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Sample records for multiply morbid patients

  1. Morbidity of Early Spine Surgery in the Multiply Injured Patient

    DTIC Science & Technology

    2014-07-31

    Rivera JD, Gre- nier ES, Lehman RA, et al. (2012) Spinal column injuries among Americans in the global war on terrorism. J Bone Joint Surg Am 94:e135...surgery for multiply injured patients with operative spinal injuries remains unknown. The purported benefits of early intervention must be weighed...morbidity of early surgery on military casualties. The objective is to compare surgical morbidity of early spinal surgery in multiply injured patients

  2. Burns in Morbidly Obese Patients,

    DTIC Science & Technology

    1992-12-01

    tract infection and one episode C obesity. The clinical records of these patients were reviewed in of sinusitis. Two patients had documented bacteremias...veloped pneumonia and two developed tracheobronchitis. 0 Research, seven of whom clearly fulfilled the criteria for morbid There were one urinary

  3. Co-morbid anxiety and depression among pulmonary tuberculosis patients.

    PubMed

    Aamir, Siddiqua; Aisha

    2010-10-01

    The need to recognize and manage psychiatric co-morbidity in tuberculosis (TB) patients in primary care settings in order to improve adherence to the treatment is now well documented. Pulmonary TB patients at the District TB Control Office and TB Centre in Haripur from December 2007 to March 2008 were evalute in order to assess the frequency of anxiety and depression and continuation of treatment. Forty seven out of 65 (72%) TB patients had severe/moderate level of anxiety and depression according to Hospital Anxiety and Depression Scale (HADS). Fourteen (22%) TB patients with co-morbid anxiety and depression showed multi drug-resistance (MDR-TB).

  4. Psychosocial functioning of two groups of morbidly obese patients.

    PubMed

    Rosen, L W; Aniskiewicz, A S

    1983-01-01

    Fourteen morbidly obese women who were candidates for intestinal bypass surgery were compared in terms of psychosocial functioning and dietary behavior to 14 morbidly obese women who elected not to undergo the bypass procedure. Each patient underwent a psychiatric evaluation which included a developmental and dietary history, a mental status exam, and the administration of the MMPI. Diagnoses were based on the DSM-III multi-axial system. There was no difference between the bypass group and the non-bypass group on the Axis I diagnoses, however the bypass group did have a significantly higher frequency of Axis II diagnoses. The bypass group demonstrated significantly higher levels of psychosocial stressors (Axis IV) and lower levels of adaptive functioning (Axis V) when compared to the non-bypass group. The bypass patients also had a significantly higher frequency of past suicide attempts. On the MMPI, the bypass group had significantly higher elevations on scales 2 (depression), 4 (psychopathic deviate), 6 (paranoia), and 0 (social introversion). There were no significant differences between the groups in terms of dietary history and behavior, except that significantly fewer bypass patients could place a numerical estimate on their daily energy intake. These results were discussed in terms of their implications for the assessment and treatment of morbidly obese patients.

  5. Surgery for Gastroesophageal Reflux Disease in the Morbidly Obese Patient.

    PubMed

    Duke, Meredith C; Farrell, Timothy M

    2017-01-01

    The prevalence of gastroesophageal reflux disease (GERD) has mirrored the increase in obesity, and GERD is now recognized as an obesity-related comorbidity. There is growing evidence that obesity, specifically central obesity, is associated with the complications of chronic reflux, including erosive esophagitis, Barrett's esophagus, and esophageal adenocarcinoma. While fundoplication is effective in creating a competent gastroesophageal junction and controlling reflux in most patients, it is less effective in morbidly obese patients. In these patients a bariatric operation has the ability to correct both the obesity and the abnormal reflux. The Roux-en-Y gastric bypass is the preferred procedure.

  6. Morbidity and mortality in ESRD patients on dialysis.

    PubMed

    Al Wakeel, Jamal S; Mitwalli, Ahmed H; Al Mohaya, S; Abu-Aisha, Hassan; Tarif, Nauman; Malik, Ghulam H; Hammad, D

    2002-01-01

    End-stage renal disease (ESRD), due to its high morbidity and mortality as well as social and financial implications, is a major public health problem. Outcome depends not only on different modalities of treatment like hemodialysis and peritoneal dialysis, but also on existing co-morbidities, age, duration on dialysis, supportive therapies and infection control strategies. Thus, a detailed study becomes necessary to improve health care delivery, provide medical care and to establish a geographical reference. The present study was undertaken to characterize the ESRD patients by their demographic and co-morbid conditions and relate this to the morbidity and mortality trends. The medical records of 110 ESRD patients seen over a five-year period (June 1995 to December 1999) in two tertiary-care hospitals in Riyadh, Saudi Arabia were studied retrospectively. There were 79 (64.5%) males and 31 (35.5%) females; their age ranged from 17 to 92 years (mean age 53.8 +/- 17.8 years). Diabetes was the commonest cause of ESRD seen in 26 (26.6%) followed by nephrosclerosis, unknown etiology, lupus nephritis, pyelonephritis and primary glomerulonephritis. Diabetes mellitus was the most prevalent co-morbidity seen during the study period and occurred in 65 patients (59%) followed by heart disease in 36 (32.7%), liver disease in 30 (27.3%), cerebrovascular accidents in 13 (11.8%) and neoplasm in 11 (10%). Seven (6.3%) patients only were smokers. Hemodialysis was the most frequent treatment choice as renal replacement therapy. Among the causes of hospitalization, cardiovascular conditions were the leading single cause (19.1%), followed by access related reasons and infections (11.5% each). The overall hospitalization rate was 11.2 days/year. The overall mortality rate was 8.07 deaths/year. The leading cause of death was cardiovascular in 15 (51.7%) followed by unknown/sudden death in eight (27.5%). Other causes of death included fluid overload, gastrointestinal hemorrhage, septicemia

  7. [Timing of surgical treatment of fractures of multiply iniured patients - from science to tactics].

    PubMed

    Simons, Tomi; Brinck, Tuomas; Handolin, Lauri

    2016-01-01

    Timing of the treatment of orthopaedic injuries in multiply injured patients has undergone changes. The timing of definitive fracture management has varied from several weeks to within hours of injury. In many studies a clear benefit has been identified from early definitive care of long bone fractures: early total care (ETC). The most seriously injured patients benefit from damage control orthopaedics, an approach employing primary external fixator stabilization followed by secondary intramedullary nailing. Debate over these approaches with enhanced understanding of biological response to injury has led to recent emphasis on the need for aggressive patient monitoring and continued multidisciplinary evaluation of the patient's physiological response to treatment.

  8. Expiratory flow limitation in morbidly obese postoperative mechanically ventilated patients.

    PubMed

    Koutsoukou, A; Koulouris, N; Bekos, B; Sotiropoulou, C; Kosmas, E; Papadima, K; Roussos, C

    2004-10-01

    Although obesity promotes tidal expiratory flow limitation (EFL), with concurrent dynamic hyperinflation (DH), intrinsic PEEP (PEEPi) and risk of low lung volume injury, the prevalence and magnitude of EFL, DH and PEEPi have not yet been studied in mechanically ventilated morbidly obese subjects. In 15 postoperative mechanically ventilated morbidly obese subjects, we assessed the prevalence of EFL [using the negative expiratory pressure (NEP) technique], PEEPi, DH, respiratory mechanics, arterial oxygenation and PEEPi inequality index as well as the levels of PEEP required to abolish EFL. In supine position at zero PEEP, 10 patients exhibited EFL with a significantly higher PEEPi and DH and a significantly lower PEEPi inequality index than found in the five non-EFL (NEFL) subjects. Impaired gas exchange was found in all cases without significant differences between the EFL and NEFL subjects. Application of 7.5 +/- 2.5 cm H2O of PEEP (range: 4-16) abolished EFL with a reduction of PEEPi and DH and an increase in FRC and the PEEPi inequality index but no significant effect on gas exchange. The present study indicates that: (a) on zero PEEP, EFL is present in most postoperative mechanically ventilated morbidly obese subjects; (b) EFL (and concurrent risk of low lung volume injury) is abolished with appropriate levels of PEEP; and (c) impaired gas exchange is common in these patients, probably mainly due to atelectasis.

  9. Patient and Societal Value Functions for the Testing Morbidities Index

    PubMed Central

    Swan, John Shannon; Kong, Chung Yin; Lee, Janie M.; Akinyemi, Omosalewa; Halpern, Elkan F.; Lee, Pablo; Vavinskiy, Sergey; Williams, Olubunmi; Zoltick, Emilie S.; Donelan, Karen

    2013-01-01

    Background We developed preference-based and summated scale scoring for the Testing Morbidities Index (TMI) classification, which addresses short-term effects on quality of life from diagnostic testing before, during and after a testing procedure. Methods The two TMI value functions utilize multiattribute value techniques; one is patient-based and the other has a societal perspective. 206 breast biopsy patients and 466 (societal) subjects informed the models. Due to a lack of standard short-term methods for this application, we utilized the visual analog scale (VAS). Waiting trade-off (WTO) tolls provided an additional option for linear transformation of the TMI. We randomized participants to one of three surveys: the first derived weights for generic testing morbidity attributes and levels of severity with the VAS; a second developed VAS values and WTO tolls for linear transformation of the TMI to a death-healthy scale; the third addressed initial validation in a specific test (breast biopsy). 188 patients and 425 community subjects participated in initial validation, comparing direct VAS and WTO values to the TMI. Alternative TMI scoring as a non-preference summated scale was included, given evidence of construct and content validity. Results The patient model can use an additive function, while the societal model is multiplicative. Direct VAS and the VAS-scaled TMI were correlated across modeling groups (r=0.45 to 0.62) and agreement was comparable to the value function validation of the Health Utilities Index 2. Mean Absolute Difference (MAD) calculations showed a range of 0.07–0.10 in patients and 0.11–0.17 in subjects. MAD for direct WTO tolls compared to the WTO-scaled TMI varied closely around one quality-adjusted life day. Conclusions The TMI shows initial promise in measuring short-term testing-related health states. PMID:23689044

  10. Binge eating and temperament in morbidly obese prebariatric surgery patients.

    PubMed

    Müller, Astrid; Claes, Laurence; Mitchell, James E; Fischer, Julia; Horbach, Thomas; de Zwaan, Martina

    2012-01-01

    The objective of this study was to investigate the relationship between binge eating and temperament variables, controlling for depression and adult attention deficit/hyperactivity disorder (ADHD), in 90 extremely obese individuals. The participants completed questionnaires assessing eating pathology, reactive temperament, effortful control, depression and ADHD and were grouped based on the presence of regular binge eating. Patients reporting regular binge eating did not differ from patients not reporting regular binge eating with respect to BMI, age, gender, the occurrence of adult ADHD and reactive temperament. However, individuals with binge eating exhibited more pathological scores with regard to eating pathology, depression and effortful control. A logistic regression analysis revealed that only eating concerns and reduced effortful control remained significantly associated with regular binge eating. Binge eating in morbidly obese individuals appears to be associated with a lack of effortful control.

  11. LINEA ALBA COLLAGEN ASSESSMENT IN MORBIDLY OBESE PATIENTS

    PubMed Central

    GROSSI, João Vicente Machado; NICOLA, Felipe Fernandes; ZEPEDA, Ivan Alberto; BECKER, Martina; TRINDADE, Eduardo Neubarth; DIEMEN, Vinicius Von; CAVAZZOLA, Leandro Totti; TRINDADE, Manoel Roberto Maciel

    2016-01-01

    ABSTRACT Background: The evaluation of collagen in the abdominal wall has been increasingly studied because of the relevance on collagen in the healing process after laparotomy. Aim: To evaluate the amount of collagen in the linea alba of patients undergoing laparotomic bariatric surgery and comparing with non-obese cadavers. Methods: Were evaluated 88 samples of aponeurosis from abdominal linea alba of 44 obese patients (obesity group) and 44 non-obese cadavers (control group). The samples were collected in 2013 and 2104, and were sorted according to age (18-30, 31-45 and 46-60), gender, BMI, waist and cervical circumference, and subcutaneous tissue thickness. Material for biopsy was collected from the supraumbilical region of the linea alba for immunohistochemical analysis differentiating collagen type 1 and type 3 and the 1/3 ratio. Image-Pro Plus pixel counting software was used to measure the amount of collagen. Results: The obesity group evidenced mean age 44.11±9.90 years; 18-30 age group had three (6.8%) obese individuals; 31-45 had 22 (50%) and 46-60 had 19 (43.1%). Females were present in 81.8% (n=36); BMI (kg/m²) was 48.81±6.5; waist circumference (cm) was 136.761±13.55; subcutaneous tissue thickness (cm) 4.873±0.916. Considering age groups, gender and BMI, there were statistical differences in all tests when compared with the cadavers. Conclusion: The amount of collagen in the linea alba above the umbilical region in the morbidly obese patients was smaller than in the non-obese cadavers in the same age group. PMID:27683766

  12. SHOCK VOLUME: A PATIENT-SPECIFIC INDEX THAT PREDICTS TRANSFUSION REQUIREMENTS AND ORGAN DYSFUNCTION IN MULTIPLY INJURED PATIENTS.

    PubMed

    McKinley, Todd O; McCarroll, Tyler; Gaski, Greg E; Frantz, Travis L; Zarzaur, Ben L; Terry, Colin; Steenburg, Scott D

    2016-02-01

    Multiply injured patients (MIPs) in hemorrhagic shock develop oxygen debt which causes organ dysfunction and can lead to death. We developed a noninvasive patient-specific index, Shock Volume (SV), to quantify the magnitude of hypoperfusion. SV integrates the magnitude and duration that incremental shock index values are elevated above known thresholds of hypoperfusion using serial individual vital sign data. SV can be monitored in real time to assess ongoing hypoperfusion. The goal of this study was to determine how SV corresponded to transfusion requirements and organ dysfunction in a retrospective cohort of 74 MIPs. We measured SV in 6-h increments for 48 h after injury in multiply injured adults (18-65; Injury Severity Score ≥18). Patients who had accumulated 40 units of SV within 6 h of injury and 100 units of SV within 12 h of injury were at high risk for requiring massive transfusion or multiple critical administration transfusions. SV measurements were equally sensitive and specific as compared with base deficit values in predicting transfusions. SV measurements at 6 h after injury stratified patients at risk for multiple organ failure determined by Denver scores. In addition, SV values corresponded to the magnitude of organ failure determined by Sequential Organ Failure Assessment scores. SV is a patient-specific index that can be quantified in real time in critically injured patients. It is a surrogate for cumulative hypoperfusion and it predicts high-volume transfusions and organ dysfunction.

  13. MULTIPLIER CIRCUIT

    DOEpatents

    Chase, R.L.

    1963-05-01

    An electronic fast multiplier circuit utilizing a transistor controlled voltage divider network is presented. The multiplier includes a stepped potentiometer in which solid state or transistor switches are substituted for mechanical wipers in order to obtain electronic switching that is extremely fast as compared to the usual servo-driven mechanical wipers. While this multiplier circuit operates as an approximation and in steps to obtain a voltage that is the product of two input voltages, any desired degree of accuracy can be obtained with the proper number of increments and adjustment of parameters. (AEC)

  14. Multi-Morbidity in Hospitalised Older Patients: Who Are the Complex Elderly?

    PubMed Central

    Ruiz, Milagros; Bottle, Alex; Long, Susannah; Aylin, Paul

    2015-01-01

    Background No formal definition for the “complex elderly” exists; moreover, these older patients with high levels of multi-morbidity are not readily identified as such at point of hospitalisation, thus missing a valuable opportunity to manage the older patient appropriately within the hospital setting. Objectives To empirically identify the complex elderly patient based on degree of multi-morbidity. Design Retrospective observational study using administrative data. Setting English hospitals during the financial year 2012–13. Subjects All admitted patients aged 65 years and over. Methods By using exploratory analysis (correspondence analysis) we identify multi-morbidity groups based on 20 target conditions whose hospital prevalence was ≥ 1%. Results We examined a total of 2788900 hospital admissions. Multi-morbidity was highly prevalent, 62.8% had 2 or more of the targeted conditions while 4.7% had six or more. Multi-morbidity increased with age from 56% (65-69yr age-groups) up to 67% (80-84yr age-group). The average multi-morbidity was 3.2±1.2 (SD). Correspondence analysis revealed 3 distinct groups of older patients. Group 1 (multi-morbidity ≤2), associated with cancer and/or metastasis; Group 2 (multi-morbidity of 3, 4 or 5), associated with chronic pulmonary disease, lung disease, rheumatism and osteoporosis; finally Group 3 with the highest level of multi-morbidity (≥6) and associated with heart failure, cerebrovascular accident, diabetes, hypertension and myocardial infarction. Conclusions By using widely available hospital administrative data, we propose patients in Groups 2 and 3 to be identified as the complex elderly. Identification of multi-morbidity patterns can help to predict the needs of the older patient and improve resource provision. PMID:26716440

  15. Cardiovascular Autonomic Dysfunction in Patients with Morbid Obesity

    PubMed Central

    de Sant Anna Junior, Maurício; Carneiro, João Regis Ivar; Carvalhal, Renata Ferreira; Torres, Diego de Faria Magalhães; da Cruz, Gustavo Gavina; Quaresma, José Carlos do Vale; Lugon, Jocemir Ronaldo; Guimarães, Fernando Silva

    2015-01-01

    Background Morbid obesity is directly related to deterioration in cardiorespiratory capacity, including changes in cardiovascular autonomic modulation. Objective This study aimed to assess the cardiovascular autonomic function in morbidly obese individuals. Methods Cross-sectional study, including two groups of participants: Group I, composed by 50 morbidly obese subjects, and Group II, composed by 30 nonobese subjects. The autonomic function was assessed by heart rate variability in the time domain (standard deviation of all normal RR intervals [SDNN]; standard deviation of the normal R-R intervals [SDNN]; square root of the mean squared differences of successive R-R intervals [RMSSD]; and the percentage of interval differences of successive R-R intervals greater than 50 milliseconds [pNN50] than the adjacent interval), and in the frequency domain (high frequency [HF]; low frequency [LF]: integration of power spectral density function in high frequency and low frequency ranges respectively). Between-group comparisons were performed by the Student’s t-test, with a level of significance of 5%. Results Obese subjects had lower values of SDNN (40.0 ± 18.0 ms vs. 70.0 ± 27.8 ms; p = 0.0004), RMSSD (23.7 ± 13.0 ms vs. 40.3 ± 22.4 ms; p = 0.0030), pNN50 (14.8 ± 10.4 % vs. 25.9 ± 7.2%; p = 0.0061) and HF (30.0 ± 17.5 Hz vs. 51.7 ± 25.5 Hz; p = 0.0023) than controls. Mean LF/HF ratio was higher in Group I (5.0 ± 2.8 vs. 1.0 ± 0.9; p = 0.0189), indicating changes in the sympathovagal balance. No statistical difference in LF was observed between Group I and Group II (50.1 ± 30.2 Hz vs. 40.9 ± 23.9 Hz; p = 0.9013). Conclusion morbidly obese individuals have increased sympathetic activity and reduced parasympathetic activity, featuring cardiovascular autonomic dysfunction. PMID:26536979

  16. [MORPHOLOGICAL PECULIARITIES OF MUSCULO-APONEUROTIC TISSUES OF ANTERIOR ABDOMINAL WALL IN PATIENTS, SUFFERING MORBID OBESITY].

    PubMed

    Usenko, O Yu; Gomolyako, I V; Kondratenko, B M; Moskalenko, V V

    2015-11-01

    Results of morphological investigation of musculo-aponeurotic structures of anterior abdominal wall were presented in the morbid obesity patients. The role of obesity as a primary cause for morphofunctional insufficience of musculo-aponeurotic structures was established.

  17. MULTIPLIER CIRCUIT

    DOEpatents

    Thomas, R.E.

    1959-01-20

    An electronic circuit is presented for automatically computing the product of two selected variables by multiplying the voltage pulses proportional to the variables. The multiplier circuit has a plurality of parallel resistors of predetermined values connected through separate gate circults between a first input and the output terminal. One voltage pulse is applied to thc flrst input while the second voltage pulse is applied to control circuitry for the respective gate circuits. Thc magnitude of the second voltage pulse selects the resistors upon which the first voltage pulse is imprcssed, whereby the resultant output voltage is proportional to the product of the input voltage pulses

  18. Mortality, morbidity, and disease severity of patients with aspiration pneumonia

    PubMed Central

    Lanspa, Michael J.; Jones, Barbara E.; Brown, Samuel M.; Dean, Nathan C.

    2013-01-01

    Background Aspiration pneumonia is a common syndrome, although less well characterized than other pneumonia syndromes. We describe a large population of patients with aspiration pneumonia. Methods In this retrospective population study, we queried the electronic medical record at a tertiary-care, university-affiliated hospital from 1996–2006. Patients were initially identified by ICD-9 code 507.x; subsequent physician chart review excluded patients with aspiration pneumonitis and those without a confirmatory radiograph. Patients with community-acquired aspiration pneumonia were compared to a contemporaneous population of community-acquired pneumonia (CAP) patients. We compared CURB-65 predicted mortality with actual 30-day mortality. Results We identified 628 patients with aspiration pneumonia, of which 510 were community-acquired. Median age was 77, with 30-day mortality of 21%. Compared to CAP patients, patients with community-acquired aspiration pneumonia had more frequent inpatient admission (99% vs. 58%) and ICU admission (38% vs. 14%), higher Charlson comorbidity index (3 vs. 1), and higher prevalence of “do not resuscitate/intubate” orders (24% vs. 11%). CURB-65 predicted mortality poorly in aspiration pneumonia patients (AUC 0.66). Conclusions Patients with community-acquired aspiration pneumonia are older, have more comorbidities, and demonstrate higher mortality than CAP patients, even after adjustment for age and comorbidities. CURB-65 poorly predicts mortality in this population. PMID:23184866

  19. Bilateral extensor mechanism disruption after total knee arthroplasty in two morbidly obese patients.

    PubMed

    Goldstein, Zachary H; Yi, Paul H; Haughom, Bryan D; Hellman, Michael D; Levine, Brett R

    2015-05-01

    Disruption of the extensor mechanism as a result of patellar tendon or quadriceps tendon rupture is an uncommon but devastating complication after total knee arthroplasty. Treating a disrupted extensor mechanism can be challenging, particularly in patients who are morbidly obese, due to an increased risk of postoperative complications. Therefore, despite the debilitating nature of extensor mechanism disruption, many community surgeons do not feel comfortable pursuing more complex cases like revision total knee arthroplasty with extensor mechanism allograft on morbidly obese patients, and consequently many of these patients are referred to tertiary-care centers for reconstruction secondary to the complexity of this patient cohort. The authors report 2 cases of bilateral extensor mechanism disruption after total knee arthroplasty in patients who are morbidly obese. One patient experienced trauma leading to her initial rupture; however, her contralateral atraumatic disruption was subsequently diagnosed at a later date. The second patient did not experience trauma leading to either of her extensor mechanism disruptions. Despite substantial medical comorbidities and morbid obesity, revision total knee arthroplasties with extensor mechanism allografts were recommended in both cases in a staged bilateral fashion. The surgical technique is described and the unique challenges afforded by the marked obesity are detailed. The current literature on this subject is reviewed. Despite early complications related to recumbency, this report serves as an example of successful repairs of extensor mechanism disruptions in patients who are morbidly obese, suggesting that extensor mechanism allograft is viable even in patients with high risk of complications.

  20. Predictors of morbidity and mortality after hepatectomy in elderly patients: analysis of 7621 NSQIP patients

    PubMed Central

    Tzeng, Ching-Wei D; Cooper, Amanda B; Vauthey, Jean-Nicolas; Curley, Steven A; Aloia, Thomas A

    2014-01-01

    Objectives Increasingly, surgeons are performing hepatectomies in older patients. This study was designed to analyse the incidences of and risk factors for post-hepatectomy morbidity and mortality in elderly patients. Methods All elective hepatectomies for the period 2005–2010 recorded in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database were evaluated. Factors associated with 30-day rates of morbidity and mortality were compared between patients aged ≥75 years and those aged <75 years. Results Elderly patients accounted for 894 of 7621 (11.7%) hepatectomies. These patients more frequently had comorbidities (diabetes, cardiovascular or lung disease, lower albumin, elevated creatinine, anaesthesia risk; all P < 0.05) and were more likely to undergo partial or left rather than right or extended hepatectomies (P = 0.013). Despite the lesser surgical magnitude of these procedures, elderly patients experienced higher rates of severe complications (23.9% versus 18.4%; P < 0.001) and overall postoperative mortality (4.8% versus 2.0%; P < 0.001). The occurrence of any severe complication was associated with a mortality rate of 20.1% in elderly patients and 10.8% in non-elderly patients (P < 0.001). This disparity in mortality was more pronounced in patients with two or more (31.7% versus 20.2%; P < 0.001) and three or more (46.3% versus 31.1%; P < 0.001) severe complications. Independent risk factors for severe complications and/or mortality included an albumin level of < 4 g/dl, lung disease, intraoperative transfusion, a concurrent intra-abdominal operation, and an operative time of >240 min (all P < 0.05). Conclusions Given their lower physiologic reserve, elderly patients are at much greater risk for mortality after severe complications. To improve outcomes, surgeons should balance age and preoperative comorbidities with magnitude of hepatectomy. PMID:24033514

  1. The mediator role of psychological morbidity in patients with chronic low back pain in differentiated treatments.

    PubMed

    Ferreira, M Salomé; Pereira, M Graça

    2014-09-01

    This study analyzed the mediating role of psychological morbidity and the variables that discriminated low versus high disability, in patients receiving physiotherapy and acupuncture. A total of 203 patients answered measures of illness and medication representations, coping, depression, anxiety, quality of life, and functional disability. Morbidity was a mediator between functional disability and quality of life. Treatment consequences and quality of life, in the acupuncture group, and emotional representations, quality of life, depression, anxiety, and active strategies for pain relief, in the physiotherapy group, discriminated patients with low versus high disability. These results have important implications for identifying high-risk patients.

  2. Morbidity and survival patterns in patients after radical hysterectomy and postoperative adjuvant pelvic radiotherapy

    SciTech Connect

    Fiorica, J.V.; Roberts, W.S.; Greenberg, H.; Hoffman, M.S.; LaPolla, J.P.; Cavanagh, D. )

    1990-03-01

    Morbidity and survival patterns were reviewed in 50 patients who underwent radical hysterectomy, pelvic lymphadenectomy, and adjuvant postoperative pelvic radiotherapy for invasive cervical cancer. Ninety percent of the patients were FIGO stage IB, and 10% were clinical stage IIA or IIB. Indications for adjuvant radiotherapy included pelvic lymph node metastasis, large volume, deep stromal penetration, lower uterine segment involvement, or capillary space involvement. Seventy-two percent of the patients had multiple high-risk factors. An average of 4700 cGy of whole-pelvis radiotherapy was administered. Ten percent of the patients suffered major gastrointestinal complications, 14% minor gastrointestinal morbidity, 12% minor genitourinary complications, one patient a lymphocyst, and one patient lymphedema. Of the five patients with major gastrointestinal morbidity, all occurred within 12 months of treatment. Three patients required intestinal bypass surgery for distal ileal obstructions and all are currently doing well and free of disease. All of the patients who developed recurrent disease had multiple, high-risk factors. The median time of recurrence was 12 months. All patients recurred within the radiated field. Actuarial survival was 90% and disease-free survival 87% at 70 months. It is our opinion that the morbidity of postoperative pelvic radiotherapy is acceptable, and benefit may be gained in such a high-risk patient population.

  3. Panniculectomy and Cystectomy: An Approach to the Morbidly Obese Patient

    PubMed Central

    Turner, Robert M.; Gusenoff, Jeffrey A.; Correa, Andres F.; Jacobs, Bruce L.; Davies, Benjamin J.

    2016-01-01

    The obese patient undergoing radical cystectomy faces a unique set of challenges. We present the case of a 68-year-old gentleman who presented to our institution with Bacillus Calmette-Guerin refractory disease, a body mass index of 38.5, and a large pannus. The present paper describes our technique for performing radical cystectomy with ileal conduit urinary diversion and concomitant panniculectomy. We discuss the impact of obesity on patients undergoing radical cystectomy and how this may be mitigated by panniculectomy. PMID:27195168

  4. ELECTRONIC MULTIPLIER

    DOEpatents

    Collier, D.M.; Meeks, L.A.; Palmer, J.P.

    1961-01-31

    S>An electronic multiplier is described for use in analog computers. Two electrical input signals are received; one controls the slope of a saw-tooth voltage wave while the other controls the time duration of the wave. A condenser and diode clamps are provided to sustain the crest voltage reached by the wave, and for storing that voltage to provide an output signal which is a steady d-c voltage.

  5. Psychological correlates and psychiatric morbidity in patients with Dhat syndrome

    PubMed Central

    Grover, Sandeep; Gupta, Sunil; Avasthi, Ajit

    2015-01-01

    Aim: The aim of this study was to examine psychological factors in the form of somatosensory amplification, alexithymia and hypochondriasis in patients with Dhat syndrome. Secondary aims of the study were: (1) To evaluate the influence of psychiatric comorbidity on the psychological correlates; (2) to compare the prevalence of psychological correlates in those with Dhat syndrome and in those with depression and somatoform disorders. Materials and Methods: A total of 106 subjects diagnosed with Dhat syndrome as per International Classification of Diseases-10 (ICD-10) criteria were assessed on Toronto Alexithymia Scale (TAS-20), Somatosensory Amplification Scale (SSAS) and Whitely Index (WI). Psychiatric comorbidity was diagnosed as per ICD-10. Data on 50 patients with depression and 119 patients with somatoform disorder was used for comparison. Results: The age at onset of Dhat syndrome was 22.54 (standard deviation [SD] - 7.5) years, and duration of illness was 5.04 (SD - 4.2) years. Depressive disorders were diagnosed in 13.2%, anxiety disorders in 15.1%, erectile dysfunction in 14.2% and premature ejaculation in 17% of cases. The mean SSAS total score was 23.12 (SD - 7.99), mean total TAS-20 score was 63.3 (SD - 13.3) and mean WI score was 8.23 (SD - 2.7). About two third of the patients had alexithymia (n = 67; 63.2%) and hypochondriasis (n = 69; 65.1%). Comparison of the psychological correlates between those with Dhat syndrome alone (n = 59) and those with comorbid psychiatric disorder (n = 47) revealed no significant differences. Patients with only Dhat syndrome had significantly higher scores for somatosensory amplification when compared with those with somatoform disorders, but no difference was seen between those with depression and Dhat syndrome alone. Compared to patients with Dhat syndrome alone, those with depression had higher prevalence of alexithymia and hypochondriasis. Conclusion: There are differences in the prevalence of somatosensory

  6. Therapeutic outcome of adjustable gastric banding in morbid obese patients.

    PubMed

    Hotter, A; Mangweth, B; Kemmler, G; Fiala, M; Kinzl, J; Biebl, W

    2003-09-01

    We examined 77 obese patients treated with bariatric surgery in order to analyse treatment success, and compare those with a good or a poor outcome. The subjects, who were recruited one year after undergoing adjustable gastric banding, were asked questions concerning their sociodemographic status, postoperative course, past and present weight status, eating behaviours and difficulties in changing eating habits. Furthermore, we also used two body image questionnaires, and considered the patients' evaluations of positive and negative changes, as well as their wishes for the future. There were no preoperative differences between the 71% of patients in the good outcome group and the 29% in the poor outcome group. With regard to the postoperative course, the poor outcome group had more problems in adapting to new eating behaviours, experienced significantly more post-surgical complications, and had a persistently negative body evaluation. Both groups were satisfied with their achieved weight loss achieved, and their improved self-esteem and mobility. Adjustable gastric banding seems to be successful in inducing weight loss and allowing a better quality of life. However, factors such as postoperative complications, the ability and willingness to adopt new eating attitudes, and an improved body image seem to be crucial for therapeutic outcome.

  7. Resting energy expenditure of morbidly obese patients using indirect calorimetry: a systematic review.

    PubMed

    Kee, A-L; Isenring, E; Hickman, I; Vivanti, A

    2012-09-01

    The increasing proportion of acutely ill hospital patient admissions presenting with a morbidly obese body mass index (BMI ≥ 40 kg m(-2) ) as a comorbidity is an emerging clinical concern. Suboptimal food intake and malnutrition is prevalent in the acute care hospital setting. The energy requirements necessary to prevent malnutrition in acutely ill patients with morbid obesity remains unclear. The aim of this systematic review was to identify studies in the literature that have used indirect calorimetry to measure the resting energy expenditure of patients with morbid obesity to establish their minimum energy requirements and the implications for optimal feeding practices in acutely ill hospitalized patients. A total of 20 studies from PubMed, Cochrane Library and Embase met the inclusion criteria and were reviewed. All articles were graded using the Australian National Health and Medical Research Council levels of evidence and given a quality rating using the American Dietetic Association recommendations. Studies were categorized according to the mean BMI of its subjects. The most commonly measured resting energy expenditures for morbidly obese patients are between 2,000 and 3,000 kcal d(-1) (8,400-12,600 kJ d(-1) ). Activity and injury factors of acutely ill morbidly obese patients could result in significantly greater energy requirements for this patient group and are unlikely to be met by standard hospital menus. Establishing the minimum energy requirements for this population group will help inform adequate and accurate energy provision in the acute setting. Outcomes of underfeeding and overfeeding in morbidly obese patients warrant further research.

  8. Relationship between anxiety, depression, and morbidity in adult asthma patients

    PubMed Central

    Rimington, L; Davies, D; Lowe, D; Pearson, M

    2001-01-01

    BACKGROUND—Symptoms of disease reported by patients reflect the effects of the disease process within the individual and the person's physical and mental ability to tolerate or otherwise cope with the limitations on their functioning. This study examines the relationship between asthma symptoms, disease severity, and psychological status in patients being managed in routine primary healthcare settings.
METHODS—One hundred and fourteen subjects from four GP practices, two inner city and two suburban, were studied. Symptoms were assessed by means of the Asthma Quality of Life questionnaire (AQLQ) and a locally devised Q score, and psychological status with the Hospital Anxiety and Depression (HAD) scale. Spirometric values and details of current asthma treatment (BTS asthma guidelines treatment step) were recorded as markers of asthma severity.
RESULTS—Symptoms as measured by AQLQ correlated with peak expiratory flow (rS = 0.40) and with BTS guidelines treatment step (rS =0.25). Similarly, the Q score correlated with peak expiratory flow (rS = 0.44) and with BTS guidelines treatment step (rS =0.42). Similar levels of correlation of forced expiratory volume in one second (FEV1) with symptoms were reported. HAD anxiety and depression scores also correlated to a similar extent with these two symptom scores, but there was hardly any correlation with lung function. Logistic regression analysis showed that HAD scores help to explain symptom scores over and above the effects of lung function and BTS guidelines treatment step. Symptoms, depression, and anxiety were higher for inner city patients while little difference was observed in objective measures of asthma.
CONCLUSIONS—Asthma guidelines suggest that changing levels of symptoms should be used to monitor the effectiveness of treatment. These data suggest that reported symptoms may be misleading and unreliable because they may reflect non-asthma factors that cannot be expected to respond to changes in

  9. Laparoscopic Gastric Plication in the Morbidly Obese Adolescent Patient

    PubMed Central

    Vanguri, Poornima; Brengman, Matthew; Oiticica, Claudio; Wickham, Edmond; Bean, Melanie; Lanning, David

    2014-01-01

    Childhood obesity is a significant problem. Due in part to suboptimal weight loss with lifestyle intervention alone, bariatric surgery, combined with ongoing lifestyle changes, has become a favorable approach in adolescents with severe obesity and weight-related comorbidities and is associated with effective weight loss and reducing weight-related comorbidities. Laparoscopic greater curvature plication is a promising new bariatric surgical procedure that has been shown to be effective in adults with severe obesity but has not been evaluated in the adolescent population. Gastric plication may be a particularly attractive approach for the adolescent patient as it is potentially reversible, does not involve the surgical removal of tissue and is without a significant malabsorptive component. Our team has obtained approval from our Institutional Review Board to perform a laparoscopic greater curvature plication on 30 adolescent patients with severe obesity and study its effect on weight loss, metabolic effects, and psychological functioning in the setting of a multidisciplinary program. Results of this study, including comprehensive clinical and psychological data collected over a three and a half year span, will inform larger prospective investigations comparing the laparoscopic greater curvature plication and other bariatric operations in the adolescent population. PMID:24491365

  10. Morbidly obese patient with obstructive sleep apnoea for major spine surgery: An anaesthetic challenge

    PubMed Central

    Redhu, Shruti; Prakash, Prabhakar Suman; Jain, Virendra; Dash, Hari Hara

    2016-01-01

    Morbidly obese patients with clinical features of obstructive sleep apnoea can present a myriad of challenges to the anaesthesiologists which must be addressed to minimise the perioperative risks. Initiation of continuous positive airway pressure (CPAP) therapy early in the pre- and post-operative period along with appropriate anaesthetic planning is of paramount importance in such patients. This case report emphasises the usefulness of CPAP therapy, even for a short duration, to minimise morbidity, improve recovery and hasten early discharge from the hospital after major surgery. PMID:27330205

  11. Resistin levels in morbid obese patients following the biliopancreatic diversion surgery.

    PubMed

    de Luis, D A; Terroba, M C; Cuellar, L; Conde, R; Primo, D; Aller, R; Sagrado, M G; Izaola, O

    2011-03-01

    Previous studies addressing the changes of resistin concentrations in morbidly obese patients after bariatric surgery have yielded conflicting results. The purpose of the present study was to investigate the changes in serum resistin levels 1 year after biliopancreatic diversion in morbidly obese patients without diabetes mellitus. A cohort of 39 morbidly obese patients without diabetes mellitus was operated. Biochemical and anthropometric evaluation were realized at basal visit and at each visit. The frequency of patients with hypertension and hyperlipidemia was recorded at each visit. Overall the mean patient age was 44.8 ± 14.1, and the mean preoperative BMI was 47.3 ± 6.5 kg/m². After one year of surgery, a significant decrease was observed in BMI, weight, waist circumference, fat mass, blood pressure, total cholesterol, LDL cholesterol, and triglyceride levels. Resistin levels did not change after surgery (5.61 ± 1.93 ng/ml vs. 6.41 ± 3.58 ng/ml; ns). Correlation analysis showed a positive association between basal resistin and weight (r = 0.68, p < 0.01) and fat mass (r = 0.65, p < 0.05). Resistin concentrations did not change after massive weight loss with biliopancreatic diversion in morbid obese patients without diabetes mellitus.

  12. Morbidity after reversal of Hartmann operation: retrospective analysis of 56 patients

    PubMed Central

    Zarnescu (Vasiliu), EC; Zarnescu, NO; Costea, R; Rahau, L; Neagu, S

    2015-01-01

    Background: Despite patient selection, postoperative morbidity after reversal of Hartmann’s procedure remains significant. Aim: The objective of this study was to investigate risk factors associated with morbidity after conversion of Hartmann’s operation. Patients and methods: We retrospectively analyzed data of 56 patients who underwent reversal procedures between January 2004 and May 2015 in a single center. We evaluated the following variables: demographic characteristics, medical comorbidities, etiology for Hartmann operation, preoperative lab values, intraoperative surgical details and short-term outcomes (hospital stay, medical and surgical complications, mortality). Results: There were 37 men (66.1%) and the mean age was 57 years. The most frequent indications for Hartmann’s procedure were colorectal cancer in 25 patients (44.6%) and complicated diverticulitis in 10 patients (17.9%). The mean time to the reversal procedure was 9 months. Morbidity rate was 16.1% (9 patients) with an anastomotic leakage rate of 3.6% (2 patients) and mortality rate was 3.6% (2 patients). The most common medical complication was diarrhea (4 patients, 7.2%). Bivariate analysis demonstrated that the only factor significantly associated with postoperative complications was presence of multiple comorbidities. Conclusions: Multiple medical comorbidities is the only predictive factor for postoperative complications after Hartmann’s reversal and therefore patient selection for this type of surgery is critical. PMID:26664476

  13. Thrombosis Related ABO, F5, MTHFR, and FGG Gene Polymorphisms in Morbidly Obese Patients

    PubMed Central

    Kupcinskiene, Kristina; Murnikovaite, Martyna; Varkalaite, Greta; Juzenas, Simonas; Trepenaitis, Darius; Petereit, Ruta; Maleckas, Almantas

    2016-01-01

    Objective. Obesity is a well-known risk factor for thrombotic complications. The aim of the present study was to determine the frequency of thrombosis related ABO, F5, MTHFR, and FGG gene polymorphisms in morbidly obese patients and compare them with the group of nonobese individuals. Methods. Gene polymorphisms were analyzed in 320 morbidly obese patients (BMI > 40 kg/m2) and 303 control individuals (BMI < 30 kg/m2) of European descent. ABO C>T (rs505922), F5 C>G (rs6427196), MTHFR C>T (rs1801133), and FGG C>T (rs6536024) SNPs were genotyped by RT-PCR. Results. We observed a tendency for MTHFR rs1801133 TT genotype to be linked with morbid obesity when compared to CC genotype; however, the difference did not reach the significant P value (OR 1.84, 95% CI 0.83–4.05, P = 0.129). Overall, the genotypes and alleles of rs505922, rs6427196, rs1801133, and rs6536024 SNPs had similar distribution between morbidly obese and nonobese control individuals. Distribution of height and weight means among individuals carrying different rs505922, rs6427196, rs1801133, and rs6536024 genotypes did not differ significantly. Conclusions. Gene polymorphisms ABO C>T (rs505922), F5 C>G (rs6427196), MTHFR C>T (rs1801133), and FGG C>T (rs6536024) were not associated with height, weight, or morbid obesity among European subjects. PMID:27999448

  14. Elephantiasis nostras verrucosa on the abdomen of a Turkish female patient caused by morbid obesity.

    PubMed

    Buyuktas, D; Arslan, E; Celik, O; Tasan, E; Demirkesen, C; Gundogdu, S

    2010-08-15

    Elephantiasis Nostras Verrucosa is a rare disorder of an extremity or a body region, which is associated with chronic lymphedema. There are 7 reported cases of abdominal elephantiasis in the medical literature. Here we report a morbidly obese female patient with elephantiasis nostras verrucosa on the abdominal wall.

  15. Heartburn during sleep: a clinical marker of gastro-oesophageal reflux disease in morbidly obese patients.

    PubMed

    Fornari, F; Madalosso, C A S; Callegari-Jacques, S M; Gurski, R R

    2009-02-01

    Gastro-oesophageal reflux disease (GORD) and morbid obesity are entities with increasing prevalence. New clinical strategies are cornerstones for their management. The aim of this study was to assess the prevalence of heartburn during sleep (HDS) and whether this symptom predicts the presence of objective GORD parameters and increased heartburn perception in morbidly obese patients. Ninety-one consecutive morbidly obese patients underwent clinical evaluation, upper gastrointestinal endoscopy and oesophageal pH monitoring. HDS was characterized when patients replied positively to the question, 'Does heartburn wake you from sleep?'. A General Score for Heartburn (GSH) ranging between 0 and 5 was assessed with the question 'How bad is your heartburn?'. HDS was reported by 33 patients (36%). More patients with HDS had abnormal acid contact time or reflux oesophagitis than patients without HDS (94%vs 57%, P < 0.001). HDS had a positive predictive value of 94% (0.95 CI 82-98), sensitivity of 48% (0.95 CI 37-60%) and specificity of 93% (0.95 CI 77-98%) for detection of GORD. A higher proportion of patients with HDS perceived heartburn preceded by acid reflux in diurnal (39%vs 9%; P < 0.001) periods during pH-metry. HDS patients showed higher GSH (2.4 +/- 0.5 vs 1.7 +/- 0.4; P < 0.0001) compared with patients who denied HDS but reported diurnal heartburn. HDS occurs in a significant minority of patients with morbid obesity and has high positive predictive value for GORD. Symptomatic reflux during the sleep seems to be a marker of increased heartburn perception in this population.

  16. Risk factors for obstetric morbidity in patients with uterine atony undergoing Caesarean delivery†

    PubMed Central

    Butwick, A. J.; Carvalho, B.; El-Sayed, Y. Y.

    2014-01-01

    Background Uterine atony (UA) is recognized as a leading cause of postpartum haemorrhage. However, knowledge of risk factors of haemorrhage-related morbidity among patients diagnosed with UA is uncertain. We investigated risk factors for haemorrhage-related morbidity among patients undergoing Caesarean delivery with UA. Methods We conducted a secondary analysis of data sourced from a 4-yr observational study at 19 US academic centres. Patients with UA were identified based on receiving methylergonovine or carboprost. Our primary outcome (haemorrhage-related morbidity) included a composite of intra- or postpartum transfusion; Caesarean hysterectomy; uterine or hypogastric artery ligation; intensive care admission for: pulmonary oedema, coagulopathy, adult respiratory distress syndrome, postoperative ventilation, or invasive line monitoring. Results Among 57 182 patients who underwent Caesarean delivery, 2294 (4%) patients developed UA. Haemorrhage-related morbidity occurred in 450 (19.6%) patients with UA. The risk of haemorrhage-related morbidity was increased among African-Americans [adjusted odds ratio (aOR)=2.36; 95% confidence interval (CI)=1.73–3.23], Hispanics (aOR=1.4; 95% CI=1.04–1.9), women with multiple gestations (aOR=1.59; 95% CI=1.06–2.38), placenta praevia (aOR=4.89; 95% CI=3.04–7.87), patients with ASA class III (aOR=1.4; 95 CI=1.03–1.9), or ASA class IV (aOR=5.88; 95% CI=2.48–13.9), exposure to general anaesthesia (GA) (aOR=2.4; 95% CI=1.59–3.62) and combined general and regional anaesthesia (aOR=4.0; 95% CI=2.62–6.09), and ≥2 prior Caesarean deliveries (aOR=1.62; 95% CI=1.1–2.39). Conclusions Among patients with UA undergoing Caesarean delivery, the risk of haemorrhage-related morbidity is increased in African-Americans, Hispanics, patients with multiple gestations, placenta praevia, ASA class III or IV, ≥2 prior Caesarean deliveries and those undergoing GA. PMID:24907281

  17. Morbidity, mortality, and categorization of the risk of perioperative complications in lung cancer patients*

    PubMed Central

    Stanzani, Fabiana; Paisani, Denise de Moraes; de Oliveira, Anderson; de Souza, Rodrigo Caetano; Perfeito, João Aléssio Juliano; Faresin, Sonia Maria

    2014-01-01

    OBJECTIVE: To determine morbidity and mortality rates by risk category in accordance with the American College of Chest Physicians guidelines, to determine what role pulmonary function tests play in this categorization process, and to identify risk factors for perioperative complications (PCs). METHODS: This was a historical cohort study based on preoperative and postoperative data collected for cases of lung cancer diagnosed or suspected between 2001 and 2010. RESULTS: Of the 239 patients evaluated, only 13 (5.4%) were classified as being at high risk of PCs. Predicted postoperative FEV1 (FEV1ppo) was sufficient to define the risk level in 156 patients (65.3%); however, cardiopulmonary exercise testing (CPET) was necessary for identifying those at high risk. Lung resection was performed in 145 patients. Overall morbidity and mortality rates were similar to those reported in other studies. However, morbidity and mortality rates for patients at an acceptable risk of PCs were 31.6% and 4.3%, respectively, whereas those for patients at high risk were 83.3% and 33.3%. Advanced age, COPD, lobe resection, and lower FEV1ppo were correlated with PCs. CONCLUSIONS: Although spirometry was sufficient for risk assessment in the majority of the population studied, CPET played a key role in the identification of high-risk patients, among whom the mortality rate was seven times higher than was that observed for those at an acceptable risk of PCs. The risk factors related to PCs coincided with those reported in previous studies. PMID:24626266

  18. Sternal wrapping for the prevention of sternal morbidity in elderly osteoporotic patients undergoing median sternotomy.

    PubMed

    Kirbas, Ahmet; Celik, Sezai; Gurer, Onur; Yildiz, Yahya; Isik, Omer

    2011-01-01

    Osteoporosis, a major risk factor for sternum-related morbidity after median sternotomy, is quite prevalent among the elderly. In this prospective study, we investigated the potential of sternal protection by use of the "sternal wrapping method" in elderly osteoporotic patients who were undergoing median sternotomy.For this study, we chose 100 elderly osteoporotic patients who were scheduled to undergo median sternotomy. During surgery, we wrapped the sternal edges with polyvinyl chloride tubing in 50 patients (group 1) and omitted the sternal wrapping in the remaining 50 patients (group 2). We then compared the groups with regard to postoperative pain, bleeding, early and late sternum-related morbidity, sternal fractures, and duration of hospitalization.Sternal wrapping was associated with fewer sternal fractures, less chest pain, and shorter hospital stays. Overall sternal morbidity was significantly less common among patients with sternal wrapping (4% vs. 20%, P = 0.03); however, the difference in individual rates for early and late dehiscence or deep sternal infection did not reach statistical significance.Sternal wrapping using polyvinyl chloride tubes provides mechanical protection and, apparently, less postoperative chest pain and shorter hospitalizations. Probably, it reduces sternum-related complications, particularly in high-risk patients. Its benefits, however, should be confirmed in larger studies.

  19. Morbidity of "DSM-IV" Axis I Disorders in Patients with Noncardiac Chest Pain: Psychiatric Morbidity Linked with Increased Pain and Health Care Utilization

    ERIC Educational Resources Information Center

    White, Kamila S.; Raffa, Susan D.; Jakle, Katherine R.; Stoddard, Jill A.; Barlow, David H.; Brown, Timothy A.; Covino, Nicholas A.; Ullman, Edward; Gervino, Ernest V.

    2008-01-01

    The present study examined current and lifetime psychiatric morbidity, chest pain, and health care utilization in 229 patients with noncardiac chest pain (NCCP), angina-like pain in the absence of cardiac etiology. Diagnostic interview findings based on the "Diagnostic and Statistical Manual of Mental Disorders" (4th ed.; "DSM-IV"; American…

  20. Effect of oral taurine on morbidity and mortality in elderly hip fracture patients: a randomized trial.

    PubMed

    Van Stijn, Mireille F M; Bruins, Arnoud A; Vermeulen, Mechteld A R; Witlox, Joost; Teerlink, Tom; Schoorl, Margreet G; De Bandt, Jean Pascal; Twisk, Jos W R; Van Leeuwen, Paul A M; Houdijk, Alexander P J

    2015-05-29

    Hip fracture patients represent a large part of the elderly surgical population and face severe postoperative morbidity and excessive mortality compared to adult surgical hip fracture patients. Low antioxidant status and taurine deficiency is common in the elderly, and may negatively affect postoperative outcome. We hypothesized that taurine, an antioxidant, could improve clinical outcome in the elderly hip fracture patient. A double blind randomized, placebo controlled, clinical trial was conducted on elderly hip fracture patients. Supplementation started after admission and before surgery up to the sixth postoperative day. Markers of oxidative status were measured during hospitalization, and postoperative outcome was monitored for one year after surgery. Taurine supplementation did not improve in-hospital morbidity, medical comorbidities during the first year, or mortality during the first year. Taurine supplementation lowered postoperative oxidative stress, as shown by lower urinary 8-hydroxy-2-deoxyguanosine levels (Generalized estimating equations (GEE) analysis average difference over time; regression coefficient (Beta): -0.54; 95% CI: -1.08--0.01; p = 0.04), blunted plasma malondialdehyde response (Beta: 1.58; 95% CI: 0.00-3.15; p = 0.05) and a trend towards lower lactate to pyruvate ratio (Beta: -1.10; 95% CI: -2.33-0.12; p = 0.08). We concluded that peri-operative taurine supplementation attenuated postoperative oxidative stress in elderly hip fracture patients, but did not improve postoperative morbidity and mortality.

  1. Effect of Oral Taurine on Morbidity and Mortality in Elderly Hip Fracture Patients: A Randomized Trial

    PubMed Central

    Van Stijn, Mireille F. M.; Bruins, Arnoud A.; Vermeulen, Mechteld A. R.; Witlox, Joost; Teerlink, Tom; Schoorl, Margreet G.; De Bandt, Jean Pascal; Twisk, Jos W. R.; Van Leeuwen, Paul A. M.; Houdijk, Alexander P. J.

    2015-01-01

    Hip fracture patients represent a large part of the elderly surgical population and face severe postoperative morbidity and excessive mortality compared to adult surgical hip fracture patients. Low antioxidant status and taurine deficiency is common in the elderly, and may negatively affect postoperative outcome. We hypothesized that taurine, an antioxidant, could improve clinical outcome in the elderly hip fracture patient. A double blind randomized, placebo controlled, clinical trial was conducted on elderly hip fracture patients. Supplementation started after admission and before surgery up to the sixth postoperative day. Markers of oxidative status were measured during hospitalization, and postoperative outcome was monitored for one year after surgery. Taurine supplementation did not improve in-hospital morbidity, medical comorbidities during the first year, or mortality during the first year. Taurine supplementation lowered postoperative oxidative stress, as shown by lower urinary 8-hydroxy-2-deoxyguanosine levels (Generalized estimating equations (GEE) analysis average difference over time; regression coefficient (Beta): −0.54; 95% CI: −1.08–−0.01; p = 0.04), blunted plasma malondialdehyde response (Beta: 1.58; 95% CI: 0.00–3.15; p = 0.05) and a trend towards lower lactate to pyruvate ratio (Beta: −1.10; 95% CI: −2.33–0.12; p = 0.08). We concluded that peri-operative taurine supplementation attenuated postoperative oxidative stress in elderly hip fracture patients, but did not improve postoperative morbidity and mortality. PMID:26035756

  2. Medical co-morbidities of patients with haemophilia: pain, obesity and hepatitis C.

    PubMed

    Witkop, M L; Peerlinck, K; Luxon, B A

    2016-07-01

    Clinical care of patients with haemophilia (PWH) has progressed rapidly over the past decade. Current therapy has allowed patients with haemophilia to live longer and many patients are now experiencing the co-morbidities of the general population. In this review article, we focus on three common diseases states that affect PWH: chronic pain, obesity and hepatitis C. Pain has been a co-morbidity for many years and PWH often have unusual needs for chronic pain relief compared to the general population. Obesity is not only increasing in the general population but also in patients with hereditary bleeding disorders. The co-morbidity of obesity not only causes increased pain progression and joint damage but also affects the dosing of factor concentrates. Finally, hepatitis C is known to have infected the majority of patients who received non-virally inactivated pooled factor concentrates in the past. New treatment regimens have been developed that allow the nearly uniform cure of chronic hepatitis C with a short course of oral medications.

  3. Pilot testing the augmentech body position sensor on the morbidly obese patient.

    PubMed

    Hand, Mark C; Rose, Mary Ann; Pokorny, Marie Elizabeth; Castles, Ricky T; Watkins, Frank; Kirkpatrick, Mary K; Swanson, Melvin; Engelke, Martha; Moore, Rachel; Wu, Qiang; Chen, Kaun

    2013-05-01

    The Augmentech Body Position Sensor (ABPS), a device for monitoring patient repositioning, was tested for use in morbidly obese patients. Specific aims were to: determine whether there was correspondence between data on patient turning and repositioning from the ABPS and data gathered through human observation; determine whether the ABPS is an acceptable instrument for measuring body movements in morbidly obese patients in terms of ease of use, comfort and ability to stay in place. A descriptive study was conducted. Data from the ABPS recording patients' body positions were compared with data from videotapes taken of the same patients during the same time period. The sleep center of a tertiary care facility in the southeastern United States was used. Ten participants with BMI ≥30 were selected from patients referred to the sleep center for polysomnography. Positioning the device on the patient's thigh, data were collected from midnight until discharge. Videotapes taken of the same patient during the same time period were examined for changes in body position over time. There was a strong correspondence between the videotaped data and the ABPS data. The device was comfortable and not irritating to the patient. The APBS can be a useful measure for determining changes in body position but further study should be undertaken to test other sites for placement.

  4. Evaluation of a New Vancomycin Dosing Protocol in Morbidly Obese Patients

    PubMed Central

    Kosmisky, Desiree E.; Griffiths, Carrie L.; Templin, Megan A.; Norton, James

    2015-01-01

    Background: Optimal dosing of vancomycin in morbidly obese patients (>100 kg and at least 140% of their ideal body weight) has not been determined. Conventional dosing strategies have led to the observation of supratherapeutic trough concentrations (>20 mcg/mL). Objective: To evaluate the effectiveness of a new vancomycin dosing protocol in morbidly obese patients in achieving therapeutic trough concentrations between 10 and 20 mcg/mL and to determine patient-specific factors influencing the trough concentration attained. Methodology: A single-center, retrospective chart review included morbidly obese adult patients with a pharmacy-to-dose vancomycin consult and at least 1 trough concentration obtained at steady state. Patients were excluded if they had a creatinine clearance (CrCl) less than 35 mL/min or unstable renal function, were not dosed according to the revised protocol, or received vancomycin prior to initiation of the protocol. Results: Of the 48 patients included, 17 (35.4%) achieved a therapeutic vancomycin trough concentration. Subtherapeutic concentrations (<10 mcg/mL) were observed in 27 patients (56.3%) and supratherapeutic concentrations were observed in 4 (8.3%) patients. Age less than 45 years and CrCl greater than 100 mL/min were associated with subtherapeutic trough concentrations. Conclusion: This study demonstrates that the revised vancomycin dosing protocol led to the attainment of therapeutic trough concentrations in 35.4% of patients. The majority had subtherapeutic concentrations, which increases the risk of treatment failures and resistance. Further study is needed to determine the optimal dosing strategy in this patient population. PMID:26912920

  5. Pathogenic conjunctival bacteria associated with systemic co-morbidities of patients undergoing cataract surgery

    PubMed Central

    Fernández-Rubio, M-E; Cuesta-Rodríguez, T; Urcelay-Segura, J-L; Cortés-Valdés, C

    2013-01-01

    Purpose To identify the risk of patients undergoing cataract surgery of having pathogenic conjunctival bacteria associated with their systemic co-morbidities. Methods Retrospective study of consecutive patients undergoing their first cataract operation from July 2005 to April 2010. Their preoperative conjunctival bacteria were cultured, identified, and classified in bacterial groups. Their co-morbidities were defined from their clinical data and the answers to systematic questions asked in the anaesthetic evaluation. The Microsoft Access databases of the two data sets were merged for carrying out the statistical analysis. Univariate association of each bacterial group with each co-morbidity was studied by using χ2-test for categorical data and Student's t-test for continuous variables. Also, logistic regression models were used adjusting for age and sex. SPSS statistic programme, version 18 was used for all these analyses. Endophthalmitis cases in this surgical series were searched. Results In the 8333 selected patients, age was associated with increased conjunctival bacteria in all groups except for Streptococcus pneumoniae and Propionibacteriae. However, male sex was associated with these two groups and also with coagulase-negative Staphylococci, Corynebacterium xerosis, Staphylococcus aureus, and Gram-negative rods. After adjusting for age and sex, S. aureus was associated with diabetes, lung diseases, and renal and heart insufficiency; Gram-negative rods with smoking habit; Enterococci with diabetes; Streptococcus pneumoniae with kyphoscoliosis; and other Streptococci with diabetes and handicapped patients. Conclusion The more pathogenic conjunctival bacteria were more likely associated with patients' co-morbidities, such as diabetes, lung diseases, renal and heart insufficiency, kyphoscoliosis, and smoking habit, than the less pathogenic ones. PMID:23703631

  6. Neoadjuvant Chemotherapy and Short-term Morbidity in Patients Undergoing Mastectomy With and Without Breast Reconstruction

    PubMed Central

    Abt, Nicholas B.; Flores, José M.; Baltodano, Pablo A.; Sarhane, Karim A.; Abreu, Francis M.; Cooney, Carisa M.; Manahan, Michele A.; Stearns, Vered; Makary, Martin A.; Rosson, Gedge D.

    2015-01-01

    IMPORTANCE Neoadjuvant chemotherapy (NC) is increasingly being used in patients with breast cancer, and evidence-based reports related to its independent effects on morbidity after mastectomy with immediate breast reconstruction are limited. OBJECTIVE To determine the effect of NC on 30-day postoperative morbidity in women undergoing mastectomy with or without immediate breast reconstruction. DESIGN, SETTING, AND PARTICIPANTS All women undergoing mastectomy with or without immediate breast reconstruction from January 1, 2005, through December 31, 2011, at university and private hospitals internationally were analyzed using the American College of Surgeons National Surgical Quality Improvement Program 2005-2011 databases. Patients who received NC were compared with those without a history of NC to estimate the relative odds of 30-day postoperative overall, systemic, and surgical site morbidity using model-wise multivariable logistic regression. EXPOSURE Neoadjuvant chemotherapy. MAIN OUTCOMES AND MEASURES Thirty-day postoperative morbidity (overall, systemic, and surgical site). RESULTS Of 85 851 women, 66 593 (77.6%) underwent mastectomy without breast reconstruction, with 2876 (4.3%) receiving NC; 7893 patients were excluded because of missing exposure data. The immediate breast reconstruction population included 19 258 patients (22.4%), with 820 (4.3%) receiving NC. After univariable analysis, NC was associated with a 20% lower odds of overall morbidity in the group undergoing mastectomy without breast reconstruction (odds ratio [OR], 0.80; 95% CI, 0.71-0.91) but had no significant effect in the immediate breast reconstruction group (OR, 0.98; 95% CI, 0.79-1.23). After adjustment for confounding, NC was independently associated with lower overall morbidity in the group undergoing mastectomy without breast reconstruction (OR, 0.61; 95% CI, 0.51-0.73) and the immediate tissue expander reconstruction subgroup (OR, 0.49; 95% CI, 0.30-0.84). Neoadjuvant chemotherapy

  7. Laparoscopic Single Site Surgery for Repair of Retrocaval Ureter in a Morbidly Obese Patient

    PubMed Central

    Abdel-Karim, Aly M.; Yahia, Elsayed; Hassouna, M.; Missiry, M.

    2015-01-01

    This is to describe a case of a morbidly obese (BMI = 40) female with retrocaval ureter treated with laparoendoscopic single-site surgery. A JJ stent was positioned. A 2 cm umbilical access was created. A single port platform was positioned. The entire ureter was mobilized posterior to the vena cava and transected where the dilated portion ended. The distal ureter was repositioned lateral to the inferior vena cava. Anastomosis was done. A 3 mm trocar was used to assist suturing. At 4-month follow-up, CT revealed no evidence of obstruction of the right kidney and the patient was symptomless. Although challenging, in a morbidly obese patient, LESS repair for retrocaval ureter is feasible. PMID:26793585

  8. The Perspectives of Patients on Health-Care for Co-Morbid Diabetes and Chronic Kidney Disease: A Qualitative Study

    PubMed Central

    Lo, Clement; Ilic, Dragan; Teede, Helena; Cass, Alan; Fulcher, Greg; Gallagher, Martin; Johnson, Greg; Kerr, Peter G.; Mathew, Tim; Murphy, Kerry; Polkinghorne, Kevan; Walker, Rowan; Zoungas, Sophia

    2016-01-01

    Background Multi-morbidity due to diabetes and chronic kidney disease (CKD) remains challenging for current health-systems, which focus on single diseases. As a first step toward health-care improvement, we explored the perspectives of patients and their carers on factors influencing the health-care of those with co-morbid diabetes and CKD. Methods In this qualitative study participants with co-morbid diabetes and CKD were purposively recruited using maximal variation sampling from 4 major tertiary health-services from 2 of Australia’s largest cities. Separate focus groups were conducted for patients with CKD stages 3, 4 and 5. Findings were triangulated with semi-structured interviews of carers of patients. Discussions were transcribed verbatim and thematically analysed. Results Twelve focus groups with 58 participants and 8 semi-structured interviews of carers were conducted. Factors influencing health-care of co-morbid diabetes and CKD grouped into patient and health service level factors. Key patient level factors identified were patient self-management, socio-economic situation, and adverse experiences related to co-morbid diabetes and CKD and its treatment. Key health service level factors were prevention and awareness of co-morbid diabetes and CKD, poor continuity and coordination of care, patient and carer empowerment, access and poor recognition of psychological co-morbidity. Health-service level factors varied according to CKD stage with poor continuity and coordination of care and patient and carer empowerment emphasized by participants with CKD stage 4 and 5, and access and poor recognition of psychological co-morbidity emphasised by participants with CKD stage 5 and carers. Conclusions According to patients and their carers the health-care of co-morbid diabetes and CKD may be improved via a preventive, patient-centred health-care model which promotes self-management and that has good access, continuity and coordination of care and identifies and

  9. Laparoscopic hepatectomy in a morbidly obese patient with liver cirrhosis: A case report

    PubMed Central

    Machairas, Nikolaos; Kostakis, Ioannis D.; Mantas, Dimitrios; Sotiropoulos, Georgios C.

    2017-01-01

    Cirrhotic patients constitute a high-risk population, and present a major challenge for the performance of minimally invasive laparoscopic resections due to difficulties in parenchymal transection. The present study describes the case of a 71-year-old morbidly obese male patient who was referred to our department with a hepatic mass identified on routine abdominal ultrasound. Abdominal computer tomography and magnetic resonance imaging confirmed a mass in segments V–VI of the liver, highly suspicious for HCC. The patient's past medical history additionally included non-alcoholic steatohepatitis, diabetes mellitus and arterial hypertension and myocardial infarction. The patient's body mass index was 45 kg/m2, and the American Society of Anesthesiologists' classification of preoperative risk was 3. The patient underwent laparoscopic resection of segments V–VI and cholecystectomy. Two years postoperatively, the patient remains disease-free and in excellent condition. To the best of our knowledge, this is the first report on laparoscopic liver resection for such a morbidly obese patient in the context of advanced liver cirrhosis.

  10. Effect of Co-Morbid Conditions on Persistent Neuropathic Pain after Brachial Plexus Injury in Adult Patients

    PubMed Central

    Chaudakshetrin, Pongparadee; Chotisukarat, Haruthai; Mandee, Sahatsa

    2016-01-01

    Background and Purpose Neuropathic pain (NeuP) associated with traumatic brachial plexus injury (BPI) can be severe, persistent, and resistant to treatment. Moreover, comorbidity associated with NeuP may worsen the pain and quality of life. This study compared persistent NeuP after BPI between patients with and without co-morbid conditions (psychiatric dysfunction and other painful conditions) and tramadol usage as a second-line agent in combination with an antiepileptic and/or antidepressant during a 2-year follow-up. Methods The medical records of patients diagnosed with BPI referred to a pain center between 2006 and 2010 were reviewed for 2 years retrospectively. Data regarding patient demographics, injury and surgical profiles, characteristics of NeuP and its severity, and treatment received were compared between patients with and without manifesting co-morbid conditions. The NeuP and pain intensity assessments were based on the DN4 questionnaire and a numerical rating scale, respectively. Results Of the 45 patients studied, 24 patients presented with one of the following co-morbid conditions: myofascial pain (21%), psychiatric disorder (17%), phantom limb pain (4%), complex regional pain syndrome (21%), and insomnia (37%). Tramadol was required by 20 patients with co-morbidity and, 9 patients without co-morbidity (p<0.001). The mean pain score after 2 years was higher in patients with co-morbidity than in those without co-morbidity (p<0.05). Conclusions Persistent pain following BPI was more common in patients manifesting other painful conditions or psychiatric co-morbidity. A higher proportion of the patients in the co-morbid group required tramadol as a second-line of agent for pain relief. PMID:27819420

  11. MORBIDITY AND SURVIVAL PROBABILITY IN BURN PATIENTS IN MODERN BURN CARE

    PubMed Central

    Jeschke, Marc G.; Pinto, Ruxandra; Kraft, Robert; Nathens, Avery B.; Finnerty, Celeste C.; Gamelli, Richard L.; Gibran, Nicole S.; Klein, Matthew B.; Arnoldo, Brett D.; Tompkins, Ronald G.; Herndon, David N.

    2014-01-01

    Objective Characterizing burn sizes that are associated with an increased risk of mortality and morbidity is critical because it would allow identifying patients who might derive the greatest benefit from individualized, experimental, or innovative therapies. Although scores have been established to predict mortality, few data addressing other outcomes exist. The objective of this study was to determine burn sizes that are associated with increased mortality and morbidity after burn. Design and Patients Burn patients were prospectively enrolled as part of the multicenter prospective cohort study, Inflammation and the Host Response to Injury Glue Grant, with the following inclusion criteria: 0–99 years of age, admission within 96 hours after injury, and >20% total body surface area burns requiring at least one surgical intervention. Setting Six major burn centers in North America. Measurements and Main Results Burn size cutoff values were determined for mortality, burn wound infection (at least two infections), sepsis (as defined by ABA sepsis criteria), pneumonia, acute respiratory distress syndrome, and multiple organ failure (DENVER2 score >3) for both children (<16 years) and adults (16–65 years). Five-hundred seventy-three patients were enrolled, of which 226 patients were children. Twenty-three patients were older than 65 years and were excluded from the cutoff analysis. In children, the cutoff burn size for mortality, sepsis, infection, and multiple organ failure was approximately 60% total body surface area burned. In adults, the cutoff for these outcomes was lower, at approximately 40% total body surface area burned. Conclusions In the modern burn care setting, adults with over 40% total body surface area burned and children with over 60% total body surface area burned are at high risk for morbidity and mortality, even in highly specialized centers. PMID:25559438

  12. Effects of bariatric surgery for knee complaints in (morbidly) obese adult patients: a systematic review.

    PubMed

    Groen, V A; van de Graaf, V A; Scholtes, V A B; Sprague, S; van Wagensveld, B A; Poolman, R W

    2015-02-01

    Obesity is a major risk factor for the development of knee osteoarthritis, and over the past 30 years the prevalence of obesity has more than doubled. In an advanced-stage knee osteoarthritis is treated with total knee arthroplasty, and the demand for primary total knee arthroplasties is expected to grow exponentially. However, total knee arthroplasty in obese patients is associated with more complications, longer hospital stay and higher costs. We aimed to determine the effects of bariatric surgery on knee complaints in (morbidly) obese (body mass index >30 kg m(-2) ) adult patients. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, TRIP, BIOSIS-Previews and reference lists of retrieved publications were systematically searched from earliest available up to 20 April 2014 for any English, German, French and Dutch studies. There was no restriction on study design. We included studies on the effect of surgically induced weight reduction on knee complaints in (morbidly) obese adult patients, with a minimal follow-up of 3 months. Studies on the effects of lipectomy or liposuction and studies in which patients had already received a total knee arthroplasty were excluded. Thirteen studies were included in this systematic review with a total of 3,837 patients. Although different assessment tools were used, an overall significant improvement in knee pain was seen in 73% out of the used assessments. All studies measuring intensity of knee pain, knee physical function and knee stiffness showed a significant improvement after bariatric surgery. The quality of evidence was very low or too low for most of the included studies and moderate for one study. Bariatric surgery with subsequent marked weight loss is likely to improve knee pain, physical function and stiffness in (morbidly) obese adult patients. However, with the current available evidence, there is need for high-quality studies.

  13. Use of Gelatin Sponge Affects Postoperative Morbidity In Cesarean Section Patients

    PubMed Central

    Özer, Alev; Köstü, Bülent

    2017-01-01

    Background This study aimed to determine the effects of use of a local hemostatic gelatin sponge (GS) on postoperative morbidity in patients undergoing cesarean section (CS). Material/Methods The records of 318 patients who underwent CS surgery were retrospectively evaluated. Group 1 consisted of 59 patients with gelatin sponge (GS) applied, and Group 2 consisted of 259 patients with no GS applied. The groups were compared for time to the first flatus, nausea and vomiting, requirement for anti-emetic drugs, development of postoperative ileus, and the length of hospitalization. Results The patients in Group 1 and Group 2 were statistically similar in mean age, gravida, parity, and body mass index (BMI) (p=0.352, p=0.275, p=0.458, and p=0.814, respectively). No significant difference was determined in the number of patients with nausea, vomiting, anti-emetic drug use, febrile morbidity, and postoperative ileus (p=0.063, p=0.436, p=328, p=0.632, and p=0.179, respectively). Time to the first flatus and length of hospitalization were significantly longer in Group 2 (p<0.001 and p<0.001, respectively). Conclusions Delay in recovery of bowel motility may be due to the local hypersensitivity reaction caused by GS and/or dislocation of this local hemostat. Women who receive gelatin sponge treatment during CS should be monitored closely for the recovery of postoperative intestinal motility. PMID:28258978

  14. Activities enjoyed by patients with dementia together with their spouses and psychological morbidity in carers.

    PubMed

    Searson, R; Hendry, A M; Ramachandran, R; Burns, A; Purandare, N

    2008-03-01

    Caring for a spouse with dementia is stressful and respite care is sometimes used to reduce this burden. Spouses may find some aspects of caring rewarding but the literature on positive aspects of caring is limited. To describe activities enjoyed by patients with dementia together with their spouses, and examine their relationship with psychological morbidity in carers. A convenience sample of 46 patients with mild to moderate dementia (91% with Alzheimer's disease, AD) and their spouses were interviewed at home. Spouses completed the Pleasant Events Schedule (PES-AD) to identify activities enjoyed by patients and spouses on their own and together. Psychological morbidity in spouses was assessed using the General Health Questionnaire (GHQ-12). Cognitive functions, and non-cognitive symptoms were also assessed in patients. Multiple regression analysis using age, Mini-Mental State Examination, Cornell Scale for Depression in Dementia, Revised Memory and Behaviour Problems (RMBP) checklist frequency, and PES-AD- together scores as independent variables found PES-AD-together and RMBP-frequency to be independent predictors of GHQ-12 scores in spouses, but the model could explain only 28% of variance. Facilitating activities that are enjoyed by both patients with dementia and spouses may be an alternative intervention strategy to reduce carer burden.

  15. Early and late radiotherapeutic morbidity in 442 consecutive patients with locally advanced carcinoma of the uterine cervix

    SciTech Connect

    Pedersen, D.; Bentzen, S.M.; Overgaard, J.

    1994-07-30

    The purpose of this study was to evaluate the early and late radiotherapeutic morbidity after combined external and intracavitary radiotherapy to the uterine cervix. Early morbidity was most frequently seen in the rectosigmoideum (61%) and urinary bladder (27%). Medication for early morbidity was required 68% and hospitalization in 10% of the patients. The frequencies of each late morbidity grade did not differ in relation to FIGO State while the actuarial estimates increased significantly with increasing stage. This reflects the poor prognosis in the more advanced stages, where few patients survived to develop late morbidity, and also points to the importance of latency in reporting late radiotherapeutic morbidity. In Stage IVA patients, the ratios between the actuarial estimate and the frequency of late severe rectosigmoid and urinary bladder morbidity were as high as 2.5 and 3, respectively. The highest 5-year risk ({+-} 1 SE of the estimate) of late severe morbidity were found for the rectosignoideum (28% {+-} 3), small intestine (13% {+-} 2) and urinary bladder (10% {+-} 2). Rectosigmoid and urinary bladder complications constituted the most important part of the combined organ morbidity. Almost half of the patients developing late moderate rectosigmoid and one-third of those developing late moderate bladder complications, did so within one year after radiotherapy. Almost all complications were developed within 3 to 4 years after radiotherapy. The probability of surviving without recurrence and/or severe combined rectosigmoid and urinary bladder morbidity was low (23% {+-} 2). Actuarial estimates rather than frequencies should be reported to avoid underestimation of the risk of late radiotherapeutic morbidity in long-term survivors. 29 refs., 5 figs. 7 tabs.

