry is not without limitations.

Alternative practices of achieving anaesthesia for dental procedures: a review

PubMed Central

2018-01-01

Managing pain and anxiety in patients has always been an essential part of dentistry. To prevent pain, dentists administer local anaesthesia (LA) via a needle injection. Unfortunately, anxiety and fear that arise prior to and/or during injection remains a barrier for many children and adults from receiving dental treatment. There is a constant search for techniques to alleviate the invasive and painful nature of the needle injection. In recent years, researchers have developed alternative methods which enable dental anaesthesia to be less invasive and more patient-friendly. The aim of this review is to highlight the procedures and devices available which may replace the conventional needle-administered local anaesthesia. The most known alternative methods in providing anaesthesia in dentistry are: topical anaesthesia, electronic dental anaesthesia, jet-injectors, iontophoresis, and computerized control local anaesthesia delivery systems. Even though these procedures are well accepted by patients to date, it is the authors' opinion that the effectiveness practicality of such techniques in general dentistry is not without limitations. PMID:29744382

Development and Design of Binder Systems for Titanium Metal Injection Molding: An Overview

NASA Astrophysics Data System (ADS)

Wen, Guian; Cao, Peng; Gabbitas, Brian; Zhang, Deliang; Edmonds, Neil

2013-03-01

Titanium metal injection molding (Ti-MIM) has been practiced since the late 1980s. Logically, the Ti-MIM practice follows the similar processes developed for the antecedent materials such as stainless steel and ceramics. Although Ti-MIM is a favorite research topic today, the issue of convincing the designers to use Ti injection-molded parts still exists. This is mainly because of the concern about contamination which seems unavoidable during the Ti-MIM process. Much information about the binder formulation, powder requirements, debinding, and sintering is available in the literature. There are several powder vendors and feedstock suppliers. However, most of the binders in the feedstock are proprietarily protected. The disclosed information on the binders used for formulating powder feedstock is very limited, which in turn discourages their adoption by engineering designers. This overview intends to discuss some of major binder systems for Ti-MIM available in the literature. It serves to provide a guideline for the Ti-MIM practitioners to choose a suitable powder feedstock.

Predictors of Sharing Injection Equipment by HIV-Seropositive Injection Drug Users

PubMed Central

Latkin, Carl A.; Buchanan, Amy S.; Metsch, Lisa R.; Knight, Kelly; Latka, Mary H.; Mizuno, Yuko; Knowlton, Amy R.

2009-01-01

Among HIV-positive injection drug users (IDUs), we examined baseline predictors of lending needles and syringes, and sharing cookers, cotton, and rinse water in the prior 3 months at follow-up. Participants were enrolled in INSPIRE, a secondary prevention intervention for sexually active HIV-positive IDUs in four US cities during 2001–2005. The analyses involved 357 participants who reported injecting drugs in the prior six months at either the 6- or 12-months follow-up visit. About half (49%) reported at least one sharing episode. In adjusted analyses, peer norms supporting safer injection practices, and having primary HIV medical care visits in the prior 6 months were associated with reporting no sharing of injection equipment. Higher levels of psychological distress was associated with a greater likelihood of reporting drug paraphernalia sharing. These findings suggest that intervention approaches for reducing HIV-seropositive IDUs’ transmission of blood-borne infections should include peer-focused interventions to alter norms of drug paraphernalia sharing and promoting primary HIV care and mental health services. PMID:19186356

INVERSE COMPTON SCATTERING MODEL FOR X-RAY EMISSION OF THE GAMMA-RAY BINARY LS 5039

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

Yamaguchi, M. S.; Takahara, F.

2012-12-20

We propose a model for the gamma-ray binary LS 5039 in which the X-ray emission is due to the inverse Compton (IC) process instead of the synchrotron radiation. Although the synchrotron model has been discussed in previous studies, it requires a strong magnetic field which leads to a severe suppression of the TeV gamma-ray flux in conflict with H.E.S.S. observations. In this paper, we calculate the IC emission by low energy electrons ({gamma}{sub e} {approx}< 10{sup 3}) in the Thomson regime. We find that IC emission of the low energy electrons can explain the X-ray flux and spectrum observed withmore » Suzaku if the minimum Lorentz factor of injected electrons {gamma}{sub min} is around 10{sup 3}. In addition, we show that the Suzaku light curve is well reproduced if {gamma}{sub min} varies in proportion to the Fermi flux when the distribution function of injected electrons at higher energies is fixed. We conclude that the emission from LS 5039 is well explained by the model with the IC emission from electrons whose injection properties are dependent on the orbital phase. Since the X-ray flux is primarily determined by the total number of cooling electrons, this conclusion is rather robust, although some mismatches between the model and observations at the GeV band remain in the present formulation.« less

Effect of toroidal field ripple on plasma rotation in JET

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

De Vries, P.; Salmi, A.; Parail, V.

Dedicated experiments on TF ripple effects on the performance of tokamak plasmas have been carried out at JET. The TF ripple was found to have a profound effect on the plasma rotation. The central Mach number, M, defined as the ratio of the rotation velocity and the thermal velocity, was found to drop as a function of TF ripple amplitude ( ) from an average value of M = 0.40 0.55 for operations at the standard JET ripple of = 0.08% to M = 0.25 0.40 for = 0.5% and M = 0.1 0.3 for = 1%. TF ripple effectsmore » should be considered when estimating the plasma rotation in ITER. With standard co-current injection of neutral beam injection (NBI), plasmas were found to rotate in the co-current direction. However, for higher TF ripple amplitudes ( ~ 1%) an area of counter rotation developed at the edge of the plasma, while the core kept its co-rotation. The edge counter rotation was found to depend, besides on the TF ripple amplitude, on the edge temperature. The observed reduction of toroidal plasma rotation with increasing TF ripple could partly be explained by TF ripple induced losses of energetic ions, injected by NBI. However, the calculated torque due to these losses was insufficient to explain the observed counter rotation and its scaling with edge parameters. It is suggested that additional TF ripple induced losses of thermal ions contribute to this effect.« less

A practical laboratory study simulating the percutaneous lumbar transforaminal epidural injection: training model in fresh cadaveric sheep spine.

PubMed

Suslu, Husnu

2012-01-01

Laboratory training models are essential for developing and refining treatment skills before the clinical application of surgical and invasive procedures. A simple simulation model is needed for young trainees to learn how to handle instruments, and to perform safe lumbar transforaminal epidural injections. Our aim is to present a model of a fresh cadaveric sheep lumbar spine that simulates the lumbar transforaminal epidural injection. The material consists of a 2-year-old fresh cadaveric sheep spine. A 4-step approach was designed for lumbar transforaminal epidural injection under C-arm scopy. For the lumbar transforaminal epidural injection, the fluoroscope was adjusted to get a proper oblique view while the material was stabilized in a prone position. The procedure then begin, using the C-arm guidance scopy. The model simulates well the steps of standard lumbar transforaminal epidural injections in the human spine. The cadaveric sheep spine represents a good method for training and it simulates fluoroscopic lumbar transforaminal epidural steroid injection procedures performed in the human spine.

Intraarticular triamcinolone hexacetonide injection in children with chronic arthritis: a survey of clinical practice.

PubMed

Yang, M H; Lee, W I; Chen, L C; Lin, S J; Huang, J L

1999-01-01

To assess the efficacy of the intraarticular steroid(IAS) injection in the management of arthritis and the possible related complications in children with chronic arthritis. We evaluated 11 children of chronic arthritis (4 girls and 7 boys), age of onset ranged from 2-13.6 years, who had persistent arthritis treated with IAS from November 1994 to June 1997. The results of injections showed that the beneficial effect was noted within one day to 2 weeks without significant adverse reactions, remission exceeding 6 months was seen in 10 of 11 patients (in 14 of 18 joints). According to subgroups of chronic arthritis, the remission rate of IAS injection in children with pauciarticular arthritis reached 100%. A significant fall in C-reactive protein (CRP) between pre- and post-IAS injection (p = 0.03), but there were no differences in hemoglobin (Hb), white blood cells (WBCs), thrombocytes (Plts), erythrocyte sedimentation rate (ESR) and osteocalcin level. No injection-related complications were found. In conclusion, the IAS injection was an effective and safe treatment in children with chronic arthritis with no obvious complications especially in pauciarticular arthritis.

Do procedural skills workshops during family practice residency work?

PubMed Central

MacKenzie, Mark S.; Berkowitz, Jonathan

2010-01-01

ABSTRACT OBJECTIVE To determine if participation in a procedural skills workshop during family practice residency affects future use of these skills in postgraduate clinical practice. DESIGN Survey involving self-assessment of procedural skills experience and competence. SETTING British Columbia. PARTICIPANTS Former University of British Columbia family practice residents who trained in Vancouver, BC, including residents who participated in a procedural skills workshop in 2001 or 2003 and residents graduating in 2000 and 2002 who did not participate in the procedural skills workshop. MAIN OUTCOME MEASURES Self-assessed experience and competence in the 6 office-based procedural skills that were taught during the procedural skills workshops in 2001 and 2003. RESULTS Participation in a procedural skills workshop had no positive effect on future use of these skills in clinical practice. Participation in the workshop was associated with less reported experience (P = .091) in injection of lateral epicondylitis. As with previous Canadian studies, more women than men reported experience and competence in gynecologic procedures. More women than men reported experience (P = .001) and competence (P = .004) in intrauterine device insertion and experience (P = .091) in endometrial aspiration biopsy. More men than women reported competence (P = .052) in injection of trochanteric bursae. A third year of emergency training was correlated with an increase in reported experience (P = .021) in shoulder injection. CONCLUSION Participation in a procedural skills workshop during family practice residency did not produce a significant increase in the performance of these skills on the part of participants once they were in clinical practice. The benefit of a skills workshop might be lost when there is no opportunity to practise and perfect these skills. Sex bias in the case of some procedures might represent a needs-based acquisition of skills on the part of practising physicians. Short procedural skills workshops might be better suited to graduated physicians with more clinical experience. PMID:20705868

Speech sequence skill learning in adults who stutter.

PubMed

Bauerly, Kim R; De Nil, Luc F

2011-12-01

The present study compared the ability of 12 people who stutter (PWS) and 12 people who do not stutter (PNS) to consolidate a novel sequential speech task. Participants practiced 100 repetitions of a single, monosyllabic, nonsense word sequence during an initial practice session and returned 24-h later to perform an additional 50 repetitions. Results showed significantly slower sequence durations in the PWS compared to PNS following extensive practice and consolidation. However, the hypothesis that poor performance gains in PWS compared to PNS during practice would be maintained following a 24-h consolidation period was not supported. Further descriptive analysis revealed large within group differences in PWS which to some extent were attributed to a subgroup of PWS who failed to show any improvements in performance following practice or consolidation. The results and the possible presence of subgroups of PWS are discussed with regard to their limitations in motor learning abilities. The reader will be able to (1) explain the difference between practice and learning, (2) define consolidation and explain the importance of measuring performance following a consolidation period, (3) understand past research on PWS' performance during both speech and nonspeech motor tasks, and (4) explain why individual differences in practice effects and learning may have important implications for client variability in treatment outcome. Copyright © 2011 Elsevier Inc. All rights reserved.

Evidence of Multi-Component Ion Exchange in Dolomite Formation during Low Salinity Waterflooding

NASA Astrophysics Data System (ADS)

Srisuriyachai, Falan; Meekangwal, Suthida

2017-12-01

Low salinity waterflooding is a technique performed in many oil reservoirs around the globe. The technique is simply implemented by injecting water with very low ionic activity compared to formation water into an injection well. The injected water will increase reservoir pressure that is compulsory to drive oil moving toward production well. More than just maintaining reservoir pressure as obtained from conventional waterflooding, low salinity water creates shifting of surface condition, resulting in additional amount of liberated oil. Nevertheless, exact oil recovery mechanisms are still discussed. Among these proposed mechanisms, Multi-component Ion Exchange (MIE) together with wettability alteration is believed to be a major mechanism leading to higher oil recovery compared to conventional waterflooding. In this study, detection of calcium and magnesium ions which are Potential Determining Ions (PDI) for carbonate reservoirs are detected during the coreflood experiment. Dolomite rock sample is used to represent carbonate formation and detection of previously mentioned ions is performed by complexometric titration of the effluents. From the study, it is observed that during conventional waterflooding and low salinity waterflooding at low temperature of 30 degrees Celsius, calcium and magnesium ions in the produced water is increased compared to the amount of these ions in the injected water. This incremental of ions can be explained by the dissolution of calcium and magnesium from dolomite which is chemically composed of calcium magnesium carbonate. At this temperature, the portion of calcium ion is always less than magnesium ion even though the amount of calcium ion is higher than magnesium ion in injected water. However, at higher temperatures which are 50 and 70 degrees Celsius, ratio of calcium and magnesium ions in injected and produced water is reversed. Disappearance of magnesium ion in the effluent is more obvious especially at 70 degrees Celsius and by low salinity waterflooding. This can be explained that at lower temperature, calcium ion disappears to form of calcium carboxylate complex with oil and at higher temperature, magnesium ion disappears as magnesium can start to form magnesium carboxylate complex with oil and hence, the amount of both calcium and magnesium ions is decreased compared to lower temperature. In dolomite reservoir, since both calcium ions and magnesium ions are provided from dissolution mechanism, the benefit from multi-component ion exchange will occur at high temperature as both calcium and magnesium ions will be consumed for oil recovery mechanism.

Anomalous transport in fracture networks: field scale experiments and modelling

NASA Astrophysics Data System (ADS)

Kang, P. K.; Le Borgne, T.; Bour, O.; Dentz, M.; Juanes, R.

2012-12-01

Anomalous transport is widely observed in different settings and scales of transport through porous and fractured geologic media. A common signature of anomalous transport is the late-time power law tailing in breakthrough curves (BTCs) during tracer tests. Various conceptual models of anomalous transport have been proposed, including multirate mass transfer, continuous time random walk, and stream tube models. Since different conceptual models can produce equally good fits to a single BTC, tracer test interpretation has been plagued with ambiguity. Here, we propose to resolve such ambiguity by analyzing BTCs obtained from both convergent and push-pull flow configurations at two different fracture planes. We conducted field tracer tests in a fractured granite formation close to Ploemeur, France. We observe that BTC tailing depends on the flow configuration and the injection fracture. Specifically the tailing disappears under push-pull geometry, and when we injected at a fracture with high flux (Figure 1). This indicates that for this fractured granite, BTC tailing is controlled by heterogeneous advection and not by matrix diffusion. To explain the change in tailing behavior for different flow configurations, we employ a simple lattice network model with heterogeneous conductivity distribution. The model assigns random conductivities to the fractures and solves the Darcy equation for an incompressible fluid, enforcing mass conservation at fracture intersections. The mass conservation constraint yields a correlated random flow through the fracture system. We investigate whether BTC tailing can be explained by the spatial distribution of preferential flow paths and stagnation zones, which is controlled by the conductivity variance and correlation length. By combining the results from the field tests and numerical modeling, we show that the reversibility of spreading is a key mechanism that needs to be captured. We also demonstrate the dominant role of the injection fracture on the tailing behavior: where we inject makes the difference in the tailing. Blue line is a BTC with injection into a slow velocity zone under convergent flow configuration. The late-time tailing observed for the convergent test diminished for push-pull experiment performed in the same zone(red line). Black line is a BTC with injection into a high velocity zone under convergent flow configuration. Insets: illustration of convergent and push-pull tracer tests using a double packer system.

Usage of Policies and Practices Promoted by Race to the Top and School Improvement Grants: Executive Summary. NCEE 2015-4017

ERIC Educational Resources Information Center

James-Burdumy, Susanne

2015-01-01

The American Recovery and Reinvestment Act of 2009 injected $7 billion into two of the Obama administration's signature competitive education grant programs: Race to the Top (RTT) and School Improvement Grants (SIG). While RTT focused on state policies and SIG focused on school practices, both programs promoted related policies and practices,…

Body Fat of Mice and Men: A Class Exercise in Theory or Practice.

ERIC Educational Resources Information Center

Webb, G. P.; Jakobson, M. E.

1980-01-01

Four means of altering fat levels in laboratory mice, contrasting invasive injection techniques with non-invasive dietary and behavioral means, are described. Relates these investigations concerning obesity to the practicality of using animal models as an approach in searching for physiological knowledge about human beings. (CS)

Detection of the spin injection into silicon by broadband ferromagnetic resonance spectroscopy

NASA Astrophysics Data System (ADS)

Ohshima, Ryo; Dushenko, Sergey; Ando, Yuichiro; Weiler, Mathias; Klingler, Stefan; Huebl, Hans; Shinjo, Teruya; Goennenwein, Sebastian; Shiraishi, Masashi

Silicon (Si) based spintronics was eagerly studied to realize spin metal-oxide-semiconductor field-effect-transistors (MOSFETs) since it has long spin lifetime and gate tunability. The operation of n-type Si spin MOSFET was successfully demonstrated, however, their resistivity is still too low for practical applications and a systematic study of spin injection properties (such as spin lifetime, spin injection efficiency and so on) from the ferromagnet into the Si with different resistivity is awaited for further progress in Si spintronics. In this study, we show the spin injection by spin pumping technique in the NiFe(Py)/Si system. Broadband FMR measurement was carried out to see the enhancement of the Gilbert damping parameter with different resistivity of the Si channel. Additional damping indicated the successful spin injection by spin pumping and observed even for the Si channel with high resistivity, which is necessary for the gate operation of the device.

Fault Injection Validation of a Safety-Critical TMR Sysem

NASA Astrophysics Data System (ADS)

Irrera, Ivano; Madeira, Henrique; Zentai, Andras; Hergovics, Beata

2016-08-01

Digital systems and their software are the core technology for controlling and monitoring industrial systems in practically all activity domains. Functional safety standards such as the European standard EN 50128 for railway applications define the procedures and technical requirements for the development of software for railway control and protection systems. The validation of such systems is a highly demanding task. In this paper we discuss the use of fault injection techniques, which have been used extensively in several domains, particularly in the space domain, to complement the traditional procedures to validate a SIL (Safety Integrity Level) 4 system for railway signalling, implementing a TMR (Triple Modular Redundancy) architecture. The fault injection tool is based on JTAG technology. The results of our injection campaign showed a high degree of tolerance to most of the injected faults, but several cases of unexpected behaviour have also been observed, helping understanding worst-case scenarios.

History of medication-assisted treatment and its association with initiating others into injection drug use in San Diego, CA.

PubMed

Mittal, Maria Luisa; Vashishtha, Devesh; Sun, Shelly; Jain, Sonia; Cuevas-Mota, Jazmine; Garfein, Richard; Strathdee, Steffanie A; Werb, Dan

2017-10-03

Medication-assisted treatment (MAT) remains the gold standard for the treatment of opioid use disorder. MAT also reduces the frequency of injecting among people who inject drugs (PWID). Relatedly, data suggest that PWID play a key role in the initiation of others into drug injecting by exposing injecting practices to injection-naïve drug users. Our primary objective was to test whether a history of MAT enrollment is associated with a reduced odds of PWID providing injection initiation assistance. Preventing Injecting by Modifying Existing Responses (PRIMER; NIDA DP2-DA040256-01), is a multi-site cohort study assessing the impact of socio-structural factors on the risk that PWID provide injection initiation assistance. Data were drawn from a participating cohort of PWID in San Diego, CA. The primary outcome was reporting ever providing injection initiation assistance; the primary predictor was reporting ever being enrolled in MAT. Logistic regression was used to model associations between MAT enrollment and ever initiating others into injecting while adjusting for potential confounders. Participants (n = 354) were predominantly male (n = 249, 70%). Thirty-eight percent (n = 135) of participants reported ever initiating others into injection drug use. In multivariate analysis, participants who reported a history of MAT enrollment had significantly decreased odds of ever providing injection initiation assistance (Adjusted Odds Ratio [AOR]: 0.62, 95% Confidence Interval [CI]: 0.39-0.99). These preliminary findings suggest an association between MAT enrollment and a lower odds that male PWID report providing injection initiation assistance to injection-naïve drug users. Further research is needed to identify the pathways by which MAT enrollment may impact the risk that PWID initiate others into drug injecting.

Practice patterns for the use of iodinated i.v. contrast media for pediatric CT studies: a survey of the Society for Pediatric Radiology.

PubMed

Callahan, Michael J; Servaes, Sabah; Lee, Edward Y; Towbin, Alexander J; Westra, Sjirk J; Frush, Donald P

2014-04-01

There are limited data available on the use of i.v. contrast media for CT studies in the pediatric population. The purpose of this study is to determine the practice patterns of i.v. contrast media usage for pediatric CT by members of the Society for Pediatric Radiology (SPR). SPR members were surveyed regarding the use of i.v. contrast media for pediatric CT studies. Questions pertained to information required before administering i.v. contrast media, types of central catheters for injecting i.v. contrast media, injection rates based on angiocatheter size and study type, and management of i.v. contrast media extravasation. The response rate of 6% (88/1545) represented practice patterns of 26% (401/1545) of the SPR membership. Most respondents thought the following clinical information was mandatory before i.v. contrast media administration: allergy to i.v. contrast media (97%), renal insufficiency (97%), current metformin use (72%), significant allergies (61%), diabetes (54%), and asthma (52%). Most administered i.v. contrast media through nonimplanted central venous catheters (78%), implanted venous ports (78%), and peripherally inserted central catheters (72%). The most common maximum i.v. contrast media injection rates were 5.0 mL/s or greater for a 16-gauge angiocatheter, 4.0 mL/s for an 18-gauge angiocatheter, 3.0 mL/s for a 20-gauge angiocatheter, and 2.0 mL/s for a 22-gauge angiocatheter. For soft-tissue extravasation of i.v. contrast media, 95% elevate the affected extremity, 76% use ice, and 45% use heat. The results of this survey illustrate the collective opinion of a subset of SPR members relating to the use of i.v. contrast media in pediatric CT, providing guidelines for clinical histories needed before i.v. contrast media, maximum i.v. contrast injection rates for standard angiocatheters, contrast media injection rates for specific CT studies, and management of i.v. contrast media soft-tissue extravasation.

The injecting use of image and performance-enhancing drugs (IPED) in the general population: a systematic review.

PubMed

Brennan, Rebekah; Wells, John S G; Van Hout, Marie Claire

2017-09-01

Injecting use of image and performance-enhancing drugs (IPED) in the general population is a public health concern. A wide and varied range of IPED are now easily accessible to all through the online market. A comprehensive literature review was undertaken according to Critical Appraisal Skills Programme (CASP) guidelines for systematic review, to identify the relevant literature. No date restrictions were placed on the database search in the case of human growth hormone melanotan I and II, and oil and cosmetic injectables. In the case of anabolic androgenic steroids search dates were restricted to January 2014-2015. Publications not in English and with a lack of specificity to the topic were excluded. The review yielded 133 relevant quantitative and qualitative papers, clinical trials, clinical case presentations and editorials/reports. Findings were examined/reviewed under emergent themes which identified/measured extent of use, user profiling, sourcing, product endorsement, risk behaviours and health outcomes in users. Motivation for IPED use may be grounded in appearance, pursuit of health and youth, and body image disturbance. IPED users can practice moderated use, with pathological use linked to high-risk behaviours, which may be normalised within IPED communities. Many IPED trajectories and pathways of use are not scientifically documented. Much of this information may be available online in IPED specific discussion forums, an underutilised setting for research, where uncensored discourse takes place among users. This review underscores the need for future internet and clinical research to investigate prevalence and patterns of injecting use, and to map health outcomes in IPED users. This paper provides community-based clinical practice and health promotion services with a detailed examination and analysis of the injecting use of IPED, highlighting the patterns of this public health issue. It serves to disseminate updated publication information to health and social policy makers and those in health service practice who are involved in harm reduction intervention. © 2016 John Wiley & Sons Ltd.

Solute plumes mean velocity in aquifer transport: Impact of injection and detection modes

NASA Astrophysics Data System (ADS)

Dagan, Gedeon

2017-08-01

Flow of mean velocity U takes place in a heterogeneous aquifer of random spatially variable conductivity K. A solute plume is injected instantaneously along a plane normal to U, over a large area relative to the logconductivity integral scale I (ergodic plume). Transport is by advection by the spatially variable Eulerian velocity. The study is focused on the derivation of the mean plume velocity in the four modes set forth by Kreft and Zuber [1978] for one dimensional flow in a homogeneous medium. In the resident injection mode the mass is initially distributed uniformly in space while in the flux mode it is proportional to the local velocity. In the resident detection mode the mean velocity pertains to the plume centroid, whereas in flux detection it is quantified with the aid of the BTC and the corresponding mean arrival time. In agreement with the literature, it is shown that URR and UFF, pertaining to same injection and detection modes, either resident or flux, are equal to U. In contrast, in the mixed modes the solute velocity may differ significantly from U near the injection plane, approaching it at large distances relative to I. These effects are explained qualitatively with the aid of the exact solution for stratified aquifers.

Biomedical HIV prevention including pre-exposure prophylaxis and opiate agonist therapy for women who inject drugs: State of research and future directions

PubMed Central

Page, Kimberly; Tsui, Judith; Maher, Lisa; Choopanya, Kachit; Vanichseni, Suphak; Mock, Philip A.; Celum, Connie; Martin, Michael

2015-01-01

Women who inject drugs are at higher risk of HIV compared to their male counterparts as a result of multiple factors including biological, behavioral and socio-structural, yet comparatively little effort has been invested in testing and delivering prevention methods that directly target this group. In this paper, we discuss the need for expanded prevention interventions for women who inject drugs, focusing on two safe, effective, and approved, yet underutilized biomedical prevention methods: opiate agonist therapy (OAT) and oral pre-exposure prophylaxis (PrEP). While both interventions are well researched they have not been well examined in the context of gender. We discuss the drivers of women injectors’ higher HIV risk, review the effectiveness of OAT and PrEP interventions among women, and explain why these new HIV prevention tools should be prioritized for women who inject drugs. There is substantial potential for impact of OAT and PrEP programs for women who inject drugs in the context of broader gender-responsive HIV prevention initiatives. While awaiting efficacy data on other biomedical approaches in the HIV prevention research ‘pipeline’, we propose that the scale up and implementation of these proven, safe, and effective interventions are needed now. PMID:25978484

Filling of high aspect ratio micro features of a microfluidic flow cytometer chip using micro injection moulding

NASA Astrophysics Data System (ADS)

Zhang, Haoyang; Fang, Fengzhou; Gilchrist, Michael D.; Zhang, Nan

2018-07-01

Micro injection moulding has been demonstrated as one of the most efficient mass production technologies for manufacturing polymeric microfluidic devices, which have been widely used in life sciences, environmental and analytical fields and agro-food industries. However, the filling of micro features for typical microfluidic devices is complicated and not yet fully understood, which consequently restricts the chip development. In the present work, a microfluidic flow cytometer chip with essential high aspect ratio micro features was used as a typical model to study their filling process. Short-shot experiments and single factor experiments were performed to examine the filling progress of such features during the injection and packing stages of the micro injection moulding process. The influence of process parameters such as shot size, packing pressure, packing time and mould temperature were systematically monitored, characterised and correlated with 3D measurements and real response of the machine such as screw velocity and screw position. A combined melt flow and creep deformation model was proposed to explain the complex influence of process on replication. An approach of over-shot micro injection moulding was proposed and was shown to be effective at improving the replication quality of high aspect ratio micro features.

Medieval Literacy Outside the Academy: Popular Practice and Individual Technique.

ERIC Educational Resources Information Center

Glenn, Cheryl

1993-01-01

Argues that medieval popular literacy can provide a crucial link for understanding alternative literacies. Claims that medieval practices explain some contemporary literacy practices, especially those outside the academy. (HB)

New Hope for Children with Cerebral Palsy.

ERIC Educational Resources Information Center

Obringer, S. John

This paper explains the use of a unique experimental therapy for students with a type of cerebral palsy specifically called Botox. Botulinum Toxin Type A has been tried on a sizable number of students with cerebral palsy in clinical settings to reduce spastic and dystonic movements. By injecting Botox into overly tight heel cords, a normal or near…

An audit of the use of intra-septal local anaesthesia in a dental practice in the South of England.

PubMed

Doman, Stephen M

2011-04-01

The aim of this audit was to evaluate the efficacy, when used by the author, of the intra-septal local anaesthetic technique for cavity preparation in mandibular molar and premolar teeth. One hundred and thirteen consecutive patients who required local anaesthesia (LA) for cavity preparation in lower molar and premolar teeth in a general dental practice took part in the audit sample. Articaine 4%, with 1:100,000 adrenaline (epinephrine), was administered using the intra-septal technique. Visual analogue scales (VAS) were used to record pain experienced on injection and the quality of anaesthesia obtained. Any side-effects reported were recorded. The standards set were that at least 70% should find the administration of the LA pain-free and that at least 80% should experience no pain during cavity preparation. Sixty-nine (62%) patients reported the injection technique to be completely pain-free and a further 23 (20%) reported very minor pain on injection. Eighty (71%) patients reported pain-free treatment and 18 (16%) experienced very minor pain during treatment. No side-effects were reported. Patients aged under 40 years and those who had cavities prepared in first premolar teeth appeared more likely to experience pain during cavity preparation. The intra-septal injection technique requires no specialist equipment, is easily administered, rapid in onset and provides a level of anaesthesia equivalent to that produced by an inferior dental nerve block and with fewer side-effects. The injection is relatively painless to administer.

Triamcinolone acetonide activates an anti-inflammatory and folate receptor-positive macrophage that prevents osteophytosis in vivo.

PubMed

Siebelt, Michiel; Korthagen, Nicoline; Wei, Wu; Groen, Harald; Bastiaansen-Jenniskens, Yvonne; Müller, Christina; Waarsing, Jan Hendrik; de Jong, Marion; Weinans, Harrie

2015-12-05

Triamcinolone acetonide (TA) is used for osteoarthritis management to reduce pain, and pre-clinical studies have shown that TA limits osteophyte formation. Osteophyte formation is known to be facilitated by synovial macrophage activation. TA injections might influence macrophage activation and subsequently reduce osteophytosis. Although widely applied in clinical care, the mechanism through which TA exerts this effect remains unknown. In this animal study, we investigated the in vivo effects of TA injections on macrophage activation, osteophyte development and joint degeneration. Furthermore, in vitro macrophage differentiation experiments were conducted to further explain working mechanisms of TA effects found in vivo. Osteoarthritis was induced in rat knees using papain injections and a running protocol. Untreated and TA-treated animals were longitudinally monitored for 12 weeks with in vivo micro-computed tomography (μCT) to measure subchondral bone changes. Synovial macrophage activation was measured in vivo using folate receptor β (FRβ)-targeted single-photon emission computed tomography/computed tomography. Articular cartilage was analyzed at 6 and 12 weeks with ex vivo contrast-enhanced μCT and histology. To further explain the outcomes of our in vivo study, TA on macrophages was also studied in vitro. These cultured macrophages were either M1- or M2-activated, and they were analyzed using fluorescence-activated cell sorting for CD163 and FRβ expression as well as for messenger RNA (mRNA) expression of interleukin (IL)-10. Our in vivo study showed that intra-articular injections with TA strongly enhanced FRβ(+) macrophage activation. Despite stimulated macrophage activation, osteophyte formation was fully prevented. There was no beneficial effect of TA against cartilage degradation or subchondral bone sclerosis. In vitro macrophage cultures showed that TA strongly induced monocyte differentiation towards CD163(+) and FRβ(+) macrophages. Furthermore, TA-stimulated M2 macrophages showed enhanced IL-10 expression at the mRNA level. TA injections potently induce a CD163(+)- and FRβ(+)-activated macrophage with anti-inflammatory characteristics such as reduced IL-10 production in vitro and lack of osteophytosis in vivo.

Replication fidelity improvement of PMMA microlens array based on weight evaluation and optimization

NASA Astrophysics Data System (ADS)

Jiang, Bing-yan; Shen, Long-jiang; Peng, Hua-jiang; Yin, Xiang-lin

2007-12-01

High replication fidelity is a prerequisite of high quality plastic microlens array in injection molding. But, there's not an economical and practical method to evaluate and improve the replication fidelity until now. Based on part weight evaluation and optimization, this paper presents a new method of replication fidelity improvement. Firstly, a simplified analysis model of PMMA micro columns arrays (5×16) with 200μm diameter was set up. And then, Flow (3D) module of Moldflow MPI6.0 based on Navier-Stokes equations was used to calculate the weight of the micro columns arrays in injection molding. The effects of processing parameters (melt temperature, mold temperature, injection time, packing pressure and packing time) on the part weight were investigated in the simulations. The simulation results showed that the mold temperature and the injection time have important effects on the filling of micro columns; the optimal mold temperature and injection time for better replication fidelity could be determined by the curves of mold temperature vs part weight and injection time vs part weight. At last, the effects of processing parameters on part weight of micro columns array were studied experimentally. The experimental results showed that the increase of melt temperature and mold temperature can make the packing pressure transfer to micro cavity more effectively through runner system, and increase the part weight. From the observation results of the image measuring apparatus, it was discovered that the higher the part weight, the better the filling of the microstructures. In conclusion, part weight can be used to evaluate the replication fidelity of micro-feature structured parts primarily; which is an economical and practical method to improve the replication fidelity of microlens arrays based on weight evaluation and optimization.

