Comparison of two doses of heparin on outcome in off-pump coronary artery bypass surgery patients: A prospective randomized control study.

PubMed

Chakravarthy, Murali; Prabhakumar, Dattatreya; Thimmannagowda, Patil; Krishnamoorthy, Jayaprakash; George, Antony; Jawali, Vivek

2017-01-01

While off pump coronary artery bypass surgery is practiced with an intention to reduce the morbidity associated with cardiopulmonary bypass, the resultant 'hypercoagulability' needs to be addressed. Complications such as cavitary thrombus possibly due to the hyper coagulability after off pump coronary artery bypass surgery have been described. Many clinicians use higher doses of heparin - up to 5 mg/kg in order to thwart this fear. Overall, there appears to be no consensus on the dose of heparin in off pump coronary artery bypass surgeries. The aim of the study was understand the differences in outcome of such as transfusion requirement, myocardial ischemia, and morbidity when two different doses were used for systemic heparinization. Elective patients scheduled for off pump coronary artery bypass surgery were included. Ongoing anti platelet medication was not an exclusion criteria, however, anti platelet medications were ceased about a week prior to surgery when possible. Thoracic epidural anesthesia was administered as an adjunct in patients who qualified for it. By computer generated randomization chart, patients were chosen to receive either 2 or 3 mg/kg of intravenous unfractioned heparin to achieve systemic heparinization with activated clotting time targeted at >240 secs. Intraoperative blood loss, postoperative blood loss, myocardial ischemic episodes, requirement of intraaortic balloon counter pulsation and transfusion requirement were analyzed. Sixty two patients participated in the study. There was one conversion to cardiopulmonary bypass. The groups had comparable ACT at baseline (138.8 vs. 146.64 seconds, P = 0.12); 3 mg/kg group had significantly higher values after heparin, as expected. But after reversal with protamine, ACT and need for additional protamine was similar among the groups. Intraoperative (685.56 ± 241.42 ml vs. 675.15 ± 251.86 ml, P = 0.82) and postoperative blood loss (1906.29 ± 611.87 ml vs 1793.65 ± 663.54 ml , p value 0.49) were similar among the groups [Table 4]. The incidence of ECG changes of ischemia, arrhythmias, conversion to CPB, or need for intra-aortic balloon counter pulsation were not different. Use of either 2 or 3 mg/kg heparin for systemic heparinization in patients undergoing OPCAB did not affect the outcome.

Effects of dexmedetomidine on heart arrhythmia prevention in off-pump coronary artery bypass surgery: A randomized clinical trial

PubMed Central

Soltani, Ghasem; Jahanbakhsh, Saeed; Tashnizi, Mohammad Abbasi; Fathi, Mehdi; Amini, Shahram; Zirak, Nahid; Sheybani, Shima

2017-01-01

Background Arrhythmia occurring during and after surgery is one of the major complications in open-heart surgery. Dexmedetomidine is an intravenous alpha-2 agonist and very specific short-acting drug to protect the various organs against ischemic injuries and blood reflow. However, the effect of dexmedetomidine for preventing intraoperative heart arrhythmias has not been recognized. Objective This study aimed to determine the effect of dexmedetomidine on the incidence rate of heart arrhythmias and anesthetic required in off-pump coronary artery bypass surgery. Methods This randomized clinical trial was conducted on patients who were candidates for off-pump coronary artery bypass referring to Imam Reza Hospital of Mashhad, Iran, from July 2016 through January 2017. The patients were randomly assigned to two groups of intervention (infusion of 0.5 mcg/kg/h dexmedetomidine together with induction followed by infusion of 0.5 mcg/kg/h by the end of the surgery) or control (saline infusion). Mean arterial pressure (MAP) and heart rate (HR) were measured before induction, during surgery operation and ICU admission. Data were analyzed by SPSS version 18 using Chi Square and independent-samples t-test. Results A total of 76 patients with a mean age of 59.8 ± 8.2 years (in two groups of 38) were studied. The two groups had no statistically significant difference in terms of background variables. The MAP and HR values before induction, during surgery and ICU admission were significantly higher in the control group than in the intervention group (p=0.001). Out of the studied arrhythmias, the values of PAC (55.2% vs. 15.7%), PVC (81.5% vs. 21.0%), AF (26.3% vs. 7.8%), VTAC (21.0% vs. 2.6%) were significantly lower in dexmedetomidine group (p=0.001). Conclusion It seems that dexmedetomidine administration during induction and surgery can cause significant reduction in most of the common arrhythmias in off-pump coronary bypass surgery. The use of dexmedetomidine maintains MAP and HR at significantly lower values, and changes compared to the control group as well as reduces the need for anesthetic compounds. Trial Registration The present study has been registered at the Iranian Registry of Clinical Trials (www.IRCT.IR) with a code of IRCT2016072413159N9 before starting the study. Founding This study was fully sponsored by the Research Deputy at Mashhad University of Medical Sciences, Iran (grant number 941413). PMID:29238500

Effect of milrinone on short term outcome of patients with myocardial dysfunction undergoing off-pump coronary artery bypass graft: a randomized clinical trial.

PubMed

Hadadzadeh, Mehdi; Hosseini, Seyed Habib; Mostafavi Pour Manshadi, Seyed Mohammad Yousof; Naderi, Nafiseh; Emami Meybodi, Mahmood

2013-01-01

Myocardial dysfunction is a major complication in cardiac surgery that needs inotropic support. This study evaluates the effect of milrinone on patients with low ventricular ejection fraction undergoing off- pump coronary artery bypass graft (OPCAB). The present study is designed to evaluate the effect of milrinone on myocardial dysfunction. Eighty patients with low ventricular ejection fraction (<35%), candidate for elective OPCAB, were enrolled in this study. They were randomly assigned to two groups. One group received milrinone (50 μg/kg) intravenously and another group received a saline as placebo followed by 24 hours infusion of each agent (0.5 μg/kg/min). Short outcome of patients such as hemodynamic parameters and left ventricular ejection fraction were variables evaluated. Serum levels of creatine phosphokinase, the MB isoenzyme of creatine kinase, occurrence of arrhythmias and mean duration of mechanical ventilation were significantly lower in milrinone group (P<0.05). The mean post operative left ventricular ejection fraction was significantly higher in milrinone group (P=0.031). There were no statistical significant differences between the two groups in terms of intra-aortic balloon pump, inotropic support requirement, myocardial ischemia, myocardial infarction, duration of inotropic support, duration of intensive care unit stay, mortality and morbidity rate. Administration of milrinone in patients undergoing OPCAB with low ventricular ejection fraction is useful and effective.

Off-pump versus on-pump revascularization in females: a meta-analysis of observational studies.

PubMed

Attaran, S; Harling, L; Ashrafian, H; Moscarelli, M; Casula, R; Anderson, J; Punjabi, P; Athanasiou, T

2014-09-01

Coronary revascularization in female patients presents several challenges, including smaller target vessels and smaller conduits. Furthermore, late presentation and more co-morbidities than males may increase complication rates. The aim of this study was to assess whether off-pump coronary artery bypass (OPCAB) improves outcomes when compared to on-pump coronary artery bypass (ONCAB) in the female population. A systematic literature review identified six observational studies, incorporating 23313 patients (n=9596 OPCAB, 13717 ONCAB). These were meta-analyzed using random effects modeling. Heterogeneity, subgroup analysis, quality scoring and publication bias were assessed. The primary endpoints were 30-day mortality and major cardiac, respiratory and renal complications. Secondary endpoints were the number of grafts per patient. No statistically significant difference was observed in 30-day mortality between the OPCAB and ONCAB groups (4.8% vs. 0.7%; OR 0.96; 95% CI [0.41, 2.24], p=0.92). Significant inter-study heterogeneity was also present (I2=94%) and was not explained by study size or quality. Peri-operative myocardial infarction (OR 0.65; 95% CI [0.51, 0.84], p=0.0009) was significantly lower with OPCAB without significant heterogeneity; however, OPCAB did not significantly alter other morbidity outcomes. OPCAB was associated with a trend towards fewer grafts per patient than ONCAB. OPCAB is a safe alternative to ONCAB in the surgical revascularisation of female patients and may reduce post-operative myocardial infarction (MI). However, this does not translate into a reduction in 30-day mortality and OPCAB does not significantly improve other cardiovascular, renal or neurological outcomes. Late outcome data remains lacking and a well-structured, randomized trial is required to answer vital questions regarding the effect of OPCAB on women in the long-term. © The Author(s) 2014.

Does off-pump coronary artery bypass graft surgery have a beneficial effect on long-term mortality and morbidity compared with on-pump coronary artery bypass graft surgery?

PubMed

Chaudhry, Umar A R; Rao, Christopher; Harling, Leanne; Athanasiou, Thanos

2014-07-01

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether off-pump coronary artery bypass grafting (CABG) surgery offered superior long-term outcomes compared with on-pump CABG surgery. Best evidence papers were considered to be those that had a follow-up period of ≥5 years, had >50 patients in either cohort, did not utilize concomitant interventions nor comprised low-risk, high-risk or sub-population groups. Where potential duplicate data sets from the same institution were likely, the more credible and recently published study was included. Two hundred and fifty-six papers were found as a result of the reported search, of which 16 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The 16 studies comprised 4 prospective randomized controlled trials (RCTs), with the remaining 12 retrospective, of which 8 were propensity-score matched. All 4 RCTs contained fewer than 450 participants. Two studies concluded with a survival advantage towards on-pump CABG: one, a large registry-based study, the Veterans Affairs, with >25 000 patients, and another, a propensity-matched retrospective study involving almost 8000 patients. The remaining 14 studies all provided evidence to suggest comparable long-term survival. In addition, all other long-term outcomes mentioned within these studies including angina recurrence, myocardial infarction heart failure, need for revascularization, stroke, graft patency, cognitive and quality of life showed similar results between the two groups. We conclude that off-pump CABG surgery may have similar or slightly reduced long-term survival compared with on-pump CABG surgery. Other long-term indicators such as cardiovascular or cerebrovascular events or neuro-psychological outcomes were similar between the two groups. Despite these conclusions, the evidence is limited by substantial variability in patient selection and study methods. The CORONARY (coronary artery bypass surgery off- or on-pump revascularization study) trial recently presented results, which showed no significant differences in composite outcomes at 1 year; it will be interesting to observe whether these comparable outcomes are maintained for a much longer time frame. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

On-pump versus off-pump coronary artery bypass graft surgery among patients with type 2 diabetes in the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial†

PubMed Central

Singh, Ashima; Schaff, Hartzell V.; Mori Brooks, Maria; Hlatky, Mark A.; Wisniewski, Stephen R.; Frye, Robert L.; Sako, Edward Y.

2016-01-01

OBJECTIVES Conclusive evidence is lacking regarding the benefits and risks of performing off-pump versus on-pump coronary artery bypass graft (CABG) for patients with diabetes. This study aims to compare clinical outcomes after off-pump and on-pump procedures for patients with diabetes. METHODS The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial enrolled patients with type 2 diabetes and documented coronary artery disease, 615 of whom underwent CABG during the trial. The procedural complications, 30-day outcomes, long-term clinical and functional outcomes were compared between the off-pump and on-pump groups overall and within a subset of patients matched on propensity score. RESULTS On-pump CABG was performed in 444 (72%) patients, and off-pump CABG in 171 (28%). The unadjusted 30-day rate of death/myocardial infarction (MI)/stroke was significantly higher after off-pump CABG (7.0 vs 2.9%, P = 0.02) despite fewer complications (10.3 vs 20.7%, P = 0.003). The long-term risk of death [adjusted hazard ratio (aHR): 1.41, P = 0.2197] and major cardiovascular events (death, MI or stroke) (aHR: 1.47, P = 0.1061) did not differ statistically between the off-pump and on-pump patients. Within the propensity-matched sample (153 pairs), patients who underwent off-pump CABG had a higher risk of the composite outcome of death, MI or stroke (aHR: 1.83, P = 0.046); the rates of procedural complications and death did not differ significantly, and there were no significant differences in the functional outcomes. CONCLUSIONS Patients with diabetes had greater risk of major cardiovascular events long-term after off-pump CABG than after on-pump CABG. PMID:25968885

Neurologic complications after off-pump coronary artery bypass grafting with and without aortic manipulation: meta-analysis of 11,398 cases from 8 studies.

PubMed

Misfeld, Martin; Brereton, R John L; Sweetman, Elizabeth A; Doig, Gordon S

2011-08-01

Neurologic complications after coronary artery bypass grafting remain a concern. Off-pump coronary artery bypass grafting is a surgical strategy proposed to decrease this risk. Use of an off-pump anaortic technique, which leaves the ascending aorta untouched, may result in further reductions. This systematic review of all published evidence compares neurologic complications after anaortic off-pump coronary artery bypass grafting versus that with aortic manipulation. PubMed and Embase were searched up to August 2008. Experts were contacted, and reference lists of retrieved articles were hand searched. The search process was not limited to English-language sources. Observational studies comparing standard off-pump coronary artery bypass grafting technique with anaortic technique were eligible for inclusion if they reported neurologic complications (stroke and transient ischemic attack). Meta-analysis was conducted to assess differences between groups with regard to neurologic complications. Electronic search identified 1428 abstracts, which resulted in retrieval and detailed review of 331 full-text articles. Eight observational studies reported neurologic complications in 5619 anaortic off-pump coronary artery bypass grafting cases and 5779 cases with aortic manipulation. Postsurgical neurologic complications were significantly lower in anaortic off-pump coronary artery bypass grafting cases (odds ratio, 0.46; 95% confidence interval, 0.29-0.72; I(2) = 0.8%; P = .0008). Avoidance of aortic manipulation during off-pump coronary artery bypass grafting decreases neurologic complications relative to standard technique in which the ascending aorta is manipulated. In patients at high risk for stroke or transient ischemic attack, we recommend avoidance of aortic manipulation during off-pump coronary artery bypass grafting. Copyright © 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Sodium bicarbonate does not prevent postoperative acute kidney injury after off-pump coronary revascularization: a double-blinded randomized controlled trial.

PubMed

Soh, S; Song, J W; Shim, J K; Kim, J H; Kwak, Y L

2016-10-01

Acute kidney injury (AKI) is a common morbidity after off-pump coronary revascularization. We investigated whether perioperative administration of sodium bicarbonate, which might reduce renal injury by alleviating oxidative stress in renal tubules, prevents postoperative AKI in off-pump coronary revascularization patients having renal risk factors. Patients (n=162) having at least one of the following AKI risk factors were enrolled: (i) age >70 yr; (ii) diabetes mellitus; (iii) chronic renal disease; (iv) congestive heart failure or left ventricular ejection fraction <35%; and (v) reoperation or emergency. Patients were evenly randomized to receive either sodium bicarbonate (0.5 mmol kg -1 for 1 h upon induction of anaesthesia followed by 0.15 mmol kg -1 h -1 for 23 h) or 0.9% saline. Acute kidney injury within 48 h after surgery was assessed using the Acute Kidney Injury Network criteria. The incidences of AKI were 21 and 26% in the bicarbonate and control groups, respectively (P=0.458). Serially measured serum creatinine concentrations and perioperative fluid balance were also comparable between the groups. The length of postoperative hospitalization and incidence of morbidity end points were similar between the groups, whereas significantly more patients in the bicarbonate group required prolonged mechanical ventilation (>24 h) relative to the control group (20 vs 6, P=0.003). Perioperative sodium bicarbonate administration did not decrease the incidence of AKI after off-pump coronary revascularization in high-risk patients and might even be associated with a need for prolonged ventilatory care. NCT01840241. © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Effects of glargine insulin on glycemic control in patients with diabetes mellitus type II undergoing off-pump coronary artery bypass graft.

PubMed

Gandhi, Hemang; Sarvaia, Alpesh; Malhotra, Amber; Acharya, Himanshu; Shah, Komal; Rajavat, Jeevraj

2018-01-01

The prevalence of diabetes mellitus in patients requiring coronary artery bypass grafting (CABG) is noticeably high (20%-30%). These patients have inferior perioperative outcome, reduced long-term survival, and high risk of recurrent episodes of angina. To improve perioperative outcome surgical unit defined satisfactory glycemic control is desired during this period. Hence, the aim of our study is to compare the efficacy of glargine insulin combination with continuous human insulin infusion for perioperative glycemic control in patients with diabetes undergoing CABG. Fifty Patients, who were posted for off-pump CABG with diabetes mellitus type II, were randomized in two group, Group I normal saline + human insulin infusion during the perioperative period, Group II (glargine group): Glargine + human insulin infusion during perioperative period. During surgery and in the postoperative period, random blood sugar and human insulin requirement are significantly higher in control group than glargine group. Other infection, step-up antibiotics, intensive care unit (ICU) stay, and hospital stay were significantly higher in control groups in postoperative period. Our study results suggest that glargine effectively manages blood glucose level with significantly greater control over postoperative morbidity.

Experimental demonstration of localized Brillouin gratings with low off-peak reflectivity established by perfect Golomb codes.

PubMed

Antman, Yair; Yaron, Lior; Langer, Tomi; Tur, Moshe; Levanon, Nadav; Zadok, Avi

2013-11-15

Dynamic Brillouin gratings (DBGs), inscribed by comodulating two writing pump waves with a perfect Golomb code, are demonstrated and characterized experimentally. Compared with pseudo-random bit sequence (PRBS) modulation of the pump waves, the Golomb code provides lower off-peak reflectivity due to the unique properties of its cyclic autocorrelation function. Golomb-coded DBGs allow the long variable delay of one-time probe waveforms with higher signal-to-noise ratios, and without averaging. As an example, the variable delay of return-to-zero, on-off keyed data at a 1 Gbit/s rate, by as much as 10 ns, is demonstrated successfully. The eye diagram of the reflected waveform remains open, whereas PRBS modulation of the pump waves results in a closed eye. The variable delay of data at 2.5 Gbit/s is reported as well, with a marginally open eye diagram. The experimental results are in good agreement with simulations.

A randomized controlled trial of the Arctic Sun Temperature Management System versus conventional methods for preventing hypothermia during off-pump cardiac surgery.

PubMed

Grocott, Hilary P; Mathew, Joseph P; Carver, Elizabeth H; Phillips-Bute, Barbara; Landolfo, Kevin P; Newman, Mark F

2004-02-01

In this trial we compared the hypothermia avoidance abilities of the Arctic Sun Temperature Management System (a servo-regulated system that circulates temperature-controlled water through unique energy transfer pads adherent to the patient's body) with conventional temperature control methods. Patients undergoing off-pump coronary artery bypass (OPCAB) surgery were randomized to either the Arctic Sun System alone (AS group) or conventional methods (control group; increased room temperature, heated IV fluids, convective forced air warming system) for the prevention of hypothermia (defined by a temperature <36 degrees C). The AS group had nasopharyngeal temperature servo-regulated to a target of 36.8 degrees C. Temperature was recorded throughout the operative period and comparisons were made between groups for both the time and area under the curve (AUC) for a temperature <36 degrees C (AUC<36 degrees C). Twenty-nine patients (AS group = 14, control group = 15) were studied. The AS group had significantly less hypothermia than the control group, both for duration of time <36 degrees C (2.5 [0-22] min, median [interquartile range] AS group versus 118 [49-192] min, control group; P = 0.0008) as well as for AUC<36 degrees C (0.3 [0-2.2] degrees C x min, AS group versus 17.1 [3.6-173.4] degrees C x min, control group; P = 0.002). The Arctic Sun Temperature Management System significantly reduced intraoperative hypothermia during OPCAB surgery. Importantly, this was achieved in the absence of any other temperature modulating techniques, including the use of IV fluid warming or increases in the ambient operating room temperature. The Arctic Sun Temperature Management System was more effective than conventional methods in preventing hypothermia during off-pump coronary artery bypass graft surgery.

Early outcomes of on-pump versus off-pump coronary artery bypass grafting.

PubMed

Hussain, Ghulam; Azam, Hammad; Baig, Mirza Ahmad Raza; Ahmad, Naseem

2016-01-01

To see the early post-operative outcomes of off-pump versus on-pump coronary artery bypass graft surgery. This retrospective analytical study was conducted at Ch. Pervaiz Elahi Institute of Cardiology Multan, Pakistan. Our Primary outcome variables were; necessity of inotropic support, nonfatal myocardial infarction, ICU stay, nonfatal stroke, new renal failure requiring dialysis and death within 30 days after operation. There were two groups of patients; Group-I (On-pump group) and Group-II (Off-pump Group). SPSS V17 was used for data analysis. Independent sample t-test and Mann Whitney U test were used to compare quantitative Variables. Chi-square test and Fisher's exact test were used to analyze qualitative variables. P-value ≤ 0.05 was considered significant. Three hundred patients were included in this study. There were no significant difference regarding risk factors except hyper-cholestrolemia which was high in off pump group (p-value 0.05). Angiographic and Echocardiographic characteristics e.g. preoperative ejection fraction, LV function grade and severity of CAD was same between the groups. Mortality risk scores and Priority status for surgery were also same. Regarding post-operative outcomes; Post-op CKMB Levels, need and duration of inotropic support, mechanical ventilation time and ICU stay was significantly less in Off-Pump group (p-value 0.001, <0.0001, 0.006, 0.025 and 0.001 resp.). Peri-operative chest drainage was significantly high in On-pump CABG group (p-value 0.027). Incidence of post-op complications was not statistically different between the groups. At 30 days follow-up, Incidence of myocardial infarction, necessity and duration of inotropic support, ICU stay period and peri-operative bleeding were significantly less in off-pump group. The incidence of neurologic, pulmonary and renal complications was same between the off-pump and on-pump groups.

Early outcomes of on-pump versus off-pump coronary artery bypass grafting

PubMed Central

Hussain, Ghulam; Azam, Hammad; Baig, Mirza Ahmad Raza; Ahmad, Naseem

2016-01-01

Objectives: To see the early post-operative outcomes of off-pump versus on-pump coronary artery bypass graft surgery. Methods: This retrospective analytical study was conducted at Ch. Pervaiz Elahi Institute of Cardiology Multan, Pakistan. Our Primary outcome variables were; necessity of inotropic support, nonfatal myocardial infarction, ICU stay, nonfatal stroke, new renal failure requiring dialysis and death within 30 days after operation. There were two groups of patients; Group-I (On-pump group) and Group-II (Off-pump Group). SPSS V17 was used for data analysis. Independent sample t-test and Mann Whitney U test were used to compare quantitative Variables. Chi-square test and Fisher’s exact test were used to analyze qualitative variables. P-value ≤ 0.05 was considered significant. Results: Three hundred patients were included in this study. There were no significant difference regarding risk factors except hyper-cholestrolemia which was high in off pump group (p-value 0.05). Angiographic and Echocardiographic characteristics e.g. preoperative ejection fraction, LV function grade and severity of CAD was same between the groups. Mortality risk scores and Priority status for surgery were also same. Regarding post-operative outcomes; Post-op CKMB Levels, need and duration of inotropic support, mechanical ventilation time and ICU stay was significantly less in Off-Pump group (p-value 0.001, <0.0001, 0.006, 0.025 and 0.001 resp.). Peri-operative chest drainage was significantly high in On-pump CABG group (p-value 0.027). Incidence of post-op complications was not statistically different between the groups. Conclusions: At 30 days follow-up, Incidence of myocardial infarction, necessity and duration of inotropic support, ICU stay period and peri-operative bleeding were significantly less in off-pump group. The incidence of neurologic, pulmonary and renal complications was same between the off-pump and on-pump groups. PMID:27648039

Advantages of autologous blood transfusion in off-pump coronary artery bypass.

PubMed

Ela, Yuksel; Emmiler, Mustafa; Kocogullari, Cevdet Ugur; Terzi, Yuksel; Sivaci, Remziye Gul; Cekirdekci, Ahmet

2009-10-01

In this randomized controlled study, we investigated the effects of autologous Hemobag blood transfusion (AHBT) and allogenic blood transfusion (ABT) in off-pump coronary artery bypass (OPCAB) surgery. Sixty patients who underwent surgery between February 2008 and August 2008 were randomized into 2 groups. The AHBT group (n = 30) consisted of patients who received autologous Hemobag blood transfusion, and the ABT group (n = 30) consisted of patients who received allogenic blood transfusion. All patients underwent OPCAB via sternotomy. The time to extubation, chest tube drainage volume, postoperative white blood cell counts, amount of blood transfusion, sedimentation rate, C-reactive protein concentration, postoperative temperature, and the presence of atelectasis were recorded in the intensive care unit. Intraoperative bleeding and fluid resuscitation were similar in the 2 groups (P > .05); however, there were significant decreases in postoperative blood loss, extubation period, postoperative white cell counts, sedimentation rate, incidence of atelectasis, C-reactive protein, and fever in the AHBT group compared with the ABT group (P < .05). The rate of atrial fibrillation in the AHBT group tended to be lower than in the ABT group. Autologous blood transfusion in OPCAB may be beneficial in certain cardiac surgery patients; however, these beneficial effects require further study to be proved.