  16. Gastroesophageal reflux in morbidly obese patients treated with gastric banding or vertical banded gastroplasty.

    PubMed Central

    Ovrebø, K K; Hatlebakk, J G; Viste, A; Bassøe, H H; Svanes, K

    1998-01-01

    OBJECTIVE: To compare gastric banding (GB) and vertical banded gastroplasty (VBG) with respect to postsurgical gastroesophageal reflux (GER) and to investigate the role of preexisting hiatus hernia. SUMMARY BACKGROUND DATA: GB and VBG have for a long time been used in the treatment of morbidly obese patients. The introduction of laparoscopic techniques has renewed the interest in these operations. The long-term results after GB have, however, been poor. VBG was suggested to have antireflux properties because it involves repositioning and retaining the gastroesophageal junction within the abdomen and constructing an elongated intraabdominal tube. METHODS: Forty-three morbidly obese patients accepted for GB or VBG were evaluated for GER before and at regular intervals after surgery. All patients were questioned about adverse symptoms and need for antireflux medication. Both before and after surgery, 24-hour pH measurement and upper gastrointestinal endoscopies were performed. RESULTS: The prevalence of heartburn and acid regurgitation among patients treated with GB increased from 14% and 13% to 63% and 69%, respectively. Heartburn and acid regurgitation were present before surgery in 32% and 23% of patients treated with VBG, percentages unchanged by the procedure. The 24-hour reflux time increased significantly from 6.4% to 30.9% in patients treated with GB but was essentially unchanged in patients treated with VBG. The prevalence of esophagitis after GB and VBG was 75% and 20%. Acid inhibitors were needed in 81% of patients after GB and 29% of patients after VBG. CONCLUSIONS: The prevalence of GER was unchanged by VBG, but VBG did not demonstrate antireflux properties. The incidence of GER increased markedly after GB. PMID:9671066

  17. Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients.

    PubMed

    Malik, S A; Murphy, M; Connolly, P; O'Byrne, J

    2008-04-01

    We analysed the morbidity, mortality and outcome of cervical spine injuries in patients over the age of 65 years. This study was a retrospective review of 107 elderly patients admitted to our tertiary referral spinal injuries unit with cervical spine injuries between 1994 and 2002. The data was acquired by analysis of the national spinal unit database, hospital inpatient enquiry system, chart and radiographic review. Mean age was 74 years (range 66-93 years). The male to female ratio was 2.1:1 (M = 72, F = 35). The mean follow-up was 4.4 years (1-9 years) and mean in-hospital stay was 10 days (2-90 days). The mechanism of injury was a fall in 75 and road traffic accident in the remaining 32 patients. The level involved was atlanto-axial in 44 cases, sub-axial in 52 cases and the remaining 11 had no bony injury. Multilevel involvement occurred in 48 patients. C2 dominated the single level injury and most of them were type II odontoid fractures. Four patients had complete neurology, 27 had incomplete neurology, and the remaining 76 had no neurological deficit. Treatment included cervical orthosis in 67 cases, halo immobilization in 25, posterior stabilization in 12 patients and anterior cervical fusion in three patients. The overall complication rate was 18.6% with an associated in-hospital mortality of 11.2%. The complications included loss of reduction due to halo and Minerva loosening, non-union and delayed union among conservatively treated patients, pin site and wound infection, gastrointestinal bleeding and complication due to associated injuries. Among the 28.9% patients with neurological involvement, 37.7% had significant neurological recovery. Outcome was assessed using a cervical spine outcome questionnaire from Johns Hopkins School of Medicine. Sixty-seven patients (70%) completed the form, 20 patients (19%) were deceased at review and 8 patients (7%) were uncontactable. Functional disability was more marked in the patients with neurologically deficit at

  18. Cardiovascular and musculskeletal co-morbidities in patients with alpha 1 antitrypsin deficiency

    PubMed Central

    2010-01-01

    Background Determining the presence and extent of co-morbidities is fundamental in assessing patients with chronic respiratory disease, where increased cardiovascular risk, presence of osteoporosis and low muscle mass have been recognised in several disease states. We hypothesised that the systemic consequences are evident in a further group of subjects with COPD due to Alpha-1 Antitrypsin Deficiency (A1ATD), yet are currently under-recognised. Methods We studied 19 patients with PiZZ A1ATD COPD and 20 age, sex and smoking matched controls, all subjects free from known cardiovascular disease. They underwent spirometry, haemodynamic measurements including aortic pulse wave velocity (aPWV), an independent predictor or cardiovascular risk, dual energy X-ray absorptiometry to determine body composition and bone mineral density. Results The aPWV was greater in patients: 9.9(2.1) m/s than controls: 8.5(1.6) m/s, p = 0.03, despite similar mean arterial pressure (MAP). The strongest predictors of aPWV were age, FEV1% predicted and MAP (all p < 0.01). Osteoporosis was present in 8/19 patients (2/20 controls) and was previously unsuspected in 7 patients. The fat free mass and bone mineral density were lower in patients than controls (p < 0.001). Conclusions Patients with A1ATD related COPD have increased aortic stiffness suggesting increased risk of cardiovascular disease and evidence of occult musculoskeletal changes, all likely to contribute hugely to overall morbidity and mortality. PMID:21138571

  19. Predictors for advanced fibrosis in morbidly obese non-alcoholic fatty liver patients

    PubMed Central

    Zelber-Sagi, Shira; Shoham, Dafna; Zvibel, Isabel; Abu-Abeid, Subhi; Shibolet, Oren; Fishman, Sigal

    2017-01-01

    AIM To investigate predictors for fibrosis specifically in a high risk population of morbidly obese patients, including detailed evaluation of lifestyle. METHODS We conducted a cross-sectional study among morbidly obese patients attending the bariatric clinic at the Tel-Aviv Medical Center between the years 2013-2014 with body mass index (BMI) above 40 or above 35 with co-morbidity. Patients with serum hepatitis B surface antigen or anti-hepatitis C virus antibodies, genetic liver diseases, autoimmune disease or high alcohol intake (≥ 30 g/d in men or ≥ 20 g/d in women) were excluded from the study. Liver fibrosis was estimated by transient elastography (FibroScan®), using the ‘‘XL’’ probe. We collected data on age and gender, education, smoking status and amount, medical history, nutrition and lifestyle habits. All these data were collected using structured and validated questionnaires. Fasting blood test were available for a subsample. RESULTS Fibroscan was performed on a total of 91 patients, of which 77 had a valid examination according to the accepted criteria. Of those, 21% had significant fibrosis (F2) and 39% had advanced or severe fibrosis (F3 or F4). In multivariate analysis, male gender and BMI had a positive association with advanced fibrosis; the OR for fibrosis F ≥ 2 was 7.93 (95%CI: 2.36-26.64, P = 0.001) for male gender and 1.33 (1.11-1.60 kg/m2, P = 0.002) for BMI. The OR for fibrosis F ≥ 3 was 2.92 (1.08-7.91, P = 0.035) for male gender and 1.17 (1.03-1.33, P = 0.018) for BMI. Subjects were categorized to subgroups based on the combination of male gender and BMI of 40 and above. A significant dose response association with stiffness level was noted across these categories, with the highest stiffness among men with a higher BMI (P = 0.001). In addition, a significant positive correlation between pack-years cigarette smoking and liver stiffness was demonstrated among men (r = 0.54, P = 0.012). CONCLUSION In the morbidly obese

  20. Homocysteine levels in morbidly obese patients: its association with waist circumference and insulin resistance.

    PubMed

    Vayá, Amparo; Rivera, Leonor; Hernández-Mijares, Antonio; de la Fuente, Miguel; Solá, Eva; Romagnoli, Marco; Alis, R; Laiz, Begoña

    2012-01-01

    The association between morbid obesity and hyperhomocysteinemia (HH) remains controversial and the nature of this relationship needs to be clarified as several metabolic, lipidic, inflammatory and anthropometric alterations that accompany morbid obesity may be involved. In 66 morbidly obese patients, 47 women and 19 men aged 41 ± 12 years and 66 normo-weight subjects, 43 women and 23 men, aged 45 ± 11 years, we determined homocysteine (Hcy) levels along with lipidic, anthropometric, inflammatory and insulin resistance markers. In addition, we investigated the effect of Metabolic Syndrome (MS) and its components on Hcy levels. Obese patients had statistically higher Hcy levels than controls: 12.76 ± 5.30 μM vs. 10.67 ± 2.50 μM; p = 0.006. Moreover, morbidly obese subjects showed higher waist circumference, glucose, insulin, HOMA, leptin, triglycerides, fibrinogen, C reactive protein (CRP) (p < 0.001, respectively), and lower vitamin B12 (p = 0.002), folic acid and HDL-cholesterol (p < 0.001, respectively). In the multivariate regression analysis, waist circumference, glucose, leptin and folic acid levels were independent predictors for Hcy values (p < 0.050). When obese patients were classified as having MS or not, no differences in Hcy levels were found between the two groups (p = 0.752). Yet when we analysed separately each MS component, only abdominal obesity was associated with Hcy levels (p = 0.031). Moreover when considering glucose >110 mg/dL (NCEP-ATPIII criteria) instead of glucose intolerance >100 mg/dl (updated ATPIII criteria), it also was associated with HH (p = 0.042). These results were confirmed in the logistic regression analysis where abdominal obesity and glucose >115 mg/dL constitute independent predictors for HH (OR = 3.2; CI: 1.23-13.2; p = 0.032, OR: 4.6; CI: 1.7-22.2; p = 0.016, respectively). The results of our study indicate that increased Hcy levels are related mostly with abdominal obesity and with insulin resistance. Thus, HH may

  1. The impact of co-morbid factors on the psychological outcome of tinnitus patients.

    PubMed

    Pajor, Anna Maria; Ormezowska, Elżbieta Agata; Jozefowicz-Korczynska, Magdalena

    2013-03-01

    The study was carried out to determine the impact of some co-morbid otological symptoms and demographic factors on the emotional distress and cognitive functioning in patients with tinnitus. One hundred consecutive patients, complaining of constant idiopathic tinnitus, were enrolled into the study. Four tests were administered: Beck Depression Inventory, Hospital Anxiety Depression Scale (HADS, A--anxiety, D--depression), Mini-Mental State Examination (MMSE) and Trail Making Test (TMT). A multivariate stepwise linear regression analysis was performed to estimate the relationship between the results of each of the tests and following co-morbid factors: age, sex, tinnitus duration, tinnitus laterality, hearing status (normal hearing, unilateral hearing loss and bilateral hearing loss) and vertigo/dizziness. It was found that the scores of MMSE and TMT were negatively correlated with age and with hearing status and the scores of HADS-A were slightly correlated with sex. In regression analysis, in HADS-A, sex and to a lesser extent tinnitus duration, in MMSE and TMT age and to a lesser extent tinnitus laterality were the variables that were comprised in the final model. Demographic factors had contributed more than overlapping otological symptoms to the psychological outcome in tinnitus patients.

  2. [Bariatrica paraplegia patient and morbid obesity. New challenge in bariatric surgery].

    PubMed

    Gros Herguido, Noelia; Pereira Cunill, José Luis; Barranco Moreno, Antonio; Socas Macias, Maria; Morales-Conde, Salvador; Garcia-Luna, Pedro Pablo

    2014-06-01

    The loss of mobility due to spinal cord injury is a risk factor for weight gain. Despite the well-documented outcomes of bariatric surgery in outpatients, little information is available about the surgery in paraplegic patients. We present two cases of patients with morbid obesity and spinal cord injury. After several attempts to lose weight conservatively, were assessed by the multidisciplinary team of our hospital and finally intervened by laparoscopic gastric bypass. After surgery have been no post-surgical complications. The patient in case 1, after two years of follow-up, a weight of 84 kg (BMI 25.08 kg/m2). Case 2, after a month of surgery has reduced weight and stopped taking antihypertensive therapy. It 's available to bariatric surgery as an important option to consider if all non-surgical interventions fail is highlighted.

  3. ELECTRONIC MULTIPLIER CIRCUIT

    DOEpatents

    Thomas, R.E.

    1959-08-25

    An electronic multiplier circuit is described in which an output voltage having an amplitude proportional to the product or quotient of the input signals is accomplished in a novel manner which facilitates simplicity of circuit construction and a high degree of accuracy in accomplishing the multiplying and dividing function. The circuit broadly comprises a multiplier tube in which the plate current is proportional to the voltage applied to a first control grid multiplied by the difference between voltage applied to a second control grid and the voltage applied to the first control grid. Means are provided to apply a first signal to be multiplied to the first control grid together with means for applying the sum of the first signal to be multiplied and a second signal to be multiplied to the second control grid whereby the plate current of the multiplier tube is proportional to the product of the first and second signals to be multiplied.

  4. Laparoscopy versus laparotomy for the management of endometrial carcinoma in morbidly obese patients: a prospective study

    PubMed Central

    Bige, Özgür; Demir, Ahmet; Saatli, Bahadır; Koyuncuoğlu, Meral; Saygılı, Uğur

    2015-01-01

    Objective To compare the results of total laparoscopic hysterectomy and total abdominal hysterectomy in morbidly obese women with early stage endometrial cancer. Material and Methods This prospective study was conducted on 140 morbidly obese women with body mass indices ≥35 kg/m2 and presenting with clinical stage 1 endometrial cancer. The patients underwent total laparoscopic hysterectomy (n=70) or total abdominal hysterectomy (n=70), bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and peritoneal washing. Age, parity, menopausal status, weight, height, medical problems, history of previous laparotomy, surgical procedure, operative time, estimated amount of blood loss, preoperative hematocrit, postoperative hematocrit, operative complications, conversion to laparotomy, need for intraoperative or postoperative blood transfusion, intraoperative and postoperative complications, secondary surgery, tumor stage, grade, histology, number of recovered lymph nodes, and visual pain scores of the patients were recorded. Results Postoperative complications were significantly higher in the laparotomy group. Hospital stay in the laparoscopy group was significantly lower than that in the laparotomy group. The visual pain scores were significantly higher in the laparotomy group on the first, second, and third postoperative days and on the day of discharge from the hospital. Resuming activity took a significantly longer time in the laparotomy group (34.70 days) than in the laparoscopic group (17.89 days). Conclusion With the availability of skilled endoscopic surgeons, most obese women with early stage endometrial cancer can be safely managed by performing laparoscopy with an excellent surgical outcome, shorter hospitalization, less postoperative pain, and faster resumption of full activity. PMID:26401110

  5. 24 h electrocardiographic monitoring in morbidly obese patients during short-term zero calorie diet.

    PubMed

    Zuckerman, E; Yeshurun, D; Goldhammer, E; Shiran, A

    1993-06-01

    The medical literature of the previous decades has reported sudden unexpected death among cases of very low calorie dieters. Cardiac arrhythmias, possibly produced by a prolonged QT interval, were suspected to be the main cause of death in a considerable number of these cases. The aim of this study was to investigate the occurrence of significant cardiac arrhythmias and prolongation of the QT interval, during short-term zero calorie diet, in morbidly obese patients. A group of 11 such patients (BMI > 35 kg/m2) were treated with a short-term zero calorie diet, as in-patients for ten days, followed by an out-patient regime on an 800 kcal diet. Their ages ranged from 19-58 years (mean 43.6). None had diabetes mellitus, cardiac, liver or renal disease, or thyroid or pituitary abnormalities, and none took any medication except Allupurinol 300 mg/day. We used a 24h holter monitoring system to detect cardiac arrhythmias or prolonged QT interval. Recordings were performed on the day before starting the fast, while the patients were on their regular diet, and compared with similar recordings of the same patients taken on the 10th day of the fast. No significant cardiac arrhythmias or prolongation of the QT interval were recorded during the fasting period. Short-term zero calorie dieting provided the patients with physical and psychological encouragement and is a safe method for reducing weight if it is carried out under strict medical supervision.

  6. Morbidity and mortality of adult patients with congenital dyserythropoietic anemia type I.

    PubMed

    Shalev, Hanna; Al-Athamen, Kaid; Levi, Itai; Levitas, Aviva; Tamary, Hannah

    2017-01-01

    Congenital dyserythropoietic anemia type I (CDAI) is a rare autosomal recessive disease characterized by macrocytic anemia, ineffective erythropoiesis, and secondary hemochromatosis. To better define the natural history of the disease among adult patients, we studied 32 Bedouin patients (median age 34 yr; range 21-60) all carrying the same CDAN1 founder mutation. Follow-up studies included complete blood count, blood chemistry, abdominal ultrasound, echocardiography, and T2*MRI. Main complications were due to anemia and ineffective erythropoiesis [osteoporosis (8/9, 89%), cholelithiasis (21/30, 70%), pulmonary arterial hypertension (PAH) (6/25, 24%)] and iron overload [hypothyroidism (9/24, 38%), and diabetes mellitus (6/32, 19%)]. T2* MRI revealed increased liver iron but no cardiac iron (13/13). Anemia improved in the majority of patients who underwent splenectomy (5/6). Three patients died (9%) at the age of 46-56 due to PAH (1) and sepsis (2). All previously underwent splenectomy. Analyzing both our patients and the 21 patients previously described by Heimpel et al. (Blood 107:334, 2006), we conclude that adults with CDA I suffer significant morbidity and mortality. Careful monitoring of iron overload and prompt iron chelation therapy is mandatory. Due to possible complications and inconsistent response to splenectomy α-interferon, transfusion therapy or stem cell transplantation should be considered as alternatives to this procedure in severely affected patients.

  7. Neuropathic Pain and Psychological Morbidity in Patients with Treated Leprosy: A Cross-Sectional Prevalence Study in Mumbai

    PubMed Central

    Lasry-Levy, Estrella; Hietaharju, Aki; Pai, Vivek; Ganapati, Ramaswamy; Rice, Andrew S. C.; Haanpää, Maija; Lockwood, Diana N. J.

    2011-01-01

    Background Neuropathic pain has been little studied in leprosy. We assessed the prevalence and clinical characteristics of neuropathic pain and the validity of the Douleur Neuropathique 4 questionnaire as a screening tool for neuropathic pain in patients with treated leprosy. The association of neuropathic pain with psychological morbidity was also evaluated. Methodology/Principal Findings Adult patients who had completed multi-drug therapy for leprosy were recruited from several Bombay Leprosy Project clinics. Clinical neurological examination, assessment of leprosy affected skin and nerves and pain evaluation were performed for all patients. Patients completed the Douleur Neuropathique 4 and the 12-item General Health Questionnaire to identify neuropathic pain and psychological morbidity. Conclusions/Significance One hundred and one patients were recruited, and 22 (21.8%) had neuropathic pain. The main sensory symptoms were numbness (86.4%), tingling (68.2%), hypoesthesia to touch (81.2%) and pinprick (72.7%). Neuropathic pain was associated with nerve enlargement and tenderness, painful skin lesions and with psychological morbidity. The Douleur Neuropathique 4 had a sensitivity of 100% and specificity of 92% in diagnosing neuropathic pain. The Douleur Neuropathique 4 is a simple tool for the screening of neuropathic pain in leprosy patients. Psychological morbidity was detected in 15% of the patients and 41% of the patients with neuropathic pain had psychological morbidity. PMID:21408111

  8. Two patients with co-morbid myasthenia gravis in a Brazilian cohort of inflammatory bowel disease.

    PubMed

    Gondim, Francisco de A A; de Oliveira, Gisele R; Araújo, Davi F; Souza, Marcellus Henrique Loiola Ponte; Braga, Lúcia Libanez Bessa Campelo; Thomas, Florian P

    2014-11-01

    Co-morbid auto-immune disorders may affect 0.2% of the population. We present the clinical and electrodiagnostic findings of 2 patients with inflammatory bowel disease and myasthenia gravis from a Brazilian cohort of 218 inflammatory bowel disease patients. Patient 1: A 40year-old man was diagnosed with ulcerative colitis at age 37 and underwent total colectomy 3years later. After prednisone was tapered, he experienced a clinical relapse and was diagnosed with Crohn's disease. He then developed quadriparesis, bilateral ptosis, dysphagia and dysarthria. Patient 2: A 41year-old woman (diagnosed with ulcerative colitis and primary sclerosing cholangitis at age 35) developed speech impairment and ptosis. On both patients, symptoms quickly progressed over few weeks. Myasthenia gravis was diagnosed and confirmed by abnormal repetitive nerve stimulation and elevated anti-acetylcholine receptor antibody titers. Pyridostigmine and prednisone successfully treated both patients. Myasthenia gravis prevalence over 9years was 0.9%. Myasthenia gravis clinical course was not significantly modified by inflammatory bowel disease relapses and should be suspected with new onset weakness.

  9. The treatment outcomes and the use of adjuvant therapies in breast cancer patients with severe co-morbidities

    PubMed Central

    Han, Jaihong; Lee, Han-Byoel; Lee, Eun-Shin; Kang, Young Joon; Kim, Yumi; Choi, Jihye; Rhu, Jiyoung; Shin, Hee-Chul; Han, Wonshik; Noh, Dong-Young

    2017-01-01

    Purpose Studies have suggested a potential role of patient’s co-morbidity in determining the survival outcomes of breast cancer. In this study, we examined the long-term oncologic outcomes in breast cancer patients who underwent curative surgery according to their pre-existing comorbid conditions and analyzed the association between the co-morbidity and the use of adjuvant therapies. Methods The medical records of 2,501 patients who underwent surgery for primary breast cancer from June 2006 to June 2010 were reviewed retrospectively. The patients were classified into three groups according to preoperative ASA status determined by the anesthesiologists. Clinico-pathologic characteristics and survival outcomes of the patients were compared among the different co-morbidity groups. Results There were 1,792 (71.6%), 665 (26.6%), and 44 (1.8%) patients in ASA I, II, and III, respectively. Total 95 (3.8%) deaths and 269 (10.8%) recurrences (loco-regional and distant) occurred during the median follow-up period of 71 months. Patients with high comorbidity showed significantly higher rate of deaths (51 (2.8%), 38 (5.7%) and 6 (13.6%) deaths in ASA I, II and III group, respectively, p<0.001). The ASA 3 patients also showed significantly higher rate of breast cancer recurrence when compared to other groups (180 (10.0%), 80 (12.0%) and 9 (20.5%) in ASA I, II, and III, respectively, p = 0.041). Significantly fewer patients in the high co-morbidity group received adjuvant therapies (77 (4.3%), 44 (6.6%) and 8 (18.2%) in ASA I, II, and III, respectively, p<0.001). The increased recurrence of breast cancer in the high morbidity group was mostly seen in patients who did not receive adjuvant therapies. The incidence of serious adverse effect during the adjuvant therapy did not differ according to the co-morbidity conditions. Conclusions In this study, high comorbidity was related to increased risk of death and recurrence in breast cancer. The increased risk of recurrence in high

  10. Airway pressure release ventilation in morbidly obese surgical patients with acute lung injury and acute respiratory distress syndrome.

    PubMed

    Testerman, George M; Breitman, Igal; Hensley, Sarah

    2013-03-01

    Morbidly obese patients with body mass index greater than 40 kg/m(2) and respiratory failure requiring critical care services are increasingly seen in trauma and acute care surgical centers. Baseline respiratory pathophysiology including decreased pulmonary compliance with dependent atelectasis and abnormal ventilation-perfusion relationships predisposes these patients to acute lung injury (ALI) and adult respiratory distress syndrome (ARDS) as well as prolonged stays in the intensive care unit. Airway pressure release ventilation (APRV) is an increasingly used alternative mode for salvage therapy in patients with hypoxemic respiratory failure that also provides lung protection from ventilator-induced lung injury. APRV provides the conceptual advantage of an "open lung" approach to ventilation that may be extended to the morbidly obese patient population with ALI and ARDS. We discuss the theoretical benefits and a recent clinical experience of APRV ventilation in the morbidly obese patient with respiratory failure at a Level I trauma, surgical critical care, and acute care surgery center.

  11. Fluconazole pharmacokinetics in a morbidly obese, critically ill patient receiving continuous venovenous hemofiltration.

    PubMed

    Lopez, Natasha D; Phillips, Kristy M

    2014-09-01

    Current fluconazole dosing strategies can be described using either standardized doses (800 or 400 mg) or as weight-based dosing recommendations (12 mg/kg loading dose followed by 6 mg/kg maintenance dose). The ideal method of fluconazole dosing is still unclear for certain patient populations, such as those receiving renal replacement therapy or the morbidly obese. We describe a 48-year-old man with a body mass index of 84 kg/m(2) who was receiving continuous venovenous hemofiltration (CVVH) and was treated with fluconazole by using a weight-based dose determined by lean body weight, infused at a rate of 200 mg/hour. Blood samples were collected at hour 0 (i.e., ~24 hrs after the loading dose was administered) and at 3.5, 6.8, and 11.3 hours after the start of the 600-mg maintenance dose, infused over 3 hours. Pharmacokinetic parameters calculated were maximum serum concentration 9.64 mg/L, minimum serum concentration 5.98 mg/L, area under the serum concentration-time curve from 0-24 hours (AUC0-24 ) 184.75 mg/L•hour, elimination rate constant 0.0199 hour(-1) , elimination half-life 34.8 hours, and total body clearance 3.25 L/hour. Our data, when combined with previously published literature, do not support using a linear dose-to-AUC approximation to estimate drug dosing needs in the critically ill patient population receiving CVVH. In addition, our results suggest that morbidly obese patients are able to achieve pharmacodynamic goals defined as an AUC:MIC ratio higher than 25 by using a lean body weight for fluconazole dosing calculations.

  12. Optical Coherence Tomography Parameters in Morbidly Obese Patients Who Underwent Laparoscopic Sleeve Gastrectomy

    PubMed Central

    Dogan, Ugur; Habibi, Mani; Bulbuller, Nurullah

    2016-01-01

    Purpose. To investigate changes in optical coherence tomography parameters in morbidly obese patients who had undergone laparoscopic sleeve gastrectomy (LSG). Methods. A total of 41 eyes of 41 morbidly obese patients (BMI ≥ 40) who had undergone LSG were included in study. The topographic optic disc parameters, central macular thickness (CMT), total macular volume (TMV), and retinal ganglion cell layer (RGCL) were measured by spectral-domain optical coherence tomography (SD-OCT). Subfoveal choroidal thickness (SFCT) was measured by enhanced deep imaging-optical coherence tomography (EDI-OCT). Results. The mean CMT was 237.4 ± 24.5 μm, 239.3 ± 24.1 μm, and 240.4 ± 24.5 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p < 0.01). The mean TMV was 9.88 ± 0.52 mm3, 9.96 ± 0.56 mm3, and 9.99 ± 0.56 mm3 preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p < 0.01). The mean RGCL was 81.2 ± 6.5 μm, 82.7 ± 6.6 μm, and 82.9 ± 6.5 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p < 0.01). The mean SFCT was 309.8 ± 71.8 μm, 331.0 ± 81.4 μm, and 352.7 ± 81.4 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p < 0.01). No statistically significant differences were found between the preoperative values and 3- and 6-month postoperative values in rim area (p = 0.34), disc area (p = 0.64), vertical cup/disc ratio (p = 0.39), cup volume (p = 0.08), or retinal nerve fiber layer (p = 0.90). Conclusions. Morbidly obese patients who undergo LSG experience a statistically significant increase in CMT, TMV, SFCT, and RGCL at 3 months and 6 months after surgery. PMID:27413543

  13. Bariatric surgery. Surgery for weight control in patients with morbid obesity.

    PubMed

    Balsiger, B M; Murr, M M; Poggio, J L; Sarr, M G

    2000-03-01

    Morbid obesity has become a health crisis in the United States. Medical programs developed at nonoperative attempts to lose (and maintain) an adequate weight loss are largely unsuccessful. Bariatric surgery has been proven to be effective at inducing and maintaining a satisfactory weight loss to decrease weight-related comorbidity. Bariatric operations include procedures that decrease mechanically the volume capacitance of the proximal stomach (vertical banded gastroplasty, laparoscopic gastric banding) or decrease the proximal gastric capacitance and establish a partial selective malabsorption (gastric bypass and its modifications, partial biliopancreatic bypass, and duodenal switch with partial biliopancreatic bypass). These operations should induce a loss of at least 50% (or more) of excess body weight. Not all patients are candidates for these procedures, and the best results are obtained by a multidisciplinary team (including nutritionist, physician, dietitian, psychologist or psychiatrist interested in eating disorders, and surgeon).

  14. Robotic pancreas transplantation in a type 1 diabetic patient with morbid obesity

    PubMed Central

    Yeh, Chun Chieh; Spaggiari, Mario; Tzvetanov, Ivo; Oberholzer, José

    2017-01-01

    Abstract Rationale: Obesity is considered a relative contraindication to pancreas transplantation due to increased risks of wound-related complications. Robotic surgeries have never been applied for pancreas transplantation in obese recipients though robotic kidney transplantation did and already proved its value in reducing wound-related complications in obese recipients. Patient concerns & Diagnoses: We performed the first robotic pancreas after kidney transplantation for a 34-year-old Hispanic type 1 diabetic male with class III obesity (BMI = 41 kg/m2). Interventions: The pancreas graft was procured and benched in the standard fashion. Methylene blue was used to detect any vascular leaks. The operation was completed via two 12-mm ports (camera, laparoscopic bed-side assistance), two 8-mm ports for robotic arms, and a 7-cm epigastric incision for hand port. The portal vein and arterial Y-graft of the pancreas were anastomosed to the recipient's left external iliac vein and artery, respectively. Duodenum-bladder drainage was performed with a circular stapler. Outcomes: Duration of warm and cold ischemia was: 45 minutes and 7 hours, respectively. The patient was discharged uneventfully without wound-related complications. Excellent metabolic control was achieved with hemoglobin A1c lowering from 9% before transplantation to 4.4% on day 120. The patient remained in nondiabetic status in 1-year follow-up. Lessons: In conclusion, robotic pancreas transplantation is feasible in patients with morbid obesity. PMID:28178127

  15. [Clinical experience with a C-section surgical technique in patients with morbid obesity: a case series].

    PubMed

    Hernández Carrazco, Mayra Elena; Rodríguez Torres, Alejandra; Ortiz Pineda, Omar; Rodríguez Torres, Juan; Casas Patiño, Donovan

    2014-07-04

    Obesity is a public health challenge that has crossed into the area of reproductive health. An obese pregnant woman has multiple complications before, during, and after pregnancy. Likewise, cesarean section is more difficult and has slower recovery times in this group of patients. This paper proposes a surgical technique adapted to the morbidly obese pregnant patient that aims to reduce cesarean section complications.

  16. Relative risk for cardiovascular morbidity in hemodialysis patients regarding gene polymorphism for IL-10, IL-6, and TNF.

    PubMed

    Tosic Dragovic, J; Popovic, J; Djuric, P; Jankovic, A; Bulatovic, A; Barovic, M; Pravica, V; Marinkovic, J; Dimkovic, N

    2016-10-01

    Uremia-related inflammation is prone to be a key factor to explain high cardiovascular morbidity in hemodialysis patients. Genetic susceptibility may be of importance, including IL-10, IL-6, and TNF. The aim was to analyze IL-10, IL-6, and TNF gene polymorphisms in a group of hemodialysis patients and to correlate the findings with cardiovascular morbidity. This study included 169 patients on regular hemodialysis at Zvezdara University Medical Center. Gene polymorphisms for IL-10, IL-6 and TNF were determined using PCR. These findings were correlated with the cardiovascular morbidity data from patient histories. Heterozygots for IL-10 gene showed significantly lower incidence of cardiovascular events (p = 0.05) and twice lower risk for development of myocardial infarction, but experienced twice higher risk for left ventricular hypertrophy. Regarding TNF gene polymorphism, patients with A allele had 1.5-fold higher risk for cerebrovascular accident and cardiovascular events and 2-fold higher risk for hypertension and peripheral vascular disease. Patients with G allele of IL-6 gene experienced 1.5-fold higher risks for cerebrovascular accident. We need studies with larger number of patients for definitive conclusion about the influence of gene polymorphisms on cardiovascular morbidity in hemodialysis patients and its importance in everyday clinical practice.

  17. Non-Alcoholic Steatohepatitis (NASH): Risk Factors in Morbidly Obese Patients

    PubMed Central

    Losekann, Alexandre; Weston, Antonio C.; de Mattos, Angelo A.; Tovo, Cristiane V.; de Carli, Luis A.; Espindola, Marilia B.; Pioner, Sergio R.; Coral, Gabriela P.

    2015-01-01

    The aim was to investigate the prevalence of non-alcoholic steatohepatitis (NASH) and risk factors for hepatic fibrosis in morbidly obese patients submitted to bariatric surgery. This retrospective study recruited all patients submitted to bariatric surgery from January 2007 to December 2012 at a reference attendance center of Southern Brazil. Clinical and biochemical data were studied as a function of the histological findings of liver biopsies done during the surgery. Steatosis was present in 226 (90.4%) and NASH in 176 (70.4%) cases. The diagnosis of cirrhosis was established in four cases (1.6%) and fibrosis in 108 (43.2%). Risk factors associated with NASH at multivariate analysis were alanine aminotransferase (ALT) >1.5 times the upper limit of normal (ULN); glucose ≥ 126 mg/dL and triglycerides ≥ 150 mg/dL. All patients with ALT ≥1.5 times the ULN had NASH. When the presence of fibrosis was analyzed, ALT > 1.5 times the ULN and triglycerides ≥ 150 mg/dL were risk factors, furthermore, there was an increase of 1% in the prevalence of fibrosis for each year of age increase. Not only steatosis, but NASH is a frequent finding in MO patients. In the present study, ALT ≥ 1.5 times the ULN identifies all patients with NASH, this finding needs to be further validated in other studies. Moreover, the presence of fibrosis was associated with ALT, triglycerides and age, identifying a subset of patients with more severe disease. PMID:26512661

  18. Non-Alcoholic Steatohepatitis (NASH): Risk Factors in Morbidly Obese Patients.

    PubMed

    Losekann, Alexandre; Weston, Antonio C; de Mattos, Angelo A; Tovo, Cristiane V; de Carli, Luis A; Espindola, Marilia B; Pioner, Sergio R; Coral, Gabriela P

    2015-10-23

    The aim was to investigate the prevalence of non-alcoholic steatohepatitis (NASH) and risk factors for hepatic fibrosis in morbidly obese patients submitted to bariatric surgery. This retrospective study recruited all patients submitted to bariatric surgery from January 2007 to December 2012 at a reference attendance center of Southern Brazil. Clinical and biochemical data were studied as a function of the histological findings of liver biopsies done during the surgery. Steatosis was present in 226 (90.4%) and NASH in 176 (70.4%) cases. The diagnosis of cirrhosis was established in four cases (1.6%) and fibrosis in 108 (43.2%). Risk factors associated with NASH at multivariate analysis were alanine aminotransferase (ALT) >1.5 times the upper limit of normal (ULN); glucose ≥ 126 mg/dL and triglycerides ≥ 150 mg/dL. All patients with ALT ≥1.5 times the ULN had NASH. When the presence of fibrosis was analyzed, ALT > 1.5 times the ULN and triglycerides ≥ 150 mg/dL were risk factors, furthermore, there was an increase of 1% in the prevalence of fibrosis for each year of age increase. Not only steatosis, but NASH is a frequent finding in MO patients. In the present study, ALT ≥ 1.5 times the ULN identifies all patients with NASH, this finding needs to be further validated in other studies. Moreover, the presence of fibrosis was associated with ALT, triglycerides and age, identifying a subset of patients with more severe disease.

  19. Coexisting chronic conditions associated with mortality and morbidity in adult patients with asthma

    PubMed Central

    Sumino, Kaharu; O’Brian, Katiuscia; Bartle, Brian; Au, David H.; Castro, Mario; Lee, Todd A.

    2014-01-01

    Objective Many asthma patients suffer from chronic conditions other than asthma. We investigated the specific contribution of common comorbidities on mortality and morbidity in adult asthma. Methods In an observational study of adults with incident asthma identified between 1999 and 2003 using National Veterans Affairs and Centers for Medicare and Medicaid Services encounter databases (n=25,975, follow-up 3.0±1.7 years), association between 13 most prevalent comorbidities (hypertension, ischemic heart disease (IHD), osteoarthritis, rheumatoid arthritis, diabetes, mental disorders, substance/drug abuse, enlarged prostate, depression, cancer, alcoholism, HIV, and heart failure) and 4 conditions previously associated with asthma (sleep apnea, gastroesophageal reflux disease (GERD), rhinitis, and sinusitis) and mortality, hospitalizations and asthma exacerbations were assessed using multivariate regression analyses adjusted for other clinically important covariates. Results HIV followed by alcoholism and mental disorders among 18–45 years old, and heart failure, diabetes, IHD, and cancer among those ≥65 years old were associated with an increased risk of all-cause mortality. Many conditions were associated with increased risk for all-cause hospitalizations, but the increased risk was consistent across all ages for mental disorders. For asthma exacerbations, mental disorder followed by substance abuse and IHD were associated with increased risk among those 18–45 years old, and chronic sinusitis, mental disorder, and IHD among those ≥65 years old. GERD was associated with decreased risk for asthma exacerbation in all ages. Conclusions Many comorbidities are associated with poor outcome in adult asthmatics and their effect differs by age. Mental disorders are associated with increased risk of mortality and morbidity across ages. PMID:24432868

  20. Cardiovascular Morbidity After Radiotherapy or Chemoradiation in Patients With Cervical Cancer

    SciTech Connect

    Maduro, John H.; Dekker, Helena A. den; Pras, Elisabeth; Vries, Elisabeth G. de; Zee, Ate G. van der; Klokman, Willem J.; Reyners, Anna K.; Leeuwen, Flora E. van; Langendijk, Johannes A.; Bock, Geertruida H. de; Gietema, Jourik A.

    2010-12-01

    Purpose: To evaluate the risk of cardiovascular events (CVE) in patients with cervical cancer treated with radiotherapy or chemoradiation. Methods and Materials: The incidence of CVE in patients treated between 1989 and 2002 by radiotherapy or chemoradiation was compared with a Dutch reference population. Standardized incidence ratios (SIRs) were calculated for myocardial infarction (MI), angina pectoris (AP), congestive heart failure (CHF), cerebrovascular accident (CVA) separately and for any cardiac event combined (MI, AP, and CHF). Results: In 277 patients with a median follow-up of 4.5 years (range, 0.1-17 years) and a median survival of 9.2 years, 27 cardiac events occurred. The 5-, 10-, and 15-year actuarial incidence of any cardiac event were 9, 14, and 16%, respectively. For the whole population, the SIR for MI was elevated (2.05, 95% CI: 1.12-3.43). The radiotherapy group (n = 132) was older and had more cardiovascular risk factors than the chemoradiation group (n = 145). The SIR for MI in the radiotherapy group was 2.88 (95% CI: 1.44-5.15) and in the chemoradiation group 1.00 (95% CI: 0.21-7.47). In multivariate analyses, there was no relation between treatment modality and the risk for MI. Conclusions: In this cohort of cervical cancer patients, an increased risk for developing a MI was observed. This increased risk of MI, in combination with the high prevalence of cardiovascular risk factors in cervical cancer patients, urges the need to explore strategies to reduce their risk for cardiovascular morbidity.

  1. Impact of concomitant laparoscopic sleeve gastrectomy and hiatal hernia repair on gastro-oesophageal reflux disease in morbidly obese patients

    PubMed Central

    Garg, Harshit; Vigneshwaran, Balasubiramaniyan; Aggarwal, Sandeep; Ahuja, Vineet

    2017-01-01

    BACKGROUND: The aim of this study was to analyse the impact of hiatal hernia repair (HHR) on gastro-oesophageal reflux disease (GERD) in morbidly obese patients with hiatus hernia undergoing laparoscopic sleeve gastrectomy (LSG). MATERIALS AND METHODS: It is a retrospective study involving ten morbidly obese patients with large hiatus hernia diagnosed on pre-operative endoscopy who underwent LSG and simultaneous HHR. The patients were assessed for symptoms of GERD using a Severity symptom score (SS) questionnaire and anti-reflux medications. RESULTS: Of the ten patients, five patients had GERD preoperatively. At the mean follow-up of 11.70 ± 6.07 months after surgery, four patients (80%) showed complete resolution while one patient complained of persistence of symptoms. Endoscopy in this patient revealed resolution of esophagitis indicating that the persistent symptoms were not attributable to reflux. The other five patients without GERD remained free of any symptom attributable to GERD. Thus, in all ten patients, repair of hiatal hernia (HH) during LSG led to either resolution of GERD or prevented any new onset symptom related to GER. CONCLUSION: In morbidly obese patients with HH with or without GERD undergoing LSG, repair of the hiatus hernia helps in amelioration of GERD and prevents any new onset GER. Thus, the presence of HH should not be considered as a contraindication for LSG. PMID:28281472

  2. Severe maternal morbidity among immigrant women in the Netherlands: patients' perspectives.

    PubMed

    Jonkers, Marina; Richters, Annemiek; Zwart, Joost; Öry, Ferko; van Roosmalen, Jos

    2011-05-01

    This 2006 study investigated ethnicity-related factors contributing to sub-standard maternity care and the effects on severe maternal morbidity among immigrant women in the Netherlands. In-depth interviews were carried out with 40 immigrant and 10 native Dutch women. The immigrant women reported that health care providers often paid insufficient attention to their pregnancy-related complaints, especially in cases of pre-eclampsia. They also reported delays in receiving information about diagnosis and treatment. Obstetricians who reviewed 20 of these cases judged sub-standard care to have played a role in the development of complications in 16 of them. The women themselves had problems identifying medically significant complications, presenting their complaints to health care providers effectively, and taking an active role as patients. Even highly educated migrant women showed low health literacy skills in their interaction with doctors. Patients' perspectives are valuable as one of the tools to evaluate the quality of maternity care. Communication by maternal health professionals can be improved through more sensitivity to social factors that affect immigrant women's health problems. Women with limited health literacy should be empowered through education about danger signs in pregnancy and information about preferences and policies in obstetrics in the Netherlands. They should also be invited to participate in medical decision-making.

  3. Co-Morbid Erectile Dysfunction (Ed) and Antidepressant Treatment in a Patient - A Management Challenge?

    PubMed

    Zainol, Maszaidi; Sidi, Hatta; Kumar, Jaya; Das, Srijit; Ismail, Shaiful; Hatta, Muhammad Hizri; Baharudin, Najwa; Ravindran, Arun

    2017-03-15

    Across the globe, antidepressants (AD) and phosphodiesterase-5 inhibitors (PDE-5i) are commonly prescribed psychopharmacological agents for patients with co-morbid mental-health problem and sexual dysfunction (SD). The serotonergic and/or noradrenergic ADs, although is an effective agent are not without SD side-effects, especially erectile dysfunction (ED). ED is an inability to achieve, or maintain an erection for satisfactory sexual intercourse during the phases of male's sexual arousal. It is recognized as an important reason why non-adherence to treatment was observed in patients who are on AD. AD intervention caused remission to some of the pre-treatment psychopathology of ED, but to many patients, AD potentially magnified the unwanted sexual side-effects. This made this situation a challenging task for the mental health professional. These challenges are based on the complexity of ED - its etiology, and the associated risk factors, which further compounded with AD side-effect. The neuro-psychopharmacological basis for AD treatment selection used was deliberated. Biopsychosocial interventions are recommended at a two pivotal stage. First, a step should be taken for proper assessment (e.g. detailed history, psychosocial and laboratory investigations); and identifying some modifiable risk factors for ED and associated mental health issue. Secondly, with guidance of an algorithm pathway, a practical intervention should include steps like dose reduction, augmentation or changing to an AD with lesser/ no sexual side-effects like bupropion and mirtazepine. Some achievable suggestions, e.g. revising sexual scripts and improving sexual techniques, life-style modifications, psychotherapy and other non-pharmacological approaches will be beneficial for both patients and his partner.

  4. SECONDARY ELECTRON MULTIPLIERS

    DOEpatents

    Morton, G.A.; Green, M.W.

    1959-01-01

    A secondary emission multiplier having exceptionally high output signal current is described. In previous multiplier tubes the output signal current was limited by the space charge surrounding the electrodes. The present multiplier tubes provides a source of ions within the tube adjacent the anode to neutralize the space charge effect, and the dynode voltage is switched on intermittently for periods of time so brief that the ions do not move towards the cathode.

  5. Effect of aspirin continuation on blood loss and postoperative morbidity in patients undergoing laparoscopic cholecystectomy or colorectal cancer resection.

    PubMed

    Ono, Kazumi; Idani, Hitoshi; Hidaka, Hidekuni; Kusudo, Kazuhito; Koyama, Yusuke; Taguchi, Shinya

    2013-02-01

    No consensus exists whether to continue or withdraw aspirin therapy perioperatively in patients undergoing major laparoscopic abdominal surgery. To investigate whether preoperative continuation of aspirin therapy increases blood loss and associated morbidity during laparoscopic cholecystectomy and colorectal cancer resection, we compared duration of surgical procedures, amount of intraoperative blood loss, rate of blood transfusion, length of postoperative stay, rate of conversion to open surgery, and reoperation within 48 hours between patients with and without aspirin therapy preoperatively. Twenty-nine of 270 patients who underwent laparoscopic cholecystectomy and 23 of 218 patients who underwent laparoscopic colorectal cancer resection, respectively, were on aspirin therapy. We found no significant difference in the investigated outcome between groups with the exception of longer surgical duration of laparoscopic cholecystectomy in aspirin-treated patients. Although underpowered, above findings may suggest that aspirin continuation is unlikely to increase blood loss or postoperative morbidity in patients undergoing laparoscopic cholecystectomy or colorectal cancer resection.

  6. Dialyzer reuse impact on dialyzer efficiency, patient morbidity and mortality and cost effectiveness.

    PubMed

    Mitwalli, A H; Abed, J; Tarif, N; Alam, A; Al-Wakeel, J S; Abu-Aisha, H; Memon, N; Sulaimani, F; Ternate, B; Mensah, M O

    2001-01-01

    Since the introduction of dialyzer reuse more than three decades ago, several studies have reported its safety, efficacy and cost effectiveness. Reuse of hemodialyzer was prospectively studied in ten chronic hemodialysis (HD) patients recruited from the renal unit, the King Khalid University Hospital, Riyadh, Saudi Arabia, for three months. During the study period, 66 dialyzers were used for 408 sessions of HD, with a mean reuse of 6.2 +/- 5.3 episodes per dialyser, the mean of maximum reuse episodes being 13.7 +/- 8.0. The urea reduction ratio was maintained between 73 +/- 5% at baseline to 71.2 +/- 9.03% (p=0.53) at the maximum reuse. Similarly phosphate reduction with each HD session was maintained; mean decrease in phosphate levels was 0.67 mmol/L. Significant increase in heparin requirement was noted; however, the risk of bleeding was not increased. Hematocrit levels increased from 30.4 +/- 4.1% to 33.2 +/- 3.6% at the end of the study (p=0.6). Albumin leak in dialysate decreased with each reuse; baseline 8.27 +/- 7.93 mg/L to 2.8 +/- 0.4 mg/L at maximum reuse (p=0.04). Serum albumin levels remained stable. No short-term adverse effects on patients' morbidity and mortality were noted. Total cost savings of 53% was achieved with the reuse of dialyzers, excluding capital equipment used for preparation for reuse. In conclusion, dialyzer reuse seems to be safe and may provide an economical and efficient dialysis. Studies involving larger number of patients is required to validate this observation.

  7. Insulin resistance is associated with specific gut microbiota in appendix samples from morbidly obese patients

    PubMed Central

    Moreno-Indias, Isabel; Sánchez-Alcoholado, Lidia; García-Fuentes, Eduardo; Cardona, Fernando; Queipo-Ortuño, Maria Isabel; Tinahones, Francisco J

    2016-01-01

    Alterations in intestinal microbiota composition could promote a proinflammatory state in adipose tissue that is associated with obesity and insulin resistance. Our aim was to identify the gut microbiota associated with insulin resistance in appendix samples from morbidly obese patients classified in 2 groups, high (IR-MO) and low insulin-resistant (NIR-MO), and to determine the possible association between these gut microbiota and variables associated with insulin resistance and the expression of genes related to inflammation and macrophage infiltration in adipose tissue. Appendix samples were obtained during gastric bypass surgery and the microbiome composition was determined by 16S rRNA pyrosequencing and bioinformatics analysis by QIIME. The Chao and Shannon indices for each study group suggested similar bacterial richness and diversity in the appendix samples between both study groups. 16S rRNA pyrosequencing showed that the IR-MO group had a significant increase in the abundance of Firmicutes, Fusobacteria, Pseudomonaceae, Prevotellaceae, Fusobacteriaceae, Pseudomonas, Catenibacterium, Prevotella, Veillonella and Fusobacterium compared to the NIR-MO group. Moreover, in the IR-MO group we found a significant positive correlation between the abundance of Prevotella, Succinovibrio, Firmicutes and Veillonella and the visceral adipose tissue expression level of IL6, TNF alpha, ILB1 and CD11b respectively, and significant negative correlations between the abundance of Butyricimonas and Bifidobacterium, and plasma glucose and insulin levels, respectively. In conclusion, an appendix dysbiosis occurs in IR-MO patients, with a loss of butyrate-producing bacteria, essential to maintenance of gut integrity, together with an increase in mucin-degrading bacteria and opportunistic pathogens. The microbiota present in the IR-MO group were related to low grade inflammation in adipose tissue and could be useful for developing strategies to control the development of insulin

  8. Changes in SCD gene DNA methylation after bariatric surgery in morbidly obese patients are associated with free fatty acids

    PubMed Central

    Morcillo, Sonsoles; Martín-Núñez, Gracia Mª; García-Serrano, Sara; Gutierrez-Repiso, Carolina; Rodriguez-Pacheco, Francisca; Valdes, Sergio; Gonzalo, Montserrat; Rojo-Martinez, Gemma; Moreno-Ruiz, Francisco J.; Rodriguez-Cañete, Alberto; Tinahones, Francisco; García-Fuentes, Eduardo

    2017-01-01

    Stearoyl CoA Desaturase-1 (SCD) is considered as playing an important role in the explanation of obesity. The aim of this study was to evaluate whether the DNA methylation SCD gene promoter is associated with the metabolic improvement in morbidly obese patients after bariatric surgery. The study included 120 subjects with morbid obesity who underwent a laparoscopic Roux-en Y gastric by-pass (RYGB) and a control group of 30 obese subjects with a similar body mass index (BMI) to that found in morbidly obese subjects six months after RYGB. Fasting blood samples were obtained before and at six months after RYGB. DNA methylation was measured by pyrosequencing technology. DNA methylation levels of the SCD gene promoter were lower in morbidly obese subjects before bariatric surgery but increased after RYGB to levels similar to those found in the control group. Changes of DNA methylation SCD gene were associated with the changes of free fatty acids levels (r = −0.442, p = 0.006) and HOMA-IR (r = −0.249, p = 0.035) after surgery. RYGB produces an increase in the low SCD methylation promoter levels found in morbidly obese subjects. This change of SCD methylation levels is associated with changes in FFA and HOMA-IR. PMID:28393901

  9. [Mortality and morbidity in HIV-infected patients undergoing coronary artery bypass surgery: a case control study].

    PubMed

    Jiménez-Expósito, María J; Mestres, Carlos A; Claramonte, Xavier; Cartañá, Ramón; Josa, Miquel; Pomar, José L; Mulet, Jaume; Miró, José M

    2006-03-01

    The use of highly active antiretroviral therapy (HAART) in patients with HIV infection has improved survival. This improvement combined with the metabolic effects of treatment has increased cardiovascular risk and the need for cardiac surgery in these patients. We compared morbidity and mortality in HIV-infected patients (cases, n=7) and non-HIV-infected patients (controls, n=21) who underwent isolated coronary artery surgery between 1997 and 2004. The durations of extracorporeal circulation and aortic cross-clamping were shorter in HIV-infected patients (P=.002 and P=.014, respectively). The percentage of patients who experienced complications was similar, at 57.1% in both groups, but there was a slightly higher number of complications per patient in non-HIV-infected individuals. The mean length of total hospitalization was greater in HIV-infected patients (27.1 [13.3] versus 8.8 [5.3] days; P=.003), as was that of postoperative hospitalization (18.2 [15.4] vs 7.9 [4.2] days; P=.08). No HIV-infected patient died or needed a repeat cardiac operation. No progression of the HIV infection was observed. Isolated coronary artery surgery in HIV-infected patients produces good results, and there is no increase in morbidity or mortality. Extracorporeal circulation did not influence disease progression.

  10. Bariatric Surgery to Correct Morbid Obesity Also Ameliorates Atherosclerosis in Patients with Type 2 Diabetes Mellitus

    PubMed Central

    Wang, Yong; Zhang, Cuihua

    2009-01-01

    Morbid obesity, a physiological dysfunction in humans associated with environmental, genetic and endocrinological origins, has significantly increased in the past few decades in the USA. Many methods have emerged for treating morbid obesity, such as diets, exercise, behavior modification, liposuction, drugs, and surgery; among these, bariatric surgery reduces weight and appears to have other curative effects. Roux-en-Y gastric bypass is the principal form of bariatric surgery, followed by laparoscopic adjustable gastric banding, gastric sleeve operation, duodenojejunal bypass and biliopancreatic diversion. This weight-loss surgery may also affect comorbidities of morbid obesity, such as type 2 diabetes mellitus (T2D), atherosclerosis, hypertension and steatohepatitis. Weight-loss surgery, for example, is associated with a more than 80% diabetes (data indicates > 80%) remission rate in severely obese persons. Empirical evidence also suggests that the use of bariatric surgery reduces atherosclerosis, and may ameliorate other comorbities. This warrants closer examination. PMID:19915685

  11. Pressure multiplying dispenser

    DOEpatents

    DeFord, Henry S.; Moss, Owen R.

    1986-01-01

    A pressure multiplying dispenser for delivering fluid, preferably as a spray to the atmosphere, from a source of fluid, preferably a spray bottle, is described. The dispenser includes in combination a hollow cylindrical member, a nozzle delivery tube within the cylindrical member and a hollow actuator piston slideable within the cylindrical member which acts to multiply the pressure of a squeeze applied to the spray bottle.

  12. [Outcome of diabetic patients on chronic hemodialysis. Comparative analysis of survival and morbidity of polycystic and elderly patients].

    PubMed

    Mascheroni, C; Puentes, M A; Cusumano, A M

    1997-01-01

    We analyzed retrospectively the outcome of 169 patients in chronic hemodialysis (CHD), divided into four groups: 1) 24 patients with diabetic nephropathy (age 53.7 +/- 11 years); 2) 19 with polycystic kidney disease (age 55.3 +/- 9 years) 3) 43 patients older than 60 when starting chronic hemodialysis with etiologies different from diabetes and polycystic kidney disease (age 69.2 +/- 5.8 years) and 4) 83 patients younger than 60 with diverse etiologies (age 42.8 +/- 12.4 years). In groups 1, 2 and 3 serum creatinine, arterial hypertension at the beginning, morbility, mortality and its causes were registered. In group 1, the prevalence of severe diabetic retinopathy and cardiovascular disease at the beginning were also analyzed. In all groups survival was determined. Of the diabetics, 92% presented severe diabetic retinopathy and 88% cardiovascular disease. The prevalence of hypertension was 100, 74 and 67% in groups 1, 2 and 3, respectively (p = 0.13). Twelve diabetics died before the first year of treatment; there was no difference in creatinine, age, cardiovascular disease, severe retinopathy and hypertension with those who lived more than one year. The percentage of time in risk hospitalized and the days/patients/year hospitalized were significantly different between group 1 and 3 and group 2 (p < 0.001). Patients were hospitalized for similar causes in groups 1 and 3: the initiation of CHD, cardiovascular and neurological diseases. The main causes of death in groups 1 and 3 were: cardiovascular disease and sudden death at home. Survival was better in group 2 compared with group 1 (p = 0.0014) but was similar between groups 1 and 3 (p = 0.21) even though there was a difference of 15 years between them. The Cox's proportional hazard model identified as risk factors diabetes, age, year of starting chronic hemodialysis and hospitalization episodes, adjusted for covariates. The outcome of diabetic patients in chronic hemodialysis showed high morbidity and mortality

  13. Hardware multiplier processor

    DOEpatents

    Pierce, P.E.

    A hardware processor is disclosed which in the described embodiment is a memory mapped multiplier processor that can operate in parallel with a 16 bit microcomputer. The multiplier processor decodes the address bus to receive specific instructions so that in one access it can write and automatically perform single or double precision multiplication involving a number written to it with or without addition or subtraction with a previously stored number. It can also, on a single read command automatically round and scale a previously stored number. The multiplier processor includes two concatenated 16 bit multiplier registers, two 16 bit concatenated 16 bit multipliers, and four 16 bit product registers connected to an internal 16 bit data bus. A high level address decoder determines when the multiplier processor is being addressed and first and second low level address decoders generate control signals. In addition, certain low order address lines are used to carry uncoded control signals. First and second control circuits coupled to the decoders generate further control signals and generate a plurality of clocking pulse trains in response to the decoded and address control signals.

  14. Hardware multiplier processor

    DOEpatents

    Pierce, Paul E.

    1986-01-01

    A hardware processor is disclosed which in the described embodiment is a memory mapped multiplier processor that can operate in parallel with a 16 bit microcomputer. The multiplier processor decodes the address bus to receive specific instructions so that in one access it can write and automatically perform single or double precision multiplication involving a number written to it with or without addition or subtraction with a previously stored number. It can also, on a single read command automatically round and scale a previously stored number. The multiplier processor includes two concatenated 16 bit multiplier registers, two 16 bit concatenated 16 bit multipliers, and four 16 bit product registers connected to an internal 16 bit data bus. A high level address decoder determines when the multiplier processor is being addressed and first and second low level address decoders generate control signals. In addition, certain low order address lines are used to carry uncoded control signals. First and second control circuits coupled to the decoders generate further control signals and generate a plurality of clocking pulse trains in response to the decoded and address control signals.

  15. Two loose screws: near-miss fall of a morbidly obese patient after an operating room table failure.

    PubMed

    McAllister, Russell K; Booth, Robert T; Bittenbinder, Timothy M

    2016-09-01

    Operating room surgical table failure is a rare event but can lead to a dangerous situation when it does occur. The dangers can be compounded in the presence of obesity, especially in the anesthetized or sedated patient. We present a case of a near-miss fall of a morbidly obese patient while turning the patient in preparation to transfer from the operating room table to the hospital bed when 2 fractured bolts in the tilt cylinder mechanism led to an operating room table failure.

  16. Depressive Symptoms in Patients Scheduled for Hyperthermic Intraperitoneal Chemotherapy With Cytoreductive Surgery: Prospective Associations With Morbidity and Mortality

    PubMed Central

    Bovbjerg, Dana H.; Ahrendt, Steven; Alhelo, Sara; Choudry, Haroon; Holtzman, Matthew; Jones, Heather L.; Pingpank, James F.; Ramalingam, Lekshmi; Zeh, Herbert J.; Zureikat, Amer H.; Bartlett, David L.

    2016-01-01

    Purpose The current study examined prospective relationships between preoperative depressive symptoms and short-term (30-day morbidity and readmission) and long-term (overall survival) outcomes after hyperthermic intraperitoneal chemotherapy with cytoreductive surgery (HIPEC + CS). Methods Ninety-eight patients scheduled for HIPEC + CS completed the Center for Epidemiologic Studies–Depression (CES-D) scale before surgery. Demographic and disease-specific factors and information about morbidity and readmission within 30 days after discharge were gathered from medical records. Survival was measured from date of surgery to death. Results Twenty-eight percent of patients had CES-D scores indicative of clinically significant depressive symptoms. Thirty-day morbidity occurred in 31.9% of patients and readmission in 22.2%. At the time of analysis (median follow-up of 49 months), 71.6% of patients were deceased, with median survival time of 11 months for those who died. After adjusting for relevant preoperative demographic and disease-specific factors, depressive symptoms were associated with greater odds of 30-day morbidity (n = 68; odds ratio, 5.50; 95% CI, 1.23 to 24.73; P = .03) and greater likelihood of 30-day readmission (n = 72; odds ratio, 5.92; 95% CI, 1.27 to 27.64; P = .02). Depressive symptoms were associated with shorter survival after adjustment for preoperative demographic and disease-specific factors (n = 87; hazard ratio, 1.88; 95% CI, 1.07 to 3.31; P = .03). This association was no longer significant when intraoperative/postoperative prognostic variables were added to the statistical model (n = 87; hazard ratio, 1.31; 95% CI, 0.72 to 2.37; P = .37). Conclusion Patients with clinically significant levels of preoperative depressive symptoms are at risk for poor clinical outcomes after HIPEC + CS, including greater risk of 30-day morbidity and readmission. Further research is warranted to determine biobehavioral mechanisms and examine whether effective

  17. Do Elderly Patients Experience Increased Perioperative or Postoperative Morbidity or Mortality When Given Neoadjuvant Chemoradiation Before Esophagectomy?

    SciTech Connect

    Fogh, Shannon E.; Yu, Anthony; Kubicek, Gregory J.; Scott, Walter; Mitchell, Edith; Rosato, Ernest L.; Berger, Adam C.

    2011-08-01

    Background: The use of induction chemoradiotherapy followed by surgery has been widely used for the treatment of esophageal cancer. The presumed risk of increased postoperative morbidity and mortality with this regimen has led to reluctance to offer this therapy to elderly patients. We compared the perioperative morbidity and mortality of patients 70 years old and older with those of patients younger than 70 who received CRT followed by esophagectomy and sought to identify preoperative risk factors that may predict higher risk of postoperative death or complications. Methods and Materials: We identified 260 patients who underwent preoperative chemoradiotherapy followed by esophagectomy. The association of age with postoperative death and complications was evaluated. The Charlson index, prior cardiac history, and diabetes were identified as preoperative risk factors and were evaluated as potential confounders or effect modifiers. Results: Cardiac disease and the Charlson index were potential modifiers of the effect of age on length of hospital stay (p = 0.08 and p = 0.07, respectively) and postoperative complications (p = 0.1 and p = 0.2) but were not statistically significant. There was a slight nonsignificant decrease in the risk of death in elderly patients after adjustment for the Charlson index (p = 0.2). Conclusion: No significant differences were detected with respect to morbidity and mortality in elderly patients. The presence of cardiac disease, higher scores on the Charlson index, or diabetes did not significantly influence length of stay, postoperative complications, or postoperative death. Given the potential to improve outcomes, this regimen should not be discounted in elderly patients.

  18. Patient Factors and Their Association with Nonmelanoma Skin Cancer Morbidity and the Performance of Self-skin Exams

    PubMed Central

    Amber, Kyle T.; Bloom, Romi; Abyaneh, Mohammad-Ali Yazdani; Falto-Aizpurua, Leyre A.; Viera, Martha; Zaiac, Martin N.; Nouri, Keyvan

    2016-01-01

    Objective: Mohs micrographic surgery is widely utilized for the treatment of nonmelanoma skin cancers with the advantage of tissue sparing and higher cure rate. The preoperative tumor size and post-Mohs micrographic surgery defect size are useful surrogate measures of nonmelanoma skin cancer morbidity. The authors sought to evaluate whether gender, Hispanic ethnicity, socioeconomic status, sun-safe practices and self-skin exams affected tumor size and Mohs micrographic surgery defect size. They also investigated factors associated with self-skin exams. Design: A cross-sectional survey-based study. Setting: Two dermatologic surgery clinics—one academic-associated and the other private. Participants: Patients receiving Mohs surgery for nonmelanoma skin cancers. Measurements: Tumor size and Mohs defect size and their relationship to patient factors ascertained from a survey, as well as the number of patients performing self-skin exams. The authors used t-tests and analysis of variance to compare tumor and defect sizes for each patient factor. Chi-squared tests were used to determine the factors associated with self-skin exams performance. Results: Lower education was associated with greater head and face tumor area (95mm2 vs. 41mm2, P=0.019), but not Mohs micrographic surgery defect size. Other studied patient factors were not associated with an increased morbidity. Hispanics performed self-skin exams at a lower rate than non-Hispanics (27% vs. 46%, p=0.03). Conclusion: This study innovatively uses tumor and Mohs micrographic surgery defect area as a measure of morbidity, allowing for identification of populations at need for improved education and prevention. (J Clin Aesthet Dermatol. 2016;9(9):16–22.) PMID:27878058

  19. Upper extremity acute compartment syndrome during tissue plasminogen activator therapy for pulmonary embolism in a morbidly obese patient

    PubMed Central

    Tuna, Serkan; Duymus, Tahir Mutlu; Mutlu, Serhat; Ketenci, Ismail Emre; Ulusoy, Ayhan

    2015-01-01

    Introduction Deep vein thrombosis (DVT) and pulmonary embolism (PE) are more frequently observed in morbidly obese patients. Tissue plasminogen activator (tPA) is a thrombolytic agent which dissolves the thrombus more rapidly than conventional heparin therapy and reduces the mortality and morbidity rates associated with PE. Compartment syndrome is a well-known and documented complication of thrombolytic treatment. In awake, oriented and cooperative patients, the diagnosis of compartment syndrome is made based on clinical findings including swelling, tautness, irrational and continuous pain, altered sensation, and severe pain due to passive stretching. These clinical findings may not be able to be adequately assessed in unconscious patients. Presentation of case In this case report, we present compartment syndrome observed, for which fasciotomy was performed on the upper right extremity of a 46-year old morbidly obese, conscious female patient who was receiving tPA due to a massive pulmonary embolism. Discussion Compartment syndrome had occurred due to the damage caused by the repeated unsuccessful catheterisation attempts to the brachial artery and the accompanying tPA treatment. Thus, the bleeding that occurred in the volar compartment of the forearm and the anterior compartment of the arm led to acute compartment syndrome (ACS). After relaxation was brought about in the volar compartment of the forearm and the anterior compartment of the arm, the circulation in the limb was restored. Conclusion As soon as the diagnosis of compartment syndrome is made, an emergency fasciotomy should be performed. Close follow-up is required to avoid wound healing problems after the fasciotomy. PMID:25618841

  20. Glucose Homeostasis and Weight Loss in Morbidly Obese Patients Undergoing Banded Sleeve Gastrectomy: A Prospective Clinical Study

    PubMed Central

    Miguel, Gustavo Peixoto Soares; Azevedo, Joao Luiz Moreira Coutinho; Neto, Carlos Gicovate; Moreira, Cora Lavigne Castelo Branco; Viana, Elaine Cristina; Carvalho, Perseu Seixas

    2009-01-01

    OBJECTIVE To assess glucose homeostasis and weight loss in morbidly obese patients undergoing Silastic® ring sleeve gas-trectomy. METHODS This was a prospective clinical study. Thirty-three female patients with a mean body mass index (BMI) of 42.33 ± 1.50 kg/m2 (range: 40–45 kg/m2), a mean age of 36.7 ± 9.4 years and a mean waist circumference of 118.7 ± 5.98 cm were included in this study. Type 2 diabetes mellitus was observed in 11 patients (33.3%), and glucose intolerance was observed in 4 patients (12.1%). Mean plasma fasting glucose levels were 109.77 ± 44.19 mg/dl (75–320) in the preoperative period. All Silastic® ring sleeve gastrectomy procedures were performed by the same surgical team using the same anesthetic technique. The patients were monitored for at least 12 months after surgery. RESULTS The mean weight of the patients decreased from 107.69 ± 6.57 kg to 70.52 ± 9.36 kg (p < 0.001), the mean BMI decreased to 27.4 ± 2.42 kg/m2 (p < 0.001), and the mean waist circumference decreased to 89.87 cm ± 6.66 (p < 0.001) in the postoperative period. Excess BMI loss was 86.5 ± 14.2%. Fasting glucose levels were reduced to 80.94 ± 6.3 mg/dl (p < 0.001). Remission of diabetes and glucose intolerance was observed in all patients. CONCLUSION Silastic® ring sleeve gastrectomy was effective in promoting weight loss, waist circumference reduction and control of glucose homeostasis in morbidly obese patients. PMID:19936183

  1. The Multiply Handicapped Child.

    ERIC Educational Resources Information Center

    Wolf, James M., Ed.; Anderson, Robert M., Ed.

    Articles presented in the area of the medical and educational challenge of the multiply handicapped child are an overview of the problem, the increasing challenge, congenital malformations, children whose mothers had rubella, prematurity and deafness, the epidemiology of reproductive casualty, and new education for old problems. Discussions of…

  2. Omega, the final multiplier

    NASA Astrophysics Data System (ADS)

    Buckley, T. N.

    2008-12-01

    The application of optimisation theory to vegetation processes has rarely extended beyond the context of diurnal to intra-annual gas exchange of individual leaves and crowns. One reason is that the Lagrange multipliers in the leaf-scale solutions, which are marginal products for allocatable photosynthetic resource inputs (water and nitrogen), are mysterious in origin, and their numerical values are difficult to measure -- let alone to predict or interpret in concrete physiological or ecological terms. These difficulties disappear, however, when the optimisation paradigm itself is extended to encompass carbon allocation and growth at the lifespan scale. The trajectories of leaf (and canopy) level marginal products are then implicit in the trajectory of plant and stand structure predicted by optimal carbon allocation. Furthermore, because the input and product are the same resource -- carbon -- in the whole plant optimisation, the product in one time step defines the input constraint, and hence implicitly the marginal product for carbon, in the next time step. This effectively converts the problem from a constrained optimisation of a definite integral, in which the multipliers are undetermined, to an unconstrained maximisation of a state, in which the multipliers are all implicit. This talk will explore how the marginal products for photosynthetic inputs as well as the marginal product for carbon -- i.e., the 'final multiplier,' omega -- are predicted to vary over time and in relation to environmental change during tree growth.

  3. Comparing propensity score methods for creating comparable cohorts of chiropractic users and non-users in older, multiply comorbid Medicare patients with chronic low back pain

    PubMed Central

    Weeks, William B; Tosteson, Tor D; Whedon, James M; Leininger, Brent; Lurie, Jon D; Swenson, Rand; Goertz, Christine M; O’Malley, Alistair J

    2015-01-01

    Objective Patients who use complementary and integrative health services like chiropractic manipulative treatment (CMT) often have different characteristics than patients who do not, and these differences can confound attempts to compare outcomes across treatment groups, particularly in observational studies when selection bias may occur. The purposes of this study were to provide an overview on how propensity scoring methods can be used address selection bias by balancing treatment groups on key variables and to use Medicare data to compare different methods for doing so. Methods We described 2 propensity score methods (matching and weighting). Then we used Medicare data from 2006-2012 on older, multiply comorbid patients who had a chronic low back pain episode to demonstrate the impact of applying methods on the balance of demographics of patients between 2 treatment groups (those who received only CMT and those who received no CMT during their episodes). Results Before application of propensity score methods, patients who used only CMT had different characteristics from those who did not. Propensity score matching diminished observed differences across the treatment groups at the expense of reduced sample size. However, propensity score weighting achieved balance in patient characteristics between the groups and allowed us to keep the entire sample. Conclusions While propensity score matching and weighting have similar effects in terms of balancing covariates, weighting has the advantage of maintaining sample size, preserving external validity, and generalizing more naturally to comparisons of 3 or more treatment groups. Researchers should carefully consider which propensity score method to use, as using different methods can generate different results. PMID:26547763

  4. Comparison between laparoscopic paraesophageal hernia repair with sleeve gastrectomy and paraesophageal hernia repair alone in morbidly obese patients.

    PubMed

    Merchant, Aziz M; Cook, Michael W; Srinivasan, Jahnavi; Davis, S Scott; Sweeney, John F; Lin, Edward

    2009-07-01

    Treatment options for morbidly obese patients with complications from large paraesophageal hernias (PEH) are limited. Simple repair of the PEH has a high recurrence rate and may be associated with poor gastric function. We compared a series of patients who underwent repair of large PEH plus gastrostomy tube gastropexy (PEH-GT) with PEH plus sleeve gastrectomy (PEH-SG). Retrospective review of patients undergoing PEH-SG and patients with PEH-GT was performed. We assessed symptoms of delayed gastric emptying and reflux postoperatively. In selected patients, gastric-emptying studies and upper gastrointestinal contrast studies were also obtained. All patients with large PEH were repaired laparoscopically with sac resection, primary crural closure using pledgeted sutures, and biologic patch onlay. SG for patients undergoing concomitant weight loss surgery (PEH-SG) was performed with linear endoscopic staplers and staple line reinforcement. Patients undergoing PEH repair alone had a gastrostomy tube gastropexy (PEH-GT). Patients had intraoperative endoscopic evaluation and postoperative contrast swallow studies. In a 12-month period, five patients underwent laparoscopic PEH-SG; two of five had previous antireflux surgery and one of five with a previous diagnosis of delayed gastric emptying. Postoperatively, two patients undergoing PEH-SG had readmission for dehydration and odynophagia. Six-month follow-up body mass index was 32 kg/m2 for the PEH-SG group with no hernia recurrence and complete resolution of gastroesophageal reflux disorder symptoms. Six patients underwent PEH-GT, one for acute incarceration and anemia and four with previous antireflux surgery. Follow up at 8 months demonstrated one recurrence, four of six had severe delayed gastric emptying and reflux, three of six had additional hospitalization for poor oral intake, and three of six underwent reoperation for delayed gastric emptying. There were no perforations, leaks, or deaths in either group. Combined

  5. High mortality and poor morbidity after hip fracture in patients with previous vertebral fractures.

    PubMed

    Ha, Yong-Chan; Baek, Ji-Hoon; Ko, Young-Bong; Park, Sang-Min; Song, Sang-Heon

    2015-09-01

    Although vertebral fracture in patients is a predictor of subsequent hip fracture, no study has assessed the mortality and functional outcome in hip fracture patients with previous vertebral fracture. Between September 2009 and December 2012, we evaluated 246 patients over 50-years-of-age diagnosed with femoral neck or intertrochanteric fractures who underwent surgery. The patients were categorized into two groups and two subgroups. Group Ia comprised 150 patients with previous vertebral fracture at the time of hip fracture. Group Ib comprised 96 patients with no vertebral fracture. Group IIa consisted of 76 patients <80-years-of-age with previous vertebral fracture. Group IIb comprised 69 patients <80-years-of-age without previous vertebral fracture. The mortality rate and functional outcome of osteoporotic hip fracture patients with and without vertebral fractures were compared. The cumulative mortality rate at 6 and 12 months post-fracture was 19 and 23 % in Group Ia and 6 and 7 % in Group Ib, respectively. In subgroup analysis, the cumulative mortality rate at 6 and 12 months was 13 and 17 % in Group IIa and 3 and 4 % in Group IIb, respectively. Shut-in patients at the final follow-up included 51 of 103 (49.5 %) patients in Group Ia and 19 of 83 (22.9 %) patients in Group Ib. In subgroup analysis, the shut-in patients included 18 of 58 (31.0 %) patients in Group IIa and 10 of 62 (16.1 %) patients in Group IIb. Previous vertebral fracture was associated with a poor functional outcome and increased mortality in patients with hip fracture.

  6. Impact of the immune reconstitution inflammatory syndrome (IRIS) on mortality and morbidity in HIV-infected patients in Mexico

    PubMed Central

    Hoyo-Ulloa, Irma; Belaunzarán-Zamudio, Pablo F.; Crabtree-Ramirez, Brenda; Galindo-Fraga, Arturo; Pérez-Aguinaga, María Eugenia; Sierra-Madero, Juan G.

    2013-01-01

    Summary Objectives To estimate the impact of immune reconstitution inflammatory syndrome (IRIS) on morbidity and mortality in patients starting highly-active antiretroviral therapy (HAART). Methods A retrospective cohort study of HIV-positive patients starting HAART was conducted at a tertiary care referral center in Mexico City. We estimated the incidence of IRIS, hospitalizations and death rates during the first 2 years of HAART. The relative risk of death (RR) and hospitalization for patients with IRIS were adjusted for relevant covariates using regression methods. Results During the 2-year follow-up period, 27% of patients developed IRIS (14 IRIS cases per 100 person-years). The relative risk of death among patients who developed IRIS was 3 times higher (95% confidence interval (CI) 1.19–7.65, p = 0.03). After adjusting for previous opportunistic infections we still observed a higher death rate among patients with IRIS (RR 2.3, 95% CI 0.9–5.9, p = 0.09). An effect modification of IRIS over mortality was observed by previous opportunistic infection. Conclusions IRIS-associated mortality is strongly confounded by previous opportunistic infection. Patients with AIDS who eventually developed IRIS had the highest risk of death at the 2-year follow-up. PMID:21493116

  7. Frequency of vascular and pregnancy morbidity in patients with low vs. moderate-to-high titers of antiphospholipid antibodies.

    PubMed

    Ofer-Shiber, Shachaf; Molad, Yair

    2015-04-01

    Antiphospholipid syndrome (APLS) is an autoimmune hypercoagulable syndrome characterized by thrombotic and obstetric manifestations. We sought to determine the rate of APLS feature in patients tested positive for antiphospholipid antibodies (APLA) regardless of the serum level of anticardiolipin (ACL) and/or anti-β2-glycoprotein I (β2GPI) antibodies. An inception cohort of individuals who were tested positive for ACL and/or β2GPI IgG/IgM antibody, and/or lupus anticoagulant (LAC) on two occasions of at least 12 weeks apart. A total of 243 patients were included; their mean age was 40.1 ± 15.9 years. Thrombotic vascular events occurred in 118 patients (48.5%) of the entire cohort, of which 62 patients (25.5%) suffered from an arterial event and 56 patients (23%) from thrombotic venous events. Obstetrical morbidity occurred in 106 female patients (43.6%). In our cohort, we found no difference in the frequency of thrombotic or obstetric manifestations of APLS between patients with ACL IgG/IgM of low serum antibody level (<40 U) and medium-to-high level (≥40 U) and/or anti-β2GPI IgG, IgM higher than the 99th percentile vs. lower (>20 U). We suggest that in 'real life' the diagnosis of APLS should not be excluded because of low titer of APLA.

  8. Why Multiply by "g"?

    ERIC Educational Resources Information Center

    Nelson, Jane Bray

    2012-01-01

    As a new physics teacher, I was explaining how to find the weight of an object sitting on a table near the surface of the Earth. It bothered me when a student asked, "The object is not accelerating so why do you multiply the mass of the object by the acceleration due to gravity?" I answered something like, "That's true, but if the table were not…

  9. Outcomes of Bariatric Surgery in Morbidly Obese Patients with Multiple Sclerosis

    PubMed Central

    Jammoul, Adham; Aminian, Ali; Shimizu, Hideharu; Fisher, Carolyn J.; Schauer, Philip R.; Rae-Grant, Alexander; Brethauer, Stacy A.

    2017-01-01

    Obesity is common in patients with multiple sclerosis (MS); however, safety and efficacy of bariatric surgery in this population remain unclear. A database of 2,918 was retrospectively reviewed, yielding 22 (0.75%) severely obese patients with MS who underwent bariatric surgery. Sixteen surgical patients with complete follow-up data were matched to a nonsurgical control group of MS patients, based on age, BMI, MS subtype, and length of follow-up. MS relapse rates and trends in the timed twenty-five foot walk test (T25FW) were compared. In the surgical group (gastric bypass n = 19, sleeve gastrectomy n = 3), preoperative BMI was 46.5 ± 7.2 Kg/m2 and average excess weight was 60.4 kg. Follow-up data was collected at 59.0 ± 29.8 months. There were two major and four minor complications. Five patients required readmission and there were no mortalities. Percent excess weight loss was 75.5 ± 27.0%. In the 16 patients with follow-up data, patients who underwent bariatric surgery were significantly faster on the T25FW compared to the nonsurgical population. In conclusion, bariatric surgery is relatively safe and effective in achieving weight loss in patients with MS. In addition, surgery may help patients maintain ambulation. Findings support the need for further studies on bariatric surgery and disease-specific outcomes in this population. PMID:28299203

  10. Cardiac morbidity and mortality in deferoxamine- or deferiprone-treated patients with thalassemia major.

    PubMed

    Borgna-Pignatti, Caterina; Cappellini, Maria Domenica; De Stefano, Piero; Del Vecchio, Giovanni Carlo; Forni, Gian Luca; Gamberini, Maria Rita; Ghilardi, Roberta; Piga, Antonio; Romeo, Maria Antonietta; Zhao, Huaqing; Cnaan, Avital

    2006-05-01

    Deferoxamine (DFO) therapy has been associated with improved survival of thalassemia patients. However, cardiac disease remains the main cause of death in those patients. In 1995, the oral chelator deferiprone became available for clinical use. We compared the occurrence of cardiac disease in patients treated only with DFO and in those whose therapy was switched to deferiprone during the period of observation, from January 31, 1995, to December 31, 2003. All patients with thalassemia major treated in 7 Italian centers who were born between 1970 and 1993 and who had not experienced a cardiac event prior to January 1995 were included. DFO only was given to 359 patients, and 157 patients received deferiprone for part of the time. A total of 3,610 patient-years were observed on DFO and 750 on deferiprone. At baseline, the 2 groups were comparable for age and sex, while ferritin levels were significantly higher in patients switched to deferiprone. Fifty-two cardiac events, including 10 cardiac deaths, occurred during therapy with DFO. No cardiac events occurred during deferiprone therapy or within at least 18 months after the end of it. In the setting of a natural history study, deferiprone therapy was associated with significantly greater cardiac protection than deferoxamine in patients with thalassemia major.

  11. Alfentanil versus ketamine combined with propofol for sedation during upper gastrointestinal system endoscopy in morbidly obese patients

    PubMed Central

    Kılıc, Ertugrul; Demiriz, Barıs; Isıkay, Nurgül; Yıldırım, Abdullah E.; Can, Selman; Basmacı, Cem

    2016-01-01

    Objectives: To observe the effects of both propofol/alfentanil and propofol/ketamine on sedation during upper gastrointestinal system endoscopy in morbidly obese patients (UGSEMOP). Methods: In a prospective, double-blinded, randomized clinical study, 52 patients scheduled for UGSEMOP were assigned to either group A (n=26; 10 µg/kg intravenous [IV] alfentanil) or group K (n=26; 0.5 mg/kg IV ketamine). Each patient was administered 0.7 mg/kg propofol for induction. If it was needed, the patients were administered an additional dose of IV propofol. This study was performed in Sehitkamil State Hospital, Gaziantep, Turkey, between January 2014-2015. Total propofol consumption, time to achieve Modified Aldrete Scores (MAS) of 5 and 10 following the procedure, physician and patient satisfaction scores, and instances of side effects, such as bradycardia and hypotension were recorded. Results: Time to onset of sedation and duration of sedation were both significantly shorter in group A. Patients in group A also required less time to achieve an MAS of 5. Total propofol consumption was significantly lower in group A. Conclusion: Both propofol/alfentanil and propofol/ketamine combinations provided appropriate hypnosis and analgesia during UGSEMOP. However, propofol consumption was significantly higher using the propofol/ketamine combination. PMID:27761556

  12. The association between the use of urinary catheters and morbidity and mortality among elderly patients in nursing homes.

    PubMed

    Kunin, C M; Douthitt, S; Dancing, J; Anderson, J; Moeschberger, M

    1992-02-01

    To determine whether the use of urinary catheters in elderly patients in nursing homes has an independent effect on morbidity and mortality, the authors conducted a 1-year prospective study among 1,540 patients in a stratified random sample of nursing homes. Patient mortality was assessed at 1 year in relation to the presence or absence of a catheter at entry to the study, acquisition of a catheter, and the proportion of nursing home days spent catheterized during the study year. The independent association of catheter use with mortality was assessed by logistic regression analysis adjusted for age, activities of daily living, mental status, skin condition (decubitus ulcers), and 20 medical diagnoses. The effect of catheterization on hospitalization, use of systemic antimicrobial drugs, and mortality was also examined by matched pairs analysis. At entry, 10.5% of patients had catheters, and they tended to remain catheterized during most of the study year. An additional 10% were catheterized during the year. The following factors were found to have a significant independent association with mortality: urinary catheters, age, mental status or activities of daily living, cancer, cardiac disease, diabetes, and skin condition. There was a stepwise increase in mortality with duration of catheterization. Patients who were catheterized for 76% or more of their days in the nursing home were three times more likely to die within a year. The number of hospitalizations, duration of hospitalization, and use of antimicrobial drugs were all three times greater among catheterized patients.

  13. In-Hospital Morbidity and Mortality Following Total Joint Arthroplasty in Patients with Hemoglobinopathies.

    PubMed

    Enayatollahi, Mohammad Ali; Novack, Thomas A; Maltenfort, Mitchell G; Tabatabaee, Reza Mostafavi; Chen, Antonia F; Parvizi, Javad

    2015-08-01

    Given the growing patient population with hemoglobinopathies needing total joint arthroplasty (TJA) and paucity of literature addressing this cohort, we examined the in-hospital complications in patients with hemoglobinopathies undergoing TJA. International Classification of Diseases, Ninth Revision codes were used to search the Nationwide Inpatient Sample database for hemoglobinopathy patients undergoing primary or revision TJA. Hemoglobinopathy patients had a significant increase in cardiac, respiratory, and wound complications; blood product transfusion; pulmonary embolism; surgical site infection; and systemic infection events, while there was no significant effect on deaths, deep vein thrombosis, and renal complications. It may be prudent to implement blood conservation strategies as well as diligent postoperative protocols to minimize the need for transfusion and related complications in this patient population.

  14. Increased morbidity associated with chronic infection by an epidemic Pseudomonas aeruginosa strain in CF patients

    PubMed Central

    Al-Aloul, M; Crawley, J; Winstanley, C; Hart, C; Ledson, M; Walshaw, M

    2004-01-01

    Background: Chronic pulmonary infection with transmissible Pseudomonas aeruginosa strains in individuals with cystic fibrosis (CF) has been reported, raising issues of cross infection and patient segregation. The first such strain to be described (the Liverpool epidemic strain, LES) is now widespread in many UK CF centres. However, whether such infection carries a worse prognosis is unknown. To address this, the clinical course of a group of CF patients chronically infected by LES was compared with that in patients harbouring unique strains. Methods: Using P aeruginosa strain genotyping, two cohorts of CF patients attending the Liverpool CF service were identified who were LES positive or negative in 1998 and remained so until 2002. From these, two groups of 12 patients were matched in 1998 for age, spirometric parameters, and nutritional state and their clinical course was followed for 5 years. Patients chronically infected with Burkholderia cepacia were excluded. Results: Patients chronically infected with LES had a greater annual loss of lung function than those not chronically infected by LES (mean difference between groups -4.4% (95% CI -8.1 to -0.9; p<0.02)), and by 2002 their percentage predicted forced expiratory volume in 1 second (FEV1) was worse (mean 65.0% v 82.6%, p<0.03). Their nutritional state also deteriorated over the study period (mean difference between groups in body mass index -0.7 (95% CI -1.2 to -0.2; p<0.01)), such that by 2002 they were malnourished compared with LES negative patients (mean BMI 19.4 v 22.7, p<0.02). Conclusions: Chronic infection with the Liverpool epidemic P aeruginosa strain in CF patients confers a worse prognosis than infection with unique strains alone, confirming the need for patient segregation. Since this strain is common in many CF units, strain identification in all CF centres is essential. This can only be carried out using genomic typing methods. PMID:15047956

  15. Long-term androgen deprivation increases Grade 2 and higher late morbidity in prostate cancer patients treated with three-dimensional conformal radiation therapy

    SciTech Connect

    Feigenberg, Steven J. . E-mail: S_Feigenberg@fccc.edu; Hanlon, Alexandra L.; Horwitz, Eric M.; Uzzo, Robert G.; Eisenberg, Debra; Pollack, Alan

    2005-06-01

    Purpose: To determine whether the use of androgen deprivation (AD) increases late morbidity when combined with high-dose three-dimensional conformal radiation therapy (3D-CRT). Methods and materials: Between May 1989 and November 1998, 1,204 patients were treated for prostate cancer with 3D-CRT to a median dose of 74 Gy. Patients were evaluated every 3-6 months. No AD was given to 945 patients, whereas 140 and 119 patients, respectively, received short-term AD (STAD; {<=}6 months) and long-term AD (LTAD; > 6 months). Radiation morbidity was graded according to the Fox Chase modification of the Late Effects Normal Tissue Task Force late morbidity scale. Covariates in the multivariate analysis (MVA) included age, history of diabetes mellitus, prostate-specific antigen (PSA) level, Gleason score, T category, RT field size, total RT dose, use of rectal shielding, and AD status (no AD vs. STAD vs. LTAD). Results: The only independent predictor for Grade 2 or higher genitourinary (GU) morbidity in the MVA was the use of AD (p = 0.0065). The 5-year risk of Grade 2 or higher GU morbidity was 8% for no AD, 8% for STAD, and 14% for LTAD (p = 0.02). Independent predictors of Grade 2 or higher gastrointestinal (GI) morbidity in the MVA were the use of AD (p = 0.0079), higher total radiation dose (p < 0.0001), the lack of a rectal shield (p = 0.0003), and older age (p = 0.0009). The 5-year actuarial risk of Grade 2 or higher GI morbidity was 17% for no AD vs. 18% for STAD and 26% for LTAD (p = 0.017). Conclusions: The use of LTAD seems to significantly increase the risk of both GU and GI morbidity for patients treated with 3D-CRT.

  16. Relevance of Adipose Tissue Stiffness Evaluated by Transient Elastography (AdipoScan™) in Morbidly Obese Patients before Bariatric Surgery

    NASA Astrophysics Data System (ADS)

    Sasso, Magali; Abdennour, Meriem; Liu, Yuejun; Hazrak, Hecham; Aron-Wisnewsky, Judith; Bouillot, Jean-Luc; Le Naour, Gilles; Bedossa, Pierre; Torjman, Joan; Clément, Karine; Miette, Véronique

    Subcutaneous adipose tissue (scAT) in human obesity undergoes severe alteration such as fibrosis which is related to metabolic alterations and to less efficiency in losing weight after bariatric surgery. There is currently no non-invasive tool to assess fibrosis in scAT. Vibration Controlled Transient Elastography (VCTE) using FibroScan® is widely used to assess liver fibrosis in clinical practice. A novel device named AdipoScan™ which is based on VCTE has been developed by Echosens (Paris) so as to assess scAT. The objective of this study is to show the first AdipoScan clinical results. AdipoScan™ was assessed in vivo on 73 morbidly obese patients candidate for bariatric surgery who were enrolled in the Pitié Salpêtrière hospital. scAT shear wave speed measured by AdipoScan™ is significantly associated with scAT fibrosis, gender, hypertension status, total body fat mass assessed by DXA, hypertension status, glycemic, lipid, hepatic parameters and adiponectin. Results suggest that scAT evaluation before bariatric surgery can be useful in clinical practice since it is related to scAT fibrosis -who plays in role in weight loss resistance after bariatric surgery- and to obesity induced co-morbidities such as diabetes, hypertension liver dysfunction.

  17. Febrile morbidity and hospital stay in high-risk cesarian section patients at a non-teaching hospital.

    PubMed

    Persad

    1998-07-01

    Objective: The objective of the study was to determine the incidence of postcesarian febrile morbidity and relate this to hospital stay in a high-risk indigent population treated at a private non-teaching hospital.Methods: This was a retrospective chart review of all patients done between January 1995 and December 1996. Discharge summaries, antepartums, progress notes, and labs were reviewed for each patient. Of 257 charts reviewed, 5 were inadequate for various reasons. Board-certified surgeons performed and assisted in the operations. Twenty-one patients had scant prenatal care and 6 had no prenatal care. All patients had the abdomen scrubbed with Betadine soap prior to painting. No shaving was done. Gloves were changed after closure of uterine incision. The pelvis was copiously irrigated with 3-4 L of saline. The subcutaneous layer was irrigated from a height of 6-12" with 12 to 1 L of fluid. After this step, this layer is not touched by anything from the operating field.Results: Of 162 patients with primary cesarian, 20 had postoperative fever, 18 with endometritis, 2 with wound infections. All but 5 of these patients had labor as ruptured membranes of 12 hours or more. Four had prolonged 2nd stage. Of 28 failed VBACs, 2 had fever vs none for 59 elective repeat cesarians. The average hospital stay for febrile patients was 4.4 days vs 2.7 for afebrile patients. The incidence of wound infection was 0.8%. The incidence of fever was 12.2% for primary cesarians and 8.8% in the total study group of 249 patients.Conclusion: This study demonstrates that the adoption of simple measures presented in Methods can dramatically decrease the incidence and severity of postcesarian fever, especially wound infection, thereby allowing safe, early hospital discharge.

  18. Indication of pre-surgical radiochemotherapy enhances psychosocial morbidity among patients with resectable locally advanced rectal cancer.

    PubMed

    Bencova, V; Krajcovicova, I; Svec, J

    2016-01-01

    Patients with cancer experience stress-determined psychosocial comorbidities and behavioural alterations. Patients expectation to be cured by the first line surgery and their emotional status can be negatively influenced by the decision to include neoadjuvant long-course radiotherapy prior to surgical intervention. From the patient's perspective such treatment algorithmindicates incurability of the disease. The aim of this study was to analyse the extent and dynamics of stress and related psychosocial disturbances among patients with resectable rectal cancer to whom the neoadjuvant radiochemotherapy before surgery has been indicated.Three standardised assessment tools evaluating psychosocial morbidity of rectal cancer patients have been implemented: The EORTC QLQ C30-3, the EORTC QLQ CR29 module and the HADS questionnaires previously tested for internal consistency were answered by patients before and after long-course radiotherapy and after surgery and the scores of clinical and psychosocial values were evaluated by means of the EORTC and HADS manuals. The most profound psychosocial distress was experienced by patients after the decision to apply neoadjuvant radiotherapy and concomitant chemotherapy before surgical intervention. The involvement of pre-surgical radiotherapy into the treatment algorithm increased emotional disturbances (anxiety, feelings of hopelessness) and negatively influenced patient's treatment adherence and positive expectations from the healing process. The negative psychosocial consequences appeared to be more enhanced in female patients. Despite provided information about advances of neoadjuvant radiotherapy onto success of surgical intervention, the emotional and cognitive disorders improved only slightly. The results clearly indicate that addressed communication and targeted psychosocial support has to find place before pre-surgical radiochemotherapy and as a standard part through the trajectory of the entire multimodal rectal cancer

  19. A population-level analysis of abdominal wall reconstruction by component separation in the morbidly obese patient: can it be performed safely?

    PubMed

    Nelson, Jonas A; Fischer, John P; Wink, Jason D; Kovach, Stephen J

    2014-10-01

    Morbid obesity is increasing at an alarming rate and a significant portion of patients presenting for complex abdominal wall reconstruction (AWR) and component separation fall into this category, creating added medical and surgical challenges to an already difficult operation. The goal of this study was to utilise the Nationwide 2005-2010 American College of Surgeons National Surgical Quality Improvement database (ACS-NSQIP) to perform a population level analysis of the role of morbid obesity on 30-day perioperative morbidity with the hope of improving patient care, counselling and risk stratification. Morbidly obese patients (BMI > 40 kg/m(2)) were compared to non-obese patients (BMI < 30 kg/m(2)). Outcome variables assessed included major surgical complications, major medical complications, major renal complications, major wound complications, return to OR (ROR), and venous thromboembolism (VTE). Significant variables in a univariate analysis were included in a multivariate logistic regression controlling for patient characteristics (p < 0.05). In total, 1695 patients undergoing AWR were identified in the ACS-NSQIP database. Of these, 614 patients were non-obese (average BMI = 25.7 ± 3.0 kg/m(2)) and 314 were morbidly obese (average BMI = 45.9 ± 5.8 kg/m(2)). Multivariate analyses determined that morbid obesity did not significantly contribute to major surgical, medical, renal or wound complications. However, it was significantly associated with ROR (OR = 2.8, p < 0.001) and VTE (OR = 5.2, p = 0.04). Morbid obesity is an independent risk factor for ROR and VTE related complications, in the 30 day post-operative period. Additional perioperative care is warranted to decrease such early re-operations and for preventable complications.

  20. Does neoadjuvant chemotherapy affect morbidity, mortality, reoperations, or readmissions in patients undergoing lumpectomy or mastectomy for breast cancer?

    PubMed Central

    Bennie, Barbara; Bray, Mallory S.; Vang, Choua A.; Linebarger, Jared H.

    2017-01-01

    Background The influence of neoadjuvant chemotherapy (NAC) prior to breast cancer surgery on postoperative complications is unclear. Our objective was to determine whether NAC was associated with postoperative outcomes in patients undergoing lumpectomy or mastectomy without reconstruction. Methods Patients meeting inclusion criteria were identified from the National Surgical Quality Improvement Program (NSQIP) database participant user files from 2005 through 2012, after which NSQIP discontinued the NAC variable. Primary outcome measures included a composite measure of morbidity and mortality (M&M) and reoperations and readmissions within 30 days of the index procedure. Rates of postoperative complications stratified by receipt of NAC were compared by χ2. A logistic regression model was then built that included confounding factors for M&M. Results There were 30,309 patients meeting inclusion criteria. NAC was not associated with any postoperative outcomes from 2005 through 2012, but it was associated with higher M&M in lumpectomy patients during 2011 to 2012 [P=0.011, odds ratio (OR) 2.579; 95% confidence interval (CI), 1.239–5.368]. Conclusions The finding that NAC was associated with higher M&M in lumpectomy patients during 2011 to 2012 warrants further investigation. Therefore, we recommend that the NSQIP database reinstitute the NAC variable to allow monitoring during anticipated changes in chemotherapy agents and protocols. PMID:28210548

  1. Lipogenic potential of liver from morbidly obese patients with and without non-insulin-dependent diabetes

    SciTech Connect

    Barakat, H.A.; McLendon, V.D.; Carpenter, J.W.; Marks, R.H.; Legett, N.; O'Brien, K.; Caro, J.F. )

    1991-03-01

    Intra-abdominal liver biopsies were obtained during surgery from fasted obese patients with non-insulin-dependent diabetes mellitus (NIDDM), obese normoglycemic controls, and lean controls. Lipid synthesis was studied in freshly isolated hepatocytes and liver homogenates from the three groups of subjects. Incorporation of 3H2O into the lipids of hepatocytes was determined in the absence and presence of insulin (0.1 mumol/L). The activities of five enzymes involved in fatty acid synthesis, and the incorporation of 14C-glycerol-3-phosphate into lipids were determined in liver homogenates. Basal lipid synthesis by hepatocytes was not different in the three groups of patients. Insulin stimulated lipogenesis by 8% +/- 30% in the lean controls, 33% +/- 8% in the obese controls and 17% +/- 6% in the NIDDM patients. No significant differences in the activities of the five enzymes that are involved in de novo fatty acid synthesis among the three groups of patients were observed. Similarly, incorporation of 14C-glycerol-3-phosphate by liver homogenates, in the presence of saturating or submaximal concentrations of fatty acids, did not differ among the three groups. These results show that under the experimental conditions of this study, including the fasted state of the patients, the basal capacity of liver of NIDDM patients to synthesize fatty acids or glycerides is the same as that of liver from obese and lean controls. Thus, it is likely that an increase in fatty acid flux into a liver with normal lipogenic potential may contribute to the increased synthesis of triglycerides by the liver of these patients in vivo.

  2. [Psychological morbidity in spouses of laryngectomized cancer patients: factors related to the probability of its occurrence].

    PubMed

    Meyer, Alexandra; Wollbrück, Dorit; Dietz, Andreas; Brähler, Elmar; Guntinas-Lichius, Orlando; Vogel, Hans-Joachim; Meister, Eberhard F; Körner, Annett; Singer, Susanne

    2012-05-01

    In a multicenter cross-sectional study of 106 spouses of laryngectomized patients differences between spouses with a mental disorder and spouses without were analyzed. The probability of occurrence was mainly related to relationship factors: Spouses, who reported a better quality of their relationship with the patient (OR=0.77; 95% CI: 0.631-0.939; p=0.010), whose sexual desire was not diminished in response to their partner's disease (OR=0.077; 95% CI: 0.011-0.527; p=0.009) and who had no problems in dealing with the tracheostomy (OR=0.062; 95% CI: 0.006-0.619; p=0.018) presented a mental disorder less frequently. The cross-sectional nature of this study does not allow conclusions regarding causality. The results should be reappraised in a longitudinal study. However, the findings suggest that patients with laryngectomy and their families should be also offered couple interventions besides individual counseling.

  3. Preoperative nutritional status of patients undergoing Roux-en-Y gastric bypass for morbid obesity.

    PubMed

    Flancbaum, Louis; Belsley, Scott; Drake, Victoria; Colarusso, Toni; Tayler, Ezekiel

    2006-01-01

    Few data exist concerning preoperative nutritional status in patients undergoing bariatric surgery. We retrospectively analyzed the preoperative values of serum albumin, calcium, 25-OH vitamin D, iron, ferritin, hemoglobin, vitamin B12, and thiamine in 379 consecutive patients (320 women and 59 men; mean body mass index 51.8 +/- 10.6 kg/m2; 25.8% white, 28.4% African American, 45.8% Hispanic) undergoing bariatric surgery between 2002 and 2004. Preoperative deficiencies were noted for iron (43.9%), ferritin (8.4%), hemoglobin (22%; women 19.1%, men 40.7%), thiamine (29%), and 25-OH vitamin D (68.1%). Low ferritin levels were more prevalent in females (9.9% vs. 0%; P = 0.01); however, anemia was more prevalent in males (19.1% vs. 40.7%; P < 0.005). Patients younger than 25 years were more likely to be anemic than patients over 60 years (46% vs. 15%; P < 0.005). This correlated with iron deficiency, which was more prevalent in younger patients (79.2% vs. 41.7%; P < 0.005). Whites (78.8%) and African Americans (70.4%) had a higher prevalence of vitamin D deficiency than Hispanics (56.4%), P = 0.01. Whites were the least likely group to be thiamine deficient (6.8% vs 31.0% African Americans and 47.2% Hispanics; P < 0.005). Nutritional deficiencies are common in patients undergoing Roux-en-Y gastric bypass, and these deficiencies should be detected and corrected early to avoid postoperative complications.

  4. Differential expression of monocyte surface markers among TB patients with diabetes co-morbidity

    PubMed Central

    Stew, Samuel S.; Martinez, Perla J.; Schlesinger, Larry S.; Restrepo, Blanca I.

    2014-01-01

    The expression of monocyte surface markers was compared between tuberculosis patients with and without type 2 diabetes (DM2). DM2 was associated with increased CCR2 expression, which may restrain monocyte traffic to the lung. Other host factors associated with baseline monocyte changes were older age (associated with lower CD11b) and obesity (associated with higher RAGE). Given that DM2 patients are more likely to be older and obese, their monocytes are predicted to be altered in function in ways that affect their interaction with Mycobacterium tuberculosis. PMID:24388654

  5. Insulin resistance is associated with elevated serum pigment epithelium-derived factor (PEDF) levels in morbidly obese patients.

    PubMed

    Gattu, Arijeet K; Birkenfeld, Andreas L; Jornayvaz, Francois; Dziura, James; Li, Fangyong; Crawford, Susan E; Chu, Xin; Still, Christopher D; Gerhard, Glenn S; Chung, Chuhan; Samuel, Varman

    2012-12-01

    Obesity is a significant risk factor for developing diabetes. Pigment epithelium-derived factor (PEDF) has been identified by experimental and clinical studies as both a causative and counter-regulatory factor in the metabolic syndrome. We set out to determine whether serum PEDF levels correlated with the degree of insulin resistance in morbidly obese patients. Sera from 53 patients who were evaluated prior to gastric bypass surgery were analyzed for PEDF levels using a commercial ELISA. None of the patients were on diabetes medications prior to enrollment. Baseline data included BMI, serum glucose and insulin, and homeostasis model assessment (HOMA) scores. Patients were stratified based on HOMA score and glucose levels into three groups: insulin sensitive (IS): HOMA <2 and glucose <126; insulin resistant (IR): HOMA >2 and glucose ≤126; and diabetes mellitus (DM): HOMA >2 and glucose >126. Pre- and post-gastric bypass sera from 12 patients were obtained for serial assessment of metabolic parameters and PEDF levels. PEDF secretion was assessed in primary human hepatocytes, HCC cells, and cultured adipocytes in the absence and presence of high glucose media. No significant differences in age, gender, and BMI were found among the three groups. PEDF levels were similar between IR patients and the other groups, but were significantly higher in DM compared to IS patients (p = 0.01). Serum PEDF in individual patients declined significantly after gastric bypass (p = 0.006). High glucose media led to significantly higher PEDF release by human hepatocytes in vitro (p = 0.016). These data demonstrate that serum PEDF concentrations better relate to insulin resistance than to adiposity and suggest that PEDF expression is closely linked to the development of insulin resistance.

  6. The Finnish Cardiovascular Study (FINCAVAS): characterising patients with high risk of cardiovascular morbidity and mortality

    PubMed Central

    Nieminen, Tuomo; Lehtinen, Rami; Viik, Jari; Lehtimäki, Terho; Niemelä, Kari; Nikus, Kjell; Niemi, Mari; Kallio, Janne; Kööbi, Tiit; Turjanmaa, Väinö; Kähönen, Mika

    2006-01-01

    Background The purpose of the Finnish Cardiovascular Study (FINCAVAS) is to construct a risk profile – using genetic, haemodynamic and electrocardiographic (ECG) markers – of individuals at high risk of cardiovascular diseases, events and deaths. Methods and design All patients scheduled for an exercise stress test at Tampere University Hospital and willing to participate have been and will be recruited between October 2001 and December 2007. The final number of participants is estimated to reach 5,000. Technically successful data on exercise tests using a bicycle ergometer have been collected of 2,212 patients (1,400 men and 812 women) by the end of 2004. In addition to repeated measurement of heart rate and blood pressure, digital high-resolution ECG at 500 Hz is recorded continuously during the entire exercise test, including the resting and recovery phases. About 20% of the patients are examined with coronary angiography. Genetic variations known or suspected to alter cardiovascular function or pathophysiology are analysed to elucidate the effects and interactions of these candidate genes, exercise and commonly used cardiovascular medications. Discussion FINCAVAS compiles an extensive set of data on patient history, genetic variation, cardiovascular parameters, ECG markers as well as follow-up data on clinical events, hospitalisations and deaths. The data enables the development of new diagnostic and prognostic tools as well as assessments of the importance of existing markers. PMID:16515696

  7. Early mortality and morbidity after total hip arthroplasty in patients with femoral neck fracture

    PubMed Central

    Hailer, Nils P; Garland, Anne; Rogmark, Cecilia; Garellick, Göran; Kärrholm, Johan

    2016-01-01

    Background and purpose — Early postoperative mortality is relatively high after total hip arthroplasty (THA) that has been performed due to femoral neck fracture. However, this has rarely been investigated after adjustment for medical comorbidity and comparison with the mortality in an age-matched population. We therefore assessed early mortality in hip fracture patients treated with a THA, in the setting of a nationwide matched cohort study. Patients and methods — 24,699 patients who underwent THA due to a femoral neck fracture between 1992 and 2012 were matched with 118,518 controls. Kaplan-Meier survival analysis was used to calculate cumulative unadjusted survival, and Cox regression models were fitted to compute hazard ratios (HRs) and 95% confidence intervals (CIs), with adjustment for age, sex, comorbidity, and socioeconomic background. Results — 90-day survival was 96.3% (95% CI: 96.0–96.5) for THA cases and 98.7% (95% CI: 98.6–98.8) for control individuals, giving an adjusted HR of 2.2 (95% CI: 2.0–2.4) for THA cases compared to control individuals. Comorbidity burden increased in THA cases over time, but the adjusted risk of death within 90 days did not differ statistically significantly between the time periods investigated (1992–1998, 1999–2005, and 2006–2012). A Charlson comorbidity index of 3 or more, an American Society of Anesthesiologists (ASA) grade of 3 and above, male sex, an age of 80 years and above, an income below the first quartile, and a lower level of education were all associated with an increased risk of 90-day mortality. Interpretation — The adjusted early mortality in femoral neck fracture patients who underwent THA was about double that in a matched control population. Patients with femoral neck fracture but with no substantial comorbidity and an age of less than 80 years appear to have a low risk of early death. Patients older than 80 years and those with a Charlson comorbidity index of more than 2 have a high

  8. Psychiatric morbidity of overseas patients in inner London: A hospital based study

    PubMed Central

    Carranza, Fredy J; Parshall, Alice M

    2005-01-01

    Background Evaluation of the referral, admission, treatment, and outcome of overseas patients admitted to a psychiatric hospital in central London. Ethical, legal and economic implications, and the involvement of consulates in the admission process, are discussed. Method Assessment and review of overseas patients admitted between 1 January 1999 and 31 December 1999. Non-parametric statistical tests were used, and relevant outcomes described. Results 19% of admissions were overseas patients. Mean age was 38 years. 90% were unattached; 84% were white, 71% from European countries. 45% spoke fluent English. Differences in socio-economic status between home country and England were found. 74% were unwell on arrival; 65% travelled to England as tourists. 65% of admissions came via the police. 32% had been ill for more than one year before admission; 68% had psychiatric history. 77% were admitted and 48% discharged under section of the Mental Health Act. 74% had psychotic disorders, all of them with positive symptoms. 55% showed little to moderate improvement in mental state; 10% were on Enhanced Care Programme Approach. Relatives of 48% of patients were contacted. The Hospital repatriated 52% of patients; the Mental Health Team followed up 13% of those discharged. The average length of admission was 43.4 days (range 1–365). Total cost of admissions was GBP350, 600 ($577, 490); average individual cost was GBP11, 116 (range GBP200-81, 000). Conclusions Mentally ill overseas individuals are a vulnerable group that need recognition by health organisations to adapt current practice to better serve their needs. The involvement of consulates needs further evaluation. PMID:15845140

  9. Bilayered negative-pressure wound therapy preventing leg incision morbidity in coronary artery bypass graft patients

    PubMed Central

    Yu, Yongchao; Song, Zhigang; Xu, Zhiyun; Ye, Xiaofei; Xue, Chunyu; Li, Junhui; Bi, Hongda

    2017-01-01

    Abstract Backgrounds: The harvesting of great saphenous veins for coronary artery bypass graft (CABG) patients may result in significant complications, including lymphorrhagia, lymphoedema, incision infection, wound dehiscence, and skin flap necrosis. We investigated the function of a self-designed bilayered negative pressure wound therapy (b-NPWT) for reducing the above-mentioned complications using a clinical randomized controlled trial. Methods: A single-center, pilot randomized controlled trial was conducted. From December 2013 to March 2014, a total of 72 coronary heart disease patients (48 men and 24 women) received CABG therapy, with great saphenous veins were selected as grafts. Patients were equally randomized into a treatment and a control group. After the harvesting of the great saphenous veins and direct closure of the wound with sutures, b-NPWT was used for the thigh incision in the treatment group for 5 days (treatment thigh). Traditional surgical pads were applied to both the shank incisions of the treatment group patients (treatment shank) and the entire incisions of the control group (control thigh, control shank). Postoperative complications were recorded and statistically analyzed based on outcomes of thigh treatment, shank treatment, thigh control, and shank control groups. Results: The incidence rates of early complications, such as lymphorrhagia, lymphoedema, infection, wound dehiscence, and skin flap necrosis, of the vascular donor site in the thigh treatment group was significantly lower than those in the 3 other groups. Conclusions: The self-designed b-NPWT can effectively reduce postoperative complications, such as lymphedema, incision infection, wound dehiscence, and skin flap necrosis, in CABG patients who underwent great saphenous veins harvesting. Trial registration: ClinicalTrials.gov. The unique registration number is NCT02010996. PMID:28099357

  10. Perioperative morbidity and mortality of cardiothoracic surgery in patients with a do-not-resuscitate order

    PubMed Central

    Lobato, Robert L.; Cason, Molly B.; Wong, Jim K.

    2014-01-01

    Background. Do-not-resuscitate (DNR) orders are often active in patients with multiple comorbidities and a short natural life expectancy, but limited information exists as to how often these patients undergo high-risk operations and of the perioperative outcomes in this population. Methods. Using comprehensive inpatient administrative data from the Public Discharge Data file (years 2005 through 2010) of the California Office of Statewide Health Planning and Development, which includes a dedicated variable recording DNR status, we identified cohorts of DNR patients who underwent major cardiac or thoracic operations and compared themto age- and procedure-matched comparison cohorts. The primary study outcome was in-hospital mortality. Results. DNR status was not uncommon in cardiac (n = 2,678, 1.1% of all admissions for cardiac surgery, age 71.6 ± 15.9 years) and thoracic (n = 3,129, 3.7% of all admissions for thoracic surgery, age 73.8 ± 13.6 years) surgical patient populations. Relative to controls, patients who were DNR experienced significantly greater inhospital mortality after cardiac (37.5% vs. 11.2%, p < 0.0001 and thoracic (25.4% vs. 6.4%) operations. DNR status remained an independent predictor of in-hospital mortality onmultivariate analysis after adjustment for baseline and comorbid conditions in both the cardiac (OR 4.78, 95% confidence interval 4.21–5.41, p < 0.0001) and thoracic (OR 6.11, 95% confidence interval 5.37–6.94, p < 0.0001) cohorts. Conclusions. DNR status is associated with worse outcomes of cardiothoracic surgery even when controlling for age, race, insurance status, and serious comorbid disease. DNR status appears to be a marker of substantial perioperative risk, and may warrant substantial consideration when framing discussions of surgical risk and benefit, resource utilization, and biomedical ethics surrounding end-of-life care. PMID:24498575

  11. Interest, views and perceived barriers to bariatric surgery in patients with morbid obesity.

    PubMed

    Wharton, S; Serodio, K J; Kuk, J L; Sivapalan, N; Craik, A; Aarts, M-A

    2016-04-01

    The objective of the study was to assess the interest, views and patient-perceived barriers to bariatric surgery among surgery-eligible patients. Surveys were completed at a weight management clinic and local hospital in Ontario, Canada. Patients were ≥18 years of age with a body mass index (BMI) >40 kg m(-2) or BMI > 35 kg m(-2) with ≥1 comorbidity. The sample included 105 participants, 73.3% female, with a mean BMI of 46.6 ± 7.1 kg m(-2) . Only 33.3% of participants were interested in surgery; 50.5% of participants were not interested and 16.2% had mixed feelings. Participants identified risks (69.5%) and side effects (57.1%) as significant surgical barriers. Interested participants were more likely to perceive themselves as obese, were unhappy with their current weight loss method and were less likely to fear surgery (P < 0.05). The prevalence of comorbidities was not different by surgical interest (P = 0.17). Despite the effectiveness of bariatric surgery, the majority of qualified patients are not interested in surgery mainly due to the perceived risk of surgery in general and satisfaction with current non-surgical weight loss efforts. The self-perception of obesity, as opposed to medical comorbidities, may be a stronger driver of the decision to have bariatric surgery. It is unclear if patients are aware of the effectiveness of bariatric surgery to help improve comorbidities or if bariatric surgery is perceived as being more cosmetic in nature.

  12. Videoscope-Assisted Minimally Invasive Periodontal Surgery: One-Year Outcome and Patient Morbidity.

    PubMed

    Harrel, Stephen K; Abraham, Celeste M; Rivera-Hidalgo, Francisco; Shulman, Jay D; Nunn, Martha E

    2016-01-01

    The aim of this study was to report the 1-year clinical outcomes from videoscope-assisted minimally invasive surgery (V-MIS). A sample of 18 patients having sites with residual pocket probing depth (PPD) of at least 5 mm and 2 mm loss in clinical attachment level (CAL) following initial nonsurgical therapy were treated with V-MIS. At 12 months postsurgery, there was a statistically significant improvement (P < .001) in mean PPD (4.11 ± 0.98 mm) and CAL (4.58 ± 1.19 mm) in all surgical sites. A mean improvement in soft tissue height (0.48 ± 0.65 mm, P = .006) was also observed. In most cases, patients reported no postoperative discomfort. The improvements associated with V-MIS appear to be favorable when compared with previously reported results of periodontal regenerative surgery. The lack of postsurgical recession following V-MIS has not been reported with traditional regenerative surgery.

  13. Evaluating the Effects of an Interdisciplinary Practice Model with Pharmacist Collaboration on HIV Patient Co-Morbidities.

    PubMed

    Cope, Rebecca; Berkowitz, Leonard; Arcebido, Rebecca; Yeh, Jun-Yen; Trustman, Nathan; Cha, Agnes

    2015-08-01

    Treatment of HIV now occurs largely within the primary care setting, and the principal focus of most visits has become the management of chronic disease states. The clinical pharmacist's potential role in improving chronic disease outcomes for HIV patients is unknown. A retrospective cohort study was performed for HIV-positive patients also diagnosed with diabetes, hypertension, or hyperlipidemia. Characteristics and outcomes in 96 patients treated by an interdisciplinary team that included a clinical pharmacist (i.e., the intervention group) were compared to those in 50 patients treated by an individual healthcare provider (i.e., the control group). Primary outcomes were changes from baseline over 18 months of HbA1c, low density lipoprotein (LDL), and blood pressure, respectively. Secondary outcomes included number of drug-drug interactions, HIV viral load, CD4 count, percent change in smoking status, and percent of patients treated to cardiovascular guideline recommendations. The interdisciplinary team had a significant improvement in lipid management over the control group (LDL: -8.8 vs. +8.4 mg/dL; p=0.014), and the smoking cessation rate over the study period was doubled in the interdisciplinary group (20.4% vs. 11.8%). Among those with an indication for aspirin, a significantly higher percentage of patients were prescribed the medication in the interdisciplinary group compared to the control group (85.5% vs. 64.9%; p=0.014). An informal cost analysis estimated savings of more than $3000 per patient treated by the interdisciplinary team. Based on these results, pharmacist involvement in an HIV primary care clinic appears to lead to more appropriate management of chronic co-morbidities in a cost-effective manner.

  14. Multivariate Analysis Approach to the Serum Peptide Profile of Morbidly Obese Patients

    PubMed Central

    Agostini, M.; Bedin, C.; Enzo, M.V.; Molin, L.; Traldi, P.; D'Angelo, E.; Maschietto, E.; Serraglia, R.; Ragazzi, E.; Prevedello, L.; Foletto, M.; Nitti, D.

    2013-01-01

    Background: Obesity is currently epidemic in many countries worldwide and is strongly related to diabetes and cardiovascular disease. Mass spectrometry, in particular matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) is currently used for detecting different pattern of expressed protein. This study investigated the differences in low molecular weight (LMW) peptide profiles between obese and normal-weight subjects in combination with multivariate statistical analysis. Materials: Serum samples of 60 obese patients and 10 healthy subjects were treated by cut-off membrane (30000 Da) to remove the most abundant proteins. The filtrates containing the LMW protein/peptides were analyzed by MALDI-TOF mass spectrometry. Dataset was elaborated to align and normalize the spectra. We performed cluster analysis and principal component analysis to detect some ionic species that could characterize and classify the subject groups. Results: We observed a down-expression of ionic species at m/z 655.94 and an over-expression of species at m/z 1518.78, 1536.77, 1537.78 and 1537.81 in obese patients. Furthermore we found some ionic species that can distinguish obese patients with diabetes from those with normal glucose level. Conclusion: Serum peptide profile of LMW associate with multivariate statistical approach was revealed as a promising tool to discriminate and characterize obese patients and it was able to stratify them in relation to comorbidity that usually are associated with this disease. Further research involving a larger sample will be required to validate these findings. PMID:23396294

  15. Psychiatric Morbidity and Other Factors Affecting Treatment Adherence in Pulmonary Tuberculosis Patients

    PubMed Central

    Pachi, Argiro; Bratis, Dionisios; Moussas, Georgios; Tselebis, Athanasios

    2013-01-01

    As the overall prevalence of TB remains high among certain population groups, there is growing awareness of psychiatric comorbidity, especially depression and its role in the outcome of the disease. The paper attempts a holistic approach to the effects of psychiatric comorbidity to the natural history of tuberculosis. In order to investigate factors associated with medication nonadherence among patients suffering from tuberculosis, with emphasis on psychopathology as a major barrier to treatment adherence, we performed a systematic review of the literature on epidemiological data and past medical reviews from an historical perspective, followed by theoretical considerations upon the relationship between psychiatric disorders and tuberculosis. Studies reporting high prevalence rates of psychiatric comorbidity, especially depression, as well as specific psychological reactions and disease perceptions and reviews indicating psychiatric complications as adverse effects of anti-TB medication were included. In sum, data concerning factors affecting medication nonadherence among TB patients suggested that better management of comorbid conditions, especially depression, could improve the adherence rates, serving as a framework for the effective control of tuberculosis, but further studies are necessary to identify the optimal way to address such issues among these patients. PMID:23691305

  16. Monolithic THz Frequency Multipliers

    NASA Technical Reports Server (NTRS)

    Erickson, N. R.; Narayanan, G.; Grosslein, R. M.; Martin, S.; Mehdi, I.; Smith, P.; Coulomb, M.; DeMartinez, G.

    2001-01-01

    Frequency multipliers are required as local oscillator sources for frequencies up to 2.7 THz for FIRST and airborne applications. Multipliers at these frequencies have not previously been demonstrated, and the object of this work was to show whether such circuits are really practical. A practical circuit is one which not only performs as well as is required, but also can be replicated in a time that is feasible. As the frequency of circuits is increased, the difficulties in fabrication and assembly increase rapidly. Building all of the circuit on GaAs as a monolithic circuit is highly desirable to minimize the complexity of assembly, but at the highest frequencies, even a complete monolithic circuit is extremely small, and presents serious handling difficulty. This is compounded by the requirement for a very thin substrate. Assembly can become very difficult because of handling problems and critical placement. It is very desirable to make the chip big enough to that it can be seen without magnification, and strong enough that it may be picked up with tweezers. Machined blocks to house the chips present an additional challenge. Blocks with complex features are very expensive, and these also imply very critical assembly of the parts. It would be much better if the features in the block were as simple as possible and non-critical to the function of the chip. In particular, grounding and other electrical interfaces should be done in a manner that is highly reproducible.

  17. Cases of Psychiatric Morbidity in Pediatric Patients After Remission of Cushing Syndrome.

    PubMed

    Keil, Margaret F; Zametkin, Alan; Ryder, Celia; Lodish, Maya; Stratakis, Constantine A

    2016-04-01

    Endogenous Cushing syndrome (CS) may have different effects in children than what has been described in adults. Previous studies of children and adolescents with CS have identified cognitive decline despite reversal of brain atrophy after remission of CS. Although the observations of parents of children and adolescents with CS support personality changes, significant psychopathology has not been described in the literature. We report 9 children who underwent successful surgery (transsphenoidal surgery [TSS] or resection of bronchial carcinoid) for treatment of CS and subsequently developed significant affective pathology. Affective symptoms included anger-rage outbursts, suicidal ideation, irritability, anxiety, and depression. One child, who committed suicide 60 months after TSS, had recently discontinued antidepressant medication. She had a history of anxiety during active CS and was treated with an anxiolytic. The 7 patients with onset of symptoms within 7 months of TSS were on glucocorticoid replacement, and 1-year follow-up evaluation showed recovery of hypothalamic-pituitary-adrenal axis and biochemical evidence of remission. The 2 patients who presented with onset of symptoms at 48 months or later underwent endocrine evaluation that showed biochemical evidence of remission and normal anterior pituitary hormone levels. This is the first report of affective symptoms and behavioral dysregulation, including suicidal ideation, in a subgroup of children and adolescents after remission of CS. Health care providers caring for children with CS who have been cured should continue to screen for mental illness, monitor for changes in behavior, and refer as appropriate to mental health professionals.

  18. Cases of Psychiatric Morbidity in Pediatric Patients After Remission of Cushing Syndrome

    PubMed Central

    Zametkin, Alan; Ryder, Celia; Lodish, Maya; Stratakis, Constantine A.

    2016-01-01

    Endogenous Cushing syndrome (CS) may have different effects in children than what has been described in adults. Previous studies of children and adolescents with CS have identified cognitive decline despite reversal of brain atrophy after remission of CS. Although the observations of parents of children and adolescents with CS support personality changes, significant psychopathology has not been described in the literature. We report 9 children who underwent successful surgery (transsphenoidal surgery [TSS] or resection of bronchial carcinoid) for treatment of CS and subsequently developed significant affective pathology. Affective symptoms included anger–rage outbursts, suicidal ideation, irritability, anxiety, and depression. One child, who committed suicide 60 months after TSS, had recently discontinued antidepressant medication. She had a history of anxiety during active CS and was treated with an anxiolytic. The 7 patients with onset of symptoms within 7 months of TSS were on glucocorticoid replacement, and 1-year follow-up evaluation showed recovery of hypothalamic–pituitary–adrenal axis and biochemical evidence of remission. The 2 patients who presented with onset of symptoms at 48 months or later underwent endocrine evaluation that showed biochemical evidence of remission and normal anterior pituitary hormone levels. This is the first report of affective symptoms and behavioral dysregulation, including suicidal ideation, in a subgroup of children and adolescents after remission of CS. Health care providers caring for children with CS who have been cured should continue to screen for mental illness, monitor for changes in behavior, and refer as appropriate to mental health professionals. PMID:27025959

  19. Models predicting the risks of six life-threatening morbidities and bile leakage in 14,970 hepatectomy patients registered in the National Clinical Database of Japan

    PubMed Central

    Yokoo, Hideki; Miyata, Hiroaki; Konno, Hiroyuki; Taketomi, Akinobu; Kakisaka, Tatsuhiko; Hirahara, Norimichi; Wakabayashi, Go; Gotoh, Mitsukazu; Mori, Masaki

    2016-01-01

    Abstract To construct a robust morbidity risk-prediction model based on a Japanese nationwide web-based database of patients who underwent liver surgery. Although liver resection has become safer, patient mortality and morbidity still occur. This study investigated postoperative morbidity risks in patients who underwent hepatectomy in Japan at institutions registered in the National Clinical Database. This analysis involved 14,970 patients who underwent hepatectomy of more than 1 section, except for left lateral sectionectomy, during 2011 and 2012 at 1192 hospitals in Japan. Patients were randomized into 2 subsets, with 80% of patients analyzed for model development and the remaining 20% for model validation. Rates of 90-day inhospital mortality and overall morbidity were 3.7% and 25.7%, respectively. Rates of surgical site infection and bile leakage were 9.0% and 8.0%, respectively, but these morbidities showed little association with mortality. Rates of nonsurgical complications, including postoperative transfusion over 5 units, unexpected intubation, renal failure, cardiac events, septic shock, and postoperative pneumonia, ranged from 0.2% to 2.6%. These complications were highly associated with mortality, suggesting they were life-threatening. Risk models for morbidity yielded high C-indices for transfusion of over 5 units (0.758), unplanned intubation (0.755), renal failure (0.80), cardiac events (0.779), septic shock (0.783), pneumonia (0.768), and bile leakage (0.676). Preoperative parameters/comorbidities can accurately predict life-threatening complications after hepatectomy. These models allow early identification of patients at risk of mortality and may be useful in deciding on surgical interventions and in improving surgical quality. PMID:27930526

  20. Effects of Smoking on Non-AIDS-Related Morbidity in HIV-Infected Patients

    PubMed Central

    Shirley, Daniel K.; Kaner, Robert J.; Glesby, Marshall J.

    2013-01-01

    Tobacco smoking has many adverse health consequences. Patients with human immunodeficiency virus (HIV) infection smoke at very high rates, and many of the comorbidities associated with smoking in the general population are more prevalent in this population. It is likely that a combination of higher smoking rates along with an altered response to cigarette smoke throughout the body in persons with HIV infection leads to increased rates of the known conditions related to smoking. Several AIDS-defining conditions associated with smoking have been reviewed elsewhere. This review aims to summarize the data on non-AIDS-related health consequences of smoking in the HIV-infected population and explore evidence for the potential compounding effects on chronic systemic inflammation due to HIV infection and smoking. PMID:23572487

  1. Changes in Albuminuria Predict Mortality and Morbidity in Patients with Vascular Disease

    PubMed Central

    Mann, Johannes F. E.; Schumacher, Helmut; Gao, Peggy; Mancia, Giuseppe; Weber, Michael A.; McQueen, Matthew; Koon, Teo; Yusuf, Salim

    2011-01-01

    The degree of albuminuria predicts cardiovascular and renal outcomes, but it is not known whether changes in albuminuria also predict similar outcomes. In two multicenter, multinational, prospective observational studies, a central laboratory measured albuminuria in 23,480 patients with vascular disease or high-risk diabetes. We quantified the association between a greater than or equal to twofold change in albuminuria in spot urine from baseline to 2 years and the incidence of cardiovascular and renal outcomes and all-cause mortality during the subsequent 32 months. A greater than or equal to twofold increase in albuminuria from baseline to 2 years, observed in 28%, associated with nearly 50% higher mortality (HR 1.48; 95% CI 1.32 to 1.66), and a greater than or equal to twofold decrease in albuminuria, observed in 21%, associated with 15% lower mortality (HR 0.85; 95% CI 0.74 to 0.98) compared with those with lesser changes in albuminuria, after adjustment for baseline albuminuria, BP, and other potential confounders. Increases in albuminuria also significantly associated with cardiovascular death, composite cardiovascular outcomes (cardiovascular death, myocardial infarction, stroke, and hospitalization for heart failure), and renal outcomes including dialysis or doubling of serum creatinine (adjusted HR 1.40; 95% CI 1.11 to 1.78). In conclusion, in patients with vascular disease, changes in albuminuria predict mortality and cardiovascular and renal outcomes, independent of baseline albuminuria. This suggests that monitoring albuminuria is a useful strategy to help predict cardiovascular risk. PMID:21719791

  2. Multiplier operator algebras and applications

    PubMed Central

    Blecher, David P.; Zarikian, Vrej

    2004-01-01

    The one-sided multipliers of an operator space X are a key to “latent operator algebraic structure” in X. We begin with a survey of these multipliers, together with several of the applications that they have had to operator algebras. We then describe several new results on one-sided multipliers, and new applications, mostly to one-sided M-ideals. PMID:14711990

  3. Morbid obese adults increased their sense of coherence 1 year after a patient education course: a longitudinal study

    PubMed Central

    Fagermoen, May Solveig; Hamilton, Glenys; Lerdal, Anners

    2015-01-01

    Background Personal factors are key elements to understand peoples’ health behavior. Studies of such factors are important to develop targeted interventions to improve health. The main purpose of this study is to explore sense of coherence (SOC) in a sample of persons with morbid obesity before and after attending a patient education course and to explore the association between SOC and sociodemographic and other personal factors. Methods In this longitudinal purposely sampled study, the participants completed questionnaires on the first day of the course and 12 months after course completion. Sixty-eight participants had valid scores on the selected variables at follow-up: SOC, self-esteem, and self-efficacy. Relationships were assessed with correlation analyses and paired and independent samples t-tests and predictors with linear regression analyses. Results From baseline to follow-up, the total SOC score and the subdimension scores comprehensibility, manageability, and meaningfulness all increased significantly. At both time points, the SOC scores were low compared to the general population but similar to scores in other chronically ill. At baseline, a multivariate analysis showed that older age, having paid work, and higher self-esteem were directly related to higher total SOC score after controlling for other sociodemographic factors and the participants’ level of self-efficacy. Multivariate analyses of the relationship between baseline predictors of SOC at 12-month follow-up, controlling for baseline SOC scores or sociodemographic or personal factors, revealed that none of these variables independently predicted SOC scores at follow-up. Conclusion The total SOC score and its subdimensions increased significantly at follow-up. SOC may be a useful outcome measure for lifestyle interventions in people with morbid obesity and possibly other health care problems. Subdimension scores may give an indication of what is poorly developed and needs strengthening

  4. Influence of Irradiated Lung Volumes on Perioperative Morbidity and Mortality in Patients After Neoadjuvant Radiochemotherapy for Esophageal Cancer

    SciTech Connect

    Daehn, Doreen; Martell, Joachim; Vorwerk, Hilke; Hess, Clemens F.; Becker, Heinz; Jung, Klaus; Hilgers, Reinhard; Wolff, Hendrik Andreas; Hermann, Robert Michael; Christiansen, Hans

    2010-05-01

    Purpose: In some randomized trials, the treatment outcome of locally advanced esophageal cancer has been significantly improved by neoadjuvant radiochemotherapy (RCT). However, increased perioperative pulmonary toxicity in terms of acute respiratory distress syndrome (ARDS) has been linked to radiation exposure of the lungs. In our study we evaluated perioperative morbidity and mortality in patients with cancer Stages IIA-IVA treated with curative intent either with surgery alone (S) or with neoadjuvant RCT followed by surgery (RCTS). Patients and Methods: Between 1996 and 2003, 55 patients received S, and 98 received RCTS. In the RCTS group, most patients received two cycles of 5-fluorouracil plus cisplatinum simultaneously with normofractionated radiotherapy (40Gy). Four weeks later they underwent surgery. Endpoints were the incidence of acute lung injury (ALI), ARDS, other postoperative complications, and mortality within 31 days. Results: Between both groups there were no significant differences between the incidence and severity of ALI and ARDS (RCTS: 42.9%, 42.9%; S: 45.5%, 38.2%). Furthermore, there were no significant differences in the incidences of pneumonia, pleural effusion, and pneumothorax (RCTS 29.6% vs. S 16.4%, p = 0.07). Perioperative complication rates and mortality did not vary significantly (mortality after RCTS 5.1% vs. S 3.6%). A detailed analysis of 54 RCTS patients according to lung dose-volume histograms did not show any correlation between ARDS and pulmonary exposure. In univariate analysis, only respiratory comorbidity correlated with ARDS. Conclusion: Neoadjuvant cisplatinum and 5-fluorouracil-based RCT apparently has no detrimental impact on the postoperative course.

  5. [Use of supportive autogenic training in multiple morbidity in geriatric psychiatry patients].

    PubMed

    Kircher, T; Stetter, F; Wormstall, H

    1997-01-01

    23 multimorbid, geronto-psychiatric patients, aged 60 years or older, participated in a "supportive" course of autogenic training according to Schultz. Participating in the course an average of 7 +/- 3 weeks, 17 (76%) of the subjects were able to learn the training. In general, subjects reported a better general condition after the training sessions, measured with visual analogue scales (p < 0.001). The psychopathological status improved significantly during the time of the course (BPRS: p < 0.001; GDS: p < 0.001). No significant change was found in the cognitive state (MMSE) and the statements on the "list of complaints" ("Beschwerdenliste"). The global training success was better in the psychopathological less affected than in the more severely ill (BPRS prior r = 0.64, p = 0.001, GDS prior r = 0.46, p < 0.05). No correlation was found between training success and age, number of somatic diseases, number of medication, MMSE and the "Beschwerdenliste". Autogenic training is a useful component in psychotherapeutic and psychiatric therapy for elderly multimorbid in- and outpatients. A half-open group, two therapy sessions per week, reciting the training formulae aloud, a structured, simple setting and co-therapists proved to be worthwhile.

  6. Torque multiplier subsea tool

    SciTech Connect

    Leicht, F. M.; Baugh, B. F.; Palany, H. C.

    1985-10-22

    A torque multiplier subsea tool for setting a seal between a casing hanger and a subsea wellhead includes a mandrel having a sun gear with axial elongate teeth. An outer barrel is disposed around the mandrel forming an annulus therebetween. A planetary gear assembly is disposed in the annulus between the barrel and the sun gear to transmit to the barrel a torque which is higher in magnitude than that applied to the mandrel. A connector body disposed around the mandrel, below the planetary gear assembly, includes radially movable dogs for engaging the casing hanger. The barrel engages the sealing assembly and transmits the increased torque thereto to advance the sealing assembly downwards and to set the seal. The mandrel advances downwards with the sealing assembly and releases the dogs from the casing hanger. An emergency release mechanism is provided to advance the mandrel downwards to release the dogs in the event such downward movement is prevented during normal seal setting operation.

  7. Multiplying with Neurons

    NASA Astrophysics Data System (ADS)

    Gabbiani, F.; Krapp, H.; Koch, C.; Laurent, G.

    1998-03-01

    LGMD and DCMD are a pair of identified neurons in the locust brain thought to be involved in visually triggered escape behavior. LGMD integrates visual inputs in its dendritic arbor, converts them into spikes transmitted in a 1:1 manner to DCMD which relays this information to motor centers. We measured the spike activity of DCMD during simulated object approach and observed that its peak occured prior to the expected collision. The time difference between peak activity and collision depended linearly on the ratio of object size to approach velocity, as expected if LGMD/DCMD were detecting the moment in time when the approaching object reaches a fixed angular threshold θ_thresh on the locust's retina. The response of LGMD/DCMD could be fitted by multiplying the angular velocity at which an approaching object is increasing in size over the retina, dot θ, with an exponential function of the object's angular size, θ: f(t) = g(dot θ(t-δ) e^-α θ(t-δ)) where g is a static non-linearity, α a constant related to the angular threshold detected by LGMD/DCMD (θ_thresh = arctan (2/α)) and δ denotes the lag of the neuronal response with respect to the stimulus. This suggests that LGMD/DCMD derives its angular threshold sensitivity by multiplying dot θ with an exponential of θ. A biophysical implementation would be through linear summation of excitatory and inhibitory inputs proportional to log(dot θ) and -α θ, followed by a conversion to spike rate according to the static non-linearity (g circ exp). We have performed several experiments to test this hypothesis.

  8. Association of Hyperglycemia with In-Hospital Mortality and Morbidity in Libyan Patients with Diabetes and Acute Coronary Syndromes

    PubMed Central

    Benamer, Sufyan; Eljazwi, Imhemed; Mohamed, Rima; Masoud, Heba; Tuwati, Mussa; Elbarsha, Abdulwahab M.

    2015-01-01

    Objective Hyperglycemia on admission and during hospital stay is a well-established predictor of short-term and long-term mortality in patients with acute myocardial infarction. Our study investigated the impact of blood glucose levels on admission and in-hospital hyperglycemia on the morbidity and mortality of Libyan patients admitted with acute coronary syndromes (acute myocardial infarction and unstable angina). Methods In this retrospective study, the records of patients admitted with acute coronary syndrome to The 7th Of October Hospital, Benghazi, Libya, between January 2011 and December 2011 were reviewed. The level of blood glucose on admission, and the average blood glucose during the hospital stay were recorded to determine their effects on in-hospital complications (e.g. cardiogenic shock, acute heart failure, arrhythmias, and/or heart block) and mortality. Results During the study period, 121 patients with diabetes were admitted with acute coronary syndrome. The mortality rate in patients with diabetes and acute coronary syndrome was 12.4%. Patients with a mean glucose level greater than 200mg/dL had a higher in-hospital mortality and a higher rate of complications than those with a mean glucose level ≤200mg/dL (27.5% vs. 2.6%, p<0.001 and 19.7% vs. 45.5%, p=0.004, respectively). There was no difference in in-hospital mortality between patients with a glucose level at admission ≤140mg/dL and those admitted with a glucose level >140mg/dL (6.9% vs. 14.3%; p=0.295), but the rate of complications was higher in the latter group (13.8% vs. 34.1%; p=0.036). Patients with admission glucose levels >140mg/dL also had a higher rate of complications at presentation (26.4% vs. 6.9%; p=0.027). Conclusion In patients with diabetes and acute coronary syndrome, hyperglycemia during hospitalization predicted a worse outcome in terms of the rates of in-hospital complications and in-hospital mortality. Hyperglycemia at the time of admission was also associated with

  9. Audit of preoperative fluid resuscitation in perforation peritonitis patients using Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity

    PubMed Central

    Kumar, Sunil

    2017-01-01

    Context: Debate continues regarding fluid (crystalloid vs. colloid) of choice for resuscitation. Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity (POSSUM) may be used to compare the benefits of preoperative fluid resuscitation with crystalloids and colloids in peritonitis patients. Aims: The aim of this study is to compare crystalloid and colloid for preoperative resuscitation using morbidity, mortality, length of hospital stay (LOS), and time taken to resuscitate as the outcome parameters. Settings and Design: This was a prospective randomized clinical trial. Subjects and Methods: One hundred and seven peritonitis patients were prospectively randomized to fluid resuscitation by crystalloid (Group A) and colloid (Group B) solutions. Physiological score component of POSSUM was recorded before and after fluid resuscitation; operative score component was recorded at discharge/death. These scores were then used to calculate the predicted morbidity and mortality before and after the fluid resuscitation. Statistical Analysis Used: Effect on morbidity and mortality were compared by repeated measure analysis of variance, and its significance was tested by Tukey's test. LOS and time taken to resuscitate were compared using unpaired t-test. Significance was taken at 5%. Results: Fluid resuscitation improved mean predicted morbidity by 0.095 and 0.137 in Group A and Group B, respectively. Similarly, fluid resuscitation improved predicted mortality by 0.145 and 0.185 in Group A and Group B, respectively. These changes were statistically significant. Improvement in morbidity and mortality appeared greater in Group B. No difference was found in the two groups for LOS and time to resuscitate. Conclusions: Preoperative fluid resuscitation using either crystalloid or colloidal solutions decreases morbidity as well as mortality in peritonitis patients. PMID:28243006

  10. Metabolic co-morbidities revealed in patients with childhood-onset adult GH deficiency after cessation of GH replacement therapy for short stature.

    PubMed

    Fukuda, Izumi; Hizuka, Naomi; Yasumoto, Kumiko; Morita, Junko; Kurimoto, Makiko; Takano, Kazue

    2008-12-01

    GH therapy was approved in 2006 for treatment of adult growth hormone deficiency (GHD) in Japan. Until then, GH was used only to treat short stature in children with GHD and the treatment was stopped when the final height was reached. In the present study, we investigated metabolic co-morbidities experienced by adults with childhood-onset (CO) GHD after the cessation of GH. Forty-two patients with COGHD (M/F 22/20, age at follow up when the retrospective analysis was carried out: 18-52 yr) treated with GH in childhood were studied. We reviewed the medical records of these patients to determine the metabolic co-morbidities that developed after cessation of GH. The median age was 19 yrs (range: 14-38) at cessation of GH, and the following co-morbidities were observed: hypertriglyceridemia in 15 (41%) patients, non-alcoholic fatty liver disease (NAFLD) in 11 (29%) patients, hypercholesterolemia in 10 (26%) patients, diabetes mellitus (DM) in 4 (10%) patients, and hypertension in 1 (2.4%) patient. The median BMI when these complications became overt was 23.5 kg/m(2) for those with hypertriglyceridemia, 26.0 kg/m(2) for those with NAFLD, 20.9 kg/m(2) for those with hypercholesterolemia, and 27.2 kg/m(2 ) for those with DM. More than two co-morbidities were experienced by 32% of men and 30% of women. In conclusion, adults with COGHD after the cessation of GH have multiple metabolic co-morbidities. Lifelong GH replacement might be important for improving the overall metabolic profiles in these patients.

  11. UWB delay and multiply receiver

    SciTech Connect

    Dallum, Gregory E.; Pratt, Garth C.; Haugen, Peter C.; Romero, Carlos E.

    2013-09-10

    An ultra-wideband (UWB) delay and multiply receiver is formed of a receive antenna; a variable gain attenuator connected to the receive antenna; a signal splitter connected to the variable gain attenuator; a multiplier having one input connected to an undelayed signal from the signal splitter and another input connected to a delayed signal from the signal splitter, the delay between the splitter signals being equal to the spacing between pulses from a transmitter whose pulses are being received by the receive antenna; a peak detection circuit connected to the output of the multiplier and connected to the variable gain attenuator to control the variable gain attenuator to maintain a constant amplitude output from the multiplier; and a digital output circuit connected to the output of the multiplier.

  12. The morbidity of trauma nephrectomy.

    PubMed

    Edwards, Norma M; Claridge, Jeffrey A; Forsythe, Raquel M; Weinberg, Jordan A; Croce, Martin A; Fabian, Timothy C

    2009-11-01

    Mortality has been shown to be high in patients after trauma nephrectomy (TN). However, there are little data regarding morbidity in survivors. The objective of this study was to determine the morbidity rates associated with TN with attention directed to renal failure (RF) and formation of intra-abdominal abscess (IAA). Patients who underwent TN over a 9-year period (1996 to 2004) were identified from the trauma registry. Records were reviewed for all complications after TN in patients surviving at least 48 hours. Eighty-nine patients were identified with TN; 61 per cent resulted after penetrating trauma. Overall mortality was 34 per cent. Seventy-one patients survived greater than 48 hours; 51 (72%) experienced at least one morbidity. There was no difference in morbidity rates between patients undergoing blunt trauma and those undergoing penetrating trama. Patients with morbidities were significantly older, more severely injured, and had higher mortality rates and longer hospital courses. Infectious complications were seen in 52 per cent, respiratory in 48 per cent, gastrointestinal in 30 per cent, coagulopathy in 25 per cent, and RF and IAA were each seen in 14 per cent of patients. Patients undergoing TN are severely injured with significant morbidity. The results from this study allow us to establish benchmarks to assess complication rates for patients who undergo TN, which can provide prognostic information and goals to improve patient outcomes.

  13. Optical Sidebands Multiplier

    NASA Technical Reports Server (NTRS)

    Strekalov, Dmitry V.; Yu, Nan

    2010-01-01

    Optical sidebands have been generated with relative frequency tens to hundreds of GHz by using optical sidebands that are generated in a cascade process in high-quality optical resonators with Kerr nonlinearity, such as whispering gallery mode (WGM) resonators. For this purpose, the WGM resonator needs to be optically pumped at two frequencies matching its resonances. These two optical components can be one or several free spectral ranges (FSRs), equal to approximately 12 GHz, in this example, apart from each other, and can be easily derived from a monochromatic pump with an ordinary EOM (electro-optic modulation) operating at half the FSR frequency. With sufficient nonlinearity, an optical cascade process will convert the two pump frequencies into a comb-like structure extending many FSRs around the carrier frequency. This has a demonstratively efficient frequency conversion of this type with only a few milliwatt optical pump power. The concept of using Kerr nonlinearity in a resonator for non-degenerate wave mixing has been discussed before, but it was a common belief that this was a weak process requiring very high peak powers to be observable. It was not thought possible for this approach to compete with electro-optical modulators in CW applications, especially those at lower optical powers. By using the high-Q WGM resonators, the effective Kerr nonlinearity can be made so high that, using even weak seeding bands available from a conventional EOM, one can effectively multiply the optical sidebands, extending them into an otherwise inaccessible frequency range.

  14. Bariatric bypasses contribute to loss of bone mineral density but reduce axial back pain in morbidly obese patients considering spine surgery

    PubMed Central

    Epstein, Nancy E.

    2017-01-01

    Background: Many spine surgeons recommend stringent weight loss, including bariatric bypass procedures, prior to “elective” spine surgery (should not be for axial back pain alone) in morbidly obese patients (defined by a body mass index (BMI) of >40 mg/kg2 or >35 mg/kg2 with two or more major comorbidities) to reduce their greater risk for major perioperative complications. Although bypasses typically lead to marked weight reduction and even reduced axial back pain, they also promote unrecognized and often insufficiently treated vitamin D deficiency and loss of bone mineral density. Methods: Morbidly obese patients who are under consideration for “elective” spine operations (other than for back pain alone) are often told to lose weight. Some choose to undergo bariatric bypass procedures, but are unaware of the potential risks/complications of these procedures. Results: Within the first 2 years following most bariatric bypass procedures, patients experience not only marked loss of weight and muscle mass, but also significant vitamin D deficiency and loss of bone mineral density, increasing their susceptibility to fractures. Nevertheless, some patients also experience a sufficient reduction of axial back pain to avoid spinal surgery. Conclusions: Morbidly obese patients under consideration for “elective” spine surgery may undergo bariatric bypass procedures that lead to a significant reduction of vitamin D levels and loss of bone mineral density. However, potential benefits may include a sufficient reduction of axial back pain to avoid surgery in a select subset of patients altogether. PMID:28217392

  15. Analysis of 30-Day Postdischarge Morbidity and Readmission after Radical Gastrectomy for Gastric Carcinoma: A Single-Center Study of 2107 Patients With Prospective Data

    PubMed Central

    Jeong, Oh; Kyu Park, Young; Ran Jung, Mi; Yeop Ryu, Seong

    2015-01-01

    Abstract PD morbidity and readmission pose a substantial clinical and economic burden to the healthcare system. Comprehensive PD complications and readmission data are essential for developing initiatives to improve patient care. No previous studies have extensively investigated PD complications after gastric cancer surgery. We investigated the incidence, types, treatment, and risk factors of 30-day postdischarge (PD) complications after gastric cancer surgery. Between 2010 and 2013, data concerning complications and readmission within 30 days of hospital discharge were prospectively collected in 2107 patients undergoing gastric cancer surgery. In total, 1642 patients (77.9%) underwent distal gastrectomy, 418 (19.8%) total gastrectomy, and 47 (2.3%) other procedures. Postoperative morbidity and mortality were 17.4% and 0.6%, respectively, with a mean 8.8-day hospital stay. Sixty-one patients (2.9%) developed 30-day PD morbidity (58 local and 3 systemic complications), accounting for 16.6% of overall morbidity; 47 (2.2%) were readmitted; and 7 (0.3%) underwent a reoperation. The mean time to PD complications was 9.5 days after index hospital discharge. The most common complication was intra-abdominal abscess (n = 14), followed by wound, ascites, and anastomosis leakage. No mortality occurred resulting from PD complications. In the univariate and multivariate analyses, underlying comorbidity (hypertension and liver cirrhosis) and obesity were independent risk factors for developing PD complications. The early PD period is a vulnerable time for surgical patients with substantial risk of complication and readmission. Tailored discharge plans along with appropriate PD patient support are essential for improving the quality of patient care. PMID:25789945

  16. Patients with irritable bowel syndrome are more burdened by co-morbidity and worry about serious diseases than healthy controls- eight years follow-up of IBS patients in primary care

    PubMed Central

    2013-01-01

    Background Irritable Bowel Syndrome (IBS) is a hidden public health disease that affects up to 20% of the general population. Although co-morbidity can affect diagnose setting and treatment of the disease, there are few studies concerning diagnosed and registered co-morbidity for IBS patients in primary care. The aim of this study was to analyse co-morbidity among IBS-patients compared to age- and sex-matched controls from the general population using data from a county-wide computerized medical record system. Methods IBS cases were recruited from three Swedish primary health care centres during a five-years period and controls from the same corresponding geographical areas. Co-morbidity data for IBS-patients and morbidity data for controls were derived from a population-based Health Care Register (HCR) covering all diagnoses in primary as well as hospital care in the region. Odds Ratios with 95% confidence intervals for morbidity in gastro-intestinal and non-gastrointestinal diagnoses for cases with irritable bowel syndrome compared to controls were calculated separately for each gender and diagnosis. Results We identified more co-morbidity among IBS patients of both sexes, compared to matched controls in the general population. Patients with IBS were particularly more worried about having a serious disease than their control group. The risk among male IBS-cases to get this latter diagnose was three times higher compared to the male controls. Conclusions In this population based case–control study, the analysis of diagnoses from the HCR revealed a broad spectrum of common co-morbidity and significantly more physician-recorded diagnoses among IBS-patients in comparisons to the control group. PMID:24025070

  17. NULL convention floating point multiplier.

    PubMed

    Albert, Anitha Juliette; Ramachandran, Seshasayanan

    2015-01-01

    Floating point multiplication is a critical part in high dynamic range and computational intensive digital signal processing applications which require high precision and low power. This paper presents the design of an IEEE 754 single precision floating point multiplier using asynchronous NULL convention logic paradigm. Rounding has not been implemented to suit high precision applications. The novelty of the research is that it is the first ever NULL convention logic multiplier, designed to perform floating point multiplication. The proposed multiplier offers substantial decrease in power consumption when compared with its synchronous version. Performance attributes of the NULL convention logic floating point multiplier, obtained from Xilinx simulation and Cadence, are compared with its equivalent synchronous implementation.

  18. NULL Convention Floating Point Multiplier

    PubMed Central

    Ramachandran, Seshasayanan

    2015-01-01

    Floating point multiplication is a critical part in high dynamic range and computational intensive digital signal processing applications which require high precision and low power. This paper presents the design of an IEEE 754 single precision floating point multiplier using asynchronous NULL convention logic paradigm. Rounding has not been implemented to suit high precision applications. The novelty of the research is that it is the first ever NULL convention logic multiplier, designed to perform floating point multiplication. The proposed multiplier offers substantial decrease in power consumption when compared with its synchronous version. Performance attributes of the NULL convention logic floating point multiplier, obtained from Xilinx simulation and Cadence, are compared with its equivalent synchronous implementation. PMID:25879069

  19. Effective switching frequency multiplier inverter

    DOEpatents

    Su, Gui-Jia; Peng, Fang Z.

    2007-08-07

    A switching frequency multiplier inverter for low inductance machines that uses parallel connection of switches and each switch is independently controlled according to a pulse width modulation scheme. The effective switching frequency is multiplied by the number of switches connected in parallel while each individual switch operates within its limit of switching frequency. This technique can also be used for other power converters such as DC/DC, AC/DC converters.

  20. Microwave Frequency Multiplier

    NASA Astrophysics Data System (ADS)

    Velazco, J. E.

    2017-02-01

    High-power microwave radiation is used in the Deep Space Network (DSN) and Goldstone Solar System Radar (GSSR) for uplink communications with spacecraft and for monitoring asteroids and space debris, respectively. Intense X-band (7.1 to 8.6 GHz) microwave signals are produced for these applications via klystron and traveling-wave microwave vacuum tubes. In order to achieve higher data rate communications with spacecraft, the DSN is planning to gradually furnish several of its deep space stations with uplink systems that employ Ka-band (34-GHz) radiation. Also, the next generation of planetary radar, such as Ka-Band Objects Observation and Monitoring (KaBOOM), is considering frequencies in the Ka-band range (34 to 36 GHz) in order to achieve higher target resolution. Current commercial Ka-band sources are limited to power levels that range from hundreds of watts up to a kilowatt and, at the high-power end, tend to suffer from poor reliability. In either case, there is a clear need for stable Ka-band sources that can produce kilowatts of power with high reliability. In this article, we present a new concept for high-power, high-frequency generation (including Ka-band) that we refer to as the microwave frequency multiplier (MFM). The MFM is a two-cavity vacuum tube concept where low-frequency (2 to 8 GHz) power is fed into the input cavity to modulate and accelerate an electron beam. In the second cavity, the modulated electron beam excites and amplifies high-power microwaves at a frequency that is a multiple integer of the input cavity's frequency. Frequency multiplication factors in the 4 to 10 range are being considered for the current application, although higher multiplication factors are feasible. This novel beam-wave interaction allows the MFM to produce high-power, high-frequency radiation with high efficiency. A key feature of the MFM is that it uses significantly larger cavities than its klystron counterparts, thus greatly reducing power density and arcing

  1. Twelve year experience of laparoscopic gastric plication in morbid obesity: development of the technique and patient outcomes

    PubMed Central

    2012-01-01

    Background Laparoscopic Gastric Plication (LGP) is a new restrictive bariatric surgery, previously introduced by the author. The aim of this study is to explain the modifications and to present the 12-year experience, regarding early and long term results, complications and cost. Methods We used LGP for morbid obesity during the past 12 years. Anterior plication (10 cases), one-row bilateral plication while right gastroepiploic artery included (42 cases), and excluded from the plication (104 cases) and two-row plication (644 cases). The gastric greater curvature was plicated using 2/0 prolen from fundus at the level of diaphragm preserving the His angle to just proximal to the pylorus. The anatomic and functional volume of stomach was 50cc and 25cc respectively in two-row method. Ordered postop visits also included evaluation of weight loss, complications, change of diet and control of exercise. Results LGP was performed in 800 cases (mean age: 27.5, range: 12 to 65 years, nine under 18). Female to male ratio was 81% to 19% and average BMI was 42.1 (35-59). The mean excess weight loss (EWL) was 70% (40% to 100%) after 24 months and 55% (28% to 100%) after 5 years following surgery. 134 cases (16.7%) did not completed long term follow-up. The average time of follow up was 5 years (1 month to 12 years). 5.5% and 31% of cases complained from weight regain respectively during 4 and 12 years after LGP. The mean time of operation was 72 (49–152) minutes and average hospitalization time was 72 hours (24 hours to 45 days). The cost of operation was 2000 $ less than gastric banding or sleeve and 2500 $ less than gastric bypass. Eight patients out of 800 cases (1%) required reoperation due to complications like: micro perforation, obstruction and vomiting following adhesion of His angle. Other complications included hepatitis pneumonia, self-limiting intra-abdominal bleeding and hypocalcaemia. Conclusion The percentage of EWL in this technique is comparable to other

  2. Management of Septic Open Abdomen in a Morbid Obese Patient with Enteroatmospheric Fistula by Using Standard Abdominal Negative Pressure Therapy in Conjunction with Intrarectal One

    PubMed Central

    Yetisir, Fahri; Salman, A. Ebru; Acar, Hasan Zafer; Özer, Mehmet; Aygar, Muhittin; Osmanoglu, Gokhan

    2015-01-01

    Introduction. Management of open abdomen (OA) with enteroatmospheric fistula (EAF) in morbid obese patient with comorbid disease is challenging. We would like to report the management of septic OA in morbid obese patient with EAF which developed after strangulated recurrent giant incisional hernia repair. We would also like to emphasize, in this case, the conversion of EAF to ileostomy by the help of second Negative Pressure Therapy (NPT) on ostomy side, and the chance of new EAF occurrence was reduced with intrarectal NPT. Case Presentation. 62-year-old morbid obese woman became an OA patient with EAF after strangulated recurrent giant hernia. EAF was converted to ostomy with pezzer drain by the help of second NPT on ostomy. Colonic distention was reduced with the third NPT application via rectum. Abdominal reapproximation anchor (ABRA) system was used for delayed abdominal closure. Conclusions. Using the 2nd NPT on ostomy side may help in the maturation of the ostomy created in a difficult condition in an open abdomen. Using the 3rd NPT through rectum may decrease the chance of EAF formation by reducing the pressure difference between intraluminal pressure and extraluminal pressure in hollow viscera. PMID:26779360

  3. Baseline characteristics and treatment of patients in Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure trial (PARADIGM-HF)

    PubMed Central

    McMurray, John J V; Packer, Milton; Desai, Akshay S; Gong, Jianjian; Lefkowitz, Martin; Rizkala, Adel R; Rouleau, Jean L; Shi, Victor C; Solomon, Scott D; Swedberg, Karl; Zile, Michael R

    2014-01-01

    Aim To describe the baseline characteristics and treatment of the patients randomized in the PARADIGM-HF (Prospective comparison of ARNi with ACEi to Determine Impact on Global Mortality and morbidity in Heart Failure) trial, testing the hypothesis that the strategy of simultaneously blocking the renin–angiotensin–aldosterone system and augmenting natriuretic peptides with LCZ696 200 mg b.i.d. is superior to enalapril 10 mg b.i.d. in reducing mortality and morbidity in patients with heart failure and reduced ejection fraction. Methods Key demographic, clinical and laboratory findings, along with baseline treatment, are reported and compared with those of patients in the treatment arm of the Studies Of Left Ventricular Dysfunction (SOLVD-T) and more contemporary drug and device trials in heart failure and reduced ejection fraction. Results The mean age of the 8442 patients in PARADIGM-HF is 64 (SD 11) years and 78% are male, which is similar to SOLVD-T and more recent trials. Despite extensive background therapy with beta-blockers (93% patients) and mineralocorticoid receptor antagonists (60%), patients in PARADIGM-HF have persisting symptoms and signs, reduced health related quality of life, a low LVEF (mean 29 ± SD 6%) and elevated N-terminal-proB type-natriuretic peptide levels (median 1608 inter-quartile range 886–3221 pg/mL). Conclusion PARADIGM-HF will determine whether LCZ696 is more beneficial than enalapril when added to other disease-modifying therapies and if further augmentation of endogenous natriuretic peptides will reduce morbidity and mortality in heart failure and reduced ejection fraction. PMID:24828035

  4. Case Report: Double lumen tube insertion in a morbidly obese patient through the non-channelled blade of the King Vision (™) videolaryngoscope.

    PubMed

    El-Tahan, Mohamed; Doyle, D John; Khidr, Alaa M; Hassieb, Ahmed G

    2014-01-01

    We describe the insertion of the double lumen endobronchial tube (DLT) using a non-channeled standard blade of the King Vision (TM) videolaryngoscope for one lung ventilation (OLV) in a morbidly obese patient with a predicted difficult airway, severe restrictive pulmonary function, asthma, and hypertension. The patient was scheduled for a video-assisted thoracoscopic lung biopsy. The stylet of the DLT was bent to fit the natural curve of the #3 non-channeled blade of the King Vision (™) videolaryngoscope. We conclude that the use of King Vision (™) videolaryngoscope could offer an effective method of DLT placement for OLV.

  5. Case Report: Double lumen tube insertion in a morbidly obese patient through the non-channelled blade of the King Vision ™ videolaryngoscope

    PubMed Central

    El-Tahan, Mohamed; Doyle, D. John; Khidr, Alaa M; Hassieb, Ahmed G

    2014-01-01

    We describe the insertion of the double lumen endobronchial tube (DLT) using a non-channeled standard blade of the King Vision TM videolaryngoscope for one lung ventilation (OLV) in a morbidly obese patient with a predicted difficult airway, severe restrictive pulmonary function, asthma, and hypertension. The patient was scheduled for a video-assisted thoracoscopic lung biopsy. The stylet of the DLT was bent to fit the natural curve of the #3 non-channeled blade of the King Vision ™ videolaryngoscope. We conclude that the use of King Vision ™ videolaryngoscope could offer an effective method of DLT placement for OLV. PMID:25309730

  6. A comparison of post-operative morbidity following outpatient dental care under general anaesthesia in paediatric patients with and without disabilities.

    PubMed

    Enever, G R; Nunn, J H; Sheehan, J K

    2000-06-01

    An investigation was undertaken of morbidity after outpatient general anaesthesia for comprehensive dental care in a group of paediatric patients over a 1-year period. Data were collated from the patient's hospital notes and from the response to a questionnaire sent to parents/carers. Clinical data were obtained for 55 cases (age range 3-17 years) for whom parents/carers had returned questionnaires. There were 27 intellectually and/or physically impaired patients, the other 28 being anxious or phobic. After discharge, 44% of all parents/carers reported symptoms post-operatively in their child, the prevalence being similar in both groups. The symptoms were nausea/vomiting (20%), unexpected drowsiness (13%) and the need for pain relief at home (13%). Dental procedures were routine restorations (42%), or a combination of restoration, extractions and preventive care for the remainder. Only four patients had extractions only. One teenager had to be admitted for persistent nausea and vomiting, despite prophylactic measures. In conclusion, post-operative morbidity appears to be low after outpatient general anaesthesia for dental procedures, and is no greater in patients with disabilities.

  7. Severity of non-alcoholic fatty liver disease is associated with high systemic levels of tumor necrosis factor alpha and low serum interleukin 10 in morbidly obese patients.

    PubMed

    Paredes-Turrubiarte, Gabriela; González-Chávez, Antonio; Pérez-Tamayo, Ruy; Salazar-Vázquez, Beatriz Y; Hernández, Vito S; Garibay-Nieto, Nayeli; Fragoso, José Manuel; Escobedo, Galileo

    2016-05-01

    Morbid obesity has been shown to increase the risk to develop hepatic steatosis, also referred to as non-alcoholic fatty liver disease (NAFLD). Emerging evidence suggests that the severity of NAFLD may associate with increased serum levels of inflammatory markers as well as decreased concentration of mediators with anti-inflammatory actions, such as tumor necrosis factor alpha (TNF-α) and interleukin (IL) 10, respectively. We thus examined the serum levels of TNF-α and IL-10 in 102 morbidly obese women and men (body mass index > 40 kg/m(2)), exhibiting different grades of NAFLD. Blood glucose, glycated hemoglobin, insulin, the homeostatic model assessment of insulin resistance (HOMA-IR), total cholesterol, triglycerides, high- and low-density lipoproteins, parameters of liver function, TNF-α, and IL-10 were measured in each subject. The stage of NAFLD was estimated by abdominal ultrasound imaging. In comparison with morbidly obese subjects without steatosis, morbidly obese patients with NAFLD showed increased age (39.23 ± 9.80 years), HOMA-IR (6.74 ± 1.62), total cholesterol (219.7 ± 9.58 mg/dl), aspartate aminotransferase (36.25 ± 3.24 UI/l), gamma-glutamyl transpeptidase (37.12 ± 3.41 UI/l), and TNF-α (37.41 ± 1.72 pg/ml) as well as decreased serum levels of IL-10 (61.05 ± 2.43 pg/ml). Interestingly, the systemic levels of TNF-α increased, while IL-10 decreased in accordance with the severity of NAFLD, which supports a role for systemic inflammatory mediators in promoting steatosis progression. Further clinical prospective studies need to be addressed to elucidate the role of TNF-α and IL-10 in the development of NAFLD while also establishing their clinical utility in the assessment of morbidly obese patients at higher risk to develop severe steatosis.

  8. C1 lateral mass screw placement with intentional sacrifice of the C2 ganglion: functional outcomes and morbidity in elderly patients.

    PubMed

    Squires, Jason; Molinari, Robert W

    2010-08-01

    Placement of C1 lateral mass screws may be facilitated by intentional C2 root sacrifice. Functional outcomes and morbidity following intentional sacrifice of the C2 root have not been reported in the literature. The objective is to find out if intentional C2 nerve root sacrifice affects functional outcomes and operative morbidity in patients undergoing posterior cervical fusion with C1 lateral mass screws. The study is a case report. Twenty-two consecutive elderly patients (10 males, 12 females with an average age of 77 years) with C1-2 instability were treated with posterior cervical fusion using C1 lateral mass screw placement. Five patients had preservation of the bilateral C2 nerve roots (PRES group) and 18 patients had intentional sacrifice of the bilateral C2 nerve root (SAC group). Operative times, blood loss, hospital length of stay, and complications were recorded for each patient. Functional outcomes, pain, and satisfaction scores were compared between the two groups at the time of ultimate follow-up. Average follow-up time was 19.3 months (range 6-66). The SAC group demonstrated significantly decreased operative time (109.4 vs. 187 min) and a trend towards decreased blood loss (344 vs. 1,030 mL). At ultimate follow-up both groups experienced similar mild disability with no significant difference in NDI scores, analog pain, and satisfaction scores. No patient had C2 root dysesthesia, swallowing, or speech difficulty. In this small case series, intentional sacrifice of the bilateral C2 nerve root ganglion resulted in less operative time and decreased blood loss in elderly patents undergoing C1-2 posterior fusion with the Harms technique. Functional outcome, pain and satisfaction scores were not adversely affected when this technique was used in elderly patients.

  9. The impacts of super obesity versus morbid obesity on red blood cell aggregation and deformability among patients qualified for bariatric surgery.

    PubMed

    Wiewiora, Maciej; Piecuch, Jerzy; Glûck, Marek; Slowinska-Lozynska, Ludmila; Sosada, Krystyn

    2014-01-01

    The aim of this study was to evaluate the effects of the obesity degree on red blood cell aggregation and deformability. We studied 56 obese patients before weight loss surgery who were divided into two groups: morbid obesity and super obesity. The aggregation and deformability of RBCs were evaluated using a Laser-assisted Optical Rotational Cell Analyzer (Mechatronics, the Netherlands). The following parameters specific to the aggregation process were estimated: aggregation index (AI), aggregation half-time (t1/2) and threshold shear rate (γthr). RBC deformability was expressed as erythrocyte elongation (EI), which was measured at 18.49 Pa and 30.2 Pa shear stresses. Super obese patients presented significantly higher AI (P < 0.05) and γthr (P < 0.05) and significantly lower t1/2 (P < 0.05) compared with morbidly obese individuals. Multivariate analyses showed that fibrinogen (β 0.46, P < 0.01 and β 0.98, P < 0.01) and hematocrit (β 0.38, P < 0.05 and β 1.01, P < 0.01) independently predicted the AI in morbidly obese and super obese patients. Fibrinogen (β -0.4, P < 0.05 and β -0.91, P < 0.05) and hematocrit (β -0.38, P < 0.05 and β -1.11, P < 0.01) were also independent predictors of the t1/2 in both obese groups. The triglyceride level (β 0.32, P < 0.05) was an independent predictor of the t1/2 in the morbidly obese group. No differences in EI were observed between obese subjects. Multivariate analyses showed that the triglyceride level independently predicted EI at 18.49 Pa (β -0.42, P < 0.05 and β -0.53, P < 0.05) and 30.2 Pa (β -0.44, P < 0.01 and β -0.49, P < 0.05) in both obese groups. This study indicated that the obesity degree of patients who qualify for bariatric surgery affects RBC aggregation properties, but it does not indicate the reasons for this difference. Further studies are needed to determine factors associated with hyperaggregation in super obesity.

  10. Coping and quality of life in patients with skin tumors in the follow-up stage: The mediating role of body image and psychological morbidity.

    PubMed

    Pereira, M Graça; Baia, Vânia; Machado, José C

    2016-01-01

    This study examined the relationships between coping style, body image, psychological morbidity, and quality of life. A total of 58 patients who were diagnosed with skin tumors, had been submitted to surgery, and were in the follow-up phase answered the following instruments: dermatology life quality index (DLQI), hospital anxiety and depression scales (HADS), body image scale (BIS), and the mini mental adjustment to cancer scale (Mini-MAC). The results showed that patients with a higher use of the coping styles of helplessness/hopelessness, anxious preoccupation, and cognitive avoidance reported a worse quality of life. Body image mediated the relationship between the coping styles of anxious preoccupation, helplessness/hopelessness, and quality of life. Psychological morbidity mediated the relationship between helplessness/hopelessness and quality of life. Therefore, even in the follow-up phase, it is important that health professionals are aware of the patient's emotional distress and body image to identify those at a higher risk of having a poorer quality of life.

  11. Interdisciplinary Quality Improvement Conference: Using a Revised Morbidity and Mortality Format to Focus on Systems-Based Patient Safety Issues in a VA Hospital: Design and Outcomes.

    PubMed

    Gerstein, Wendy H; Ledford, Judith; Cooper, Jacqueline; Lloyd, Melissa G; Moore, Timothy; Harji, Farzana; Twitty, Vivian; Brooks, Annette; Oliver, Rosalinda C; Goff, James M

    2016-01-01

    The Veterans Healthcare Administration (VA) has embraced patient safety and quality improvement in the quest to improve care for veterans. The New Mexico VA Health Care System introduced a new morbidity and mortality conference, called the Interdisciplinary Quality Improvement Conference (IQIC), using patient case presentations to focus on underlying systems in the clinical care environment. The revised conference design also effectively teaches the 6 Accreditation Council for Graduate Medical Education (ACGME) core requirements for resident education. A formal process was established for case selection, presentation, systems issue identification, tracking, and follow-up. The IQIC has enabled the identification of more than 20 system issues at the study institution. Outcome data show lasting improvement in system issues that were addressed by this mechanism. The VA IQIC is an effective method to both identify and correct systems issues that affect patient care and is an effective method for teaching residents the 6 ACGME requirements for residency education.

  12. Switched-Capacitor Voltage Multiplier

    NASA Technical Reports Server (NTRS)

    Sridharan, Govind

    1991-01-01

    Dc-to-dc power converter multiplies input supply potential by factor of nearly 40. Design does not make use of transformers or inductors but effects voltage boost-up by capacitive energy transfer. Circuit primarily made up of banks of capacitors, connected by network of integrated-circuit relays. Converter functionally linear voltage amplifier with fixed gain figure. Bipolar in operation. Output fully floating, and excellent dc isolation between input and output terminals.

  13. Contributing Factors for Morbidity and Mortality in Patients with Organophosphate Poisoning on Mechanical Ventilation: A Retrospective Study in a Teaching Hospital

    PubMed Central

    Patil, Gurulingappa; Nikhil, M.

    2016-01-01

    Introduction One of the most common causes of poisoning in agricultural based developing countries like India is due to Organophosphorus (OP) compound. Its widespread use and easy availability has increased the likelihood of poisoning with these compounds. Aim To study the morbidity and mortality in patients with acute OP poisoning requiring mechanical ventilation. Materials and Methods This was a retrospective study constituting patients of all age groups admitted to the Intensive Care Unit (ICU) with diagnosis of OP poisoning between January 2015 to December 2015. Of 66 OP poisoning cases those patients who went against medical advice, 20 were excluded from the study and thus 46 patients were included. Diagnosis was performed from the history taken either from the patient or from the patient’s relatives and presenting symptoms. Demographic data, month of the year, age of patient, mode of poisoning, cholinesterase levels, duration of mechanical ventilation and mortality were recorded. Data are presented as mean±SD. Results A 97.83% (45/46) of cases were suicidal. Out of 46, 9 were intubated and mechanically ventilated. Duration of mechanical ventilation varied from less than 48 hours to more than 7 days. Mortality rate was 50%, 0% and 100% in those who required mechanical ventilation for more than 7 days, 2 to 7 days and <2days respectively. None of the predictors like age, severity of poisoning, cholinesterase levels and duration of ventilation were independent predictors of death and all of them contributed to the mortality. Overall mortality rate in those who required mechanical ventilation was 22.22%. Conclusion Morbidity and mortality due to OP poisoning is directly proportional to the age, severity of poisoning and duration of mechanical ventilation and inversely proportional to serum cholinesterase level. PMID:28208980

  14. Increased Expression Profile and Functionality of TLR6 in Peripheral Blood Mononuclear Cells and Hepatocytes of Morbidly Obese Patients with Non-Alcoholic Fatty Liver Disease

    PubMed Central

    Arias-Loste, María Teresa; Iruzubieta, Paula; Puente, Ángela; Ramos, David; Santa Cruz, Carolina; Estébanez, Ángel; Llerena, Susana; Alonso-Martín, Carmen; San Segundo, David; Álvarez, Lorena; López Useros, Antonio; Fábrega, Emilio; López-Hoyos, Marcos; Crespo, Javier

    2016-01-01

    Current evidence suggests that gut dysbiosis drives obesity and non-alcoholic fatty liver disease (NAFLD) pathogenesis. Toll-like receptor 2 (TLR2) and TLR6 specifically recognize components of Gram-positive bacteria. Despite the potential implications of TLR2 in NAFLD pathogenesis, the role of TLR6 has not been addressed. Our aim is to study a potential role of TLR6 in obesity-related NAFLD. Forty morbidly obese patients undergoing bariatric surgery were prospectively studied. Cell surface expression of TLR2 and TLR6 was assessed on peripheral blood mononuclear cells (PBMCs) by flow cytometry. Freshly isolated monocytes were cultured with specific TLR2/TLR6 agonists and intracellular production of cytokines was determined by flow-cytometry. In liver biopsies, the expression of TLR2 and TLR6 was analyzed by immunohistochemistry and cytokine gene expression using RT-qPCR. TLR6 expression in PBMCs from non-alcoholic steatohepatitis (NASH) patients was significantly higher when compared to those from simple steatosis. The production of pro-inflammatory cytokines in response to TLR2/TLR6 stimulation was also significantly higher in patients with lobular inflammation. Hepatocyte expression of TLR6 but not that of TLR2 was increased in NAFLD patients compared to normal liver histology. Deregulated expression and activity of peripheral TLR6 in morbidly obese patients can mirror the liver inflammatory events that are well known drivers of obesity-related NASH pathogenesis. Moreover, TLR6 is also significantly overexpressed in the hepatocytes of NAFLD patients compared to their normal counterparts. Thus, deregulated TLR6 expression may potentiate TLR2-mediated liver inflammation in NAFLD pathogenesis, and also serve as a potential peripheral biomarker of obesity-related NASH. PMID:27834919

  15. The multipliers of multiple trigonometric Fourier series

    NASA Astrophysics Data System (ADS)

    Ydyrys, Aizhan; Sarybekova, Lyazzat; Tleukhanova, Nazerke

    2016-11-01

    We study the multipliers of multiple Fourier series for a regular system on anisotropic Lorentz spaces. In particular, the sufficient conditions for a sequence of complex numbers {λk}k∈Zn in order to make it a multiplier of multiple trigonometric Fourier series from Lp[0; 1]n to Lq[0; 1]n , p > q. These conditions include conditions Lizorkin theorem on multipliers.

  16. Planar diode multiplier chains for THz spectroscopy

    NASA Technical Reports Server (NTRS)

    Maiwald, Frank W.; Drouin, Brian J.; Pearson, John C.; Mehdi, Imran; Lewena, Frank; Endres, Christian; Winnewisser, Gisbert

    2005-01-01

    High-resolution laboratory spectroscopy is utilized as a diagnostic tool to determine noise and harmonic content of balanced [9]-[11] and unbalanced [12]-[14] multiplier designs. Balanced multiplier designs suppress unintended harmonics more than -20dB. Much smaller values were measured on unbalanced multipliers.

  17. Psychological morbidity and illness perception among patients receiving treatment for tuberculosis in a tertiary care centre in Sri Lanka.

    PubMed

    Galhenage, J S; Rupasinghe, J P; Abeywardena, G S; de Silva, A P; Williams, S S; Gunasena, B

    2016-03-01

    A descriptive cross sectional study was carried out to determine prevalence of depression and anxiety and to describe disease perception among patients with tuberculosis (TB) at National Hospital for Respiratory Diseases (NHRD), Welisara. Consecutive patients on anti-TB therapy admitted to wards and attending clinic were recruited until the estimated sample of 430 was reached. They were assessed using Hospital Anxiety and Depression Scale (HADS) and Brief Illness Perception Questionnaire (BIPQ). A total of 254 in-ward patients and 176 clinic patients were included. Of the inward patients, 25.2% had depression and 12.6% had anxiety. Of the clinic patients, 17.6% screened were positive for anxiety and 8.5% screened were positive for depression. Mean BIPQ score was 27.44 for the whole population. Prevalence of depression was significantly higher among in-ward patients (25.2%, p<0.0001), elderly age groups (20.5%, p=0.007), patients with lower education levels (20.6%, p= 0.012) and previously treated patients (32.3%, p=0.004). In-ward group (50.8%, p=0.002), lower education group (48.7%, p<0.0001), previously treated group (60%, p=0.005) and patients with depression (60.8%, p=0.001) and anxiety (68.3%, p<0.0001) showed significanly higher BIPQ scores. Our study shows that depression and anxiety are common among patients receiving treatment for TB.

  18. Analysis of the Human Proteome in Subcutaneous and Visceral Fat Depots in Diabetic and Non-diabetic Patients with Morbid Obesity

    PubMed Central

    Fang, Lingling; Kojima, Kyoko; Zhou, Lihua; Crossman, David K; Mobley, James A; Grams, Jayleen

    2015-01-01

    No longer regarded as simply a storage depot, fat is a dynamic organ acting locally and systemically to modulate energy homeostasis, glucose sensitivity, insulin resistance, and inflammatory pathways. Here, mass spectrometry was used to survey the proteome of patient matched subcutaneous fat and visceral fat in 20 diabetic vs 22 nondiabetic patients with morbid obesity. A similar number of proteins (~600) were identified in each tissue type. When stratified by diabetic status, 19 and 41 proteins were found to be differentially abundant in subcutaneous fat and omentum, respectively. These proteins represent pathways known to be involved in metabolism. Five of these proteins were differentially abundant in both fat depots: moesin, 78 kDa glucose-regulated protein, protein cordon-bleu, zinc finger protein 611, and cytochrome c oxidase subunit 6B1. Three proteins, decorin, cytochrome c oxidase subunit 6B1, and 78 kDa glucose-regulated protein, were further tested for validation by western blot analysis. Investigation of the proteins reported here is expected to expand on the current knowledge of adipose tissue driven biochemistry in diabetes and obesity, with the ultimate goal of identifying clinical targets for the development of novel therapeutic interventions in the treatment of type 2 diabetes mellitus. To our knowledge, this study is the first to survey the global proteome derived from each subcutaneous and visceral adipose tissue obtained from the same patient in the clinical setting of morbid obesity, with and without diabetes. It is also the largest study of diabetic vs nondiabetic patients with 42 patients surveyed. PMID:26472921

  19. A recommended early goal-directed management guideline for the prevention of hypothermia-related transfusion, morbidity, and mortality in severely injured trauma patients.

    PubMed

    Perlman, Ryan; Callum, Jeannie; Laflamme, Claude; Tien, Homer; Nascimento, Barto; Beckett, Andrew; Alam, Asim

    2016-04-20

    Hypothermia is present in up to two-thirds of patients with severe injury, although it is often disregarded during the initial resuscitation. Studies have revealed that hypothermia is associated with mortality in a large percentage of trauma cases when the patient's temperature is below 32 °C. Risk factors include the severity of injury, wet clothing, low transport unit temperature, use of anesthesia, and prolonged surgery. Fortunately, associated coagulation disorders have been shown to completely resolve with aggressive warming. Selected passive and active warming techniques can be applied in damage control resuscitation. While treatment guidelines exist for acidosis and bleeding, there is no evidence-based approach to managing hypothermia in trauma patients. We synthesized a goal-directed algorithm for warming the severely injured patient that can be directly incorporated into current Advanced Trauma Life Support guidelines. This involves the early use of warming blankets and removal of wet clothing in the prehospital phase followed by aggressive rewarming on arrival at the hospital if the patient's injuries require damage control therapy. Future research in hypothermia management should concentrate on applying this treatment algorithm and should evaluate its influence on patient outcomes. This treatment strategy may help to reduce blood loss and improve morbidity and mortality in this population of patients.

  20. Canonical forms of unconditionally convergent multipliers.

    PubMed

    Stoeva, D T; Balazs, P

    2013-03-01

    Multipliers are operators that combine (frame-like) analysis, a multiplication with a fixed sequence, called the symbol, and synthesis. They are very interesting mathematical objects that also have a lot of applications for example in acoustical signal processing. It is known that bounded symbols and Bessel sequences guarantee unconditional convergence. In this paper we investigate necessary and equivalent conditions for the unconditional convergence of multipliers. In particular, we show that, under mild conditions, unconditionally convergent multipliers can be transformed by shifting weights between symbol and sequence, into multipliers with symbol (1) and Bessel sequences (called multipliers in canonical form).

  1. The influence of American Society of Anesthesiologists Physical Status on patient morbidity and survival after total thyroidectomy.

    PubMed

    Shinohara, Shogo; Kikuchi, Masahiro; Harada, Hiroyuki; Takebayashi, Shinji; Yunoki, Kazuma; Yamazaki, Kazuo

    2016-11-30

    In cases of thyroid papillary carcinoma, a less aggressive cancer, surgeons may hesitate to perform total thyroidectomy on patients with poor general condition because these may experience longer survival without undergoing surgery. To investigate the influence of general patient condition on the patients' survival who received total thyroidectomy, we utilized the American Society of Anesthesiologists Physical Status (ASA-PS). We retrospectively reviewed all patients undergoing total thyroidectomy under general anesthesia and graded by ASA-PS between 2004 and 2014. Patients with anaplastic carcinoma and metastatic thyroid renal cell carcinoma were excluded. There were 77 (30%), 149 (58%), and 30 (12%) ASA-PS 1, 2, and 3 cases, respectively. Patient age increased significantly with increasing ASA-PS score (median age of 53, 64, and 71 years for ASA-PS 1, 2, and 3). Hospitalization periods extended significantly for patients with ASA-PS 3. Twenty patients died during the study (3.89 median years). Five-year overall survival rates were 100%, 93%, and 79% for ASA-PS 1, 2 and 3, respectively. Patients in the ASA-PS 1 group had significantly better prognosis by log-rank test. Univariate analysis showed an increased risk of death as ASA-PS score increased (hazard ratio: 3.03, 95% confidence interval: 1.55-5.92, p=0.00). In multivariate analysis, including patient age and presence of malignancy, patient age was the only significant predictor of overall survival (hazard ratio: 1.09 by year, 95% confidence interval: 1.03-1.14, p=0.00). We concluded that a high ASA-PS score should not inhibit performance of total thyroidectomy if a patient's age is suitable for the surgery.

  2. [Update on the morbidity of psychiatric disorders in patients with AIDS: results of a clinical follow-up].

    PubMed

    Crespo, M D; Ochoa, E; Vicente, N; Pérez de los Cobos, J; Morales, P

    1990-01-01

    A follow-up study after one or two years of treatment was carried out on 107 AIDS patients who were seen by the Consultation-Liaison Psychiatry Unit of the Ramon y Cajal Hospital. The sample was reduced to 52 patients (49%) mainly due to the lack of check-ups in 43% and to the death of 8% of the cases. 36% of patients suffered from Delirium or Dementia and these had the greater mortality rate. Grade IV patients and those with a diagnosis of Adjustment Disorders came to the check-ups most frequently.

  3. The Effect of Haemodialysis Access Types on Cardiac Performance and Morbidities in Patients with Symptomatic Heart Disease

    PubMed Central

    Chuang, Min-Kai; Chang, Chin-Hao; Chan, Chih-Yang

    2016-01-01

    Background Little is known about whether the arteriovenous type haemodialysis access affects cardiac function and whether it is still advantageous to the uremic patient with symptomatic heart disease. Methods We conducted a retrospective comparative study. Patients with heart disease and end-stage renal disease that had a new chronic access created between January 2007 and December 2008 and met the inclusion criteria were assessed. The endpoint was major adverse event (MAE)-free survivals of arteriovenous access (AVA) and tunneled cuffed double-lumen central venous catheter (CVC) groups. Whether accesses worsened heart failure was also evaluated. Results There were 43 CVC patients and 60 AVA patients. The median follow-up time from access creation was 27.6 months (IQR 34.7, 10.9~45.6). Although CVC patients were older than AVA patients (median age 78.0, IQR 14.0 vs. 67.5, IQR 16.0, respectively, p = .009), they manifested non-inferior MAE-free survival (mean 17.1, 95% CI 10.3~24.0 vs. 12.9, 95% CI 8.5~17.4 months in CVC and AVA patients, respectively, p = .290). During follow-up, more patients in the AVA group than in the CVC group deteriorated in heart failure status (35 of 57 vs. 10 of 42, respectively, odds ratio 5.1, p < .001). Preoperative-postoperative pairwise comparison of echocardiographic scans revealed an increased number of abnormal findings in the AVA group (Z = 3.91, p < .001), but not in the CVC group. Conclusions In patients with both symptomatic heart disease and end stage renal disease (ESRD), CVC patients showed non-inferior MAE-free survival in comparison to those in the AVA group. AV type access could deteriorate heart failure. Accordingly, uremic patients with symptomatic heart disease are not ideal candidates for AV type access creation. PMID:26848850

  4. CRP, but not TNF-α or IL-6, decreases after weight loss in patients with morbid obesity exposed to intensive weight reduction and balneological treatment*

    PubMed Central

    Rość, Danuta; Adamczyk, Przemysław; Boinska, Joanna; Szafkowski, Robert; Ponikowska, Irena; Stankowska, Katarzyna; Góralczyk, Barbara; Ruszkowska-Ciastek, Barbara

    2015-01-01

    Objective: The aim of this study was to evaluate the concentrations of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and the degree of homeostasis model assessment-insulin resistance (HOMA-IR) in patients with morbid obesity exposed to a three-week low-calorie diet and balneotherapy. Methods: The study included 33 patients (25 females and 8 males; mean age 46 years) with body mass index (BMI) values of >40 kg/m2. Evaluations of CRP, IL-6, TNF-α, lipid profile, HOMA-IR, and fasting glucose were carried out before (baseline data) and three weeks after the treatment. The control group consisted of 20 healthy volunteers (15 females and 5 males) with a mean age of 39 years and BMI values of ≤24.9 kg/m2. Results: In the blood of patients with morbid obesity we found significantly elevated levels of CRP, TNF-α, triglycerides, HOMA-IR and fasting glucose, but a decreased level of high density lipoprotein (HDL)-cholesterol, compared with the healthy individuals. The treatment resulted in about a 9.4% reduction in body weight from 122.5 to 111.0 kg and a significant decrease in the concentration of CRP, but no change in TNF-α or IL-6. HOMA-IR was significantly reduced. Conclusions: The decrease in CRP level without changes in TNF-α or IL-6 concentrations after the low-calorie diet and balneological treatment, suggests that an essential amount of adipose tissue must be removed before proper adipocyte function is restored. The decrease in HOMA-IR indicates an improvement in insulin sensitivity, which is beneficial in obese patients. PMID:25990058

  5. Radiotherapy for testicular seminoma stage I: treatment results and long-term post-irradiation morbidity in 365 patients

    SciTech Connect

    Fossa, S.D.A.; Aass, N.; Kaalhus, O.

    1989-02-01

    After infradiaphragmatic radiotherapy the cancer-related 10 year survival was 99% in 365 patients with seminoma Stage I referred to the Norwegian Radium Hospital between 1970 and 1982. Thirteen patients relapsed, 11 of them within the first 3 years after treatment. Nine of the recurrent patients were cured by radiotherapy alone (4) or in combination with chemotherapy (5). There is no need to include the inguinal lymph nodes into the irradiation field or to give scrotal irradiation, not even to patients with tumor infiltration beyond the testicular tissue, or to those with prior scrotal or inguinal surgery. At least 1 year after radiotherapy moderate or more severe dyspepsia was observed in 16 patients. Nine patients developed a peptic ulcer. In general, there was no increased risk for development of a second non-germ cell cancer after radiotherapy. However, 4 patients developed a pulmonary cancer indicating a border-line significance of increased risk for this type of malignancy. (p:0.05). In conclusion, infradiaphragmatic radiotherapy remains the optimal routine treatment in seminoma patients with Stage I.

  6. Impact of Increasing Age on Cause-Specific Mortality and Morbidity in Patients With Stage I Non-Small-Cell Lung Cancer: A Competing Risks Analysis.

    PubMed

    Eguchi, Takashi; Bains, Sarina; Lee, Ming-Ching; Tan, Kay See; Hristov, Boris; Buitrago, Daniel H; Bains, Manjit S; Downey, Robert J; Huang, James; Isbell, James M; Park, Bernard J; Rusch, Valerie W; Jones, David R; Adusumilli, Prasad S

    2017-01-20

    Purpose To perform competing risks analysis and determine short- and long-term cancer- and noncancer-specific mortality and morbidity in patients who had undergone resection for stage I non-small-cell lung cancer (NSCLC). Patients and Methods Of 5,371 consecutive patients who had undergone curative-intent resection of primary lung cancer at our institution (2000 to 2011), 2,186 with pathologic stage I NSCLC were included in the analysis. All preoperative clinical variables known to affect outcomes were included in the analysis, specifically, Charlson comorbidity index, predicted postoperative (ppo) diffusing capacity of the lung for carbon monoxide, and ppo forced expiratory volume in 1 second. Cause-specific mortality analysis was performed with competing risks analysis. Results Of 2,186 patients, 1,532 (70.1%) were ≥ 65 years of age, including 638 (29.2%) ≥ 75 years of age. In patients < 65, 65 to 74, and ≥ 75 years of age, 5-year lung cancer-specific cumulative incidence of death (CID) was 7.5%, 10.7%, and 13.2%, respectively (overall, 10.4%); noncancer-specific CID was 1.8%, 4.9%, and 9.0%, respectively (overall, 5.3%). In patients ≥ 65 years of age, for up to 2.5 years after resection, noncancer-specific CID was higher than lung cancer-specific CID; the higher noncancer-specific, early-phase mortality was enhanced in patients ≥ 75 years of age than in those 65 to 74 years of age. Multivariable analysis showed that low ppo diffusing capacity of lung for carbon monoxide was an independent predictor of severe morbidity ( P < .001), 1-year mortality ( P < .001), and noncancer-specific mortality ( P < .001), whereas low ppo forced expiratory volume in 1 second was an independent predictor of lung cancer-specific mortality ( P = .002). Conclusion In patients who undergo curative-intent resection of stage I NSCLC, noncancer-specific mortality is a significant competing event, with an increasing impact as patient age increases.

  7. Childhood Respiratory Morbidity after Late Preterm and Early Term Delivery: a Study of Medicaid Patients in South Carolina

    PubMed Central

    Odibo, Imelda N.; Mac Bird, T.; McKelvey, Samantha S.; Sandlin, Adam; Lowery, Curtis; Magann, E. F.

    2017-01-01

    Background There is a growing body of research documenting an increased risk of neonatal morbidity for late preterm infants (LPI, 340/7 weeks to 366/7 weeks) and early term infants (ETI, 370/7 weeks to 386/7 weeks) compared with term infants (TI, 390/7 to 416/7); however, there has been little research on outcomes beyond the first year of life. In this study, we examined respiratory outcomes of LPI and ETI in early childhood. Methods South Carolina Medicaid claims data for maternal delivery and infant birth hospitalisations were linked to vital records data for the years 2000 through 2003. Medicaid claims for all infants were then followed until their fifth birthday or until a break in their eligibility. Infants born between 340/7 and 416/7 weeks were eligible. Infants with congenital anomaly, birthweight below 500 g or above 6000 g, and multiple births were excluded. We fit Cox proportional hazard models from which adjusted hazard ratio (HR) and 95% confidence interval (CI) were derived. Results A total of 3476 LPI, 12 398 ETI, and 25 975 term infants were included. Both LPI and ETI were associated with an increased risk for asthma (LPI: HR 1.24, 95% CI 1.10, 1.40; ETI: HR 1.12, 95% CI 1.06, 1.19), and bronchitis (LPI: HR 1.15, 95% CI 1.00, 1.34; ETI: HR 1.13, 95% CI 1.05, 1.2) at 3 to 5 years of age. Conclusions Late preterm infants and early term infants are at increased risk for asthma and bronchitis. PMID:26480292

  8. The TeleGuard trial of additional telemedicine care in CAD patients. 2 Morbidity and mortality after 12 months.

    PubMed

    Waldmann, Annika; Katalinic, Alexander; Schwaab, Bernhard; Richardt, Gert; Sheikhzadeh, Abdolhamid; Raspe, Heiner

    2008-01-01

    In the TeleGuard trial, 1500 patients with established coronary artery disease (CAD) were recruited and randomized to control or intervention groups. Patients in the intervention group were equipped with a 12-lead event recorder and could contact a call centre and transmit an ECG whenever they wished. In a 12-month study, the composite endpoint (all-cause mortality, myocardial infarction, re-hospitalization or re-vascularization) was seen in 40% of the intervention patients and in 38% of the control patients. In both groups, approximately 40% were re-hospitalized. In total, 73 patients experienced re-vascularization, 75 showed an infarction and 33 died. Equipping CAD patients with a 12-lead ECG device and providing a telemedicine centre with 24-hour availability did not decrease risk for the composite endpoint (re-hospitalization, re-vascularization, (subsequent) myocardial infarction and/or death). It is likely that the clinical pathway used in the telemedicine centre led to an increased hospital admission rate in the intervention group.

  9. Adjunctive aripiprazole therapy with escitalopram in patients with co-morbid major depressive disorder and alcohol dependence: Clinical and neuroimaging evidence

    PubMed Central

    Han, Doug Hyun; Kim, Sun Mi; Choi, Jung Eun; Min, Kyung Joon; Renshaw, Perry F.

    2015-01-01

    The effective treatment of depression has been reported to reduce the severity of alcohol use, potentially reflecting improvements in common brain reward circuits. We hypothesized that augmentation therapy of escitalopram with aripiprazole would improve depressive symptoms as well as reduce craving for alcohol and cue-induced brain activity in patients with co-morbid alcohol dependence and major depressive disorder, compared with treatment with escitalopram alone. Thirty-five subjects with major depressive disorder and alcohol dependence were recruited and randomly assigned into 17 aripiprazole + escitalopram and 18 escitalopram only groups. At baseline and following six weeks of treatment, symptoms of depression, craving for alcohol and brain activity were evaluated. During the six week treatment period, Beck Depression Inventory and clinical global index-severity (CGI-S) scores decreased in both the aripiprazole + escitalopram and escitalopram only groups. In addition, following the treatment period, the Korean alcohol urge questionnaire scores in the aripiprazole + escitalopram group were reduced from 23.3±8.4 to 14.3±4.9, compared with those of the escitalopram group of from 21.6±8.4 to 19.3±7.1 (F=13.1, p<0.01). The activity within the anterior cingulate was increased in response to the presentation of alcohol drinking scenes following treatment in the aripiprazole + escitalopram group. The change of brain activity within the left anterior cingulate gyrus in all patients with co-morbid alcohol dependence and major depressive disorder was negatively correlated with the change in craving for alcohol. These findings suggest that the effects of aripiprazole on anterior cingulate cortex might mediate the successful treatment of alcohol dependence in patients with major depressive disorder. PMID:23325372

  10. Adjunctive aripiprazole therapy with escitalopram in patients with co-morbid major depressive disorder and alcohol dependence: clinical and neuroimaging evidence.

    PubMed

    Han, Doug Hyun; Kim, Sun Mi; Choi, Jung Eun; Min, Kyung Joon; Renshaw, Perry F

    2013-03-01

    The effective treatment of depression has been reported to reduce the severity of alcohol use, potentially reflecting improvements in common brain reward circuits. We hypothesized that augmentation therapy of escitalopram with aripiprazole would improve depressive symptoms as well as reduce craving for alcohol and cue-induced brain activity in patients with co-morbid alcohol dependence and major depressive disorder, compared with treatment with escitalopram alone. Thirty-five subjects with major depressive disorder and alcohol dependence were recruited and randomly assigned into 17 aripiprazole + escitalopram and 18 escitalopram only groups. At baseline and following six weeks of treatment, symptoms of depression, craving for alcohol and brain activity were evaluated. During the six week treatment period, Beck Depression Inventory and clinical global index-severity (CGI-S) scores decreased in both the aripiprazole + escitalopram and escitalopram only groups. In addition, following the treatment period, the Korean alcohol urge questionnaire scores in the aripiprazole + escitalopram group were reduced from 23.3±8.4 to 14.3±4.9, compared with those of the escitalopram group of from 21.6±8.4 to 19.3±7.1 (F=13.1, p<0.01). The activity within the anterior cingulate was increased in response to the presentation of alcohol drinking scenes following treatment in the aripiprazole + escitalopram group. The change of brain activity within the left anterior cingulate gyrus in all patients with co-morbid alcohol dependence and major depressive disorder was negatively correlated with the change in craving for alcohol. These findings suggest that the effects of aripiprazole on anterior cingulate cortex might mediate the successful treatment of alcohol dependence in patients with major depressive disorder.

  11. Social determinants and maternal exposure to intimate partner violence of obstetric patients with severe maternal morbidity in the intensive care unit: a systematic review protocol

    PubMed Central

    Ayala Quintanilla, Beatriz Paulina; Taft, Angela; McDonald, Susan; Pollock, Wendy; Roque Henriquez, Joel Christian

    2016-01-01

    Introduction Maternal mortality is a potentially preventable public health issue. Maternal morbidity is increasingly of interest to aid the reduction of maternal mortality. Obstetric patients admitted to the intensive care unit (ICU) are an important part of the global burden of maternal morbidity. Social determinants influence health outcomes of pregnant women. Additionally, intimate partner violence has a great negative impact on women's health and pregnancy outcome. However, little is known about the contextual and social aspects of obstetric patients treated in the ICU. This study aimed to conduct a systematic review of the social determinants and exposure to intimate partner violence of obstetric patients admitted to an ICU. Methods and analysis A systematic search will be conducted in MEDLINE, CINAHL, ProQuest, LILACS and SciELO from 2000 to 2016. Studies published in English and Spanish will be identified in relation to data reporting on social determinants of health and/or exposure to intimate partner violence of obstetric women, treated in the ICU during pregnancy, childbirth or within 42 days of the end of pregnancy. Two reviewers will independently screen for study eligibility and data extraction. Risk of bias and assessment of the quality of the included studies will be performed by using the Critical Appraisal Skills Programme (CASP) checklist. Data will be analysed and summarised using a narrative description of the available evidence across studies. This systematic review protocol will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. Ethics and dissemination Since this systematic review will be based on published studies, ethical approval is not required. Findings will be presented at La Trobe University, in Conferences and Congresses, and published in a peer-reviewed journal. Trial registration number CRD42016037492. PMID:27895065

  12. Unexpectedly Higher Morbidity and Mortality of Hospitalized Elderly Patients Associated with Rhinovirus Compared with Influenza Virus Respiratory Tract Infection

    PubMed Central

    Hung, Ivan F. N.; Zhang, Anna Jinxia; To, Kelvin K. W.; Chan, Jasper F. W.; Zhu, Shawn H. S.; Zhang, Ricky; Chan, Tuen-Ching; Chan, Kwok-Hung; Yuen, Kwok-Yung

    2017-01-01

    Rhinovirus is a common cause of upper and lower respiratory tract infections in adults, especially among the elderly and immunocompromised. Nevertheless, its clinical characteristics and mortality risks have not been well described. A retrospective analysis on a prospective cohort was conducted in a single teaching hospital center over a one-year period. We compared adult patients hospitalized for pneumonia caused by rhinovirus infection with those hospitalized for influenza infection during the same period. All recruited patients were followed up for at least 3 months up to 15 months. Independent risk factors associated with mortality for rhinovirus infection were identified. Between 1 March 2014 and 28 February 2015, a total of 1946 patients were consecutively included for analysis. Of these, 728 patients were hospitalized for rhinovirus infection and 1218 patients were hospitalized for influenza infection. Significantly more rhinovirus patients were elderly home residents and had chronic lung diseases (p < 0.001), whereas more influenza patients had previous stroke (p = 0.02); otherwise, there were no differences in the Charlson comorbidity indexes between the two groups. More patients in the rhinovirus group developed pneumonia complications (p = 0.03), required oxygen therapy, and had a longer hospitalization period (p < 0.001), whereas more patients in the influenza virus group presented with fever (p < 0.001) and upper respiratory tract symptoms of cough and sore throat (p < 0.001), and developed cardiovascular complications (p < 0.001). The 30-day (p < 0.05), 90-day (p < 0.01), and 1-year (p < 0.01) mortality rate was significantly higher in the rhinovirus group than the influenza virus group. Intensive care unit admission (odds ratio (OR): 9.56; 95% confidence interval (C.I.) 2.17–42.18), elderly home residents (OR: 2.60; 95% C.I. 1.56–4.33), requirement of oxygen therapy during hospitalization (OR: 2.62; 95% C.I. 1.62–4.24), and hemoglobin level <13

  13. Prospective randomized clinical trial of laparoscopic sleeve gastrectomy versus open Roux-en-Y gastric bypass for the management of patients with morbid obesity

    PubMed Central

    Kalinowski, Piotr; Wróblewski, Tadeusz; Bartoszewicz, Zbigniew; Białobrzeska-Paluszkiewicz, Janina; Ziarkiewicz-Wróblewska, Bogna; Remiszewski, Piotr; Grodzicki, Mariusz; Krawczyk, Marek

    2012-01-01

    Introduction Roux-en-Y gastric bypass (RYGB) is considered the gold standard bariatric procedure with documented safety and effectiveness. Laparoscopic sleeve gastrectomy (LSG) is a newer procedure being done with increasing frequency. Randomized comparisons of LSG and other bariatric procedures are limited. We present the results of the first prospective randomized trial comparing LSG and RYGB in the Polish population. Aim To assess the efficacy and safety of LSG versus RYGB in the treatment of morbid obesity and obesity-related comorbidities. Material and methods Seventy-two morbidly obese patients were randomized to RYGB (36 patients) or LSG (36 patients). Both groups were comparable regarding age, gender, body mass index (BMI) and comorbidities. The follow-up period was at least 12 months. Baseline and 6 and 12 month outcomes were analyzed including assessment of percent excess weight lost (%EWL), reduction in BMI, morbidity (minor, major, early and late complications), mortality, reoperations, comorbidities and nutritional deficiencies. Results There was no 30-day mortality and no significant difference in major complication rate (0% after RYGB and 8.3% after LSG, p > 0.05) or minor complication rate (16.6% after RYGB and 10.1% after LSG, p > 0.05). There were no early reoperations after RYGB and 2 after LSG (5.5%) (p > 0.05). Weight loss was significant after RYGB and LSG but there was no difference between both groups at 6 and 12 months of follow-up. At 12 months %EWL in RYGB and LSG groups reached 64.2% and 67.6% respectively (p > 0.05). There was no significant difference in the overall prevalence of comorbidities and nutritional deficiencies. Conclusions Both LSG and RYGB produce significant weight loss at 6 and 12 months after surgery. The procedures are equally effective with regard to %EWL, reduction in BMI and amelioration of comorbidities at 6 and 12 months of follow-up. Laparoscopic sleeve gastrectomy and RYGB are comparably safe techniques with no

  14. Age, Neurological Status MRC Scale, and Postoperative Morbidity are Prognostic Factors in Patients with Glioblastoma Treated by Chemoradiotherapy

    PubMed Central

    Verlut, Clotilde; Mouillet, Guillaume; Magnin, Eloi; Buffet-Miny, Joëlle; Viennet, Gabriel; Cattin, Françoise; Billon-Grand, Nora Clelia; Bonnet, Emilie; Servagi-Vernat, Stéphanie; Godard, Joël; Billon-Grand, Romain; Petit, Antoine; Moulin, Thierry; Cals, Laurent; Pivot, Xavier; Curtit, Elsa

    2016-01-01

    INTRODUCTION Temozolomide and concomitant radiotherapy followed by temozolomide has been used as a standard therapy for the treatment of newly diagnosed glioblastoma multiform since 2005. A search for prognostic factors was conducted in patients with glioblastoma routinely treated by this strategy in our institution. METHODS This retrospective study included all patients with histologically proven glioblastoma diagnosed between June 1, 2005, and January 1, 2012, in the Franche-Comté region and treated by radiotherapy (daily fractions of 2 Gy for a total of 60 Gy) combined with temozolomide at a dose of 75 mg/m2 per day, followed by six cycles of maintenance temozolomide (150–200 mg/m2, five consecutive days per month). The primary aim was to identify prognostic factors associated with overall survival (OS) in this cohort of patients. RESULTS One hundred three patients were included in this study. The median age was 64 years. The median OS was 13.7 months (95% confidence interval, 12.5–15.9 months). In multivariate analysis, age over 65 years (hazard ratio [HR] = 1.88; P = 0.01), Medical Research Council (MRC) scale 3–4 (HR = 1.62; P = 0.038), and occurrence of postoperative complications (HR = 2.15; P = 0.028) were associated with unfavorable OS. CONCLUSIONS This study identified three prognostic factors in patients with glioblastoma eligible to the standard chemotherapy and radiotherapy treatment. Age over 65 years, MRC scale 3–4, and occurrence of postoperative complications were associated with unfavorable OS. A simple clinical evaluation including these three factors enables to estimate the patient prognosis. MRC neurological scale could be a useful, quick, and simple measure to assess neurological status in glioblastoma patients. PMID:27559302

  15. The addition of cyclophosphamide to lenalidomide and dexamethasone in multiply relapsed/refractory myeloma patients; a phase I/II study.

    PubMed

    Schey, Stephen A; Morgan, Gareth J; Ramasamy, Karthik; Hazel, Beth; Ladon, Dariusz; Corderoy, Sophie; Jenner, Matthew; Phekoo, Karen; Boyd, Kevin; Davies, Faith E

    2010-08-01

    We report the results of a Phase I/II dose escalation study to determine the maximum tolerated dose (MTD) of cyclophosphamide when combined with lenalidomide and dexamethasone in relapsed/refractory myeloma. Thirty-one patients were enrolled in cohorts of 3, at five dose levels of cyclophosphamide to a maximum of 700 mg on days 1 and 8 of a 28-d cycle. Patients received lenalidomide 25 mg days 1-21 and dexamethasone 20 mg orally days 1-4 and 8-11. The MTD was 600 mg cyclophosphamide, days 1 and 8. Grade 3/4 haematological complications occurred in 26% of patients, grade 3/4 infection in 3% (both at 700 mg cyclophosphamide), with thromboembolic complications in 6% of patients. Overall complete response (CR) rate was 29%, very good partial response rate 7% and partial response rate 45% giving an overall response rate of 81%. After 21 months median follow-up, projected 2-year progression-free survival was 56%, with 80% overall survival at 30 months. Ten further patients were treated at MTD with a 40% CR rate. No dose reductions for any study drugs or deaths occurred during cycles 1-9. Lenalidomide, cyclophosphamide and dexamethasone is a safe, effective combination in relapsed myeloma inducing a high response rate, warranting further investigation in phase III trials.

  16. Factors affecting morbidity, mortality and survival in patients undergoing surgery for rectal cancer in a district general hospital.

    PubMed Central

    Macadam, Robert; Yeomans, Neil; Wilson, Jonathan; Case, William; White, Clive; Lovegrove, John; Lyndon, Philip

    2005-01-01

    INTRODUCTION: This is a review of elective rectal cancer surgery during 1993-1999 at a single district general hospital to investigate the variables that affected the care of these patients. PATIENTS AND METHODS: A retrospective study of patients presenting with rectal adenocarcinoma to a district general hospital where total mesorectal excision was practiced over a 7-year period was performed to identify factors associated with complications, death and disease recurrence. RESULTS: Sixty-one patients developed a total of 89 complications and 30-day mortality was 8.3%. Overall, 81% of all resections and 86% of potentially curative resections were free of tumour at the circumferential resection margin. A positive circumferential resection margin and 30-day mortality were both associated with increased postoperative blood transfusion volume. Twenty-nine recurrences were detected during the follow-up period (mean, 21.7 months) and circumferential margin involvement by tumour, Dukes' stage, pre-operative functional status (ASA grade) and length of hospital stay correlated with disease-free survival. CONCLUSIONS: Surgical outcomes in lower volume hospitals are comparable with those reported by larger centres. PMID:16176691

  17. Morbidity and impact on quality of life in patients with indwelling ureteral stents: A 10-year clinical experience

    PubMed Central

    Scarneciu, Ioan; Lupu, Sorin; Pricop, Catalin; Scarneciu, Camelia

    2015-01-01

    Objective: Prospective analysis of the prevalence of symptoms, tolerability and complications associated with ureteral stents and their impact on quality of life based on the Flanagan Quality of Life Scale and a not-validated questionnaire from our clinic. Methods: A total of 2200 adult patient participated to this study in a period of 10 years (2003-2012). Those patients were asked to complete the QOLS and a not-validated questionnaire from our clinic, before ureteral indwelling, 7 day after ureteral indwelling and 14 days after removal of the stent. Results: Total 1520 patient aged between 18 and 84 years completed the study. The analysis of data showed that the unpleasant symptoms caused by stent were encountered more frequently at 7 days after stent insertion, in terms of urinary frequency, dysuria, urgency and macroscopic haematuria, this difference being statistically significant (p<0.05). After analysis the responses to QOLS questionnaire, at 7 days after stent placement, mean scores show a clear reduction in the QoL of those patients, in all cases the standard deviation being at a great value, indicating a high variability of responses, but at 14 days after its suppression of stent the average scores are somewhat closer to the baseline. Conclusions: Our study brings many elements that shows a statistically significant increase in the incidence of numerous side effects and impaired quality of life. It contributes to existing data from the literature as regards the knowledge of the pathology determined by the presence of foreign body in the urinary tract and in providing patient counseling. PMID:26150836

  18. Web-based cognitive behavioural therapy (W-CBT) for diabetes patients with co-morbid depression: Design of a randomised controlled trial

    PubMed Central

    van Bastelaar, Kim MP; Pouwer, Frans; Cuijpers, Pim; Twisk, Jos WR; Snoek, Frank J

    2008-01-01

    Background Depression is common among people with diabetes, negatively affecting quality of life, treatment adherence and diabetes outcomes. In routine clinical care, diabetes patients have limited access to mental health services and depression therefore often remains untreated. Web-based therapy could potentially be an effective way to improve the reach of psychological care for diabetes patients, at relatively low costs. This study seeks to test the effectiveness of a web-based self-help depression programme for people with diabetes and co-morbid depression. Methods/Design The effectiveness of a web-based self-help course for adults with diabetes with co-morbid depression will be tested in a randomised trial, using a wait-list controlled design. The intervention consists of an 8-week, moderated self-help course that is tailored to the needs of persons living with diabetes and is offered on an individual basis. Participants receive feedback on their homework assignments by e-mail from their coach. We aim to include 286 patients (143/143), as power analyses showed that this number is needed to detect an effect size of 0.35, with measurements at baseline, directly after completing the web-based intervention and at 1, 3, 4 and 6 months follow-up. Patients in the control condition are placed on a waiting list, and follow the course 12 weeks after randomisation. Primary outcomes are depressive symptoms and diabetes-specific emotional distress. Secondary outcomes are satisfaction with the course, perceived health status, self-care behaviours, glycaemic control, and days in bed/absence from work. Questionnaires are administered via the Internet. Discussion The intervention being trialled is expected to help improve mood and reduce diabetes-specific emotional distress in diabetes patients with depression, with subsequent beneficial effects on diabetes self-care and glycaemic outcomes. When proven efficacious, the intervention could be disseminated to reach large groups

  19. [Study of morbidity in patients hospitalized at the Clinic Hospital at the Medical School of the USP-1989].

    PubMed

    Lebrão, M L; Litvoc, J; Figueiredo, G M; Leite, R M

    1993-01-01

    The diagnostic categories of the patients discharged from the "Hospital das Clínicas" of the University of São Paulo in 1989 were arranged according the International Classification of Diseases (I.C.D.) and analysed. In each Group sex, age and the reason of discharge or death was indicated. The data concerning 39,601 cases were provided by the Medical Data Service of the "Instituto Central" of the "Hospital das Clínicas". Only the principal diagnosis was taken into account. In the "Instituto de Psiquiatria" most the patients (55.4%) were males between 20 and 49 years of age. The main diagnostic categories were affective psychoses (20.3%), schizophrenic disorders (15%), and disorders related to alcoholism (9.5%). The mortality rate was 0.27%. In the "Instituto da Criança" 56% of the patients that left the hospital were male children and 45.8% of them were less than one year old. Regarding to the diagnostic categories the most important one was that of the diseases of the respiratory system with 27.1% of cases, followed by that of infectious and parasitic diseases with 16.0% of cases. Within the respiratory diseases the most important were the pneumonias caused by not specified microorganisms, and within the infectious diseases the most important was the diarrhea of presumably infectious origin. The mortality rate in this Institute was 9.4%. The "Instituto de Ortopedia e Traumatologia" left 3,825 patients 61.7% males, and 46.9% of them were aged between 20 and 49 years. The greatest number of cases (57.1%) belonged to the Chapter "Injury and Poisoning" followed by that of "Diseases of the Muscoleskeletal System" and Connective Tissue Diseases (23.5%). In this Institute the mortality rate was 1.2%. From the "Instituto do Coração" 7,194 patients were discharged; 65% of them were males, varying their age between 50 and 69 years. The diseases of the circulatory system were mostly ischemic heart disease, miocardiopathies and rheumatic heart diseases. Mortality rate

  20. A Multidisciplinary Clinical Pathway Decreases Rib Fracture-Associated Infectious Morbidity and Mortality in High-Risk Trauma Patients

    DTIC Science & Technology

    2006-01-01

    monitored bed (Surgical Intermediate Care Unit or Shock Trauma Intensive Care Unit) where they received patient-controlled analgesia and incentive ...cough. Pain was assessed during incentive spirometry or coughing using a visual analogue scale (score from 1 to 10) with failure being a score...greater thann 6. Inspiratory volume was determined using the in- centive spirometer . A volume less than 15 mL/kg was con- sidered failure [14]. For the

  1. Morbidly adherent placenta.

    PubMed

    Abuhamad, Alfred

    2013-10-01

    Morbidly adherent placenta, which describes placenta accreta, increta, and percreta, implies an abnormal implantation of the placenta into the uterine wall. The incidence of placenta accreta has increased significantly over the past several decades, with the main risk factors include prior cesarean section and placental previa. Sonographic markers of placenta accreta can be present as early as the first trimester and include a low uterine implantation of a gestational sac, multiple vascular lacunae within the placenta, loss of the normal hypoechoic retroplacental zone, and abnormality of the uterine serosa-bladder interface, among others. Ultrasound has high sensitivity and specificity for the diagnosis of placenta accreta and MRI should be reserved for rare cases in which the ultrasound is non-diagnostic. The optimum time for planned delivery for a patient with placenta accreta is around 34-35 weeks following a course of corticosteroid injection. The successful management of placenta accreta includes a multidisciplinary care team approach with the successful management relying heavily on the prenatal diagnosis of this entity and preparing for the surgical management in a multidisciplinary approach by assuring the most skilled team is available for those patients.

  2. Predictors of Health-Related Quality of Life in Patients with Co-Morbid Diabetes and Chronic Kidney Disease

    PubMed Central

    Lo, Clement; Ranasinha, Sanjeeva; Gallagher, Martin; Fulcher, Gregory; Kerr, Peter G.; Russell, Grant; Teede, Helena; Usherwood, Tim; Walker, Rowan; Zoungas, Sophia

    2016-01-01

    Background People living with diabetes and chronic kidney disease (CKD) experience compromised quality of life. Consequently, it is critical to identify and understand factors influencing their health-related quality of life (HRQoL). This study examined factors associated with HRQoL among patients with diabetes and CKD. Methods A cross sectional study among adults with comorbid diabetes and CKD (eGFR <60 mL/min/1.73m2) recruited from renal and diabetes clinics of four large tertiary referral hospitals in Australia was performed. Each participant completed the Kidney Disease Quality of Life (KDQoL ™ -36) questionnaire, which is comprised of two composite measures of physical and mental health and 3 kidney disease specific subscales with possible scores ranging from 0 to 100 with higher values indicating better HRQoL. Demographic and clinical data were also collected. Regression analyses were performed to determine the relationship between HRQoL and potential predictor factors. Results A total of 308 patients were studied with a mean age of 66.9 (SD = 11.0) years and 70% were males. Mean scores for the physical composite summary, mental composite summary, symptom/problem list, effects of kidney disease and burden of kidney disease scales were 35.2, 47.0, 73.8, 72.5 and 59.8 respectively. Younger age was associated with lower scores in all subscales except for the physical composite summary. Female gender, obese or normal weight rather than overweight, and smoking were all associated with lower scores in one or more subscales. Scores were progressively lower with more advanced stage of CKD (p<0.05) in all subscales except for the mental composite summary. Conclusion In patients with diabetes and CKD, younger age was associated with lower scores in all HRQoL subscales except the physical composite summary and female gender, obese or normal weight and more advanced stages of CKD were associated with lower scores in one or more subscales. Identifying these factors will

  3. A CMOS floating point multiplier

    NASA Astrophysics Data System (ADS)

    Uya, M.; Kaneko, K.; Yasui, J.

    1984-10-01

    This paper describes a 32-bit CMOS floating point multiplier. The chip can perform 32-bit floating point multiplication (based on the proposed IEEE Standard format) and 24-bit fixed point multiplication (two's complement format) in less than 78.7 and 71.1 ns, respectively, and the typical power dissipation is 195 mW at 10 million operations per second. High-speed multiplication techniques - a modified Booth's allgorithm, a carry save adder scheme, a high-speed CMOS full adder, and a modified carry select adder - are used to achieve the above high performance. The chip is designed for compatibility with 16-bit microcomputer systems, and is fabricated in 2 micron n-well CMOS technology; it contains about 23000 transistors of 5.75 x 5.67 sq mm in size.

  4. Evaluation of Transient Elastography, Acoustic Radiation Force Impulse Imaging (ARFI), and Enhanced Liver Function (ELF) Score for Detection of Fibrosis in Morbidly Obese Patients

    PubMed Central

    Karlas, Thomas; Dietrich, Arne; Peter, Veronica; Wittekind, Christian; Lichtinghagen, Ralf; Garnov, Nikita; Linder, Nicolas; Schaudinn, Alexander; Busse, Harald; Prettin, Christiane; Keim, Volker; Tröltzsch, Michael; Schütz, Tatjana; Wiegand, Johannes

    2015-01-01

    Background Liver fibrosis induced by non-alcoholic fatty liver disease causes peri-interventional complications in morbidly obese patients. We determined the performance of transient elastography (TE), acoustic radiation force impulse (ARFI) imaging, and enhanced liver fibrosis (ELF) score for fibrosis detection in bariatric patients. Patients and Methods 41 patients (median BMI 47 kg/m2) underwent 14-day low-energy diets to improve conditions prior to bariatric surgery (day 0). TE (M and XL probe), ARFI, and ELF score were performed on days -15 and -1 and compared with intraoperative liver biopsies (NAS staging). Results Valid TE and ARFI results at day -15 and -1 were obtained in 49%/88% and 51%/90% of cases, respectively. High skin-to-liver-capsule distances correlated with invalid TE measurements. Fibrosis of liver biopsies was staged as F1 and F3 in n = 40 and n = 1 individuals. However, variations (median/range at d-15/-1) of TE (4.6/2.6–75 and 6.7/2.9–21.3 kPa) and ARFI (2.1/0.7–3.7 and 2.0/0.7–3.8 m/s) were high and associated with overestimation of fibrosis. The ELF score correctly classified 87.5% of patients. Conclusion In bariatric patients, performance of TE and ARFI was poor and did not improve after weight loss. The ELF score correctly classified the majority of cases and should be further evaluated. PMID:26528818

  5. Morbidity, beta S haplotype and alpha-globin gene patterns among sickle cell anemia patients in Kuwait.

    PubMed

    Adekile, A D; Haider, M Z

    1996-01-01

    Admission records of children with sickle cell anemia (SS), in the two main teaching hospitals in Kuwait, were reviewed for a 1-year period. The haplotypes of 92 beta s chromosomes (from 39 SS, 11 AS, 2 S beta-thalassemia [S beta-thal] and 1 SD individuals) were determined using an allele-specific oligonucleotide (ASO) hybridization technique, while the alpha-globin gene status of 27 SS and 33 AS individuals, i.e. 120 chromosomes, was determined with a combination of polymerase chain reaction and AS techniques. A vasooclusive crisis was the most common (60.0%) cause of hospitalization, followed by infections (20%). Hospital admissions were most common during the hottest month of the year (July). Few complications of the disease were seen among patients on follow-up; however, splenomegaly was present in 24.0%, hepatomegaly in 15.2%, gallstones in 15.2% and aseptic necrosis of the femoral head in 6.1%. Haplotype 31 (Saudi Arabia/India) is the most frequent in this community, being present in 80.4% of the chromosomes tested; Benin haplotype 19 was found in 12.0% and Bantu haplotype 20 in 6.5%. Hb F in the haplotype 31 homozygotes and heterozygotes ranged from 11.4 to 35.1% (mean 22.5 +/- 5.2%). The frequency of alpha-thal determinants in the study was 40.0%, the commonest being the -alpha 3.7-kb deletion (27.5%), the alpha 2 polyadenylation signal (AATAAA-> AATAAG) mutation (10.2%) and the IVS-I 5' end GAGGT-GAGG->GAGG pentanucleotide (5 nt) deletion (3.3%). SS patients with coexistent alpha-thal trait did not have severe recurrent infections and none had gallstones. The high frequencies of the Saudi Arabia/India beta s haplotype and alpha-thalassemia trait contribute to the mild nature of SS disease among Kuwaiti Arabs comparable to that in eastern Saudi Arabia.

  6. Correlates of asthma morbidity in primary care.

    PubMed Central

    Jones, K. P.; Bain, D. J.; Middleton, M.; Mullee, M. A.

    1992-01-01

    OBJECTIVES--To explore the morbidity of patients diagnosed as asthmatic in general practice, to examine the determinants of this morbidity, and to derive a simple morbidity screening tool for use in primary care. DESIGN--Patient interviews, lung function measurements, and data extraction from general practice case notes. SUBJECTS--300 asthmatic patients aged 5 to 65 years randomly selected from the repeat prescribing registers of three general practices in the Southampton area. MAIN OUTCOME MEASURES--Reported morbidity using a calculated index based on three questions (Are you in a wheezy or asthmatic condition at least once per week; Have you had time off work or school in the past year because of your asthma; Do you suffer from attacks of wheezing during the night?); mean forced expiratory volume in one second and mean peak expiratory flow (over a seven day period); diurnal variation in peak flow; and the relation of the morbidity index to lung function. RESULTS--Mean forced expiratory volume in one second was 67% predicted (SD 18.4), mean peak expiratory flow was 80% predicted (SD 18.9), and mean diurnal variation was 10% (SD 7.7). 76 subjects were classified as having low morbidity, 95 medium, and 125 high. The morbidity index was significantly associated with forced expiratory volume in one second, mean peak expiratory flow rate, and diurnal variation (p less than 0.05); it was not significantly associated with inhaler technique or use of prophylaxis. CONCLUSIONS--There was a large burden of persisting morbidity across all ages of patients diagnosed as asthmatic in the three well resourced practices studied. The use of the morbidity index may help to target the asthmatic patients needing more attention by concentrating on those reporting medium to high morbidity. PMID:1540736

  7. Inverse regulation of inflammation and mitochondrial function in adipose tissue defines extreme insulin sensitivity in morbidly obese patients.

    PubMed

    Qatanani, Mohammed; Tan, Yejun; Dobrin, Radu; Greenawalt, Danielle M; Hu, Guanghui; Zhao, Wenqing; Olefsky, Jerrold M; Sears, Dorothy D; Kaplan, Lee M; Kemp, Daniel M

    2013-03-01

    Obesity is associated with insulin resistance, a major risk factor for type 2 diabetes and cardiovascular disease. However, not all obese individuals are insulin resistant, which confounds our understanding of the mechanistic link between these conditions. We conducted transcriptome analyses on 835 obese subjects with mean BMI of 48.8, on which we have previously reported genetic associations of gene expression. Here, we selected ~320 nondiabetic (HbA(1c) <7.0) subjects and further stratified the cohort into insulin-resistant versus insulin-sensitive subgroups based on homeostasis model assessment-insulin resistance. An unsupervised informatics analysis revealed that immune response and inflammation-related genes were significantly downregulated in the omental adipose tissue of obese individuals with extreme insulin sensitivity and, to a much lesser extent, in subcutaneous adipose tissue. In contrast, genes related to β-oxidation and the citric acid cycle were relatively overexpressed in adipose of insulin-sensitive patients. These observations were verified by querying an independent cohort of our published dataset of 37 subjects whose subcutaneous adipose tissue was sampled before and after treatment with thiazolidinediones. Whereas the immune response and inflammation pathway genes were downregulated by thiazolidinedione treatment, β-oxidation and citric acid cycle genes were upregulated. This work highlights the critical role that omental adipose inflammatory pathways might play in the pathophysiology of insulin resistance, independent of body weight.

  8. Treatment for morbid obesity

    PubMed Central

    Carmichael, A

    1999-01-01

    There is no single unifying theory to explain the aetiology of obesity but several environmental factors, such as decreased physical activity and increased fat intake may contribute to its development in genetically predisposed individuals. Dietary and pharmacological treatments of morbid obesity have been proven to be unsuccessful. Modern surgical treatments have been shown to be effective in achieving significant weight loss with consequent reduction in morbidity. Despite the fact that surgical treatment of morbid obesity is the only therapeutic form that has stood the test of time, it still remains a crisis-driven form of therapy in the UK. It is probable that a better understanding of the aetiology and physiology of obesity may lead to the development of an effective pharmacological treatment of obesity in the future. However, until then, surgical treatment of morbid obesity should be considered as an effective and efficient way of treatment in selected cases.


Keywords: obesity PMID:10396579

  9. Keynesian multiplier versus velocity of money

    NASA Astrophysics Data System (ADS)

    Wang, Yougui; Xu, Yan; Liu, Li

    2010-08-01

    In this paper we present the relation between Keynesian multiplier and the velocity of money circulation in a money exchange model. For this purpose we modify the original exchange model by constructing the interrelation between income and expenditure. The random exchange yields an agent's income, which along with the amount of money he processed determines his expenditure. In this interactive process, both the circulation of money and Keynesian multiplier effect can be formulated. The equilibrium values of Keynesian multiplier are demonstrated to be closely related to the velocity of money. Thus the impacts of macroeconomic policies on aggregate income can be understood by concentrating solely on the variations of money circulation.

  10. Serial multiplier arrays for parallel computation

    NASA Technical Reports Server (NTRS)

    Winters, Kel

    1990-01-01

    Arrays of systolic serial-parallel multiplier elements are proposed as an alternative to conventional SIMD mesh serial adder arrays for applications that are multiplication intensive and require few stored operands. The design and operation of a number of multiplier and array configurations featuring locality of connection, modularity, and regularity of structure are discussed. A design methodology combining top-down and bottom-up techniques is described to facilitate development of custom high-performance CMOS multiplier element arrays as well as rapid synthesis of simulation models and semicustom prototype CMOS components. Finally, a differential version of NORA dynamic circuits requiring a single-phase uncomplemented clock signal introduced for this application.

  11. Three-year mortality in previously hospitalized older patients from rural areas - the importance of co-morbidity and self-reported poor health

    PubMed Central

    2013-01-01

    Background The risk factors for mortality after hospitalization in older persons are not fully understood. The aim of the present study was to examine the three-year (1,096 days) mortality in previously hospitalized older patients from rural areas, and to explore how objectively and self-reported health indicators at baseline were associated with mortality. Methods The study included 484 (241 men) medical inpatients with age range 65–101 (mean 80.7, SD 7.4) years. Baseline information included the following health measures: the Charlson Index, the Mini-Mental-State Examination, Lawton and Brody’s scales for physical self-maintenance and the instrumental activities of daily living, the Hospital Anxiety and Depression scale, self-reported health (one item), and perceived social functioning (one item) and assistance in living at discharge. Results In all, 172 (35.5%) of those patients included had died within the three years of the follow-up period. Three-year mortality was associated with a high score at baseline on the Charlson Index (HR 1.73, 95%CI 1.09-2.74) and poor self-reported health (HR 1.52, 95%CI 1.03-2.25) in a Cox regression analysis adjusted for age, gender, other objectively measured health indicators, and perceived impaired social functioning. Conclusion In a study of older adults admitted to a general hospital for a wide variety of disorders, we found co-morbidity (as measured with the Charlson Index) and poor self-reported health associated with three-year mortality in analysis adjusting for age, gender, and other health-related indicators. The results suggest that self-reported health is a measure that should be included in future studies. PMID:23419167

  12. Prevalence of undiagnosed and inadequately treated type 2 diabetes mellitus, hyperension, and dyslipidemia in morbidly obese patients who present for bariatric surgery

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Context: Pharmacotherapy is considered the primary treatment modality for metabolic diseases, such as diabetes mellitus (DM), hypertension (HTN), and dyslipidemia (DYS). Objective: We hypothesize that these metabolic diseases become exceedingly difficult to treat with pharmacotherapy in morbidly ob...

  13. Multipliers for continuous frames in Hilbert spaces

    NASA Astrophysics Data System (ADS)

    Balazs, P.; Bayer, D.; Rahimi, A.

    2012-06-01

    In this paper, we examine the general theory of continuous frame multipliers in Hilbert space. These operators are a generalization of the widely used notion of (discrete) frame multipliers. Well-known examples include anti-Wick operators, STFT multipliers or Calderón-Toeplitz operators. Due to the possible peculiarities of the underlying measure spaces, continuous frames do not behave quite as their discrete counterparts. Nonetheless, many results similar to the discrete case are proven for continuous frame multipliers as well, for instance compactness and Schatten-class properties. Furthermore, the concepts of controlled and weighted frames are transferred to the continuous setting. This article is part of a special issue of Journal of Physics A: Mathematical and Theoretical devoted to ‘Coherent states: mathematical and physical aspects’.

  14. Open-loop digital frequency multiplier

    NASA Technical Reports Server (NTRS)

    Moore, R. C.

    1977-01-01

    Monostable multivibrator is implemented by using digital integrated circuits where multiplier constant is too large for conventional phase-locked-loop integrated circuit. A 400 Hz clock is generated by divide-by-N counter from 1 Hz timing reference.

  15. Comparison of maternal morbidity and medical costs during pregnancy and delivery between patients with gestational diabetes and patients with pre-existing diabetes

    PubMed Central

    Son, K H; Lim, N-K; Lee, J-W; Cho, M-C; Park, H-Y

    2015-01-01

    Aims To evaluate the effects of gestational diabetes and pre-existing diabetes on maternal morbidity and medical costs, using data from the Korea National Health Insurance Claims Database of the Health Insurance Review and Assessment Service. Methods Delivery cases in 2010, 2011 and 2012 (459 842, 442 225 and 380 431 deliveries) were extracted from the Health Insurance Review and Assessment Service database. The complications and medical costs were compared among the following three pregnancy groups: normal, gestational diabetes and pre-existing diabetes. Results Although, the rates of pre-existing diabetes did not fluctuate (2.5, 2.4 and 2.7%) throughout the study, the rate of gestational diabetes steadily increased (4.6, 6.2 and 8.0%). Furthermore, the rates of pre-existing diabetes and gestational diabetes increased in conjunction with maternal age, pre-existing hypertension and cases of multiple pregnancy. The risk of pregnancy-induced hypertension, urinary tract infections, premature delivery, liver disease and chronic renal disease were greater in the gestational diabetes and pre-existing diabetes groups than in the normal group. The risk of venous thromboembolism, antepartum haemorrhage, shoulder dystocia and placenta disorder were greater in the pre-existing diabetes group, but not the gestational diabetes group, compared with the normal group. The medical costs associated with delivery, the costs during pregnancy and the number of in-hospital days for the subjects in the pre-existing diabetes group were the highest among the three groups. Conclusions The study showed that the rates of pre-existing diabetes and gestational diabetes increased with maternal age at pregnancy and were associated with increases in medical costs and pregnancy-related complications. PMID:25472691

  16. Fingerprinting ordered diffractions in multiply diffracted waves

    NASA Astrophysics Data System (ADS)

    Meles, Giovanni Angelo; Curtis, Andrew

    2014-09-01

    We show how to `fingerprint' individual diffractors inside an acoustic medium using interrogative wave energy from arrays of sources and receivers. For any recorded multiply diffracted wave observed between any source and any receiver, the set of such fingerprints is sufficient information to identify all diffractors involved in the corresponding diffraction path, and the sequential order in which diffractors are encountered. The method herein thus decomposes complex, multiply diffracted wavefields into constituent, single-diffraction interactions.

  17. Endothelial dysfunction in morbid obesity.

    PubMed

    Mauricio, Maria Dolores; Aldasoro, Martin; Ortega, Joaquin; Vila, José María

    2013-01-01

    Morbid obesity is a chronic multifunctional disease characterized by an accumulation of fat. Epidemiological studies have shown that obesity is associated with cardiovascular and metabolic disorders. Endothelial dysfunction, as defined by an imbalance between relaxing and contractile endothelial factors, plays a central role in the pathogenesis of these cardiometabolic diseases. Diminished bioavailability of nitric oxide (NO) contributes to endothelial dysfunction and impairs endothelium- dependent vasodilatation. But this is not the only mechanism that drives to endothelial dysfunction. Obesity has been associated with a chronic inflammatory process, atherosclerosis, and oxidative stress. Moreover levels of asymmetrical dimethyl-L-arginine (ADMA), an endogenous inhibitor of endothelial nitric oxide synthase (eNOS), are elevated in obesity. On the other hand, increasing prostanoid-dependent vasoconstriction and decreasing vasodilator prostanoids also lead to endothelial dysfunction in obesity. Other mechanisms related to endothelin-1 (ET-1) or endothelium derived hyperpolarizing factor (EDHF) have been proposed. Bariatric surgery (BS) is a safe and effective means to achieve significant weight loss, but its use is limited only to patients with severe obesity including morbid obesity. BS also proved efficient in endothelial dysfunction reduction improving cardiovascular and metabolic comorbidities associated with morbid obesity such as diabetes, coronary artery disease, nonalcoholic fatty liver disease and cancer. This review will provide a brief overview of the mechanisms that link obesity with endothelial dysfunction, and how weight loss is a cornerstone treatment for cardiovascular comorbidities obesity-related. A better understanding of the mechanisms of obesity-induced endothelial dysfunction may help develop new therapeutic strategies to reduce cardiovascular morbidity and mortality.

  18. Self Report Co-Morbidity and Health Related Quality of Life -- A Comparison with Record Based Co-Morbidity Measures

    ERIC Educational Resources Information Center

    Voaklander, Donald C.; Kelly, Karen D.; Jones, C. Allyson; Suarez-Almazor, Maria E.

    2004-01-01

    The purpose of this project was to compare three hospital-based measures of co-morbidity to patient self-report co-morbidity and to determine the relative proportion of outcome predicted by each of the co-morbidity measures in a population of individuals receiving major joint arthroplasty. Baseline measures using the SF-36 general health…

  19. The Association of Peri-Procedural Blood Transfusion with Morbidity and Mortality in Patients Undergoing Percutaneous Lower Extremity Vascular Interventions: Insights from BMC2 VIC

    PubMed Central

    Henke, Peter K.; Park, Yeo Jung; Hans, Sachinder; Bove, Paul; Cuff, Robert; Kazmers, Andris; Schreiber, Theodore; Gurm, Hitinder S.; Grossman, P. Michael

    2016-01-01

    Objective To determine the predictors of periprocedural blood transfusion and the association of transfusion on outcomes in high risk patients undergoing endoluminal percutaneous vascular interventions (PVI) for peripheral arterial disease. Methods/Results Between 2010–2014 at 47 hospitals participating in a statewide quality registry, 4.2% (n = 985) of 23,273 patients received a periprocedural blood transfusion. Transfusion rates varied from 0 to 15% amongst the hospitals in the registry. Using multiple logistic regression, factors associated with increased transfusion included female gender (OR = 1.9; 95% CI: 1.6–2.1), low creatinine clearance (1.3; 1.1–1.6), pre-procedural anemia (4.7; 3.9–5.7), family history of CAD (1.2; 1.1–1.5), CHF (1.4; 1.2–1.6), COPD (1.2; 1.1–1.4), CVD or TIA (1.2; 1.1–1.4), renal failure CRD (1.5; 1.2–1.9), pre-procedural heparin use (1.8; 1.4–2.3), warfarin use (1.2; 1.0–1.5), critical limb ischemia (1.7; 1.5–2.1), aorta-iliac procedure (1.9; 1.5–2.5), below knee procedure (1.3; 1.1–1.5), urgent procedure (1.7; 1.3–2.2), and emergent procedure (8.3; 5.6–12.4). Using inverse weighted propensity matching to adjust for confounders, transfusion was a significant risk factor for death (15.4; 7.5–31), MI (67; 29–150), TIA/stroke (24; 8–73) and ARF (19; 6.2–57). A focused QI program was associated with a 28% decrease in administration of blood transfusion (p = 0.001) over 4 years. Conclusion In a large statewide PVI registry, post procedure transfusion was highly correlated with a specific set of clinical risk factors, and with in-hospital major morbidity and mortality. However, using a focused QI program, a significant reduction in transfusion is possible. PMID:27835656

  20. Co-Morbid Disorders in Tourette Syndrome

    PubMed Central

    Mol Debes, Nanette M. M.

    2013-01-01

    Tourette syndrome (TS) is often accompanied by other symptoms and syndromes. The two best-known co-morbidities are Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive Compulsive Disorder (OCD), but also other conditions like rage-attacks, depression, and sleeping disturbances are frequent in persons with TS. Both in clinical cohorts and in population-based cohorts the prevalence of co-morbidities is high. The presence of co-morbid ADHD and/or OCD has an impact on psychosocial, educational, and neuropsychological consequences of TS and it is associated with higher rates of other co-morbid disorders, like rage, anxiety, and conduct disorders. The symptoms of a co-morbid disorder might appear prior to the time that tics reach clinical attention. The TS phenotype probably changes during the course of the disease. The exact aetiology of the co-occurrence of co-morbid disorders and TS is not known, but they probably all are neurotransmitter disorders. European guidelines recommend first-choice pharmacological treatment, but randomised double-blinded trials are needed. Professionals need to be aware of the close relationship between TS and co-morbidities in order to give the patients the right treatment and support. PMID:23187139

  1. Psychiatric morbidity in prisoners

    PubMed Central

    Goyal, Sandeep Kumar; Singh, Paramjit; Gargi, Parshotam D.; Goyal, Samta; Garg, Aseem

    2011-01-01

    Context: The prevalence of psychiatric illness in correctional settings is significantly elevated, with higher than community rates reported for most mental disorders. Aims: (1) To examine the socio-demographic profile of convicted prisoners. (2) To evaluate the prevalence of psychiatric disorders in convicted prisoners. Materials and Methods: 500 convicts were assessed for psychiatric morbidity with the help of (a) Socio-demographic proforma, (b) Pareek Udai and Trivedi G's socio-economic status scale (rural) (household schedule), (c) Kuppuswamy's economic status scale (urban) and (d) Present State Examination (PSE). Results: 23.8% of the convicted prisoners were suffering from psychiatric illness excluding substance abuse. 56.4% of the prisoners had history of substance abuse / dependence prior to incarceration. Conclusions: The results suggest that a substantial burden of psychiatric morbidity exists in the prison population of India and the burden of psychiatric illness in this vulnerable and marginalized population poses a serious challenge to psychiatrists. PMID:22135446

  2. Problem of Electromagnetoviscoelasticity for Multiply Connected Plates

    NASA Astrophysics Data System (ADS)

    Kaloerov, S. A.; Samodurov, A. A.

    2015-11-01

    A method for solving the problem of electromagnetoviscoelasticity for multiply connected plates is proposed. The small-parameter method is used to reduce this problem to a recursive sequence of problems of electromagnetoelasticity, which are solved by using complex potentials. A procedure is developed to determine, using complex potentials, approximations of the basic characteristics (stresses, electromagnetic-field strength, electromagnetic-flux density) of the electromagnetoelastic state at any time after application of a load. A plate with an elliptic hole is considered as an example. The variation in the electromagnetoelastic state of the multiply connected plate with time is studied

  3. WIDE BAND REGENERATIVE FREQUENCY DIVIDER AND MULTIPLIER

    DOEpatents

    Laine, E.F.

    1959-11-17

    A regenerative frequency divider and multiplier having wide band input characteristics is presented. The circuit produces output oscillations having frequencies related by a fixed ratio to input oscillations over a wide band of frequencies. In accomplishing this end, the divider-multiplier includes a wide band input circuit coupled by mixer means to a wide band output circuit having a pass band related by a fixed ratio to that of the input circuit. A regenerative feedback circuit derives a fixed frequency ratio feedback signal from the output circuit and applies same to the mixer means in proper phase relation to sustain fixed frequency ratio oscillations in the output circuit.

  4. Temperature Effects in Varactors and Multipliers

    NASA Technical Reports Server (NTRS)

    East, J.; Mehdi, Imran

    2001-01-01

    Varactor diode multipliers are a critical part of many THz measurement systems. The power and efficiencies of these devices limit the available power for THz sources. Varactor operation is determined by the physics of the varactor device and a careful doping profile design is needed to optimize the performance. Higher doped devices are limited by junction breakdown and lower doped structures are limited by current saturation. Higher doped structures typically have higher efficiencies and lower doped structures typically have higher powers at the same operating frequency and impedance level. However, the device material properties are also a function of the operating temperature. Recent experimental evidence has shown that the power output of a multiplier can be improved by cooling the device. We have used a particle Monte Carlo simulation to investigate the temperature dependent velocity vs. electric field in GaAs. This information was then included in a nonlinear device circuit simulator to predict multiplier performance for various temperatures and device designs. This paper will describe the results of this analysis of temperature dependent multiplier operation.

  5. Factors influencing the morbidity of colostomy closure.

    PubMed

    Demetriades, D; Pezikis, A; Melissas, J; Parekh, D; Pickles, G

    1988-04-01

    A series consisting of 110 patients who had colostomy closure was studied in an attempt to define the role of various factors in causing colon-related morbidity. The overall complication rate was 14.5 percent (wound sepsis 11.8 percent and anastomotic leak 2.7 percent). Patient age, the underlying pathologic abnormality (trauma versus nontrauma), the type of colostomy (loop versus end colostomy), the site of the stoma (right side, left side, or transverse), whether a drain was inserted or not, and the timing of the operation did not influence morbidity. Oral preoperative antibiotics appeared to be associated with less morbidity than parenteral antibiotics (p less than 0.01), and experienced surgeons had less complications than junior surgeons (p less than 0.05).

  6. Instabilities in a Layer-Multiplying Device

    NASA Astrophysics Data System (ADS)

    Sollogoub, Cyrille; Grandmontagne, Anne; Guinault, Alain

    2011-01-01

    The application of a layer-multiplying device to coextrusion has resulted in a process, called microlayer coextrusion, producing films with ten to thousands of layers of two different polymers. It was shown that this device is quite versatile and can be used to produce new layered systems with improved mechanical, optical, electrical and barrier properties. However, instabilities may occur in the feedblock and/or the layer multiplying unit, affecting the uniformity and the continuity of the created layers. Those instabilities have been widely studied for classical systems with three to five layer structures, while very few studies deal with microlayer coextrusion process. The aim of this paper is to study the flow instabilities in multilayered films. In particular, the role of polymer properties and the effect of some parameters, such as the viscosity ratio, will be investigated.

  7. Low-Jitter Digital Rate Multiplier

    NASA Technical Reports Server (NTRS)

    Katz, Richard B.; Rakow, Glenn P.

    1993-01-01

    Jitter in digital rate multiplier reduced by improved method involving use of two slightly different minor clock periods. Original application to divide measured period of spin of spacecraft into large number of equal subintervals, by counting cycles of master oscillator running at high frequency. Method also used to reduce jitter in other situations necessary to generate equal subintervals from synchronizing clock signal of arbitrary period. Particularly valuable in situations where synchronizing signals lost temporarily and where drift in analog circuit unacceptable.

  8. Perioperative morbidity of intracavitary gynecologic brachytherapy

    SciTech Connect

    Lanciano, R.; Corn, B.; Martin, E.; Schulthesis, T.; Hogan, W.M.; Rosenblum, N.

    1994-07-30

    The purpose was to define the incidence and severity of perioperative morbidity and its subsequent management with standard tandem and ovoid insertions to evaluate pretreatment and treatment factors associated with an increased risk of perioperative morbidity. Intraoperative complications were seen in 3% of implants and included two perforations and a vaginal laceration in two patients. Twenty-four percent of implants (16 patients) developed temperatures of > 100.5 (range 100.6 to 103), although only one patient required implant removal because of fever. Management of fever included antibiotics in 35% and acetaminophen only in 65%. Five implants were removed emergently secondary to presumed sepsis, exacerbation of chronic obstructive pulmonary disease, hypotension, change in mental status, and myocardial infarction/congestive heart failure. No patient developed a deep-vein thrombosis, pulmonary embolism, gastrointestinal obstruction, or died of a postoperative complication. Univariate analysis of pretreatment and treatment factors revealed older age and spinal/epidural anesthesia to be associated with increased perioperative morbidity, and older age and higher ASA classification to be associated with severe complications requiring removal of implant. Multivariate analysis revealed only older age to be significantly related to perioperative morbidity. Fever of > 100.5 was seen in 24% of implants and can be managed successfully without removal of the implant in 96% of cases. Use of antibiotics preoperatively and intraoperatively did not reduce the risk of perioperative temperature elevation. Use of routine diphenoxylate hydrochloride prophylaxis was tolerated without ileus or gastrointestinal obstruction clinically. Although routine deep-vein thrombosis prophylaxis is reasonable, the data would support a low risk of deep-vein thrombosis for untreated patients. Severe perioperative morbidity necessitated premature implant removal in only 5% of cases. 24 refs., 2 tabs.

  9. Lagrange multipliers in theories of gravitation

    SciTech Connect

    Kichenassamy, S.

    1986-05-01

    In gravitatinal theories, P-italic-variation (independepent variation of metric and connection) and H-variation (variation of the metric alone) may be reconciled through C-italic-variation (use of Lagrange multipliers ..lambda.. in P-italic-variation). We extend C-italic-variation to fields coupled with gravitational field and elucidate the cases of vanishing ..lambda... We show that the interpretation of ..lambda.. as constraint reaction forces sheds new light on the structure of these theories; we are thus led to question the necessary of relating torsion to spin, and as an alternative to the theory of Dirac particles in Einstein-Cartan space-time, we propose in a Lorentzian space-time a theory in which Lagrange multipliers corresponding to the vanishing of torsion lead to the symmetrization of canonical energy-momentum tensor and avoid the Heisenberg-Pauli-type terms. Lagrange multipliers also serve to reduce the fourth-order differential equations of gravitational quadratic Lagrangians to second-order ones with additional field variables (a scalar P-italic and a traceless tensor P-italic-tilde/sub i//sub j/); this reduction helps to make precise the compatibility of these theories with General Relativity. Simple derivations are also given for Chern and Euler characteristics c-italic/sub 2/ and /sub Chi//sub 2/, and for other identities.

  10. Yeast peroxisomes multiply by growth and division.

    PubMed

    Motley, Alison M; Hettema, Ewald H

    2007-07-30

    Peroxisomes can arise de novo from the endoplasmic reticulum (ER) via a maturation process. Peroxisomes can also multiply by fission. We have investigated how these modes of multiplication contribute to peroxisome numbers in Saccharomyces cerevisiae and the role of the dynamin-related proteins (Drps) in these processes. We have developed pulse-chase and mating assays to follow the fate of existing peroxisomes, de novo-formed peroxisomes, and ER-derived preperoxisomal structures. We find that in wild-type (WT) cells, peroxisomes multiply by fission and do not form de novo. A marker for the maturation pathway, Pex3-GFP, is delivered from the ER to existing peroxisomes. Strikingly, cells lacking peroxisomes as a result of a segregation defect do form peroxisomes de novo. This process is slower than peroxisome multiplication in WT cells and is Drp independent. In contrast, peroxisome fission is Drp dependent. Our results show that peroxisomes multiply by growth and division under our assay conditions. We conclude that the ER to peroxisome pathway functions to supply existing peroxisomes with essential membrane constituents.

  11. Automobile Industry Retail Price Equivalent and Indirect Cost Multipliers

    EPA Science Inventory

    This report develops a modified multiplier, referred to as an indirect cost (IC) multiplier, which specifically evaluates the components of indirect costs that are likely to be affected by vehicle modifications associated with environmental regulation. A range of IC multipliers a...

  12. Histidine-tryptophan-ketoglutarate solution decreases mortality and morbidity in high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease: an 11-year experience from a single institution

    PubMed Central

    Li, X.W.; Lin, Y.Z.; Lin, H.; Huang, J.B.; Tang, X.M.; Long, X.M.; Lu, W.J.; Wen, Z.K.; Liang, J.; Li, D.Y.; Zhao, X.F.

    2016-01-01

    Cardioplegic reperfusion during a long term ischemic period interrupts cardiac surgery and also increases cellular edema due to repeated solution administration. We reviewed the clinical experiences on myocardial protection of a single perfusion with histidine-tryptophan-ketoglutarate (HTK) for high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease. This retrospective study included 101 high-risk patients undergoing arterial switch operation between March 2001 and July 2012. We divided the cohort into two groups: HTK group, myocardial protection was carried out with one single perfusion with HTK solution; and St group, myocardial protection with conventional St. Thomas' crystalloid cardioplegic solution. The duration of cardiopulmonary bypass did not differ between the two groups. The mortality, morbidity, ICU stay, post-operative hospitalization time, and number of transfusions in HTK group were lower than those in St group (P<0.05). Univariate and multivariate analysis showed that HTK is a statistically significant independent predictor of decreased early mortality and morbidity (P<0.05). In conclusion, HTK solution seems to be an effective and safe alternative to St. Thomas' solution for cardioplegic reperfusion in high-risk patients with complex congenital heart disease. PMID:27191607

  13. Morbidity and mortality of diabetes with surgery.

    PubMed

    Chuah, L L; Papamargaritis, D; Pillai, D; Krishnamoorthy, A; le Roux, C W

    2013-03-01

    The prevalence of Type 2 diabetes mellitus (T2DM) has increased; as a result the number of patients with T2DM undergoing surgical procedures has also increased. This population is at high risk of macrovascular (cardiovascular disease, peripheral vascular disease) or microvascular (retinopathy, nephropathy or neuropathy) complications, both increasing their perioperative morbidity and mortality. Diabetes patients are more at risk of poor wound healing, respiratory infection, myocardial infarction, admission to intensive care, and increased hospital length of stay. This leads to increased inpatient costs. The outcome of perioperative glycaemia management remains a significant clinical problem without a universally accepted solution. The majority of evidence on morbidity and mortality of T2DM patients undergoing surgery comes from the setting of cardiac surgery; there was less evidence on noncardiac surgery and bariatric surgery. Bariatric surgery is increasingly performed in patients with severe obesity complicated by T2DM, but is distinguished from general surgery as it immediately improves the glucose homeostasis postoperatively. The improvements in glycaemia are thought to be independent of weight loss and this requires different postoperative management. Patients usually have to follow specific preoperative diets which lead to improvement in glycaemia immediately before surgery. Here we review the available data on the mortality and morbidity of patients with T2DM who underwent elective surgery (cardiac, non-cardiac and bariatric surgery) and the current knowledge of the impact that preoperative, intraoperative and postoperative glycaemic management has on operative outcomes.

  14. Factors Affecting Morbidity in Solid Organ Injuries.

    PubMed

    Baygeldi, Serdar; Karakose, Oktay; Özcelik, Kazım Caglar; Pülat, Hüseyin; Damar, Sedat; Eken, Hüseyin; Zihni, İsmail; Çalta, Alpaslan Fedai; Baç, Bilsel

    2016-01-01

    Background and Aim. The aim of this study was to investigate the effects of demographic characteristics, biochemical parameters, amount of blood transfusion, and trauma scores on morbidity in patients with solid organ injury following trauma. Material and Method. One hundred nine patients with solid organ injury due to abdominal trauma during January 2005 and October 2015 were examined retrospectively in the General Surgery Department of Dicle University Medical Faculty. Patients' age, gender, trauma interval time, vital status (heart rate, arterial tension, and respiratory rate), hematocrit (HCT) value, serum area aminotransferase (ALT) and aspartate aminotransferase (AST) values, presence of free abdominal fluid in USG, trauma mechanism, extra-abdominal system injuries, injured solid organs and their number, degree of injury in abdominal CT, number of blood transfusions, duration of hospital stay, time of operation (for those undergoing operation), trauma scores (ISS, RTS, Glasgow coma scale, and TRISS), and causes of morbidity and mortality were examined. In posttraumatic follow-up period, intra-abdominal hematoma infection, emboli, catheter infection, and deep vein thrombosis were monitored as factors of morbidity. Results. One hundred nine patients were followed up and treated due to isolated solid organ injury following abdominal trauma. There were 81 males (74.3%) and 28 females (25.7%), and the mean age was 37.6 ± 18.28 (15-78) years. When examining the mechanism of abdominal trauma in patients, the following results were obtained: 58 (53.3%) traffic accidents (22 out-vehicle and 36 in-vehicle), 27 (24.7%) falling from a height, 14 (12.9%) assaults, 5 (4.5%) sharp object injuries, and 5 (4.5%) gunshot injuries. When evaluating 69 liver injuries scaled by CT the following was detected: 14 (20.3%) of grade I, 32 (46.4%) of grade II, 22 (31.8%) of grade III, and 1 (1.5%) of grade IV. In 63 spleen injuries scaled by CT the following was present: grade I in 21

  15. Pipeline active filter utilizing a booth type multiplier

    NASA Technical Reports Server (NTRS)

    Nathan, Robert (Inventor)

    1987-01-01

    Multiplier units of the modified Booth decoder and carry-save adder/full adder combination are used to implement a pipeline active filter wherein pixel data is processed sequentially, and each pixel need only be accessed once and multiplied by a predetermined number of weights simultaneously, one multiplier unit for each weight. Each multiplier unit uses only one row of carry-save adders, and the results are shifted to less significant multiplier positions and one row of full adders to add the carry to the sum in order to provide the correct binary number for the product Wp. The full adder is also used to add this product Wp to the sum of products .SIGMA.Wp from preceding multiply units. If m.times.m multiplier units are pipelined, the system would be capable of processing a kernel array of m.times.m weighting factors.

  16. Targeting asthma care in general practice using a morbidity index.

    PubMed Central

    Jones, K. P.; Charlton, I. H.; Middleton, M.; Preece, W. J.; Hill, A. P.

    1992-01-01

    OBJECTIVES--To evaluate a morbidity index as a postal surveillance tool in defining previously diagnosed asthmatic patients needing extra education or management; to determine the accuracy of a computerised asthma register in general practice. DESIGN--Postal questionnaire survey of asthmatic patients identified from a computer register. Questionnaire comprised three morbidity questions, two questions about current asthma status, and one about treatments. SETTING--Urban general practice of 8400 patients linked to academic unit. SUBJECTS--853 asthmatic patients of all ages. MAIN OUTCOME MEASURES--Numbers of patients with low, medium, and high morbidity; associations of these groups with age, asthma status, and drugs taken. RESULTS--Two mailings yielded 621 replies (73%); 28 patients (5%) had moved away, leaving 593 for analysis. Attempts were subsequently made to contact 20% sample of non-respondents. 234 respondents (40%) were in the "low morbidity" group, 149 (25%) in the "medium morbidity" group, and 210 (35%) in the "high morbidity" category. 53% of patients perceiving themselves as currently asthmatic (193/362) were in the high morbidity group, but 7% (11/153) who said they were no longer asthmatic and 8% (6/78) who did not believe they had ever been asthmatic were also in that group. High morbidity was also found in 10% (18/185) of those on no treatment, 38% (59/154) of those on bronchodilators alone, and 54% (119/220) of those on inhaled corticosteroids. 25 patients (4%) were wrongly identified as asthmatic; when combined with returns marked "gone away" this gave a disease register accuracy of 91%. CONCLUSIONS--This exercise identified subgroups of previously diagnosed asthmatic patients with high morbidity in general practice who might benefit from extra education and management and revealed some misclassification on the asthma disease register. PMID:1611335

  17. Electrical Characterization of Silicon Photo-Multipliers

    NASA Astrophysics Data System (ADS)

    Mwathi, John; Woody, Craig; Stoll, Sean

    2014-09-01

    Silicon photo-multipliers (SiPM) also known as Multi-Pixel Photon Counters (MPPC) are single photon sensitive, semiconductor devices built from Avalanche Photo Diodes (APDs) working in the Geiger mode. The SiPM detectors provide an attractive solution for the detection of signals with low numbers of photons and are suitable candidates to replace Vacuum Photo-Multiplier Tubes (PMTs). They offer advantages over both PMTs and the APDs, including compactness, insensitivity to magnetic fields, high gain (105), ability to be operated at moderate bias voltage (normally lower than 100 volts), and excellent timing properties these characteristics make them suitable for applications in several fields of high energy physics and medical imaging. At Brookhaven National Laboratory, silicon photo-multipliers have been suggested as the readout device to be used in the upgraded sPHENIX in the area of high-energy physics calorimetry and future Positron Emission Tomography (PET) medical imaging systems. Despite all these advantages SiPMs have several drawbacks such as crosstalk, after pulse rate and dark-count rate, exposure to radiation damages the detector and greatly affects its efficiency. We characterized SiPMs of different pixel sizes from SensL and Hamamatsu to determine the SiPM's performance and which of these detectors would best be suited for application. We characterized these SiPM samples using lab instruments including a Picometer and a digital oscilloscope. A Lab view program controlling and reading out the Keithley Picometer via an IEEE-GPIB interface was developed to automate the dark current as a function of bias voltage measurement. Silicon photo-multipliers (SiPM) also known as Multi-Pixel Photon Counters (MPPC) are single photon sensitive, semiconductor devices built from Avalanche Photo Diodes (APDs) working in the Geiger mode. The SiPM detectors provide an attractive solution for the detection of signals with low numbers of photons and are suitable candidates

  18. Gas Electron Multiplier Tracking Telescopes for OLYMPUS

    NASA Astrophysics Data System (ADS)

    McMahon, Joshua; Campbell, Miles

    2011-10-01

    The OLYMPUS collaboration is conducting an experiment to measure two-photon contributions to elastic electron scattering. The experiment is taking place at the DORIS storage ring at DESY, Hamburg, Germany using the upgraded BLAST detector from the MIT-Bates Linear Accelerator Center. Gas Electron Multiplier (GEM) telescopes are used to detect scattered leptons at a forward angle to monitor the luminosity. The GEM detectors have been commissioned at the test facility at DESY and were installed along with the main detector in the DORIS storage ring. With the testbeam the performance characteristics such as gain, efficiency, multiplicity, and resolution of the GEMs were studied.

  19. Spectral Multipliers for Schrodinger Operators: 1

    DTIC Science & Technology

    2007-01-18

    harmonic analysis and PDEs. It is closely related to the study of the associated function spaces and Littlewood -Paley theory. Let H = −∆ + V be a...Secondary: 35J10, 35P25, 35Q40. Key words and phrases. spectral multiplier, Schrödinger operator, Littlewood - Paley theory. The author is supported...to the identity, so that ρ ∈ L1(Rn) is positive and decreasing, then sup t>0 |ρt ∗ f(x)| ≤Mf(x) where M denotes the Hardy- Littlewood maximal function

  20. Vascular complications following prophylactic balloon occlusion of the internal iliac arteries resolved by successful interventional thrombolysis in a patient with morbidly adherent placenta*

    PubMed Central

    Zhang, Ning; Lou, Wei-hua; Zhang, Xue-bin; Fu, Jia-ning; Chen, Yun-yan; Zhuang, Zhi-guo; Lin, Jian-hua

    2017-01-01

    The increasing incidence of morbidly adherent placenta (MAP) is placing women at a higher risk of life-threatening massive hemorrhage. The involvement of interventional radiology to manage this complex condition by performing prophylactic iliac artery balloon occlusion has been reported recently. However, the effectiveness and safety of this technique have not been fully determined. Here we report the case of a 25-year-old woman with placenta increta with preemptive bilateral internal iliac artery balloons who had external iliac artery thrombosis detected by computed tomography angiography (CTA) 72 h post cesarean section. A digital subtraction angiogram (DSA) and intra-arterial thrombolysis were instantly performed followed by supplementary conservative treatments, leading to a desirable resolution of thrombus without sequela. This is the first report of vascular complications with successful interventional thrombolysis in this setting. Our experience suggests that prophylactic iliac artery balloon occlusion should be used cautiously in cases of MAP and consideration given to minimizing vascular complications given the hypercoagulable state of pregnancy. PMID:28271663

  1. [Prospective epidemiologic considerations on asthma morbidity in patients admitted to the St. Maria Emergency Hospital Clinic for Children, Iaşi].

    PubMed

    Duceac, Letiţia-Doina; Goţia, Stela; Manole, Alina

    2005-01-01

    Authors present the results of a clinical epidemiological assessment of a retroprospective study carried out on a sample of 6717 records of children assisted for asthma in the "Sf. Maria" Emergency Clinic Hospital for Children Iasi, between 1990-2004. The epidemiological and statistical mathematics methods, both classical and computerized, highlighted an increase in the incidence and prevalence values in 2000, as a consequence of National Program for Asthma. For the entire period of study, the morbidity values increased in the cold and transit season, due to the acute respiratory infections, and in the warm season, by the atmospheric pollen. The anatomic-physiological peculiarities of the respiratory tubes explained the higher prevalence of asthma in males aged until 10 years old. Asthma had an increased incidence in the age groups of 4-6 years old (28.21%) and 7-9 (30.42%), as a result of the entrance in collectivities where there is a high risk for acute respiratory infections. A lower prevalence of asthma in young-age groups was explained by a difficult diagnosis. The results above-mentioned can offer orientations for the clinical epidemiological surveillance programs of asthma.

  2. VAGINAL PROGESTERONE IN WOMEN WITH AN ASYMPTOMATIC SONOGRAPHIC SHORT CERVIX IN THE MIDTRIMESTER DECREASES PRETERM DELIVERY AND NEONATAL MORBIDITY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF INDIVIDUAL PATIENT DATA

    PubMed Central

    ROMERO, Roberto; NICOLAIDES, Kypros; CONDE-AGUDELO, Agustin; TABOR, Ann; O’BRIEN, John M.; CETINGOZ, Elcin; DA FONSECA, Eduardo; CREASY, George; KLEIN, Katharina; RODE, Line; SOMA-PILLAY, Priya; FUSEY, Shalini; CAM, Cetin; ALFIREVIC, Zarko; HASSAN, Sonia S.

    2012-01-01

    OBJECTIVE To determine whether the use of vaginal progesterone in asymptomatic women with a sonographic short cervix in the mid-trimester reduces the risk of preterm birth and improves neonatal morbidity and mortality. STUDY DESIGN Individual patient data meta-analysis of randomized controlled trials. RESULTS Five trials of high quality were included with a total of 775 women and 827 infants. Treatment with vaginal progesterone was associated with a significant reduction in the rate of preterm birth <33 weeks (RR 0.58, 95% CI 0.42–0.80), <35 weeks (RR 0.69, 95% CI 0.55–0.88) and <28 weeks (RR 0.50, 95% CI 0.30–0.81), respiratory distress syndrome (RR 0.48, 95% CI 0.30–0.76), composite neonatal morbidity and mortality (RR 0.57, 95% CI 0.40–0.81), birth weight <1500 g (RR 0.55, 95% CI 0.38–0.80), admission to NICU (RR 0.75, 95% CI 0.59–0.94), and requirement for mechanical ventilation (RR 0.66, 95% CI 0.44–0.98). There were no significant differences between the vaginal progesterone and placebo groups in the rate of adverse maternal events or congenital anomalies. CONCLUSION Vaginal progesterone administration to asymptomatic women with a sonographic short cervix reduces the risk of preterm birth and neonatal morbidity and mortality. PMID:22284156

  3. Co-morbidity but not dysglycaemia reduces quality of life in patients with type-2 diabetes treated with oral mono- or dual combination therapy – an analysis of the DiaRegis registry

    PubMed Central

    2013-01-01

    Background Type-2 diabetes mellitus has a major impact on health related quality of life (HRQoL). We aimed to identify patient and treatment related variables having a major impact. Methods DiaRegis is a prospective diabetes registry. The EQ-5D was used to describe differences in HRQoL at baseline. Odds ratios (OR) with 95% confidence intervals (CI) were determined from univariable regression analysis. For the identification of independent predictors of a low score on the EQ-5D, multivariable unconditional logistic regression analysis was performed. Results A total of 2,760 patients were available for the present analysis (46.7% female, median age 66.2 years). Patients had considerable co-morbidity (18.3% coronary artery disease, 10.6% heart failure, 5.9% PAD and 5.0% stroke/TIA). Baseline HbA1c was 7.4%, fasting- and postprandial plasma glucose 139 mg/dl and 183 mg/dl. The median EQ-5D was 0.9 (interquartile range [IQR] 0.8–1.0). Independent predictors for a low EQ-5D were age > 66 years (OR 1.49; 95%CI 1.08–2.06), female gender (2.11; 1.55–2.86), hypertension (1.73; 1.03–2.93), peripheral neuropathy (1.62; 0.93–2.84) and clinically relevant depression (11.01; 3.97–30.50). There was no influence of dysglycaemia on the EQ-5D score. Conclusion The present study suggests, that co-morbidity but not average glycaemic control reduces health related quality of life in type 2 diabetes mellitus. PMID:23510200

  4. [Diabetic co-morbidities: prevalences in Germany].

    PubMed

    Heller, T; Blum, M; Spraul, M; Wolf, G; Müller, U A

    2014-04-01

    In some patients with diabetes mellitus (DM) chronic hyperglycemia leads to microvascular complications in retina, kidney and nerves. Concerning missing data from Germany cited prevalence in German educational books and guidelines arise from other countries. This review demonstrates the prevalence of diabetic comorbidities in Germany. The largest investigation in Germany is the Disease-Management-Programm Nordrhein with more than 450.000 surveyed DM  patients. These researches show good comparability with most analyses respective to the prevalence of diabetic comorbidities in Germany. Patients with DM2 have a mean Hba1c of 7 % and patients with DM1 of 7.9 %. In patients with DM2 the prevalence of retinopathy is 11 %, nephropathy 10 % and neuropathy 20 %. Co-morbidities are more commonin patients with long diabetes duration and high HbA1c. In patients with DM1 the prevalence of retinopathy is 25 %, of nephropathy 15 % and neuropathy 27 %. The prevalence of diabetic co-morbidities in primary care in Germany is considerably lower as mentioned in educational books or guidelines. This positive development is reasonable through a better quality of care, nationwide early detection examinations and training programmes.

  5. Multiplier Accounting of Indian Mining Industry--The Concept

    NASA Astrophysics Data System (ADS)

    Hussain, A.; Karmakar, N. C.

    2015-04-01

    Input-output multipliers are indicators used for predicting the total impact on an economy due to the changes in its industrial demand and output. Also, input-output tables provide detailed dissection of the intermediate transactions in an economy. The aim of the paper is to put forward a basic framework of input-output economics as well as the multiplier concept. The outline of the methodology for calculating the multiplier associated with Indian mining industry is also presented.

  6. [Morbidity in draft military personnel].

    PubMed

    Mukhametzhanov, A M; Smagulov, N K

    2015-01-01

    Military service activity appeared to influence health state of military personnel. Body strain at initial stages of the service, connected with stress situation, affects general body resistance and manifests in higher general morbidity level with transitory disablement that decreases with adaptation. Based on normalized intensity parameters, the equation enables to ease a procedure of evaluation and forecast of transitory disablement morbidity in draft military personnel.

  7. Cognitive-behavioral therapy of insomnia: a clinical case series study of patients with co-morbid disorders and using hypnotic medications.

    PubMed

    Dolan, Diana C; Taylor, Daniel J; Bramoweth, Adam D; Rosenthal, Leon D

    2010-04-01

    Cognitive-behavioral therapy for insomnia (CBTi) has demonstrated considerable efficacy within randomized clinical trials and case-series designs. This case-series study in a community sleep medicine clinic assessed the effectiveness of an eight-session CBTi protocol chronic insomnia patients who were allowed to continue their use of hypnotics (intent-to-treat n = 48), administered by a clinical psychology doctoral student receiving training and supervision in CBTi by a behavioral sleep medicine certified clinician. Outcome measures included daily sleep diaries, self-report measures on insomnia severity, dysfunctional beliefs and attitudes about sleep, daytime sleepiness, as well as medication usage. Patients showed significant improvements in sleep onset latency, wake time after sleep onset, sleep efficiency, insomnia severity, and dysfunctional sleep beliefs from pre- to post-treatment. No changes were seen in daytime sleepiness - patients were not excessively sleepy either before or after treatment. Use of sleep medication declined significantly from 87.5% pre-treatment to 54% post-treatment, despite no active efforts to encourage patients to withdraw. Results demonstrate that a CBTi conducted in a community sleep medicine clinic with patients not required to discontinue sleep-related medications can have similar effects as therapy delivered among those not on medication.

  8. Functional outcomes, morbidity, mortality, and fracture healing in 58 consecutive patients with geriatric odontoid fracture treated with cervical collar or posterior fusion.

    PubMed

    Molinari, William J; Molinari, Robert W; Khera, Oner A; Gruhn, William L

    2013-03-01

    Controversy exists as to the most effective management option for elderly patients with type II odontoid fractures. The purpose of this study is to evaluate outcomes associated with rigid cervical collar and posterior fusion surgery. Patients with ≥ 50% odontoid displacement were treated with posterior fusion surgery including C1-2 (PSF group, n = 25, average age = 80 years). Patients with < 50% odontoid displacement were treated with a rigid cervical collar for 12 weeks (collar group, n = 33, average age = 83 years). These inhomogeneous groups were followed for an average of 14 months. Fracture healing rates were higher in the operative group (28% versus 6%). Neck Disability Index scores were slightly lower in the nonoperative group (13 versus 18.3, p = 0.23). Analogue pain scores were also slightly lower in the nonoperative group (1.3 versus 1.9, p = 0.26). The mortality rate was 12.5% in the collar group and 20% in the operative group. Complications were higher in the operative group (24% versus 6%). Rates of type II odontoid facture healing and stability appear to be higher in geriatric patients treated with posterior fusion surgery. Fracture healing and stability did not correlate with improved outcomes with respect to levels of pain, function, and satisfaction. Mortality and complication rates are lower in those patients with lesser-displaced fractures who are treated with a cervical collar and early mobilization.

  9. Topological Interactions in Multiply Linked DNA Rings

    NASA Astrophysics Data System (ADS)

    Otto, M.; Vilgis, T. A.

    1998-01-01

    The elasticity of DNA catenanes, i.e., multiply linked DNA rings, is investigated using the Gauss invariant as a minimal model for topology conservation. An effective elastic free energy as a function of the distance R between segments located on different rings is obtained. An anharmonic part at large distances, growing as R4, if R>>RG ( RG being the radius of gyration), is found, for R<

  10. Capacitance multiplier and filter synthesizing network

    NASA Technical Reports Server (NTRS)

    Kline, A. J. (Inventor)

    1974-01-01

    A circuit using a differential amplifier multiplies the capacitance of a discrete interating capacitor by (r sub 1 + R sub 2)/R sub 2, where R sub 1 and R sub 2 are values of discrete resistor coupling an input signal e sub 1 of the amplifier inputs. The output e sub 0 of the amplifier is fed back and added to the signal coupled by the resistor R sub 2 to the amplifier through a resistor of value R sub 1. A discrete resistor R sub x may be connected in series for a lag filter, and a discrete resistor may be connected in series with the capacitor for a lead-lag filter. Voltage dividing resistors R sub a and R sub b may be included in the feedback circuit of the amplifier output e sub o to independently adjust the circuit gain e sub i/e sub o.

  11. Analysis of Variance of Multiply Imputed Data.

    PubMed

    van Ginkel, Joost R; Kroonenberg, Pieter M

    2014-01-01

    As a procedure for handling missing data, Multiple imputation consists of estimating the missing data multiple times to create several complete versions of an incomplete data set. All these data sets are analyzed by the same statistical procedure, and the results are pooled for interpretation. So far, no explicit rules for pooling F-tests of (repeated-measures) analysis of variance have been defined. In this paper we outline the appropriate procedure for the results of analysis of variance for multiply imputed data sets. It involves both reformulation of the ANOVA model as a regression model using effect coding of the predictors and applying already existing combination rules for regression models. The proposed procedure is illustrated using three example data sets. The pooled results of these three examples provide plausible F- and p-values.

  12. Four-gate transistor analog multiplier circuit

    NASA Technical Reports Server (NTRS)

    Mojarradi, Mohammad M. (Inventor); Blalock, Benjamin (Inventor); Cristoloveanu, Sorin (Inventor); Chen, Suheng (Inventor); Akarvardar, Kerem (Inventor)

    2011-01-01

    A differential output analog multiplier circuit utilizing four G.sup.4-FETs, each source connected to a current source. The four G.sup.4-FETs may be grouped into two pairs of two G.sup.4-FETs each, where one pair has its drains connected to a load, and the other par has its drains connected to another load. The differential output voltage is taken at the two loads. In one embodiment, for each G.sup.4-FET, the first and second junction gates are each connected together, where a first input voltage is applied to the front gates of each pair, and a second input voltage is applied to the first junction gates of each pair. Other embodiments are described and claimed.

  13. The right team at the right time - Multidisciplinary approach to multi-trauma patient with orthopedic injuries.

    PubMed

    Bach, John A; Leskovan, John J; Scharschmidt, Thomas; Boulger, Creagh; Papadimos, Thomas J; Russell, Sarah; Bahner, David P; Stawicki, Stanislaw P A

    2017-01-01

    Integrated, multidisciplinary team approach to the multiply injured patient can help optimize care, minimize morbidity, and reduce mortality. It also provides a framework for accelerated postinjury rehabilitation course. The characteristics and potential benefits of this approach, including team dynamics and interactions, are discussed in this brief review. Emphasis is placed on synergies provided by specialty teams working together in the framework of care coordination, timing of surgical and nonsurgical interventions, and injury/physiologic considerations.

  14. Functional Outcomes, Morbidity, Mortality, and Fracture Healing in 58 Consecutive Patients with Geriatric Odontoid Fracture Treated with Cervical Collar or Posterior Fusion

    PubMed Central

    Molinari, William J.; Molinari, Robert W.; Khera, Oner A.; Gruhn, William L.

    2013-01-01

    Controversy exists as to the most effective management option for elderly patients with type II odontoid fractures. The purpose of this study is to evaluate outcomes associated with rigid cervical collar and posterior fusion surgery. Patients with ≥ 50% odontoid displacement were treated with posterior fusion surgery including C1–2 (PSF group, n = 25, average age = 80 years). Patients with < 50% odontoid displacement were treated with a rigid cervical collar for 12 weeks (collar group, n = 33, average age = 83 years). These inhomogeneous groups were followed for an average of 14 months. Fracture healing rates were higher in the operative group (28% versus 6%). Neck Disability Index scores were slightly lower in the nonoperative group (13 versus 18.3, p = 0.23). Analogue pain scores were also slightly lower in the nonoperative group (1.3 versus 1.9, p = 0.26). The mortality rate was 12.5% in the collar group and 20% in the operative group. Complications were higher in the operative group (24% versus 6%). Rates of type II odontoid facture healing and stability appear to be higher in geriatric patients treated with posterior fusion surgery. Fracture healing and stability did not correlate with improved outcomes with respect to levels of pain, function, and satisfaction. Mortality and complication rates are lower in those patients with lesser-displaced fractures who are treated with a cervical collar and early mobilization. PMID:24436848

  15. Morbidity assessment in sand flea disease (tungiasis).

    PubMed

    Kehr, Judith Dorothea; Heukelbach, Jörg; Mehlhorn, Heinz; Feldmeier, Hermann

    2007-01-01

    Tungiasis, caused by the sand flea Tunga penetrans, is a health problem in many impoverished communities in Latin America, the Caribbean, and sub-Saharan Africa. Sand flea disease is associated with a broad spectrum of clinical and histological pathology. The factors determining the disease burden in endemic communities are not well understood, and severity of clinical pathology has never been assessed quantitatively. Thus, two severity scores were developed: one for acute disease and one for chronic sequels. These scores were evaluated in a cohort of 70 severely infested patients living in a shantytown in Fortaleza, a capital city in Northeast Brazil. Patients were examined during a period of 25 days and followed-up after a twice daily application of a plant-based repellent to prevent reinfestation. The severity score for acute disease symptoms significantly correlated with the infestation rate and the number of embedded fleas. It turned zero when reinfestation was prevented. The score for chronic disease also significantly correlated with the infestation rate. Tungiasis is associated with considerable acute and chronic morbidity. The degree of acute morbidity is directly related to the number of embedded sand fleas. When transmission is interrupted, the chronic morbidity reflects the infestation rates individuals have experienced in the past.

  16. Immediate postoperative morbidity in patients with indwelling double-J stent versus overnight-externalized ureteral catheter after tubeless percutaneous nephrolithotomy: a prospective, randomized study.

    PubMed

    Mercado, Alejandro; Fernández, Mario I; Recabal, Pedro; Fleck, Daniela; Ledezma, Rodrigo; Moya, Francisco; Sepúlveda, Francisco; Vilches, Roberto; Reyes, Diego; Marchant, Fernando

    2013-06-01

    The conventional technique for percutaneous nephrolithotomy (PNL) ends by placing a nephrostomy tube within the access tract. However, feasibility and safety of tubeless PNL have been widely demonstrated. In this modification, a ureteral stent is usually left in place instead of the nephrostomy tube. The aim of this study is to compare the use of a postoperative indwelling double-J stent versus an overnight-externalized ureteral catheter in patients undergoing tubeless PNL. Sixty-eight patients undergoing tubeless PNL were randomized either for a postoperative double-J stent (group 1) or for an overnight-externalized ureteral catheter (group 2). Outcomes evaluated included postoperative pain, hospital stay length, incidence of hemorrhagic complications, residual lithiasis and urinary leakage. Groups were similar according to age, sex, body mass index and stone burden. There were no significant differences in terms of postoperative pain, incidence of perirenal hematomas, residual lithiasis and urinary leakage. However, patients in group 1 presented longer hospital stays (3.7 ± 1.7 vs. 1.9 ± 0.3 days; p < 0.001) and greater hematocrit drops (4.9 ± 2.2 vs. 2.1 ± 1.8 %; p < 0.001). Our results confirm that among patients undergoing tubeless PNL, both alternatives (i.e. leaving a double-J stent or an overnight-externalized ureteral catheter) are reliable and safe. However, further considerations, like the need of double-J stent removal under cystoscopy, need to be taken into account when deciding which modality to use.

  17. Asymmetric Dimethylarginine Is a Well Established Mediating Risk Factor for Cardiovascular Morbidity and Mortality—Should Patients with Elevated Levels Be Supplemented with Citrulline?

    PubMed Central

    McCarty, Mark F.

    2016-01-01

    The arginine metabolite asymmetric dimethylarginine (ADMA) is a competitive inhibitor and uncoupler of endothelial nitric oxide synthase (eNOS), an enzyme that acts in multifarious ways to promote cardiovascular health. This phenomenon likely explains, at least in part, why elevated ADMA has been established as an independent risk factor for cardiovascular events, ventricular hypertrophy, and cardiovascular mortality. Fortunately, the suppressive impact of ADMA on eNOS activity can be offset by increasing intracellular arginine levels with supplemental citrulline. Although the long-term impact of supplemental citrulline on cardiovascular health in patients with elevated ADMA has not yet been studied, shorter-term clinical studies of citrulline administration demonstrate effects suggestive of increased NO synthesis, such as reductions in blood pressure and arterial stiffness, improved endothelium-dependent vasodilation, increased erection hardness, and increased ejection fractions in patients with heart failure. Supplemental citrulline could be a practical option for primary or secondary prevention of cardiovascular events and mortality, as it is inexpensive, has a mild flavor, and is well tolerated in doses (3–6 g daily) that can influence eNOS activity. Large and long-term clinical trials, targeting patients at high risk for cardiovascular events in whom ADMA is elevated, are needed to evaluate citrulline’s potential for aiding cardiovascular health. PMID:27417628

  18. Improved Quality of Life after bariatric surgery in morbidly obese patients. Interdisciplinary group of bariatric surgery of Verona (G.I.C.O.V.)

    PubMed Central

    NADALINI, L.; ZENTI, M.G.; MASOTTO, L.; INDELICATO, L.; FAINELLI, G.; BONORA, F.; BATTISTONI, M.; ROMANI, B.; GENNA, M.; ZOPPINI, G.; BONORA, E.

    2014-01-01

    Background Our aim was to evaluate the changes of health-related Quality of Life (HR-QoL) after bariatric surgery. Patients and methods 110 patients, who underwent laparoscopic bariatric surgery (N=34 gastric banding; N= 69 Roux-en-Y gastric bypass, N=7 sleeve gastrectomy), were evaluated before surgery and after an average of 36±13 months with SF-36 Health Survey. Results Mean preoperative age and body mass index (BMI) were 43±12 years and 45±7 kg/m2 respectively. At follow-up, mean BMI was 33±6 kg/m2. A significant improvement was observed for all dimensions of SF-36, except for General and Mental Health dimension. Satisfaction was greater in patients with the higher reduction in weight. Only the PF (Physical Functioning) domain (F=6,349, p=0.01) resulted a significant predictor of the weight lost after surgery independently of age, sex and type of surgery. Conclusions We confirm a beneficial effect of bariatric surgery on HR-QoL. Moreover, we found that PF domain of SF-36 is a significant predictor of weight loss. PMID:25174289

  19. Severe hypotension and water intoxication developed after an accidental oxytocin overdose in a morbidly obese patient undergoing cesarean section -A case report-.

    PubMed

    In, Jang Hyeok; Choi, Jin Woo; Jung, Hong Soo; Lee, Jung-Ah; Joo, Jin-Deok; Kim, Dae-Woo; Jeon, Yeon Soo; Park, Ju-Seon

    2011-04-01

    We present a 32-year-old, extremely obese, pregnant woman who developed severe hypotension and water intoxication after an accidental injection of large bolus of oxytocin during cesarean section under general anesthesia. The patient was initially thought to have an amniotic fluid embolism because of the abrupt hemodynamic changes developed immediately after fetal delivery and lack of recognition of medication error. It is highly recommended that careful attention should be paid not only to the possibility of hemodynamic deterioration and water intoxication if oxytocin is given rapidly in excessive doses, but to the confirmation of the proper use of the drug before it is injected.

  20. Severe hypotension and water intoxication developed after an accidental oxytocin overdose in a morbidly obese patient undergoing cesarean section -A case report-

    PubMed Central

    In, Jang Hyeok; Choi, Jin Woo; Jung, Hong Soo; Lee, Jung-Ah; Joo, Jin-Deok; Kim, Dae-Woo; Park, Ju-Seon

    2011-01-01

    We present a 32-year-old, extremely obese, pregnant woman who developed severe hypotension and water intoxication after an accidental injection of large bolus of oxytocin during cesarean section under general anesthesia. The patient was initially thought to have an amniotic fluid embolism because of the abrupt hemodynamic changes developed immediately after fetal delivery and lack of recognition of medication error. It is highly recommended that careful attention should be paid not only to the possibility of hemodynamic deterioration and water intoxication if oxytocin is given rapidly in excessive doses, but to the confirmation of the proper use of the drug before it is injected. PMID:21602981

  1. Pedigree and BRCA gene analysis in breast cancer patients to identify hereditary breast and ovarian cancer syndrome to prevent morbidity and mortality of disease in Indian population.

    PubMed

    Darooei, Mina; Poornima, Subhadra; Salma, Bibi Umae; Iyer, Gayatri R; Pujar, Akhilesh N; Annapurna, Srirambhatla; Shah, Ashwin; Maddali, Srinivas; Hasan, Qurratulain

    2017-02-01

    Global burden of breast cancer is expected to increase to >2 million new cases every year by 2030 and 10% of these are likely to have hereditary breast and ovarian cancer syndrome. Identifying these individuals by pedigree and BRCA1/2 mutation analyses will enable us to offer targeted mutation testing and appropriate counseling. This study from a tertiary care hospital showed that of the 127 breast cancer patients on treatment during 2014-2015, 24 of them fulfilled the criteria of hereditary breast and ovarian cancer syndrome after detailed verbal autopsy and pedigree analysis, and BRCA1 and 2 next-generation sequencing done after pre-test counseling revealed mutations in 13 cases (54%), these included 9 BRCA1 mutations (69%) and 4 BRCA2 mutation (31%). Subsequent post-test counseling recommended targeted mutation analysis for 64 high-risk members in these 13 families with pathogenic mutations, which will help in surveillance for early detection, appropriate management, and prevention of the disease by decreasing the burden to both family and nation. Results from this preliminary study highlight the importance of genetic counseling, pedigree analysis, and genetic testing. It can be recommended that all oncology units should have a genetic counseling service for providing appropriate support to oncologists, patients, and families to prevent unnecessary testing; however, breast cancer screening program is incomplete without evaluating for hereditary breast and ovarian cancer syndrome.

  2. Surgically and Conservatively Treated Obese Patients Differ in Psychological Factors, Regardless of Body Mass Index or Obesity-Related Co-Morbidities: A Comparison between Groups and an Analysis of Predictors

    PubMed Central

    Ahnis, Anne; Figura, Andrea; Hofmann, Tobias; Stengel, Andreas; Elbelt, Ulf; Klapp, Burghard F.

    2015-01-01

    Objective For the treatment of obesity, both conservative and surgical procedures are available. Psychological factors are likely to influence the choice of treatment; however, to date, systematic studies that investigate these factors are few in number. The aim of our study was to analyze whether patients who undergo a surgical treatment differ from those who require a conservative treatment in regard to psychological factors, regardless of their somatic conditions. Furthermore, predictors of treatment choice will be examined. Methods A total of 244 patients (189 women), with a mean body mass index of 45.1 kg/m2, underwent a weight reduction treatment, with 126 patients undergoing bariatric surgery and 118 patients participating in a conservative, multimodal outpatient weight reduction program. Differences in the results of the psychological questionnaires between conservatively and surgically treated patients were evaluated through the use of t-tests, χ2-tests and an ANCOVA. For the analysis of the predictors, logistic regression models were calculated. Results Surgically and conservatively treated obese patients differ in psychological, somatic, and socio-demographic factors. The psychological differences between the groups are independent of obesity-related co-morbidities, such as body mass index (BMI), type 2 diabetes mellitus, hypertension and coronary heart disease. The following psychological and somatic factors equally predict the choice of bariatric surgery: apathy, delegated active coping, a sense of coherence, complaints, type 2 diabetes mellitus, BMI, and age. Conclusion Longitudinal studies are required to assess the predictive value of the psychological factors in regard to the postsurgical weight course to improve the pre-surgical screening and treatment selection process. The pre-surgical identification of psychological predictors should result in a more personalized medicine course and may ensure long term outcomes. PMID:25679521

  3. QUIT EMR trial: a prospective, observational, multicentre study to evaluate quality and 24 hours post-transport morbidity of interhospital transportation of critically ill patients: study protocol

    PubMed Central

    Strauch, Ulrich; Bergmans, Dennis C J J; Habers, Joachim; Jansen, Jochen; Winkens, Bjorn; Veldman, Dirk J; Roekaerts, Paul M H J; Beckers, Stefan K

    2017-01-01

    Introduction It is widely accepted that transportation of critically ill patients is high risk. Unfortunately, however, there are currently no evidence-based criteria with which to determine the quality of various interhospital transport systems and their impact on the outcomes for patients. We aim to rectify this by assessing 2 scores which were developed in our hospital in a prospective, observational study. Primarily, we will be examining the Quality of interhospital critical care transportation in the Euregion Meuse-Rhine (QUIT EMR) score, which focuses on the quality of the transport system, and secondarily the SEMROS (Simplified EMR outcome score) which detects changes in the patient's clinical condition in the 24 hours following their transportation. Methods and analysis A web-based application will be used to document around 150 pretransport, intratransport and post-transport items of each patient case. To be included, patients must be at least 18-years of age and should have been supervised by a physician during an interhospital transport which was started in the study region. The quality of the QUIT EMR score will be assessed by comparing 3 predefined levels of transport facilities: the high, medium and low standards. Subsequently, SEMROS will be used to determine the effect of transport quality on the morbidity 24 hours after transportation. It is estimated that there will be roughly 3000 appropriate cases suitable for inclusion in this study per year. Cases shall be collected from 1 April 2015 until 31 December 2017. Ethics and dissemination This trial was approved by the Ethics committees of the university hospitals of Maastricht (Netherlands) and Aachen (Germany). The study results will be published in a peer reviewed journal. Results of this study will determine if a prospective randomised trial involving patients of various categories being randomly assigned to different levels of transportation system shall be conducted. Trial registration

  4. An Efficient 16-Bit Multiplier based on Booth Algorithm

    NASA Astrophysics Data System (ADS)

    Khan, M. Zamin Ali; Saleem, Hussain; Afzal, Shiraz; Naseem, Jawed

    2012-11-01

    Multipliers are key components of many high performance systems such as microprocessors, digital signal processors, etc. Optimizing the speed and area of the multiplier is major design issue which is usually conflicting constraint so that improving speed results mostly in bigger areas. A VHDL designed architecture based on booth multiplication algorithm is proposed which not only optimize speed but also efficient on energy use.

  5. Effect of statin treatment on vasospasm-related morbidity and functional outcome in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis.

    PubMed

    Shen, Jian; Huang, Kai-Yuan; Zhu, Yu; Pan, Jian-Wei; Jiang, Hao; Weng, Yu-Xiang; Zhan, Ren-Ya

    2016-10-07

    OBJECTIVE The efficacy of statin therapy in treating aneurysmal subarachnoid hemorrhage (SAH) remains controversial. In this meta-analysis, the authors investigated whether statin treatment significantly reduced the incidence of cerebral vasospasm and delayed neurological deficits, promoting a better outcome after aneurysmal SAH. METHODS A literature search of the PubMed, Ovid, and Cochrane Library databases was performed for randomized controlled trials (RCTs) and prospective cohort studies investigating the effect of statin treatment. The end points of cerebral vasospasm, delayed ischemic neurological deficit (DIND), delayed cerebral infarction, mortality, and favorable outcome were statistically analyzed. RESULTS Six RCTs and 2 prospective cohort studies met the eligibility criteria, and a total of 1461 patients were included. The meta-analysis demonstrated a significant decrease in the incidence of cerebral vasospasm (relative risk [RR] 0.76, 95% confidence interval [CI] 0.61-0.96) in patients treated with statins after aneurysmal SAH. However, no significant benefit was observed for DIND (RR 0.88, 95% CI 0.70-1.12), delayed cerebral infarction (RR 0.66, 95% CI 0.33-1.31), mortality (RR 0.69, 95% CI 0.39-1.24) or favorable outcome, according to assessment by the modified Rankin Scale or Glasgow Outcome Scale (RR 0.99, 95% CI 0.92-1.17). CONCLUSIONS Treatment with statins significantly decreased the occurrence of vasospasm after aneurysmal SAH. The incidence of DIND, delayed cerebral infarction, and mortality were not affected by statin treatment. Future research should focus on DIND and how statins influence DIND.

  6. Morbidly obese patient with non-alcoholic steatohepatitis-related cirrhosis who died from sepsis caused by dental infection of Porphyromonas gingivalis: A case report.

    PubMed

    Omura, Yuno; Kitamoto, Mikiya; Hyogo, Hideyuki; Yamanoue, Takao; Tada, Yoshihiro; Boku, Noriko; Nishisaka, Takashi; Miyauchi, Mutsumi; Takata, Takashi; Chayama, Kazuaki

    2016-03-01

    Non-alcoholic steatohepatitis (NASH) is associated with increased risks of developing lifestyle-related diseases including type 2 diabetes, cardiovascular disease and cerebral vessel disease. While the two-hit hypothesis and, recently, multiple parallel hits hypothesis of NASH pathogenesis were proposed, further details have not emerged. Recently, dental infection of Porphyromonas gingivalis (P. gingivalis) has been reported as a critical risk factor for NASH progression, which acts as multiple parallel hits to induce inflammation and fibrogenic responses in steatosis. We describe here a 54-year-old woman who died from sepsis and was diagnosed with NASH. Briefly, her body mass index (BMI) at the age of 35 years old had been 25.6 kg/m(2) , but she became obese after withdrawing into her home at the age of 45 years. Severe obesity continued over 19 years without diabetes mellitus. She was admitted to our hospital due to a sudden disturbance of consciousness. On admission, her BMI was 48.5 kg/m(2) . Computed tomography revealed cirrhotic liver with massive ascites, and laboratory data indicated increased inflammatory responses, renal failure and C grade Child-Pugh classification, suggesting the diagnosis of sepsis. Also, severe periodontal disease was present, because the patient's front teeth fell out easily during intubation. Although the focus of infection was not specified, the oral flora Parvimonas micra, a periodontal pathogen, was detected in venous blood. In spite of intensive care including artificial respiration management and continuous hemodiafiltration, she died on the 43rd day after admission. Surprisingly, P. gingivalis was detected in her hepatocytes. This case may represent the significance of P. gingivalis in the progress to cirrhosis in NASH patients.

  7. Intraoperative transfusion of packed red blood cells in microvascular free tissue transfer patients: assessment of 30-day morbidity using the NSQIP dataset.

    PubMed

    Kim, Bobby D; Ver Halen, Jon P; Mlodinow, Alexei S; Kim, John Y S

    2014-02-01

    Although often a life-saving therapeutic maneuver, there is minimal data available that details the effects of intraoperative packed red blood cell transfusion (IOT) after microvascular free tissue transfer. The National Surgical Quality Improvement Program database was queried to identify all patients who underwent microvascular free tissue transfer between 2006 and 2010. Multivariate logistic regression models were used to determine the association between intraoperative transfusion and outcomes. Upon bivariate and multivariate analyses, IOT was significantly associated with higher rates of overall complications (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.12-3.63), medical complications (OR, 3.35; 95% CI, 1.75-6.42), postoperative transfusion (OR, 6.02; 95% CI, 2.02-17.97), and reoperation (OR, 2.24; 95% CI, 1.24-4.04). IOT was not associated with either surgical complications or free flap loss. IOT significantly increases risk for adverse overall and medical complications. However, IOT was not associated with surgical complications or free flap loss. Transfusion practices in the operating room should be reevaluated to improve overall outcomes.

  8. Gain of a single gas electron multiplier

    NASA Astrophysics Data System (ADS)

    Nemallapudi, Mythra Varun

    Gas Electron Multiplier (GEM) is a gaseous detector used in particle detection and is known for its high rate capability. Ever since its invention in 1997, GEM was applied in many areas and recently has been proposed to be installed in the CMS high η regions for upgrade at LHC, CERN. A complete understanding of the working and gain behaviour does not exist. GEM gain is influenced by charging up and this has been variedly interpreted in literature lacking consensus. I have attempted in this work through simulations and measurements to achieve a better understanding of single GEM gain and how it is affected by various factors. Specific experimental methods which evolved with subsequent measurements were employed to systematically study the charging up effect. Information from simulations was applied to characterize measurements thereby enabling the development of a model for charging up. Conductivity mechanism of the dielectric used in GEM was analyzed and the resistivity measured. Gain free of charging up effects was measured and this is appropriate for comparison with simulations.

  9. Preoperative anemia increases postoperative morbidity in elective cranial neurosurgery

    PubMed Central

    Bydon, Mohamad; Abt, Nicholas B.; Macki, Mohamed; Brem, Henry; Huang, Judy; Bydon, Ali; Tamargo, Rafael J.

    2014-01-01

    Background: Preoperative anemia may affect postoperative mortality and morbidity following elective cranial operations. Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to identify elective cranial neurosurgical cases (2006-2012). Morbidity was defined as wound infection, systemic infection, cardiac, respiratory, renal, neurologic, and thromboembolic events, and unplanned returns to the operating room. For 30-day postoperative mortality and morbidity, adjusted odds ratios (ORs) were estimated with multivariable logistic regression. Results: Of 8015 patients who underwent elective cranial neurosurgery, 1710 patients (21.4%) were anemic. Anemic patients had an increased 30-day mortality of 4.1% versus 1.3% in non-anemic patients (P < 0.001) and an increased 30-day morbidity rate of 25.9% versus 14.14% in non-anemic patients (P < 0.001). The 30-day morbidity rates for all patients undergoing cranial procedures were stratified by diagnosis: 26.5% aneurysm, 24.7% sellar tumor, 19.7% extra-axial tumor, 14.8% intra-axial tumor, 14.4% arteriovenous malformation, and 5.6% pain. Following multivariable regression, the 30-day mortality in anemic patients was threefold higher than in non-anemic patients (4.1% vs 1.3%; OR = 2.77; 95% CI: 1.65-4.66). The odds of postoperative morbidity in anemic patients were significantly higher than in non-anemic patients (OR = 1.29; 95% CI: 1.03-1.61). There was a significant difference in postoperative morbidity event odds with a hematocrit level above (OR = 1.07; 95% CI: 0.78-1.48) and below (OR = 2.30; 95% CI: 1.55-3.42) 33% [hemoglobin (Hgb) 11 g/dl]. Conclusions: Preoperative anemia in elective cranial neurosurgery was independently associated with an increased risk of 30-day postoperative mortality and morbidity when compared to non-anemic patients. A hematocrit level below 33% (Hgb 11 g/dl) was associated with a significant increase in postoperative morbidity. PMID

  10. T-cell-depleted allogeneic transplant without donor leukocyte infusions results in excellent long-term survival in patients with multiply relapsed Lymphoma. Predictors for survival after transplant relapse

    PubMed Central

    KENKRE, VAISHALEE P.; HOROWITZ, SARAH; ARTZ, ANDREW S.; LIAO, CHUANHONG; COHEN, KENNETH S.; GODLEY, LUCY A.; KLINE, JUSTIN P.; SMITH, SONALI M.; STOCK, WENDY; VAN BESIEN, KOEN

    2013-01-01

    We analyzed 67 patients with lymphoma who received alemtuzumab-based conditioning regimens for allogeneic stem cell transplant and no post-transplant DLI. The median age was 54 (24–70), 43% had unrelated donors, 34% had chemotherapy refractory disease, and 25% had an elevated LDH. With a median follow-up for survivors of 35 months, the estimated 3-year progression-free survival (PFS) and overall survival (OS) were 30% and 47%, respectively. Chemosensitivity by CT and pre-transplant LDH were independent prognostic factors for both overall survival and progression-free survival. Patient age, performance status, donor type, lymphoma subtype, disease sensitivity by PET, and conditioning regimen did not correlate with PFS and OS. Patients who relapsed greater than 6 months after allogeneic transplant were frequently able to re-enter a subsequent durable remission. Our experience confirms the curative potential of alemtuzumab-containing RIC regimens for allogeneic HCT in patients with relapsed lymphoma without prophylactic DLI. An elevated pre-transplant LDH and chemorefractory disease prior to transplant confer a worse prognosis, while PET scan findings do not have this same implication. Patients who relapse greater than 6 months after their transplant are likely to achieve a subsequent remission with any of a variety of interventions, suggesting that GVL effects can be operative even after recurrence. Our outcomes challenge the utility of the common practice of prophylactic DLI after T-depleted transplant for lymphoma. PMID:21142785

  11. Synthesis and characterization of multiply-tyrosinated, multiply-iodinated somatostatin analogs

    SciTech Connect

    Woltering, E A.; O'Dorisio, M S.; Murphy, W A.; Chen, F; Drouant, G J.; Espenan, G D.; Fisher, Darrell R.; Sharma, C; Diaco, D S.; Maloney, T M.; Fuselier, J A.; Nelson, J A.; O'Dorisio, T M.; Coy, D H.

    1999-02-01

    Radio-labeled somatostatin analogs have recently gained popularity as agents useful in intraoperative tumor localization, external scintigraphy and in situ radiotherapy. We have synthesized and characterized a series of novel N-terminally extended multiply-tyrosinated somatostatin analogs that possess high binding affinity for somatostatin receptors, exhibit biological activity comparable to the native peptide and retain these characteristics after iodination. These analogs can be radio-iodinated to high specific activities. Following radio-iodination, these analogs exhibit minimal radiolysis and may be clinically useful for tumor localization, scanning and therapy.

  12. Planar Monolithic Schottky Varactor Diode Millimeter-Wave Frequency Multipliers

    DTIC Science & Technology

    1992-06-01

    power 175 of the 80/160 GHz doubler. 6.23 The output power versus frequency for three 176 80/160 GHz chips. 6.24 The multiplier efficiency for...versions of the 31/94 GHz tripler. (iteration one). 8.33 Multiplier efficiency versus available 249 input power for the four versions of the 31/94 GHz ...8.48 Output power versus available input power 267 for the four versions of the 31/94 GHz tripler. (interation two). 22 8.49 Multiplier

  13. Disease Severity, Quality of Life, and Psychiatric Morbidity in Patients With Psoriasis With Reference to Sociodemographic, Lifestyle, and Clinical Variables: A Prospective, Cross-Sectional Study From Lahore, Pakistan

    PubMed Central

    Khawaja, Abdul Rahman; Bokhari, Syed Muhammad Azam; Rasheed, Tariq; Shahzad, Atif; Hanif, Muhammad; Qadeer, Faisal

    2015-01-01

    Background: Psoriasis is an immune-mediated, chronic disease with a genetic background that involves skin, nails, and joints. The incidence of psoriasis varies from 2.0% to 4.0% depending on the geographical location, ethnic background, and environmental conditions. Recent research has proved that psoriasis is a systemic inflammatory disease with extensive systemic implications. Objectives of the study were to explore the severity of psoriasis, dermatology-related quality of life, and psychiatric health of the patients with reference to sociodemographic, lifestyle, and clinical characteristics. Method: Consecutive patients with psoriasis (ICD-10 criteria) from skin outpatient clinics of 3 tertiary care hospitals in Lahore, Pakistan, between November 1, 2012, and December 31, 2012, were assessed in this prospective cross-sectional study. The final sample includes 87 patients who were evaluated for severity of psoriasis (Psoriasis Area Severity Index [PASI]), dermatology-related quality of life (Dermatology Life Quality Index [DLQI]), and psychiatric morbidity (12-item General Health Questionnaire [GHQ-12]) and were assessed on 23 sociodemographic, lifestyle, and clinical variables. Results: Of the 23 variables, the PASI was significantly associated with education and habit of drinking alcohol (P < .05), the DLQI was significantly associated with disturbed eating (P < .05), and the GHQ-12 score was significantly associated with hair disease (P < .05), current income (P < .05), and disturbed eating and sleeping (P < .01). The PASI, DLQI, and GHQ-12 were not usually affected by sociodemographic, lifestyle, and clinical factors, except for some variables such as education of the patient, alcohol intake, eating and sleeping disturbance, and income status. A statistically significant correlation (P < .01) was found between all 3 scores (ie, PASI, DLQI, and GHQ-12). The correlation coefficients of the PASI with the DLQI and GHQ-12 are 0.345 and 0.460, respectively, and

  14. Predictors of Urinary Morbidity in Cs-131 Prostate Brachytherapy Implants

    SciTech Connect

    Smith, Ryan P.; Jones, Heather A.; Beriwal, Sushil; Gokhale, Abhay; Benoit, Ronald

    2011-11-01

    Purpose: Cesium-131 is a newer radioisotope being used in prostate brachytherapy (PB). This study was conducted to determine the predictors of urinary morbidity with Cs-131 PB. Methods and Materials: A cohort of 159 patients underwent PB with Cs-131 at our institution and were followed by using Expanded Prostate Cancer Index Composite (EPIC) surveys to determine urinary morbidity over time. EPIC scores were obtained preoperatively and postoperatively at 2 and 4 weeks, and 3 and 6 months. Different factors were evaluated to determine their individual effect on urinary morbidity, including patient characteristics, disease characteristics, treatment, and dosimetry. Multivariate analysis of covariance was carried out to identify baseline determinants affecting urinary morbidity. Factors contributing to the need for postoperative catheterization were also studied and reported. Results: At 2 weeks, patient age, dose to 90% of the organ (D90), bladder neck maximum dose (D{sub max}), and external beam radiation therapy (EBRT) predicted for worse function. At 4 weeks, age and EBRT continued to predict for worse function. At the 3-month mark, better preoperative urinary function, preoperative alpha blockers, bladder neck D{sub max}, and EBRT predicted for worse urinary morbidity. At 6 months, better preoperative urinary function, preoperative alpha blockers, bladder neck D{sub max}, and EBRT were predictive of increased urinary problems. High bladder neck D{sub max} and poor preoperative urinary function predicted for the need for catheterization. Conclusions: The use of EBRT plus Cs-131 PB predicts for worse urinary toxicity at all time points studied. Patients should be cautioned about this. Age was a consistent predictor of worsened morbidity immediately following Cs-131 PB, while bladder D{sub max} was the only consistent dosimetric predictor. Paradoxically, patients with better preoperative urinary function had worse urinary morbidity at 3 and 6 months, consistent with

  15. Leg morbidity and function following fibular free flap harvest.

    PubMed

    Shpitzer, T; Neligan, P; Boyd, B; Gullane, P; Gur, E; Freeman, J

    1997-05-01

    Over a period of 3 years, 50 consecutive free fibular flaps for mandibular reconstruction were performed on 47 patients. In 38 patients (81%) a skin paddle was included with the flap to provide either mucosal lining or skin cover; in 9 patients (19%) bone alone was used. Thirty-one patients (66%) required a skin graft to close the donor defect in the leg. Donor leg morbidity and function were determined by patient questionnaire and by physical examination. Forty-one donor sites in 40 patients were available for long-term follow-up. The follow-up ranged from 4 to 39 months with an average of 17 months. Immediate postoperative infection occurred in the donor site of 1 patient (2%) and required additional surgery. There was no other immediate donor site complications when closure required skin grafting. Eleven patients (27%) had late donor site morbidity, consisting of motor weakness of the great toe in 5 patients, ankle instability and/or stiffness in 3 patients, donor site pain in 1 patient, and edema in 2 patients. All complications were graded as mild in severity by the patient and by the examiner. In this series, although most donor site defects required skin grafting, short- and long-term morbidity was minimal. After a short rehabilitation period, all patients were fully able to engage in all daily and recreational activities.

  16. Sociophysics of sexism: normal and anomalous petrie multipliers

    NASA Astrophysics Data System (ADS)

    Eliazar, Iddo

    2015-07-01

    A recent mathematical model by Karen Petrie explains how sexism towards women can arise in organizations where male and female are equally sexist. Indeed, the Petrie model predicts that such sexism will emerge whenever there is a male majority, and quantifies this majority bias by the ‘Petrie multiplier’: the square of the male/female ratio. In this paper—emulating the shift from ‘normal’ to ‘anomalous’ diffusion—we generalize the Petrie model to a stochastic Poisson model that accommodates heterogeneously sexist men and woman, and that extends the ‘normal’ quadratic Petrie multiplier to ‘anomalous’ non-quadratic multipliers. The Petrie multipliers span a full spectrum of behaviors which we classify into four universal types. A variation of the stochastic Poisson model and its Petrie multipliers is further applied to the context of cyber warfare.

  17. Multiplier less high-speed squaring circuit for binary numbers

    NASA Astrophysics Data System (ADS)

    Sethi, Kabiraj; Panda, Rutuparna

    2015-03-01

    The squaring operation is important in many applications in signal processing, cryptography etc. In general, squaring circuits reported in the literature use fast multipliers. A novel idea of a squaring circuit without using multipliers is proposed in this paper. Ancient Indian method used for squaring decimal numbers is extended here for binary numbers. The key to our success is that no multiplier is used. Instead, one squaring circuit is used. The hardware architecture of the proposed squaring circuit is presented. The design is coded in VHDL and synthesised and simulated in Xilinx ISE Design Suite 10.1 (Xilinx Inc., San Jose, CA, USA). It is implemented in Xilinx Vertex 4vls15sf363-12 device (Xilinx Inc.). The results in terms of time delay and area is compared with both modified Booth's algorithm and squaring circuit using Vedic multipliers. Our proposed squaring circuit seems to have better performance in terms of both speed and area.

  18. Operational Safety Requirements Neutron Multiplier Facility in 329 Building

    SciTech Connect

    EA. Lepel

    1992-10-01

    The operational safety requirements (OSRs) presented in this report define the conditions, safe boundaries and management control needed for safely operating the Neutron Multiplier Facility in the 329 Building Annex.

  19. Auditory Reinforcement in Profoundly Retarded Multiply Handicapped Children

    ERIC Educational Resources Information Center

    Remington, R. E.; And Others

    1977-01-01

    Four profoundly retarded multiply handicapped children (with a mean age of 12 years) were placed in a situation where auditory stimulation was made contingent on a visually directed lever-pulling response. (Author/MH)

  20. Radial Fourier multipliers of Lp(R2)

    PubMed Central

    Carbery, Anthony; Gasper, George; Trebels, Walter

    1984-01-01

    We give sufficient conditions (in terms of differentiability and growth properties) for a radial function to be an Lp(R2) Fourier multiplier. These conditions are in the nature of best possible. PMID:16593468

  1. High speed multiplier using Nikhilam Sutra algorithm of Vedic mathematics

    NASA Astrophysics Data System (ADS)

    Pradhan, Manoranjan; Panda, Rutuparna

    2014-03-01

    This article presents the design of a new high-speed multiplier architecture using Nikhilam Sutra of Vedic mathematics. The proposed multiplier architecture finds out the compliment of the large operand from its nearest base to perform the multiplication. The multiplication of two large operands is reduced to the multiplication of their compliments and addition. It is more efficient when the magnitudes of both operands are more than half of their maximum values. The carry save adder in the multiplier architecture increases the speed of addition of partial products. The multiplier circuit is synthesised and simulated using Xilinx ISE 10.1 software and implemented on Spartan 2 FPGA device XC2S30-5pq208. The output parameters such as propagation delay and device utilisation are calculated from synthesis results. The performance evaluation results in terms of speed and device utilisation are compared with earlier multiplier architecture. The proposed design has speed improvements compared to multiplier architecture presented in the literature.

  2. Four-quadrant analogue multiplier using operational amplifier

    NASA Astrophysics Data System (ADS)

    Riewruja, Vanchai; Rerkratn, Apinai

    2011-04-01

    A method to realise a four-quadrant analogue multiplier using general-purpose operational amplifiers (opamps) as only the active elements is described in this article. The realisation method is based on the quarter-square technique, which utilises the inherent square-law characteristic of class AB output stage of the opamp. The multiplier can be achieved from the proposed structure with using either bipolar or complementary metal-oxide-semiconductor (CMOS) opamps. The operation principle of the proposed multiplier has been confirmed by PSPICE analogue simulation program. Simulation results reveal that the principle of proposed scheme provides an adequate performance for a four-quadrant analogue multiplier. Experimental implementations of the proposed multiplier using bipolar and CMOS opamps are performed to verify the circuit performances. Measured results of the experimental proposed schemes based on the use of bipolar and CMOS opamps with supply voltage ±2.4 V show the worst-case relative errors of 0.32% and 0.47%, and the total harmonic distortions of 0.47% and 0.98%, respectively.

  3. Representation of the inverse of a frame multiplier.

    PubMed

    Balazs, P; Stoeva, D T

    2015-02-15

    Certain mathematical objects appear in a lot of scientific disciplines, like physics, signal processing and, naturally, mathematics. In a general setting they can be described as frame multipliers, consisting of analysis, multiplication by a fixed sequence (called the symbol), and synthesis. In this paper we show a surprising result about the inverse of such operators, if any, as well as new results about a core concept of frame theory, dual frames. We show that for semi-normalized symbols, the inverse of any invertible frame multiplier can always be represented as a frame multiplier with the reciprocal symbol and dual frames of the given ones. Furthermore, one of those dual frames is uniquely determined and the other one can be arbitrarily chosen. We investigate sufficient conditions for the special case, when both dual frames can be chosen to be the canonical duals. In connection to the above, we show that the set of dual frames determines a frame uniquely. Furthermore, for a given frame, the union of all coefficients of its dual frames is dense in [Formula: see text]. We also introduce a class of frames (called pseudo-coherent frames), which includes Gabor frames and coherent frames, and investigate invertible pseudo-coherent frame multipliers, allowing a classification for frame-type operators for these frames. Finally, we give a numerical example for the invertibility of multipliers in the Gabor case.

  4. Social factors and cardiovascular morbidity.

    PubMed

    Brunner, Eric John

    2017-03-01

    Recent progress in population health at aggregate level, measured by life expectancy, has been accompanied by lack of progress in reducing the difference in health prospects between groups defined by social status. Cardiovascular disease is an important contributor to this undesirable situation. The stepwise gradient of higher risk with lower status is accounted for partly by social gradients in health behaviors. The psychosocial hypothesis provides a stronger explanation, based on social patterning of living and working environments and psychological assets that individuals develop during childhood. Three decades of research based on Whitehall II and other cohort studies provide evidence for psychosocial pathways leading to cardiovascular morbidity and mortality. Job stress is a useful paradigm because exposure is long term and depends on occupational status. Studies of social-biological translation implicate autonomic and neuroendocrine function among the biological systems that mediate between chronic adverse psychosocial exposures and increased cardiometabolic risk and cardiovascular disease incidence.

  5. Inverse Jacobi multipliers and first integrals for nonautonomous differential systems

    NASA Astrophysics Data System (ADS)

    Buică, Adriana; García, Isaac A.

    2015-06-01

    In this paper, we consider nonautonomous differential systems of arbitrary dimension and first find expressions for their inverse Jacobi multipliers and first integrals in some nonautonomous invariant set in terms of the solutions of the differential system. Given an inverse Jacobi multiplier V, we find a relation between the Poincaré translation map Π at time T that extends to arbitrary dimensions the fundamental relation for scalar equations, , found in García et al. (Trans Am Math Soc 362:3591-3612, 2010). The main result guarantees the existence of continua of T-periodic solutions for T-periodic systems in the presence of T-periodic first integrals and inverse Jacobi multipliers.

  6. MULTIPLY: Development of a European HSRL Airborne Facility

    NASA Astrophysics Data System (ADS)

    Binietoglou, Ioannis; Serikov, Ilya; Nicolae, Doina; Amiridis, Vassillis; Belegante, Livio; Boscornea, Andrea; Brugmann, Bjorn; Costa Suros, Montserrat; Hellmann, David; Kokkalis, Panagiotis; Linne, Holger; Stachlewska, Iwona; Vajaiac, Sorin-Nicolae

    2016-08-01

    MULTIPLY is a novel airborne high spectral resolution lidar (HSRL) currently under development by a consortium of European institutions from Romania, Germany, Greece, and Poland. Its aim is to contribute to calibration and validations activities of the upcoming ESA aerosol sensing missions like ADM-Aeolus, EarthCARE and the Sentinel-3/-4/-5/-5p which include products related to atmospheric aerosols. The effectiveness of these missions depends on independent airborne measurements to develop and test the retrieval methods, and validate mission products following launch. The aim of ESA's MULTIPLY project is to design, develop, and test a multi-wavelength depolarization HSRL for airborne applications. The MULTIPLY lidar will deliver the aerosol extinction and backscatter coefficient profiles at three wavelengths (355nm, 532nm, 1064nm), as well as profiles of aerosol intensive parameters (Ångström exponents, extinction- to-backscatter ratios, and linear particle depolarization ratios).

  7. Multiply-Twisted Helices of Various Inter-Round Couplings

    NASA Astrophysics Data System (ADS)

    Ugajin, R.; Watanabe, Y.; Mori, Y.

    Multiply-twisted helices in which a helical chain of components, i.e. atoms or nanoclusters, is twisted, producing a doubly-twisted helix, which if itself is twisted produces a triply-twisted helix, and so on, are characterized by inter-round couplings, through which electrons in the structure transit between adjacent rounds. The multiply-twisted helix of inter-round couplings via a chain of sites and that of inter-round couplings through a single site are compared with that of the direct inter-round couplings previously reported by R. Ugajin [J. Nanosci. Nanotechnol. 1, 227 (2001)]. Monte Carlo simulations of classical spins suggest that the multiply-twisted helix of inter-round couplings through a single site, in which the Curie temperature of ferromagnetic transition is robust against the change of a basal helix, might be critical among these three types.

  8. Multiplier Accounting of Indian Mining Industry: The Application

    NASA Astrophysics Data System (ADS)

    Hussain, Azhar; Karmakar, Netai Chandra

    2016-10-01

    In the previous paper (Hussain and Karmakar in Inst Eng India Ser, 2014. doi: 10.1007/s40033-014-0058-0), the concepts of input-output transaction matrix and multiplier were explained in detail. Input-output multipliers are indicators used for predicting the total impact on an economy due to changes in its industrial demand and output which is calculated using transaction matrix. The aim of this paper is to present an application of the concepts with respect to the mining industry, showing progress in different sectors of mining with time and explaining different outcomes from the results obtained. The analysis shows that a few mineral industries saw a significant growth in their multiplier values over the years.

  9. Cancer morbidity in alcohol abusers.

    PubMed Central

    Tønnesen, H.; Møller, H.; Andersen, J. R.; Jensen, E.; Juel, K.

    1994-01-01

    Data on the association between alcohol abuse and cancer morbidity are scarce in large cohorts of non-hospitalised alcoholic men and women. Of 18,368 alcohol abusers who entered an outpatient clinic in Copenhagen during 1954-87, 18,307 were followed and their cancer incidence was compared with that of the total Danish population. On average the 15,214 men were observed for 12.9 years and the 3,093 women for 9.4 years. The overall morbidity of cancer was increased significantly. Of the men, 1,441 developed cancer [relative risk (RR) = 1.6; 95% confidence interval (CI) = 1.5-1.7], while 182 women did (RR = 1.5; 95% CI 1.3-1.8). Significantly increased incidences were found of cancer in the tongue, mouth, pharynx, oesophagus, liver, larynx, lung and pleura and secondary cancer. The women had significantly increased risk of cervical cancer (RR = 2.0; 95% CI 1.2-3.0). The men developed prostatic cancer significantly more frequently than expected (RR = 1.4; 95% CI 1.2-1.8). The risk of melanomas (RR = 0.5; 95% CI 0.2-0.8) was significantly lower than expected. The relative risks of cancer of the stomach, pancreas, kidney and endocrine system were only slightly increased. The study group did not develop more colonic (RR = 1.0; 95% CI 0.8-1.3) or rectal cancer (RR = 1.0; CI 0.7-1.3) than expected. The risk of breast cancer in women was slightly increased (RR = 1.3; 95% CI 0.9-1.7), but not statistically significant. Thus, the associations between alcohol and cancer of the upper digestive and respiratory tract and the liver are confirmed. In addition, this study indicates an increased occurrence of cancer of the prostate gland, pleura and uterine cervix in alcohol abusers. PMID:8297729

  10. Interleukin-17A Gene Expression in Morbidly Obese Women

    PubMed Central

    Zapata-Gonzalez, Fernando; Auguet, Teresa; Aragonès, Gemma; Guiu-Jurado, Esther; Berlanga, Alba; Martinez, Salomé; Martí, Andreu; Sabench, Fátima; Hernandez, Mercé; Aguilar, Carmen; Sirvent, Joan Josep; Jorba, Rosa; Del Castillo, Daniel; Richart, Cristóbal

    2015-01-01

    Data from recent studies conducted in rodent models and humans suggest that interleukin-17A (IL-17A) plays a role in the induction of inflammation in adipose tissue during obesity. The aim of this study was to assess the gene expression of IL-17A in adipose tissue of morbidly obese patients. We used RT-PCR to evaluate the expression of IL-17A and several adipo/cytokines in the visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) of 10 normal-weight control women (BMI < 25 kg/m2) and 30 morbidly obese women (MO, BMI > 40 kg/m2). We measured serum levels of IL-17A and adipo/cytokines in MO and normal weight women. IL-17A expression was significantly higher in VAT than in SAT in MO patients (p = 0.0127). It was very low in normal-weight controls in both VAT and SAT tissues. We found positive correlations between IL-17A and IL-6, lipocalin-2 and resistin in VAT of MO patients. The circulating level of IL-17A was higher in the normal-weight group than the MO patients (p = 0.032), and it was significantly related to adiponectin and TNFRII levels. In conclusion, IL-17A expression in VAT is increased in morbidly obese women, which suggests a link between obesity and innate immunity in low-grade chronic inflammation in morbidly obese women. PMID:26263971

  11. Interleukin-17A Gene Expression in Morbidly Obese Women.

    PubMed

    Zapata-Gonzalez, Fernando; Auguet, Teresa; Aragonès, Gemma; Guiu-Jurado, Esther; Berlanga, Alba; Martinez, Salomé; Martí, Andreu; Sabench, Fátima; Hernandez, Mercé; Aguilar, Carmen; Sirvent, Joan Josep; Jorba, Rosa; Del Castillo, Daniel; Richart, Cristóbal

    2015-07-30

    Data from recent studies conducted in rodent models and humans suggest that interleukin-17A (IL-17A) plays a role in the induction of inflammation in adipose tissue during obesity. The aim of this study was to assess the gene expression of IL-17A in adipose tissue of morbidly obese patients. We used RT-PCR to evaluate the expression of IL-17A and several adipo/cytokines in the visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) of 10 normal-weight control women (BMI < 25 kg/m2) and 30 morbidly obese women (MO, BMI > 40 kg/m2). We measured serum levels of IL-17A and adipo/cytokines in MO and normal weight women. IL-17A expression was significantly higher in VAT than in SAT in MO patients (p = 0.0127). It was very low in normal-weight controls in both VAT and SAT tissues. We found positive correlations between IL-17A and IL-6, lipocalin-2 and resistin in VAT of MO patients. The circulating level of IL-17A was higher in the normal-weight group than the MO patients (p = 0.032), and it was significantly related to adiponectin and TNFRII levels. In conclusion, IL-17A expression in VAT is increased in morbidly obese women, which suggests a link between obesity and innate immunity in low-grade chronic inflammation in morbidly obese women.

  12. Spatial frequency multiplier with active linearly tapered slot antenna array

    NASA Technical Reports Server (NTRS)

    Simons, Rainee N.; Lee, Richard Q.

    1994-01-01

    A frequency multiplier with active linearly tapered slot antennas (LTSA's) has been demonstrated at the second harmonic frequency. In each antenna element, a GaAs monolithic microwave integrated circuit (MMIC) distributed amplifier is integrated with two LTSA's. The multiplier has a very wide bandwidth and large dynamic range. The fundamental-to-second harmonic conversion efficiency is 8.1 percent. The spatially combined second harmonic signal is 50 dB above the noise level. The design is suitable for constructing a large array using monolithic integration techniques.

  13. Californium Multiplier Part I: design for neutron radiography

    SciTech Connect

    Crosbie, K.L.; Preskitt, C.A.; John, J.; Hastings, J.D.

    1982-01-01

    The Californium Multiplier (CFX) is a subcritical assembly of enriched uranium surrounding a californium-252 neutron source. The function of the CFX is to multiply the neutrons emitted by the source to a number sufficient for neutron radiography. The CFX is designed to provide a collimated beam of thermal neutrons from which the gamma radiation is filtered, and the scattered neutrons are reduced to make it suitable for high resolution radiography. The entire system has inherent safety features, which provide for system and personnel safety, and it operates at moderate cost. In Part I, the CFX and the theory of its operation are described in detail.

  14. Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation

    PubMed Central

    Shin, Rumi; Lee, Sang Mok; Sohn, Beonghoon; Lee, Dong Woon; Song, Inho; Chai, Young Jun; Lee, Hae Won; Ahn, Hye Seong; Jung, In Mok; Chung, Jung Kee

    2016-01-01

    Purpose An intestinal perforation is a rare condition, but has a high mortality rate, even after immediate surgical intervention. The clinical predictors of postoperative morbidity and mortality are still not well established, so this study attempted to identify risk factors for postoperative morbidity and mortality after surgery for an intestinal perforation. Methods We retrospectively analyzed the cases of 117 patients who underwent surgery for an intestinal perforation at a single institution in Korea from November 2008 to June 2014. Factors related with postoperative mortality at 1 month and other postoperative complications were investigated. Results The mean age of enrolled patients was 66.0 ± 15.8 years and 66% of the patients were male. Fifteen patients (13%) died within 1 month after surgical treatment. Univariate analysis indicated that patient-related factors associated with mortality were low systolic and diastolic blood pressure, low serum albumin, low serum protein, low total cholesterol, and high blood urea nitrogen; the surgery-related factor associated with mortality was feculent ascites. Multivariate analysis using a logistic regression indicated that low systolic blood pressure and feculent ascites independently increased the risk for mortality; postoperative complications were more likely in both females and those with low estimated glomerular filtration rates and elevated serum C-reactive protein levels. Conclusion Various factors were associated with postoperative clinical outcomes of patients with an intestinal perforation. Morbidity and mortality following an intestinal perforation were greater in patients with unstable initial vital signs, poor nutritional status, and feculent ascites. PMID:28119865

  15. Long-term maternal morbidity associated with repeat cesarean delivery.

    PubMed

    Clark, Erin A S; Silver, Robert M

    2011-12-01

    Concern regarding the association between cesarean delivery and long-term maternal morbidity is growing as the rate of cesarean delivery continues to increase. Observational evidence suggests that the risk of morbidity increases with increasing number of cesarean deliveries. The dominant maternal risk in subsequent pregnancies is placenta accreta spectrum disorder and its associated complications. A history of multiple cesarean deliveries is the major risk factor for this condition. Pregnancies following cesarean delivery also have increased risk for other types of abnormal placentation, reduced fetal growth, preterm birth, and possibly stillbirth. Chronic maternal morbidities associated with cesarean delivery include pelvic pain and adhesions. Adverse reproductive effects may include decreased fertility and increased risk of spontaneous abortion and ectopic pregnancy. Clinicians and patients need to be aware of the long-term risks associated with cesarean delivery so that they can be considered when determining the method of delivery for first and subsequent births.

  16. Morbidity in early Parkinson's disease and prior to diagnosis

    PubMed Central

    Frandsen, Rune; Kjellberg, Jakob; Ibsen, Rikke; Jennum, Poul

    2014-01-01

    Background Nonmotor symptoms are probably present prior to, early on, and following, a diagnosis of Parkinson's disease. Nonmotor symptoms may hold important information about the progression of Parkinson's disease. Objective To evaluated the total early and prediagnostic morbidities in the 3 years before a hospital contact leading to a diagnosis of Parkinson's disease. Methods Retrospective morbidity data from Danish National Patient Registry records (1997–2007) of 10,490 adult patients with a secondary care diagnosis of Parkinson's disease were compared with 42,505 control cases. Results Parkinson's disease was associated with significantly higher morbidity rates associated with conditions in the following categories: mental and psychiatric, nervous system, gastrointestinal, musculoskeletal system and connective tissue, genitourinary, abnormal clinical and laboratory findings, injury, poisoning and certain other external causes, and other factors influencing health status and contact with health services. It was negatively associated with neoplasm, cardiovascular, and respiratory diseases. Conclusions Patients with a diagnosis of Parkinson's disease present significant differences in morbidities early on, following, and prior to, their diagnosis, compared with healthy controls. PMID:24944873

  17. Capability and Schur multiplier of a pair of Lie algebras

    NASA Astrophysics Data System (ADS)

    Johari, Farangis; Parvizi, Mohsen; Niroomand, Peyman

    2017-04-01

    The aim of this work is to find some criteria for detecting the capability of a pair of Lie algebras. We characterize the exact structure of all pairs of capable Lie algebras in the class of abelian and Heisenberg ones. Among the other results, we also give some exact sequences on the Schur multiplier and exterior product of Lie algebras.

  18. Fixed-Tuned Submillimeter Waveguide Multipliers Using MMIC Technology

    NASA Technical Reports Server (NTRS)

    Bruston, J.; Kim, M.; Martin, S. C.; Pease, A.; Smith, R. P.; Siegel, P. H.

    1997-01-01

    In preparation for the insturment ammouncement of opportunity for the Far Infrared and Submillimeter Space Telescope, and ESA/NASA space astrophysics observatory mission, local oscillator sources at high frequencies (1200 GHz) are being developed. As part of a multiplier chain beginning at 100 GHz we are developing single and multiple diode waveguide circuits up to 640 GHz.

  19. Gilles de la Tourette Disease in Multiply Disabled Children.

    ERIC Educational Resources Information Center

    Kerbeshian, Jacob; And Others

    1985-01-01

    Giles de La Tourette disease (TD) is characterized by multiform changing vocal and motor tics with a wide range of accompanying behavioral symptoms. The range of tics and behavioral problems seen in TD is described along with a typcial case report in a multiply disabled child. Diagnostic criteria, and treatment recommendations are also given.…

  20. Familiar Sports and Activities Adapted for Multiply Impaired Persons.

    ERIC Educational Resources Information Center

    Schilling, Mary Lou, Ed.

    1984-01-01

    Means of adapting some familiar and popular physical activities for multiply impaired persons are described. Games reviewed are dice baseball, one base baseball, in-house bowling, wheelchair bowling, ramp bowling, swing-ball bowling, table tennis, shuffleboard, beanbag bingo and tic-tac-toe, balloon basketball, circle football, and wheelchair…

  1. Multiplying Is More than Math--It's Also Good Management

    ERIC Educational Resources Information Center

    Foster, Elise; Wiseman, Liz

    2015-01-01

    Studying more than 400 educational leaders, the authors propose a new model for leadership and management rooted in the belief that there is latent intelligence inside schools and educational organizations. Their findings suggest two dramatically different types of leaders, Multipliers and Diminishers. The five disciplines that distinguish…

  2. Multiply-Impaired Blind Children: A National Problem.

    ERIC Educational Resources Information Center

    Graham, Milton D.

    In 1966, a national survey reported on 8,887 multiply impaired (MI) blind children. About 56% were boys; 85% had been blind since before age 3, and half were totally blind. The principal causes of blindness were retrolental fibroplasia and congenital cataracts. Almost 63% had two or more additional disabilities (86.8% of those under age 6), such…

  3. The structure of Airy's stress function in multiply connected regions

    NASA Technical Reports Server (NTRS)

    Grioli, Giusippe

    1951-01-01

    In solving two-dimensional problems using Airy's stress function for multiply connected regions, the form of the function depends on the dislocations and boundary forces present. The structure of Airy's function is shown to consist of a part expressible in terms of boundary forces and a part expressible in the manner of Poincare. Meanings of the constants occurring in Poincare's expression are discussed.

  4. Medium power voltage multipliers with a large number of stages

    NASA Technical Reports Server (NTRS)

    Harrigill, W. T.; Myers, I. T.

    1978-01-01

    Voltage multiplier techniques are extended at medium power levels to larger multiplication ratios. A series of dc-dc converters were built, with from 20 to 45 stages and with power levels up to 100 watts. Maximum output voltages were about 10,000 volts.

  5. Multiply-Constrained Semantic Search in the Remote Associates Test

    ERIC Educational Resources Information Center

    Smith, Kevin A.; Huber, David E.; Vul, Edward

    2013-01-01

    Many important problems require consideration of multiple constraints, such as choosing a job based on salary, location, and responsibilities. We used the Remote Associates Test to study how people solve such multiply-constrained problems by asking participants to make guesses as they came to mind. We evaluated how people generated these guesses…

  6. Problems with Accurate Atomic Lfetime Measurements of Multiply Charged Ions

    SciTech Connect

    Trabert, E

    2009-02-19

    A number of recent atomic lifetime measurements on multiply charged ions have reported uncertainties lower than 1%. Such a level of accuracy challenges theory, which is a good thing. However, a few lessons learned from earlier precision lifetime measurements on atoms and singly charged ions suggest to remain cautious about the systematic errors of experimental techniques.

  7. Treatment of multiply controlled destructive behavior with food reinforcement.

    PubMed

    Adelinis, J D; Piazza, C C; Goh, H L

    2001-01-01

    We evaluated the extent to which the positive reinforcement of communication would reduce multiply controlled destructive behavior in the absence of relevant extinction components. When edible reinforcement for appropriate communication and nonfood reinforcers for problem behavior were available simultaneously, responding was allocated almost exclusively toward the behavior that produced edible reinforcement.

  8. Treatment of multiply controlled destructive behavior with food reinforcement.

    PubMed Central

    Adelinis, J D; Piazza, C C; Goh, H L

    2001-01-01

    We evaluated the extent to which the positive reinforcement of communication would reduce multiply controlled destructive behavior in the absence of relevant extinction components. When edible reinforcement for appropriate communication and nonfood reinforcers for problem behavior were available simultaneously, responding was allocated almost exclusively toward the behavior that produced edible reinforcement. PMID:11317997

  9. Hybrid Voltage-Multipliers Based Switching Power Converters

    NASA Astrophysics Data System (ADS)

    Rosas-Caro, Julio C.; Mayo-Maldonado, Jonathan C.; Vazquez-Bautista, Rene Fabian; Valderrabano-Gonzalez, Antonio; Salas-Cabrera, Ruben; Valdez-Resendiz, Jesus Elias

    2011-08-01

    This work presents a derivation of PWM DC-DC hybrid converters by combining traditional converters with the Cockcroft-Walton voltage multiplier, the voltage multiplier of each converter is driven with the same transistor of the basic topology; this fact makes the structure of the new converters very simple and provides high-voltage gain. The traditional topologies discussed are the boost, buck-boost, Cuk and SEPIC. They main features of the discussed family are: (i) high-voltage gain without using extreme duty cycles or transformers, which allow high switching frequency and (ii) low voltage stress in switching devices, along with modular structures, and more output levels can be added without modifying the main circuit, which is highly desirable in some applications such as renewable energy generation systems. It is shown how a multiplier converter can become a generalized topology and how some of the traditional converters and several state-of-the-art converters can be derived from the generalized topologies and vice-versa. All the discussed converters were simulated, additionally experimental results are provided with an interleaved multiplier converter.

  10. Civil law problems and morbidity

    PubMed Central

    Pleasence, P; Balmer, N; Buck, A; O'Grady, A; Genn, H

    2004-01-01

    Study objective: In the United Kingdom, recognition of the links between social and health problems has led to government initiatives such as health action zones. The principles of civil law apply to many types of social problem, and the civil justice system provides one means through which they can be tackled. However, little research has been undertaken into the particular links between problems to which civil legal principles and processes can be applied and morbidity. This study examines these links, and the role of legal advice and services in preventing ill health. Design: This study examined survey respondents' self reports of longstanding illness/disability and experience of 18 problems to which legal principles can be applied. Setting: A random national survey conducted across England and Wales. Participants: 5611 adults drawn from 3348 residential households. Main results: Significant associations were found between illness/disability and 13 of the problem types. Moreover, experience of greater numbers of problems increased the likelihood of reported illness/disability. In attempting to resolve problems respondents' health also frequently suffered. Conclusions: This study highlights the contribution that public legal education and legal advice can make to the promotion of public health, and the importance of further integration of health and civil justice initiatives through health action zones, community legal service partnerships, etc, to further this end. PMID:15194714

  11. [Occupational morbidity of railway transport workers].

    PubMed

    Karetskaia, T D; Pfaf, V F; Chernov, O E

    2015-01-01

    The authors present results of medical social monitoring of occupationalhazards that are the most prevalent in railway occupations workers, statistic data on occupational morbidity of railway transport workers over last 10 years. The article covers major causes of unfavorable effects resulting from occupational hazards in various workers categories. Dynamics of occupational morbidity parameters and its structure concerning separate nosologic entities are analyzed.

  12. Simultaneous Prediction of New Morbidity, Mortality, and Survival without New Morbidity from Pediatric Intensive Care: A New Paradigm for Outcomes Assessment

    PubMed Central

    Pollack, Murray M.; Holubkov, Richard; Funai, Tomohiko; Berger, John T.; Clark, Amy E.; Meert, Kathleen; Berg, Robert A.; Carcillo, Joseph; Wessel, David L.; Moler, Frank; Dalton, Heidi; Newth, Christopher J. L.; Shanley, Thomas; Harrison, Rick E.; Doctor, Allan; Jenkins, Tammara L.; Tamburro, Robert; Dean, J. Michael

    2015-01-01

    Objective Assessments of care including quality assessments adjusted for physiological status should include the development of new morbidities as well as mortalities. We hypothesized that morbidity, like mortality, is associated with physiological dysfunction and could be predicted simultaneously with mortality. Design Prospective cohort study from December 4, 2011 to April 7, 2013. Setting and Patients General and cardiac/cardiovascular pediatric intensive care units at 7 sites. Measurements and Main Results Among 10,078 admissions, the unadjusted morbidity rates (measured with the Functional Status Scale (FSS), and defined as an increase of ≥ 3 from pre-illness to hospital discharge) were 4.6% (site range 2.6% to 7.7%) and unadjusted mortality rates were 2.7% (site range 1.3% – 5.0%). Morbidity and mortality were significantly (p<0.001) associated with physiological instability (measured with the PRISM III score) in dichotomous (survival, death) and trichotomous (survival without new morbidity, survival with new morbidity, death) models without covariate adjustments. Morbidity risk increased with increasing PRISM III scores and then decreased at the highest PRISM III values as potential morbidities became mortalities. The trichotomous model with covariate adjustments included age, admission source, diagnostic factors, baseline FSS and the PRISM III score. The three-level goodness of fit test indicated satisfactory performance for the derivation and validation sets (p>0.20). Predictive ability assessed with the volume under the surface (VUS) was 0.50 ± 0.019 (derivation) and 0.50 ± 0.034 (validation) (versus chance performance = 0.17). Site-level standardized morbidity ratios were more variable than standardized mortality ratios. Conclusions New morbidities were associated with physiological status and can be modeled simultaneously with mortality. Trichotomous outcome models including both morbidity and mortality based on physiological status are suitable

  13. Morbidity, mortality and local anaesthesia.

    PubMed

    Malamed, S F

    1999-01-01

    Two cases of local anaesthetic overdose and death are described. The patients, a four-year-old child and a 68-year old female, received local anaesthetic doses greatly in excess of those recommended. Their overdose reactions are described as well as subsequent management. The paper reviews the causes of local anaesthetic overdose, its signs and symptoms, and the recommended management of these reactions. Specific discussion as to the cause of death of these two patients and of the means to prevent such occurrences in the future concludes the paper.

  14. Proton Transfer Reactivity of Large Multiply Charged Ions

    PubMed Central

    Williams, Evan R.

    2005-01-01

    Charge-charge interactions dramatically influence the dissociation and proton transfer reactivity of large multiply protonated ions. In combination with tandem mass spectrometry, proton transfer reactions have been used to determine the charge state of an ion and to increase the effective mass resolution of electrospray ionization mass spectra. A model for the proton transfer reactivity of multiply protonated ions, in which protons are assigned to specific sites in an ion based on the intrinsic reactivity of the site and the sum of point-charge Coulomb interactions between charges, is discussed. In combination with experimentally measured rates of proton transfer to bases of known gas-phase basicity, information about the intramolecular electrostatic interactions, gas-phase ion conformation and maximum charge state of an ion produced by electrospray ionization can be obtained. PMID:8799309

  15. Californium Multiplier. Part I. Design for neutron radiography

    SciTech Connect

    Crosbie, K.L.; Preskitt, C.A.; John, J.; Hastings, J.D.

    1982-04-01

    The Californium Multiplier (CFX) is a subcritical assembly of enriched uranium surrounding a californium-252 neutron source. The function of the CFX is to multiply the neutrons emitted by the source to a number sufficient for neutron radiography. The CFX is designed to provide a collimated beam of thermal neutrons from which the gamma radiation is filtered, and the scattered neutrons are reduced to make it suitable for high resolution radiography. The entire system has inherent safety features, which provide for system and personnel safety, and it operates at moderate cost. In Part I, the CFX and the theory of its operation are described in detail. Part II covers the performance of the Mound Facility CFX.

  16. Mass-dependent channel electron multiplier operation. [for ion detection

    NASA Technical Reports Server (NTRS)

    Fields, S. A.; Burch, J. L.; Oran, W. A.

    1977-01-01

    The absolute counting efficiency and pulse height distributions of a continuous-channel electron multiplier used in the detection of hydrogen, argon and xenon ions are assessed. The assessment technique, which involves the post-acceleration of 8-eV ion beams to energies from 100 to 4000 eV, provides information on counting efficiency versus post-acceleration voltage characteristics over a wide range of ion mass. The charge pulse height distributions for H2 (+), A (+) and Xe (+) were measured by operating the experimental apparatus in a marginally gain-saturated mode. It was found that gain saturation occurs at lower channel multiplier operating voltages for light ions such as H2 (+) than for the heavier ions A (+) and Xe (+), suggesting that the technique may be used to discriminate between these two classes of ions in electrostatic analyzers.

  17. Photoelectron Angular Distribution and Molecular Structure in Multiply Charged Anions

    SciTech Connect

    Xing, Xiaopeng; Wang, Xue B.; Wang, Lai S.

    2009-02-12

    Photoelectrons emitted from multiply charged anions (MCAs) carry information of the intramolecular Coulomb repulsion (ICR), which is dependent on molecular structures. Using photoelectron imaging, we observed the effects of ICR on photoelectron angular distributions (PAD) of the three isomers of benzene dicarboxylate dianions C6H4(CO2)22– (o-, m- and p-BDC2–). Photoelectrons were observed to peak along the laser polarization due to the ICR, but the anisotropy was the largest for p-BDC2–, followed by the m- and o-isomer. The observed anisotropy is related to the direction of the ICR or the detailed molecular structures, suggesting that photoelectron imaging may allow structural information to be obtained for complex multiply charged anions.

  18. Myocardial revascularisation in women: evaluation of hospital mortality and morbidity

    PubMed Central

    Cloin, E.C.W.; Noyez, L.

    2006-01-01

    Background Although women are reported to be at higher risk for mortality and morbidity after coronary artery bypass graft (CABG), there is no consensus in literature. Method Pre-, peri- and postoperative hospital data of 8578 patients undergoing an isolated myocardial revascularisation from January 1987 to December 2004 were analysed. Of these patients, 2083 (24.3%) were female. Results Female patients were significantly older (p=0.001), and risk factors as diabetes (p=0.001), hypertension (p=0.001), hyperlipidaemia (p=0.001) were significantly more prevalent than in men. The incidence of preoperative myocardial infarction (p=0.001) and triple-vessel disease (p=0.001) was lower, but the incidence of unstable angina (NYHA IV) (p=0.001) was significantly higher than in men. Significantly fewer women (p=0.04) received an arterial graft. Postoperatively, there was no significant difference in the registered morbidity, with the exception of a lower incidence of female patients with non-sinus rhythm (p=0.001) and a higher incidence of pulmonary problems (p=0.006). Hospital mortality was not significantly different between the genders: 3.5 vs. 3.4% (p=0.9). A preoperative myocardial infarction was identified as the only independent predictor for hospital mortality. Conclusion The preoperative profiles of women and men undergoing CABG are dissimilar. However, the incidences of hospital mortality, and morbidity were not statistically different. Female gender was not identified as predictor for death or adverse outcome. PMID:25696593

  19. Cleaning and activation of beryllium-copper electron multiplier dynodes.

    NASA Technical Reports Server (NTRS)

    Pongratz, M. B.

    1972-01-01

    Description of a cleaning and activation procedure followed in preparing beryllium-copper dynodes for electron multipliers used in sounding-rocket experiments to detect auroral electrons. The initial degreasing step involved a 5-min bath in trichloroethylene in an ultrasonic cleaner. This was followed by an ultrasonic rinse in methanol and by a two-step acid pickling treatment to remove the oxides. Additional rinsing in water and methanol was followed by activation in a stainless-steel RF induction oven.

  20. Mesh quality control for multiply-refined tetrahedral grids

    NASA Technical Reports Server (NTRS)

    Biswas, Rupak; Strawn, Roger

    1994-01-01

    A new algorithm for controlling the quality of multiply-refined tetrahedral meshes is presented in this paper. The basic dynamic mesh adaption procedure allows localized grid refinement and coarsening to efficiently capture aerodynamic flow features in computational fluid dynamics problems; however, repeated application of the procedure may significantly deteriorate the quality of the mesh. Results presented show the effectiveness of this mesh quality algorithm and its potential in the area of helicopter aerodynamics and acoustics.

  1. Study of the electric field inside microchannel plate multipliers

    SciTech Connect

    Gatti, E.; Oba, K.; Rehak, P.

    1982-01-01

    Electric field inside high gain microchannel plate multipliers was studied. The calculations were based directly on the solution of the Maxwell equations applied to the microchannel plate (MCP) rather than on the conventional lumped RC model. The results are important to explain the performance of MCP's, (1) under a pulsed bias tension and, (2) at high rate conditions. The results were tested experimentally and a new method of MCP operation free from the positive ion feedback was demonstrated.

  2. High performance pipelined multiplier with fast carry-save adder

    NASA Technical Reports Server (NTRS)

    Wu, Angus

    1990-01-01

    A high-performance pipelined multiplier is described. Its high performance results from the fast carry-save adder basic cell which has a simple structure and is suitable for the Gate Forest semi-custom environment. The carry-save adder computes the sum and carry within two gate delay. Results show that the proposed adder can operate at 200 MHz for a 2-micron CMOS process; better performance is expected in a Gate Forest realization.

  3. Comparison of indirect cost multipliers for vehicle manufacturing

    SciTech Connect

    Vyas, A.; Santini, D.; Cuenca, R.

    2000-05-16

    In the process of manufacturing and selling vehicles, a manufacturer incurs certain costs. Among these costs are those incurred directly as a part of manufacturing operations and those incurred indirectly in the processes of manufacturing and selling. The indirect costs may be production-related, such as R and D and engineering; business-related, such as corporate staff salaries and pensions; or retail-sales-related, such as dealer support and marketing. These indirect costs are recovered by allocating them to each vehicle. Under a stable, high-volume production process, the allocation of these indirect costs can be approximated as multipliers (or factors) applied to the direct cost of manufacturing. A manufacturer usually allocates indirect costs to finished vehicles according to a corporation-specific pricing strategy. Because the volumes of sales and production vary widely by model within a corporation, the internal corporate percent allocation of various accounting categories (such as profit or corporate overheat) can vary widely among individual models. Approaches also vary across corporations. For these purposes, an average value is constructed, by means of a generic representative method, for vehicle models produced at high volume. To accomplish this, staff at Argonne National Laboratory's (ANL's) Center for Transportation Research analyzed the conventional vehicle cost structure and developed indirect cost multipliers for passenger vehicles. This memorandum summarizes the results of an effort to compare and put on a common basis the cost multipliers used in ANL's electric and hybrid electric vehicle cost estimation procedures with those resulting from two other methodologies. One of the two compared methodologies is derived from a 1996 presentation by Dr. Chris Borroni-Bird of Chrysler Corporation, the other is by Energy and Environmental Analysis, Inc. (EEA), as described in a 1995 report by the Office of Technology Assessment (OTA), Congress of the United

  4. Female Stick Insects Mate Multiply to Find Compatible Mates.

    PubMed

    Arbuthnott, Devin; Crespi, Bernard J; Schwander, Tanja

    2015-10-01

    Why females of many species mate multiply in the absence of direct benefits remains an open question in evolutionary ecology. Interacting and mating with multiple males can be costly to females in terms of time, resources, predation risk, and disease transmission. A number of indirect genetic benefits have been proposed to explain such behaviors, but the relative importance of these mechanisms in natural systems remains unclear. We tested for several direct and indirect benefits of polyandry in the walking stick Timema cristinae. We found no evidence of direct benefits with respect to longevity or fecundity. However, male × female genotypic interactions affected egg-hatching success and offspring production independent of relatedness, suggesting that mating with certain males benefits females and that the best male may differ for each female. Furthermore, multiply mated females biased paternity toward one or few males, and the extent of this bias was positively correlated to egg-hatching success. Our data, therefore, provide evidence for indirect benefits through compatibility effects in this species. By mating multiply, females may improve their chances of mating with a compatible male if compatibility cannot be assessed before mating. Such compatibility effects can explain the evolution and maintenance of polyandry in Timema and many other species.

  5. [Morbidity and mortality of carotid endarterectomy].

    PubMed

    Rodríguez Pérez, A; Cabrera Morán, V; Abad Vázquez, C; Muñoz Falcón, L; Hernández Ruiz, A; Hermida Anllo, M; Cárdenes Romero, I

    1993-01-01

    In order to investigate the peroperative complications in carotid surgery, a cohort of 64 patients operated of carotid endarterectomy (EC) were evaluated. A total 78 EC were performed, 56 unilateral (EC-U) and 11 bilateral (EC-B). All the cases were managed in a similar manner regarding surgical technique, monitoring, anesthetic management and pre and postoperative care. A temporary shunt was inserted in 6 cases. The hospital mortality has been 0. We registered the following postoperative complications: arterial hypertension in 23.1 of EC-U and 18.2% of EC-B, cervical hematoma in 5.3% (EC-U) and 13.6% (EC-B), TIA in 5.3% (EC-U) and 4.5% (EC-B), stroke 1.7% (EC-U) and 4.5% (EC-B), vocal cord injury in 3.5% of EC-U and chest pain with angina in 1.7% of EC-U. A review of the mortality and morbidity in carotid surgery is done.

  6. [Ankylosing spondylitis is associated with increased cardiovascular morbidity and mortality].

    PubMed

    Madsen, Ole Rintek; Lindhardsen, Jesper

    2011-05-23

    Ankylosing spondylitis is an inflammatory disorder primarily affecting the axial skeleton. The disease is associated with increased cardiovascular morbidity and mortality. Structural changes in the heart, and arteriosclerosis secondary to inflammation may be of importance. The role of traditional cardiovascular risk factors and of anti-inflammatory treatment is unclear. Tumor necrosis factor inhibitors seem to increase cholesterol levels. Evaluation of the cardiovascular risk in these patients should be considered. Cardiovascular risk factors should be managed according to ordinary guidelines.

  7. Pediatric Intensive Care Outcomes: Development of New Morbidities During Pediatric Critical Care

    PubMed Central

    Pollack, Murray M.; Holubkov, Richard; Funai, Tomohiko; Clark, Amy; Berger, John T.; Meert, Kathleen; Newth, Christopher J. L.; Shanley, Thomas; Moler, Frank; Carcillo, Joseph; Berg, Robert A.; Dalton, Heidi; Wessel, David L.; Harrison, Rick E.; Doctor, Allan; Dean, J. Michael; Jenkins, Tammara L.

    2014-01-01

    Objective Investigate significant new morbidities associated with pediatric critical care. Design Randomly selected, prospective cohort Setting PICU patients from 8 Medical and Cardiac PICUs. Patients This was a randomly selected, prospective cohort of PICU patients from 8 Medical and Cardiac PICUs. Measurements and Main Results The main outcomes measures were hospital discharge functional status measured by Functional Status Scale (FSS) scores and new morbidity defined as an increase in the FSS of ≥ 3. Of the 5017 patients, there were 242 new morbidities (4.8%), 99 PICU deaths (2.0%) and 120 hospital deaths (2.4%). Both morbidity and mortality rates differed (p<.001) among the sites. The worst functional status profile was on PICU discharge and improved on hospital discharge. On hospital discharge, the good category decreased from a baseline of 72% to 63%, mild abnormality increased from 10% to 15%, moderate abnormality status increased from 13% to 14%, severe status increased from 4% to 5% and very severe was unchanged at 1%. The highest new morbidity rates were in the neurological diagnoses (7.3%), acquired cardiovascular disease (5.9%), cancer (5.3%) and congenital cardiovascular disease (4.9%). New morbidities occurred in all ages with more in those under 12 months. New morbidities involved all FSS domains with the highest proportions involving respiratory, motor, and feeding dysfunction. Conclusions The incidence of new morbidity was 4.8%, twice the mortality rate, and occurred in essentially all types of patients, in relatively equal proportions, and involved all aspects of function. Compared to historical data, it is possible that pediatric critical care has exchanged improved mortality rates for increased morbidity rates. PMID:25226501

  8. Keep it simple? Predicting primary health care costs with clinical morbidity measures

    PubMed Central

    Brilleman, Samuel L.; Gravelle, Hugh; Hollinghurst, Sandra; Purdy, Sarah; Salisbury, Chris; Windmeijer, Frank

    2014-01-01

    Models of the determinants of individuals’ primary care costs can be used to set capitation payments to providers and to test for horizontal equity. We compare the ability of eight measures of patient morbidity and multimorbidity to predict future primary care costs and examine capitation payments based on them. The measures were derived from four morbidity descriptive systems: 17 chronic diseases in the Quality and Outcomes Framework (QOF); 17 chronic diseases in the Charlson scheme; 114 Expanded Diagnosis Clusters (EDCs); and 68 Adjusted Clinical Groups (ACGs). These were applied to patient records of 86,100 individuals in 174 English practices. For a given disease description system, counts of diseases and sets of disease dummy variables had similar explanatory power. The EDC measures performed best followed by the QOF and ACG measures. The Charlson measures had the worst performance but still improved markedly on models containing only age, gender, deprivation and practice effects. Comparisons of predictive power for different morbidity measures were similar for linear and exponential models, but the relative predictive power of the models varied with the morbidity measure. Capitation payments for an individual patient vary considerably with the different morbidity measures included in the cost model. Even for the best fitting model large differences between expected cost and capitation for some types of patient suggest incentives for patient selection. Models with any of the morbidity measures show higher cost for more deprived patients but the positive effect of deprivation on cost was smaller in better fitting models. PMID:24657375

  9. The July Effect in Radical Cystectomy: Mortality, Morbidity, and Efficiency

    PubMed Central

    Zuk, Keegan; Jensen, Derek; Gills, Jessie; Wyre, Hadley; Holzbeierlein, Jeffrey M.; Lopez-Corona, Ernesto; Lee, Eugene K.

    2016-01-01

    Background: The “July effect” is the potential effect that new and recently promoted residents have on patient care during the first months of the academic year. Literature suggests that the July effect may worsen patient outcomes and lead to systemic inefficiencies. Objective: We evaluate the July effect on mortality, morbidity, and efficiency outcomes in patients undergoing radical cystectomy. Methods: A chart review was performed in patients who underwent radical cystectomy between January 2008 and April 2012. Demographic information was abstracted from patient charts and outcomes compared between operations performed in July, September, and November (first month of each resident’s university rotation) to the remainder of the year. Outcomes of interest included mortality, complications, and markers of efficiency (operative time, length of hospital stay, and estimated blood loss). Results: Two hundred and fifty one patients were included in the analysis. There were no major differences in mortality or morbidity between the July, September, November group and the rest of the year. Multivariable analysis demonstrates a trend for operations performed in the months of July, September, and November to be associated with longer OR times 2.06 (0.99–4.27), p = 0.053. Length of hospital stay and estimated blood loss were no different between the two groups. Conclusions: These data demonstrate no increase in mortality or morbidity during the early academic period. Additionally, while there is a trend for OR time to be longer in the early group, length of hospital stay and estimated blood loss were no different. These data may be used as an impetus to continue to investigate technical/clinical teaching practices, strategies to assess resident progression, and to initiate protocols to support residents early in the academic year in efforts to prevent inefficiencies. PMID:28035324

  10. Auditing the multiply-related concepts within the UMLS

    PubMed Central

    Mougin, Fleur; Grabar, Natalia

    2014-01-01

    Objective This work focuses on multiply-related Unified Medical Language System (UMLS) concepts, that is, concepts associated through multiple relations. The relations involved in such situations are audited to determine whether they are provided by source vocabularies or result from the integration of these vocabularies within the UMLS. Methods We study the compatibility of the multiple relations which associate the concepts under investigation and try to explain the reason why they co-occur. Towards this end, we analyze the relations both at the concept and term levels. In addition, we randomly select 288 concepts associated through contradictory relations and manually analyze them. Results At the UMLS scale, only 0.7% of combinations of relations are contradictory, while homogeneous combinations are observed in one-third of situations. At the scale of source vocabularies, one-third do not contain more than one relation between the concepts under investigation. Among the remaining source vocabularies, seven of them mainly present multiple non-homogeneous relations between terms. Analysis at the term level also shows that only in a quarter of cases are the source vocabularies responsible for the presence of multiply-related concepts in the UMLS. These results are available at: http://www.isped.u-bordeaux2.fr/ArticleJAMIA/results_multiply_related_concepts.aspx. Discussion Manual analysis was useful to explain the conceptualization difference in relations between terms across source vocabularies. The exploitation of source relations was helpful for understanding why some source vocabularies describe multiple relations between a given pair of terms. PMID:24464853

  11. Magnetic states in multiply-connected flat nanoelements

    NASA Astrophysics Data System (ADS)

    Bogatyrev, Andrei B.; Metlov, Konstantin L.

    2015-10-01

    Flat magnetic nanoelements are an essential component of current and future spintronic devices. By shaping an element it is possible to select and stabilize chosen metastable magnetic states, control its magnetization dynamics. Here, using a recent significant development in mathematics of conformal mapping, complex variable based approach to the description of magnetic states in planar nanoelements is extended to the case when elements are multiply-connected (that is, contain holes or magnetic antidots). We show that presence of holes implies a certain restriction on the set of magnetic states of nanoelement.

  12. Monolithic millimeter-wave diode grid frequency multiplier arrays

    NASA Technical Reports Server (NTRS)

    Liu, Hong-Xia L.; Qin, X.-H.; Sjogren, L. B.; Wu, W.; Chung, E.; Domier, C. W.; Luhmann, N. C., Jr.

    1992-01-01

    Monolithic diode frequency multiplier arrays, including barrier-N-N(+) (BNN) doubler, multi-quantum-barrier-varactor (MQBV) tripler, Schottky-quantum-barrier-varactor (SQBV) tripler, and resonant-tunneling-diode (RTD) tripler arrays, have been successfully fabricated with yields between 85 and 99 percent. Frequency doubling and/or tripling have been observed for all the arrays. Output powers of 2.4-2.6 W (eta = 10-18 percent) at 66 GHz with the BNN doubler and 3.8-10 W (eta = 1.7-4 percent) at 99 GHz with the SQBV tripler have been achieved.

  13. Multiply-agile encryption in high speed communication networks

    SciTech Connect

    Pierson, L.G.; Witzke, E.L.

    1997-05-01

    Different applications have different security requirements for data privacy, data integrity, and authentication. Encryption is one technique that addresses these requirements. Encryption hardware, designed for use in high-speed communications networks, can satisfy a wide variety of security requirements if that hardware is key-agile, robustness-agile and algorithm-agile. Hence, multiply-agile encryption provides enhanced solutions to the secrecy, interoperability and quality of service issues in high-speed networks. This paper defines these three types of agile encryption. Next, implementation issues are discussed. While single-algorithm, key-agile encryptors exist, robustness-agile and algorithm-agile encryptors are still research topics.

  14. An Accelerated Linearized Alternating Direction Method of Multipliers

    DTIC Science & Technology

    2014-02-01

    The idea of analyzing (1.8) in order to solve (1.1) is essentially the augmented Lagrangian method ( ALM ) by Hestenes [26] and Powell [44] (It is...originally called the method of multipliers in [26, 44]; see also the textbooks, e.g., [5, 41, 6]). The ALM is a special case of the Douglas-Rachford...splitting method [19, 16, 32], which is also an instance of the proximal point algorithm [17, 46]. The iteration complexity of an inexact version of ALM

  15. Calculation evaluation of multiplying properties of LWR with thorium fuel

    NASA Astrophysics Data System (ADS)

    Shamanin, I. V.; Grachev, V. M.; Knyshev, V. V.; Bedenko, S. V.; Novikova, N. G.

    2017-01-01

    The results of multiplying properties design research of the unit cell and LWR fuel assembly with the high temperature gas-cooled thorium reactor fuel pellet are presented in the work. The calculation evaluation showed the possibility of using thorium in LWR effectively. In this case the amount of fissile isotope is 2.45 times smaller in comparison with the standard loading of LWR. The research and numerical experiments were carried out using the verified accounting code of the program MCU5, modern libraries of evaluated nuclear data and multigroup approximations.

  16. Convergence of a Substructuring Method with LaGrange Multipliers

    NASA Technical Reports Server (NTRS)

    Mandel, Jan; Tezaur, Radek

    1996-01-01

    We analyze the convergence of a substructuring iterative method with Lagrange multipliers, proposed recently by Farhat and Roux. The method decomposes finite element discretization of an elliptic boundary value problem into Neumann problems on the subdomains and a coarse problem for the subdomain nullspace components. For linear conforming elements and preconditioning by the Dirichlet problems on the subdomains, we prove the asymptotic bound on the condition number C(1 + log(H/h))(sup gamma), gamma = 2 or 3, where h is the characteristic element size and H is the subdomain size.

  17. Reduced social morbidity of laparoscopic appendectomy in children.

    PubMed

    Tantoco, Joselito G; Levitt, Marc A; Hollands, Celeste M; Brisseau, Guy F; Caty, Michael G; Glick, Philip L

    2004-09-01

    Laparoscopic appendectomy has not been uniformly adopted by pediatric surgeons. Our children's hospital adopted laparoscopic appendectomy due to perceived benefits to patients and their families. We hypothesized that laparoscopic appendectomy in children resulted in less social morbidity than those undergoing open appendectomy. A questionnaire focused on a set of postoperative variables affecting the patient's and the family's return to normal activities. Families expressed their answers as a range of days. Five different ranges were assigned a numerical value for 10 different social morbidity variables. The numerical values were analyzed using Pearson chi2 test; statistical significance was defined as P < 0.05. The response rate was 55 per cent (134 of 244). Seventy-four had open and 47 laparoscopic appendectomy with a comparable incidence of acute and perforated appendicitis. Children undergoing laparoscopic appendectomy had shorter hospital stays and earlier resumption of feeding, return to school, return to pain-free walking and stair climbing, and resumption of normal activities including gym. Additionally, they had fewer wound problems, shorter duration of oral pain medication usage, and their parents returned to work quicker than the open group. All these were statistically significant. Laparoscopic appendectomy results in significantly reduced social morbidity for children and their families.

  18. Association between respiratory mechanics and autonomic function in morbid obesity.

    PubMed

    Sant' Anna, M; Carvalhal, R F; Carneiro, J R I; Lapa, M S; Zin, W A; Lugon, J R; Guimarães, F S

    2014-01-01

    This study aimed to investigate the association between respiratory mechanics and autonomic modulation in morbidly obese patients. We evaluated 10 morbidly obese subjects (BMI=52.9±11.2kg/m(2)), aged 23-58 years. Assessment of respiratory mechanics was done by the forced oscillation technique (FOT), and cardiovascular autonomic function was recorded by heart rate variability analysis (HRV). The Pearson correlation coefficient was used to test the associations between respiratory mechanics and HRV variables. There were associations between the standard deviation of all RR intervals (SDNN) and airway resistance (Rm) (r=-0.82; p=0.004), SDNN and respiratory system resistance (R0) (r=-0.79; p=0.006), root mean square of successive differences between adjacent normal RR intervals (rMSSD) and respiratory system resistance (R5) (r=-0.643; p=0.0451), rMSSD and R0 (r=-0.64; p=0.047), and rMSSD and Rm (r=-0.658; p=0.039). We concluded that the airway and respiratory system resistances are negatively associated with parasympathetic activity in patients with morbid obesity.

  19. Power spectrum analysis and cardiovascular morbidity in anxiety disorders.

    PubMed

    Cohen, Hagit; Benjamin, Jonathan

    2006-07-30

    Spectral analysis of heart rate variability (HRV) and related measures has been shown to be a reliable noninvasive technique enabling quantitative assessment of cardiovascular autonomic regulatory responses to autonomic regulatory mechanisms; it provides a dynamic probe of sympathetic and parasympathetic tone, reflecting the interactions between the two. Over 20 studies reported abnormalities of HRV in anxiety, and patients with heart disease and anxiety are at increased risk for morbidity and mortality. Psychiatric drugs partly correct abnormalities of HRV and, recently, autonomic drugs (beta-blockers) have been studied in anxiety disorders. The authors call for further studies, especially in patients with co-existing anxiety disorders and heart disease, incorporating assessment of HRV.

  20. Intelligent postoperative morbidity prediction of heart disease using artificial intelligence techniques.

    PubMed

    Hsieh, Nan-Chen; Hung, Lun-Ping; Shih, Chun-Che; Keh, Huan-Chao; Chan, Chien-Hui

    2012-06-01

    Endovascular aneurysm repair (EVAR) is an advanced minimally invasive surgical technology that is helpful for reducing patients' recovery time, postoperative morbidity and mortality. This study proposes an ensemble model to predict postoperative morbidity after EVAR. The ensemble model was developed using a training set of consecutive patients who underwent EVAR between 2000 and 2009. All data required for prediction modeling, including patient demographics, preoperative, co-morbidities, and complication as outcome variables, was collected prospectively and entered into a clinical database. A discretization approach was used to categorize numerical values into informative feature space. Then, the Bayesian network (BN), artificial neural network (ANN), and support vector machine (SVM) were adopted as base models, and stacking combined multiple models. The research outcomes consisted of an ensemble model to predict postoperative morbidity after EVAR, the occurrence of postoperative complications prospectively recorded, and the causal effect knowledge by BNs with Markov blanket concept.

  1. Maternal mortality and severe morbidity in a migration perspective.

    PubMed

    van den Akker, Thomas; van Roosmalen, Jos

    2016-04-01

    Among migrants in high-income countries, maternal mortality and severe morbidity generally occur more frequently as compared to host populations. There is marked variation between groups of migrants and host countries, with much elevated risks in some groups and no elevated risk at all in others. Those without a legal resident permit are most vulnerable. A reason for these elevated risks could be a different risk profile in migrants, but risk factors are unevenly distributed and not always present. Another reason is substandard care, which is identified more frequently in migrants, and comprises patient delays, for example, due to a lack of knowledge about the health system in the host country, and health worker delays, often compounded by communication barriers. Improvements in family planning and antenatal services are needed, and audits and confidential enquiries should be extended to include maternal morbidity and ethnic background. This requires scientific and political efforts.

  2. A Highly Linear and Wide Input Range Four-Quadrant CMOS Analog Multiplier Using Active Feedback

    NASA Astrophysics Data System (ADS)

    Huang, Zhangcai; Jiang, Minglu; Inoue, Yasuaki

    Analog multipliers are one of the most important building blocks in analog signal processing circuits. The performance with high linearity and wide input range is usually required for analog four-quadrant multipliers in most applications. Therefore, a highly linear and wide input range four-quadrant CMOS analog multiplier using active feedback is proposed in this paper. Firstly, a novel configuration of four-quadrant multiplier cell is presented. Its input dynamic range and linearity are improved significantly by adding two resistors compared with the conventional structure. Then based on the proposed multiplier cell configuration, a four-quadrant CMOS analog multiplier with active feedback technique is implemented by two operational amplifiers. Because of both the proposed multiplier cell and active feedback technique, the proposed multiplier achieves a much wider input range with higher linearity than conventional structures. The proposed multiplier was fabricated by a 0.6µm CMOS process. Experimental results show that the input range of the proposed multiplier can be up to 5.6Vpp with 0.159% linearity error on VX and 4.8Vpp with 0.51% linearity error on VY for ±2.5V power supply voltages, respectively.

  3. Interatomic Coulombic decay cascades in multiply excited neon clusters

    PubMed Central

    Nagaya, K.; Iablonskyi, D.; Golubev, N. V.; Matsunami, K.; Fukuzawa, H.; Motomura, K.; Nishiyama, T.; Sakai, T.; Tachibana, T.; Mondal, S.; Wada, S.; Prince, K. C.; Callegari, C.; Miron, C.; Saito, N.; Yabashi, M.; Demekhin, Ph. V.; Cederbaum, L. S.; Kuleff, A. I.; Yao, M.; Ueda, K.

    2016-01-01

    In high-intensity laser light, matter can be ionized by direct multiphoton absorption even at photon energies below the ionization threshold. However on tuning the laser to the lowest resonant transition, the system becomes multiply excited, and more efficient, indirect ionization pathways become operative. These mechanisms are known as interatomic Coulombic decay (ICD), where one of the species de-excites to its ground state, transferring its energy to ionize another excited species. Here we show that on tuning to a higher resonant transition, a previously unknown type of interatomic Coulombic decay, intra-Rydberg ICD occurs. In it, de-excitation of an atom to a close-lying Rydberg state leads to electron emission from another neighbouring Rydberg atom. Moreover, systems multiply excited to higher Rydberg states will decay by a cascade of such processes, producing even more ions. The intra-Rydberg ICD and cascades are expected to be ubiquitous in weakly-bound systems exposed to high-intensity resonant radiation. PMID:27917867

  4. Interatomic Coulombic decay cascades in multiply excited neon clusters

    NASA Astrophysics Data System (ADS)

    Nagaya, K.; Iablonskyi, D.; Golubev, N. V.; Matsunami, K.; Fukuzawa, H.; Motomura, K.; Nishiyama, T.; Sakai, T.; Tachibana, T.; Mondal, S.; Wada, S.; Prince, K. C.; Callegari, C.; Miron, C.; Saito, N.; Yabashi, M.; Demekhin, Ph. V.; Cederbaum, L. S.; Kuleff, A. I.; Yao, M.; Ueda, K.

    2016-12-01

    In high-intensity laser light, matter can be ionized by direct multiphoton absorption even at photon energies below the ionization threshold. However on tuning the laser to the lowest resonant transition, the system becomes multiply excited, and more efficient, indirect ionization pathways become operative. These mechanisms are known as interatomic Coulombic decay (ICD), where one of the species de-excites to its ground state, transferring its energy to ionize another excited species. Here we show that on tuning to a higher resonant transition, a previously unknown type of interatomic Coulombic decay, intra-Rydberg ICD occurs. In it, de-excitation of an atom to a close-lying Rydberg state leads to electron emission from another neighbouring Rydberg atom. Moreover, systems multiply excited to higher Rydberg states will decay by a cascade of such processes, producing even more ions. The intra-Rydberg ICD and cascades are expected to be ubiquitous in weakly-bound systems exposed to high-intensity resonant radiation.

  5. Low voltage electron multiplying CCD in a CMOS process

    NASA Astrophysics Data System (ADS)

    Dunford, Alice; Stefanov, Konstantin; Holland, Andrew

    2016-07-01

    Low light level and high-speed image sensors as required for space applications can suffer from a decrease in the signal to noise ratio (SNR) due to the photon-starved environment and limitations of the sensor's readout noise. The SNR can be increased by the implementation of Time Delay Integration (TDI) as it allows photoelectrons from multiple exposures to be summed in the charge domain with no added noise. Electron Multiplication (EM) can further improve the SNR and lead to an increase in device performance. However, both techniques have traditionally been confined to Charge Coupled Devices (CCD) due to the efficient charge transfer required. With the increase in demand for CMOS sensors with equivalent or superior functionality and performance, this paper presents findings from the characterisation of a low voltage EMCCD in a CMOS process using advanced design features to increase the electron multiplying gain. By using the CMOS process, it is possible to increase chip integration and functionality and achieve higher readout speeds and reduced pixel size. The presented characterisation results include analysis of the photon transfer curve, the dark current, the electron multiplying gain and analysis of the parameters' dependence on temperature and operating voltage.

  6. Multiplying optical tweezers force using a micro-lever.

    PubMed

    Lin, Chih-Lang; Lee, Yi-Hsiung; Lin, Chin-Te; Liu, Yi-Jui; Hwang, Jiann-Lih; Chung, Tien-Tung; Baldeck, Patrice L

    2011-10-10

    This study presents a photo-driven micro-lever fabricated to multiply optical forces using the two-photon polymerization 3D-microfabrication technique. The micro-lever is a second class lever comprising an optical trapping sphere, a beam, and a pivot. A micro-spring is placed between the short and long arms to characterize the induced force. This design enables precise manipulation of the micro-lever by optical tweezers at the micron scale. Under optical dragging, the sphere placed on the lever beam moves, resulting in torque that induces related force on the spring. The optical force applied at the sphere is approximately 100 to 300 pN, with a laser power of 100 to 300 mW. In this study, the optical tweezers drives the micro-lever successfully. The relationship between the optical force and the spring constant can be determined by using the principle of leverage. The arm ratio design developed in this study multiplies the applied optical force by 9. The experimental results are in good agreement with the simulation of spring property.

  7. Compliant displacement-multiplying apparatus for microelectromechanical systems

    DOEpatents

    Kota, Sridhar; Rodgers, M. Steven; Hetrick, Joel A.

    2001-01-01

    A pivotless compliant structure is disclosed that can be used to increase the geometric advantage or mechanical advantage of a microelectromechanical (MEM) actuator such as an electrostatic comb actuator, a capacitive-plate electrostatic actuator, or a thermal actuator. The compliant structure, based on a combination of interconnected flexible beams and cross-beams formed of one or more layers of polysilicon or silicon nitride, can provide a geometric advantage of from about 5:1 to about 60:1 to multiply a 0.25-3 .mu.m displacement provided by a short-stroke actuator so that such an actuator can be used to generate a displacement stroke of about 10-34 .mu.m to operate a ratchet-driven MEM device or a microengine. The compliant structure has less play than conventional displacement-multiplying devices based on lever arms and pivoting joints, and is expected to be more reliable than such devices. The compliant structure and an associated electrostatic or thermal actuator can be formed on a common substrate (e.g. silicon) using surface micromachining.

  8. Variables Associated with Effects on Morbidity in Older Adults Following Disasters

    PubMed Central

    Jenkins, J Lee; Levy, Matthew; Rutkow, Lainie; Spira, Adam

    2014-01-01

    Introduction: Older adults are vulnerable to disproportionately higher morbidity following disasters. Reasons for this vulnerability are multifaceted and vary by disaster type as well as patient comorbidities. Efforts to mitigate this increased morbidity require identification of at-risk older adults who can be targeted for intervention. Methods: A PubMed search was performed using the search terms “geriatric, disaster” and “morbidity, disaster” to identify published articles that reported variables associated with increased morbidity of older adults during and after disasters. A review of article titles and abstracts was then conducted to identify those articles that contained evidence-based variables that render older adults vulnerable to poor health outcomes during disasters. Results: A total of 233 studies was initially identified. After applying exclusion criteria, nine studies were chosen for the comprehensive review. Based on the synthesis of the literature, factors were identified that were repeatedly associated with morbidity and mortality among older adults during and shortly after disasters. Conclusion: Older adults, especially those with multiple co-morbidities, are at risk of increased morbidity after disasters and catastrophic events. Factors such as the need for prescription medications, low social support, visual and hearing impairment, impaired mobility, and poor economic status are associated with an increased risk of morbidity. PMID:25685623

  9. [Morbidity parameters in mining industry workers of Southern Urals].

    PubMed

    Askarova, Z F; Askarov, R A

    2009-01-01

    The authors presented parameters of transitory disablement morbidity, occupational morbidity for workers in two mining enterprises (Bashkortostan Republic), calculated integral parameter of disablement.

  10. Diamond Heat-Spreader for Submillimeter-Wave Frequency Multipliers

    NASA Technical Reports Server (NTRS)

    Lin, Robert H.; Schlecht, Erich T.; Chattopadhyay, Goutam; Gill, John J.; Mehdi, Imran; Siegel, Peter H.; Ward, John S.; Lee, Choonsup; Thomas, Bertrand C.; Maestrini, Alain

    2010-01-01

    The planar GaAs Shottky diode frequency multiplier is a critical technology for the local oscillator (LO) for submillimeter- wave heterodyne receivers due to low mass, tenability, long lifetime, and room-temperature operation. The use of a W-band (75-100 GHz) power amplifier followed by a frequency multiplier is the most common for submillimeter-wave sources. Its greatest challenge is to provide enough input power to the LO for instruments onboard future planetary missions. Recently, JPL produced 800 mW at 92.5 GHz by combining four MMICs in parallel in a balanced configuration. As more power at W-band is available to the multipliers, their power-handling capability be comes more important. High operating temperatures can lead to degradation of conversion efficiency or catastrophic failure. The goal of this innovation is to reduce the thermal resistance by attaching diamond film as a heat-spreader on the backside of multipliers to improve their power-handling capability. Polycrystalline diamond is deposited by hot-filament chemical vapor deposition (CVD). This diamond film acts as a heat-spreader to both the existing 250- and 300-GHz triplers, and has a high thermal conductivity (1,000-1,200 W/mK). It is approximately 2.5 times greater than copper (401 W/mK) and 20 times greater than GaAs (46 W/mK). It is an electrical insulator (resistivity approx. equals 10(exp 15) Ohms-cm), and has a low relative dielectric constant of 5.7. Diamond heat-spreaders reduce by at least 200 C at 250 mW of input power, compared to the tripler without diamond, according to thermal simulation. This superior thermal management provides a 100-percent increase in power-handling capability. For example, with this innovation, 40-mW output power has been achieved from a 250-GHz tripler at 350-mW input power, while the previous triplers, without diamond, suffered catastrophic failures. This breakthrough provides a stepping-stone for frequency multipliers-based LO up to 3 THz. The future work

  11. Four-Quadrant Analog Multipliers Using G4-FETs

    NASA Technical Reports Server (NTRS)

    Mojarradi, Mohammad; Blalock, Benjamin; Christoloveanu, Sorin; Chen, Suheng; Akarvardar, Kerem

    2006-01-01

    Theoretical analysis and some experiments have shown that the silicon-on-insulator (SOI) 4-gate transistors known as G4-FETs can be used as building blocks of four-quadrant analog voltage multiplier circuits. Whereas a typical prior analog voltage multiplier contains between six and 10 transistors, it is possible to construct a superior voltage multiplier using only four G4-FETs. A G4-FET is a combination of a junction field-effect transistor (JFET) and a metal oxide/semiconductor field-effect transistor (MOSFET). It can be regarded as a single transistor having four gates, which are parts of a structure that affords high functionality by enabling the utilization of independently biased multiple inputs. The structure of a G4-FET of the type of interest here (see Figure 1) is that of a partially-depleted SOI MOSFET with two independent body contacts, one on each side of the channel. The drain current comprises of majority charge carriers flowing from one body contact to the other that is, what would otherwise be the side body contacts of the SOI MOSFET are used here as the end contacts [the drain (D) and the source (S)] of the G4-FET. What would otherwise be the source and drain of the SOI MOSFET serve, in the G4-FET, as two junction-based extra gates (JG1 and JG2), which are used to squeeze the channel via reverse-biased junctions as in a JFET. The G4-FET also includes a polysilicon top gate (G1), which plays the same role as does the gate in an accumulation-mode MOSFET. The substrate emulates a fourth MOS gate (G2). By making proper choices of G4-FET device parameters in conjunction with bias voltages and currents, one can design a circuit in which two input gate voltages (Vin1,Vin2) control the conduction characteristics of G4-FETs such that the output voltage (Vout) closely approximates a value proportional to the product of the input voltages. Figure 2 depicts two such analog multiplier circuits. In each circuit, there is the following: The input and output

  12. Morbidity pattern among refugees in Eastern Ethiopia.

    PubMed

    Bisrat, F; Berhane, Y; Mamo, A; Asefa, E

    1995-11-01

    The population of refugees in eastern Africa and the health problems affecting them are enormous. This study was conducted to document the morbidity pattern among refugees in eastern Ethiopia. The study was conducted to document the morbidity pattern among refugees in eastern Ethiopia. The study utilized a descriptive cross sectional design. Data were collected using a uniform format from all refugee camps in the eastern Ethiopia. Respiratory tract infection and diarrhoeal diseases were identified to be the major causes of morbidity, accounting for 31.8% and 27.3% respectively in children under five years, and for 34.9% and 8.5% respectively in the other age groups. The findings were consistent with other studies done in refugee populations elsewhere. Universality of the problems was noted and a coordinated multidisciplinary approach is recommended to alleviate the health problems of refugees.

  13. Acute Morbidity of Proton Therapy for Prostate Cancer: The Hyogo Ion Beam Medical Center Experience

    SciTech Connect

    Mayahara, Hiroshi Murakami, Masao; Kagawa, Kazufumi; Kawaguchi, Atsuya; Oda, Yasue; Miyawaki, Daisuke; Sasaki, Ryohei; Sugimura, Kazuro; Hishikawa, Yoshio

    2007-10-01

    Purpose: To investigate the incidence and influencing factors of acute genitourinary (GU) and gastrointestinal morbidities in patients with prostate cancer treated with proton therapy. Methods and Materials: A total of 287 patients with histologically proven Stage cT1-T4N0M0 prostate cancer were treated with proton therapy between 2003 and 2004. Of these, 204 (71%) received neoadjuvant androgen suppression therapy. The patients were treated with 190-230-MeV protons using lateral-opposed techniques to a dose of 74 GyE. Dose-volume histogram analyses were performed. The incidence of acute morbidity was evaluated using the National Cancer Institute Common Toxicity Criteria, version 2.0. Clinical factors, including age, clinical target volume, initial prostate-specific antigen level, T stage, presence of diabetes mellitus, and the use of androgen suppression therapy, were investigated to determine whether those affected the incidence of acute GU morbidity. Results: None developed Grade 2 or higher acute gastrointestinal morbidity. In contrast, 111 (39%) and 4 (1%) patients experienced acute Grade 2 and Grade 3 GU morbidities, respectively. However, 87% of the patients were successfully relieved by the administration of a selective {alpha}-1 blocker. Multivariate analysis showed that a larger clinical target volume (p = 0.001) and the use of androgen suppression therapy (p = 0.017) were significant factors for the prediction of acute Grade 2-3 GU morbidity. Conclusion: In our experience with proton therapy, a low incidence of acute gastrointestinal morbidity was observed. In contrast, the incidence of acute GU morbidity was similar to that in other reports of photon radiotherapy. Additional follow-up is warranted to elucidate the long-term safety and efficacy of proton therapy for prostate cancer.

  14. Collecting baseline information for national morbidity alleviation programs: different methods to estimate lymphatic filariasis morbidity prevalence.

    PubMed

    Mathieu, Els; Amann, Josef; Eigege, Abel; Richards, Frank; Sodahlon, Yao

    2008-01-01

    The lymphatic filariasis elimination program aims not only to stop transmission, but also to alleviate morbidity. Although geographically limited morbidity projects exist, few have been implemented nationally. For advocacy and planning, the program coordinators need prevalence estimates that are currently rarely available. This article compares several approaches to estimate morbidity prevalence: (1) data routinely collected during mapping or sentinel site activities; (2) data collected during drug coverage surveys; and (3) alternative surveys. Data were collected in Plateau and Nasarawa States in Nigeria and in 6 districts in Togo. In both settings, we found that questionnaires seem to underestimate the morbidity prevalence compared with existing information collected through clinical examination. We suggest that program managers use the latter for advocacy and planning, but if not available, questionnaires to estimate morbidity prevalence can be added to existing surveys. Even though such data will most likely underestimate the real burden of disease, they can be useful in resource-limited settings.

  15. Non-inferiority of retrospective data collection for assessing perioperative morbidity.

    PubMed

    Patel, Amour B U; Reyes, Anna; Ackland, Gareth L

    2015-01-01

    Background. Postoperative morbidity has immediate and delayed consequences for surgical patients, including excess risk of premature death. Capturing these data objectively and routinely in large electronic databases using tools such as the Postoperative Morbidity Survey (POMS) would offer tremendous clinical and translational potential. However, POMS has thus far only utilised prospective data collection by research staff. We hypothesised that retrospective data collection from routinely collated hospital data from paper and electronic charts, medical and nursing notes was non-inferior to prospective data collection requiring research staff capturing POMS-defined morbidity in real-time. Methods. Morbidity was recorded by a trained investigator as defined by POMS prospectively on postoperative days 3 and 7. Separately, an independent investigator blinded to prospectively acquired data retrospectively assessed the same patients' morbidity as defined by POMS criteria, using medical charts, nursing summaries and electronic data. Equivalence was accepted when the confidence limits for both modes of data collection fell completely inside the equivalence bounds, with the maximum equivalence difference (i.e., the largest value of the difference in sensitivities deemed to reach a conclusion of equivalence) set a priori at 0.2. Differences for confidence limits between retrospective and prospective data collection were based on Nam's RMLE method. The relationship between morbidity on postoperative day 3 as recorded by each data collection method on time to become morbidity free and length of hospital stay was compared using the log-rank test. Results. POMS data from 85 patients undergoing elective or emergency surgery were analyzed. At postoperative day 3, POMS-defined morbidity was similar regardless of whether data were collected prospectively or retrospectively (95% CI [-0.13-0.013]; p < 0.001). Non-inferiority for sensitivity was observed for all other POMS domains and

  16. [The dynamics of morbidity of population of the city of Ufa].

    PubMed

    Askarova, Z F; Baiykina, I M; Tchuyenkova, G A; Askarov, R A

    2012-01-01

    The article deals with analysis of general and primary morbidity of population of Ufa in all age groups according the data of form N 12 of state statistical supervision "The information of number of diseases registered in patients residing in the district of medical institution support" of Minzdrav of Republic of Bashkortostan in 2000-2008. It is established that during the mentioned period of time, an increase occurred of general and primary morbidity. The particular classes of diseases and age groups are detected which are characterized by a significant increase of indicators of morbidity.

  17. Minor psychiatric morbidity and labour turnover.

    PubMed Central

    Jenkins, R

    1985-01-01

    The relation of minor psychiatric morbidity with labour turnover is examined, using data from a study of young, predominantly middle class, white collar men and women. The results suggest that the presence of psychiatric symptomatology is at least as important as occupational attitudes in identifying individuals who would subsequently leave the organisation. PMID:4016004

  18. Morbidity and Infant Development: A Hypothesis.

    ERIC Educational Resources Information Center

    Pollitt, Ernesto

    1983-01-01

    Results of a study conducted in 14 villages of Sui Lin Township, Taiwan, suggest the hypothesis that, under conditions of extreme economic impoverishment and among children within populations where energy protein malnutrition is endemic, there is an inverse relationship between incidence of morbidity in infancy and measures of motor and mental…

  19. Co-Morbidity of Conditions among Prisoners

    ERIC Educational Resources Information Center

    Shinkfield, Alison J.; Graffam, J.; Meneilly, Sharn

    2009-01-01

    Eighty seven adult prisoners (58 males, 29 females) completed the Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), and a questionnaire on current health in order to examine both the prevalence of co-morbid conditions and the relation of depression and anxiety to ill-health and prior substance use. High prevalence rates of…

  20. The morbid anatomy of high altitude

    PubMed Central

    Heath, Donald

    1979-01-01

    The morbid anatomical changes which take place in man and animals exposed to the chronic hypoxia of residence at high altitude are briefly reviewed. ImagesFig. 1Fig. 2Fig. 3Fig. 5Fig. 4Fig. 6Fig. 7Fig. 8 PMID:493205

  1. How Communication Among Members of the Health Care Team Affects Maternal Morbidity and Mortality.

    PubMed

    Brennan, Rita Allen; Keohane, Carol Ann

    In the United States, rates of severe maternal morbidity and mortality have escalated in the past decade. Communication failure among members of the health care team is one associated factor that can be modified. Nurses can promote effective communication. We provide strategies that incorporate team training principles and structured communication processes for use by providers and health care systems to improve the quality and safety of patient care and reduce the incidence of maternal mortality and morbidity.

  2. Evaluation of interventions to reduce multiply controlled vocal stereotypy.

    PubMed

    Scalzo, Rachel; Henry, Kelsey; Davis, Tonya N; Amos, Kally; Zoch, Tamara; Turchan, Sarah; Wagner, Tara

    2015-07-01

    This study examined four interventions targeted at decreasing multiply controlled vocal stereotypy for a 12-year-old boy diagnosed with autism spectrum disorder and a severe intellectual disability. These interventions included Noncontingent Music, Differential Reinforcement of Other Behaviors, Self-Recording, and Functional Communication Training (FCT). In addition to measuring vocal stereotypy during each condition, task engagement and challenging behavior were also monitored. Across conditions, vocal stereotypy did not vary significantly from baseline except in FCT, when it decreased significantly. Task engagement was higher in this condition as well. It is hypothesized that FCT provided an enriched environment by increasing social interaction and access to desired items as well as removal of less preferred activities. For these reasons, there was a decrease in the need for the participant to engage in vocal stereotypy and challenging behavior and increase in his ability to engage in a task.

  3. Slow Interatomic Coulombic Decay of Multiply Excited Neon Clusters

    NASA Astrophysics Data System (ADS)

    Iablonskyi, D.; Nagaya, K.; Fukuzawa, H.; Motomura, K.; Kumagai, Y.; Mondal, S.; Tachibana, T.; Takanashi, T.; Nishiyama, T.; Matsunami, K.; Johnsson, P.; Piseri, P.; Sansone, G.; Dubrouil, A.; Reduzzi, M.; Carpeggiani, P.; Vozzi, C.; Devetta, M.; Negro, M.; Calegari, F.; Trabattoni, A.; Castrovilli, M. C.; Faccialà, D.; Ovcharenko, Y.; Möller, T.; Mudrich, M.; Stienkemeier, F.; Coreno, M.; Alagia, M.; Schütte, B.; Berrah, N.; Kuleff, A. I.; Jabbari, G.; Callegari, C.; Plekan, O.; Finetti, P.; Spezzani, C.; Ferrari, E.; Allaria, E.; Penco, G.; Serpico, C.; De Ninno, G.; Nikolov, I.; Diviacco, B.; Di Mitri, S.; Giannessi, L.; Prince, K. C.; Ueda, K.

    2016-12-01

    Ne clusters (˜5000 atoms ) were resonantly excited (2 p →3 s ) by intense free electron laser (FEL) radiation at FERMI. Such multiply excited clusters can decay nonradiatively via energy exchange between at least two neighboring excited atoms. Benefiting from the precise tunability and narrow bandwidth of seeded FEL radiation, specific sites of the Ne clusters were probed. We found that the relaxation of cluster surface atoms proceeds via a sequence of interatomic or intermolecular Coulombic decay (ICD) processes while ICD of bulk atoms is additionally affected by the surrounding excited medium via inelastic electron scattering. For both cases, cluster excitations relax to atomic states prior to ICD, showing that this kind of ICD is rather slow (picosecond range). Controlling the average number of excitations per cluster via the FEL intensity allows a coarse tuning of the ICD rate.

  4. Imaging With Nature: Compressive Imaging Using a Multiply Scattering Medium

    PubMed Central

    Liutkus, Antoine; Martina, David; Popoff, Sébastien; Chardon, Gilles; Katz, Ori; Lerosey, Geoffroy; Gigan, Sylvain; Daudet, Laurent; Carron, Igor

    2014-01-01

    The recent theory of compressive sensing leverages upon the structure of signals to acquire them with much fewer measurements than was previously thought necessary, and certainly well below the traditional Nyquist-Shannon sampling rate. However, most implementations developed to take advantage of this framework revolve around controlling the measurements with carefully engineered material or acquisition sequences. Instead, we use the natural randomness of wave propagation through multiply scattering media as an optimal and instantaneous compressive imaging mechanism. Waves reflected from an object are detected after propagation through a well-characterized complex medium. Each local measurement thus contains global information about the object, yielding a purely analog compressive sensing method. We experimentally demonstrate the effectiveness of the proposed approach for optical imaging by using a 300-micrometer thick layer of white paint as the compressive imaging device. Scattering media are thus promising candidates for designing efficient and compact compressive imagers. PMID:25005695

  5. Multiplying steady-state culture in multi-reactor system.

    PubMed

    Erm, Sten; Adamberg, Kaarel; Vilu, Raivo

    2014-11-01

    Cultivation of microorganisms in batch experiments is fast and economical but the conditions therein change constantly, rendering quantitative data interpretation difficult. By using chemostat with controlled environmental conditions the physiological state of microorganisms is fixed; however, the unavoidable stabilization phase makes continuous methods resource consuming. Material can be spared by using micro scale devices, which however have limited analysis and process control capabilities. Described herein are a method and a system combining the high throughput of batch with the controlled environment of continuous cultivations. Microorganisms were prepared in one bioreactor followed by culture distribution into a network of bioreactors and continuation of independent steady state experiments therein. Accelerostat cultivation with statistical analysis of growth parameters demonstrated non-compromised physiological state following distribution, thus the method effectively multiplied steady state culture of microorganisms. The theoretical efficiency of the system was evaluated in inhibitory compound analysis using repeated chemostat to chemostat transfers.

  6. Multigroup diffusion preconditioners for multiplying fixed-source transport problems

    NASA Astrophysics Data System (ADS)

    Roberts, Jeremy A.; Forget, Benoit

    2014-10-01

    Several preconditioners based on multigroup diffusion are developed for application to multiplying fixed-source transport problems using the discrete ordinates method. By starting from standard, one-group, diffusion synthetic acceleration (DSA), a multigroup diffusion preconditioner is constructed that shares the same fine mesh as the transport problem. As a cheaper but effective alternative, a two-grid, coarse-mesh, multigroup diffusion preconditioner is examined, for which a variety of homogenization schemes are studied to generate the coarse mesh operator. Finally, a transport-corrected diffusion preconditioner based on application of the Newton-Shulz algorithm is developed. The results of several numerical studies indicate the coarse-mesh, diffusion preconditioners work very well. In particular, a coarse-mesh, transport-corrected, diffusion preconditioner reduced the computational time of multigroup GMRES by up to a factor of 17 and outperformed best-case Gauss-Seidel results by over an order of magnitude for all problems studied.

  7. A Gas Electron Multiplier (GEM) Detector for Fast Neutron Imaging

    NASA Astrophysics Data System (ADS)

    Jewett, C. C.; McMahan, M.; Cerny, J.; Heilbronn, L.; Johnson, M.

    2008-10-01

    We have built a Gas Electron Multiplier (GEM) detector for detection of fast neutrons at Lawrence Berkeley National Laboratory. The detector consists of a 0.0625 inch thick polypropylene neutron converter, three GEM foils and a grid of 16 readout pads on a printed circuit board. In this talk, we present images of the GEM detector, the results of tests with ^60Co, AmBe sources and our neutron beam, and a comparison between the proposed fast neutron GEM detector and a fast neutron ^238U fission chamber we purchased. One of the advantages of the GEM detector over the fission chamber is the fact that it provides the x-y position information of the neutrons.

  8. Multiply-warped product metrics and reduction of Einstein equations

    NASA Astrophysics Data System (ADS)

    Gholami, Fateme; Darabi, Farhad; Haji-Badali, Ali

    It is shown that for every multidimensional metric in the multiply-warped product form M¯ = K ×f1M1 ×f2M2 with warp functions f1, f2, associated to the submanifolds M1, M2 of dimensions n1, n2 respectively, one can find the corresponding Einstein equations ḠAB = -Λ¯ḡAB, with cosmological constant Λ¯, which are reducible to the Einstein equations Gαβ = -Λ1gαβ and Gij = -Λ2hij on the submanifolds M1, M2, with cosmological constants Λ1 and Λ2, respectively, where Λ¯, Λ1 and Λ2 are functions of f1, f2 and n1, n2.

  9. Characterization of Silicon PhotoMultipliers at LNS-INFN

    SciTech Connect

    Cosentino, L.; Finocchiaro, P.; Pappalardo, A.

    2011-12-13

    The Silicon PhotoMultipliers (SiPMs) are a new generation of photodetectors having high sensitivity, excellent time resolution, compactness, low power supply, and insensitivity to magnetic fields. Their properties make them a valid alternative to the PMTs in several fields, such as particle physics, medicine, and space technology. At Laboratori Nazionali del Sud (LNS), a complete characterization of samples developed by different companies (Hamamatsu, STM, SensL) has been performed in order to measure the most significant properties, consisting of the dark noise, cross talk probability, photon detection efficiency, and charge and timing resolutions. Measurements have also been performed coupling the SiPMs with scintillating fibres and small size LYSO scintillators in order to investigate possible applications in Positron Emission Tomography (PET) diagnostics and in the monitoring of nuclear waste sites.

  10. Development of a thick gas electron multiplier for microdosimetry

    NASA Astrophysics Data System (ADS)

    Orchard, G. M.; Chin, K.; Prestwich, W. V.; Waker, A. J.; Byun, S. H.

    2011-05-01

    A new tissue-equivalent proportional counter based on a thick gas electron multiplier (THGEM) was developed and tested for microdosimetry. A systematic test was conducted at the McMaster Accelerator Laboratory to investigate the overall performance of the prototype detector. A mixed neutron-gamma-ray radiation field was generated using the 7Li(p,n) reaction. The detector was operated at low voltage initially to test the stability and then the relative multiplication gain was measured as a function of the operating high voltage. A drift potential of 100 V and a THGEM bias of 727 V generated a multiplication gain sufficient for the detection of both neutron and gamma-ray radiation. A consistent microdosimetric pattern was observed between the THGEM detector and standard TEPC for microdosimetry.

  11. Characterization of Silicon PhotoMultipliers at LNS-INFN

    NASA Astrophysics Data System (ADS)

    Cosentino, L.; Finocchiaro, P.; Pappalardo, A.

    2011-12-01

    The Silicon PhotoMultipliers (SiPMs) are a new generation of photodetectors having high sensitivity, excellent time resolution, compactness, low power supply, and insensitivity to magnetic fields. Their properties make them a valid alternative to the PMTs in several fields, such as particle physics, medicine, and space technology. At Laboratori Nazionali del Sud (LNS), a complete characterization of samples developed by different companies (Hamamatsu, STM, SensL) has been performed in order to measure the most significant properties, consisting of the dark noise, cross talk probability, photon detection efficiency, and charge and timing resolutions. Measurements have also been performed coupling the SiPMs with scintillating fibres and small size LYSO scintillators in order to investigate possible applications in Positron Emission Tomography (PET) diagnostics and in the monitoring of nuclear waste sites.

  12. Individual Effect Modifiers of Dust Exposure Effect on Cardiovascular Morbidity

    PubMed Central

    Vodonos, Alina; Friger, Michael; Katra, Itzhak; Krasnov, Helena; Zahger, Doron; Schwartz, Joel; Novack, Victor

    2015-01-01

    Background High concentrations of particulate matter (PM) air pollution have been associated with death and hospital admissions due to cardiovascular morbidity. However, it is not clear a) whether high levels of non-anthropogenic PM from dust storms constitute a health risk; and b) whether these health risks are exacerbated in a particular demographic. Methods This study comprised all patients above 18 years old admitted to Soroka University Medical Center (1000 bed tertiary hospital, Be’er- Sheva, Israel, 2001–2010) with a primary diagnosis of acute coronary syndrome (ACS). Data on meteorological parameters and PM10 (particulate matter <10 μm in aerodiameter) were obtained from monitoring stations in the city of Be'er-Sheva. Data were analyzed using a case crossover analysis to examine the effect of dust exposure on hospitalization due to ACS and the interaction with co-morbidities and demographic factors. Results There were 16,734 hospitalizations due to ACS during the study period. The estimated odds of hospitalization due to ACS was significantly associated with PM10 during non dust storm days at the same day of the exposure (lag0); OR = 1.014 (95%CI 1.001–1.027) for a 10 μg/m3 increase, while a delayed response (lag1) was found during the dust storm days; OR = 1.007 (95%CI 1.002–1.012). The effect size for the dust exposure association was larger for older (above the age of 65), female or Bedouin patients. Conclusions Exposure to non-anthropogenic PM is associated with cardiovascular morbidity. Health risk associated dust exposure is gender and age specific with older women and Bedouin patients being the most vulnerable groups. PMID:26381397

  13. Planar varactor frequency multiplier devices with blocking barrier

    NASA Technical Reports Server (NTRS)

    Lieneweg, Udo (Inventor); Frerking, Margaret A. (Inventor); Maserjian, Joseph (Inventor)

    1994-01-01

    The invention relates to planar varactor frequency multiplier devices with a heterojunction blocking barrier for near millimeter wave radiation of moderate power from a fundamental input wave. The space charge limitation of the submillimeter frequency multiplier devices of the BIN(sup +) type is overcome by a diode structure comprising an n(sup +) doped layer of semiconductor material functioning as a low resistance back contact, a layer of semiconductor material with n-type doping functioning as a drift region grown on the back contact layer, a delta doping sheet forming a positive charge at the interface of the drift region layer with a barrier layer, and a surface metal contact. The layers thus formed on an n(sup +) doped layer may be divided into two isolated back-to-back BNN(sup +) diodes by separately depositing two surface metal contacts. By repeating the sequence of the drift region layer and the barrier layer with the delta doping sheet at the interfaces between the drift and barrier layers, a plurality of stacked diodes is formed. The novelty of the invention resides in providing n-type semiconductor material for the drift region in a GaAs/AlGaAs structure, and in stacking a plurality of such BNN(sup +) diodes stacked for greater output power with and connected back-to-back with the n(sup +) GaAs layer as an internal back contact and separate metal contact over an AlGaAs barrier layer on top of each stack.

  14. [Primary-care morbidity and true morbidity due to acute respiratory infections].

    PubMed

    Pérez Rodríguez, A E; González Ochoa, E; Bravo González, J R; Carlos Silva, L; Linton, T

    1992-01-01

    The present work presents the study of morbidity due to acute respiratory infections (ARI) in areas of the town of Lisa in Ciudad Habana, and Isla Juventud (Cuba), to characterize different aspects of morbidity measured by health care attendance and to measure true morbidity. About 90% of consultations for ARI were first-time consultations, while their ratio to further consultations was 5.3. True morbidity rates (TMR), obtained trough active research, ranged from 110.4 to 163.4 cases per 1000 inhabitants, considerably higher than morbidity rates measured by primary care consultations (MRPCC) in the same time period. The true morbidity index (TMI), as measured by the ratio of the two previous rates, ranged from 5 to 15. A high proportion (47.6%) of cases reported no medical care attendance. These results provide approximate estimates of true morbidity in the study area, and allow the establishment of a new control program, also improving epidemiologic surveillance within primary care activities.

  15. Non-inferiority of retrospective data collection for assessing perioperative morbidity

    PubMed Central

    Patel, Amour B.U.; Reyes, Anna

    2015-01-01

    Background. Postoperative morbidity has immediate and delayed consequences for surgical patients, including excess risk of premature death. Capturing these data objectively and routinely in large electronic databases using tools such as the Postoperative Morbidity Survey (POMS) would offer tremendous clinical and translational potential. However, POMS has thus far only utilised prospective data collection by research staff. We hypothesised that retrospective data collection from routinely collated hospital data from paper and electronic charts, medical and nursing notes was non-inferior to prospective data collection requiring research staff capturing POMS-defined morbidity in real-time. Methods. Morbidity was recorded by a trained investigator as defined by POMS prospectively on postoperative days 3 and 7. Separately, an independent investigator blinded to prospectively acquired data retrospectively assessed the same patients’ morbidity as defined by POMS criteria, using medical charts, nursing summaries and electronic data. Equivalence was accepted when the confidence limits for both modes of data collection fell completely inside the equivalence bounds, with the maximum equivalence difference (i.e., the largest value of the difference in sensitivities deemed to reach a conclusion of equivalence) set a priori at 0.2. Differences for confidence limits between retrospective and prospective data collection were based on Nam’s RMLE method. The relationship between morbidity on postoperative day 3 as recorded by each data collection method on time to become morbidity free and length of hospital stay was compared using the log-rank test. Results. POMS data from 85 patients undergoing elective or emergency surgery were analyzed. At postoperative day 3, POMS-defined morbidity was similar regardless of whether data were collected prospectively or retrospectively (95% CI [−0.13–0.013]; p < 0.001). Non-inferiority for sensitivity was observed for all other POMS

  16. [Morbidity among mothers and infants after ambulatory deliveries].

    PubMed

    Kierkegaard, O

    1991-07-29

    Postpartum early discharge programs are reviewed. Few programs were mandatory and both primi- and multiparae were included. Discharge varied from two to 72 hours after delivery. Nearly all programs had prenatal preparation and all patients had postpartum follow-up at home. Approximately one per cent of the infants were readmitted mostly on account of hyperbilirubinemia and infections, and half as many mothers were readmitted mostly for hemorrhage and endometritis. Infants discharged very early were readmitted more frequently than others. There were no statistical significant difference in mortality or morbidity between mothers or infants in early discharge groups and control groups.

  17. [The possibilities for the correction of the co-morbid anxiety and depressive disorders in the patients suffering from chronic obstructive pulmonary disease by the methods of climatic therapy].

    PubMed

    Yusupalieva, M M

    2016-01-01

    The present study included 142 patients presenting with grade I-III chronic obstructive pulmonary disease (COPD) treated based at a spa and health resort (SHR) facility located on the southern coast of the Crimea. The psycho-diagnostic testing was performed with the use of the Hamilton Rating Scale for Depression (HDRS) and the Ch.D. Spielberger - Yu.L. Khanin scale for reactive (situational) and personal anxiety. The anxiety-depressive disorders were diagnosed in 59,2% of the patients; their intensity correlated with the severity of COPD. The questionnaire study based at the Spilberger-Khanin made it possible to document the presence of moderate and severe anxiety in 68,3% of the patients. It was shown that a course of the spa and health resort-based treatment produced beneficial effect on the psycho-functional status of the patients with COPD that was especially well apparent in those with the mild form of COPD.

  18. Swift recovery of severe hypoxemic pneumonia upon morbid obesity.

    PubMed

    Galland, C; Ferrand, F X; Cividjian, A; Sergent, B; Pichot, C; Ghignone, M; Quintin, L

    2014-01-01

    A morbidly obese (body mass index = 55.5) female patient presented with severe hypoxemic community acquired pneumonia [PaO2/FiO2 (P/F) = 57] with primarily right basal atelectasis, but without bilateral opacities in the upper lobes on the chest X-ray. Major O2 desaturations led the nurses to object to moving the patient to the prone position: muscle relaxation combined to prone position was impossible. Therefore, stringent 60 degrees reverse Trendelenburg legs down position was constantly maintained during mechanical ventilation through the endotracheal tube, using low pressure support (pressure support = 5-10 cmH2O) and high positive end-expiratory pressure (PEEP). PEEP was progressively increased to 20 cmH2O, and little or no sedation was used. A P/F improvement from 57 to 200 over three days allowed removing the tracheal tube. The patient was discharged 13 days after admission. In this paper, the use of high PEEP in the context of morbid obesity, and low pressure support are discussed.

  19. [Surgical treatment of morbid obesity--gastric banding].

    PubMed

    Kasalický, M; Fried, M; Pesková, M

    2001-01-01

    Approximately 16% of male and 20% of female of the age from 20 to 65 years are obese in the Czech Republic. The restrictive bariatric procedure of stomach--gastric banding (GB) is one of possibilities to cure the morbid obese patients after failure of conservative therapy. The ratio of complications (5-18%) after GB presenting in various papers is comparable with the ratio of complications (4-23%) in others bariatric procedures. From 1993 to 1999, 517 morbid obese patients (mean BMI 51.1) underwent laparoscopic nonadjustable gastric banding (LNGB) at 1st Surgical Department, Charles University Teaching Faculty Hospital in Prague. As the early complications (during hospitalization) offered swelling of the gastric mucous in the place of GB in 5.6% (n = 29), the oesophagitis, the gastritis or the gastric ulcer in 1.5% (n = 9) and perforation of the stomach wall in 0.6% (n = 3). As the late complications offered the bleeding from peptic ulcer in 0.4% (n = 2), sequential migration of gastric band through the stomach wall inside in 0.6% (n = 3) and the slippage of anterior stomach wall or the dilatation of the pouch above gastric bandage in 5.1% (n = 26). The serious complications in 6.3% (n = 32) claimed surgical procedures. Other complications in 7.5% (n = 39) have been treated conservatively. The 86% (n = 446) of obese patients after LNGB were without complications.

  20. The influence of population characteristics on variation in general practice based morbidity estimations

    PubMed Central

    2011-01-01

    Background General practice based registration networks (GPRNs) provide information on morbidity rates in the population. Morbidity rate estimates from different GPRNs, however, reveal considerable, unexplained differences. We studied the range and variation in morbidity estimates, as well as the extent to which the differences in morbidity rates between general practices and networks change if socio-demographic characteristics of the listed patient populations are taken into account. Methods The variation in incidence and prevalence rates of thirteen diseases among six Dutch GPRNs and the influence of age, gender, socio economic status (SES), urbanization level, and ethnicity are analyzed using multilevel logistic regression analysis. Results are expressed in median odds ratios (MOR). Results We observed large differences in morbidity rate estimates both on the level of general practices as on the level of networks. The differences in SES, urbanization level and ethnicity distribution among the networks' practice populations are substantial. The variation in morbidity rate estimates among networks did not decrease after adjusting for these socio-demographic characteristics. Conclusion Socio-demographic characteristics of populations do not explain the differences in morbidity estimations among GPRNs. PMID:22111707

  1. Estimating lifetime healthcare costs with morbidity data

    PubMed Central

    2013-01-01

    Background In many developed countries, the economic crisis started in 2008 producing a serious contraction of the financial resources spent on healthcare. Identifying which individuals will require more resources and the moment in their lives these resources have to be allocated becomes essential. It is well known that a small number of individuals with complex healthcare needs consume a high percentage of health expenditures. Conversely, little is known on how morbidity evolves throughout life. The aim of this study is to introduce a longitudinal perspective to chronic disease management. Methods Data used relate to the population of the county of Baix Empordà in Catalonia for the period 2004–2007 (average population was N = 88,858). The database included individual information on morbidity, resource consumption, costs and activity records. The population was classified using the Clinical Risk Groups (CRG) model. Future morbidity evolution was simulated under different assumptions using a stationary Markov chain. We obtained morbidity patterns for the lifetime and the distribution function of the random variable lifetime costs. Individual information on acute episodes, chronic conditions and multimorbidity patterns were included in the model. Results The probability of having a specific health status in the future (healthy, acute process or different combinations of chronic illness) and the distribution function of healthcare costs for the individual lifetime were obtained for the sample population. The mean lifetime cost for women was €111,936, a third higher than for men, at €81,566 (all amounts calculated in 2007 Euros). Healthy life expectancy at birth for females was 46.99, lower than for males (50.22). Females also spent 28.41 years of life suffering from some type of chronic disease, a longer period than men (21.9). Conclusions Future morbidity and whole population costs can be reasonably predicted, combining stochastic microsimulation with a

  2. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a review of factors contributing to morbidity and mortality

    PubMed Central

    Newton, Andrew D.; Bartlett, Edmund K.

    2016-01-01

    Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with prolonged survival for appropriately selected patients with peritoneal dissemination of abdominal malignancies. CRS and HIPEC has been criticized for perceived high rates of morbidity and mortality. Morbidity and mortality rates of CRS and HIPEC, however, do not appear dissimilar to those of other large abdominal surgeries, particularly when relevant patient and operative factors are accounted for. The risk of morbidity and mortality following this surgery for a given individual can be predicted in part by a variety of patient and operative factors. While strong data are lacking, the limited data that exists on the matter suggests that the independent contribution of the heated intraperitoneal chemotherapy to CRS and HIPEC morbidity is relatively small. A more thorough understanding of the patient and operative factors associated with CRS and HIPEC morbidity and mortality, as well as the specific complications related to the intraperitoneal chemotherapy, can better inform clinicians in multidisciplinary teams and patients alike in the decision-making for this surgery. PMID:26941988

  3. Psoriasis beyond the skin: a review of the literature on cardiometabolic and psychological co-morbidities of psoriasis.

    PubMed

    Puig, Lluis; Kirby, Brian; Mallbris, Lotus; Strohal, Robert

    2014-01-01

    Psoriasis is increasingly associated with a range of co-morbid diseases and risk factors. Patients with co-morbidities are more likely to need hospitalisation for non-dermatological conditions, and incur greater total costs than those without co-morbidities. A literature review was conducted on two of the most common co-morbidities of psoriasis (cardiovascular (CV) and psychological co-morbidities), to establish their incidence and impact and to raise awareness of unanswered questions and highlight knowledge gaps. A large number of small controlled or cross-sectional studies report increased prevalence of cardiometabolic and psychological co-morbidities in psoriasis patients. A number of large cohort studies documented the incidence of various cardiometabolic co-morbidities. Severe psoriasis is associated with increased mortality, and the most common cause of death is CV disease. Studies on the management of co-morbidities and their impact on psoriasis treatment are scarce. Many questions on the co-morbidities of psoriasis remain to be answered.

  4. "Vicious circles": the development of morbid obesity.

    PubMed

    Owen-Smith, Amanda; Donovan, Jenny; Coast, Joanna

    2014-09-01

    Although there has been extensive research around the etiology of moderate obesity, there are still important questions relating to the development and lived experience of extreme obesity. We present a synthesis of data from two in-depth qualitative studies in which morbidly obese participants (N = 31) were able to explain the development of the condition in their own terms. We identified consistent themes in the two datasets, and undertook a detailed data synthesis. Particularly salient themes in the development of morbid obesity related to family structures and early socialization experiences, and the role of emotional distress was dominant in both initial weight gain and ongoing cycles of loss and regain. All informants accepted some responsibility for their health state, but identified a number of mitigating factors that limited personal culpability that were often related to the fulfillment of gendered social expectations.

  5. Central blood pressure and pulse wave velocity: relationship to target organ damage and cardiovascular morbidity-mortality in diabetic patients or metabolic syndrome. An observational prospective study. LOD-DIABETES study protocol

    PubMed Central

    2010-01-01

    Background Diabetic patients show an increased prevalence of non-dipping arterial pressure pattern, target organ damage and elevated arterial stiffness. These alterations are associated with increased cardiovascular risk. The objectives of this study are the following: to evaluate the prognostic value of central arterial pressure and pulse wave velocity in relation to the incidence and outcome of target organ damage and the appearance of cardiovascular episodes (cardiovascular mortality, myocardial infarction, chest pain and stroke) in patients with type 2 diabetes mellitus or metabolic syndrome. Methods/Design Design: This is an observational prospective study with 5 years duration, of which the first year corresponds to patient inclusion and initial evaluation, and the remaining four years to follow-up. Setting: The study will be carried out in the urban primary care setting. Study population: Consecutive sampling will be used to include patients diagnosed with type 2 diabetes between 20-80 years of age. A total of 110 patients meeting all the inclusion criteria and none of the exclusion criteria will be included. Measurements: Patient age and sex, family and personal history of cardiovascular disease, and cardiovascular risk factors. Height, weight, heart rate and abdominal circumference. Laboratory tests: hemoglobin, lipid profile, creatinine, microalbuminuria, glomerular filtration rate, blood glucose, glycosylated hemoglobin, blood insulin, fibrinogen and high sensitivity C-reactive protein. Clinical and 24-hour ambulatory (home) blood pressure monitoring and self-measured blood pressure. Common carotid artery ultrasound for the determination of mean carotid intima-media thickness. Electrocardiogram for assessing left ventricular hypertrophy. Ankle-brachial index. Retinal vascular study based on funduscopy with non-mydriatic retinography and evaluation of pulse wave morphology and pulse wave velocity using the SphygmoCor system. The medication used for

  6. Mortality and cancer morbidity among cement workers.

    PubMed Central

    Jakobsson, K; Horstmann, V; Welinder, H

    1993-01-01

    OBJECTIVE--To explore associations between exposure to cement dust and cause specific mortality and tumour morbidity, especially gastrointestinal tumours. DESIGN--A retrospective cohort study. SUBJECTS AND SETTING--2400 men, employed for at least 12 months in two Swedish cement factories. MAIN OUTCOME MEASURES--Cause specific morality from death certificates (1952-86). Cancer morbidity from tumour registry information (1958-86). Standardised mortality rates (SMRs; national reference rates) and standardised morbidity incidence rates (SIRs; regional reference rates) were calculated. RESULTS--An increased risk of colorectal cancer was found > or = 15 years since the start of employment (SIR 1.6, 95% confidence interval (95% CI) 1.1-2.3), mainly due to an increased risk for tumours in the right part of the colon (SIR 2.7, 95% CI 1.4-4.8), but not in the left part (SIR 1.0, 95% CI 0.3-2.5). There was a numerical increase of rectal cancer (SIR 1.5, 95% CI 0.8-2.5). Exposure (duration of blue collar employment)-response relations were found for right sided colon cancer. After > or = 25 years of cement work, the risk was fourfold (SIR 4.3, 95% CI 1.7-8.9). There was no excess of stomach cancer or respiratory cancer. Neither total mortality nor cause specific mortality were significantly increased. CONCLUSIONS--Diverging risk patterns for tumours with different localisations within the large bowel were found in the morbidity study. Long term exposure to cement dust was a risk factor for right sided colon cancer. The mortality study did not show this risk. PMID:8457494

  7. Life Satisfaction and Morbidity among Postmenopausal Women

    PubMed Central

    Lukkala, Pyry S.; Honkanen, Risto J.; Rauma, Päivi H.; Williams, Lana J.; Quirk, Shae E.; Kröger, Heikki; Koivumaa-Honkanen, Heli

    2016-01-01

    Objective To investigate associations between morbidity and global life satisfaction in postmenopausal women taking into account type and number of diseases. Materials and Methods A total of 11,084 women (age range 57–66 years) from a population-based cohort of Finnish women (OSTPRE Study) responded to a postal enquiry in 1999. Life satisfaction was measured with a 4-item scale. Self-reported diseases diagnosed by a physician and categorized according to ICD-10 main classes were used as a measure of morbidity. Enquiry data on health and lifestyle were used as covariates in the multivariate logistic models. Results Morbidity was strongly associated with life dissatisfaction. Every additional disease increased the risk of life dissatisfaction by 21.1% (p < .001). The risk of dissatisfaction was strongest among women with mental disorders (OR = 5.26; 95%CI 3.84–7.20) and neurological disorders (OR = 3.62; 95%CI 2.60–5.02) compared to the healthy (each p < .001). Smoking, physical inactivity and marital status were also associated with life dissatisfaction (each p < .001) but their introduction to the multivariate model did not attenuate the pattern of associations. Conclusions Morbidity and life dissatisfaction have a disease-specific and dose-dependent relationship. Even if women with mental and neurological disorders have the highest risk for life dissatisfaction, monitoring life satisfaction among aging women regardless of disorders should be undertaken in order to intervene the joint adverse effects of poor health and poor well-being. PMID:26799838

  8. [Morbidity in the ghettos during the Holocaust].

    PubMed

    Shasha, Shaul M

    2002-04-01

    The environmental conditions and daily life in the ghettos of Europe during the holocaust are reviewed, and their effect on morbidity in different ghettos is scrutinized in an attempt to construct a typical morbidity profile. The outstanding characteristics were: crowding, shortage of basic necessities (such as food, clothing and medications), harsh environmental and sanitary conditions, inclement weather, poor personal hygiene, chronic undernutrition and malnutrition, physical and mental exhaustion. Morbidity was mainly due to infectious diseases, both endemic and epidemic outbreaks with high mortality, and high infestation rates of lice and other parasites. The dominant feature was "hunger disease" with its protean clinical expressions, endocine pathology, growth and development retardation in children, and amenorrhea and infertility among women of child-bearing age. Polyuria, nocturia and increased frequency of bowel movement were common. The typical presentation of a ghetto dweller was of extreme emaciation (a loss of up to 50% body weight); muscle weakness and skeletal abnormalities; pale, dry skin with excoriations; pedal edema; anxiety and nervousness; often goiter in children. Most of the inhabitants had some, or all, of those signs and symptoms (there were times when more than half the population was sick). This syndrome complex was termed "Ghetto Sickness" or "Ghetto Fatigue" (ghetto schwachkeit).

  9. Bariatric Surgery for People with Diabetes and Morbid Obesity

    PubMed Central

    2009-01-01

    to bariatric surgery and the improvement of diabetes from the full evidence-based analysis of bariatric surgery for the treatment of morbid obesity completed by the Medical Advisory Secretariat (MAS) in January 2005. To view the full report, please visit the MAS website at: http://www.health.gov.on.ca/english/providers/program/mas/tech/techmn.html. Clinical Need: Condition and Target Population Obesity is defined as an excessive accumulation of body fat as measured by the body mass index (BMI) and calculated as body weight in kilograms (kg) divided by height in metres squared (m2). People with a BMI over 30 kg/m2 are considered obese in most countries. The condition is associated with the development of several diseases, including hypertension, diabetes mellitus (type 2 diabetes), hyperlipidemia, coronary artery disease, obstructive sleep apnea, depression, and cancers of the breast, uterus, prostate, and colon. Clinically severe, or morbid obesity, is commonly defined by a BMI of at least 40 kg/m2, or a BMI of at least 35 kg/m2 if there are comorbid conditions such as diabetes, cardiovascular disease, or arthritis. The prevalence of morbid obesity among people with type 2 diabetes has been examined and of 2,460 patients with type 2 diabetes, 52% (n = 1,279) were obese (BMI ≥ 30 kg/m2) and 23% (n = 561) had a BMI ≥ 35 kg/m2. Bariatric Surgery Men and women with morbid obesity may be eligible for surgical intervention. There are numerous surgical options available, all of which can be divided into two general types, both of which can be performed either as open surgery or laparoscopically: malabsorptive - bypassing parts of the gastrointestinal tract to limit the absorption of food, and restrictive - decreasing the size of the stomach in order for the patient to feel satiated with a smaller amount food Surgery for morbid obesity is usually considered a last resort for people who have attempted first-line medical management (e.g. diet, behaviour modification

  10. On-Chip Power-Combining for High-Power Schottky Diode Based Frequency Multipliers

    NASA Technical Reports Server (NTRS)

    Siles Perez, Jose Vicente (Inventor); Chattopadhyay, Goutam (Inventor); Lee, Choonsup (Inventor); Schlecht, Erich T. (Inventor); Jung-Kubiak, Cecile D. (Inventor); Mehdi, Imran (Inventor)

    2015-01-01

    A novel MMIC on-chip power-combined frequency multiplier device and a method of fabricating the same, comprising two or more multiplying structures integrated on a single chip, wherein each of the integrated multiplying structures are electrically identical and each of the multiplying structures include one input antenna (E-probe) for receiving an input signal in the millimeter-wave, submillimeter-wave or terahertz frequency range inputted on the chip, a stripline based input matching network electrically connecting the input antennas to two or more Schottky diodes in a balanced configuration, two or more Schottky diodes that are used as nonlinear semiconductor devices to generate harmonics out of the input signal and produce the multiplied output signal, stripline based output matching networks for transmitting the output signal from the Schottky diodes to an output antenna, and an output antenna (E-probe) for transmitting the output signal off the chip into the output waveguide transmission line.

  11. MANAGEMENT OF ENDOCRINE DISEASE: Morbidity in polycystic ovary syndrome.

    PubMed

    Glintborg, Dorte; Andersen, Marianne

    2017-02-01

    Polycystic ovary syndrome (PCOS) is the most prevalent endocrine condition in premenopausal women. The syndrome is characterized by hyperandrogenism, irregular menses and polycystic ovaries when other etiologies are excluded. Obesity, insulin resistance and low vitamin D levels are present in more than 50% patients with PCOS, these factors along with hyperandrogenism could have adverse effects on long-term health. Hyperinflammation and impaired epithelial function were reported to a larger extent in women with PCOS and could particularly be associated with hyperandrogenism, obesity and insulin resistance. Available data from register-based and data linkage studies support that metabolic-vascular and thyroid diseases, asthma, migraine, depression and cancer are diagnosed more frequently in PCOS, whereas fracture risk is decreased. Drug prescriptions are significantly more common in PCOS than controls within all diagnose categories including antibiotics. The causal relationship between PCOS and autoimmune disease represents an interesting new area of research. PCOS is a lifelong condition and long-term morbidity could be worsened by obesity, sedentary way of life, Western-style diet and smoking, whereas lifestyle intervention including weight loss may partly or fully resolve the symptoms of PCOS and could improve the long-term prognosis. In this review, the possible implications of increased morbidity for the clinical and biochemical evaluation of patients with PCOS at diagnosis and follow-up is further discussed along with possible modifying effects of medical treatment.

  12. Female patient with autistic disorder, intellectual disability, and co-morbid anxiety disorder: Expanding the phenotype associated with the recurrent 3q13.2-q13.31 microdeletion.

    PubMed

    Quintela, Ines; Gomez-Guerrero, Lorena; Fernandez-Prieto, Montse; Resches, Mariela; Barros, Francisco; Carracedo, Angel

    2015-12-01

    In recent years, the advent of comparative genomic hybridization (CGH) and single nucleotide polymorphism (SNP) arrays and its use as a first genetic test for the diagnosis of patients with neurodevelopmental phenotypes has allowed the identification of novel submicroscopic chromosomal abnormalities (namely, copy number variants or CNVs), imperceptible by conventional cytogenetic techniques. The 3q13.31 microdeletion syndrome (OMIM #615433) has been defined as a genomic disorder mainly characterized by developmental delay, postnatal overgrowth, hypotonia, genital abnormalities in males, and characteristic craniofacial features. Although the 3q13.31 CNVs are variable in size, a 3.4 Mb recurrently altered region at 3q13.2-q13.31 has been recently described and non-allelic homologous recombination (NAHR) mediated by flanking human endogenous retrovirus (HERV-H) elements has been suggested as the mechanism of deletion formation. We expand the phenotypic spectrum associated with this recurrent deletion performing the clinical description of a 9-year-old female patient with autistic disorder, total absence of language, intellectual disability, anxiety disorder and disruptive, and compulsive eating behaviors. The array-based molecular karyotyping allowed the identification of a de novo recurrent 3q13.2-q13.31 deletion encompassing 25 genes. In addition, we compare her clinical phenotype with previous reports of patients with neurodevelopmental and behavioral disorders and proximal 3q microdeletions. Finally, we also review the candidate genes proposed so far for these phenotypes.

  13. Effects of low-dose oral enoximone administration on mortality, morbidity, and exercise capacity in patients with advanced heart failure: the randomized, double-blind, placebo-controlled, parallel group ESSENTIAL trials

    PubMed Central

    Metra, Marco; Eichhorn, Eric; Abraham, William T.; Linseman, Jennifer; Böhm, Michael; Corbalan, Ramon; DeMets, David; De Marco, Teresa; Elkayam, Uri; Gerber, Michael; Komajda, Michel; Liu, Peter; Mareev, Vyacheslev; Perrone, Sergio V.; Poole-Wilson, Philip; Roecker, Ellen; Stewart, Jennifer; Swedberg, Karl; Tendera, Michal; Wiens, Brian; Bristow, Michael R.

    2009-01-01

    Aims Use of inotropic agents in patients with heart failure (HF) has been limited by adverse effects on outcomes. However, administration of positive inotropes at lower doses and concomitant treatment with beta-blockers might increase benefit–risk ratio. We investigated the effects of low doses of the positive inotrope enoximone on symptoms, exercise capacity, and major clinical outcomes in patients with advanced HF who were also treated with beta-blockers and other guideline-recommended background therapy. Methods and results The Studies of Oral Enoximone Therapy in Advanced HF (ESSENTIAL) programme consisted of two identical, randomized, double-blind, placebo-controlled trials that differed only by geographic location (North and South America: ESSENTIAL-I; Europe: ESSENTIAL-II). Patients with New York Heart Association class III–IV HF symptoms, left ventricular ejection fraction ≤30%, and one hospitalization or two ambulatory visits for worsening HF in the previous year were eligible for participation in the trials. The trials had three co-primary endpoints: (i) the composite of time to all-cause mortality or cardiovascular hospitalization, analysed in the two ESSENTIAL trials combined; (ii) the 6 month change from baseline in the 6 min walk test distance (6MWTD); and (iii) the Patient Global Assessment (PGA) at 6 months, both analysed in each trial separately. ESSENTIAL-I and -II randomized 1854 subjects at 211 sites in 16 countries. In the combined trials, all-cause mortality and the composite, first co-primary endpoint did not differ between the two treatment groups [hazard ratio (HR) 0.97; 95% confidence interval (CI) 0.80–1.17; and HR 0.98; 95% CI 0.86–1.12, respectively, for enoximone vs. placebo]. The two other co-primary endpoints were analysed separately in the two ESSENTIAL trials, as prospectively designed in the protocol. The 6MWTD increased with enoximone, compared with placebo, in ESSENTIAL-I (P = 0.025, not reaching, however, the pre

  14. Multiply-ionized Atoms at Low Energy for Precise Measurements

    NASA Astrophysics Data System (ADS)

    Fogwell Hoogerheide, Shannon; Tan, Joseph N.

    2014-05-01

    Recent work at NIST introduced a new system for the slowing, capture and manipulation of multiply-ionized atoms in a controlled environment suitable for precision measurements. As a demonstration of its potentials, we have measured the lifetimes of metastable states in krypton and argon (gases), and are now extending this technique to metals such as iron. Work is also underway on a table-top apparatus that incorporates a miniature electron-beam ion trap (EBIT) coupled to a cryo-cooled, compact Penning trap to enable spectroscopic studies of interest for atomic physics, astrophysics, and metrology. This apparatus will allow charge exchange between laser-excited Rydberg rubidium atoms and isolated bare nuclei, opening the way for precision spectroscopy of one-electron ions in Rydberg states using optical frequency comb technology. Earlier theoretical work at NIST has shown that such measurements would provide a new determination of the Rydberg constant that was independent of the proton radius. Such a measurement could help resolve the proton-radius puzzle. Additional applications could include the study of very-long-lived atomic states proposed for new atomic frequency standards or laboratory studies of potential time variation of the fine structure constant. SFH acknowledges funding through a National Research Council Reseach Associateship award.

  15. Development of Resistive Electrode Gas Electron Multiplier (RE-GEM)

    NASA Technical Reports Server (NTRS)

    Yoshikawa, A.; Tamagawa, T.; Iwahashi, T.; Asami, F.; Takeuchi, Y.; Hayato, A.; Hamagaki, H.; Gunji, T.; Akimoto, R.; Nukariya, A.; Hayashi, S.; Ueno, K.; Ochi, A.; Oliveria, R.

    2012-01-01

    We successfully produced Resistive-Electrode Gas Electron Multiplier (RE-GEM) which has resistive electrodes instead of the metal ones which are employed for the standard GEM foils. RE-GEM has a resistive electrode of 25 micron-thick and an insulator layer of 100 micron-thick. The hole structure of RE-GEM is a single conical with the wider and narrower hole diameters of 80 micron and 60 micron, respectively. A hole pitch of RE-GEM is 140 micron. We obtained the maximum gain of about 600 and the typical energy resolution of about 20% (FWHM) at an applied voltage between the resistive electrodes of 620 V, using a collimated 8 keV X-rays from a generator in a gas mixture of 70% Ar and 30% CO2 by volume at the atmospheric pressure. We measured the effective gain as a function of the electric field of the drift region and obtained the maximum gain at an drift field of 0.5 kV/cm.

  16. Alternating Direction Method of Multiplier for Tomography With Nonlocal Regularizers

    PubMed Central

    Dewaraja, Yuni K.; Fessler, Jeffrey A.

    2015-01-01

    The ordered subset expectation maximization (OSEM) algorithm approximates the gradient of a likelihood function using a subset of projections instead of using all projections so that fast image reconstruction is possible for emission and transmission tomography such as SPECT, PET, and CT. However, OSEM does not significantly accelerate reconstruction with computationally expensive regularizers such as patch-based nonlocal (NL) regularizers, because the regularizer gradient is evaluated for every subset. We propose to use variable splitting to separate the likelihood term and the regularizer term for penalized emission tomographic image reconstruction problem and to optimize it using the alternating direction method of multiplier (ADMM). We also propose a fast algorithm to optimize the ADMM parameter based on convergence rate analysis. This new scheme enables more sub-iterations related to the likelihood term. We evaluated our ADMM for 3-D SPECT image reconstruction with a patch-based NL regularizer that uses the Fair potential function. Our proposed ADMM improved the speed of convergence substantially compared to other existing methods such as gradient descent, EM, and OSEM using De Pierro’s approach, and the limited-memory Broyden–Fletcher–Goldfarb–Shanno algorithm. PMID:25291351

  17. Fabrication of an electron multiplier utilizing diamond films

    NASA Technical Reports Server (NTRS)

    Mearini, G. T.; Krainsky, I. L.; Wang, Y. X.; Dayton, JR., J. a.; Ramesham, R.; Rose, M. F.

    1994-01-01

    High secondary electron yields (sigma=14-27) from polycrystalline diamond films on Mo substrates have been reported previously. We observed that continuous exposure to an electron beam degraded the secondary yield in vacuum as a function of fluence owing to a loss of surface hydrogen. However, the hydrogen partial pressure could be adjusted such that the high secondary yield remained stable during beam exposure. We have constructed a prototype electron multiplier using these diamond films for use in ultrahigh vacuum. A gain of 0.9 times 10(exp 5) has been measured in a d.c. mode. Palladium, titanium and aluminum nitride have been studied for possible dynode substrate materials which might eliminate the need for hydrogen during operation. Total secondary yields as high as 50 were measured from diamond on palladium and sigma was stable at 25 during heating at 700 K in vacuum. Raman spectroscopy and scanning electron microscopy showed that variations in sigma from diamond films on Pd were due to differing concentrations of non-diamond carbon.

  18. THz frequency multiplier chains base on planar Schottky diodes

    NASA Technical Reports Server (NTRS)

    Maiwald, F.; Schlecht, E.; Maestrini, A.; Chattopadhyay, G.; Pearson, J.; Pukala, D.; Mehdi, I.

    2002-01-01

    The Herschel Space Observatory (HSO), an ESA cornerstone mission with NASA contribution, will enable a comprehensive study of the galactic as well as the extra galactic universe. At the heart of this exploration are ultra sensitive coherent detectors that can allow for high-resolution spectroscopy. Successful operation of these receivers is predicated on providing a sufficiently powerful local oscillator (LO) source. Historically, a versatile space qualified LO source for frequencies beyond 500 GHz has been difficult if not impossible. This paper will focus on the effort under way to develop, build, characterize and qualify a LO chain to 1200 GHz (Band 5 on HSO) that is based on planar GaAs diodes mounted in waveguide circuits. State-of-the-art performance has been obtained from a three-stage ( x2 x 2 x 3 ) multiplier chain that can provide a peak output power of 120 uW (1178 GHz) at room temperature and a peak output power of 190 uW at 1183 GHz when cooled to 113 K. Implementation of this LO source for the Heterodyne Instrument for Far Infrared (HIFI) on HSO will be discussed in detail.

  19. Suborbital Soft X-Ray Spectroscopy with Gaseous Electron Multipliers

    NASA Astrophysics Data System (ADS)

    Rogers, Thomas D.

    This thesis consists of the design, fabrication, and launch of a sounding rocket payload to observe the spectrum of the soft X-ray emission (0.1-1 keV) from the Cygnus Loop supernova remnant. This instrument, designated the Off-plane Grating Rocket for Extended Source Spectroscopy (OGRESS), was launched from White Sands Missile Range on May 2nd, 2015. The X-ray spectrograph incorporated a wire-grid focuser feeding an array of gratings in the extreme off-plane mount which dispersed the spectrum onto Gaseous Electron Multiplier (GEM) detectors. The gain characteristics of OGRESS's GEM detectors were fully characterized with respect to applied voltage and internal gas pressure, allowing operational settings to be optimized. The GEMs were optimized to operate below laboratory atmospheric pressure, allowing lower applied voltages, thus reducing the risk of both electrical arcing and tearing of the thin detector windows. The instrument recorded 388 seconds of data and found highly uniform count distributions over both detector faces, in sharp contrast to the expected thermal line spectrum. This signal is attributed to X-ray fluorescence lines generated inside the spectrograph. The radiation is produced when thermal ionospheric particles are accelerated into the interior walls of the spectrograph by the high voltages of the detector windows. A fluorescence model was found to fit the flight data better than modeled supernova spectra. Post-flight testing and analysis revealed that electrons produce distinct signal on the detectors which can also be successfully modeled as fluorescence emission.

  20. Measurement Of Gas Electron Multiplier (GEM) Detector Characteristics

    NASA Astrophysics Data System (ADS)

    Park, Seongtae; Baldelomar, Edwin; Park, Kwangjune; Sosebee, Mark; White, Andy; Yu, Jaehoon

    2011-06-01

    The High Energy Physics group of the University of Texas at Arlington has been developing gas electron multiplier detectors to use them as sensitive gap detectors in digital hadron calorimeters for the International Linear Collider, a future high energy particle accelerator. For this purpose, we constructed numerous GEM detectors that employ double GEM layers. In this study, two kinds of prototype GEM detectors were tested; one with 28×28 cm2 active area double GEM structure with a 3 mm drift gap, a 1 mm transfer gap and a 1 mm induction gap and the other with two 3×3 cm2 GEM foils in the amplifier stage with a 5 mm drift gap, a 2 mm transfer gap and a 1 mm induction gap. The detectors' characteristics from exposure to high-energy charged particles and other radiations were measured using cosmic rays and 55Fe radioactive source. From the 55Fe tests, we observed two well separated characteristic X-ray emission peaks and confirmed the detectors' functionality. We also measured chamber gains to be over 6000 at a high voltage of 395 V across each GEM electrode. The responses to cosmic rays show the spectra that fit well to Landau distributions as expected from minimum ionizing particles.

  1. Proximity effects in cold gases of multiply charged atoms (Review)

    NASA Astrophysics Data System (ADS)

    Chikina, I.; Shikin, V.

    2016-07-01

    Possible proximity effects in gases of cold, multiply charged atoms are discussed. Here we deal with rarefied gases with densities nd of multiply charged (Z ≫ 1) atoms at low temperatures in the well-known Thomas-Fermi (TF) approximation, which can be used to evaluate the statistical properties of single atoms. In order to retain the advantages of the TF formalism, which is successful for symmetric problems, the external boundary conditions accounting for the finiteness of the density of atoms (donors), nd ≠ 0, are also symmetrized (using a spherical Wigner-Seitz cell) and formulated in a standard way that conserves the total charge within the cell. The model shows that at zero temperature in a rarefied gas of multiply charged atoms there is an effective long-range interaction Eproxi(nd), the sign of which depends on the properties of the outer shells of individual atoms. The long-range character of the interaction Eproxi is evaluated by comparing it with the properties of the well-known London dispersive attraction ELond(nd) < 0, which is regarded as a long-range interaction in gases. For the noble gases argon, krypton, and xenon Eproxi>0 and for the alkali and alkaline-earth elements Eproxi < 0. At finite temperatures, TF statistics manifests a new, anomalously large proximity effect, which reflects the tendency of electrons localized at Coulomb centers to escape into the continuum spectrum. The properties of thermal decay are interesting in themselves as they determine the important phenomenon of dissociation of neutral complexes into charged fragments. This phenomenon appears consistently in the TF theory through the temperature dependence of the different versions of Eproxi. The anomaly in the thermal proximity effect shows up in the following way: for T ≠ 0 there is no equilibrium solution of TS statistics for single multiply charged atoms in a vacuum when the effect is present. Instability is suppressed in a Wigner-Seitz model under the assumption that

  2. Electron interactions with positively and negatively multiply charged biomolecular clusters

    NASA Astrophysics Data System (ADS)

    Feketeová, Linda

    2012-07-01

    Interactions of positively and negatively multiply charged biomolecular clusters with low-energy electrons, from ~ 0 up to 50 eV of electron energy, were investigated in a high resolution Fourier-Transform Ion Cyclotron Resonance mass spectrometer equipped with an electrospray ionisation source. Electron-induced dissociation reactions of these clusters depend on the energy of the electrons, the size and the charge state of the cluster. The positively charged clusters [Mn+2H]2+ of zwitterionic betaines, M = (CH3)2XCH2CO2 (X = NCH3 and S), do capture an electron in the low electron energy region (< 10 eV). At higher electron energies neutral evaporation from the cluster becomes competitive with Coulomb explosion. In addition, a series of singly charged fragments arise from bond cleavage reactions, including decarboxylation and CH3 group transfer, due to the access of electronic excited states of the precursor ions. These fragmentation reactions depend on the type of betaine (X = NCH3 or S). For the negative dianionic clusters of tryptophan [Trp9-2H]2-, the important channel at low electron energies is loss of a neutral. Coulomb explosion competes from 19.8 eV and dominates at high electron energies. A small amount of [Trp2-H-NH3]- is observed at 21.8 eV.

  3. [Very low calorie diets in clinical management of morbid obesity].

    PubMed

    Vilchez López, Francisco Javier; Campos Martín, Cristina; Amaya García, María José; Sánchez Vera, Pilar; Pereira Cunill, José Luis

    2013-01-01

    Morbid obesity and its complications are an increasingly prevalent problem. Very low calorie diets (VLCD), providing between 450 and 800 kcal per day, are an option increasingly used. After proper patient selection, VLCD can result in significant weight loss in 8-16 weeks, contributing to improve control of chronic complications such as diabetes, hypertension, dyslipidemia (except for initial elevation of HDL cholesterol) and apnea-hypopnea syndrome. VLDC are increasingly used prior to bariatric surgery, showing a decrease in hepatic steatosis and visceral abdominal fat. Although the results of the different studies are controversial, preoperative use of VLDC may decrease the rate of perioperative complications, operative time and hospital length of stay. a drastic decrease in intake occurs after bariatric surgery, with risk of protein deficiency, which should be frequently corrected with supplementation by protein modules. Side effects such as cholelithiasis, hyperuricemia and bone loss among others should be monitored in patients undergoing this type of diet.

  4. Envenoming by European vipers antivenom treatment--influence on morbidity.

    PubMed

    Persson, H

    2001-01-01

    The incidence of venomous viper bites in Europe is difficult to assess. Mortality after bites by European vipers is nowadays low, but morbidity is by no means negligible. Serious and life-threatening reactions occur, especially in small children and elderly people. The critically ill can nowadays be managed with symptomatic and supportive care in an astonishing way, but antivenom treatment may reduce the extent of such treatment and also reduced the overall risk for the patient. In particular, the only way to prevent extensive swelling and related complications is to give antivenom. The aim of this study was to test efficacy and safety of ovine Fab (a new specific ovine Fab fragments against various snake venoms) as an alternative to equine F(ab)2 antibodies in patients presenting with moderate and severe envenoming.

  5. Vincristine-associated neurological morbidity in the treatment of hepatoblastoma.

    PubMed

    Lombardi, Anne J; Sutton, Mary E; Tiao, Gregory M; Geller, James I

    2015-05-01

    Chemotherapy is an essential component of therapy for infants and children with hepatoblastoma. Vincristine has been a mainstay of chemotherapeutic regimens used by North American cooperative groups, based on indirect evidence of benefit and an assumption of minimal added toxicity. European cooperative group trials have reported comparable survival rates using regimens that omit vincristine. Further examination of the risk and benefit profile of vincristine relevant to hepatoblastoma clinical care paradigms is thus warranted. We evaluated the incidence of vincristine-related sensorimotor peripheral, autonomic, and cranial nerve neurological morbidities in 45 consecutive hepatoblastoma patients treated at our institution. Data suggest an increased risk of vincristine-associated neuropathic grade 2 and 3 events (neuropathic pain and gross motor impairment) in children ages 24 months old or younger, and particularly in children born prematurely. Formal prospective investigation of the relative risks and benefits of vincristine in hepatoblastoma treatment is warranted to assess the value of continued use of vincristine in this patient population.

  6. [Wernicke encephalopathy after subtotal gastrectomy for morbid obesity].

    PubMed

    Gabaudan, C; La-Folie, T; Sagui, E; Soulier, B; Dion, A-M; Richez, P; Brosset, C

    2008-05-01

    Wernicke's encephalopathy (WE) is one of the potential complications of obesity surgery. It is an acute neuropsychiatric syndrome resulting from thiamine deficiency often associated with repeated vomiting. The classic triad is frequently reported in these patients (optic neuropathy, ataxia and confusion), associated with uncommon features. Cerebral impairment affects the dorsal medial nucleus of the thalamus and the periaqueductal grey area, appearing on MRI, as hyperintense signals on T2, Flair and Diffusion weighted imaging. Early diagnosis and parenteral thiamine are required to decrease morbidity and mortality. We report a case of WE and Korsakoff's syndrome in a young obese patient after subtotal gastrectomy, who still has substantial sequelae. The contribution of MRI with diffusion-weighted imaging is illustrated. The interest of nutritional supervision in the first weeks and preventive thiamine supplementation in case of repeated vomiting are of particular importance in these risky situations.

  7. Socioeconomic factors, morbidity and drug utilization--an ecological study.

    PubMed

    Henricson, K; Stenberg, P; Rametsteiner, G; Ranstam, J; Hanson, B S; Melander, A

    1998-07-01

    The aim of the present study was to elucidate the relations between demographic and socioeconomic factors, morbidity and the utilization of major drug groups in an urban Swedish population. The study was performed as an ecological analysis during November 1991 in the 17 different districts of Malmö, the third largest Swedish city (235,000 inhabitants). The material comprised 86,228 ACT-coded drug items which corresponded to 76% of all prescriptions dispensed during the study month. Of these, 43,032, dispensed to patients aged 15-64 years, were analysed in the present work. Age standardized drug utilization was expressed as the number of dispensed Defined Daily Doses per 1000 inhabitants per day. Morbidity was measured in terms of reimbursed days on sick leave. The sociodemographic parameters used were socioeconomic status (SES), employment rate, median income per family, households on social allowance, and ethnicity. For four of the five major pharmacological groups (ATC-groups A, C, J, N and R, i.e. alimentation, circulation, infectious diseases, nervous system and respiration), most pronouncedly group N and least so group R, utilization correlated positively with not only the extent of morbidity but also with an unfavourable socioeconomic situation, high proportion of immigrants, and households on social allowance or with low income and/or with a low employment rate. The utilization of antibiotics (group J), however, instead correlated negatively with these parameters. For all five drug groups, these trends were similar among men and women, albeit with varying strength. In conclusion, socioeconomic factors may have a profound influence on the utilization of several major drug groups. At least in the case of antibiotics, the consequence of this influence is irrational drug use.

  8. [Multiple pregnancies. Neonatal morbidity and mortality].

    PubMed

    Lenclen, R; Chassevent, J; Blanc, P; Hoenn, E; Olivier-Martin, M; Paupe, A; Philippe, H J

    1991-10-01

    The increase in the number of multiple pregnancies and the high incidence of prematurity in this type of pregnancy justifies a pediatric evaluation. A retrospective study (1985-1989) compared the perinatal and neonatal characteristics of children resulting from 14 multifetal (at least 3 fetuses) pregnancies, with a gestational age of less than 34 weeks, with 27 children resulting from monofetal pregnancies of the same duration. Neonatal morbidity and mortality appeared to be similar in both groups. Thus at this very early time of onset of labour (mean gestational age of 30 weeks), fetal multiplicity expressed itself neither by any particular neonatal pathology nor by malnutrition.

  9. Expansion of capabilities of the short-duration wind tunnel with an opposing pressure multiplier

    NASA Astrophysics Data System (ADS)

    Shumskii, V. V.; Yaroslavtsev, M. I.

    2016-11-01

    A method for raising the maximum settling-chamber pressure in a short-duration wind tunnel equipped with pressure multipliers arranged in opposition to each other for stabilization of test gas parameters is proposed. For this purpose, a wind-tunnel design with an additional third pressure multiplier attached to the body of the second pressure multiplier was developed. The rod of the additional multiplier contacts the large-area piston stage of the second multiplier, and the pre-piston space being connected to the receiver. The inclusion of an additional pressure multiplier in the wind-tunnel design at the maximum attainable driver-gas pressure of 150-170 bar, defined by the standard industrial pressure of air used for filling wind-tunnel receivers with the driver gas, allows a two-fold increase in the maximum settling-chamber pressure, from 1100 to 2000-2200 bar. For raising the maximum settling-chamber pressure above 2000-2200 bar, the use of one additional pressure multiplier proved to be insufficient because, in the latter case, its becomes necessary to simultaneously raise the driver-gas pressure over 150-170 bar.

  10. The Origins of the SPAR-H Method's Performance Shaping Factor Multipliers

    SciTech Connect

    Ronald L. Boring; Harold S. Blackman

    2007-08-01

    The Standardized Plant Analysis Risk-Human Reliability Analysis (SPAR-H) method has proved to be a reliable, easy-to-use method for human reliability analysis. Calculation of human error probability (HEP) rates is especially straightforward, starting with pre-defined nominal error rates for cognitive vs. action oriented tasks, and incorporating performance shaping factor (PSF) multipliers upon those nominal error rates. SPAR-H uses eight PSFs with multipliers typically corresponding to nominal, degraded, and severely degraded human performance for individual PSFs. Additionally, some PSFs feature multipliers to reflect enhanced performance. Although SPAR-H enjoys widespread use among industry and regulators, current source documents on SPAR-H such as NUREG/CR-6883 do not provide a clear account of the origin of these multipliers. The present paper redresses this shortcoming and documents the historic development of the SPAR-H PSF multipliers, from the initial use of nominal error rates, to the selection of the eight PSFs, to the mapping of multipliers to available data sources such as a Technique for Human Error Rate Prediction (THERP). Where error rates were not readily derived from THERP and other sources, expert judgment was used to extrapolate appropriate values. In documenting key background information on the multipliers, this paper provides a much needed cross-reference for human reliability practitioners and researchers of SPAR-H to validate analyses and research findings.

  11. Configurable multiplier modules for an adaptive computing system

    NASA Astrophysics Data System (ADS)

    Pfänder, O. A.; Pfleiderer, H.-J.; Lachowicz, S. W.

    2006-09-01

    The importance of reconfigurable hardware is increasing steadily. For example, the primary approach of using adaptive systems based on programmable gate arrays and configurable routing resources has gone mainstream and high-performance programmable logic devices are rivaling traditional application-specific hardwired integrated circuits. Also, the idea of moving from the 2-D domain into a 3-D design which stacks several active layers above each other is gaining momentum in research and industry, to cope with the demand for smaller devices with a higher scale of integration. However, optimized arithmetic blocks in course-grain reconfigurable arrays as well as field-programmable architectures still play an important role. In countless digital systems and signal processing applications, the multiplication is one of the critical challenges, where in many cases a trade-off between area usage and data throughput has to be made. But the a priori choice of word-length and number representation can also be replaced by a dynamic choice at run-time, in order to improve flexibility, area efficiency and the level of parallelism in computation. In this contribution, we look at an adaptive computing system called 3-D-SoftChip to point out what parameters are crucial to implement flexible multiplier blocks into optimized elements for accelerated processing. The 3-D-SoftChip architecture uses a novel approach to 3-dimensional integration based on flip-chip bonding with indium bumps. The modular construction, the introduction of interfaces to realize the exchange of intermediate data, and the reconfigurable sign handling approach will be explained, as well as a beneficial way to handle and distribute the numerous required control signals.

  12. Prevalence of asymptomatic urinary tract infections in morbidly obese dogs

    PubMed Central

    Witzel, Angela L.; Bartges, Joseph W.; Moyers, Tamberlyn S.; Kirk, Claudia A.

    2016-01-01

    Background. Obesity has reached epidemic proportions in dogs and, as in humans, cost of care has increased due to associated comorbidities. In humans, asymptomatic urinary tract infections (UTI) may be more prevalent in the obese. Asymptomatic bacteriuria (AB) is the term used when UTI are asymptomatic. We hypothesized that morbidly obese dogs are similarly more likely to have asymptomatic bacteriuria than lean, overweight, and moderately obese dogs. Methods. A retrospective study was undertaken to explore a possible association between obesity and asymptomatic bacteriuria. Records from lean, overweight, and obese dogs receiving both a dual energy absorptiometry (DXA) scan and urine culture were included. Results. Six positive urine cultures were identified among 46 dogs fulfilling search criteria. All six positive cultures were found in dogs with body fat percentage of >45%. In dogs with body fat percentage of <45%, there were no positive urine cultures. Discussion. There was an increased prevalence of asymptomatic bacteriuria in the morbidly obese dogs in this study compared to those that were lean, overweight, or moderately obese. Whether antibiotic therapy is necessary in such cases is still being debated, but because asymptomatic bacteriuria may be associated with ascending infections, uroliths, or other complications, the data reported herein support the screening of obese patients for bacteriuria. PMID:26989606

  13. Computation of Floquet Multipliers Using an Iterative Method for Variational Equations

    NASA Astrophysics Data System (ADS)

    Nureki, Yu; Murashige, Sunao

    This paper proposes a new method to numerically obtain Floquet multipliers which characterize stability of periodic orbits of ordinary differential equations. For sufficiently smooth periodic orbits, we can compute Floquet multipliers using some standard numerical methods with enough accuracy. However, it has been reported that these methods may produce incorrect results under some conditions. In this work, we propose a new iterative method to compute Floquet multipliers using eigenvectors of matrix solutions of the variational equations. Numerical examples show effectiveness of the proposed method.

  14. Does BMI influence hospital stay and morbidity after fast-track hip and knee arthroplasty?

    PubMed

    Husted, Henrik; Jørgensen, Christoffer C; Gromov, Kirill; Kehlet, Henrik

    2016-10-01

    Background and purpose - Body mass index (BMI) outside the normal range possibly affects the perioperative morbidity and mortality following total hip arthroplasty (THA) and total knee arthroplasty (TKA) in traditional care programs. We determined perioperative morbidity and mortality in such patients who were operated with the fast-track methodology and compared the levels with those in patients with normal BMI. Patients and methods - This was a prospective observational study involving 13,730 procedures (7,194 THA and 6,536 TKA operations) performed in a standardized fast-track setting. Complete 90-day follow-up was achieved using national registries and review of medical records. Patients were grouped according to BMI as being underweight, of normal weight, overweight, obese, very obese, and morbidly obese. Results - Median length of stay (LOS) was 2 (IQR: 2-3) days in all BMI groups. 30-day re-admission rates were around 6% for both THA (6.1%) and TKA (5.9%), without any statistically significant differences between BMI groups in univariate analysis (p > 0.4), but there was a trend of a protective effect of overweight for both THA (p = 0.1) and TKA (p = 0.06). 90-day re-admission rates increased to 8.6% for THA and 8.3% for TKA, which was similar among BMI groups, but there was a trend of lower rates in overweight and obese TKA patients (p = 0.08 and p = 0.06, respectively). When we adjusted for preoperative comorbidity, high BMI in THA patients (very obese and morbidly obese patients only) was associated with a LOS of >4 days (p = 0.001), but not with re-admission. No such relationship existed for TKA. Interpretation - A fast-track setting resulted in similar length of hospital stay and re-admission rates regardless of BMI, except for very obese and morbidly obese THA patients.

  15. [Functional status, morbidity, and mortality of centenarians].

    PubMed

    Arai, Yasumichi; Hirose, Nobuyoshi

    2013-01-01

    Prevention or postponement of age-related diseases and functional limitation is the key component of successful aging. We studied centenarians, a model for successful aging in terms of functional status and morbidities. Vast majority of centenarians had chronic disease such as hypertension (63.6%) , heart disease (28.8%) , stroke (15.9%) , fragile fracture (46.4%) , and few centenarians were free from any chronic diseases. Male centenarians had better physical function than female counterparts. Stroke and fragile fracture had negative impacts on their functional status, but hypertension was paradoxically associated with better physical function. When we looked at mortality beyond 100 years of age, physical function, but not morbidity profile had significant impact on their mortality. These results raised a notion that age-related frailty or diminution of functional reserve may be the major cause both for physical disability and poor prognosis of centenarians. Previous results from our study suggested that stability of energy homeostasis, in which neuroendocrine system has a key role, may be important to maintain physical function at the extreme old age.

  16. Morbidity markers for Schistosoma haematobium infection.

    PubMed

    Vennervald, B J; Reimert, C M; Ouma, J H; Kilama, W L; Deelder, A M; Hatz, C

    1994-01-01

    A description is given of a field study design, including pretreatment and short and long-term posttreatment measurements, which is conducted as a case-control study among school children in Kaloleni District, Kenya, and Kilosa District, Tanzania, including 500 school children from each endemic setting. The aim of the study is to evaluate eosinophil cationic protein (ECP) in urine as a marker for Schistosoma haematobium morbidity by comparing levels of ECP in urine with S. haematobium egg counts in urine, level of excreted S. haematobium egg antigen in urine, microhaematuria and urinary tract pathology assessed by ultrasonography. Initial results have been promising and are now subject to an extensive evaluation. Strong training components and transfer of technology are included in the project, thus contributing to the strengthening of the research capacity of the collaborating African institutions. Simple non-invasive assays for ECP and excreted S. haematobium egg antigen could provide new tools for evaluation of chemotherapy effects and morbidity in urinary schistosomiasis, helping to understand the dynamic process of posttreatment resolution and reappearance of pathological changes.

  17. Travel health preparation and travel-related morbidity of splenectomised individuals.

    PubMed

    Boeddha, Christien; de Graaf, Wilmar; Overbosch, David; van Genderen, Perry J J

    2012-07-01

    Asplenic or hyposplenic patients are at an increased risk of encapsulated bacterial and intraerythrocytic parasitic infections, which are endemic at many travel destinations. With proper travel health advice and preparation splenectomised individuals could have comparable travel-related morbidity as healthy control subjects. We conducted a prospective case-control study with 21 travel pairs. Each pair consisted of a splenectomised patient (case) and a healthy, non-splenectomised travel companion (control) in order to match for travel destination, duration and potential exposures to travel-related health risks. All participants filled out a questionnaire detailing travel health preparation including vaccination and malaria prophylaxis as well as travel-related morbidity. Cases and controls were comparable for age and gender. Cases received significantly more information about on demand use of antibiotics in case of fever. Immunisation coverage against encapsulated bacteria and adherence to malaria prophylaxis guidelines was suboptimal. There were no significant differences in the occurrence of travel-related ailments nor differences in severity of ailments. The immunisation coverage against encapsulated bacteria and adherence to malaria prophylaxis guidelines was suboptimal in some splenectomised patients and should be improved. Strict adherence to national travel health advice guidelines and specific guidelines for asplenic patients is advisable. However, with regard to travel-related morbidity there are no significant differences in morbidity between splenectomised patients and healthy controls, at least in the setting of short-term travel.

  18. Laparoscopic Sleeve Gastrectomy and Crural Repair as a Treatment of Morbid Obesity Associated with Gastroesophageal Reflux

    PubMed Central

    Attia, Sameh Gabr

    2017-01-01

    Objective The aim of this study was to evaluate the Laparoscopic Sleeve Gastrectomy (LSG) with simultaneous crural repair in treatment of morbid obesity associated with gastroesophageal reflux disease. Methods This prospective observational study was carried out from September 2012 to July 2016 in Al-Azhar University Hospital (Egypt). The study was conducted on 53 patients, 14 males (26.4%) and 39 females (73.6%) with the mean age 36.2 years (range 18–52 years), presenting with morbid obesity and reflux disease either symptomatic patients or asymptomatic (Endoscopic & Manometric), their mean Body Mass Index (BMI) was 50.1 kg/m2 (range 40–62 kg/m2), who underwent LSG and antireflux procedure (crural repair). Results Excess weight Loss (EWL); the mean EWL at 6 months postoperatively was 46.3%, at 12 months was 54%, and at 18 months was 61%. Also, we found that, preoperative co-morbidities are resolved by 53% and improved by 23%. Reflux symptoms were absent in 30 patients (56 %), improved in 14 patients (26.4 %), but persistent in 7 patients (13.2 %). Conclusion Laparoscopic crural closure, during LSG, represents a valuable option for the treatment of morbid obesity and gastroesophageal reflux, and can result in favorable outcomes in terms of weight loss and gastroesophageal reflux disease (GERD) symptoms control. PMID:28243403

  19. Dual angiotensin receptor and neprilysin inhibition as an alternative to angiotensin-converting enzyme inhibition in patients with chronic systolic heart failure: rationale for and design of the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure trial (PARADIGM-HF)

    PubMed Central

    McMurray, John J. V.; Packer, Milton; Desai, Akshay S.; Gong, Jim; Lefkowitz, Martin P.; Rizkala, Adel R.; Rouleau, Jean; Shi, Victor C.; Solomon, Scott D.; Swedberg, Karl; Zile, Michael R.

    2013-01-01

    Aims Although the focus of therapeutic intervention has been on neurohormonal pathways thought to be harmful in heart failure (HF), such as the renin–angiotensin–aldosterone system (RAAS), potentially beneficial counter-regulatory systems are also active in HF. These promote vasodilatation and natriuresis, inhibit abnormal growth, suppress the RAAS and sympathetic nervous system, and augment parasympathetic activity. The best understood of these mediators are the natriuretic peptides which are metabolized by the enzyme neprilysin. LCZ696 belongs to a new class of drugs, the angiotensin receptor neprilysin inhibitors (ARNIs), which both block the RAAS and augment natriuretic peptides. Methods Patients with chronic HF, NYHA class II–IV symptoms, an elevated plasma BNP or NT-proBNP level, and an LVEF of ≤40% were enrolled in the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortailty and morbidity in Heart Failure trial (PARADIGM-HF). Patients entered a single-blind enalapril run-in period (titrated to 10 mg b.i.d.), followed by an LCZ696 run-in period (100 mg titrated to 200 mg b.i.d.). A total of 8436 patients tolerating both periods were randomized 1:1 to either enalapril 10 mg b.i.d. or LCZ696 200 mg b.i.d. The primary outcome is the composite of cardiovascular death or HF hospitalization, although the trial is powered to detect a 15% relative risk reduction in cardiovascular death. Perspectives PARADIGM-HF will determine the place of the ARNI LCZ696 as an alternative to enalapril in patients with systolic HF. PARADIGM-HF may change our approach to neurohormonal modulation in HF. Trial registration NCT01035255 PMID:23563576

  20. Evaluation of a Transitional Training Program for Mentally Retarded, Multiply Handicapped High School Students.

    ERIC Educational Resources Information Center

    O'Brien, Patrick J.; Schiller, William J.

    1979-01-01

    A comparative study was made of 18 mentally retarded, multiply handicapped high school students who attended a work study program and 12 students who were traditionally serviced in the academic program. (CL)

  1. Design of Pipeline Multiplier Based on Modified Booth's Algorithm and Wallace Tree

    NASA Astrophysics Data System (ADS)

    Yao, Aihong; Li, Ling; Sun, Mengzhe

    A design of 32*32 bit pipelined multiplier is presented in this paper. The proposed multiplier is based on the modified booth algorithm and Wallace tree structure. In order to improve the throughput rate of the multiplier, pipeline architecture is introduced to the Wallace tree. Carry Select Adder is deployed to reduce the propagation delay of carry signal for the final level 64-bit adder. The multiplier is fully implemented with Verilog HDL and synthesized successfully with Quartus II. The experiment result shows that the resource consumption and power consumption is reduced to 2560LE and 120mW, the operating frequency is improved from 136.21MHz to 165.07MHz.

  2. Morbid obesity treated by gastroplasty: radionuclide gastric emptying studies

    SciTech Connect

    Arnstein, N.B.; Shapiro, B.; Eckhauser, F.E.; Dmuchowski, C.F.; Knol, J.A.; Strodel, W.E.; Nakajo, M.; Swanson, D.P.

    1985-08-01

    Mechanisms by which gastroplasty for morbid obesity causes weight loss are poorly understood. The authors studied the role of altered gastric emptying in 50 patients before surgery, 1-4 weeks after surgery, and 2-24 months after surgery using technetium-99m pentetate in water for liquid meals and a Tc-99m styrene divinylbenzene copolymer resin in oatmeal for semisolid meals. They determined the emptying half-times of the stomach before and after surgery in the proximal and distal compartments. The proximal compartment emptied promptly in the early and late postoperative periods. The distal compartment emptied liquid at rates similar to those before surgery, while the late postoperative emptying of semisolids was significantly faster. No correlation was seen between the emptying half-times or changes thereof and eventual weight loss. Delayed gastric emptying is therefore not the mechanism for satiety and weight loss after gastroplasty has been performed.

  3. Rural Residents' Perspectives on Multiple Morbidity Management and Disease Prevention.

    PubMed

    Bardach, Shoshana H; Schoenberg, Nancy E; Tarasenko, Yelena N; Fleming, Steven T

    2011-12-01

    Middle-aged and older adults often experience several simultaneously occurring chronic conditions or "multiple morbidity" (MM). The task of both managing MM and preventing chronic conditions can be overwhelming, particularly in populations with high disease burdens, low socioeconomic status, and health care provider shortages. This article sought to understand Appalachian residents' perspectives on MM management and prevention. Forty-one rural Appalachian residents aged 50 and above with MM were interviewed about disease management and colorectal cancer (CRC) prevention. Transcripts were examined for overall analytic categories and coded using techniques to enhance transferability and rigor. Participants indicate facing various challenges to prevention due, in part, to conditions within their rural environment. Patients and providers spend significant time and energy on MM management, often precluding prevention activities. This article discusses implications of MM management for CRC prevention and strategies to increase disease prevention among this rural, vulnerable population burdened by MM.

  4. Cost-efficient design of a quantum multiplier-accumulator unit

    NASA Astrophysics Data System (ADS)

    Babu, Hafiz Md. Hasan

    2017-01-01

    This paper proposes a cost-efficient quantum multiplier-accumulator unit. The paper also presents a fast multiplication algorithm and designs a novel quantum multiplier device based on the proposed algorithm with the optimum time complexity as multiplier is the major device of a multiplier-accumulator unit. We show that the proposed multiplication technique has time complexity O((3 log2n)+1), whereas the best known existing technique has O(n log2 n), where n is the number of qubits. In addition, our design proposes three new quantum circuits: a circuit representing a quantum full-adder, a circuit known as quantum ANDing circuit, which performs the ANDing operation and a circuit presenting quantum accumulator. Moreover, the proposed quantum multiplier-accumulator unit is the first ever quantum multiplier-accumulator circuit in the literature till now, which has reduced garbage outputs and ancillary inputs to a great extent. The comparative study shows that the proposed quantum multiplier performs better than the existing multipliers in terms of depth, quantum gates, delays, area and power with the increasing number of qubits. Moreover, we design the proposed quantum multiplier-accumulator unit, which performs better than the existing ones in terms of hardware and delay complexities, e.g., the proposed (n× n)—qubit quantum multiplier-accumulator unit requires O(n2) hardware and O(log2n) delay complexities, whereas the best known existing quantum multiplier-accumulator unit requires O(n3) hardware and O((n-1)2 +1+n) delay complexities. In addition, the proposed design achieves an improvement of 13.04, 60.08 and 27.2% for 4× 4, 7.87, 51.8 and 27.1% for 8× 8, 4.24, 52.14 and 27% for 16× 16, 2.19, 52.15 and 27.26% for 32 × 32 and 0.78, 52.18 and 27.28% for 128 × 128-qubit multiplications over the best known existing approach in terms of number of quantum gates, ancillary inputs and garbage outputs, respectively. Moreover, on average, the proposed design gains an

  5. Doubles counting of highly multiplying items in reflective surroundings

    SciTech Connect

    Croft, Stephen; Evans, Louise G; Schear, Melissa A; Tobin, Stephen J

    2010-11-18

    When a neutrons are counted from a spontaneously fissile multiplying item in a reflecting environment the temporal behavior of the correlated signal following neutron birth is complex. At early times the signal is dominated by prompt fission events coming from spontaneous fission bursts and also from prompt fast-neutron induced fission events. At later times neutrons 'returning' from the surroundings induce fission and give rise to an additional chain of correlated events. The prompt and returning components probe the fissile and fertile constituents of the item in different ways and it is potentially beneficial to exploit this fact. In this work we look at how the two components can be represented using a linear combination of two simple functions. Fitting of the composite function to the capture time distribution represents one way of quantifying the proportion of each contribution. Another approach however is to use a dual shift register analysis where after each triggering event two coincidence gates are opened, one close to the trigger that responds preferentially to the prompt dynamics and one later in time which is more sensitive to the returning neutron induced events. To decide on the best gate positions and gate widths and also to estimate the counting precision we can use the analytical fit to work out the necessary gate utilization factors which are required in both these calculations. In this work, we develop the approach. Illustrative examples are given using spent Low Enriched Uranium (LEU) Pressurized light Water Reactor (LWR) fuel assemblies submersed in borated water and counted in a ring of {sup 3}He gas-filled proportional counters. In this case the prompt component is dominated by {sup 244}Cm spontaneous fission and induced fast neutron fission in for example {sup 238}U while the returning low energy neutrons induce fission mainly in the fissile nuclides such as {sup 239}Pu, {sup 241}Pu and {sup 235}U. One requirement is to calculate the Random

  6. Diagnosis trajectories of prior multi-morbidity predict sepsis mortality

    PubMed Central

    Beck, Mette K.; Jensen, Anders Boeck; Nielsen, Annelaura Bach; Perner, Anders; Moseley, Pope L.; Brunak, Søren

    2016-01-01

    Sepsis affects millions of people every year, many of whom will die. In contrast to current survival prediction models for sepsis patients that primarily are based on data from within-admission clinical measurements (e.g. vital parameters and blood values), we aim for using the full disease history to predict sepsis mortality. We benefit from data in electronic medical records covering all hospital encounters in Denmark from 1996 to 2014. This data set included 6.6 million patients of whom almost 120,000 were diagnosed with the ICD-10 code: A41 ‘Other sepsis’. Interestingly, patients following recurrent trajectories of time-ordered co-morbidities had significantly increased sepsis mortality compared to those who did not follow a trajectory. We identified trajectories which significantly altered sepsis mortality, and found three major starting points in a combined temporal sepsis network: Alcohol abuse, Diabetes and Cardio-vascular diagnoses. Many cancers also increased sepsis mortality. Using the trajectory based stratification model we explain contradictory reports in relation to diabetes that recently have appeared in the literature. Finally, we compared the predictive power using 18.5 years of disease history to scoring based on within-admission clinical measurements emphasizing the value of long term data in novel patient scores that combine the two types of data. PMID:27812043

  7. Productivity cost calculations in health economic evaluations: correcting for compensation mechanisms and multiplier effects.

    PubMed

    Krol, Marieke; Brouwer, Werner B F; Severens, Johan L; Kaper, Janneke; Evers, Silvia M A A

    2012-12-01

    Productivity costs related to paid work are commonly calculated in economic evaluations of health technologies by multiplying the relevant number of work days lost with a wage rate estimate. It has been argued that actual productivity costs may either be lower or higher than current estimates due to compensation mechanisms and/or multiplier effects (related to team dependency and problems with finding good substitutes in cases of absenteeism). Empirical evidence on such mechanisms and their impact on productivity costs is scarce, however. This study aims to increase knowledge on how diminished productivity is compensated within firms. Moreover, it aims to explore how compensation and multiplier effects potentially affect productivity cost estimates. Absenteeism and compensation mechanisms were measured in a randomized trial among Dutch citizens examining the cost-effectiveness of reimbursement for smoking cessation treatment. Multiplier effects were extracted from published literature. Productivity costs were calculated applying the Friction Cost Approach. Regular estimates were subsequently adjusted for (i) compensation during regular working hours, (ii) job dependent multipliers and (iii) both compensation and multiplier effects. A total of 187 respondents included in the trial were useful for inclusion in this study, based on being in paid employment, having experienced absenteeism in the preceding six months and completing the questionnaire on absenteeism and compensation mechanisms. Over half of these respondents stated that their absenteeism was compensated during normal working hours by themselves or colleagues. Only counting productivity costs not compensated in regular working hours reduced the traditional estimate by 57%. Correcting for multiplier effects increased regular estimates by a quarter. Combining both impacts decreased traditional estimates by 29%. To conclude, large amounts of lost production are compensated in normal hours. Productivity costs

  8. Smoking and the compression of morbidity

    PubMed Central

    Nusselder, W; Looman, C; de Mheen, P J M.-v.; van de Mheen, H; Mackenbach, J

    2000-01-01

    OBJECTIVE—To examine whether eliminating smoking will lead to a reduction in the number of years lived with disability (that is, absolute compression of morbidity).
DESIGN—Multistate life table calculations based on the longitudinal GLOBE study (the Netherlands) combined with the Longitudinal Study of Aging (LSOA, United States of America).
SETTING—the Netherlands.
SUBJECTS—Dutch nationals aged 30-74 years living in the city of Eindhoven and surrounding municipalities (GLOBE) and United States citizens age 70 and over (LSOA).
MAIN OUTCOME MEASURES—Life expectancy with and without disability and total life expectancy at ages 30 and 70.
RESULTS—A non-smoking population on balance spends fewer years with disability than a mixed smoking-non-smoking population. Although non-smokers have lower mortality risks and thus are exposed to disability over a longer period of time, their lower incidence of disability and higher recovery from disability yield a net reduction of the length of time spent with disability (at age 30: −0.9 years in men and −1.1 years in women) and increases the length of time lived without disability (2.5 and 1.9 years, for men and women, respectively). These outcomes indicate that elimination of smoking will extend life and the period of disability free life, and will compress disability into a shorter period.
CONCLUSIONS—Eliminating smoking will not only extend life and result in an increase in the number of years lived without disability, but will also compress disability into a shorter period. This implies that the commonly found trade off between longer life and a longer period with disability does not apply. Interventions to discourage smoking should receive high priority.


Keywords: smoking; morbidity PMID:10890867

  9. Cancer mortality and morbidity among rubber workers.

    PubMed

    Monson, R R; Fine, L J

    1978-10-01

    Mortality and morbidity from cancer among a cohort of 13,570 white male rubber workers were examined. Each man worked for at least 5 years at the Akron, Ohio, plant of the B. F. Goodrich Company. The potential period of follow-up was from January 1, 1940 to June 30, 1976. Departmental work histories were based primarily on records maintained by Local no. 5, United Rubber Workers. The occurrence of cancer was measured by death certificates and by a survey of Akron-area hospital tumor registries from 1964 to 1974. Two types of analyses were made: 1) an external comparison of mortality rates of rubber workers versus rates of U.S. white males, and 2) an internal comparison of cancer morbidity rates among persons who were employed in various work areas of the plant. Excess cases of specific cancers (observed/expected numbers) among workers in specific work areas included: stomach and intestine: rubber making (30/14.4); lung: tire curing (31/14.1), fuel cells and/or deicers (46/29.1); bladder: chemical plant (6/2.4), and tire building (16/10.7); skin cancer: tire assembly (12/1.9); brain cancer: tire assembly (8/2.0); lymphatic cancer: tire building (8/3.2); and leukemia: calendering (8/2.2), tire curing (8/2.6), tire building (12/7.5), elevators (4/1.4), tubes (4/1.6), and rubber fabrics (4/1.1). Agents that may be responsible for these excesses were considered.

  10. Multiply-primed rolling circle amplification of human papillomavirus using sequence-specific primers.

    PubMed

    Marincevic-Zuniga, Yanara; Gustavsson, Inger; Gyllensten, Ulf

    2012-10-10

    Multiply-primed rolling circle amplification (RCA) is a suitable technique for amplification of circular templates and has been used to identify novel human papillomaviruses (HPV). In this study we develop an efficient RCA for whole genome amplification of HPV using HPV-specific primers in clinical samples and establish a protocol for whole genome sequencing using the Sanger method. Amplification of cloned HPV-genomes by RCA was compared using specific primers against random hexamers. Using HPV-specific primers increased the effectiveness on average 15.2 times and the enrichment of HPV relative to human gDNA on average 62.2 times, as compared to using random hexamer. RCA products were sequenced without need for cloning, even when using low-input amounts. The technique was successfully used on 4 patient samples from FTA cards, to generate whole HPV-genome sequences. Degenerated HPV-specific primers for RCA produce DNA of sufficient quality and quantity suitable for sequencing and other potential downstream analyses.

  11. Febrile morbidity in severe and critical ovarian hyperstimulation syndrome: a multicentre study.

    PubMed

    Abramov, Y; Elchalal, U; Schenker, J G

    1998-11-01

    The objective of this study was to define the incidence of febrile morbidity and its causes in severe and critical ovarian hyperstimulation syndrome (OHSS). For this purpose, we reviewed the medical records of all OHSS patients hospitalized in 16 out of 19 tertiary medical centres in Israel between January 1987 and December 1996. Febrile morbidity was defined as at least one episode of temperature rise above 38 degrees C lasting > or =24 h. A total of 2902 patients (3305 hospitalizations) with OHSS was identified, of whom 196 had severe, and 13 critical, OHSS. Among the 209 patients investigated the incidence of febrile morbidity was 82.3%, of which 20.5% was attributed to urinary tract infection, 3.8% to pneumonia, 3.3% to upper respiratory tract infection, 2.0% to intravenous line phlebitis, 1.0% to cellulitis at an abdominal puncture site, 1.0% to postoperative wound infections and 0.5 % to gluteal abscess at the site of progesterone injection. Non-typical organisms were frequently isolated, such as Pseudomonas, Proteus, Klebsiella and Enterobacter species. No infectious aetiology was found in 105 patients (50.2%). Hypoglobulinaemia was recorded in most patients, while ascitic and pleural fluids aspirated from these patients contained high globulin concentrations. We conclude that infection-related febrile morbidity in severe and critical OHSS is high, and may be attributed to some degree of immunodeficiency associated with loss of plasma globulins to the third space. However, non-infection-related febrile morbidity is even higher and may be attributed to endogenous pyrogenic mechanisms.

  12. Pulmonary Hypertension: Epidemiology in Different CKD Stages and Its Association with Cardiovascular Morbidity

    PubMed Central

    Liu, Shuangxin; Ye, Zhiming; Chen, Yuanhan; Wang, Wenjian; Li, Ruizhao; Xu, Lixia; Feng, Zhonglin; Shi, Wei

    2014-01-01

    Background Pulmonary hypertension (PH) was recently recognized as a common complication of end-stage renal disease (ESRD) that causes an increased risk of mortality. Epidemiological data for this disorder in earlier stages of chronic kidney disease (CKD) and its association with cardiovascular (CV) morbidity are scarce. Methods We retrospectively analyzed 2,351 Chinese CKD patients with complete clinical records and echocardiography data between Jan 2008 and May 2012. The patients were divided into the following 6 groups: CKD Stages 1–4; Stage 5 for those not on or initiated on hemodialysis for <3 months; and Stage 5D for the patients undergoing hemodialysis for ≥3 months. The prevalence of PH and CV morbidity was investigated, and their association was evaluated with a logistic regression model. Results PH was detected in 426 patients (18.1%). Mild, moderate and severe PH was diagnosed in 12.1%, 4.9% and 1.1% of the patients, respectively. Severe PH was detected in CKD Stages 5 and 5D. CV morbidity was found in 645 patients (27.4%). Compared with the non-PH group, the PH group had a higher risk for cardiac disease but not for cerebrovascular disease risk. PH severity was associated with cardiac morbidity risk [odds ratio (95% CI) for mild PH: 1.79 (1.30–2.47); moderate PH: 2.75 (1.73–4.37); severe PH: 3.90 (1.46–10.42)]. Conclusions Our study showed for the first time the epidemiology profile of PH across the spectrum of CKD. Mild-to-moderate PH occurs with more frequency in advanced CKD, and severe PH is scarce in non-ESRD CKD. PH in CKD is associated with cardiac but not cerebrovascular disease, with increasing cardiac morbidity seen with increasing PH severity. Evidence from prospective studies addressing PH in this population is needed to predict cardiac events. PMID:25525807

  13. Elephantiasis nostras verrucosa on the legs and abdomen with morbid obesity in an Indian lady.

    PubMed

    Sarma, Podila S; Ghorpade, Ashok

    2008-12-15

    Elephantiasis nostras verrucosa (ENV) of the legs and abdomen in a morbidly obese woman with multiple medical problems is reported. The diagnosis was suggested by the classical clinical features and confirmed by histopathology. The patient succumbed due to her multisystem diseases. Elephantiasis nostras verrucosa involving the abdomen is uncommon and has been reported only five times in the past.

  14. Causal Attribution, Perceived Benefits, and Morbidity After a Heart Attack: An 8-Year Study.

    ERIC Educational Resources Information Center

    Affleck, Glenn; And Others

    1987-01-01

    Interviewed heart attack victims (N=287) seven weeks and eight years after their attack. Explored interrelations among causal attributions for the attack, survivor morbidity, and heart attack recurrence. Found that patients who cited benefits from their misfortune seven weeks after the first attack were less likely to have another attack and had…

  15. Epilepsy and Intellectual Disability: Does Epilepsy Increase the Likelihood of Co-Morbid Psychopathology?

    ERIC Educational Resources Information Center

    Arshad, Saadia; Winterhalder, Robert; Underwood, Lisa; Kelesidi, Katerina; Chaplin, Eddie; Kravariti, Eugenia; Anagnostopoulos, Dimitrios; Bouras, Nick; McCarthy, Jane; Tsakanikos, Elias

    2011-01-01

    Although epilepsy is particularly common among people with intellectual disability (ID) it remains unclear whether it is associated with an increased likelihood of co-morbid psychopathology. We therefore investigated rates of mental health problems and other clinical characteristics in patients with ID and epilepsy (N=156) as compared to patients…

  16. Venous thromboembolism in patients with inflammatory bowel disease: Focus on prevention and treatment

    PubMed Central

    Papa, Alfredo; Gerardi, Viviana; Marzo, Manuela; Felice, Carla; Rapaccini, Gian Lodovico; Gasbarrini, Antonio

    2014-01-01

    Inflammatory bowel disease (IBD) patients have an increased risk of venous thromboembolism (VTE), which represents a significant cause of morbidity and mortality. The most common sites of VTE in IBD patients are the deep veins of the legs and pulmonary system, followed by the portal and mesenteric veins. However, other sites may also be involved, such as the cerebrovascular and retinal veins. The aetiology of VTE is multifactorial, including both inherited and acquired risk factors that, when simultaneously present, multiply the risk to the patient. VTE prevention involves correcting modifiable risk factors, such as disease activity, vitamin deficiency, dehydration and prolonged immobilisation. The role of mechanical and pharmacological prophylaxis against VTE using anticoagulants is also crucial. However, although guidelines recommend thromboprophylaxis for IBD patients, this method is still poorly implemented because of concerns about its safety and a lack of awareness of the magnitude of thrombotic risk in these patients. Further efforts are required to increase the rate of pharmacological prevention of VTE in IBD patients to avoid preventable morbidity and mortality. PMID:24695669

  17. Ambient Temperature and Morbidity: A Review of Epidemiological Evidence

    PubMed Central

    Ye, Xiaofang; Wolff, Rodney; Yu, Weiwei; Vaneckova, Pavla; Pan, Xiaochuan

    2011-01-01

    Objective: In this paper, we review the epidemiological evidence on the relationship between ambient temperature and morbidity. We assessed the methodological issues in previous studies and proposed future research directions. Data sources and data extraction: We searched the PubMed database for epidemiological studies on ambient temperature and morbidity of noncommunicable diseases published in refereed English journals before 30 June 2010. Forty relevant studies were identified. Of these, 24 examined the relationship between ambient temperature and morbidity, 15 investigated the short-term effects of heat wave on morbidity, and 1 assessed both temperature and heat wave effects. Data synthesis: Descriptive and time-series studies were the two main research designs used to investigate the temperature–morbidity relationship. Measurements of temperature exposure and health outcomes used in these studies differed widely. The majority of studies reported a significant relationship between ambient temperature and total or cause-specific morbidities. However, there were some inconsistencies in the direction and magnitude of nonlinear lag effects. The lag effect of hot temperature on morbidity was shorter (several days) compared with that of cold temperature (up to a few weeks). The temperature–morbidity relationship may be confounded or modified by sociodemographic factors and air pollution. Conclusions: There is a significant short-term effect of ambient temperature on total and cause-specific morbidities. However, further research is needed to determine an appropriate temperature measure, consider a diverse range of morbidities, and to use consistent methodology to make different studies more comparable. PMID:21824855

  18. The Impact of Cardiac Diseases during Pregnancy on Severe Maternal Morbidity and Mortality in Brazil

    PubMed Central

    Campanharo, Felipe F.; Cecatti, Jose G.; Haddad, Samira M.; Parpinelli, Mary A.; Born, Daniel; Costa, Maria L.; Mattar, Rosiane

    2015-01-01

    Background To evaluate maternal heart disease as a cause or complicating factor for severe morbidity in the setting of the Brazilian Network for Surveillance of Severe Maternal Morbidity. Methods and Findings Secondary data analysis of this multicenter cross-sectional study was implemented in 27 referral obstetric units in Brazil. From July 2009 to June 2010, a prospective surveillance was conducted among all delivery hospitalizations to identify cases of severe maternal morbidity (SMM), including Potentially Life-Threatening Conditions (PLTC) and Maternal Near Miss (MNM), using the new criteria established by the WHO. The variables studied included: sociodemographic characteristics, clinical and obstetric history of the women; perinatal outcome and the occurrence of maternal outcomes (PLTC, MNM, MD) between groups of cardiac and non-cardiac patients. Only heart conditions with hemodynamic impact characterizing severity of maternal morbidity were considered. 9555 women were included in the Network with severe pregnancy-related complications: 770 maternal near miss cases and 140 maternal death cases. A total of 293 (3.6%) cases were related to heart disease and the condition was known before pregnancy in 82.6% of cases. Maternal near miss occurred in 15% of cardiac disease patients (most due to clinical-surgical causes, p<0.001) and 7.7% of non-cardiac patients (hemorrhagic and hypertensive causes, p<0.001). Maternal death occurred in 4.8% of cardiac patients and in 1.2% of non-cardiac patients, respectively. Conclusions In this study, heart disease was significantly associated with a higher occurrence of severe maternal outcomes, including maternal death and maternal near miss, among women presenting with any severe maternal morbidity. PMID:26650684

  19. Morbidity Profile and Functional Outcome of Modified Facial Translocation Approaches for Skull Base Tumors

    PubMed Central

    Kekatpure, Vikram D.; Rajan, Gunesh P.; Patel, Daxesh; Trivedi, Nirav P.; Arun, P.; Iyer, Subramania; Kuriakose, Moni Abraham

    2011-01-01

    The primary objective of this study was to evaluate morbidity associated with facial translocation approaches for skull base and results of various technical modifications. Forty consecutive patients who underwent facial translocation approaches for accessing skull base tumors from July 2005 to June 2010 were included in this study. There were 25 patients who underwent standard facial translocation, 4 patients medial mini, and 11 patients underwent extended facial translocation. Thirteen patients had benign disease and 27 patients had malignant disease. Resection was R0 in 36 and R1 in 4 patients. Most patients had acceptable cosmetic results. None of the patients had problems related to occlusion or speech and swallowing. The commonest complication observed was nasal crusting in 16 patients. Grade 2 trismus and exposure of mini plate was seen in three patients. Two patients developed necrosis of translocated bone. Three patients developed palatal fistula before modification of palatal incision. Facial translocation provides a satisfactory access for adequate clearance of skull base tumors with satisfactory aesthetic and functional results. With modifications of the surgical technique and implementation of new surgical tools, the morbidity of facial translocation approaches will continue to decrease. PMID:22470269

  20. [Reducing postoperative morbidity and mortality with preoperative risk evaluation and with refined perioperative medical care].

    PubMed

    Uchida, Kanji

    2012-05-01

    Reducing postoperative morbidity and mortality is important not only for patients' outcome but for reduction of financial burden on society. Precise and accurate preoperative evaluation of surgical risk factors is crucial to plan appropriate postoperative allocation of medical resources. American Society of Anesthesiologists physical status is a traditional measure to describe preoperative risk of patients undergoing surgery. In the last decade, several scoring systems with better sensitivity and specificity were reported and validated. Charlson Age-comorbidity Index, Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) are frequently used scoring systems. Several lines of evidence indicate that negligence of medical caregivers cause substantial numbers of errors to patients and often leads to severe complications or deaths. Full compliances to surgical checklists and implementation of medical team will help reduce these errors and lead to better patients' postoperative outcomes.

  1. Is Total Knee Replacement Justified in the Morbidly Obese? A Systematic Review

    PubMed Central

    Vaishya, Raju; Wamae, David; Agarwal, Amit Kumar

    2016-01-01

    Total knee replacement (TKR) comprises a significant, growing aspect in the management of patients with advanced arthritis of the knee for which conservative medical therapy has failed. Obesity, a rising epidemic, is considered an important independent risk factor in the development of osteoarthritis (OA). An aging population and increasing incidence of obesity contribute to a higher prevalence of OA and a subsequent greater need for TKR. The numbers of morbidly obese (MO) people undergoing TKR has consistently been rising. However, there have been concerns among patients and surgeons about the outcomes and complications of TKR in MO patients, especially given the morbidities associated with obesity. The goal of this systematic review was to assess relevant, up-to-date data on the safety, outcomes, and complications associated with TKR in MO patients. PMID:27790392

  2. Morbid Obesity—The New Pandemic: Medical and Surgical Management, and Implications for the Practicing Gastroenterologist

    PubMed Central

    Cello, John P; Rogers, Stanley J

    2013-01-01

    The gastroenterologist, whether in academic or clinical practice, must face the reality that an increasingly large percentage of adult patients are morbidly obese. Morbid obesity is associated with significant morbidity and mortality including enhanced morbidity from cardiovascular, cerebrovascular, hepatobiliary and colonic diseases. Most of these associated diseases are actually preventable. Based on the 1991 NIH consensus conference criteria, for most patients with a body mass index (BMI=weight in kilograms divided by the height in meters squared) of 40 or more, or for patients with a BMI of 35 or more and significant health complications, surgery may be the only reliable option. Currently in the United States, over 250,000 bariatric surgical procedures are being performed annually. The practicing gastroenterologist in every community, large and small, must be familiar with the various surgical procedures together with their associated anatomic changes. These changes may dramatically increase the prevalence of nutritional deficiencies and profoundly alter the clinical and endoscopic approaches to diagnosis and management. PMID:23739585

  3. Association between co-morbidities and labour force participation amongst persons with back problems.

    PubMed

    Schofield, Deborah J; Callander, Emily J; Shrestha, Rupendra N; Passey, Megan E; Percival, Richard; Kelly, Simon J

    2012-10-01

    There are few studies that have looked at the occurrence of co-morbid conditions amongst patients with back problems. This study assesses the association between of a range of co-morbidities and the labour force participation rates of 45- to 64-year-old Australians with back problems. Logistic regression models were applied to the 2003 Survey of Disability, Ageing and Carers (SDAC) data to look at the relationship between chronic back problems, labour force participation and comorbidities. For some conditions, there is a significant increase in the chance of an individual being out of the labour force, relative to those with back problems alone. For example, an individual with back problems and heart disease is more than 10 times more likely to be out of the labour force than those with back problems alone (OR=10.90, 95% CI=2.91-40.79, P=.0004). Amongst conditions that have a significant impact on labour force participation rates, back problems and multiple co-morbidities are significantly more likely to cause persons with these conditions to be out of the labour force than those with back problems alone or those with no chronic health condition. It is important to consider which co-morbidities an individual has when assessing the impact of back problems on labour force participation, as co-morbid conditions vary in their association with labour force participation.

  4. Prevalence of Psychiatric Morbidity in Females amongst Infertile Couples- A Hospital Based Report

    PubMed Central

    Sethi, Pragati; Goyal, Lajya Devi; Kaur, Gurmeet

    2016-01-01

    Introduction Infertility leads to significant stress among couple and the reaction to infertility differs among males and females. Aim To know the prevalence of psychiatric morbidity in infertile couples and compare the prevalence of various psychiatric disorders among husband and wife. Materials and Methods A cross-sectional study was conducted on 50 couples diagnosed with infertility from outdoor clinics. Both male and female partner of couple were interviewed for detailed history and clinical examination was done. General Health Questionnaire (GHQ-12) was applied to detect any psychological strain in couples and in those with illness, final diagnosis were made on the basis of DSM -IV (TR). The data thus generated was subjected to appropriate Statistical Analysis. Results Out of the 50 couples, 54% of females had psychiatric morbidity. The most common diagnosis amongst the female participants was MDD (Major Depressive Disorder) (18%), whereas the second most common diagnosis was GAD (Generalized Anxiety Disorder) (16%). Psychiatric morbidity was found in only 26% of males suffering with Adjustment Disorder being most common diagnosis (8%) and Dysthymia and MDD as the second most common diagnosis (6% each). Majority of patients having psychiatric morbidity were from age group 20-29 years. The difference between females and male counterparts was statistically significant. Conclusion Psychiatric morbidity was higher among female partners than male partners. The difference was statistically significant and the situation needs further workup. PMID:27630933

  5. Incidence of Post-Operative Sepsis and Role of Charlson Co-Morbidity Score for Predicting Postoperative Sepsis.

    PubMed

    Emami-Razavi, Seyed Hassan; Mohammadi, Atefeh; Alibakhshi, Abbas; Jalali, Mehdi; Ghajarzadeh, Mahsa

    2016-05-01

    Sepsis and septic shock are among mortality causes following major surgeries. The Charlson co-morbidity index consists of 19 weighted categories related to chronic health which measures the burden of co-morbidity. The goal of this study was to determine the incidence of postoperative sepsis in patients underwent gynecological and gastrointestinal cancer surgeries and predictive role of Charlson index for this situation. Two hundred and twenty-two patients who underwent gynecological and gastrointestinal cancer surgeries were evaluated. Sixty-four (28.6%) patients developed SIRS postoperatively. Forty-four (19.7%) patients developed sepsis postoperatively. Mean age, duration of hospitalization and surgery, the Charlson score were significantly higher in patients who developed sepsis than other cases. Blood transfusion and Charlson score were independent predictors of sepsis occurrence. Charlson co-morbidity index is a predictive factor for developing postoperative sepsis.

  6. Successful treatment of cervical myelopathy with minimal morbidity by circumferential decompression and fusion

    PubMed Central

    Sanchez-Mejia, Rene O.; Ben-Haim, Sharona; Ames, Christopher P.

    2007-01-01

    Circumferential cervical decompression and fusion (CCDF) is an important technique for treating patients with severe cervical myelopathy. While circumferential cervical decompression and fusion may provide improved spinal cord decompression and stability compared to unilateral techniques, it is commonly associated with increased morbidity and mortality. We performed a retrospective analysis of patients undergoing CCDF at the University of California, San Francisco (UCSF) between January 2003 and December 2004. We identified 53 patients and reviewed their medical records to determine the effectiveness of CCDF for improving myelopathy, pain, and neurological function. Degree of fusion, functional anatomic alignment, and stability were also assessed. Operative morbidity and mortality were measured. The most common causes of cervical myelopathy, instability, or deformity were degenerative disease (57%) and traumatic injury (34%). Approximately one-fifth of patients had a prior fusion performed elsewhere and presented with fusion failure or adjacent-level degeneration. Postoperatively, all patients had stable (22.6%) or improved (77.4%) Nurick grades. The average preoperative and postoperative Nurick grades were 2.1 ± 1.9 and 0.4 ± 0.9, respectively. Pain improved in 85% of patients. All patients had radiographic evidence of fusion at last follow-up. The most common complication was transient dysphagia. Our average clinical follow-up was 27.5 ± 9.5 months. We present an extensive series of patients and demonstrate that cervical myelopathy can successfully be treated with CCDF with minimal operative morbidity. CCDF may provide more extensive decompression of the spinal cord and may be more structurally stable. Concerns regarding operation-associated morbidity should not strongly influence whether CCDF is performed. PMID:17216528

  7. [Indications of efficacy of bariatric surgery in the management of morbid obesity].

    PubMed

    Pascual, J M; Rodilla, E

    2006-09-01

    Its indications should only be considered in patients with morbid obesity (BMI>40 kg/m2) or severe obesity (BMI>35 kg/m2) with serious associated comorbidity. In general, significant weight loss with marked improvement of the cardiovascular comorbidity is obtained. There are still no studies that show long term survival. It must be stressed that the patients should follow a subsequent and continuous medical monitoring to prevent important secondary metabolic complications.

  8. Cancer morbidity in lamp manufacturing workers.

    PubMed

    Shannon, H S; Haines, T; Bernholz, C; Julian, J A; Verma, D K; Jamieson, E; Walsh, C

    1988-01-01

    A historical prospective study of cancer in lamp manufacturing workers in one plant was conducted. All men and women who worked for a total of at least 6 months and were employed at some time between 1960 and 1975 were included. Work histories were abstracted and subjects were divided according to whether they had worked in the coiling and wire drawing area (CWD). Cancer morbidity from 1964 to 1982 was ascertained via the provincial registry, and was compared with the site-specific incidence in Ontario, adjusting for age, sex and calendar period. Of particular interest were primary breast and gynecological cancers in women. The cancers of a priori concern were significantly increased in women in CWD, but not elsewhere in the plant. The excess was greatest in those with more than 5 yr exposure (in CWD) and more than 15 yr since first working in CWD, with eight cases of breast and gynecological cancers observed in this category compared with 2.67 expected. Only three cancers occurred in men in CWD. Environmental measurements had not been made in the past and little information was available on substances used in the 1940s and 1950s, the period when the women with the highest excess began employment. It is known that methylene chloride and trichlorethylene have been used, but not enough is known about the dates and patterns of use to draw any conclusions about their relationship with the increase in disease.

  9. Reducing morbidity and mortality among pregnant obese.

    PubMed

    Harper, Ann

    2015-04-01

    Obesity is increasing; in the UK, almost 20% of pregnant women have a body mass index (BMI) of ≥30 kg/m(2). Obese mothers have increased risks of pregnancy complications including miscarriage, congenital anomaly, gestational diabetes, pre-eclampsia, macrosomia, induction of labour, caesarean section, anaesthetic and surgical complications, post-partum haemorrhage, infection and venous thromboembolism. Complications tend to be greater in those with the highest BMIs. In recent triennia, obesity (27-29%) was over-represented in maternal mortality figures. Strategies to reduce morbidity and mortality include calculating BMI at booking visit to identify obese mothers and plan their antenatal care and delivery. This should include nutritional and lifestyle advice, screening for gestational diabetes and pre-eclampsia, thromboembolism risk assessment, antenatal anaesthetic review if BMI is ≥ 40 kg/m(2), ensuring availability of robust theatre tables and other equipment and involving senior doctors, especially in the labour ward. Afterwards, continuing weight reduction should be encouraged to reduce future pregnancy and health risks.

  10. [Sitting and cardiovascular morbidity and mortality].

    PubMed

    Shiyovich, Arthur; Shlyakhover, Vladimir; Katz, Amos

    2013-01-01

    Prolonged sitting and sedentary behavior comprises a major part of the modern lifestyle: at work, leisure (watching television, Internet) and commuting/traveling. Studies have shown that adults spend about half of their time at work and even more sitting. Similarly, a significant part of the leisure time is spent doing sedentary activities usually in front of a screen (TV or a computer). However, current recommendations focus on increasing moderate-to-vigorous physical activity with almost no recommendations relating to sedentary activities. Recent evidence from several research papers showed deleterious relationships of sedentary behavior with cardiovascular risk factors (e.g., obesity, type 2 diabetes mellitus and waist circumference). Furthermore, consistent independent associations have been observed between sitting time/sedentary behaviors and elevated all-cause and cardiovascular disease mortality risk. Generally, these associations have persisted following adjustment for physical activity. Recent emerging findings have shown that breaking up sedentary time potentially has a beneficial impact on cardiovascular health (independent of total sedentary time and moderate-to-vigorous intensity activity). In this article, we review the association between the time spent in various sedentary activities (occupational, leisure and commuting/transportation) and cardiovascular risk factors and cardiovascular morbidity and mortality. In addition, we review the suggested mechanisms that explain the empiric associations.

  11. The nature of unemployment morbidity. 2. Description

    PubMed Central

    Beale, Norman; Nethercott, Susan

    1988-01-01

    A longitudinal, controlled study on job loss and health using general practice records has concluded that unemployment morbidity among men made redundant can be identified as an increase in those episodes of illness which are associated with many consultations. The possibility that these episodes represent chronic ill health has been tested using the same data base. If chronic illnesses are defined as those requiring active management after one year, their incidence among unemployed men was over six times that among controls (P<0.001). Cardiovascular disorders were frequently detected in the unemployed men and several of the other chronic complaints they suffered may also have had a psychosomatic aetiology related to stress. The consequent workload in terms of consultations, investigations, referrals, outpatient attendances and drug therapy increased significantly after job loss. More frequent, short-lived illnesses showed continuing downward trends in study and control men. The results suggest that unskilled men face a serious health hazard if made redundant. Investigating and treating their chronic disabilities leads to an increased medical workload and must further burden the health service. PMID:3210181

  12. Geomagnetic Storms and Acute Myocardial Infarctions Morbidity in Middle Latitudes

    NASA Astrophysics Data System (ADS)

    Dimitrova, S.; Babayev, E. S.; Mustafa, F. R.; Stoilova, I.; Taseva, T.; Georgieva, K.

    2009-12-01

    Results of collaborative studies on revealing a possible relationship between solar activity (SA) and geomagnetic activity (GMA) and pre-hospital acute myocardial infarction (AMI) morbidity are presented. Studies were based on medical data from Bulgaria and Azerbaijan. Bulgarian data, covering the period from 01.12.1995 to 31.12.2004, concerned daily distribution of number of patients with AMI diagnose (in total 1192 cases) from Sofia Region on the day of admission at the hospital. Azerbaijani data contained 4479 pre-hospital AMI incidence cases for the period 01.01.2003-31.12.2005 and were collected from 21 emergency and first medical aid stations in Grand Baku Area (including Absheron Economical Region with several millions of inhabitants). Data were "cleaned" as much as possible from social and other factors and were subjected to medical and mathematical/statistical analysis. Medical analysis showed reliability of the used data. Method of ANalysis Of VAriance (ANOVA) was applied to check the significance of GMA intensity effect and the type of geomagnetic storms - those caused by magnetic clouds (MC) and by high speed solar wind streams (HSSWS) - on AMI incidences. Relevant correlation coefficients were calculated. Results were outlined for both considered data. Results obtained for the Sofia data showed statistically significant positive correlation between considered GMA indices and AMI occurrence. ANOVA revealed that AMI incidence number was significantly increased from the day before till the day after geomagnetic storms with different intensities. Geomagnetic storms caused by MC were related to significant increase of AMI number in comparison with the storms caused by HSSWS. There was a trend for such different effects even on -1st and +1st day for the period 1995-2004. Results obtained for the Baku data revealed trends similar to those obtained for Sofia data. AMI morbidity increment was observed on the days with higher GMA intensity and after these days

  13. Treating Multiply Relapsed or Refractory Hairy Cell Leukemia

    Cancer.gov

    In this trial, patients with hairy cell leukemia who have not responded or relapsed after initial chemotherapy will be randomly assigned to receive rituximab combined with either pentostatin or bendamustine.

  14. Simplified cesarean section: a strategic surgical approach to minimize postoperative infectious morbidity.

    PubMed

    Pelosi

    1998-07-01

    Objective: A simplified method of cesarean delivery aimed at minimizing postoperative morbidity is illustrated.Methods: Two hundred consecutive cesarean deliveries were performed by the authors' simplified cesarean technique. Mean patient age was 27 years (range 17-46), and mean weight was 169 pounds (range 112-414). Indications for cesarean delivery included dystocia or failure to progress in labor (38%), repeat cesarean (32%), malpresentation (11.5%), fetal distress (9.5%), and other (9%).Results: Simplified cesarean delivery was successfully completed in all cases. Mean operating time was 16 minutes (range 9-33), mean blood loss was 460 mL (range 100-1150), and mean postsurgical hospitalization time was 72 hours (range 36-120). No bowel, bladder, or vascular injuries occurred. Postoperative febrile morbidity occurred in one patient (0.5%), ileus occurred in one patient (0.5%), and blood transfusion was administered to one patient (0.5%). No cases of wound infection, wound dehiscence, hematoma, or incisional hernia occurred. All patients were ambulatory on the first postoperative day. All but one patient (99.5%) tolerated a regular diet on the first postoperative day.Conclusions: The authors' technique of cesarean section appears to be a safe and efficient method for cesarean delivery associated with minimal postoperative infectious morbidity and rapid resumption of bowel and ambulatory function.

  15. Subtle to severe hepatobiliary morbidity in Opisthorchis viverrini endemic settings in southern Laos.

    PubMed

    Ayé Soukhathammavong, Phonepasong; Rajpho, Virasack; Phongluxa, Khampheng; Vonghachack, Youthanavanh; Hattendorf, Jan; Hongvanthong, Bouasy; Rasaphon, Oroth; Sripa, Banchob; Akkhavong, Kongsap; Hatz, Christoph; Odermatt, Peter

    2015-01-01

    Evidence of severe hepatobiliary morbidity associated with Opisthorchis viverrini liver fluke infection including cholangiocarcinoma (CCA) is scarce in Laos although O. viverrini infection is highly prevalent. We assessed hepatobiliary morbidity using abdominal ultrasonography (US) in O. viverrini adult patients in Saravan province, Southern Laos. A random sample of 431 O. viverrini patients from 10 villages underwent abdominal US. Mild, moderate and markedly advanced periductal fibrosis was diagnosed in 7.0%, 66.5%, and 17.0% of patients, respectively. Normal liver parenchyma was seen in only 9.5% of patients. Presence of gall stones (13.2%), sludge (1.4%), gall wall thickening (1.2%), bile duct dilatation (1.6%), fatty liver (12.0%), kidney stones (8.6%) and cysts (7.9%) were diagnosed in considerable frequencies. In five patients (1.2%) hepatobiliary lesions suggesting CCA were diagnosed. Tumour markers, i.e. Interleukin-6, plasminogen activator inhibitor and carbohydrate antigen 19-9 were within normal range. The number of CCA suspected liver masses and hepatobiliary morbidity diagnosed among clinically asymptomatic adult patients in O. viverrini endemic area presents a major public health concern in Laos. However, definitive diagnosis of Opisthorchis-related severe sequelae including CCA is urgently needed to gauge the burden of this deadly disease in Laos.

  16. The role of co-morbidity in the selection of antidiabetic pharmacotherapy in type-2 diabetes.

    PubMed

    Tschöpe, Diethelm; Hanefeld, Markolf; Meier, Juris J; Gitt, Anselm K; Halle, Martin; Bramlage, Peter; Schumm-Draeger, Petra-Maria

    2013-04-10

    Metformin is, if not contraindicated and if tolerated, usually preferred over other antidiabetic drugs for the first line treatment of type-2 diabetes. The particular decision on which antidiabetic agent to use is based on variables such as efficacy, cost, potential side effects, effects on weight, comorbidities, hypoglycemia, risk, and patient preferences. However, there is no guidance how to consider these in the selection of antidiabetic drug treatment. In this work, we aimed to summarize available evidence and tried to give pragmatic treatment recommendations from a clinical practice perspective.There are clear contraindications for some drugs in those with impaired renal and liver function and precautions in those with heart failure for the use of metformin (NYHA III-IV) and glitazones. On the other hand, GLP-1 analogs, DPP-4 inhibitors and acarbose are generally less critical and can be used in the majority of patients. We identified the following gaps with respect to the selection of antidiabetic drug treatment in patients with co-morbid disease conditions: 1) Guidelines fail to give advice on the use of specific antidiabetic drugs in patients with co-morbidity. 2) The literature is deficient in studies documenting antidiabetic drug use in patients with severely impaired renal function, diabetic retinopathy, cerebrovascular disease and systolic heart failure. 3) Further there are no specific data on patients with multiple of these co-morbid disease conditions. We postulate that differential use of antidiabetic drugs in patients with co-morbid disease constellations will help to reduce treatment related complications and might improve prognosis.

  17. The role of co-morbidity in the selection of antidiabetic pharmacotherapy in type-2 diabetes

    PubMed Central

    2013-01-01

    Metformin is, if not contraindicated and if tolerated, usually preferred over other antidiabetic drugs for the first line treatment of type-2 diabetes. The particular decision on which antidiabetic agent to use is based on variables such as efficacy, cost, potential side effects, effects on weight, comorbidities, hypoglycemia, risk, and patient preferences. However, there is no guidance how to consider these in the selection of antidiabetic drug treatment. In this work, we aimed to summarize available evidence and tried to give pragmatic treatment recommendations from a clinical practice perspective. There are clear contraindications for some drugs in those with impaired renal and liver function and precautions in those with heart failure for the use of metformin (NYHA III-IV) and glitazones. On the other hand, GLP-1 analogs, DPP-4 inhibitors and acarbose are generally less critical and can be used in the majority of patients. We identified the following gaps with respect to the selection of antidiabetic drug treatment in patients with co-morbid disease conditions: 1) Guidelines fail to give advice on the use of specific antidiabetic drugs in patients with co-morbidity. 2) The literature is deficient in studies documenting antidiabetic drug use in patients with severely impaired renal function, diabetic retinopathy, cerebrovascular disease and systolic heart failure. 3) Further there are no specific data on patients with multiple of these co-morbid disease conditions. We postulate that differential use of antidiabetic drugs in patients with co-morbid disease constellations will help to reduce treatment related complications and might improve prognosis. PMID:23574917

  18. Does Shamblin's classification predict postoperative morbidity in carotid body tumors? A proposal to modify Shamblin's classification.

    PubMed

    Luna-Ortiz, Kuauhyama; Rascon-Ortiz, Mario; Villavicencio-Valencia, Veronica; Herrera-Gomez, Angel

    2006-02-01

    The objective of this study was to analyze the possible correlation between Shamblin's classification and post-surgical morbidity in the treatment of carotid body tumors (CBTs). Seventy-two patients with carotid body tumors were seen over a 22-year period. Twenty-three patients were excluded as they did not comply with the criteria of the objectives. All patients were grouped according to Shamblin's classification. We propose a modification to this classification and make a comparison by analyzing the surgical time and bleeding, as well as the neurological and vascular damage. We resected 50 CBTs in 49 patients, ranging in age from 18 to 73 years. Three groups were formed: group I with 8 (16%) patients, group II with 17 (34%) and group III with 24 (49%). Post-surgical neurological damage was observed in one patient (12.5%) from group I, in six (35%) from group II and in nine patients (37.5%) from group III. Vascular sacrifice had to be performed in 21% of class II tumors and in 8.7% of class III. None of the class I tumors required vascular sacrifice. No statistically significant difference existed for vascular or neurological risk in relation to Shamblin's classification. However, when analyzed according to the classification proposed herein, there was a correlation between Shamblin's classification and vascular sacrifice (P =0.001). There was a statistically significant correlation between the original Shamblin and the modified Shamblin regarding surgical time and bleeding. Shamblin's classification predicts only vascular morbidity. Neurological morbidity is not reflected in it and only reflects the surgeon's experience with CBT resections. Surgical time and bleeding are directly related to the Shamblin as it reflects the size of tumors in relation to the blood vessels. Shamblin's classification must be modified to be more objective so that the international reports can accurately reflect the morbidity related to it.

  19. FamNet: A Framework to Identify Multiplied Modules Driving Pathway Expansion in Plants1

    PubMed Central

    Tohge, Takayuki; Klie, Sebastian; Fernie, Alisdair R.

    2016-01-01

    Gene duplications generate new genes that can acquire similar but often diversified functions. Recent studies of gene coexpression networks have indicated that, not only genes, but also pathways can be multiplied and diversified to perform related functions in different parts of an organism. Identification of such diversified pathways, or modules, is needed to expand our knowledge of biological processes in plants and to understand how biological functions evolve. However, systematic explorations of modules remain scarce, and no user-friendly platform to identify them exists. We have established a statistical framework to identify modules and show that approximately one-third of the genes of a plant’s genome participate in hundreds of multiplied modules. Using this framework as a basis, we implemented a platform that can explore and visualize multiplied modules in coexpression networks of eight plant species. To validate the usefulness of the platform, we identified and functionally characterized pollen- and root-specific cell wall modules that multiplied to confer tip growth in pollen tubes and root hairs, respectively. Furthermore, we identified multiplied modules involved in secondary metabolite synthesis and corroborated them by metabolite profiling of tobacco (Nicotiana tabacum) tissues. The interactive platform, referred to as FamNet, is available at http://www.gene2function.de/famnet.html. PMID:26754669

  20. Idiopathic Polyhydramnios: Severity and Perinatal Morbidity.

    PubMed

    Wiegand, Samantha L; Beamon, Carmen J; Chescheir, Nancy C; Stamilio, David

    2016-06-01

    Objective To estimate the association between the severity of idiopathic polyhydramnios and adverse outcomes. Study Design Retrospective cohort study of deliveries at one hospital from 2000 to 2012 with an amniotic fluid index (AFI) measurement ≥24 + 0 weeks' gestation. Pregnancies complicated by diabetes, multiples, or fetal anomalies were excluded. Exposure was the degree of polyhydramnios: normal (AFI 5-24 cm), mild (≥ 24-30 cm), and moderate-severe (> 30 cm). Primary outcomes were perinatal mortality, neonatal intensive care unit (NICU) admission, and postpartum hemorrhage. Results There were 10,536 pregnancies: 10,188 with a normal AFI, 274 mild (78.74%), and 74 moderate-severe polyhydramnios (21.26%). Adverse outcomes were increased with idiopathic polyhydramnios: NICU admission (adjusted odds ratio [AOR] 3.71, 95% confidence interval [CI] 2.77-4.99), postpartum hemorrhage (AOR 15.81, 95% CI 7.82-31.96), macrosomia (AOR 3.41, 95% CI 2.61-4.47), low 5-minute Apgar score (AOR 2.60, 95% CI 1.57-4.30), and cesarean (AOR 2.16, 95% CI 1.74-2.69). There were increasing odds of macrosomia (mild: AOR 3.19, 95% CI 2.36-4.32; moderate-severe: AOR 4.44, 95% CI 2.53-7.79) and low 5-minute Apgar score (mild: AOR 2.24, 95% CI 1.23-4.08; moderate-severe: AOR 3.93, 95% CI 1.62-9.55) with increasing severity of polyhydramnios. Conclusion Idiopathic polyhydramnios is independently associated with increased risks of morbidity. There appears to be a dose-response relationship for neonatal macrosomia and low 5-minute Apgar score risks.

  1. Morbidity and mortality following induced abortion in Nnewi, Nigeria.

    PubMed

    Ikechebelu, J I; Okoli, C C

    2003-07-01

    We present a study of the maternal morbidity and mortality among 76 patients treated at the Nnamdi Azikiwe University Teaching Hospital, Nnewi for complications of induced abortion from January 1996 to December 2000. The total number of maternal admissions over this period was 5750, and illegal induced abortion was responsible for 1.3% of the admissions, with a mortality rate of 5.3% (n = 4) for induced abortion. This accounted for 21.1% of the total maternal deaths (n = 19) for the period. The mean age of the women was 20.6 years (range 15-34 years), 94.7% (n = 72) were unmarried, 93.5% (n = 71) were nulliparous and 76.5% (n = 58) were unemployed, 67.1% (n = 51) had had a mid-trimester termination at > 13 weeks gestational age. It is significant that 55.3% of the patients were teenagers and 45.1% of the mid-trimester abortions occurred in this group. Genital sepsis, haemorrhage, pelvic infection with peritonitis and abscess formation, uterine perforation, and gut injury were the major complications encountered. This study demonstrates that induced abortion is still a major cause of maternal mortality in Nigeria. Integrated family health education, planned parenthood and contraceptive education, a mass literacy campaign and improvement of the existing national health services are recommended in order to ameliorate the problems of illegally induced abortion in Nigeria.

  2. Morbidities in rapid eye movement sleep behavior disorder.

    PubMed

    Jennum, Poul; Mayer, Geert; Ju, Yo-El; Postuma, Ron

    2013-08-01

    Idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD, RBD without any obvious comorbid major neurological disease), is strongly associated with numerous comorbid conditions. The most prominent is that with neurodegenerative disorders, especially synuclein-mediated disorders, above all Parkinson disease (PD). Idiopathic RBD is an important risk factor for the development of synucleinopathies. Comorbidity studies suggest that iRBD is associated with a number of other potential pre-motor manifestations of synucleinopathies such as, cognitive and olfactory impairment, reduced autonomic function, neuropsychiatric manifestations and sleep complaints. Furthermore, patients with PD and RBD may have worse prognosis in terms of impaired cognitive function and overall morbidity/mortality; in dementia, the presence of RBD is strongly associated with clinical hallmarks and pathological findings of dementia with Lewy bodies. These findings underline the progressive disease process, suggesting involvement of more brain regions in patients with a more advanced disease stage. RBD is also associated with narcolepsy, and it is likely that RBD associated with narcolepsy is a distinct subtype associated with different comorbidities. RBD is also associated with antidepressant medications, autoimmune conditions, and, in rare cases, brainstem lesions.

  3. Optimizing bone health and minimizing skeletal morbidity in men with prostate cancer.

    PubMed

    McKay, Rana R; Taplin, Mary-Ellen; Choueiri, Toni K

    2013-12-01

    Maintaining bone health is important in the management of men with prostate cancer. Patients receiving androgen deprivation therapy are at increased risk for treatment-related osteoporosis, and patients with bone metastases are at increased risk for skeletal morbidity related to debilitating skeletal-related events (SREs). Optimizing bone health in these patients includes lifestyle modifications, calcium/vitamin D supplementation, and osteoclast-targeted agents in select high-risk patients. No agent is approved for the prevention of bone metastases. Novel systemic agents have shown a beneficial effect bone by directly affecting tumor growth. Integration of these anticancer agents with osteoclast-targeted agents warrants further investigation.

  4. Consequences of morbid obesity on the kidney. Where are we going?

    PubMed Central

    2016-01-01

    Obesity and morbid obesity are modifiable risk factors for the development and progression of kidney disease. Obesity has reached epidemic proportions and is currently an important health problem in Europe, so it is necessary to develop therapeutic and preventive strategies. The obesity-related glomerulopathy has been defined as a secondary form of focal segmental glomerulosclerosis, and its most characteristic feature is glomerulomegaly. The renal evolution of patients with obesity-related glomerulopathy (ORG) who have not been treated is unfavourable. However, morbidly obese patients with ORG that underwent bariatric surgery and drastic weight loss had a better outcome. Many inflammatory factors have been implicated in the pathogenic mechanism of renal disease in obesity. Hypoadiponectinaemia, hyperleptinaemia and hyperaldosteronism have been associated with glomerular injury in obese patients. The application of modern techniques has provided important insights that increase the current understanding of ORG. However, further investigation is needed. PMID:27994854

  5. How co-morbidities magnify the effect of arthritis on labour force participation and economic status: a costs of illness study in Australia.

    PubMed

    Schofield, Deborah J; Callander, Emily J; Shrestha, Rupendra N; Passey, Megan E; Percival, Richard; Kelly, Simon J

    2014-04-01

    Few studies have assessed the impact of co-morbid conditions amongst patients with arthritis. This study will quantify the impact co-morbid health conditions have on the labour force status and economic circumstances of people with arthritis. This study uses a microsimulation model, Health&WealthMOD, to quantify the impact of co-morbidities on the labour force participation and economic circumstances of 45- to 64-year-old Australians with arthritis. The results show that the probability of being out of the labour force increases with increasing number of co-morbidities. However, there was no statistically significant difference in the amount of weekly private income received by people with arthritis and no co-morbidities, and people with arthritis and one or two co-morbidities. However, those with arthritis and three or more co-morbidities received a weekly private income 72 % lower than people with arthritis alone (95 % CI -82, -57). People with arthritis and co-morbidities paid less in tax and received more in government transfer payments. As such, it is important to consider the co-morbid conditions an individual has when assessing the impact of arthritis on labour force participation and economic circumstances. People with arthritis that have multiple co-morbid conditions are likely to have their labour force participation and economic circumstances interrupted much more than those with arthritis only.

  6. Acute pain management in morbid obesity - an evidence based clinical update.

    PubMed

    Budiansky, Adele Sandra; Margarson, Michael P; Eipe, Naveen

    2017-03-01

    Increasing numbers of patients with morbid obesity are presenting for surgery and their acute pain management requires an evidence-based clinical update. The objective of this study was to complete a literature review for acute pain management in morbid obesity and provide an evidence-based clinical update with recommendations. Using standardized search terms, in March 2015, we completed a literature search to determine evidence for different acute pain pharmacological modalities in morbid obesity. For each modality the highest level of evidence was ascertained and recommendations for each pharmacological modality are presented. Though overall evidence is limited to few well conducted clinical trials, mostly related to weight loss surgery, multimodal analgesia with step-wise, severity-based, opioid-sparing approach appears to improve acute pain management in morbid obesity. The perioperative use of non-opioid adjuvants appears to offer further improvements in patient safety and outcomes. Further research into standardization of pain assessments and implementation of acute pain management protocols is required.

  7. Fragmentation of multiply-charged intact protein ions using MALDI TOF-TOF mass spectrometry.

    PubMed

    Liu, Zhaoyang; Schey, Kevin L

    2008-02-01

    Top down proteomics in a TOF-TOF instrument was further explored by examining the fragmentation of multiply charged precursors ions generated by matrix-assisted laser desorption ionization. Evaluation of sample preparation conditions allowed selection of solvent/matrix conditions and sample deposition methods to produce sufficiently abundant doubly and triply charged precursor ions for subsequent CID experiments. As previously reported, preferential cleavage was observed at sites C-terminal to acidic residues and N-terminal to proline residues for all ions examined. An increase in nonpreferential fragmentation as well as additional low mass product ions was observed in the spectra from multiply charged precursor ions providing increased sequence coverage. This enhanced fragmentation from multiply charged precursor ions became increasingly important with increasing protein molecular weight and facilitates protein identification using database searching algorithms. The useable mass range for MALDI TOF-TOF analysis of intact proteins has been expanded to 18.2 kDa using this approach.

  8. New architecture of fast parallel multiplier using fast parallel counter with FPA (first partial product addition)

    NASA Astrophysics Data System (ADS)

    Lee, Mike M.; Cho, Byung Lok

    2001-11-01

    In this paper, we proposed a new First Partial product Addition (FPA) architecture with new compressor (or parallel counter) to CSA tree built in the process of adding partial product for improving speed in the fast parallel multiplier to improve the speed of calculating partial product by about 20% compared with existing parallel counter using full Adder. The new circuit reduces the CLA bit finding final sum by N/2 using the novel FPA architecture. A 5.14ns of multiplication speed of the 16X16 multiplier is obtained using 0.25um CMOS technology. The architecture of the multiplier is easily opted for pipeline design and demonstrates high speed performance.

  9. Multiply Confined Nickel Nanocatalysts Produced by Atomic Layer Deposition for Hydrogenation Reactions.

    PubMed

    Gao, Zhe; Dong, Mei; Wang, Guizhen; Sheng, Pei; Wu, Zhiwei; Yang, Huimin; Zhang, Bin; Wang, Guofu; Wang, Jianguo; Qin, Yong

    2015-07-27

    To design highly efficient catalysts, new concepts for optimizing the metal-support interactions are desirable. Here we introduce a facile and general template approach assisted by atomic layer deposition (ALD), to fabricate a multiply confined Ni-based nanocatalyst. The Ni nanoparticles are not only confined in Al2 O3 nanotubes, but also embedded in the cavities of Al2 O3 interior wall. The cavities create more Ni-Al2 O3 interfacial sites, which facilitate hydrogenation reactions. The nanotubes inhibit the leaching and detachment of Ni nanoparticles. Compared with the Ni-based catalyst supported on the outer surface of Al2 O3 nanotubes, the multiply confined catalyst shows a striking improvement of catalytic activity and stability in hydrogenation reactions. Our ALD-assisted template method is general and can be extended for other multiply confined nanoreactors, which may have potential applications in many heterogeneous reactions.

  10. Non-cross talk multi-channel photomultiplier using guided electron multipliers

    DOEpatents

    Gomez, J.; Majewski, S.; Weisenberger, A.G.

    1995-09-26

    An improved multi-channel electron multiplier is provided that exhibits zero cross-talk and high rate operation. Resistive material input and output masks are employed to control divergence of electrons. Electron multiplication takes place in closed channels. Several embodiments are provided for these channels including a continuous resistive emissive multiplier and a discrete resistive multiplier with discrete dynode chains interspaced with resistive layers-masks. Both basic embodiments provide high gain multiplication of electrons without accumulating surface charges while containing electrons to their proper channels to eliminate cross-talk. The invention can be for example applied to improve the performance of ion mass spectrometers, positron emission tomography devices, in DNA sequencing and other beta radiography applications and in many applications in particle physics. 28 figs.

  11. Non cross talk multi-channel photomultiplier using guided electron multipliers

    DOEpatents

    Gomez, Javier; Majewski, Stanislaw; Weisenberger, Andrew G.

    1995-01-01

    An improved multi-channel electron multiplier is provided that exhibits zero cross-talk and high rate operation. Resistive material input and output masks are employed to control divergence of electrons. Electron multiplication takes place in closed channels. Several embodiments are provided for these channels including a continuous resistive emissive multiplier and a discrete resistive multiplier with discrete dynode chains interspaced with resistive layers-masks. Both basic embodiments provide high gain multiplication of electrons without accumulating surface charges while containing electrons to their proper channels to eliminate cross-talk. The invention can be for example applied to improve the performance of ion mass spectrometers, positron emission tomography devices, in DNA sequencing and other beta radiography applications and in many applications in particle physics.

  12. A structural analysis of small vapor-deposited 'multiply twinned' gold particles

    NASA Technical Reports Server (NTRS)

    Yang, C. Y.; Heinemann, K.; Yacaman, M. J.; Poppa, H.

    1979-01-01

    High resolution selected zone dark field, Bragg reflection imaging and weak beam dark field techniques of transmission electron microscopy were used to determine the structure of small gold particles vapor deposited on NaCl substrates. Attention was focused on the analysis of those particles in the 50-150 A range that have pentagonal or hexagonal bright field profiles. These particles have been previously described as multiply twinned crystallites composed of face-centered cubic tetrahedra. The experimental evidence of the present studies can be interpreted on the assumption that the particle structure is a regular icosahedron or decahedron for the hexagonal or the pentagonal particles respectively. The icosahedron is a multiply twinned rhombohedral crystal and the decahedron is a multiply twinned body-centered orthorhombic crystal, each of which constitutes a slight distortion from the face-centered cubic structure.

  13. Coherent Raman scattering with incoherent light for a multiply resonant mixture: Theory

    NASA Astrophysics Data System (ADS)

    Kirkwood, Jason C.; Ulness, Darin J.; Stimson, Michael J.; Albrecht, A. C.

    1998-02-01

    The theory for coherent Raman scattering (CRS) with broadband incoherent light is presented for a multiply resonant, multicomponent mixture of molecules that exhibits simultaneous multiple resonances with the frequencies of the driving fields. All possible pairwise hyperpolarizability contributions to the signal intensity are included in the theoretical treatment-(resonant-resonant, resonant-nonresonant, and nonresonant-nonresonant correlations between chromophores) and it is shown how the different types of correlations manifest themselves as differently behaved components of the signal intensity. The Raman resonances are modeled as Lorentzians in the frequency domain, as is the spectral density of the incoherent light. The analytic results for this multiply resonant mixture are presented and applied to a specific binary mixture. These analytic results will be used to recover frequencies and dephasing times in a series of experiments on multiply resonant mixtures.

  14. The formation of molecules in interstellar clouds from singly and multiply ionized atoms

    NASA Technical Reports Server (NTRS)

    Langer, W. D.

    1978-01-01

    The suggestion is considered that multiply ionized atoms produced by K- and L-shell X-ray ionization and cosmic-ray ionization can undergo ion-molecule reactions and also initiate molecule production. The role of X-rays in molecule production in general is discussed, and the contribution to molecule production of the C(+) radiative association with hydrogen is examined. Such gas-phase reactions of singly and multiply ionized atoms are used to calculate molecular abundances of carbon-, nitrogen-, and oxygen-bearing species. The column densities of the molecules are evaluated on the basis of a modified version of previously developed isobaric cloud models. It is found that reactions of multiply ionized carbon with H2 can contribute a significant fraction of the observed CH in diffuse interstellar clouds in the presence of diffuse X-ray structures or discrete X-ray sources and that substantial amounts of CH(+) can be produced under certain conditions.

  15. Schedulling Economical Thermal Power Plant 500 KV Java-Bali System Using Lagrange Multiplier

    NASA Astrophysics Data System (ADS)

    Sartika, N.; Abdullah, A. G.; Hakim, D. L.

    2017-03-01

    The highest cost of electricity generation operation is fuel cost. Therefore, it is necessary to optimize the thermal generator scheduling. The present study aimed at obtaining the schedule and load sharing of the electric power generation, in order to gain the minimum fuel cost, with regard to inequality and equality constraints. The data tested was the thermal generation system of 500 kV Java-Bali using daily loads. This study employed a lagrange multiplier method to perform the economic scheduling. This method is one of mathematical techniques commonly used to solve economic dispatch problems. The results of the optimation of lagrange multiplier were compared with the real condition in the field. Based on the optimation results, it was found that the lagrange multiplier method is more economical than the real condition of system.

  16. The right team at the right time – Multidisciplinary approach to multi-trauma patient with orthopedic injuries

    PubMed Central

    Bach, John A.; Leskovan, John J.; Scharschmidt, Thomas; Boulger, Creagh; Papadimos, Thomas J.; Russell, Sarah; Bahner, David P.; Stawicki, Stanislaw P. A.

    2017-01-01

    Integrated, multidisciplinary team approach to the multiply injured patient can help optimize care, minimize morbidity, and reduce mortality. It also provides a framework for accelerated postinjury rehabilitation course. The characteristics and potential benefits of this approach, including team dynamics and interactions, are discussed in this brief review. Emphasis is placed on synergies provided by specialty teams working together in the framework of care coordination, timing of surgical and nonsurgical interventions, and injury/physiologic considerations. Republished with permission from: Bach JA, Leskovan JJ, Scharschmidt T, Boulger C, Papadimos TJ, Russell S, Bahner DP, Stawicki SPA. Multidisciplinary approach to multi-trauma patient with orthopedic injuries: the right team at the right time. OPUS 12 Scientist 2012;6(1):6-10. PMID:28382257

  17. [Contemporary features of occupational morbidity formation in major machinery enterprise].