Access to Sterile Syringes through San Francisco Pharmacies and the Association with HIV Risk Behavior among Injection Drug Users

PubMed Central

Kral, Alex H.; Stopka, Thomas J.; Garfein, Richard S.; Reuckhaus, Paul; Bluthenthal, Ricky N.

2010-01-01

Increased options for syringe acquisition and disposal have been associated with reductions in high-risk behaviors. This study determined the extent of pharmacy uptake in accessing syringes among injection drug users (IDUs) and estimated associations between pharmacy uptake and safer injection/disposal practices. Two years after the implementation of California’s Disease Prevention Demonstration Project, which removed restrictions to non-prescription syringe sales through pharmacies with local authorization, IDUs were recruited through street outreach in San Francisco and interviewed regarding recent syringe acquisition, use, and disposal. The sample of 105 persons included a high proportion of men (67%), people of color (49%), and homeless persons (71%). The most common syringe source was a syringe exchange program (SEP) (80%), with pharmacies being accessed by 39% of respondents. The most commonly cited source of disposal was a SEP (65%), with very few reports of pharmacy disposal (2%). Adjusted analysis showed that unsuccessful attempts to purchase syringes at a pharmacy increased the odds of both injecting with a used syringe and giving away a used syringe. Using a SEP decreased the odds of unsafe injection and disposal practices. Thus, 2 years after the initiation of the California Disease Prevention Demonstration Project, results from this small study suggest that SEPs still provide the majority of syringe distribution and disposal services to San Francisco IDUs; however, pharmacies now augment syringe access. In addition, unsafe injection behavior is reported more often among those who do not use these syringe sources. These results are consistent with prior studies in suggesting that increasing the availability of syringes through SEPs and pharmacies, and developing bridges between them, may further reduce syringe-related risk. PMID:20526690

Patterns of Drug Use, Risky Behavior, and Health Status Among Persons Who Inject Drugs Living in San Diego, California: A Latent Class Analysis

PubMed Central

Roth, Alexis M.; Armenta, Richard A.; Wagner, Karla D.; Roesch, Scott C.; Bluthenthal, Ricky N.; Cuevas-Mota, Jazmine; Garfein, Richard S.

2015-01-01

Background Among persons who inject drugs (PWID), polydrug use (the practice of mixing multiple drugs/alcohol sequentially or simultaneously) increases risk for HIV transmission and unintentional overdose deaths. Research has shown local drug markets influence drug use practices. However, little is known about the impact of drug mixing in markets dominated by black tar heroin and methamphetamine, such as the western United States. Methods Data were collected through an ongoing longitudinal study examining drug use, risk behavior, and health status among PWID. Latent class analysis (LCA) was used to identify patterns of substance use (heroin, methamphetamine, prescription drugs, alcohol, and marijuana) via multiple administration routes (injecting, smoking, and swallowing). Logistic regression was used to identify behaviors and health indicators associated with drug use class. Results The sample included 511 mostly white (51.5%) males (73.8%), with mean age of 43.5 years. Two distinct classes of drug users predominated: methamphetamine by multiple routes (51%) and heroin by injection (49%). In multivariable logistic regression, class membership was associated with age, race, and housing status. PWID who were HIV-seropositive and reported prior sexually transmitted infections had increased odds of belonging to the methamphetamine class. Those who were HCV positive and reported previous opioid overdose had an increased odds of being in the primarily heroin injection class (all P-values < .05). Conclusion Risk behaviors and health outcomes differed between PWID who primarily inject heroin vs. those who use methamphetamine. The findings suggest that in a region where PWID mainly use black tar heroin or methamphetamine, interventions tailored to sub-populations of PWID could improve effectiveness. PMID:25313832

Factors associated with drug-related harms related to policing in Tijuana, Mexico

PubMed Central

2011-01-01

Objective To assess factors associated with drug-related harms related to policing among injection drug users (IDUs) in Tijuana, Mexico. Methods IDUs who were over 18 years old and had injected drugs within the last six months were recruited via respondent-driven sampling and underwent questionnaires and testing for HIV (human immunodeficiency virus), syphilis and TB (tuberculosis). Random effects logistic regression was used to simultaneously model factors associated with five drug-related harms related to policing practices in the prior six months (i.e., police led them to rush injections; affected where they bought drugs; affected locations where they used drugs; feared that police will interfere with their drug use; receptive syringe sharing). Results Of 727 IDUs, 85% were male; median age was 38 years. Within the last 6 months, 231 (32%) of IDUs reported that police had led them to rush injections, affected where they bought or used drugs or were very afraid police would interfere with their drug use, or shared syringes. Factors independently associated with drug-related harms related to policing within the last six months included: recent arrest, homelessness, higher frequencies of drug injection, use of methamphetamine, using the local needle exchange program and perceiving a decrease in the purity of at least one drug. Conclusions IDUs who experienced drug-related harms related to policing were those who were most affected by other micro and macro influences in the physical risk environment. Police education programs are needed to ensure that policing practices do not exacerbate risky behaviors or discourage protective behaviors such as needle exchange program use, which undermines the right to health for people who inject drugs. PMID:21477299

Lethal Injection for Execution: Chemical Asphyxiation?

PubMed Central

Zimmers, Teresa A; Sheldon, Jonathan; Lubarsky, David A; López-Muñoz, Francisco; Waterman, Linda; Weisman, Richard; Koniaris, Leonidas G

2007-01-01

Background Lethal injection for execution was conceived as a comparatively humane alternative to electrocution or cyanide gas. The current protocols are based on one improvised by a medical examiner and an anesthesiologist in Oklahoma and are practiced on an ad hoc basis at the discretion of prison personnel. Each drug used, the ultrashort-acting barbiturate thiopental, the neuromuscular blocker pancuronium bromide, and the electrolyte potassium chloride, was expected to be lethal alone, while the combination was intended to produce anesthesia then death due to respiratory and cardiac arrest. We sought to determine whether the current drug regimen results in death in the manner intended. Methods and Findings We analyzed data from two US states that release information on executions, North Carolina and California, as well as the published clinical, laboratory, and veterinary animal experience. Execution outcomes from North Carolina and California together with interspecies dosage scaling of thiopental effects suggest that in the current practice of lethal injection, thiopental might not be fatal and might be insufficient to induce surgical anesthesia for the duration of the execution. Furthermore, evidence from North Carolina, California, and Virginia indicates that potassium chloride in lethal injection does not reliably induce cardiac arrest. Conclusions We were able to analyze only a limited number of executions. However, our findings suggest that current lethal injection protocols may not reliably effect death through the mechanisms intended, indicating a failure of design and implementation. If thiopental and potassium chloride fail to cause anesthesia and cardiac arrest, potentially aware inmates could die through pancuronium-induced asphyxiation. Thus the conventional view of lethal injection leading to an invariably peaceful and painless death is questionable. PMID:17455994

Testing a fall risk model for injection drug users.

PubMed

Pieper, Barbara; Templin, Thomas N; Goldberg, Allon

2012-01-01

Fall risk is a critical component of clinical assessment and has not been examined for persons who have injected illicit drugs and are aging. The aim of this study was to test and develop the Fall Risk Model for Injection Drug Users by examining the relationships among injection drug use, chronic venous insufficiency, lower extremity impairments (i.e., decreased ankle range of motion, reduced calf muscle endurance, and leg pain), age and other covariates, and the Tinetti balance and gait total score as a measure of fall risk. A cross-sectional comparative design was used with four crossed factors. Standardized instruments were used to assess the variables. Moderated multiple regression with linear and quadratic trends in age was used to examine the nature of the relationship between the Tinetti balance and gait total and age and the potential moderating role of injection drug use. A prespecified series of models was tested. Participants (n = 713) were men (46.9%) and women with a mean age of 46.26 years and primarily African American (61.7%) in methadone treatment centers. The fall risk of a 48-year-old leg injector was comparable with the fall risk of a 69-year-old who had not injected drugs. Variables were added to the model sequentially, resulting in some lost significance of some when they were explained by subsequent variables. Final significant variables in the model were employment status, number of comorbidities, ankle range of motion, leg pain, and calf muscle endurance. Fall risk was associated with route of drug use. Lower extremity impairments accounted for the effects of injection drug use and chronic venous insufficiency on risk for falls. Further understanding of fall risk in injection users is necessary as they age, attempt to work, and participate in activities.

Coupled reservoir-geomechanical analysis of CO2 injection and ground deformations at In Salah, Algeria

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

Rutqvist, J.; Vasco, D.W.; Myer, L.

2009-11-01

In Salah Gas Project in Algeria has been injecting 0.5-1 million tonnes CO{sub 2} per year over the past five years into a water-filled strata at a depth of about 1,800 to 1,900 m. Unlike most CO{sub 2} storage sites, the permeability of the storage formation is relatively low and comparatively thin with a thickness of about 20 m. To ensure adequate CO{sub 2} flow-rates across the low-permeability sand-face, the In Salah Gas Project decided to use long-reach (about 1 to 1.5 km) horizontal injection wells. In an ongoing research project we use field data and coupled reservoir-geomechanical numerical modelingmore » to assess the effectiveness of this approach and to investigate monitoring techniques to evaluate the performance of a CO{sub 2}-injection operation in relatively low permeability formations. Among the field data used are ground surface deformations evaluated from recently acquired satellite-based inferrometry (InSAR). The InSAR data shows a surface uplift on the order of 5 mm per year above active CO{sub 2} injection wells and the uplift pattern extends several km from the injection wells. In this paper we use the observed surface uplift to constrain our coupled reservoir-geomechanical model and conduct sensitivity studies to investigate potential causes and mechanisms of the observed uplift. The results of our analysis indicates that most of the observed uplift magnitude can be explained by pressure-induced, poro-elastic expansion of the 20 m thick injection zone, but there could also be a significant contribution from pressure-induced deformations within a 100 m thick zone of shaly sands immediately above the injection zone.« less

Acetate Production from Oil under Sulfate-Reducing Conditions in Bioreactors Injected with Sulfate and Nitrate

PubMed Central

Callbeck, Cameron M.; Agrawal, Akhil

2013-01-01

Oil production by water injection can cause souring in which sulfate in the injection water is reduced to sulfide by resident sulfate-reducing bacteria (SRB). Sulfate (2 mM) in medium injected at a rate of 1 pore volume per day into upflow bioreactors containing residual heavy oil from the Medicine Hat Glauconitic C field was nearly completely reduced to sulfide, and this was associated with the generation of 3 to 4 mM acetate. Inclusion of 4 mM nitrate inhibited souring for 60 days, after which complete sulfate reduction and associated acetate production were once again observed. Sulfate reduction was permanently inhibited when 100 mM nitrate was injected by the nitrite formed under these conditions. Pulsed injection of 4 or 100 mM nitrate inhibited sulfate reduction temporarily. Sulfate reduction resumed once nitrate injection was stopped and was associated with the production of acetate in all cases. The stoichiometry of acetate formation (3 to 4 mM formed per 2 mM sulfate reduced) is consistent with a mechanism in which oil alkanes and water are metabolized to acetate and hydrogen by fermentative and syntrophic bacteria (K. Zengler et al., Nature 401:266–269, 1999), with the hydrogen being used by SRB to reduce sulfate to sulfide. In support of this model, microbial community analyses by pyrosequencing indicated SRB of the genus Desulfovibrio, which use hydrogen but not acetate as an electron donor for sulfate reduction, to be a major community component. The model explains the high concentrations of acetate that are sometimes found in waters produced from water-injected oil fields. PMID:23770914

Acetate production from oil under sulfate-reducing conditions in bioreactors injected with sulfate and nitrate.

PubMed

Callbeck, Cameron M; Agrawal, Akhil; Voordouw, Gerrit

2013-08-01

Oil production by water injection can cause souring in which sulfate in the injection water is reduced to sulfide by resident sulfate-reducing bacteria (SRB). Sulfate (2 mM) in medium injected at a rate of 1 pore volume per day into upflow bioreactors containing residual heavy oil from the Medicine Hat Glauconitic C field was nearly completely reduced to sulfide, and this was associated with the generation of 3 to 4 mM acetate. Inclusion of 4 mM nitrate inhibited souring for 60 days, after which complete sulfate reduction and associated acetate production were once again observed. Sulfate reduction was permanently inhibited when 100 mM nitrate was injected by the nitrite formed under these conditions. Pulsed injection of 4 or 100 mM nitrate inhibited sulfate reduction temporarily. Sulfate reduction resumed once nitrate injection was stopped and was associated with the production of acetate in all cases. The stoichiometry of acetate formation (3 to 4 mM formed per 2 mM sulfate reduced) is consistent with a mechanism in which oil alkanes and water are metabolized to acetate and hydrogen by fermentative and syntrophic bacteria (K. Zengler et al., Nature 401:266-269, 1999), with the hydrogen being used by SRB to reduce sulfate to sulfide. In support of this model, microbial community analyses by pyrosequencing indicated SRB of the genus Desulfovibrio, which use hydrogen but not acetate as an electron donor for sulfate reduction, to be a major community component. The model explains the high concentrations of acetate that are sometimes found in waters produced from water-injected oil fields.

Explaining Variation in How Classroom Communities Adapt the Practice of Scientific Argumentation

ERIC Educational Resources Information Center

Berland, Leema K.

2011-01-01

Research and practice has placed an increasing emphasis on aligning classroom practices with scientific practices such as scientific argumentation. In this paper, I explore 1 challenge associated with this goal by examining how existing classroom practices influence students' engagement in the practice of scientific argumentation. To do so, I…

Anti-VEGF treatment of macular edema associated with retinal vein occlusion: patterns of use and effectiveness in clinical practice (ECHO study report 2)

PubMed Central

Jumper, J Michael; Dugel, Pravin U; Chen, Sanford; Blinder, Kevin J; Walt, John G

2018-01-01

Purpose To evaluate the efficacy, safety, and injection frequency of vascular endothelial growth factor (VEGF) antagonists in the treatment of macular edema secondary to retinal vein occlusion (RVO) in clinical practice. Patients and methods A multicenter retrospective study of the medical records of 165 patients (95 branch RVO, 70 central RVO) treated with at least three anti-VEGF injections in the study eye was conducted. Available data collected for at least 6 months after the first injection included Snellen best-corrected visual acuity (BCVA), central retinal thickness (CRT) by time-domain optical coherence tomography (TD-OCT) or spectral-domain optical coherence tomography (SD-OCT), anti-VEGF injections, other treatments/procedures for RVO, and adverse events. Results At baseline prior to anti-VEGF treatment, mean BCVA was 20/80 Snellen equivalent and mean CRT was 499 μm. Mean number of anti-VEGF injections received was 7.1 during the first year, 5.4 during the second year, and 5.9 during the third year; 51.3% (842/1,641) of injections were ranibizumab, 44.1% (724/1,641) were bevacizumab, and 4.6% (75/1,641) were aflibercept. One in five patients received concomitant focal laser treatment. The percentage of patients achieving both BCVA of 20/40 or better and CRT ≤250 μm on TD-OCT or ≤300 μm on SD-OCT at the same visit (primary endpoint) was 26.1% (30/115) after the first anti-VEGF injection and ranged from 20.0% (7/35) to 36.7% (11/30) after the first 16 injections. After each anti-VEGF injection from the 1st to the 16th, <60% of patients achieved 20/40 or better BCVA and ≤70% of patients achieved CRT ≤250 μm on TD-OCT or ≤300 μm on SD-OCT. The most common treatment-related adverse event was blurry or cloudy vision. Conclusion In this real-world study, a mean of five to seven anti-VEGF injections was administered yearly, and the response to anti-VEGF therapy was suboptimal in many patients. Anti-VEGF therapy was well tolerated. PMID:29662298

Evolution of the Global Use of Unsafe Medical Injections, 2000–2010

PubMed Central

Pépin, Jacques; Abou Chakra, Claire Nour; Pépin, Eric; Nault, Vincent

2013-01-01

Objective Since 1999, substantial efforts have been made by the international community to reduce the risks associated with unsafe injections, through ministries of health, international donors, the World Health Organization and the Safe Injection Global Network. The present study attempted to measure the progress, or lack thereof, made over the 2000–2010 decade in reducing unsafe injections in ten regions of the world corresponding to developing and transitional economies. Methods Data about the number of injections per person per year and the proportion of re-use of syringes and needles were obtained for 2010, mainly from population surveys, and compared with previous estimates for 2000 which had used various sources of information including injection safety assessments, population surveys and published studies on injection practices. Results From 2000 to 2010, in developing countries and transitional economies, the average number of injections per person per year decreased from 3.40 to 2.88, while the proportion of re-use of injection devices dropped from 39.8% to 5.5%. Combining both factors the number of unsafe injections per person per year decreased from 1.35 to 0.16. Even if substantial progress has been made, the Eastern Mediterranean region remains problematic, with 0.57 unsafe injections per person per year. In sub-Saharan Africa and Latin America, people now receive on average only 0.04–0.05 unsafe injections per year. Conclusion Substantial progress has been made in reducing the number of unsafe injections in developing countries and transitional economies, essentially through a reduction in the re-use of injection devices. In some regions, elimination of unsafe injections might become a reasonable goal. PMID:24324650

Towards safe injection practices for prevention of hepatitis C transmission in South Asia: Challenges and progress

PubMed Central

Janjua, Naveed Zafar; Butt, Zahid Ahmad; Mahmood, Bushra; Altaf, Arshad

2016-01-01

AIM: To summarize the available information about injection use and its determinants in the South Asian region. METHODS: We searched published and unpublished literature on injection safety in South Asia published during 1995-2016 using the keywords “injection” “unsafe injection” and “immunization injection” and combined these with each of the countries and/or their respective states or provinces in South Asia. We used a standardized questionnaire to abstract the following data from the articles: the annual number of injections per capita, the proportion of injections administered with a reused syringe or needle, the distribution of injections with respect to prescribers and providers and determinants of injection use. RESULTS: Although information is very limited for certain countries (i.e., Bhutan, Maldives and Sri Lanka), healthcare injection use is very common across South Asia, with cross-country rates ranging from 2.4 to 13.6 injections/person/year. Furthermore, recent studies show that 5% to 50% of these injections are provided with reused syringes, thus creating potential to transmission of blood-borne pathogens. Qualified and unqualified practitioners, especially in the private sector, are the major drivers behind injection use, but patients also prefer injections, especially among the rural, poor or uneducated in certain countries. According to available data, Pakistan and India have recently taken steps towards achieving safe injection. Potential interventions include the introduction of reuse prevention devices, and patient-, community- and patient/community and provider-centered interventions to change population and practitioner behavior. CONCLUSION: Injection use is common in South Asian countries. Multilevel interventions aiming at patients, providers and the healthcare system are needed to reduce injection use and reuse. PMID:27433097

Prevalence and Correlates of Heroin–Methamphetamine Co-Injection Among Persons Who Inject Drugs in San Diego, California, and Tijuana, Baja California, Mexico

PubMed Central

Meacham, Meredith C.; Strathdee, Steffanie A.; Rangel, Gudelia; Armenta, Richard F.; Gaines, Tommi L.; Garfein, Richard S.

2016-01-01

Objective: Although persons who inject drugs (PWID) in the western United States–Mexico border region are known to inject both heroin and methamphetamine, little is known about the prevalence and risks associated with co-injection of this depressant–stimulant combination (also known as “goofball” and “Mexican speedball”). Method: Baseline data from parallel cohort studies of PWID conducted concurrently in San Diego, CA, and Tijuana, Mexico, were used to estimate the prevalence and identify correlates of heroin–methamphetamine co-injection. PWID older than 18 years of age who reported injecting illicit drugs in the past month (N = 1,311; 32.7% female) were recruited in San Diego (n = 576) and Tijuana (n = 735) and completed interviewer-administered questionnaires. Bivariate and multivariable logistic regression analyses were used to identify correlates of heroin–methamphetamine co-injection. Results: The prevalence of co-injection in the past 6 months was 39.9% overall and was higher in Tijuana (55.8%) than in San Diego (19.8%). In multivariable analyses adjusting for study cohort, distributive syringe sharing, purchasing syringes prefilled with drugs, finding it hard to get new syringes, reporting great or urgent need for treatment, and younger age were independently associated with co-injection. Past-6-month overdose was significantly associated with higher odds of co-injection in San Diego than in Tijuana. Conclusions: These findings indicate that heroin–methamphetamine co-injection is more common in Tijuana than in San Diego, yet this practice was only associated with overdose in San Diego. Heroin–methamphetamine co-injection was also independently associated with HIV-associated injection risk behaviors. Overdose-prevention interventions should address co-injection of depressants and stimulants. PMID:27588536

Technologist radiation exposure in routine clinical practice with 18F-FDG PET.

PubMed

Guillet, Benjamin; Quentin, Pierre; Waultier, Serge; Bourrelly, Marc; Pisano, Pascale; Mundler, Olivier

2005-09-01

The use of 18F-FDG for clinical PET studies increases technologist radiation dose exposure because of the higher gamma-radiation energy of this isotope than of other conventional medical gamma-radiation-emitting isotopes. Therefore, 18F-FDG imaging necessitates stronger radiation protection requirements. The aims of this study were to assess technologist whole-body and extremity exposure in our PET department and to evaluate the efficiency of our radiation protection devices (homemade syringe drawing device, semiautomated injector, and video tracking of patients). Radiation dose assessment was performed for monodose as well as for multidose 18F-FDG packaging with both LiF thermoluminescence dosimeters (TLD) and electronic personal dosimeters (ED) during 5 successive 18F-FDG PET steps (from syringe filling to patient departure). The mean +/- SD total effective doses received by technologists (n = 50) during all of the working steps were 3.24 +/- 2.1 and 3.01 +/- 1.4 microSv, respectively, as measured with ED and TLD (345 +/- 84 MBq injected). These values were confirmed by daily TLD technologist whole-body dose measurements (2.98 +/- 1.8 microSv; 294 +/- 78 MBq injected; n = 48). Finger irradiation doses during preparation of single 18F-FDG syringes were 204.9 +/- 24 and 198.4 +/- 23 microSv with multidose vials (345 +/- 93 MBq injected) and 127.3 +/- 76 and 55.9 +/- 47 microSv with monodose vials (302 +/- 43 MBq injected) for the right hand and the left hand, respectively. The protection afforded by the semiautomated injector, estimated as the ratio of the doses received by TLD placed on the syringe shield and on the external face of the injector, was near 2,000. These results showed that technologist radiation doses in our PET department were lower than those reported in the literature. This finding may be explained by the use of a homemade syringe drawing device, a semiautomated injector, and patient video tracking, allowing a shorter duration of contact between the technologist and the patient. Extrapolation of these results to an annual dose (4 patients per day per technologist) revealed that the annual extrapolated exposure values remained under the authorized limits for workers classified to work in a radioactivity-controlled area.

Field reversed configuration confinement enhancement through edge biasing and neutral beam injection.

PubMed

Tuszewski, M; Smirnov, A; Thompson, M C; Korepanov, S; Akhmetov, T; Ivanov, A; Voskoboynikov, R; Schmitz, L; Barnes, D; Binderbauer, M W; Brown, R; Bui, D Q; Clary, R; Conroy, K D; Deng, B H; Dettrick, S A; Douglass, J D; Garate, E; Glass, F J; Gota, H; Guo, H Y; Gupta, D; Gupta, S; Kinley, J S; Knapp, K; Longman, A; Hollins, M; Li, X L; Luo, Y; Mendoza, R; Mok, Y; Necas, A; Primavera, S; Ruskov, E; Schroeder, J H; Sevier, L; Sibley, A; Song, Y; Sun, X; Trask, E; Van Drie, A D; Walters, J K; Wyman, M D

2012-06-22

Field reversed configurations (FRCs) with high confinement are obtained in the C-2 device by combining plasma gun edge biasing and neutral beam injection. The plasma gun creates an inward radial electric field that counters the usual FRC spin-up. The n = 2 rotational instability is stabilized without applying quadrupole magnetic fields. The FRCs are nearly axisymmetric, which enables fast ion confinement. The plasma gun also produces E × B shear in the FRC edge layer, which may explain the observed improved particle transport. The FRC confinement times are improved by factors 2 to 4, and the plasma lifetimes are extended from 1 to up to 4 ms.

Transport limited interfacial carrier relaxation in a double-layer device investigated by time-resolved second harmonic generation and impedance spectroscopy

NASA Astrophysics Data System (ADS)

Zhang, Le; Taguchi, Dai; Li, Jun; Manaka, Takaaki; Iwamoto, Mitsumasa

2011-02-01

The interfacial carrier relaxation in an indium tin oxide/polyimide/pentacene/Au double-layer device was studied in both time and frequency domains by using time-resolved second harmonic generation (TR-SHG) and impedance spectroscopy (IS), respectively. Although both hole and electron injection into the pentacene layer and their accumulation at the pentacene/polyimide interface were revealed in TR-SHG, it was only observed in IS under the hole injection condition. The "contradiction" between the two methods for the same carrier relaxation process was explained on the basis of a model, transport limited interfacial carrier relaxation, in which the quasistatic state governs the one-directional carrier transport.

Health-damaging policing practices among persons who inject drugs in Mexico: Are deported migrants at greater risk?

PubMed

Pinedo, Miguel; Beletsky, Leo; Alamillo, Nathan; Ojeda, Victoria D

2017-08-01

Evidence-based public health and criminal justice policies aimed at addressing the structurally vulnerable population of persons who inject drugs (PWID) and who are involved in the immigrant enforcement and deportation system are lacking. Policing practices are critical structural determinants of HIV among PWID. PWID in Mexico who have been deported from the US are at elevated risk of HIV. From 2011 to 2013, 733 PWID were recruited to complete structured questionnaires, including past 6-month experiences with police. Eligible PWID were 18 years or older, had injected in the past month, and resided in Tijuana, Mexico with no intentions of moving. To determine if deportation status was associated with experiences of arrests and problematic policing practices, we conducted separate multivariate logistic regression models for independent policing variables. In multivariate analyses, deportation status was independently associated with higher odds of being arrested (Adjusted Odds Ratio (AOR): 1.45; 95% Confidence Interval (CI): 1.02-2.05), being asked for a bribe (AOR: 1.39; 95% CI: 1.05-2.04), and being forced to leave a place of residence (AOR: 2.00; 95% CI: 1.08-3.70) in the past 6 months. Results highlight a previously poorly understood elements of the US-deportation experience: migrants' experiences with law enforcement post-deportation and the role of deportation policies and practices as structural drivers of public health risk in destination countries. We provide policy recommendations for Mexico and the US based on our findings, which have potential application in other countries seeking to improve enforcement and related policing practices from a public health perspective. Copyright © 2017. Published by Elsevier B.V.

Do flexible inter-injection intervals improve the effects of botulinum toxin A treatment in reducing impairment and disability in patients with spasticity?

PubMed

Trompetto, Carlo; Marinelli, Lucio; Mori, Laura; Puce, Luca; Pelosin, Elisa; Serrati, Carlo; Fattapposta, Francesco; Rinalduzzi, Steno; Abbruzzese, Giovanni; Currà, Antonio

2017-05-01

In patients treated with botulinum toxin-A (BoNT-A), toxin-directed antibody formation was related to the dosage and frequency of injections, leading to the empirical adoption of minimum time intervals between injections of 3months or longer. However, recent data suggest that low immunogenicity of current BoNT-A preparations could allow more frequent injections. Our hypothesis is that a short time interval between injections may be safe and effective in reducing upper limb spasticity and related disability. IncobotulinumtoxinA was injected under ultrasound guidance in spastic muscles of 11 subjects, who were evaluated just before BoNT-A injection (T0), and 1month (T1), 2months (T2) and 4months (T3) after injecting. At T1, in the case of persistent disability related to spasticity interfering with normal activities, patients received an additional toxin dose. Seven subjects received the additional dose at T1 because of persistent disability; 4 of them had a decrease of disability 1month later (T2). Rethinking the injection scheme for BoNT-A treatment may have a major impact in the management of spasticity and related disability. Future studies with larger sample sizes are warranted to confirm that injection schedules with short time intervals should no longer be discouraged in clinical practice. Copyright © 2017 Elsevier Ltd. All rights reserved.

Associations between injection risk and community disadvantage among suburban injection drug users in southwestern Connecticut, USA.

PubMed

Heimer, Robert; Barbour, Russell; Palacios, Wilson R; Nichols, Lisa G; Grau, Lauretta E

2014-03-01

Increases in drug abuse, injection, and opioid overdoses in suburban communities led us to study injectors residing in suburban communities in southwestern Connecticut, US. We sought to understand the influence of residence on risk and injection-associated diseases. Injectors were recruited by respondent-driven sampling and interviewed about sociodemographics, somatic and mental health, injection risk, and interactions with healthcare, harm reduction, substance abuse treatment, and criminal justice systems. HIV, hepatitis B and C (HBV and HCV) serological testing was also conducted. Our sample was consistent in geographic distribution and age to the general population and to the patterns of heroin-associated overdose deaths in the suburban towns. High rates of interaction with drug abuse treatment and criminal justice systems contrasted with scant use of harm reduction services. The only factors associated with both dependent variables-residence in less disadvantaged census tracts and more injection risk-were younger age and injecting in one's own residence. This contrasts with the common association among urban injectors of injection-associated risk behaviors and residence in disadvantaged communities. Poor social support and moderate/severe depression were associated with risky injection practices (but not residence in specific classes of census tracts), suggesting that a region-wide dual diagnosis approach to the expansion of harm reduction services could be effective at reducing the negative consequences of injection drug use.

Overcoming the Practical Barriers to Spinal Cord Cell Transplantation for ALS

DTIC Science & Technology

2013-10-01

not be neglected. Moreover, escalating numbers and volumes of injections seem to be associated with lack of accuracy and reflux . Histological...with intact segments. Histological analysis will also determine whether reflux occurs with volume escalation as well as with fast (hand-held...analysis of reflux and transient morbidity with number and volume of injection of hNPCs (Boulis). Create a cell bank of astrocyte restricted

Multicenter case-control study of risk factors associated with development of vaccine-associated sarcomas in cats.

PubMed

Kass, Philip H; Spangler, William L; Hendrick, Mattie J; McGill, Lawrence D; Esplin, D Glen; Lester, Sally; Slater, Margaret; Meyer, E Kathryn; Boucher, Faith; Peters, Erika M; Gobar, Glenna G; Htoo, Thurein; Decile, Kendra

2003-11-01

To determine whether particular vaccine brands, other injectable medications, customary vaccination practices, or various host factors were associated with the formation of vaccine-associated sarcomas in cats. Prospective multicenter case-control study. Cats in the United States and Canada with soft tissue sarcomas or basal cell tumors. Veterinarians submitting biopsy specimens from cats with a confirmed diagnosis of soft tissue sarcoma or basal cell tumor were contacted for patient medical history. Time window statistical analyses were used in conjunction with various assumptions about case definitions. No single vaccine brand or manufacturer within antigen class was found to be associated with sarcoma formation. Factors related to vaccine administration were also not associated with sarcoma development, with the possible exception of vaccine temperature prior to injection. Two injectable medications (long-acting penicillin and methyl prednisolone acetate) were administered to case cats more frequently than to control cats. Findings do not support the hypotheses that specific brands or types of vaccine within antigen class, vaccine practices such as reuse of syringes, concomitant viral infection, history of trauma, or residence either increase or decrease the risk of vaccine-associated sarcoma formation in cats. There was evidence to suggest that certain long-acting injectable medications may also be associated with sarcoma formation.

Errors in preparation and administration of parenteral drugs in neonatology: evaluation and corrective actions.