The dependency of expiratory airway collapse on pump system and flow rate in liquid ventilated rabbits.

PubMed

Meinhardt, J P; Ashton, B A; Annich, G M; Quintel, M; Hirschl, R B

2003-05-30

To evaluate the influence of pump system and flow pattern on expiratory airway collapse (EAC) in total perfluorocarbon ventilation. - Prospective, controlled, randomized animal trial for determination of (1) post-mortem changes by repeated expiration procedures (EP) with a constant flow piston pump (PP) before and after sacrifice (n = 8 rabbits), (2) differences between pump systems by subjecting animals to both PP and roller pump (RP) circuits for expiration (n = 16 rabbits). EP were performed using a servo-controlled shut-off at airway pressures < 25 cm H subset 2O randomly with either pump at different flows. - Expired volumes before and after sacrifice were not significantly different. PP and RP revealed identical mean flows, while significantly more liquid was drained using PP (p<0.05). Increasing differences towards higher flow rates indicated profound flow pulsatility in RP. - (1) post-mortem changes in expired volumes are not significant, (2) EAC is related to flow rate and pump system; (3) relationship between expiratory flow rate and drainable liquid volume is linear inverse; (4) PP provides higher drainage than RP. - Expiratory airway collapse is related to flow rate and pump system, post mortem changes in expirable volumes are not significant. Relationship between expiratory flow rate and drainable liquid volume is linear inverse, piston pump expiration provides higher drainage volumes than roller pump expiration.

Does off-pump coronary surgery reduce morbidity and mortality?

PubMed

Sabik, Joseph F; Gillinov, A Marc; Blackstone, Eugene H; Vacha, Catherine; Houghtaling, Penny L; Navia, Jose; Smedira, Nicholas G; McCarthy, Patrick M; Cosgrove, Delos M; Lytle, Bruce W

2002-10-01

To compare hospital outcomes of on-pump and off-pump coronary artery bypass surgery. From 1997 to 2000, primary coronary artery bypass grafting was performed in 481 patients off pump and in 3231 patients on pump. Hospital outcomes were compared between propensity-matched pairs of 406 on-pump and 406 off-pump patients. The 2 groups were similar in age (P =.9), left ventricular function (P =.7), extent of coronary artery disease (P =.5), carotid artery disease (P =.4), and chronic obstructive pulmonary disease (P =.5). However, off-pump patients had more previous strokes (P =.05) and peripheral vascular disease (P =.02); on-pump patients had a higher preoperative New York Heart Association class (P =.01). In the matched pairs the mean number of bypass grafts was 2.8 +/- 1.0 in off-pump patients and 3.5 +/- 1.1 in on-pump patients (P <.001). Fewer grafts were performed to the circumflex (P <.001) and right coronary (P =.006) artery systems in the off-pump patients. Postoperative mortality, stroke, myocardial infarction, and reoperation for bleeding were similar in the 2 groups. There was more encephalopathy (P =.02), sternal wound infection (P =.04), red blood cell use (P =.002), and renal failure requiring dialysis (P =.03) in the on-pump patients. Both off- and on-pump procedures produced excellent early clinical results with low mortality. An advantage of an off-pump operation was less postoperative morbidity; however, less complete revascularization introduced uncertainty about late results. A disadvantage of on-pump bypass was higher morbidity that seemed attributable to cardiopulmonary bypass.

Short-term clinical outcomes after off-pump coronary artery bypass grafting at a single Veterans Affairs Medical Center.

PubMed

Lushaj, Entela B; Schreiner, Athanasia; Jonuzi, Besa; Badami, Abbasali; DeOliveira, Nilto; Lozonschi, Lucian

2016-05-17

We retrospectively assessed the outcomes after coronary revascularization at a single Veterans Affairs Medical Center when a strategy of assigning higher risk patients to off-pump coronary artery bypass grafting (CABG) was employed. Over a 5 year period all consecutive patients that underwent CABG at our VA Medical Center were assigned to a surgeon who either performs the CABG exclusively off-pump or to one who performed the CABG on-pump. The higher risk patients were assigned preferentially for off-pump revascularization. VASQIP (VA Hospitals Surgical Quality Improvement Program) data between 10/2007 and 12/2012 were retrospectively reviewed at our VA Medical Center and the short term outcomes were assessed. A total of 252 consecutive patients underwent off-pump CABG (n = 170) and on-pump CABG (n = 82). There were significantly more patients with low LVEF (<45 %; p = 0.008) and cerebrovascular disease in the off-pump group (p = 0.024). The number of patients smoking at the time of surgery was significantly higher in the off-pump group (p = 0.002) as well. The 30-day composite morbidity and mortality was 6 % for all CABG patients and significantly lower with off-pump vs. on-pump CABG (3.5 % vs. 11 %; p = 0.019). There were no conversions from off-pump to on-pump surgery. A selective strategy to direct higher risk patients towards an off-pump revascularization yielded favorable outcomes in an unselected veteran population treated at a single VA Medical Center over a 5 year period.

Reduction in duration of hypoglycemia by automatic suspension of insulin delivery: the in-clinic ASPIRE study.

PubMed

Garg, Satish; Brazg, Ronald L; Bailey, Timothy S; Buckingham, Bruce A; Slover, Robert H; Klonoff, David C; Shin, John; Welsh, John B; Kaufman, Francine R

2012-03-01

The efficacy of automatic suspension of insulin delivery in induced hypoglycemia among subjects with type 1 diabetes was evaluated. In this randomized crossover study, subjects used a sensor-augmented insulin pump system with a low glucose suspend (LGS) feature that automatically stops insulin delivery for 2 h following a sensor glucose (SG) value ≤70 mg/dL. Subjects fasted overnight and exercised until their plasma glucose (measured with the YSI 2300 STAT Plus™ glucose and lactate analyzer [YSI Life Sciences, Yellow Springs, OH]) value reached ≤85 mg/dL on different occasions separated by washout periods lasting 3-10 days. Exercise sessions were done with the LGS feature turned on (LGS-On) or with continued insulin delivery regardless of SG value (LGS-Off). The order of LGS-On and LGS-Off sessions was randomly assigned. YSI glucose data were used to compare the duration and severity of hypoglycemia from successful LGS-On and LGS-Off sessions and to estimate the risk of rebound hyperglycemia after pump suspension. Fifty subjects attempted 134 sessions, 98 of which were successful. The mean±SD hypoglycemia duration was less during LGS-On than during LGS-Off sessions (138.5±76.68 vs. 170.7±75.91 min, P=0.006). During LGS-On compared with LGS-Off sessions, mean nadir YSI glucose was higher (59.5±5.72 vs. 57.6±5.69 mg/dL, P=0.015), as was mean end-observation YSI glucose (91.4±41.84 vs. 66.2±13.48 mg/dL, P<0.001). Most (53.2%) end-observation YSI glucose values in LGS-On sessions were in the 70-180 mg/dL range, and none was >250 mg/dL. Automatic suspension of insulin delivery significantly reduced the duration and severity of induced hypoglycemia without causing rebound hyperglycemia.

On pump versus off pump coronary artery bypass grafting in patients with end-stage renal disease and coronary artery disease - A nation-wide, propensity score matched database analyses.

PubMed

Chen, Jien-Jiun; Lin, Lian-Yu; Yang, Yao-Hsu; Hwang, Juey-Jen; Chen, Pau-Chung; Lin, Jiunn-Lee; Chi, Nai-Hsin

2017-01-15

The usage of on or off cardiopulmonary bypass in patients with coronary artery disease receiving coronary artery bypass grafting (CABG) surgery had been debated and had not yet been investigated thoroughly in patients with end-stage renal disease (ESRD). We aimed to study cardiovascular outcomes and total mortality in these patients by using our National Health Insurance (NHI) database. By using our NHI ESRD claim database, we searched ESRD patients aged more than 18years, who received CABG and divided them into on pump and off pump groups. Baseline characteristics and underlying comorbidities were identified from the database. Propensity score (PS) method was used to match all the potential confounders between patients. Outcomes including mortality, myocardial infarction, stroke and repeat revascularization within 30days, 1year and whole follow-up period were also obtained. A total of 134,410 ESRD patients were identified in the database. We included 341 patients and 543 patients who received off pump and on pump CABG respectively. The hazard ratios of different outcomes at 30days, 1year and a median of 745days after CABG did not show significant different between on, or off pump groups before and after PS match. ESRD patients with CAD undergoing either on pump or off pump CABG surgery showed similar outcomes in 30days, 1year and whole follow-up period. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Prevention of Hypoglycemia With Predictive Low Glucose Insulin Suspension in Children With Type 1 Diabetes: A Randomized Controlled Trial.

PubMed

Battelino, Tadej; Nimri, Revital; Dovc, Klemen; Phillip, Moshe; Bratina, Natasa

2017-06-01

To investigate whether predictive low glucose management (PLGM) of the MiniMed 640G system significantly reduces the rate of hypoglycemia compared with the sensor-augmented insulin pump in children with type 1 diabetes. This randomized, two-arm, parallel, controlled, two-center open-label study included 100 children and adolescents with type 1 diabetes and glycated hemoglobin A 1c ≤10% (≤86 mmol/mol) and using continuous subcutaneous insulin infusion. Patients were randomly assigned to either an intervention group with PLGM features enabled (PLGM ON) or a control group (PLGM OFF), in a 1:1 ratio, all using the same type of sensor-augmented insulin pump. The primary end point was the number of hypoglycemic events below 65 mg/dL (3.6 mmol/L), based on sensor glucose readings, during a 14-day study treatment. The analysis was performed by intention to treat for all randomized patients. The number of hypoglycemic events below 65 mg/dL (3.6 mmol/L) was significantly smaller in the PLGM ON compared with the PLGM OFF group (mean ± SD 4.4 ± 4.5 and 7.4 ± 6.3, respectively; P = 0.008). This was also true when calculated separately for night ( P = 0.025) and day ( P = 0.022). No severe hypoglycemic events occurred; however, there was a significant increase in time spent above 140 mg/dL (7.8 mmol/L) in the PLGM ON group ( P = 0.0165). The PLGM insulin suspension was associated with a significantly reduced number of hypoglycemic events. Although this was achieved at the expense of increased time in moderate hyperglycemia, there were no serious adverse effects in young patients with type 1 diabetes. © 2017 by the American Diabetes Association.

On- vs. off-pump coronary artery bypass grafting: A systematic review and meta-analysis.

PubMed

Dieberg, Gudrun; Smart, Neil A; King, Nicola

2016-11-15

To reduce complications during coronary artery bypass grafting (CABG) off-pump CABG was introduced; however, results have been mixed. The aim of this work was to conduct a systematic review and meta-analysis of off-pump vs. on-pump CABG. To identify potential studies systematic searches were carried out using various databases. The search strategy included the key concepts of "cardiopulmonary bypass" AND "coronary artery bypass grafting" AND "off pump". This was followed by a meta-analysis investigating post-operative atrial fibrillation, myocardial infarction, ≤30day mortality, stroke, ventilation time, intensive care unit (ICU) stay and hospital stay. Fifty four studies (59 intervention groups), totalling 16,261 participants were analysed. Off pump CABG led to a significantly lower incidence of post-operative atrial fibrillation odds ratio (OR) 0.87 (95% confidence interval [CI] 0.78 to 0.97, p=0.01), but no differences in either myocardial infarction OR 0.98 (95% CI 0.82 to 1.15, p=0.77) or ≤30day mortality OR 0.85 (95% CI 0.68 to 1.06, p=0.16). There was a strong trend towards a reduced incidence of stroke OR 0.77 (95% CI 0.59 to 1.00, p=0.05); however this did not quite reach significance. Ventilation time mean difference (MD) -3.78h (95% CI -4.75 to -2.82, p<0.00001); ICU stay MD -0.34days (95% CI -0.50 to -0.17, p<0.0001); and hospital stay MD -0.9days (95% CI -1.25 to -0.56, p<0.00001) were all significantly shorter in the off-pump group. Off-pump CABG has some benefits over on-pump CABG, particularly in relation to post-operative atrial fibrillation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Off-pump versus on-pump coronary artery revascularization: effects on pulmonary function.

PubMed

e Silva, Ana M R P; Saad, Roberto; Stirbulov, Roberto; Rivetti, Luiz A

2010-07-01

Many studies have shown important changes in lung function tests after coronary artery surgeries. It is controversial if off-pump surgery can give a better and shorter recovery than the on-pump. A prospective study was conducted on 42 patients submitted to coronary artery surgery and divided into two groups: 21 off-pump using intraluminal shunt (G (I)) and 21 on-pump (G (II)), matched by the anatomical location of the coronary arteries lesions. All patients had spirometric evaluation, blood gas measurements and alveolo-arterial oxygen gradient (A-aDO(2)), at the fourth and 10th postoperative days (PO(4) and PO(10)). Preoperatively, G(I) and G(II) had similar results (P>0.372). Spirometry showed decreases at PO(4) and remained decreased until PO(10) for both groups, with significant differences between the groups. The blood gas measurements showed reduction in arterial oxygen pressure (PaO(2)) and carbon dioxide pressure (PaCO(2)), while there was an increase in A-aDO(2) at PO(4) and PO(10) in both groups. The results suggest that different changes occur in pulmonary function when the surgery is performed with or without cardiopulmonary bypass. The off-pump patients showed significantly greater improvement than the on-pump group.

Thermo-wrap technology preserves normothermia better than routine thermal care in patients undergoing off-pump coronary artery bypass and is associated with lower immune response and lesser myocardial damage.

PubMed

Nesher, Nahum; Uretzky, Gideon; Insler, Steven; Nataf, Patrick; Frolkis, Inna; Pineau, Emmanuelle; Cantoni, Emmanuel; Bolotin, Gil; Vardi, Moshe; Pevni, Dimitry; Lev-Ran, Oren; Sharony, Ram; Weinbroum, Avi A

2005-06-01

Perioperative hypothermia might be detrimental to the patient undergoing off-pump coronary artery bypass surgery. We assessed the efficacy of the Allon thermoregulation system (MTRE Advanced Technologies Ltd, Or-Akiva, Israel) compared with that of routine thermal care in maintaining normothermia during and after off-pump coronary artery bypass surgery. Patients undergoing off-pump coronary artery bypass surgery were perioperatively and randomly warmed with the 2 techniques (n = 45 per group). Core temperature, hemodynamics, and troponin I, interleukin 6, interleukin 8, and interleukin 10 blood levels were assessed. The mean temperature of the patients in the Allon thermoregulation system group (AT group) was significantly ( P < .005) higher than that of the patients receiving routine thermal care (the RTC group); less than 40% of the latter reached 36 degrees C compared with 100% of the former. The cardiac index was higher and the systemic vascular resistance was lower ( P < .05) by 16% and 25%, respectively, in the individuals in the AT group compared with in the individuals in the RTC group during the 4 postoperative hours. End-of-surgery interleukin 6 levels and 24-hour postoperative troponin I levels were significantly ( P < .01) lower in the patients in the AT group than in the RTC group. The RTC group's troponin levels closely correlated with their interleukin 6 levels at the end of the operation ( R = 0.51, P = .002). Unlike routine thermal care, the Allon thermoregulation system maintains core normothermia in more than 80% of patients undergoing off-pump coronary artery bypass surgery. Normothermia is associated with better cardiac and vascular conditions, a lower cardiac injury rate, and a lower inflammatory response. The close correlation between the increased interleukin 6 and troponin I levels in the routine thermal care group indicates a potential deleterious effect of lowered temperature on the patient's outcome.

Preoperative intra-aortic counterpulsation in high-risk patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials†.

PubMed

Pilarczyk, Kevin; Boening, Andreas; Jakob, Heinz; Langebartels, Georg; Markewitz, Andreas; Haake, Nils; Heringlake, Matthias; Trummer, Georg

2016-01-01

In contrast to the results of previous studies, recent randomized controlled trials (RCTs) failed to show a benefit of prophylactic aortic counterpulsation in high-risk patients undergoing cardiac surgery. The present analysis aims to redefine the effects of this treatment modality in the light of this new evidence. MEDLINE, EMBASE, CENTRAL/CCTR, Google Scholar and reference lists of relevant articles were searched for full-text articles of RCTs in English or German. Assessments for eligibility, relevance, study validity and data extraction were performed by two reviewers independently using prespecified criteria. The primary outcome was hospital mortality. A total of nine eligible RCTs with 1171 patients were identified: 577 patients were treated preoperatively with intra-aortic balloon pump (IABP) and 594 patients served as controls. The pooled odds ratio (OR) for hospital mortality (22 hospital deaths in the intervention arm, 54 in the control group) was 0.381 (95% CI 0.230-0.629; P < 0.001). The pooled analyses of five RCTs including only patients undergoing isolated on-pump coronary artery bypass grafting (n[IABP] = 348, n[control] = 347) also showed a statistically significant improvement in mortality for preoperative IABP implantation (fixed-effects model: OR 0.267, 95% CI 0.129-0.552, P < 0.001). The pooled OR for hospital mortality from two randomized off-pump trials was 0.556 (fixed-effects model, 95% CI 0.207-1.493, P = 0.226). Preoperative aortic counterpulsation was associated with a significant reduction in low cardiac output syndrome (LCOS) in the total population (fixed-effects model: OR 0.330, 95% CI 0.214-0.508, P < 0.001) as well as in the subgroup of CAGB patients (fixed-effects model: OR 0.113, 95% CI 0.056-0.226, P < 0.001), whereas there was no benefit in the off-pump population (fixed-effects model: OR 0.555, 95% CI 0.209-1.474, P = 0.238). Preoperative IABP implantation was associated with a reduction of intensive care unit (ICU) stay in all investigated populations with a greater effect in the total population [fixed-effects model: standard mean difference (SMD) -0.931 ± 0.198, P < 0.001] as well as in the subgroup of CAGB patients (fixed-effects model: SMD -1.240 ± 0.156, P < 0.001), compared with the off-pump group (fixed-effects model: SMD -0.723 ± 0.128, P < 0.001). Despite contradictory results from recent trials, the present study confirms the findings of previous meta-analyses that prophylactic aortic counterpulsation reduces hospital mortality, incidence of LCOS and ICU requirement in high-risk patients undergoing on-pump cardiac surgery. However, owing to small sample sizes and the lack of a clear-cut definition of high-risk patients, an adequately powered, prospective RCT is necessary to find a definite answer to the question, if certain groups of patients undergoing cardiac surgery benefit from a prophylactic IABP insertion. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Sub-xyphoid pleural drain as a determinant of functional capacity and clinical results after off-pump coronary artery bypass surgery: a randomized clinical trial.

PubMed

Guizilini, Solange; Alves, Daniel F; Bolzan, Douglas W; Cancio, Andreia S A; Regenga, Marisa M; Moreira, Rita S L; Trimer, Renata; Gomes, Walter J

2014-09-01

The aim of this trial was to compare functional capacity, pulmonary shunt fraction and clinical outcomes between patients undergoing pleurotomy with a pleural drain inserted in the sub-xyphoid position and patients with a pleural drain placed in the intercostal position after off-pump coronary artery bypass surgery. Patients were randomized into two groups according to the pleural drain site: Group II (n = 33 intercostal pleural drain); and Group SI (n = 35 sub-xyphoid pleural drain). Functional capacity was assessed by the distance covered on the 6-min walking test performed preoperatively and on postoperative day (POD) 5; in addition, pulmonary function test was determined preoperatively and on POD 1 and 5. Pulmonary shunt fraction was evaluated preoperatively and on POD 1, and clinical outcomes were recorded throughout the study. Group SI had better preservation of lung volumes and capacities in POD compared with Group II (P <0.05). Pulmonary shunt fraction increased in both groups postoperatively; however, Group SI showed a smaller pulmonary shunt fraction (0.26 ± 0.04 vs 0.21 ± 0.04%; P = 0.0014). Functional capacity was significantly reduced in both groups on POD 5; however, Group SI showed better preservation of functional capacity (P = 0.0001). Group SI had better postoperative clinical results, with lower incidence of atelectasis and pleural effusion (P <0.05), lower pain scores (P <0.0001), and shorter orotracheal intubation and hospitalization lengths (P <0.001). Sub-xyphoid pleural drain determined better functional capacity and exercise tolerance with a smaller pulmonary shunt fraction and improved clinical outcomes compared with intercostal pleural drainage after off-pump coronary artery bypass surgery. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

The systemic factor: the comparative roles of cardiopulmonary bypass and off-pump surgery in the genesis of patient injury during and following cardiac surgery.

PubMed

Menasché, P

2001-12-01

There is compelling evidence that off-pump coronary artery bypass operations are associated with reduced circulating levels of inflammatory mediators. Whereas complement activation and release of acute-phase reactants such as interleukin-6 are still expected to occur as consequences of a nonbypass-related general surgical trauma, a major feature of off-pump surgery seems to be a decreased production of interleukin-8, which may have important practical implications because of the participation of this cytokine in neutrophil trafficking and myocardial injury. The scarcity of carefully controlled, randomized trials precludes firm conclusions regarding the extent to which these biological changes translate into meaningful improvements in clinical outcomes. The problem is further complicated by the fact that the adverse effects of cardiopulmonary bypass largely depend on a genetically controlled balance between proinflammatory and antiinflammatory mediators. Currently, it is still impossible to predict, in a given patient, the side toward which this balance will be shifted. Nevertheless, accumulating experience identifies patient subgroups who may greatly benefit from avoiding extracorporeal circulation. These subsets include patients with severe extracardiac comorbidities (in particular, renal failure) and, possibly, patients with advanced left ventricular dysfunction, who may poorly tolerate superimposed, bypass-related, inflammatory tissue injuries.

Effect of Perioperative Pregabalin on Postoperative Quality of Recovery in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting (OPCABG): A Prospective, Randomized, Double-Blind Trial.

PubMed

Borde, Deepak Prakash; Futane, Savani Sameer; Asegaonkar, Balaji; Apsingekar, Pramod; Khade, Sujeet; Khodve, Bapu; Puranik, Manish; George, Antony; Joshi, Shreedhar

2017-08-01

Use of pregabalin is increasing in cardiac surgical patients. However, studies using comprehensive scoring systems are lacking on the drug's impact on postoperative recovery. The authors tested the hypothesis that perioperative oral pregabalin improves the postoperative quality of recovery as assessed using the Quality of Recovery (QoR-40) questionnaire in patients undergoing off-pump coronary artery bypass grafting (OPCABG). This was a randomized, double-blind, placebo-controlled study. Tertiary-care hospital. Patients undergoing OPCABG. Patients were assigned randomly to the following 2 groups: the pregabalin group (those who received pregabalin, 150 mg capsule orally, 1 hour before surgery and 2 days postoperatively [75 mg twice a day] starting after extubation; n = 37); and the control group (those who received 2 similar-looking multivitamin capsules at similar times; n = 34). The QoR-40 scores were noted preoperatively and 24 hours after extubation. Both groups were comparable in terms of preoperative patient characteristics and baseline QoR-40 scores. Global scores were significantly improved in the pregabalin group compared with the control group in the postoperative period (177±9 v 170±9; p = 0.002). QoR-40 values in the dimensions of emotional state (p = 0.005), physical comfort (p = 0.04), and pain (p = 0.02) were improved in the pregabalin group. Perioperative pregabalin improved postoperative quality of recovery as assessed using the QoR-40 questionnaire in patients undergoing OPCABG. Perioperative pregabalin offered advantages beyond better pain control, such as improved physical comfort and better emotional state; therefore, the drug's use in the perioperative period is recommended. Copyright © 2017 Elsevier Inc. All rights reserved.

Effects of preoperative aspirin on perioperative platelet activation and dysfunction in patients undergoing off-pump coronary artery bypass graft surgery: A prospective randomized study.

PubMed

Lee, Jiwon; Jung, Chul-Woo; Jeon, Yunseok; Kim, Tae Kyong; Cho, Youn Joung; Koo, Chang-Hoon; Choi, Yoon Hyeong; Kim, Ki-Bong; Hwang, Ho Young; Kim, Hang-Rae; Park, Ji-Young

2017-01-01

The benefit of aspirin use after coronary artery bypass graft surgery has been well proven. However, the effect of preoperative aspirin use in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB) has not been evaluated sufficiently. To evaluate platelet function changes during OPCAB due to preoperative aspirin use, we conducted a randomized controlled trial using flow cytometry and the Multiplate® analyzer. Forty-eight patients scheduled for elective OPCAB were randomized to the aspirin continuation (100 mg/day until operative day) and discontinuation (4 days before the operative day) groups. Platelet function was measured using the platelet activation markers CD62P, CD63, and PAC-1 by flow cytometry, and platelet aggregation was measured using the Multiplate® analyzer, after the induction of anesthesia (baseline), at the end of the operation, and 24 and 48 h postoperatively. Findings of conventional coagulation assays, thromboelastography by ROTEM® assays, and postoperative bleeding-related clinical outcomes were compared between groups. No significant change in CD62P, CD63, or PAC-1 was observed at the end of the operation or 24 or 48 h postoperatively compared with baseline in either group. The area under the curve for arachidonic acid-stimulated platelet aggregation, measured by the Multiplate® analyzer, was significantly smaller in the aspirin continuation group (P < 0.01). However, chest tube drainage and intraoperative and postoperative transfusion requirements did not differ between groups. Our study showed that preoperative use of aspirin for OPCAB did not affect perioperative platelet activation, but it impaired platelet aggregation, which did not affect postoperative bleeding, by arachidonic acid.

Clinical outcome and quality of life after reoperative CABG: off-pump versus on-pump – observational pilot study

PubMed Central

2013-01-01

Background Coronary artery bypass grafting (CABG) on cardiopulmonary bypass (CBP) is associated with significant morbidity and mortality. In high-risk patients, doomed for reoperation the adverse effects of CBP may be more striking. We evaluated the results of reoperative CABG (redo-CABG) by either off-pump (OPCAB) or on-pump (ONCAB). Clinical endpoints were perioperative myocardial infarction, mortality, survival and as the most striking difference between prior studies the quality of life (QoL). Methods We performed a prospective, non-randomized assessment for patients who underwent redo-CABG by redo-OPCAB (n = 40) or redo-ONCAB (n = 40) at our institution between January 2007 and December 2010. For evaluation of QoL the SF-36 health survey was used with self-administered assessment. Results During follow-up 37 of 40 patients were alive in the redo-OPCAB group versus 32 of 40 patients in the redo-ONCAB group (p < 0.05). The shorter operation time, less blood loss, fewer perioperative myocardial infarctions, the higher rate of totally arterial revascularisation and shorter intensive care stay were the significantly beneficial differences for patients in the redo-OPCAB group (p < 0.05). The 3-year survival rate was higher in the redo-OPCAB group with 81 ± 12% versus 63 ± 9%in the redo-ONCAB group. The quality of life survey did not reveal any significant differences between both groups. Conclusion In conclusion, with our present retrospective study, we could demonstrate the safety and efficacy of the redo-OPCAB technique with even higher 3-year survival rate. Both techniques seem to have similar impact on the outcome of patients. PMID:23561396

Dynamic analysis of a pumped-storage hydropower plant with random power load

NASA Astrophysics Data System (ADS)

Zhang, Hao; Chen, Diyi; Xu, Beibei; Patelli, Edoardo; Tolo, Silvia

2018-02-01

This paper analyzes the dynamic response of a pumped-storage hydropower plant in generating mode. Considering the elastic water column effects in the penstock, a linearized reduced order dynamic model of the pumped-storage hydropower plant is used in this paper. As the power load is always random, a set of random generator electric power output is introduced to research the dynamic behaviors of the pumped-storage hydropower plant. Then, the influences of the PI gains on the dynamic characteristics of the pumped-storage hydropower plant with the random power load are analyzed. In addition, the effects of initial power load and PI parameters on the stability of the pumped-storage hydropower plant are studied in depth. All of the above results will provide theoretical guidance for the study and analysis of the pumped-storage hydropower plant.

Off-pump versus on-pump coronary artery bypass surgery in patients with actively treated diabetes and multivessel coronary disease.

PubMed

Benedetto, Umberto; Caputo, Massimo; Vohra, Hunaid; Davies, Alan; Hillier, James; Bryan, Alan; Angelini, Gianni D

2016-11-01

We conducted a single-center analysis on short-term outcomes and long-term survival in actively treated diabetic patients undergoing off-pump coronary artery bypass versus on-pump coronary artery bypass surgery. The final population consisted of 2450 patients with actively treated diabetes (mean age, 66 ± 9 years; female/male 545/1905, 22%). Of those, 1493 subjects were orally treated and 1011 subjects were taking insulin. Off-pump coronary artery bypass and on-pump coronary artery bypass were performed in 1253 and 1197 patients, respectively. Propensity score matching was used to compare the 2 matched groups. When compared with on-pump coronary artery bypass, off-pump coronary artery bypass was associated with a significant risk reduction for postoperative cerebrovascular accident (odds ratio, 0.49; 95% confidence interval [CI], 0.25-0.99; P = .04), need for postoperative intra-aortic balloon pump (odds ratio, 0.48; 95% CI, 0.30-0.77; P = .002), and reexploration for bleeding (odds ratio, 0.55; 95% CI, 0.33-0.94; P = .02). Off-pump coronary artery bypass did not significantly affect early (hazard ratio [HR], 1.32; 95% CI, 0.73-2.40; P = .36) and late (HR, 1.08; 95% CI, 0.92-1.28; P = .32) mortality. However, off-pump coronary artery bypass with incomplete revascularization was associated with reduced survival when compared with off-pump coronary artery bypass with complete revascularization (HR, 1.82; 95% CI, 1.34-2.46; P = .0002) and on-pump coronary artery bypass with complete revascularization (HR, 1.83; 95% CI, 1.36-2.47; P < .0001). Off-pump coronary artery bypass is a safe and feasible option for diabetic patients with multivessel disease, reduces the incidence of early complications including postoperative cerebrovascular events, and provides excellent long-term survival similar to on-pump coronary artery bypass surgery in case of complete revascularization. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Zero Gravity Cryogenic Vent System Concepts for Upper Stages

NASA Technical Reports Server (NTRS)

Flachbart, Robin H.; Holt, James B.; Hastings, Leon J.

1999-01-01

The capability to vent in zero gravity without resettling is a technology need that involves practically all uses of sub-critical cryogenics in space. Venting without resettling would extend cryogenic orbital transfer vehicle capabilities. However, the lack of definition regarding liquid/ullage orientation coupled with the somewhat random nature of the thermal stratification and resulting pressure rise rates, lead to significant technical challenges. Typically a zero gravity vent concept, termed a thermodynamic vent system (TVS), consists of a tank mixer to destratify the propellant, combined with a Joule-Thomson (J-T) valve to extract thermal energy from the propellant. Marshall Space Flight Center's (MSFC's) Multipurpose Hydrogen Test Bed (MHTB) was used to test both spray bar and axial jet TVS concepts. The axial jet system consists of a recirculation pump heat exchanger unit. The spray bar system consists of a recirculation pump, a parallel flow concentric tube, heat exchanger, and a spray bar positioned close to the longitudinal axis of the tank. The operation of both concepts is similar. In the mixing mode, the recirculation pump withdraws liquid from the tank and sprays it into the tank liquid, ullage, and exposed tank surfaces. When energy is required. a small portion of the recirculated liquid is passed sequentially through the J-T expansion valve, the heat exchanger, and is vented overboard. The vented vapor cools the circulated bulk fluid, thereby removing thermal energy and reducing tank pressure. The pump operates alone, cycling on and off, to destratify the tank liquid and ullage until the liquid vapor pressure reaches the lower set point. At that point. the J-T valve begins to cycle on and off with the pump. Thus, for short duration missions, only the mixer may operate, thus minimizing or even eliminating, boil-off losses.

Zero Gravity Cryogenic Vent System Concepts for Upper Stages

NASA Technical Reports Server (NTRS)

Flachbart, Robin H.; Holt, James B.; Hastings, Leon J.

2001-01-01

The capability to vent in zero gravity without resettling is a technology need that involves practically all uses of sub-critical cryogenics in space, and would extend cryogenic orbital transfer vehicle capabilities. However, the lack of definition regarding liquid/ullage orientation coupled with the somewhat random nature of the thermal stratification and resulting pressure rise rates, lead to significant technical challenges. Typically a zero gravity vent concept, termed a thermodynamic vent system (TVS), consists of a tank mixer to destratify the propellant, combined with a Joule-Thomson (J-T) valve to extract thermal energy from the propellant. Marshall Space Flight Center's (MSFC's) Multipurpose Hydrogen Test Bed (MHTB) was used to test both spray-bar and axial jet TVS concepts. The axial jet system consists of a recirculation pump heat exchanger unit. The spray-bar system consists of a recirculation pump, a parallel flow concentric tube heat exchanger, and a spray-bar positioned close to the longitudinal axis of the tank. The operation of both concepts is similar. In the mixing mode, the recirculation pump withdraws liquid from the tank and sprays it into the tank liquid, ullage, and exposed tank surfaces. When energy extraction is required, a small portion of the recirculated liquid is passed sequentially through the J-T expansion valve, the heat exchanger, and is vented overboard. The vented vapor cools the circulated bulk fluid, thereby removing thermal energy and reducing tank pressure. The pump operates alone, cycling on and off, to destratify the tank liquid and ullage until the liquid vapor pressure reaches the lower set point. At that point, the J-T valve begins to cycle on and off with the pump. Thus, for short duration missions, only the mixer may operate, thus minimizing or even eliminating boil-off losses.

Chronic Obstructive Pulmonary Disease and Off-Pump Coronary Surgery.

PubMed

Ovalı, Cengiz; Şahin, Aykut

2018-05-18

To determine to what extent chronic obstructive pulmonary disease (COPD) affects mortality and morbidity rates in patients treated with off-pump coronary artery bypass graft (CABG). A total of 321 patients treated with off-pump CABG were included in the present study. Of the 321 patients, 46 patients had COPD and they were designated as Group 1 and the remaining 275 patients did not have COPD and they were considered as Group 2. We compared the data obtained from the patients in both groups. While preoperative spirometry values and arterial blood gas oxygen saturation levels were significantly lower, the partial values of carbon dioxide were higher in Group 1. Likewise, extubation time, the amount of drainage and blood transfusion, inotropic support, prolonged intubation, pulmonary complications, the use of bronchodilators, and steroids were statistically higher in Group 1 when compared with Group 2. Overall, there was no marked difference between the two groups in terms of mortality incidence. We found similar morbidity and mortality rates among the patients with COPD and without COPD when they were treated with off-pump CABG. Therefore, the present results indicate that the presence of COPD is not associated with in-hospital mortality or severe morbidity post-CABG by off-pump approach.

In-hospital outcomes of a minimally invasive off-pump left thoracotomy approach using a centrifugal continuous-flow left ventricular assist device.

PubMed

Sileshi, Bantayehu; Haglund, Nicholas A; Davis, Mary E; Tricarico, Nicole M; Stulak, John M; Khalpey, Zain; Danter, Matthew R; Deegan, Robert; Kennedy, Jason; Keebler, Mary E; Maltais, Simon

2015-01-01

Minimally invasive left thoracotomy (MILT) and off-pump implantation strategies have been anecdotally reported for implantation of the HeartWare ventricular assist device (HVAD). We analyzed our experience with off-pump MILT implantation techniques and compared early in-hospital outcomes with conventional on-pump sternotomy (CS) implantation strategy. Between January 2013 and February 2014, 51 patients underwent HVAD implantation and were included in this study. Thirty-three patients had CS, whereas 18 patients underwent off-pump MILT. To compare outcomes of these techniques, a multivariate analysis using propensity score modeling was performed after adjusting for age, INTERMACS, Kormos and Leitz-Miller (LM) scores. Mean age at implant was 57 (range 18 to 69) years, and overall in-hospital mortality was 8%. Univariate analysis revealed a statistically significant reduction in days on inotropes (p = 0.04), and a trend toward reduced intra-operative blood product administration (p = 0.08) in the MILT group. There was no difference in intensive-care-unit length of stay (p = 0.5), total length of stay (p = 0.76), post-operative blood product administration (p = 0.34) and total time on mechanical ventilation (p = 0.32). After adjusting for age, INTERMACS profile and Kormos and LM scores, no statistically significant differences were observed between the MILT and CS groups. An off-pump MILT implantation strategy can be utilized as a safe surgical approach for patients undergoing HVAD implantation. Further large collaborative studies are needed to identify advantages of the MILT approach. Published by Elsevier Inc.

Off-pump coronary artery bypass surgery in severe left ventricular dysfunction.

PubMed

Azarfarin, Rasoul; Pourafkari, Leili; Parvizi, Rezayat; Alizadehasl, Azin; Mahmoodian, Roghaiyeh

2010-02-01

Our aim was to examine hospital outcomes of coronary artery bypass surgery in patients with and without left ventricular dysfunction, with regard to the surgical technique (off- or on-pump). Between March 2007 and March 2008, 689 consecutive patients underwent isolated first-time coronary artery bypass; 127 had ejection fractions < or = 30% (group 1) and 562 had ejection fractions >30% (group 2). Data of preoperative risk profiles and hospital outcomes were collected prospectively. Off-pump operations were performed in 49 (38.6%) patients in group 1 and 196 (34.9%) in group 2. The incidences of infectious, neurologic, and cardiac complications postoperatively were significantly higher in group 1. In multivariate analysis, preoperative ejection fraction < or = 30% was found to be an independent risk factor for postoperative complications and hospital mortality. The subgroup of patients undergoing off-pump surgery in both groups had a significantly lower rate of total complications than those undergoing conventional on-pump operations, but no significant difference in mortality was observed between those undergoing off-pump or conventional surgery in either group. Off-pump surgery helped to limit the increased morbidity rate after coronary bypass in patients with ventricular dysfunction.

Low-noise delays from dynamic Brillouin gratings based on perfect Golomb coding of pump waves.

PubMed

Antman, Yair; Levanon, Nadav; Zadok, Avi

2012-12-15

A method for long variable all-optical delay is proposed and simulated, based on reflections from localized and stationary dynamic Brillouin gratings (DBGs). Inspired by radar methods, the DBGs are inscribed by two pumps that are comodulated by perfect Golomb codes, which reduce the off-peak reflectivity. Compared with random bit sequence coding, Golomb codes improve the optical signal-to-noise ratio (OSNR) of delayed waveforms by an order of magnitude. Simulations suggest a delay of 5  Gb/s data by 9 ns, or 45 bit durations, with an OSNR of 13 dB.

Evaluation of a Novel Laser-assisted Coronary Anastomotic Connector - the Trinity Clip - in a Porcine Off-pump Bypass Model

PubMed Central

Stecher, David; Bronkers, Glenn; Noest, Jappe O.T.; Tulleken, Cornelis A.F.; Hoefer, Imo E.; van Herwerden, Lex A.; Pasterkamp, Gerard; Buijsrogge, Marc P.

2014-01-01

To simplify and facilitate beating heart (i.e., off-pump), minimally invasive coronary artery bypass surgery, a new coronary anastomotic connector, the Trinity Clip, is developed based on the excimer laser-assisted nonocclusive anastomosis technique. The Trinity Clip connector enables simplified, sutureless, and nonocclusive connection of the graft to the coronary artery, and an excimer laser catheter laser-punches the opening of the anastomosis. Consequently, owing to the complete nonocclusive anastomosis construction, coronary conditioning (i.e., occluding or shunting) is not necessary, in contrast to the conventional anastomotic technique, hence simplifying the off-pump bypass procedure. Prior to clinical application in coronary artery bypass grafting, the safety and quality of this novel connector will be evaluated in a long-term experimental porcine off-pump coronary artery bypass (OPCAB) study. In this paper, we describe how to evaluate the coronary anastomosis in the porcine OPCAB model using various techniques to assess its quality. Representative results are summarized and visually demonstrated. PMID:25490000

Transoral Incisionless Fundoplication Effective in Eliminating GERD Symptoms in Partial Responders to Proton Pump Inhibitor Therapy at 6 Months

PubMed Central

Barnes, William E.; Simoni, Gilbert; Shughoury, Ahmad B.; Mavrelis, Peter G.; Raza, Mamoon; Heise, Jeffrey A.; Turgeon, Daniel G.; Fox, Mark A.

2015-01-01

Background. Incomplete control of troublesome regurgitation and extraesophageal manifestations of chronic gastroesophageal reflux disease (GERD) is a known limitation of proton pump inhibitor (PPI) therapy. This multicenter randomized study compared the efficacy of transoral incisionless fundoplication (TIF) against PPIs in controlling these symptoms in patients with small hiatal hernias. Methods. Between June and August 2012, 63 patients were randomized at 7 US community hospitals. Patients in the PPI group were placed on maximum standard dose (MSD). Patients in the TIF group underwent esophagogastric fundoplication using the EsophyX2 device. Primary outcome was elimination of daily troublesome regurgitation or extraesophageal symptoms. Secondary outcomes were normalization of esophageal acid exposure (EAE), PPI usage and healing of esophagitis. Results. Of 63 randomized patients (40 TIF and 23 PPI), 3 were lost to follow-up leaving 39 TIF and 21 PPI patients for analysis. At 6-month follow-up, troublesome regurgitation was eliminated in 97% of TIF patients versus 50% of PPI patients, relative risk (RR) = 1.9, 95% confidence interval (CI) = 1.2-3.11 (P = .006). Globally, 62% of TIF patients experienced elimination of regurgitation and extraesophageal symptoms versus 5% of PPI patients, RR = 12.9, 95% CI = 1.9-88.9 (P = .009). EAE was normalized in 54% of TIF patients (off PPIs) versus 52% of PPI patients (on MSD), RR = 1.0, 95% CI = 0.6-1.7 (P = .914). Ninety percent of TIF patients were off PPIs. Conclusion. At 6-month follow-up, TIF was more effective than MSD PPI therapy in eliminating troublesome regurgitation and extraesophageal symptoms of GERD. PMID:24756976

The ASPIRE study: design and methods of an in-clinic crossover trial on the efficacy of automatic insulin pump suspension in exercise-induced hypoglycemia.

PubMed

Brazg, Ronald L; Bailey, Timothy S; Garg, Satish; Buckingham, Bruce A; Slover, Robert H; Klonoff, David C; Nguyen, Xuan; Shin, John; Welsh, John B; Lee, Scott W

2011-11-01

The Paradigm®Veo™ System includes a low glucose suspend (LGS) feature which suspends insulin delivery when a prespecified glucose threshold setting is reached by the associated continuous glucose monitoring (CGM) sensor. The ASPIRE (Automation to Simulate Pancreatic Insulin REsponse) study is a multicenter, in-clinic, randomized, crossover study to examine the efficacy of LGS in exercise-induced hypoglycemia. Insulin-pump users underwent two separate exercise sessions, one with the LGS feature set to suspend insulin (LGS-on) when the CGM-detected glucose concentration was ≤ 70 mg/dl and one with the LGS feature off. Exercise sessions were conducted after an overnight fast and with initial plasma glucose level as measured by the YSI 2300 STAT Plus glucose analyzer (YSI) of 100-140 mg/dl. Subjects exercised until their YSI value fell to ≤ 85 mg/dl; subsequent YSI values <70 mg/dl were recorded for up to 4 h to measure the duration and nadir of hypoglycemia. The protocol required that subjects with YSI values <50 or >300 mg/dl were rescued with carbohydrates or insulin, respectively, based on the provider's recommendation. The primary end point was comparison of duration and severity of hypoglycemia between LGS-on and LGS-off sessions. Secondary end points included areas under the glucose concentration curve, CGM sensor accuracy, and last YSI glucose. Device- and procedure-related adverse events and serious adverse events were recorded. Fifty adults and teenagers (17-58 years) with type 1 diabetes were randomized. Study completion is expected in November 2011. © 2011 Diabetes Technology Society.

Systemic and myocardial inflammatory response in coronary artery bypass graft surgery with miniaturized extracorporeal circulation: differences with a standard circuit and off-pump technique in a randomized clinical trial.

PubMed

Formica, Francesco; Mariani, Silvia; Broccolo, Francesco; Caruso, Rosa; Corti, Fabrizio; D'Alessandro, Stefano; Amigoni, Pietro; Sangalli, Fabio; Paolini, Giovanni

2013-01-01

Inflammatory response and hemodilution are the main drawbacks of extracorporeal circulation. We hypothesize that the use of miniaturized extracorporeal circulation (MECC) might lower the systemic and myocardial inflammatory patterns compared with a standard system (SECC) and off-pump coronary artery bypass grafting (OPCABG). Sixty-one patients undergoing isolated coronary artery bypass graft were prospectively randomized to MECC (n = 19), SECC (n = 20), or OPCABG (n = 22). Blood samples were collected from radial artery and coronary sinus to analyze blood lactate, hemodilution, and markers for inflammation and endothelial activation such as tumor necrosis factor (TNF)-α, interleukin-6, monocyte chemotactic protein-1, and E-selectin. No differences were observed in early clinical outcome. Interleukin -6 levels increased in every group during and after cardiac surgery, whereas TNF-α values grew in the SECC group (p = 0.05). E-selectin systemic values decreased during and after operation (p = 0.001) in every group. Monocyte chemotactic protein-1 systemic and cardiac levels raised only in SECC group (p = 0.014). In conclusion, MECC is comparable to SECC and OPCABG in the clinical outcome of low-risk patients, and it might be extensively used with no additional intraoperative risk. The analysis of the inflammatory patterns of endothelial activation shows MECC as effective as OPCABG, suggesting further studies to clarify MECC recommendation in high-risk patients.

Effect of Exogenous Albumin on the Incidence of Postoperative Acute Kidney Injury in Patients Undergoing Off-pump Coronary Artery Bypass Surgery with a Preoperative Albumin Level of Less Than 4.0 g/dl.

PubMed

Lee, Eun-Ho; Kim, Wook-Jong; Kim, Ji-Yeon; Chin, Ji-Hyun; Choi, Dae-Kee; Sim, Ji-Yeon; Choo, Suk-Jung; Chung, Cheol-Hyun; Lee, Jae-Won; Choi, In-Cheol

2016-05-01

Hypoalbuminemia may increase the risk of acute kidney injury (AKI). The authors investigated whether the immediate preoperative administration of 20% albumin solution affects the incidence of AKI after off-pump coronary artery bypass surgery. In this prospective, single-center, randomized, parallel-arm double-blind trial, 220 patients with preoperative serum albumin levels less than 4.0 g/dl were administered 100, 200, or 300 ml of 20% human albumin according to the preoperative serum albumin level (3.5 to 3.9, 3.0 to 3.4, or less than 3.0 g/dl, respectively) or with an equal volume of saline before surgery. The primary outcome measure was AKI incidence after surgery. Postoperative AKI was defined by maximal AKI Network criteria based on creatinine changes. Patient characteristics and perioperative data except urine output during surgery were similar between the two groups studied, the albumin group and the control group. Urine output (median [interquartile range]) during surgery was higher in the albumin group (550 ml [315 to 980]) than in the control group (370 ml [230 to 670]; P = 0.006). The incidence of postoperative AKI in the albumin group was lower than that in the control group (14 [13.7%] vs. 26 [25.7%]; P = 0.048). There were no significant between-group differences in severe AKI, including renal replacement therapy, 30-day mortality, and other clinical outcomes. There were no significant adverse events. Administration of 20% exogenous albumin immediately before surgery increases urine output during surgery and reduces the risk of AKI after off-pump coronary artery bypass surgery in patients with a preoperative serum albumin level of less than 4.0 g/dl.

Pump efficiency in solar-energy systems

NASA Technical Reports Server (NTRS)

1978-01-01

Study investigates characteristics of typical off-the-shelf pumping systems that might be used in solar systems. Report includes discussion of difficulties in predicting pump efficiency from manufacturers' data. Sample calculations are given. Peak efficiencies, flow-rate control, and noise levels are investigated. Review or theory of pumps types and operating characteristics is presented.

Numerical and In Vitro Experimental Investigation of the Hemolytic Performance at the Off-Design Point of an Axial Ventricular Assist Pump.

PubMed

Liu, Guang-Mao; Jin, Dong-Hai; Jiang, Xi-Hang; Zhou, Jian-Ye; Zhang, Yan; Chen, Hai-Bo; Hu, Sheng-Shou; Gui, Xing-Min

The ventricular assist pumps do not always function at the design point; instead, these pumps may operate at unfavorable off-design points. For example, the axial ventricular assist pump FW-2, in which the design point is 5 L/min flow rate against 100 mm Hg pressure increase at 8,000 rpm, sometimes works at off-design flow rates of 1 to 4 L/min. The hemolytic performance of the FW-2 at both the design point and at off-design points was estimated numerically and tested in vitro. Flow characteristics in the pump were numerically simulated and analyzed with special attention paid to the scalar sheer stress and exposure time. An in vitro hemolysis test was conducted to verify the numerical results. The simulation results showed that the scalar shear stress in the rotor region at the 1 L/min off-design point was 70% greater than at the 5 L/min design point. The hemolysis index at the 1 L/min off-design point was 3.6 times greater than at the 5 L/min design point. The in vitro results showed that the normalized index of hemolysis increased from 0.017 g/100 L at the 5 L/min design point to 0.162 g/100 L at the 1 L/min off-design point. The hemolysis comparison between the different blood pump flow rates will be helpful for future pump design point selection and will guide the usage of ventricular assist pumps. The hemolytic performance of the blood pump at the working point in the clinic should receive more focus.

Partially anaortic clampless off-pump coronary artery bypass prevents neurologic injury compared to on-pump coronary surgery: a propensity score-matched study on 286 patients.

PubMed

Bassano, Carlo; Bovio, Emanuele; Uva, Floriano; Iacobelli, Simona; Iasevoli, Nicola; Farinaccio, Andrea; Ruvolo, Giovanni

2016-09-01

Anaortic coronary artery bypass proved to prevent early neurologic injury compared to on-pump CABG. The Cardica PAS-Port(®) is a fully automated device that might be able to perform proximal aorto-venous anastomoses without an increased embolic risk. We evaluated early post-operative neurologic outcome in a matched population following clampless OPCAB (CCAB: either "all-arterial" or with automatically anastomosed venous grafts) or on-pump CABG. 366 consecutive patients were submitted to isolated coronary bypass by a single surgeon experienced in both off and on-pump procedures between January 2009 and December 2013. Of these patients, 223 underwent a clampless off-pump revascularization. After propensity score matching, 143 pairs were selected, who received either off-pump or on-pump surgery. In the off-pump group, CCAB was performed with an all-arterial approach (n = 33) or with automated proximal anastomosis of the venous graft(s) by means of the Cardica PAS-Port(®) connector (n = 110). Neurologic injury was defined as non-reversible (NRNI: lethal coma or stroke) or reversible (RNI: TIA or delirium). Operative mortality was 2.4 % (CCAB 1.4 %; CABG 3.5 %; p = 0.14). The global rate of early neurologic injury was 5.6 % (CCAB 2.1 vs. CABG 9.1 %; p = 0.006). Incidence was 1.4 % for NRNI (CCAB 0 vs. CABG 2.8 %; p = 0.04) and 4.2 % for RNI (CCAB 2.1 vs. CABG 6.3 %; p = 0.06). No differences were found among other major perioperative outcomes. CCAB prevents both early post-operative RNI and NRNI. This result can be achieved with a totally anaortic strategy and also with the aid of a fully automated device for proximal aorto-venous anastomoses.

Target vessel detection by epicardial ultrasound in off-pump coronary bypass surgery.

PubMed

Hayakawa, Masato; Asai, Tohru; Kinoshita, Takeshi; Suzuki, Tomoaki; Shiraishi, Shoichiro

2013-01-01

The detection of embedded coronary arteries is difficult especially in off-pump coronary bypass surgery. From June 2010, we introduced high-frequency epicardial ultrasound (ECUS) to assess and evaluate embedded arteries during off-pump coronary bypass surgery. Between June 2010 and June 2011, a total of 89 consecutive patients underwent isolated coronary bypass surgery at our institution. The patients consisted of 72 men and 17 women with a mean age of 67.9 years. We routinely use the VeriQC system (MediStim, Oslo, Norway) to detect the target vessels in the operation. The patients were assigned to one of two groups, depending on whether ECUS was used in the operation (n = 10, ECUS group) or not (n = 79, non-ECUS group). We analyzed the impact of introducing the ECUS in terms of operative outcome. All patients underwent revascularization using the off-pump technique without emergent conversion to cardiopulmonary bypass during surgery. The total number of distal anastomoses was 299, and 12 target vessels could not be identified either visually or on palpation. Thus, the frequency of the embedded coronary arteries was 4.01% (12/299 cases). The preoperative profiles of the two groups were not significantly different. Operation time was significantly longer in the ECUS group (P = 0.02). There were no significant differences in postoperative outcome between the two groups. In the present study, in which the target coronary arteries could not be detected either visually or on palpation in 12 (4.01%) of 299 cases, the use of high-frequency ECUS allowed all patients to undergo off-pump coronary bypass surgery without conversion to cardiopulmonary bypass during the operation. High-frequency ECUS is therefore useful in off-pump coronary bypass surgery.

Numerical investigation of output beam quality in efficient broadband optical parametric chirped pulse amplification

NASA Astrophysics Data System (ADS)

Liu, Xiao-Di; Xu, Lu; Liang, Xiao-Yan

2017-01-01

We theoretically analyzed output beam quality of broad bandwidth non-collinear optical parametric chirped pulse amplification (NOPCPA) in LiB3O5 (LBO) centered at 800 nm. With a three-dimensional numerical model, the influence of the pump intensity, pump and signal spatial modulations, and the walk-off effect on the OPCPA output beam quality are presented, together with conversion efficiency and the gain spectrum. The pump modulation is a dominant factor that affects the output beam quality. Comparatively, the influence of signal modulation is insignificant. For a low-energy system with small beam sizes, walk-off effect has to be considered. Pump modulation and walk-off effect lead to asymmetric output beam profile with increased modulation. A special pump modulation type is found to optimize output beam quality and efficiency. For a high-energy system with large beam sizes, the walk-off effect can be neglected, certain back conversion is beneficial to reduce the output modulation. A trade-off must be made between the output beam quality and the conversion efficiency, especially when the pump modulation is large since. A relatively high conversion efficiency and a low output modulation are both achievable by controlling the pump modulation and intensity.

Centrifugal and Axial Pump Design and Off-Design Performance Prediction

NASA Technical Reports Server (NTRS)

Veres, Joseph P.

1995-01-01

A meanline pump-flow modeling method has been developed to provide a fast capability for modeling pumps of cryogenic rocket engines. Based on this method, a meanline pump-flow code PUMPA was written that can predict the performance of pumps at off-design operating conditions, given the loss of the diffusion system at the design point. The design-point rotor efficiency and slip factors are obtained from empirical correlations to rotor-specific speed and geometry. The pump code can model axial, inducer, mixed-flow, and centrifugal pumps and can model multistage pumps in series. The rapid input setup and computer run time for this meanline pump flow code make it an effective analysis and conceptual design tool. The map-generation capabilities of the code provide the information needed for interfacing with a rocket engine system modeling code. The off-design and multistage modeling capabilities of PUMPA permit the user to do parametric design space exploration of candidate pump configurations and to provide head-flow maps for engine system evaluation.

Right atrium positioning for exposure of right pulmonary veins during off-pump atrial fibrillation ablation.

PubMed

Suwalski, Grzegorz; Emery, Robert; Mróz, Jakub; Kaczejko, Kamil; Gryszko, Leszek; Cwetsch, Andrzej; Skrobowski, Andrzej

2017-06-01

Concomitant surgical ablation of atrial fibrillation (AF) is recommended for patients undergoing off-pump coronary revascularization in the presence of this arrhythmia. Achievement of optimal visualization of pulmonary veins while maintaining stable haemodynamic conditions is crucial for proper completion of the ablation procedure. This study evaluates the safety and feasibility of right atrial positioning using a suction-based cardiac positioner as opposed to compressive manoeuvres for exposure during off-pump surgical ablation for AF. Thirty-four consecutive patients underwent pulmonary vein isolation, ganglionated plexi ablation and left atrial appendage occlusion during off-pump coronary artery bypass grafting. Right atrial suction positioning was used to visualize right pulmonary veins. Safety and feasibility end points were analysed intraoperatively and in the early postoperative course. In all patients, right atrial positioning created optimal conditions to complete transverse and oblique sinus blunt dissection, correct placement of a bipolar ablation probe, detection and ablation of ganglionated plexi and conduction block assessment. In all patients, this entire right-sided ablation procedure was completed with a single exposure manoeuvre. Feasibility end points were achieved in all study patients. This report documents the safety and feasibility of right atrial exposure using a suction-based cardiac positioner to complete ablation for AF concomitant with off-pump coronary revascularization. This technique may be widely adopted to create stable haemodynamic conditions and optimal visualization of the right pulmonary veins. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Effects of preoperative aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in patients undergoing off-pump coronary artery bypass graft surgery.

PubMed

Shim, Jae Kwang; Choi, Yong Seon; Oh, Young Jun; Bang, Sou Ouk; Yoo, Kyung Jong; Kwak, Young Lan

2007-07-01

Preoperative exposure to clopidogrel and aspirin significantly increases postoperative bleeding in patients undergoing on-pump coronary artery bypass graft surgery. Off-pump coronary bypass grafting has been proposed as an alternative technique to attenuate postoperative bleeding associated with clopidogrel. This study aimed to determine the effects of aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in off-pump coronary artery bypass grafting. One hundred six patients scheduled for off-pump coronary artery bypass grafting were divided into three groups: aspirin and clopidogrel discontinued more than 6 days before surgery (group 1, n = 35), aspirin and clopidogrel continued until 3 to 5 days before surgery (group 2, n = 51), and both medications continued within 2 days of surgery (group 3, n = 20). Thromboelastographic tracings were analyzed before induction of anesthesia. Routine coagulation profiles were measured before and after surgery. A cell salvage device was used during surgery and salvaged blood was reinfused. Chest tube drainage and blood transfusion requirement were recorded postoperatively. Patient characteristics, operative data, and thromboelastographic tracings were similar among the groups. There were significant decreases in hematocrit level and platelet count and prolongation in prothrombin time postoperatively in all groups without any intergroup differences. The amounts of perioperative blood loss and blood transfusion required were all similar among the groups. Preoperative clopidogrel and aspirin exposure even within 2 days of surgery does not increase perioperative blood loss and blood transfusion requirements in patients undergoing elective off-pump coronary artery bypass grafting.

Off-pump coronary artery bypass grafting. The 1st Medical Faculty of Charles University study.

PubMed

Semrád, M; Bodlák, P; Stríteský, M; Kristof, J; Lindner, J; Urban, T; Vondrácek, V; Vanĕk, I

2002-01-01

To explore the surgical technique, anaesthesiological management, immediate and mid-term results, graft patency and effectiveness of less invasive coronary artery bypass grafting through a median sternotomy. From January 1998 through December 1999, 144 patients had coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) done by one surgeon through a median sternotomy. The cohort of 107 men and 37 women averaged 60.8 years, mean ejection fraction (EF) was 51.8%. An average of 2.7 (range 1 to 5) grafts/patients was achieved. Results are compared with a CPB subgroup of patients operated on through a median sternotomy in the same time (N = 234). In a random subgroup of 100 patients (50 per group) an angiographic control of graft patency was done. A non-CPB group showed less postoperative acute myocardial infarction (0.7% vs. 3.8%, p < 0.05) and atrial fibrillation (14.6% vs. 26%, p < 0.05), lower incidence of renal (2.8% vs. 5.1%, p < 0.05) and respiratory complications (2.0% vs. 3.8%, NS). We observed lower operative mortality (0.7% vs. 3.4%, p < 0.05), as well as the occurrence of low cardiac output syndrome (0.7% vs. 5.6%, p < 0.05) in the off-pump group. The follow-up is 36 +/- 12 months and the number of patients with recurrent angina, late AMI and late death is acceptable. We did not find an inordinate number of vein grafts occlusions (0.7% vs. 1.8%, NS) and stenoses (6.6% vs. 6.7%, NS) at anastomotic sites. None of the arterial grafts in both groups were occluded. There was little known about the efficacy of the less invasive coronary artery bypass grafting at the beginning of our study. Starting with pioneering the operative technique, we have discovered and proposed three types of a heart verticalization and a reusable stabilizing device. We detected lower incidence of postoperative complications and decreased operative mortality in a non-CPB group. Angiographic assessment displayed an excellent run-off in both groups of patients. Off-pump coronary bypass grafting is associated with sufficient short-term graft patency and mid-term clinical outcomes.

Numerical study on the selective excitation of Helmholtz-Gauss beams in end-pumped solid-state digital lasers with the control of the laser gain transverse position provided by off-axis end pumping

NASA Astrophysics Data System (ADS)

Tsai, Ko-Fan; Chu, Shu-Chun

2018-03-01

This study proposes a complete and unified method for selective excitation of any specified nearly nondiffracting Helmholtz-Gauss (HzG) beam in end-pumped solid-state digital lasers. Four types of the HzG beams: cosine-Gauss beams, Bessel-Gauss beams, Mathieu-Gauss beams, and, in particular, parabolic-Gauss beams are successfully demonstrated to be generated with the proposed methods. To the best of the authors’ knowledge, parabolic-Gauss beams have not yet been directly generated from any kind of laser system. The numerical results of this study show that one can successfully achieve any lasing HzG beams directly from the solid-state digital lasers with only added control of the laser gain transverse position provided by off-axis end pumping. This study also presents a practical digital laser set-up for easily manipulating off-axis pumping in order to achieve the control of the laser gain transverse gain position in digital lasers. The reported results in this study provide advancement of digital lasers in dynamically generating nondiffracting beams. The control of the digital laser cavity gain position creates the possibility of achieving real-time selection of more laser modes in digital lasers, and it is worth further investigation in the future.

Aircraft Alerting Systems Standardization Study. Volume I. Candidate System Validation and Time-Critical Display Evaluation.

DTIC Science & Technology

1981-01-01

SELCAL FLT ALT ATNI AUO ALT BRK CANSELCAL OVSO CALL CONTRL ALRT _ I7CT be SPLR b 0 11CALL Figure 5.4.4-1 Pilot’s Response Panel Figure 5.4.4-2 Flight...Galley bus off 27 GLY BUS OFF A RP ELEC CYCLE SWITCH Utility bus off 28 UTIL BUS OFF A RP ELEC CYCLE SWITCH Right engine 29 R ENG HYD PUMP A RP HYD...CYCLE SWITCH hydraulic pump Left engine 30 L ENG FIRE DET A RP FIRE RP FIRE fire detector Left brake overheat 31 L BRAKE OVHT A RP BRK RP BRK Right

Prospective randomized comparison of coronary bypass grafting with minimal extracorporeal circulation system (MECC) versus off-pump coronary surgery.

PubMed

Mazzei, Valerio; Nasso, Giuseppe; Salamone, Giovanni; Castorino, Filippo; Tommasini, Antonello; Anselmi, Amedeo

2007-10-16

We aimed to evaluate the clinical results and biocompatibility of the minimal extracorporeal circulation system (MECC) compared with off-pump coronary revascularization (OPCABG). In a prospective randomized study, 150 patients underwent coronary surgery with the use of MECC and 150 underwent OPCABG. End points were (1) circulating markers of inflammation and organ injury, (2) operative results, and (3) outcome at 1-year follow-up. Operative mortality and morbidity were comparable between the groups. Release of inflammatory markers was similar between groups at all time points (peak interleukin-6 167.2+/-13.5 versus 181+/-6.5 pg/mL, P=0.14, OPCABG versus MECC group, respectively). Peak creatine kinase was 419.3+/-103.5 versus 326+/-84.2 mg/dL (P=0.28), and peak S-100 protein was 0.13+/-0.08 versus 0.29+/-0.1 pg/mL (P=0.058, OPCABG versus MECC group, respectively). Length of hospital stay and use of blood products were similar between groups. Two cases of angina recurrence at 1 year in the MECC group were observed versus 5 cases observed in the OPCABG group (P=0.44). A residual perfusion defect at myocardial nuclear scan was less frequent among patients in the MECC group (3 versus 9 cases, P=0.14; odds ratio 0.32, 95% confidence interval 0.07 to 1.32). Six (OPCABG group) versus 3 (MECC group) coronary grafts were occluded or severely stenotic at 1 year (P=0.33, odds ratio 0.47, 95% confidence interval 0.09 to 2.14). Clinical results of coronary revascularization with MECC are optimal when this procedure is performed by experienced teams. Postoperative morbidity is comparable to that with OPCABG. MECC is associated with little pump-related systemic and organ injury. It may achieve the benefits of OPCABG (less morbidity in high-risk patients) while facilitating complete revascularization in the case of complex lesions unsuitable for OPCABG.

Less invasive coronary artery revascularization with a minimized extracorporeal circulation system: preliminary results of a comparative study with off-pump-procedures

PubMed Central

2013-01-01

Background Coronary-artery-bypass-grafting (CABG) with conventional extracorporeal circulation (CECC) is associated with adverse effects such as systemic inflammatory response leading to a decrease in systemic vascular resistance and hemodynamic instability. Modern "less invasive" procedures have been established recently which potentially avoid negative side effects of CECC. The aim of this study was to compare perioperative outcome following coronary revascularization using either a minimized extracorporeal circuit (Mini-HLM) or off-pump technique (OPCAB). Methods In this prospective ethics-approved trial, 120 patients referred for CABG were randomly assigned either to off-pump coronary artery bypass (OPCAB) or to a Mini-HLM procedure. Patient demographics, preoperative characteristics and extensive postoperative outcome were analyzed for both groups. Hemodynamic data were measured at seven time points perioperatively. Results Operation-time was longer in the Mini-HLM group (178,3 ± 32,9 min) compared to OPCAB (133,2 ± 32,7 min, p < 0,001) with higher graft numbers in Mini-HLM group (3,11 ± 0,7 vs. 1,78 ± 0,7, p < 0.001). There were no significant differences in perioperative hemodynamic criteria, catecholaminergic support, hospital (p = 0,534) and intensive care unit stay (p = 0,880), ventilation time (p = 0,113), blood loss (p = 0,570), transfusion requirements, postoperative atrial fibrillation rate (p = 0,706) and neurocognitive disturbance (p = 0,297). No deaths and no myocardial infarctions were observed. Conclusions Coronary revascularisation with Mini-HLM represents a suitable and "less invasive" procedure which achieves all benefits of OPCAB but may allow for less demanding revascularisation than OPCAB in special patients with complex coronary anatomy and can therefore be used both on a routine basis and in all "conversion" cases of OPCAB. PMID:23577663

28. PUMP/ENGINE ROOM OFF THE BASEMENT OF MILL NO. 1. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

28. PUMP/ENGINE ROOM OFF THE BASEMENT OF MILL NO. 1. ENGINE PLATFORM IS SEEN BEHIND PUMP. THIS AMERICAN MOISTURE CO. PUMP WAS USED TO HUMIDIFY UPPER FLOORS OF MILL. NOTE TANK TO LEFT, UNKNOWN USE. NOTHING IN THIS ROOM HAS BEEN USED SINCE 1945. - Prattville Manufacturing Company, Number One, 242 South Court Street, Prattville, Autauga County, AL

Double-blinded, randomized controlled trial of N-acetylcysteine for prevention of acute kidney injury in high risk patients undergoing off-pump coronary artery bypass.

PubMed

Song, Jong Wook; Shim, Jae Kwang; Soh, Sarah; Jang, Jaewon; Kwak, Young Lan

2015-02-01

The aim of this study was to investigate the influence of perioperative N-acetylcysteine (NAC) administration, a known antioxidant, on the incidence of acute kidney injury (AKI) after off-pump coronary bypass surgery (OPCAB) in patients with known risk factors of AKI. One hundred and seventeen patients with ≥1 of the following risk factors of AKI were randomized into either the control (n = 57) or the NAC (n = 60) group; (i) preoperative serum creatinine >1.4 mg/dL; (ii) left ventricular ejection fraction <35% or congestive heart failure (iii) age >70 years (iv) diabetes or (v) re-operation. Patients in the NAC group received 150 mg/kg of NAC IV bolus at anaesthetic induction followed by a continuous infusion at 150 mg/kg per day for 24 h. AKI was diagnosed based on Acute Kidney Injury Network criteria during 48 h postoperatively. The incidence of AKI was 32% (19/60) and 35% (20/57) in the control and the NAC group, respectively (P = 0.695). The serum concentrations of creatinine and cystatin C were similar between the groups throughout the study period. Fluid balance including the amount of blood loss and transfusion requirement were similar between the groups except the amount of postoperative urine output, which was higher in the control group compared with the NAC group (5528 ± 1247 mL vs. 4982 ± 1185 mL, control vs. NAC, P = 0.017). Perioperative administration of NAC did not prevent the development of postoperative AKI after OPCAB in highly susceptible patients to AKI. © 2014 Asian Pacific Society of Nephrology.

Off-pump supra-arterial myotomy for myocardial bridging.

PubMed

Crespo, Alejandro; Aramendi, José I; Hamzeh, Gadah; Voces, Roberto

2008-09-01

We report the results of surgery and midterm outcome in two patients with symptomatic myocardial bridging who underwent off-pump supra-arterial myotomy. Both patients were operated upon through a median sternotomy. The anterior wall of the heart was exposed in the same manner as in off-pump CABG. The left anterior descending coronary artery is unroofed from its myocardial bridge with the aid of a heart stabilizer and a blower. Neither heparin nor blood transfusion was required. Both patients survived the operation and are asymptomatic. Postoperative coronary angiogram showed good resolution of the muscle bridge in one patient. We conclude that in symptomatic patients with myocardial bridging despite medical therapy, surgical myotomy can be considered an adequate therapy. It can be safely done off-pump.

Effectiveness of Additives in Improving Fuel Lubricity and Preventing Pump Failure at High Temperature

DTIC Science & Technology

2013-01-01

after pump calibrations , transfer pump blade measurements, injector nozzle tests, pump parts evaluation, and parts conditions photographs are also... Injectors –0 0.53 5,500 0.257 1 2-15293089 DF2 As Purchased 105 (40) 1,000 1,000 Calibration off spec areas–4 Pump Rating–1.04 Failed Injectors –0 0.53...5,500 0.257 2 1-15382732 DF2 As Purchased 135 (57) 1,000 1,000 Calibration off spec areas–4 Pump Rating–1.13 Failed Injectors –0 0.55

Volume, distribution and acidity of gastric secretion on and off proton pump inhibitor treatment: a randomized double-blind controlled study in patients with gastro-esophageal reflux disease (GERD) and healthy subjects.

PubMed

Steingoetter, Andreas; Sauter, Matthias; Curcic, Jelena; Liu, Dian; Menne, Dieter; Fried, Michael; Fox, Mark; Schwizer, Werner

2015-09-02

Postprandial accumulation of gastric secretions in the proximal stomach above the meal adjacent to the esophagogastric junction (EGJ), referred to as the 'acid pocket', has been proposed as a pathophysiological factor in gastro-esophageal reflux disease (GERD) and as a target for GERD treatment. This study assessed the effect of proton pump inhibitor (PPI) therapy on the volume, distribution and acidity of gastric secretions in GERD and healthy subjects (HS). A randomized, double blind, cross-over study in 12 HS and 12 GERD patients pre-treated with 40 mg pantoprazole (PPI) or placebo b.i.d. was performed. Postprandial secretion volume (SV), formation of a secretion layer and contact between the layer and the EGJ were quantified by Magnetic Resonance Imaging (MRI). Multi-channel pH-monitoring assessed intragastric pH. A distinct layer of undiluted acid secretion was present on top of gastric contents in almost all participants on and off high-dose acid suppression. PPI reduced SV (193 ml to 100 ml, in HS, 227 ml to 94 ml in GERD; p < 0.01) and thickness of the acid layer (26 mm to 7 mm, 36 mm to 9 mm respectively, p < 0.01). No differences in secretion volume or layer thickness were observed between groups; however, off treatment, contact time between the secretion layer and EGJ was 2.6 times longer in GERD compared to HS (p = 0.012). This was not the case on PPI. MRI can visualize and quantify the volume and distribution dynamics of gastric secretions that form a layer in the proximal stomach after ingestion of a liquid meal. The secretion volume and the secretion layer on top of gastric contents is similar in GERD patients and HS; however contact between the layer of undiluted secretion and the EGJ is prolonged in patients. High dose PPI reduced secretion volume by about 50% and reduced contact time between secretion and EGJ towards normal levels. NCT01212614.

Off-pump surgery: a choice in unstable angina.

PubMed

Kohli, Vijay; Goel, Mukesh; Sharma, Vijay Kumar; Mishra, Yugal; Malhotra, Rajneesh; Mehta, Yatin; Trehan, Naresh

2003-12-01

The benefit and safety of off-pump coronary artery bypass surgery in patients with unstable angina was assessed retrospectively. From February 1996 to October 2001, 5,306 patients underwent multivessel off-pump coronary artery bypass, of whom 920 (17%) had unstable angina. In these 920 patients, ejection fractions ranged from 15% to 70%, 203 (22%) had an ejection fraction of 20%-35%, and 11 (1%) had an ejection fraction < 20%. Triple-vessel disease was present in 625 patients. Preoperative intraaortic balloon pump support was used in 28 patients. Operative approaches included mid sternotomy (86%), lower partial sternotomy (9%), and left anterior thoracotomy (2%). The number of grafts ranged from 1 to 5 with a mean of 2.43 +/- 0.86, and 92.3% of patients received a left internal mammary artery graft. Twenty-two patients need intraoperative intraaortic balloon pumping. Ten patients (1%) suffered perioperative myocardial infarction. The mean hospital stay was 7.8 +/- 4.3 days. Hospital mortality was 2/920 (0.22%). Intraaortic balloon pumping was helpful in these cases of unstable angina refractory to medical therapy. Off-pump coronary artery surgery was found to be safe and beneficial in these patients.

Off-pump myocardial revascularisation in an octogenarian patient with dextrocardia and situs inversus.

PubMed

Ennker, I C; Pietrowski, D; Ennker, J

2006-01-01

Dextrocardia associated with situs inversus totalis is a rare condition and there are few reports of myocardial revascularisation in such patients. An 82-year-old woman with dextrocardia and situs inversus totalis underwent successful off-pump coronary artery bypass grafting using internal mammary arteries. The operative technique was similar to that of off-pump coronary artery bypass grafting for situs solitus. However, for a right-handed surgeon the operation was easier standing on the left side of the patient.

Should we consider off-pump coronary artery bypass grafting in patients with acute coronary syndrome?

PubMed

Moscarelli, Marco; Harling, Leanne; Ashrafian, Hutan; Athanasiou, Thanos

2013-03-01

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether off-pump coronary artery bypass (OPCAB) grafting should be considered as an alternative to the conventional on-pump surgery (ONCAB) in patients presenting with acute coronary syndrome (ACS) requiring emergency revascularization. Eighty-two papers were identified by a systematic search, of which nine were judged to best answer the clinical question. Of these, one was a randomized controlled trial and the remaining eight were retrospective observational studies. The author, journal, date, patient group, country of publication, relevant outcomes, results and study weaknesses were tabulated. In total, these nine studies included 3001 patients (n = 817 OPCAB, 2184 ONCAB) undergoing emergency revascularization in the setting of ACS. The timing between the onset of ACS and operative intervention ranged from 6 to 72 h. All cases were categorized as urgent/emergent according to the National confidential enquiry into patient outcome and death classification of intervention. Six studies included patients with preoperative cardiogenic shock; however the majority of patients were haemodynamically stable at the time of surgery. Three out of nine studies showed an improvement in 30-day mortality with OPCAB although the remaining six reveal no significant mortality benefit. No difference in long-term mortality was observed between the two techniques. OPCAB was associated with significantly fewer grafts per patient (six studies) and less complete revascularization (two studies). We conclude that whilst OPCAB may have a beneficial effect on 30-day mortality in haemodynamically stable patients undergoing emergency revascularization, there is a lack of high-quality data with clearly defined patient demographics. Future studies must ensure adequate preoperative matching between OPCAB and ONCAB groups and clearly categorize haemodynamic status, disease pattern and time to surgery in order to determine the patients in whom OPCAB may confer the greatest benefit.

Early and mid-term results of off-pump endarterectomy of the left anterior descending artery

PubMed Central

Takahashi, Mitsuko; Gohil, Sunir; Tong, Bonnie; Lento, Patrick; Filsoufi, Farzan; Reddy, Ramachandra C.

2013-01-01

OBJECTIVES Many patients referred for coronary artery bypass surgery (CABG) today have diffusely diseased coronary vessels, and some of them may require coronary endarterectomy to provide adequate revascularization. Most reports of coronary endarterectomy describe an on-pump procedure. As off-pump coronary artery bypass graft has become safer and more routine, there is renewed interest in off-pump coronary endarterectomy. We report on our series of patients who underwent off-pump coronary endarterectomy of the left anterior descending (LAD) artery using an open endarterectomy technique. METHODS All patients undergoing open heart surgery at The Mount Sinai Medical Center are entered into a state-mandated, audited database. A retrospective review of this database revealed 12 patients between January 2008 and June 2012 who underwent off-pump endarterectomy of the LAD as part of their coronary revascularization. Additional data were collected from a review of the patients' charts. RESULTS There were a total of 12 patients, with a mean age of 72 ± 4 years. Nine (75%) were male and 3 (25%) were female. Comorbidities included hypertension in 11 (92%) patients, dyslipidaemia in 10 (83%), diabetes in 8 (67%), renal failure in 6 (50%) and stroke in 1 (8%). The mean number of diseased coronary territories was 3 ± 0.4 (range 2–3), and the mean number of coronary bypass grafts performed was 4 ± 0.8 (range 2–5). Eight patients required transfusion with packed red blood cells (67%). One (8%) patient was converted from off-pump to on-pump. The mean intensive care unit stay was 3 ± 2.8 (range 1–8 days), and the mean hospital length of stay was 15 ± 13 (range 4–54 days). Postoperative follow-up (mean 24 ± 19 months, range 1–53) is complete, and no ischaemic events have occurred in the early and mid-term follow-up period. CONCLUSIONS We conclude that off-pump endarterectomy of the LAD is a viable option for patients with diffuse LAD disease. PMID:23190620

A novel coronary active perfusion system using a conventional intra-aortic balloon pump for off-pump coronary artery bypass grafting.

PubMed

Kiuchi, Ryuta; Tomita, Shigeyuki; Yamaguchi, Shojiro; Nishida, Yuji; Ohtake, Hiroshi; Nakamura, Hiroyuki; Watanabe, Go

2014-07-01

It is important for coronary active perfusion systems to avoid myocardial ischemia during off-pump coronary artery bypass grafting. We have developed a new concept for a perfusion system to pump blood based on changes in helium gas volume. This system uses a conventional intra-aortic balloon pump to activate the perfusion pump. Our study used basic and animal experiments to investigate the most suitable system for coronary perfusion using this new concept. A conventional intra-aortic balloon pump was used to supply power. A device for perfusion was developed with a balloon placed inside a stiff syringe barrel. The device was connected to the helium gas line of the intra-aortic balloon pump. Changes in flow with changes in augmentation level were noted when volumes outside and within the balloon were changed. Six pigs with occlusion of the left anterior descending artery were used for system validation, with monitoring to identify changes in hemodynamics and cardiac enzyme levels. In the basic experiment, an 80-mL outside volume and 3.0-mL inner volume resulted in the greatest percentage change in flow rate with respect to changes in augmentation. In the animal experiment, the new coronary active perfusion system prevented myocardial ischemia during coronary occlusion. We clarified the most suitable method for our new coronary active perfusion system. Using this system, safe anastomosis was consistently performed in animal experiments. Clinically, off-pump coronary artery bypass may potentially be performed more safely and easily using this new system. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Mechanical performance comparison between RotaFlow and CentriMag centrifugal blood pumps in an adult ECLS model.

PubMed

Yulong Guan; Xiaowei Su; McCoach, Robert; Kunselman, Allen; El-Banayosy, Aly; Undar, Akif

2010-03-01

Centrifugal blood pumps have been widely adopted in conventional adult cardiopulmonary bypass and circulatory assist procedures. Different brands of centrifugal blood pumps incorporate distinct designs which affect pump performance. In this adult extracorporeal life support (ECLS) model, the performances of two brands of centrifugal blood pump (RotaFlow blood pump and CentriMag blood pump) were compared. The simulated adult ECLS circuit used in this study included a centrifugal blood pump, Quadrox D membrane oxygenator and Sorin adult ECLS tubing package. A Sorin Cardiovascular(R) VVR(R) 4000i venous reservoir (Sorin S.p.A., Milan, Italy) with a Hoffman clamp served as a pseudo-patient. The circuit was primed with 900ml heparinized human packed red blood cells and 300ml lactated Ringer's solution (total volume 1200 ml, corrected hematocrit 40%). Trials were conducted at normothermia (36 degrees C). Performance, including circuit pressure and flow rate, was measured for every setting analyzed. The shut-off pressure of the RotaFlow was higher than the CentriMag at all measurement points given the same rotation speed (p < 0.0001). The shut-off pressure differential between the two centrifugal blood pumps was significant and increased given higher rotation speeds (p < 0.0001). The RotaFlow blood pump has higher maximal flow rate (9.08 +/- 0.01L/min) compared with the CentriMag blood pump (8.37 +/- 0.02L/min) (p < 0.0001). The blood flow rate differential between the two pumps when measured at the same revolutions per minute (RPM) ranged from 1.64L/min to 1.73L/min. The results obtained in this experiment demonstrate that the RotaFlow has a higher shut-off pressure (less retrograde flow) and maximal blood flow rate than the CentriMag blood pump. Findings support the conclusion that the RotaFlow disposable pump head has a better mechanical performance than the CentriMag. In addition, the RotaFlow disposable pump is 20-30 times less expensive than the CentriMag.

Circulating and Urinary miR-210 and miR-16 Increase during Cardiac Surgery Using Cardiopulmonary Bypass - A Pilot Study.

PubMed

Mazzone, Annette L; Baker, Robert A; McNicholas, Kym; Woodman, Richard J; Michael, Michael Z; Gleadle, Jonathan M

2018-03-01

A pilot study to measure and compare blood and urine microRNAs miR-210 and miR-16 in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) and off-pump coronary artery bypass grafting surgery. Frequent serial blood and urine samples were taken from patients undergoing cardiac surgery with CPB (n = 10) and undergoing off-pump cardiac surgery (n = 5) before, during, and after surgery. Circulating miR-210 and miR-16 levels were determined by relative quantification real-time polymerase chain reaction. Levels of plasma-free haemoglobin (fHb), troponin-T, creatine kinase, and creatinine were measured. Perioperative serum miR-210 and miR-16 were elevated significantly compared to preoperative levels in patients undergoing cardiac surgery with CPB (CPB vs. Pre Op and Rewarm vs. Pre Op; p < .05 for both). There were increases of greater than 200% in miR-210 levels during rewarming and immediately postoperatively and a 3,000% increase in miR-16 levels immediately postoperatively in urine normalized to urinary creatinine concentration. Serum levels of miR-16 were relatively constant during off-pump surgery. miR-210 levels increased significantly in off-pump patients perioperatively ( p < .05 Octopus on vs. Pre Op); however, the release was less marked when compared to cardiac surgery with CPB. A significant association was observed between both miR-16 and miR-210 and plasma fHb when CPB was used ( r = -.549, p < .0001 and r = -.463, p < .0001 respectively). Serum and urine concentrations of hypoxically regulated miR-210 and hemolysis-associated miR-16 increased in cardiac surgery using CPB compared to off-pump surgery. These molecules may have utility in indicating severity of cardiac, red cell, and renal injury during cardiac surgery.

Long pulse pumping behavior of a cryopump for the neutral beam injector

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

Chakrapani, Ch.; Sharma, S. K.; Chakraborty, A. K.

2007-01-15

This article presents studies on the long term pumping behavior of a cryopump. It is shown that the pumping speed does not deteriorate on a time scale of 4200 s for a gas load of 2.4x10{sup 5} torr l, corresponding to {approx}10{sup 6} ML of hydrogen. It has also been observed that the need for regeneration of the pump is dictated by the safety limits of operation rather than its pumping capability. No sudden boil off of the cryogen takes place during the regeneration phase.

The Effects of On-Pump and Off-Pump Coronary Artery Bypass Surgery on Respiratory Function in the Early Postoperative Period.

PubMed

Chiarenza, Federica; Tsoutsouras, Theodoros; Cassisi, Cesare; Santonocito, Cristina; Gerry, Stephen; Astuto, Marinella; George, Shane; Sanfilippo, Filippo

2017-01-01

Respiratory complications are common after cardiac surgery and the use of extracorporeal circulation is one of the main causes of lung injury. We hypothesized a better postoperative respiratory function in off-pump coronary artery bypass grafting (OPCABG) as compared with "on-pump coronary artery bypass grafting" (ONCABG). This is a retrospective, single-center study at a cardiothoracic intensive care unit (ICU) in a tertiary university hospital. Consecutive data on 339 patients undergoing elective CABG (n = 215 ONCABG, n = 124 OPCABG) were collected for 1 year from the ICU electronic medical records. We compared respiratory variables (Pao 2 , Pao 2 /Fio 2 ratio, Sao 2 , and Paco 2 ) at 7 predefined time points (ICU admission, postoperative hours 1, 3, 6, 12, 18, and 24). We also evaluated time to extubation, rates of reintubation, and use of noninvasive ventilation (NIV). We used mixed-effects linear regression models (with time as random effect for clustering of repeated measures) adjusted for a predetermined set of covariates. The values of Pao 2 and Pao 2 /Fio 2 were significantly higher in the OPCABG group only at ICU admission (mean differences: 9.7 mm Hg, 95% confidence interval [CI] 3.1-16.2; and 27, 95% CI 6.1-47.7, respectively). The OPCABG group showed higher Paco 2 , overall ( P = .02) and at ICU admission (mean difference 1.8 mm Hg, 95% CI: 0.6-3), although mean values were always within normal range in both groups. No differences were seen in Sao 2 values, time to extubation, rate of reintubation rate, and use of postoperative NIV. Extubation rate was higher in OPCABG only at postoperative hour 12 (92% vs ONCABG 82%, P = .02). The OPCABG showed only marginal improvements of unlikely clinical meaning in oxygenation as compared to ONCABG in elective low-risk patients.

Xenon anaesthesia for patients undergoing off-pump coronary artery bypass graft surgery: a prospective randomized controlled pilot trial.

PubMed

Al Tmimi, L; Van Hemelrijck, J; Van de Velde, M; Sergeant, P; Meyns, B; Missant, C; Jochmans, I; Poesen, K; Coburn, M; Rex, S

2015-10-01

Off-pump coronary artery bypass (OPCAB) surgery carries a high risk for haemodynamic instability and perioperative organ injury. Favourable haemodynamic effects and organ-protective properties could render xenon an attractive anaesthetic for OPCAB surgery. The primary aim of this study was to assess whether xenon anaesthesia for OPCAB surgery is non-inferior to sevoflurane anaesthesia with regard to intraoperative vasopressor requirements. Forty-two patients undergoing elective OPCAB surgery were enrolled in this prospective, single-blind, randomized controlled pilot trial. Patients were randomized to either xenon (50-60 vol%) or sevoflurane (1.1-1.4 vol%) anaesthesia. Primary outcome was intraoperative noradrenaline requirements necessary to achieve predefined haemodynamic goals. Secondary outcomes included safety variables such as the occurrence of adverse events (intraoperatively and during a 6-month follow-up after surgery) and the perioperative cardiorespiratory and inflammatory profile. Baseline and intraoperative data did not differ between groups. Xenon was non-inferior to sevoflurane, as xenon patients required significantly less noradrenaline intraoperatively to achieve the predefined haemodynamic goals {geometric mean 428 [95% confidence interval (CI) 312, 588] vs 1702 [1267, 2285] µg, P<0.0001}. No differences were found for safety. Significantly more sevoflurane patients developed postoperative delirium (POD) (hazard ratio 4.2, P=0.044). The average arterial pressure was lower in the sevoflurane group {median75 [interquartile range (IQR) 6] vs 72 [4] mmHg, P=0.002}. No differences were found for other haemodynamic parameters, the respiratory profile and the perioperative release of inflammatory cytokines, troponin T, serum protein S-100β and erythropoietin. Compared with sevoflurane, xenon anaesthesia allows a significant reduction in vasopressor administration in OPCAB surgery. Moreover, xenon anaesthesia was associated with a lower risk for POD, a finding that has to be confirmed in larger studies. ClinicalTrials.gov (NCT01757106) and EudraCT (2012-002316-12). © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Effect of a Perioperative Intra-Aortic Balloon Pump in High-Risk Cardiac Surgery Patients: A Randomized Clinical Trial.

PubMed

Rocha Ferreira, Graziela Santos; de Almeida, Juliano Pinheiro; Landoni, Giovanni; Vincent, Jean Louis; Fominskiy, Evgeny; Gomes Galas, Filomena Regina Barbosa; Gaiotto, Fabio A; Dallan, Luís Oliveira; Franco, Rafael Alves; Lisboa, Luiz Augusto; Palma Dallan, Luis Roberto; Fukushima, Julia Tizue; Rizk, Stephanie Itala; Park, Clarice Lee; Strabelli, Tânia Mara; Gelas Lage, Silvia Helena; Camara, Ligia; Zeferino, Suely; Jardim, Jaquelline; Calvo Arita, Elisandra Cristina Trevisan; Caldas Ribeiro, Juliana; Ayub-Ferreira, Silvia Moreira; Costa Auler, Jose Otavio; Filho, Roberto Kalil; Jatene, Fabio Biscegli; Hajjar, Ludhmila Abrahao

2018-04-30

The aim of this study was to evaluate the efficacy of perioperative intra-aortic balloon pump use in high-risk cardiac surgery patients. A single-center randomized controlled trial and a meta-analysis of randomized controlled trials. Heart Institute of São Paulo University. High-risk patients undergoing elective coronary artery bypass surgery. Patients were randomized to receive preskin incision intra-aortic balloon pump insertion after anesthesia induction versus no intra-aortic balloon pump use. The primary outcome was a composite endpoint of 30-day mortality and major morbidity (cardiogenic shock, stroke, acute renal failure, mediastinitis, prolonged mechanical ventilation, and a need for reoperation). A total of 181 patients (mean [SD] age 65.4 [9.4] yr; 32% female) were randomized. The primary outcome was observed in 43 patients (47.8%) in the intra-aortic balloon pump group and 42 patients (46.2%) in the control group (p = 0.46). The median duration of inotrope use (51 hr [interquartile range, 32-94 hr] vs 39 hr [interquartile range, 25-66 hr]; p = 0.007) and the ICU length of stay (5 d [interquartile range, 3-8 d] vs 4 d [interquartile range, 3-6 d]; p = 0.035) were longer in the intra-aortic balloon pump group than in the control group. A meta-analysis of 11 randomized controlled trials confirmed a lack of survival improvement in high-risk cardiac surgery patients with perioperative intra-aortic balloon pump use. In high-risk patients undergoing cardiac surgery, the perioperative use of an intra-aortic balloon pump did not reduce the occurrence of a composite outcome of 30-day mortality and major complications compared with usual care alone.

Series-parallel solar-augmented rock-bed heat pump. Final report

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

Sowell, E.F.; Othmer, P.W.

1979-12-31

This report deals with a system representing an alternate arrangement of the components in an air-type, heat pump augmented solar heating system. In this system, referred to as Series-Parallel, the heat pump coils are at opposite ends of the rock bed, allowing heating and cooling of the air entering and leaving the bed. This allows a number of unique modes of operation, some of which allow off-peak use of the necessary utility power. Cooling modes are also available, including off-peak cooling-effect storage, night cooling, and free cooling (economizing). The system finds applications principally in single-family residences. The study examined themore » performance of this system at three locations (Sacramento, Albuquerque, and New York) by means of a simulation model. Seasonal heating and cooling performance factors of about 3 were obtained for Albuquerque for the system integrated into a 200 m/sup 2/ residence. Design integration studies suggest an installed cost of approximately $28,000 above a conventional heat pump system using commercially available components. This high cost is largely due to solar hardware, although system complexity also adds. Availability of low-cost air type collectors may make the system attractive. The study also addresses the general problem of predictive control necessary whenever off-peak storage is employed. An algorithm is presented, along with results.« less

Brain function monitoring during off-pump cardiac surgery: a case report

PubMed Central

Zanatta, Paolo; Bosco, Enrico; Di Pasquale, Piero; Nivedita, Agarwal; Valfrè, Carlo; Sorbara, Carlo

2008-01-01

Background Early postoperative stroke is an adverse syndrome after coronary bypass surgery. This report focuses on overcoming of cerebral ischemia as a result of haemodynamic instability during heart enucleation in off-pump procedure. Case presentation A 67 year old male patient, Caucasian race, with a body mass index of 28, had a recent non-Q posterolateral myocardial infarction one month before and recurrent instable angina. His past history includes an uncontrolled hypertension, dyslipidemia, insulin dependent diabetes mellitus, epiaortic vessel stenosis. The patient was scheduled for an off-pump procedure and monitored with bilateral somatosensory evoked potentials, whose alteration signalled the decrement of the cardiac index during operation. The somatosensory evoked potentials appeared when the blood pressure was increased with a pharmacological treatment. Conclusion During the off-pump coronary bypass surgery, a lower cardiac index, predisposes patients, with multiple stroke risk factors, to a reduction of the cerebral blood flow. Intraoperative somatosensory evoked potentials monitoring provides informations about the functional status of somatosensory cortex to reverse effects of brain ischemia. PMID:18706094

Selective suppression of CARS signal with three-beam competing stimulated Raman scattering processes.

PubMed

Choi, Dae Sik; Rao, B Jayachander; Kim, Doyeon; Shim, Sang-Hee; Rhee, Hanju; Cho, Minhaeng

2018-06-14

Coherent Raman scattering spectroscopy and microscopy are useful methods for studying the chemical and biological structures of molecules with Raman-active modes. In particular, coherent anti-Stokes Raman scattering (CARS) microscopy, which is a label-free method capable of imaging structures by displaying the vibrational contrast of the molecules, has been widely used. However, the lack of a technique for switching-off the CARS signal has prevented the development of the super-resolution Raman imaging method. Here, we demonstrate that a selective suppression of the CARS signal is possible by using a three-beam double stimulated Raman scattering (SRS) scheme; the three beams are the pump, Stokes, and depletion lights in order of frequency. Both pump-Stokes and pump-depletion beam pairs can generate SRS processes by tuning their beat frequencies to match two different vibrational modes, then two CARS signals induced by pump-Stokes-pump and pump-depletion-pump interactions can be generated, where the two CARS signals are coupled with each other because they both involve interactions with the common pump beam. Herein, we show that as the intensity of the depletion beam is increased, one can selectively suppress the pump-Stokes-pump CARS signal because the pump-depletion SRS depletes the pump photons. A detailed theoretical description of the coupled differential equations for the three incident fields and the generated CARS signal fields is presented. Taking benzene as a molecular system, we obtained a maximum CARS suppression efficiency of about 97% with our experimental scheme, where the ring breathing mode of the benzene is associated with pump-Stokes-pump CARS, while the C-H stretching mode is associated with the competing pump-depletion SRS process. We anticipate that this selective switching-off scheme will be of use in developing super-resolution label-free CARS microscopy.

Intermediate coronary revascularization using the Deltastream blood pump: results from an experimental study.

PubMed

Litmathe, J; Hansen, E; Feindt, P; Kurt, M; Boeken, U; Gams, E

2009-01-01

Myocardial revascularization using a complete heart-lung machine may involve many problems, as do complete off-pump attempts. Thus, it was the aim of this study to evaluate the effects of intermediate on-pump/off-pump myocardial revascularization using the miniaturized Deltastream blood pump, on ischemia and hemolysis, in comparison with standard myocardial revascularization. In a group of 8 mini-pigs, combined on-pump/off-pump myocardial revascularization was performed using the Deltastream blood pump as beating-heart support for the on-pump part of the operation (group A). Seven other animals served as controls and underwent standard myocardial revascularization with the same device as integrated pump of a complete heart-lung machine (group B). Blood samples for blood gas metabolism, creatine kinase (CK), troponin I, lactate dehydrogenase (LDH), and hydroxybutyrate dehydrogenase (HBDH) were taken before and after the entire operation. Comparing the baseline values, the increase of CK was more pronounced in group B than in group A (176.4-/+41.2 to 279.7-/+29 U/L vs. 274-/+142.7 to 288.1-/+118.6 U/L, respectively; p=0.0006). Increase of troponin I was significantly higher in group B than in group A (1-/+0.3 to 2.9-/+1 ng/mL vs. 1.1-/+0.9 to 3-/+3.8 ng/mL, respectively; p=0.002). LDH increase was also more pronounced in group B (231.7-/+54.3 to 299.9-/+39.8 U/L vs. 274.9-/+59.7 to 263.8-/+57.9 U/L, respectively; p=0.01). HBDH values increased significantly in group B after the operation (group A: 215.9-/+34.7 to 200-/+39.2 U/L vs. group B: 195.4-/+41.7 to 274.9-/+51.6 U/L; p=0.02). Hemodynamic measures and LDH values under luxation (group A: 1.9-/+0.6 U/L; B: 3.5-/+1 U/L,p=0.001) were also superior in the study group. The current set-up might be superior to conventional extracorporeal circulation and thus be an alternative for high-risk candidates to avoid the adverse events of a complete heart-lung machine, when they are scheduled for complete myocardial revascularization.

Design trade-offs among shunt current, pumping loss and compactness in the piping system of a multi-stack vanadium flow battery

NASA Astrophysics Data System (ADS)

Ye, Qiang; Hu, Jing; Cheng, Ping; Ma, Zhiqi

2015-11-01

Trade-off between shunt current loss and pumping loss is a major challenge in the design of the electrolyte piping network in a flow battery system. It is generally recognized that longer and thinner ducts are beneficial to reduce shunt current but detrimental to minimize pumping power. Base on the developed analog circuit model and the flow network model, we make case studies of multi-stack vanadium flow battery piping systems and demonstrate that both shunt current and electrolyte flow resistance can be simultaneously minimized by using longer and thicker ducts in the piping network. However, extremely long and/or thick ducts lead to a bulky system and may be prohibited by the stack structure. Accordingly, the intrinsic design trade-off is between system efficiency and compactness. Since multi-stack configurations bring both flexibility and complexity to the design process, we perform systematic comparisons among representative piping system designs to illustrate the complicated trade-offs among numerous parameters including stack number, intra-stack channel resistance and inter-stack pipe resistance. As the final design depends on various technical and economical requirements, this paper aims to provide guidelines rather than solutions for designers to locate the optimal trade-off points according to their specific cases.

Investigation of an ejector heat pump by analytical methods

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

Hsu, C.T.

1984-07-01

Using existing theories of ejector design, the optimum geometry of a high-efficiency ejector - including mixing section cross-sectional area, mass flow entrainment rate, ejector efficiency, and overall COP - for a heat pump cycle was determined. A parametric study was performed to evaluate the COP values for different operating conditions. A sensitivity study determined th effects of nozzle efficiency and diffuser efficiency on the overall ejector heat pump COP. The off-design study estimated the COP for an ejector heat pump operating at off-design conditions. Refrigerants 11, 113, and 114 are three of the halocarbons which best satisfy the criteria formore » an ejector heat pump system. The estimated COPs were 0.3 for the cooling mode and 1.3 for the heating mode at standard operating conditions: a boiler temperature of 93.3/sup 0/C (200/sup 0/F), a condenser temperature of 43.3/sup 0/C (110/sup 0/F), and an evaporator temperature of 10/sup 0/C (50/sup 0/F). Based on the same operating conditions, an optimum ejector geometry was estimated for each of the refrigerants R-11 and R-113. Since the COP values for heating obtained in this analysis are greater than unity, the performance of an ejector heat pump operating in the heating mode should be competitive with that of oil- or gas-fired furnaces or electrical resistance heaters.« less

Off-pump repair of a post-infarct ventricular septal defect: the 'Hamburger procedure'

PubMed Central

Barker, Thomas A; Ng, Alexander; Morgan, Ian S

2006-01-01

We report a novel off-pump technique for the surgical closure of post-infarct ventricular septal defects (VSDs). The case report describes the peri-operative management of a 76 year old lady who underwent the 'Hamburger procedure' for closure of her apical VSD. Refractory cardiogenic shock meant that traditional patch repairs requiring cardiopulmonary bypass would be poorly tolerated. We show that echocardiography guided off-pump posterior-anterior septal plication is a safe, effective method for closing post-infarct VSDs in unstable patients. More experience is required to ascertain whether this technique will become an accepted alternative to patch repairs. PMID:16722552

Right pleuropericardial release: a useful technique in off-pump coronary surgery.

PubMed

Velissaris, Theodore; Stuklis, Robert G; Hett, David A; Ohri, Sunil K

2003-06-01

We describe the use of right pleurotomy combined with right pericardial release during off-pump coronary surgery. The maneuver releases the compression exerted on the right cardiac chambers during cardiac verticalization and improves hemodynamic stability during exposure of the posterior or lateral coronary vessels.

Lessons Learned From a Pilot RCT of Simultaneous Versus Delayed Initiation of Continuous Glucose Monitoring in Children and Adolescents With Type 1 Diabetes Starting Insulin Pump Therapy

PubMed Central

Olivier, Patricia; Huot, Celine; Richardson, Christine; Nakhla, Meranda; Romain, Judette

2014-01-01

Uncertainty remains about effectiveness of continuous glucose monitoring (CGM) in pediatric type 1 diabetes (T1D). Success with CGM is related to CGM adherence, which may relate to readiness to make the behavior changes required for effective use. We hypothesize that readiness for change will be greater at initiation of insulin pump therapy than in established pump users, and that this will predict CGM adherence. Our objective was to evaluate the feasibility of a randomized controlled trial (RCT) in children with established T1D comparing simultaneous pump and CGM initiation to standard pump therapy with delayed CGM initiation. We randomized participants to simultaneous pump and CGM initiation or to standard pump therapy with the option of adding CGM 4 months later. CGM adherence was tracked via web-based download and readiness for change assessed with the SOCRATES questionnaire. Of 41 eligible children, 20 agreed to participate; 15 subjects completed the study (7 males; baseline age 11.8 ± 4.0 years; T1D duration 2.7 ± 2.7 years; mean A1C 8.2 ± 0.8%). Six of 8 simultaneous group subjects used CGM > 60% of the time for 4 months compared to 1 of 7 delayed group subjects (P = .02). Using SOCRATES, we could assign 87-100% of subjects to a single motivation stage at baseline and 4 months. This pilot study demonstrates the feasibility of randomizing pump naïve children and adolescents with established T1D to simultaneous pump and CGM initiation versus standard pump therapy with delayed CGM initiation. Lessons from this pilot study were used to inform development of a full-scale multicenter RCT. PMID:24876616

The importance of intraoperative selenium blood levels on organ dysfunction in patients undergoing off-pump cardiac surgery: a randomised controlled trial.

PubMed

Stevanovic, Ana; Coburn, Mark; Menon, Ares; Rossaint, Rolf; Heyland, Daren; Schälte, Gereon; Werker, Thilo; Wonisch, Willibald; Kiehntopf, Michael; Goetzenich, Andreas; Rex, Steffen; Stoppe, Christian

2014-01-01

Cardiac surgery is accompanied by an increase of oxidative stress, a significantly reduced antioxidant (AOX) capacity, postoperative inflammation, all of which may promote the development of organ dysfunction and an increase in mortality. Selenium is an essential co-factor of various antioxidant enzymes. We hypothesized a less pronounced decrease of circulating selenium levels in patients undergoing off-pump coronary artery bypass (OPCAB) surgery due to less intraoperative oxidative stress. In this prospective randomised, interventional trial, 40 patients scheduled for elective coronary artery bypass grafting were randomly assigned to undergo either on-pump or OPCAB-surgery, if both techniques were feasible for the single patient. Clinical data, myocardial damage assessed by myocard specific creatine kinase isoenzyme (CK-MB), circulating whole blood levels of selenium, oxidative stress assessed by asymmetric dimethylarginine (ADMA) levels, antioxidant capacity determined by glutathionperoxidase (GPx) levels and perioperative inflammation represented by interleukin-6 (IL-6) levels were measured at predefined perioperative time points. At end of surgery, both groups showed a comparable decrease of circulating selenium concentrations. Likewise, levels of oxidative stress and IL-6 were comparable in both groups. Selenium levels correlated with antioxidant capacity (GPx: r = 0.720; p<0.001) and showed a negative correlation to myocardial damage (CK-MB: r =  -0.571, p<0.001). Low postoperative selenium levels had a high predictive value for the occurrence of any postoperative complication. OPCAB surgery is not associated with less oxidative stress and a better preservation of the circulating selenium pool than on-pump surgery. Low postoperative selenium levels are predictive for the development of complications. ClinicalTrials.gov NCT01409057.

RESONATORS. MODES: Modes of a plano - spherical laser resonator with the Gaussian gain distribution of the active medium

NASA Astrophysics Data System (ADS)

Malyutin, A. A.

2007-03-01

Modes of a laser with plano-spherical degenerate and nondegenerate resonators are calculated upon diode pumping producing the Gaussian gain distribution in the active medium. Axially symmetric and off-axis pumpings are considered. It is shown that in the first case the lowest Hermite-Gaussian mode is excited with the largest weight both in the degenerate and nondegenerate resonator if the pump level is sufficiently high or the characteristic size wg of the amplifying region greatly exceeds the mode radius w0. The high-order Ince-Gaussian modes are excited upon weak off-axis pumping in the nondegenerate resonator both in the absence and presence of the symmetry of the gain distribution with respect to the resonator axis. It is found that when the level of off-axis symmetric pumping of the resonator is high enough, modes with the parameters of the TEM00 mode periodically propagating over a closed path in the resonator can exist. The explanation of this effect is given.

Modeling and design of a high efficiency hybrid heat pump clothes dryer

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

TeGrotenhuis, Ward; Butterfield, Andrew; Caldwell, Dustin

Computational modeling is used to design a hybrid heat pump clothes dryer capable of saving 50% of the energy used by residential clothes dryers with comparable drying times. The model represents the various stages of a drying cycle from warm-up through constant drying rate and falling drying rate phases and finishing with a cooldown phase. The model is fit to data acquired from a U.S. commercial standard vented electric dryer, and when a hybrid heat pump system is added, the energy factor increases from 3.0 lbs/kWh to 5.7-6.0 lbs/kWh, depending on the increase in blower motor power. The hybrid heatmore » pump system is designed from off-the-shelf components and includes a recuperative heat exchanger, an electric element, and an R-134a vapor compression heat pump. Parametric studies of element power and heating element use show a trade-off between energy savings and cycle time. Results show a step-change in energy savings from heat pump dryers currently marketed in the U.S. based on performance represented by Enery Star from standardized DOE testing.« less

Do Arthroscopic Fluid Pumps Display True Surgical Site Pressure During Hip Arthroscopy?

PubMed

Ross, Jeremy A; Marland, Jennifer D; Payne, Brayden; Whiting, Daniel R; West, Hugh S

2018-01-01

To report on the accuracy of 5 commercially available arthroscopic fluid pumps to measure fluid pressure at the surgical site during hip arthroscopy. Patients undergoing hip arthroscopy for femoroacetabular impingement were block randomized to the use of 1 of 5 arthroscopic fluid pumps. A spinal needle inserted into the operative field was used to measure surgical site pressure. Displayed pump pressures and surgical site pressures were recorded at 30-second intervals for the duration of the case. Mean differences between displayed pump pressures and surgical site pressures were obtained for each pump group. Of the 5 pumps studied, 3 (Crossflow, 24K, and Continuous Wave III) reflected the operative field fluid pressure within 11 mm Hg of the pressure readout. In contrast, 2 of the 5 pumps (Double Pump RF and FMS/DUO+) showed a difference of greater than 59 mm Hg between the operative field fluid pressure and the pressure readout. Joint-calibrated pumps more closely reflect true surgical site pressure than gravity-equivalent pumps. With a basic understanding of pump design, either type of pump can be used safely and efficiently. The risk of unfamiliarity with these differences is, on one end, the possibility of pump underperformance and, on the other, potentially dangerously high operating pressures. Level II, prospective block-randomized study. Copyright © 2017. Published by Elsevier Inc.

Analysis of off-grid hybrid wind turbine/solar PV water pumping systems

USDA-ARS?s Scientific Manuscript database

While many remote water pumping systems exist (e.g. mechanical windmills, solar photovoltaic , wind-electric, diesel powered), very few combine both the wind and solar energy resources to possibly improve the reliability and the performance of the system. In this paper, off-grid wind turbine (WT) a...

Effect of pumping pressure on onset of lactation after caesarean section: A randomized controlled study.

PubMed

Zhang, Feng; Yang, Yahui; Bai, Ting; Sun, Lele; Sun, Mingzhu; Shi, Xueling; Zhu, Meng; Ge, Meijuan; Xia, Haiou

2018-01-01

Caesarean section is associated with weaker newborn suction pressure. This nonblinded, randomized trial explored the effect of suction pressures generating by a breast pump on mothers' onset of lactation and milk supply after caesarean section. A high pressure group (-150 mmHg), a low pressure group (-100 mmHg), and a control group (none) were generated under computer random assignment with concealed allocation in 2 tertiary hospitals. The breast pumping began within 2 hr after caesarean operation (6 times a day and 30 min per time) until onset of lactation. The primary outcomes were the timing of onset of lactation, milk supply, and mother's satisfaction in lactation, using both intention-to-treat and per-protocol analyses. The secondary endpoints were the pumping-related pain, nipple injury, and maternal fatigue. All 164 women randomized were included in analysis. The breast pumping at -150 mmHg optimally advanced the timing of the onset of lactation and increased daytime milk supply. The pumping also appeared to boost mothers' confidence in lactation. The results in the per-protocol population (n = 148) were consistent with those of intention-to-treat population (n = 164). However, the pumping aggravated maternal nipple pain and fatigue, though there was no statistical significance. The findings suggest that a higher pumping pressure within the range of normal vaginally born infant suction could promote onset of lactation and milk supply among mothers giving birth by caesarean section. The pumping could also enhance mothers' confidence in breastfeeding. © 2017 John Wiley & Sons Ltd.

Current Status of Off-pump Coronary Artery Bypass Grafting in Patients with Multiple Coronary Artery Disease Compared with On-pump Coronary Artery Bypass Grafting: The Korean National Cohort Study.

PubMed

Kim, Hee Jung; Chung, Jae Eun; Jung, Jae Seung; Kim, In Seup; Son, Ho Sung

2018-05-31

 Despite advance in off-pump coronary artery bypass (OPCAB) grafting, there are large debating issues regarding survival benefit between OPCAB and on-pump coronary artery bypass grafting (CABG). The aim of this study is to address appropriateness of OPCAB approach in patients with ischemic heart disease having multiple vessels using South Korea national cohort data.  To evaluate the safety and efficacy of OPCAB, we accessed all causes of death, late repeat revascularization, hospitalization for cerebrovascular accident (CVA), and new renal replacement therapy in patients who underwent isolated CABG with multiple grafting (≥2 grafts) and who were registered in the Korean Health Insurance Review and Assessment Service Database between April 2011 and September 2014.  OPCAB was performed in 4,692 patients and on-pump CABG in 2,999 patients from 82 hospitals in South Korea. On multivariable analysis, on-pump CABG was associated with a significantly higher adjusted risk of overall all-cause death (hazard ratio [HR]: 1.876, 95% confidence interval [CI]: 1.587-2.216, p  < 0.001) and initiation of new renal replacement therapy (HR: 1.618, 95% CI: 1.124-2.331, p  = 0.009). However, we observed no significant difference in repeat revascularization and hospitalization for CVA between the two groups. In propensity score matching, matched patients (2,940 pairs) showed results similar to multivariable analysis that on-pump CABG was associated with a higher overall mortality and initiation of new renal replacement therapy ( p  < 0.001).  In this study, we found that OPCAB was associated with better survival rates and renal preservation compared with on-pump CABG. Georg Thieme Verlag KG Stuttgart · New York.

Mold Heating and Cooling Pump Package Operator Interface Controls Upgrade

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

Josh A. Salmond

2009-08-07

The modernization of the Mold Heating and Cooling Pump Package Operator Interface (MHC PP OI) consisted of upgrading the antiquated single board computer with a proprietary operating system to off-the-shelf hardware and off-the-shelf software with customizable software options. The pump package is the machine interface between a central heating and cooling system that pumps heat transfer fluid through an injection or compression mold base on a local plastic molding machine. The operator interface provides the intelligent means of controlling this pumping process. Strict temperature control of a mold allows the production of high quality parts with tight tolerances and lowmore » residual stresses. The products fabricated are used on multiple programs.« less

Classroom attention in children with type 1 diabetes mellitus: the effect of stabilizing serum glucose.

PubMed

Daley, Kelly B; Wodrich, David L; Hasan, Khalid

2006-02-01

To determine whether stabilizing serum glucose, via introduction of an insulin pump, improves classroom attention among children with type-1 diabetes mellitus. Four boys having type-1 diabetes mellitus with unstable serum glucose were observed in their classroom for 10 baseline days. An insulin pump was placed and serum glucose stabilized, and they were then observed again for 10 days. A modified multiple baseline design was used to determine if improved on-task and off-task behavior was associated with better glycemic control. Rating scales and a laboratory measure of attention, measures of secondary interest, were also administered before and after pump introduction, and potential improvement in individuals' scores was evaluated. All boys had apparent improvement in on-task and off-task behavior as observed in their classrooms. Improvements were substantial, averaging 20% in on-task behavior and 34% in off-task behavior. However, no changes were detected on rating scales or laboratory measures. This study offers preliminary evidence that stabilizing serum glucose improves classroom attention, although the effect was detected only by observation of classroom behavior using highly structured techniques. Consequently, use of direct observation techniques may be important in studying the effects of chronic illness on classroom functioning.

Transient simulation of coolant peak temperature due to prolonged fan and/or water pump operation after the vehicle is keyed-off

NASA Astrophysics Data System (ADS)

Pang, Suh Chyn; Masjuki, Haji Hassan; Kalam, Md. Abul; Hazrat, Md. Ali

2014-01-01

Automotive designers should design a robust engine cooling system which works well in both normal and severe driving conditions. When vehicles are keyed-off suddenly after some distance of hill-climbing driving, the coolant temperature tends to increase drastically. This is because heat soak in the engine could not be transferred away in a timely manner, as both the water pump and cooling fan stop working after the vehicle is keyed-off. In this research, we aimed to visualize the coolant temperature trend over time before and after the vehicles were keyed-off. In order to prevent coolant temperature from exceeding its boiling point and jeopardizing engine life, a numerical model was further tested with prolonged fan and/or water pump operation after keying-off. One dimensional thermal-fluid simulation was exploited to model the vehicle's cooling system. The behaviour of engine heat, air flow, and coolant flow over time were varied to observe the corresponding transient coolant temperatures. The robustness of this model was proven by validation with industry field test data. The numerical results provided sensible insights into the proposed solution. In short, prolonging fan operation for 500 s and prolonging both fan and water pump operation for 300 s could reduce coolant peak temperature efficiently. The physical implementation plan and benefits yielded from implementation of the electrical fan and electrical water pump are discussed.

Risk Factors of On-Pump Conversion during Off-Pump Coronary Artery Bypass Graft

PubMed Central

Yoon, Sung Sil; Bang, Jung Hee; Jeong, Sang Seok; Jeong, Jae Hwa; Woo, Jong Soo

2017-01-01

Background Off-pump coronary artery bypass grafting (OPCABG) procedures can avoid the complications of an on-pump bypass. However, some cases unexpectedly require conversion to cardiopulmonary bypass during OPCABG. The risk factors associated with a sudden need for cardiopulmonary bypass were analyzed. Methods This retrospective study included 283 subjects scheduled for OPCABG from 2001 to 2010. These were divided into an OPCABG group and an on-pump conversion group. Preoperative, operative, and postoperative variables were compared between the 2 groups. Results Of the 283 patients scheduled for OPCABG, 47 (16%) were switched to on-pump coronary artery bypass grafting (CABG). The mortality of the both the OPCABG and on-pump conversion groups was not significantly different. The major risk factors for conversion to on-pump CABG were congestive heart failure (CHF) (odds ratio [OR], 3.5; p=0.029), ejection fraction (EF) <35% (OR, 4.4; p=0.012), and preoperative beta-blocker (BB) administration (OR, 0.3; p=0.007). The use of intraoperative (p=0.007) and postoperative (p=0.021) inotropics was significantly higher in the conversion group. The amount of postoperative drainage (p<0.001) and transfusion (p<0.001) also was significantly higher in the conversion group. There were no significant differences in stroke or cardiovascular complications between the groups over the course of short-term and long-term follow-up. Conclusion Patients who undergo OPCABG and have CHF or a lower EF (<35%) are more likely to undergo on-pump conversion, while preoperative BB administration could help prevent conversions from OPCABG to on-pump CABG. PMID:29124027

Off-pump compared to minimal extracorporeal circulation surgery in coronary artery bypass grafting.

PubMed

Reuthebuch, Oliver; Koechlin, Luca; Gahl, Brigitta; Matt, Peter; Schurr, Ulrich; Grapow, Martin; Eckstein, Friedrich

2014-01-01

Coronary artery bypass grafting (CABG) using extracorporeal circulation (ECC) is still the gold standard. However, alternative techniques have been developed to avoid ECC and its potential adverse effects. These encompass minimal extracorporeal circulation (MECC) or off-pump coronary artery bypass grafting (OPCAB). However, the prevailing potential benefits when comparing MECC and OPCABG are not yet clearly established. In this retrospective study we investigated the potential benefits of MECC and OPCABG in 697 patients undergoing CABG. Of these, 555 patients had been operated with MECC and 142 off-pump. The primary endpoint was Troponin T level as an indicator for myocardial damage. Study groups were not significantly different in general. However, patients undergoing OPCABG were significantly older (65.01 years ± 9.5 vs. 69.39 years ± 9.5; p value <0.001) with a higher Logistic EuroSCORE I (4.92% ± 6.5 vs. 5.88% ± 6.8; p value = 0.017). Operating off pump significantly reduced the need for intra-operative blood products (0.7% vs. 8.6%; p-value <0.001) and the length of stay in the intensive care unit (ICU) (2.04 days ± 2.63 vs. 2.76 days ± 2.79; p value <0.001). Regarding other blood values a significant difference could not be found in the adjusted calculations. The combined secondary endpoint, major cardiac or cerebrovascular events (MACCE), was equal in both groups as well. Coronary artery bypass grafting using MECC or OPCABG are two comparable techniques with advantages for OPCABG regarding the reduced need for intra-operative blood products and shorter length of stay in the ICU. However serological values and combined endpoint MACCE did not differ significantly in both groups.

Off-pump coronary artery bypass surgery in selected patients is superior to the conventional approach for patients with severely depressed left ventricular function

PubMed Central

Caputti, Guido Marco; Palma, José Honório; Gaia, Diego Felipe; Buffolo, Enio

2011-01-01

OBJECTIVES: Patients with coronary artery disease and left ventricular dysfunction have high mortality when kept in clinical treatment. Coronary artery bypass grafting can improve survival and the quality of life. Recently, revascularization without cardiopulmonary bypass has been presented as a viable alternative. The aim of this study is to compare patients with left ventricular ejection fractions of less than 20% who underwent coronary artery bypass graft with or without cardiopulmonary bypass. METHODS: From January 2001 to December 2005, 217 nonrandomized, consecutive, and nonselected patients with an ejection fraction less than or equal to 20% underwent coronary artery bypass graft surgery with (112) or without (off-pump) (105) the use of cardiopulmonary bypass. We studied demographic, operative, and postoperative data. RESULTS: There were no demographic differences between groups. The outcome variables showed similar graft numbers in both groups. Mortality was 12.5% in the cardiopulmonary bypass group and 3.8% in the off-pump group. Postoperative complications were statistically different (cardiopulmonary bypass versus off-pump): total length of hospital stay (days)—11.3 vs. 7.2, length of ICU stay (days)—3.7 vs. 2.1, pulmonary complications—10.7% vs. 2.8%, intubation time (hours)—22 vs. 10, postoperative bleeding (mL)—654 vs. 440, acute renal failure—8.9% vs. 1.9% and left-ventricle ejection fraction before discharge—22% vs. 29%. CONCLUSION: Coronary artery bypass grafting without cardiopulmonary bypass in selected patients with severe left ventricular dysfunction is valid and safe and promotes less mortality and morbidity compared with conventional operations. PMID:22189729

Embracing the heart: perioperative management of patients undergoing off-pump coronary artery bypass grafting using the octopus tissue stabilizer.

PubMed

Nierich, A P; Diephuis, J; Jansen, E W; van Dijk, D; Lahpor, J R; Borst, C; Knape, J T

1999-04-01

To describe hemodynamic alterations during coronary artery bypass grafting (CABG) without extracorporeal circulation using the Octopus Tissue Stabilizer, and to describe the two anesthetic management protocols based on either general anesthesia with opioids (34 patients) or general anesthesia with high thoracic epidural anesthesia (TEA; 66 patients). A prospective observational report. An academic university heart center. First 100 patients undergoing CABG using the Octopus Tissue Stabilizer. None. Current management provided satisfactory results in preventing hypoperfusion of the heart and inadequate systemic circulation without the use of major pharmacologic interventions. Movement of the heart to reach the target site of anastomosis caused hemodynamic alterations. These could easily be corrected by anesthetic interventions, such as fluid load and low doses of inotropes. High TEA allows earlier extubation compared with the opioid anesthesia technique (0.9 v 4.5 hours). Perioperative management and the incidence of postoperative complications did not differ between anesthetic techniques. Major complications, such as death, intraoperative myocardial infarction, and stroke, did not occur. Both anesthetic protocols are safe and effective in handling these patients. Off-pump CABG surgery requires anesthetic interventions because hemodynamic alterations are caused by the presentation of the heart to the surgeon. The complication rate is low but needs to be evaluated, compared with conventional CABG, in a prospective randomized study. High thoracic epidural anesthesia allows early recovery, but improved outcome could not be proved in this patient group.

Mean Line Pump Flow Model in Rocket Engine System Simulation

NASA Technical Reports Server (NTRS)

Veres, Joseph P.; Lavelle, Thomas M.

2000-01-01

A mean line pump flow modeling method has been developed to provide a fast capability for modeling turbopumps of rocket engines. Based on this method, a mean line pump flow code PUMPA has been written that can predict the performance of pumps at off-design operating conditions, given the loss of the diffusion system at the design point. The pump code can model axial flow inducers, mixed-flow and centrifugal pumps. The code can model multistage pumps in series. The code features rapid input setup and computer run time, and is an effective analysis and conceptual design tool. The map generation capability of the code provides the map information needed for interfacing with a rocket engine system modeling code. The off-design and multistage modeling capabilities of the code permit parametric design space exploration of candidate pump configurations and provide pump performance data for engine system evaluation. The PUMPA code has been integrated with the Numerical Propulsion System Simulation (NPSS) code and an expander rocket engine system has been simulated. The mean line pump flow code runs as an integral part of the NPSS rocket engine system simulation and provides key pump performance information directly to the system model at all operating conditions.

The Predictive Value of Integrated Pulmonary Index after Off-Pump Coronary Artery Bypass Grafting: A Prospective Observational Study.

PubMed

Fot, Evgenia V; Izotova, Natalia N; Yudina, Anjelika S; Smetkin, Aleksei A; Kuzkov, Vsevolod V; Kirov, Mikhail Y

2017-01-01

The early warning scores may increase the safety of perioperative period. The objective of this study was to assess the diagnostic and predictive role of Integrated Pulmonary Index (IPI) after off-pump coronary artery bypass grafting (OPCAB). Forty adult patients undergoing elective OPCAB were enrolled into a single-center prospective observational study. We assessed respiratory function using IPI that includes oxygen saturation, end-tidal CO 2 , respiratory rate, and pulse rate. In addition, we evaluated blood gas analyses and hemodynamics, including ECG, invasive arterial pressure, and cardiac index. The measurements were performed after transfer to the intensive care unit, after spontaneous breathing trial and at 2, 6, 12, and 18 h after extubation. The value of IPI registered during respiratory support correlated weakly with cardiac index (rho = 0.4; p  = 0.04) and ScvO 2 (rho = 0.4, p  = 0.02). After extubation, IPI values decreased significantly, achieving a minimum by 18 h. The IPI value ≤9 at 6 h after extubation was a predictor of complicated early postoperative period (AUC = 0.71; p  = 0.04) observed in 13 patients. In off-pump coronary surgery, the IPI decreases significantly after tracheal extubation and may predict postoperative complications.

Zero Gravity Cryogenic Vent System Concepts for Upper Stages

NASA Astrophysics Data System (ADS)

Ravex, Alain; Flachbart, Robin; Holt, Barney

The capability to vent in zero gravity without resettling is a technology need that involves practically all uses of sub-critical cryogenics in space. Venting without resettling would extend cryogenic orbital transfer vehicle capabilities. However, the lack of definition regarding liquid/ullage orientation coupled with the somewhat random nature of the thermal stratification and resulting pressure rise rates, lead to significant technical challenges. Typically a zero gravity vent concept, termed a thermodynamic vent system (TVS), consists of a tank mixer to destratify the propellant, combined with a Joule-Thomson (J-T) valve to extract thermal energy from the propellant. Marshall Space Flight Center's (MSFC's) Multipurpose Hydrogen Test Bed (MHTB) was used to test both spray bar and axial jet TVS concepts. The axial jet system consists of a recirculation pump heat exchanger unit. The spray bar system consists of a recirculation pump, a parallel flow concentric tube, heat exchanger, and a spray bar positioned close to the longitudinal axis of the tank. The operation of both concepts is similar. In the mixing mode, the recirculation pump withdraws liquid from the tank and sprays it into the tank liquid, ullage, and exposed tank surfaces. When energy extraction is required, a small portion of the recirculated liquid is passed sequentially through the J-T expansion valve, the heat exchanger, and is vented overboard. The vented vapor cools the circulated bulk fluid, thereby removing thermal energy and reducing tank pressure. The pump operates alone, cycling on and off, to destratify the tank liquid and ullage until the liquid vapor pressure reaches the lower set point. At that point, the J-T valve begins to cycle on and off with the pump. Thus, for short duration missions, only the mixer may operate, thus minimizing or even eliminating boil-off losses. TVS performance testing demonstrated that the spray bar was effective in providing tank pressure control within a 6.89 kPa (1psi) band for fill levels of 90%, 50%, and 25%. Complete destratification of the liquid and ullage was achieved at these fill levels. The axial jet was effective in providing tank pressure control within the same pressure control band at the 90% fill level. However, at the 50% level, the system reached a point at which it was unable to extract enough energy to keep up with the heat leak into the tank. Due to a hardware problem, the recirculation pump operated well below the axial jet design flow rate. Therefore, it is likely that the performance of the axial jet would have improved had the pump operated at the proper flow rate. A CFD model is being used to determine if the desired axial jet performance would be achieved if a higher pump flow rate were available. Testing conducted thus far has demonstrated that both TVS concepts can be effective in destratifying a propellant tank, rejecting stored heat energy, and thus, controlling tank pressure.

Tricuspid valve excision using off-pump inflow occlusion technique: role of intra-operative trans-esophageal echocardiography.

PubMed

Gadhinglajkar, Shrinivas; Sreedhar, Rupa; Karunakaran, Jayakumar; Misra, Manoranjan; Somasundaram, Ganesh; Mathew, Thomas

2010-01-01

A pacing system infection may lead to infective endocarditis and systemic sepsis. Tricuspid valve surgery may be required if the valve is severely damaged in the process of endocarditis. Although, cardiopulmonary bypass is the safe choice for performing right-heart procedures, it may carry risk of inducing systemic inflammatory response and multi-organ dysfunction. Some studies have advocated TV surgery without institution of CPB. We report tricuspid valve excision using the off-pump inflow occlusion technique in a 68-year-old man. We also describe role of intra-operative TEE as a monitoring tool at different stages of the surgical procedure.

Automated Weaning from Mechanical Ventilation after Off-Pump Coronary Artery Bypass Grafting.

PubMed

Fot, Evgenia V; Izotova, Natalia N; Yudina, Angelika S; Smetkin, Aleksei A; Kuzkov, Vsevolod V; Kirov, Mikhail Y

2017-01-01

The discontinuation of mechanical ventilation after coronary surgery may prolong and significantly increase the load on intensive care unit personnel. We hypothesized that automated mode using INTELLiVENT-ASV can decrease duration of postoperative mechanical ventilation, reduce workload on medical staff, and provide safe ventilation after off-pump coronary artery bypass grafting (OPCAB). The primary endpoint of our study was to assess the duration of postoperative mechanical ventilation during different modes of weaning from respiratory support (RS) after OPCAB. The secondary endpoint was to assess safety of the automated weaning mode and the number of manual interventions to the ventilator settings during the weaning process in comparison with the protocolized weaning mode. Forty adult patients undergoing elective OPCAB were enrolled into a prospective single-center study. Patients were randomized into two groups: automated weaning ( n  = 20) using INTELLiVENT-ASV mode with quick-wean option; and protocolized weaning ( n  = 20), using conventional synchronized intermittent mandatory ventilation (SIMV) + pressure support (PS) mode. We assessed the duration of postoperative ventilation, incidence and duration of unacceptable RS, and the load on medical staff. We also performed the retrospective analysis of 102 patients (standard weaning) who were weaned from ventilator with SIMV + PS mode based on physician's experience without prearranged algorithm. Realization of the automated weaning protocol required change in respiratory settings in 2 patients vs. 7 (5-9) adjustments per patient in the protocolized weaning group. Both incidence and duration of unacceptable RS were reduced significantly by means of the automated weaning approach. The FiO 2 during spontaneous breathing trials was significantly lower in the automated weaning group: 30 (30-35) vs. 40 (40-45) % in the protocolized weaning group ( p  < 0.01). The average time until tracheal extubation did not differ in the automated weaning and the protocolized weaning groups: 193 (115-309) and 197 (158-253) min, respectively, but increased to 290 (210-411) min in the standard weaning group. The automated weaning system after off-pump coronary surgery might provide postoperative ventilation in a more protective way, reduces the workload on medical staff, and does not prolong the duration of weaning from ventilator. The use of automated or protocolized weaning can reduce the duration of postoperative mechanical ventilation in comparison with non-protocolized weaning based on the physician's decision.

The Effect of Milrinone on the Right Ventriclular Function in Patients with Reduced Right Ventricular Function Undergoing Off-pump Coronary Artery Bypass Graft Surgery

PubMed Central

Lee, Jong Hwa; Oh, Young Jun; Shim, Yon Hee; Hong, Yong Woo; Yi, Gijong

2006-01-01

This investigation evaluated the effect of continuous milrinone infusion on right ventriclular (RV) function during off-pump coronary artery bypass graft (OPCAB) surgery in patients with reduced RV function. Fifty patients scheduled for OPCAB, with thermodilution RV ejection fraction (RVEF) <35% after anesthesia induction, were randomly allocated to either milrinone (0.5 µg/kg/min) or control (saline) group. Hemodynamic variables and RV volumetric data measured by thermodilution method were collected as follows: after anesthesia induction (T1); 10 min after heart displacement for obtuse marginal artery anastomosis (T2); after pericardial closure (T3). Cardiac index and heart rate increased and systemic vascular resistance significantly decreased in milrinone group at T2. Initially lower RVEF of milrinone group was eventually comparable to control group after milrinone infusion. RVEF did not significantly change at T2 and T3 in both groups. RV end-diastolic volume in milrinone group consistently decreased from the baseline at T2 and T3. Continuous infusion of milrinone without a bolus demonstrated potentially beneficial effect on cardiac output and RV afterload in patients with reduced RV function during OPCAB. However, aggressive augmentation of intravascular volume seems to be necessary to maximize the effect of the milrinone in these patients. PMID:17043419

Solute Concentration at a Pumping Well in Non-Gaussian Random Aquifers under Time-Varying Operational Schedules

NASA Astrophysics Data System (ADS)

Libera, A.; de Barros, F.; Riva, M.; Guadagnini, A.

2016-12-01

Managing contaminated groundwater systems is an arduous task for multiple reasons. First, subsurface hydraulic properties are heterogeneous and the high costs associated with site characterization leads to data scarcity (therefore, model predictions are uncertain). Second, it is common for water agencies to schedule groundwater extraction through a temporal sequence of pumping rates to maximize the benefits to anthropogenic activities and minimize the environmental footprint of the withdrawal operations. The temporal variability in pumping rates and aquifer heterogeneity affect dilution rates of contaminant plumes and chemical concentration breakthrough curves (BTCs) at the well. While contaminant transport under steady-state pumping is widely studied, the manner in which a given time-varying pumping schedule affects contaminant plume behavior is tackled only marginally. At the same time, most studies focus on the impact of Gaussian random hydraulic conductivity (K) fields on transport. Here, we systematically analyze the significance of the random space function (RSF) model characterizing K in the presence of distinct pumping operations on the uncertainty of the concentration BTC at the operating well. We juxtapose Monte Carlo based numerical results associated with two models: (a) a recently proposed Generalized Sub-Gaussian model which allows capturing non-Gaussian statistical scaling features of RSFs such as hydraulic conductivity, and (b) the commonly used Gaussian field approximation. Our novel results include an appraisal of the coupled effect of (a) the model employed to depict the random spatial variability of K and (b) transient flow regime, as induced by a temporally varying pumping schedule, on the concentration BTC at the operating well. We systematically quantify the sensitivity of the uncertainty in the contaminant BTC to the RSF model adopted for K (non-Gaussian or Gaussian) in the presence of diverse well pumping schedules. Results contribute to determine conditions under which any of these two key factors prevails on the other.

Generation of vortex array laser beams with Dove prism embedded unbalanced Mach-Zehnder interferometer

NASA Astrophysics Data System (ADS)

Chu, Shu-Chun

2009-02-01

This paper introduces a scheme for generation of vortex laser beams from a solid-state laser with off-axis laser-diode pumping. The proposed system consists of a Dove prism embedded in an unbalanced Mach-Zehnder interferometer configuration. This configuration allows controlled construction of p × p vortex array beams from Ince-Gaussian modes, IGep,p modes. An incident IGe p,p laser beam of variety order p can easily be generated from an end-pumped solid-state laser with an off-axis pumping mechanism. This study simulates this type of vortex array laser beam generation and discusses beam propagation effects. The formation of ordered transverse emission patterns have applications in a variety of areas such as optical data storage, distribution, and processing that exploit the robustness of soliton and vortex fields and optical manipulations of small particles and atoms in the featured intensity distribution.

The optimal operation of cooling tower systems with variable-frequency control

NASA Astrophysics Data System (ADS)

Cao, Yong; Huang, Liqing; Cui, Zhiguo; Liu, Jing

2018-02-01

This study investigates the energy performance of chiller and cooling tower systems integrated with variable-frequency control for cooling tower fans and condenser water pumps. With regard to an example chiller system serving an office building, Chiller and cooling towers models were developed to assess how different variable-frequency control methods of cooling towers fans and condenser water pumps influence the trade-off between the chiller power, pump power and fan power under various operating conditions. The matching relationship between the cooling tower fans frequency and condenser water pumps frequency at optimal energy consumption of the system is introduced to achieve optimum system performance.

Real-time Control of sewer pumps by using ControlNEXT to smooth inflow at Waste Water Treatment Plant Garmerwolde

NASA Astrophysics Data System (ADS)

van Heeringen, Klaas-Jan; van Nooijen, Ronald; Kooij, Kees; Postma, Bokke

2016-04-01

The Garmerwolde waste water treatment plant (WWTP) in the Groningen area of the Netherlands, receives waste water from a large area. That waste water is collected from many sewer systems and transported to the WWTP through pressurized pipes. The supply of waste water to the WWTP is relatively low and very irregular during dry-weather conditions, resulting in a random pattern of flows. This irregularity is the effect of the local control of the pumps, where the pumps are individually operated as an on/off control based on the water levels in the connected sewer system. The influent may change from zero to high values in a few minutes. The treatment processes at the WWTP are negatively influenced by this irregularity, which ends in high costs for energy and use of chemicals. The ControlNEXT central control system is used to control the 5 largest pump stations, such that the total inflow at the WWTP becomes much smoother. This results in a reduction of operational costs of about 10%. The control algorithm determines whether the actual condition is dry or wet, based on real-time radar precipitation images and the rainfall forecast product HiRLAM. All actual data is also collected and validated, like water levels, pump operations and pump availability. This data management is done using Delft-FEWS. If the situation is identified as "wet", the sewer systems are emptied as far as possible to create maximum storage. If the situation is "dry" (and of course there is a dead band between dry and wet), the pumps are operated such that the total inflow into the WWTP is smoothed. This is done with a Greedy algorithm, developed by Delft University of Technology. The algorithm makes a plan for the next 24 hours (as the daily inflow has a typical daily pattern) and generally stores some water volume in the sewer systems during the day to be able to continue operations during the night. The pumps are controlled with a time step of 5 minutes, where ControlNEXT manages the communication of pump operation setpoints to the SCADA system. In case of failing communication, backup procedures are programmed in the PLC of the pump stations. In that case the old on/off operation based on local water levels will be used. The system has been operational since January 2016 and has been monitored since then. In addition to monitoring the positive effect on the inflow at the WWTP, an important issue is the possible sedimentation in the sewer systems. This will be monitored too.

Xenon as an Adjuvant to Propofol Anesthesia in Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery: A Pragmatic Randomized Controlled Clinical Trial.

PubMed

Al Tmimi, Layth; Devroe, Sarah; Dewinter, Geertrui; Van de Velde, Marc; Poortmans, Gert; Meyns, Bart; Meuris, Bart; Coburn, Mark; Rex, Steffen

2017-10-01

Xenon was shown to cause less hemodynamic instability and reduce vasopressor needs during off-pump coronary artery bypass (OPCAB) surgery when compared with conventionally used anesthetics. As xenon exerts its organ protective properties even in subanesthetic concentrations, we hypothesized that in patients undergoing OPCAB surgery, 30% xenon added to general anesthesia with propofol results in superior hemodynamic stability when compared to anesthesia with propofol alone. Fifty patients undergoing elective OPCAB surgery were randomized to receive general anesthesia with 30% xenon adjuvant to a target-controlled infusion of propofol or with propofol alone. The primary end point was the total intraoperative dose of norepinephrine required to maintain an intraoperative mean arterial pressure >70 mm Hg. Secondary outcomes included the perioperative cardiorespiratory profile and the incidence of adverse and serious adverse events. Adding xenon to propofol anesthesia resulted in a significant reduction of norepinephrine required to attain the predefined hemodynamic goals (cumulative intraoperative dose: median [interquartile range]: 370 [116-570] vs 840 [335-1710] µg, P = .001). In the xenon-propofol group, significantly less propofol was required to obtain a similar depth of anesthesia as judged by clinical signs and the bispectral index (propofol effect site concentration [mean ± SD]: 1.8 ± 0.5 vs 2.8 ± 0.3 mg, P≤ .0001). Moreover, the xenon-propofol group required significantly less norepinephrine during the first 24 hours on the intensive care unit (median [interquartile range]: 1.5 [0.1-7] vs 5 [2-8] mg, P = .048). Other outcomes and safety parameters were similar in both groups. Thirty percent xenon added to propofol anesthesia improves hemodynamic stability by decreasing norepinephrine requirements in patients undergoing OPCAB surgery.

B-1 Systems Approach to Training. Task Analysis Listings

DTIC Science & Technology

1975-07-01

OFF FUEL VALVES AND PUMPS PHR-OFF FUEL VALVES AND PUMPS = AUTO ^FT TFR MODE LAND SELECTOR SWITCHES TQ *QFF...TFR MODE SWITCH-RIGHT «JFT L TFR MODE SELECT SWITCH TQ * TF1 CHECKLIST TFR MODE SWITCH-LEFT TFR MODE SWITCH-LEFT...DOOR HANDLE ENTRY LADDER CONTROL SWITCH ENTRY LADDER CONTROL SWITCH = DN* 16.1.1.001.OC* SET TANK FILL VALVE SWS ON

A randomized study comparing blood glucose control and risk of severe hypoglycemia achieved by non-programmable versus programmable external insulin pumps.

PubMed

Catargi, B; Breilh, D; Gin, H; Rigalleau, V; Saux, M C; Roger, P; Tabarin, A

2001-06-01

To compare a non-programmable and a programmable insulin external pump using regular insulin on glycemic stability, the risk of severe hypoglycemia and metabolic control in type 1 diabetic patients. Ten type 1 diabetic patients were involved in a randomized, crossover study comparing two periods of 3 months with continuous subcutaneous insulin infusion (CSII) either with a non-programmable insulin pump or a programmable insulin pump. Comparisons were made among mean blood glucose values before and after meals, at bedtime and at 2: 00 a.m.; the risk of severe hypoglycemia assessed by the low blood glucose index (LBGI); and HbA1c. Mean average blood glucose (BG) measurements were significantly lower with the programmable in comparison with the non-programmable insulin pump (respectively 157+/-78 vs. 165+/-79, p=0.034). While postprandial values for BG were not different between the two pumps, the use of the programmable pump resulted in a significant decrease in mean preprandial BG levels (140+/-68 vs. 150+/-73 mg/dl p=0.039). Conversely mean BG level was lower at 2 a.m. with the non-prgrammable pump (125+/-81 vs. 134 +/-93 mg/dl, p=0.02) but with a higher incidence of hypoglycemia. Mean LBGI was comparable with the two pumps (3.1+/-8.6 vs. 2.8+/-6.9, p=0.1). There was a 0.2% decrease in HbA1c during the programmable pump period that did not reach statistical significance (p=0.37). The present study suggests that programmable external insulin pumps, although more complex and more expensive than non-programmable insulin pumps, significantly reduce fasting glycemia during the day without increasing the risk of severe hypoglycemia and are safer during the night.

Experimental Study of Unshrouded Impeller Pump Stage Sensitivity to Tip Clearance

NASA Technical Reports Server (NTRS)

Williams, Robert W.; Zoladz, Thomas; Storey, Anne K.; Skelley, Stephen E.

2002-01-01

This viewgraph presentation provides information on an experiment. Its objective is to experimentally determine unshrouded impeller performance sensitivity to tip clearance. The experiment included: Determining impeller efficiency at scaled operating conditions in water at MSFC's Pump Test Equipment (PTE) Facility; Testing unshrouded impeller at three different tip clearances; Testing each tip clearance configuration at on- and off-design conditions, and collecting unsteady- and steady-state data in each configuration; Determining impeller efficiency directly using drive line torquemeter and pump inlet and exit total pressure measurements.

Method, system and computer program product for monitoring and optimizing fluid extraction from geologic strata

DOEpatents

Medizade, Masoud [San Luis Obispo, CA; Ridgely, John Robert [Los Osos, CA

2009-12-15

An arrangement which utilizes an inexpensive flap valve/flow transducer combination and a simple local supervisory control system to monitor and/or control the operation of a positive displacement pump used to extract petroleum from geologic strata. The local supervisory control system controls the operation of an electric motor which drives a reciprocating positive displacement pump so as to maximize the volume of petroleum extracted from the well per pump stroke while minimizing electricity usage and pump-off situations. By reducing the electrical demand and pump-off (i.e., "pounding" or "fluid pound") occurrences, operating and maintenance costs should be reduced sufficiently to allow petroleum recovery from marginally productive petroleum fields. The local supervisory control system includes one or more applications to at least collect flow signal data generated during operation of the positive displacement pump. No flow, low flow and flow duration are easily evaluated using the flap valve/flow transducer arrangement.

Evaluation of mitral valve replacement anchoring in a phantom

NASA Astrophysics Data System (ADS)

McLeod, A. Jonathan; Moore, John; Lang, Pencilla; Bainbridge, Dan; Campbell, Gordon; Jones, Doug L.; Guiraudon, Gerard M.; Peters, Terry M.

2012-02-01

Conventional mitral valve replacement requires a median sternotomy and cardio-pulmonary bypass with aortic crossclamping and is associated with significant mortality and morbidity which could be reduced by performing the procedure off-pump. Replacing the mitral valve in the closed, off-pump, beating heart requires extensive development and validation of surgical and imaging techniques. Image guidance systems and surgical access for off-pump mitral valve replacement have been previously developed, allowing the prosthetic valve to be safely introduced into the left atrium and inserted into the mitral annulus. The major remaining challenge is to design a method of securely anchoring the prosthetic valve inside the beating heart. The development of anchoring techniques has been hampered by the expense and difficulty in conducting large animal studies. In this paper, we demonstrate how prosthetic valve anchoring may be evaluated in a dynamic phantom. The phantom provides a consistent testing environment where pressure measurements and Doppler ultrasound can be used to monitor and assess the valve anchoring procedures, detecting pararvalvular leak when valve anchoring is inadequate. Minimally invasive anchoring techniques may be directly compared to the current gold standard of valves sutured under direct vision, providing a useful tool for the validation of new surgical instruments.

Generation of high-order Hermite-Gaussian modes in end-pumped solid-state lasers for square vortex array laser beam generation.

PubMed

Chu, Shu-Chun; Chen, Yun-Ting; Tsai, Ko-Fan; Otsuka, Kenju

2012-03-26

This study reports the first systematic approach to the excitation of all high-order Hermite-Gaussian modes (HGMs) in end-pumped solid-state lasers. This study uses a metal-wire-inserted laser resonator accompanied with the "off axis pumping" approach. This study presents numerical analysis of the excitation of HGMs in end-pumped solid-state lasers and experimentally generated HGM patterns. This study also experimentally demonstrates the generation of an square vortex array laser beams by passing specific high-order HGMs (HGn,n + 1 or HGn + 1,n modes) through a Dove prism-embedded unbalanced Mach-Zehnder interferometer [Optics Express 16, 19934-19949]. The resulting square vortex array laser beams with embedded vortexes aligned in a square array can be applied to multi-spot dark optical traps in the future.

Hydraulic and Thermal Response to Intermittent Pumping in Unconfined Alluvial Aquifers along a Regulated Stream

NASA Astrophysics Data System (ADS)

Maharjan, Madan

Groundwater response to stream stage fluctuations was studied using a year-long time series of stream stage and well heads in Glen Dale and New Martinsville, WV. Stream stage fluctuations exerted primary control over groundwater levels, especially during high flows. The location and operation of river pools created by dams alter groundwater flow paths and velocities. Aquifers are more prone to surface water infiltration in the upper reaches of pools than in lower reaches. Aquifer diffusivity is heterogeneous within and between the two sites. Temperature fluctuations were observed for 2.5 years in 14 wells in three alluvial aquifers. Temperature signals have 2 components corresponding to pump-on and pump-off periods. Both components vary seasonality at different magnitudes. While pump-off temperatures fluctuated up to 3.8o C seasonally, short-term temperature shifts induced by turning the pump on were 0.2 to 2.5o C. Pumping-induced temperature shifts were highest in magnitude in summer and winter. Groundwater temperature lagged behind that of surface water by approximately six months. Pumping induced and seasonal temperature shifts were spatially and temporally complex but indicate stream exfiltration is a major driver for a number of these wells. Numerical simulation of aquifer response to pumping show different conditions before and after well-field development. During pre-development, the stream was losing at high flow and gaining at low flow. During post-development, however, the stream was losing at high flow and spatially variable at low flow. While bank storage gained only during high stage, stream exfiltration occurred year-round. Pumping induced stream exfiltration by creating an extensive cone of depression beneath the stream in both upstream and downstream directions. Spatially and temporally variable groundwater-surface water interaction next to a regulated stream were studied using analytical and numerical models, based on field observations. Seasonality plays an important role in these interactions, but human activity may also alter its intensity.

Investigation of lunar base thermal control system options

NASA Technical Reports Server (NTRS)

Ewart, Michael K.

1993-01-01

Long duration human exploration missions to the Moon will require active thermal control systems which have not previously been used in space. The two technologies which are most promising for long term lunar base thermal control are heat pumps and radiator shades. Recent trade-off studies at the Johnson Space Center have focused development efforts on the most promising heat pump and radiator shade technologies. Since these technologies are in the early stages of development and many parameters used in the study are not well defined, a parametric study was done to test the sensitivity to each assumption. The primary comparison factor in these studies was the total mass system, with power requirements included in the form of a mass penalty for power. Heat pump technologies considered were thermally driven heat pumps such as metal hydride, complex compound, absorption and zeolite. Also considered were electrically driven Stirling and vapor compression heat pumps. Radiator shade concepts considered included step shaped, V-shaped and parabolic (or catenary) shades and ground covers. A further trade study compared the masses of heat pump and radiator shade systems.

Testing of a Spray-Bar Zero Gravity Cryogenic Vent System for Upper Stages

NASA Technical Reports Server (NTRS)

Lak, Tibor; Flachbart, Robin; Nguyen, Han; Martin, James

1999-01-01

The capability to vent in zero gravity without resettling is a fundamental technology need that involves practically all uses of subcritical cryogenics in space. Venting without resettling would extend cryogenic orbital transfer vehicle capabilities. However, the lack of definition regarding liquid/ullage orientation coupled with the somewhat random nature of the thermal stratification and resulting pressure rise rates, lead to significant technical challenges. Typically a zero gravity vent concept, termed a thermodynamic vent system (TVS), consists of a tank mixer to destratify the propellant, combined with a Joule- Thomson (J-T) valve to extract then-nal energy from the propellant. In a cooperative effort, Marshall Space Flight Center's (MSFC's) Multipurpose Hydrogen Test Bed (N4HTB) was used to test a unique "spray bar" TVS system developed by Boeing. A schematic of this system is included in Figure 1. The system consists of a recirculation pump, a parallel flow concentric tube, heat exchanger, and a spray bar positioned close to the longitudinal axis of the tank. In the mixing mode, the recirculation pump withdraws liquid from the tank and sprays it radially into the tank liquid, ullage, and exposed tank surfaces. When energy extraction is required, a small portion of the recirculated liquid is passed sequentially through the J-T expansion valve, the spray bar heat exchanger element, and is vented overboard. The vented vapor cools the circulated bulk fluid, thereby removing thermal energy and reducing tank pressure. Figure 2 is a plot of ullage pressure (P4) and liquid vapor pressure (PSAI) versus time. The pump operates alone, cycling on and off, to destratify the tank liquid and ullage until the liquid vapor pressure reaches the lower set point. At that point, the J-T valve begins to cycle on and off with the pump. Thus, for short duration missions, only the mixer may operate, thus minimizing or even eliminating boil-off losses. The primary advantage of the spray bar configuration is that pressure reduction is achieved independent of liquid and vapor location, thereby enhancing the applicability of normal gravity test data to zero gravity conditions. The in-tank components are minimized with the proposed TVS design. Because the recirculation pump is external to the tank, no electrical power penetration of the tank is required for pump or valve operation. This is especially desirable for L02 tanks since the presence of an electrical ignition source in oxygen represents a critical failure mode. Also, since the critical components (pump, motor, valve, orifice) are external to the tank, system checkout and ground servicing/replacement are easier. For zero-g operation, component replacement external to the tank may be a significant benefit. In addition to satisfying the zero g TVS design objectives, the TVS concept tested offers additional benefits to the integrated subcritical cryogenic storage and launch system.

Perioperative Outcomes, Transfusion Requirements, and Inflammatory Response After Coronary Artery Bypass Grafting With Off-Pump, Mini-Extracorporeal, and On-Pump Circulation Techniques.

PubMed

Brinkman, William T; Squiers, John J; Filardo, Giovanni; Arsalan, Mani; Smith, Robert L; Moore, David; Mack, Michael J; DiMaio, J Michael

2015-12-01

Mini-extracorporeal circulation (MECC) units were developed to reduce postoperative morbidity, transfusion requirements, and inflammation associated with conventional on-pump coronary artery bypass (ONCAB) surgery without the technical demands of the off-pump (OPCAB) technique. We compared perioperative outcomes and inflammatory mediation among OPCAB, MECC, and ONCAB techniques. We prospectively enrolled 102 patients undergoing elective isolated coronary bypass grafting. Perfusion methods were OPCAB (n = 34), MECC (n = 34), and ONCAB (n = 34). Serial blood samples were collected to measure serum inflammatory markers. There were no operative deaths or strokes. Total red blood cell (RBC) products used in OPCAB, MECC, and ONCAB patients were 0.676, 1.000, and 1.235 units, respectively. Adjusted (by splined Society of Thoracic Surgeons operative risk score) analysis showed no statistically significant differences in mean RBC product use among the different operative systems (OPCAB vs MECC, P = 0.580; OPCAB vs ONCAB, P = 0.311; MECC vs ONCAB, P = 0.633). Adjusted (by Society of Thoracic Surgeons risk score and baseline level) mean plasma level differences (24 hours postoperative - baseline) of C-reactive protein for OPCAB (117.89; 95% confidence interval [95% CI], 106.23-129.54) and for MECC (124.88; 95% CI, 113.45-136.32) were significantly higher than for ONCAB (98.82; 95% CI, 86.40-111.24). No significant adjusted differences (P = 0.304) in interleukin-6 level changes were observed. Off-pump coronary artery bypass and MECC did not significantly reduce mean total RBC transfusion requirements. Off-pump coronary artery bypass and MECC were associated with greater C-reactive protein elevation than ONCAB, suggestive of an increased inflammatory response to each of these techniques.

Study of Stage-wise Pressure Pulsation in an Electric Submersible Pump under Variable Frequency Operation at Shut-off Condition

NASA Astrophysics Data System (ADS)

Dhanasekaran, A.; Kumaraswamy, S.

2018-01-01

Pressure pulsation causes vibration in the Electric Submersible Pump (ESP) and affects the life and performance of its system. ESP systems are installed at depths ranging from a few meters to several hundred meters. Unlike pumps used on the surface, once they are installed they become inaccessible for maintenance or for any kind of diagnostic measurement that might be taken directly on them. Therefore a detailed knowledge of mean and fluctuating pressures is required to achieve an optimal pressure distribution inside the ESP. This paper presents the results of an experimental investigation of the stage-wise pulsating pressure in ESP at shut-off condition at different speeds. Experiments were conducted on a pump having five stages. A variable frequency drive was used to operate the pump at five different speeds. Piezoresistive transducers were mounted at each stage of ESP to capture the unsteady pressure signals. Fast Fourier Transformation was carried out on the pressure signals to convert into frequency domain and the spectra of pressure pulsation signals were analyzed. The obtained results indicated the existence of fundamental frequency corresponding to the speed of rotation times the number of impeller blades and of the whole series of harmonics of higher frequencies.

Individualized strategy for clopidogrel suspension in patients undergoing off-pump coronary surgery for acute coronary syndrome: a case-control study.

PubMed

Mannacio, Vito; Meier, Pascal; Antignano, Anita; Di Tommaso, Luigi; De Amicis, Vincenzo; Vosa, Carlo

2014-10-01

An increasing number of patients presenting for urgent coronary surgery have been exposed to clopidogrel, which constitutes a risk of bleeding and related events. Based on the wide variability in clopidogrel response and platelet function recovery after cessation, we evaluated the role of point-of-care platelet function testing to define the optimal time for off-pump coronary artery bypass graft (CABG) surgery in a case-control study. Three equally matched groups (300 patients in total) undergoing isolated off-pump CABG for acute coronary syndrome were compared. Group A were treated with clopidogrel and prospectively underwent a strategy guided by platelet function testing. Outcomes were compared with 2 propensity score matched groups: group B underwent CABG after the currently recommended 5 days without clopidogrel; group C were never exposed to clopidogrel. Patients in group A had reduced postoperative bleeding compared with those in group B (523±202 mL vs 851±605 mL; P<.001) and a lower number of units packed red blood cells (PRBCs) transfused during the postoperative hospital stay (1.2±1.6 units vs 1.9±1.8 units; P=.004). Postoperative bleeding and the number of units of PRBCs transfused were similar in group A and group C. There was no difference in blood-derived products and platelet consumption, mortality, or the need for reoperation among the groups. Patients in group A waited 3.6±1.7 days for surgery. The strategy used for group A saved 280 days of hospital stay in total. The strategy guided by platelet function testing for off-pump CABG offers improved guidance for optimal timing of CABG in patients treated with clopidogrel. This strategy significantly reduces postoperative bleeding and blood consumption, and has a shorter waiting time for surgery than current clinical practice. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Off-pump transapical implantation of artificial neo-chordae to correct mitral regurgitation: the TACT Trial (Transapical Artificial Chordae Tendinae) proof of concept.

PubMed

Seeburger, Joerg; Rinaldi, Mauro; Nielsen, Sten Lyager; Salizzoni, Stefano; Lange, Ruediger; Schoenburg, Markus; Alfieri, Ottavio; Borger, Michael Andrew; Mohr, Friedrich Wilhelm; Aidietis, Audrius

2014-03-11

The goal of this study was to evaluate the safety and performance of the NeoChord DS1000 system (NeoChord, Inc., Minneapolis, Minnesota). There is an increasing interest in transcatheter mitral valve (MV) treatment. The NeoChord DS 1000 system enables off-pump beating heart transapical MV repair with implantation of artificial neo-chordae. Patients with severe mitral regurgitation (MR) due to isolated posterior prolapse were included in this TACT (Transapical Artificial Chordae Tendinae) trial. All patients were scheduled for off-pump transapical implantation of neo-chordae. Thirty patients at 7 centers were enrolled. Major adverse events included 1 death due to post-cardiotomy syndrome and concomitant sepsis and 1 minor stroke with the patient fully recovered at the 30-day follow-up visit. Additional patients experienced procedural major adverse events related to a reoperation or conversion to standard of care. Acute procedural success (placement of at least 1 neo-chord and reduction of MR from 3+ or 4+ to ≤2+) was achieved in 26 patients (86.7%). In 4 patients neo-chordae were not placed for technical and/or patient-specific reasons. These patients underwent intraoperative (3 patients) or post-operative (1 patient) standard MV repair. At 30 days, 17 patients maintained an MR grade ≤2+. Four patients who developed recurrent MR were successfully treated with open MV repair during 30-day follow-up. Results improved with experience: durable reduction in MR to ≤2+ at 30 days was achieved in 5 (33.3%) of the first 15 patients and 12 (85.7%) of the last 14 patients. Off-pump transapical implantation of artificial chordae to correct MR is technically safe and feasible; however, it yields further potential for improvement of efficacy and durability. (Safety and Performance Study of the NeoChord Device [TACT]; NCT01777815). Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Measuring axial pump thrust

DOEpatents

Suchoza, Bernard P.; Becse, Imre

1988-01-01

An apparatus for measuring the hydraulic axial thrust of a pump under operation conditions is disclosed. The axial thrust is determined by forcing the rotating impeller off of an associated thrust bearing by use of an elongate rod extending coaxially with the pump shaft. The elongate rod contacts an impeller retainer bolt where a bearing is provided. Suitable measuring devices measure when the rod moves to force the impeller off of the associated thrust bearing and the axial force exerted on the rod at that time. The elongate rod is preferably provided in a housing with a heat dissipation mechanism whereby the hot fluid does not affect the measuring devices.

Measuring axial pump thrust

DOEpatents

Suchoza, B.P.; Becse, I.

1988-11-08

An apparatus for measuring the hydraulic axial thrust of a pump under operation conditions is disclosed. The axial thrust is determined by forcing the rotating impeller off of an associated thrust bearing by use of an elongate rod extending coaxially with the pump shaft. The elongate rod contacts an impeller retainer bolt where a bearing is provided. Suitable measuring devices measure when the rod moves to force the impeller off of the associated thrust bearing and the axial force exerted on the rod at that time. The elongate rod is preferably provided in a housing with a heat dissipation mechanism whereby the hot fluid does not affect the measuring devices. 1 fig.

Effects of a Foot Pump on the Incidence of Deep Vein Thrombosis After Total Knee Arthroplasty in Patients Given Edoxaban: A Randomized Controlled Study.

PubMed

Sakai, Tatsuya; Izumi, Masahiro; Kumagai, Kenji; Kidera, Kenichi; Yamaguchi, Takayuki; Asahara, Tomohiko; Kozuru, Hideko; Jiuchi, Yuka; Mawatari, Masaaki; Osaki, Makoto; Motokawa, Satoru; Migita, Kiyoshi

2016-01-01

We conducted a randomized clinical trial to compare the effectiveness of the A-V Impulse System foot pump for reducing the incidence of deep-vein thrombosis (DVT) after total knee arthroplasty (TKA) in patients under edoxaban thromboprophylaxis. Patients undergoing primary TKA at our institution between September 2013 and March 2015 were enrolled after obtaining informed consent. The patients were randomized to use the foot pump (n = 58) and not to use the foot pump (n = 62). Both groups were given prophylactic edoxaban. Primary outcomes were any DVT as detected by bilateral ultrasonography up to postoperative day 10 (POD10) and pulmonary embolism (PE) up to POD28. The safety outcomes were bleeding and death of any cause up to POD28. Plasma D-dimer levels were measured before TKA and on POD10 after TKA. Immunoglobulin G (IgG)-class anti-PF4/heparin antibodies were measured using an IgG-specific enzyme-linked immunosorbent assay. The incidences of any DVT up to POD28 were 31.0% and 17.7% in patients with or without the foot pump, respectively. The incidences of major bleeding up to POD28 were 5.1% and 4.8% in patients with or without the foot pump, respectively. Foot pump use did not significantly reduce the incidence of DVTs in patients undergoing TKA under edoxaban thromboprophylaxis. Although seroconversion of anti-PF4/heparin antibodies was confirmed in one-fourth of patients, the seroconversion rates did not differ between patients with (20.7%) or without (25.8%) foot pump use. This study shows that the A-V Impulse system foot pump did not affect the incidence of DVT under edoxaban thromboprophylaxis in patients undergoing TKA. Seroconversion of anti-PF4/heparin antibodies was detected in a significant number of patients who underwent TKA under antithrombotic prophylaxis using edoxaban.

Three-dimensional analysis for liquid hydrogen in a cryogenic storage tank with heat pipe pump system

NASA Astrophysics Data System (ADS)

Ho, Son H.; Rahman, Muhammad M.

2008-01-01

This paper presents a study on fluid flow and heat transfer of liquid hydrogen in a zero boil-off cryogenic storage tank in a microgravity environment. The storage tank is equipped with an active cooling system consisting of a heat pipe and a pump-nozzle unit. The pump collects cryogen at its inlet and discharges it through its nozzle onto the evaporator section of the heat pipe in order to prevent the cryogen from boiling off due to the heat leaking through the tank wall from the surroundings. A three-dimensional (3-D) finite element model is employed in a set of numerical simulations to solve for velocity and temperature fields of liquid hydrogen in steady state. Complex structures of 3-D velocity and temperature distributions determined from the model are presented. Simulations with an axisymmetric model were also performed for comparison. Parametric study results from both models predict that as the speed of the cryogenic fluid discharged from the nozzle increases, the mean or bulk cryogenic fluid speed increases linearly and the maximum temperature within the cryogenic fluid decreases.

Magnetized Target Fusion - Field Reversed Configuration Formation and Injection (MTF-FRC)

DTIC Science & Technology

2009-11-06

from accidental breakage and personnel from injury in that event. The pumps for the vacuum system included a Varian dry scroll pump that was...a dry scroll (oil-free) mechanical pump could be used, as mTorr pressures would be sufficient for the vacuum switch voltage hold-off and operation...56 FIGURE 46. ROUGHING PUMP AND VACUUM -GAUGE CONTROLLERS BENEATH THETA COIL CABLE HEADER

A comparison of hybrid coronary revascularization and off-pump coronary revascularization.

PubMed

Umakanthan, Ramanan; Leacche, Marzia; Gallion, Anna H; Byrne, John G

2013-04-01

Minimally invasive approaches to treat vascular disease have been accruing significant popularity over the last several decades. Due to progressive advances in technology, a variety of techniques are being now utilized in the field of cardiovascular surgery. The objectives of minimally invasive techniques are to curtail operative trauma and minimize perioperative morbidity without decreasing the quality of the treatment. The standard surgical approach for the treatment of coronary artery disease has traditionally been coronary artery bypass grafting surgery via median sternotomy. Off-pump coronary artery bypass grafting surgery offers a less invasive alternative and enables coronary revascularization to be performed without cardiopulmonary bypass. Hybrid coronary revascularization offers an even less invasive option in which minimally invasive direct coronary artery bypass can be combined with percutaneous coronary intervention. In this article, the authors review a recent publication comparing hybrid coronary revascularization and off-pump coronary artery bypass grafting surgery.

Giant narrowband twin-beam generation along the pump-energy propagation direction

NASA Astrophysics Data System (ADS)

Pérez, Angela M.; Spasibko, Kirill Yu; Sharapova, Polina R.; Tikhonova, Olga V.; Leuchs, Gerd; Chekhova, Maria V.

2015-07-01

Walk-off effects, originating from the difference between the group and phase velocities, limit the efficiency of nonlinear optical interactions. While transverse walk-off can be eliminated by proper medium engineering, longitudinal walk-off is harder to avoid. In particular, ultrafast twin-beam generation via pulsed parametric down-conversion and four-wave mixing is only possible in short crystals or fibres. Here we show that in high-gain parametric down-conversion, one can overcome the destructive role of both effects and even turn them into useful tools for shaping the emission. In our experiment, one of the twin beams is emitted along the pump Poynting vector or its group velocity matches that of the pump. The result is markedly enhanced generation of both twin beams, with the simultaneous narrowing of angular and frequency spectrum. The effect will enable efficient generation of ultrafast twin photons and beams in cavities, waveguides and whispering-gallery mode resonators.

Wavelength-tunable Hermite-Gaussian modes and an orbital-angular-momentum-tunable vortex beam in a dual-off-axis pumped Yb:CALGO laser.

PubMed

Shen, Yijie; Meng, Yuan; Fu, Xing; Gong, Mali

2018-01-15

A dual-off-axis pumping scheme is presented to generate wavelength-tunable high-order Hermite-Gaussian (HG) modes in Yb:CaGdAlO 4 lasers. The mode and wavelength can be actively controlled by the off-axis displacements and pump power. The purities of the output HG modes are quantified by intensity distributions and the measured M 2 values. The highest order reaches m=15 for stable HG m,0 mode, and wavelength-tunable width is about 10 nm. Moreover, through externally converting the HG m,0 modes, the vortex beams carrying orbital angular momentum (OAM) with a large OAM-tunable range from ±1ℏ to ±15ℏ are produced. This work is effective for largely scaling the spectral and OAM tunable ranges of optical vortex beams.

77 FR 54793 - Airworthiness Directives; the Boeing Company Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-06

... was prompted by fuel system reviews conducted by the manufacturer. This AD requires adding design... system must shut off each pump no later than 60 seconds after the fuel tank is emptied. Noting that the... paragraph (g)(2): ``The pump shutoff system design must preclude undetected running of a fuel pump in an...

Peculiarities of the statistics of spectrally selected fluorescence radiation in laser-pumped dye-doped random media

NASA Astrophysics Data System (ADS)

Yuvchenko, S. A.; Ushakova, E. V.; Pavlova, M. V.; Alonova, M. V.; Zimnyakov, D. A.

2018-04-01

We consider the practical realization of a new optical probe method of the random media which is defined as the reference-free path length interferometry with the intensity moments analysis. A peculiarity in the statistics of the spectrally selected fluorescence radiation in laser-pumped dye-doped random medium is discussed. Previously established correlations between the second- and the third-order moments of the intensity fluctuations in the random interference patterns, the coherence function of the probe radiation, and the path difference probability density for the interfering partial waves in the medium are confirmed. The correlations were verified using the statistical analysis of the spectrally selected fluorescence radiation emitted by a laser-pumped dye-doped random medium. Water solution of Rhodamine 6G was applied as the doping fluorescent agent for the ensembles of the densely packed silica grains, which were pumped by the 532 nm radiation of a solid state laser. The spectrum of the mean path length for a random medium was reconstructed.

[Coronary revascularization in patients with preoperative electrical storm].

PubMed

Kawashima, Toshiya; Naraoka, S

2007-03-01

We report 5 cases who underwent surgical coronary revascularization for subacute myocardial ischemia with preoperative electrical storm. All patients showed severe left ventricular dysfunction. Mean ejection fraction was 24.4 +/- 7.6%. