Reducing Risk in CO2 Sequestration: A Framework for Integrated Monitoring of Basin Scale Injection

NASA Astrophysics Data System (ADS)

Seto, C. J.; Haidari, A. S.; McRae, G. J.

2009-12-01

Geological sequestration of CO2 is an option for stabilization of atmospheric CO2 concentrations. Technical ability to safely store CO2 in the subsurface has been demonstrated through pilot projects and a long history of enhanced oil recovery and acid gas disposal operations. To address climate change, current injection operations must be scaled up by a factor of 100, raising issues of safety and security. Monitoring and verification is an essential component in ensuring safe operations and managing risk. Monitoring provides assurance that CO2 is securely stored in the subsurface, and the mechanisms governing transport and storage are well understood. It also provides an early warning mechanism for identification of anomalies in performance, and a means for intervention and remediation through the ability to locate the CO2. Through theoretical studies, bench scale experiments and pilot tests, a number of technologies have demonstrated their ability to monitor CO2 in the surface and subsurface. Because the focus of these studies has been to demonstrate feasibility, individual techniques have not been integrated to provide a more robust method for monitoring. Considering the large volumes required for injection, size of the potential footprint, length of time a project must be monitored and uncertainty, operational considerations of cost and risk must balance safety and security. Integration of multiple monitoring techniques will reduce uncertainty in monitoring injected CO2, thereby reducing risk. We present a framework for risk management of large scale injection through model based monitoring network design. This framework is applied to monitoring CO2 in a synthetic reservoir where there is uncertainty in the underlying permeability field controlling fluid migration. Deformation and seismic data are used to track plume migration. A modified Ensemble Kalman filter approach is used to estimate flow properties by jointly assimilating flow and geomechanical

Intravitreally Injected Anti-VEGF Antibody Reduces Brown Fat in Neonatal Mice.

PubMed

Jo, Dong Hyun; Park, Sung Wook; Cho, Chang Sik; Powner, Michael B; Kim, Jin Hyoung; Fruttiger, Marcus; Kim, Jeong Hun

2015-01-01

Anti-vascular endothelial growth factor (VEGF) agents are the mainstay treatment for various angiogenesis-related retinal diseases. Currently, bevacizumab, a recombinant humanized anti-VEGF antibody, is trailed in retinopathy of prematurity, a vasoproliferative retinal disorder in premature infants. However, the risks of systemic complications after intravitreal injection of anti-VEGF antibody in infants are not well understood. In this study, we show that intravitreally injected anti-VEGF antibody is transported into the systemic circulation into the periphery where it reduces brown fat in neonatal C57BL/6 mice. A considerable amount of anti-VEGF antibody was detected in serum after intravitreal injection. Furthermore, in interscapular brown adipose tissue, we found lipid droplet accumulation, decreased VEGF levels, loss of vascular network, and decreased expression of mitochondria-related genes, Ppargc1a and Ucp1, all of which are characteristics of "whitening" of brown fat. With increasing age and body weight, brown fat restored its morphology and vascularity. Our results show that there is a transient, but significant impact of intravitreally administered anti-VEGF antibody on brown adipose tissue in neonatal mice. We suggest that more attention should be focused on the metabolic and developmental significance of brown adipose tissue in bevacizumab treated retinopathy of prematurity infants.

Intravitreally Injected Anti-VEGF Antibody Reduces Brown Fat in Neonatal Mice

PubMed Central

Powner, Michael B.; Kim, Jin Hyoung; Fruttiger, Marcus; Kim, Jeong Hun

2015-01-01

Anti-vascular endothelial growth factor (VEGF) agents are the mainstay treatment for various angiogenesis-related retinal diseases. Currently, bevacizumab, a recombinant humanized anti-VEGF antibody, is trailed in retinopathy of prematurity, a vasoproliferative retinal disorder in premature infants. However, the risks of systemic complications after intravitreal injection of anti-VEGF antibody in infants are not well understood. In this study, we show that intravitreally injected anti-VEGF antibody is transported into the systemic circulation into the periphery where it reduces brown fat in neonatal C57BL/6 mice. A considerable amount of anti-VEGF antibody was detected in serum after intravitreal injection. Furthermore, in interscapular brown adipose tissue, we found lipid droplet accumulation, decreased VEGF levels, loss of vascular network, and decreased expression of mitochondria-related genes, Ppargc1a and Ucp1, all of which are characteristics of “whitening” of brown fat. With increasing age and body weight, brown fat restored its morphology and vascularity. Our results show that there is a transient, but significant impact of intravitreally administered anti-VEGF antibody on brown adipose tissue in neonatal mice. We suggest that more attention should be focused on the metabolic and developmental significance of brown adipose tissue in bevacizumab treated retinopathy of prematurity infants. PMID:26226015

Utility of Vibratory Stimulation for Reducing Intraoral Injection Pain.

PubMed

Erdogan, Ozgur; Sinsawat, Anatachai; Pawa, Sudeep; Rintanalert, Duangtawan; Vuddhakanok, Suchada

2018-01-01

Intraoral local anesthesia injection is often perceived as a painful and anxiety-causing dental procedure. Vibration stimulus is one of the nonpharmacologic methods used to reduce unwanted sensations of local anesthesia injection. This clinical study evaluated the effectiveness of a recently introduced vibratory stimulation device in intraoral local anesthesia administration. Thirty-two subjects underwent 2 maxillary local anesthesia injections in 2 different sessions: 1 with conventional techniques and 1 with the aid of a vibratory stimulation device (DentalVibe). The pain levels were evaluated with a visual analog scale and the Wong-Baker FACES Pain Rating Scale. The subjects were asked to choose the preferred method for future injections. The data were evaluated statistically. There were no significant differences between the 2 injection methods with regard to either pain evaluation method. The preference of the subjects regarding future injection technique was evenly distributed between the groups. The vibratory stimulation device used in this study did not provide any reduction in pain level associated with maxillary infiltration local anesthesia administration.

Extraforaminal needle tip position reduces risk of intravascular injection in CT-fluoroscopic lumbar transforaminal epidural steroid injections

PubMed Central

Yu, Robinson K.; Ghodadra, Anish; Agarwal, Vikas

2016-01-01

Background Lumbar transforaminal epidural steroid injection is a common and effective tool for managing lumbar radicular pain, although accidental intravascular injection can rarely result in paralysis. The purpose of this study is to determine the safest needle tip position for computed tomography (CT)-guided lumbar transforaminal epidural steroid injections as determined by incidence of intravascular injection. Methods Three radiologists, in consensus, reviewed procedural imaging for consecutive CT-fluoroscopic lumbar transforaminal epidural steroid injections performed during a 16-month period. Intravascular injections were identified and categorized by needle tip position, vessel type injected, intravascular injection volume and procedural phase containing the intravascular injection. Pearson chi-square and logistic regression testing were used to assess differences between groups, as appropriate. Results Intravascular injections occurred in 9% (52/606) of injections. The intravascular injection rate was significantly lower (P<0.001) for extraforaminal needle position (0%, 0/109) compared to junctional (8%, 27/319) and foraminal (14%, 25/178) needle tip positions. Of the intravascular injections, 4% (2/52) were likely arterial, 35% (18/52) were likely venous, and 62% (32/52) were indeterminate for vessel type injected. 46% (24/52) of intravascular injections were large volume, 33% (17/52) were small volume, and 21% (11/52) were trace volume. 56% (29/52) of intravascular injections occurred with the contrast trial dose, 29% (15/52) with the steroid/analgesic cocktail, and 15% (8/52) with both. Conclusions An extraforaminal needle position for CT-fluoroscopic lumbar transforaminal epidural steroid injections decreases the risk of intravascular injection and therefore may be safer than other needle tip positions. PMID:28097241

Reducing ultrafine particle emissions using air injection in wood-burning cookstoves

DOE PAGES

Rapp, Vi H.; Caubel, Julien J.; Wilson, Daniel L.; ...

2016-06-27

In order to address the health risks and climate impacts associated with pollution from cooking on biomass fires, researchers have focused on designing new cookstoves that improve cooking performance and reduce harmful emissions, specifically particulate matter (PM). One method for improving cooking performance and reducing emissions is using air injection to increase turbulence of unburned gases in the combustion zone. Although air injection reduces total PM mass emissions, the effect on PM size-distribution and number concentration has not been thoroughly investigated. Using two new wood-burning cookstove designs from Lawrence Berkeley National Laboratory, this research explores the effect of air injectionmore » on cooking performance, PM and gaseous emissions, and PM size distribution and number concentration. Both cookstoves were created using the Berkeley-Darfur Stove as the base platform to isolate the effects of air injection. The thermal performance, gaseous emissions, PM mass emissions, and particle concentrations (ranging from 5 nm to 10 μm in diameter) of the cookstoves were measured during multiple high-power cooking tests. Finally, the results indicate that air injection improves cookstove performance and reduces total PM mass but increases total ultrafine (less than 100 nm in diameter) PM concentration over the course of high-power cooking.« less

Reducing ultrafine particle emissions using air injection in wood-burning cookstoves

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

Rapp, Vi H.; Caubel, Julien J.; Wilson, Daniel L.

In order to address the health risks and climate impacts associated with pollution from cooking on biomass fires, researchers have focused on designing new cookstoves that improve cooking performance and reduce harmful emissions, specifically particulate matter (PM). One method for improving cooking performance and reducing emissions is using air injection to increase turbulence of unburned gases in the combustion zone. Although air injection reduces total PM mass emissions, the effect on PM size-distribution and number concentration has not been thoroughly investigated. Using two new wood-burning cookstove designs from Lawrence Berkeley National Laboratory, this research explores the effect of air injectionmore » on cooking performance, PM and gaseous emissions, and PM size distribution and number concentration. Both cookstoves were created using the Berkeley-Darfur Stove as the base platform to isolate the effects of air injection. The thermal performance, gaseous emissions, PM mass emissions, and particle concentrations (ranging from 5 nm to 10 μm in diameter) of the cookstoves were measured during multiple high-power cooking tests. Finally, the results indicate that air injection improves cookstove performance and reduces total PM mass but increases total ultrafine (less than 100 nm in diameter) PM concentration over the course of high-power cooking.« less

The evidence for reducing the pain of administration of local anesthesia and cosmetic injectables.

PubMed

Babamiri, Kajal; Nassab, Reza

2010-09-01

Administration of injections, whether local anesthetic or cosmetic injectable, can result in significant distress and discomfort to patients. This review explores factors that can alleviate anxiety and pain associated with injections including cosmetic injectables. We highlight that many techniques used to reduce pain have only been reported based on anecdotal evidence and small series. The techniques that have been reported to reduce pain, by randomized controlled trials, include pretreatment with topical local anesthetic agents and combined cosmetic injectables with local anesthetics. © 2010 Wiley Periodicals, Inc.

Tunable Oscillations in Optically Injected Semiconductor Lasers With Reduced Sensitivity to Perturbations - Postprint

DTIC Science & Technology

2014-09-01

Squeezed light from injection- locked quantum well lasers ,” Phys. Rev. Lett., vol. 71, pp. 3951–3954, 1993. [30] A. E. Siegman , Lasers , 1st ed...AFRL-RY-WP-TP-2014-0297 TUNABLE OSCILLATIONS IN OPTICALLY INJECTED SEMICONDUCTOR LASERS WITH REDUCED SENSITIVITY TO PERTURBATIONS -POSTPRINT...OSCILLATIONS IN OPTICALLY INJECTED SEMICONDUCTOR LASERS WITH REDUCED SENSITIVITY TO PERTURBATIONS - POSTPRINT 5a. CONTRACT NUMBER In-House 5b. GRANT NUMBER

Intraoperative Transpedicular Onyx Injection to Reduce Vascularity of a Thoracic Hemangiopericytoma After Unsuccessful Preoperative Endovascular Embolization: a Technical Report.

PubMed

Mashaly, Hazem; Zhang, Zoe; Shaw, Andrew; Youssef, Patrick; Mendel, Ehud

2018-02-01

Hemangiopericytoma is a rare vascular tumor with central nervous system involvement representing only 1% of central nervous system tumors. They rarely affect the vertebral column. Complete surgical resection is the treatment of choice for hemangiopericytoma given their high rates of local recurrence. However, the high vascularity of such tumors with the risk of massive bleeding during surgery represents a significant challenge to surgeons. Therefore, preoperative endovascular embolization via the transarterial route has been advocated. In the current study, we present a case of a T12 hemangiopericytoma that was managed by a 2-stage surgical resection, with the use of intraoperative transpedicular onyx injection to reduce intraoperative blood loss following an unsuccessful trial of preoperative endovascular embolization. Preoperative endovascular embolization is not feasible in some cases due to the location of the segmental or radiculomedullary arteries in relation to tumor feeders and, rarely, small size of these arterial feeders. Percutaneous injection of onyx is an option. In this case report, we discuss direct intraoperative injection via a transpedicular route as a safe and effective method for decreasing the vascularity of some lesions and improving intraoperative blood loss. Copyright © 2017 by the Congress of Neurological Surgeons

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.

Surveillance Recommendations in Reducing Risk of and Optimally Managing Breast Cancer-Related Lymphedema

PubMed Central

Ostby, Pamela L.; Armer, Jane M.; Dale, Paul S.; Van Loo, Margaret J.; Wilbanks, Cassie L.; Stewart, Bob R.

2014-01-01

Breast cancer survivors are at increased risk for the development of breast cancer-related lymphedema (BCRL), a chronic, debilitating, and disfiguring condition that is progressive and requires lifelong self-management of symptoms. It has been reported that over 40% of the 2.5 million breast cancer survivors in the United States may meet the criteria for BCRL during their lifetimes. Ongoing surveillance, beginning with pre-operative assessment, has been effective in identifying subclinical lymphedema (LE). A prospective model for surveillance is necessary in order to detect BCRL at an early stage when there is the best chance to reduce risk or slow progression. Physical methods for monitoring and assessment, such as circumferential arm measures, perometry, bioimpedance; exercise programs; prophylactic and early-intervention compression garments; and referral for complete decongestive therapy are all interventions to consider in the development of a BCRL surveillance program. In addition, supportive-educative programs and interactive engagement for symptom self-management should also be implemented. The importance of interdisciplinary collaboration is integral to the success of an effective personalized medicine program in breast cancer-related lymphedema surveillance. PMID:25563360

Clinical evaluation of pazopanib eye drops versus ranibizumab intravitreal injections in subjects with neovascular age-related macular degeneration.

PubMed

Csaky, Karl G; Dugel, Pravin U; Pierce, Amy J; Fries, Michael A; Kelly, Deborah S; Danis, Ronald P; Wurzelmann, John I; Xu, Chun-Fang; Hossain, Mohammad; Trivedi, Trupti

2015-03-01

To evaluate pazopanib eye drops in subjects with active subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). Multicountry, randomized, parallel-group, double-masked, active and placebo-controlled, dose-ranging study of eye drops. A total of 510 subjects (93% white; 58% female; mean age, 75.3 years) whose AMD was previously managed by anti-vascular endothelial growth factor intravitreal injections. Treatments administered for 52 weeks included placebo eye drops instilled 4 times daily (n=73); pazopanib 5 mg/ml instilled 3 (n=72) or 4 times daily (n=74); pazopanib 10 mg/ml instilled 2 (n=73), 3 (n=73), or 4 times daily (n=72); or ranibizumab injection administered once every 4 weeks (n=73). In addition, for all eye drop treatment groups, open-label ranibizumab was administered as needed. The main outcome measures were best-corrected visual acuity (BCVA) and injection frequency assessed at week 52. Safety was assessed every 4 weeks and pazopanib plasma concentrations were determined at weeks 4 and 24. At week 52, pazopanib, with allowance for as-needed ranibizumab injections, was noninferior to monthly ranibizumab as well as to as-needed ranibizumab administered with placebo eye drops in maintaining BCVA (estimated BCVA gains of 0.3-1.8 vs. 1.4 vs. 0.2 letters, respectively). Pazopanib treatment did not reduce as-needed ranibizumab injections by ≥50% (prespecified efficacy criterion). At week 52, there were no clinically meaningful changes from baseline in retinal thickness or morphology, CNV size, or lesion characteristics on optical coherence tomography or fluorescein angiography. Complement factor H genotype had no effect on the responses to pazopanib and/or ranibizumab (BCVA, injection rate, or optical coherence tomography/fluorescein angiography changes). Steady-state concentrations of pazopanib in plasma seemed to be reached by week 4. The most common ocular adverse events related to pazopanib and ranibizumab were

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.

Early intervention reduces morbidity in extravasation injuries from 'lighter fuel' injection.

PubMed

Thaha, M A; McKinnell, T H; Graham, K E; Naasan, A N

2007-01-01

Injection of 'lighter fuel' with suicidal intent is rare. Extravasation of the chemical may rarely cause systemic toxicity, but usually it results in extensive soft tissue damage. Such injuries when managed by the traditional expectant policy are associated with considerable morbidity. Early aggressive surgical management using 'saline flush out' limits the tissue damage by stopping the natural progression of the chemical mediated injury and the subsequent inflammatory response, thereby allowing better skin preservation and functional outcome in these cases. We report a case of 'lighter fuel' subcutaneous extravasation injury managed by 'saline flush out' technique soon after presentation.

Mujer Mas Segura (Safer Women): a combination prevention intervention to reduce sexual and injection risks among female sex workers who inject drugs.

PubMed

Vera, Alicia; Abramovitz, Daniela; Lozada, Remedios; Martinez, Gustavo; Rangel, M Gudelia; Staines, Hugo; Patterson, Thomas L; Strathdee, Steffanie A

2012-08-14

Female sex workers who inject drugs (FSW-IDUs) are at risk of acquiring HIV, sexually transmitted infections (STI) and blood-borne infections through unprotected sex and sharing injection equipment. We conducted a 2×2 factorial randomized controlled trial to evaluate combination interventions to simultaneously reduce sexual and injection risks among FSW-IDUs in Tijuana and Ciudad Juarez, Mexico. FSW-IDUs ≥18 years reporting sharing injection equipment and unprotected sex with clients within the last month were randomized to one of four conditions based on an a priori randomization schedule, blinding interviewer/counselors to assignment. Due to the extreme vulnerability of this population, we did not include a control group that would deny some women access to preventive information. All women received similar information regardless of group allocation; the difference was in the way the information was delivered and the extent to which women had an interactive role. Each condition was a single 60-minute session, including either an interactive or didactic version of an injection risk intervention and sexual risk intervention. Women underwent interviewer-administered surveys and testing for HIV, syphilis, gonorrhea, Chlamydia, and Trichomonas at baseline and quarterly for 12 months. Combined HIV/STI incidence will be the primary outcome. Secondary outcomes are proportionate reductions in sharing of injection equipment and unprotected sex with clients. Of 1,132 women, 548 (48.4%) were excluded (88.9% were ineligible; 11.1% refused to participate or did not return); 584 eligible women enrolled (284 in Tijuana; 300 in Ciudad Juarez). All 584 participants completed the baseline interview, provided biological samples and were randomized to one of the four groups. During follow-up, 17 participants (2.9%) were lost to follow-up, of whom 10 (58.8%) had died, leaving 567 participants for analysis. This study appears to be the first intervention to attempt to simultaneously

Mujer Mas Segura (Safer Women): a combination prevention intervention to reduce sexual and injection risks among female sex workers who inject drugs

PubMed Central

2012-01-01

Background Female sex workers who inject drugs (FSW-IDUs) are at risk of acquiring HIV, sexually transmitted infections (STI) and blood-borne infections through unprotected sex and sharing injection equipment. We conducted a 2×2 factorial randomized controlled trial to evaluate combination interventions to simultaneously reduce sexual and injection risks among FSW-IDUs in Tijuana and Ciudad Juarez, Mexico. Methods/design FSW-IDUs ≥18 years reporting sharing injection equipment and unprotected sex with clients within the last month were randomized to one of four conditions based on an a priori randomization schedule, blinding interviewer/counselors to assignment. Due to the extreme vulnerability of this population, we did not include a control group that would deny some women access to preventive information. All women received similar information regardless of group allocation; the difference was in the way the information was delivered and the extent to which women had an interactive role. Each condition was a single 60-minute session, including either an interactive or didactic version of an injection risk intervention and sexual risk intervention. Women underwent interviewer-administered surveys and testing for HIV, syphilis, gonorrhea, Chlamydia, and Trichomonas at baseline and quarterly for 12 months. Combined HIV/STI incidence will be the primary outcome. Secondary outcomes are proportionate reductions in sharing of injection equipment and unprotected sex with clients. Discussion Of 1,132 women, 548 (48.4%) were excluded (88.9% were ineligible; 11.1% refused to participate or did not return); 584 eligible women enrolled (284 in Tijuana; 300 in Ciudad Juarez). All 584 participants completed the baseline interview, provided biological samples and were randomized to one of the four groups. During follow-up, 17 participants (2.9%) were lost to follow-up, of whom 10 (58.8%) had died, leaving 567 participants for analysis. This study appears to be the first

[Managment of subretinal heamorrhages within the macular area using intravitreal injections of recombined tissue plasminogen activator, sulphur hexafluoride and ranihizumab--preliminary report].

PubMed

Miniewicz, Joanna; Kubicka-Trząska, Agnieszka; Karska-Basta, Izabella; Romanowska-Dixon, Boźena

2015-01-01

Submacular hemorrhages cause serious vision impairment. Patient observation, waiting for the spontaneous blood reabsorption and resolution of the haemorrhage leads to the severe damage to retinal tissue as a result of scar formation. The paper presents 7 cases of patients with submacular haemorrhages treated with intravitreal injections of recombined tissue plasminogen activator (rtPA) and sulphur hexafluoride (SFG). In 4 cases, the haemorrhage was secondary to AMD, in two cases to trauma, and it was idiopathic in one case. All patients were treated with intravitreal injections of rtPA and SF6 for thrombolysis and pneumatic displacement of haemorrhage outside macular structures. Ranibizumab was additionally administered to patients with age-related macular degeneration. Such treatment improved visual acuity in all patients, reducing the central retinal thickness as shown in follow-up optical coherence tomography. The presented treatment of submacular hemorrhages with intravitreal injections of rtPA and SF6 provided good results, but in order to develop a standard management algorithm for this disease, the analysis of larger patient sample is required.

Nanoceria-loaded injectable hydrogels for potential age-related macular degeneration treatment.

PubMed

Wang, Kai; Mitra, Rajendra Narayan; Zheng, Min; Han, Zongchao

2018-05-12

The major purpose of this article is to evaluate oligochitosan coated cerium oxide nanoparticles (OCCNPs) alginate laden injectable hydrogels and their potential treatment for age-related macular degeneration (AMD). The water soluble OCCNPs were loaded within injectable hydrogels as antioxidative agents. The release of OCCNPs from hydrogel, radical scavenging properties, and biocompatibility were evaluated and calculated in vitro. The effects of OCCNP laden hydrogel downregulating expression of angiogenic proteins and pro-inflammatory cytokines were quantified in human retinal pigment epithlium-19 (ARPE-19) and umbilical endothelium cell lines. The hydrogels behaved with moderate swelling and controllable degradation. The laden OCCNPs were released in a controlled manner in vitro during two months of testing. The OCCNP loaded hydrogels exhibited robust antioxidative properties in oxygen radical absorbance capacity tests and reduced apoptosis in H 2 O 2 -induced ARPE-19 cells. Furthermore, OCCNP loaded injectable hydrogels are biocompatible and suppressed the LPS-induced inflammation response in ARPE-19 cells, and inhibited expression of vascular endothelium growth factor in human ARPE-19 and umbilical endothelium cell lines. The alginate-gelatin injectable hydrogel loaded OCCNPs are biocompatible and have high potential in protecting cells from apoptosis, angiogenesis, and production of pro-inflammatory cytokines in AMD cellular models. This article is protected by copyright. All rights reserved. © 2018 Wiley Periodicals, Inc.

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 relative effectiveness of managed care penetration and the healthcare safety net in reducing avoidable hospitalizations.

PubMed

Pracht, Etienne E; Orban, Barbara L; Comins, Meg M; Large, John T; Asin-Oostburg, Virginia

2011-01-01

Avoidable hospitalizations represent a key indicator for access to, and the quality of, primary care. Therefore, understanding their behavior is essential in terms of management of healthcare resources and costs. This analysis examines the affect of 2 healthcare strategies on the rate of avoidable hospitalization, managed care and the healthcare safety net. The avoidable hospitalizations definition developed by Weissman et al. (1992) was used to identify relevant inpatient episodes. A 2-stage simultaneous equations multivariate regression model with instrumental variables was used to estimate the relative influence of HMO penetration and the composition of local hospital markets on the rate of avoidable hospitalizations. Control variables in the model include healthcare supply and demand, demographic, socioeconomic, and health status characteristics. Increased market presence of public hospitals significantly reduced avoidable hospitalizations. HMO penetration did not influence the rate of avoidable hospitalizations. The results suggest that public investments in healthcare facilities and infrastructure are more effective in reducing avoidable hospitalizations. © 2011 National Association for Healthcare Quality.

Management of Patient Experience With ATX-101 (Deoxycholic Acid Injection) for Reduction of Submental Fat.

PubMed

Dover, Jeffrey S; Kenkel, Jeffrey M; Carruthers, Alastair; Lizzul, Paul F; Gross, Todd M; Subramanian, Meenakshi; Beddingfield, Frederick C

2016-11-01

ATX-101 (deoxycholic acid injection; Kythera Biopharmaceuticals, Inc., Westlake Village, CA [an affiliate of Allergan plc, Dublin, Ireland]) was recently approved for submental fat (SMF) reduction in the United States (Kybella) and Canada (Belkyra). The pivotal trials supporting these approvals revealed that ATX-101 is associated with common injection-site treatment reactions consistent with its mechanism of action and administration procedure. The purpose of this study was to evaluate 4 patient experience management paradigms targeting the common injection-site adverse events of pain, swelling/edema, and bruising after a single treatment session with ATX-101. In this double-blind, parallel-group, exploratory Phase 3b study (ClinicalTrials.gov identifier: NCT02007434), subjects with moderate to severe SMF were randomized 4:1 within each paradigm to receive ATX-101 2 mg/cm or placebo. In Paradigm 1, subjects received a cold pack application to the treatment area. In Paradigm 2, in addition to cold pack application, subjects were treated with topical lidocaine and injectable lidocaine containing epinephrine. In Paradigm 3, in addition to the interventions of Paradigm 2, subjects received loratadine and ibuprofen. Subjects in Paradigm 4 received the same interventions in Paradigm 3, plus application of a chin strap. Eighty-three subjects were treated. In ATX-101-treated subjects, peak pain occurred within 1 to 5 minutes of treatment, with median values at these time points ranging from 21.4 to 35.7 mm on a 100-mm pain visual analog scale ("mild"). Pain ratings reduced substantially by 15 minutes; at 4 hours after injection, pain was characterized as mild tenderness or mild achiness. Compared with cold alone, treatment with topical and injectable lidocaine reduced median peak pain by 17%. Addition of ibuprofen and loratadine resulted in a total reduction in pain by 40%. Peak swelling/edema in ATX-101-treated subjects was "modest," with mean values ≤1.7 (on a 0

Local injections of corticotropin releasing factor reduce doxorubicin-induced acute inflammation in the eyelid.

PubMed

McLoon, L K; Wirtschafter, J

1997-04-01

Doxorubicin chemomyectomy is an effective alternative treatment option for patients with blepharospasm and hemifacial spasm. One side effect of the use of doxorubicin in localized injections is the development of acute inflammation and skin injury at the injection site. Corticotropin releasing factor (CRF) was reported to reduce inflammation after acute inflammatory injuries due to other causes and at other sites. This study was performed to assess the potential of CRF to prevent the development of skin injury and eyelid soreness after local doxorubicin injection. Rabbits received lower eyelid injections of either 75 or 150 micrograms CRF followed by injection of either 0.5, 1, or 2 mg doxorubicin or doxorubicin alone. Eyelids were assessed for changes in acute inflammation by immunohistochemical localization of macrophages and monocytes using anti-CD11, an antibody specific for these cell types. Short-term alterations in vascular permeability were assessed using an Evans blue assay. Additional eyelids were followed daily for changes in the skin over the injection site to determine day of onset of skin injury and the total duration of skin injury. After 1 month, the eyelids were processed histologically for morphometric analysis of muscle fiber loss. Monkey eyelids also were examined for the effect of CRF and doxorubicin injections. Doxorubicin alone produced an acute inflammatory reaction in the treated eyelids, with a large influx of macrophages and monocytes throughout the connective tissue at 1 and 2 days. Corticotropin releasing factor pretreatment significantly reduced this influx of inflammatory cells into the connective tissue. Doxorubicin produced a large increase in vascular permeability in the treated eyelids, with resultant edema. Corticotropin releasing factor did not alter this change in vascular permeability, indicating that CRF appears to have a specific effect on migration of inflammatory cells rather than just a generalized effect on vascular

The effect of platelet-rich plasma injection on lateral epicondylitis following failed conservative management.

PubMed

Brkljac, Milos; Kumar, Shyam; Kalloo, Dale; Hirehal, Kiran

2015-12-01

We assessed the effect PRP injection on pain and function in patients with lateral epicondylitis where conservative management had failed. We prospectively reviewed 34 patients. The mean follow-up was 26 weeks (range 6-114 weeks). We used the Oxford Elbow Score (OES) and progression to surgery to assess outcomes. 88.2% improved their OES. 8.8% reported symptom progression. One patient had no change. No patients suffered adverse reactions. Two patients underwent an open release procedure. One had the injection repeated. An injection of PRP improves pain and function in patients suffering from LE where conservative management has failed.

The Effect of Pretreatment with Thiopental on Reducing Pain Induced by Rocuronium Injection

PubMed Central

Park, Jong-Taek; Choi, Jae-Chan; Yoo, Young-Soo; Lee, Young-Bok; Kim, Soon-Yul

2005-01-01

We examined whether pretreatment with a small dose of thiopental was effective in reducing pain induced by the intravenous injection of rocuronium. Withdrawal movement was used to assess pain reduction. Ninety patients were randomly assigned to one of two groups: patients in the control group were pretreated with 2 mL saline, and those in the thiopental group were pretreated with 2 mL (50 mg) thiopental. Thiopental 5 mg/kg was injected intravenously. After a loss of consciousness, the upper arm was compressed with a rubber tourniquet, and the pretreatment drugs were administered. Thirty seconds later the tourniquet was removed and 0.6 mg/kg rocuronium was administered. Withdrawal movement was assessed using a four-grade scale: no movement, movement limited to the wrist, to the elbow or to the shoulder. The frequency of withdrawal movement in the group pretreated with thiopental was lower than in the control group (34 vs. 13, p < 0.05). We concluded that pretreatment with 2 mL (50 mg) thiopental is effective in reducing pain caused by the intravenous injection of rocuronium. PMID:16385651

Antibacterial properties of 2% lidocaine and reduced rate of endophthalmitis after intravitreal injection.

PubMed

Tustin, Aaron; Kim, Stephen J; Chomsky, Amy; Hubbard, G Baker; Sheng, Jinsong

2014-05-01

To determine whether the application of subconjunctival 2% lidocaine/0.1% methylparaben for anesthesia may reduce rates of endophthalmitis after intravitreal (IVT) injection. We performed in vitro experiments to determine the antibacterial properties of 2% lidocaine/0.1% methylparaben (lidocaine) against causative organisms of endophthalmitis. Isolates of Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus viridans from patients with endophthalmitis were incubated with or without lidocaine. Aliquots (100 µL) were plated on Mueller-Hinton (S. aureus and S. epidermidis) or blood agar plates (S. viridans) at 0, 10, 30, 120, and 240 minutes, and colonies were counted after 24 hours. A retrospective review of 15,042 IVT injections was performed from January 2004 to February 2011 to determine the rate of endophthalmitis with or without application of subconjunctival lidocaine for anesthesia. Lidocaine demonstrated rapid bactericidal effects against all 3 organisms. After 10 minutes of exposure, there was approximately a 90% (P < 0.01), 95% (P < 0.001), and 92% (P < 0.001) reduction in colony forming units when compared with time 0 for S. aureus, S. epidermidis, and S. viridans, respectively. Complete elimination of colony forming units occurred at subsequent time points for each organism in contrast to logarithmic increase for control plates. There were a total of 0 cases of endophthalmitis of 6,853 IVT injections performed with subconjunctival lidocaine and 8 cases of endophthalmitis of 8,189 (0.1%) IVT injections performed with other methods of anesthesia (P = 0.03). Application of subconjunctival 2% lidocaine/0.1% methylparaben for anesthesia may reduce the incidence of endophthalmitis after IVT injection.

Randomised, prospective, non-blinded pilot study comparing the effect of intramuscular steroid injections and intralesional steroid injections in the management of tennis elbow

PubMed Central

Tahir, Hasan; Biro, Izolda; Donnelly, Simon; Greenwood, Mandy

2016-01-01

Background Tennis elbow is an overuse injury affecting people performing repetitive forearm movements. It is a soft tissue disorder that causes significant disability and pain. The aim of the study was to establish that an intramuscular steroid injection is effective in the short-term pain relief and functional improvement of tennis elbow. The severity of pain at the injection site was monitored to determine whether the intramuscular injection is better tolerated than the intralesional injection. Methods and results 19 patients, who had no treatment for tennis elbow in the preceding 3 months, were recruited from Whipps Cross University Hospital, London, and were randomised to receive either 80 mg of intramuscular Depo-Medrone or 40 mg of intralesional Depo-Medrone injection. Blinding proved difficult as the injection sites differed and placebo arms were not included in the study. A Patient-Rated Tennis Elbow Evaluation (PRTEE) Questionnaire and a 10-point Likert scale were used to assess primary outcome. Six weeks after the treatment, there was a reduction in pain, improvement in function and total PRTEE scores in both intramuscular and intralesional groups (p=0.008) using a 95% CI for mean treatment difference of −26 to +16 points. A statistically significant result (p=0.001) in favour of intramuscular causing less pain at the injection site was noted. Conclusion Non-inferiority of intramuscular to intralesional injections was not confirmed; however, the intramuscular injection proved to be effective in reducing tennis elbow-related symptoms and was found less painful at the site of injection at the time of administration. Trial registration number EUDRACT Number: 2010-022131-11. REC Number: 10/H0718/76 (NRES, Central London REC 1). PMID:28879024

[Reducing the Incidence of Phlebitis Related to Intravenous Injection in Pediatric Patients].

PubMed

Cho, Yen-Hua; Yen, Li-Ling; Yu, Kai-Ling; Chang, Chun-Chu; Chen, Hsuen-Ling

2015-06-01

Peripheral venous catheter (PVC) is commonly used to provide nutrition and medicine to pediatric inpatients. Phlebitis is a common side effect of PVC insertion. Over 90% of pediatric patients in the paedi-atric medical ward at the Chang Gung Memorial Hospital (CGMH) receive PVC insertion, with an incident rate of phlebitis of 5.07%. Common cause factors of phlebitis are: insufficient sterilization time, inappropriate methods used to fix the PVC, the use of fixtures that loosen easily, high re-fix rates, and inadequate wound care after catheter removal. The purpose of this project was to reduce the incidence rate of PVC-insertion-related phlebitis in children from 5.07% to 2.5%. A one-week clinical observation identified the re-inserting / re-fixing of existing PVCs as the principal cause of phlebitis in the CGMH paediatric ward. Therefore, the researchers modified the catheter care bundle based on a review of the literature and the suggestions of clinical pediatric experts. Modifications included applying 2% chlorhexidine to sterilize the insertion site; using a new, non-woven fabric splint to fix the PVC site; providing cartoon-themed waterproof dressings for the first bath after the removal of the PVC; and setting standard operating procedures (SOPs) for PVC insertion and catheter removal. After applying these modifications, the incident rate of phlebitis in children with PVC insertions decreased from 5.07% to 2.08%. The application of 2% chlorhexidine reduces the waiting time for sterilization; the purpose-designed splint strengthens the fixation of the PVC; and the development of the SOPs for PVC insertion and post-removal catheter care reduces the risk of phlebitis. The combination of these strategies effectively reduces the incidence of phlebitis and improves the nursing care quality.

Fluoroscopic lumbar interlaminar epidural injections in managing chronic lumbar axial or discogenic pain

PubMed Central

Manchikanti, Laxmaiah; Cash, Kimberly A; McManus, Carla D; Pampati, Vidyasagar; Benyamin, Ramsin

2012-01-01

Among the multiple causes of chronic low back pain, axial and discogenic pain are common. Various modalities of treatments are utilized in managing discogenic and axial low back pain including epidural injections. However, there is a paucity of evidence regarding the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or discogenic pain, including epidural injections. In an interventional pain management practice in the US, a randomized, double-blind, active control trial was conducted. The objective was to assess the effectiveness of lumbar interlaminar epidural injections of local anesthetic with or without steroids for managing chronic low back pain of discogenic origin. However, disc herniation, radiculitis, facet joint pain, or sacroiliac joint pain were excluded. Two groups of patients were studied, with 60 patients in each group receiving either local anesthetic only or local anesthetic mixed with non-particulate betamethasone. Primary outcome measures included the pain relief-assessed by numeric rating scale of pain and functional status assessed by the, Oswestry Disability Index, Secondary outcome measurements included employment status, and opioid intake. Significant improvement or success was defined as at least a 50% decrease in pain and disability. Significant improvement was seen in 77% of the patients in Group I and 67% of the patients in Group II. In the successful groups (those with at least 3 weeks of relief with the first two procedures), the improvement was 84% in Group I and 71% in Group II. For those with chronic function-limiting low back pain refractory to conservative management, it is concluded that lumbar interlaminar epidural injections of local anesthetic with or without steroids may be an effective modality for managing chronic axial or discogenic pain. This treatment appears to be effective for those who have had facet joints as well as sacroiliac joints eliminated as the pain source

Reduced injection pressures using a compressed air injection technique (CAIT): an in vitro study.

PubMed

Tsui, Ban C H; Knezevich, Mark P; Pillay, Jennifer J

2008-01-01

High injection pressures have been associated with intraneural injection and persistent neurological injury in animals. Our objective was to test whether a reported simple compressed air injection technique (CAIT) would limit the generation of injection pressures to below a suggested 1,034 mm Hg limit in an in vitro model. After ethics board approval, 30 consenting anesthesiologists injected saline into a semiclosed system. Injection pressures using 30 mL syringes connected to a 22 gauge needle and containing 20 mL of saline were measured for 60 seconds using: (1) a typical "syringe feel" method, and (2) CAIT, thereby drawing 10 mL of air above the saline and compressing this to 5 mL prior to and during injections. All anesthesiologists performed the syringe feel method before introduction and demonstration of CAIT. Using CAIT, no anesthesiologist generated pressures above 1,034 mm Hg, while 29 of 30 produced pressures above this limit at some time using the syringe feel method. The mean pressure using CAIT was lower (636 +/- 71 vs. 1378 +/- 194 mm Hg, P = .025), and the syringe feel method resulted in higher peak pressures (1,875 +/- 206 vs. 715 +/- 104 mm Hg, P = .000). This study demonstrated that CAIT can effectively keep injection pressures under 1,034 mm Hg in this in vitro model. Animal and clinical studies will be needed to determine whether CAIT will allow objective, real-time pressure monitoring. If high pressure injections are proven to contribute to nerve injury in humans, this technique may have the potential to improve the safety of peripheral nerve blocks.

Efficacy of Silk Channel Injections with Insecticides for Management of Lepidoptera Pests of Sweet Corn.

PubMed

Sparks, A N; Gadal, L; Ni, X

2015-08-01

The primary Lepidoptera pests of sweet corn (Zea mays L. convar. saccharata) in Georgia are the corn earworm, Helicoverpa zea (Boddie), and the fall armyworm, Spodoptera frugiperda (J. E. Smith). Management of these pests typically requires multiple insecticide applications from first silking until harvest, with commercial growers frequently spraying daily. This level of insecticide use presents problems for small growers, particularly for "pick-your-own" operations. Injection of oil into the corn ear silk channel 5-8 days after silking initiation has been used to suppress damage by these insects. Initial work with this technique in Georgia provided poor results. Subsequently, a series of experiments was conducted to evaluate the efficacy of silk channel injections as an application methodology for insecticides. A single application of synthetic insecticide, at greatly reduced per acre rates compared with common foliar applications, provided excellent control of Lepidoptera insects attacking the ear tip and suppressed damage by sap beetles (Nitidulidae). While this methodology is labor-intensive, it requires a single application of insecticide at reduced rates applied ∼2 wk prior to harvest, compared with potential daily applications at full rates up to the day of harvest with foliar insecticide applications. This methodology is not likely to eliminate the need for foliar applications because of other insect pests which do not enter through the silk channel or are not affected by the specific selective insecticide used in the silk channel injection, but would greatly reduce the number of applications required. This methodology may prove particularly useful for small acreage growers. © The Authors 2015. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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.

Swine manure injection with low-disturbance applicator and cover crops reduce phosphorus losses.

PubMed

Kovar, J L; Moorman, T B; Singer, J W; Cambardella, C A; Tomer, M D

2011-01-01

Injection of liquid swine manure disturbs surface soil so that runoff from treated lands can transport sediment and nutrients to surface waters. We determined the effect of two manure application methods on P fate in a corn (Zea mays L.)-soybean [Glycine max (L.) Merr.] production system, with and without a winter rye (Secale cereale L.)-oat (Avena sativa L.) cover crop. Treatments included: (i) no manure; (ii) knife injection; and (iii) low-disturbance injection, each with and without the cover crop. Simulated rainfall runoff was analyzed for dissolved reactive P (DRP) and total P (TP). Rainfall was applied 8 d after manure application (early November) and again in May after emergence of the corn crop. Manure application increased soil bioavailable P in the 20- to 30-cm layer following knife injection and in the 5- to 20-cm layer following low-disturbance injection. The low-disturbance system caused less damage to the cover crop, so that P uptake was more than threefold greater. Losses of DRP were greater in both fall and spring following low-disturbance injection; however, application method had no effect on TP loads in runoff in either season. The cover crop reduced fall TP losses from plots with manure applied by either method. In spring, DRP losses were significantly higher from plots with the recently killed cover crop, but TP losses were not affected. Low-disturbance injection of swine manure into a standing cover crop can minimize plant damage and P losses in surface runoff while providing optimum P availability to a subsequent agronomic crop.

Pharmacological and Combined Interventions to Reduce Vaccine Injection Pain in Children and Adults

PubMed Central

Taddio, Anna; McMurtry, C. Meghan; Halperin, Scott A.; Noel, Melanie; Pillai Riddell, Rebecca; Chambers, Christine T.

2015-01-01

Background: This systematic review assessed the effectiveness and safety of pharmacotherapy and combined interventions for reducing vaccine injection pain in individuals across the lifespan. Design/Methods: Electronic databases were searched for relevant randomized and quasi-randomized controlled trials. Self-reported pain and fear as well as observer-rated distress were critically important outcomes. Data were combined using standardized mean difference (SMD) or relative risk with 95% confidence intervals (CI). Results: Fifty-five studies that examined breastfeeding (which combines sweet-tasting solution, holding, and sucking), topical anesthetics, sweet-tasting solutions (sucrose, glucose), vapocoolants, oral analgesics, and combination of 2 versus 1 intervention were included. The following results report findings of analyses of critical outcomes with the largest number of participants. Compared with control, acute distress was lower for infants breastfed: (1) during vaccination (n=792): SMD −1.78 (CI, −2.35, −1.22) and (2) before vaccination (n=100): SMD −1.43 (CI, −2.14, −0.72). Compared with control/placebo, topical anesthetics showed benefit on acute distress in children (n=1424): SMD −0.91 (CI, −1.36, −0.47) and self-reported pain in adults (n=60): SMD −0.85 (CI, −1.38, −0.32). Acute and recovery distress was lower for children who received sucrose (n=2071): SMD −0.76 (CI, −1.19, −0.34) or glucose (n=818): SMD −0.69 (CI, −1.03, −0.35) compared with placebo/no treatment. Vapocoolants reduced acute pain in adults [(n=185), SMD −0.78 (CI, −1.08, −0.48)] but not children. Evidence from other needle procedures showed no benefit of acetaminophen or ibuprofen. The administration of topical anesthetics before and breastfeeding during vaccine injections showed mixed results when compared with topical anesthetics alone. There were no additive benefits of combining glucose and non-nutritive sucking (pacifier) compared with

Fifteen-second skin icing using a frozen gel pack is effective for reducing goserelin injection pain.

PubMed

Naya, Yoshio; Hagiwara, Nobuhisa; Takeuchi, Ichiro; Mori, Masaru; Inagaki, Akinori; Nakanouchi, Tsuneyuki; Mikami, Kazuya

2014-01-01

The efficacy of skin icing to reduce the pain of goserelin injection has been reported. We investigated the optimal icing time with a frozen gel pack and its effectiveness. Abdominal skin temperatures of 49 healthy volunteers were measured after application of the frozen gel pack for 10, 15 and 30 s, and it was decided that a 15-second icing was adequate. For 55 consecutive patients who received goserelin (10.8 mg) injection, pain was evaluated employing a visual analog scale (VAS). The first injection was administered routinely. A second injection was administered after skin icing in 27 of 55 patients who wanted to try icing. At the time of the third injection, all patient decided whether they were to receive icing or the routine method. After icing, VAS scores decreased in 20 of 27 patients. At the third injection, 18 patients requested icing. When a patient complains of injection pain, the icing method should be considered for pain reduction. 2014 S. Karger AG, Basel.

Pharmacological and non-pharmacological interventions for reducing rocuronium bromide induced pain on injection in children and adults.

PubMed

Prabhakar, Hemanshu; Singh, Gyaninder Pal; Ali, Zulfiqar; Kalaivani, Mani; Smith, Martha A

2016-02-12

Rocuronium bromide is a routinely used muscle relaxant in anaesthetic practice. Its use, however, is associated with intense pain on injection. While it is well established that rocuronium bromide injection causes pain in awake patients, anaesthetized patients also tend to show withdrawal movements of the limbs when this muscle relaxant is administered. Various strategies, both pharmacological and non-pharmacological, have been studied to reduce the incidence and severity of pain on rocuronium bromide injection. We wanted to find out which of the existing modalities was best to reduce pain on rocuronium injection. The objectives of this review were to assess the ability of both pharmacological and non-pharmacological interventions to reduce or eliminate the pain that accompanies rocuronium bromide administration. We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2013, Issue 7), MEDLINE via Ovid SP (1966 to July 2013) and EMBASE via Ovid SP (1980 to July 2013). We also searched specific websites. We reran the searches in February 2015 and will deal with the 11 studies of interest found through this search when we update the review. We included all randomized controlled trials (RCTs) that compared the use of any drug or a non-pharmacological method with control patients, or those receiving no treatment to reduce the severity of pain with rocuronium injection. Our primary outcome was pain on rocuronium bromide injection measured by a pain score assessment. Our secondary outcomes were rise in heart rate and blood pressure following administration of rocuronium and adverse events related to the interventions. We used the standardized methods for conducting a systematic review as described in the Cochrane Handbook for Systematic Reviews of Interventions. Two authors independently extracted details of trial methodology and outcome data from reports of all trials considered eligible for inclusion. We made all analyses on an intention-to-treat basis

Non-injection Drug Use and Injection Initiation Assistance among People Who Inject Drugs in Tijuana, Mexico.

PubMed

Ben Hamida, Amen; Rafful, Claudia; Jain, Sonia; Sun, Shelly; Gonzalez-Zuniga, Patricia; Rangel, Gudelia; Strathdee, Steffanie A; Werb, Dan

2018-02-01

Although most people who inject drugs (PWID) report receiving assistance during injection initiation events, little research has focused on risk factors among PWID for providing injection initiation assistance. We therefore sought to determine the influence of non-injection drug use among PWID on their risk to initiate others. We used generalized estimating equation (GEE) models on longitudinal data among a prospective cohort of PWID in Tijuana, Mexico (Proyecto El Cuete IV), while controlling for potential confounders. At baseline, 534 participants provided data on injection initiation assistance. Overall, 14% reported ever initiating others, with 4% reporting this behavior recently (i.e., in the past 6 months). In a multivariable GEE model, recent non-injection drug use was independently associated with providing injection initiation assistance (adjusted odds ratio [AOR] = 2.42, 95% confidence interval [CI] = 1.39-4.20). Further, in subanalyses examining specific drug types, recent non-injection use of cocaine (AOR = 9.31, 95% CI = 3.98-21.78), heroin (AOR = 4.00, 95% CI = 1.88-8.54), and methamphetamine (AOR = 2.03, 95% CI = 1.16-3.55) were all significantly associated with reporting providing injection initiation assistance. Our findings may have important implications for the development of interventional approaches to reduce injection initiation and related harms. Further research is needed to validate findings and inform future approaches to preventing entry into drug injecting.

Environmental response nanosilica for reducing the pressure of water injection in ultra-low permeability reservoirs

NASA Astrophysics Data System (ADS)

Liu, Peisong; Niu, Liyong; Li, Xiaohong; Zhang, Zhijun

2017-12-01

The super-hydrophobic silica nanoparticles are applied to alter the wettability of rock surface from water-wet to oil-wet. The aim of this is to reduce injection pressure so as to enhance water injection efficiency in low permeability reservoirs. Therefore, a new type of environmentally responsive nanosilica (denote as ERS) is modified with organic compound containing hydrophobic groups and "pinning" groups by covalent bond and then covered with a layer of hydrophilic organic compound by chemical adsorption to achieve excellent water dispersibility. Resultant ERS is homogeneously dispersed in water with a size of about 4-8 nm like a micro-emulsion system and can be easily injected into the macro or nano channels of ultra-low permeability reservoirs. The hydrophobic nanosilica core can be released from the aqueous delivery system owing to its strong dependence on the environmental variation from normal condition to injection wells (such as pH and salinity). Then the exposed silica nanoparticles form a thin layer on the surface of narrow pore throat, leading to the wettability from water-wet to oil-wet. More importantly, the two rock cores with different permeability were surface treated with ERS dispersion with a concentration of 2 g/L, exhibit great reduce of water injection pressure by 57.4 and 39.6%, respectively, which shows great potential for exploitation of crude oil from ultra-low permeability reservoirs during water flooding. [Figure not available: see fulltext.

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

Documents related to Proposed Class II injection well permit modification MI-147-2D-0014

EPA Pesticide Factsheets

Public notice for proposed modification of permit number MI-147-2D-0014 (St. Clair County, MI). The proposed modification would change the injection zone, the construction, and reduce the injection pressure.

Impulsive Injection for Compressor Stator Separation Control

NASA Technical Reports Server (NTRS)

Culley, Dennis E.; Braunscheidel, Edward P.; Bright, Michelle M.

2005-01-01

Flow control using impulsive injection from the suction surface of a stator vane has been applied in a low speed axial compressor. Impulsive injection is shown to significantly reduce separation relative to steady injection for vanes that were induced to separate by an increase in vane stagger angle of 4 degrees. Injected flow was applied to the airfoil suction surface using spanwise slots pitched in the streamwise direction. Injection was limited to the near-hub region, from 10 to 36 percent of span, to affect the dominant loss due to hub leakage flow. Actuation was provided externally using high-speed solenoid valves closely coupled to the vane tip. Variations in injected mass, frequency, and duty cycle are explored. The local corrected total pressure loss across the vane at the lower span region was reduced by over 20 percent. Additionally, low momentum fluid migrating from the hub region toward the tip was effectively suppressed resulting in an overall benefit which reduced corrected area averaged loss through the passage by 4 percent. The injection mass fraction used for impulsive actuation was typically less than 0.1 percent of the compressor through flow.

Psychosocial interventions for reducing injection and sexual risk behaviour for preventing HIV in drug users.

PubMed

Meader, Nicholas; Li, Ryan; Des Jarlais, Don C; Pilling, Stephen

2010-01-20

Drug users (including both injection drug users and crack cocaine users), are at high levels of risk for contracting HIV. Therefore it is important to reduce the injection and/or sexual risk behaviours of these groups both for the benefit of themselves and for society as a whole. To assess the efficacy of multi-session psychosocial interventions in comparison with standard education and minimal intervention controls for the reduction of injection and sexual risk behaviour. Electronic searches were conducted of a number of bibliographic databases (including Cochrane Library, CINAHL, MEDLINE, PsycINFO). In addition, other methods of locating papers were employed including contacting various authors working in the field of HIV risk reduction and examining reference lists of applicable papers identified in the electronic search. The inclusion criteria consisted of randomised and quazi-randomised trials assessing the efficacy of psychosocial interventions in the reduction of injection and sexual risk behaviour for people who misused opiates, cocaine, or a combination of these drugs. Two authors independently assessed the eligibility of studies identified by the search strategy, quality assessed these studies and extracted the data. A total of 35 trials met the eligibility criteria of the review providing data on 11,867 participants. There were minimal differences identified between multi-session psychosocial interventions and standard educational interventions for both injection and sexual risk behaviour. Although it should be noted there were large pre-post changes for both groups suggesting both were effective in reducing risk behaviours. In addition, there was some evidence of benefit for multi-session psychosocial interventions when compared with minimal controls. Subgroup analyses suggest that people in formal treatment are likely to respond to multi-session psychosocial interventions. It also appears single-gender groups may be associated with greater benefit

Nurse-led ranibizumab intravitreal injections in wet age-related macular degeneration: a literature review.

PubMed

Gregg, Emma

2017-04-12

Aim The aim of this literature review was to explore the development of the role of specialist ophthalmic nurses in delivering ranibizumab intravitreal injections to patients with wet age-related macular degeneration (AMD), and to evaluate their contribution to reducing capacity pressures in medical retina services, while maintaining safe and effective standards of care. Method A systematic literature search was undertaken to identify relevant articles published between January 2000 and June 2015. A search of electronic databases was undertaken, and selected relevant journals were searched manually. A free text and subject heading search strategy was conducted, in which the abstracts of publications identified for review were assessed for relevance. Inclusion criteria were: nurses delivering ranibizumab intravitreal treatment; studies performed in the UK and other countries; and patients with AMD, diabetic macular oedema or central retinal vein occlusion receiving nurse-led ranibizumab (Lucentis) intravitreal treatment. Findings Five studies were identified from the literature search, which audited a total of 31,303 injections delivered by nurse practitioners between January 2007 and November 2013. The visual outcomes and the rate of complications from intravitreal injections delivered by trained ophthalmic nurse practitioners were comparable to intravitreal injections delivered by ophthalmologists. Four of the five studies reported increased patient satisfaction, patients consenting to nurse-delivered intravitreal injections, favourable pain experience, and absence of complaints. Conclusion Practice innovation is an example of a quality, innovation, productivity and prevention process. Role expansion, in which specialist ophthalmic nurses deliver intravitreal injections, has been shown to be economical, safe and effective. It enables timely delivery of the service, thereby preventing irreversible blindness for individuals with wet AMD.

Management of chronic low back pain: rationales, principles, and targets of imaging-guided spinal injections.

PubMed

Fritz, Jan; Niemeyer, Thomas; Clasen, Stephan; Wiskirchen, Jakub; Tepe, Gunnar; Kastler, Bruno; Nägele, Thomas; König, Claudius W; Claussen, Claus D; Pereira, Philippe L

2007-01-01

If low back pain does not improve with conservative management, the cause of the pain must be determined before further therapy is initiated. Information obtained from the patient's medical history, physical examination, and imaging may suffice to rule out many common causes of chronic pain (eg, fracture, malignancy, visceral or metabolic abnormality, deformity, inflammation, and infection). However, in most cases, the initial clinical and imaging findings have a low predictive value for the identification of specific pain-producing spinal structures. Diagnostic spinal injections performed in conjunction with imaging may be necessary to test the hypothesis that a particular structure is the source of pain. To ensure a valid test result, diagnostic injection procedures should be monitored with fluoroscopy, computed tomography, or magnetic resonance imaging. The use of controlled and comparative injections helps maximize the reliability of the test results. After a symptomatic structure has been identified, therapeutic spinal injections may be administered as an adjunct to conservative management, especially in patients with inoperable conditions. Therapeutic injections also may help hasten the recovery of patients with persistent or recurrent pain after spinal surgery. RSNA, 2007

Optimization of Micro Metal Injection Molding By Using Grey Relational Grade

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

Ibrahim, M. H. I.; Precision Process Research Group, Dept. of Mechanical and Materials Engineering, Faculty of Engineering, Universiti Kebangsaan Malaysia; Muhamad, N.

2011-01-17

Micro metal injection molding ({mu}MIM) which is a variant of MIM process is a promising method towards near net-shape of metallic micro components of complex geometry. In this paper, {mu}MIM is applied to produce 316L stainless steel micro components. Due to highly stringent characteristic of {mu}MIM properties, the study has been emphasized on optimization of process parameter where Taguchi method associated with Grey Relational Analysis (GRA) will be implemented as it represents novel approach towards investigation of multiple performance characteristics. Basic idea of GRA is to find a grey relational grade (GRG) which can be used for the optimization conversionmore » from multi objectives case which are density and strength to a single objective case. After considering the form 'the larger the better', results show that the injection time(D) is the most significant followed by injection pressure(A), holding time(E), mold temperature(C) and injection temperature(B). Analysis of variance (ANOVA) is also employed to strengthen the significant of each parameter involved in this study.« less

Hydrocortisone Injection

MedlinePlus

Hydrocortisone injection is used to treat symptoms of low corticosteroid levels (lack of certain substances that are ... is also used to treat severe allergic reactions. Hydrocortisone injection is used in the management of multiple ...

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.

Potential geographic "hotspots" for drug-injection related transmission of HIV and HCV and for initiation into injecting drug use in New York City, 2011-2015, with implications for the current opioid epidemic in the US.

PubMed

Des Jarlais, D C; Cooper, H L F; Arasteh, K; Feelemyer, J; McKnight, C; Ross, Z

2018-01-01

We identified potential geographic "hotspots" for drug-injecting transmission of HIV and hepatitis C virus (HCV) among persons who inject drugs (PWID) in New York City. The HIV epidemic among PWID is currently in an "end of the epidemic" stage, while HCV is in a continuing, high prevalence (> 50%) stage. We recruited 910 PWID entering Mount Sinai Beth Israel substance use treatment programs from 2011-2015. Structured interviews and HIV/ HCV testing were conducted. Residential ZIP codes were used as geographic units of analysis. Potential "hotspots" for HIV and HCV transmission were defined as 1) having relatively large numbers of PWID 2) having 2 or more HIV (or HCV) seropositive PWID reporting transmission risk-passing on used syringes to others, and 3) having 2 or more HIV (or HCV) seronegative PWID reporting acquisition risk-injecting with previously used needles/syringes. Hotspots for injecting drug use initiation were defined as ZIP codes with 5 or more persons who began injecting within the previous 6 years. Among PWID, 96% injected heroin, 81% male, 34% White, 15% African-American, 47% Latinx, mean age 40 (SD = 10), 7% HIV seropositive, 62% HCV seropositive. Participants resided in 234 ZIP codes. No ZIP codes were identified as potential hotspots due to small numbers of HIV seropositive PWID reporting transmission risk. Four ZIP codes were identified as potential hotspots for HCV transmission. 12 ZIP codes identified as hotspots for injecting drug use initiation. For HIV, the lack of potential hotspots is further validation of widespread effectiveness of efforts to reduce injecting-related HIV transmission. Injecting-related HIV transmission is likely to be a rare, random event. HCV prevention efforts should include focus on potential hotspots for transmission and on hotspots for initiation into injecting drug use. We consider application of methods for the current opioid epidemic in the US.

Mobile ultra-clean unidirectional airflow screen reduces air contamination in a simulated setting for intra-vitreal injection.

PubMed

Lapid-Gortzak, Ruth; Traversari, Roberto; van der Linden, Jan Willem; Lesnik Oberstein, Sarit Y; Lapid, Oren; Schlingemann, Reinier O

2017-02-01

The aim of this study is to determine whether the use of a mobile ultra-clean laminar airflow screen reduces the air-borne particle counts in the setting of a simulated procedure of an intra-vitreal injection. A mobile ultra-clean unidirectional airflow (UDF) screen was tested in a simulated procedure for intra-vitreal injections in a treatment room without mechanical ventilation. One UDF was passed over the instrument tray and the surgical area. The concentration of particles was measured in the background, over the instrument table, and next to the ocular area. The degree of protection was calculated at the instrument table and at the surgical site. Use of the UDF mobile screen reduced the mean particle concentration (particles > 0.3 microns) on the instrument table by a factor of at least 100.000 (p < 0.05), and over the patient's eye by at least a factor of 436 (p < 0.05), which in clinical practice translates into significantly reduced air contamination. Mobile UDF screen reduces the mean particle concentration substantially. The mobile UDF screen may therefore allow for a safer procedural environment for ambulatory care procedures such as intra-vitreal injections in treatment rooms.

Intraumbilical injection of three different uterotonics in the management of retained placenta.

PubMed

Harara, Rany; Hanafy, Sherif; Zidan, Mahmoud Saad Alsayed; Alberry, Medhat

2011-09-01

The aim of this work was to compare the effect of intraumbilical injection of three different uterotonic solutions in the management of retained placenta. This study was conducted in Ain-Shams University Maternity Hospital, Cairo, Egypt. A total of 78 women with retained placenta (>30 min after delivery of the fetus) were included in the study and subdivided into three groups. Each group was injected with a different type of uterotonic into the umbilical vein after clamping it using the Pipingas technique. Uterotonics used were either 20 IU oxytocin dissolved in 30 mL saline (n=26), ergometrine 0.2 mg dissolved in 30 mL saline (n=27) or misoprostol 800 µg dissolved in 30 mL saline (n=25). The overall success rate of spontaneous placental separation within 30 min after intraumbilical injection of uterotonics was 56/78 (71.79%). The success rate was higher with misoprostol when compared to oxytocin and ergometrine but the difference was not significant (20/25 [80%], 19/26 [73.08%], 17/27 [62.96%], respectively, P>0.05). The injection-to-separation interval was significantly shorter in the misoprostol group than in the oxytocin and ergometrine groups (7.0±2.2 min, 13.14±3.76 min, 22.5±4.37 min, respectively, P<0.001). Intraumbilical injection of uterotonics, namely oxytocin, ergometrine and dissolved misoprostol in saline, are closely effective in the management of retained placenta, with misoprostol being slightly more effective. This method may have a role in minimizing the need for manual removal of the placenta and its adverse sequelae. © 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.

Cutaneous cooling to manage botulinum toxin injection-associated pain in patients with facial palsy: A randomised controlled trial.

PubMed

Pucks, N; Thomas, A; Hallam, M J; Venables, V; Neville, C; Nduka, C

2015-12-01

Botulinum toxin injections are an effective, well-established treatment to manage synkinesis secondary to chronic facial palsy, but they entail painful injections at multiple sites on the face up to four times per year. Cutaneous cooling has long been recognised to provide an analgesic effect for cutaneous procedures, but evidence to date has been anecdotal or weak. This randomised controlled trial aims to assess the analgesic efficacy of cutaneous cooling using a cold gel pack versus a room-temperature Control. The analgesic efficacy of a 1-min application of a Treatment cold (3-5 °C) gel pack versus a Control (room-temperature (20 °C)) gel pack prior to botulinum toxin injection into the platysma was assessed via visual analogue scale (VAS) ratings of pain before, during and after the procedure. Thirty-five patients received both trial arms during two separate clinic appointments. Cold gel packs provided a statistically significant reduction in pain compared with a room-temperature Control (from 26.4- to 10.2-mm VAS improvement (p < 0.001)), with no variance noted secondary to age, the hemi-facial side injected or the order in which the Treatment or Control gel packs were applied. Cryoanalgesia using a fridge-cooled gel pack provides an effective, safe and cheap method for reducing pain at the botulinum toxin injection site in patients with facial palsy. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Mental health and family relations among people who inject drugs and their family members in Vietnam.

PubMed

Li, Li; Tuan, Nguyen Anh; Liang, Li-Jung; Lin, Chunqing; Farmer, Shu C; Flore, Martin

2013-11-01

This article explores the association of people who inject drugs and their family members in terms of mental health and family relations. The objective was to understand the family context and its impact on people who inject drugs in a family-oriented culture in Vietnam. Cross-sectional assessment data were gathered from 83 people who inject drugs and 83 of their family members recruited from four communes in Phú Thọ province, Vietnam. Depressive symptoms and family relations were measured for both people who inject drugs and family members. Internalized shame and drug-using behavior were reported by people who inject drugs, and caregiver burden was reported by family members. We found that higher level of drug using behavior of people who inject drugs was significantly associated with higher depressive symptoms and lower family relations reported by themselves as well as their family members. Family relations reported by people who inject drugs and their family members were positively correlated. The findings highlight the need for interventions that address psychological distress and the related challenges faced by family members of people who inject drugs. The article has policy implication which concludes with an argument for developing strategies that enhance the role of families in supporting behavioral change among people who inject drugs. Copyright © 2013 Elsevier B.V. All rights reserved.

Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials.

PubMed

Coombes, Brooke K; Bisset, Leanne; Vicenzino, Bill

2010-11-20

Few evidence-based treatment guidelines for tendinopathy exist. We undertook a systematic review of randomised trials to establish clinical efficacy and risk of adverse events for treatment by injection. We searched eight databases without language, publication, or date restrictions. We included randomised trials assessing efficacy of one or more peritendinous injections with placebo or non-surgical interventions for tendinopathy, scoring more than 50% on the modified physiotherapy evidence database scale. We undertook meta-analyses with a random-effects model, and estimated relative risk and standardised mean differences (SMDs). The primary outcome of clinical efficacy was protocol-defined pain score in the short term (4 weeks, range 0-12), intermediate term (26 weeks, 13-26), or long term (52 weeks, ≥52). Adverse events were also reported. 3824 trials were identified and 41 met inclusion criteria, providing data for 2672 participants. We showed consistent findings between many high-quality randomised controlled trials that corticosteroid injections reduced pain in the short term compared with other interventions, but this effect was reversed at intermediate and long terms. For example, in pooled analysis of treatment for lateral epicondylalgia, corticosteroid injection had a large effect (defined as SMD>0·8) on reduction of pain compared with no intervention in the short term (SMD 1·44, 95% CI 1·17-1·71, p<0·0001), but no intervention was favoured at intermediate term (-0·40, -0·67 to -0·14, p<0·003) and long term (-0·31, -0·61 to -0·01, p=0·05). Short-term efficacy of corticosteroid injections for rotator-cuff tendinopathy is not clear. Of 991 participants who received corticosteroid injections in studies that reported adverse events, only one (0·1%) had a serious adverse event (tendon rupture). By comparison with placebo, reductions in pain were reported after injections of sodium hyaluronate (short [3·91, 3·54-4·28, p<0·0001], intermediate

Relationships between Induced Seismicity and Fluid Injection: Development of Strategies to Manage Injection

NASA Astrophysics Data System (ADS)

Eichhubl, Peter; Frohlich, Cliff; Gale, Julia; Olson, Jon; Fan, Zhiqiang; Gono, Valerie

2014-05-01

Induced seismicity during or following the subsurface injection of waste fluids such as well stimulation flow back and production fluids has recently received heightened public and industry attention. It is understood that induced seismicity occurs by reactivation of existing faults that are generally present in the injection intervals. We seek to address the question why fluid injection triggers earthquakes in some areas and not in others, with the aim toward improved injection methods that optimize injection volume and cost while avoiding induced seismicity. A GIS database has been built of natural and induced earthquakes in four hydrocarbon-producing basins: the Fort Worth Basin, South Texas, East Texas/Louisiana, and the Williston Basin. These areas are associated with disposal from the Barnett, Eagle Ford, Bakken, and Haynesville Shales respectively. In each region we analyzed data that were been collected using temporary seismographs of the National Science Foundation's USArray Transportable Array. Injection well locations, formations, histories, and volumes are also mapped using public and licensed datasets. Faults are mapped at a range of scales for selected areas that show different levels of seismic activity, and scaling relationships used to extrapolate between the seismic and wellbore scale. Reactivation potential of these faults is assessed using fault occurrence, and in-situ stress conditions, identifying areas of high and low fault reactivation potential. A correlation analysis between fault reactivation potential, induced seismicity, and fluid injection will use spatial statistics to quantify the probability of seismic fault reactivation for a given injection pressure in the studied reservoirs. The limiting conditions inducing fault reactivation will be compared to actual injection parameters (volume, rate, injection duration and frequency) where available. The objective of this project is a statistical reservoir- to basin-scale assessment of fault

Comparing badger (Meles meles) management strategies for reducing tuberculosis incidence in cattle.

PubMed

Smith, Graham C; McDonald, Robbie A; Wilkinson, David

2012-01-01

Bovine tuberculosis (bTB), caused by Mycobacterium bovis, continues to be a serious economic problem for the British cattle industry. The Eurasian badger (Meles meles) is partly responsible for maintenance of the disease and its transmission to cattle. Previous attempts to manage the disease by culling badgers have been hampered by social perturbation, which in some situations is associated with increases in the cattle herd incidence of bTB. Following the licensing of an injectable vaccine, we consider the relative merits of management strategies to reduce bTB in badgers, and thereby reduce cattle herd incidence. We used an established simulation model of the badger-cattle-TB system and investigated four proposed strategies: business as usual with no badger management, large-scale proactive badger culling, badger vaccination, and culling with a ring of vaccination around it. For ease of comparison with empirical data, model treatments were applied over 150 km(2) and were evaluated over the whole of a 300 km(2) area, comprising the core treatment area and a ring of approximately 2 km. The effects of treatment were evaluated over a 10-year period comprising treatment for five years and the subsequent five year period without treatment. Against a background of existing disease control measures, where 144 cattle herd incidents might be expected over 10 years, badger culling prevented 26 cattle herd incidents while vaccination prevented 16. Culling in the core 150 km(2) plus vaccination in a ring around it prevented about 40 cattle herd breakdowns by partly mitigating the negative effects of culling, although this approach clearly required greater effort. While model outcomes were robust to uncertainty in parameter estimates, the outcomes of culling were sensitive to low rates of land access for culling, low culling efficacy, and the early cessation of a culling strategy, all of which were likely to lead to an overall increase in cattle disease.

Management of orbital lymphangioma using intralesional injection of OK-432

PubMed Central

Suzuki, Y.; Obana, A.; Gohto, Y.; Miki, T.; Otuka, H.; Inoue, Y.

2000-01-01

AIM—To treat orbital lymphangioma with an intralesional injection of OK-432 (group A Streptococcus pyogenes of human origin).
METHOD—A 14 year old boy had a right orbital cystic lymphangioma. The visual acuity in the eye was 20/28. In an initial treatment, 0.02 mg of OK-432, was injected into the tumour after aspiration of the fluid contents, but no effect was seen. The second treatment was performed with 0.04 mg of OK-432.
RESULT—4 months later, the lesion had totally shrunk to fibrous tissue. The side effects were fever, a local inflammatory reaction lasting 3 days, and increased intraocular pressure, which was managed by draining the fluid contents. Visual acuity improved to 20/15, and the visual field defect and restriction of eye movement seen before treatment disappeared. No recurrence was noted 1 year after treatment.
CONCLUSION—An intralesional injection of OK-432 shrunk the lymphangioma without functional disturbance and scar in the facial skin. OK-432 may be useful for orbital lymphangioma, but further studies are still warranted to determine efficacy, complications, and the optimal dose for safe treatment.

 PMID:10837387

Efficacy of tramadol and butorphanol pretreatment in reducing pain on propofol injection: A placebo-controlled randomized study.

PubMed

Singh, Arvinderpal; Sharma, Geeta; Gupta, Ruchi; Kumari, Anita; Tikko, Deepika

2016-01-01

Pain of propofol injection has been recalled by many patients as the most painful part of the induction of anesthesia. Tramadol and butorphanol are commonly used analgesics for perioperative analgesia in anesthesia practice. However, their potential to relieve propofol injection pain still needs to be explored. A randomized, double-blind, placebo-controlled study was conducted on 90 American Society of Anesthesiologists I and II adult patients undergoing elective surgery under general anesthesia with propofol as an induction agent. Consecutive sampling technique with random assignment was used to allocate three groups of 30 patients each. Group I patients received an injection of normal saline 3 ml intravenously (placebo) while Group II and Group III patients received injection of tramadol 50 mg and butorphanol 1 mg intravenously, respectively. Before induction of anesthesia patients were asked about the intensity of pain on propofol injection by using visual analog scale (VAS) before the loss of consciousness. Descriptive statistics and analysis of variance with Chi-square test were used to analyze the data. The value of P < 0.05 was considered as a significant and P < 0.0001 as highly significant. The incidence of pain in Group I was observed in 80% of the patients, while it was observed in 23.33% and 20% of patients in Group II and III, respectively. Mean VAS scores were 2.27 ± 1.51, 1.14 ± 1.74, and 1.03 ± 1.72 in Group I, II, and Group III patients, respectively. The incidence of pruritus was 10% and 6.7% and erythema in 13.2% and 6.7% in Group II and III, respectively. Pretreatment with both butorphanol and tramadol significantly reduced pain on propofol injection; however, they exhibited comparable efficacy among each other. Thus, either of these two drugs can be considered for pretreatment to reduce propofol injection pain.

Ducted fuel injection: A new approach for lowering soot emissions from direct-injection engines

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

Mueller, Charles J.; Nilsen, Christopher W.; Ruth, Daniel J.

Designers of direct-injection compression-ignition engines use a variety of strategies to improve the fuel/charge-gas mixture within the combustion chamber for increased efficiency and reduced pollutant emissions. Strategies include the use of high fuel-injection pressures, multiple injections, small injector orifices, flow swirl, long-ignition-delay conditions, and oxygenated fuels. This is the first journal publication paper on a new mixing-enhancement strategy for emissions reduction: ducted fuel injection. The concept involves injecting fuel along the axis of a small cylindrical duct within the combustion chamber, to enhance the mixture in the autoignition zone relative to a conventional free-spray configuration (i.e., a fuel spray thatmore » is not surrounded by a duct). Finally, the results described herein, from initial proof-of-concept experiments conducted in a constant-volume combustion vessel, show dramatically lower soot incandescence from ducted fuel injection than from free sprays over a range of charge-gas conditions that are representative of those in modern direct-injection compression-ignition engines.« less

Ducted fuel injection: A new approach for lowering soot emissions from direct-injection engines

DOE PAGES

Mueller, Charles J.; Nilsen, Christopher W.; Ruth, Daniel J.; ...

2017-07-18

Designers of direct-injection compression-ignition engines use a variety of strategies to improve the fuel/charge-gas mixture within the combustion chamber for increased efficiency and reduced pollutant emissions. Strategies include the use of high fuel-injection pressures, multiple injections, small injector orifices, flow swirl, long-ignition-delay conditions, and oxygenated fuels. This is the first journal publication paper on a new mixing-enhancement strategy for emissions reduction: ducted fuel injection. The concept involves injecting fuel along the axis of a small cylindrical duct within the combustion chamber, to enhance the mixture in the autoignition zone relative to a conventional free-spray configuration (i.e., a fuel spray thatmore » is not surrounded by a duct). Finally, the results described herein, from initial proof-of-concept experiments conducted in a constant-volume combustion vessel, show dramatically lower soot incandescence from ducted fuel injection than from free sprays over a range of charge-gas conditions that are representative of those in modern direct-injection compression-ignition engines.« less

Intravitreal, Subretinal, and Suprachoroidal Injections: Evolution of Microneedles for Drug Delivery.

PubMed

Hartman, Rachel R; Kompella, Uday B

Even though the very thought of an injection into the eye may be frightening, an estimated 6 million intravitreal (IVT) injections were made in the USA during 2016. With the introduction of new therapeutic agents, this number is expected to increase. In addition, drug products that are injectable in ocular compartments other than the vitreous humor are expected to enter the back of the eye market in the not so distant future. Besides the IVT route, some of the most actively investigated routes of invasive administration to the eye include periocular, subretinal, and suprachoroidal (SC) routes. While clinical efficacy is the driving force behind new injectable drug product development for the eye, safety is also being improved with time. In the case of IVT injections, the procedural guidelines have evolved over the years to improve patient comfort and reduce injection-related injury and infection. Similar advances are anticipated for other routes of administration of injectable products to the eye. In addition to procedural improvements, the design of needles, particularly those with smaller diameters, length, and controlled bevel angles are expected to improve overall safety and acceptance of injected ophthalmic drug products. A key development in this area is the introduction of microneedles of a length less than a millimeter that can target the SC space. In the future, needles with smaller diameters and lengths, potentially approaching nanodimensions, are expected to revolutionize ophthalmic disease management.

Characterization of a high-pressure diesel fuel injection system as a control technology option to improve engine performance and reduce exhaust emissions

NASA Technical Reports Server (NTRS)

Mcfadden, J. J.; Dezelick, R. A.; Barrows, R. R.

1983-01-01

Test results from a high pressure electronically controlled fuel injection system are compared with a commercial mechanical injection system on a single cylinder, diesel test engine using an inlet boost pressure of 2.6:1. The electronic fuel injection system achieved high pressure by means of a fluid intensifier with peak injection pressures of 47 to 69 MPa. Reduced exhaust emissions were demonstrated with an increasing rate of injection followed by a fast cutoff of injection. The reduction in emissions is more responsive to the rate of injection and injection timing than to high peak injection pressure.

Dexmedetomidine reduces pain associated with rocuronium injection without causing a decrease in BIS values: a dose-response study.

PubMed

Joo, Jin; Baek, Jungwon; Lee, Jaemin

2014-09-01

To examine whether dexmedetomidine reduces the injection pain of propofol and rocuronium and to investigate whether the decrease in injection pain is associated with the known sedative action of dexmedetomidine. Randomized, double-blind, placebo-controlled clinical comparison study. Patients undergoing general anesthesia with intubation received 40 mg of 1% lidocaine (lidocaine group; n = 28), 0.25 μg/kg of dexmedetomidine (low-dose group; n = 27), 0.5 μg/kg of dexmedetomidine (subclinical dose group; n = 28), 1.0 μg/kg of dexmedetomidine (clinical dose group, n = 27), or normal saline (saline group; n = 28) before anesthetic induction. Pain associated with propofol and rocuronium injection was assessed using a 10-point verbal analog scale (VAS) and a 4-point withdrawal movement scale, respectively. The BIS value was measured 60 seconds after administration of the study drug, and at the time of rocuronium injection and intubation. The overall incidence of withdrawal movements due to rocuronium decreased significantly as the dose of dexmedetomidine increased (92.8%, 85.2%, 78.6%, and 51.9% in the saline, low-dose, subclinical dose, and clinical dose groups, respectively; P = 0.001). There was no significant difference in BIS values among the groups 60 seconds after study drug administration or at the time of rocuronium injection. Dexmedetomidine reduced pain associated with rocuronium injection in a dose-dependent manner. This effect was not associated with the decrease in BIS value. Copyright © 2014 Elsevier Inc. All rights reserved.

Arginine and lysine reduce the high viscosity of serum albumin solutions for pharmaceutical injection.

PubMed

Inoue, Naoto; Takai, Eisuke; Arakawa, Tsutomu; Shiraki, Kentaro

2014-05-01

Therapeutic protein solutions for subcutaneous injection must be very highly concentrated, which increases their viscosity through protein-protein interactions. However, maintaining a solution viscosity below 50 cP is important for the preparation and injection of therapeutic protein solutions. In this study, we examined the effect of various amino acids on the solution viscosity of very highly concentrated bovine serum albumin (BSA) and human serum albumin (HSA) at a physiological pH. Among the amino acids tested, l-arginine hydrochloride (ArgHCl) and l-lysine hydrochloride (LysHCl) (50-200 mM) successfully reduced the viscosity of both BSA and HSA solutions; guanidine hydrochloride (GdnHCl), NaCl, and other sodium salts were equally as effective, indicating the electrostatic shielding effect of these additives. Fourier transform infrared spectroscopy showed that BSA is in its native state even in the presence of ArgHCl, LysHCl, and NaCl at high protein concentrations. These results indicate that weakened protein-protein interactions play a key role in reducing solution viscosity. ArgHCl and LysHCl, which are also non-toxic compounds, will be used as additives to reduce the solution viscosity of concentrated therapeutic proteins. Copyright © 2013 The Society for Biotechnology, Japan. Published by Elsevier B.V. All rights reserved.

Managing work-related stress in the district nursing workplace.

PubMed

Burke, Michelle

2013-11-01

This article aims to highlight the issue of work-related stress within the district nursing workplace. It will acknowledge how the management of work-related stress has previously been discussed within nursing literature and will consider the emerging relationship between staff working conditions, staff wellbeing and quality of patient care. It will reintroduce the Health and Safety Executive's (HSE's) Management Standards approach to tackling work-related stress, which provides management support to reduce environmental work stressors and encourage enabling work environments and a positive workplace culture.

Effectiveness of HIV prevention social marketing with injecting drug users.

PubMed

Gibson, David R; Zhang, Guili; Cassady, Diana; Pappas, Les; Mitchell, Joyce; Kegeles, Susan M

2010-10-01

Social marketing involves applying marketing principles to promote social goods. In the context of health behavior, it has been used successfully to reduce alcohol-related car crashes, smoking among youths, and malaria transmission, among other goals. Features of social marketing, such as audience segmentation and repeated exposure to prevention messages, distinguish it from traditional health promotion programs. A recent review found 8 of 10 rigorously evaluated social marketing interventions responsible for changes in HIV-related behavior or behavioral intentions. We studied 479 injection drug users to evaluate a community-based social marketing campaign to reduce injection risk behavior among drug users in Sacramento, California. Injecting drugs is associated with HIV infection in more than 130 countries worldwide.

Effectiveness of HIV Prevention Social Marketing With Injecting Drug Users

PubMed Central

Zhang, Guili; Cassady, Diana; Pappas, Les; Mitchell, Joyce; Kegeles, Susan M.

2010-01-01

Social marketing involves applying marketing principles to promote social goods. In the context of health behavior, it has been used successfully to reduce alcohol-related car crashes, smoking among youths, and malaria transmission, among other goals. Features of social marketing, such as audience segmentation and repeated exposure to prevention messages, distinguish it from traditional health promotion programs. A recent review found 8 of 10 rigorously evaluated social marketing interventions responsible for changes in HIV-related behavior or behavioral intentions. We studied 479 injection drug users to evaluate a community-based social marketing campaign to reduce injection risk behavior among drug users in Sacramento, California. Injecting drugs is associated with HIV infection in more than 130 countries worldwide. PMID:20724686

Injections during labor and intrapartum-related hypoxic injury and mortality in rural southern Nepal

PubMed Central

Mullany, Luke C.; Khatry, Subarna K.; Katz, Joanne; Stanton, Cynthia K.; Lee, Anne C.C.; Darmstadt, Gary L.; LeClerq, Steven C.; Tielsch, James M.

2013-01-01

Objective To estimate the association between unmonitored use of injections during labor and intrapartum-related neonatal mortality and morbidity among home births. Methods Recently delivered women in Sarlahi, Nepal, reported whether they had received injections during labor. Data on breathing and crying status at birth, time to first breath, respiratory rate, sucking ability, and lethargy were gathered. Neonatal respiratory depression (NRD) and encephalopathy (NE) were compared by injection receipt status using multivariate regression models. Results Injections during labor were frequently reported (7108 of 22 352 [31.8%]) and were predominantly given by unqualified village “doctors.” Multivariate analysis (excluding facility births and complicated deliveries) revealed associations with intrapartum-related NRD (relative risk [RR] 2.52; 95% CI, 2.29–2.78) and NE (RR 3.48; 95% CI, 2.46–4.93). The risks of neonatal death associated with intrapartum-related NRD (RR 3.78; 95% CI, 2.53–5.66) or NE (RR 4.47; 95% CI, 2.78–7.19) were also elevated. Conclusion Injection during labor was widespread at the community level. This practice was associated with poor outcomes and possibly related to the inappropriate use of uterotonics by unqualified providers. Interventions are required to increase the safety of childbirth in the community and in peripheral health facilities. Parent trial registered at clinicaltrials.gov (NCT00 109616). PMID:23523332

Potential geographic "hotspots" for drug-injection related transmission of HIV and HCV and for initiation into injecting drug use in New York City, 2011-2015, with implications for the current opioid epidemic in the US

PubMed Central

Cooper, H. L. F.; Arasteh, K.; Feelemyer, J.; McKnight, C.; Ross, Z.

2018-01-01

Objective We identified potential geographic “hotspots” for drug-injecting transmission of HIV and hepatitis C virus (HCV) among persons who inject drugs (PWID) in New York City. The HIV epidemic among PWID is currently in an “end of the epidemic” stage, while HCV is in a continuing, high prevalence (> 50%) stage. Methods We recruited 910 PWID entering Mount Sinai Beth Israel substance use treatment programs from 2011–2015. Structured interviews and HIV/ HCV testing were conducted. Residential ZIP codes were used as geographic units of analysis. Potential “hotspots” for HIV and HCV transmission were defined as 1) having relatively large numbers of PWID 2) having 2 or more HIV (or HCV) seropositive PWID reporting transmission risk—passing on used syringes to others, and 3) having 2 or more HIV (or HCV) seronegative PWID reporting acquisition risk—injecting with previously used needles/syringes. Hotspots for injecting drug use initiation were defined as ZIP codes with 5 or more persons who began injecting within the previous 6 years. Results Among PWID, 96% injected heroin, 81% male, 34% White, 15% African-American, 47% Latinx, mean age 40 (SD = 10), 7% HIV seropositive, 62% HCV seropositive. Participants resided in 234 ZIP codes. No ZIP codes were identified as potential hotspots due to small numbers of HIV seropositive PWID reporting transmission risk. Four ZIP codes were identified as potential hotspots for HCV transmission. 12 ZIP codes identified as hotspots for injecting drug use initiation. Discussion For HIV, the lack of potential hotspots is further validation of widespread effectiveness of efforts to reduce injecting-related HIV transmission. Injecting-related HIV transmission is likely to be a rare, random event. HCV prevention efforts should include focus on potential hotspots for transmission and on hotspots for initiation into injecting drug use. We consider application of methods for the current opioid epidemic in the US. PMID

Intraarticular local anesthesia: can it reduce pain related to MR or CT arthrography of the shoulder?

PubMed

Choo, Hye Jung; Lee, Sun Joo; Kim, Dong Wook; Choi, Seok Jin; Lee, In Sook

2013-04-01

The objective of this study was to prospectively evaluate whether intraarticular anesthesia can reduce pain after MR or CT arthrography of the shoulder. This study included 120 patients who underwent CT or MR arthrography of the shoulder. The patients were randomized into two groups: the study group (n = 60), each administered an intraarticular injection of the contrast agent mixed with a local anesthetic (2% mepivacaine); and the control group (n = 60), each injected with the contrast agent only. Each patient's pain level was assessed at five phases-baseline and immediately, 2 hours, 1 day, and 2 days after injection-by using a visual analog scale or a verbal rating scale. The net pain score at each phase was also calculated. The pain course and net pain score were compared between study and control groups by repeated-measures analysis of variance. After the patients were divided into subgroups according to patient- or procedure-related factors, the efficacy of the intraarticular local anesthetic in each subgroup was evaluated. The pain course showed a quadratic trend and was not significantly different between study and control groups. The net pain score also was not significantly different between the two groups. No subgroup showed a significantly different efficacy of the intraarticular local anesthetic between the two groups. Intraarticular local anesthesia did not reduce arthrography-related pain.

Effectiveness of a Comprehensive Stress Management Program to Reduce Work-Related Stress in a Medium-Sized Enterprise

PubMed Central

2014-01-01

Objectives To assess the effectiveness of a comprehensive workplace stress management program consisting of participatory action-oriented training (PAOT) and individual management. Methods A comprehensive workplace stress management program was conducted in a medium-sized enterprise. The baseline survey was conducted in September 2011, using the Korean Occupational Stress Scale (KOSS) and Worker’s Stress Response Inventory (WSRI). After implementing both organizational and individual level interventions, the follow up evaluation was conducted in November 2011. Results Most of the workers participated in the organizational level PAOT and made Team-based improvement plans. Based on the stress survey, 24 workers were interviewed by a researcher. After the organizational and individual level interventions, there was a reduction of several adverse psychosocial factors and stress responses. In the case of blue-collar workers, psychosocial factors such as the physical environment, job demands, organizational system, lack of rewards, and occupational climate were significantly improved; in the case of white-collar workers, the occupational climate was improved. Conclusions In light of these results, we concluded that the comprehensive stress management program was effective in reducing work-related stress in a short-term period. A persistent long-term follow up is necessary to determine whether the observed effects are maintained over time. Both team-based improvement activities and individual interviews have to be sustainable and complementary to each other under the long-term plan. PMID:24524591

Focal macular electroretinograms after intravitreal injections of bevacizumab for age-related macular degeneration.

PubMed

Iwata, Eiji; Ueno, Shinji; Ishikawa, Kohei; Ito, Yasuki; Uetani, Ruka; Piao, Chang-Hua; Kondo, Mineo; Terasaki, Hiroko

2012-06-28

To evaluate the changes in the best-corrected visual acuity (BCVA), macular thickness, and focal macular electroretinograms (FMERGs) after three intravitreal injections of bevacizumab for a choroidal neovascularization (CNV) associated with age-related macular degeneration (AMD). The medical records of 18 eyes of 18 patients who had received three consecutive monthly intravitreal injections of bevacizumab were retrospectively studied. The BCVA, macular thickness determined by optical coherence tomography (OCT), and FMERGs were measured before the first injection, and 10 days after each of the intravitreal bevacizumab injections. The number of eyes with improvement in BCVA after the first injection was one (6%), after the second injection was four (22%), and after the third injection was five (28%). The number of eyes with reduction in macular thickness was 4 (33%), 8 (44%), and 10 (56%) after each of the three injections. The number of eyes with increase in b-wave amplitude of the FMERGs was 7 (38%), 6 (33%), and 10 (56%) after each of the three each injections. The mean macular thickness was significantly thinner after the first injection, and the mean BCVA was significantly improved after the second injection. The mean amplitude and implicit time of the b-wave of the FMERGs were significantly improved only after the third injection (P<0.05). All parameters improved but the best was after the third injection, indicating that three monthly intravitreous injections with bevacizumab may be an effective treatment regimen for AMD.

Change to earlier surgical interventions: contemporary management of unilateral vocal fold paralysis.

PubMed

Costello, Declan

2015-06-01

The management of unilateral vocal fold paralysis has undergone significant changes in the last 2 decades. This has largely been made possible by advances in endoscope technology and new injectable materials. This article will cover the main changes in management of patients with unilateral vocal fold paralysis and summarize the recent literature in relation to early intervention in this group. Several recent studies have suggested that early vocal fold injection medialization reduces the likelihood of needing open laryngeal framework surgery in future. Early injection medialization appears to give good long-term results with few complications and minimizes the need for future laryngeal framework surgery. It should be considered in centres wherein the equipment and trained staff are available.

Dexamethasone Injection

MedlinePlus

... severe allergic reactions. It is used in the management of certain types of edema (fluid retention and ... needed for normal body functioning) and in the management of certain types of shock. Dexamethasone injection is ...

The role of work-related and personal factors in diabetes self-management.

PubMed

Weijman, Iris; Ros, Wynand J G; Rutten, Guy E H M; Schaufeli, Wilmar B; Schabracq, Marc J; Winnubst, Jacques A M

2005-10-01

The aim of this study was to investigate how factors in the workplace and personal factors are related to the frequency with which people with diabetes perform self-management activities and the degree to which they do or do not experience the performing of self-management activities as a burden. Two hundred and ninety-two employees with insulin-treated diabetes completed questionnaires on socio-demographic and illness-related background variables, work experience, diabetes self-efficacy, social support outside of work, coping styles and self-management activities. The results indicate that employees who reported a high workload were more likely to perceive injecting insulin as a burden. The level of social support was positively related to the frequency of dietary self-management in type 2 diabetes and negatively related to the sense of being burdened by dietary self-management in type 1 diabetes. With respect to personal factors, we found that a diabetes avoidance coping style was associated particularly with infrequent blood glucose monitoring and a high sense of being burdened by blood glucose monitoring. Individuals with a low level of self-efficacy were more likely to perceive all types of self-management activities as a burden. These results may guide health professionals when counseling individuals with diabetes.

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.

Undesirable leakage to overlying formations with horizontal and vertical injection wells

NASA Astrophysics Data System (ADS)

Mosaheb, M.; Zeidouni, M.

2017-12-01

Deep saline aquifers are considered for underground storage of carbon dioxide. Undesirable leakage of injected CO2 to adjacent layers would disturb the storage process and can pollute shallower fresh water resources as well as atmosphere. Leaky caprocks, faults, and abandoned wells are examples of leaky pathways. In addition, the overpressure can reactivate a sealing fault or damage the caprock layer. Pressure management is applicable during the storage operation to avoid these consequences and to reduce undesirable leakage.The fluids can be injected through horizontal wells with a wider interval than vertical wells. Horizontal well injection would make less overpressure by delocalizing induced pressure especially in thin formations. In this work, numerical and analytical approaches are applied to model different leaky pathways with horizontal and vertical injection wells. we compare leakage rate and overpressure for horizontal and vertical injection wells in different leaky pathway systems. Results show that the horizontal well technology would allow high injection rates with lower leakage rate for leaky well, leaky fault, and leaky caprock cases. The overpressure would reduce considerably by horizontal well comparing to vertical well injection especially in leaky fault system. The horizontal well injection is an effective method to avoid reaching to threshold pressure of fault reactivation and prevent the consequent induced seismicity.

Evolocumab Injection

MedlinePlus

... coronary artery bypass (CABG) surgery in people with cardiovascular disease. Evolocumab injection is also used along with diet ... evolocumab injection is used to treat HeFH or cardiovascular disease or to reduce the risk of a stroke, ...

Caseload management, work-related stress and case manager self-efficacy among Victorian mental health case managers.

PubMed

King, Robert

2009-05-01

supervisor, may be effective in reducing work-related stress and enhancing case manager personal efficacy.

Human Collagen Injections to Reduce Rectal Dose During Radiotherapy

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

Noyes, William R., E-mail: noyes@cancercenternd.com; Hosford, Charles C.; Schultz, Steven E.

Objectives: The continuing search for interventions, which address the incidence and grade of rectal toxicities associated with radiation treatment of prostate cancer, is a major concern. We are reporting an investigational trial using human collagen to increase the distance between the prostate and anterior rectal wall, thereby decreasing the radiation dose to the rectum. Methods: This is a pilot study evaluating the use of human collagen as a displacing agent for the rectal wall injected before starting a course of intensity-modulated radiotherapy (IMRT) for prostate cancer. Using a transperineal approach, 20 mL of human collagen was injected into the perirectalmore » space in an outpatient setting. Computerized IMRT plans were performed pre- and postcollagen injection, and after a patient completed their radiotherapy, to determine radiation dose reduction to the rectum associated with the collagen injection. Computed tomography scans were performed 6 months and 12 months after completing their radiotherapy to evaluate absorption rate of the collagen. All patients were treated with IMRT to a dose of 75.6 Gy to the prostate. Results: Eleven patients were enrolled into the study. The injection of human collagen in the outpatient setting was well tolerated. The mean separation between the prostate and anterior rectum was 12.7 mm. The mean reduction in dose to the anterior rectal wall was 50%. All men denied any rectal symptoms during the study. Conclusions: The transperineal injection of human collagen for the purpose of tissue displacement is well tolerated in the outpatient setting. The increased separation between the prostate and rectum resulted in a significant decrease in radiation dose to the rectum while receiving IMRT and was associated with no rectal toxicities.« less

Goals Set by Patients Using the ICF Model before Receiving Botulinum Injections and Their Relation to Spasticity Distribution

PubMed Central

Choi, Kevin; Peters, Jaclyn; Tri, Andrew; Chapman, Elizabeth; Sasaki, Ayako; Ismail, Farooq; Boulias, Chris; Reid, Shannon

2017-01-01

Purpose: Goal Attainment Scaling (GAS) is used to assess functional gains in response to treatment. Specific characteristics of the functional goals set by individuals receiving botulinum toxin type A (BoNTA) injections for spasticity management are unknown. The primary objectives of this study were to describe the characteristics of the goals set by patients before receiving BoNTA injections using the International Classification of Functioning, Disability and Health (ICF) and to determine whether the pattern of spasticity distribution affected the goals set. Methods: A cross-sectional retrospective chart review was carried out in an outpatient spasticity-management clinic in Toronto. A total of 176 patients with a variety of neurological lesions attended the clinic to receive BoNTA injections and completed GAS from December 2012 to December 2013. The main outcome measures were the characteristics of the goals set by the participants on the basis of ICF categories (body functions and structures, activity and participation) and the spasticity distribution using Modified Ashworth Scale scores. Results: Of the patients, 73% set activity and participation goals, and 27% set body functions and structures goals (p<0.05). In the activity and participation category, 30% of patients set moving and walking goals, 28% set self-care and dressing goals, and 12% set changing and maintaining body position goals. In the body functions and structures category, 18% set neuromuscular and movement-related goals, and 8% set pain goals. The ICF goal categories were not related to the patterns of spasticity (upper limb vs. lower limb or unilateral vs. bilateral spasticity) or type of upper motor neuron (UMN) lesion (p>0.05). Conclusion: Our results show that patients receiving BoNTA treatment set a higher percentage of activity and participation goals than body functions and structures goals. Goal classification was not affected by type of spasticity distribution or type of UMN disorder

Field demonstration of foam injection to confine a chlorinated solvent source zone.

PubMed

Portois, Clément; Essouayed, Elyess; Annable, Michael D; Guiserix, Nathalie; Joubert, Antoine; Atteia, Olivier

2018-05-01

A novel approach using foam to manage hazardous waste was successfully demonstrated under active site conditions. The purpose of the foam was to divert groundwater flow, that would normally enter the source zone area, to reduce dissolved contaminant release to the aquifer. During the demonstration, foam was pre generated and directly injected surrounding the chlorinated solvent source zone. Despite the constraints related to the industrial activities and non-optimal position of the injection points, the applicability and effectiveness of the approach have been highlighted using multiple metrics. A combination of measurements and modelling allowed definition of the foam extent surrounding each injection point, and this appears to be the critical metric to define the success of the foam injection approach. Information on the transport of chlorinated solvents in groundwater showed a decrease of contaminant flux by a factor of 4.4 downstream of the confined area. The effective permeability reduction was maintained over a period of three months. The successful containment provides evidence for consideration of the use of foam to improve traditional flushing techniques, by increasing the targeting of contaminants by remedial agents. Copyright © 2018 Elsevier B.V. All rights reserved.

Botulinum toxin injection techniques for the management of adult spasticity.

PubMed

Walker, Heather W; Lee, Michael Y; Bahroo, Laxman B; Hedera, Peter; Charles, David

2015-04-01

Spasticity is often experienced by individuals with injury or illness of the central nervous system from etiologies such as stroke, spinal cord injury, brain injury, multiple sclerosis, or other neurologic conditions. Although spasticity may provide benefits in some patients, it more often leads to complications negatively impacting the patient. Nonpharmacologic treatment options often do not provide long-term reduction of spasticity, and systemic interventions, such as oral medications, can have intolerable side effects. The use of botulinum neurotoxin injections is one option for management of focal spasticity. Several localization techniques are available to physicians that allow for identification of the selected target muscles. These methods include anatomic localization in isolation or in conjunction with electromyography guidance, electrical stimulation guidance, or ultrasound guidance. This article will focus on further description of each of these techniques in relation to the treatment of adult spasticity and will discuss the advantages and disadvantages of each technique, as well as review the literature comparing the techniques. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Lift, Drag, and Pressure Distribution Effects Accompanying Drag-Reducing Polymer Injection on Two-Dimensional Hydrofoil

DTIC Science & Technology

1975-10-01

associated with drag- reducing polymers since Wu’s discovery of pump effects in 1969(16) Some of the research has involved tests on propellers finite span...AD-A022 433 LIFT, DRAG, AND PRESSURE DISTRIBUTION EFFECTS ACCOMPANYING DRAG- REDUCING POLYMER INJECTION ON TWO-DIMENSIONAL HYDROFOIL Daniel H. Fruman...et al Hydronautits, IncorponAted "Prepared f’or: Office of Naval Research October 197’ .!. S.IIE KA NTO CmaY - t 093103 A pprove!- for p~thic relpsa

Office-Based Intracordal Hyaluronate Injections Improve Quality of Life in Thoracic-Surgery-Related Unilateral Vocal Fold Paralysis.

PubMed

Fang, Tuan-Jen; Hsin, Li-Jen; Chung, Hsiu-Feng; Chiang, Hui-Chen; Li, Hsueh-Yu; Wong, Alice M K; Pei, Yu-Chen

2015-10-01

Thoracic-surgery-related unilateral vocal fold paralysis (UVFP) may cause severe morbidity and can cause profound functional impairment and psychosocial stress in patients with pre-existing thoracic diseases. In-office intracordal hyaluronate (HA) injections have recently been applied to improve voice and quality of life in patients with vocal incompetence, but their effect on thoracic-surgery-related UVFP remains inconclusive. We therefore conducted a prospective study to clarify the effect of early HA injection on voice and quality of life in patients with thoracic-surgery-related UVFP. Patients with UVFP within 3 months after thoracic surgery who received office-based HA injection were recruited. Quantitative laryngeal electromyography, videolaryngostroboscopy, voice-related life quality (voice outcome survey), laboratory voice analysis, and health-related quality of life (SF-36) were evaluated at baseline, and at 1 month postinjection. A total of 104 consecutive patients accepted office-based HA intracordal injection during the study period, 34 of whom were treated in relation to thoracic surgery and were eligible for inclusion. Voice-related life quality, voice laboratory analysis, and most generic quality of life domains were significantly improved at 1 month after in-office HA intracordal injection. No HA-related complications were reported. Single office-based HA intracordal injection is a safe and effective treatment for thoracic-surgery-related UVFP, resulting in immediate improvements in patient quality of life, voice quality, and swallowing ability.

Knee joint mobilization reduces secondary mechanical hyperalgesia induced by capsaicin injection into the ankle joint.

PubMed

Sluka, K A; Wright, A

2001-01-01

Joint mobilization is a treatment approach commonly used by physical therapists for the management of a variety of painful conditions. However, the clinical effectiveness when compared to placebo and the neurophysiological mechanism of action are not known. The purpose of this study was to establish that application of a manual therapy technique will produce antihyperalgesia in an animal model of joint inflammation and that the antihyperalgesia produced by joint mobilization depends on the time of treatment application. Capsaicin (0.2%, 50 microl) was injected into the lateral aspect of the left ankle joint and mechanical withdrawal threshold assessed before and after capsaicin injection in Sprague-Dawley rats. Joint mobilization of the ipsilateral knee joint was performed 2 h after capsaicin injection for a total of 3 min, 9 min or 15 min under halothane anaesthesia. Control groups included animals that received halothane for the same time as the group that received joint mobilization and those whose limbs were held for the same duration as the mobilization (no halothane). Capsaicin resulted in a decreased mechanical withdrawal threshold by 2 h after injection that was maintained through 4 h. Both 9 and 15 min of mobilization, but not 3 min of mobilization, increased the withdrawal threshold to mechanical stimuli to baseline values when compared with control groups. The antihyperalgesic effect of joint mobilization lasted 30 min. Thus, joint mobilization (9 or 15 min duration) produces a significant reversal of secondary mechanical hyperalgesia induced by intra-articular injection of capsaicin. Copyright 2001 European Federation of Chapters of the International Association for the Study of Pain.

Agreement between a physiotherapist and an orthopaedic surgeon regarding management and prescription of corticosteroid injection for patients with shoulder pain.

PubMed

Marks, Darryn; Comans, Tracy; Thomas, Michael; Ng, Shu Kay; O'Leary, Shaun; Conaghan, Philip G; Scuffham, Paul A; Bisset, Leanne

2016-12-01

Physiotherapists increasingly manage shoulder referrals in place of orthopaedic doctors. Better understanding the agreement between these professionals will help inform the safety, quality and potential costs of these care models. To establish the level of agreement between a physiotherapist and an orthopaedic surgeon regarding diagnosis, management and corticosteroid injection, in a representative sample of orthopaedic shoulder referrals. Blinded inter-rater agreement study. 274 public orthopaedic shoulder patients were independently assessed by a physiotherapist and an orthopaedic surgeon. Management, subacromial corticosteroid injection, diagnosis and investigation decisions were compared using inter-rater reliability statistics. Agreement between the physiotherapist and the orthopaedic surgeon was near perfect for surgical versus nonsurgical management (Gwets agreement coefficient AC1 = 0.93, 95%CI: 0.90-0.93), safety of injection (AC1 = 0.85, CI: 0.79-0.91) and investigations requested (AC1 = 0.87, CI: 0.83-0.91); substantial for the presence of subacromial pain (AC1 = 0.74, CI: 0.66-0.81) and diagnosis (AC1 = 0.72, CI: 0.66-0.78); and moderate regarding delivery of subacromial corticosteroid injection as an immediate treatment (AC1 = 0.48, CI 0.33-0.53), with the physiotherapist less inclined to select corticosteroid injection as the first intervention. In this study a physiotherapist with prescribing and injection training made decisions analogous to those of an orthopaedic surgeon at initial consultation for orthopaedic shoulder pain, including the safe identification of patients for subacromial injection, without prior screening of referrals by orthopaedic doctors. Australia and New Zealand Clinical Trials Registry, number 12612000532808. Copyright © 2016 Elsevier Ltd. All rights reserved.

Umbilical vein injection for management of retained placenta.

PubMed

Nardin, Juan Manuel; Weeks, Andrew; Carroli, Guillermo

2011-05-11

If a retained placenta is left untreated, there is a high risk of maternal death. However, manual removal of the placenta is an invasive procedure with serious complications of haemorrhage, infection or genital tract trauma. To assess the use of umbilical vein injection (UVI) of saline solution alone or with oxytocin in comparison either with expectant management or with an alternative solution or other uterotonic agent for retained placenta. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 February 2011). Randomized trials comparing UVI of saline or other fluids, with or without oxytocics, either with expectant management or with an alternative solution or other uterotonic agent, in the management of retained placenta. Two review authors assessed the methodological quality of the studies and extracted the data. We included 15 trials (1704 women). The trials were of variable quality. Compared with expectant management, UVI of saline solution alone did not show any significant difference in the incidence of manual removal of the placenta (risk ratio (RR) 0.99; 95% confidence interval (CI) 0.84 to 1.16). UVI of oxytocin solution compared with expectant management showed no reduction in the need for manual removal (RR 0.87; 95% CI 0.74 to 1.03).Oxytocin solution compared with saline solution alone showed a reduction in manual removal of the placenta, but this was not statistically significant (RR 0.91; 95% CI 0.82 to 1.00). When only high-quality studies were assessed, there was no statistical difference (RR 0.92; 95% CI 0.83 to 1.01). We detected no differences in any of the other outcomes.UVI of oxytocin solution compared with UVI of plasma expander showed no statistically significant difference in the outcomes assessed by the only one small trial included. Prostaglandin solution compared with saline solution alone was associated with a statistically significant lower incidence in manual removal of placenta (RR 0.42; 95% CI 0.22 to 0

Cystic fibrosis-related diabetes mellitus: etiology, evaluation, and management.

PubMed

Fischman, Daniel; Nookala, Vinod K

2008-12-01

To review the pathophysiology, diagnosis, and management of cystic fibrosis-related diabetes mellitus (CFRD). We performed a MEDLINE search of the literature, using the search terms "cystic fibrosis-related diabetes, "CFRD," and "cystic fibrosis and diabetes," to identify pertinent articles available in English. In patients with cystic fibrosis (CF), CFRD is a major cause for an accelerated decline in health. It is the result of multiple pathophysiologic mechanisms, including destruction of pancreatic islet cells, impaired hepatic response to the antigluconeogenic effects of insulin, and impaired insulin sensitivity. Nutritional management and adequate caloric intake are paramount to successful management of CF. Although insulin remains the standard of care for treating CFRD in conjunction with fasting hyperglycemia, a small but growing body of literature supports the use of oral therapies. In this article, we discuss the benefits of and possible adverse reactions to the various classes of oral and injectable agents used in the treatment of diabetes mellitus, with special attention to the population of patients with CF. Orally administered agents can have a role in the treatment of CFRD. Further study is needed to determine the optimal combination of therapeutic modalities for CFRD.

Medical managers' beliefs about reduced-hour physicians.

PubMed

Hartwell, Jennifer K; Barnett, Rosalind C; Borgatti, Stephen

2004-01-01

This paper examines medical managers' beliefs about the impact reduced-hour career paths for physicians has on organizational effectiveness. The findings of this exploratory inductive study of 17 medical managers at nine medical organizations in the Boston area suggest that managers believe the benefits of reduced-hour physicians (RHPs) far outweigh the disadvantages. However, many of their reasons appear to be exploitative of RHPs. In particular, managers believe that employing RHPs results in increased managerial control and that RHPs should: work more than they are compensated for; do a disproportionate share of the undesirable work; and remain extra flexible and available to the organization. An interpretation of the findings based on psychological contract theory is offered, and may help to illuminate other results reported in the literature, including some controversial findings that reduced-hour workers tend to have poor health outcomes.

Zidovudine Injection

MedlinePlus

... immunodeficiency virus (HIV) infection. Zidovudine is given to HIV-positive pregnant women to reduce the chance of passing the infection to the baby. Zidovudine injection is in a class of medications ... the amount of HIV in the blood. Although zidovudine injection does not ...

A randomized study of contingency management and spirometric lung age for motivating smoking cessation among injection drug users.

PubMed

Drummond, Michael B; Astemborski, Jacquie; Lambert, Allison A; Goldberg, Scott; Stitzer, Maxine L; Merlo, Christian A; Rand, Cynthia S; Wise, Robert A; Kirk, Gregory D

2014-07-28

Even after quitting illicit drugs, tobacco abuse remains a major cause of morbidity and mortality in former injection drug users. An important unmet need in this population is to have effective interventions that can be used in the context of community based care. Contingency management, where a patient receives a monetary incentive for healthy behavior choices, and incorporation of individual counseling regarding spirometric "lung age" (the age of an average healthy individual with similar spirometry) have been shown to improve cessation rates in some populations. The efficacy of these interventions on improving smoking cessation rates has not been studied among current and former injection drug users. In a randomized, factorial design study, we recruited 100 active smokers from an ongoing cohort study of current and former injection drug users to assess the impact of contingency management and spirometric lung age on smoking cessation. The primary outcome was 6-month biologically-confirmed smoking cessation comparing contingency management, spirometric lung age or both to usual care. Secondary outcomes included differences in self-reported and biologically-confirmed cessation at interim visits, number of visits attended and quit attempts, smoking rates at interim visits, and changes in Fagerstrom score and self-efficacy. Six-month biologically-confirmed smoking cessations rates were 4% usual care, 0% lung age, 14% contingency management and 0% for combined lung age and contingency management (p = 0.13). There were no differences in secondary endpoints comparing the four interventions or when pooling the lung age groups. Comparing contingency management to non-contingency management, 6-month cessation rates were not different (7% vs. 2%; p = 0.36), but total number of visits with exhaled carbon monoxide-confirmed abstinence were higher for contingency management than non-contingency management participants (0.38 vs. 0.06; p = 0.03), and more contingency management

Mental Health and Family Relations: Correlated Reports from People Who Inject Drugs and their Family Members in Vietnam

PubMed Central

Li, Li; Tuan, Nguyen Anh; Liang, Li-Jung; Lin, Chunqing; Farmer, Shu C.; Flore, Martin

2013-01-01

Background This article explores the association of people who inject drugs and their family members in terms of mental health and family relations. The objective was to understand the family context and its impact on people who inject drugs in a family-oriented culture in Vietnam. Methods Cross-sectional assessment data were gathered from 83 people who inject drugs and 83 of their family members recruited from four communes in Phú Thọ province, Vietnam. Depressive symptoms and family relations were measured for both people who inject drugs and family members. Internalized shame and drug-using behavior were reported by people who inject drugs, and caregiver burden was reported by family members. Results We found that higher level of drug using behavior of people who inject drugs was significantly associated with higher depressive symptoms and lower family relations reported by themselves as well as their family members. Family relations reported by people who inject drugs and their family members were positively correlated. Conclusion The findings highlight the need for interventions that address psychological distress and the related challenges faced by family members of people who inject drugs. The article has policy implication which concludes with an argument for developing strategies that enhance the role of families in supporting behavioral change of people who inject drugs. PMID:23910167

Effects of Facet Joint Injection Reducing the Need for Percutaneous Vertebroplasty in Vertebral Compression Fractures

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

Im, Tae Seong; Lee, Joon Woo; Lee, Eugene

ObjectiveTo evaluate the effects of facet joint injection (FJI) reducing the need for percutaneous vertebroplasty (PVP) in cases of vertebral compression fracture (VCF).Materials and MethodsA total of 169 patients who were referred to the radiology department of our institution for PVP between January 2011 and December 2014 were retrospectively evaluated. The effectiveness of FJI was evaluated by the proportion of patients who cancelled PVP and who experienced reduced pain. In addition, by means of medical chart and MRI review, those clinical factors (age, sex, history of trauma, amount of injected steroids and interval days elapsed between VCF and FJI) andmore » MR image factors (kyphosis angle, height loss, single or multiple level of VCF, burst fracture, central canal compromise, posterior element injury) that were believed to be significant for the effectiveness of FJI were statistically analysed.ResultsIn the 26 patients with FJI prior to PVP, six (23 %) patients cancelled PVP with considerable improvement in reported pain. In the 20 patients with PVP after FJI, improvement in pain after FJI was reported by six patients, resulting in a total of 12 patients (46 %) who experienced reduced pain after FJI. Clinical factors and MR image factors did not show any statistically significant difference between those groups, divided by PVP cancellation and by improvement of pain.ConclusionAfter FJI prior to PVP, about one quarter of patients cancelled PVP due to reduced pain and overall about half of the patients experienced reduced pain.« less

Injection locked coupled opto-electronic oscillator for optical frequency comb generation

NASA Astrophysics Data System (ADS)

Williams, Charles; Mandridis, Dimitrios; Davila-Rodriguez, Josue; Delfyett, Peter J.

2011-06-01

A CW injection locked Coupled Opto-Electronic Oscillator (COEO) is presented with a 10.24 GHz spaced optical frequency comb output as well as a low noise RF output. A modified Pound-Drever-Hall scheme is employed to ensure long-term stability of the injection lock, feeding back into the cavity length to compensate for cavity resonance drifts relative to the injection seed frequency. Error signal comparison to an actively mode-locked injection locked laser is presented. High optical signal-to-noise ratio of ~35 dB is demonstrated with >20 comblines of useable bandwidth. The optical linewidth, in agreement with injection locking theory, reduces to that of the injection seed frequency, <5 kHz. Low amplitude and absolute phase noise are presented from the optical output of the laser system. The integrated pulse-to-pulse energy fluctuation was found to be reduced by up to a factor of two due to optical injection. Additional decreases were shown for varying injection powers.

CO2 plume management in saline reservoir sequestration

USGS Publications Warehouse

Frailey, S.M.; Finley, R.J.

2011-01-01

close to the injection well, compared to monitoring wells intended to measure CO2 saturation via fluid sampling or cased-hole well logs. If pressure monitoring wells become mandated, these wells could be used for managing the CO2 saturation and aquifer pressure distribution. To understand the relevance and effectiveness of producing and injecting brine to improve storage efficiency, direct the plume to specific pore space, and redistribute the pressure, numerical models of CO2 injection into aquifers are used. Simulated cases include various aquifer properties at a single well site and varying the number and location of surrounding wells for plume management. Strategies in terms of completion intervals can be developed to effectively contact more vertical pore space in relatively thicker geologic formations. Inter-site plume management (or cooperative) wells for the purpose of pressure monitoring and plume management may become the responsibility of a consortium of operators or a government entity, not individual sequestration site operators. ?? 2011 Published by Elsevier Ltd.

Subthreshold micropulse laser reduces anti-VEGF injection burden in patients with diabetic macular edema.

PubMed

Moisseiev, Elad; Abbassi, Sam; Thinda, Sumeer; Yoon, Joseph; Yiu, Glenn; Morse, Lawrence S

2018-01-01

To evaluate the efficacy of micropulse laser in the early treatment of diabetic macular edema (DME) and its associated burden of anti-vascular endothelial growth factor (VEGF) injections. This retrospective comparative study compared a group of 19 eyes with DME treated with micropulse laser to a matched control group of 19 eyes with DME treated with ranibizumab injections without micropulse laser. Recorded parameters included previous medical and ocular history, previous and subsequent ranibizumab injections administered for DME, visual acuity (VA), central macular thickness throughout the follow-up period, and the occurrence of any complications. The improvement in VA was comparable in both groups, at 12 months and at the final follow-up. Patients treated with micropulse laser required significantly fewer ranibizumab injections than their controls, both at 12 months (1.7 ± 2.3 vs 5.6 ± 2.1) and by the end of the follow-up (2.6 ± 3.3 vs 9.3 ± 5.1) (p<0.001 for both). No complications related to the micropulse laser were encountered. Micropulse laser is a safe and effective treatment for DME, which may achieve comparable improvement in VA along with a significant reduction in the burden of anti-VEGF injections. We suggest a treatment approach for its inclusion in the early stages of DME.

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.

Drawing attention to a neglected injecting-related harm: a systematic review of AA amyloidosis among people who inject drugs.

PubMed

Harris, Magdalena; Brathwaite, Rachel; Scott, Jenny; Gilchrist, Gail; Ciccarone, Dan; Hope, Vivian; McGowan, Catherine R

2018-04-26

Chronic skin and soft tissue infections (SSTI) among people who inject drugs (PWID) can lead to AA amyloidosis: a serious, yet neglected, multi-organ disease. We aim to synthesize findings on the epidemiology, risk factors, clinical outcomes, screening recommendations and challenges to treatment for AA amyloidosis among PWID. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched the following bibliographic databases in July 2017: CINAHL Plus, Embase, Global Health, MEDLINE, PsycEXTRA, PsycINFO and SCOPUS. Studies were included if they investigated AA amyloidosis in PWID. Studies were not restricted to location, study type, year or language of publication. Study heterogeneity precluded meta-analysis; we present a narrative review of the literature. Thirty-seven papers from eight countries met inclusion criteria. A total of 781 PWID are reported on, of whom 177 had AA amyloidosis. Where disease causality is established, it is attributed to chronic inflammation caused by injecting-related SSTIs. Most (88.7%) PWID with AA amyloidosis had SSTIs. The proportion of PWID with AA amyloidosis at post-mortem ranged from 1.6% (Germany) to 22.5% (Serbia). Biopsy studies reported from 5.26% (Portugal) to 50% (Germany) of AA amyloidosis in PWID with suspected or known kidney disease. Following diagnosis, the typical trajectory for PWID with AA amyloidosis was rapid deterioration of renal function requiring haemodialysis. Treatment difficulties, end-stage renal failure and premature death from sepsis were observed. Good outcomes, including reversibility of AA amyloidosis, are attributed to rapid treatment of the underlining inflammation and injecting cessation. Notably, given the population in question, no studies were published in addiction or harm reduction journals; most (92%) appeared in specialist nephrology and medical journals. There is strong evidence of an association between skin

High hepatitis C incidence in relation to prescription opioid injection and poly-drug use: Assessing barriers to hepatitis C prevention.

PubMed

Puzhko, Svetlana; Roy, Élise; Jutras-Aswad, Didier; Artenie, Andreea Adelina; Fortier, Emmanuel; Zang, Geng; Bruneau, Julie

2017-09-01

Prescription opioid (PO) injection and poly-drug use have been associated with hepatitis C virus (HCV) infection among people who inject drugs (PWID). Poly-drug use is often a barrier to key HCV preventive programmes including opioid agonist treatment. The contribution of specific drug combinations to high HCV incidence in poly-drug users has not been assessed previously. Addressing this knowledge gap could enhance HCV treatment and prevention efforts. We examined the association between specific drugs and number of drugs used in addition to injected POs, and HCV seroconversion. PWID participating in a cohort study in Montréal (HEPCO), HCV-seronegative at baseline and followed between 2004 and 2013, were included. Data were collected by interview-administered questionnaires. Blood samples were tested for HCV new infections at each 3-6 month follow-up visit. Time-varying Cox regression models were utilized. Of 356 participants (81.5% males; mean age: 34.7 years), 123 (34.6%) reported injected POs in the past month at baseline. In univariate analyses, recent use of the following drugs was associated with HCV seroconversion: injected POs, injected cocaine, injected heroin, non-injected tranquilisers, and smoked crack/cocaine. The relative excess risk of HCV seroconversion due to interaction (RER1 HR ) was the highest for co-use of injected POs with the following substances: injected cocaine (RER1 HR =3.44), smoked crack/cocaine (RER1 HR =1.27), and non-injected tranquilisers (RER1 HR =0.8). In addition, a significant linear trend (p<0.001) towards higher risk was observed with increasing the number of these three drugs used in combination with injected POs. Specific drugs and number of drugs used in addition to injected POs play a modulating role in the risk of HCV primary infection. Poly-drug use among people who inject POs has to be addressed in order to improve harm reduction programmes and reduce HCV transmission in this high-risk population. Copyright © 2017

Insights gained from relating cumulative seismic moments to fluid injection activities

NASA Astrophysics Data System (ADS)

McGarr, A.; Barbour, A. J.

2017-12-01

The three earthquakes with magnitudes of 5 or greater that were induced in Oklahoma during 2016 motivated efforts to improve our understanding of how fluid injection operations are related to earthquake activity. In this study, we have addressed the question of whether the volume of fluid injected down wells within 10 km of the mainshock of an induced earthquake sequence can account for its total moment release. Specifically, is the total moment release equal to, or less than, twice the product of the shear modulus and the total volume injected (McGarr, JGR, 2014, equation 7)? In contrast to McGarr's (2014, equation 13) relationship for the maximum moment, M0(max), the relationship for the total moment release has the advantage of being independent of the magnitude distribution. We find that the three sequences in Oklahoma in 2016, M5.1 Fairview, M5.8 Pawnee, M5.0 Cushing, and the 2011 M5.7 Prague sequence all adhere to this relationship. We also found that eight additional sequences of earthquakes induced by various fluid injection activities, widely distributed worldwide, show the same relationship between total moment-release and injected volume. Thus, for injected volumes ranging from 103 up to 107 cubic m, the moment release of an induced earthquake sequence appears to be similarly limited. These results imply that M0(max) for a sequence induced by fluid injection could be as high as twice the product of the shear modulus and the injected volume if the mainshock in the sequence accounts for nearly all of the total moment, as was the case for the 2016 Pawnee M5.8 mainshock. This new upper bound for maximum moment is twice what was proposed by McGarr (2014, equation 13). Our new results also support the assumption in our analysis that the induced earthquake rupture is localized to the seismogenic region that is weakened owing to a pore pressure increase of the order of a seismic stress drop.

Intravenous injections of soluble drag-reducing polymers reduce foreign body reaction to implants.

PubMed

Marascalco, Philip J; Blair, Harry C; Nieponice, Alejandro; Robinson, Lisa J; Kameneva, Marina V

2009-01-01

We tested whether soluble viscoelastic drag-reducing polymers (DRPs), which modify blood flow in the macro- and microcirculation, affect host response to implanted biomaterials and control biodegradation and tissue ingrowth processes. Porous poly(L-lactate) (PLLA) implants, which are naturally hydrolyzed by foreign body giant cells, were used to evaluate differences in host response. Intravenous DRPs, high-molecular weight poly(ethylene oxide) (PEO) or poly(mannose) (PMNN), were given biweekly at 0.3-0.4 nM in saline (equivalent volumes of saline in controls) to rats with subcutaneous PLLA implants. After 7 weeks, there was no difference in weight gain or behavior between control and DRP-injected groups. Implanted PLLA scaffolds in controls were almost totally degraded and replaced by giant cell granulomas. On the contrary, PEO- or PMNN-treated animals retained a significant part of the implanted scaffold (p < 0.0001 vs. controls). The foreign body reaction was markedly decreased, and there was an increase in well-oriented collagen deposition within the implanted scaffold area in the animals treated with DRPs. The DRP-mediated effects observed in this study potentially reflect alteration in inflammatory events in response to implanted bioengineered materials, and, thus, warrant further investigation.

[Reducing the Care-Related Burdens of a Family Caregiver of a Person With Mild Cognitive Impairment: A Home-Based Case Management Program].

PubMed

Chen, Min-Chia; Chiu, Yi-Chen; Wei, Pi-Mei; Hsu, Wen-Chuin

2017-06-01

The long-term care of cognitively impaired patients with concomitant behavioral problems brings great stress and burdens to family caregivers. The present article describes a family caregiver with multiple chronic diseases who concurrently shouldered primary care responsibilities for her husband, a patient with mild cognitive impairment, problematic behaviors, and medication non-adherence issues. The period of care was between September 23rd and December 29th, 2015. Data on physiological, psychological, and social burdens were collected based on a stress process model for family caregiving. We then applied a home-based, individually tailored intervention, which included nursing education, skills training, listening/counseling, and resource connecting, that effectively helped the family caregiver reduce her burdens. Our assessment identified nursing-care-related problems as the primary source of caregiver burden in this case, with identified stressors including a lack of knowledge regarding patient care, medication management problems, sleep disorders, and inadequate social resources. Using continuous care interactions, we established a trust relationship with the family caregiver, prioritized her needs, and provided dementia care knowledge and skills, which gradually improved her caregiving competence. Our instruction included increasing caregiver understanding of the disease course of dementia, related problematic behaviors, and medication management. Our intervention enhanced the disease awareness of the caregiver and helped her become more positive about her caregiving tasks. Therefore, the negative impacts on her family were reduced. Social support and long-term care resources further reduced her burden and improved her quality of life.

Assistive Device for Efficient Intravitreal Injections.

PubMed

Ullrich, Franziska; Michels, Stephan; Lehmann, Daniel; Pieters, Roel S; Becker, Matthias; Nelson, Bradley J

2016-08-01

Intravitreal therapy is the most common treatment for many chronic ophthalmic diseases, such as age-related macular degeneration. Due to the increasing worldwide demand for intravitreal injections, there exists a need to render this medical procedure more time- and cost-efficient while increasing patient safety. The authors propose a medical assistive device that injects medication intravitreally. Compared to the manual intravitreal injection procedure, an automated device has the potential to increase safety for patients, decrease procedure times, allow for integrated data storage and documentation, and reduce costs for medical staff and expensive operating rooms. This work demonstrates the development of an assistive injection system that is coarsely positioned over the patient's head by the human operator, followed by automatic fine positioning and intravitreal injection through the pars plana. Several safety features, such as continuous eye tracking and iris recognition, have been implemented. The functioning system is demonstrated through ex vivo experiments with porcine eyes. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:752-762.]. Copyright 2016, SLACK Incorporated.

Effect of reduced dose schedules and intramuscular injection of anthrax vaccine adsorbed on immunological response and safety profile: a randomized trial.

PubMed

Wright, Jennifer G; Plikaytis, Brian D; Rose, Charles E; Parker, Scott D; Babcock, Janiine; Keitel, Wendy; El Sahly, Hana; Poland, Gregory A; Jacobson, Robert M; Keyserling, Harry L; Semenova, Vera A; Li, Han; Schiffer, Jarad; Dababneh, Hanan; Martin, Sandra K; Martin, Stacey W; Marano, Nina; Messonnier, Nancy E; Quinn, Conrad P

2014-02-12

We evaluated an alternative administration route, reduced schedule priming series, and increased intervals between booster doses for anthrax vaccine adsorbed (AVA). AVA's originally licensed schedule was 6 subcutaneous (SQ) priming injections administered at months (m) 0, 0.5, 1, 6, 12 and 18 with annual boosters; a simpler schedule is desired. Through a multicenter randomized, double blind, non-inferiority Phase IV human clinical trial, the originally licensed schedule was compared to four alternative and two placebo schedules. 8-SQ group participants received 6 SQ injections with m30 and m42 "annual" boosters; participants in the 8-IM group received intramuscular (IM) injections according to the same schedule. Reduced schedule groups (7-IM, 5-IM, 4-IM) received IM injections at m0, m1, m6; at least one of the m0.5, m12, m18, m30 vaccine doses were replaced with saline. All reduced schedule groups received a m42 booster. Post-injection blood draws were taken two to four weeks following injection. Non-inferiority of the alternative schedules was compared to the 8-SQ group at m2, m7, and m43. Reactogenicity outcomes were proportions of injection site and systemic adverse events (AEs). The 8-IM group's m2 response was non-inferior to the 8-SQ group for the three primary endpoints of anti-protective antigen IgG geometric mean concentration (GMC), geometric mean titer, and proportion of responders with a 4-fold rise in titer. At m7 anti-PA IgG GMCs for the three reduced dosage groups were non-inferior to the 8-SQ group GMCs. At m43, 8-IM, 5-IM, and 4-IM group GMCs were superior to the 8-SQ group. Solicited injection site AEs occurred at lower proportions in the IM group compared to SQ. Route of administration did not influence the occurrence of systemic AEs. A 3 dose IM priming schedule with doses administered at m0, m1, and m6 elicited long term immunological responses and robust immunological memory that was efficiently stimulated by a single booster vaccination at

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

Targeted Injection of a Biocomposite Material Alters Macrophage and Fibroblast Phenotype and Function following Myocardial Infarction: Relation to Left Ventricular Remodeling

PubMed Central

McGarvey, Jeremy R.; Pettaway, Sara; Shuman, James A.; Novack, Craig P.; Zellars, Kia N.; Freels, Parker D.; Echols, Randall L.; Burdick, Jason A.; Gorman, Joseph H.; Gorman, Robert C.

2014-01-01

A treatment target for progressive left ventricular (LV) remodeling prevention following myocardial infarction (MI) is to affect structural changes directly within the MI region. One approach is through targeted injection of biocomposite materials, such as calcium hydroxyapatite microspheres (CHAM), into the MI region. In this study, the effects of CHAM injections upon key cell types responsible for the MI remodeling process, the macrophage and fibroblast, were examined. MI was induced in adult pigs before randomization to CHAM injections (20 targeted 0.1-ml injections within MI region) or saline. At 7 or 21 days post-MI (n = 6/time point per group), cardiac magnetic resonance imaging was performed, followed by macrophage and fibroblast isolation. Isolated macrophage profiles for monocyte chemotactic macrophage inflammatory protein-1 as measured by real-time polymerase chain reaction increased at 7 days post-MI in the CHAM group compared with MI only (16.3 ± 6.6 versus 1.7 ± 0.6 cycle times values, P < 0.05), and were similar by 21 days post-MI. Temporal changes in fibroblast function and smooth muscle actin (SMA) expression relative to referent control (n = 5) occurred with MI. CHAM induced increases in fibroblast proliferation, migration, and SMA expression—indicative of fibroblast transformation. By 21 days, CHAM reduced LV dilation (diastolic volume: 75 ± 2 versus 97 ± 4 ml) and increased function (ejection fraction: 48 ± 2% versus 38 ± 2%) compared with MI only (both P < 0.05). This study identified that effects on macrophage and fibroblast differentiation occurred with injection of biocomposite material within the MI, which translated into reduced adverse LV remodeling. These unique findings demonstrate that biomaterial injections impart biologic effects upon the MI remodeling process over any biophysical effects. PMID:25022514

Effect of current injection into thin-film Josephson junctions

DOE PAGES

Kogan, V. G.; Mints, R. G.

2014-11-11

New thin-film Josephson junctions have recently been tested in which the current injected into one of the junction banks governs Josephson phenomena. One thus can continuously manage the phase distribution at the junction by changing the injected current. Our method of calculating the distribution of injected currents is also proposed for a half-infinite thin-film strip with source-sink points at arbitrary positions at the film edges. The strip width W is assumed small relative to Λ=2λ 2/d;λ is the bulk London penetration depth of the film material and d is the film thickness.

Injections of Local Anesthetics into the Pharyngeal Region Reduce Trapezius Muscle Tenderness.

PubMed

Weinschenk, Stefan; Hollmann, Markus W; Göllner, Richard; Picardi, Susanne; Strowitzki, Thomas; Diehl, Leon; Hotz, Lorenz; Meuser, Thomas

2016-01-01

Neck pain is a frequent reason for seeking medical advice. Neuroanatomical findings suggest a close connection between the pharynx and the trapezius region. Irritation of the pharynx may induce tenderness of this area. Specific tender points, called neck reflex points (NRPs), can be identified here with high reproducibility. We hypothesized that therapeutic local anesthesia (TLA; or neural therapy, NT) in the pharyngeal region can reduce tenderness in patients with therapy-resistant neck pain. 17 consecutive female patients with chronic cervical pain and positive trapezius NRPs received bilateral injections of 0.5 ml 1% procaine into the palatine velum. The NRPs were assessed using a 3-level pain index (PI = 0, 1, or 2) before and 3-5 min after each injection. We found a significant reduction in tenderness of the NRP of the trapezius region (NRP C7) immediately after TLA/NT. 30 positive NRPs were found before therapy and only 13 after therapy (p < 0.01). The average PI of the NRP C7 was 1.24 ± 0.77 before and 0.35 ± 0.59 after therapy (right side), and 1.34 ± 0.59 before and 0.59 ± 0.69 after therapy (left side). The pre- and post-therapy PI values were significantly different on both the right and left sides of the trapezius region (p < 0.01). No adverse effects were observed. Pharyngeal irritation may induce and maintain therapy-resistant cervical pain in patients with chronic pharyngeal disease. These patients could benefit from remote TLA/NT injections in the pharyngeal region. © 2016 S. Karger GmbH, Freiburg.

Finding Balance Between Biological Groundwater Treatment and Treated Injection Water

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

Carlson, Mark A.; Nielsen, Kellin R.; Byrnes, Mark E.

2015-01-14

At the U.S. Department of Energy’s Hanford Site, CH2M HILL Plateau Remediation Company operates the 200 West Pump and Treat which was engineered to treat radiological and chemical contaminants in groundwater as a result of the site’s former plutonium production years. Fluidized bed bioreactors (FBRs) are used to remove nitrate, metals, and volatile organic compounds. Increasing nitrate concentrations in the treatment plant effluent and the presence of a slimy biomass (a typical microorganism response to stress) in the FBRs triggered an investigation of nutrient levels in the system. Little, if any, micronutrient feed was coming into the bioreactors. Additionally, carbonmore » substrate (used to promote biological growth) was passing through to the injection wells, causing biological fouling of the wells and reduced specific injectivity. Adjustments to the micronutrient feed improved microorganism health, but the micronutrients were being overfed (particularly manganese) plugging the injection wells further. Injection well rehabilitation to restore specific injectivity required repeated treatments to remove the biological fouling and precipitated metal oxides. A combination of sulfamic and citric acids worked well to dissolve metal oxides and sodium hypochlorite effectively removed the biological growth. Intensive surging and development techniques successfully removed clogging material from the injection wells. Ultimately, the investigation and nutrient adjustments took months to restore proper balance to the microbial system and over a year to stabilize injection well capacities. Carefully tracking and managing the FBRs and well performance monitoring are critical to balancing the needs of the treatment system while reducing fouling mechanisms in the injection wells.« less

Evaluation of the painful athletic hip: imaging options and imaging-guided injections.

PubMed

Jacobson, Jon A; Bedi, Asheesh; Sekiya, Jon K; Blankenbaker, Donna G

2012-09-01

This article reviews diagnostic imaging tests and injections that provide important information for clinical management of patients with sports-related hip pain. In the evaluation of sports-related hip symptoms, MR arthrography is often used to evaluate intraarticular pathology of the hip. The addition of short- and long-acting anesthetic agents with the MR arthrography injection adds additional information that can distinguish between symptomatic and asymptomatic imaging findings. Osseous abnormalities can be characterized with radiography, MRI, or CT. Ultrasound is important in the assessment of iliopsoas abnormalities, including tendon snapping, and to guide diagnostic anesthetic injection.

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.

Do law enforcement interactions reduce the initiation of injection drug use? An investigation in three North American settings.

PubMed

Melo, J S; Garfein, R S; Hayashi, K; Milloy, M J; DeBeck, K; Sun, S; Jain, S; Strathdee, S A; Werb, D

2018-01-01

The prevention of drug injecting is often cited as a justification for the deployment of law enforcement and for the continuation of drug criminalization policies. We sought to characterize the impact of law enforcement interactions on the risk that people who inject drugs (PWID) report assisting others with injection initiation in three North American countries. Cross-sectional data from PWID participating in cohort studies in three cities (San Diego, USA; Tijuana, Mexico; Vancouver, Canada) were pooled (August 2014-December 2016). The dependent variable was defined as recently (i.e., past six months) providing injection initiation assistance; the primary independent variable was the frequency of recent law enforcement interactions, defined categorically (0 vs. 1 vs. 2-5 vs. ≥6). We employed multivariable logistic regression analyses to assess this relationship while controlling for potential confounders. Among 2122 participants, 87 (4.1%) reported recently providing injection initiation assistance, and 802 (37.8%) reported recent law enforcement interactions. Reporting either one or more than five recent interactions with law enforcement was not significantly associated with injection initiation assistance. Reporting 2-5 law enforcement interactions was associated with initiation assistance (Adjusted Odds Ratio=1.74, 95% Confidence Interval: 1.01-3.02). Reporting interactions with law enforcement was not associated with a reduced likelihood that PWID reported initiating others into injection drug use. Instead, we identified a positive association between reporting law enforcement interactions and injection initiation assistance among PWID in multiple settings. These findings raise concerns regarding the effectiveness of drug law enforcement to deter injection drug use initiation. Copyright © 2017 Elsevier B.V. All rights reserved.

Facility Management as a Way of Reducing Costs in Transport Companies

NASA Astrophysics Data System (ADS)

Matusova, Dominika; Gogolova, Martina

2017-10-01

For facility management exists a several interpretations. These interpretations emerged progressively. At the time of the notion of facility management was designed to manage an administrative building, in the United States (US). They can ensure their operation and maintenance. From the US, this trend is further moved to Europe and now it start becoming a current and actual topic also in Slovakia. Facility management is contractually agreed scheme of services, semantically recalls traditional building management. There by finally pushed for activities related to real estates. For facility management is fundamental - certification and certification systems. Therefore, is essential to know, the cost structure of certification. The most commonly occurring austerity measures include: heat pumps, use of renewable energy, solar panels and water savings. These measures can reduce the cost.

Assessment of regional management strategies for controlling seawater intrusion

USGS Publications Warehouse

Reichard, E.G.; Johnson, T.A.

2005-01-01

Simulation-optimization methods, applied with adequate sensitivity tests, can provide useful quantitative guidance for controlling seawater intrusion. This is demonstrated in an application to the West Coast Basin of coastal Los Angeles that considers two management options for improving hydraulic control of seawater intrusion: increased injection into barrier wells and in lieu delivery of surface water to replace current pumpage. For the base-case optimization analysis, assuming constant groundwater demand, in lieu delivery was determined to be most cost effective. Reduced-cost information from the optimization provided guidance for prioritizing locations for in lieu delivery. Model sensitivity to a suite of hydrologic, economic, and policy factors was tested. Raising the imposed average water-level constraint at the hydraulic-control locations resulted in nonlinear increases in cost. Systematic varying of the relative costs of injection and in lieu water yielded a trade-off curve between relative costs and injection/in lieu amounts. Changing the assumed future scenario to one of increasing pumpage in the adjacent Central Basin caused a small increase in the computed costs of seawater intrusion control. Changing the assumed boundary condition representing interaction with an adjacent basin did not affect the optimization results. Reducing the assumed hydraulic conductivity of the main productive aquifer resulted in a large increase in the model-computed cost. Journal of Water Resources Planning and Management ?? ASCE.

Injectable Nanocomposite Analgesic Delivery System for Musculoskeletal Pain Management.

PubMed

Khanal, Manakamana; Gohil, Shalini V; Kuyinu, Emmanuel; Kan, Ho-Man; Knight, Brittany E; Baumbauer, Kyle M; Lo, Kevin W-H; Walker, Joseph; Laurencin, Cato T; Nair, Lakshmi S

2018-05-24

Musculoskeletal pain is a major health issue which results from surgical procedures (i.e. total knee and/ or hip replacements and rotator cuff repairs), as well as from non-surgical conditions (i.e. sympathetically-mediated pain syndrome and occipital neuralgia). Local anesthetics, opioids or corticosteroids are currently used for the pain management of musculoskeletal conditions. Even though local anesthetics are highly preferred, the need for multiple administration presents significant disadvantages. Development of unique delivery systems that can deliver local anesthetics at the injection site for prolonged time could significantly enhance the therapeutic efficacy and patient comfort. The goal of the present study is to evaluate the efficacy of an injectable local anesthetic nanocomposite carrier to provide sustained analgesic effect. The nanocomposite carrier was developed by encapsulating ropivacaine, a local anesthetic, in lipid nanocapsules (LNC-Rop), and incorporating the nanocapsules in enzymatically crosslinked glycol chitosan (0.3GC) hydrogels. Cryo Scanning Electron Microscopic (Cryo SEM) images showed the ability to distribute the LNCs within the hydrogel without adversely affecting their morphology. The study demonstrated the feasibility to achieve sustained release of lipophilic molecules from the nanocomposite carrier in vitro and in vivo. A rat chronic constriction injury (CCI) pain model was used to evaluate the efficacy of the nanocomposite carrier using thermal paw withdrawal latency (TWL). The nanocomposite carriers loaded with ropivacaine and dexamethasone showed significant improvement in pain response compared to the control groups for at least 7 days. The study demonstrated the clinical potential of these nanocomposite carriers for post-operative and neuropathic pain. Acute or chronic pain associated with musculoskeletal conditions is considered a major health issue, with healthcare costs totaling several billion dollars. The opioid crisis

Decrease in health-related quality of life associated with awareness of hepatitis C virus infection among people who inject drugs in Scotland.

PubMed

McDonald, Scott A; Hutchinson, Sharon J; Palmateer, Norah E; Allen, Elizabeth; Cameron, Sheila O; Goldberg, David J; Taylor, Avril

2013-03-01

Chronic hepatitis C virus (HCV) infection can significantly reduce health-related quality of life (QoL), but it is not clear if reduction is associated with the infection or with being aware of one's infection status. Understanding the impact of a HCV diagnosis on QoL is essential to inform decision-making regarding screening/testing and treatment. Using a cross-sectional design, we assessed QoL in 2898 people who inject drugs (PWID), surveyed in Scotland during 2010 using EQ-5D. Multifactorial regression compared self-reported QoL between PWID who were (i) chronically HCV-infected and aware of their infected status, (ii) chronically HCV-infected but unaware, and (iii) not chronically infected. Median time since onset of injecting was 10years; not chronically infected PWID were younger and had shorter injecting careers than chronically infected PWID. Median EQ-5D was highest for the not chronically infected and the chronic/unaware groups (0.73) compared with the chronic/aware group (0.66). After adjustment for demographic and behavioural co-factors, QoL was significantly reduced in chronic/aware compared with chronic/unaware PWID (adjusted B=-0.09, p=0.005); there was no evidence for a difference in QoL between not chronically infected and chronic/unaware PWID (adjusted B=-0.03, p=0.13). Awareness of one's chronic HCV status was associated with reduced health-related QoL, but there was no evidence for further reduction attributable to chronic infection itself after adjusting for important covariate differences. Copyright © 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Re-examining blood donor deferral criteria relating to injecting drug use.

PubMed

Quinn, Brendan; Seed, Clive; Keller, Anthony; Maher, Lisa; Wilson, David; Farrell, Michael; Caris, Sharon; Williams, Jennifer; Madden, Annie; Thompson, Alexander; Pink, Joanne; Hellard, Margaret E

2017-10-01

Potential Australian blood donors are deferred indefinitely if they report a history of injecting drug use (IDU), or for 12 months if they report having engaged in sexual activity with someone who might have ever injected. Given incremental improvements in blood safety, this study sought to examine whether Australia's IDU-related eligibility criteria reflected current scientific evidence, were consistent with international best practice and, if current IDU-related policies were to be changed, how this should happen. An expert committee was formed to review relevant literature with a focus on issues including: the epidemiology of IDU in Australia and key transfusion-transmissible infections (TTIs) among Australian people who inject drugs (PWID); and, 'non-compliance' among PWID regarding IDU-related blood donation guidelines. International policies relating to blood donation and IDU were also reviewed. Modelling with available data estimated the risk of TTIs remaining undetected if the Blood Service's IDU-related guidelines were changed. Very few (<1%) Australians engage in IDU, and IDU risk practices are reported by only a minority of PWID. However, the prevalence of HCV remains high among PWID, and IDU remains a key transmission route for various TTIs. Insufficient data were available to inform appropriate estimates of cessation and relapse among Australian PWID. Modelling findings indicated that the risk of not detecting HIV becomes greater than the reference group at a threshold of non-admission of being an active PWID of around 1.8% (0.5-5.1%). Excluding Japan, all Organisation for the Economic Co-operation and Development member countries permanently exclude individuals with a history of IDU from donating. Numerous research gaps meant that the study's expert Review Committee was unable to recommend altering Australia's current IDU-related blood donation guidelines. However, having identified critical knowledge gaps and future areas of research, the review made

Drug use in business bathrooms: An exploratory study of manager encounters in New York City.

PubMed

Wolfson-Stofko, Brett; Bennett, Alex S; Elliott, Luther; Curtis, Ric

2017-01-01

Though public bathroom drug injection has been documented from the perspective of people who inject drugs, no research has explored the experiences of the business managers who oversee their business bathrooms and respond to drug use. These managers, by default, are first-responders in the event of a drug overdose and thus of intrinsic interest during the current epidemic of opioid-related overdoses in the United States. This exploratory study assists in elucidating the experiences that New York City business managers have with people who inject drugs, their paraphernalia, and their overdoses. A survey instrument was designed to collect data on manager encounters with drug use occurring in their business bathrooms. Recruitment was guided by convenience and purposive approaches. More than half of managers interviewed (58%, n=50/86) encountered drug use in their business bathrooms, more than a third (34%) of these managers also found syringes, and the vast majority (90%) of managers had received no overdose recognition or naloxone training. Seven managers encountered unresponsive individuals who required emergency assistance. The results from this study underscore the need for additional research on the experiences that community stakeholders have with public injection as well as educational outreach efforts among business managers. This research also suggests that there is need for a national dialogue about potential interventions, including expanded overdose recognition and naloxone training and supervised injection facilities (SIF)/drug consumption rooms (DCR), that could reduce public injection and its associated health risks. Copyright © 2016 Elsevier B.V. All rights reserved.

Drug use in business bathrooms: An exploratory study of manager encounters in New York City

PubMed Central

Wolfson-Stofko, Brett; Bennett, Alex S.; Elliott, Luther; Curtis, Ric

2017-01-01

Background Though public bathroom drug injection has been documented from the perspective of people who inject drugs, no research has explored the experiences of the business managers who oversee their business bathrooms and respond to drug use. These managers, by default, are first-responders in the event of a drug overdose and thus of intrinsic interest during the current epidemic of opioid-related overdoses in the United States. This exploratory study assists in elucidating the experiences that New York City business managers have with people who inject drugs, their paraphernalia, and their overdoses. Methods A survey instrument was designed to collect data on manager encounters with drug use occurring in their business bathrooms. Recruitment was guided by convenience and purposive approaches. Results More than half of managers interviewed (58%, n = 50/86) encountered drug use in their business bathrooms, more than a third (34%) of these managers also found syringes, and the vast majority (90%) of managers had received no overdose recognition or naloxone training. Seven managers encountered unresponsive individuals who required emergency assistance. Conclusion The results from this study underscore the need for additional research on the experiences that community stakeholders have with public injection as well as educational outreach efforts among business managers. This research also suggests that there is need for a national dialogue about potential interventions, including expanded overdose recognition and naloxone training and supervised injection facilities (SIF)/drug consumption rooms (DCR), that could reduce public injection and its associated health risks. PMID:27768996

Intra-articular injection of mesenchymal stem cells leads to reduced inflammation and cartilage damage in murine antigen-induced arthritis.

PubMed

Kehoe, Oksana; Cartwright, Alison; Askari, Ayman; El Haj, Alicia J; Middleton, Jim

2014-06-03

Rheumatoid arthritis (RA) is a debilitating and painful disease leading to increased morbidity and mortality and novel therapeutic approaches are needed. The purpose of this study was to elucidate if mesenchymal stem cells (MSCs) injected in the joints of mice with arthritis are therapeutic, reducing joint swelling and cartilage destruction. Murine mesenchymal stem cells (mMSCs) were isolated from bone marrow of C57Bl/6 mice and expanded in culture. Cells were tested for immunophenotype and their ability to form colonies and to differentiate into chondrocytes, osteocytes and adipocytes. Antigen-induced arthritis (AIA) was induced by intra-articular injection of methylated bovine serum albumin into the knee joints of preimmunized C57Bl/6 mice. After one day, when peak swelling occurs, 500,000 mMSCs labelled with red fluorescent cell tracker CM-DiI were injected intra-articularly in the right knee joint. Left knee joints were treated as controls by receiving PBS injections. Differences between groups were calculated by Mann Whitney U test or unpaired t tests using GraphPad Prism software version 5. Knee joint diameter (swelling) was measured as a clinical indication of joint inflammation and this parameter was significantly less in MSC-treated mice compared to control-treated animals 48 hours after arthritis induction. This difference continued for ~7 days. CM-DiI-labelled MSCs were clearly visualised in the lining and sublining layers of synovium, in the region of the patella and femoral and tibial surfaces. By day 3, parameters indicative of disease severity, including cartilage depletion, inflammatory exudate and arthritic index were shown to be significantly reduced in MSC-treated animals. This difference continued for 7 days and was further confirmed by histological analysis. The serum concentration of tumour necrosis factor α was significantly decreased following MSC administration. Our results reveal that MSCs injected in the joints of mice with AIA are

Management of iatrogenic crystalline lens injury occurred during intravitreal injection.

PubMed

Erdogan, Gurkan; Gunay, Betul Onal; Unlu, Cihan; Gunay, Murat; Ergin, Ahmet

2016-08-01

To evaluate the approach to management of iatrogenic crystalline lens injury occurred during intravitreal injection (IVI). The patients who were managed operatively or followed-up without intervention after the iatrogenic lens injury due to IVI were included in the study. Capsular breaks remained either quiescent or resulted in cataract formation in the patients with inadvertent crystalline lens capsule damage. Phacoemulsification surgery was performed in patients with cataract formation with lower fluidic settings. A total of 9 cases included in the study. Seven cases underwent phacoemulsification with intraocular lens implantation. Two cases remained as quiescent lens injury during the follow-up. In 2 cases, dislocation of lens fragments occurred during phacoemulsification where pars plana vitrectomy was performed at the same session. After iatrogenic crystalline lens injury, capsular damage could remain quiescent or progress to cataract formation. Although phacoemulsification surgery can be performed with appropriate parameters, lens fragment dislocation can be observed in cases with traumatic lens damage secondary to IVI.

Injection-controlled laser resonator

DOEpatents

Chang, J.J.

1995-07-18

A new injection-controlled laser resonator incorporates self-filtering and self-imaging characteristics with an efficient injection scheme. A low-divergence laser signal is injected into the resonator, which enables the injection signal to be converted to the desired resonator modes before the main laser pulse starts. This injection technique and resonator design enable the laser cavity to improve the quality of the injection signal through self-filtering before the main laser pulse starts. The self-imaging property of the present resonator reduces the cavity induced diffraction effects and, in turn, improves the laser beam quality. 5 figs.

Injection-controlled laser resonator

DOEpatents

Chang, Jim J.

1995-07-18

A new injection-controlled laser resonator incorporates self-filtering and self-imaging characteristics with an efficient injection scheme. A low-divergence laser signal is injected into the resonator, which enables the injection signal to be converted to the desired resonator modes before the main laser pulse starts. This injection technique and resonator design enable the laser cavity to improve the quality of the injection signal through self-filtering before the main laser pulse starts. The self-imaging property of the present resonator reduces the cavity induced diffraction effects and, in turn, improves the laser beam quality.

Efficacy and safety of point-of-care ultrasound-guided intra-articular corticosteroid joint injections in patients with haemophilic arthropathy.

PubMed

Martin, E J; Cooke, E J; Ceponis, A; Barnes, R F W; Moran, C M; Holle, S; Hughes, T H; Moore, R E; von Drygalski, A

2017-01-01

Intra-articular corticosteroid injections are standard of care for managing joint pain secondary to osteoarthritis or rheumatoid arthritis but are rarely used in haemophilic arthropathy. We have introduced and evaluated the efficacy and safety of ultrasound-guided corticosteroid injections for pain relief in patients with haemophilic arthropathy. Ultrasound-guided intra-articular injections performed on haemophilia patients at UCSD between March 2012 and January 2016 were analysed. Needle placement and injection (40 mg triamcinolone; 3-5 mL lidocaine) were performed with musculoskeletal ultrasound and Power Doppler. Analysis included patient demographics, joint-specific parameters such as tissue hypervascularity and effusions, pain relief, and procedure-associated complications. Forty-five injections (14 ankles, 13 elbows, 18 knees) were administered in 25 patients. Advanced arthropathy with hypervascularity and/or effusions was present in 91% and 61% of joints, respectively. Ninety-one per cent of injections resulted in pain relief which was significant in 84% (>30% reduction). Median pain score was reduced from 7 of 10 to 1 of 10 (P < 0.001), usually within 24 h. Median duration of pain relief was 8 weeks (range 1-16 weeks). Haemophilia B patients experienced longer periods of relief, and high Pettersson scores were associated with shorter duration of relief. There were no procedure-associated complications. Repeat ultrasound of eight joints within 4 weeks of injection demonstrated nearly complete resolution of hypervascularity. Point-of-care ultrasound enabled intra-articular corticosteroid injections that provided highly effective, safe, and relatively long-lasting pain relief in haemophilic arthropathy. This approach should be used to improve pain management in haemophilic arthropathy. © 2016 John Wiley & Sons Ltd.

KINETIC STUDIES RELATED TO THE LIMB (LIMESTONE INJECTION MULTISTAGE BURNER) BURNER

EPA Science Inventory

The report gives results of theoretical and experimental studies of subjects related to the limestone injection multistage burner (LIMB). The main findings include data on the rate of evolution of H2S from different coals and on the dependence of the rate of evolution on the dist...

Can climate-effective land management reduce regional warming?

NASA Astrophysics Data System (ADS)

Hirsch, A. L.; Wilhelm, M.; Davin, E. L.; Thiery, W.; Seneviratne, S. I.

2017-02-01

Limiting global warming to well below 2°C is an imminent challenge for humanity. However, even if this global target can be met, some regions are still likely to experience substantial warming relative to others. Using idealized global climate simulations, we examine the potential of land management options in affecting regional climate, with a focus on crop albedo enhancement and irrigation (climate-effective land management). The implementation is performed over all crop regions globally to provide an upper bound. We find that the implementation of both crop albedo enhancement and irrigation can reduce hot temperature extremes by more than 2°C in North America, Eurasia, and India over the 21st century relative to a scenario without management application. The efficacy of crop albedo enhancement scales with the magnitude, where a cooling response exceeding 0.5°C for hot temperature extremes was achieved with a large (i.e., ≥0.08) change in crop albedo. Regional differences were attributed to the surface energy balance response with temperature changes mostly explained by latent heat flux changes for irrigation and net shortwave radiation changes for crop albedo enhancement. However, limitations do exist, where we identify warming over the winter months when climate-effective land management is temporarily suspended. This was associated with persistent cloud cover that enhances longwave warming. It cannot be confirmed if the magnitude of this feedback is reproducible in other climate models. Our results overall demonstrate that regional warming of hot extremes in our climate model can be partially mitigated when using an idealized treatment of climate-effective land management.

Predicting reduced visibility related crashes on freeways using real-time traffic flow data.

PubMed

Hassan, Hany M; Abdel-Aty, Mohamed A

2013-06-01

The main objective of this paper is to investigate whether real-time traffic flow data, collected from loop detectors and radar sensors on freeways, can be used to predict crashes occurring at reduced visibility conditions. In addition, it examines the difference between significant factors associated with reduced visibility related crashes to those factors correlated with crashes occurring at clear visibility conditions. Random Forests and matched case-control logistic regression models were estimated. The findings indicated that real-time traffic variables can be used to predict visibility related crashes on freeways. The results showed that about 69% of reduced visibility related crashes were correctly identified. The results also indicated that traffic flow variables leading to visibility related crashes are slightly different from those variables leading to clear visibility crashes. Using time slices 5-15 minutes before crashes might provide an opportunity for the appropriate traffic management centers for a proactive intervention to reduce crash risk in real-time. Copyright © 2013 Elsevier Ltd. All rights reserved.

[Prevention and management of locoregional complications of botulinum A toxin injections in cosmetic treatment].

PubMed

Gassia, V

2009-05-01

Botulinum toxin serotype A injections used in treating dynamic wrinkles is one of the least invasive cosmetic procedures. High patient satisfaction and low onset of always moderate side effects contribute to the growing popularity of botulinum toxin injections in cosmetic treatment over the past few years. Years of experience and use, in therapeutics [1,2] and esthetics (20 years) have proven the efficacy and the safety of this wrinkle treatment. Today, no severe or long-term side effects have been reported in esthetics. This article discusses only the most frequent locoregional effects. They are rare, moderate, transitory, and totally reversible. Properly informing and selecting patients will contribute to successfully preventing and managing these effects.

Diabetes disease management in Medicare Advantage reduces hospitalizations and costs.

PubMed

Rosenzweig, James L; Taitel, Michael S; Norman, Gordon K; Moore, Tim J; Turenne, Wendy; Tang, Pei

2010-07-01

To evaluate the effectiveness of a telephonic diabetes disease management intervention in a Medicare Advantage population with comorbid diabetes and coronary artery disease (CAD). Prospective unequal randomization design of 526 members from a Medicare Advantage segment of one region of a large national health plan from May 2005 through April 2007. High-risk and high-cost patients with diabetes and CAD who were enrolled in telephonic diabetes disease management were compared with a randomly selected comparison group receiving usual care. Wilcoxon signed-rank tests were used to compare the groups on all-cause hospital admissions, diabetes-related hospital admissions, all-cause and diabetes-related emergency department (ED) visits, and all-cause medical costs. Changes in self-reported clinical outcomes also were measured in the intervention group. Patients receiving telephonic diabetes disease management had significantly decreased all-cause hospital admissions and diabetes-related hospital admissions (P <.05). The intervention group had decreased all-cause and diabetes-related ED visits, although the difference was not statistically significant. The comparison group had increased ED utilization. The intervention group decreased their all-cause total medical costs by $984.87 per member per year (PMPY) compared with a $4547.06 PMPY increase in the comparison group (P <.05). All clinical measures significantly improved (P <.05) in the intervention group. A disease management program for high-risk patients with diabetes and CAD was effective in reducing hospital inpatient admission and total costs in a Medicare Advantage population.

Prophylactic Injection of Recombinant Alpha-Enolase Reduces Arthritis Severity in the Collagen-Induced Arthritis Mice Model

PubMed Central

Guillou, Clément; Derambure, Céline; Fréret, Manuel; Verdet, Mathieu; Avenel, Gilles; Golinski, Marie-Laure; Sabourin, Jean-Christophe; Loarer, François Le; Adriouch, Sahil; Boyer, Olivier; Lequerré, Thierry; Vittecoq, Olivier

2015-01-01

Objective To evaluate the ability of the glycolytic enzyme alpha-enolase (ENO1) or its immunodominant peptide (pEP1) to reduce the severity of CIA in DBA/1 mice when injected in a prophylactic way. Methods Mice were treated with mouse ENO1 or pEP1 one day prior to collagen II immunization. Clinical assessment was evaluated using 4 parameters (global and articular scores, ankle thickness and weight). Titers of serum anti-ENO1, anti-cyclic citrullinated peptides (anti-CCP) and anti-CII (total IgG and IgG1/IgG2a isotypes) antibodies were measured by ELISA at different time-points. Disease activity was assessed by histological analysis of both anterior and hind paws at the end of experimentation. Results Prophylactic injection of 100 μg of ENO1 reduced severity of CIA. Serum levels of anti-CII antibodies were reduced in ENO1-treated mice. Concordantly, ENO1-treated mice joints presented less severe histological signs of arthritis. ENO1 did not induce a shift toward a Th2 response since IgG1/IgG2a ratio of anti-CII antibodies remained unchanged and IL-4 serum levels were similar to those measured in the control group. Conclusions Pre-immunization with ENO1 or its immunodominant peptide pEP1 reduces CIA severity at the clinical, immunological and histological levels. Effects of pEP1 were less pronounced. This immunomodulatory effect is associated with a reduction in anti-CII antibodies production but is not due to a Th1/Th2 shift. PMID:26302382

Work-related stress management between workplace and occupational health care.

PubMed

Kinnunen-Amoroso, Maritta; Liira, Juha

2016-06-13

Work-related stress has been evaluated as one of the most important health risks in Europe. Prevention of work related stress and interventions to reduce risk factors for stress in the workplace are conducted together by the enterprise and occupational health services. The aim of the study was to examine the experiences of Finnish occupational physicians on the stress management with enterprises. From the Finnish Association of Occupational Health Physicians membership list 207 physicians responded to self-administered anonymous questionnaire. The data were analysed using SPSS 17.0. The client enterprises contacted occupational health services frequently about work-related stress. Collaboration between occupational health and enterprises was strongest in companies' own occupational health services and generally with most experienced physicians. Occupational health services and enterprises shared responsibility for managing work-related stress. Professional experience and close contact with organisation management favours successful stress management between occupational health and enterprises.

Method of controlling injection of oxygen into hydrogen-rich fuel cell feed stream

DOEpatents

Meltser, Mark Alexander; Gutowski, Stanley; Weisbrod, Kirk

2001-01-01

A method of operating a H.sub.2 --O.sub.2 fuel cell fueled by hydrogen-rich fuel stream containing CO. The CO content is reduced to acceptable levels by injecting oxygen into the fuel gas stream. The amount of oxygen injected is controlled in relation to the CO content of the fuel gas, by a control strategy that involves (a) determining the CO content of the fuel stream at a first injection rate, (b) increasing the O.sub.2 injection rate, (c) determining the CO content of the stream at the higher injection rate, (d) further increasing the O.sub.2 injection rate if the second measured CO content is lower than the first measured CO content or reducing the O.sub.2 injection rate if the second measured CO content is greater than the first measured CO content, and (e) repeating steps a-d as needed to optimize CO consumption and minimize H.sub.2 consumption.

Effectiveness of cervical epidural injections in the management of chronic neck and upper extremity pain.

PubMed

Diwan, Sudhir; Manchikanti, Laxmaiah; Benyamin, Ramsin M; Bryce, David A; Geffert, Stephanie; Hameed, Haroon; Sharma, Manohar Lal; Abdi, Salahadin; Falco, Frank J E

2012-01-01

Chronic persistent neck pain with or without upper extremity pain is common in the general adult population with prevalence of 48% for women and 38% for men, with persistent complaints in 22% of women and 16% of men. Multiple modalities of treatments are exploding in managing chronic neck pain along with increasing prevalence. However, there is a paucity of evidence for all modalities of treatments in managing chronic neck pain. Cervical epidural injections for managing chronic neck pain are one of the commonly performed interventions in the United States. However, the literature supporting cervical epidural steroids in managing chronic pain problems has been scant. A systematic review of cervical interlaminar epidural injections for cervical disc herniation, cervical axial discogenic pain, cervical central stenosis, and cervical postsurgery syndrome. To evaluate the effect of cervical interlaminar epidural injections in managing various types of chronic neck and upper extremity pain emanating as a result of cervical spine pathology. The available literature on cervical interlaminar epidural injections in managing chronic neck and upper extremity pain were reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, and limited based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to December 2011, and manual searches of the bibliographies of known primary and review articles. The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status

Oklahoma's induced seismicity strongly linked to wastewater injection depth

NASA Astrophysics Data System (ADS)

Hincks, Thea; Aspinall, Willy; Cooke, Roger; Gernon, Thomas

2018-03-01

The sharp rise in Oklahoma seismicity since 2009 is due to wastewater injection. The role of injection depth is an open, complex issue, yet critical for hazard assessment and regulation. We developed an advanced Bayesian network to model joint conditional dependencies between spatial, operational, and seismicity parameters. We found that injection depth relative to crystalline basement most strongly correlates with seismic moment release. The joint effects of depth and volume are critical, as injection rate becomes more influential near the basement interface. Restricting injection depths to 200 to 500 meters above basement could reduce annual seismic moment release by a factor of 1.4 to 2.8. Our approach enables identification of subregions where targeted regulation may mitigate effects of induced earthquakes, aiding operators and regulators in wastewater disposal regions.

Development of a local anesthetic lidocaine-loaded redox-active injectable gel for postoperative pain management.

PubMed

Nagasaki, Yukio; Mizukoshi, Yutaro; Gao, Zhenyu; Feliciano, Chitho P; Chang, Kyungho; Sekiyama, Hiroshi; Kimura, Hiroyuki

2017-07-15

Although local anesthesia is commonly applied for pain relief, there are several issues such as its short duration of action and low effectiveness at the areas of inflammation due to the acidic pH. The presence of excessive amount of reactive oxygen species (ROS) is known to induce inflammation and aggravate pain. To resolve these issues, we developed a redox-active injectable gel (RIG) with ROS-scavenging activity. RIG was prepared by mixing polyamine-b-poly(ethylene glycol)-b-polyamine with nitroxide radical moieties as side chains on the polyamine segments (PMNT-b-PEG-b-PMNT) with a polyanion, which formed a flower-type micelle via electrostatic complexation. Lidocaine could be stably incorporated in its core. When the temperature of the solution was increased to 37°C, the PIC-type flower micelle transformed to gel. The continuous release of lidocaine from the gel was observed for more than three days, without remarkable initial burst, which is probably owing to the stable entrapment of lidocaine in the PIC core of the gel. We evaluated the analgesic effect of RIG in carrageenan-induced arthritis mouse model. Results showed that lidocaine-loaded RIG has stronger and longer analgesic effect when administered in inflamed areas. In contrast, while the use of non-complexed lidocaine did not show analgesic effect one day after its administration. Note that no effect was observed when PIC-type flower micelle without ROS-scavenging ability was used. These findings suggest that local anesthetic-loaded RIG can effectively reduce the number of injection times and limit the side effects associated with the use of anti-inflammatory drugs for postoperative pain management. 1. We have been working on nanomaterials, which effectively eliminate ROS, avoiding dysfunction of mitochondria in healthy cells. 2. We designed redox injectable gel using polyion complexed flower type micelle, which can eliminates ROS locally. 3. We could prepare local anesthesia-loaded redox injectable

Tanshinon IIA injection accelerates tissue expansion by reducing the formation of the fibrous capsule.

PubMed

Yu, Qingxiong; Sheng, Lingling; Yang, Mei; Zhu, Ming; Huang, Xiaolu; Li, Qingfeng

2014-01-01

The tissue expansion technique has been applied to obtain new skin tissue to repair large defects in clinical practice. The implantation of tissue expander could initiate a host response to foreign body (FBR), which leads to fibrotic encapsulation around the expander and prolongs the period of tissue expansion. Tanshinon IIA (Tan IIA) has been shown to have anti-inflammation and immunoregulation effect. The rat tissue expansion model was used in this study to observe whether Tan IIA injection systematically could inhibit the FBR to reduce fibrous capsule formation and accelerate the process of tissue expansion. Forty-eight rats were randomly divided into the Tan IIA group and control group with 24 rats in each group. The expansion was conducted twice a week to maintain a capsule pressure of 60 mmHg. The expansion volume and expanded area were measured. The expanded tissue in the two groups was harvested, and histological staining was performed; proinflammatory cytokines such as tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-1β (IL-1β) and transforming growth factor-β (TGF-β) were examined. The expansion volume and the expanded area in the Tan IIA group were greater than that of the control group. The thickness of the fibrous capsule in the Tan IIA group was reduced with no influence on the normal skin regeneration. Decreased infiltration of macrophages, lower level of TNF-α, IL-6, IL-1β and TGF-β, less proliferating myofibroblasts and enhanced neovascularization were observed in the Tan IIA group. Our findings indicated that the Tan IIA injection reduced the formation of the fibrous capsule and accelerated the process of tissue expansion by inhibiting the FBR.

Use of remifentanil to reduce propofol injection pain and the required propofol dose in upper digestive tract endoscopy diagnostic tests.

PubMed

Uliana, Gustavo Nadal; Tambara, Elizabeth Milla; Baretta, Giorgio Alfredo Pedroso

2015-01-01

The introduction of propofol (2,6-diisopropylphenol) as a sedative agent has transformed the area of sedation for endoscopic procedures. However, a major drawback of sedation with the use of propofol is its high incidence of injection pain. The most widely used technique in reducing propofol injection pain is through the association of other drugs. The aim of this study was to evaluate the effect of remifentanil-propofol combination on the incidence of propofol injection pain and its influence on the total dose of propofol required for sedation in upper digestive tract endoscopy (UDE) diagnostic tests. One hundred and five patients undergoing upper digestive tract endoscopy were evaluated and randomly divided into 3 groups of 35 patients each. The Control Group received propofol alone; Study-group 1 received remifentanil at a fixed dose of 0.2mg/kg combined with propofol; Study-group 2 received remifentanil at a fixed dose of 0.3mg/kg combined with propofol. The incidence of propofol injection pain and the total dose of propofol required for the test were evaluated. The sample was very similar regarding age, weight, height, sex, and physical status. Statistical analysis was performed according to the nature of the evaluated data. Student's t-test was used to compare the mean of age, weight, height (cm), and dose (mg/kg) variables between groups. The χ(2) test was used to compare sex, physical status, and propofol injection pain between groups. The significance level was α<0.05. There was significant statistical difference between the study groups and the control group regarding the parameters of propofol injection pain and total dose of propofol (mg/kg) used. However, there were no statistical differences between the two study groups for these parameters. We conclude that the use of remifentanil at doses of 0.2mg/kg and 0.3mg/kg was effective for reducing both the propofol injection pain and the total dose of propofol used. Copyright © 2015 Sociedade Brasileira

[Onyx embolization for treatment of dural arteriovenous fistula: comparison of long- distance versus routine injection method].

PubMed

He, Xiao-Yan; Zhang, Guo-Zhong; Li, Ming-Zhou; Wang, Gang; Liu, Dan; Qi, Song-Tao; Li, Wei-Guang; Feng, Wen-Feng

2016-03-01

To compare the efficacy, clinical characteristics, safety, injection time and radiation exposure of Onyx embolization using a long-distance injection method and routine injection method for management of dural arteriovenous fistula (DAVF). The clinical data were retrospectively analyzed in 59 patients with DAVF treated with Onyx embolization using long-distance injection method (28 patients) and routine injection method (31 patients). The efficacy, safety, injection time and radiation exposure during Onyx embolization were compared between the two injections methods. The average radiation dose exposure to the surgeon per procedure was significantly lower in the long-distance injection group than in the routine group. The injection time (P=0.53), injection volume (P=0.78), number of supply arteries (P=0.80), Cognard types (P=0.67), and effect of embolization (P=0.88) were all similar between the two groups. Endovaseular treatment of intracranial DAVF with Onyx embolization using the long-distance injection method is feasible, safe and effective and can reduce the radiation exposure to the surgeon.

Narrating the social relations of initiating injecting drug use: transitions in self and society.

PubMed

Rhodes, Tim; Bivol, Stela; Scutelniciuc, Otilia; Hunt, Neil; Bernays, Sarah; Busza, Joanna

2011-11-01

Few studies have explored drug injectors' accounts of their initiation of others into injecting. There also lacks research on the social relations of initiating injecting drug use in transitional society. We draw upon analyses of 42 audio-recorded semi-structured interviews with current and recent injecting drug users, conducted in 2009 in the Republic of Moldova, a transitional society of south-eastern Europe. A thematic analysis informed by narrative theory was undertaken, focusing on accounts of self-initiation and the initiation of others. We also reflect upon the potential of peer efforts to dissuade would-be injectors from initiating. Findings emphasise initiation into injecting as a symbolic identity transition, enabled through everyday social relations. In turn, our analysis locates the drug transitions of the self inside an account of societal transition. We find that personal narratives of self transition are made sense of, and presented, in relation to broader narratives of social transition and change. Furthermore, we explore how narratives of self-initiation, and especially the initiation of others, serve to negotiate initiation as a moral boundary crossing. Self-initiation is located inside an account of transitioning social values. In looking back, initiation is depicted as a feature of a historically situated aberration in normative values experienced by the 'transition generation'. Accounts of the initiation of others (which a third of our sample describe) seek to qualify the act as acceptable given the circumstances. These accounts also connect the contingency of agency with broader narratives of social condition. Lastly, the power of peers to dissuade others from initiating injection was doubted, in part because most self-initiations were accomplished as a product of agency enabled by environment as well as in the face of peer attempts to dissuade. Copyright © 2011. Published by Elsevier B.V.

A qualitative exploration of travel-related risk behaviours of injection drug users from two Slovene regions

PubMed Central

2011-01-01

This qualitative study of travel-related risk behaviours of Slovene injection drug users was based on interviews with individuals enrolled in drug addiction treatment programmes run by three regional centres for prevention and treatment of drug addiction. The primary objective of the study was to analyse behaviour patterns and practices of injection drug users during travel. Methods Travel-related problems of Slovene injection drug users were identified on the basis of data obtained by 25 in-depth interviews. A semi-structured questionnaire with 13 open-ended questions was developed after a preliminary study and review of the literature, and on the basis of experience with the treatment of drug addiction in Slovenia. Results The sample comprised 25 individuals, 18 men and seven women, aged 25 to 53 years. The interviews were 10 to 30 minutes long. The results obtained were presented as identified risk behaviours. Five categories were generated, providing information on the following topics: procurement of illicit drugs, criminal acts/environment, HIV and hepatitis B and C infections, storage and transport of substitution medication and pre-travel health protection. The first three categories comprise the injection drug users' risk behaviours that are most frequently explored in the literature. The other two categories - storage and transport of medication across the border and pre-travel health protection - reflect national specificities and the effectiveness of substitution treatment programmes. The majority of participants denied having shared needles and other injecting equipment when travelling. Participants who had no doctor's certificate had recourse to various forms of risk behaviour, finding a number of ways to hide the medication at the border. Conclusion This qualitative study provides insight into potential travel-related risk behaviour of injection drug users from two Slovene regions - central and coastal. The potential value of this qualitative study

Nonsurgical management of an enlarging pneumatocele by fibrin sealant injection via pigtail catheter.

PubMed

Park, Tae Hyun; Kim, Jin Kyu

2016-02-01

Most pneumatoceles disappear spontaneously and do not cause severe symptoms. Treatment alternatives include various conventional or surgical methods. However, an enlarging, complicated pneumatocele with cardiorespiratory instability requires imaging-guided catheter drainage or surgery. Here, we report the case of a newborn girl with an enlarging pneumatocele accompanied by pulmonary interstitial emphysema secondary to mechanical ventilation. The pneumatocele was successfully managed by the injection of fibrin sealant via a pigtail catheter. © 2015 Wiley Periodicals, Inc.

Botulinum Toxin A for Oral Cavity Cancer Patients: In Microsurgical Patients BTX Injections in Major Salivary Glands Temporarily Reduce Salivary Production and the Risk of Local Complications Related to Saliva Stagnation

PubMed Central

Bartolo, Corradino; Sara, Di Lorenzo; Francesco, Moschella

2012-01-01

In patients suffering from oral cavity cancer surgical treatment is complex because it is necessary to remove carcinoma and lymph node metastasis (through a radical unilateral or bilateral neck dissection) and to reconstruct the affected area by means of free flaps. The saliva stagnation in the post-operative period is a risk factor with regard to local complications. Minor complications related to saliva stagnation (such as tissue maceration and wound dehiscence) could become major complications compromising the surgery or the reconstructive outcome. In fact the formation of oro-cutaneous fistula may cause infection, failure of the free flap, or the patient’s death with carotid blow-out syndrome. Botulinum injections in the major salivary glands, four days before surgery, temporarily reduces salivation during the healing stage and thus could reduce the incidence of saliva-related complications. Forty three patients with oral cancer were treated with botulinum toxin A. The saliva quantitative measurement and the sialoscintigraphy were performed before and after infiltrations of botulinum toxin in the major salivary glands. In all cases there was a considerable, but temporary, reduction of salivary secretion. A lower rate of local complications was observed in the post-operative period. The salivary production returned to normal within two months, with minimal side effects and discomfort for the patients. The temporary inhibition of salivary secretion in the post-operative period could enable a reduction in saliva-related local complications, in the incidence of oro-cutaneous fistulas, and improve the outcome of the surgery as well as the quality of residual life in these patients. PMID:23202301

Botulinum toxin A for oral cavity cancer patients: in microsurgical patients BTX injections in major salivary glands temporarily reduce salivary production and the risk of local complications related to saliva stagnation.

PubMed

Corradino, Bartolo; Di Lorenzo, Sara; Moschella, Francesco

2012-10-24

In patients suffering from oral cavity cancer surgical treatment is complex because it is necessary to remove carcinoma and lymph node metastasis (through a radical unilateral or bilateral neck dissection) and to reconstruct the affected area by means of free flaps. The saliva stagnation in the post-operative period is a risk factor with regard to local complications. Minor complications related to saliva stagnation (such as tissue maceration and wound dehiscence) could become major complications compromising the surgery or the reconstructive outcome. In fact the formation of oro-cutaneous fistula may cause infection, failure of the free flap, or the patient’s death with carotid blow-out syndrome. Botulinum injections in the major salivary glands, four days before surgery, temporarily reduces salivation during the healing stage and thus could reduce the incidence of saliva-related complications. Forty three patients with oral cancer were treated with botulinum toxin A. The saliva quantitative measurement and the sialoscintigraphy were performed before and after infiltrations of botulinum toxin in the major salivary glands. In all cases there was a considerable, but temporary, reduction of salivary secretion. A lower rate of local complications was observed in the post-operative period. The salivary production returned to normal within two months, with minimal side effects and discomfort for the patients. The temporary inhibition of salivary secretion in the post-operative period could enable a reduction in saliva-related local complications, in the incidence of oro-cutaneous fistulas, and improve the outcome of the surgery as well as the quality of residual life in these patients.

Injection frequency and anatomic outcomes 1 year following conversion to aflibercept in patients with neovascular age-related macular degeneration.

PubMed

Messenger, Wyatt B; Campbell, J Peter; Faridi, Ambar; Shippey, Loton; Bailey, Steven T; Lauer, Andreas K; Flaxel, Christina J; Hwang, Thomas S

2014-09-01

To evaluate the clinical, anatomic and functional effects of conversion to aflibercept following ranibizumab and/or bevacizumab in patients with neovascular age-related macular degeneration (AMD). A retrospective review of patients with neovascular AMD treated with intravitreal ranibizumab and/or bevacizumab who were switched to aflibercept was performed. The primary outcome was change in injection frequency in the year following the change. Secondary outcomes included change in central macular thickness (CMT) at 6 months and 1 year, presence of intraretinal and subretinal fluid at 6 months and visual acuity at 1 year. A total of 109 eyes with neovascular AMD were switched to aflibercept and met inclusion criteria. Overall, aflibercept injection frequency was unchanged with patients receiving 7.4 antivascular endothelial growth factor (VEGF) injections the year prior to conversion compared with 7.2 aflibercept injections in the year following (p=0.47). However, the change to aflibercept was associated with improvement in CMT from 324 to 295 μm (p=0.0001) at 6 months and 299 μm (p=0.0047) at 1 year. There was no effect on visual acuity at 1 year. In a subgroup analysis, patients who had received ≥10 anti-VEGF injections in the year prior had fewer injections (11.1 to 8.4, p<0.0001) and clinic visits (13.9 to 9.6, p<0.0001) as well as a significant decrease in CMT (-35 μm, p=0.02). In our population, switching to aflibercept therapy was not associated with a change in injection frequency nor improved visual acuity, but was associated with improved CMT at 6 months and 1 year. In patients who received at least 10 anti-VEGF injections in the year prior, transitioning to aflibercept was associated with a reduced injection frequency and CMT, suggesting potential cost savings in this population. 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.

Comparison of incidence of intravascular injections during transforaminal epidural steroid injection using different needle types

PubMed Central

Lee, Yong Ho

2014-01-01

Background Infrequent but serious complications of transforaminal epidural steroid injection (TFESI) occur due to inadvertent intravascular injections. A few studies reported that the different needle types can influence on the occurrences of intravascular incidence in TFESI. This study prospectively evaluated whether short-bevel needle can reduce the incidences of intravascular injection of TFESI compared to long-bevel needles. Methods From March 2013 to December 2013, 239 consecutive patients were enrolled and received 249 fluoroscopically guided TFESI using the classic technique. Confirmation of intravascular spread was done initially with real time fluoroscopy and then with digital subtraction angiography method in a same patient. Injection technique for TFESI was the same for both short-bevel and long-bevel needle types. Results The incidences of intravascular injections with the long-bevel and short-bevel needles were 15.0% (21/140) and 9.2% (4/140), respectively. More than half of intravascular injections occurred simultaneously with epidural injections (8.0%, 20/249). There were no statistically significant differences between the long-bevel and the short-bevel needles in the rates of intravascular injections (P = 0.17). Conclusions Short-bevel needles did not demonstrate any benefits in reducing the incidence of intravascular injection. PMID:25302096

Antihistamine Pretreatment to Reduce Incidence of Withdrawal Movement After Rocuronium Injection

PubMed Central

Lee, Ho Jun; Han, Sung Jin; Kim, Heezoo; Lee, Il Ok; Kong, Myoung Hoon; Kim, Nan Suk; Lim, Sang Ho

2009-01-01

The purpose of this study was to determine the effectiveness of antihistamine therapy for withdrawal movements caused by rocuronium injection. One hundred seventy one ASA I-II adults undergoing elective surgery were randomly assigned to one of two groups. Patients in the control group (Group C) were premedicated with 2 mL normal saline, and those in the antihistamine group (Group A) were pre-medicated with 2 mL (45.5 mg) pheniramine maleate. After the administration of thiopental sodium 5 mg/kg, rocuronium 0.6 mg/kg was injected. Withdrawal movements were assessed using a four-grade scale. The administration of antihistamine reveals lower grade of withdrawal movement after rocuronium injection. PMID:19794987

JNK inhibition reduces apoptosis and neovascularization in a murine model of age-related macular degeneration.

PubMed

Du, Hongjun; Sun, Xufang; Guma, Monica; Luo, Jing; Ouyang, Hong; Zhang, Xiaohui; Zeng, Jing; Quach, John; Nguyen, Duy H; Shaw, Peter X; Karin, Michael; Zhang, Kang

2013-02-05

Age-related macular degeneration (AMD) is the leading cause of registered blindness among the elderly and affects over 30 million people worldwide. It is well established that oxidative stress, inflammation, and apoptosis play critical roles in pathogenesis of AMD. In advanced wet AMD, although, most of the severe vision loss is due to bleeding and exudation of choroidal neovascularization (CNV), and it is well known that vascular endothelial growth factor (VEGF) plays a pivotal role in the growth of the abnormal blood vessels. VEGF suppression therapy improves visual acuity in AMD patients. However, there are unresolved issues, including safety and cost. Here we show that mice lacking c-Jun N-terminal kinase 1 (JNK1) exhibit decreased inflammation, reduced CNV, lower levels of choroidal VEGF, and impaired choroidal macrophage recruitment in a murine model of wet AMD (laser-induced CNV). Interestingly, we also detected a substantial reduction in choroidal apoptosis of JNK1-deficient mice. Intravitreal injection of a pan-caspase inhibitor reduced neovascularization in the laser-induced CNV model, suggesting that apoptosis plays a role in laser-induced pathological angiogenesis. Intravitreal injection of a specific JNK inhibitor decreased choroidal VEGF expression and reduced pathological CNV. These results suggest that JNK1 plays a key role in linking oxidative stress, inflammation, macrophage recruitment apoptosis, and VEGF production in wet AMD and pharmacological JNK inhibition offers a unique and alternative avenue for prevention and treatment of AMD.

HIV, HCV, and Health-Related Harms Among Women Who Inject Drugs: Implications for Prevention and Treatment.

PubMed

Iversen, Jenny; Page, Kimberly; Madden, Annie; Maher, Lisa

2015-06-01

Although an estimated 3.5 million women inject drugs globally, women are outnumbered 4 to one by men who inject drugs and are often ignored or overlooked in the development and delivery of prevention and treatment services for this population. This study aimed to identify key comorbidities prevalent among women who inject drugs (WWID), consider factors that contribute to vulnerability of this population, and examine implications for prevention and treatment. The literature was reviewed to examine the specific challenges and needs of WWID. We searched health-related bibliographic databases and grey literature to identify studies conducted among WWID and studies conducted among people who inject drugs (PWID), where results were disaggregated by gender and policies/guidelines/reports relevant to WWID. WWID face a range of unique, gender-specific, and often additional challenges and barriers. The lack of a targeted focus on WWID by prevention and treatment services and harm-reduction programs increases women's vulnerability to a range of health-related harms, including blood-borne viral and sexually transmitted infections, injection-related injuries, mental health issues, physical and sexual violence, poor sexual and reproductive health, issues in relation to childbearing and child care, and pervasive stigma and discrimination. There is a need to improve the collection and reporting of gender-disaggregated data on prevalence of key infections and prevention and treatment service access and program coverage. Women-focussed services and integrating gender equity and human rights into the harm-reduction programming will be a prerequisite if improvements in the health, safety, and well-being of this often invisible and highly vulnerable population are to be achieved.

A Vibration Device to Control Injection Discomfort.

PubMed

Shaefer, Jeffry R; Lee, Stephanie J; Anderson, Nina K

2017-06-01

Pain from local anesthesia injections can be reduced by distraction and counter-stimulation techniques. This study investigated the DentalVibe® Injection Comfort System (third-generation, DV3), developed to lessen anesthesia pain through pulsed vibration, a form of counter-stimulation. The aim of the study was to evaluate both the efficacy of DV3 in reducing pain and discomfort from intraoral long buccal (LB) and inferior alveolar nerve (IAN) injections and the time needed to achieve complete anesthesia during an IAN block. The study enrolled 60 subjects, 30 men and 30 women, aged 21 to 32 years, who rated both injection pain on a visual analog scale and discomfort, unpleasantness, and difficulty in enduring the injection on a modified symptom severity index. Each subject received bilateral LB injections and an IAN block. Using block design, the third-generation DV (DV3) was randomly assigned to either the first or second LB injection and to 30 subjects on their third injection, the IAN block. No topical anesthesia was applied. Subjects receiving DV3 reported significantly less pain, discomfort, unpleasantness, and difficulty in enduring LB and IAN injections (P < .05), regardless of whether DV3 was used on the first or second LB injection. Time to complete anesthesia was not significantly different (P > .05) when DV3 was used on IAN block injections. The DV3 significantly (P < .02) reduced pain/discomfort from anesthetic injections in this pilot study, in which many subjects were either dental or medical students familiar with performing and enduring injections. More studies are warranted on layperson populations.

Management of Chronic Pain of Cervical Disc Herniation and Radiculitis with Fluoroscopic Cervical Interlaminar Epidural Injections

PubMed Central

Manchikanti, Laxmaiah; Cash, Kimberly A.; Pampati, Vidyasagar; Wargo, Bradley W.; Malla, Yogesh

2012-01-01

Study Design: A randomized, double-blind, active controlled trial. Objective: To evaluate the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids in the management of chronic neck pain and upper extremity pain in patients with disc herniation and radiculitis. Summary of Background Data: Epidural injections in managing chronic neck and upper extremity pain are commonly employed interventions. However, their long-term effectiveness, indications, and medical necessity, of their use and their role in various pathologies responsible for persistent neck and upper extremity pain continue to be debated, even though, neck and upper extremity pain secondary to disc herniation and radiculitis, is described as the common indication. There is also paucity of high quality literature. Methods: One-hundred twenty patients were randomly assigned to one of 2 groups: Group I patients received cervical interlaminar epidural injections of local anesthetic (lidocaine 0.5%, 5 mL); Group II patients received 0.5% lidocaine, 4 mL, mixed with 1 mL of nonparticulate betamethasone. Primary outcome measure was ≥ 50 improvement in pain and function. Outcome assessments included Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), opioid intake, employment, and changes in weight. Results: Significant pain relief and functional status improvement (≥ 50%) was demonstrated in 72% of patients who received local anesthetic only and 68% who received local anesthetic and steroids. In the successful group of participants, significant improvement was illustrated in 77% in local anesthetic group and 82% in local anesthetic with steroid group. Conclusions: Cervical interlaminar epidural injections with or without steroids may provide significant improvement in pain and function for patients with cervical disc herniation and radiculitis. PMID:22859902

Management of chronic pain of cervical disc herniation and radiculitis with fluoroscopic cervical interlaminar epidural injections.

PubMed

Manchikanti, Laxmaiah; Cash, Kimberly A; Pampati, Vidyasagar; Wargo, Bradley W; Malla, Yogesh

2012-01-01

A randomized, double-blind, active controlled trial. To evaluate the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids in the management of chronic neck pain and upper extremity pain in patients with disc herniation and radiculitis. Epidural injections in managing chronic neck and upper extremity pain are commonly employed interventions. However, their long-term effectiveness, indications, and medical necessity, of their use and their role in various pathologies responsible for persistent neck and upper extremity pain continue to be debated, even though, neck and upper extremity pain secondary to disc herniation and radiculitis, is described as the common indication. There is also paucity of high quality literature. One-hundred twenty patients were randomly assigned to one of 2 groups: Group I patients received cervical interlaminar epidural injections of local anesthetic (lidocaine 0.5%, 5 mL); Group II patients received 0.5% lidocaine, 4 mL, mixed with 1 mL of nonparticulate betamethasone. Primary outcome measure was ≥ 50 improvement in pain and function. Outcome assessments included Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), opioid intake, employment, and changes in weight. Significant pain relief and functional status improvement (≥ 50%) was demonstrated in 72% of patients who received local anesthetic only and 68% who received local anesthetic and steroids. In the successful group of participants, significant improvement was illustrated in 77% in local anesthetic group and 82% in local anesthetic with steroid group. Cervical interlaminar epidural injections with or without steroids may provide significant improvement in pain and function for patients with cervical disc herniation and radiculitis.

Pre-emptive ice cube cryotherapy for reducing pain from local anaesthetic injections for simple lacerations: a randomised controlled trial.

PubMed

Song, JaeWoo; Kim, HyukHoon; Park, EunJung; Ahn, Jung Hwan; Yoon, Eunhui; Lampotang, Samsun; Gravenstein, Nikolaus; Choi, SangChun

2018-02-01

Subcutaneous local anaesthetic injection can be painful to patients in the ED. We evaluated the effect of cryotherapy by application of an ice cube to the injection site prior to injection in patients with simple lacerations. We conducted a prospective, randomised, controlled trial in consented patients with simple lacerations needing primary repair at a single emergency centre from April to July 2016. We randomly assigned patients undergoing repair for simple lacerations to either the cryotherapy group or the control group (standard care; no cryotherapy or other pretreatment of the injection site). In cryotherapy group subjects, we applied an ice cube (size: 1.5×1.5×1.5 cm) placed inside a sterile glove on the wound at the anticipated subcutaneous lidocaine injection site for 2 min prior to injection. The primary outcome was a subjective numeric rating (0-10 scale) of the perceived pain from the subcutaneous local anaesthetic injections. Secondary outcomes were (a) perceived pain on a numeric scale for cryotherapy itself, that is, pain from contact of the ice cube/glove with the skin and (b) the rate of complications after primary laceration repair. Fifty patients were enrolled, consented and randomised, with 25 in the cryotherapy group and 25 in the control group. The numeric rating scale for subcutaneous anaesthetic injections was median, IQR, 95% CI 2.0 (1 to 3.5), 1.81 to 3.47, respectively, in the cryotherapy group and 5.0 (3 to 7), 3.91 to 6.05 in the control group (Mann-Whitney U=147.50, p=0.001). No wound complications occurred in either group. The numeric rating scale for cryotherapy itself was median, IQR, 95% CI: 2.0 (1 to 3.5), 1.90 to 3.70. Pre-emptive topical injection site cryotherapy lasting 2 min before subcutaneous local anaesthetic injections can significantly reduce perceived pain from subcutaneous local anaesthetic injections in patients presenting for simple laceration repair. KCT0001990. © Article author(s) (or their employer

Using Pharmacies in a Structural Intervention to Distribute Low Dead Space Syringes to Reduce HIV and HCV Transmission in People Who Inject Drugs.

PubMed

Oramasionwu, Christine U; Johnson, Terence L; Zule, William A; Carda-Auten, Jessica; Golin, Carol E

2015-06-01

Ongoing injection drug use contributes to the HIV and HCV epidemics in people who inject drugs. In many places, pharmacies are the primary source of sterile syringes for people who inject drugs; thus, pharmacies provide a viable public health service that reduces blood-borne disease transmission. Replacing the supply of high dead space syringes with low dead space syringes could have far-reaching benefits that include further prevention of disease transmission in people who inject drugs and reductions in dosing inaccuracies, medication errors, and medication waste in patients who use syringes. We explored using pharmacies in a structural intervention to increase the uptake of low dead space syringes as part of a comprehensive strategy to reverse these epidemics.

Interactional group discussion: results of a controlled trial using a behavioral intervention to reduce the use of injections in public health facilities.

PubMed

Hadiyono, J E; Suryawati, S; Danu, S S; Sunartono; Santoso, B

1996-04-01

Injections are commonly overused in Indonesia. More than 60% of patients attending public health facilities receive at least one injection, which increases clinical risk and has adverse economic impact. This study assesses the efficacy of an innovative behavioral intervention, the Interactional Group Discussion (IGD), for reducing the overuse of injections. This study was a controlled trial in a single district with 24 public health centers randomized to intervention and control groups. Prescribers in the intervention group were invited to one IGD, each of which consisted of 6 prescribers and 6 patients; a total of 24 IGDs were held in a 4-week period, and all invited prescribers participated. The groups, which lasted 90-120 minutes, were facilitated by a behavioral scientist and a clinician, who also served as a scientific resource person. The hypothesized mechanism of behavior change involved reality testing prescribers' assumptions about patient beliefs, imparting scientific information about injection efficacy, and establishing peer norms about correct behavior. Outcomes were measured by a retrospective prescribing survey covering the periods 3 months before and 3 months after the intervention, with samples of 100 prescriptions per center per month. Rates of injection and average number of drugs per prescription were computed separately for each center, and t-tests were used to compare pre-post changes in outcomes in both groups. Results showed a significant decrease in injection use from 69.5 to 42.3% in the intervention group, compared to a decrease from 75.6 to 67.1% among controls [-18.7.0% intervention vs control, 95% CI = (-31.1%, -6.4%), P < 0.025]. There was also a significant reduction in average number of drugs per prescription [-0.37 drugs prescribed per patient, 95% CI = (-0.04, -0.52), P < 0.05], indicating that injections were not substituted with other drugs. We conclude that the IGD significantly reduces the overuse of injections. It is

Female mating receptivity after injection of male-derived extracts in Callosobruchus maculatus.

PubMed

Yamane, Takashi; Miyatake, Takahisa; Kimura, Yoshinobu

2008-12-01

The effects of male-derived extracts on female receptivity were investigated in Callosobruchus maculatus (Coleoptera: Bruchidae). Injection of aqueous extracts of the male reproductive tract into the abdomen of females reduced receptivity. Aqueous extracts of male reproductive tracts were divided to three molecular weight (MW) fractions by ultrafiltration: Fractions: (I) MW<3 kDa, (II) 3-14 kDa, and (III)>14 kDa. Fraction II reduced female receptivity from 3h after injection, and Fraction III reduced female receptivity from 2 days after injection. On the other hand, no effect on receptivity was found for Fraction I. Furthermore, male reproductive tract organs were divided into accessory gland, testis, and seminal vesicle including the ejaculatory duct. Aqueous extracts of the seminal vesicle reduced receptivity of females immediately following injection, while aqueous extracts of the accessory gland reduced receptivity at the second day. The results suggest that the components of Fraction II existed in the seminal vesicle, and those of Fraction III in the accessory gland. The results of the present and the previous studies in Callosobruchus chinensis, a species closely related to C. maculatus, were compared and are discussed from the viewpoint of the significance of ejaculation in the two species.

Using prescribed fire to reduce the risk of smoke related traffic problems on I-95

Treesearch

Steven R. Miller

2015-01-01

In many areas of the United States, prescribed burning near highways is considered too risky because of the potential for smoke to obscure the highway. In one area in Florida, prescribed fire is used to reduce the risks of smoke related impacts to Interstate 95. The St Johns River Water Management District manages over 400,000 acres of land. Seventy percent of those...

Optimizing Water Management for Collocated Conventional and Unconventional Reservoirs

NASA Astrophysics Data System (ADS)

Reedy, R. C.; Scanlon, B. R.; Walsh, M.

2016-12-01

With the U.S. producing much more water than oil from oil and gas reservoirs, managing produced water is becoming a critical issue. Here we quantify water production from collocated conventional and unconventional reservoirs using well by well analysis and evaluate various water management strategies using the U.S. Permian Basin as a case study. Water production during the past 15 years in the Permian Basin totaled 55×109 barrels (bbl), 95% from wells in conventional reservoirs resulting in an average water to oil ratio of 12 compared to ratios of 2-3 in wells in unconventional reservoirs. Some of this water ( 25%) is returned to the reservoir for secondary oil recovery (water flooding) while the remaining water is injected into an average of 18,000 salt water disposal wells. Total water production over the past 15 yr (2000 - 2015) exceeds water used for hydraulic fracturing by almost 40 times. Analyzing water injection into salt water disposal wells relative to water requirements for hydraulic fracturing at a 5 square mile grid scale based on 2014 data indicates that water disposal exceeds water requirements for hydraulic fracturing throughout most of the play. Reusing/recycling of produced water for hydraulic fracturing would reduce sourcing and disposal issues related to hydraulic fracturing. Because shales (unconventional reservoirs) provide the source rocks for many conventional reservoirs, coordinating water management from both conventional and unconventional reservoirs can help resolve issues related to sourcing of water for hydraulic fracturing and disposing of produced water. Reusing/recycling produced water can also help reduce water scarcity concerns in some regions.

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

Epidural steroid injections: update on efficacy, safety, and newer medications for injection.

PubMed

Kozlov, N; Benzon, H T; Malik, K

2015-08-01

The best evidence for epidural injection appears to be in the setting of radicular pain with epidural steroid and non-steroid injections more efficacious than non-epidural injections. Studies showed the efficacy of non-particulate steroid to approach the efficacy of particulate steroid and very limited comparisons demonstrated no significant difference between epidural steroid and epidural non-steroid (local anesthetic) injection. Preliminary studies evaluating epidural injection of disease modifying anti-rheumatic drugs such etanercept and tocilizumab showed conflicting results and had significant limitations. Randomized studies support better efficacy of transforaminal injection due to greater incidence of ventral epidural spread of injectate when compared to interlaminar injection. Thus, the transforaminal approach is recommended when unilateral radicular pain is limited to one nerve root. However, the transforaminal approach is associated with greater incidence of central nervous system injury, including paraplegia, attributed to embolization of the particulate steroid. Recent studies showed that non-particulate steroids potentially last as long as particulate steroids. Therefore non-particulate steroid should be used in initial transforaminal epidural injection. Future studies should look into the role of adjunct diagnostic aids, including digital subtraction angiography, in detecting intravascular injection and the ideal site of needle placement, whether it is the safe triangle or the triangle of Kambin. Finally, the role of epidural disease -modifying antirheumatic drugs in the management of back pain needs to be better elucidated.

Evaluating Swine Injection Technologies as a Workplace Musculoskeletal Injury Intervention: A Study Protocol.

PubMed

Trask, Catherine; Bath, Brenna; Milosavljevic, Stephan; Kociolek, Aaron M; Predicala, Bernardo; Penz, Erika; Adebayo, Olugbenga; Whittington, Lee

2017-01-01

Intensification of modern swine production has led to many new technologies, including needleless injectors. Although needleless injectors may increase productivity (by reducing injection time) and reduce needlestick injuries, the effect on risk for musculoskeletal disorders is not clear. This project will compare conventional needles with needleless injectors in terms of cost, productivity, injury rates, biomechanical exposures, and worker preference. Muscle activity (EMG) and hand/wrist posture will be measured on swine workers performing injection tasks with both injection methods. Video recordings during the exposure assessments will compare the duration and productivity for each injection method using time-and-motion methods. Injury claim data from up to 60 pig barns will be analyzed for needlestick and musculoskeletal injuries before/after needleless injector adoption. Workers and managers will be asked about what they like and dislike about each method and what helps and hinders successful implementation. The information above will be input into a cost-benefit model to determine the incremental effects of needleless injectors in terms of occupational health, worker preference, and the financial "bottom line" of the farm. Findings will be relevant to the swine industry and are intended to be transferable to other new technologies in animal production.

Water Injection on Commercial Aircraft to Reduce Airport Nitrogen Oxides

NASA Technical Reports Server (NTRS)

Daggett, David L.; Hendricks, Robert C.; Fucke, Lars; Eames, David J. H.

2010-01-01

The potential nitrogen oxide (NO(x) reductions, cost savings, and performance enhancements identified in these initial studies of waterinjection technology strongly suggest that it be further pursued. The potential for engine maintenance cost savings from this system should make it very attractive to airline operators and assure its implementation. Further system tradeoff studies and engine tests are needed to answer the optimal system design question. Namely, would a low-risk combustor injection system with 70- to 90-percent NO(x) reduction be preferable, or would a low-pressure compressor (LPC) misting system with only 50-percent NO(x) reduction but larger turbine inlet temperature reductions be preferable? The low-pressure compressor injection design and operability issues identified in the report need to be addressed because they might prevent implementation of the LPC type of water-misting system. If water-injection technology challenges are overcome, any of the systems studied would offer dramatic engine NO(x) reductions at the airport. Coupling this technology with future emissions-reduction technologies, such as fuel-cell auxiliary power units will allow the aviation sector to address the serious challenges of environmental stewardship, and NO(x) emissions will no longer be an issue at airports.

Novel Treatment of Chronic Bladder Pain Syndrome and Other Pelvic Pain Disorders by OnabotulinumtoxinA Injection.

PubMed

Jhang, Jia-Fong; Kuo, Hann-Chorng

2015-06-18

Chronic pelvic pain (CPP) is defined as pain in the pelvic organs and related structures of at least 6 months' duration. The pathophysiology of CPP is uncertain, and its treatment presents challenges. Botulinum toxin A (BoNT-A), known for its antinociceptive, anti-inflammatory, and muscle relaxant activity, has been used recently to treat refractory CPP with promising results. In patients with interstitial cystitis/bladder pain syndrome, most studies suggest intravesical BoNT-A injection reduces bladder pain and increases bladder capacity. Repeated BoNT-A injection is also effective and reduces inflammation in the bladder. Intraprostatic BoNT-A injection could significantly improve prostate pain and urinary frequency in the patients with chronic prostatitis/chronic pelvic pain syndrome. Animal studies also suggest BoNT-A injection in the prostate decreases inflammation in the prostate. Patients with CPP due to pelvic muscle pain and spasm also benefit from localized BoNT-A injections. BoNT-A injection in the pelvic floor muscle improves dyspareunia and decreases pelvic floor pressure. Preliminary studies show intravesical BoNT-A injection is useful in inflammatory bladder diseases such as chemical cystitis, radiation cystitis, and ketamine related cystitis. Dysuria is the most common adverse effect after BoNT-A injection. Very few patients develop acute urinary retention after treatment.

Warfarin-related recurrent knee haemarthrosis treated with arterial embolisation and intra-articular injection of tranexamic acid

PubMed Central

Kunugiza, Yasuo; Nakamura, Yoshiharu; Mikami, Koji; Suzuki, Shozo

2015-01-01

Haemarthrosis is an uncommon complication of anticoagulation therapy. Tranexamic acid (TXA) has a high clinical value for the treatment of bleeding due to fibrinolysis. We describe a case of a 61-year-old woman with a mechanical heart valve who presented with warfarin-related recurrent haemarthrosis of her right knee, which recurred after transarterial embolisation. Intra-articular injection of TXA led to a cessation of haemarthrosis without any adverse event for 1 year. Intra-articular injection of TXA may be an effective treatment for warfarin-related haemarthrosis. PMID:26142391

Drug-Related Arrest Rates and Spatial Access to Syringe Exchange Programs in New York City Health Districts: Combined Effects on the Risk of Injection-Related Infections among Injectors

PubMed Central

Jarlais, Don C Des; Tempalski, Barbara; Bossak, Brian H; Ross, Zev; Friedman, Samuel R

2011-01-01

Drug-related law enforcement activities may undermine the protective effects of syringe exchange programs (SEPs) on local injectors’ risk of injection-related infections. We explored the spatial overlap of drug-related arrest rates and access to SEPs over time (1995-2006) in New York City health districts, and used multilevel models to investigate the relationship of these two district-level exposures to the odds of injecting with an unsterile syringe. Districts with better SEP access had higher arrest rates, and arrest rates undermined SEPs’ protective relationship with unsterile injecting. Drug-related enforcement strategies targeting drug users should be de-emphasized in areas surrounding SEPs. PMID:22047790

Fast plasma shutdown by killer pellet injection in JT-60U with reduced heat flux on the divertor plate and avoiding runaway electron generation

NASA Astrophysics Data System (ADS)

Yoshino, R.; Kondoh, T.; Neyatani, Y.; Itami, K.; Kawano, Y.; Isei, N.

1997-02-01

A killer pellet is an impurity pellet that is injected into a tokamak plasma in order to terminate a discharge without causing serious damage to the tokamak machine. In JT-60U neon ice pellets have been injected into OH and NB heated plasmas and fast plasma shutdowns have been demonstrated without large vertical displacement. The heat pulse on the divertor plate has been greatly reduced by killer pellet injection (KPI), but a low-power heat flux tail with a long time duration is observed. The total energy on the divertor plate increases with longer heat flux tail, so it has been reduced by shortening the tail. Runaway electron (RE) generation has been observed just after KPI and/or in the later phase of the plasma current quench. However, RE generation has been avoided when large magnetic perturbations are excited. These experimental results clearly show that KPI is a credible fast shutdown method avoiding large vertical displacement, reducing heat flux on the divertor plate, and avoiding (or minimizing) RE generation.

Using Pharmacies in a Structural Intervention to Distribute Low Dead Space Syringes to Reduce HIV and HCV Transmission in People Who Inject Drugs

PubMed Central

Johnson, Terence L.; Zule, William A.; Carda-Auten, Jessica; Golin, Carol E.

2015-01-01

Ongoing injection drug use contributes to the HIV and HCV epidemics in people who inject drugs. In many places, pharmacies are the primary source of sterile syringes for people who inject drugs; thus, pharmacies provide a viable public health service that reduces blood-borne disease transmission. Replacing the supply of high dead space syringes with low dead space syringes could have far-reaching benefits that include further prevention of disease transmission in people who inject drugs and reductions in dosing inaccuracies, medication errors, and medication waste in patients who use syringes. We explored using pharmacies in a structural intervention to increase the uptake of low dead space syringes as part of a comprehensive strategy to reverse these epidemics. PMID:25880955

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.

Diagnostics and Identification of Injection Duration of Common Rail Diesel Injectors

NASA Astrophysics Data System (ADS)

Krogerus, Tomi R.; Huhtala, Kalevi J.

2018-02-01

In this paper, we study the diagnostics and identification of injection duration of common rail (CR) diesel pilot injectors of dual-fuel engines. In these pilot injectors, the injected volume is small and the repeatability of the injections and identification of the drifts of the injectors are important factors, which need to be taken into account in achieving good repeatability (shot-to-shot with every cylinder) and therefore a well-balanced engine and reduced overall wear. A diagnostics method based on analysis of CR pressure signal with experimental verification results is presented. Using the developed method, the relative duration of injection events can be identified. In the method, the pressure signal during the injection is first extracted after the control of each injection event. After that, the signal is normalized and filtered. Then a derivative of the filtered signal is calculated. Change in the derivative of the filtered signal larger than a predefined threshold indicates an injection event which can be detected and its relative duration can be identified. The efficacy of the proposed diagnostics method is presented with the experimental results, which show that the developed method detects drifts in injection duration and the magnitude of drift. According to the result, ≥ 10 μs change (2%, 500 μs) in injection time can be identified.

Do Intra-anal Bowel Management Devices Reduce Incontinence-Associated Dermatitis and/or Pressure Injuries?

PubMed

Beeson, Terrie; Eifrid, Bethany; Pike, Caitlin A; Pittman, Joyce

The purpose of this article was to examine the evidence and provide recommendations related to the effectiveness of intra-anal bowel management systems including intra-anal bowel catheters and rectal trumpets in reducing incontinence-associated dermatitis and pressure injuries. Does the use of an intra-anal bowel management system (intra-anal bowel catheter or rectal trumpet) reduce incontinence-associated skin damage and/or hospital-acquired pressure injuries in the acute care adult patient population? A search of the literature was performed by a trained university librarian, which resulted in 133 articles that examined intra-anal bowel management systems (intra-anal bowel catheter and rectal trumpet), incontinence-associated dermatitis, and pressure injuries. A systematic approach was used to review titles, abstracts, and text yielding 6 studies that met inclusion criteria. Strength of the evidence was rated using rating methodology from Essential Evidence Plus: Levels of evidence and Oxford Center for Evidence-based Medicine, adapted by Gray and colleagues. Five of the 6 studies reported positive results concerning the effectiveness of intra-anal bowel management systems to reduce incontinence-associated dermatitis and/or pressure injuries. One randomized control trial found no improvement in incontinence-associated dermatitis in the intra-anal bowel management system (intra-anal bowel catheter or rectal trumpet) groups or pressure injuries as compared to usual care. The strength of the evidence for the identified studies was moderate (2 level A, 3 level B, and 1 level C). An important finding in 2 of the studies was the safety of the intra-anal bowel management systems-both intra-anal bowel catheter and rectal trumpet. Evidence indicates intra-anal bowel management system (intra-anal bowel catheters and rectal trumpet) provides a viable option for fecal incontinence management and these devices reduce incontinence-associated dermatitis and/or pressure injuries.

Fluoroscopic caudal epidural injections in managing chronic axial low back pain without disc herniation, radiculitis, or facet joint pain

PubMed Central

Manchikanti, Laxmaiah; Cash, Kimberly A; McManus, Carla D; Pampati, Vidyasagar

2012-01-01

Background Chronic low back pain without disc herniation is common. Various modalities of treatments are utilized in managing this condition, including epidural injections. However, there is continued debate on the effectiveness, indications, and medical necessity of any treatment modality utilized for managing axial or discogenic pain, including epidural injections. Methods A randomized, double-blind, actively controlled trial was conducted. The objective was to evaluate the ability to assess the effectiveness of caudal epidural injections of local anesthetic with or without steroids for managing chronic low back pain not caused by disc herniation, radiculitis, facet joints, or sacroiliac joints. A total of 120 patients were randomized to two groups; one group did not receive steroids (group 1) and the other group did (group 2). There were 60 patients in each group. The primary outcome measure was at least 50% improvement in Numeric Rating Scale and Oswestry Disability Index. Secondary outcome measures were employment status and opioid intake. These measures were assessed at 3, 6, 12, 18, and 24 months after treatment. Results Significant pain relief and functional status improvement (primary outcome) defined as a 50% or more reduction in scores from baseline, were observed in 54% of patients in group 1 and 60% of patients in group 2 at 24 months. In contrast, 84% of patients in group 1 and 73% in group 2 saw significant pain relief and functional status improvement in the successful groups at 24 months. Conclusion Caudal epidural injections of local anesthetic with or without steroids are effective in patients with chronic axial low back pain of discogenic origin without facet joint pain, disc herniation, and/or radiculitis. PMID:23091395

Predictors of injecting cessation among a cohort of people who inject drugs in Tijuana, Mexico.

PubMed

Horyniak, Danielle; Strathdee, Steffanie A; West, Brooke S; Meacham, Meredith; Rangel, Gudelia; Gaines, Tommi L

2018-04-01

Little is known about the cessation of injecting drug use (IDU) among people who inject drugs (PWID) in low and middle-income settings, where access to effective interventions for reducing drug use (e.g., opioid substitution treatment; OST), may be limited. We measured the incidence and identified predictors of IDU cessation among a cohort of PWID in Tijuana, Mexico. Data were drawn from 621 participants in Proyecto El Cuete IV, a prospective cohort of PWID recruited in 2011 and interviewed biannually to 2016. A multivariable Extended Cox model was constructed to identify socio-demographic, drug use, risk environment and health-related predictors of IDU cessation (no IDU for ≥six months). 141 participants (23%) reported at least one IDU cessation event during follow-up. The crude IDU cessation rate was 7.3 per 100 person-years (95% Confidence Interval [CI]: 6.2-8.7). IDU cessation was negatively associated with injecting at least daily on average and heroin/methamphetamine co-injection in the past six months, and positively associated with testing HIV positive at baseline, being on methadone maintenance therapy in the past six months, and recent arrest. Concern for personal safety was also independently associated with IDU cessation. The rate of IDU cessation among PWID in Tijuana was low. These findings underscore the importance of expansion of services including OST to help reduce drug use and facilitate IDU cessation for those who wish to do so. In this setting, interventions addressing individual-level economic barriers as well as broader social and structural barriers to harm reduction services are integral. Copyright © 2018 Elsevier B.V. All rights reserved.

Delineating Area of Review in a System with Pre-injection Relative Overpressure

DOE PAGES

Oldenburg, Curtis M.; Cihan, Abdullah; Zhou, Quanlin; ...

2014-12-31

The Class VI permit application for geologic carbon sequestration (GCS) requires delineation of an area of review (AoR), defined as the region surrounding the (GCS) project where underground sources of drinking water (USDWs) may be endangered. The methods for estimating AoR under the Class VI regulation were developed assuming that GCS reservoirs would be in hydrostatic equilibrium with overlying aquifers. Here we develop and apply an approach to estimating AoR for sites with preinjection relative overpressure for which standard AoR estimation methods produces an infinite AoR. The approach we take is to compare brine leakage through a hypothetical open flowmore » path in the base-case scenario (no-injection) to the incrementally larger leakage that would occur in the CO 2-injection case. To estimate AoR by this method, we used semi-analytical solutions to single-phase flow equations to model reservoir pressurization and flow up (single) leaky wells located at progressively greater distances from the injection well. We found that the incrementally larger flow rates for hypothetical leaky wells located 6 km and 4 km from the injection well are ~20% and 30% greater, respectively, than hypothetical baseline leakage rates. If total brine leakage is considered, the results depend strongly on how the incremental increase in total leakage is calculated, varying from a few percent to up to 40% greater (at most at early time) than base-case total leakage.« less

The Efficacy of Platelets Rich Plasma Injection in the Superior Joint Space of the Tempromandibular Joint Guided by Ultra Sound in Patients with Non-reducing Disk Displacement.

PubMed

Al-Delayme, Ra'ed M Ayoub; Alnuamy, Shefaa H; Hamid, Firas Taha; Azzamily, Tariq Jassim; Ismaeel, Salah AbdulMahdy; Sammir, R; Hadeel, M; Nabeel, Jafaar; Shwan, R; Alfalahi, Shahad Jamal; Yasin, Alaa

2017-03-01

The objective of this study was to determine average improvement during the rest and active mouth opening after ultrasound guided platelets rich plasma injection in the tempromandibular superior joint space for the patients complaining from non-reducing disk displacement. Thirty-four patients with non-reducing disk displacement underwent guided ultrasound injection of platelet rich plasma to the upper joint space. The extent of maximal mouth opening, chewing efficiency, sound intensity of the TMJ, and tenderness of the TMJ and the masticatory muscles at rest, motion and mastication were thoroughly assessed at the beginning of the study and scheduled for next follow-up at 1st, 3rd, and 6th months. Injection with platelets rich plasma was significantly more effective in improvements of the extent of maximal mouth opening, statistics result demonstrated a significant reduction in the VAS values of pain at rest, motion and mastication compared to the baseline VAS values. PRP injection to the upper temporomandibular joint space provided improvement in signs and symptoms of patient with non-reducing disk displacement of the temporomandibular joint.

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

Compressed air injection technique to standardize block injection pressures.

PubMed

Tsui, Ban C H; Li, Lisa X Y; Pillay, Jennifer J

2006-11-01

Presently, no standardized technique exists to monitor injection pressures during peripheral nerve blocks. Our objective was to determine if a compressed air injection technique, using an in vitro model based on Boyle's law and typical regional anesthesia equipment, could consistently maintain injection pressures below a 1293 mmHg level associated with clinically significant nerve injury. Injection pressures for 20 and 30 mL syringes with various needle sizes (18G, 20G, 21G, 22G, and 24G) were measured in a closed system. A set volume of air was aspirated into a saline-filled syringe and then compressed and maintained at various percentages while pressure was measured. The needle was inserted into the injection port of a pressure sensor, which had attached extension tubing with an injection plug clamped "off". Using linear regression with all data points, the pressure value and 99% confidence interval (CI) at 50% air compression was estimated. The linearity of Boyle's law was demonstrated with a high correlation, r = 0.99, and a slope of 0.984 (99% CI: 0.967-1.001). The net pressure generated at 50% compression was estimated as 744.8 mmHg, with the 99% CI between 729.6 and 760.0 mmHg. The various syringe/needle combinations had similar results. By creating and maintaining syringe air compression at 50% or less, injection pressures will be substantially below the 1293 mmHg threshold considered to be an associated risk factor for clinically significant nerve injury. This technique may allow simple, real-time and objective monitoring during local anesthetic injections while inherently reducing injection speed.

Unintended consequences of atmospheric injection of sulphate aerosols.

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

Brady, Patrick Vane; Kobos, Peter Holmes; Goldstein, Barry

2010-10-01

Most climate scientists believe that climate geoengineering is best considered as a potential complement to the mitigation of CO{sub 2} emissions, rather than as an alternative to it. Strong mitigation could achieve the equivalent of up to -4Wm{sup -2} radiative forcing on the century timescale, relative to a worst case scenario for rising CO{sub 2}. However, to tackle the remaining 3Wm{sup -2}, which are likely even in a best case scenario of strongly mitigated CO{sub 2} releases, a number of geoengineering options show promise. Injecting stratospheric aerosols is one of the least expensive and, potentially, most effective approaches and formore » that reason an examination of the possible unintended consequences of the implementation of atmospheric injections of sulphate aerosols was made. Chief among these are: reductions in rainfall, slowing of atmospheric ozone rebound, and differential changes in weather patterns. At the same time, there will be an increase in plant productivity. Lastly, because atmospheric sulphate injection would not mitigate ocean acidification, another side effect of fossil fuel burning, it would provide only a partial solution. Future research should aim at ameliorating the possible negative unintended consequences of atmospheric injections of sulphate injection. This might include modeling the optimum rate and particle type and size of aerosol injection, as well as the latitudinal, longitudinal and altitude of injection sites, to balance radiative forcing to decrease negative regional impacts. Similarly, future research might include modeling the optimum rate of decrease and location of injection sites to be closed to reduce or slow rapid warming upon aerosol injection cessation. A fruitful area for future research might be system modeling to enhance the possible positive increases in agricultural productivity. All such modeling must be supported by data collection and laboratory and field testing to enable iterative modeling to

Calculation method of water injection forward modeling and inversion process in oilfield water injection network

NASA Astrophysics Data System (ADS)

Liu, Long; Liu, Wei

2018-04-01

A forward modeling and inversion algorithm is adopted in order to determine the water injection plan in the oilfield water injection network. The main idea of the algorithm is shown as follows: firstly, the oilfield water injection network is inversely calculated. The pumping station demand flow is calculated. Then, forward modeling calculation is carried out for judging whether all water injection wells meet the requirements of injection allocation or not. If all water injection wells meet the requirements of injection allocation, calculation is stopped, otherwise the demand injection allocation flow rate of certain step size is reduced aiming at water injection wells which do not meet requirements, and next iterative operation is started. It is not necessary to list the algorithm into water injection network system algorithm, which can be realized easily. Iterative method is used, which is suitable for computer programming. Experimental result shows that the algorithm is fast and accurate.

A survey of UK practice patterns in the delivery of intravitreal injections.

PubMed

Samia-Aly, Emma; Cassels-Brown, Andrew; Morris, Daniel S; Stancliffe, Rachel; Somner, John E A

2015-07-01

To assess UK practice patterns related to the prescription of antibiotics before, during and after intravitreal injections, the location where injections are carried out and the qualifications of those administering the injections. Every ophthalmology unit featured in the Royal College of Ophthalmologists (UK) training directory was contacted. A healthcare professional involved in giving intravitreal injections at each institution completed a questionnaire regarding local practice patterns. A response rate of 85% (115/136) was achieved. Seventy four percent of hospitals (85/115) gave take home antibiotics post intravitreal injection. Twenty three percent (26/115) of hospitals employed non-medical healthcare professionals to administer injections and 83% (96/115) administered intravitreal injections in a dedicated clean room as opposed to an operating theatre. Practice patterns for intravitreal injection vary considerably. Guidelines alone do not appear to be effective in reducing practices which are considered wasteful and other approaches need to be developed. © 2015 The Authors Ophthalmic & Physiological Optics © 2015 The College of Optometrists.

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.

Adaptive engine injection for emissions reduction

DOEpatents

Reitz, Rolf D. : Sun, Yong

2008-12-16

NOx and soot emissions from internal combustion engines, and in particular compression ignition (diesel) engines, are reduced by varying fuel injection timing, fuel injection pressure, and injected fuel volume between low and greater engine loads. At low loads, fuel is injected during one or more low-pressure injections occurring at low injection pressures between the start of the intake stroke and approximately 40 degrees before top dead center during the compression stroke. At higher loads, similar injections are used early in each combustion cycle, in addition to later injections which preferably occur between about 90 degrees before top dead center during the compression stroke, and about 90 degrees after top dead center during the expansion stroke (and which most preferably begin at or closely adjacent the end of the compression stroke). These later injections have higher injection pressure, and also lower injected fuel volume, than the earlier injections.

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

Social network-related risk factors for bloodborne virus infections among injection drug users receiving syringes through secondary exchange.

PubMed

De, Prithwish; Cox, Joseph; Boivin, Jean-François; Platt, Robert W; Jolly, Ann M

2008-01-01

Secondary syringe exchange (SSE) refers to the exchange of sterile syringes between injection drug users (IDUs). To date there has been limited examination of SSE in relation to the social networks of IDUs. This study aimed to identify characteristics of drug injecting networks associated with the receipt of syringes through SSE. Active IDUs were recruited from syringe exchange and methadone treatment programs in Montreal, Canada, between April 2004 and January 2005. Information on each participant and on their drug-injecting networks was elicited using a structured, interviewer-administered questionnaire. Subjects' network characteristics were examined in relation to SSE using regression models with generalized estimating equations. Of 218 participants, 126 were SSE recipients with 186 IDUs in their injecting networks. The 92 non-recipients reported 188 network IDUs. Networks of SSE recipients and non-recipients were similar with regard to network size and demographics of network members. In multivariate analyses adjusted for age and gender, SSE recipients were more likely than non-recipients to self-report being HIV-positive (OR=3.56 [1.54-8.23]); require or provide help with injecting (OR=3.74 [2.01-6.95]); have a social network member who is a sexual partner (OR=1.90 [1.11-3.24]), who currently attends a syringe exchange or methadone program (OR=2.33 [1.16-4.70]), injects daily (OR=1.77 [1.11-2.84]), and shares syringes with the subject (OR=2.24 [1.13-4.46]). SSE is associated with several injection-related risk factors that could be used to help focus public health interventions for risk reduction. Since SSE offers an opportunity for the dissemination of important prevention messages, SSE-based networks should be used to improve public health interventions. This approach can optimize the benefits of SSE while minimizing the potential risks associated with the practice of secondary exchange.

Drug-related stigma and access to care among people who inject drugs in Vietnam.

PubMed

Lan, Chiao-Wen; Lin, Chunqing; Thanh, Duong Cong; Li, Li

2018-03-01

There are considerable challenges faced by people with a history of injecting drug use (PWID) in Vietnam, including drug-related stigma and lack of access to healthcare. Seeking and utilising healthcare, as well as harm reduction programs for PWID, are often hampered by drug-related stigma. This study aimed to examine the impacts of drug-related stigma on access to care and utilisation of harm reduction programs among PWID in Vietnam. A cross-sectional study was conducted in two provinces in Vietnam, Phú Thọ and Vinh Phúc. The study participants completed the survey by using Audio Computer-Assisted Self-Interview between late 2014 and early 2015. Linear multiple regression models and logistic regression models were used to assess the relationship among drug-related stigma, access to care and utilisation of harm reduction programs, including methadone maintenance treatment (MMT) and needle exchange programs (NEP). A total of 900 PWID participated in this study. Drug-related stigma was significantly associated with lower level of access to care, but not with utilisation of MMT or NEP. Older age was positively associated with higher levels of access to care. Levels of education were positively correlated with access to care, as well as utilisation of MMT and NEP. This study underscores the need for future interventions to reduce drug-related stigma in society and in health-care settings to improve PWID's utilisation of care services. Special attention should be paid to younger PWID and those with lower levels of education. © 2017 Australasian Professional Society on Alcohol and other Drugs.

Efficacy of a Multi-level Intervention to Reduce Injecting and Sexual Risk Behaviors among HIV-Infected People Who Inject Drugs in Vietnam: A Four-Arm Randomized Controlled Trial

PubMed Central

Go, Vivian F.; Frangakis, Constantine; Minh, Nguyen Le; Latkin, Carl; Ha, Tran Viet; Mo, Tran Thi; Sripaipan, Teerada; Davis, Wendy W.; Zelaya, Carla; Vu, Pham The; Celentano, David D.; Quan, Vu Minh

2015-01-01

Introduction Injecting drug use is a primary driver of HIV epidemics in many countries. People who inject drugs (PWID) and are HIV infected are often doubly stigmatized and many encounter difficulties reducing risk behaviors. Prevention interventions for HIV-infected PWID that provide enhanced support at the individual, family, and community level to facilitate risk-reduction are needed. Methods 455 HIV-infected PWID and 355 of their HIV negative injecting network members living in 32 sub-districts in Thai Nguyen Province were enrolled. We conducted a two-stage randomization: First, sub-districts were randomized to either a community video screening and house-to-house visits or standard of care educational pamphlets. Second, within each sub-district, participants were randomized to receive either enhanced individual level post-test counseling and group support sessions or standard of care HIV testing and counseling. This resulted in four arms: 1) standard of care; 2) community level intervention; 3) individual level intervention; and 4) community plus individual intervention. Follow-up was conducted at 6, 12, 18, and 24 months. Primary outcomes were self-reported HIV injecting and sexual risk behaviors. Secondary outcomes included HIV incidence among HIV negative network members. Results Fewer participants reported sharing injecting equipment and unprotected sex from baseline to 24 months in all arms (77% to 4% and 24% to 5% respectively). There were no significant differences at the 24-month visit among the 4 arms (Wald = 3.40 (3 df); p = 0.33; Wald = 6.73 (3 df); p = 0.08). There were a total of 4 HIV seroconversions over 24 months with no significant difference between intervention and control arms. Discussion Understanding the mechanisms through which all arms, particularly the control arm, demonstrated both low risk behaviors and low HIV incidence has important implications for policy and prevention programming. Trial Registration ClinicalTrials.gov NCT

Efficacy of a Multi-level Intervention to Reduce Injecting and Sexual Risk Behaviors among HIV-Infected People Who Inject Drugs in Vietnam: A Four-Arm Randomized Controlled Trial.

PubMed

Go, Vivian F; Frangakis, Constantine; Minh, Nguyen Le; Latkin, Carl; Ha, Tran Viet; Mo, Tran Thi; Sripaipan, Teerada; Davis, Wendy W; Zelaya, Carla; Vu, Pham The; Celentano, David D; Quan, Vu Minh

2015-01-01

Injecting drug use is a primary driver of HIV epidemics in many countries. People who inject drugs (PWID) and are HIV infected are often doubly stigmatized and many encounter difficulties reducing risk behaviors. Prevention interventions for HIV-infected PWID that provide enhanced support at the individual, family, and community level to facilitate risk-reduction are needed. 455 HIV-infected PWID and 355 of their HIV negative injecting network members living in 32 sub-districts in Thai Nguyen Province were enrolled. We conducted a two-stage randomization: First, sub-districts were randomized to either a community video screening and house-to-house visits or standard of care educational pamphlets. Second, within each sub-district, participants were randomized to receive either enhanced individual level post-test counseling and group support sessions or standard of care HIV testing and counseling. This resulted in four arms: 1) standard of care; 2) community level intervention; 3) individual level intervention; and 4) community plus individual intervention. Follow-up was conducted at 6, 12, 18, and 24 months. Primary outcomes were self-reported HIV injecting and sexual risk behaviors. Secondary outcomes included HIV incidence among HIV negative network members. Fewer participants reported sharing injecting equipment and unprotected sex from baseline to 24 months in all arms (77% to 4% and 24% to 5% respectively). There were no significant differences at the 24-month visit among the 4 arms (Wald = 3.40 (3 df); p = 0.33; Wald = 6.73 (3 df); p = 0.08). There were a total of 4 HIV seroconversions over 24 months with no significant difference between intervention and control arms. Understanding the mechanisms through which all arms, particularly the control arm, demonstrated both low risk behaviors and low HIV incidence has important implications for policy and prevention programming. ClinicalTrials.gov NCT01689545.

The impact of injection anxiety on education of travelers about common travel risks.

PubMed

Noble, Lorraine M; Farquharson, Lorna; O'Dwyer, Niamh A; Behrens, Ron H

2014-01-01

Despite many travelers receiving at least one vaccination during the pre-travel consultation, little is known about travelers' fear of injections and the impact this may have on educating travelers about health risks associated with their trip. This study aimed to investigate: (1) the prevalence of injection anxiety in travelers attending a pre-travel consultation, (2) whether anxiety due to anticipating a vaccination adversely affects recall of information and advice, and (3) whether clinicians can recognize travelers' anxiety, and how they respond to anxious travelers. Consecutive adult travelers (N = 105) attending one of two inner-city travel clinics completed self-report measures of state anxiety, injection anxiety, and symptoms of needle phobia immediately before and after their pre-travel consultation. Clinicians were also asked to rate travelers' anxiety and report any anxiety management strategies. Standardized information was presented during the consultation and recall of information and advice was assessed immediately post-consultation. Delayed recall (24 hours) was assessed for a subsample (20%) of participants. More than one third of travelers reported feeling nervous or afraid when having an injection (39%). Travelers' state anxiety was related to their psychological and physiological reactions to needles, and reduced significantly post-consultation. Recall of information and advice varied, with failure of recall ranging from 2 to 70% across 15 items, and delayed recall being significantly lower. No relationship was found between recall and anxiety. Clinician-rated anxiety moderately correlated with travelers' self-reported anxiety. A significant proportion of travelers experienced injection anxiety when attending the pre-travel consultation, with some travelers reporting symptoms consistent with criteria for Blood Injection Injury phobia. There were important gaps in recall of information and advice about common travel risks. Although no

Injecting and Sexual Networks and Sociodemographic Factors and Dual HIV Risk among People Who Inject Drugs: A Cross-sectional Study in Kermanshah Province, Iran

PubMed Central

Noroozi, Mehdi; Mirzazadeh, Ali; Noroozi, Alireza; Sharifi, Hamid; Higgs, Peter; Jorjoran-Shushtari, Zahra; Farhoudian, Ali; Fadai, Farbod; Mohhamadi-Shahboulaghi, Farahnaz; Armoon, Bahram; Hajebi, Ahmad; Massah, Omid

2016-01-01

Background Few studies suggest that social network factors, including size of sexual network may associate with drug-related and sexual high-risk behaviors. The objective of this study is to investigate injecting and sexual networks and sociodemographic factors that might be associated with dual HIV risk (DHR) among people who inject drug (PWID). Methods The data from a cross-sectional study of 455 PWID that were recruited through peer-referral sampling were used in this study. The data were collected using a structured questionnaire consisted of modules on sociodemographic characteristics, sexual and injection-related risk behaviors during 12 months before the interview. DHR was defined as engaged in both using a syringe previously used by other PWIDs and unprotected sex during last 12 months. Data analysis was performed with descriptive and logistic regression. In final model, we considered variables with P < 0.500 as statistically significant. Finally, reported adjusted odds ratio (AOR) and confidence interval (95% CI) for variables that were significant in the final model. Findings A total of 455 men who injected drugs participated in this study. The mean age ± standard deviation (SD) was 33.2 ± 7.3 (range 19-58) years. Overall, the prevalence of DHR In the last 12 months, 38% (95% CI: 18.3-51.2%). Multivariate model showed that regular visit to needle, syringe programs (NSPs) reduced odd of HDR to 50% when adjusted for other covariates, but still remained statistically significant (P < 0.050). The odds of reporting DHR was significantly higher in those ≥ 2 sex partners and injection partner (P < 0.010). Odds of DHR was higher (AOR: 2.3) among participants who had more than 2 injection per day but was not statistically significant (P > 0.050). Conclusion DHR was common in PWID in Kermanshah, Iran. Having multiple injecting and sexual partners increased the odds of engaging in dual risk behaviors, but regular visit of NSPs can reduce the DHR among PWID. PMID

Injecting and Sexual Networks and Sociodemographic Factors and Dual HIV Risk among People Who Inject Drugs: A Cross-sectional Study in Kermanshah Province, Iran.

PubMed

Noroozi, Mehdi; Mirzazadeh, Ali; Noroozi, Alireza; Sharifi, Hamid; Higgs, Peter; Jorjoran-Shushtari, Zahra; Farhoudian, Ali; Fadai, Farbod; Mohhamadi-Shahboulaghi, Farahnaz; Armoon, Bahram; Hajebi, Ahmad; Massah, Omid

2016-07-01

Few studies suggest that social network factors, including size of sexual network may associate with drug-related and sexual high-risk behaviors. The objective of this study is to investigate injecting and sexual networks and sociodemographic factors that might be associated with dual HIV risk (DHR) among people who inject drug (PWID). The data from a cross-sectional study of 455 PWID that were recruited through peer-referral sampling were used in this study. The data were collected using a structured questionnaire consisted of modules on sociodemographic characteristics, sexual and injection-related risk behaviors during 12 months before the interview. DHR was defined as engaged in both using a syringe previously used by other PWIDs and unprotected sex during last 12 months. Data analysis was performed with descriptive and logistic regression. In final model, we considered variables with P < 0.500 as statistically significant. Finally, reported adjusted odds ratio (AOR) and confidence interval (95% CI) for variables that were significant in the final model. A total of 455 men who injected drugs participated in this study. The mean age ± standard deviation (SD) was 33.2 ± 7.3 (range 19-58) years. Overall, the prevalence of DHR In the last 12 months, 38% (95% CI: 18.3-51.2%). Multivariate model showed that regular visit to needle, syringe programs (NSPs) reduced odd of HDR to 50% when adjusted for other covariates, but still remained statistically significant (P < 0.050). The odds of reporting DHR was significantly higher in those ≥ 2 sex partners and injection partner (P < 0.010). Odds of DHR was higher (AOR: 2.3) among participants who had more than 2 injection per day but was not statistically significant (P > 0.050). DHR was common in PWID in Kermanshah, Iran. Having multiple injecting and sexual partners increased the odds of engaging in dual risk behaviors, but regular visit of NSPs can reduce the DHR among PWID.

The effect of corticosteroid versus platelet-rich plasma injection therapies for the management of lateral epicondylitis: A systematic review

PubMed Central

Ben-Nafa, Walid; Munro, Wendy

2018-01-01

Introduction: Lateral epicondylitis is a common musculoskeletal disorder of the upper limb. Corticosteroid injection has been widely used as a major mode of treatment. However, better understanding of the pathophysiology of the disease led to a major change in treating the disease, with new options including platelet-rich plasma (PRP) are currently used. Objectives/research aim: To systematically evaluate the effect of corticosteroid versus PRP injections for the treatment of LE. Hypothesis: PRP injections provide longer-term therapeutic effect and less rate of complications compared to corticosteroid injection. Level of evidence: Level 2 evidence (4 included studies are of level 1 evidence, 1 study of level 2 evidence). Design: Systematic Review (according to PRISMA guidelines). Methods: Eleven databases used to search for relevant primary studies comparing the effects of corticosteroid and PRP injections for the treatment of LE. Quality appraisal of studies performed using Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0, CASP Randomised Controlled Trial Checklist, and SIGN Methodology Checklist 2. Results: 732 papers were identified. Five randomised controlled trials (250 Patients) met the inclusion criteria. Clinical findings: Corticosteroid injections provided rapid symptomatic improvement with maximum effect at 6/8/8 weeks before symptoms recurrence, whereas PRP showed slower ongoing improvements up to 24/52/104 weeks(3 studies). Corticosteroid showed more rapid symptomatic improvement of symptoms compared to PRP up to the study end-point of 3 months(1 study). Comparable therapeutic effects of corticosteroid and PRP were observed at 6 weeks(1 study). Ultrasonographic Findings: (1) Doppler activity decreased more significantly in patients who received corticosteroid compared to PRP. (2) Reduced tendon thickness and more patients with cortical erosion noted in corticosteroid group whereas increased tendon thickness and less number of

Searching for management approaches to reduce HAI transmission (SMART): a study protocol.

PubMed

McAlearney, Ann Scheck; Hefner, Jennifer L; Sieck, Cynthia J; Walker, Daniel M; Aldrich, Alison M; Sova, Lindsey N; Gaughan, Alice A; Slevin, Caitlin M; Hebert, Courtney; Hade, Erinn; Buck, Jacalyn; Grove, Michele; Huerta, Timothy R

2017-06-28

Healthcare-associated infections (HAIs) impact patients' lives through prolonged hospitalization, morbidity, and death, resulting in significant costs to both health systems and society. Central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) are two of the most preventable HAIs. As a result, these HAIs have been the focus of significant efforts to identify evidence-based clinical strategies to reduce infection rates. The Comprehensive Unit-based Safety Program (CUSP) provides a formal model for translating CLABSI-reduction evidence into practice. Yet, a national demonstration project found organizations experienced variable levels of success using CUSP to reduce CLABSIs. In addition, in Fiscal year 2019, Medicare will expand use of CLABSI and CAUTI metrics beyond ICUs to the entire hospital for reimbursement purposes. As a result, hospitals need guidance about how to successfully translate HAI-reduction efforts such as CUSP to non-ICU settings (clinical practice), and how to shape context (management practice)-including culture and management strategies-to proactively support clinical teams. Using a mixed-methods approach to evaluate the contribution of management factors to successful HAI-reduction efforts, our study aims to: (1) Develop valid and reliable measures of structural management practices associated with the recommended CLABSI Management Strategies for use as a survey (HAI Management Practice Guideline Survey) to support HAI-reduction efforts in both medical/surgical units and ICUs; (2) Develop, validate, and then deploy the HAI Management Practice Guideline Survey, first across Ohio hospitals, then nationwide, to determine the positive predictive value of the measurement instrument as it relates to CLABSI- and CAUTI-prevention; and (3) Integrate findings into a Management Practices Toolkit for HAI reduction that includes an organization-specific data dashboard for monitoring progress and an

Mental and Physical Health Correlates of Discrimination Against People Who Inject Drugs: A Systematic Review.

PubMed

Couto Cruz, Camila E; Salom, Caroline; Maravilla, Joemer; Alati, Rosa

2018-05-01

The perception that people who use illicit drugs are deviant has contributed to the stigmatization of this population. The primary aim of this review is to examine the links among injection-related discrimination, mental health, physical health, and quality of life in people who inject drugs. We also identify settings, perpetrators of discrimination, and coping strategies developed by people who inject drugs to deal with the issue. Online databases MEDLINE (PubMed), EMBASE, CINAHL (EbscoHost), and PsycINFO (APA PsycNET) were searched for articles focusing on injection-related discrimination against people who inject drugs. Findings were compared for consistency. Qualitative and quantitative articles were evaluated separately. Eleven articles were included in the final review. Several links between discrimination and negative health outcomes were identified. Discrimination was associated with engagement in risky injecting behavior as well as psychological distress. The perpetrators of discrimination against people who inject drugs included general community members and service providers. Attempts to hide addiction was the main strategy used to cope with discrimination. Injection-related discrimination was associated with higher psychological distress levels, unhealthy behaviors, and low quality of life in people who inject drugs. By addressing the stigma of deviance, discrimination and associated negative health outcomes may be reduced.

Evaluating Swine Injection Technologies as a Workplace Musculoskeletal Injury Intervention: A Study Protocol

PubMed Central

Bath, Brenna; Milosavljevic, Stephan; Kociolek, Aaron M.; Predicala, Bernardo; Penz, Erika; Adebayo, Olugbenga; Whittington, Lee

2017-01-01

Intensification of modern swine production has led to many new technologies, including needleless injectors. Although needleless injectors may increase productivity (by reducing injection time) and reduce needlestick injuries, the effect on risk for musculoskeletal disorders is not clear. This project will compare conventional needles with needleless injectors in terms of cost, productivity, injury rates, biomechanical exposures, and worker preference. Muscle activity (EMG) and hand/wrist posture will be measured on swine workers performing injection tasks with both injection methods. Video recordings during the exposure assessments will compare the duration and productivity for each injection method using time-and-motion methods. Injury claim data from up to 60 pig barns will be analyzed for needlestick and musculoskeletal injuries before/after needleless injector adoption. Workers and managers will be asked about what they like and dislike about each method and what helps and hinders successful implementation. The information above will be input into a cost-benefit model to determine the incremental effects of needleless injectors in terms of occupational health, worker preference, and the financial “bottom line” of the farm. Findings will be relevant to the swine industry and are intended to be transferable to other new technologies in animal production. PMID:29214171

A videotaped intervention to enhance child control and reduce anxiety of the pain of dental injections.

PubMed

Weinstein, P; Raadal, M; Naidu, S; Yoshida, T; Kvale, G; Milgrom, P

2003-12-01

While the psychological literature shows that perceptions of uncontrollability contribute to anxiety and other pathologies, interventions that enhance perceived control have been shown to reduce anxiety. This study attempted to assess a brief videotape to enhance child perceived control in a dental setting. 101 children aged 7-9 years completed warm-up procedures and viewed either: a) the experimental intervention, a 2 minutes video of a dentist explaining what an injection will feel like and proposing hand raising as a signal mechanism; or b) the control condition, a 2 minutes video of Disneyland. Fear of dental injections was assessed on a 10 cm visual analogue scale before and after the intervention. In the experimental group there was a significant fear reduction from pre- to post-intervention, while this was not the case in the control group. Children with higher pre-existing levels of fear benefited more from the intervention than children with lower levels of fear. The results of this pilot study suggest that intervention packages that impact child control have promise in lowering anxiety.

Inferior gluteal artery pseudoaneurysm related to intramuscular injection

PubMed Central

Saad, Paulo Fernandes; Saad, Karen Ruggeri; Armstrong, Dinani Matoso Fialho de Oliveira; Soares, Bruno Leonardo de Freitas; de Almeida, Paulo Henrique Freitas; Razuk Filho, Álvaro

2014-01-01

INTRODUCTION Gluteal artery pseudoaneurysms are rare, yet the most common in cases involving the superior gluteal artery. Pseudoaneurysms of the inferior gluteal artery are uncommon and are often related to blunt or penetrating trauma, infections and fractures of the pelvis. PRESENTATION OF CASE The authors present a case of pseudoaneurysm of the inferior gluteal artery related to an iatrogenic injury due to intramuscular injection of medication, which was treated with selective embolization of the artery during angiography. DISCUSSION The most common manifestation of an inferior gluteal artery pseudoaneurysm is the presence of a painful mass in the buttock that may or may not be associated with neurological symptoms due to compression of the sciatic nerve. Ultrasound with color Doppler and computerized tomography with multi-detectors are useful non-invasive tools for diagnosis. However, both diagnosis and therapy are facilitated by catheter angiography. CONCLUSION This case cautions that although pseudoaneurysms are rare, pseudoaneurysms of the inferior gluteal artery require a high index of suspicion and careful physical examination by the physician in order to avoid misdiagnosis. It also illustrates the usefulness of a minimally invasive modality for treatment of these lesions. PMID:25506847

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

PubMed

Tuchman, Ellen

2015-03-07

. 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.

Do managed alcohol programs change patterns of alcohol consumption and reduce related harm? A pilot study.

PubMed

Vallance, Kate; Stockwell, Tim; Pauly, Bernie; Chow, Clifton; Gray, Erin; Krysowaty, Bonnie; Perkin, Kathleen; Zhao, Jinhui

2016-05-09

Managed alcohol programs (MAPs) are a harm reduction strategy for people with severe alcohol dependence and unstable housing. MAPs provide controlled access to alcohol usually alongside accommodation, meals, and other supports. Patterns of alcohol consumption and related harms among MAP participants and controls from a homeless shelter in Thunder Bay, Ontario, were investigated in 2013. Structured interviews were conducted with 18 MAP and 20 control participants assessed as alcohol dependent with most using non-beverage alcohol (NBA). Qualitative interviews were conducted with seven participants and four MAP staff concerning perceptions and experiences of the program. Program alcohol consumption records were obtained for MAP participants, and records of police contacts and use of health services were obtained for participants and controls. Some participants' liver function test (LFT) results were available for before and after MAP entry. Compared with periods off the MAP, MAP participants had 41 % fewer police contacts, 33 % fewer police contacts leading to custody time (x (2) = 43.84, P < 0.001), 87 % fewer detox admissions (t = -1.68, P = 0.06), and 32 % fewer hospital admissions (t = -2.08, P = 0.03). MAP and control participants shared similar characteristics, indicating the groups were broadly comparable. There were reductions in nearly all available LFT scores after MAP entry. Compared with controls, MAP participants had 43 % fewer police contacts, significantly fewer police contacts (-38 %) that resulted in custody time (x (2) = 66.10, P < 0.001), 70 % fewer detox admissions (t = -2.19, P = 0.02), and 47 % fewer emergency room presentations. NBA use was significantly less frequent for MAP participants versus controls (t = -2.34, P < 0.05). Marked but non-significant reductions were observed in the number of participants self-reporting alcohol-related harms in the domains of home life, legal issues, and

Endoscopic Ultrasound (EUS) for Esophageal and Gastric Varices: How Can it Improve the Outcomes and Reduce Complications of Glue Injection

PubMed Central

Bhatia, Vikram

2012-01-01

A large part of portal venous system and the paragastric and para-esophageal collateral circulation is within the reach of endoscopic ultrasound (EUS). The EUS is more sensitive than gastroscopy for the detection of gastric varices (GV), and can accurately distinguish GV from thickened gastric folds. Gastric varices are depicted by serpiginous, anechoic, Doppler-positive mural channels, with larger collateral channels visible outside the gastric wall. The EUS has also been used to monitor the completeness of GV obturation after glue injection. There are limited data that this strategy may be clinically beneficial to prevent GV re-bleed. The EUS has been used to deliver glue injections under real-time monitoring into the vascular channels, with or without steel coils as scaffolding for the glue. The potential advantages of this technique include a straight scope position, lack of hindrance from pooled blood in gastric fundus, smaller glue volume requirements, and precise intra-vascular placement of glue with avoidance of intramural injections, and reduced embolic complications. PMID:25755407

Evolution of the global burden of viral infections from unsafe medical injections, 2000-2010.

PubMed

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

2014-01-01

In 2000, the World Health Organization estimated that, in developing and transitional countries, unsafe injections accounted for respectively 5%, 32% and 40% of new infections with HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV). Safe injection campaigns were organized worldwide. The present study sought to measure the progress in reducing the transmission of these viruses through unsafe injections over the subsequent decade. A mass action model was updated, to recalculate the number of injection-related HIV, HCV and HBV infections acquired in 2000 and provide estimates for 2010. Data about the annual number of unsafe injections were updated. HIV prevalence in various regions in 2000 and 2010 were calculated from UNAIDS data. The ratio of HIV prevalence in healthcare settings compared to the general population was estimated from a literature review. Improved regional estimates of the prevalence of HCV seropositivity, HBsAg and HBeAg antigenemia were used for 2000 and 2010. For HIV and HCV, revised estimates of the probability of transmission per episode of unsafe injection were used, with low and high values allowing sensitivity analyses. Despite a 13% population growth, there was a reduction of respectively 87% and 83% in the absolute numbers of HIV and HCV infections transmitted through injections. For HBV, the reduction was more marked (91%) due to the additional impact of vaccination. While injections-related cases had accounted for 4.6%-9.1% of newly acquired HIV infections in 2000, this proportion decreased to 0.7%-1.3% in 2010, when unsafe injections caused between 16,939 and 33,877 HIV infections, between 157,592 and 315,120 HCV infections, and 1,679,745 HBV infections. From 2000 to 2010, substantial progress was made in reducing the burden of HIV, HCV and HBV infections transmitted through injections. In some regions, their elimination might become a reasonable public health goal.

Progressive outer retinal necrosis in the era of highly active antiretroviral therapy: successful management with intravitreal injections and monitoring with quantitative PCR.

PubMed

Yin, Philip D; Kurup, Shree K; Fischer, Steven H; Rhee, Henry H; Byrnes, Gordon A; Levy-Clarke, Grace A; Buggage, Ronald R; Nussenblatt, Robert B; Mican, JoAnn M; Wright, Mary E

2007-03-01

Progressive outer retinal necrosis (PORN) is an ocular disease in individuals with AIDS and is associated with substantial morbidity. The optimal management of PORN and its clinical course in the HAART era is unclear. We report a case of successfully managed PORN that provides insight into the monitoring and treatment of this disease. Intravitreal injections and intravenous therapy targeted towards varicella zoster virus (VZV) were used to treat PORN. HAART was initiated for HIV-1 therapy. Serial PCR for VZV was performed on aqueous humor to monitor the clinical course. The presence of VZV DNA from aqueous humor correlated with clinical exacerbations of disease. Initiation of twice weekly intravitreal injections with dual antiviral drugs appeared to be an important therapeutic intervention that resulted in remission of PORN. Secondary prophylaxis against VZV was successfully withdrawn after HAART induced partial immune recovery. In addition to aggressive therapy with intravitreal injections, HAART and quantitative measurements of VZV DNA from aqueous humor have important roles in the management of PORN. A multidisciplinary approach involving specialists in infectious diseases, ophthalmology, and clinical microbiology will improve the chances for successful long-term outcomes.

Sediment Management Methods to Reduce Dredging: Part 2, Sediment Collector Technology

DTIC Science & Technology

2017-04-01

Approved for public release; distribution is unlimited. ERDC TN-DOER-T13 April 2017 Sediment Management Methods to Reduce Dredging: Part 2...DOER) Program technical note (TN) is the second in a series evaluating sediment management methods to reduce dredging through a research task (RT...in the DOER Program.1 This TN presents an evaluation of sediment collector technology, one promising new device that may help better manage

Evaluation of neonicotinoid, organophosphate and avermectin trunk injections for the management of avocado thrips in California avocado groves.

PubMed

Byrne, Frank J; Urena, Anthony A; Robinson, Lindsay J; Krieger, Robert I; Doccola, Joe; Morse, Joseph G

2012-05-01

Trunk injections of systemic insecticides were evaluated for the management of avocado thrips. Insecticide residues were quantified in leaves to determine when after treatment, and for how long, toxic concentrations of the insecticides were present. Residues in fruit were quantified to determine whether trunk injection of insecticides might present a greater risk than traditional application methods for contaminating fruit. Residues of imidacloprid and dinotefuran were at least tenfold higher in leaves when trees were treated via trunk injection compared with soil application. Dinotefuran uptake was more rapid than imidacloprid, and no residues were detected within fruit. Acephate was also mobilized very rapidly and gave good control of thrips in bioassays; however, residues of acephate and its insecticidal metabolite methamidophos were detected in the fruit for up to 4 weeks after injection. Avermectin uptake was very slow, and it was ineffective against avocado thrips. Trunk injections of acephate and dinotefuran permitted rapid uptake into avocados, and they are strong candidates as control methods for avocado thrips. However, residues of organophosphates in fruit could necessitate increased preharvest intervals. Residues of neonicotinoids were below detection limits in fruit, suggesting that neonicotinoids may be the more suitable control option of the two chemical classes. Copyright © 2012 Society of Chemical Industry.

What controls the maximum magnitude of injection-induced earthquakes?

NASA Astrophysics Data System (ADS)

Eaton, D. W. S.

2017-12-01

Three different approaches for estimation of maximum magnitude are considered here, along with their implications for managing risk. The first approach is based on a deterministic limit for seismic moment proposed by McGarr (1976), which was originally designed for application to mining-induced seismicity. This approach has since been reformulated for earthquakes induced by fluid injection (McGarr, 2014). In essence, this method assumes that the upper limit for seismic moment release is constrained by the pressure-induced stress change. A deterministic limit is given by the product of shear modulus and the net injected fluid volume. This method is based on the assumptions that the medium is fully saturated and in a state of incipient failure. An alternative geometrical approach was proposed by Shapiro et al. (2011), who postulated that the rupture area for an induced earthquake falls entirely within the stimulated volume. This assumption reduces the maximum-magnitude problem to one of estimating the largest potential slip surface area within a given stimulated volume. Finally, van der Elst et al. (2016) proposed that the maximum observed magnitude, statistically speaking, is the expected maximum value for a finite sample drawn from an unbounded Gutenberg-Richter distribution. These three models imply different approaches for risk management. The deterministic method proposed by McGarr (2014) implies that a ceiling on the maximum magnitude can be imposed by limiting the net injected volume, whereas the approach developed by Shapiro et al. (2011) implies that the time-dependent maximum magnitude is governed by the spatial size of the microseismic event cloud. Finally, the sample-size hypothesis of Van der Elst et al. (2016) implies that the best available estimate of the maximum magnitude is based upon observed seismicity rate. The latter two approaches suggest that real-time monitoring is essential for effective management of risk. A reliable estimate of maximum

Repeated intraperitoneal injections of liposomes containing phosphatidic acid and cardiolipin reduce amyloid-β levels in APP/PS1 transgenic mice.

PubMed

Ordóñez-Gutiérrez, Lara; Re, Francesca; Bereczki, Erika; Ioja, Eniko; Gregori, Maria; Andersen, Alina J; Antón, Marta; Moghimi, S Moein; Pei, Jin-Jing; Masserini, Massimo; Wandosell, Francisco

2015-02-01

The accumulation of extracellular amyloid-beta (Aβ) peptide and intracellular neurofibrillary tangles in the brain are two major neuropathological hallmarks of Alzheimer's disease (AD). It is thought that an equilibrium exists between Aβ in the brain and in the peripheral blood and thus, it was hypothesized that shifting this equilibrium towards the blood by enhancing peripheral clearance might reduce Aβ levels in the brain: the 'sink effect'. We tested this hypothesis by intraperitoneally injecting APP/PS1 transgenic mice with small unilamellar vesicles containing either phosphatidic acid or cardiolipin over 3weeks. This treatment reduced significantly the amount of Aβ in the plasma and the brain levels of Aβ were lighter affected. Nevertheless, this dosing regimen did modulate tau phosphorylation and glycogen synthase kinase 3 activities in the brain, suggesting that the targeting of circulating Aβ may be therapeutically relevant in AD. Intraperitoneal injection of small unilamellar vesicles containing phosphatidic acid or cardiolipin significantly reduced the amount of amyloid-beta (Aß) peptide in the plasma in a rodent model. Brain levels of Aß were also affected - although to a lesser extent - suggesting that targeting of circulating Aß may be therapeutically relevant of Alzheimer's disease. Copyright © 2015 Elsevier Inc. All rights reserved.

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

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

Factors influencing exacerbation-related self-management in patients with COPD: a qualitative study.

PubMed

Korpershoek, Yjg; Vervoort, Scjm; Nijssen, Lit; Trappenburg, Jca; Schuurmans, M J

2016-01-01

In patients with COPD, self-management skills are important to reduce the impact of exacerbations. However, both detection and adequate response to exacerbations appear to be difficult for some patients. Little is known about the underlying process of exacerbation-related self-management. Therefore, the objective of this study was to identify and explain the underlying process of exacerbation-related self-management behavior. A qualitative study using semi-structured in-depth interviews was performed according to the grounded theory approach, following a cyclic process in which data collection and data analysis alternated. Fifteen patients (male n=8; age range 59-88 years) with mild to very severe COPD were recruited from primary and secondary care settings in the Netherlands, in 2015. Several patterns in exacerbation-related self-management behavior were identified, and a conceptual model describing factors influencing exacerbation-related self-management was developed. Acceptance, knowledge, experiences with exacerbations, perceived severity of symptoms and social support were important factors influencing exacerbation-related self-management. Specific factors influencing recognition of exacerbations were heterogeneity of exacerbations and habituation to symptoms. Feelings of fear, perceived influence on exacerbation course, patient beliefs, ambivalence toward treatment, trust in health care providers and self-empowerment were identified as specific factors influencing self-management actions. This study provided insight into factors influencing exacerbation-related self-management behavior in COPD patients. The conceptual model can be used as a framework for health care professionals providing self-management support. In the development of future self-management interventions, factors influencing the process of exacerbation-related self-management should be taken into account.

The role of fluoroscopic interlaminar epidural injections in managing chronic pain of lumbar disc herniation or radiculitis: a randomized, double-blind trial.

PubMed

Manchikanti, Laxmaiah; Singh, Vijay; Cash, Kimberly A; Pampati, Vidyasagar; Falco, Frank J E

2013-09-01

There is continued debate on the effectiveness, indications, and medical necessity of epidural injections in managing pain and disability from lumbar disc herniation, despite extensive utilization. There is paucity of literature on interlaminar epidural injections in managing lumbar disc herniation or radiculitis in contemporary interventional pain management settings utilizing fluoroscopy. A randomized, double-blind, active-control trial was undertaken to assess the effectiveness of lumbar interlaminar epidural injections with or without steroids for disc herniation and radiculitis. The primary outcome was defined as pain relief and functional status improvement of ≥ 50%. One hundred twenty patients were randomly assigned to 1 of the 2 groups. Group I patients received lumbar interlaminar injections containing a local anesthetic (lidocaine 0.5%, 6 mL), whereas Group II patients received lumbar interlaminar epidural injections of 0.5% lidocaine, 5 mL, mixed with 1 mL of non-particulate betamethasone. In the patients who responded with initial 2 procedures with at least 3 weeks of relief, significant improvement was seen in 80% of the patients in the local anesthetic group and 86% of the patients in the local anesthetic and steroid group. The overall average procedures per year were 3.6 in the local anesthetic group and 4.1 in the local anesthetic and steroid group, with an average relief of 33.7 ± 18.1 weeks in the local anesthetic group and 39.1 ± 12.2 weeks in the local anesthetic and steroid group over a period of 52 weeks in the overall population. Lumbar interlaminar epidural injections of local anesthetic with or without steroids might be effective in patients with disc herniation or radiculitis, with potential superiority of steroids compared with local anesthetic alone at 1 year follow-up. © 2012 The Authors Pain Practice © 2012 World Institute of Pain.

Fluoroscopic cervical epidural injections in chronic axial or disc-related neck pain without disc herniation, facet joint pain, or radiculitis

PubMed Central

Manchikanti, Laxmaiah; Cash, Kimberly A; Pampati, Vidyasagar; Malla, Yogesh

2012-01-01

Background While chronic neck pain is a common problem in the adult population, with a typical 12-month prevalence of 30%–50%, there is a lack of consensus regarding its causes and treatment. Despite limited evidence, cervical epidural injections are one of the commonly performed nonsurgical interventions in the management of chronic neck pain. Methods A randomized, double-blind, active, controlled trial was conducted to evaluate the effectiveness of cervical interlaminar epidural injections of local anesthetic with or without steroids for the management of chronic neck pain with or without upper extremity pain in patients without disc herniation, radiculitis, or facet joint pain. Results One hundred and twenty patients without disc herniation or radiculitis and negative for facet joint pain by means of controlled diagnostic medial branch blocks were randomly assigned to one of two treatment groups, ie, injection of local anesthetic only (group 1) or local anesthetic mixed with nonparticulate betamethasone (group 2). The primary outcome of significant pain relief and improvement in functional status (≥50%) was demonstrated in 72% of group 1 and 68% of group 2. The overall average number of procedures per year was 3.6 in both groups with an average total relief per year of 37–39 weeks in the successful group over a period of 52 weeks. Conclusion Cervical interlaminar epidural injections of local anesthetic with or without steroids may be effective in patients with chronic function-limiting discogenic or axial pain. PMID:22826642

Reducing Water/Hull Drag By Injecting Air Into Grooves

NASA Technical Reports Server (NTRS)

Reed, Jason C.; Bushnell, Dennis M.; Weinstein, Leonard M.

1991-01-01

Proposed technique for reduction of friction drag on hydrodynamic body involves use of grooves and combinations of surfactants to control motion of layer on surface of such body. Surface contains many rows of side-by-side, evenly spaced, longitudinal grooves. Dimensions of grooves and sharpnesses of tips in specific case depends on conditions of flow about vessel. Requires much less air than does microbubble-injection method.

Dermal Filler Injection: A Novel Approach for Limiting Infarct Expansion

PubMed Central

Ryan, Liam P.; Matsuzaki, Kanji; Noma, Mio; Jackson, Benjamin M.; Eperjesi, Thomas J.; Plappert, Theodore J.; St. John-Sutton, Martin G.; Gorman, Joseph H.; Gorman, Robert C.

2011-01-01

Background Early infarct expansion after coronary occlusion compromises contractile function in perfused myocardial regions and promotes adverse long-term left ventricular (LV) remodeling. We hypothesized that injection of a tissue-expanding dermal filler material into a myocardial infarction (MI) would attenuate infarct expansion and limit LV remodeling. Methods Fifteen sheep were subjected to an anteroapical MI involving approximately 20% of the LV followed by the injection of 1.3 mL of a calcium hydroxyapatite–based dermal filler into the infarct. Real-time three-dimensional echocardiography was performed at baseline, 30 minutes after MI, and 15 minutes after injection to assess infarct expansion. Sixteen additional sheep were subjected to the same infarction and followed echocardiographically and hemodynamically for 4 weeks after MI to assess chronic remodeling. Eight animals had injection with dermal filler as described above immediately after MI, and 8 animals were injected with an equal amount of saline solution. Results All animals exhibited infarct expansion soon after coronary occlusion. The regional ejection fraction of the apex became negative after infarction, consistent with systolic dyskinesia. Injection of the dermal filler converted the apical wall motion from dyskinetic to akinetic and resulted immediately in significant decreases in global, regional, and segmental LV volumes. Chronically, relative to saline control, dermal filler injection significantly reduced LV end-systolic volume (62.2 ± 3.6 mL versus 44.5 ± 3.9 mL; p < 0.05) and improved global ejection fraction (0.295 ± 0.016 versus 0.373 ± 0.017; p < 0.05) at 4 weeks after infarction. Conclusions Injection of an acellular dermal filler into an MI immediately after coronary occlusion reduces early infarct expansion and limits chronic LV remodeling. PMID:19101288

Long-acting injectable antipsychotics for prevention and management of violent behaviour in psychotic patients.

PubMed

Mohr, Pavel; Knytl, Pavel; Voráčková, Veronika; Bravermanová, Anna; Melicher, Tomáš

2017-09-01

It has been well established that long-term antipsychotic treatment prevents relapse, lowers number of rehospitalisations, and also effectively reduces violent behaviour. Although violent behaviour is not a typical manifestation of schizophrenia or other psychotic disorders, the diagnosis of psychosis increases the overall risk of violence. One of the few modifiable factors of violence risk is adherence with medication. In contrast, non-adherence with drug treatment and subsequent relapse increases risk of violent acts. Non-adherence can be addressed partially by long-acting injectable antipsychotics (LAI). The aim of our review was to examine the role of antipsychotic drugs, especially LAI, in prevention and management of violent behaviour in psychosis. This is a non-systematic, narrative review of the data from open, naturalistic, retrospective, and population studies, case series, and post hoc analyses of randomised controlled trials. Search of electronic databases (PubMed, Embase) was performed to identify relevant papers. Nine published papers (3 cross-sectional chart reviews, 4 retrospective studies, 2 prospective, randomised trials) were found. The results indicated positive clinical and antiaggressive effects of LAI in psychotic patients with high risk of violent behaviour. Reviewed evidence suggests that secured drug treatment with LAI may have clinical benefit in schizophrenia patients with high risk of violent behaviour. LAI significantly reduced the severity of hostility, aggressivity, number of violent incidents, and criminal offences. These findings are supported further by the empirical evidence from clinical practice, high rates of prescribed LAI to schizophrenia patients in high-security and forensic psychiatric facilities. Available data encourage the use of LAI in forensic psychiatry, especially during court-ordered commitment treatment. © 2017 John Wiley & Sons Ltd.

Is Eye Color Related to Dental Injection Pain? A Prospective, Randomized, Single-blind Study.

PubMed

Hyde, Jason; Fowler, Sara; Drum, Melissa; Reader, Al; Nusstein, John; Beck, Mike

2018-05-01

Recent studies have investigated the relationship between pain perception and specific phenotypes such as red hair color and various eye colors. Further investigations into biomarkers as they relate to pain could be useful in understanding underlying genetic components involved in these pathways. Additionally, it would be clinically useful to determine if a patient would be more likely to experience pain during dental treatment based on eye color. The purpose of this study was to investigate a link between eye color and perceived injection pain in healthy, asymptomatic white women. Three hundred healthy, adult, white female patients were included, 133 with dark eyes and 167 with light eyes. Dental anxiety was assessed with the Corah Dental Anxiety Scale. Subjects with their eye color masked by dark glasses received a right maxillary lateral incisor infiltration of 1 cartridge of 2% lidocaine with 1:100,000 epinephrine. Patients rated their injection pain on a 170-mm Heft-Parker visual analog scale. Photographs of the subjects' eyes were taken after the infiltrations and categorized into dark- and light-eyed groups by 3 independent observers. Comparisons for injection pain were analyzed using analysis of variance and the Tukey-Kramer test. No significant differences were found for pain of injection between dark- or light-eyed subjects. Eye color was not shown to be a predictor for injection pain in white women. Therefore, eye color would not be clinically useful in determining if a patient would be more likely to experience pain during dental treatment. Copyright © 2018 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Seasonal persistence of faecal indicator organisms in soil following dairy slurry application to land by surface broadcasting and shallow injection.

PubMed

Hodgson, Christopher J; Oliver, David M; Fish, Robert D; Bulmer, Nicholas M; Heathwaite, A Louise; Winter, Michael; Chadwick, David R

2016-12-01

Dairy farming generates large volumes of liquid manure (slurry), which is ultimately recycled to agricultural land as a valuable source of plant nutrients. Different methods of slurry application to land exist; some spread the slurry to the sward surface whereas others deliver the slurry under the sward and into the soil, thus helping to reduce greenhouse gas (GHG) emissions from agriculture. The aim of this study was to investigate the impact of two slurry application methods (surface broadcast versus shallow injection) on the survival of faecal indicator organisms (FIOs) delivered via dairy slurry to replicated grassland plots across contrasting seasons. A significant increase in FIO persistence (measured by the half-life of E. coli and intestinal enterococci) was observed when slurry was applied to grassland via shallow injection, and FIO decay rates were significantly higher for FIOs applied to grassland in spring relative to summer and autumn. Significant differences in the behaviour of E. coli and intestinal enterococci over time were also observed, with E. coli half-lives influenced more strongly by season of application relative to the intestinal enterococci population. While shallow injection of slurry can reduce agricultural GHG emissions to air it can also prolong the persistence of FIOs in soil, potentially increasing the risk of their subsequent transfer to water. Awareness of (and evidence for) the potential for 'pollution-swapping' is critical in order to guard against unintended environmental impacts of agricultural management decisions. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Deltoid Injections of Risperidone Long-acting Injectable in Patients with Schizophrenia

PubMed Central

Quiroz, Jorge A.; Rusch, Sarah; Thyssen, An; Kushner, Stuart

2011-01-01

Background Risperidone long-acting injectable was previously approved for treatment of schizophrenia as biweekly injections in the gluteal muscle only. We present data on local injection-site tolerability and safety of risperidone long-acting injectable and comparability of systemic exposure of deltoid versus gluteal injections. Methods Risperidone long-acting injectable was administered in an open-label, single-dose, two-way crossover study, with patients randomized to receive either 25mg gluteal/37.5mg deltoid crossover in two treatment periods or 50mg gluteal/50mg deltoid injections crossover; each treatment period was separated by an 85-day observation period (Study 1) and an open-label, multiple-dose study (4 sequential 37.5mg or 50mg deltoid injections every 2 weeks) (Study 2). The pharmacokinetic results from both the studies have already been published. Results In Study 1 (n=170), the majority of patients had no local injection-site findings, based on investigator and patient-rated evaluations. In Study 2 (n=53), seven of the 51 patients who received at least two deltoid injections discontinued (primary endpoint). However, none of the discontinuations were due to injection-site related reasons. The 90-percent upper confidence limit of the true proportion of injection-site issue withdrawals was 5.7 percent. No moderate or severe injection-site reactions were reported. Conclusion Intramuscular injections via the deltoid and gluteal sites are equivalent routes of administration of risperidone long-acting injectable with respect to local injection-site tolerability. The overall safety and tolerability profile of risperidone long-acting injectable was comparable when administered as an intramuscular injection in the deltoid (37.5mg and 50mg) and gluteal (25mg and 50mg) sites. PMID:21779538

Using Contingency Management Procedures to Reduce At-Risk Drinking in Heavy Drinkers

PubMed Central

Dougherty, Donald M.; Lake, Sarah L.; Hill-Kapturczak, Nathalie; Liang, Yuanyuan; Karns, Tara E.; Mullen, Jillian; Roache, John D.

2017-01-01

Background Treatments for alcohol use disorders typically have been abstinence-based, but harm reduction approaches that encourage drinkers to alter their drinking behavior to reduce the probability of alcohol-related consequences, have gained in popularity. The current study used a contingency management procedure to determine its effectiveness in reducing alcohol consumption among heavy drinkers. Methods Eighty non-treatment-seeking heavy drinkers (ages 21–54, M = 30.20) who did not meet diagnostic criteria for alcohol dependence participated in the study. The study had three phases: 1) an Observation phase (4 weeks) where participants drank normally; 2) a Contingency Management phase (12 weeks) where participants were paid $50 weekly for not exceeding low levels of alcohol consumption as measured by transdermal alcohol concentrations, < 0.03 g/dL; and 3) a Follow-up phase (12 weeks) where participants (n = 66) returned monthly for 3 months to self-report drinking after the contingencies were removed. Transdermal alcohol monitors were used to verify meeting contingency requirements; all other analyses were conducted on self-reported alcohol use. Results On average 42.3% of participants met the contingency criteria and were paid an average of $222 during the Contingency Management phase, with an average $1998 in total compensation throughout the study. Compared to the Observation phase, the percent of any self-reported drinking days significantly decreased from 59.9% to 40.0% in the Contingency Management and 32.0% in the Follow-up phases. The percent of self-reported heavy drinking days reported also significantly decreased from 42.4% in the Observation phase to 19.7% in the Contingency Management phase, which was accompanied by a significant increase in percent days of self-reported no (from 40.1% to 60.0%) and low level drinking (from 9.9% to 15.4%). Self-reported reductions in drinking either persisted, or became more pronounced, during the Follow-up phase

Using contingency management procedures to reduce at-risk drinking in heavy drinkers.

PubMed

Dougherty, Donald M; Lake, Sarah L; Hill-Kapturczak, Nathalie; Liang, Yuanyuan; Karns, Tara E; Mullen, Jillian; Roache, John D

2015-04-01

Treatments for alcohol use disorders typically have been abstinence based, but harm reduction approaches that encourage drinkers to alter their drinking behavior to reduce the probability of alcohol-related consequences, have gained in popularity. This study used a contingency management procedure to determine its effectiveness in reducing alcohol consumption among heavy drinkers. Eighty-two nontreatment-seeking heavy drinkers (ages 21 to 54, M = 30.20) who did not meet diagnostic criteria for alcohol dependence participated in the study. The study had 3 phases: (i) an Observation phase (4 weeks) where participants drank normally; (ii) a Contingency Management phase (12 weeks) where participants were paid $50 weekly for not exceeding low levels of alcohol consumption as measured by transdermal alcohol concentrations, <0.03 g/dl; and (iii) a Follow-up phase (12 weeks) where participants (n = 66) returned monthly for 3 months to self-report drinking after the contingencies were removed. Transdermal alcohol monitors were used to verify meeting contingency requirements; all other analyses were conducted on self-reported alcohol use. On average 42.3% of participants met the contingency criteria and were paid an average of $222 during the Contingency Management phase, with an average $1,998 in total compensation throughout the study. Compared to the Observation phase, the percent of any self-reported drinking days significantly decreased from 59.9 to 40.0% in the Contingency Management and 32.0% in the Follow-up phases. The percent of self-reported heavy drinking days reported also significantly decreased from 42.4% in the Observation phase to 19.7% in the Contingency Management phase, which was accompanied by a significant increase in percent days of self-reported no (from 40.1 to 60.0%) and low-level drinking (from 9.9 to 15.4%). Self-reported reductions in drinking either persisted, or became more pronounced, during the Follow-up phase. Contingency management

A rational-emotive stress management intervention for reducing job burnout and dysfunctional distress among special education teachers

PubMed Central

Ugwoke, Samuel C.; Eseadi, Chiedu; Onuigbo, Liziana N.; Aye, Eucharia N.; Akaneme, Immaculata N.; Oboegbulem, Angie I.; Ezenwaji, Ifeyinwa O.; Nwobi, Anthonia U.; Nwaubani, Okechukwu O.; Ezegbe, Bernedeth N.; Ede, Moses O.; Orji, Chibueze T.; Onuoha, Joseph C.; Onu, Eucharia U.; Okeke, Francisca; Agu, Patricia; Omeje, Joachim C.; Omeke, Faith; Ugwu, Romanus; Arumede, Florence; Eneh, Annastasia

2018-01-01

Abstract Background: Job-related burnout and distress are adverse stress responses which affect individuals in their occupational environment. This study aimed at investigating the effect of a rational-emotive stress management program on job burnout and dysfunctional distress among special education teachers in Nigeria. Methods: A pretest–posttest randomized control group design was used. The participants in the study were 54 special education teachers. Data were collected using self-report questionnaires. Participants were allocated to either the treatment group (n = 28 [59.1%]) or the waitlist control group (n = 26 [48.1%]), respectively. A rational-emotive stress management manual was used to deliver the intervention. We statistically analyzed the data collected at three-time points with repeated-measures analysis of variance. Results: At baseline, the job-related burnout symptoms and distress scores of participants were high. However, an intention-to-treat analysis showed that the rational-emotive stress management intervention program was efficacious in reducing the levels of job-related burnout symptoms and dysfunctional distress among participants assigned to the treatment group, compared to a waitlisted group at post-treatment and follow-up meetings. Conclusion: Our study demonstrates the effectiveness of a rational-emotive stress management intervention in reducing the level of job-related burnout and distress in a sample of special education teachers in Nigeria. Occupational health counsellors and other clinicians with sufficient knowledge of rational-emotive behavior therapy framework are urged to employ this approach in assisting other employees in managing job burnout symptoms, and distress. PMID:29703004

Tibetan Plateau glacier and hydrological change under stratospheric aerosol injection

NASA Astrophysics Data System (ADS)

Ji, D.

2017-12-01

As an important inland freshwater resource, mountain glaciers are highly related to human life, they provide water for many large rivers and play a very important role in regional water cycles. The response of mountain glaciers to future climate change is a topic of concern especially to the many people who rely on glacier-fed rivers for purposes such as irrigation. Geoengineering by stratospheric aerosol injection is a method of offsetting the global temperature rise from greenhouse gases. How the geoengineering by stratospheric aerosol injection affects the mass balance of mountain glaciers and adjacent river discharge is little understood. In this study, we use regional climate model WRF and catchment-based river model CaMa-Flood to study the impacts of stratospheric aerosol injection to Tibetan Plateau glacier mass balance and adjacent river discharge. To facilitate mountain glacier mass balance study, we improve the description of mountain glacier in the land surface scheme of WRF. The improvements include: (1) a fine mesh nested in WRF horizontal grid to match the highly non-uniform spatial distribution of the mountain glaciers, (2) revising the radiation flux at the glacier surface considering the surrounding terrain. We use the projections of five Earth system models for CMIP5 rcp45 and GeoMIP G4 scenarios to drive the WRF and CaMa-Flood models. The G4 scenario, which uses stratospheric aerosols to reduce the incoming shortwave while applying the rcp4.5 greenhouse gas forcing, starts stratospheric sulfate aerosol injection at a rate of 5 Tg per year over the period 2020-2069. The ensemble projections suggest relatively slower glacier mass loss rates and reduced river discharge at Tibetan Plateau and adjacent regions under geoengineering scenario by stratospheric aerosol injection.

Application of an EGR system in a direct injection diesel engine to reduce NOx emissions

NASA Astrophysics Data System (ADS)

De Serio, D.; De Oliveira, A.; Sodré, J. R.

2016-09-01

This work presents the application of an exhaust gas recirculation (EGR) system in a direct injection diesel engine operating with diesel oil containing 7% biodiesel (B7). EGR rates of up to 10% were applied with the primary aim to reduce oxides of nitrogen (NOx) emissions. The experiments were conducted in a 44 kW diesel power generator to evaluate engine performance and emissions for different load settings. The use of EGR caused a peak pressure reduction during the combustion process and a decrease in thermal efficiency, mainly at high engine loads. A reduction of NOx emissions of up to 26% was achieved, though penalizing carbon monoxide (CO) and total hydrocarbons (THC) emissions.

Temporal pore pressure induced stress changes during injection and depletion

NASA Astrophysics Data System (ADS)

Müller, Birgit; Heidbach, Oliver; Schilling, Frank; Fuchs, Karl; Röckel, Thomas

2016-04-01

Induced seismicity is observed during injection of fluids in oil, gas or geothermal wells as a rather immediate response close to the injection wells due to the often high-rate pressurization. It was recognized even earlier in connection with more moderate rate injection of fluid waste on a longer time frame but higher induced event magnitudes. Today, injection-related induced seismicity significantly increased the number of events with M>3 in the Mid U.S. However, induced seismicity is also observed during production of fluids and gas, even years after the onset of production. E.g. in the Groningen gas field production was required to be reduced due to the increase in felt and damaging seismicity after more than 50 years of exploitation of that field. Thus, injection and production induced seismicity can cause severe impact in terms of hazard but also on economic measures. In order to understand the different onset times of induced seismicity we built a generic model to quantify the role of poro-elasticity processes with special emphasis on the factors time, regional crustal stress conditions and fault parameters for three case studies (injection into a low permeable crystalline rock, hydrothermal circulation and production of fluids). With this approach we consider the spatial and temporal variation of reservoir stress paths, the "early" injection-related induced events during stimulation and the "late" production induced ones. Furthermore, in dependence of the undisturbed in situ stress field conditions the stress tensor can change significantly due to injection and long-term production with changes of the tectonic stress regime in which previously not critically stressed faults could turn to be optimally oriented for fault reactivation.

Sonographically guided deep plantar fascia injections: where does the injectate go?

PubMed

Maida, Eugene; Presley, James C; Murthy, Naveen; Pawlina, Wojciech; Smith, Jay

2013-08-01

To determine the distribution of sonographically guided deep plantar fascia injections in an unembalmed cadaveric model. A single experienced operator completed 10 sonographically guided deep plantar fascia injections in 10 unembalmed cadaveric specimens (5 right and 5 left) obtained from 6 donors (2 male and 4 female) aged 49 to 95 years (mean, 77.5 years) with a mean body mass index of 23.2 kg/m(2) (range, 18.4-26.3 kg/m(2)). A 12-3-MHz linear array transducer was used to direct a 22-gauge, 38-mm stainless steel needle deep to the plantar fascia at the anterior aspect of the calcaneus using an in-plane, medial-to-lateral approach. In each case, 1.5 mL of 50% diluted colored latex was injected deep to the plantar fascia. After a minimum of 72 hours, study coinvestigators dissected each specimen to assess injectate placement. All 10 injections accurately placed latex adjacent to the deep side of the plantar fascia at the anterior calcaneus. However, the flexor digitorum brevis (FDB) origin from the plantar fascia variably limited direct latex contact with the plantar fascia, and small amounts of latex interdigitated with the FDB origin in 90% (9 of 10). In all 10 specimens, latex also covered the traversing first branch of the lateral plantar nerve (FBLPN, ie, Baxter nerve) between the FDB and quadratus plantae muscles. No latex was found in the plantar fat pad or plantar fascia in any specimen. Sonographically guided deep plantar fascia injections reliably deliver latex deep to the plantar fascia while avoiding intrafascial injection. However, the extent of direct plantar fascia contact is variable due to the intervening FDB. On the contrary, the traversing FBLPN is reliably covered by the injection. Deep plantar fascia injections may have a role in the management of refractory plantar fasciitis, particularly following failed superficial perifascial or intrafascial injections, in cases of preferential deep plantar fascia involvement, or when entrapment

Impact of Air Injection on Jet Noise

NASA Technical Reports Server (NTRS)

Henderson, Brenda; Norum, Tom

2007-01-01

The objective of this viewgraph presentation is to review the program to determine impact of core fluidic chevrons on noise produced by dual stream jets (i.e., broadband shock noise - supersonic, and mixing noise - subsonic and supersonic). The presentation reviews the sources of jet noise. It shows designs of Generation II Fluidic Chevrons. The injection impacts shock structure and stream disturbances through enhanced mixing. This may impact constructive interference between acoustic sources. The high fan pressures may inhibit mixing produced by core injectors. A fan stream injection may be required for better noise reduction. In future the modification of Gen II nozzles to allow for some azimuthal control: will allow for higher mass flow rates and will allow for shallower injection angles A Flow field study is scheduled for spring, 2008 The conclusions are that injection can reduce well-defined shock noise and injection reduces mixing noise near peak jet noise angle

Reducing toughness of beef from Bos indicus draught steers by injection of calcium chloride: Effect of concentration and time postmortem.

PubMed

Jaturasitha, S; Thirawong, P; Leangwunta, V; Kreuzer, M

2004-09-01

Calcium chloride (CaCl(2)) solution in concentrations of 0, 0.2, 0.3 and 0.4 M was injected at 10% (wt/wt) either 45 min or 24 h postmortem into longissimus dorsi muscles of eight draught steers discharged from work and >4 years of age. Shear force, after 7 days of aging, declined by CaCl(2) injection by up to 50% of control, depending on CaCl(2) concentration. Prerigor treatment was twice as efficient as postrigor injection. Collagen content and solubility were less clearly affected. Sensory tenderness scores were higher by 50% with all CaCl(2) concentrations, but only with prerigor treatment. A bitter taste was noted only with the highest concentration of CaCl(2), but overall acceptance did not increase with CaCl(2) concentration. CaCl(2) enhanced electrical conductivity, reduced redness and luminosity, and increased drip and thawing loss, but not boiling loss, of longissiumus dorsi. Results indicate a high potential of CaCl(2) treatment in extraordinarily tough meat.

An Innovative Needle-free Injection System: Comparison to 1 ml Standard Subcutaneous Injection.

PubMed

Kojic, Nikola; Goyal, Pragun; Lou, Cheryl Hamer; Corwin, Michael J

2017-11-01

A needle-free delivery system may lead to improved satisfaction and compliance, as well as reduced anxiety among patients requiring frequent or ongoing injections. This report describes a first-in-man assessment comparing Portal Instruments' innovative needle-free injection system with subcutaneous injections using a 27G needle. Forty healthy volunteer participants each received a total of four injections of 1.0 mL sterile saline solution, two with a standard subcutaneous injection using a 27G needle, and two using the Portal injection system. Perception of pain was measured using a 100-mm visual analog scale (VAS). Injection site reactions were assessed at 2 min and at 20-30 min after each injection. Follow-up contact was made 24-48 h after the injections. Subject preference regarding injection type was also assessed. VAS pain scores at Portal injection sites met the criteria to be considered non-inferior to the pain reported at 27G needle injection sites (i.e., upper 95% confidence bound less than +5 mm). Based on a mixed effects model, at time 0, accounting for potential confounding variables, the adjusted difference in VAS scores indicated that Portal injections were 6.5 mm lower than the 27G needle injections (95% CI -10.5, -2.5). No clinically important adverse events were noted. Portal injections were preferred by 24 (60%) of the subjects (P = 0.0015). As an early step in the development of this new needle-free delivery system, the current study has shown that a 1.0-mL saline injection can be given with less pain reported than a standard subcutaneous injection using a 27G needle.

Individual and Network Interventions With Injection Drug Users in 5 Ukraine Cities

PubMed Central

Lehman, Wayne E. K.; Latkin, Carl A.; Dvoryak, Sergey; Brewster, John T.; Royer, Mark S.; Sinitsyna, Larisa

2011-01-01

Objectives. We evaluated the effects of an individual intervention versus a network intervention on HIV-related injection and sexual risk behaviors among street-recruited opiate injection drug users in 5 Ukraine cities. Methods. Between 2004 and 2006, 722 opiate injection drug users were recruited to participate in interventions that were either individually based or based on a social network model in which peer educators intervened with their network members. Audio computer-assisted self-interview techniques were used to interview participants at baseline and follow-up. Results. Multiple logistic analyses controlling for baseline injection and sexual risks revealed that both peer educators and network members in the network intervention reduced injection-related risk behaviors significantly more than did those in the individually based intervention and that peer educators increased condom use significantly more than did those in the individual intervention. Individual intervention participants, however, showed significantly greater improvements than did network members with respect to reductions in sexual risk behaviors. Conclusions. Social network interventions may be more effective than individually based interventions in changing injection risk behaviors among both peer educators and network members. The effectiveness of network interventions in changing sexual risk behaviors is less clear, probably owing to network composition and inhibitions regarding discussing sexual risk behaviors. PMID:20395584

Relationship Between the Provision of Injection Services in Ambulatory Physician Offices and Prescribing Injectable Medicines.

PubMed

Yousefi, Naeimeh; Rashidian, Arash; Soleymani, Fatemeh; Kebriaeezade, Abbas

2017-01-01

Overuse of injections is a common problem in many low-income and middle income countries. While cultural factors and attitudes of both physicians and patients are important factors, physicians› financial intensives may play an important role in overprescribing of injections. This study was designed to assess the effects of providing injection- services in physicians› ambulatory offices on prescribing injectable medicines. This cross-sectional study was conducted in Tehran in 2012 -2013and included a random sample of general physicians, pediatricians and infectious disease specialists. We collected data on the provision of injection services in or in proximity of physician offices, and obtained data from physicians› prescriptions in the previous three-month period. We analyzed the data using ANOVA, Student›s t-test and linear regression methods. We obtained complete data from 465 of 600 sampled physicians. Overall 41.9% of prescriptions contained injectable medicines. 75% of physicians offered injection services in their offices. Male physicians and general physicians were more likely to offer the services, and more likely to prescribe injectables. We observed a clear linear relationship between the injection service working hours and the proportion of prescriptions containing injectables (p-value<0.001). Providing injection service in the office was directly linked with the proportion of prescriptions containing injectables. While provision of injection services may provide a direct financial benefit to physicians, it is unlikely to be able to substantially reduce injectable medicines› prescription without addressing the issue.

Procedural and Physical Interventions for Vaccine Injections: Systematic Review of Randomized Controlled Trials and Quasi-Randomized Controlled Trials.

PubMed

Taddio, Anna; Shah, Vibhuti; McMurtry, C Meghan; MacDonald, Noni E; Ipp, Moshe; Riddell, Rebecca Pillai; Noel, Melanie; Chambers, Christine T

2015-10-01

This systematic review evaluated the effectiveness of physical and procedural interventions for reducing pain and related outcomes during vaccination. Databases were searched using a broad search strategy to identify relevant randomized and quasi-randomized controlled trials. Data were extracted according to procedure phase (preprocedure, acute, recovery, and combinations of these) and pooled using established methods. A total of 31 studies were included. Acute infant distress was diminished during intramuscular injection without aspiration (n=313): standardized mean difference (SMD) -0.82 (95% confidence interval [CI]: -1.18, -0.46). Injecting the most painful vaccine last during vaccinations reduced acute infant distress (n=196): SMD -0.69 (95% CI: -0.98, -0.4). Simultaneous injections reduced acute infant distress compared with sequential injections (n=172): SMD -0.56 (95% CI: -0.87, -0.25). There was no benefit of simultaneous injections in children. Less infant distress during the acute and recovery phases combined occurred with vastus lateralis (vs. deltoid) injections (n=185): SMD -0.70 (95% CI: -1.00, -0.41). Skin-to-skin contact in neonates (n=736) reduced acute distress: SMD -0.65 (95% CI: -1.05, -0.25). Holding infants reduced acute distress after removal of the data from 1 methodologically diverse study (n=107): SMD -1.25 (95% CI: -2.05, -0.46). Holding after vaccination (n=417) reduced infant distress during the acute and recovery phases combined: SMD -0.65 (95% CI: -1.08, -0.22). Self-reported fear was reduced for children positioned upright (n=107): SMD -0.39 (95% CI: -0.77, -0.01). Non-nutritive sucking (n=186) reduced acute distress in infants: SMD -1.88 (95% CI: -2.57, -1.18). Manual tactile stimulation did not reduce pain across the lifespan. An external vibrating device and cold reduced pain in children (n=145): SMD -1.23 (95% CI: -1.58, -0.87). There was no benefit of warming the vaccine in adults. Muscle tension was beneficial in selected

Is there enough evidence to use botulinum toxin injections for bruxism management? A systematic literature review.

PubMed

De la Torre Canales, Giancarlo; Câmara-Souza, Mariana Barbosa; do Amaral, Camilla Fraga; Garcia, Renata Cunha Matheus Rodrigues; Manfredini, Daniele

2017-04-01

The objective of the study was to conduct a systematic review of the literature assessing the effects of botulinum toxin (BoNT-A) injections in the management of bruxism. Search for articles involved the PubMed, Scopus, Web of Science, Embase, Cochrane, Scielo and Lilacs databases. Specific terms were used and the search carried out from 1980 to March 2016 by three independent researchers. Randomized controlled studies (RCTs), prospective and before-after studies that applied BoNT-A at the masseter and/or temporalis muscles were included. Three RCTs and two uncontrolled before-after studies out of 904 identified citations were included in this review. All five articles dealt with sleep bruxism and featured a small sample size. None of them was about awake bruxism. Two randomized clinical trials were double-blinded, with a control group using saline solution. Two studies used polysomnography/electromyography for sleep bruxism diagnosis, whilst others were based on history taking and clinical examination. All studies using subjective evaluations for pain and jaw stiffness showed positive results for the BoNT-A treatment. In contrast, the two studies using objective evaluations did not demonstrate any reduction in bruxism episodes, but a decrease in the intensity of muscles contractions. Despite the paucity of works on the topic, BoNT-A seems to be a possible management option for sleep bruxism, minimizing symptoms and reducing the intensity of muscle contractions, although further studies are necessary especially as far as the treatment indications for bruxism itself is concerned. BoNT-A has been increasingly diffused in dentistry over recent years, being also used for pain management in patients with bruxism. Nonetheless, there is no consensus about its effects in this disorder.

Analysis of Tests of Subsurface Injection, Storage, and Recovery of Freshwater in Lancaster, Antelope Valley, California

USGS Publications Warehouse

Phillips, Steven P.; Carlson, Carl S.; Metzger, Loren F.; Howle, James F.; Galloway, Devin L.; Sneed, Michelle; Ikehara, Marti E.; Hudnut, Kenneth W.; King, Nancy E.

2003-01-01

Ground-water levels in Lancaster, California, declined more than 200 feet during the 20th century, resulting in reduced ground-water supplies and more than 6 feet of land subsidence. Facing continuing population growth, water managers are seeking solutions to these problems. Injection of imported, treated fresh water into the aquifer system when it is most available and least expensive, for later use during high-demand periods, is being evaluated as part of a management solution. The U.S. Geological Survey, in cooperation with the Los Angeles County Department of Public Works and the Antelope Valley-East Kern Water Agency, monitored a pilot injection program, analyzed the hydraulic and subsidence-related effects of injection, and developed a simulation/optimization model to help evaluate the effectiveness of using existing and proposed wells in an injection program for halting the decline of ground-water levels and avoiding future land subsidence while meeting increasing ground-water demand. A variety of methods were used to measure aquifer-system response to injection. Water levels were measured continuously in nested (multi-depth) piezometers and monitoring wells and periodically in other wells that were within several miles of the injection site. Microgravity surveys were done to estimate changes in the elevation of the water table in the absence of wells and to estimate specific yield. Aquifer-system deformation was measured directly and continuously using a dual borehole extensometer and indirectly using continuous Global Positioning System (GPS), first-order spirit leveling, and an array of tiltmeters. The injected water and extracted water were sampled periodically and analyzed for constituents, including chloride and trihalomethanes. Measured injection rates of about 750 gallons per minute (gal/min) per well at the injection site during a 5-month period showed that injection at or above the average extraction rates at that site (about 800 gal/min) was

Can agent based models effectively reduce fisheries management implementation uncertainty?

NASA Astrophysics Data System (ADS)

Drexler, M.

2016-02-01

Uncertainty is an inherent feature of fisheries management. Implementation uncertainty remains a challenge to quantify often due to unintended responses of users to management interventions. This problem will continue to plague both single species and ecosystem based fisheries management advice unless the mechanisms driving these behaviors are properly understood. Equilibrium models, where each actor in the system is treated as uniform and predictable, are not well suited to forecast the unintended behaviors of individual fishers. Alternatively, agent based models (AMBs) can simulate the behaviors of each individual actor driven by differing incentives and constraints. This study evaluated the feasibility of using AMBs to capture macro scale behaviors of the US West Coast Groundfish fleet. Agent behavior was specified at the vessel level. Agents made daily fishing decisions using knowledge of their own cost structure, catch history, and the histories of catch and quota markets. By adding only a relatively small number of incentives, the model was able to reproduce highly realistic macro patterns of expected outcomes in response to management policies (catch restrictions, MPAs, ITQs) while preserving vessel heterogeneity. These simulations indicate that agent based modeling approaches hold much promise for simulating fisher behaviors and reducing implementation uncertainty. Additional processes affecting behavior, informed by surveys, are continually being added to the fisher behavior model. Further coupling of the fisher behavior model to a spatial ecosystem model will provide a fully integrated social, ecological, and economic model capable of performing management strategy evaluations to properly consider implementation uncertainty in fisheries management.

[Reliability theory based on quality risk network analysis for Chinese medicine injection].

PubMed

Li, Zheng; Kang, Li-Yuan; Fan, Xiao-Hui

2014-08-01

A new risk analysis method based upon reliability theory was introduced in this paper for the quality risk management of Chinese medicine injection manufacturing plants. The risk events including both cause and effect ones were derived in the framework as nodes with a Bayesian network analysis approach. It thus transforms the risk analysis results from failure mode and effect analysis (FMEA) into a Bayesian network platform. With its structure and parameters determined, the network can be used to evaluate the system reliability quantitatively with probabilistic analytical appraoches. Using network analysis tools such as GeNie and AgenaRisk, we are able to find the nodes that are most critical to influence the system reliability. The importance of each node to the system can be quantitatively evaluated by calculating the effect of the node on the overall risk, and minimization plan can be determined accordingly to reduce their influences and improve the system reliability. Using the Shengmai injection manufacturing plant of SZYY Ltd as a user case, we analyzed the quality risk with both static FMEA analysis and dynamic Bayesian Network analysis. The potential risk factors for the quality of Shengmai injection manufacturing were identified with the network analysis platform. Quality assurance actions were further defined to reduce the risk and improve the product quality.

Oral substitution treatment of injecting opioid users for prevention of HIV infection.

PubMed

Gowing, Linda; Farrell, Michael F; Bornemann, Reinhard; Sullivan, Lynn E; Ali, Robert

2011-08-10

Injecting drug users are vulnerable to infection with Human Immunodeficiency Virus (HIV) and other blood borne viruses as a result of collective use of injecting equipment as well as sexual behaviour To assess the effect of oral substitution treatment for opioid dependent injecting drug users on risk behaviours and rates of HIV infections We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and PsycINFO to May 2011. We also searched reference lists of articles, reviews and conference abstracts Studies were required to consider the incidence of risk behaviours, or the incidence of HIV infection related to substitution treatment of opioid dependence. All types of original studies were considered. Two authors independently assessed each study for inclusion Two authors independently extracted key information from each of the included studies. Any differences were resolved by discussion or by referral to a third author. Thirty-eight studies, involving some 12,400 participants, were included. The majority were descriptive studies, or randomisation processes did not relate to the data extracted, and most studies were judged to be at high risk of bias. Studies consistently show that oral substitution treatment for opioid-dependent injecting drug users with methadone or buprenorphine is associated with statistically significant reductions in illicit opioid use, injecting use and sharing of injecting equipment. It is also associated with reductions in the proportion of injecting drug users reporting multiple sex partners or exchanges of sex for drugs or money, but has little effect on condom use. It appears that the reductions in risk behaviours related to drug use do translate into reductions in cases of HIV infection. However, because of the high risk of bias and variability in several aspects of the studies, combined totals were not calculated. Oral substitution treatment for injecting opioid users reduces drug-related behaviours with a high

Accuracy of acromioclavicular joint injections.

PubMed

Wasserman, Bradley R; Pettrone, Sarah; Jazrawi, Laith M; Zuckerman, Joseph D; Rokito, Andrew S

2013-01-01

Injection to the acromioclavicular (AC) joint can be both diagnostic and therapeutic. The purpose of this study was to evaluate the accuracy of in vivo AC joint injections. Case series; Level of evidence, 4. Thirty patients with pain localized to the AC joint were injected with 1 mL of 1% lidocaine and 0.5 mL of radiographic contrast material (Isovue). Radiographs of the AC joint were taken after the injection. Each radiograph was reviewed by a musculoskeletal radiologist and graded as intra-articular, extra-articular, or partially intra-articular. Of the 30 injections performed, 13 (43.3%) were intra-articular, 7 (23.3%) were partially articular, and 10 (33.3%) were extra-articular. When the intra-articular and the partially articular groups were combined, 20 patients (66.7%) had some contrast dye in the AC joint. This study demonstrates that despite the relatively superficial location of the AC joint, the clinical accuracy of AC joint injections remains relatively low.

Numerical simulation of water injection into vapor-dominated reservoirs

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

Pruess, K.

1995-01-01

Water injection into vapor-dominated reservoirs is a means of condensate disposal, as well as a reservoir management tool for enhancing energy recovery and reservoir life. We review different approaches to modeling the complex fluid and heat flow processes during injection into vapor-dominated systems. Vapor pressure lowering, grid orientation effects, and physical dispersion of injection plumes from reservoir heterogeneity are important considerations for a realistic modeling of injection effects. An example of detailed three-dimensional modeling of injection experiments at The Geysers is given.

Predicting injection related changes in seismic properties at Kevin Dome, north central Montana, using well logs and laboratory measurements

NASA Astrophysics Data System (ADS)

Saltiel, S.; Bonner, B. P.; Ajo Franklin, J. B.

2014-12-01

Time-lapse seismic monitoring (4D) is currently the primary technique available for tracking sequestered CO2 in a geologic storage reservoir away from monitoring wells. The main seismic responses to injection are those due to direct fluid substitution, changes in differential pressure, and chemical interactions with reservoir rocks; the importance of each depends on reservoir/injection properties and temporal/spatial scales of interest. As part of the Big Sky Carbon Sequestration Partnership, we are monitoring the upcoming large scale (1 million ton+) CO2 injection in Kevin Dome, north central Montana. As part of this research, we predict the relative significance of these three effects, as an aid in design of field surveys. Analysis is undertaken using existing open-hole well log data and cores from wells drilled at producer and injector pads as well as core experiments. For this demonstration site, CO2 will be produced from a natural reservoir and re-injected down dip, where the formation is saturated with brine. Effective medium models based on borehole seismic velocity measurements predict relatively small effects (less than 40 m/s change in V¬p) due to the injection of more compressible supercritical CO2. This is due to the stiff dolomite reservoir rock, with high seismic velocities (Vp~6000 m/s, Vs~3000 m/s) and fairly low porosity (<10%). Assuming pure dolomite mineralogy, these models predict a slight increase in Vp during CO2 injection. This velocity increase is due to the lower density of CO2 relative to brine; which outweighs the small change in modulus compared to the stiff reservoir rock. We present both room pressure and in-situ P/T ultrasonic experiments using core samples obtained from the reservoir; such measurements are undertaken to access the expected seismic velocities under pressurized injection. The reservoir appears to have fairly low permeability. Large-volume injection is expected to produce large local pore pressure increases, which may

Single-use autoinjector for once-weekly intramuscular injection of IFNβ-1a.

PubMed

Limmroth, Volker; Gerbershagen, Kathrin

2014-12-01

IFNβ products and glatiramer acetate are established treatment first-line options in long-term disease-modifying therapy of multiple sclerosis (MS). These self-injectable medications are used once weekly to once daily. Injection-related issues are common patient-cited reasons for nonadherence. Autoinjectors have been shown to support long-term adherence to injectable medications. The ability to self-inject in MS patients has been associated with a reduced risk of missed injections and drug discontinuation, and a beneficial effect on patient independence. The recently introduced easy-to-use prefilled once-weekly pen is a safe and effective device for intramuscular (IM) IFNβ-1a application and provides a convenient method for self-injection. We reviewed the available published evidence on the characteristics of this device. The once-weekly pen facilitates self-injection and was preferred over prefilled syringes by patients in a prospective open-label, multicenter Phase IIIb trial in MS patients who had been using IM IFNβ-1a in prefilled syringes. The simple and safe handling, shielded short needle, single-use disposable design and virtually painless injection by the device may contribute to adherence, quality of life and independence in patients using IM IFNβ-1a.

Ultrasound guided platelet-rich plasma injection for the treatment of rotator cuff tendinopathy.

PubMed

Tahririan, Mohammad Ali; Moezi, Mehdi; Motififard, Mahdi; Nemati, Mahdi; Nemati, Amin

2016-01-01

Degenerative changes and inflammation in the rotator cuff (RC) are the most important causes of shoulder pain. The aim of the present study was to determine the effectiveness of platelet-rich plasma (PRP) in patients with chronic RC tendinopathy. This study was an open-label study performed at Kashani Hospital between April 2012 and June 2014. Patients with a <1 cm partial tearing of the bursal side of RC with no or little response to conservative management were included. PRP injection was done using ultrasonography guide via posterior subacromial approach. Demographic data were obtained in all patient before the study, and shoulder function was evaluated using Constant shoulder score (CSS) before and 3 months after PRP injection. A total number of 17 patients were enrolled. The mean of CSS before and after intervention was 37.05 ± 11.03 and 61.76 ± 14.75, respectively ( P < 0.001). There was no statistically significant correlation between the pain score before the study and the improvement in CSS ( P = 0.45, r = 0.03). Significant relation was observed between the individuals' age and improvement of CSS ( P = 0.02, r = -0.49). There was no significant difference in CSS improvement between genders ( P = 0.23). Single injection of PRP is effective to reduce pain and improve range of motion in patients with bursal side partial tearing of RC who failed to respond to conservative treatments.

Modeling the effects of auxiliary gas injection and fuel injection rate shape on diesel engine combustion and emissions

NASA Astrophysics Data System (ADS)

Mather, Daniel Kelly

1998-11-01

The effect of auxiliary gas injection and fuel injection rate-shaping on diesel engine combustion and emissions was studied using KIVA a multidimensional computational fluid dynamics code. Auxiliary gas injection (AGI) is the injection of a gas, in addition to the fuel injection, directly into the combustion chamber of a diesel engine. The objective of AGI is to influence the diesel combustion via mixing to reduce emissions of pollutants (soot and NO x). In this study, the accuracy of modeling high speed gas jets on very coarse computational grids was addressed. KIVA was found to inaccurately resolve the jet flows near walls. The cause of this inaccuracy was traced to the RNG k - ɛ turbulence model with the law-of-the-wall boundary condition used by KIVA. By prescribing the lengthscale near the nozzle exit, excellent agreement between computed and theoretical jet penetration was attained for a transient gas jet into a quiescent chamber at various operating conditions. The effect of AGI on diesel engine combustion and emissions was studied by incorporating the coarse grid gas jet model into a detailed multidimensional simulation of a Caterpillar 3401 heavy-duty diesel engine. The effects of AGI timing, composition, amount, orientation, and location were investigated. The effects of AGI and split fuel injection were also investigated. AGI was found to be effective at reducing soot emissions by increasing mixing within the combustion chamber. AGI of inert gas was found to be effective at reducing emissions of NOx by depressing the peak combustion temperatures. Finally, comparison of AGI simulations with experiments were conducted for a TACOM-LABECO engine. The results showed that AGI improved soot oxidation throughout the engine cycle. Simulation of fuel injection rate-shaping investigated the effects of three injection velocity profiles typical of unit-injector type, high-pressure common-rail type, and accumulator-type fuel injectors in the Caterpillar 3401 heavy

Geographic Variations in Arthritis Prevalence, Health-Related Characteristics, and Management - United States, 2015.

PubMed

Barbour, Kamil E; Moss, Susan; Croft, Janet B; Helmick, Charles G; Theis, Kristina A; Brady, Teresa J; Murphy, Louise B; Hootman, Jennifer M; Greenlund, Kurt J; Lu, Hua; Wang, Yan

2018-03-16

Doctor-diagnosed arthritis is a common chronic condition affecting an estimated 23% (54 million) of adults in the United States, greatly influencing quality of life and costing approximately $300 billion annually. The geographic variations in arthritis prevalence, health-related characteristics, and management among states and territories are unknown. Therefore, public health professionals need to understand arthritis in their areas to target dissemination of evidence-based interventions that reduce arthritis morbidity. 2015. The Behavioral Risk Factor Surveillance System is an annual, random-digit-dialed landline and cellular telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. Self-reported data are collected from the 50 states, the District of Columbia, Guam, and Puerto Rico. Unadjusted and age-standardized prevalences of arthritis, arthritis health-related characteristics, and arthritis management were calculated. County-level estimates were calculated using a validated statistical modeling method. In 2015, in the 50 states and the District of Columbia, median age-standardized prevalence of arthritis was 23.0% (range: 17.2%-33.6%). Modeled prevalence of arthritis varied considerably by county (range: 11.2%-42.7%). In 13 states that administered the arthritis management module, among adults with arthritis, the age-standardized median percentage of participation in a self-management education course was 14.5% (range: 9.1%-19.0%), being told by a health care provider to engage in physical activity or exercise was 58.5% (range: 52.3%-61.9%), and being told to lose weight to manage arthritis symptoms (if overweight or obese) was 44.5% (range: 35.1%-53.2%). Respondents with arthritis who lived in the quartile of states with the highest prevalences of arthritis had the highest percentages of negative health-related characteristics (i.e., arthritis-attributable activity limitations, arthritis-attributable severe joint pain

Evaluation of relational and NoSQL database architectures to manage genomic annotations.

PubMed

Schulz, Wade L; Nelson, Brent G; Felker, Donn K; Durant, Thomas J S; Torres, Richard

2016-12-01

While the adoption of next generation sequencing has rapidly expanded, the informatics infrastructure used to manage the data generated by this technology has not kept pace. Historically, relational databases have provided much of the framework for data storage and retrieval. Newer technologies based on NoSQL architectures may provide significant advantages in storage and query efficiency, thereby reducing the cost of data management. But their relative advantage when applied to biomedical data sets, such as genetic data, has not been characterized. To this end, we compared the storage, indexing, and query efficiency of a common relational database (MySQL), a document-oriented NoSQL database (MongoDB), and a relational database with NoSQL support (PostgreSQL). When used to store genomic annotations from the dbSNP database, we found the NoSQL architectures to outperform traditional, relational models for speed of data storage, indexing, and query retrieval in nearly every operation. These findings strongly support the use of novel database technologies to improve the efficiency of data management within the biological sciences. Copyright © 2016 Elsevier Inc. All rights reserved.

Water Injected Turbomachinery

NASA Technical Reports Server (NTRS)

Hendricks, R. C.; Shouse, D. T.; Roquemore, W. M.

2005-01-01

From antiquity, water has been a source of cooling, lubrication, and power for energy transfer devices. More recent applications in gas turbines demonstrate an added facet, emissions control. Fogging gas turbine inlets or direct injection of water into gas turbine combustors, decreases NOx and increases power. Herein we demonstrate that injection of water into the air upstream of the combustor reduces NOx by factors up to three in a natural gas fueled Trapped Vortex Combustor (TVC) and up to two in a liquid JP-8 fueled (TVC) for a range in water/fuel and fuel/air ratios.

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

Apomorphine Subcutaneous Injection for the Management of Morning Akinesia in Parkinson's Disease.

PubMed

Isaacson, Stuart; Lew, Mark; Ondo, William; Hubble, Jean; Clinch, Thomas; Pagan, Fernando

2017-01-01

In patients with motor fluctuations complicating Parkinson's disease (PD), delays in time-to-ON with levodopa are common. This open-label study aimed to assess the effect of apomorphine on time-to-ON in PD patients with morning akinesia. The safety population included 127 enrolled patients, and the full analysis set (FAS) included 88 patients. Patients completed a 7-day levodopa baseline period recording their time-to-ON following each morning dose of levodopa. Patients were titrated to an optimal dose of apomorphine (2-6 mg) while taking trimethobenzamide antiemetic therapy. Apomorphine was injected each morning for a 7-day treatment period and time-to-ON was self-recorded in 5-minute blocks. The primary efficacy variable was time-to-ON in the apomorphine treatment period versus the baseline levodopa period. Secondary assessments included and global impression scales. Safety and tolerability were assessed through adverse events (AEs). Patients receiving apomorphine achieved mean ± standard deviation (SD) time-to-ON 23.72 ± 14.55 minutes, reduced from 60.86 ± 18.11 minutes with levodopa ( P < 0.0001). Dose failures (defined as time-to-ON >60 minutes) were more commonly reported with levodopa versus apomorphine (46% vs. 7% of diary entries, respectively). Secondary endpoints supported the primary efficacy findings, with significant improvements from levodopa baseline to apomorphine treatment period (all P < 0.0001). The most common AEs were nausea and dizziness. Most patients who discontinued because of AEs did so in the titration phase. Apomorphine injections significantly reduced time-to-ON in PD patients experiencing delayed onset of their morning levodopa dose, and was well tolerated in most patients. After apomorphine treatment, fluctuating patients with morning akinesia experienced rapid and reliable improvement of time-to-ON.

Intra-accumbens injections of the adenosine A2A agonist CGS 21680 affect effort-related choice behavior in rats

PubMed Central

Font, Laura; Mingote, Susana; Farrar, Andrew M.; Pereira, Mariana; Worden, Lila; Stopper, Colin; Port, Russell G.

2009-01-01

Rationale Nucleus accumbens dopamine (DA) participates in the modulation of instrumental behavior, including aspects of behavioral activation and effort-related choice behavior. Rats with impaired accumbens DA transmission reallocate their behavior away from food-reinforced activities that have high response requirements and instead select less-effortful types of food-seeking behavior. Although accumbens DA is considered a critical component of the brain circuitry regulating effort-related processes, emerging evidence also implicates adenosine A2A receptors. Objective The present work was undertaken to test the hypothesis that accumbens A2A receptor stimulation would produce effects similar to those produced by DA depletion or antagonism. Materials and methods Three experiments assessed the effects of the adenosine A2A agonist CGS 21680 on performance of a concurrent choice task (lever pressing for preferred food vs. intake of less preferred chow) that is known to be sensitive to DA antagonists and accumbens DA depletions. Results Systemic injections of CGS 21680 reduced lever pressing but did not increase feeding. In contrast, bilateral infusions of the adenosine A2A receptor agonist CGS 21680 (6.0–24.0 ng) into the nucleus accumbens decreased lever pressing for the preferred food but substantially increased consumption of the less preferred chow. Injections of CGS 21680 into a control site dorsal to the accumbens were ineffective. Conclusions Taken together, these results are consistent with the hypothesis that local stimulation of adenosine A2A receptors in nucleus accumbens produces behavioral effects similar to those induced by accumbens DA depletions. Accumbens adenosine A2A receptors appear to be a component of the brain circuitry regulating effort-related choice behavior. PMID:18491078

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

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.

Options for reducing HIV transmission related to the dead space in needles and syringes.

PubMed

Zule, William A; Pande, Poonam G; Otiashvili, David; Bobashev, Georgiy V; Friedman, Samuel R; Gyarmathy, V Anna; Des Jarlais, Don C

2018-01-15

When shared by people who inject drugs, needles and syringes with different dead space may affect the probability of HIV and hepatitis C virus (HCV) transmission differently. We measured dead space in 56 needle and syringe combinations obtained from needle and syringe programs across 17 countries in Europe and Asia. We also calculated the amounts of blood and HIV that would remain in different combinations following injection and rinsing. Syringe barrel capacities ranged from 0.5 to 20 mL. Needles ranged in length from 8 to 38 mm. The average dead space was 3 μL in low dead space syringes with permanently attached needles, 13 μL in high dead space syringes with low dead space needles, 45 μL in low dead space syringes with high dead space needles, and 99 μL in high dead space syringes with high dead space needles. Among low dead space designs, calculated volumes of blood and HIV viral burden were lowest for low dead space syringes with permanently attached needles and highest for low dead space syringes with high dead space needles. The dead space in different low dead space needle and syringe combinations varied substantially. To reduce HIV transmission related to syringe sharing, needle and syringe programs need to combine this knowledge with the needs of their clients.

Avoiding Repetitions Reduces ADHD Children's Management Problems in the Classroom

ERIC Educational Resources Information Center

Kapalka, George M.

2005-01-01

Students with attention-deficit hyperactivity disorder (ADHD) often exhibit non-compliance that presents a significant management problem for classroom teachers. Student behavior management training programs suggest that reducing repetitions of commands improves student compliance. To examine this claim, 86 teachers of ADHD students between the…

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.

Fuel Vapor Pressures and the Relation of Vapor Pressure to the Preparation of Fuel for Combustion in Fuel Injection Engines

NASA Technical Reports Server (NTRS)

Joachim, William F; Rothrock, A M

1930-01-01

This investigation on the vapor pressure of fuels was conducted in connection with the general research on combustion in fuel injection engines. The purpose of the investigation was to study the effects of high temperatures such as exist during the first stages of injection on the vapor pressures of several fuels and certain fuel mixtures, and the relation of these vapor pressures to the preparation of the fuel for combustion in high-speed fuel injection engines.

High-pressure Injection Injuries of the Hand.

PubMed

Cannon, Tyler A

2016-07-01

High-pressure injection hand injuries are often overlooked, with severe complications owing to the acute inflammatory response. Prognosis for depends on the type of material injected, location of injection, involved pressure, and timing to surgical decompression and debridement. Acute management involves broad-spectrum antibiotics, tetanus prophylaxis, emergent decompression within 6 hours, and complete removal of the injected material. Most patients have residual sequelae of stiffness, pain, sensation loss, and difficulties in returning to work. The hand surgeon's role is prompt surgical intervention, early postoperative motion, and education of patient and staff regarding short- and long-term expectations. Copyright © 2016 Elsevier Inc. All rights reserved.

Reducing uncertainty about objective functions in adaptive management

USGS Publications Warehouse

Williams, B.K.

2012-01-01

This paper extends the uncertainty framework of adaptive management to include uncertainty about the objectives to be used in guiding decisions. Adaptive decision making typically assumes explicit and agreed-upon objectives for management, but allows for uncertainty as to the structure of the decision process that generates change through time. Yet it is not unusual for there to be uncertainty (or disagreement) about objectives, with different stakeholders expressing different views not only about resource responses to management but also about the appropriate management objectives. In this paper I extend the treatment of uncertainty in adaptive management, and describe a stochastic structure for the joint occurrence of uncertainty about objectives as well as models, and show how adaptive decision making and the assessment of post-decision monitoring data can be used to reduce uncertainties of both kinds. Different degrees of association between model and objective uncertainty lead to different patterns of learning about objectives. ?? 2011.

Failure of botulinum toxin injection for neurogenic detrusor overactivity: Switch of toxin versus second injection of the same toxin.

PubMed

Peyronnet, Benoit; Castel-Lacanal, Evelyne; Manunta, Andréa; Roumiguié, Mathieu; Marque, Philippe; Rischmann, Pascal; Gamé, Xavier

2015-12-01

To evaluate the efficacy of a second injection of the same toxin versus switching to a different botulinum toxin A after failure of a first detrusor injection in patients with neurogenic detrusor overactivity. The charts of all patients who underwent detrusor injections of botulinum toxin A (either abobotulinumtoxinA or onabotulinumtoxinA) for the management of neurogenic detrusor overactivity at a single institution were retrospectively reviewed. Patients in whom a first detrusor injection had failed were included in the present study. They were managed by a second injection of the same toxin at the same dosage or by a new detrusor injection using a different botulinum toxin A. Success was defined as a resolution of urgency, urinary incontinence and detrusor overactivity in a patient self-catheterizing seven times or less per 24 h. A total of 58 patients were included for analysis. A toxin switch was carried out in 29 patients, whereas the other 29 patients received a reinjection of the same toxin at the same dose. The success rate was higher in patients who received a toxin switch (51.7% vs. 24.1%, P = 0.03). Patients treated with a switch from abobotulinumtoxinA to onabotulinumtoxinA and those treated with a switch from onabotulinumtoxinA to abobotulinumtoxinA had similar success rates (52.9% vs. 50%, P = 0.88). After failure of a first detrusor injection of botulinum toxin for neurogenic detrusor overactivity, a switch to a different toxin seems to be more effective than a second injection of the same toxin. The replacement of onabotulinumtoxin by abobotulinumtoxin or the reverse provides similar results. © 2015 The Japanese Urological Association.

Can managed care reduce employers' retiree medical liability?

PubMed

Taylor, R S; Newton, B

1991-01-01

The Financial Accounting Standards Board (FASB) has forced U.S. companies to look squarely at their current retiree health obligations and their future commitments. Accounting Statement No. 106 (FAS 106) requires employers to accrue liabilities for retiree health benefits during employees' active service, rather than record the costs as benefits are paid. Employers are scrambling to find ways to reduce the statement's effect on corporate balance sheets. While managed health care has been increasingly employed to control benefit costs in active employee health plans, it has not been as popular in retiree plans. This article reviews important demographic and health trends in the retiree population and summarizes employers' early responses to FAS 106. It explores why managed health care has thus far played a limited role in reducing employers' postretirement medical liability, and offers insight into how that role could be increased in the future.

Forum for Injection Technique and Therapy Expert Recommendations, India: The Indian Recommendations for Best Practice in Insulin Injection Technique, 2017

PubMed Central

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

2017-01-01

Health-care professionals in India frequently manage injection or infusion therapies in persons with diabetes (PWD). Patients taking insulin should know the importance of proper needle size, correct injection process, complication avoidance, and all other aspects of injection technique from the first visit onward. To assist health-care practitioners in their clinical practice, Forum for Injection Technique and Therapy Expert Recommendations, India, has updated the practical advice and made it more comprehensive evidence-based best practice information. Adherence to these updated recommendations, learning, and translating them into clinical practice should lead to effective therapies, improved outcomes, and lower costs for PWD. PMID:28670547

Improved characterization of heterogeneous permeability in saline aquifers from transient pressure data during freshwater injection

DOE PAGES

Kang, Peter K.; Lee, Jonghyun; Fu, Xiaojing; ...

2017-05-31

Managing recharge of freshwater into saline aquifers requires accurate estimation of the heterogeneous permeability field for maximizing injection and recovery efficiency. Here we present a methodology for subsurface characterization in saline aquifers that takes advantage of the density difference between the injected freshwater and the ambient saline groundwater. We combine high-resolution forward modeling of density-driven flow with an efficient Bayesian geostatistical inversion algorithm. In the presence of a density difference between the injected and ambient fluids due to differences in salinity, the pressure field is coupled to the spatial distribution of salinity. This coupling renders the pressure field transient: themore » time evolution of the salinity distribution controls the density distribution which then leads to a time-evolving pressure distribution. We exploit this coupling between pressure and salinity to obtain an improved characterization of the permeability field without multiple pumping tests or additional salinity measurements. We show that the inversion performance improves with an increase in the mixed convection ratio—the relative importance between viscous forces from injection and buoyancy forces from density difference. Thus, our work shows that measuring transient pressure data at multiple sampling points during freshwater injection into saline aquifers can be an effective strategy for aquifer characterization, key to the successful management of aquifer recharge.« less

Improved characterization of heterogeneous permeability in saline aquifers from transient pressure data during freshwater injection

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

Kang, Peter K.; Lee, Jonghyun; Fu, Xiaojing

Managing recharge of freshwater into saline aquifers requires accurate estimation of the heterogeneous permeability field for maximizing injection and recovery efficiency. Here we present a methodology for subsurface characterization in saline aquifers that takes advantage of the density difference between the injected freshwater and the ambient saline groundwater. We combine high-resolution forward modeling of density-driven flow with an efficient Bayesian geostatistical inversion algorithm. In the presence of a density difference between the injected and ambient fluids due to differences in salinity, the pressure field is coupled to the spatial distribution of salinity. This coupling renders the pressure field transient: themore » time evolution of the salinity distribution controls the density distribution which then leads to a time-evolving pressure distribution. We exploit this coupling between pressure and salinity to obtain an improved characterization of the permeability field without multiple pumping tests or additional salinity measurements. We show that the inversion performance improves with an increase in the mixed convection ratio—the relative importance between viscous forces from injection and buoyancy forces from density difference. Thus, our work shows that measuring transient pressure data at multiple sampling points during freshwater injection into saline aquifers can be an effective strategy for aquifer characterization, key to the successful management of aquifer recharge.« less

Reduced No.sub.x combustion method

DOEpatents

Delano, Mark A.

1991-01-01

A combustion method enabling reduced NO.sub.x formation wherein fuel and oxidant are separately injected into a combustion zone in a defined velocity relation, combustion gases are aspirated into the oxidant stream prior to intermixture with the fuel, and the fuel is maintained free from contact with oxygen until the intermixture.

Influence of the recycled material percentage on the rheological behaviour of HDPE for injection moulding process.

PubMed

Javierre, C; Clavería, I; Ponz, L; Aísa, J; Fernández, A

2007-01-01

The amount of polymer material wasted during thermoplastic injection moulding is very high. It comes from both the feed system of the part, and parts necessary to set up the mould, as well as the scrap generated along the process due to quality problems. The residues are managed through polymer recycling that allows reuse of the materials in the manufacturing injection process. Recycling mills convert the parts into small pieces that are used as feed material for injection, by mixing the recycled feedstock in different percentages with raw material. This mixture of both raw and recycled material modifies material properties according to the percentage of recycled material introduced. Some of the properties affected by this modification are those related to rheologic behaviour, which strongly conditions the future injection moulding process. This paper analyzes the rheologic behaviour of material with different percentages of recycled material by means of a capillary rheometer, and evaluates the influence of the corresponding viscosity curves obtained on the injection moulding process, where small variations of parameters related to rheological behaviour, such as pressure or clamping force, can be critical to the viability and cost of the parts manufactured by injection moulding.

Epidural steroid injections are useful for the treatment of low back pain and radicular symptoms: pro.

PubMed

Sethee, Jai; Rathmell, James P

2009-02-01

Epidural steroid injection has been used to treat low back pain for many decades. Numerous randomized trials have examined the efficacy of this approach. This review details the findings of older systematic reviews, newer randomized controlled trials, and two recent systematic reviews that examine the effectiveness of this treatment. Collectively, studies in acute radicular pain due to herniated nucleus pulposus have failed to show that epidural steroid injection reduces long-term pain or obviates the need for surgery. Similarly, there is scant evidence that epidural steroids have any beneficial effect in those with acute low back pain without leg pain or in those with chronic low back or leg pain. However, most studies have demonstrated more rapid resolution of leg pain in those who received epidural steroid injections versus those who did not. The role of epidural steroid injections in the management of acute radicular pain due to herniated nucleus pulposus is simply to provide earlier pain relief.

Estimated cases of blindness and visual impairment from neovascular age-related macular degeneration avoided in Australia by ranibizumab treatment.

PubMed

Mitchell, Paul; Bressler, Neil; Doan, Quan V; Dolan, Chantal; Ferreira, Alberto; Osborne, Aaron; Rochtchina, Elena; Danese, Mark; Colman, Shoshana; Wong, Tien Y

2014-01-01

Intravitreal injections of anti-vascular endothelial growth factor agents, such as ranibizumab, have significantly improved the management of neovascular age-related macular degeneration. This study used patient-level simulation modelling to estimate the number of individuals in Australia who would have been likely to avoid legal blindness or visual impairment due to neovascular age-related macular degeneration over a 2-year period as a result of intravitreal ranibizumab injections. The modelling approach used existing data for the incidence of neovascular age-related macular degeneration in Australia and outcomes from ranibizumab trials. Blindness and visual impairment were defined as visual acuity in the better-seeing eye of worse than 6/60 or 6/12, respectively. In 2010, 14,634 individuals in Australia were estimated to develop neovascular age-related macular degeneration who would be eligible for ranibizumab therapy. Without treatment, 2246 individuals would become legally blind over 2 years. Monthly 0.5 mg intravitreal ranibizumab would reduce incident blindness by 72% (95% simulation interval, 70-74%). Ranibizumab given as needed would reduce incident blindness by 68% (64-71%). Without treatment, 4846 individuals would become visually impaired over 2 years; this proportion would be reduced by 37% (34-39%) with monthly intravitreal ranibizumab, and by 28% (23-33%) with ranibizumab given as needed. These data suggest that intravitreal injections of ranibizumab, given either monthly or as needed, can substantially lower the number of cases of blindness and visual impairment over 2 years after the diagnosis of neovascular age-related macular degeneration.

Evolution of the Global Burden of Viral Infections from Unsafe Medical Injections, 2000–2010

PubMed Central

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

2014-01-01

Background In 2000, the World Health Organization estimated that, in developing and transitional countries, unsafe injections accounted for respectively 5%, 32% and 40% of new infections with HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV). Safe injection campaigns were organized worldwide. The present study sought to measure the progress in reducing the transmission of these viruses through unsafe injections over the subsequent decade. Methods A mass action model was updated, to recalculate the number of injection-related HIV, HCV and HBV infections acquired in 2000 and provide estimates for 2010. Data about the annual number of unsafe injections were updated. HIV prevalence in various regions in 2000 and 2010 were calculated from UNAIDS data. The ratio of HIV prevalence in healthcare settings compared to the general population was estimated from a literature review. Improved regional estimates of the prevalence of HCV seropositivity, HBsAg and HBeAg antigenemia were used for 2000 and 2010. For HIV and HCV, revised estimates of the probability of transmission per episode of unsafe injection were used, with low and high values allowing sensitivity analyses. Results Despite a 13% population growth, there was a reduction of respectively 87% and 83% in the absolute numbers of HIV and HCV infections transmitted through injections. For HBV, the reduction was more marked (91%) due to the additional impact of vaccination. While injections-related cases had accounted for 4.6%–9.1% of newly acquired HIV infections in 2000, this proportion decreased to 0.7%–1.3% in 2010, when unsafe injections caused between 16,939 and 33,877 HIV infections, between 157,592 and 315,120 HCV infections, and 1,679,745 HBV infections. Conclusion From 2000 to 2010, substantial progress was made in reducing the burden of HIV, HCV and HBV infections transmitted through injections. In some regions, their elimination might become a reasonable public health goal. PMID:24911341

Adventitial nab-rapamycin injection reduces porcine femoral artery luminal stenosis induced by balloon angioplasty via inhibition of medial proliferation and adventitial inflammation.

PubMed

Gasper, Warren J; Jimenez, Cynthia A; Walker, Joy; Conte, Michael S; Seward, Kirk; Owens, Christopher D

2013-12-01

Endovascular interventions on peripheral arteries are limited by high rates of restenosis. Our hypothesis was that adventitial injection of rapamycin nanoparticles would be safe and reduce luminal stenosis in a porcine femoral artery balloon angioplasty model. Eighteen juvenile male crossbred swine were included. Single-injury (40%-60% femoral artery balloon overstretch injury; n=2) and double-injury models (endothelial denudation injury 2 weeks before a 20%-30% overstretch injury; n=2) were compared. The double-injury model produced significantly more luminal stenosis at 28 days, P=0.002, and no difference in medial fibrosis or inflammation. Four pigs were randomized to the double-injury model and adventitial injection of saline (n=2) or 500 μg of nanoparticle albumin-bound rapamycin (nab-rapamycin; n=2) with an endovascular microinfusion catheter. There was 100% procedural success and no difference in endothelial regeneration. At 28 days, nab-rapamycin led to significant reductions in luminal stenosis, 17% (interquartile range, 12%-35%) versus 10% (interquartile range, 8.3%-14%), P=0.001, medial cell proliferation, P<0.001, and fibrosis, P<0.001. There were significantly fewer adventitial leukocytes at 3 days, P<0.001, but no difference at 28 days. Pharmacokinetic analysis (single-injury model) found rapamycin concentrations 1500× higher in perivascular tissues than in blood at 1 hour. Perivascular rapamycin persisted ≥8 days and was not detectable at 28 days. Adventitial nab-rapamycin injection was safe and significantly reduced luminal stenosis in a porcine femoral artery balloon angioplasty model. Observed reductions in early adventitial leukocyte infiltration and late medial cell proliferation and fibrosis suggest an immunosuppressive and antiproliferative mechanism. An intraluminal microinfusion catheter for adventitial injection represents an alternative to stent- or balloon-based local drug delivery.

Topical glycopyrrolate reduces axillary hyperhidrosis.

PubMed

Baker, D M

2016-12-01

Oral anti-cholinergic medications reduce generalized hyperhidrosis, but the effectiveness of topical anticholinergic solutions on axillary hyperhidrosis is unclear. This study determines the initial effectiveness of 1% and 2% topical glycopyrrolate spray and compares this with Botulinum toxin type A injections for the management of axillary hyperhidrosis. In a non-randomized, consecutive patient, prospective questionnaire, treatment comparison study, 40 patients with axillary hyperhidrosis were allocated to one of four study groups (10 patients to each group): (a) 1% glycopyrrolate spray, (b) 2% glycopyrrolate spray, (c) subcutaneous Botulinum toxin type A injections, (d) no treatment. Clinical outcomes were measured by comparing a prospectively administered questionnaire, completed both pre-treatment and 6 weeks after starting treatment. Forty healthy volunteers without axillary hyperhidrosis completed the same questionnaire. The three treatment groups showed a significant (P < 0.05) improvement in their hyperhidrosis scores following treatment. The degree of improvement was less for the 1% glycopyrrolate group when compared with the Botulinum toxin type A group (P < 0.05), but there was no difference in treatment outcomes between the 2% glycopyrrolate and Botulinum toxin type A groups. No treatment group experienced reduced hyperhidrosis to a level similar to those without hyperhidrosis. Patients in both, the 2% glycopyrrolate and Botulinum toxin type A groups reported a significant improvement in axillary hyperhidrosis symptoms. These included reduction in psychologically precipitating factors (e.g. public speaking) and axillary hyperhidrosis-specific physical effects (e.g. limitation of clothing choice). Topical glycopyrrolate spray could provide a further treatment modality to manage axillary hyperhidrosis. © 2016 European Academy of Dermatology and Venereology.

The Climate Response to Stratospheric Aerosol Geoengineering Can Be Tailored Using Multiple Injection Locations

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

MacMartin, Douglas G.; Kravitz, Ben; Tilmes, Simone

The climate response to geoengineering with stratospheric aerosols has the potential to be designed to achieve some chosen objectives. By injecting different amounts of SO2 at multiple different latitudes, the spatial pattern of aerosol optical depth (AOD) can be partially controlled. We use simulations from the fully-coupled whole-atmosphere chemistry-climate model CESM1(WACCM), to demonstrate that three spatial degrees of freedom of AOD can be achieved by appropriately combining injection at different locations: an approximately spatially-uniform AOD distribution, the relative difference in AOD between Northern and Southern hemispheres, and the relative AOD in high versus low latitudes. For forcing levels that yieldmore » 1–2°C cooling, the AOD and surface temperature response are sufficiently linear in this model so that many climate effects can be predicted from single-latitude injection simulations. Optimized injection at multiple locations is predicted to improve compensation of CO2-forced climate change, relative to a case using only equatorial aerosol injection. The additional degrees of freedom can be used, for example, to balance interhemispheric temperature differences and the equator to pole temperature difference in addition to the global mean temperature; this is projected in this model to reduce the mean-square error in temperature compensation by 30%.« less

A well-tolerated grass pollen-specific allergy vaccine containing a novel adjuvant, monophosphoryl lipid A, reduces allergic symptoms after only four preseasonal injections.

PubMed

Drachenberg, K J; Wheeler, A W; Stuebner, P; Horak, F

2001-06-01

We present data showing that a Th1-inducing adjuvant can reduce the number of injections required for allergy vaccination. Allergy vaccination is the only treatment for type 1 hypersensitivity that can alter the underlying disease process. A switch of specific T-cell activity from Th2 >Th1 to Th1 >Th2 is believed to be an important change seen after long-term vaccination therapy. An immunologic adjuvant that enhances such a switch could be used to reduce the number of injections required. This would improve compliance with the treatment and provide pharmacoeconomic advantages. Such an adjuvant is 3-deacylated monophosphoryl lipid A (MPL adjuvant, Corixa). A multicentre, placebo-controlled, randomized, double-blind clinical study was performed with a new standardized allergy vaccine comprising a tyrosine-adsorbed glutaraldehyde-modified grass pollen extract containing MPL adjuvant. Four subcutaneous injections of the active product were given preseasonally to 81 grass pollen-sensitive subjects, and 60 received placebo injections (tyrosine alone). Diary cards were used to record symptoms and medication taken during approximately 30 days of the grass pollen season. There was a statistical advantage in favour of the active treatment for nasal (P = 0.016) and ocular (P = 0.003) symptoms and combined symptom and medication scores (P=0.013). Titrated skin prick testing revealed a significant reduction of skin sensitivity in the active group compared to placebo (P = 0.04). Grass-pollen-specific IgG antibody was raised by active treatment (P < 0.01). A rise in IgE antibody was seen in the placebo group during the season (P < 0.01). The first year's treatment rise of IgE was not seen in the active group, and no rise occurred during the pollen season. More local adverse events were seen in the active group. There was no difference in generalized adverse events. A new, well-tolerated allergy vaccine, incorporating a Th1-inducing adjuvant, MPL, was efficacious and after only

Pain and pain management in haemophilia

PubMed Central

Auerswald, Günter; Dolan, Gerry; Duffy, Anne; Hermans, Cedric; Jiménez-Yuste, Victor; Ljung, Rolf; Morfini, Massimo; Lambert, Thierry; Šalek, Silva Zupančić

2016-01-01

Joint pain is common in haemophilia and may be acute or chronic. Effective pain management in haemophilia is essential to reduce the burden that pain imposes on patients. However, the choice of appropriate pain-relieving measures is challenging, as there is a complex interplay of factors affecting pain perception. This can manifest as differences in patients’ experiences and response to pain, which require an individualized approach to pain management. Prophylaxis with factor replacement reduces the likelihood of bleeds and bleed-related pain, whereas on-demand therapy ensures rapid bleed resolution and pain relief. Although use of replacement or bypassing therapy is often the first intervention for pain, additional pain relief strategies may be required. There is an array of analgesic options, but consideration should be paid to the adverse effects of each class. Nevertheless, a combination of medications that act at different points in the pain pathway may be beneficial. Nonpharmacological measures may also help patients and include active coping strategies; rest, ice, compression, and elevation; complementary therapies; and physiotherapy. Joint aspiration may also reduce acute joint pain, and joint steroid injections may alleviate chronic pain. In the longer term, increasing use of prophylaxis or performing surgery may be necessary to reduce the burden of pain caused by the degenerative effects of repeated bleeds. Whichever treatment option is chosen, it is important to monitor pain and adjust patient management accordingly. Beyond specific pain management approaches, ongoing collaboration between multidisciplinary teams, which should include physiotherapists and pain specialists, may improve outcomes for patients. PMID:27439216

A TYPOLOGY OF DRUG-RELATED OFFENDING AMONG YOUNG HOMELESS INJECTION DRUG USERS

PubMed Central

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

2011-01-01

Research indicates a link between drug use and offending, particularly amongst high-risk individuals, such as homeless youth. The extent to which such youth interpret their offending as being related to their drug use, though, is understudied. This manuscript investigates the interpretations of drug-related offenses offered by 151 primarily white, male, homeless IDUs aged 16–29 years. Youth were asked specific questions about their drug-related offenses during in-depth interviews as part of a larger study investigating health risks surrounding drug injection between 2004 and 2006. The first section of the manuscript outlines offenses youth revealed committing either in pursuit of or after using a variety of substances. The second part of the manuscript examines the overall context (motivation, environment), and provides a seven-tiered typology of drug-related offending based on youth's interpretations, linking certain drugs to specific offenses within particular contexts. From here, some theoretical and practical implications of the findings are discussed. PMID:21423855

Use of abdominal field block injections with liposomal bupivicaine to control postoperative pain after abdominoplasty.

PubMed

Morales, Rolando; Mentz, Henry; Newall, Germán; Patronella, Christopher; Masters, Oscar

2013-11-01

It is well known that improving postoperative pain control in plastic surgery procedures leads to earlier mobilization, shortened hospital stay, reduced hospital costs, and increased patient satisfaction. The authors evaluate the use of abdominal field block injections with liposomal bupivicaine (Exparel; Pacira Pharmaceuticals, Inc, San Diego, California) in postoperative pain management in patients undergoing abdominoplasty with rectus plication. Case records from 64 female patients who underwent abdominoplasty with rectus plication were reviewed. We performed a total of 118 abdominoplasties with rectus plication, alone or in combination with other surgical procedures, from August 2012 to December 2012, but 54 patients were excluded from the series due to inadequate follow-up. Patients received liposomal bupivicaine injections in an abdominal field block fashion. Patient age, height, weight, and smoking status were recorded. Delivery of standardized postoperative intramuscular or intravenous injections and oral pain pills was recorded. Postoperative data and questionnaires were used to evaluate clinical efficacy. The average number of procedures (including abdominoplasty with rectus plication) per patient was 7. Average patient body mass index was 27 kg/m(2). Average pain scores were 3.5 (postoperative visit 1) and 2.8 (visit 2). The average number of oral pain pills required was 14 at the first postoperative visit and 11.5 at the second postoperative visit. Patients were able to resume normal activity at an average of 6.4 days. Our experience with liposomal bupivicaine injections for regional blocks in abdominoplasty with rectus plication indicates that patients experienced reduced postoperative pain, required less postoperative narcotic medication, and resumed both earlier ambulation and normal activity. Further investigation is warranted with more clinical cases to recommend the use of this medication for routine pain management after an abdominoplasty.

Legal space for syringe exchange programs in hot spots of injection drug use-related crime.

PubMed

Allen, Sean T; Ruiz, Monica S; Jones, Jeff; Turner, Monique M

2016-04-26

Copious evidence indicates that syringe exchange programs (SEPs) are effective structural interventions for HIV prevention among persons who inject drugs (PWID). The efficacy of SEPs in supporting the public health needs of PWID populations is partially dependent on their accessibility and consistent utilization among injectors. Research has shown that SEP access is an important predictor of PWID retention at SEPs, yet policies exist that may limit the geographic areas where SEP operations may legally occur. Since 2000 in the District of Columbia (DC), SEP operations have been subject to the 1000 Foot Rule (§48-1121), a policy that prohibits the distribution of "any needle or syringe for the hypodermic injection of any illegal drug in any area of the District of Columbia which is within 1000 feet of a public or private elementary or secondary school (including a public charter school)." The 1000 Foot Rule may impede SEP services in areas that are in urgent need for harm reduction services, such as locations where injections are happening in "real time" or where drugs are purchased or exchanged. We examined the effects of the 1000 Foot Rule on SEP operational space in injection drug use (IDU)-related crime (i.e., heroin possession or distribution) hot spots from 2000 to 2010. Data from the DC Metropolitan Police Department were used to identify IDU-related crime hot spots. School operation data were matched to a dataset that described the approximate physical property boundaries of land parcels. A 1000-ft buffer was applied to all school property boundaries. The overlap between the IDU-related crime hot spots and the school buffer zones was calculated by academic year. When overlaying the land space associated with IDU-related crime hot spots on the maps of school boundaries per the 1000-ft buffer zone stipulation, we found that the majority of land space in these locations was ineligible for legal SEP operations. More specifically, the ineligible space in the

Peer-Assisted Leadership: Reducing Educational Managers' Professional Isolation.

ERIC Educational Resources Information Center

Dussault, Marc; Barnett, Bruce G.

1996-01-01

Presents a study that verified the effects of the peer-assisted leadership program (PAL) on communication networks and professional isolation of 41 Quebec educational managers, using a one-group pretest posttest design. Results showed that PAL significantly reduced professional isolation without widening participants' communication networks. (34…

Injecting drug users in Scotland, 2006: Listing, number, demography, and opiate-related death-rates.

PubMed

King, Ruth; Bird, Sheila M; Overstall, Antony; Hay, Gordon; Hutchinson, Sharon J

2013-06-01

Using Bayesian capture-recapture analysis, we estimated the number of current injecting drug users (IDUs) in Scotland in 2006 from the cross-counts of 5670 IDUs listed on four data-sources: social enquiry reports (901 IDUs listed), hospital records (953), drug treatment agencies (3504), and recent Hepatitis C virus (HCV) diagnoses (827 listed as IDU-risk). Further, we accessed exact numbers of opiate-related drugs-related deaths (DRDs) in 2006 and 2007 to improve estimation of Scotland's DRD rates per 100 current IDUs. Using all four data-sources, and model-averaging of standard hierarchical log-linear models to allow for pairwise interactions between data-sources and/or demographic classifications, Scotland had an estimated 31700 IDUs in 2006 (95% credible interval: 24900-38700); but 25000 IDUs (95% CI: 20700-35000) by excluding recent HCV diagnoses whose IDU-risk can refer to past injecting. Only in the younger age-group (15-34 years) were Scotland's opiate-related DRD rates significantly lower for females than males. Older males' opiate-related DRD rate was 1.9 (1.24-2.40) per 100 current IDUs without or 1.3 (0.94-1.64) with inclusion of recent HCV diagnoses. If, indeed, Scotland had only 25000 current IDUs in 2006, with only 8200 of them aged 35+ years, the opiate-related DRD rate is higher among this older age group than has been appreciated hitherto. There is counter-balancing good news for the public health: the hitherto sharp increase in older current IDUs had stalled by 2006.

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

Potential concerns for tree response from stem injection

Treesearch

Kevin T. Smith; Phillip A. Lewis

2005-01-01

Stem injection of imidacloprid is an available component of management strategies for hemlock woolly adelgid. Preliminary observations of similar treatments of maple and ash show that the injury sustained by injection warrants investigation of the wound response in eastern hemlock. Such investigations need adequate experimental controls to identify the role of...

Persisting stigma reduces the utilisation of HIV-related care and support services in Viet Nam.

PubMed

Thanh, Duong Cong; Moland, Karen Marie; Fylkesnes, Knut

2012-11-25

Seeking and utilisation of HIV prevention, treatment, care, and support services for people living with HIV is often hampered by HIV-related stigma. The study aimed to explore the perceptions and experiences regarding treatment, care, and support amongst people living with HIV in Viet Nam, where the HIV epidemic is concentrated among injecting drug users, sex workers, and men who have sex with men. In-depth interviews and focus group discussions were conducted during September 2007 in 6 districts in Hai Phong with a very high HIV prevalence among injecting drug users. The information obtained was analysed and merged within topic areas. Illustrative quotes were selected. Stigma and discrimination against people living with HIV in the community and healthcare settings was commonly reported, and substantially hampered the seeking and the utilisation of HIV-related services. The informants related the high level of stigma to the way the national HIV preventive campaigns played on fear, by employing a "scare tactic" mainly focusing on drug users and sex workers, who were defined as "social evils" in the anti-drug and anti-prostitution policy. There was a strong exclusion effect caused by the stigma, with serious implications, such as loss of job opportunities and isolation. The support and care provided by family members was experienced as vital for the spirit and hope for the future among people living with HIV. A comprehensive care and support programme is needed. The very high levels of stigma experienced seem largely to have been created by an HIV preventive scare tactic closely linked to the "social evil" approach in the national policy on drug and prostitution. In order to reduce the stigma and create more effective interventions, this tactic will have to be replaced with approaches that create better legal and policy environments for drug users and sex workers.

Platelet-rich plasma injection reduces pain in patients with recalcitrant epicondylitis.

PubMed

Hechtman, Keith S; Uribe, John W; Botto-vanDemden, Angie; Kiebzak, Gary M

2011-01-01

Thirty patients (31 elbows) with epicondylitis unresponsive to nonsurgical treatment (including steroid injection) for >6 months received a single treatment of platelet-rich plasma injected with a peppering technique. Patients were followed using a 5-subcategory visual analog scale (VAS) for pain (0, no pain; 10, worst possible pain), modified American Shoulder and Elbow Surgeons assessment survey, and VAS for patient satisfaction (0, not at all satisfied; 10, very satisfied). Successful treatment was defined as a 25% decrease in worst pain at follow-up with no intervention after 1 year. Two patients (2 elbows) elected for surgery 1 month postinjection. Of the remaining 29 elbows followed, 28 had a 25% reduction in worst pain at ≥1 follow-up visits, for an overall success rate of 90% (28 of 31 elbows). Mean scores for worst pain at baseline, 3 months, and last follow-up (patients with at least 6 months of follow-up; 25±14 months) were 7.2±1.6 (n=30 elbows), 4.0±2.2 (n=23), and 1.1±1.7 (n=26), respectively (P<.01 or less comparing follow-up scores to baseline using each patient as his or her own control). Patient satisfaction scores improved from 5.1±2.5 at 1 month to 9.1±1.9 at last follow-up (P<.01). Only 1 patient reported no improvement after 6 months. Results suggest that a single platelet-rich plasma injection can improve pain and function scores, thus avoiding surgery. Copyright 2011, SLACK Incorporated.

Summary of findings from the evaluation of a pilot medically supervised safer injecting facility

PubMed Central

Wood, Evan; Tyndall, Mark W.; Montaner, Julio S.; Kerr, Thomas

2006-01-01

In many cities, infectious disease and overdose epidemics are occurring among illicit injection drug users (IDUs). To reduce these concerns, Vancouver opened a supervised safer injecting facility in September 2003. Within the facility, people inject pre-obtained illicit drugs under the supervision of medical staff. The program was granted a legal exemption by the Canadian government on the condition that a 3-year scientific evaluation of its impacts be conducted. In this review, we summarize the findings from evaluations in those 3 years, including characteristics of IDUs at the facility, public injection drug use and publicly discarded syringes, HIV risk behaviour, use of addiction treatment services and other community resources, and drug-related crime rates. Vancouver's safer injecting facility has been associated with an array of community and public health benefits without evidence of adverse impacts. These findings should be useful to other cities considering supervised injecting facilities and to governments considering regulating their use. PMID:17116909

Contributions of Abiotic and Biotic Dechlorination Following Carboxymethyl Cellulose Stabilized Nanoscale Zero Valent Iron Injection.

PubMed

Kocur, Chris M D; Lomheim, Line; Boparai, Hardiljeet K; Chowdhury, Ahmed I A; Weber, Kela P; Austrins, Leanne M; Edwards, Elizabeth A; Sleep, Brent E; O'Carroll, Denis M

2015-07-21

A pilot scale injection of nanoscale zerovalent iron (nZVI) stabilized with carboxymethyl cellulose (CMC) was performed at an active field site contaminated with a range of chlorinated volatile organic compounds (cVOC). The cVOC concentrations and microbial populations were monitored at the site before and after nZVI injection. The remedial injection successfully reduced parent compound concentrations on site. A period of abiotic degradation was followed by a period of enhanced biotic degradation. Results suggest that the nZVI/CMC injection created conditions that stimulated the native populations of organohalide-respiring microorganisms. The abundance of Dehalococcoides spp. immediately following the nZVI/CMC injection increased by 1 order of magnitude throughout the nZVI/CMC affected area relative to preinjection abundance. Distinctly higher cVOC degradation occurred as a result of the nZVI/CMC injection over a 3 week evaluation period when compared to control wells. This suggests that both abiotic and biotic degradation occurred following injection.

Organization of pERK-immunoreactive cells in trigeminal spinal nucleus caudalis, upper cervical cord, NTS and Pa5 following capsaicin injection into masticatory and swallowing-related muscles in rats.

PubMed

Tsujimura, Takanori; Shinoda, Masamichi; Honda, Kuniya; Hitomi, Suzuro; Kiyomoto, Masaaki; Matsuura, Shingo; Katagiri, Ayano; Tsuji, Kojun; Inoue, Makoto; Shiga, Yoshi; Iwata, Koichi

2011-10-12

Many phosphorylated extracellular signal-regulated kinase (pERK)-immunoreactive (IR) cells are expressed in the trigeminal spinal subnucleus caudalis (Vc), upper cervical spinal cord (C1-C2), nucleus tractus solitarii (NTS) and paratrigeminal nucleus (Pa5) after capsaicin injection into the whisker pad (WP), masseter muscle (MM), digastric muscle (DM) or sternohyoideus muscle (SM). The pERK-IR cells also showed NeuN immunoreactivity, indicating that ERK phosphorylation occurs in neurons. The pERK-IR cells were significantly reduced after intrathecal injection of MEK 1/2 inhibitor PD98059. The pERK-IR cells expressed bilaterally in the Vc and C1-C2 after capsaicin injection into the unilateral DM or SM, whereas unilaterally in the Vc and C1-C2 after unilateral WP or MM injection. After capsaicin injection into the WP or MM, the pERK-IR cell expression in the Vc was restricted rostrocaudally within a narrow area. However, the distribution of pERK-IR cells was more wide spread without a clear peak in the Vc and C1-C2 after capsaicin injection into the DM or SM. In the NTS, the unimodal pERK-IR cell expression peaked at 0-720μm rostral from the obex following capsaicin injection into WP, MM, DM or SM. In the ipsilateral Pa5, many pERK-IR cells were observed following capsaicin injection into the SM. The number of swallows elicited by distilled water administration was significantly smaller after capsaicin injection into the WP, MM or DM but not SM compared to that of vehicle-injected rats. Various noxious inputs due to the masticatory or swallowing-related muscle inflammation may be differentially involved in muscle pain and swallowing reflex activity. Copyright © 2011 Elsevier B.V. All rights reserved.

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 association between neighborhood socioeconomic disadvantage and high-risk injection behavior among people who inject drugs.

PubMed

DeCuir, Jennifer; Lovasi, Gina S; El-Sayed, Abdulrahman; Lewis, Crystal Fuller

2018-02-01

Although much research has been conducted on the determinants of HIV risk behavior among people who inject drugs (PWID), the influence of the neighborhood context on high-risk injection behavior remains understudied. To address this gap in the literature, we measured associations between neighborhood socioeconomic disadvantage and high-risk injection behavior, and determined whether these associations were modified by drug-related police activity and syringe exchange program (SEP) accessibility. Our sample was comprised of 484 pharmacy-recruited PWID in New York City. Measures of neighborhood socioeconomic disadvantage were created using data from the 2006-2010 American Community Survey. Associations with high-risk injection behavior were estimated using multivariable Poisson regression. Effect modification by drug-related police activity and SEP accessibility was assessed by entering cross-product terms into adjusted models of high-risk injection behavior. Neighborhood socioeconomic disadvantage was associated with decreased receptive syringe sharing and unsterile syringe use. In neighborhoods with high drug-related police activity, associations between neighborhood disadvantage and unsterile syringe use were attenuated to the null. In neighborhoods with high SEP accessibility, neighborhood disadvantage was associated with decreased acquisition of syringes from an unsafe source. PWID in disadvantaged neighborhoods reported safer injection behaviors than their counterparts in neighborhoods that were relatively better off. The contrasting patterns of effect modification by SEP accessibility and drug-related police activity support the use of harm reduction approaches over law enforcement-based strategies for the control of blood borne virus transmission among PWID in disadvantaged urban areas. Copyright © 2017 Elsevier B.V. All rights reserved.

Injection molding ceramics to high green densities

NASA Technical Reports Server (NTRS)

Mangels, J. A.; Williams, R. M.

1983-01-01

The injection molding behavior of a concentrated suspension of Si powder in wax was studied. It was found that the injection molding behavior was a function of the processing techniques used to generate the powder. Dry ball-milled powders had the best molding behavior, while air classified and impact-milled powders demonstrated poorer injection moldability. The relative viscosity of these molding batches was studied as a function of powder properties: distribution shape, surface area, packing density, and particle morphology. The experimental behavior, in all cases, followed existing theories. The relative viscosity of an injection molding composition composed of dry ball-milled powders could be expressed using Farris' relation.

Multi-faceted case management: reducing compensation costs of musculoskeletal work injuries in Australia.

PubMed

Iles, Ross Anthony; Wyatt, M; Pransky, G

2012-12-01

This study aimed to determine whether a multi-faceted model of management of work related musculoskeletal disorders reduced compensation claim costs and days of compensation for injured workers. An intervention including early reporting, employee centred case management and removal of barriers to return to work was instituted in 16 selected companies with a combined remuneration over $337 million. Outcomes were evaluated by an administrative dataset from the Victorian WorkCover Authority database. A 'quasi experimental' pre-post design was employed with 492 matched companies without the intervention used as a control group and an average of 21 months of post-intervention follow-up. Primary outcomes were average number of days of compensation and average cost of claims. Secondary outcomes were total medical costs and weekly benefits paid. Information on 3,312 claims was analysed. In companies where the intervention was introduced the average cost of claims was reduced from $6,019 to $3,913 (estimated difference $2,329, 95 % CI $1,318-$3,340) and the number of days of compensation decreased from 33.5 to 14.1 (HR 0.77, 95 % CI 0.67-0.88). Medical costs and weekly benefits costs were also lower after the intervention (p < 0.05). Reduction in claims costs were noted across industry types, injury location and most employer sizes. The model of claims management investigated was effective in reducing the number of days of compensation, total claim costs, total medical costs and the amount paid in weekly benefits. Further research should investigate whether the intervention improves non-financial outcomes in the return to work process.

Managing a subsidized predator population: Reducing common raven predation on desert tortoises

USGS Publications Warehouse

Boarman, W.I.

2003-01-01

Human communities often are an inadvertent source of food, water, and other resources to native species of wildlife. Because these resources are more stable and predictable than those in a natural environment, animals that subsist on them are able to increase in numbers and expand their range, much to the detriment of their competitors and species they prey upon. In the Mojave Desert, common ravens (Corvus corax) have benefited from human-provided resources to increase in population size precipitously in recent years. This trend has caused concern because ravens prey on juvenile desert tortoises (Gopherus agassizii), a federally threatened species. In this paper, I discuss management strategies to reduce raven predation on desert tortoises. The recommendations fall into three categories: (1) managing raven populations by reducing access to anthropogenic resources; (2) removing offending ravens or other birds in specially targeted tortoise management zones; and (3) continuing research on raven ecology, raven behavior, and methods of reducing raven predation on tortoises. I also recommend approaching the problem within an adaptive management framework: management efforts should first be employed as scientific experiments - with replicates and controls - to yield an unbiased assessment of their effectiveness. Furthermore, these strategies should be implemented in concert with actions that reduce other causes of desert tortoise mortality to aid the long-term recovery of their populations. Overall, the approaches outlined in this paper are widely applicable to the management of subsidized predators, particularly where they present a threat to a declining species of prey.

Prospective, Multicenter, Randomized, Crossover Clinical Trial Comparing the Safety and Effectiveness of Cooled Radiofrequency Ablation With Corticosteroid Injection in the Management of Knee Pain From Osteoarthritis.

PubMed

Davis, Tim; Loudermilk, Eric; DePalma, Michael; Hunter, Corey; Lindley, David; Patel, Nilesh; Choi, Daniel; Soloman, Marc; Gupta, Anita; Desai, Mehul; Buvanendran, Asokumar; Kapural, Leonardo

2018-01-01

Osteoarthritis (OA) of the knee affects the aging population and has an associated influence on the health care system. Rigorous studies evaluating radiofrequency ablation for OA-related knee pain are lacking. This study compared long-term clinical safety and effectiveness of cooled radiofrequency ablation (CRFA) with intra-articular steroid (IAS) injection in managing OA-related knee pain. This is a prospective, multicenter, randomized trial with 151 subjects with chronic (≥6 months) knee pain that was unresponsive to conservative modalities. Knee pain (Numeric Rating Scale [NRS]), Oxford Knee Score, overall treatment effect (Global Perceived Effect), analgesic drug use, and adverse events were compared between CRFA and IAS cohorts at 1, 3, and 6 months after intervention. There were no differences in demographics between study groups. At 6 months, the CRFA group had more favorable outcomes in NRS: pain reduction 50% or greater: 74.1% versus 16.2%, P < 0.0001 (25.9% and 83.8% of these study cohorts, respectively, were nonresponders). Mean NRS score reduction was 4.9 ± 2.4 versus 1.3 ± 2.2, P < 0.0001; mean Oxford Knee Score was 35.7 ± 8.8 vs 22.4 ± 8.5, P < 0.0001; mean improved Global Perceived Effect was 91.4% vs 23.9%, P < 0.0001; and mean change in nonopioid medication use was CRFA > IAS (P = 0.02). There were no procedure-related serious adverse events. This study demonstrates that CRFA is an effective long-term therapeutic option for managing pain and improving physical function and quality of life for patients with painful knee OA when compared with IAS injection. ClinicalTrials.gov (NCT02343003).

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.

Discontinuation rates and inter-injection interval for repeated intravesical botulinum toxin type A injections for detrusor overactivity.

PubMed

Veeratterapillay, Rajan; Harding, Chris; Teo, Luke; Vasdev, Nikhil; Abroaf, Ahmed; Dorkin, Trevor J; Pickard, Robert S; Hasan, Tahseen; Thorpe, Andrew C

2014-02-01

To report discontinuation rates, inter-injection interval and complication rates after repeated intravesical botulinum toxin type A for the treatment of detrusor overactivity. Patients with urodyamically proven detrusor overactivity who had two or more botulinum toxin type A injections in the period 2004-2011 at Freeman Hospital, Newcastle Upon Tyne, UK, were considered for the present study. Discontinuation rates, complication rates and interval between botulinum toxin type A treatments were retrospectively analyzed. Overall, 125 patients (median age 53 years, range 19-83 years) were included in the analysis. The female-to-male ratio was 2.4:1 and median follow up was 38 months. A total of 96 patients had idiopathic detrusor overactivity, whereas 29 had neurogenic detrusor overactivity. A total of 667 injections were carried out, with 125 patients receiving two injections, 60 receiving three injections, 28 receiving four injections, 14 receiving five injections, three receiving six injections, three receiving seven injections and two receiving eight injections. The mean interval (±standard deviation) between the first and second injection (n = 125) was 17.6 months (±10.4), between the second and third (n = 60) was 15.7 ± 7.4 months, between the third and fourth (n = 28) was 15.4 ± 8.6 months, and between the fourth and subsequent injections (n = 22) was 11.6 ± 4.5 months. A total of 26% required intermittent catheterization, and 18% developed recurrent urinary tract infections. There was a discontinuation rate of 25% at 60 months. Repeated botulinum toxin type A injections represent a safe and effective method for managing patients with idiopathic detrusor overactivity and neurogenic detrusor overactivity. We have shown that the inter-injection interval remains unchanged up to five injections. © 2013 The Japanese Urological Association.

[Developing traditional Chinese medicine injection is the need for curing sickness to save patients].

PubMed

He, Ping; Li, Feng-Jie; Li, Lian-da; Li, Yi-Kui

2017-03-01

Safety issues of traditional Chinese medicine injections has been heated debate. There are two diametrically opposed views: it should be used reasonable and developed healthily or be forbidden to use. Some people have many misunderstandings and prejudices about the safety of traditional Chinese medicine injections. Compared with western medicine,traditional Chinese medicine has its own particularity. Traditional Chinese medicine has complex components. Its research and clinical application is different from western medicine. Adverse reactions of traditional Chinese medicine injections are related to many factors,such as a large number of irrational use,blind use of traditional Chinese medicine injections and western medicine injections,counterfeit and substandard drugs,incorrect methods of intravenous infusion,toxicity of supplementary materials,drug ingredients. Developing traditional Chinese medicine injection is the need for curing sickness to save patients. The purposeful, targeted, organized and planned systematic research of traditional Chinese medicine injections should be strengthened,especially the safety of traditional Chinese medicine. Strengthen supervision and control of rational drug use.Strengthen the examination and approval,supervision and management of all aspects to ensure the safety of patients. Copyright© by the Chinese Pharmaceutical Association.

Endoscopic injection therapy.

PubMed

Kim, Sang Woon; Lee, Yong Seung; Han, Sang Won

2017-06-01

Since the U.S. Food and Drug Administration approved dextranomer/hyaluronic acid copolymer (Deflux) for the treatment of vesicoureteral reflux, endoscopic injection therapy using Deflux has become a popular alternative to open surgery and continuous antibiotic prophylaxis. Endoscopic correction with Deflux is minimally invasive, well tolerated, and provides cure rates approaching those of open surgery (i.e., approximately 80% in several studies). However, in recent years a less stringent approach to evaluating urinary tract infections (UTIs) and concerns about long-term efficacy and complications associated with endoscopic injection have limited the use of this therapy. In addition, there is little evidence supporting the efficacy of endoscopic injection therapy in preventing UTIs and vesicoureteral reflux-related renal scarring. In this report, we reviewed the current literature regarding endoscopic injection therapy and provided an updated overview of this topic.

Computerized Dental Injection Fear Treatment

PubMed Central

Heaton, L.J.; Leroux, B.G.; Ruff, P.A.; Coldwell, S.E.

2013-01-01

One in four adults reports a clinically significant fear of dental injections, leading many to avoid dental care. While systematic desensitization is the most common therapeutic method for treating specific phobias such as fear of dental injections, lack of access to trained therapists, as well as dentists’ lack of training and time in providing such a therapy, means that most fearful individuals are not able to receive the therapy needed to be able to receive necessary dental treatment. Computer Assisted Relaxation Learning (CARL) is a self-paced computerized treatment based on systematic desensitization for dental injection fear. This multicenter, block-randomized, dentist-blind, parallel-group study conducted in 8 sites in the United States compared CARL with an informational pamphlet in reducing fear of dental injections. Participants completing CARL reported significantly greater reduction in self-reported general and injection-specific dental anxiety measures compared with control individuals (p < .001). Twice as many CARL participants (35.3%) as controls (17.6%) opted to receive a dental injection after the intervention, although this was not statistically significant. CARL, therefore, led to significant changes in self-reported fear in study participants, but no significant differences in the proportion of participants having a dental injection (ClinicalTrials.gov, NCT00609648). PMID:23690352

30 CFR 250.118 - Will MMS approve gas injection?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 250.118 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS... injection of gas. (b) The Regional Supervisor will approve gas injection applications that: (1) Enhance recovery; (2) Prevent flaring of casinghead gas; or (3) Implement other conservation measures approved by...

Lethal trap trees: a potential option for emerald ash borer (Agrilus planipennis Fairmaire) management.

PubMed

McCullough, Deborah G; Poland, Therese M; Lewis, Phillip A

2016-05-01

Economic and ecological impacts of ash (Fraxinus spp.) mortality resulting from emerald ash borer (EAB) (Agrilus planipennis Fairmaire) invasion are severe in forested, residential and urban areas. Management options include girdling ash trees to attract ovipositing adult beetles and then destroying infested trees before larvae develop or protecting ash with a highly effective, systemic emamectin benzoate insecticide. Injecting this insecticide and then girdling injected trees a few weeks later could effectively create lethal trap trees, similar to a bait-and-kill tactic, if girdling does not interfere with insecticide translocation. We compared EAB larval densities on girdled trees, trees injected with the emamectin benzoate insecticide, trees injected with the insecticide and then girdled 18-21 days later and untreated controls at multiple sites. Pretreatment larval densities did not differ among treatments. Current-year larval densities were higher on girdled and control trees than on any trees treated with insecticide at all sites. Foliar residue analysis and adult EAB bioassays showed that girdling trees after insecticide injections did not reduce insecticide translocation. Girdling ash trees to attract adult EAB did not reduce efficacy of emamectin benzoate trunk injections applied ≥ 18 days earlier and could potentially be used in integrated management programs to slow EAB population growth. © 2015 Society of Chemical Industry.

Illicit and injecting drug use among Indigenous young people in urban, regional and remote Australia.

PubMed

Bryant, Joanne; Ward, James; Wand, Handan; Byron, Kat; Bamblett, Andrew; Waples-Crowe, Peter; Betts, Sarah; Coburn, Tony; Delaney-Thiele, Dea; Worth, Heather; Kaldor, John; Pitts, Marian

2016-07-01

To examine patterns of illicit drug use among Australian Indigenous young people, identify correlates of frequent use separately in urban, regional and remote settings and characterise those who inject. Cross-sectional design at 40 Indigenous events. Self-complete surveys were administered to Indigenous people aged 16-29 years using mobile devices. 2,877 participants completed the survey. One in five reported using cannabis at least weekly in the previous year, but the use of other drugs was less prevalent. Patterns of drug use were largely similar across regions, although more participants in urban and regional areas reported using ecstasy (12% vs 11% vs 5%) and cocaine (6% vs 3% vs 1%) and more reported weekly cannabis use (18% vs 22% vs 14%). Injecting was rare (3%) but those who did inject reported a high incidence of needle sharing (37%). Methamphetamine (37%), heroin (36%) and methadone (26%) were the most commonly injected drugs, and injecting was related to prison experience (AOR 5.3 95% CI 2.8-10.0). Attention is needed in relation to cannabis use, particularly among those Indigenous young people living in regional and urban settings. Also, although injecting is uncommon, it is associated with prison involvement. Priority must be given to reducing the numbers of Indigenous youth entering justice settings, delaying the age at first entry to justice settings, and reducing the risk of BBV acquisition while in custody through, for example, prison-based NSP, BBV education, and Indigenous-specific treatment that emphasises connection to country and culture. [Bryant J, Ward J, Wand H, Byron K, Bamblett A, Waples-Crowe P, Betts S, Coburn T, Delaney-Thiele D, Worth H, Kaldor J, Pitts M. Illicit and injecting drug use among Indigenous young people in urban, regional and remote Australia. Drug Alcohol Rev 2016;35:447-455]. © 2015 Australasian Professional Society on Alcohol and other Drugs.

How to reduce injuries to residual trees during stand management activities.

Treesearch

Paul E. Aho; Gary Fiddler; Gregory M. Filip

1983-01-01

Losses of trees and tree volume that result from decay initiated by mechanical injuries during stand management activities in the western United States are substantial. They can be reduced through improved logging methods and careful planning of other forest management activities.

A rational-emotive stress management intervention for reducing job burnout and dysfunctional distress among special education teachers: An effect study.

PubMed

Ugwoke, Samuel C; Eseadi, Chiedu; Onuigbo, Liziana N; Aye, Eucharia N; Akaneme, Immaculata N; Oboegbulem, Angie I; Ezenwaji, Ifeyinwa O; Nwobi, Anthonia U; Nwaubani, Okechukwu O; Ezegbe, Bernedeth N; Ede, Moses O; Orji, Chibueze T; Onuoha, Joseph C; Onu, Eucharia A; Okeke, Francisca; Agu, Patricia; Omeje, Joachim C; Omeke, Faith; Ugwu, Romanus; Arumede, Florence; Eneh, Annastasia

2018-04-01

Job-related burnout and distress are adverse stress responses which affect individuals in their occupational environment. This study aimed at investigating the effect of a rational-emotive stress management program on job burnout and dysfunctional distress among special education teachers in Nigeria. A pretest-posttest randomized control group design was used. The participants in the study were 54 special education teachers. Data were collected using self-report questionnaires. Participants were allocated to either the treatment group (n = 28 [59.1%]) or the waitlist control group (n = 26 [48.1%]), respectively. A rational-emotive stress management manual was used to deliver the intervention. We statistically analyzed the data collected at three-time points with repeated-measures analysis of variance. At baseline, the job-related burnout symptoms and distress scores of participants were high. However, an intention-to-treat analysis showed that the rational-emotive stress management intervention program was efficacious in reducing the levels of job-related burnout symptoms and dysfunctional distress among participants assigned to the treatment group, compared to a waitlisted group at post-treatment and follow-up meetings. Our study demonstrates the effectiveness of a rational-emotive stress management intervention in reducing the level of job-related burnout and distress in a sample of special education teachers in Nigeria. Occupational health counsellors and other clinicians with sufficient knowledge of rational-emotive behavior therapy framework are urged to employ this approach in assisting other employees in managing job burnout symptoms, and distress.

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

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

[Clinical research of the effect of shengmai injection on the management of "shock heart " after burns].

PubMed

Zhang, Xi-lian; Huang, Yue-sheng; Dang, Yong-ming; Zhang, Jia-ping

2006-08-01

To investigate the effect of Shengmai injection on the management of "shock heart" after burns. Twenty patients with severe burns were enrolled in the study and randomly divided into two groups according to the clinical research method, i.e. treatment group (n= 10, with intravenous infusion of 40 ml Shengmai injection together with 250ml 50 g/L glucose solution for 3 days, 1 time/ per day) and control group(n = 10, with intravenous infusion of 290 ml 50 g/L glucose injection liquid for 3 days, 1 time/per day). Beside the venous line used for routine fluid resuscitation for burn shock, another venous line was set up after hospitalization for the administration of the drug. Blood samples were obtained from the femoral vein in both groups at 12 post-burn hour( PBH) , and on 1, 2, 3, 4 and 5 post burn days (PBD) for the determination of serum contents of creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH) and cardiac troponin I (cTnI). The changes in hepatic and renal function, as well as coagulability were determined before drug infusion and on 1 , 2, 3, 5 and 7 PSDs. The serum content of CK-MB, LDH and cTnI reached the peak at 12 PBH in both groups[ (52+/-20)U/L, (5.9+/-1.3) micromol x s(-1) L(-1), (0. 274+/-0. 231) microg/L in treatment group and [(9+/-31)U/L, (8.5+/-1l.8) micromol x s(-1) x L(-1) , (0. 584+/-0. 192) microg/L in control group]. All of them decreased with the passage of time, but in the treatment group they decreased more markedly within 2 or 3 PBD compared with those in control group ( P < 0.05). Early administration of Shengmai intravenously is beneficial to the protection of myocardial cells and in the management of the "shock heart" damage.

Effect of double air injection on performance characteristics of centrifugal compressor

NASA Astrophysics Data System (ADS)

Hirano, Toshiyuki; Takano, Mizuki; Tsujita, Hoshio

2015-02-01

In the operation of a centrifugal compressor of turbocharger, instability phenomena such as rotating stall and surge are induced at a lower flow rate close to the maximum pressure ratio. In this study, for the suppression of surge phenomenon resulting in the extension of the stable operating range of centrifugal compressor to lower flow rate, the compressed air at the compressor exit was re-circulated and injected into the impeller inlet by using the double injection nozzle system. The experiments were performed to find out the optimum circumferential position of the second nozzle relative to the fixed first one and the optimum inner diameter of the injection nozzles, which are able to most effectively reduce the flow rate of surge inception. Moreover, in order to examine the universality of these optimum values, the experiments were carried out for two types of compressors.

Reducing work-related Musculoskeletal Disorders (MSDs) through design: Views of ergonomics and design practitioners.

PubMed

Punchihewa, Himan K G; Gyi, Diane E

2015-01-01

Work-related Musculoskeletal Disorders (MSDs) affect the well-being of workers. Unfortunately, user requirements for design to reduce workplace risk factors for MSDs are not always effectively communicated to designers creating a mismatch between the user requirements and what is ultimately produced. To understand the views of practitioners of design and ergonomics regarding tools for participatory design and features they would like to see in such tools. An online questionnaire survey was conducted with a cohort of practitioners of ergonomics and design (n = 32). In-depth interviews were then conducted with a subset of these practitioners (n = 8). To facilitate discussion, a prototype integrated design tool was developed and demonstrated to practitioners using a verbalized walkthrough approach. According to the results of the questionnaire survey, the majority (70%) believed an integrated approach to participatory design would help reduce work-related MSDs and suggested ways to achieve this, for example, through sharing design information. The interviews showed the majority (n = 7) valued being provided with guidance on design activities and ways to manage and present information. It is believed that an integrated approach to design in order to help reduce work-related MSDs is highly important and a provision to evaluate design solutions would be desirable for practitioners of design and ergonomics.

Does Reducing the Concentration of Bupivacaine When Performing Therapeutic Shoulder Joint Injections Impact the Clinical Outcome?

PubMed

Fox, Michael G; Patrie, James T

2016-04-01

Mixtures of local anesthetics and steroids are routinely injected intraarticularly to temporarily relieve joint pain, even though local anesthetics have been reported to cause chondrocyte death in a dose- and time-dependent manner. This study aimed to determine if intraarticular injections of bupivacaine 0.5% and bupivacaine 0.25% would provide similar pain relief. All fluoroscopically guided glenohumeral joint injections performed using 2.5 mL of bupivacaine and 0.5 mL (20 mg) of triamcinolone acetonide over a 42-month period were included if a pain score was recorded before, 5-10 minutes after, and 1 week after injection. Pain reduction of more than 2 points was considered much improved clinically with pain reduction of more than 1 point considered the minimum clinically important difference (MCID) threshold. Statistically significant and much improved pain reduction was achieved using both bupivacaine 0.5% and 0.25% 5-10 minutes (-3.7 points; 95% CI, -3.4 to -4.0 points; p ≤ 0.001; and -3.3 points; 95% CI, -3.0 to -3.5 points; p ≤ 0.001) and 1 week (-2.5 points; 95% CI, -2.2 to -2.9 points; p ≤ 0.001; and -2.1 points; 95% CI, -1.8 to -2.3 points; p ≤ 0.001) after injection, respectively. Adjusting for age, sex, pain score before injection, and indication, the mean decrease in pain was greater in the bupivacaine 0.5% group by 0.30 points 5-10 minutes after injection (95% CI, -0.03 to 0.63 points; p = 0.08) and 0.46 points 1 week after injection (95% CI, 0.13-0.77 points; p = 0.01). Both bupivacaine 0.5% and bupivacaine 0.25% provide statistically significant and much improved pain relief 5-10 minutes and 1 week after intraarticular glenohumeral injections. Bupivacaine 0.5% provided greater pain relief than bupivacaine 0.25%, but the difference was less than 0.5 points and therefore did not meet the MCID threshold.

Water cycle and its management for plant habitats at reduced pressures.

PubMed

Rygalov, Vadim Y; Fowler, Philip A; Wheeler, Raymond M; Bucklin, Ray A

2004-01-01

Experimental and mathematical models were developed for describing and testing temperature and humidity parameters for plant production in bioregenerative life support systems. A factor was included for analyzing systems operating at low (10-101.3 kPa) pressure to reduce gas leakage and structural mass (e.g., inflatable greenhouses for space application). The expected close relationship between temperature and relative humidity was observed, along with the importance of heat exchanger coil temperature and air circulation rate. The presence of plants in closed habitats results in increased water flux through the system. Changes in pressure affect gas diffusion rates and surface boundary layers, and change convective transfer capabilities and water evaporation rates. A consistent observation from studies with plants at reduced pressures is increased evapotranspiration rates, even at constant vapor pressure deficits. This suggests that plant water status is a critical factor for managing low-pressure production systems. The approach suggested should help space mission planners design artificial environments in closed habitats.

Water cycle and its management for plant habitats at reduced pressures

NASA Technical Reports Server (NTRS)

Rygalov, Vadim Y.; Fowler, Philip A.; Wheeler, Raymond M.; Bucklin, Ray A.

2004-01-01

Experimental and mathematical models were developed for describing and testing temperature and humidity parameters for plant production in bioregenerative life support systems. A factor was included for analyzing systems operating at low (10-101.3 kPa) pressure to reduce gas leakage and structural mass (e.g., inflatable greenhouses for space application). The expected close relationship between temperature and relative humidity was observed, along with the importance of heat exchanger coil temperature and air circulation rate. The presence of plants in closed habitats results in increased water flux through the system. Changes in pressure affect gas diffusion rates and surface boundary layers, and change convective transfer capabilities and water evaporation rates. A consistent observation from studies with plants at reduced pressures is increased evapotranspiration rates, even at constant vapor pressure deficits. This suggests that plant water status is a critical factor for managing low-pressure production systems. The approach suggested should help space mission planners design artificial environments in closed habitats.

Nox reduction system utilizing pulsed hydrocarbon injection

DOEpatents

Brusasco, Raymond M.; Penetrante, Bernardino M.; Vogtlin, George E.; Merritt, Bernard T.

2001-01-01

Hydrocarbon co-reductants, such as diesel fuel, are added by pulsed injection to internal combustion engine exhaust to reduce exhaust NO.sub.x to N.sub.2 in the presence of a catalyst. Exhaust NO.sub.x reduction of at least 50% in the emissions is achieved with the addition of less than 5% fuel as a source of the hydrocarbon co-reductants. By means of pulsing the hydrocarbon flow, the amount of pulsed hydrocarbon vapor (itself a pollutant) can be minimized relative to the amount of NO.sub.x species removed.

Observation of curative effect of intravitreal injection of conbercept in wet age-related macular degeneration: Optical coherence tomography analysis after injection.

PubMed

Yang, Wen; Tan, Ying; Li, Chaowei; Liu, Yi; Lu, Guohua

2018-04-01

To observe the clinical efficacy of intravitreal injection of conbercept in the treatment of wet age-related macular degeneration (wAMD), optical coherence tomography (OCT) and the best corrected visual acuity (BCVA) was observed to measure the changes of anatomical changes of central macular thickness (CMT) and the area and volume of retinal pigment epithelium (RPE) uplift. Fifteen patients (15 eyes) with wet AMD were enrolled in this study. All patients underwent intravitreal injection of conbercept of 0.05 mL once. After 1 week, 1 month, and 3 months, OCT and BCVA were used to examine and to compare with the preoperative and postoperative central macular thickness and RPE uplift area. BCVA (median) increased respectively from 0.12 ± 0.13 to 0.21 ± 0.15 at 1 week, to 0.90 ± 0.25 at 1 month, to 0.38 ± 0.17 at 3 months (p < .001). The thickness of central macular decreased from 500 ± 25 μm to 256 ± 19 μm, 221 ± 29 μm, and 215 ± 14 μm, respectively. The normal physiological structure and stratification of the macular area were clear gradually. Conbercept treatment of wet AMD can significantly improve visual acuity, after 1 month up to the plateau, 3 months of continuous drug injection can make the vision maintained at a high stage, and macular retinal normal structural morphology recovery is good, the treatment has no obvious adverse reactions, and with good security. © 2018 Wiley Periodicals, Inc.

A Serious Complication of Illicit Silicone Injections: Latent Silicone Embolization Syndrome after Incision and Drainage of Local Injection Site.

PubMed

Purdy-Payne, Erin K; Green, Jillian; Zenoni, Scott; Evans, Alexander N; Bilski, Tracy R

2015-08-01

Silicone embolization syndrome, a serious adverse effect of illicit silicone injections by laypersons, occurs when silicone particles enter the circulation and shower the lungs and other vital organs. We review the literature on silicone embolization syndrome and describe a unique case of the syndrome that developed after a latent period of several months, upon surgical debridement of an injection site abscess. In the scientific literature, silicone embolization syndrome has been well described and multiple presentations have been delineated. Immediate presentation with a rapidly fatal course occurs in cases of erroneous intra-vascular injection, in which large volumes of silicone occlude pulmonary arteries and cause cor pulmonale. Insidious presentation of progressive respiratory distress and systemic inflammatory response syndrome occurs in cases of peri-vascular injection, caused by gradual vascular infiltration by smaller silicone emboli that shower pulmonary capillaries diffusely, causing alveolar hemorrhage and inflammation. Rarely, latent cases have presented months to years later upon trauma to the original site, which disrupts the sequestered siliconoma, allowing re-exposure to the immune system and the opportunity for vascular infiltration. To the best of our knowledge, this is the first description of silicone embolization syndrome that occurred after surgical manipulation of the site. It has important management implications for patients with a history of prior silicone injections at a site being considered for surgical intervention. Strategies for managing this potential complication include adding a regimen of daily debridement, aggressive ventilator support, and maintaining close observation in an intensive care unit (ICU) or progressive care unit (PCU) during the high-risk post-operative period. Alternatively, when possible, surgeons may avoid disruption of the siliconoma by trialing medical management of localized inflammation or using alternative

Agmatine reduces only peripheral-related behavioral signs, not the central signs, of morphine withdrawal in nNOS deficient transgenic mice.

PubMed

Aricioglu, Feyza; Paul, Ian A; Regunathan, Soundar

2004-01-09

Agmatine inhibits morphine tolerance/dependence and potentiates morphine analgesia. This study was designed to investigate whether neuronal nitric oxide mediates the actions of agmatine in morphine dependence by using mice lacking a functional form of this enzyme. Mice received agmatine just after the morphine pellet implantation for 3 days twice daily or single injection 30 min before naloxone. In both genotypes treated for 3 days with morphine pellets, naloxone administration precipitated clear signs of withdrawal. Both acute and chronic administration of agmatine reduced withdrawal signs in wild type mice and reduced only peripheral signs of morphine dependence in neuronal nitric oxide synthase knockout mice. Withdrawal signs, that are related to central nervous system activity were not affected. These findings indicate that neuronal nitric oxide synthase partly mediates the effects of agmatine in morphine physical dependence.

Vibration Anesthesia for Pain Reduction During Intralesional Steroid Injection for Keloid Treatment.

PubMed

Park, Kui Young; Lee, Yohan; Hong, Ji Yeon; Chung, Won Soon; Kim, Myeung Nam; Kim, Beom Joon

2017-05-01

Patients suffer significant pain during intralesional steroid injection treatment for keloids and hypertrophic scars. Vibration anesthesia has been shown to effectively and safely alleviate pain sensations, likely by reducing pain transmission from peripheral receptors to the brain. The objective was to evaluate the efficacy, safety, and patient satisfaction associated with vibration anesthesia for reducing pain during intralesional corticosteroid injection. The authors recruited 40 patients with 58 keloids who were scheduled to undergo intralesional triamcinolone acetonide (TA) injections. Half of each keloid was injected with concomitant vibration anesthesia, whereas the other half was injected without vibration anesthesia. Pain experienced by patients during both procedures was assessed according to visual analog scale (VAS) score. The authors also assessed procedure safety. The mean VAS score during intralesional TA injection therapy without vibration was 5.88 ± 2.34. By contrast, the same patients yielded a mean VAS score during intralesional TA injection therapy with vibration of 3.28 ± 1.85; the difference between the mean scores was significant (p < .05). Thirty-nine (97.5%) patients tolerated this therapy well. Vibration anesthesia is a promising option for reducing pain during keloid treatment with intralesional steroid injection.

Polymer Injection Therapy to Reverse Remodel the Papillary Muscles: Efficacy in Reducing Mitral Regurgitation in a Chronic Ischemic Model

PubMed Central

Solis, Jorge; Levine, Robert A.; Johnson, Benjamin; Guerrero, J. Luis; Handschumacher, Mark D.; Suzanne, Suzanne; Lam, Kaitlyn; Berlin, Jason; Braithwaite, Gavin J.C.; Muratoglu, Orhun K.; Vlahakes, Gus J.; Hung, Judy

2010-01-01

Ischemic mitral regurgitation (IMR) results from displacement of the papillary muscles due to ischemic ventricular distortion. Recurrent IMR is frequent after annuloplasty, particularly when left ventricular remodeling continues to progress. Our hypothesis is that repositioning of the papillary muscles can be achieved by injection of polyvinyl-alcohol (PVA) hydrogel polymer into the myocardium in chronic MR despite advanced left ventricular remodeling. Methods Nine sheep underwent ligation of circumflex branches to produce chronic ischemic MR over eight weeks. Once MR developed, PVA was injected into the myocardium underlying the infarcted PM. 2D and 3D echocardiograms and hemodynamic data were obtained pre infarct (baseline), pre PVA (Chronic MR) and post PVA. Results One animal died early, one did not develop MR, and the remaining 7 developed moderate MR. PVA injection significantly decreased the MR from moderate to trace. This was associated with a decrease in infarcted papillary muscle-to-mitral annulus tethering distance (32.6 ± 4.4 to 27.6 ± 4.2 mm, P<0.05), tenting volume (2.1±0.3 to 1.6 ± 0.3 mm2 P<0.05) and leaflet closure area (9.3 ± 0.8 to 8.2 ± 0.7 mm2, P<0.04). PVA was not associated with significant decreases in LVEF (42 ± 3 % vs 40 ± 2 %, p=ns) or end-systolic elastance. Measures of left ventricular diastolic function, tau (99 ± 55 ms to 87 ± 36;) and left ventricular stiffness coefficient (0.04 ± 0.03 to 0.05 ± 0.03) did not increase post PVA. Conclusions PVA hydrogel injections improve coaptation and reduce remodeling in chronic MR without impairing LV systolic and diastolic function. This new approach offers a potential alternative for relieving ischemic mitral regurgitation by correcting papillary muscle position, thus relieving tethering that causes ischemic mitral regurgitation. PMID:20736444

Polymer injection therapy to reverse remodel the papillary muscles: efficacy in reducing mitral regurgitation in a chronic ischemic model.

PubMed

Solis, Jorge; Levine, Robert A; Johnson, Benjamin; Guerrero, J Luis; Handschumacher, Mark D; Sullivan, Suzanne; Lam, Kaitlyn; Berlin, Jason; Braithwaite, Gavin J C; Muratoglu, Orhun K; Vlahakes, Gus J; Hung, Judy

2010-10-01

Ischemic mitral regurgitation (MR) results from displacement of the papillary muscles caused by ischemic ventricular distortion. Progressive left ventricular (LV) remodeling has challenged therapy. Our hypothesis is that repositioning of the papillary muscles can be achieved by injection of polyvinyl-alcohol (PVA) hydrogel polymer into the myocardium in chronic MR despite advanced LV remodeling. Ten sheep underwent ligation of the circumflex branches to produce chronic ischemic MR over 8 weeks. PVA was injected into the myocardium underlying the infarcted papillary muscle. Two-dimensional and 3D echocardiograms and hemodynamic data were obtained before infarct (baseline), before PVA (chronic MR), and after PVA. PVA injection significantly decreased MR from moderate to severe to trace (MR vena contracta, 5.8±1.2 to1.8±1.3 mm; chronic MR to post-PVA stage; P=0.0003). This was associated with a decrease in infarcted papillary muscle-to-mitral annulus tethering distance (30.3±5.7 to 25.9±4.6 mm, P=0.02), tenting volume (1.8±0.7 to 1.4±0.5 mL, P=0.01), and leaflet closure area (8.8±1.3 cm(2)to 7.6±1.3 cm(2), P=0.004) from chronic MR to post-PVA stages. PVA was not associated with significant decreases in LV ejection fraction (41±3% versus 40±3%, P=NS), end-systolic elastance, τ (82±36 ms to 72±26, P=NS), or LV stiffness coefficient (0.05±0.04 to 0.03±0.01). PVA hydrogel injections improve coaptation and reduce remodeling in chronic MR without impairing LV systolic and diastolic function. This new approach offers a potential alternative for relieving tethering and ischemic MR by correcting papillary muscle position.

Staged direct injection diesel engine

DOEpatents

Baker, Quentin A.

1985-01-01

A diesel engine having staged injection for using lower cetane number fuels than No. 2 diesel fuel. The engine includes a main fuel injector and a pilot fuel injector. Pilot and main fuel may be the same fuel. The pilot injector injects from five to fifteen percent of the total fuel at timings from 20.degree. to 180.degree. BTDC depending upon the quantity of pilot fuel injected, the fuel cetane number and speed and load. The pilot fuel injector is directed toward the centerline of the diesel cylinder and at an angle toward the top of the piston, avoiding the walls of the cylinder. Stratification of the early injected pilot fuel is needed to reduce the fuel-air mixing rate, prevent loss of pilot fuel to quench zones, and keep the fuel-air mixture from becoming too fuel lean to become effective. In one embodiment, the pilot fuel injector includes a single hole for injection of the fuel and is directed at approximately 48.degree. below the head of the cylinder.

Age-related changes in localization of injected radiolabelled lymphocytes in the lymph nodes of antigen-stimulated mice.

PubMed Central

Inchley, C J; Micklem, H S; Barrett, J; Hunter, J; Minty, C

1976-01-01

The localization of i.v. injected syngeneic lymph node cells, radiolabelled with 51Cr or 75Se-L-selenomethionine, was studied in male CBA/H mice aged between 3 and 30 months. The following results were obtained. (1) Localization of cells from young adult donors was greater in the s.c. lymph nodes of old than of young recipients, the main increase being between 15 and 17 months of age. Increases in lymph node weight and DNA-synthesis were also seen at this time; but the rise in cell localization was significant even when calculated per unit of tissue weight. Splenic localization either declined slightly with age or, like the liver, showed no significant change. (2) Local antigenic stimulation by a single injection of sheep erythrocytes into one front footpad, 24 hr before lymph node cell injection, resulted in increased localization in the regional lymph nodes of 3-17 month old, but rarely of 24-30 month old mice. (3) No consistent differences in localization were observed between lymph node cells from 4-month and 25-month old donors. Both age-related and antigen-related increases in cell localization were at least partly attributable to an enhanced rate of entry of lymphocytes from the blood to the lymph nodes. Although the changes underlying the decline in antigen-related localization of cells in old recipients have still to be clarified, it is probable that the defective immune responses of old mice result partly from this decline. PMID:991459

Human Cells Display Reduced Apoptotic Function Relative to Chimpanzee Cells

PubMed Central

McDonald, John F.

2012-01-01

Previously published gene expression analyses suggested that apoptotic function may be reduced in humans relative to chimpanzees and led to the hypothesis that this difference may contribute to the relatively larger size of the human brain and the increased propensity of humans to develop cancer. In this study, we sought to further test the hypothesis that humans maintain a reduced apoptotic function relative to chimpanzees by conducting a series of apoptotic function assays on human, chimpanzee and macaque primary fibroblastic cells. Human cells consistently displayed significantly reduced apoptotic function relative to the chimpanzee and macaque cells. These results are consistent with earlier findings indicating that apoptotic function is reduced in humans relative to chimpanzees. PMID:23029431

Gas injected vacuum switch

DOEpatents

Hardin, K. Dan

1977-01-01

The disclosure relates to a gas injected vacuum switch comprising a housing having an interior chamber, a conduit for evacuating the interior chamber, within the chamber an anode and a cathode spaced from the anode, and a detonator for injecting electrically conductive gas into the chamber between the anode and the cathode to provide a current path therebetween.

[Accidental injection sodium hypochlorite during endodontic therapy. Better understand to better manage].

PubMed

Ben Rejeb, H; Douki, N

2015-09-01

The high frequency of iatrogenic incidents during endodontic treatment is a source of stress for the practitioner. These incidents may occur during the different steps of a root canal treatment. During irrigation, extrusion of sodium hypochlorite beyond the apex is a rare but impressive accident. Sodium hypochlorite, is the most common irrigant used in modern endodontics, but when it comes in contact with the periapical tissue, it can cause complications ranging from mild discomfort to serious tissue damage such as the hematoma and hemato-emphysema. The aims of this article are to discuss through the presentation of two clinical cases: Etiological and predisposing factors; Signs guiding to suspicion of accidental injection of sodium hypochlorite. In this work, we focused on clinical keys that help the practitioner in better understanding this accident in order to prevent it or to manage it well when it occurs.

Digital Inject Book v. 1.7

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

Eldridge, Bryce

2016-10-05

Digital Inject Book is a software program designed to generate and managed simulated data for radiation detectors, used to increase the realism of training where real radiation sources are impractical, expensive, or simply not available.

Polymers And Riblets Reduce Hydrodynamic Skin Friction

NASA Technical Reports Server (NTRS)

Bushnell, Dennis M.; Reed, Jason C.

1991-01-01

Polymers injected into riblet grooves dramatically reduce polymer flow rate required for drag reduction. Polymer solution injected into valleys of grooves through array of holes or slots angled downstream to keep injected streams within grooves. Injection repeated some distance downstream because volumes of grooves finite and polymer becomes depleted as slowly pulled from groove by turbulence. Potentially useful for oil tankers as means of markedly reducing cost of fuel and used extensively on submarines, other ships, and other marine vehicles.

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

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

Severe Ocular Inflammation Following Ranibizumab or Aflibercept Injections for Age-Related Macular Degeneration: A Retrospective Claims Database Analysis

PubMed Central

Souied, Eric H.; Dugel, Pravin U.; Ferreira, Alberto; Hashmonay, Ron; Lu, Jingsong; Kelly, Simon P.

2016-01-01

ABSTRACT Purpose: Intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents including ranibizumab and aflibercept are used to treat patients with ocular disorders such as neovascular age-related macular degeneration (nAMD); however, the injections are associated with rare instances of severe ocular inflammation. This study compared severe ocular inflammation rates in patients treated with ranibizumab versus aflibercept. Methods: United States physician-level claims data covering an 18-month period for each therapy were analyzed. The primary analysis compared severe ocular inflammation event rates per 1000 injections. Sensitivity and subgroup analyses evaluated the impact of factors including intraocular surgery, intravitreal antibiotic administration, and previous intravitreal injections. Results: The analysis included 432,794 injection claims (ranibizumab n = 253,647, aflibercept n = 179,147); significantly, more unique severe ocular inflammation events occurred in patients receiving aflibercept than ranibizumab (1.06/1000 injections, 95% confidence interval [CI], 0.91–1.21, vs. 0.64/1000 injections, 95% CI 0.54–0.74; p < 0.0001). Comparable results were observed for analyses of patients who had undergone glaucoma or cataract surgeries, had antibiotic-associated endophthalmitis, had non-antibiotic-associated endophthalmitis, and were non-treatment-naive. In contrast, no significant differences in severe ocular inflammation claims were recorded in treatment-naive patients who had no record of anti-VEGF treatment in the 6 months preceding the index claim. No significant change occurred in the rate of severe ocular inflammation claims over time following ranibizumab treatment. Conclusions: Severe ocular inflammation was more frequent following intravitreal injection with aflibercept than with ranibizumab during routine clinical use in patients with nAMD. This highlights the importance of real-world, post-approval, observational monitoring

ELM elimination with lithium aerosol injection in upper-single null discharges using the tungsten divertor in EAST

NASA Astrophysics Data System (ADS)

Sun, Z.; Maingi, R.; Hu, J.; Lunsford, R.; Diallo, A.; Tritz, K.; Osborne, T.; Canik, J.; Zuo, G.; Wang, L.; Xu, G.; Gong, X.; EAST Team Team

2017-10-01

A reproducible, fully non-inductive H-mode regime devoid of large ELMs has been achieved by continuous Li injection in EAST into the upper `ITER-like' tungsten divertor, extending previous results on the graphite divertor. These discharges did not suffer from density or impurity accumulation, and maintained constant core radiated power. The new results extend the energy confinement multiplier H98(y,2) 1.2, as compared to H98(y,2) 0.75 previously on the graphite divertor. The observed ELM elimination is correlated with a decrease in particle recycling, as expected from the strong Li coating before the experiment, and real-time Li aerosol injection. In addition, core W concentration was reduced during the Li injection. ELM elimination is likely related to the reduced recycling and density /temperature profile changes. A low-n electromagnetic coherent mode (MCM) at 40kHz became stronger in amplitude and also more coherent. The MCM shows strong magnetic fluctuations as measured by fast Mirnov coils, but weak density fluctuations. As compared to the graphite divertor, Li injection into the tungsten divertor eliminated ELMs at twice the previous auxiliary heating power, and reduced pedestal collisionality.

The efficacy of multiple versus single hyaluronic acid injections: a systematic review and meta-analysis.

PubMed

Concoff, Andrew; Sancheti, Parag; Niazi, Faizan; Shaw, Peter; Rosen, Jeffrey

2017-12-21

Intra-articular hyaluronic acid (IA-HA) is a common therapy used to treat knee pain and suppress knee inflammation in knee osteoarthritis (OA), typically prescribed in regimens ranging from a single injection to 5 weekly injections given once weekly. We conducted a systematic review to determine the efficacy of IA-HA, with subgroup analyses to explore the differences in knee pain and adverse events (AEs) across different dosing regimens. We conducted a systematic search of the literature to identify studies evaluating IA-HA for the management of knee OA compared to IA-saline. Primary outcome measure was the mean knee pain score at 13 Weeks (3 months) or 26 weeks (6 months). Secondary outcome was the number of treatment-related AEs and treatment-related serious adverse events (SAEs). We evaluated differences in levels of pain and AEs/SAEs between dosing regimens compared to IA-Saline. Thirty articles were included. Overall, IA-HA injections were associated with less knee pain compared to IA-Saline injections for all dosing regimens. 2-4 injections of IA-HA vs. IA-Saline produced the largest effect size at both 3-months and 6-months (Standard mean difference [SMD] = -0.76; -0.98 to -0.53, 95% CI, P < 0.00001, and SMD = -0.36; -0.63 to -0.09 95% CI, P = 0.008, respectively). Additionally, single injection studies yielded a non-significant treatment effect at 3 and 6 months, while ≥5 5 injections demonstrated a significant improvement in pain only at 6 months. Five or more injections of IA-HA were associated with a higher risk of treatment-related AEs compared to IA-Saline (Risk ratio [RR] = 1.67; 1.09 to 2.56 95% CI, p = 0.02), which was a result not seen within the 1 and 2-4 injection subgroups. Overall, 2-4 and ≥5 injection regimens provided pain relief over IA-Saline, while single injection did not. Intra-articular injections of HA used in a 2-4 injection treatment regimen provided the greatest benefit when compared to IA

Efficacy and Safety of Postoperative Pain Relief by Parecoxib Injection after Laparoscopic Surgeries: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

PubMed

Huang, Jun-Ming; Lv, Zheng-Tao; Zhang, Ya-Nan; Jiang, Wen-Xiu; Li, Han-Ning; Nie, Ming-Bo

2017-10-17

This study aims to evaluate the efficacy and safety of parecoxib injection in pain relief after laparoscopic surgeries. A comprehensive literature search based on 4 online databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science) was applied to retrieve all related randomized controlled trials (RCTs). Two independent reviewers screened each article for eligibility according to the predetermined inclusion criteria. The Cochrane Collaboration's tool was applied to evaluate the methodological quality of included studies. A standardized data collection sheet was designed to extract data from included studies. RevMan version 5.3 (The Cochrane Collaboration, Copenhagen, Denmark) was selected to perform meta-analysis. A total of 1,060 participants who were scheduled for gynecological laparoscopic surgery or laparoscopic cholecystectomy (LC) were enrolled in 12 selected RCTs. The methodological qualities of the studies were evaluated as moderate to high. The combined data showed that perioperative parecoxib injection could significantly reduce the proportion of patients who required adjuvant pain relieve after laparoscopic surgeries. Significantly lower pain scores in the parecoxib groups were observed, which proved that preoperative or intraoperative injection of 40 mg parecoxib was more effective than placebo for immediate pain relief after LC. But preoperative injection of 40 mg parecoxib showed no improvement compared with placebo in the management of immediate pain following gynecological laparoscopic surgery. The occurrence of adverse events showed no differences between perioperative parecoxib administration and placebo control. Perioperative parecoxib administration was effective in reducing the proportion of patients who required adjuvant pain relief after laparoscopic surgeries without significant adverse events compared with placebo. The effect of parecoxib injection on immediate pain relief remains in question. Future RCTs

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

Reducing work related psychological ill health and sickness absence: a systematic literature review

PubMed Central

Michie, S; Williams, S

2003-01-01

A literature review revealed the following: key work factors associated with psychological ill health and sickness absence in staff were long hours worked, work overload and pressure, and the effects of these on personal lives; lack of control over work; lack of participation in decision making; poor social support; and unclear management and work role. There was some evidence that sickness absence was associated with poor management style. Successful interventions that improved psychological health and levels of sickness absence used training and organisational approaches to increase participation in decision making and problem solving, increase support and feedback, and improve communication. It is concluded that many of the work related variables associated with high levels of psychological ill health are potentially amenable to change. This is shown in intervention studies that have successfully improved psychological health and reduced sickness absence. PMID:12499449

Closed-Loop Control of Chemical Injection Rate for a Direct Nozzle Injection System.

PubMed

Cai, Xiang; Walgenbach, Martin; Doerpmond, Malte; Schulze Lammers, Peter; Sun, Yurui

2016-01-20

To realize site-specific and variable-rate application of agricultural pesticides, accurately metering and controlling the chemical injection rate is necessary. This study presents a prototype of a direct nozzle injection system (DNIS) by which chemical concentration transport lag was greatly reduced. In this system, a rapid-reacting solenoid valve (RRV) was utilized for injecting chemicals, driven by a pulse-width modulation (PWM) signal at 100 Hz, so with varying pulse width the chemical injection rate could be adjusted. Meanwhile, a closed-loop control strategy, proportional-integral-derivative (PID) method, was applied for metering and stabilizing the chemical injection rate. In order to measure chemical flow rates and input them into the controller as a feedback in real-time, a thermodynamic flowmeter that was independent of chemical viscosity was used. Laboratory tests were conducted to assess the performance of DNIS and PID control strategy. Due to the nonlinear input-output characteristics of the RRV, a two-phase PID control process obtained better effects as compared with single PID control strategy. Test results also indicated that the set-point chemical flow rate could be achieved within less than 4 s, and the output stability was improved compared to the case without control strategy.

Closed-Loop Control of Chemical Injection Rate for a Direct Nozzle Injection System

PubMed Central

Cai, Xiang; Walgenbach, Martin; Doerpmond, Malte; Schulze Lammers, Peter; Sun, Yurui

2016-01-01

To realize site-specific and variable-rate application of agricultural pesticides, accurately metering and controlling the chemical injection rate is necessary. This study presents a prototype of a direct nozzle injection system (DNIS) by which chemical concentration transport lag was greatly reduced. In this system, a rapid-reacting solenoid valve (RRV) was utilized for injecting chemicals, driven by a pulse-width modulation (PWM) signal at 100 Hz, so with varying pulse width the chemical injection rate could be adjusted. Meanwhile, a closed-loop control strategy, proportional-integral-derivative (PID) method, was applied for metering and stabilizing the chemical injection rate. In order to measure chemical flow rates and input them into the controller as a feedback in real-time, a thermodynamic flowmeter that was independent of chemical viscosity was used. Laboratory tests were conducted to assess the performance of DNIS and PID control strategy. Due to the nonlinear input–output characteristics of the RRV, a two-phase PID control process obtained better effects as compared with single PID control strategy. Test results also indicated that the set-point chemical flow rate could be achieved within less than 4 s, and the output stability was improved compared to the case without control strategy. PMID:26805833

Effectiveness of 20% benzocaine as a topical anesthetic for intraoral injections.

PubMed Central

Nusstein, John M.; Beck, Mike

2003-01-01

The use of topical anesthetics has been advocated prior to the administration of various types of anesthetic injections. Reported results have varied between studies. The purpose of this study was to compare the effectiveness of 20% benzocaine in reducing the pain of needle insertion during maxillary posterior and anterior infiltration and inferior alveolar nerve block injections. In this retrospective study, 1080 patients received 2336 injections using a 27-gauge needle. Topical anesthetic was applied prior to 720 of the injections. Patients rated pain of needle insertion using a 0-4 pain scale. Logistic regression analysis showed no differences in pain ratings between topical and no topical groups for the inferior alveolar nerve block and posterior maxillary infiltration injections. The use of topical anesthetic did reduce the pain of needle insertion with the maxillary anterior injections (P = .0041). PMID:14959903

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.

4 CFR 7.1 - Labor management relations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 4 Accounts 1 2010-01-01 2010-01-01 false Labor management relations. 7.1 Section 7.1 Accounts GOVERNMENT ACCOUNTABILITY OFFICE PERSONNEL SYSTEM PERSONNEL RELATIONS AND SERVICES § 7.1 Labor management relations. (a) Policy. Each employee of GAO has the right, freely and without fear of penalty or reprisal...

Experiences addressing health-related financial challenges with disease management among African American women with asthma.

PubMed

Patel, Minal R; Caldwell, Cleopatra H; Id-Deen, Effat; Clark, Noreen M

2014-06-01

Despite economic hardship, compliance with self-management regimens is still evident among individuals and families managing chronic disease. The purpose of this study was to describe how women with asthma address cost-related challenges to management of their condition. In 2012 and 2013, four focus groups were conducted in Southeast Michigan with 26 African American women with asthma, recruited based on maximum variation sampling procedures. A semi-structured interview protocol was employed by trained facilitators. Coded transcripts were analyzed for themes regarding means to reduce the impact of the cost of asthma management. Major themes identified were acceptance of the status quo; stockpiling and sharing medicines; utilizing community assistance programs; reaching out to healthcare providers and social networks for help; foregoing self-management; and utilizing urgent care. Awareness of strategies that are helpful to patients in reducing out-of-pocket costs may better equip service providers and others to develop interventions to make useful strategies more widely available.

Experiences addressing health-related financial challenges with disease management among African American women with asthma

PubMed Central

Patel, Minal R.; Caldwell, Cleopatra H.; Id-Deen, Effat; Clark, Noreen M.

2018-01-01

Objective Despite economic hardship, compliance with self-management regimens is still evident among individuals and families managing chronic disease. The purpose of this study was to describe how women with asthma address cost-related challenges to management of their condition. Methods In 2012 and 2013, four focus groups were conducted in Southeast Michigan with 26 African American women with asthma, recruited based on maximum variation sampling procedures. A semi-structured interview protocol was employed by trained facilitators. Coded transcripts were analyzed for themes regarding means to reduce the impact of the cost of asthma management. Results Major themes identified were acceptance of the status quo; stockpiling and sharing medicines; utilizing community assistance programs; reaching out to healthcare providers and social networks for help; foregoing self-management; and utilizing urgent care. Conclusions Awareness of strategies that are helpful to patients in reducing out-of-pocket costs may better equip service providers and others to develop interventions to make useful strategies more widely available. PMID:24471517

Impact on caesarean section rates following injections of sterile water (ICARIS): a multicentre randomised controlled trial.

PubMed

Lee, Nigel; Mårtensson, Lena B; Homer, Caroline; Webster, Joan; Gibbons, Kristen; Stapleton, Helen; Dos Santos, Natalie; Beckmann, Michael; Gao, Yu; Kildea, Sue

2013-05-03

Sterile water injections have been used as an effective intervention for the management of back pain during labour. The objective of the current research is to determine if sterile water injections, as an intervention for back pain in labour, will reduce the intrapartum caesarean section rate. A double blind randomised placebo controlled trialSetting: Maternity hospitals in AustraliaParticipants: 1866 women in labour, ≥18 years of age who have a singleton pregnancy with a fetus in a cephalic presentation at term (between 37 + 0 and 41 + 6 weeks gestation), who assess their back pain as equal to or greater than seven on a visual analogue scale when requesting analgesia and able to provide informed consent. Participants will be randomised to receive either 0.1 to 0.3 millilitres of sterile water or a normal saline placebo via four intradermal injections into four anatomical points surrounding the Michaelis' rhomboid over the sacral area. Two injections will be administered over the posterior superior iliac spine (PSIS) and the remaining two at two centimetres posterior, and one centimetre medial to the PSIS respectively. Proportion of women who have a caesarean section in labour.Randomisation: Permuted blocks stratified by research site.Blinding (masking):Double-blind trial in which participants, clinicians and research staff blinded to group assignment. Funded by the National Health and Medical Research CouncilTrial registration:Australian New Zealand Clinical Trials Registry (No ACTRN12611000221954). Sterile water injections, which may have a positive effect on reducing the CS rate, have been shown to be a safe and simple analgesic suitable for most maternity settings. A procedure that could reduce intervention rates without adversely affecting safety for mother and baby would benefit Australian families and taxpayers and would reduce requirements for maternal operating theatre time. Results will have external validity, as the technique may be easily applied to

Prospective, Multicenter, Randomized, Crossover Clinical Trial Comparing the Safety and Effectiveness of Cooled Radiofrequency Ablation With Corticosteroid Injection in the Management of Knee Pain From Osteoarthritis

PubMed Central

Davis, Tim; Loudermilk, Eric; DePalma, Michael; Hunter, Corey; Lindley, David; Patel, Nilesh; Choi, Daniel; Soloman, Marc; Gupta, Anita; Desai, Mehul; Buvanendran, Asokumar; Kapural, Leonardo

2018-01-01

Background and Objectives Osteoarthritis (OA) of the knee affects the aging population and has an associated influence on the health care system. Rigorous studies evaluating radiofrequency ablation for OA-related knee pain are lacking. This study compared long-term clinical safety and effectiveness of cooled radiofrequency ablation (CRFA) with intra-articular steroid (IAS) injection in managing OA-related knee pain. Methods This is a prospective, multicenter, randomized trial with 151 subjects with chronic (≥6 months) knee pain that was unresponsive to conservative modalities. Knee pain (Numeric Rating Scale [NRS]), Oxford Knee Score, overall treatment effect (Global Perceived Effect), analgesic drug use, and adverse events were compared between CRFA and IAS cohorts at 1, 3, and 6 months after intervention. Results There were no differences in demographics between study groups. At 6 months, the CRFA group had more favorable outcomes in NRS: pain reduction 50% or greater: 74.1% versus 16.2%, P < 0.0001 (25.9% and 83.8% of these study cohorts, respectively, were nonresponders). Mean NRS score reduction was 4.9 ± 2.4 versus 1.3 ± 2.2, P < 0.0001; mean Oxford Knee Score was 35.7 ± 8.8 vs 22.4 ± 8.5, P < 0.0001; mean improved Global Perceived Effect was 91.4% vs 23.9%, P < 0.0001; and mean change in nonopioid medication use was CRFA > IAS (P = 0.02). There were no procedure-related serious adverse events. Conclusions This study demonstrates that CRFA is an effective long-term therapeutic option for managing pain and improving physical function and quality of life for patients with painful knee OA when compared with IAS injection. Clinical Trial Registration: ClinicalTrials.gov (NCT02343003). PMID:29095245

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.

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

Full-length silicone insoles versus ultrasound-guided corticosteroid injection in the management of plantar fasciitis: a randomized clinical trial.

PubMed

Yucel, Ufuk; Kucuksen, Sami; Cingoz, Havva T; Anliacik, Emel; Ozbek, Orhan; Salli, Ali; Ugurlu, Hatice

2013-12-01

Plantar fasciitis often leads to disability. Optimal treatment for this clinical condition is still unknown. To compare the effectiveness of wearing a full-length silicone insole with ultrasound-guided corticosteroid injection in the management of plantar fasciitis. Randomized clinical trial. Forty-two patients with chronic unilateral plantar fasciitis were allocated randomly to have an ultrasound-guided corticosteroid injection or wear a full-length silicone insole. Data were collected before the procedure and 1 month after. The primary outcome measures included first-step heel pain via Visual Analogue Scale and Heel Tenderness Index. Other outcome measures were the Foot and Ankle Outcome Score and ultrasonographic thickness of the plantar fascia. After 1 month, a significant improvement was shown in Visual Analogue Scale, Heel Tenderness Index, Foot and Ankle Outcome Score, and ultrasonographic thickness of plantar fascia in both groups. Visual Analogue Scale scores, Foot and Ankle Outcome Score pain, Foot and Ankle Outcome Score for activities of daily living, Foot and Ankle Outcome Score for sport and recreation function, and plantar fascia thickness were better in injection group than in insole group (p < 0.05). Although both ultrasound-guided corticosteroid injection and wearing a full-length silicone insole were effective in the conservative treatment of plantar fasciitis, we recommend the use of silicone insoles as a first line of treatment for persons with plantar fasciitis.

Aqueous vascular endothelial growth factor and aflibercept concentrations after bimonthly intravitreal injections of aflibercept for age-related macular degeneration.

PubMed

Sawada, Tomoko; Wang, Xiying; Sawada, Osamu; Saishin, Yoshitsugu; Ohji, Masahito

2018-01-01

Clinical evidence supports the efficacy of bimonthly aflibercept injection for age-related macular degeneration. The study aimed to evaluate aqueous vascular endothelial growth factor and aflibercept concentrations and the efficacy of bimonthly aflibercept in patients with age-related macular degeneration. This study is a prospective, interventional case series. Enrolled were 35 eyes with exudative age-related macular degeneration from 35 patients. Patients received three bimonthly intravitreal aflibercept without loading doses. We collected the aqueous humor just before each injection, measured vascular endothelial growth factor and aflibercept concentrations by enzyme-linked immunosorbent assay and measured best-corrected visual acuity and central retinal subfield thickness before and after the injections. Aqueous vascular endothelial growth factor and aflibercept concentrations were measured. The vascular endothelial growth factor concentration was 135.4 ± 60.5 pg/mL (mean ± standard deviation, range 60.6-323.4) at baseline and below the lowest detectable limit in all eyes at month 2 and in 32 eyes at month 4 (P < 0.001 [month 2] and P < 0.001 [month 4]). The mean aflibercept concentration was 20.3 ng/mL at month 2 and 28.0 ng/mL at month 4. The mean logarithm of the minimum angle of resolution visual acuity improved from 0.50 ± 0.36 at baseline to 0.36 ± 0.40 at month 6 (P < 0.001). The mean central retinal subfield thickness decreased from 353 ± 100 μm at baseline to 236 ± 45 μm at month 6 (P < 0.001). Bimonthly aflibercept injections without loading doses may be considered a treatment option for age-related macular degeneration. © 2017 Royal Australian and New Zealand College of Ophthalmologists.

Managing military training-related environmental disturbance.

PubMed

Zentelis, Rick; Banks, Sam; Roberts, J Dale; Dovers, Stephen; Lindenmayer, David

2017-12-15

Military Training Areas (MTAs) cover at least 2 percent of the Earth's terrestrial surface and occur in all major biomes. These areas are potentially important for biodiversity conservation. The greatest challenge in managing MTAs is balancing the disturbance associated with military training and environmental values. These challenges are unique as no other land use is managed for these types of anthropogenic disturbances in a natural setting. We investigated how military training-related disturbance is best managed on MTAs. Specifically, we explored management options to maximise the amount of military training that can be undertaken on a MTA while minimising the amount of environmental disturbance. MTAs comprise of a number of ranges designed to facilitate different types of military training. We simulated military training-related environmental disturbance at different range usage rates under a typical range rotation use strategy, and compared the results to estimated ecosystem recovery rates from training activities. We found that even at relatively low simulated usage rates, random allocation and random spatial use of training ranges within an MTA resulted in environmental degradation under realistic ecological recovery rates. To avoid large scale environmental degradation, we developed a decision-making tool that details the best method for managing training-related disturbance by determining how training activities can be allocated to training ranges. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

Age-related macular degeneration: current treatments

PubMed Central

Hubschman, Jean Pierre; Reddy, Shantan; Schwartz, Steven D

2009-01-01

Purpose: Although important progress has been made in understanding age-related macular degeneration (AMD), management of the disease continues to be a challenge. AMD research has led to a widening of available treatment options and improved prognostic perspectives. This essay reviews these treatment options. Design: Interpretative essay. Methods: Literature review and interpretation. Results: Current treatments to preserve vision in patients with non-exudative AMD include antioxidant vitamins and mineral supplementations. Exudative AMD is currently most often treated monthly with anti-VEGF intravitreal injections. However, investigators are beginning to experiment with combination therapy and surgical approaches in an attempt to limit the number of treatment and reduce the financial burden on the health care system. Conclusion: By better understanding the basis and pathogenesis of AMD, newer therapies will continue to be developed that target specific pathways in patients with AMD, with the hoped for outcome of better management of the disease and improved visual acuity. PMID:19668560

Reducing Health Cost: Health Informatics and Knowledge Management as a Business and Communication Tool

NASA Astrophysics Data System (ADS)

Gyampoh-Vidogah, Regina; Moreton, Robert; Sallah, David

Health informatics has the potential to improve the quality and provision of care while reducing the cost of health care delivery. However, health informatics is often falsely regarded as synonymous with information management (IM). This chapter (i) provides a clear definition and characteristic benefits of health informatics and information management in the context of health care delivery, (ii) identifies and explains the difference between health informatics (HI) and managing knowledge (KM) in relation to informatics business strategy and (iii) elaborates the role of information communication technology (ICT) KM environment. This Chapter further examines how KM can be used to improve health service informatics costs, and identifies the factors that could affect its implementation and explains some of the reasons driving the development of electronic health record systems. This will assist in avoiding higher costs and errors, while promoting the continued industrialisation of KM delivery across health care communities.

Video modelling and reducing anxiety related to dental injections - a randomised clinical trial.

PubMed

Al-Namankany, A; Petrie, A; Ashley, P

2014-06-01

This study was part of a successfully completed PhD and was presented at the IADR/AADR General Session (2013) in Seattle, Washington, USA. The report of this clinical trial conforms to the CONSORT statement. A randomised controlled trial to investigate if video modelling can influence a child's anxiety before the administration of local anaesthesia (LA). A sample of 180 (6- to 12-year-old) children due to have dental treatments under LA were randomly allocated to the modelling video or the control video (oral hygiene instruction). The level of anxiety was recorded before and after watching the video on the Abeer Children Dental Anxiety Scale (ACDAS) and the child's ability to cope with the subsequent procedure was assessed on the visual analogue scale (VAS). A two group chi-square test was used as the basis for the sample size calculation; a significance level of 0.025 was chosen rather than the conventional 0.05 to avoid spurious results arising from multiple testing. Children in the test group had significantly less anxiety after watching the video than children in the control group throughout the subsequent dental procedure; in particular at the time of the LA administration (p <0.001). Video modelling appeared to be effective at reducing dental anxiety and has a significant impact on needle phobia in children.

Diesel engine emissions reduction by multiple injections having increasing pressure

DOEpatents

Reitz, Rolf D.; Thiel, Matthew P.

2003-01-01

Multiple fuel charges are injected into a diesel engine combustion chamber during a combustion cycle, and each charge after the first has successively greater injection pressure (a higher injection rate) than the prior charge. This injection scheme results in reduced emissions, particularly particulate emissions, and can be implemented by modifying existing injection system hardware. Further enhancements in emissions reduction and engine performance can be obtained by using known measures in conjunction with the invention, such as Exhaust Gas Recirculation (EGR).

Apparatus and method for controlling the secondary injection of fuel

DOEpatents

Martin, Scott M.; Cai, Weidong; Harris, Jr., Arthur J.

2013-03-05

A combustor (28) for a gas turbine engine is provided comprising a primary combustion chamber (30) for combusting a first fuel to form a combustion flow stream (50) and a transition piece (32) located downstream from the primary combustion chamber (30). The transition piece (32) comprises a plurality of injectors (66) located around a circumference of the transition piece (32) for injecting a second fuel into the combustion flow stream (50). The injectors (66) are effective to create a radial temperature profile (74) at an exit (58) of the transition piece (32) having a reduced coefficient of variation relative to a radial temperature profile (64) at an inlet (54) of the transition piece (32). Methods for controlling the temperature profile of a secondary injection are also provided.

Intrathecal Spread of Injectate Following an Ultrasound-Guided Selective C5 Nerve Root Injection in a Human Cadaver Model.

PubMed

Falyar, Christian R; Abercrombie, Caroline; Becker, Robert; Biddle, Chuck

2016-04-01

Ultrasound-guided selective C5 nerve root blocks have been described in several case reports as a safe and effective means to anesthetize the distal clavicle while maintaining innervation of the upper extremity and preserving diaphragmatic function. In this study, cadavers were injected with 5 mL of 0.5% methylene blue dye under ultrasound guidance to investigate possible proximal and distal spread of injectate along the brachial plexus, if any. Following the injections, the specimens were dissected and examined to determine the distribution of dye and the structures affected. One injection revealed dye extended proximally into the epidural space, which penetrated the dura mater and was present on the spinal cord and brainstem. Dye was noted distally to the divisions in 3 injections. The anterior scalene muscle and phrenic nerve were stained in all 4 injections. It appears unlikely that local anesthetic spread is limited to the nerve root following an ultrasound-guided selective C5 nerve root injection. Under certain conditions, intrathecal spread also appears possible, which has major patient safety implications. Additional safety measures, such as injection pressure monitoring, should be incorporated into this block, or approaches that are more distal should be considered for the acute pain management of distal clavicle fractures.

Are ranger patrols effective in reducing poaching-related threats within protected areas?

USGS Publications Warehouse

Moore, Jennnifer F.; Mulindahabi, Felix; Masozera, Michel K.; Nichols, James; Hines, James; Turikunkiko, Ezechiel; Oli, Madan K.

2018-01-01

Poaching is one of the greatest threats to wildlife conservation world-wide. However, the spatial and temporal patterns of poaching activities within protected areas, and the effectiveness of ranger patrols and ranger posts in mitigating these threats, are relatively unknown.We used 10 years (2006–2015) of ranger-based monitoring data and dynamic multi-season occupancy models to quantify poaching-related threats, to examine factors influencing the spatio-temporal dynamics of these threats and to test the efficiency of management actions to combat poaching in Nyungwe National Park (NNP), Rwanda.The probability of occurrence of poaching-related threats was highest at lower elevations (1,801–2,200 m), especially in areas that were close to roads and tourist trails; conversely, occurrence probability was lowest at high elevation sites (2,601–3,000 m), and near the park boundary and ranger posts. The number of ranger patrols substantially increased the probability that poaching-related threats disappear at a site if threats were originally present (i.e. probability of extinction of threats). Without ranger visits, the annual probability of extinction of poaching-related threats was an estimated 7%; this probability would increase to 20% and 57% with 20 and 50 ranger visits per year, respectively.Our results suggest that poaching-related threats can be effectively reduced in NNP by adding ranger posts in areas where they do not currently exist, and by increasing the number of patrols to sites where the probability of poaching activities is high.Synthesis and applications. Our application of dynamic occupancy models to predict the probability of presence of poaching-related threats is novel, and explicitly considers imperfect detection of illegal activities. Based on the modelled relationships, we identify areas that are most vulnerable to poaching, and offer insights regarding how ranger patrols can be optimally deployed to reduce poaching-related threats and

Elimination of fuel pressure fluctuation and multi-injection fuel mass deviation of high pressure common-rail fuel injection system

NASA Astrophysics Data System (ADS)

Li, Pimao; Zhang, Youtong; Li, Tieshuan; Xie, Lizhe

2015-03-01

The influence of fuel pressure fluctuation on multi-injection fuel mass deviation has been studied a lot, but the fuel pressure fluctuation at injector inlet is still not eliminated efficiently. In this paper, a new type of hydraulic filter consisting of a damping hole and a chamber is developed for elimination of fuel pressure fluctuation and multi-injection fuel mass deviation. Linear model of the improved high pressure common-rail system(HPCRS) including injector, the pipe connecting common-rail with injector and the hydraulic filter is built. Fuel pressure fluctuation at injector inlet, on which frequency domain analysis is conducted through fast Fourier transformation, is acquired at different target pressure and different damping hole diameter experimentally. The linear model is validated and can predict the natural frequencies of the system. Influence of damping hole diameter on fuel pressure fluctuation is analyzed qualitatively based on the linear model, and it can be inferred that an optimal diameter of the damping hole for elimination of fuel pressure fluctuation exists. Fuel pressure fluctuation and fuel mass deviation under different damping hole diameters are measured experimentally, and it is testified that the amplitude of both fuel pressure fluctuation and fuel mass deviation decreases first and then increases with the increasing of damping hole diameter. The amplitude of main injection fuel mass deviation can be reduced by 73% at most under pilot-main injection mode, and the amplitude of post injection fuel mass deviation can be reduced by 92% at most under main-post injection mode. Fuel mass of a single injection increases with the increasing of the damping hole diameter. The hydraulic filter proposed by this research can be potentially used to eliminate fuel pressure fluctuation at injector inlet and improve the stability of HPCRS fuel injection.

A comparison of Quincke and Whitacre needles with respect to risk of intravascular uptake in S1 transforaminal epidural steroid injections: a randomized trial of 1376 cases.

PubMed

Shin, Jaehyuck; Kim, Yong Chul; Lee, Sang Chul; Kim, Jae Hun

2013-11-01

Transforaminal epidural steroid injection (TFESI) is a useful treatment modality for pain management. Most complications of TFESI are minor and transient. However, there is a risk of serious complications such as nerve injury, spinal cord infarct, or paraplegia. Some of the risks are related to direct injury to the vessel or intravascular injection of the particulate steroid. We prospectively tested the hypothesis that the intravascular injection rate of the Whitacre needle is lower than that of the Quincke needle during TFESI. This study was a randomized trial of 1376 TFESIs at the S1 level. We collected data of age, gender, height, weight, laterality (right/left), history of lumbosacral spine operation, history of appropriate interval discontinuation of anticoagulation medicines, and underlying disease. During the S1 TFESI, intrasacral bone contact, a blood aspiration test, and real-time fluoroscopy of the intravascular injection using contrast media were investigated. There were no significant differences in the intravascular injection rate with respect to age, gender, height, weight, hypertension, diabetes mellitus, laterality, history of lumbosacral spine operation, or history of appropriate interval discontinuation of anticoagulation medicines. Intravascular injection was significantly associated with a blood aspiration test (P < 0.001), needle tip type (P = 0.002), intrasacral bone contact (P < 0.001), and physicians (some P < 0.05). The use of Quincke needles and intrasacral bone contact increased the rate of intravascular injection. To reduce the risk of intravascular injection, the use of Whitacre needles without intrasacral bone contact may be a safer and more effective approach.

Analysis of batch-related influences on injection molding processes viewed in the context of electro plating quality demands

NASA Astrophysics Data System (ADS)

Siepmann, Jens P.; Wortberg, Johannes; Heinzler, Felix A.

2016-03-01

The injection molding process is mandatorily influenced by the viscosity of the material. By varying the material batch the viscosity of the polymer changes. For the process and part quality the initial conditions of the material in addition to the processing parameters define the process and product quality. A high percentage of technical polymers processed in injection molding is refined in a follow-up production step, for example electro plating. Processing optimized for electro plating often requires avoiding high shear stresses by using low injection speed and pressure conditions. Therefore differences in the material charges' viscosity occur especially in the quality related low shear rate area. These differences and quality related influences can be investigated by high detail rheological analysis and process simulation based on adapted material describing models. Differences in viscosity between batches can be detected by measurements with high-pressure-capillary-rheometers or oscillatory rheometers for low shear rates. A combination of both measurement techniques is possible by the Cox-Merz-Relation. The detected differences in the rheological behavior of both charges are summarized in two material behavior describing model approaches and added to the simulation. In this paper the results of processing-simulations with standard filling parameters are presented with two ABS charges. Part quality defining quantities such as temperature, pressure and shear stress are investigated and the influence of charge variations is pointed out with respect to electro plating quality demands. Furthermore, the results of simulations with a new quality related process control are presented and compared to the standard processing.

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.

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

Case series on chronic whiplash related neck pain treated with intraarticular zygapophysial joint regeneration injection therapy.

PubMed

Hooper, R Allen; Frizzell, J Bevan; Faris, Peter

2007-03-01

Although in clinical use, there is only 1 published case report on the efficacy of intraarticular regeneration injection therapy (RIT) (a.k.a. prolotheraphy). This report supports a rationale for future clinical trials of this technique. To assess the efficacy of intraarticular zygapophysial joint RIT in patients with chronic whiplash related neck pain that failed other conservative and interventional procedures. Patients were treated with intraarticular RIT and reassessed over 1 year. Retrospective case review of prospective data. Eighteen consecutive patients were treated with intraarticular prolotherapy by placing 0.5 - 1mL of 20% dextrose solution into each zygapophysial joint, after confirmation of intraarticular location with radiographic contrast, using 25-gauge spinal needles and fluoroscopic guidance. Solution was prepared by diluting D50W with 1% lidocaine. Fifteen patients completed treatment. Three patients had bilateral treatment, leaving 18 sides for analysis. Mean Neck Disability Index (NDI) pre-treatment was 24.71 and decreased post-treatment to 14.21 (2 months), 13.45 (6 months), 10.94 (12 months). Average change NDI=13.77 (p<0.0001) baseline versus 12 months. Symptoms for 14 patients were from motor vehicle accident, of which 13 were in litigation. Patients attending physiotherapy over the course of treatment had better outcomes than those without physiotherapy. Women needed more injections (5.4) than men (3.2) p=0.0003. Intraarticular RIT improved pain and function in this case series. The procedure appears safe, more effective than periarticular RIT, and lasted as long, or longer, than those patients with previous radiofrequency neurotomy. Concurrent physiotherapy helped reduce post-procedure neck stiffness. Future trials should consider gender when deciding how many treatments to administer. Litigation was not a barrier to recovery.

Reverse-Tangent Injection in a Centrifugal Compressor

NASA Technical Reports Server (NTRS)

Skoch, Gary J.

2007-01-01

Injection of working fluid into a centrifugal compressor in the reverse tangent direction has been invented as a way of preventing flow instabilities (stall and surge) or restoring stability when stall or surge has already commenced. The invention applies, in particular, to a centrifugal compressor, the diffuser of which contains vanes that divide the flow into channels oriented partly radially and partly tangentially. In reverse-tangent injection, a stream or jet of the working fluid (the fluid that is compressed) is injected into the vaneless annular region between the blades of the impeller and the vanes of the diffuser. As used here, "reverse" signifies that the injected flow opposes (and thereby reduces) the tangential component of the velocity of the impeller discharge. At the same time, the injected jet acts to increase the radial component of the velocity of the impeller discharge.

Subsurface brine injection: Proactive approach to close the produced water loop in the western desert of Egypt

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

Farid, E.E.; Nour, M.H.

1996-11-01

In 1988 a major onshore production facility was producing oil from eight formations in six oil fields located in the western desert of Egypt. Two of these formations include active water drive reservoirs, in addition; three reservoirs at that date were receiving water injection to enhance oil recovery. To handle the increasing volumes of the produced water (which is contaminated with oil, production chemicals and other pollutants), three alternatives were investigated: (1) Injection into disposal wells. (2) Dumping in surface disposal pits. (3) Re-injection to waterflood some oil reservoirs. The investigation revealed that the first two options are technically unfavorable,more » also they are conventional Waste Management Technologies (WMT) which provide short-term remedial solution. In contrast, Produced Water Re-Injection (PWRI) is an Environmental Control Technology (ECT) which minimize the environmental impact through process improvements. A state -of-the-art re-injection process was utilized using chemical treatment, gas liberation, settling, filtration and injection. This process represents a combination of two (ECT) methods: Reuse (for water flooding) and Recycling (when brine is redisposed underground). This process reduce the overall volumes of produced water to be disposed, increase the oil reserves, reservoir pressure and oil production and converse the underground water reserve.« less

Preliminary results of a randomized, equivalence trial of fluoroscopic caudal epidural injections in managing chronic low back pain: Part 2--Disc herniation and radiculitis.

PubMed

Manchikanti, Laxmaiah; Singh, Vijay; Cash, Kimberly A; Pampati, Vidyasagar; Damron, Kim S; Boswell, Mark V

2008-01-01

The pathophysiology of lumbar radicular pain is a subject of ongoing research. The prevalence of sciatica or radiculitis ranges from 1.2% to 43%. Epidural injections are one of the most commonly performed interventions in the United States in managing chronic low back and lower extremity pain secondary to disc herniation and radiculitis. There is a paucity of evidence with contemporary methodology used in performing epidural injections under fluoroscopy and based on pain relief and functional status improvement. A randomized, double-blind, equivalence trial. An interventional pain management practice, a specialty referral center, a private practice setting in the United States. To evaluate the effectiveness of caudal epidural injections with or without steroids in managing chronic low back and lower extremity pain secondary to disc herniation or radiculitis in providing effective and long-lasting pain relief and evaluate the differences between local anesthetic with or without steroids. Patients were assigned to one of 2 groups; Group I patients received caudal epidural injections with an injection of local anesthetic (lidocaine 0.5%), whereas, Group II patients received caudal epidural injections with 0.5% lidocaine 9 mL mixed with 1 mL of steroid. Randomization was performed by computer-generated random allocations sequence by simple randomization. Multiple outcome measures were utilized which included the Numeric Rating Scale (NRS), the Oswestry Disability Index 2.0 (ODI), employment status, and opioid intake with assessment at 3 months, 6 months, and 12 months post-treatment. Significant pain relief was defined as 50% or more, whereas significant improvement in disability score was defined as a reduction of 40% or more. The percentage of patients with significant pain relief of 50% or greater at 12 months was 79% in Group I and 81% in Group II. Reduction of Oswestry scores of at least 40% was seen in 83% of the patients in Group I and 91% in Group II. The

LPS-induced knee-joint reactive arthritis and spinal cord glial activation were reduced after intrathecal thalidomide injection in rats.

PubMed

Bressan, Elisângela; Mitkovski, Mišo; Tonussi, Carlos Rogério

2010-10-09

Thalidomide is thought to prevent TNF-α production, and such mechanism could be useful in a spinally delivered drug approach for the control of peripheral inflammation. This study aimed to evaluate the effect of intrathecal thalidomide, in comparison with that of intraperitoneal treatment, on articular incapacitation, edema, synovial leukocyte content, and spinal cord glial activation in a model of Escherichia coli lipopolysaccharide (LPS)-induced reactive arthritis in rats. LPS (30ng) was injected into a knee-joint previously primed with carrageenan (300μg). Systemic (30 and 100mg/kg; intraperitoneal, i.p.) and intrathecal (10 and 100μg; i.t.) thalidomide were given 1h or 20min before LPS injection, respectively. Articular incapacitation and edema were evaluated hourly. After 6h, synovial fluid and lumbar spinal cords were collected for subsequent evaluations of cell migration and expression of CD11b/c and GFAP markers, respectively. Systemic (30 and 100mg/kg) or intrathecal (10 and 100μg) thalidomide reduced articular incapacitation, edema, and polymorphonuclear migration. In addition, i.p. and i.t. thalidomide reduced the expression of CD11b/c and GFAP markers in the lumbar spinal cord. These results suggest that thalidomide can also produce peripheral anti-inflammatory effects through action in the spinal cord that may involve glia inhibition. This study provides new evidence that the direct spinal delivery of immunomodulators may be an alternative for the treatment of arthritic diseases, which require long systemic treatment with drugs associated with undesirable side effects. Copyright © 2010 Elsevier Inc. All rights reserved.