PubMed

Hasni, Nesrine; Ben Hamida, Emira; Ben Jeddou, Khouloud; Ben Hamida, Sarra; Ayadi, Imene; Ouahchi, Zeineb; Marrakchi, Zahra

2016-12-01

The medication iatrogenic risk is quite unevaluated in neonatology Objective: Assessment of errors that occurred during the preparation and administration of injectable medicines in a neonatal unit in order to implement corrective actions to reduce the occurrence of these errors. A prospective, observational study was performed in a neonatal unit over a period of one month. The practice of preparing and administering injectable medications were identified through a standardized data collection form. These practices were compared with summaries of the characteristics of each product (RCP) and the bibliography. One hundred preparations were observed of 13 different drugs. 85 errors during preparations and administration steps were detected. These errors were divided into preparation errors in 59% of cases such as changing the dilution protocol (32%), the use of bad solvent (11%) and administration errors in 41% of cases as errors timing of administration (18%) or omission of administration (9%). This study showed a high rate of errors during stages of preparation and administration of injectable drugs. In order to optimize the care of newborns and reduce the risk of medication errors, corrective actions have been implemented through the establishment of a quality assurance system which consisted of the development of injectable drugs preparation procedures, the introduction of a labeling system and staff training.

Current UK practices in the management of subacromial impingement.

PubMed

Bryceland, James K; Drury, Colin; Tait, Gavin R

2015-07-01

Controversy presently exists surrounding the management of patients with subacromial impingement. This study aims to highlight current UK practices in the management of these patients. BESS members were invited to complete a questionnaire and responses were received from 157 consultant shoulder surgeons. Physiotherapy is an integral part of management for 93% of surgeons with a minimum period of 12 weeks being most popular prior to consideration of arthroscopic subacromial decompression. Subacromial steroid injection is used by 95% and 86% repeat this if the patient has failed to respond to a previous injection by the general practioner. From initial presentation, 77% felt there should be at least 3 months of conservative management before proceeding to surgery. Good but transient response to subacromial injection was considered the best predictor of good surgical outcome by 77%. The coracoacromial ligament is fully released by 78%, although there was greater variation in how aggressive surgeons were with acromioplasty. Most (59%) do not include the nontender acromioclavicular joint to any extent in routine acromioplasty. Hospital physiotherapy protocols are used by 63% for postoperative rehabilitation. Variation exists in the management regimes offered to patients with subacromial impingement, but most employ a minimum period of 12 weeks of conservative management incorporating physiotherapy and at least 2 subacromial steriod injections.

Current UK practices in the management of subacromial impingement

PubMed Central

Drury, Colin; Tait, Gavin R

2015-01-01

Background Controversy presently exists surrounding the management of patients with subacromial impingement. This study aims to highlight current UK practices in the management of these patients. Methods BESS members were invited to complete a questionnaire and responses were received from 157 consultant shoulder surgeons. Results Physiotherapy is an integral part of management for 93% of surgeons with a minimum period of 12 weeks being most popular prior to consideration of arthroscopic subacromial decompression. Subacromial steroid injection is used by 95% and 86% repeat this if the patient has failed to respond to a previous injection by the general practioner. From initial presentation, 77% felt there should be at least 3 months of conservative management before proceeding to surgery. Good but transient response to subacromial injection was considered the best predictor of good surgical outcome by 77%. The coracoacromial ligament is fully released by 78%, although there was greater variation in how aggressive surgeons were with acromioplasty. Most (59%) do not include the nontender acromioclavicular joint to any extent in routine acromioplasty. Hospital physiotherapy protocols are used by 63% for postoperative rehabilitation. Conclusions Variation exists in the management regimes offered to patients with subacromial impingement, but most employ a minimum period of 12 weeks of conservative management incorporating physiotherapy and at least 2 subacromial steriod injections. PMID:27582972

One-year results from clinical practice of epimacular strontium-90 brachytherapy for the treatment of subfoveal choroidal neovascularization secondary to AMD.

PubMed

Zur, Dinah; Loewenstein, Anat; Barak, Adiel

2015-03-01

To evaluate clinical feasibility, safety, and efficacy of epiretinal strontium-90 brachytherapy in subfoveal choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) in eyes unresponsive to repeated anti-VEGF injections. A retrospective, single-center study on patients treated with strontium-90 brachytherapy for CNV secondary to neovascular AMD. Patients underwent pars plana vitrectomy with a single 24 Gy dose brachytherapy. They were re-treated with anti-VEGF injections on an as-needed basis if subretinal or intraretinal fluid was detected on optical coherence tomography imaging. Twenty-two patients were treated, and 20 completed 12 months of follow-up. Ten patients maintained stable vision, eight gained vision, and two lost more than three Snellen lines. The mean best corrected visual acuity change from baseline was -8 ± 5.7 letters. A mean of 5.5 ± 4.4 anti-VEGF injections were administered throughout 12 months. Epimacular brachytherapy is feasible in clinical practice. While some patients benefit from the treatment and need significantly fewer as-needed injections, others appear not to react to irradiation treatment after 1 year of follow-up. Larger numbers of patients are needed to evaluate therapeutic efficacy and to determine which patients can benefit from combined radiation and anti-VEGF therapy. Copyright 2015, SLACK Incorporated.

Methods and Variables Associated with the Risk of Septic Arthritis Following Intra-Articular Injections in Horses: A Survey of Veterinarians.

PubMed

Gillespie, Caroline C; Adams, Stephen B; Moore, George E

2016-11-01

To determine common methods for intra-articular injections and variables associated with the risk of septic arthritis following intra-articular injection in the horse. Cross-sectional survey. Equine veterinarians. A link to an online survey was distributed to equine practitioners in 2014. Responses for descriptive data were tabulated. Data on infection rates obtained from medical records were analyzed. Variables associated with the risk of septic arthritis were determined using χ 2 or Fisher's exact tests and logistic regression. Common current methods for intra-articular injections were determined from 241 surveys. Sixty-four of 241 surveys (26.6%) contained data with numbers of joints injected and number of infections obtained from review of medical records. Eight different injection methods were used by more than 2/3 of responding veterinarians. A total of 67 out of 319,760 injected joints reported became septic following injection, giving an incidence of 2.10 septic joints per 10,000 intra-articular injections. Based on multivariate analysis, infection rates were significantly lower when veterinarians prepared their own injection sites (OR=0.10) and had <20 years of practice experience (OR=0.025), whereas infection rates were significantly higher when hair was removed at the injection site (OR=19.70). There is a low incidence of septic arthritis following intra-articular injection and a large number of injection methods reported by responding veterinarians. The low reported incidence of infection may be related to the large number of practitioners frequently using common methods. © Copyright 2016 by The American College of Veterinary Surgeons.

Prevalence and characteristics of femoral injection among Seattle-area injection drug users.

PubMed

Coffin, Phillip O; Coffin, Lara S; Murphy, Shilo; Jenkins, Lindsay M; Golden, Matthew R

2012-04-01

Injection drug use (IDU) into central veins, most common among long-term IDUs with no other options, can lead to severe infectious, vascular, and traumatic medical consequences. To follow-up on anecdotal reports of femoral vein injection and related medical problems in Seattle, we analyzed data from the annual survey of a community-based syringe exchange program. A total of 276 (81%) of 343 program attendees completed the survey in August 2010. Among 248 IDUs, 66% were male, 78% white, and 86% primarily injected opiates. One hundred respondents (40%) had injected into the femoral vein, 55% of whom were actively doing so, and 58% of whom reported medical complications that they attributed to the practice. Most (66%) used the femoral vein due to difficulty accessing other veins, although 61% reported other veins they could access and 67% reporting using other sites since initiating femoral injection. While injecting into muscle was more frequent among older IDUs with longer injection careers, the prevalence of femoral injection was highest among respondents in their late twenties with 2.5-6 years of injecting drugs. Multivariate analysis demonstrated an increased risk of initiating femoral injection each calendar year after 2007. Injecting into the femoral vein was also associated with white versus other race (odds ratio [OR] 2.7, 95% CI 1.3-5.4) and injection of primarily opiates versus other drugs (OR 6.3, 95% CI 1.2-32.9) and not associated with age, length of IDU career, or a history of injecting into muscle. These findings suggest a secular trend of increasing femoral injection among Seattle-area IDUs with a high rate of related medical problems. Interventions, such as education regarding the hazards of central venous injection and guidance on safe injection into peripheral veins, are needed to minimize the health consequences of femoral injection.

Ultrasound Guidance for Botulinum Neurotoxin Chemodenervation Procedures.

PubMed

Alter, Katharine E; Karp, Barbara I

2017-12-28

Injections of botulinum neurotoxins (BoNTs) are prescribed by clinicians for a variety of disorders that cause over-activity of muscles; glands; pain and other structures. Accurately targeting the structure for injection is one of the principle goals when performing BoNTs procedures. Traditionally; injections have been guided by anatomic landmarks; palpation; range of motion; electromyography or electrical stimulation. Ultrasound (US) based imaging based guidance overcomes some of the limitations of traditional techniques. US and/or US combined with traditional guidance techniques is utilized and or recommended by many expert clinicians; authors and in practice guidelines by professional academies. This article reviews the advantages and disadvantages of available guidance techniques including US as well as technical aspects of US guidance and a focused literature review related to US guidance for chemodenervation procedures including BoNTs injection.

The discipline of hospital development: a conceptual framework incorporating marketing, managerial, consumer behavior, and adult learning theories.

PubMed

Shirley, S; Stampfl, R

1997-12-01

The purpose of this explanatory and prescriptive article is to identify interdisciplinary theories used by hospital development to direct its practice. The article explores, explains, and applies theories and principles from behavioral, social, and managerial disciplines. Learning, motivational, organizational, marketing, and attitudinal theories are incorporated and transformed into the fundamental components of a conceptual framework that provides an overview of the practice of hospital development. How this discipline incorporates these theories to design, explain, and prescribe the focus of its own practice is demonstrated. This interdisciplinary approach results in a framework for practice that is adaptable to changing social, cultural, economic, political, and technological environments.

Instructional Design: Case Studies in Communities of Practice

ERIC Educational Resources Information Center

Keppell, Michael, Ed.

2007-01-01

"Instructional Design: Case Studies in Communities of Practice" documents real-world experiences of instructional designers and staff developers who work in communities of practice. "Instructional Design: Case Studies in Communities of Practice" explains the strategies and heuristics used by instructional designers when working…

The Pawnee Sequence: Poroelastic Effects from Injection in Osage County, Oklahoma

NASA Astrophysics Data System (ADS)

Barbour, A. J.; Rubinstein, J. L.

2016-12-01

Aggregate multi-year records of wastewater injection in Oklahoma show that the strongest change in injection within 20 km of the 2016 M5.8 Pawnee strike-slip earthquake was in Osage County, where injection rates increased rapidly in late-2012 by nearly a factor of three above previous levels. After this increase, rates there declined steadily over two years to an average rate characteristic of all other injection wells in Pawnee and Noble Counties, remaining relatively constant until the beginning of the earthquake sequence. Here we test if poroelastic effects associated with this injection-rate transient can help explain the relative timing between peak injection rates and the beginning of the Pawnee sequence. Although the alternative hypothesis that regional-scale faults and fractures in critically stressed rock serve as fast-pathways for fluid diffusion cannot be ruled out, it appears to be difficult to reconcile based solely on injection data and space-time patterns for this seismic sequence. We simulate the cylindrically symmetric, transient strain and pore pressure fields for an injection-source time function emulating the injection history in a layered half-space in accordance with linear poroelasticity. In the simulation domain, injection occurs at depths of 1300 - 1900 m, into a homogeneous basal sedimentary reservoir representing the Arbuckle Group, overlying a semi-infinite layer representing granitic basement; we determined the hydraulic, elastic, and poroelastic properties of these layers from published literature. At the mainshock hypocenter, this numerical model predicts a delay between peak injection rates and pore pressure increase that is strongly dependent on hydraulic diffusivity; however, the duration is also controlled by the bulk elastic properties and the undrained Skempton's coefficient of the rock. Furthermore, because of fluid-strain coupling, pore pressures in the basement rock decrease during this delay period, which would tend to stabilize temporarily a critically stressed fault. Even though pore pressure diffusion is the dominant mechanism at play, poroelastic effects do affect the relative timing assuming a reasonable set of material parameters, even though strain rates in the basement are relatively low compared to rates in the Arbuckle layer (and above).

Syringe possession arrests are associated with receptive syringe sharing in two Mexico-US border cities

PubMed Central

Pollini, Robin A.; Brouwer, Kimberly C.; Lozada, Remedios M.; Ramos, Rebeca; Cruz, Michelle F.; Magis-Rodriguez, Carlos; Case, Patricia; Burris, Scott; Pu, Minya; Frost, Simon D. W.; Palinkas, Lawrence A.; Miller, Cari; Strathdee, Steffanie A.

2008-01-01

Aims To identify factors associated with receptive syringe sharing among injection drug users (IDUs) and elucidate the association between syringe possession arrests and syringe sharing. Design Cross-sectional study. Setting Mexican border cities of Tijuana, Baja California and Ciudad Juarez, Chihuahua. Participants IDUs in Tijuana (n = 222) and Ciudad Juarez (n = 206) were recruited using respondent-driven sampling (RDS). IDUs were ≥18 years and had injected illicit drugs in the past month. Measurements An interviewer-administered survey was used to collect quantitative data on socio-demographic, behavioral and contextual characteristics, including self-reported syringe sharing and arrests for syringe possession. Associations with receptive syringe sharing were investigated using logistic regression with RDS adjustment. Findings Overall, 48% of participants reported ever being arrested for carrying an unused/sterile syringe, even though syringe purchase and possession is legal in Mexico. Arrest for possessing unused/sterile syringes was associated independently with receptive syringe sharing [adjusted odds ratio (AOR) = 2.05; 95% confidence interval (CI): 1.26, 3.35], as was injecting in a shooting gallery (AOR = 3.60; 95% CI: 2.21, 5.87), injecting in the street (AOR = 2.05; 95% CI: 1.18, 3.54) and injecting methamphetamine (AOR = 2.77; 95% CI: 1.41, 5.47) or cocaine (AOR = 1.96; 95% CI: 1.15, 3.36). More than half of participants (57%) had been arrested for possessing a used syringe; in a second model, arrest for used syringe possession was also associated independently with receptive sharing (AOR = 2.87; 95% CI: 1.76, 4.69). Conclusions We documented high levels of syringe-related arrests in two Mexican–US border cities and an independent association between these arrests and risky injection practices. Public health collaborations with law enforcement to modify the risk environment in which drug use occurs are essential to facilitate safer injection practices. PMID:18028520

An in-depth case examination of an exotic dancer's experience of melanotan.

PubMed

Van Hout, Marie Claire; Brennan, Rebekah

2014-05-01

Cultural values placed on tanned skin equating with perceived health and attractiveness in the Western world have stimulated the development, sale and use of synthetic tanning agents. These agents are synthetic analogues of the naturally occurring melanocyte-stimulating hormones (α-MSHs) which stimulate melanogenesis or pigmentation of the skin. There is a lack of research on prevalence of use, user experiences and outcomes, despite evident 'health marketability' and diffusion of use via the Internet. We present a unique, intensive, holistic and exploratory single case study analysis of an active user's experiences of synthetic tanning product's labelled as melanotan, with rich description of the case's meanings and identities attached to being tanned, motives for use, injecting experiences and practices, sourcing routes, outcomes and future intentions to use. The case, an exotic dancer, had no prior drug injecting experience and did not identify as 'injecting drug user'. Introduction to injecting of synthetic tanning products occurred with peer assistance. She was conscious of safe injecting practices, which were described as not using needles twice, keeping the product refrigerated, disinfecting and rotating injecting sites, and using sterilised water to dissolve the product. She was aware of synthetic tanning products being unlicensed, unregulated and possibly contaminated. She appeared assured in the self-administration of double dosage and self-management of nausea with benzodiazepines and by injecting before sleep. Experiences of synthetic tanning were positive, with reported feelings of enhanced self-confidence and perceived attractiveness grounded in her confidence in the product's effectiveness to achieve a desired darkened skin tone. No long term or chronic negative outcomes were reported. Development of tolerance and awareness of dependence on synthetic tanning agents was described. We discuss her expert account as it relates to the synthetic tanning product outcomes, risk heuristics, sourcing routes and make recommendations for policy. Copyright © 2013 Elsevier B.V. All rights reserved.

Collagenase clostridium histolyticum for dupuytren contracture: patterns of use and effectiveness in clinical practice.

PubMed

Peimer, Clayton A; Skodny, Paul; Mackowiak, John I

2013-12-01

To collect data on the real-world effectiveness of collagenase clostridium histolyticum (CCH) during its first year of use following U.S. Food and Drug Administration approval and compare those results with clinical trial efficacy data. This retrospective chart review was conducted at 10 U.S. community and academic practice sites with major experience using CCH. Charts of patients treated with CCH between February and December 2010 were abstracted, and anonymized data were analyzed. Clinical use, including number of injections per cord and effectiveness outcomes (joint contracture and range of motion) were compared with results from 2 registration trials. Data were collected from 501 patients (74% male; 48% employed; mean [SD] age, 65 [10] y); 463 patients had sufficient data for analysis. We found that 1.08 CCH injections were used per treated joint, compared with a mean of 1.7 injections in registration trials. Ninety-three percent of joints received only 1 injection. The mean (SD) number of visits per injection was 2.92 (1.0). Mean (SD) contracture was reduced by 75% from 49° (21) at baseline to 12° (17), similar to the 71% to 79% reduction in clinical trials. Mean (SD) range of motion was improved by 37° from 44° (20) at baseline to 81° (14), similar to the increase of 35° and 37° in the 2 clinical trials; and 67% of first injections resulted in full correction to 0° to 5°, compared with the clinical trial rate of 39%. Despite a lower injection rate, correction of joint contracture and range of motion was similar to findings from clinical trials. Effectiveness reports using this kind of surveillance design could provide patients, physicians, and payers with the information needed to make better treatment and reimbursement decisions. Therapeutic III. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Using drugs in un/safe spaces: Impact of perceived illegality on an underground supervised injecting facility in the United States.

PubMed

Davidson, Peter J; Lopez, Andrea M; Kral, Alex H

2018-03-01

Supervised injection facilities (SIFs) are spaces where people can consume pre-obtained drugs in hygienic circumstances with trained staff in attendance to provide emergency response in the event of an overdose or other medical emergency, and to provide counselling and referral to other social and health services. Over 100 facilities with formal legal sanction exist in ten countries, and extensive research has shown they reduce overdose deaths, increase drug treatment uptake, and reduce social nuisance. No facility with formal legal sanction currently exists in the United States, however one community-based organization has successfully operated an 'underground' facility since September 2014. Twenty three qualitative interviews were conducted with people who used the underground facility, staff, and volunteers to examine the impact of the facility on peoples' lives, including the impact of lack of formal legal sanction on service provision. Participants reported that having a safe space to inject drugs had led to less injections in public spaces, greater ability to practice hygienic injecting practices, and greater protection from fatal overdose. Constructive aspects of being 'underground' included the ability to shape rules and procedures around user need rather than to meet political concerns, and the rapid deployment of the project, based on immediate need. Limitations associated with being underground included restrictions in the size and diversity of the population served by the site, and reduced ability to closely link the service to drug treatment and other health and social services. Unsanctioned supervised injection facilities can provide a rapid and user-driven response to urgent public health needs. This work draws attention to the need to ensure such services remain focused on user-defined need rather than external political concerns in jurisdictions where supervised injection facilities acquire local legal sanction. Copyright © 2017 Elsevier B.V. All rights reserved.

Epidural injections for back pain

MedlinePlus

... Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. ...

Sciatic nerve injury from intramuscular injection: a persistent and global problem.

PubMed

Mishra, P; Stringer, M D

2010-10-01

An intramuscular (i.m.) injection into the buttock risks damaging the sciatic nerve. Safe injection practices need to be understood by doctors and nurses alike. The aims of this study were to determine if sciatic nerve injury because of i.m. injection is a continuing problem and to establish the availability of published guidelines on i.m. injection techniques. Intramuscular injection related sciatic nerve injury claims to the New Zealand Accident Compensation Corporation between July 2005 and September 2008 were reviewed. Nursing organisations were surveyed to enquire about guidelines on i.m. injection. I.m. injection related sciatic nerve injuries in the medical and medicolegal literature (1989-2009) were systematically reviewed. There were eight claims for sciatic nerve injection injury made to the ACC during the 3-year study period; all were in young adults. Only one of the nursing organisations contacted had published guidelines on i.m. injection technique, and these related specifically to immunisation. Seventeen reports of patients with sciatic nerve injury from i.m. injection were identified comprising a total of 1506 patients, at least 80% of which were children. Nine court decisions finding in favour of the plaintiff were identified, all from the North American legal system. A broad range of drugs were implicated in the offending i.m. injections. Sciatic nerve injury from an i.m. injection in the upper outer quadrant of the buttock is an avoidable but persistent global problem, affecting patients in both wealthy and poorer healthcare systems. The consequences of this injury are potentially devastating. Safer alternative sites for i.m. injection exist. These should be promoted more widely by medical and nursing organisations. © 2010 Blackwell Publishing Ltd.

The Efficacy of Cyclic Injection of Bone Morphogenetic Protein-2 in Large-Scale Calvarial Bone Defects.

PubMed

Choi, Jin Mi; Jeong, Woo Shik; Park, Eun Jung; Choi, Jong Woo

2017-03-01

Bone morphogenetic protein-2 (BMP-2) appears to be one of the most potent growth factors thus far studied. However, recent publications on the clinical application of BMP-2 revealed that its correct control is the paramount issue in clinical practice. For improving BMP-2 delivery, the cyclic administration might be an alternative. Accordingly, the authors cyclically injected BMP-2 in a cyclic injection model of large cranial defects to maintain the proper dosage during the bone healing process. A 10-mm diameter calvarial bone defect was produced using a round drill in 8-week-old Sprague-Dawley rats. Silk-hydroxyapatite scaffolds soaked in the appropriate concentration of BMP-2 were implanted into the defect. The animals were split into 4 single-injection groups and 3 multiple-injection groups; the latter groups received weekly subcutaneous injections of BMP-2 solution (1, 5, and 10 μg/mL) for 4 weeks, whereas the former groups received a single injection of BMP-2 at these concentrations. Each rat underwent computed tomography at 8 weeks. In terms of total volumes of the new bone, the 5 μg/mL multiple-injection BMP-2 group had significantly greater increases in bone volume than the single-injection groups. In terms of bone thickness, the multiple-injection groups had better outcomes than the single-injection groups. Thus, the cyclic injection protocol restored the original thickness without overgrowth. Cyclic injection of BMP-2 permits more accurate dosage control than single injection and improves thickness and dense bone regeneration. Therefore, it may represent a promising approach for future clinical trials. Further investigation using a greater number of animals is required.

Prevalence and Correlates of Heroin-Methamphetamine Co-Injection Among Persons Who Inject Drugs in San Diego, California, and Tijuana, Baja California, Mexico.

PubMed

Meacham, Meredith C; Strathdee, Steffanie A; Rangel, Gudelia; Armenta, Richard F; Gaines, Tommi L; Garfein, Richard S

2016-09-01

Although persons who inject drugs (PWID) in the western United States-Mexico border region are known to inject both heroin and methamphetamine, little is known about the prevalence and risks associated with co-injection of this depressant-stimulant combination (also known as "goofball" and "Mexican speedball"). Baseline data from parallel cohort studies of PWID conducted concurrently in San Diego, CA, and Tijuana, Mexico, were used to estimate the prevalence and identify correlates of heroin-methamphetamine co-injection. PWID older than 18 years of age who reported injecting illicit drugs in the past month (N = 1,311; 32.7% female) were recruited in San Diego (n = 576) and Tijuana (n = 735) and completed interviewer-administered questionnaires. Bivariate and multivariable logistic regression analyses were used to identify correlates of heroin-meth-amphetamine co-injection. The prevalence of co-injection in the past 6 months was 39.9% overall and was higher in Tijuana (55.8%) than in San Diego (19.8%). In multivariable analyses adjusting for study cohort, distributive syringe sharing, purchasing syringes prefilled with drugs, finding it hard to get new syringes, reporting great or urgent need for treatment, and younger age were independently associated with co-injection. Past-6-month overdose was significantly associated with higher odds of co-injection in San Diego than in Tijuana. These findings indicate that heroin-methamphetamine co-injection is more common in Tijuana than in San Diego, yet this practice was only associated with overdose in San Diego. Heroin-methamphetamine coinjection was also independently associated with HIV-associated injection risk behaviors. Overdose-prevention interventions should address co-injection of depressants and stimulants.

An automated water iodinating subsystem for manned space flight

NASA Technical Reports Server (NTRS)

Houck, O. K.; Wynveen, R. A.

1974-01-01

Controlling microbial growth by injecting iodine (l2) into water supplies is a widely acceptable technique, but requires a specialized injection method for space flight. An electrochemical l2 injection method and l2 level monitor are discussed in this paper, which also describe iodination practices previously used in the manned space program and major l2 biocidal characteristics. The development and design of the injector and monitor are described, and results of subsequent experiments are presented. Also presented are expected vehicle penalties for utilizing the l2 injector in certain space missions, especially the Space Shuttle, and possible injector failure modes and their criticality.

Determinants of dermal exposure among Nicaraguan subsistence farmers during pesticide applications with backpack sprayers.

PubMed

Blanco, Luis E; Aragón, Aurora; Lundberg, Ingvar; Lidén, Carola; Wesseling, Catharina; Nise, Gun

2005-01-01

Identification of pesticide exposure determinants has become an issue in explaining exposure variability and improving control measures. Most studies have been conducted in industrialized countries. The aim of this study was to identify relevant dermal exposure determinants among Nicaraguan subsistence farmers. Field data on possible determinants were collected during 32 pesticide applications through observation and supplementary videorecording. A multistep reduction strategy brought down the 110 potential exposure determinants to 27 variables, which were grouped as worksite, spray equipment, working practices, clothing or hygiene practices related. Dermal exposure was quantified with a modification of Fenske's visual scoring method. Multivariate linear regression modeling within groups and across groups was performed. In the within-group analyses, work practices, spray equipment and worksite related determinants explained 52, 33 and 25% of the exposure variability, respectively. Clothing and hygiene practices were weaker determinants and did not always reduce the exposure. The final model included determinants from all groups except hygiene practices and explained 69% of the exposure variability. A less restricted model increased the explained variability to 75%. Several novel determinants were identified, including spraying on a muddy terrain, dew on plants, sealing the tank lid with a cloth and wiping sweat from the face. This study showed that a combination of observation and visual scoring techniques can provide valuable information on determinants of pesticide exposure and affected body parts under developing country conditions. The results could be used to develop job-specific questionnaires and to design training and preventive programs.

Assessment: Examining Practice in Entrepreneurship Education

ERIC Educational Resources Information Center

Pittaway, Luke; Edwards, Corina

2012-01-01

Purpose: The purpose of this paper is to develop knowledge about the nature of student assessment practice in entrepreneurship education. Design/methodology/approach: This paper introduces general assessment practice issues and highlights key considerations. It explains prior research on assessment practice in entrepreneurship education and argues…

Clinical and cost-effectiveness of progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of rotator cuff disorders: protocol for a 2x2 factorial randomised controlled trial (the GRASP trial)

PubMed Central

Hopewell, Sally; Keene, David J; Maia Schlüssel, Michael; Dritsaki, Melina; Dutton, Susan; Carr, Andrew; Hamilton, William; Hansen, Zara; Jaggi, Anju; Littlewood, Chris; Soutakbar, Hessam; Heine, Peter; Cureton, Lucy; Barker, Karen; Lamb, Sarah E

2017-01-01

Introduction Shoulder pain is very common, with around 70% of cases due to disorders of the rotator cuff. Despite widespread provision of physiotherapy, there is uncertainty about which type of exercise and delivery mechanisms are associated with best outcomes. There is also uncertainty around the long-term benefits and harms of corticosteroid injection therapy, which is often used in addition to physiotherapy. The Getting it Right: Addressing Shoulder Pain trial will assess the clinical and cost-effectiveness of individually tailored, progressive exercise compared with best practice advice, with or without corticosteroid injection, in adults with a rotator cuff disorder. Methods and analysis We are conducting a large multicentre randomised controlled trial (2×2 factorial design). We will recruit adults ≥18 years with a new episode of shoulder pain attributable to a rotator cuff disorder as per British Elbow and Shoulder Society guidelines, not currently receiving physiotherapy or being considered for surgery, from at least eight UK National Health Service primary care-based musculoskeletal and related physiotherapy services. Participants (n=704) will be randomised (centralised computer-generated 1:1:1:1 allocation ratio) to one of four interventions: (1) progressive exercise (≤6 physiotherapy sessions); (2) best practice advice (one physiotherapy session); (3) corticosteroid injection then progressive exercise (≤6 sessions) or (4) corticosteroid injection then best practice advice (one session). The primary outcome is the mean difference in Shoulder Pain and Disability Index (SPADI) total score at 12 months. Secondary outcomes are: pain and function SPADI subdomains; health-related quality of life (Five-Level version of the EuroQol EQ-5D-5L); sleep disturbance; return to activity; global impression of change; health resource use; out-of-pocket expenses; work disability. A parallel within-trial economic evaluation will be conducted. The primary analysis will be intention to treat. Ethics and dissemination Research Ethics Committee approval (REC: 16/SC/0508) has been obtained. Results of the main trial and secondary outcomes will be submitted for publication in a peer-reviewed journal. Trial registration number ISRCTN16539266; EudraCT number: 2016-002991-28. PMID:28716796

Clinical and cost-effectiveness of progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of rotator cuff disorders: protocol for a 2x2 factorial randomised controlled trial (the GRASP trial).

PubMed

Hopewell, Sally; Keene, David J; Maia Schlüssel, Michael; Dritsaki, Melina; Dutton, Susan; Carr, Andrew; Hamilton, William; Hansen, Zara; Jaggi, Anju; Littlewood, Chris; Soutakbar, Hessam; Heine, Peter; Cureton, Lucy; Barker, Karen; Lamb, Sarah E

2017-07-17

Shoulder pain is very common, with around 70% of cases due to disorders of the rotator cuff. Despite widespread provision of physiotherapy, there is uncertainty about which type of exercise and delivery mechanisms are associated with best outcomes. There is also uncertainty around the long-term benefits and harms of corticosteroid injection therapy, which is often used in addition to physiotherapy. The Getting it Right: Addressing Shoulder Pain trial will assess the clinical and cost-effectiveness of individually tailored, progressive exercise compared with best practice advice, with or without corticosteroid injection, in adults with a rotator cuff disorder. We are conducting a large multicentre randomised controlled trial (2×2 factorial design). We will recruit adults ≥18 years with a new episode of shoulder pain attributable to a rotator cuff disorder as per British Elbow and Shoulder Society guidelines, not currently receiving physiotherapy or being considered for surgery, from at least eight UK National Health Service primary care-based musculoskeletal and related physiotherapy services. Participants (n=704) will be randomised (centralised computer-generated 1:1:1:1 allocation ratio) to one of four interventions: (1) progressive exercise (≤6 physiotherapy sessions); (2) best practice advice (one physiotherapy session); (3) corticosteroid injection then progressive exercise (≤6 sessions) or (4) corticosteroid injection then best practice advice (one session). The primary outcome is the mean difference in Shoulder Pain and Disability Index (SPADI) total score at 12 months. Secondary outcomes are: pain and function SPADI subdomains; health-related quality of life (Five-Level version of the EuroQol EQ-5D-5L); sleep disturbance; return to activity; global impression of change; health resource use; out-of-pocket expenses; work disability. A parallel within-trial economic evaluation will be conducted. The primary analysis will be intention to treat. Research Ethics Committee approval (REC: 16/SC/0508) has been obtained. Results of the main trial and secondary outcomes will be submitted for publication in a peer-reviewed journal. ISRCTN16539266; EudraCT number: 2016-002991-28. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Evolutionary medicine: update on the relevance to family practice.

PubMed

Naugler, Christopher T

2008-09-01

To review the relevance of evolutionary medicine to family practice and family physician training. Articles were located through a MEDLINE search, using the key words evolution, Darwin, and adaptation. Most references presented level III evidence (expert opinion), while a minority provided level II evidence (epidemiologic studies). Evolutionary medicine deals with the interplay of biology and the environment in the understanding of human disease. Yet medical schools have virtually ignored the need for family physicians to have more than a cursory knowledge of this topic. A review of the main trends in this field most relevant to family practice revealed that a basic knowledge of evolutionary medicine might help in explaining the causation of diseases to patients. Evolutionary medicine has also proven key to explaining the reasons for the development of antibiotic resistance and has the potential to explain cancer pathogenesis. As an organizing principle, this field also has potential in the teaching of family medicine. Evolutionary medicine should be studied further and incorporated into medical training and practice. Its practical utility will be proven through the generation of testable hypotheses and their application in relation to disease causation and possible prevention.

Injection safety among primary health care workers in Jazan Region, Saudi Arabia.

PubMed

Ismail, A A; Mahfouz, M S; Makeen, A

2014-07-01

Occupational exposure to percutaneous injuries is a substantial source of infections with blood-borne pathogens among health-care workers. Few studies evaluated injection safety practices in Saudi Arabia. To examine the structure and process of injection safety at primary health care level in Jazan health district, to evaluate knowledge, attitudes, and practices of primary health care physicians and nurses towards injection safety, and to determine the incidence of needle stick injuries among health care workers in Jazan region, Saudi Arabia. A cross-sectional study was conducted in Jazan primary health care centers (PHCCs), Saudi Arabia from September 2011 to March 2012. Data were collected using an observational checklist and data collection sheet. Jazan city health district was chosen at random from the 14 health sectors in Jazan region. All the 33 (10 urban, and 23 rural) PHCCs of Jazan city were included in this study to get the predetermined sample size of health care workers. 200 health care workers (HCWs) were recruited (29% physicians, and 71% nurses). Syringes in the PHCCs were disposable (100%), individually packed (92%), and available at all volumes (98%). Methods of safe disposal of needles and sharps were also operated through contracting with professional companies in 84.8% of instances. Urban PHCCs had more posts for injection safety promotion than rural centers (p=0.02). Continuous Medical Education (CME) programs on infection control were present in only 60% of PHCCs. At least 95% of HCWs in Jazan believed that sharp objects should be kept in a puncture-proof container, kept in a closed container, or disposed by a professional company. More than 80% of HCWs washed their hands by soap and water and cleaned them by alcohol before giving injection, and also got the three doses of hepatitis B vaccine.The rate of needle stick injury in the past year was 14%, without a significant difference between nurses and physicians (p=0.8). Jazan PHCCs have reasonable facilities that prevent needle-stick injuries. We need to design and implement more educational programs on safety injection, and increase promotion of safety injection posters, especially in rural PHCCs.

HIV prevalence and risk among people who inject drugs in five South African cities.

PubMed

Scheibe, Andrew; Makapela, David; Brown, Ben; dos Santos, Monika; Hariga, Fabienne; Virk, Harsheth; Bekker, Linda-Gail; Lyan, Olga; Fee, Nancy; Molnar, Margarete; Bocai, Alina; Eligh, Jason; Lehtovuori, Riku

2016-04-01

Policy and programming for people who inject drugs (PWID) in South Africa is limited by the scarcity of epidemiological data. We conducted a cross-sectional survey among 450 PWID (362 males and 88 females) from five South African cities in 2013, using outreach and peer referral to recruit participants. We carried out rapid HIV tests on participants' saliva and assessed drug-using and sexual practices by means of a questionnaire. We found that 26% of females and 13% of males reported to always share injecting equipment, while 49% of all participants had used contaminated injecting equipment the last time they injected. Only 6% of participants usually used bleach to clean their injecting equipment. We found that half of participants reported using a condom the last time they had sex. A quarter of participants reported symptoms of a sexually transmitted infection (STI) in the previous 12 months and 22% had ever worked as a sex worker (51% of females). HIV prevalence among participants was 14% (18% among females and 13% among males). In multivariate analysis HIV was significantly associated with being 25 years and older (adjusted odds ratio (aOR) 2.1, 95% confidence interval (CI) 1.0-4.6, p=0.06), belonging to a racial group other than white (aOR 4.2, 95% CI 1.9-9.4, p<0.001), coming from Gauteng province (aOR 2.3, 95% CI 1.1-5.5, p=0.023), having ever worked as a sex worker (aOR 3.4, 95% CI 1.7-7.2, p=0.001) and the presence of STI symptoms in the last 12 months (aOR 2.4, 95% CI 1.1-4.4, p=0.019). This study highlights the need for increased access to sterile injecting equipment, education around safer injecting practices and access to sexual and reproductive health services for PWID in South Africa. Programmes for PWID should also address the specific needs of female PWID, PWID who sell sex and PWID from previously disadvantaged communities. Copyright © 2016 Elsevier B.V. All rights reserved.

Consensus on Current Injectable Treatment Strategies in the Asian Face.

PubMed

Wu, Woffles T L; Liew, Steven; Chan, Henry H; Ho, Wilson W S; Supapannachart, Nantapat; Lee, Hong-Ki; Prasetyo, Adri; Yu, Jonathan Nevin; Rogers, John D

2016-04-01

The desire for and use of nonsurgical injectable esthetic facial treatments are increasing in Asia. The structural and anatomical features specific to the Asian face, and differences from Western populations in facial aging, necessitate unique esthetic treatment strategies, but published recommendations and clinical evidence for injectable treatments in Asians are scarce. The Asian Facial Aesthetics Expert Consensus Group met to discuss current practices and consensus opinions on the cosmetic use of botulinum toxin and hyaluronic acid (HA) fillers, alone and in combination, for facial applications in Southeastern and Eastern Asians. Consensus opinions and statements on treatment aims and current practice were developed following discussions regarding pre-meeting and meeting survey outcomes, peer-reviewed literature, and the experts' clinical experience. The indications and patterns of use of injectable treatments vary among patients of different ages, and among Asian countries. The combination use of botulinum toxin and fillers increases as patients age. Treatment aims in Asians and current practice regarding the use of botulinum toxin and HA fillers in the upper, middle, and lower face of patients aged 18 to >55 years are presented. In younger Asian patients, addressing proportion and structural features and deficiencies are important to achieve desired esthetic outcomes. In older patients, maintaining facial structure and volume and addressing lines and folds are essential to reduce the appearance of aging. This paper provides guidance on treatment strategies to address the complex esthetic requirements in Asian patients of all ages. This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Basic Life Support Access to Injectable Epinephrine across the United States.

PubMed

Brasted, Ian D; Dailey, Michael W

2017-01-01

 Aggressive epinephrine administration has growing support in the treatment of anaphylaxis, a life-threatening allergic reaction. Emergency Medical Services (EMS) providers are frequently in a position to provide the first care to someone experiencing an anaphylactic reaction. Intramuscular injection of epinephrine is the definitive pharmacologic treatment for many associated symptoms. While easy to use, epinephrine autoinjectors (EAI) are prohibitively expensive, having increased in price ten-fold in ten years. Some states and EMS departments have begun expanding the scope of practice to allow Basic Life Support (BLS) providers, previously restricted to noninvasive therapies, to administer epinephrine by syringe. To compile a current and comprehensive list of how epinephrine is carried and used by EMS across the USA. An online survey focusing on anaphylaxis protocols and epinephrine administration was sent to state EMS medical directors and officials in all 50 states. Follow-up telephone calls were made to ensure compliance. Data were analyzed with descriptive statistics. Forty-nine of the 50 states in the USA provided a survey response. Texas responded but declined to participate in the survey because of practice variability across the state. In the other states, the form of epinephrine allowed or required on BLS ambulances was consistent with the scope of practice of their Basic Emergency Medical Technician (EMT). Thirteen states had training programs to allow BLS providers to inject epinephrine; 7 were considering it; 29 were not. Twenty-seven states specified EAI as the only form of epinephrine required or allowed on their BLS ambulances. No states reported allowing any level of EMS provider below EMT to use alternatives to EAI. This study confirms that many states have expanded the training of BLS providers to include the use of syringe injectable epinephrine. Even so, the majority of states relied on EAI in BLS ambulances.

Medical services and associated costs vary widely among surgeons treating patients with hand osteoarthritis.

PubMed

Becker, Stéphanie J E; Teunis, Teun; Blauth, Johann; Kortlever, Joost T P; Dyer, George S M; Ring, David

2015-03-01

There are substantial variations in medical services that are difficult to explain based on differences in pathophysiology alone. The scale of variation and the number of people affected suggest substantial potential to lower healthcare costs with the reduction of practice variation. Our study assessed practice variation across three affiliated urban sites in one city in the United States and related healthcare costs following the diagnosis of hand osteoarthritis (OA) in patients. (1) What are the factors associated with increased costs and surgery in the first year after diagnosis of hand OA? (2) How much practice variation exists among hand surgeons in terms of the number of patient visits, use of imaging tests, use of injections, occupational therapy use, and surgery? (3) What proportion of total cost is accounted for by patients who consult with an additional provider? Patients receiving a new diagnosis of primary hand OA between January 1, 2007, and December 31, 2011, were identified from the research database of three affiliated urban hospitals in a single city in the United States. We included 2814 patients (69%, 1929 women) treated by six hand surgeons. We recorded all visits, imaging tests, injections, occupational therapy visits, and surgical procedures in the first year after that diagnosis. Costs were extracted from the Medicare Physician Fee Schedule. Reliability of the database was assessed by manual checking of 120 patient charts (4.3% of all data); reliability was determined to be 94% (113 of 120) for diagnoses, 97% (116 of 120) correct surgeon, 100% (120 of 120) second surgeon, 99% (278 of 282) visits, 99% (132 of 134) imaging procedures, 92% (11 of 12) injections, 95% (21 of 22) surgical procedures, and 85% (102 of 120) prescribing occupational therapy. Predictors of increased costs included younger patient age (regression coefficient [β] -3.5, semipartial R(2) 0.0049, 95% confidence interval [CI] -5.4 to -1.7, p < 0.001), seeing a second surgeon (β 283, semipartial R(2) 0.0095, 95% CI 176-391, p < 0.001), and specific surgeons (surgeon 1: β -243, semipartial R(2) 0.026, 95% CI -298 to -188, p < 0.001; surgeon 2: β -177, semipartial R(2) 0.0090, 95% CI -246 to -109, p < 0.001; surgeon 6: β 124, semipartial R(2) 0.0050, 95% CI 59-189, p < 0.001) (adjusted R(2) = 0.056). Similarly, factors associated with increased surgical intervention included younger patient age (β -0.0026, semipartial R(2) 0.0071, 95% CI -0.0037 to -0.0015, p < 0.001), male sex (β 0.041, semipartial R(2) 0.0028, 95% CI -0.069 to -0.012, p = 0.005), seeing a second surgeon (β 0.16, semipartial R(2) 0.0091, 95% CI 0.094-0.22, p < 0.001), and specific surgeons (surgeon 1: β -0.14, semipartial R(2) 0.026, 95% CI -0.18 to -0.11, p < 0.001; surgeon 2: β -0.13, semipartial R(2) 0.014, 95% CI -0.17 to -0.091, p < 0.001). There were large variations in the average number of visits (1.5-fold), imaging tests (threefold), use of injections (51-fold), occupational therapy (twofold), and surgery rates (sevenfold) among providers. One hundred twenty patients (4.3%) consulted a second surgeon within the first year after receiving the diagnosis of hand OA, which accounted for 8.1% (USD 68,826/USD 845,304) of the total costs. Patients who saw additional providers and who were of younger age incurred higher costs and a greater likelihood of undergoing surgery; the latter was also greater in male patients. Use of medical services and associated costs vary widely among providers treating patients with hand OA. Initiatives addressing practice variation-increased use of decision aids, for example-merit additional study. Level III, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.

Ultrasound-guided intervention in the ankle and foot

PubMed Central

Allen, Gina M; Watura, Roland

2016-01-01

In this comprehensive review, we discuss the main interventions performed in the foot and ankle for Achilles tendinopathy, Morton's neuromas and Plantar fasciitis as well as techniques for intra-articular and peritendinous injections. We present the different imaging techniques and injectable agents that can be used in clinical practice, trying to help the reader decide the most appropriate way of managing the patient with a problem in the ankle and foot. PMID:26537692

Simulators for training in ultrasound guided procedures.

PubMed

Farjad Sultan, Syed; Shorten, George; Iohom, Gabrielle

2013-06-01

The four major categories of skill sets associated with proficiency in ultrasound guided regional anaesthesia are 1) understanding device operations, 2) image optimization, 3) image interpretation and 4) visualization of needle insertion and injection of the local anesthetic solution. Of these, visualization of needle insertion and injection of local anaesthetic solution can be practiced using simulators and phantoms. This survey of existing simulators summarizes advantages and disadvantages of each. Current deficits pertain to the validation process.

Regimes of Micro-bubble Formation Using Gas Injection into Ladle Shroud

NASA Astrophysics Data System (ADS)

Chang, Sheng; Cao, Xiangkun; Zou, Zongshu

2018-03-01

Gas injection into a ladle shroud is a practical approach to produce micro-bubbles in tundishes, to promote inclusion removal from liquid steel. A semi-empirical model was established to characterize the bubble formation considering the effect of shearing action combined with the non-fully bubble break-up by turbulence. The model shows a good accuracy in predicting the size of bubbles formed in complex flow within the ladle shroud.

Regimes of Micro-bubble Formation Using Gas Injection into Ladle Shroud

NASA Astrophysics Data System (ADS)

Chang, Sheng; Cao, Xiangkun; Zou, Zongshu

2018-06-01

Gas injection into a ladle shroud is a practical approach to produce micro-bubbles in tundishes, to promote inclusion removal from liquid steel. A semi-empirical model was established to characterize the bubble formation considering the effect of shearing action combined with the non-fully bubble break-up by turbulence. The model shows a good accuracy in predicting the size of bubbles formed in complex flow within the ladle shroud.

Time and materials needed to survey, inject systemic fungicides, and install root-graft barriers for Dutch elm disease management

Treesearch

William N., Jr. Cannon; Jack H. Barger; Charles J. Kostichka; Charles J. Kostichka

1986-01-01

Dutch elm disease control practice in 15 communities showed a wide range of time and material required to apply control methods. The median time used for each method was: sanitation survey, 9.8 hours per square mile; symptom survey, 96 hours per thousand elms; systemic fungicide injection, 1.4 hours per elm; and root-graft barrier installation, 2.2 hours per barrier (5...

Spot-checks to measure general hygiene practice.

PubMed

Sonego, Ina L; Mosler, Hans-Joachim

2016-01-01

A variety of hygiene behaviors are fundamental to the prevention of diarrhea. We used spot-checks in a survey of 761 households in Burundi to examine whether something we could call general hygiene practice is responsible for more specific hygiene behaviors, ranging from handwashing to sweeping the floor. Using structural equation modeling, we showed that clusters of hygiene behavior, such as primary caregivers' cleanliness and household cleanliness, explained the spot-check findings well. Within our model, general hygiene practice as overall concept explained the more specific clusters of hygiene behavior well. Furthermore, the higher general hygiene practice, the more likely children were to be categorized healthy (r = 0.46). General hygiene practice was correlated with commitment to hygiene (r = 0.52), indicating a strong association to psychosocial determinants. The results show that different hygiene behaviors co-occur regularly. Using spot-checks, the general hygiene practice of a household can be rated quickly and easily.

Diffractive optics in industry and research: novel components for optical security systems

NASA Astrophysics Data System (ADS)

Laakkonen, Pasi; Turunen, Jari; Pietarinen, Juha; Siitonen, Samuli; Laukkanen, Janne; Jefimovs, Konstantins; Orava, Joni; Ritala, Mikko; Pilvi, Tero; Tuovinen, Hemmo; Ventola, Kalle; Vallius, Tuomas; Kaipiainen, Matti; Kuittinen, Markku

2005-09-01

Design and manufacturing of diffractive optical elements (DOEs) are presented. Mass replication methods for DOEs are explained including UV-replication, micro-injection moulding and reel-to-reel production. Novel applications of diffractive optics including spectroscopic surface relief gratings, antireflection surfaces, infrared light rejection gratings, light incoupling into thin waveguides, and additive diffractive colour mixing are presented.

Predictors of sharing injection equipment by HIV-seropositive injection drug users.

PubMed

Latkin, Carl A; Buchanan, Amy S; Metsch, Lisa R; Knight, Kelly; Latka, Mary H; Mizuno, Yuko; Knowlton, Amy R

2008-12-01

Among HIV-positive injection drug users (IDUs), we examined baseline predictors of lending needles and syringes and sharing cookers, cotton, and rinse water in the prior 3 months at follow-up. Participants were enrolled in Intervention for Seropositive Injectors-Research and Evaluation, a secondary prevention intervention for sexually active HIV-positive IDUs in 4 US cities during 2001-2005. The analyses involved 357 participants who reported injecting drugs in the prior 6 months at either the 6- or 12-month follow-up visit. About half (49%) reported at least 1 sharing episode. In adjusted analyses, peer norms supporting safer injection practices and having primary HIV medical care visits in the prior 6 months were associated with reporting no sharing of injection equipment. Higher levels of psychological distress were associated with a greater likelihood of reporting drug paraphernalia sharing. These findings suggest that intervention approaches for reducing HIV-seropositive IDUs' transmission of blood-borne infections should include peer-focused interventions to alter norms of drug paraphernalia sharing and promoting primary HIV care and mental health services.

The Effects of Postoperative Intralesional Corticosteroids in the Prevention of Recurrent Earlobe Keloids: A Multispecialty Retrospective Review.

PubMed

Gold, Daniel A; Sheinin, Renee; Jacobsen, Gordon; Jones, Lamont R; Ozog, David M

2018-06-01

Effective treatment of keloids is challenging because the recurrence rate after surgical excision is high. Data on the best treatment practices are lacking. To investigate the recurrence rate after surgical excision of earlobe keloids based on a postoperative intralesional corticosteroid injection protocol. Retrospective chart review was performed from January 1, 2005, to March 31, 2016, of patients who had excision of ear keloids within the departments of dermatology, otorhinolaryngology, and plastic surgery. The number of postoperative injections was recorded, recurrence was reported by the patient, and the efficacy of an injection protocol was evaluated. There were 277 charts reviewed. Appropriate data were available for 184 patients. A statistically significant difference was found with recurrence associated with a lower number of injections (p < .001). Keloids were more likely to recur if they were not treated with a planned serial injection protocol (p < .001) or if they were treated outside the department of dermatology (p < .001). Intralesional corticosteroid injection after surgical excision of earlobe keloids statistically minimizes the risk of recurrence.

Modeling and investigation of refrigeration system performance with two-phase fluid injection in a scroll compressor

NASA Astrophysics Data System (ADS)

Gu, Rui

Vapor compression cycles are widely used in heating, refrigerating and air-conditioning. A slight performance improvement in the components of a vapor compression cycle, such as the compressor, can play a significant role in saving energy use. However, the complexity and cost of these improvements can block their application in the market. Modifying the conventional cycle configuration can offer a less complex and less costly alternative approach. Economizing is a common modification for improving the performance of the refrigeration cycle, resulting in decreasing the work required to compress the gas per unit mass. Traditionally, economizing requires multi-stage compressors, the cost of which has restrained the scope for practical implementation. Compressors with injection ports, which can be used to inject economized refrigerant during the compression process, introduce new possibilities for economization with less cost. This work focuses on computationally investigating a refrigeration system performance with two-phase fluid injection, developing a better understanding of the impact of injected refrigerant quality on refrigeration system performance as well as evaluating the potential COP improvement that injection provides based on refrigeration system performance provided by Copeland.

The Art of Pencil Practice.

ERIC Educational Resources Information Center

Clowes, Robert F.

1997-01-01

Proposes that music teachers should have their students practice during those spare moments during the school day by using a pencil instead of their actual instrument. Explains that students can practice chromatic fingerings, memorize short pieces of music, or review scales. Gives instructions on how to "pencil practice." (CMK)

Private rural health providers in Haryana, India: profile and practices.

PubMed

Jarhyan, P; Singh, B; Rai, S K; Nongkynrih, B

2012-01-01

Despite a widespread public health system, the private healthcare sector is the major provider of health care in rural India. This study describes the profile and medical practices of private rural health providers (PRHPs) in rural Haryana, India. A cross-sectional study was conducted among PRHPs practicing in the villages of Comprehensive Rural Health Services Project (CRHSP) at Ballabgarh block located in the Faridabad district of Haryana State. The CRHSP is an Intensive Field Practice Area (IFPA) of the Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi. Eighty PRHPs participated in this study (response rate 93%). The majority (96%) did not possess a qualification in any formal system of medicine. Half of the PRHPs had a separate space (private area) for the examination of patients. Almost all had stethoscopes, thermometers and blood pressure apparatus. The PRHPs were involved in a wide range of practices, such as dispensing medicines (98.7%), providing injections (98.7%) and intravenous fluids (98.7%), and conducting minor surgery (78.5%). Dumping biomedical waste was a common practice among these practitioners. Some PRHPs (8.7%) were involved in national health programs. Unqualified PRHPs provide substantial outpatient healthcare services in rural Ballabgarh, India. Their biomedical waste disposal practices are inadequate. There is a need for training in waste disposal practices and monitoring of safe injection techniques among PRHPs. Consideration should be given to utilising PRHPs in important public health programs such as disease surveillance.

Blocking the buccal nerve using two methods of inferior alveolar block injection.

PubMed

Aker, F D

2001-01-01

The anatomic relations of the buccal nerve branch of the mandibular division of the trigeminal nerve were studied to explain the rationale for the discrepancy in blocking the buccal nerve using two methods of blocking the inferior alveolar nerve, the conventional method and the Gow-Gates method. The conventional method rarely blocks the buccal nerve, while the Gow-Gates method is reported to consistently block the buccal nerve. Eight head and mandibular specimens were dissected to observe the path of buccal nerve and its relationship to the path of needles in the conventional and Gow-Gates techniques. The buccal nerve descends on the medial and then anterior aspect of the deep head of the temporalis muscle (Tdh). At the latter position the buccal nerve enters the retromolar fossa and is encased in a fascial sleeve created by a dense fascial band that spans between the temporalis muscle tendons and the buccinator muscle. At the level of the conventional block injection the buccal nerve was shielded from the path of the needle by the Tdh and the fascial band. In the Gow-Gates block injection, the buccal nerve was exposed on the medial surface of the Tdh, immediately lateral to the path of the needle and proximal to the fascial sleeve. Consequently, the anatomical relations of the buccal nerve in the conventional block method essentially shield the nerve from being bathed by anesthetic solution while in the Gow-Gates method the relations are such that the buccal nerve can be exposed to anesthetic solution and thus blocked, explaining the findings in clinical dentistry. Copyright Wiley-Liss, Inc.

Microgravity changes at the Laguna del Maule volcanic field: Magma-induced stress changes facilitate mass addition

NASA Astrophysics Data System (ADS)

Miller, C. A.; Le Mével, H.; Currenti, G.; Williams-Jones, G.; Tikoff, B.

2017-04-01

Time-dependent, or 4-D, microgravity changes observed at the Laguna del Maule volcanic field, Chile, since 2013, indicate significant (1.5 × 1011 kg) ongoing mass injection. Mass injection is focused along the Troncoso fault, and subparallel structures beneath the lake at 1.5-2 km depth, and is best modeled by a vertical rectangular prism source. The low-density change (156 to 307 kg/m3) and limited depth extent suggest a mechanism of hydrothermal fluid intrusion into existing voids, or voids created by the substantial uplift, rather than deeper-sourced dike intrusion of rhyolite or basalt magma. Although the gravity changes are broadly spatially coincident with ongoing surface deformation, existing models that explain the deformation are deeper sourced and cannot explain the gravity changes. To account for this discrepancy and the correspondence in time of the deformation and gravity changes, we explore a coupled magmatectonic interaction mechanism that allows for shallow mass addition, facilitated by deeper magma injection. Computing the strain, and mean, normal, and Coulomb stress changes on northeast trending faults, caused by the opening of a sill at 5 km depth, shows an increase in strain and mean and normal stresses along these faults, coincident with the areas of mass addition. Seismic swarms in mid-2012 to the west and southwest of the mass intrusion area may be responsible for dynamically increasing permeability on the Troncoso fault, promoting influx of hydrothermal fluids, which in turn causes larger gravity changes in the 2013 to 2014 interval, compared to the subsequent intervals.

Out-of-Pocket Household Expenditures on Medical Injections in Cambodia.

PubMed

Ozawa, Sachiko; Yemeke, Tatenda T; Tawah, Alie F; Kulkarni, Vivek; Villar Uribe, Manuela

2018-02-09

Cambodia has one of the highest rates of overall medical injection usage worldwide. Therapeutic injections, which are often unnecessary, contribute to the spread of blood-borne diseases. This study describes injection practices and associated household expenditures in rural northwest Cambodia. We assessed care-seeking patterns of surveyed adult family members who sought healthcare in the previous 30 days, including location of care, medical injection use, and out-of-pocket household expenditures for treatment. A regression model was used to explore the impact of injection use on out-of-pocket household expenditures. Among 480 households sampled, 298 included members who had been sick within the previous 30 days; a total of 342 episodes of care had been sought. Private providers accounted for over 66% (n = 226) of all episodes of care, with public and informal providers accounting for 20% (n = 69) and 14% (n = 47), respectively. Injections were administered in over 120 (35%) episodes of care, with 81% of injections administered by private providers. Patients who received injections incurred total out-of-pocket household expenditures that were, on average, 126,590 Cambodian Riel (KHR) (US$31.65) higher than those who did not receive injections (p < 0.01), equivalent to nearly half of the country's total annual health expenditure per capita. Receiving injections and perceived severity of illness were significantly associated with higher out-of-pocket household expenditures. This study found high levels of medical injection use, particularly among private healthcare providers, which was significantly associated with high healthcare expenditures. Reducing the number of medical injections would not only reduce disease transmission risk but also contribute to reduced healthcare costs and greater financial protection.

SCORE Study Report 7: incidence of intravitreal silicone oil droplets associated with staked-on vs luer cone syringe design.

PubMed

Scott, Ingrid U; Oden, Neal L; VanVeldhuisen, Paul C; Ip, Michael S; Blodi, Barbara A; Antoszyk, Andrew N

2009-11-01

To evaluate the incidence of intravitreal silicone oil (SO) droplets associated with intravitreal injections using a staked-on vs luer cone syringe design in the SCORE (Standard Care vs COrticosteroid in REtinal Vein Occlusion) Study. Prospective, randomized, phase III clinical trial. The incidence of intravitreal SO was compared among participants exposed to the staked-on syringe design, the luer cone syringe design, or both of the syringe designs in the SCORE Study, which evaluated intravitreal triamcinolone acetonide injection(s) for vision loss secondary to macular edema associated with central or branch retinal vein occlusion. Injections were given at baseline and 4-month intervals, based on treatment assignment and study-defined retreatment criteria. Because intravitreal SO was observed following injections in some participants, investigators were instructed, on September 22, 2006, to look for intravitreal SO at all study visits. On November 1, 2007, the luer cone syringe design replaced the staked-on syringe design. A total of 464 participants received a total of 1,205 injections between November 4, 2004 and February 28, 2009. Intravitreal SO was noted in 141 of 319 participants (44%) exposed only to staked-on syringes, 11 of 87 (13%) exposed to both syringe designs, and 0 of 58 exposed only to luer cone syringes (P < .0001). Among participants with first injections after September 22, 2006, intravitreal SO was noted in 65 of 114 (57%) injected only with staked-on syringes compared with 0 of 58 injected only with luer cone syringes. Differential follow-up is unlikely to explain these results. In the SCORE Study, luer cone syringe design is associated with a lower frequency of intravitreal SO droplet occurrence compared with the staked-on syringe design, likely attributable to increased residual space in the needle hub with the luer cone design.

Reform-based science teaching: A mixed-methods approach to explaining variation in secondary science teacher practice

NASA Astrophysics Data System (ADS)

Jetty, Lauren E.

The purpose of this two-phase, sequential explanatory mixed-methods study was to understand and explain the variation seen in secondary science teachers' enactment of reform-based instructional practices. Utilizing teacher socialization theory, this mixed-methods analysis was conducted to determine the relative influence of secondary science teachers' characteristics, backgrounds and experiences across their teacher development to explain the range of teaching practices exhibited by graduates from three reform-oriented teacher preparation programs. Data for this study were obtained from the Investigating the Meaningfulness of Preservice Programs Across the Continuum of Teaching (IMPPACT) Project, a multi-university, longitudinal study funded by NSF. In the first quantitative phase of the study, data for the sample (N=120) were collected from three surveys from the IMPPACT Project database. Hierarchical multiple regression analysis was used to examine the separate as well as the combined influence of factors such as teachers' personal and professional background characteristics, beliefs about reform-based science teaching, feelings of preparedness to teach science, school context, school culture and climate of professional learning, and influences of the policy environment on the teachers' use of reform-based instructional practices. Findings indicate three blocks of variables, professional background, beliefs/efficacy, and local school context added significant contribution to explaining nearly 38% of the variation in secondary science teachers' use of reform-based instructional practices. The five variables that significantly contributed to explaining variation in teachers' use of reform-based instructional practices in the full model were, university of teacher preparation, sense of preparation for teaching science, the quality of professional development, science content focused professional, and the perceived level of professional autonomy. Using the results from phase one, the second qualitative phase selected six case study teachers based on their levels of reform-based teaching practices to highlight teachers across the range of practices from low, average, to high levels of implementation. Using multiple interview sources, phase two helped to further explain the variation in levels of reform-based practices. Themes related to teachers' backgrounds, local contexts, and state policy environments were developed as they related to teachers' socialization experiences across these contexts. The results of the qualitative analysis identified the following factors differentiating teachers who enacted reform-based instructional practices from those who did not: 1) extensive science research experiences prior to their preservice teacher preparation; 2) the structure and quality of their field placements; 3) developing and valuing a research-based understanding of teaching and learning as a result of their preservice teacher preparation experiences; 4) the professional culture of their school context where there was support for a high degree of professional autonomy and receiving support from "educational companions" with a specific focus on teacher pedagogy to support student learning; and 5) a greater sense of agency to navigate their districts' interpretation and implementation of state polices. Implications for key stakeholders as well as directions for future research are discussed.

Preliminary assessments of CO2 storage in carbonate formations: a case study from Malaysia

NASA Astrophysics Data System (ADS)

Raza, Arshad; Gholami, Raoof; Rezaee, Reza; Bing, Chua Han; Nagarajan, Ramasamy; Hamid, Mohamed Ali

2017-06-01

The preliminary assessment of depleted reservoirs prior to the injection of CO2 is an essential step to ensure the safety and success of storage projects. Several studies have provided a preliminary assessment of depleted reservoirs as a sequestration practice. However, the screening criteria used in these studies were not able to consider all of the aspects of a storage site. The aim of this paper is to provide a reservoir-scale evaluation approach for long-term storage practice in an offshore carbonate field located in Malaysia. Recently developed screening criteria that cover the key aspects of storage sites, such as capacity, injectivity, trapping mechanisms, and containment, are taken into consideration for the purpose of this study. The results obtained suggest that the reservoir has good potential to be a storage place for CO2, although the compaction behavior and aquifer supports of the reservoir might cause some difficulties. It is, therefore, recommended that a series of experimental and numerical studies on different aspects of storage sites be performed to ensure that injectivity is not a problem when it comes to the implementation stage.

Derivation of a needs based capitation formula for allocating prescribing budgets to health authorities and primary care groups in England: regression analysis

PubMed Central

Rice, Nigel; Dixon, Paul; Lloyd, David C E F; Roberts, David

2000-01-01

Objective To develop a weighted capitation formula for setting target allocations for prescribing expenditures for health authorities and primary care groups in England. Design Regression analysis relating prescribing costs to the demographic, morbidity, and mortality composition of practice lists. Setting 8500 general practices in England. Subjects Data from the 1991 census were attributed to practice lists on the basis of the place of residence of the practice population. Main outcome measures Variation in age, sex, and temporary resident originated prescribing units (ASTRO(97)-PUs) adjusted net ingredient cost of general practices in England for 1997-8 modelled for the impact of health and social needs after controlling for differences in supply. Results A needs gradient based on the four variables: permanent sickness, percentage of dependants in no carer households, percentage of students, and percentage of births on practice lists. These, together with supply characteristics, explained 41% of variation in prescribing costs per ASTRO(97)-PU adjusted capita across practices. The latter alone explained about 35% of variation in total costs per head across practices. Conclusions The model has good statistical specification and contains intuitively plausible needs drivers of prescribing expenditure. Together with adjustments made for differences in ASTRO(97)-PUs the model is capable of explaining 62% (35%+0.65% (41%)) of variation in prescribing expenditure at practice level. The results of the study have formed the basis for setting target budgets for 1999-2000 allocations for prescribing expenditure for health authorities and primary care groups. PMID:10650026

Enhancement of plasmon-induced charge separation efficiency by coupling silver nanocubes with a thin gold film

NASA Astrophysics Data System (ADS)

Akiyoshi, Kazutaka; Saito, Koichiro; Tatsuma, Tetsu

2016-10-01

Plasmon-induced charge separation (PICS), in which an energetic electron is injected from a plasmonic nanoparticle (NP) to a semiconductor on contact, is often inhibited by a protecting agent adsorbed on the NP. We addressed this issue for an Ag nanocube-TiO2 system by coating it with a thin Au layer or by inserting the Au layer between the nanocubes (NCs) and TiO2. Both of the electrodes exhibit much higher photocurrents due to PICS than the electrodes without the Au film or the Ag NCs. These photocurrent enhancements can be explained in terms of PICS with accelerated electron transfer, in which electron injection from the Ag NCs or Ag@Au core-shell NCs to TiO2 is promoted by the Au film, or PICS enhanced by a nanoantenna effect, in which the electron injection from the Au film to TiO2 is enhanced by optical near field generated by the Ag NC.

Estimating the Magnetic Field Strength in Hot Jupiters

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

Yadav, Rakesh K.; Thorngren, Daniel P., E-mail: rakesh_yadav@fas.harvard.edu

A large fraction of known Jupiter-like exoplanets are inflated as compared to Jupiter. These “hot” Jupiters orbit close to their parent star and are bombarded with intense starlight. Many theories have been proposed to explain their radius inflation and several suggest that a small fraction of the incident starlight is injected into the planetary interior, which helps to puff up the planet. How will such energy injection affect the planetary dynamo? In this Letter, we estimate the surface magnetic field strength of hot Jupiters using scaling arguments that relate energy available in planetary interiors to the dynamo-generated magnetic fields. Wemore » find that if we take into account the energy injected in the planetary interior that is sufficient to inflate hot Jupiters to observed radii, then the resulting dynamo should be able generate magnetic fields that are more than an order of magnitude stronger than the Jovian values. Our analysis highlights the potential fundamental role of the stellar light in setting the field strength in hot Jupiters.« less

Barrier tunneling of the loop-nodal semimetal in the hyperhoneycomb lattice

NASA Astrophysics Data System (ADS)

Guan, Ji-Huan; Zhang, Yan-Yang; Lu, Wei-Er; Xia, Yang; Li, Shu-Shen

2018-05-01

We theoretically investigate the barrier tunneling in the 3D model of the hyperhoneycomb lattice, which is a nodal-line semimetal with a Dirac loop at zero energy. In the presence of a rectangular potential, the scattering amplitudes for different injecting states around the nodal loop are calculated, by using analytical treatments of the effective model, as well as numerical simulations of the tight binding model. In the low energy regime, states with remarkable transmissions are only concentrated in a small range around the loop plane. When the momentum of the injecting electron is coplanar with the nodal loop, nearly perfect transmissions can occur for a large range of injecting azimuthal angles if the potential is not high. For higher potential energies, the transmission shows a resonant oscillation with the potential, but still with peaks being perfect transmissions that do not decay with the potential width. These strikingly robust transports of the loop-nodal semimetal can be approximately explained by a momentum dependent Dirac Hamiltonian.

Magnetic field enhancement of generation-recombination and shot noise in organic light emitting diodes

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

Djidjou, T. K.; Basel, Tek; Rogachev, A.

We have studied the effect of magnetic field on noise in series of 2-methoxy-5-(2′-ethylhexyloxy)-1,4-phenylenevinylene-based organic light emitting diodes with dominant hole injection, dominant electron injection, and balanced electron and hole injection. The noise spectra of the balanced devices revealed the generation-recombination (g-r) noise term, which we associated with bimolecular electron-hole recombination. The presence of the g-r noise term is correlated with the strong organic magnetoresistance (up to 25%) observed in the balanced devices. The noise spectra also have the shot noise contribution with the Fano factor 0.25–0.4. We found that time constant of the g-r term decreases and the magnitudemore » of shot noise increases when magnetic field is applied. This behavior can be consistently explained within the polaron-polaron model of organic magnetoresistance. We have not found any evidence that the magnetoresistance in studied devices is affected by traps.« less

The Dynamics of Group Formation Among Leeches

PubMed Central

Bisson, Giacomo; Bianconi, Ginestra; Torre, Vincent

2012-01-01

Leeches exploring a new environment continuously meet each other and merge in temporary groups. After 2–3 h, leeches become attracted to each other eventually forming a large and stable group. When their number is reduced, leeches remain solitary, behaving independently. Group formation is facilitated by body injection of serotonin (5-HT) and the level of endogenous 5-HT is elevated in leeches forming a large group. In contrast, intravenous injection of 5-HT antagonists prevented injected leeches from joining a large group of conspecifics. When sensilla near the head were ablated or the supraesophageal ganglion disconnected, leeches remained solitary, but explored the environment swimming and crawling. These results suggest that group formation is initiated by a release of 5-HT triggered by sensilla stimulation and its dynamics can be explained by the establishment of a reinforcement dynamics, as observed during human group formation. As 5-HT affects social interactions also in humans, group formation in leeches and humans share a similar dynamics and hormonal control. PMID:22629247

Police Victimization Among Persons Who Inject Drugs Along the U.S.-Mexico Border.

PubMed

Pinedo, Miguel; Burgos, Jose Luis; Zuniga, Maria Luisa; Perez, Ramona; Macera, Caroline A; Ojeda, Victoria D

2015-09-01

Problematic policing practices are an important driver of HIV infection among persons who inject drugs (PWID) in the U.S.-Mexico border region. This study identifies factors associated with recent (i.e., past 6 months) police victimization (e.g., extortion, physical and sexual violence) in the border city of Tijuana, Mexico. From 2011 to 2013, 733 PWID (62% male) were recruited in Tijuana and completed a structured questionnaire. Eligible participants were age 18 years or older, injected illicit drugs within the past month, and spoke Spanish or English. Multivariable logistic regression analyses identified correlates of recent experiences of police victimization (e.g., bribes, unlawful confiscation, physical and sexual violence). Overall, 56% of PWID reported a recent police victimization experience in Tijuana. In multivariable logistic regression analyses, factors independently associated with recent police victimization included recent injection of methamphetamine (adjusted odds ratio [AOR] = 1.62; 95% CI [1.18, 2.21]) and recently received injection assistance by a "hit doctor" (AOR = 1.56; 95% CI [1.03, 2.36]). Increased years lived in Tijuana (AOR = 0.98 per year; 95% CI [0.97, 0.99]) and initiating drug use at a later age (AOR = 0.96 per year; 95% CI [0.92, 0.99]) were inversely associated with recent police victimization. Physical drugusing markers may increase PWID susceptibility to police targeting and contribute to experiences of victimization. Interventions aimed at reducing police victimization events in the U.S.-Mexico border region should consider PWID's drug-using behaviors. Reducing problematic policing practices may be a crucial public health strategy to reduce HIV risk among PWID in this region.

Commentary: the value of PrEP for people who inject drugs.

PubMed

Coleman, Rosalind L; McLean, Susie

2016-01-01

The offer of pre-exposure prophylaxis (PrEP) is recommended as an additional option for HIV prevention for people at substantial risk of HIV infection as part of combination HIV prevention approaches. Implementing this depends on integrating PrEP in public health programmes that address risky practices with evidence-based interventions, and that operate in an enabling legal and policy environment for the delivery of health services to those at higher risk of HIV infection. What does this recommendation mean in terms of the diverse range of HIV prevention needs of key populations, some of whom are so discriminated against that they exist essentially outside formal systems such as national public health services, and for whom a substantial risk of HIV is part of a larger adverse and hostile situation? We discuss this question with reference to people who inject drugs, informed by concerns and comments that emerged from a series of consultations. HIV prevention is part of a spectrum of injecting drug users' priorities, and their access and uptake of HIV prevention services is contingent on their wider "risk environment." The need to address structural barriers to services and human rights violations, and to improve access to comprehensive harm reduction programmes are of prime importance and would have higher value than a mono-focus on HIV prevention. Where existing harm reduction activities are inadequate, fragile or dependent on external donors, shifts in funding priorities, including, for example, towards PrEP, could threaten investment in the broader programmes. For these reasons, it cannot be assumed that PrEP promotion will always be supported by people who inject drugs.The sexual partners of people who inject drugs, non-opioid users who also inject and for whom there is no established substitution treatment, as well as drug users who are unable to negotiate safe sex may value PrEP. As for all key populations, the involvement of people who inject drugs in shaping services for their consumption is vital and too often ignored. For people who inject drugs and who experience discrimination, violence or harassment, implementation of PrEP should be guided by understanding and engaging with their interconnected range of needs, risk practices, priorities and options. The differentiated needs of sub-populations that inject a range of drugs, and their sexual partners, require further exploration.

Sterile syringe access and disposal among injection drug users newly enrolled in methadone maintenance treatment: a cross-sectional survey

PubMed Central

McNeely, Jennifer; Arnsten, Julia H; Gourevitch, Marc N

2006-01-01

Background We sought to assess injection practices, means of acquiring and disposing of syringes, and utilization and knowledge of harm reduction resources among injection drug users (IDUs) entering methadone maintenance treatment (MMT). Methods Interviews with 100 consecutive patients, including 35 IDUs, entering a MMT program in the Bronx, NY. Results Utilization of unsafe syringe sources was reported by 69% of IDUs in our sample. Most (80%) IDUs reused syringes, and syringe sharing was also common. Fewer than half knew that non-prescription pharmacy purchase of syringes was possible. The most common means of disposing of injecting equipment were the trash (63%) and syringe exchange programs (49%). Conclusions These findings indicate that drug users entering treatment under-utilize sanctioned venues to obtain sterile syringes or safely dispose of used injection equipment. Programs providing services to drug users should adopt a proactive stance to address the safety and health issues faced by injectors. PMID:16503997

Spanking Infants and Toddlers: Maternal Belief and Practice.

ERIC Educational Resources Information Center

Socolar, Rebecca R. S.; Stein, Ruth E. K.

1995-01-01

Interviewed mothers about spanking infants and toddlers to determine beliefs and practice and relationships between factors affecting these beliefs and practices. Found that context of the spanking affects spanking beliefs and practice and that beliefs about spanking rather than impulse largely explain the prevalence of spanking for children under…

Parents' Perceptions and Practices in Homework: Implications for School-Teacher-Parent Partnerships

ERIC Educational Resources Information Center

Fan, Qian

2012-01-01

This study examined parents' perceptions and practices of parental involvement in their children's homework process to explore how variations in parents' perceptions might explain differences in their practices. Understanding parents' perceptions and practices of involvement is essential to increasing the effectiveness of parental involvement in…

Wastewater injection and slip triggering: Results from a 3D coupled reservoir/rate-and-state model

NASA Astrophysics Data System (ADS)

Babazadeh, M.; Olson, J. E.; Schultz, R.

2017-12-01

Seismicity induced by fluid injection is controlled by parameters related to injection conditions, reservoir properties, and fault frictional behavior. We present results from a combined model that brings together injection physics, reservoir dynamics, and fault physics to better explain the primary controls on induced seismicity. We created a 3D fluid flow simulator using the embedded discrete fracture technique and then coupled it with a 3D displacement discontinuity model that uses rate and state friction to model slip events. The model is composed of three layers, including the top-seal, the injection reservoir, and the basement. Permeability is anisotropic (vertical vs horizontal) and along with porosity varies by layer. Injection control can be either rate or pressure. Fault properties include size, 2D permeability, and frictional properties. Several suites of simulations were run to evaluate the relative importance of each of the factors from all three parameter groups. We find that the injection parameters interact with the reservoir parameters in the context of the fault physics and these relations change for different reservoir and fault characteristics, leading to the need to examine the injection parameters only within the context of a particular faulted reservoir. For a reservoir with no flow boundaries, low permeability (5 md), and a fault with high fault-parallel permeability and critical stress, injection rate exerts the strongest control on magnitude and frequency of earthquakes. However, for a higher permeability reservoir (80 md), injection volume becomes the more important factor. Fault permeability structure is a key factor in inducing earthquakes in basement rocks below the injection reservoir. The initial failure state of the fault, which is challenging to assess, can have a big effect on the size and timing of events. For a fault 2 MPa below critical state, we were able to induce a slip event, but it occurred late in the injection history and was limited to a subset of the fault extent. A case starting at critical stress resulted in a rupture that propagated throughout the entire physical extent of the fault generated a larger magnitude earthquake. This physics-based model can contribute to assessing the risk associated with injection activities and providing guidelines for hazard mitigation.

Maternal presence, childrearing practices, and children's response to an injection.

PubMed

Broome, M E; Endsley, R C

1989-08-01

The purpose of the study was to investigate the effects of maternal presence or absence and childrearing practices on young children's response to an injection. One hundred thirty-eight mothers and their children, who were attending health screening clinic, were assigned to one of four groups in which mothers were either present or absent during an interview and an immunization. Mothers were asked to fill out a questionnaire about their childrearing practices. Child behavior was observed during both the interview and the immunization. Results indicated that while maternal presence was associated with the children behaving more distressed during the interview, maternal presence had no effect on child behavior during the immunization. Children whose mothers reported high levels of both control and warmth in their relationship (authoritative parents) were found to be significantly less distressed during the immunization than children of either the low-control, high-warmth (permissive), high-control, low-warmth (authoritarian) or low-control, low-warmth (nonresponsive) parent groups.

The syringe gap: an assessment of sterile syringe need and acquisition among syringe exchange program participants in New York City

PubMed Central

Heller, Daliah I; Paone, Denise; Siegler, Anne; Karpati, Adam

2009-01-01

Background Programmatic data from New York City syringe exchange programs suggest that many clients visit the programs infrequently and take few syringes per transaction, while separate survey data from individuals using these programs indicate that frequent injecting – at least daily – is common. Together, these data suggest a possible "syringe gap" between the number of injections performed by users and the number of syringes they are receiving from programs for those injections. Methods We surveyed a convenience sample of 478 injecting drug users in New York City at syringe exchange programs to determine whether program syringe coverage was adequate to support safer injecting practices in this group. Results Respondents reported injecting a median of 60 times per month, visiting the syringe exchange program a median of 4 times per month, and obtaining a median of 10 syringes per transaction; more than one in four reported reusing syringes. Fifty-four percent of participants reported receiving fewer syringes than their number of injections per month. Receiving an inadequate number of syringes was more frequently reported by younger and homeless injectors, and by those who reported public injecting in the past month. Conclusion To improve syringe coverage and reduce syringe sharing, programs should target younger and homeless drug users, adopt non-restrictive syringe uptake policies, and establish better relationships with law enforcement and homeless services. The potential for safe injecting facilities should be explored, to address the prevalence of public injecting and resolve the 'syringe gap' for injecting drug users. PMID:19138414

CRRES: The combined release and radiation effects satellite program directory

NASA Technical Reports Server (NTRS)

Layman, Laura D.; Miller, George P.

1992-01-01

As a result of natural processes, plasma clouds are often injected into the magnetosphere. These chemical releases can be used to study many aspects of such injections. When a dense plasma is injected into the inner magnetosphere, it is expected to take up the motion of the ambient plasma. However, it has been observed in previous releases at moderate altitudes that the cloud preserved its momentum for some time following the release and that parts of the cloud peeled off from the main cloud presumable due to the action of an instability. As one moves outward into the magnetosphere, the mirror force becomes less dominant and the initial conditions following a release are dominated by the formation of a diamagnetic cavity since the initial plasma pressure from the injected Ba ions is greater than the magnetic field energy density. A previous high-altitude release (31,300 km) showed this to be the case initially, but at later times there was evidence for acceleration of the Ba plasma to velocities corresponding to 60,000 K. This effect is not explained. This series of experiments is therefore designed to inject plasma clouds into the magnetosphere under widely varying conditions of magnetic field strength and ambient plasma density. In this way the coupling of injected clouds to the ambient plasma and magnetic field, the formation of striations due to instabilities, and possible heating and acceleration of the injected Ba plasma can be studied over a wide range of magnetosphere parameters. Adding to the scientific yield will be the availability of measurements for the DOD/SPACERAD instruments which can monitor plasma parameters, electric and magnetic fields, and waves before, during and after the releases.

Distribution of bupivacaine hydrochloride after sciatic and femoral nerve blocks in cats: A magnetic resonance imaging study.

PubMed

Evangelista, Marina C; de Lassalle, Julie; Chevrier, Christine; Carmel, Eric N; Fantoni, Denise T; Steagall, Paulo V M

2017-12-01

The objective of this study was to evaluate the distribution of bupivacaine hydrochloride using magnetic resonance imaging (MRI) after electrical nerve stimulator (ENS)-guided sciatic (ScN) and femoral (FN) nerve blocks in cats. Six adult cats (body weight 4.8±0.6kg) were anesthetized with acepromazine-buprenorphine-propofol-isoflurane. Transverse and sagittal plan sequences of pelvic limbs were obtained using a high-field magnet (1.5T). Afterwards, the ScN and FN blocks (one block per limb) were performed using 0.1mL/kg of bupivacaine 0.5% per site and the MRI sequence was repeated after each block. The injection was considered successful when bupivacaine was in contact with the nerve. Injectate location and complications were recorded. The length (mm) of contact (spread) between bupivacaine and nerves was measured and classified as fair (<15mm) or adequate (≥15mm). Five out of six ScN injections were successful; of these, four had adequate spread over the nerve [26 (13-39) mm]. All FN injections were successful, but in one case bupivacaine was administered over the motor branch of FN, distally to the bifurcation between the femoral and saphenous nerve. It was not possible to measure neither the length of contact between bupivacaine and FN nor to identify iatrogenic trauma caused by the injections. MRI can be used for the evaluation of bupivacaine distribution, but not complications, following ENS-guided ScN and FN blocks in cats. Despite most of the injections were considered successful, individual variability regarding the injectate location may explain differences in efficacy in the clinical setting. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Accidental injection of sodium hypochlorite in inferior alveolar nerve block anesthesia].

PubMed

Hongyan, Li; Jian, Xu; Baorong, Zhang; Yue, Jia; Minhua, Liu; Yilang, Luo; Jing, Zhao

2016-12-01

Sodium hypochlorite (NaClO) has been widely used in clinical practice as one of the most efficient root canal irrigants. Its properties include broad-spectrum antimicrobial activity and ability to dissolve necrotic tissues. However, when used improperly, NaClO can cause a series of adverse reactions, such as mucosal inflammation, irritation, or injury. This paper presents a case of accidental injection of NaClO in inferior alveolar nerve block anesthesia.

Dynamics of morphofunctional erythrocyte properties during intravenous glucose injection in patients with coronary heart disease

NASA Astrophysics Data System (ADS)

Malinova, Lidia I.; Simonenko, Georgy V.; Denisova, Tatyana P.; Tuchin, Valery V.

2007-02-01

Dynamics of glucose concentration in human organism is an important diagnostic characteristic for it's parameters correlate significantly with the severity of metabolic, vessel and perfusion disorders. 36 patients with stable angina pectoris of II and III functional classes were involved in this study. All of them were men in age range of 45-59 years old. 7 patients hospitalized with acute myocardial infarction (aged from 49 to 59 years old) form the group of compare. Control group (n = 5) was of practically healthy men in comparable age. To all patients intravenous glucose solution (40%) in standard loading dose was injected. Capillary and vein blood samples were withdrawn before, and 5, 60, 120, 180 and 240 minutes after glucose load. At these time points blood pressure and glucose concentration were measured. In prepared blood smears shape, deformability and sizes of erythrocytes, quantity and degree of shear stress resistant erythrocyte aggregates were studied. Received data were approximated by polynomial of high degree to receive concentration function of studied parameters, which first derivative elucidate velocity characteristics of morphofunctional erythrocyte properties during intravenous glucose injection in patients with coronary heart disease and practically healthy persons. Received data show principle differences in dynamics of morphofunctional erythrocyte properties during intravenous glucose injection in patients with coronary heart disease as a possible mechanism of coronary blood flow destabilization.

Factors influencing variation in dentist service rates.

PubMed

Grembowski, D; Milgrom, P; Fiset, L

1990-01-01

In the previous article, we calculated dentist service rates for 200 general dentists based on a homogeneous, well-educated, upper-middle-class population of patients. Wide variations in the rates were detected. In this analysis, factors influencing variation in the rates were identified. Variation in rates for categories of dental services was explained by practice characteristics, patient exposure to fluoridated water supplies, and non-price competition in the dental market. Rates were greatest in large, busy practices in markets with high fees. Older practices consistently had lower rates across services. As a whole, these variables explained between 5 and 30 percent of the variation in the rates.

On the transition between two-phase and single-phase interface dynamics in multicomponent fluids at supercritical pressures

NASA Astrophysics Data System (ADS)

Dahms, Rainer N.; Oefelein, Joseph C.

2013-09-01

A theory that explains the operating pressures where liquid injection processes transition from exhibiting classical two-phase spray atomization phenomena to single-phase diffusion-dominated mixing is presented. Imaging from a variety of experiments have long shown that under certain conditions, typically when the pressure of the working fluid exceeds the thermodynamic critical pressure of the liquid phase, the presence of discrete two-phase flow processes become diminished. Instead, the classical gas-liquid interface is replaced by diffusion-dominated mixing. When and how this transition occurs, however, is not well understood. Modern theory still lacks a physically based model to quantify this transition and the precise mechanisms that lead to it. In this paper, we derive a new model that explains how the transition occurs in multicomponent fluids and present a detailed analysis to quantify it. The model applies a detailed property evaluation scheme based on a modified 32-term Benedict-Webb-Rubin equation of state that accounts for the relevant real-fluid thermodynamic and transport properties of the multicomponent system. This framework is combined with Linear Gradient Theory, which describes the detailed molecular structure of the vapor-liquid interface region. Our analysis reveals that the two-phase interface breaks down not necessarily due to vanishing surface tension forces, but due to thickened interfaces at high subcritical temperatures coupled with an inherent reduction of the mean free molecular path. At a certain point, the combination of reduced surface tension, the thicker interface, and reduced mean free molecular path enter the continuum length scale regime. When this occurs, inter-molecular forces approach that of the multicomponent continuum where transport processes dominate across the interfacial region. This leads to a continuous phase transition from compressed liquid to supercritical mixture states. Based on this theory, a regime diagram for liquid injection is developed that quantifies the conditions under which classical sprays transition to dense-fluid jets. It is shown that the chamber pressure required to support diffusion-dominated mixing dynamics depends on the composition and temperature of the injected liquid and ambient gas. To illustrate the method and analysis, we use conditions typical of diesel engine injection. We also present a companion set of high-speed images to provide experimental validation of the presented theory. The basic theory is quite general and applies to a wide range of modern propulsion and power systems such as liquid rockets, gas turbines, and reciprocating engines. Interestingly, the regime diagram associated with diesel engine injection suggests that classical spray phenomena at typical injection conditions do not occur.

PubMed Central

MAZZOLA, R.F.; CANTARELLA, G.; TORRETTA, S.; SBARBATI, A.; LAZZARI, L.; PIGNATARO, L.

2011-01-01

SUMMARY Minimally-invasive autologous fat injection of the head and neck region can be considered a valid alternative to major invasive surgical procedures both for aesthetic and functional purposes. The favourable outcomes of autologous fat injection in otolaryngological practice are due to the filling of soft tissue and, mainly, to the potential regenerative effect of adipose-derived mesenchymal stem cells. Herewith, some important biological preliminary remarks are described underlying the potential of autologous fat injection in regenerative medicine, and personal experience in using it for both consolidated clinical applications, such as fat grafting to the face and vocal fold augmentation in the treatment of glottic incompetence, and more recent applications including the treatment of post-parotidectomy Frey syndrome and velopharyngeal insufficiency. PMID:22058586

Unsafe injections in the developing world and transmission of bloodborne pathogens: a review.

PubMed Central

Simonsen, L.; Kane, A.; Lloyd, J.; Zaffran, M.; Kane, M.

1999-01-01

Unsafe injections are suspected to occur routinely in developing countries. We carried out a literature review to quantify the prevalence of unsafe injections and to assess the disease burden of bloodborne infections attributable to this practice. Quantitative information on injection use and unsafe injections (defined as the reuse of syringe or needle between patients without sterilization) was obtained by reviewing the published literature and unpublished WHO reports. The transmissibility of hepatitis B and C viruses and human immunodeficiency virus (HIV) was estimated using data from studies of needle-stick injuries. Finally, all epidemiological studies that linked unsafe injections and bloodborne infections were evaluated to assess the attributable burden of bloodborne infections. It was estimated that each person in the developing world receives 1.5 injections per year on average. However, institutionalized children, and children and adults who are ill or hospitalized, including those infected with HIV, are often exposed to 10-100 times as many injections. An average of 95% of all injections are therapeutic, the majority of which were judged to be unnecessary. At least 50% of injections were unsafe in 14 of 19 countries (representing five developing world regions) for which data were available. Eighteen studies reported a convincing link between unsafe injections and the transmission of hepatitis B and C, HIV, Ebola and Lassa virus infections and malaria. Five studies attributed 20-80% of all new hepatitis B infections to unsafe injections, while three implicated unsafe injections as a major mode of transmission of hepatitis C. In conclusion, unsafe injections occur routinely in most developing world regions, implying a significant potential for the transmission of any bloodborne pathogen. Unsafe injections currently account for a significant proportion of all new hepatitis B and C infections. This situation needs to be addressed immediately, as a political and policy issue, with responsibilities clearly defined at the global, country and community levels. PMID:10593026

Controlling parental feeding practices and child body composition in ethnically and economically diverse preschool children.

PubMed

Wehrly, Sarah E; Bonilla, Chantal; Perez, Marisol; Liew, Jeffrey

2014-02-01

Controlling parental feeding practices may be associated with childhood overweight, because coercive or intrusive feeding practices may negatively impact children's development of self-regulation of eating. This study examined pressuring or forcing a child (healthy or unhealthy foods) and restricting child from unhealthy or snack foods as two types of controlling feeding practices that explain unique variances in measures of child body composition (BMI, percent body fat, and parental perception of child weight). In an ethnically and economically diverse sample of 243 children aged 4-6years old and their biological parents (89% biological mothers, 8% biological fathers, and 3% step or grand-parent), descriptive statistics indicate ethnic and family income differences in measures of feeding practices and child body composition. Additionally, the two "objective" indices of body composition (BMI and percent body fat) were related to low pressure to eat, whereas the "subjective" index (perceived child weight) was related to restriction. Regression analyses accounting for ethnic and family income influences indicate that pressure to eat and restriction both explained unique variances in the two "objective" indices of body composition, whereas only restriction explained variance in perceived child weight. Findings have implications for helping parents learn about feeding practices that promote children's self-regulation of eating that simultaneously serves as an obesity prevention strategy. Copyright © 2013 Elsevier Ltd. All rights reserved.

Dynamic Pore-Scale Imaging of Reactive Transport in Heterogeneous Carbonates at Reservoir Conditions Across Multiple Dissolution Regimes

NASA Astrophysics Data System (ADS)

Menke, H. P.; Bijeljic, B.; Andrew, M. G.; Blunt, M. J.

2014-12-01

Sequestering carbon in deep geologic formations is one way of reducing anthropogenic CO2 emissions. When supercritical CO2 mixes with brine in a reservoir, the acid generated has the potential to dissolve the surrounding pore structure. However, the magnitude and type of dissolution are condition dependent. Understanding how small changes in the pore structure, chemistry, and flow properties affect dissolution is paramount for successful predictive modelling. Both 'Pink Beam' synchrotron radiation and a Micro-CT lab source are used in dynamic X-ray microtomography to investigate the pore structure changes during supercritical CO2 injection in carbonate rocks of varying heterogeneity at high temperatures and pressures and various flow-rates. Three carbonate rock types were studied, one with a homogeneous pore structure and two heterogeneous carbonates. All samples are practically pure calcium carbonate, but have widely varying rock structures. Flow-rate was varied in three successive experiments by over an order of magnitude whlie keeping all other experimental conditions constant. A 4-mm carbonate core was injected with CO2-saturated brine at 10 MPa and 50oC. Tomographic images were taken at 30-second to 20-minute time-resolutions during a 2 to 4-hour injection period. A pore network was extracted using a topological analysis of the pore space and pore-scale flow modelling was performed directly on the binarized images with connected pathways and used to track the altering velocity distributions. Significant differences in dissolution type and magnitude were found for each rock type and flowrate. At the highest flow-rates, the homogeneous carbonate was seen to have predominately uniform dissolution with minor dissolution rate differences between the pores and pore throats. Alternatively, the heterogeneous carbonates which formed wormholes at high flow rates. At low flow rates the homogeneous rock developed wormholes, while the heterogeneous samples showed evidence of compact dissolution. This study serves as a unique benchmark for pore-scale reactive transport modelling directly on the binarized Micro-CT images. Dynamic pore-scale imaging methods offer advantages in helping explain the dominant processes at the pore scale so that they may be up-scaled for accurate model prediction.

Analysis of multiple time scales in a transistor amplifier.

PubMed

Armstead, Douglas N; Carroll, Thomas L

2005-03-01

It was shown previously in an experiment that when high frequency signals (on the order of 1 MHz) were injected into this low frequency amplifier, the nonlinearities of the pn junctions caused period doubling, chaos, and very low frequency oscillations (on the order of 1 Hz). In this paper we present theory and simulations to explain the existence of the low frequency oscillations.

Research Relating to the Learning of Children Identified as Having Experienced Malnutrition and/or Heavy Metal Poisoning. Final Report.

ERIC Educational Resources Information Center

Snowdon, Charles T.

Described was research on the behavioral and learning effects of lead poisoning or malnutrition in rats. It is explained that approximately 200 rats (either weanling, adult, pregnant, or nursing) were injected with various amounts of lead. It was found that symtomatic levels of lead in weanling or adult rats produced no obvious behavioral or…

Viral Oncolytic Therapeutics for Neoplastic Meningitis

DTIC Science & Technology

2013-07-01

infusion method, we worked with our animal vendor, Charles River Laboratories (CRL), to adopt their intrathecal catheterization service for our...traslocation of the injected material in CSF, we attempted to correlate the parameters of lumbar bolus in intrathecally catheterized rats with those in non...explained by either partial blockage of the spinal CSF compartment in catheterized animals or by variable posterior hydrodynamic compliance (or both) and

Break-even Analysis: A Practical Tool for Administrators of Continuing Education.

ERIC Educational Resources Information Center

Noel, James

1982-01-01

Explains how break-even analysis can help the continuing education administrator in planning by clarifying the relationship between costs, volume, and surplus revenues. Also explains the concepts of fixed, variable, and semivariable costs. (CT)

The Opinions of Nursing Students Regarding the Nursing Process and Their Levels of Proficiency in Turkey.

PubMed

Taskın Yilmaz, Feride; Sabanciogullari, Selma; Aldemir, Kadriye

2015-12-01

Nursing process, as a scientific method of nursing practice, is an important tool for putting nursing knowledge into practice which increases the quality of nursing care. The study was aimed to determine the opinions of nursing students regarding the nursing process and their levels of proficiency. A total of 44 nursing students participated in this descriptive study. Data were collected by a three-part questionnaire including the opinion of students on nursing process, Gordon's functional health patterns model and the NANDA diagnoses. Data were analyzed by SPSS software. Most of the students (65.9%) believed that the nursing process was necessary. half of the students explained the diagnosis, 58.3% explained the planning, 41.3% explained the implementation, and 43.6% explained the evaluation sufficiently. It is suggested for instructors to use different teaching methods in order to develop critical thinking while teaching the nursing process.

Effect of nuclear vibrations, temperature, and orientation on injection and recombination conditions in amino-phenyl acid dyes on TiO2

NASA Astrophysics Data System (ADS)

Manzhos, Sergei; Segawa, Hiroshi; Yamashita, Koichi

2012-06-01

Adsorption geometry, nuclear vibrations, and molecular orientation of the dye with respect to the oxide surface affect significantly the performance of dye-sensitized solar cells. We compute the influence of these factors on injection and recombination conditions in organic amino-phenyl acid dyes differing by the donor group on the anatase (101) surface of titania. Nuclear motions affect significantly and differently between the dyes the driving force to injection Δ G. A temperature increase from 300 to 350 K does not have a noticeable effect on the distribution of injection rates in all studied system. Molecular dynamics simulations predict configurations in which dyes tend to lay flat on the oxide surface. The resulting proximity of the oxidation equivalent hole to the oxide is expected to promote recombination. Temporal evolution of the driving force to injection is found to be independent of dye orientation and uncorrelated to the oscillations of the Odye Ti bonds through which the dye is attached to the surface. We conclude that the dynamics of Δ G(t) is explained by uncorrelated evolution of the energies of the dye excited state and of the conduction band minimum of the oxide due to their respective vibrations. This suggests that it must be possible to control independently conditions of recombination (e.g. by preventing the dye oxidation hole from approaching TiO2 by using co-adsorbates) and of injection (e.g. by designing dyes where non-equilibrium geometries strongly destabilize dye's LUMO to increase Δ G).

Cyclic powder formation during pulsed injection of hexamethyldisiloxane in an axially asymmetric radiofrequency argon discharge

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

Despax, B.; Makasheva, K.; CNRS, LAPLACE, F-31062 Toulouse cedex 09

2012-11-01

A new approach of periodic production of dusty plasma consisting of pulsed injection of hexamethyldisiloxane (HMDSO) in argon axially asymmetric radiofrequency (RF) discharge was investigated in this work. The range of plasma operating conditions in which this dusty plasma can exist was closely examined. The obtained results clearly show that a net periodicity in the formation/disappearance of dust particles in the plasma can be maintained on a very large scale of discharge duration. The significance of discharge axial asymmetry to the dust particles behaviour in the plasma is revealed by the development of an asymmetric in shape void shifted towardsmore » the powered RF electrode. The key role of the reactive gas and its pulsed injection on each stage of the oscillating process of formation/disappearance of dust particles is disclosed by optical and electrical measurements. It is shown that the period of dusty plasma formation/disappearance is inversely related to the HMDSO injection time. Moreover, the impact of time injection over short period (5 s) is examined. It indicates the conflicting role played by the HMDSO on the reduction of dusty plasma during the reactive gas injection and the reappearance of particles in the plasma during the time off. The electronegative behavior of the plasma in the presence of negatively charged particles seems to explain the energetic modifications in the discharge. A frequency analysis of the floating potential reveals all these cyclic processes. Particularly, in the 10-200 Hz frequency range, the presence and the evolution of dust particles in the plasma over one generation can be observed.« less

Injection of κ-like suprathermal particles into diffusive shock acceleration

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

Kang, Hyesung; Petrosian, Vahé; Ryu, Dongsu

2014-06-20

We consider a phenomenological model for the thermal leakage injection in the diffusive shock acceleration (DSA) process, in which suprathermal protons and electrons near the shock transition zone are assumed to have the so-called κ-distributions produced by interactions of background thermal particles with pre-existing and/or self-excited plasma/MHD waves or turbulence. The κ-distribution has a power-law tail, instead of an exponential cutoff, well above the thermal peak momentum. So there are a larger number of potential seed particles with momentum, above that required for participation in the DSA process. As a result, the injection fraction for the κ-distribution depends on themore » shock Mach number much less severely compared to that for the Maxwellian distribution. Thus, the existence of κ-like suprathermal tails at shocks would ease the problem of extremely low injection fractions, especially for electrons and especially at weak shocks such as those found in the intracluster medium. We suggest that the injection fraction for protons ranges 10{sup –4}-10{sup –3} for a κ-distribution with 10 ≲ κ {sub p} ≲ 30 at quasi-parallel shocks, while the injection fraction for electrons becomes 10{sup –6}-10{sup –5} for a κ-distribution with κ {sub e} ≲ 2 at quasi-perpendicular shocks. For such κ values the ratio of cosmic ray (CR) electrons to protons naturally becomes K {sub e/p} ∼ 10{sup –3}-10{sup –2}, which is required to explain the observed ratio for Galactic CRs.« less

Effect analysis of intradermal hyaluronic acid injection to treat enlarged facial pores.

PubMed

Qian, Wei; Zhang, Yan-Kun; Hou, Ying; Lyu, Wei; Cao, Qian; Li, Yan-Qi; Fan, Ju-Feng

2017-08-08

To investigate the clinical application and efficacy of intradermal injection of low molecular weight hyaluronic acid (LMW-HA) for treating enlarged facial pores. From January 2015 to May 2016, 42 subjects who sought aesthetic treatment underwent intradermal injection of LMW-HA to improve enlarged facial pores. For each treatment, 2.5 mL (25 mg) of LMW-HA was injected into the skin of the full face. The treatment was repeated 2-5 times with an interval of 1 to 1.5 months between consecutive treatments. The postoperative follow-up period was 1 to 6 months. Statistical analysis was used to compare the degree of enlargement of facial pores before and after injection. The clinical efficacy and adverse effects were recorded. The enlarged facial pores before and after treatment were categorized and subjected to the Wilcoxon matched-pairs signed-rank test. The difference was statistically significant (P<.01). The improvement rate was 40.03±18.41%. No infection, nodules, or pigmentation was reported at the injection sites in the subjects who sought aesthetic treatment. The overall satisfaction rate was 92.8%. Intradermal injection of LMW-HA can significantly improve skin texture, reduce pore size, and enhance skin radiance. The injection technique was simple, safe, and effective and could easily be extended to clinical practice. © 2017 Wiley Periodicals, Inc.

Venous access and care: harnessing pragmatics in harm reduction for people who inject drugs.

PubMed

Harris, Magdalena; Rhodes, Tim

2012-06-01

To explore the facilitators of long-term hepatitis C avoidance among people who inject drugs. We employed a qualitative life history design. Recruitment took place through low-threshold drug services and drug user networks in South East and North London. Participants were interviewed at the recruitment services or in their homes. The sample comprised 35 people who inject drugs, 20 of whom were hepatitis C antibody-negative. Participants' average injecting trajectory was 19 years (6-33), with 66% primarily injecting heroin, and 34% a crack and heroin mix. Nine (26%) of the sample were female and the average age was 39 years (23-53). Two interviews were conducted with each participant, with the second interview incorporating reference to a computer-constructed life history time-line. Interview accounts were audiorecorded, transcribed verbatim and analysed thematically. Hepatitis C risk awareness was recent and deprioritized by the majority of participants. The facilitation of venous access and care was an initial and enduring rationale for safe injecting practices. Difficult venous access resulted in increased contamination of injecting environments and transitions to femoral injecting. Participants expressed an unmet desire for non-judgemental venous access information and advice. Harm reduction interventions which attend to the immediate priorities of people who inject drugs, such as venous access and care, have the potential to re-engage individuals who are jaded or confused by hepatitis C prevention messages. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

Preparation of 99Tcm-MAG3: no confirmation that sodium chloride injections from plastic containers affect radiochemical purity.

PubMed

Millar, A M; O'Brien, L M

1998-05-01

Reports have suggested that when sodium chloride injections from a plastic ampoule are used during the preparation of 99Tcm-mercaptoacetyltriglycine (99Tcm-MAG3), the radiochemical purity of the final product might be reduced. A study was therefore undertaken to examine the effect of sodium chloride injections from five manufacturers on the radiochemical purity and stability of 99Tcm-MAG3. One sodium chloride injection was supplied in a glass vial, three in plastic ampoules and one in a plastic infusion bag. Three batches of sodium chloride injections from each manufacturer were tested. The radiopharmaceutical was prepared at a radioactive concentration of 1.1 GBq in 10 ml according to the instructions of the manufacturer of TechneScan MAG3. Analysis of radiochemical purity was performed by high-performance liquid chromatography immediately after preparation and 6 h later. Using 95% as the minimum acceptable radiochemical purity, all the products were satisfactory over the 6 h test period. No manufacturer's sodium chloride injection was found to have a statistically significant effect on the radiochemical purity. Based on the 15 batches of sodium chloride injection tested, this study cannot confirm that sodium chloride injections from a plastic container affect the radiochemical purity of 99Tcm-MAG3. However, in view of the known sensitivity of some 99Tcm radiopharmaceuticals to external influences, it is probably good practice to test radiochemical purity when new batches of ancillary materials, such as sodium chloride injections, are introduced.

Injection device-related risk management toward safe administration of medications: experience in a university teaching hospital in The People's Republic of China.

PubMed

Zhu, Ling-Ling; Li, Wei; Song, Ping; Zhou, Quan

2014-01-01

The use of injection devices to administer intravenous or subcutaneous medications is common practice throughout a variety of health care settings. Studies suggest that one-half of all harmful medication errors originate during drug administration; of those errors, about two-thirds involve injectables. Therefore, injection device management is pivotal to safe administration of medications. In this article, the authors summarize the relevant experiences by retrospective analysis of injection device-related near misses and adverse events in the Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, People's Republic of China. Injection device-related near misses and adverse events comprised the following: 1) improper selection of needle diameter for subcutaneous injection, material of infusion sets, and pore size of in-line filter; 2) complications associated with vascular access; 3) incidents induced by absence of efficient electronic pump management and infusion tube management; and 4) liquid leakage of chemotherapeutic infusion around the syringe needle. Safe injection drug use was enhanced by multidisciplinary collaboration, especially among pharmacists and nurses; drafting of clinical pathways in selection of vascular access; application of approaches such as root cause analysis using a fishbone diagram; plan-do-check-act and quality control circle; and construction of a culture of spontaneous reporting of near misses and adverse events. Pharmacists must be professional in regards to medication management and use. The depth, breadth, and efficiency of cooperation between nurses and pharmacists are pivotal to injection safety.

Hydraulische Optimierung des Reaktionsraumes um einen Infiltrationsbrunnen zur unterirdischen Enteisenung. Durchführung eines Feldversuchs mit Infiltrationssteuerung (Teil 2/2) Hydraulic optimization of the reaction zone around an injection well during subsurface iron removal (SIR)

NASA Astrophysics Data System (ADS)

Bartak, Rico; Macheleidt, Wolfgang; Ahrns, Johannes; Grischek, Thomas

2017-11-01

In subsurface iron removal (SIR), oxygen-enriched water is injected into an aquifer to create a reaction zone. Ahrns et al. (2017) simulated a doubling of the efficiency coefficient by the inactivation of well screen sections during injection for a vertical SIR pilot well penetrating an aquifer with varying dissolved iron concentrations. The optimized injection regime was adopted conceptually in a pilot SIR test. An inflatable packer was used to manipulate the outflow distribution. The packer was inflated before the injection phase then evacuated with a vacuum pump before pumping while remaining inside the casing. Cycles with conventional injection were performed first and iron breakthrough was monitored in the pumped water. Subsequently when the packer was used, iron removal increased by 25% and the efficiency coefficient by 50% for an adopted reference value of 5.0 mg/l. Although the study site was unfavorable for SIR because of the unfavorable low alkalinity (pH in the re- and infiltrate decreased down to 4.2), the injectant could have been pretreated by the addition of alkalis prior to injection. This was not considered in the simulation and iron concentrations were above the limits commonly used in practice. However, the overall use of an optimized injection will still be presented.

Machine learning and deep analytics for biocomputing: call for better explainability.

PubMed

Petkovic, Dragutin; Kobzik, Lester; Re, Christopher

2018-01-01

The goals of this workshop are to discuss challenges in explainability of current Machine Leaning and Deep Analytics (MLDA) used in biocomputing and to start the discussion on ways to improve it. We define explainability in MLDA as easy to use information explaining why and how the MLDA approach made its decisions. We believe that much greater effort is needed to address the issue of MLDA explainability because of: 1) the ever increasing use and dependence on MLDA in biocomputing including the need for increased adoption by non-MLD experts; 2) the diversity, complexity and scale of biocomputing data and MLDA algorithms; 3) the emerging importance of MLDA-based decisions in patient care, in daily research, as well as in the development of new costly medical procedures and drugs. This workshop aims to: a) analyze and challenge the current level of explainability of MLDA methods and practices in biocomputing; b) explore benefits of improvements in this area; and c) provide useful and practical guidance to the biocomputing community on how to address these challenges and how to develop improvements. The workshop format is designed to encourage a lively discussion with panelists to first motivate and understand the problem and then to define next steps and solutions needed to improve MLDA explainability.

Negotiation: a necessary art for dental practice.

PubMed

Fitzpatrick, William G; Renshaw, John; Batchelor, Paul

2012-01-01

This brief paper explains why the art of negotiation has become far more important for general dental practitioners. It explains that negotiations take place with patients, with practice staff, and with funding agencies such as Primary Care Trusts. It sets out the principles for successful negotiation and gives two examples of how they can be applied. It concludes that negotiation is a skill that can be learned and that it will be a key skill as the profession faces future challenges.

Strong enhancement of emission efficiency in GaN light-emitting diodes by plasmon-coupled light amplification of graphene

NASA Astrophysics Data System (ADS)

Kim, Jong Min; Kim, Sung; Hwang, Sung Won; Kim, Chang Oh; Shin, Dong Hee; Kim, Ju Hwan; Jang, Chan Wook; Kang, Soo Seok; Hwang, Euyheon; Choi, Suk-Ho; El-Gohary, Sherif H.; Byun, Kyung Min

2018-02-01

Recently, we have demonstrated that excitation of plasmon-polaritons in a mechanically-derived graphene sheet on the top of a ZnO semiconductor considerably enhances its light emission efficiency. If this scheme is also applied to device structures, it is then expected that the energy efficiency of light-emitting diodes (LEDs) increases substantially and the commercial potential will be enormous. Here, we report that the plasmon-induced light coupling amplifies emitted light by ˜1.6 times in doped large-area chemical-vapor-deposition-grown graphene, which is useful for practical applications. This coupling behavior also appears in GaN-based LEDs. With AuCl3-doped graphene on Ga-doped ZnO films that is used as transparent conducting electrodes for the LEDs, the average electroluminescence intensity is 1.2-1.7 times enhanced depending on the injection current. The chemical doping of graphene may produce the inhomogeneity in charge densities (i.e., electron/hole puddles) or roughness, which can play a role as grating couplers, resulting in such strong plasmon-enhanced light amplification. Based on theoretical calculations, the plasmon-coupled behavior is rigorously explained and a method of controlling its resonance condition is proposed.

Injectable 3-D Fabrication of Medical Electronics at the Target Biological Tissues

NASA Astrophysics Data System (ADS)

Jin, Chao; Zhang, Jie; Li, Xiaokang; Yang, Xueyao; Li, Jingjing; Liu, Jing

2013-12-01

Conventional transplantable biomedical devices generally request sophisticated surgery which however often causes big trauma and serious pain to the patients. Here, we show an alternative way of directly making three-dimensional (3-D) medical electronics inside the biological body through sequential injections of biocompatible packaging material and liquid metal ink. As the most typical electronics, a variety of medical electrodes with different embedded structures were demonstrated to be easily formed at the target tissues. Conceptual in vitro experiments provide strong evidences for the excellent performances of the injectable electrodes. Further in vivo animal experiments disclosed that the formed electrode could serve as both highly efficient ECG (Electrocardiograph) electrode and stimulator electrode. These findings clarified the unique features and practicability of the liquid metal based injectable 3-D fabrication of medical electronics. The present strategy opens the way for directly manufacturing electrophysiological sensors or therapeutic devices in situ via a truly minimally invasive approach.

Effect of Axially Staged Fuel Introduction on Performance of One-quarter Sector of Annular Turbojet Combustor

NASA Technical Reports Server (NTRS)

Zettle, Eugene V; Mark, Herman

1953-01-01

The design principle of injecting liquid fuel at more than one axial station in an annual turbojet combustor was investigated. Fuel was injected into the combustor as much as 5 inches downstream of the primary fuel injectors. Many fuel-injection configurations were examined and the performance results are presented for 11 configurations that best demonstrate the trends in performance obtained. The performance investigations were made at a constant combustor-inlet pressure of 15 inches of mercury absolute and at air flows up to 70 percent higher than values typical of current design practice. At these higher air flows, staging the fuel introduction improved the combustion efficiency considerably over that obtained in the combustor when no fuel staging was employed. At air flows currently encountered in turbojet engines, fuel staging was of minor value. Radial temperature distribution seemed relatively unaffected by the location of fuel-injection stations.

Commercial air travel after intraocular gas injection.

PubMed

Houston, Stephen; Graf, Jürgen; Sharkey, James

2012-08-01

Passengers with intraocular gas are at risk of profound visual loss when exposed to reduced absolute pressure within the cabin of a typical commercial airliner. Information provided on the websites of the world's 10 largest airlines offer a considerable range of opinion as to when it might be safe to fly after gas injection. Physicians responsible for clearing pseassengers as 'fit to fly' should be aware modern retinal surgical techniques increasingly employ long-acting gases as vitreous substitutes. The kinetics of long-acting intraocular gases must be considered when deciding how long after surgery it is safe to travel. It is standard practice to advise passengers not to fly in aircraft until the gas is fully resorbed. To achieve this, it may be necessary to delay travel for approximately 2 wk after intraocular injection of sulfur hexafluoride (SF6) and for 6 wk after injection of perfluoropropane (C3F8).

Adolescents, sex and injecting drug use: risks for HIV infection.

PubMed

Barnard, M; McKeganey, N

1990-01-01

In this paper we present data on the HIV-related risks for adolescents growing up in an area where injecting drug use is prevalent and HIV infection has been identified among local injecting drug users. We report on young peoples' knowledge, attitudes and perceptions of drug use and injectors; HIV and AIDS; sex, safer sex and condom use. These adolescents had an extensive and practically oriented knowledge of illicit drugs and drug injectors. The majority of adolescents contacted had an unsophisticated but approximate understanding of HIV transmission dynamics and how to guard against infection. Our data suggest that many adolescents find issues relating to sex awkward, embarrassing and difficult subjects for discussion. In a final section we consider some of the policy implications of our work focussing in particular on the prevention of injecting, the promotion of condom use, and the necessity of avoiding a focus upon risk groups.

Outpatient prescription practices in rural township health centers in Sichuan Province, China

PubMed Central

2012-01-01

Background Sichuan Province is an agricultural and economically developing province in western China. To understand practices of prescribing medications for outpatients in rural township health centers is important for the development of the rural medical and health services in this province and western China. Methods This is an observational study based on data from the 4th National Health Services Survey of China. A total of 3,059 prescriptions from 30 township health centers in Sichuan Province were collected and analyzed. Seven indicators were employed in the analyses to characterize the prescription practices. They are disease distribution, average cost per encounter, number of medications per encounter, percentage of encounters with antibiotics, percentage of encounters with glucocorticoids, percentage of encounters with combined glucocorticoids and antibiotics, and percentage of encounters with injections. Results The average medication cost per encounter was 16.30 Yuan ($2.59). About 60% of the prescriptions contained Chinese patent medicine (CPM), and almost all prescriptions (98.07%) contained western medicine. 85.18% of the prescriptions contained antibiotics, of which, 24.98% contained two or more types of antibiotics; the percentage of prescriptions with glucocorticoids was 19.99%; the percentage of prescriptions with both glucocorticoids and antibiotics was 16.67%; 51.40% of the prescriptions included injections, of which, 39.90% included two or more injections. Conclusions The findings from this study demonstrated irrational medication uses of antibiotics, glucocorticoids and injections prescribed for outpatients in the rural township health centers in Sichuan Province. The reasons for irrational medication uses are not only solely due to the pursuit of maximizing benefits in the township health centers, but also more likely attributable to the lack of medical knowledge of rational medication uses among rural doctors and the lack of medical devices for disease diagnosis in those township health centers. The policy implication from this study is to enhance professional training in rational medication uses for rural doctors, improve hardware facilities for township health centers, promote health education to rural residents and establish a public reporting system to monitor prescription practices in rural township health centers, etc. PMID:22988946

Clinical effectiveness of the obturator externus muscle injection in chronic pelvic pain patients.

PubMed

Kim, Shin Hyung; Kim, Do Hyeong; Yoon, Duck Mi; Yoon, Kyung Bong

2015-01-01

Because of its anatomical location and function, the obturator externus (OE) muscle can be a source of pain; however, this muscle is understudied as a possible target for therapeutic intervention in pain practice. In this retrospective observational study, we evaluated the clinical effectiveness of the OE muscle injection with a local anesthetic in chronic pelvic pain patients with suspected OE muscle problems. Twenty-three patients with localized tenderness on the inferolateral side of the pubic tubercle accompanied by pain in the groin, anteromedial thigh, or hip were studied. After identifying the OE with contrast dye under fluoroscopic guidance, 5 to 8 mL of 0.3% lidocaine was injected. Pain scores were assessed before and after injection; patient satisfaction was also assessed. Mean pain score decreased by 44.7% (6.6 ± 1.8 to 3.5 ± 0.9, P < 0.001) 2 weeks after OE muscle injection as compared with pain score before injection. In addition, 82% of patients (19 of 23 patients) reported excellent or good satisfaction during 2 weeks after injection. No patients reported complications from OE muscle injection. Fluoroscopy-guided injection of the OE muscle with local anesthetic reduced pain scores and led to a high level of satisfaction at short-term follow-up in patients with suspected OE muscle problem. The results of this study suggest that OE muscle injection may be a valuable therapeutic option for a select group of chronic pelvic pain patients who present with localized tenderness in the OE muscle that is accompanied by groin, anteromedial thigh, or hip pain. © 2013 World Institute of Pain.

Injection Force of SoloSTAR® Compared with Other Disposable Insulin Pen Devices at Constant Volume Flow Rates

PubMed Central

van der Burg, Thomas

2011-01-01

Background Injection force is a particularly important practical aspect of therapy for patients with diabetes, especially those who have dexterity problems. This laboratory-based study compared the injection force of the SoloSTAR® insulin pen (SoloSTAR; sanofi-aventis) versus other available disposable pens at injection speeds based on the delivered volume of insulin released at the needle. Method Four different prefilled disposable pens were tested: SoloSTAR containing insulin glargine; FlexPen® and the Next Generation FlexPen® (NGFP) (Novo Nordisk), both containing insulin detemir; and KwikPen® containing insulin lispro (Eli Lilly). All pens were investigated using the maximum dispense volume for each pen type [80 units (U) for SoloSTAR; 60 U for the other pens], from the free needle tip dispensing into a beaker. Twenty pens of each type were fitted with the recommended needles and tested at two dose speeds (6 and 10 U/s); each pen was tested twice. Results Mean plateau injection force and maximum injection force were consistently lower with SoloSTAR compared with FlexPen, NGFP, and KwikPen at both injection speeds tested. An injection speed of 10 U/s was associated with higher injection force compared with 6 U/s for all the pens tested (p < .001). Conclusions SoloSTAR stands out because of its low injection force, even when compared with newer insulin pen devices such as the KwikPen and NGFP. This may enable patients, especially those with dexterity problems, to administer insulin more easily and improve management of their diabetes. PMID:21303637

Polydrug Use and HIV Risk Among People Who Inject Heroin in Tijuana, Mexico: A Latent Class Analysis.

PubMed

Meacham, Meredith C; Rudolph, Abby E; Strathdee, Steffanie A; Rusch, Melanie L; Brouwer, Kimberly C; Patterson, Thomas L; Vera, Alicia; Rangel, Gudelia; Roesch, Scott C

2015-01-01

Although most people who inject drugs (PWID) in Tijuana, Mexico, primarily inject heroin, injection and non-injection use of methamphetamine and cocaine is common. We examined patterns of polydrug use among heroin injectors to inform prevention and treatment of drug use and its health and social consequences. Participants were PWID residing in Tijuana, aged ≥18 years who reported heroin injection in the past six months and were recruited through respondent-driven sampling (n = 1,025). Latent class analysis was conducted to assign individuals to classes on a probabilistic basis, using four indicators of past six-month polydrug and polyroute use: cocaine injecting, cocaine smoking or snorting, methamphetamine injecting, and methamphetamine smoking or snorting. Latent class membership was regressed onto covariates in a multinomial logistic regression. Latent class analyses testing 1, 2, 3, and 4 classes were fit, with the 3-class solution fitting best. Class 1 was defined by predominantly heroin use (50.2%, n = 515); class 2 by methamphetamine and heroin use (43.7%, n = 448), and class 3 by methamphetamine, cocaine, and heroin use (6.0%, n = 62). Bivariate and multivariate analyses indicated a group of methamphetamine and cocaine users that exhibited higher-risk sexual practices and lower heroin injecting frequency, and a group of methamphetamine users who were younger and more likely to be female. Discrete subtypes of heroin PWID were identified based on methamphetamine and cocaine use patterns. These findings have identified subtypes of heroin injectors who require more tailored interventions to reduce the health and social harms of injecting drug use.

Polydrug use and HIV risk among people who inject heroin in Tijuana, Mexico: A Latent class analysis

PubMed Central

Meacham, M.C.; Rudolph, A.E.; Strathdee, S.A.; Rusch, M.L.; Brouwer, K.C.; Patterson, T.L.; Vera, A.; Rangel, G.; Roesch, S.C.

2016-01-01

Background Although most people who inject drugs (PWID) in Tijuana, Mexico, primarily inject heroin, injection and non-injection use of methamphetamine and cocaine is common. We examined patterns of polydrug use among heroin injectors to inform prevention and treatment of drug use and its health and social consequences. Methods Participants were PWID residing in Tijuana aged ≥ 18 years who reported heroin injection in the past 6 months and were recruited through respondent driven sampling (n=1025). Latent class analysis was conducted to assign individuals to classes on a probabilistic basis, using four indicators of past 6 month polydrug and polyroute use: cocaine injecting, cocaine smoking or snorting, methamphetamine injecting, methamphetamine smoking or snorting. Latent class membership was regressed onto covariates in a multinomial logistic regression. Results Latent class analyses testing 1, 2, 3, and 4 classes were fit, with the 3-class solution fitting best. Class 1 was defined by predominantly heroin use (50.2%, n=515); class 2 by methamphetamine and heroin use (43.7%, n=448), and class 3 by methamphetamine, cocaine, and heroin use (6.0%, n=62). Bivariate and multivariate analyses indicated a group of methamphetamine and cocaine users that exhibited higher risk sexual practices and lower heroin injecting frequency, and a group of methamphetamine users who were younger and more likely to be female. Conclusions Discrete subtypes of heroin PWID were identified based on methamphetamine and cocaine use patterns. These findings have identified subtypes of heroin injectors who require more tailored interventions to reduce the health and social harms of injecting drug use. PMID:26444185

Daily testosterone and gonadotropin levels are similar in azoospermic and nonazoospermic normal men administered weekly testosterone: implications for male contraceptive development.

PubMed

Amory, J K; Anawalt, B D; Bremner, W J; Matsumoto, A M

2001-01-01

Weekly intramuscular administration of testosterone esters such as testosterone enanthate (TE) suppresses gonadotropins and spermatogenesis and has been studied as a male contraceptive. For unknown reasons, however, some men fail to achieve azoospermia with such regimens. We hypothesized that either 1) daily circulating serum fluoroimmunoreactive gonadotropins were higher or testosterone levels were lower during the weekly injection interval, or 2) monthly circulating bioactive gonadotropin levels were higher in nonazoospermic men. We therefore analyzed daily testosterone and fluoroimmunoreactive gonadotropin levels as well as pooled monthly bioactive and fluoroimmunoreactive gonadotropin levels in normal men receiving chronic TE injections and correlated these levels with sperm production. After a 3-month control period, 51 normal men were randomly assigned to receive intramuscular TE at 25 mg (n = 10), 50 mg (n = 9), 100 mg (n = 10), 300 mg (n = 10), or placebo (n = 12) weekly for 6 months. After 5 months of testosterone administration, morning testosterone and fluoroimmunoreactive follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were measured daily for a 1-week period between TE injections. In addition, fluoroimmunoreactive and bioactive FSH and LH levels were measured in pooled monthly blood samples drawn just before the next TE injection. In the 100-mg and 300-mg TE groups, mean monthly fluoroimmunoreactive FSH and LH levels were suppressed by 86%-97%, bioactive FSH and LH levels by 62%-80%, and roughly half the subjects became azoospermic. In the 1-week period of month 6, daily testosterone levels between TE injections were within the normal range in men receiving placebo, or 25 or 50 mg of weekly TE, but were significantly elevated in men receiving 100 or 300 mg of weekly TE. At no point during treatment, however, were there significant differences in daily testosterone or fluoroimmunoreactive gonadotropin levels, or monthly bioactive gonadotropin levels between men achieving azoospermia and those with persistent spermatogenesis. This study, therefore, demonstrates that neither monthly nor daily differences in serum testosterone, or fluoroimmunoreactive or bioactive gonadotropins explain why some men fail to completely suppress their sperm counts to zero with weekly TE administration. Innate differences in the testicle's ability to maintain spermatogenesis in a low-gonadotropin environment may explain persistent spermatogenesis in some men treated with androgen-based contraceptive regimens.

Tolerability and short-term effectiveness of hylan G-F 20 in 4253 patients with osteoarthritis of the knee in clinical practice.

PubMed

Kemper, Ferry; Gebhardt, Ullricht; Meng, Thomas; Murray, Christopher

2005-08-01

To determine the tolerability and short-term effectiveness of hylan G-F 20 (Synvisc) in patients with symptomatic osteoarthritis (OA) of the knee in standard clinical practice. Over 800 orthopedic surgeons in Germany recorded adverse events (AEs) for approximately five consecutive patients each following 3 weekly intra-articular hylan G-F 20 injections. Patients assessed their pain on a 4-point scale before and 3 weeks after the first injection. Potential risk factors for local AEs and possible predictors of short-term effectiveness of hylan G-F 20 were explored with logistic regression. 4253 patients were treated with 12699 injections by 840 physicians at 720 sites. Local, treatment related AEs (n = 302) were reported in 180 patients (4.2% of patients; 2.4% of injections). The most frequently reported AEs were joint effusion (2.4% of patients), joint swelling (1.3%), arthralgia (1.2%), joint warmth (0.6%), and injection site erythema (0.3%). Most AEs were mild (21.4%) to moderate (40.3%) in nature. One patient experienced a serious AE of severe swelling and synovial fluid accumulation judged as possibly treatment related. Patients < 70 years old, patients with a longer time since diagnosis, and those previously treated with visco-supplementation were more likely to experience a local AE. Pain significantly (p < 0.0001) decreased 3 weeks after the first injection compared with before treatment. Potential predictors of hylan G-F 20 short-term effectiveness were being underweight, male gender, shorter time since diagnosis, and severe baseline pain. In this population of 4253 patients treated with hylan G-F 20 for OA knee pain, the overall incidence of local, treatment-related AEs was low and consistent with those reported in the current US product labeling and previously published studies. Additionally, short-term effectiveness was confirmed.

Dynamics and Synchronization of Nonlinear Oscillators with Time Delays: A Study with Fiber Lasers

DTIC Science & Technology

2007-07-19

or coupling lines PC Polarization Controller PD Photodetector VA Variable Attenuator WDM Wavelength Division Multiplexer x Chapter 1 Introduction 1.1...lasers and detectors. Injection locking of lasers is a common practice that can be used to lock the frequency and phase of a laser to an injected signal...finding a basis vector that maximizes the mean squared projection of the data. Succeeding basis vectors are found that max- imize the projection with the

Family Planning Practices, Programmes and Policies in India Including Implants and Injectables with a Special Focus on Jharkhand, India: A Brief Review

PubMed Central

Dehury, Ranjit Kumar

2015-01-01

The National Family Health Survey (NFHS)-3 clearly delineates that the usage of contraceptive practices has increased considerably but is more inclined toward terminal methods of contraception especially the female sterilization. The fact is also evident from various studies carried out from time to time in different Indian states. Given the context we carried out a short review to understand the family planning practices, programs and policies in India including implants and injectable contraceptives with a special focus on the state of Jharkhand. We found that among the reversible methods IUCD (intra uterine contraceptive devices), OC (oral contraceptive) pills and condoms are the most commonly used methods. In this review, in addition to national picture, we specially focused on the state of Jharkhand owing to its very gloomy picture of family planning practices as per NFHS -3 reports. The current usage of any methods of contraception in Jharkhand is only 35.7% out of which terminal methods especially female sterilization accounts to 23.4% and male sterilization being only 0.4%. Similar picture is also reflected in the conventional methods such as; IUCD-0.6%, oral pill -3.8% and condom-2.7%. Compared to the national figure the unmet need for family planning in Jharkhand is also relatively high for the conventional reversible methods than that of terminal methods which is 11.9 and 11.3 respectively. Injectable contraceptives are available only through private or social marketing channels, because of which their use is limited. The studies carried out in different Indian states show improvement in contraceptive prevalence but the same needs further improvement. PMID:26674943

Family Planning Practices, Programmes and Policies in India Including Implants and Injectables with a Special Focus on Jharkhand, India: A Brief Review.

PubMed

Samal, Janmejaya; Dehury, Ranjit Kumar

2015-11-01

The National Family Health Survey (NFHS)-3 clearly delineates that the usage of contraceptive practices has increased considerably but is more inclined toward terminal methods of contraception especially the female sterilization. The fact is also evident from various studies carried out from time to time in different Indian states. Given the context we carried out a short review to understand the family planning practices, programs and policies in India including implants and injectable contraceptives with a special focus on the state of Jharkhand. We found that among the reversible methods IUCD (intra uterine contraceptive devices), OC (oral contraceptive) pills and condoms are the most commonly used methods. In this review, in addition to national picture, we specially focused on the state of Jharkhand owing to its very gloomy picture of family planning practices as per NFHS -3 reports. The current usage of any methods of contraception in Jharkhand is only 35.7% out of which terminal methods especially female sterilization accounts to 23.4% and male sterilization being only 0.4%. Similar picture is also reflected in the conventional methods such as; IUCD-0.6%, oral pill -3.8% and condom-2.7%. Compared to the national figure the unmet need for family planning in Jharkhand is also relatively high for the conventional reversible methods than that of terminal methods which is 11.9 and 11.3 respectively. Injectable contraceptives are available only through private or social marketing channels, because of which their use is limited. The studies carried out in different Indian states show improvement in contraceptive prevalence but the same needs further improvement.

Relation between the Sub-Auroral Polarization Stream and Energetic Particle Injection during Substorms

NASA Astrophysics Data System (ADS)

Wang, Z.; Zou, S.; Gjerloev, J. W.; Wygant, J. R.; Ruohoniemi, J. M.; Kunduri, B.

2017-12-01

Sub-Auroral Polarization Streams (SAPS) refer to regions with intense radial electric fields in the inner magnetosphere and poleward electric fields in the conjugate subauroral ionosphere. These large electric fields lead to westward convection flows and sometimes reduce electron density in the ionosphere. SAPS play an important role in the magnetosphere-ionosphere-thermosphere coupling process. However, their relationship with energetic particle injections during substorms are still not well understood. In this study, we report two conjugate observations of SAPS during substorms from the Van Allen Probes (VAP) and the Super Dual Auroral Radar Network (SuperDARN) on May 18, 2013 and Jun 29, 2013. In both cases, a large SAPS electric field ( 10 mV/m) pointing radially outward and a magnetic field depression are observed near the inner edge of the ring current. The first event is associated with a single short-lived injection, while the second one with a series of injections. The SuperDARN observations of these SAPS events reveal quite different lifetime ( 10 min for the first event and 40 min for the second one). Using the Assimilative Mapping of Ionospheric Electrodynamics (AMIE) model and ground-based magnetometer observations as input, we show the distribution of field-aligned currents (FACs) associated with the SAPS. The above-described complex signatures can be explained by the closure of the FACs associated with the dispersionless particle injection. We conclude that particle injections during substorm can lead to localized enhanced pressure and pressure gradient, and thus the formation of SAPS through FAC closure in the ionosphere. In addition, the lifetime of SAPS depends on the injection lifetime, i.e., a series of injections can give rise to a longer lifetime of SAPS. We also run the SWMF with anisotropic feature to simulate this case and compare results with observations.

Extended Duration Vascular Endothelial Growth Factor Inhibition in the Eye: Failures, Successes, and Future Possibilities.

PubMed

Stewart, Michael W

2018-01-27

Vascular endothelial growth factor (VEGF) plays a pivotal role in the development of neovascularization and edema from several common chorioretinal vascular conditions. The intravitreally injected drugs (aflibercept, bevacizumab, conbercept, pegaptanib, and ranibizumab) used to treat these conditions improve the visual acuity and macular morphology in most patients. Monthly or bimonthly injections were administered in the phase III pivotal trials but physicians usually individualize therapy with pro re nata (PRN) or treat and extend regimens. Despite these lower frequency treatment regimens, frequent injections and clinic visits are still needed to produce satisfactory outcomes. Newly developed drugs and refillable reservoirs with favorable pharmacokinetic profiles may extend durations of action and require fewer office visits. However, we have learned from previous experiences that the longer durations of action seen in strategically designed phase III trials often do not translate to less frequent injections in real-life clinical practice. Unfortunately, long-acting therapies that produce soluble VEGF receptors (encapsulated cell technology and adenovirus injected DNA) have failed in phase II trials. The development of longer duration therapies remains a difficult and frustrating process, and frequent drug injections are likely to remain the standard-of-care for years to come.

Psychometric properties of the Blood-borne Virus Transmission Risk Assessment Questionnaire (BBV-TRAQ).

PubMed

Fry, Craig L; Lintzeris, Nick

2003-02-01

To develop a standard measure of blood-borne virus transmission risk behaviour, and examine the underlying psychometric properties. The Blood-borne Virus Transmission Risk Assessment Questionnaire (BBV-TRAQ) was developed over three consecutive phases of the original BBV-TRAQ study in adherence to classical scale development procedures, culminating in the recruitment of a development sample of current injecting drug users via convenience and snowball sampling. Needle and syringe programmes (NSPs), medical clinics, alcohol/drug agencies, peer-based and outreach organizations across inner and outer metropolitan Melbourne. Two hundred and nine current injecting drug users. The mean age was 27 years, 68% were male, 65% unemployed, 36% with prison history and 25% in methadone maintenance. BBV-TRAQ items cover specific injecting, sexual and skin penetration risk practices. BBV-TRAQ characteristics were assessed via measures of internal and test-retest reliability; collateral validation; and principal components analyses. The BBV-TRAQ has satisfactory psychometric properties. Internal (a=0.87), test-retest (r=0.84) and inter-observer reliability results were high, suggesting that the instrument provides a reliable measure of BBV risk behaviour and is reliable over time and across interviewers. A principal components analysis with varimax rotation produced a parsimonious factor solution despite modest communality, and indicated that three factors (injecting, sex and skin penetration/hygiene risks) are required to describe BBV risk behaviour. The BBV-TRAQ is reliable and represents the first risk assessment tool to incorporate sufficient coverage of injecting, sex and other skin penetration risk practices to be considered truly content valid. The questionnaire is indicated for use in addictions research, clinical, peer education and BBV risk behaviour surveillance settings.

Police Victimization Among Persons Who Inject Drugs Along the U.S.–Mexico Border

PubMed Central

Pinedo, Miguel; Burgos, José Luis; Zúñiga, María Luisa; Perez, Ramona; Macera, Caroline A.; Ojeda, Victoria D.

2015-01-01

Objective: Problematic policing practices are an important driver of HIV infection among persons who inject drugs (PWID) in the U.S.–Mexico border region. This study identifies factors associated with recent (i.e., past 6 months) police victimization (e.g., extortion, physical and sexual violence) in the border city of Tijuana, Mexico. Method: From 2011 to 2013, 733 PWID (62% male) were recruited in Tijuana and completed a structured questionnaire. Eligible participants were age 18 years or older, injected illicit drugs within the past month, and spoke Spanish or English. Multivariable logistic regression analyses identified correlates of recent experiences of police victimization (e.g., bribes, unlawful confiscation, physical and sexual violence). Results: Overall, 56% of PWID reported a recent police victimization experience in Tijuana. In multivariable logistic regression analyses, factors independently associated with recent police victimization included recent injection of methamphetamine (adjusted odds ratio [AOR] = 1.62; 95% CI [1.18, 2.21]) and recently received injection assistance by a “hit doctor” (AOR = 1.56; 95% CI [1.03, 2.36]). Increased years lived in Tijuana (AOR = 0.98 per year; 95% CI [0.97, 0.99]) and initiating drug use at a later age (AOR = 0.96 per year; 95% CI [0.92, 0.99]) were inversely associated with recent police victimization. Conclusions: Physical drugusing markers may increase PWID susceptibility to police targeting and contribute to experiences of victimization. Interventions aimed at reducing police victimization events in the U.S.–Mexico border region should consider PWID’s drug-using behaviors. Reducing problematic policing practices may be a crucial public health strategy to reduce HIV risk among PWID in this region. PMID:26402356

Theoretical aspects for estimating anisotropic saturated hydraulic conductivity from in-well or direct-push probe injection tests in uniform media

NASA Astrophysics Data System (ADS)

Klammler, Harald; Layton, Leif; Nemer, Bassel; Hatfield, Kirk; Mohseni, Ana

2017-06-01

Hydraulic conductivity and its anisotropy are fundamental aquifer properties for groundwater flow and transport modeling. Current in-well or direct-push field measurement techniques allow for relatively quick determination of general conductivity profiles with depth. However, capabilities for identifying local scale conductivities in the horizontal and vertical directions are very limited. Here, we develop the theoretical basis for estimating horizontal and vertical conductivities from different types of steady-state single-well/probe injection tests under saturated conditions and in the absence of a well skin. We explore existing solutions and a recent semi-analytical solution approach to the flow problem under the assumption that the aquifer is locally homogeneous. The methods are based on the collection of an additional piece of information in the form of a second injection (or recirculation) test at a same location, or in the form of an additional head or flow observation along the well/probe. Results are represented in dimensionless charts for partial validation against approximate solutions and for practical application to test interpretation. The charts further allow for optimization of a test configuration to maximize sensitivity to anisotropy ratio. The two methods most sensitive to anisotropy are found to be (1) subsequent injection from a lateral screen and from the bottom of an otherwise cased borehole, and (2) single injection from a lateral screen with an additional head observation along the casing. Results may also be relevant for attributing consistent divergences in conductivity measurements from different testing methods applied at a same site or location to the potential effects of anisotropy. Some practical aspects are discussed and references are made to existing methods, which appear easily compatible with the proposed procedures.

Simulation of subsurface storage and recovery of treated effluent injected in a saline aquifer, St. Petersburg, Florida

USGS Publications Warehouse

Yobbi, D.K.

1996-01-01

The potential for subsurface storage and recovery of treated effluent into the uppermost producing zone (zone A) of the Upper Floridan aquifer in St. Petersburg, Florida, is being studied by the U.S. Geological Survey, in cooperation with the city of St. Petersburg and the Southwest Florida Water Management District. A measure of the success of this practice is the recovery efficiency, or the quantity of water relative to the quantity injected, that can be recovered before the water that is withdrawn fails to meet water-quality standards. The feasibility of this practice will depend upon the ability of the injected zone to receive, store, and discharge the injected fluid. A cylindrical model of ground-water flow and solute transport, incorporating available data on aquifer properties and water quality, was developed to determine the relation of recovery efficiency to various aquifer and fluid properties that could prevail in the study area. The reference case for testing was a base model considered representative of the saline aquifer underlying St. Petersburg. Parameter variations in the tests represent possible variations in aquifer conditions in the area. The model also was used to study the effect of various cyclic injection and withdrawal schemes on the recovery efficiency of the well and aquifer system. A base simulation assuming 15 days of injection of effluent at a rate of 1.0 million gallons per day and 15 days of withdrawal at a rate of 1.0 million gallons per day was used as reference to compare changes in various hydraulic and chemical parameters on recovery efficiency. A recovery efficiency of 20 percent was estimated for the base simulation. For practical ranges of hydraulic and fluid properties that could prevail in the study area, the model analysis indicates that (1) the greater the density contrast between injected and resident formation water, the lower the recovery efficiency, (2) recovery efficiency decreases significantly as dispersion increases, (3) high formation permeability favors low recovery efficiencies, and (4) porosity and anisotropy have little effect on recovery efficiencies. In several hypothetical tests, the recovery efficiency fluctuated between about 4 and 76 percent. The sensitivity of recovery efficiency to variations in the rate and duration of injection (0.25, 0.50, 1.0, and 2.0 million gallons per day) and withdrawal cycles (60, 180, and 365 days) was determined. For a given operational scheme, recovery efficiency increased as the injection and withdrawal rate is increased. Model results indicate that recovery efficiencies of between about 23 and 37 percent can be obtained for different subsurface storage and recovery schemes. Five successive injection, storage, and recovery cycles can increase the recovery efficiency to about 46 to 62 percent. There is a larger rate of increase at smaller rates than at larger rates. Over the range of variables studied, recovery efficiency improved with successive cycles, increasing rapidly during initial cycles tyhen more slowly at later cycles. The operation of a single well used for subsurface storage and recovery appears to be technically feasible under moderately favorable conditions; however, the recovery efficiency is higly dependent upon local physical and operational parameters. A combination of hydraulic, chemical, and operational parameters that minimize dispersion and buoyancy flow, maximizes recovery efficiency. Recovery efficiency was optimal where resident formation water density and permeabilities were relatively similar and low.

Decomposition of Economic Inequality in Needle and Syringe Programs Utilization to its Determinants among Men Who Inject Drugs in Tehran using Blinder-Oaxaca Decomposition Method.

PubMed

Noroozi, Mehdi; Rahimi, Ebrahim; Ghisvand, Hessam; Qorbani, Mostafa; Sharifi, Hamid; Noroozi, Alireza; Farhoudian, Ali; Marshall, Brandon D L; Jorjoran Shoshtari, Zahra; Karimi, Salah Eddin; Rezaei, Omid; Armoon, Bahram

2018-06-07

According to latest available data there are more of 300,000 people injects drug users (PWID) in Iran. In this study, we used a Blinder-Oaxaca (BO) decomposition to explore the relative contributions of inequality in utilization of NSPs and to decompose it to its determinants in Teheran. We used data from a cross-sectional survey using snowball sampling to recruit 500 PWID from June to July 2016 in Tehran. Participants were reported injecting drug use in the past month, were able to speak and comprehend Farsi enough to respond to survey questions, and were able to provide informed consent to complete the interview. We used a BO method to decompose the role of economic inequality on utilization of needle and syringe programs. A total 520 of clients participated in the study of which data was fully complete for 500. The selected predictor variables (age, education level, marital status, homelessness, HIV risk perception, and HIV knowledge) together explain 54% (8.5% out of 16%) of total inequality in utilization of needle and syringe programs and the remaining 46% constitute the unexplained residual. HIV risk perception status contributed about 38% (3.3% out of 8.5%) to the total health inequality, followed by HIV knowledge (26%) and education level were contributed 20% each, respectively. The results showed that contribution of economic inequalities in utilization of NSPs was primarily explained by the differential effects of HIV risk perception and HIV knowledge among PWID. Reducing HIV risk perception and increasing HIV knowledge might be essential to efforts to eliminate inequalities in access to NSPs among PWID.

Solidification effects on sill formation: An experimental approach

NASA Astrophysics Data System (ADS)

Chanceaux, L.; Menand, T.

2014-10-01

Sills represent a major mechanism for constructing continental Earth's crust because these intrusions can amalgamate and form magma reservoirs and plutons. As a result, numerous field, laboratory and numerical studies have investigated the conditions that lead to sill emplacement. However, all previous studies have neglected the potential effect magma solidification could have on sill formation. The effects of solidification on the formation of sills are studied and quantified with scaled analogue laboratory experiments. The experiments presented here involved the injection of hot vegetable oil (a magma analogue) which solidified during its propagation as a dyke in a colder and layered solid of gelatine (a host rock analogue). The gelatine solid had two layers of different stiffness, to create a priori favourable conditions to form sills. Several behaviours were observed depending on the injection temperature and the injection rate: no intrusions (extreme solidification effects), dykes stopping at the interface (high solidification effects), sills (moderate solidification effects), and dykes passing through the interface (low solidification effects). All these results can be explained quantitatively as a function of a dimensionless temperature θ, which describes the experimental thermal conditions, and a dimensionless flux ϕ, which describes their dynamical conditions. The experiments reveal that sills can only form within a restricted domain of the (θ , ϕ) parameter space. These experiments demonstrate that contrary to isothermal experiments where cooling could not affect sill formation, the presence of an interface that would be a priori mechanically favourable is not a sufficient condition for sill formation; solidification effects restrict sill formation. The results are consistent with field observations and provide a means to explain why some dykes form sills when others do not under seemingly similar geological conditions.

How to Use the School Survey of Practices Associated with High Performance. REL 2016-162

ERIC Educational Resources Information Center

Weinstock, Phyllis; Yumoto, Futoshi; Abe, Yasuyo; Meyers, Coby; Wan, Yinmei

2016-01-01

This report describes and explains how to use the School Survey of Practices Associated with High Performance, which measures the degree to which schools are engaging in practices associated with high performance. State education departments and school districts can use the survey results to identify and describe school practices associated with…

Back Labor: Childbirth Myth or Reality?

MedlinePlus

... and Gynecologists. Month 6. In: Your Pregnancy and Childbirth Month to Month. 6th ed. Washington, D.C.: ... Martensson LB, et al. Sterile water injections for childbirth pain: An evidence based guide to practice. Women ...

Hepatitis C infection among injecting drug users in general practice: a cluster randomised controlled trial of clinical guidelines' implementation.

PubMed

Cullen, Walter; Stanley, June; Langton, Deirdre; Kelly, Yvonne; Staines, Anthony; Bury, Gerard

2006-11-01

Hepatitis C is a common infection among injecting drug users and has important implications for general practice. Although several clinical guidelines concerning the infection have been published, their effectiveness has yet to be tested. To assess the effectiveness of a general practice-based complex intervention to support the implementation of clinical guidelines for hepatitis C management among current or former drug users attending general practice. Cluster randomised controlled trial. General practices in the Eastern Regional Health Authority area of Ireland. Twenty-six practices were randomly allocated within strata to receive the intervention under study or to provide care as usual for a period of 6 months. There was screening for patients attending general practice for methadone maintenance treatment for hepatitis C and referral of anti-HCV antibody positive patients to a specialist hepatology department for assessment. At study completion, patients in the intervention group were significantly more likely to have been screened for hepatitis C than those in the control group, odds ratio adjusted for clustering 3.76 (95% confidence interval [CI] = 1.3 to 11.3) and this association remained significant after adjusting for other potentially confounding variables, using multiple logistic regression, with the odds ratio adjusted for clustering 4.53 (95% CI = 1.39 to 14.78). Although anti-HCV antibody positive patients in the intervention group were more likely to have been referred to a hepatology clinic, this was not statistically significant (P = 0.06). General practice has an important role in the care of people at risk of hepatitis C and when appropriately supported can effectively implement current best practice.

A survey of local anaesthesia education in European dental schools.

PubMed

Brand, H S; Kuin, D; Baart, J A

2008-05-01

A survey of European dental schools was conducted in 2006 to determine the curricular structure, techniques and materials used in local anaesthesia teaching to dental students. A questionnaire was designed to collect information about local anaesthesia education. The questionnaires were sent to the Dean of each dental school in Europe and Israel; 49 returned the completed survey, resulting in a response rate of 18.4%. Results from this survey show that dental schools are managing local anaesthesia education in different ways. At most schools, theoretical teaching begins during the first half of the third year (41%), half a year before the practical instruction (43%). In 37% of the dental schools, students use non-human objects to practice before they inject an anaesthetic in humans. The first injection in humans, usually a fellow student (61%), is mostly supervised by an oral and maxillofacial surgeon (65%). The number of injections under supervision usually depends on the individual capabilities of the student (41%). Ten per cent of the schools need permission of a medical ethics committee for the practical instruction on fellow students. All dental curricula include teaching of mandibular block anaesthesia. The majority also include instruction of infiltration anaesthesia of the upper (98%) and lower (92%) jaws in addition to infra-orbital block anaesthesia (57%). Although 82% of the schools are satisfied with the current curriculum with regard to local anaesthesia, 43% are planning changes, frequently the introduction of preclinical training models. Local anaesthesia teaching programmes show considerable variation across the surveyed European dental schools.

Optimum oil production planning using infeasibility driven evolutionary algorithm.

PubMed

Singh, Hemant Kumar; Ray, Tapabrata; Sarker, Ruhul

2013-01-01

In this paper, we discuss a practical oil production planning optimization problem. For oil wells with insufficient reservoir pressure, gas is usually injected to artificially lift oil, a practice commonly referred to as enhanced oil recovery (EOR). The total gas that can be used for oil extraction is constrained by daily availability limits. The oil extracted from each well is known to be a nonlinear function of the gas injected into the well and varies between wells. The problem is to identify the optimal amount of gas that needs to be injected into each well to maximize the amount of oil extracted subject to the constraint on the total daily gas availability. The problem has long been of practical interest to all major oil exploration companies as it has the potential to derive large financial benefit. In this paper, an infeasibility driven evolutionary algorithm is used to solve a 56 well reservoir problem which demonstrates its efficiency in solving constrained optimization problems. Furthermore, a multi-objective formulation of the problem is posed and solved using a number of algorithms, which eliminates the need for solving the (single objective) problem on a regular basis. Lastly, a modified single objective formulation of the problem is also proposed, which aims to maximize the profit instead of the quantity of oil. It is shown that even with a lesser amount of oil extracted, more economic benefits can be achieved through the modified formulation.

Competency Based Business Education: Business Math/Related Rules.

ERIC Educational Resources Information Center

Wisconsin Univ., Madison. Wisconsin Vocational Studies Center.

Modules on fractions, decimals, percentages, discounts, interest, the adding machine, and the calculation of a depreciation are included. Each module contains objectives, learning activities, pre-practice exercises, practice exercises, and post-practice exercises. At the beginning of each module, the importance of the module is explained. (MK)

Linking Theory with Practice in Basic Management

ERIC Educational Resources Information Center

Carroll, Archie B.

1974-01-01

Instructors of management in higher education have not been cautious in explaining the relation between practice and theory in their basic courses. The author distinguished between the two in suggesting that management theory is based on observed practices and may or may not have broader application. (AG)

Effects of high optical injection levels in polycrystalline Si wafers on carrier transport

NASA Astrophysics Data System (ADS)

Steele, Doneisha; Semichaevsky, Andrey

High levels of carrier injection in polycrystalline Si may arise, for example, in solar cells under concentrated sunlight. Mechanisms for non-radiative carrier recombination include trap-mediated SRH and higher-order processes, e.g., Auger recombination. In this paper we present our experimental results for intensity-dependent carrier lifetimes and conduction currents in polycrystalline Si wafers illuminated with pulses of up to 50 Sun intensity. We also use a computational model for carrier transport that includes both SRH and Auger recombination mechanisms, in order to explain our experiments. The model allows quantifying recombination rate dependence on carrier concentration. Our goal is to relate the recombination rates to Si microstructure and defect densities that are revealed by IR PL images. We acknowledge the NSF support through Grant 1505377.

Coarse grained modeling of transport properties in monoclonal antibody solution

NASA Astrophysics Data System (ADS)

Swan, James; Wang, Gang

Monoclonal antibodies and their derivatives represent the fastest growing segment of the bio pharmaceutical industry. For many applications such as novel cancer therapies, high concentration, sub-cutaneous injections of these protein solutions are desired. However, depending on the peptide sequence within the antibody, such high concentration formulations can be too viscous to inject via human derived force alone. Understanding how heterogenous charge distribution and hydrophobicity within the antibodies leads to high viscosities is crucial to their future application. In this talk, we explore a coarse grained computational model of therapeutically relevant monoclonal antibodies that accounts for electrostatic, dispersion and hydrodynamic interactions between suspended antibodies to predict assembly and transport properties in concentrated antibody solutions. We explain the high viscosities observed in many experimental studies of the same biologics.

Botulinum Toxin for the Treatment of Myofascial Pain Syndromes Involving the Neck and Back: A Review from a Clinical Perspective

PubMed Central

Climent, José M.; Fenollosa, Pedro; Martin-del-Rosario, Francisco

2013-01-01

Introduction. Botulinum toxin inhibits acetylcholine (ACh) release and probably blocks some nociceptive neurotransmitters. It has been suggested that the development of myofascial trigger points (MTrP) is related to an excess release of ACh to increase the number of sensitized nociceptors. Although the use of botulinum toxin to treat myofascial pain syndrome (MPS) has been investigated in many clinical trials, the results are contradictory. The objective of this paper is to identify sources of variability that could explain these differences in the results. Material and Methods. We performed a content analysis of the clinical trials and systematic reviews of MPS. Results and Discussion. Sources of differences in studies were found in the diagnostic and selection criteria, the muscles injected, the injection technique, the number of trigger points injected, the dosage of botulinum toxin used, treatments for control group, outcome measures, and duration of followup. The contradictory results regarding the efficacy of botulinum toxin A in MPS associated with neck and back pain do not allow this treatment to be recommended or rejected. There is evidence that botulinum toxin could be useful in specific myofascial regions such as piriformis syndrome. It could also be useful in patients with refractory MPS that has not responded to other myofascial injection therapies. PMID:23533477

Radio observations of GRB 100418a: Test of an energy injection model explaining long-lasting GRB afterglows

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

Moin, A.; Wang, Z.; Chandra, P.

We present the results of our radio observational campaign of gamma-ray burst (GRB) 100418a, for which we used the Australia Telescope Compact Array, the Very Large Array, and the Very Long Baseline Array. GRB 100418a was a peculiar GRB with unusual X-ray and optical afterglow profiles featuring a plateau phase with a very shallow rise. This observed plateau phase was believed to be due to a continued energy injection mechanism that powered the forward shock, giving rise to an unusual and long-lasting afterglow. The radio afterglow of GRB 100418a was detectable several weeks after the prompt emission. We conducted long-termmore » monitoring observations of the afterglow and attempted to test the energy injection model advocating that the continuous energy injection is due to shells of material moving at a wide range of Lorentz factors. We obtained an upper limit of γ < 7 for the expansion rate of the GRB 100418a radio afterglow, indicating that the range-of-Lorentz factor model could only be applicable for relatively slow-moving ejecta. A preferred explanation could be that continued activity of the central engine may have powered the long-lasting afterglow.« less

A Tale of Two Cities: Stigma and Health Outcomes Among People with HIV who Inject Drugs in St. Petersburg, Russia and Kohtla-Järve, Estonia

PubMed Central

Burke, Sara E.; Calabrese, Sarah K.; Dovidio, John F.; Levina, Olga S.; Uusküla, Anneli; Niccolai, Linda M.; Abel-Ollo, Katri; Heimer, Robert

2015-01-01

Experiences of stigma are often associated with negative mental and physical health outcomes. The present work tested the associations between stigma and health-related outcomes among people with HIV who inject drugs in Kohtla-Järve, Estonia and St. Petersburg, Russia. These two cities share some of the highest rates of HIV outside of sub-Saharan Africa, largely driven by injection drug use, but Estonia has implemented harm reduction services more comprehensively. People who inject drugs were recruited using respondent-driven sampling; those who indicated being HIV-positive were included in the present sample (n=381 in St. Petersburg; n=288 in Kohtla-Järve). Participants reported their health information and completed measures of internalized HIV stigma, anticipated HIV stigma, internalized drug stigma, and anticipated drug stigma. Participants in both locations indicated similarly high levels of all four forms of stigma. However, stigma variables were more strongly associated with health outcomes in Russia than in Estonia. The St. Petersburg results were consistent with prior work linking stigma and health. Lower barriers to care in Kohtla-Järve may help explain why social stigma was not closely tied to negative health outcomes there. Implications for interventions and health policy are discussed. PMID:25703668

Polarized He 3 + 2 ions in the Alternate Gradient Synchrotron to RHIC transfer line

DOE PAGES

Tsoupas, N.; Huang, H.; Méot, F.; ...

2016-09-06

The proposed electron-hadron collider (eRHIC) to be built at Brookhaven National Laboratory (BNL) will allow the collisions of 20 GeV polarized electrons with 250 GeV polarized protons, or 100 GeV/n polarized 3He +2 ions, or other unpolarized ion species. The large value of the anomalous magnetic moment of the 3He nucleus G He=(g₋2)/2=₋4.184 (where g is the g-factor of the 3He nuclear spin) combined with the peculiar layout of the transfer line which transports the beam bunches from the Alternate Gradient Synchrotron (AGS) to the Relativistic Heavy Ion Collider (RHIC) makes the transfer and injection of polarized 3He ions frommore » AGS to RHIC (AtR) a special case as we explain in the paper. Specifically in this paper we calculate the stable spin direction of a polarized 3He beam at the exit of the AtR line which is also the injection point of RHIC, and lastly, we discuss a simple modifications of the AtR beam-transfer-line, to perfectly match the stable spin direction of the injected polarized 3He beam to that of the circulating beam, at the injection point of RHIC.« less

Heat and mass transfer of liquid nitrogen in coal porous media

NASA Astrophysics Data System (ADS)

Lang, Lu; Chengyun, Xin; Xinyu, Liu

2018-04-01

Liquid nitrogen has been working as an important medium in fire extinguishing and prevention, due to its efficiency in oxygen exclusion and heat removal. Such a technique is especially crucial for coal industry in China. We built a tunnel model with a temperature monitor system (with 36 thermocouples installed) to experimentally study heat and mass transfer of liquid nitrogen in non-homogeneous coal porous media (CPM), and expected to optimize parameters of liquid nitrogen injection in engineering applications. Results indicate that injection location and amount of liquid nitrogen, together with air leakage, significantly affect temperature distribution in CPM, and non-equilibrium heat inside and outside of coal particles. The injection position of liquid nitrogen determines locations of the lowest CPM temperature and liquid nitrogen residual. In the deeper coal bed, coal particles take longer time to reach thermal equilibrium between their surface and inside. Air leakage accelerates temperature increase at the bottom of the coal bed, which is a major reason leading to fire prevention inefficiency. Measurement fluctuation of CPM temperature may be caused by incomplete contact of coal particles with liquid nitrogen flowing in the coal bed. Moreover, the secondary temperature drop (STD) happens and grows with the more injection of liquid nitrogen, and the STD phenomenon is explained through temperature distributions at different locations.

High Power Picosecond Laser Surface Micro-texturing of H13 Tool Steel and Pattern Replication onto ABS Plastics via Injection Moulding

NASA Astrophysics Data System (ADS)

Otanocha, Omonigho B.; Li, Lin; Zhong, Shan; Liu, Zhu

2016-03-01

H13 tool steels are often used as dies and moulds for injection moulding of plastic components. Certain injection moulded components require micro-patterns on their surfaces in order to modify the physical properties of the components or for better mould release to reduce mould contamination. With these applications it is necessary to study micro-patterning to moulds and to ensure effective pattern transfer and replication onto the plastic component during moulding. In this paper, we report an investigation into high average powered (100 W) picosecond laser interactions with H13 tool steel during surface micro-patterning (texturing) and the subsequent pattern replication on ABS plastic material through injection moulding. Design of experiments and statistical modelling were used to understand the influences of laser pulse repetition rate, laser fluence, scanning velocity, and number of scans on the depth of cut, kerf width and heat affected zones (HAZ) size. The characteristics of the surface patterns are analysed. The process parameter interactions and significance of process parameters on the processing quality and efficiency are characterised. An optimum operating window is recommended. The transferred geometry is compared with the patterns generated on the dies. A discussion is made to explain the characteristics of laser texturing and pattern replication on plastics.

[Magnetic resonance spectroscopy of metabolic changes in mice brain after 2-deoxy-D-glucose injection].

PubMed

Moshkin, M P; Akulov, A E; Petrovskiĭ, D V; Saĭk, O V; Petrovskiĭ, E D; Savelov, A A; Koptug, I V

2012-10-01

In vivo proton magnetic resonance spectroscopy (1H MRS) of ICR male mice was used to study the brain (hippocampus) metabolic response to the acute deficiency of the available energy or to the pro-inflammatory stimulus. Inhibition of glycolysis by means of an intraperitoneal injection with 2-deoxy-D-glucose (2DG) reduced the levels of gamma-aminobutiric acid (GABA), N-acetylaspartate (NAA) and choline compounds, and at the same time increased the levels of glutamate and glutamine. An opposite effect was found after injection with bacterial lipopolysaccharide (LPS)--a very common pro-inflammatory inducer. An increase in the amounts of GABA, NAA and choline compounds in the brain occurred three hours after the injection of LPS. Different metabolic responses to the energy deficiency and the pro-inflammatory stimuli can explain the contradictory results of the brain MRS studies under neurodegenerative pathology, which is accompanied by both mitochondrial dysfunction and inflammation. Prevalence of the excitatory metabolites such as glutamate and glutamine in 2DG treated mice is in good agreement with excitation observed during temporary reduction of the available energy under acute hypoxia or starvation. In turn, LPS, as an inducer of the sickness behavior, shifts brain metabolic pattern to prevalence of the inhibitory neurotransmitter GABA.

Methodology for the Randomised Injecting Opioid Treatment Trial (RIOTT): evaluating injectable methadone and injectable heroin treatment versus optimised oral methadone treatment in the UK

PubMed Central

Lintzeris, Nicholas; Strang, John; Metrebian, Nicola; Byford, Sarah; Hallam, Christopher; Lee, Sally; Zador, Deborah

2006-01-01

Whilst unsupervised injectable methadone and diamorphine treatment has been part of the British treatment system for decades, the numbers receiving injectable opioid treatment (IOT) has been steadily diminishing in recent years. In contrast, there has been a recent expansion of supervised injectable diamorphine programs under trial conditions in a number of European and North American cities, although the evidence regarding the safety, efficacy and cost effectiveness of this treatment approach remains equivocal. Recent British clinical guidance indicates that IOT should be a second-line treatment for those patients in high-quality oral methadone treatment who continue to regularly inject heroin, and that treatment be initiated in newly-developed supervised injecting clinics. The Randomised Injectable Opioid Treatment Trial (RIOTT) is a multisite, prospective open-label randomised controlled trial (RCT) examining the role of treatment with injected opioids (methadone and heroin) for the management of heroin dependence in patients not responding to conventional substitution treatment. Specifically, the study examines whether efforts should be made to optimise methadone treatment for such patients (e.g. regular attendance, supervised dosing, high oral doses, access to psychosocial services), or whether such patients should be treated with injected methadone or heroin. Eligible patients (in oral substitution treatment and injecting illicit heroin on a regular basis) are randomised to one of three conditions: (1) optimized oral methadone treatment (Control group); (2) injected methadone treatment; or (3) injected heroin treatment (with access to oral methadone doses). Subjects are followed up for 6-months, with between-group comparisons on an intention-to-treat basis across a range of outcome measures. The primary outcome is the proportion of patients who discontinue regular illicit heroin use (operationalised as providing >50% urine drug screens negative for markers of illicit heroin in months 4 to 6). Secondary outcomes include measures of other drug use, injecting practices, health and psychosocial functioning, criminal activity, patient satisfaction and incremental cost effectiveness. The study aims to recruit 150 subjects, with 50 patients per group, and is to be conducted in supervised injecting clinics across England. PMID:17002810

Occurrence and extent of bruising according to duration of administration of subcutaneous low-molecular-weight heparin: a quasi-experimental case-crossover study.

PubMed

Palese, Alvisa; Aidone, Elena; Dante, Angelo; Pea, Federico

2013-01-01

Several authors have documented the role of low-molecular-weight heparin injection techniques in bruising. However, few researchers have measured the influence of injection duration on the occurrence and extent of bruising. The aim of this study was to evaluate the influence of different durations of subcutaneous heparin injection on the occurrence and extent of bruising. A quasi-experimental case-crossover study design was adopted in 2010. A consecutive series of patients admitted to 2 orthopedic units in a large (600 beds) teaching hospital located in northern Italy were eligible for enrolment. Injections were administered following a standard procedure. The manipulated variable was the duration of the injection, 10 seconds (treatment A) and 30 seconds (treatment B). The evaluation of bruise occurrence and extension performed after 48 hours and data analysis were conducted in a blinded fashion. A total of 150 patients receiving their first and second subcutaneous heparin injections (300 injections) were enrolled. Eighty-seven bruises were observed out of 300 injections (29%): 57 of 150 (38%) after injections lasting 10 seconds and 30 of 150 (20%) after injections lasting 30 seconds (relative risk, 1.50; 95% confidence interval, 1.21-1.86; P = .00). Of the 87 bruises that occurred, 69 (79.3%) were small (2-5 mm) and 18 (20.6%) were large (>5 mm), with no difference in size between 10- and 30-second injections (relative risk, 0.91; 95% confidence interval, 0.39-2.12; P = .83). Low-molecular-weight heparin injection should be administered over 30 seconds to decrease bruising. There is a need to reflect on the feasibility of such a practice because injecting low-molecular-weight heparin at 30 seconds requires accuracy, a steady hand, the absence of tremor, a calm environment, and the ability to administer an infinitesimally small amount of liquid (eg, 0.4 mL) per second.

An analysis of respondent-driven sampling with injecting drug users in a high HIV prevalent state of India.

PubMed

Phukan, Sanjib Kumar; Medhi, Gajendra Kumar; Mahanta, Jagadish; Adhikary, Rajatashuvra; Thongamba, Gay; Paranjape, Ramesh S; Akoijam, Brogen S

2017-07-03

Personal networks are significant social spaces to spread of HIV or other blood-borne infections among hard-to-reach population, viz., injecting drug users, female sex workers, etc. Sharing of infected needles or syringes among drug users is one of the major routes of HIV transmission in Manipur, a high HIV prevalence state in India. This study was carried out to describe the network characteristics and recruitment patterns of injecting drug users and to assess the association of personal network with injecting risky behaviors in Manipur. A total of 821 injecting drug users were recruited into the study using respondent-driven sampling (RDS) from Bishnupur and Churachandpur districts of Manipur; data on demographic characteristics, HIV risk behaviors, and network size were collected from them. Transition probability matrices and homophily indices were used to describe the network characteristics, and recruitment patterns of injecting drug users. Univariate and multivariate binary logistic regression models were performed to analyze the association between the personal networks and sharing of needles or syringes. The average network size was similar in both the districts. Recruitment analysis indicates injecting drug users were mostly engaged in mixed age group setting for injecting practice. Ever married and new injectors showed lack of in-group ties. Younger injecting drug users had mainly recruited older injecting drug users from their personal network. In logistic regression analysis, higher personal network was found to be significantly associated with increased likelihood of injecting risky behaviors. Because of mixed personal network of new injectors and higher network density associated with HIV exposure, older injecting drug users may act as a link for HIV transmission or other blood-borne infections to new injectors and also to their sexual partners. The information from this study may be useful to understanding the network pattern of injecting drug users for enriching the HIV prevention in this region.

Delayed hypersensitivity reaction of the knee after injection of arthroscopy portals with bupivacaine (marcaine)

PubMed

Craft, D V; Good, R P

1994-06-01

The number of arthroscopic procedures performed annually for the management of intraarticular injuries has grown at an exponential rate. Whether done with the patient under general anesthesia or local anesthesia supplemented with intravenous sedation, it is common practice to postoperatively inject each portal as well as the joint with a local anesthetic to provide pain relief in the transition to the recovery room and discharge after outpatient surgery. To our knowledge, no previous reports of localized urticaria and delayed hypersensitivity reaction have been reported in the postarthroscopy setting. We are reporting a case of delayed hypersensitivity reaction and urticaria of the knee that presented after bupivacaine (Marcaine) injection of arthroscopic portals after routine meniscectomy.

The Growing Popularity of Prescription Opioid Injection in Downtown Montréal: New Challenges for Harm Reduction

PubMed Central

Roy, Élise; Arruda, Nelson; Bourgois, Phillipe

2011-01-01

Starting in 2007, a 2-year study based on ethnographic methodology was carried out downtown Montréal, Canada. A thematic analysis of observational and interview-based notes was conducted. Illicit prescription opioid (PO) use was widespread among street-based participants. Injection was the main mode of PO administration observed among users. Some injection practices such as “doing a wash” could pose new challenges in terms of prevention of infections. More research is needed to examine the role of illicit PO use in the development of opiate addiction and to better understand drug-using contexts that put PO users at risk of infections. The study’s limitations are noted. PMID:21370963

Enhanced cuticular penetration as the mechanism for synergy of insecticidal constituents of rosemary essential oil in Trichoplusia ni

PubMed Central

Tak, Jun-Hyung; Isman, Murray B.

2015-01-01

Synergistic interactions between constituents of essential oils have been reported for several areas of research. In the present study, mechanisms that could explain the synergistic action of the two major insecticidal constituents of rosemary oil, 1,8-cineole and camphor against the cabbage looper, Trichoplusia ni were investigated. 1,8-Cineole was more toxic than camphor when applied topically to larvae, and when coadministered in their ratio naturally occurring in rosemary oil, the binary mixture was synergistic. However, when injected directly into larvae, camphor was more toxic than 1,8-cineole. GC-MS analyses showed that penetration of topically-applied camphor was significantly enhanced when it was mixed with 1,8-cineole in the natural ratio. A bioassay combining injection and topical application methods confirmed the increased penetration of both compounds when mixed, showing the same bioactivity as seen for higher amounts applied individually. Lowered surface tension as well as increased solubility of camphor by 1,8-cineole, along with the interaction between 1,8-cineole and the lipid layer of the insect’s cuticle may explain the enhanced penetration of camphor. Because of the similarities in biological function of animal and microbial membranes, our finding has potential for application in other fields of study. PMID:26223769

Photospheric Emission from Stratified Jets

NASA Astrophysics Data System (ADS)

Ito, Hirotaka; Nagataki, Shigehiro; Ono, Masaomi; Lee, Shiu-Hang; Mao, Jirong; Yamada, Shoichi; Pe'er, Asaf; Mizuta, Akira; Harikae, Seiji

2013-11-01

We explore photospheric emissions from stratified two-component jets, wherein a highly relativistic spine outflow is surrounded by a wider and less relativistic sheath outflow. Thermal photons are injected in regions of high optical depth and propagated until the photons escape at the photosphere. Because of the presence of shear in velocity (Lorentz factor) at the boundary of the spine and sheath region, a fraction of the injected photons are accelerated using a Fermi-like acceleration mechanism such that a high-energy power-law tail is formed in the resultant spectrum. We show, in particular, that if a velocity shear with a considerable variance in the bulk Lorentz factor is present, the high-energy part of observed gamma-ray bursts (GRBs) photon spectrum can be explained by this photon acceleration mechanism. We also show that the accelerated photons might also account for the origin of the extra-hard power-law component above the bump of the thermal-like peak seen in some peculiar bursts (e.g., GRB 090510, 090902B, 090926A). We demonstrate that time-integrated spectra can also reproduce the low-energy spectrum of GRBs consistently using a multi-temperature effect when time evolution of the outflow is considered. Last, we show that the empirical E p-L p relation can be explained by differences in the outflow properties of individual sources.

Water-assisted growth of graphene on carbon nanotubes by the chemical vapor deposition method.

PubMed

Feng, Jian-Min; Dai, Ye-Jing

2013-05-21

Combining carbon nanotubes (CNTs) with graphene has been proved to be a feasible method for improving the performance of graphene for some practical applications. This paper reports a water-assisted route to grow graphene on CNTs from ferrocene and thiophene dissolved in ethanol by the chemical vapor deposition method in an argon flow. A double injection technique was used to separately inject ethanol solution and water for the preparation of graphene/CNTs. First, CNTs were prepared from ethanol solution and water. The injection of ethanol solution was suspended and water alone was injected into the reactor to etch the CNTs. Thereafter, ethanol solution was injected along with water, which is the key factor in obtaining graphene/CNTs. Transmission electron microscopy, scanning electron microscopy, X-ray diffraction, and Raman scattering analyses confirmed that the products were the hybrid materials of graphene/CNTs. X-ray photo-electron spectroscopy analysis showed the presence of oxygen rich functional groups on the surface of the graphene/CNTs. Given the activity of the graphene/CNT surface, CdS quantum dots adhered onto it uniformly through simple mechanical mixing.

Injection and Sexual HIV/HCV Risk Behaviors Associated with Nonmedical Use of Prescription Opioids among Young Adults in New York City

PubMed Central

Mateu-Gelabert, Pedro; Guarino, Honoria; Jessell, Lauren; Teper, Anastasia

2014-01-01

Prevalence of nonmedical prescription opioid (PO) use has increased markedly in the U.S. This qualitative study explores the drug-use and sexual experiences of nonmedical PO users as they relate to risk for HIV and HCV transmission. Forty-six New York City young adult nonmedical PO users (ages 18–32) completed in-depth, semi-structured interviews. Despite initial perceptions of POs as less addictive and safer than illegal drugs, PO misuse often led to long-term opioid dependence and transition to heroin use and drug injection. Injectors in the sample reported sporadic syringe-sharing, frequent sharing of non-syringe injection paraphernalia and selective sharing with fellow injectors who are presumed “clean” (uninfected). Participants reported little knowledge of HCV injection-related risks and safer injection practices. They also reported engaging in unprotected sex with casual partners, exchange sex and group sex, and that PO misuse increases the risk of sexual violence. Prevention efforts addressing HIV/HCV risk should be targeted to young nonmedical PO users. PMID:25124258

Field-based simulation of a demonstration site for carbon dioxide sequestration in low-permeability saline aquifers in the Ordos Basin, China

NASA Astrophysics Data System (ADS)

Xie, Jian; Zhang, Keni; Hu, Litang; Pavelic, Paul; Wang, Yongsheng; Chen, Maoshan

2015-11-01

Saline formations are considered to be candidates for carbon sequestration due to their great depths, large storage volumes, and widespread occurrence. However, injecting carbon dioxide into low-permeability reservoirs is challenging. An active demonstration project for carbon dioxide sequestration in the Ordos Basin, China, began in 2010. The site is characterized by a deep, multi-layered saline reservoir with permeability mostly below 1.0 × 10-14 m2. Field observations so far suggest that only small-to-moderate pressure buildup has taken place due to injection. The Triassic Liujiagou sandstone at the top of the reservoir has surprisingly high injectivity and accepts approximately 80 % of the injected mass at the site. Based on these key observations, a three-dimensional numerical model was developed and applied, to predict the plume dynamics and pressure propagation, and in the assessment of storage safety. The model is assembled with the most recent data and the simulations are calibrated to the latest available observations. The model explains most of the observed phenomena at the site. With the current operation scheme, the CO2 plume at the uppermost reservoir would reach a lateral distance of 658 m by the end of the project in 2015, and approximately 1,000 m after 100 years since injection. The resulting pressure buildup in the reservoir was below 5 MPa, far below the threshold to cause fracturing of the sealing cap (around 33 MPa).

Environmental fate of emamectin benzoate after tree micro injection of horse chestnut trees.

PubMed

Burkhard, Rene; Binz, Heinz; Roux, Christian A; Brunner, Matthias; Ruesch, Othmar; Wyss, Peter

2015-02-01

Emamectin benzoate, an insecticide derived from the avermectin family of natural products, has a unique translocation behavior in trees when applied by tree micro injection (TMI), which can result in protection from insect pests (foliar and borers) for several years. Active ingredient imported into leaves was measured at the end of season in the fallen leaves of treated horse chestnut (Aesculus hippocastanum) trees. The dissipation of emamectin benzoate in these leaves seems to be biphasic and depends on the decomposition of the leaf. In compost piles, where decomposition of leaves was fastest, a cumulative emamectin benzoate degradation half-life time of 20 d was measured. In leaves immersed in water, where decomposition was much slower, the degradation half-life time was 94 d, and in leaves left on the ground in contact with soil, where decomposition was slowest, the degradation half-life time was 212 d. The biphasic decline and the correlation with leaf decomposition might be attributed to an extensive sorption of emamectin benzoate residues to leaf macromolecules. This may also explain why earthworms ingesting leaves from injected trees take up very little emamectin benzoate and excrete it with the feces. Furthermore, no emamectin benzoate was found in water containing decomposing leaves from injected trees. It is concluded, that emamectin benzoate present in abscised leaves from horse chestnut trees injected with the insecticide is not available to nontarget organisms present in soil or water bodies. Published 2014 SETAC.

Modeling earthquake rate changes in Oklahoma and Arkansas: possible signatures of induced seismicity

USGS Publications Warehouse

Llenos, Andrea L.; Michael, Andrew J.

2013-01-01

The rate of ML≥3 earthquakes in the central and eastern United States increased beginning in 2009, particularly in Oklahoma and central Arkansas, where fluid injection has occurred. We find evidence that suggests these rate increases are man‐made by examining the rate changes in a catalog of ML≥3 earthquakes in Oklahoma, which had a low background seismicity rate before 2009, as well as rate changes in a catalog of ML≥2.2 earthquakes in central Arkansas, which had a history of earthquake swarms prior to the start of injection in 2009. In both cases, stochastic epidemic‐type aftershock sequence models and statistical tests demonstrate that the earthquake rate change is statistically significant, and both the background rate of independent earthquakes and the aftershock productivity must increase in 2009 to explain the observed increase in seismicity. This suggests that a significant change in the underlying triggering process occurred. Both parameters vary, even when comparing natural to potentially induced swarms in Arkansas, which suggests that changes in both the background rate and the aftershock productivity may provide a way to distinguish man‐made from natural earthquake rate changes. In Arkansas we also compare earthquake and injection well locations, finding that earthquakes within 6 km of an active injection well tend to occur closer together than those that occur before, after, or far from active injection. Thus, like a change in productivity, a change in interevent distance distribution may also be an indicator of induced seismicity.

Distribution of effluent injected into the Boulder Zone of the Floridan aquifer system at the North District Wastewater Treatment Plant, southeastern Florida, 1997–2011

USGS Publications Warehouse

King, Jeffrey N.; Decker, Jeremy D.

2018-02-09

Nonhazardous, secondarily treated, domestic wastewater (effluent) has been injected about 1 kilometer below land surface into the Boulder Zone of the Floridan aquifer system at the North District Wastewater Treatment Plant in southeastern Florida. The Boulder Zone contains saline, nonpotable water. Effluent transport out of the injection zone is a risk of underground effluent injection. At the North District Wastewater Treatment Plant, injected effluent was detected outside the Boulder Zone. The U.S. Geological Survey, in cooperation with Miami-Dade Water and Sewer Department, investigated effluent transport from the Boulder Zone to overlying permeable zones in the Floridan aquifer system.One conceptual model is presented to explain the presence of effluent outside of the injection zone in which effluent injected into the Boulder Zone was transported to the Avon Park permeable zone, forced by buoyancy and injection pressure. In this conceptual model, effluent injected primarily into the Boulder Zone reaches a naturally occurring feature (a karst-collapse structure) near an injection well, through which the effluent is transported vertically upward to the uppermost major permeable zone of the Lower Floridan aquifer. The effluent is then transported laterally through the uppermost major permeable zone of the Lower Floridan aquifer to another naturally occurring feature northwest of the North District Wastewater Treatment Plant, through which it is then transported vertically upward into the Avon Park permeable zone. In addition, a leak within a monitoring well, between monitoring zones, allowed interflow between the Avon Park permeable zone and the Upper Floridan aquifer. A groundwater flow and effluent transport simulation of the hydrogeologic system at the North District Wastewater Treatment Plant, based on the hypothesized and non-unique conceptualization of the subsurface hydrogeology and flow system, generally replicated measured effluent constituent concentration trends. The model was calibrated to match observed concentration trends for total ammonium (NH4+) and total dissolved solids.The investigation qualitatively indicates that fractures, karst-collapse structures, faults, or other hydrogeologic features may permit effluent injected into the Boulder Zone to be transported to overlying permeable zones in the Floridan aquifer system. These findings, however, are qualitative because the locations of transport pathways that might exist from the Boulder Zone to the Avon Park permeable zone are largely unknown.

Contralateral Hyperalgesia from Injection of Endothelin-1 into the Ipsilateral Paw Requires Efferent Conduction into the Contralateral Paw.

PubMed

Strichartz, Gary R; Khodorova, Alla; Wang, Jeffrey Chi-Fei; Chen, Yu-Wen; Huang, Chuan-Chin

2015-10-01

Contralateral hyperalgesia, occurring after unilateral injury, is usually explained by central sensitization in spinal cord and brain. We previously reported that injection of endothelin-1 (ET-1) into one rat hindpaw induces prolonged mechanical and chemical sensitization of the contralateral hindpaw. Here, we examined the role of contralateral efferent activity in this process. ET-1 (2 nmol, 10 μL) was injected subcutaneously into the plantar surface of right (ipsilateral) hindpaw (ILP), and the thermal response latency and mechanical threshold for nocifensive withdrawal were determined by the use of, respectively, plantar radiant heating and von Frey filaments, for both ILP and contralateral hindpaws (CLP). Either paw was anesthetized for 60 minutes by direct injection of bupivacaine (0.25%, 40 μL), 30 minutes before ET-1. Alternatively, the contralateral sciatic nerve was blocked for 6 to 12 hours by percutaneous injection of bupivacaine-releasing microspheres 30 minutes before injection of ET-1. Systemic actions of these bupivacaine formulations were simulated by subcutaneous injection at the nuchal midline. After the injection of ET-1, the mechanical threshold of both ILP and CLP decreased by 2 hours, appeared to be lowest around 24 hours, and recovered through 48 hours to preinjection baseline at 72 hours. These hypersensitive responses were suppressed by bupivacaine injected into the ipsilateral paw before ET-1. Injection of the CLP by bupivacaine also suppressed the hypersensitivity of the CLP at all test times, and that of the ILP, except at 2 hours when it increased the sensitivity. This same pattern of change occurred when the contralateral sciatic nerve was blocked by bupivacaine-releasing microspheres. The systemic actions of these bupivacaine formulations were much smaller and only reached significance at 24 hours post-ET-1. Thermal hypersensitivity after ET-1 injection also occurred in both ILP and CLP and showed the same pattern in response to the 2 contralateral anesthetic procedures. These results show that efferent transmission through the contralateral innervation into the paw is necessary for contralateral sensitization by ET-1, suggesting that the release of substances by distal nerve endings is involved. The release of substances in the periphery is essential for contralateral sensitization by ET-1 and may also contribute to secondary hyperalgesia, occurring at loci distant from the primary injury, that occurs after surgery or nerve damage.

Factors contributing to practice variation in post-stroke rehabilitation.

PubMed Central

Lee, A J; Huber, J H; Stason, W B

1997-01-01

OBJECTIVE: To analyze geographic variability in the utilization and cost of post-stroke medical care using multiple linear regression. DATA SOURCES/STUDY SETTING: A 20 percent random sample of Medicare beneficiaries with an admission to an acute care hospital for stroke during the first six months of 1991, supplemented by data from their Medicare claims and beneficiary records, the Medicare Cost Reports for hospitals and nursing homes, and the Area Resource File. STUDY DESIGN: Weighted least squares regression is used to analyze variations in post-stroke practice patterns across 151 MSAs (Metropolitan Statistical Areas). Average post-stroke costs, utilization rates, and facility lengths of stay are regressed on patient and market characteristics. DATA COLLECTION/EXTRACTION METHODS: For a six-month post-stroke interval, beneficiary-level post-stroke costs and service utilization are averaged by MSA. Variables describing market conditions are then added to these MSA-level records. PRINCIPAL FINDINGS: Patient variables rarely explain more than a third of practice variation, and often they explain substantially less than that. Market variables (with some exception) tend to be relatively less important. Finally, one-half to two-thirds of the practice variation across MSAs is unexplained by the patient and market factors measured in our data. CONCLUSIONS: A substantial portion of inter-MSA variability in utilization and intensity of post-stroke rehabilitation services cannot be explained by differences in patient characteristics. Given the large practice differences observed across MSAs, it seems unlikely that unmeasured patient differences can account for much more of the practice differences. PMID:9180616

Chancellor Water Colloids: Characterization and Radionuclide Associated Transport

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

Reimus, Paul William; Boukhalfa, Hakim

2014-09-26

Column transport experiments were conducted in which water from the Chancellor nuclear test cavity was transported through crushed volcanic tuff from Pahute Mesa. In one experiment, the cavity water was spiked with solute 137Cs, and in another it was spiked with 239/240Pu(IV) nanocolloids. A third column experiment was conducted with no radionuclide spike at all, although the 137Cs concentrations in the water were still high enough to quantify in the column effluent. The radionuclides strongly partitioned to natural colloids present in the water, which were characterized for size distribution, mass concentration, zeta potential/surface charge, critical coagulation concentration, and qualitative mineralogy.more » In the spiked water experiments, the unanalyzed portion of the high-concentration column effluent samples were combined and re-injected into the respective columns as a second pulse. This procedure was repeated again for a third injection. Measurable filtration of the colloids was observed after each initial injection of the Chancellor water into the columns, but the subsequent injections (spiked water experiments only) exhibited no apparent filtration, suggesting that the colloids that remained mobile after relatively short transport distances were more resistant to filtration than the initial population of colloids. It was also observed that while significant desorption of 137Cs from the colloids occurred after the first injection in both the spiked and unspiked waters, subsequent injections of the spiked water exhibited much less 137Cs desorption (much greater 137Cs colloid-associated transport). This result suggests that the 137Cs that remained associated with colloids during the first injection represented a fraction that was more strongly adsorbed to the mobile colloids than the initial 137Cs associated with the colloids. A greater amount of the 239/240Pu desorbed from the colloids during the second column injection compared to the first injection, but then desorption decreased significantly in the third injection. This result suggests that the Pu(IV) nanocolloids probably at least partially dissolved during and after the first injection, resulting in enhanced desorption from the colloids during the second injection, but by the third injection the Pu started following the same trend that was observed for 137Cs. The experiments suggest a transport scale dependence in which mobile colloids and colloid-associated radionuclides observed at downstream points along a flow path have a greater tendency to remain mobile along the flow path than colloids and radionuclides observed at upstream points. This type of scale dependence may help explain observations of colloid-facilitated Pu transport over distances of up to 2 km at Pahute Mesa.« less

Practical modeling approaches for geological storage of carbon dioxide.

PubMed

Celia, Michael A; Nordbotten, Jan M

2009-01-01

The relentless increase of anthropogenic carbon dioxide emissions and the associated concerns about climate change have motivated new ideas about carbon-constrained energy production. One technological approach to control carbon dioxide emissions is carbon capture and storage, or CCS. The underlying idea of CCS is to capture the carbon before it emitted to the atmosphere and store it somewhere other than the atmosphere. Currently, the most attractive option for large-scale storage is in deep geological formations, including deep saline aquifers. Many physical and chemical processes can affect the fate of the injected CO2, with the overall mathematical description of the complete system becoming very complex. Our approach to the problem has been to reduce complexity as much as possible, so that we can focus on the few truly important questions about the injected CO2, most of which involve leakage out of the injection formation. Toward this end, we have established a set of simplifying assumptions that allow us to derive simplified models, which can be solved numerically or, for the most simplified cases, analytically. These simplified models allow calculation of solutions to large-scale injection and leakage problems in ways that traditional multicomponent multiphase simulators cannot. Such simplified models provide important tools for system analysis, screening calculations, and overall risk-assessment calculations. We believe this is a practical and important approach to model geological storage of carbon dioxide. It also serves as an example of how complex systems can be simplified while retaining the essential physics of the problem.

Treatment of rabbit cheyletiellosis with selamectin or ivermectin: a retrospective case study.

PubMed

Mellgren, Marianne; Bergvall, Kerstin

2008-01-02

A retrospective study of rabbits treated against cheyletiellosis was performed to evaluate the efficacy and safety of selamectin or ivermectin in clinical practice. Medical records from 53 rabbits with microscopically confirmed Cheyletiella infestation were collected from two small animal clinics. The rabbits were divided into three groups, based on treatment protocols. Group 1 included 11 rabbits treated with ivermectin injections at 200-476 microg kg-1 subcutaneously 2-3 times, with a mean interval of 11 days. In Group 2, 27 rabbits were treated with a combination of subcutaneous ivermectin injections (range 618-2185 microgkg-1) and oral ivermectin (range 616-2732 microgkg-1) administered by the owners, 3-6 times at 10 days interval. The last group (Group 3) included 15 rabbits treated with selamectin spot-on applications of 6.2-20,0 mgkg-1, 1-3 times with an interval of 2-4 weeks. Follow-up time was 4 months-4.5 years. Rabbits in remission were 9/11 (81,8%), 14/27 (51,9%) and 12/15 (80,8%) in groups 1, 2 and 3, respectively. All treatment protocols seemed to be sufficiently effective and safe for practice use. Though very high doses were used in Group 2 (ivermectin injections followed by oral administration), the protocol seemed less efficacious compared to ivermectin injections (Group 1) and selamectin spot on (Group 3), respectively, although not statistically significant. Controlled prospective studies including larger groups are needed to further evaluate efficacy of the treatment protocols.

AISI/DOE Technology Roadmap Program: Removal of Residual Elements in The Steel Ladle by a Combination of Top Slag and Deep Injection Practice

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

S. Street; K.S. Coley; G.A. Iron

2001-08-31

The objective of this work was to determine if tin could be removed from liquid steel by a combination of deep injection of calcium and a reducing top-slag practice. The work was carried out in three stages: injection of Ca wire into 35 Kg heats in an induction furnace under laboratory condition; a fundamental study of the solubility of Sn in the slag as a function of oxygen potential, temperature and slag composition; and, two full-scale plant trials. During the first stage, it was found that 7 to 50% of the Sn was removed from initial Sn contents of 0.1%,more » using 8 to 16 Kg of calcium per tonne of steel. The Sn solubility study suggested that low oxygen potential, high basicity of the slag and lower temperature would aid Sn removal by deep injection of Ca in the bath. However, two full-scale trials at the LMF station in Dofasco's plant showed virtually no Sn removal, mainly because of very low Ca consumption rates used (0.5 to 1.1 Kg/tonne vs. 8 to 16 Kg/tonne used during the induction furnace study in the laboratory). Based on the current price of Ca, addition of 8 to 16 Kg/tonne of steel to remove Sn is too cost prohibitive, and therefore, it is not worthwhile to pursue this process further, even though it may be technically feasible.« less

Cold Preparation of Heroin in a Black Tar Market.

PubMed

Roth, Alexis M; Armenta, Richard F; Wagner, Karla D; Strathdee, Steffanie A; Goldshear, Jesse L; Cuevas-Mota, Jazmine; Garfein, Richard S

2017-07-29

Black tar heroin is typically prepared for injection with heat which decreases the risk of HIV transmission by inactivating the virus. We received reports that persons who inject drugs (PWID) in Tijuana, Baja California, Mexico, a black tar heroin market, were using only water to dissolve heroin. Because Tijuana abuts San Diego County, CA, United States, we undertook the present analyses to determine the prevalence of this practice among PWID in San Diego, California. PWID completed quarterly behavioral assessments and serological testing for blood-borne viruses. Bivariate and multivariable logistic regression models were constructed to assess for individual, social, and structural correlates of preparing heroin without heat within the preceding 6 months. Nearly half of black tar heroin users (149/305) reported they had prepared heroin without heat within 6 months. In multivariable analysis, cold preparation was independently associated with younger age (10 year decrease; AOR = 1.25; 95% CI 1.03, 1.53), more drug injecting acquaintances (per 5 acquaintance increase; AOR = 1.05; 95% CI 1.01, 1.09) and prefilled syringe use (injecting drugs from syringes that are already filled with drugs before purchase; AOR = 1.86; 95% CI 1.14, 3.02). Conclusions/Importance: To our knowledge, this is the first paper to report that PWID living in a black tar heroin market are preparing heroin without heat. Additional research is needed to determine whether this is an endemic practice or PWID are engaging in new forms of drug preparation in response to changes in the environment.

Critical Viewing in Media Literacy Practice.

ERIC Educational Resources Information Center

Semali, Ladislaus

This paper introduces the concept of critical viewing and illustrates what it means to take a critical stance in classroom teaching practice. The paper's purposes are: first, to discuss the possibilities of criticism in classroom practice as defined by progressive educators; second, to explain the interrelationship between critical literacy and…

Ten Things Every Professor Should Know about Assessment

ERIC Educational Resources Information Center

Wolf, Kenneth; Dunlap, Joanna; Stevens, Ellen

2012-01-01

This article describes ten key assessment practices for advancing student learning that all professors should be familiar with and strategically incorporate in their classrooms and programs. Each practice or concept is explained with examples and guidance for putting it into practice. The ten are: learning outcomes, performance assessments,…

Toward practicing privacy

PubMed Central

Dwork, Cynthia; Pottenger, Rebecca

2013-01-01

Private data analysis—the useful analysis of confidential data—requires a rigorous and practicable definition of privacy. Differential privacy, an emerging standard, is the subject of intensive investigation in several diverse research communities. We review the definition, explain its motivation, and discuss some of the challenges to bringing this concept to practice. PMID:23243088

The retrobulbar sinus is superior to the lateral tail vein for the injection of contrast media in small animal cardiac imaging.

PubMed

Socher, M; Kuntz, J; Sawall, S; Bartling, S; Kachelrieß, M

2014-04-01

Cardiac perfusion studies using computed tomography are a common tool in clinical practice. Recent technical advances and the availability of dedicated small animal scanners allow the transfer of these techniques to the preclinical sector in general and to mouse models of cardiac diseases in particular. This necessitates new requirements for contrast injection techniques as a rapid transport of contrast media from the intravenous access to the animal heart. Clinical contrast agents containing high iodine concentrations are used within small animal studies although they exhibit a high viscosity which might limit their transport within the vasculature. The authors provide a comparison of the transport of contrast media following an injection into the lateral tail vein and an injection into the retrobulbar sinus and discuss the anatomy involved. The temporal evolution of a contrast bolus and its in vivo distribution is visualized. It is demonstrated that injecting contrast agents into the lateral tail vein of mice results in a retrograde blood flow to the liver veins and therefore does not deliver a detectable contrast bolus to the heart, and thus it cannot be used for cardiac perfusion studies. By contrast, boli injected into the retrobulbar sinus are rapidly transported to the heart and provide ventricular contrast enabling perfusion studies similar to those in human patients. The results demonstrate that an injection into the retrobulbar sinus is superior to an injection into the lateral tail vein for the delivery of contrast boli to the animal heart, while all drawbacks of an injection into the lateral tail vein are overcome.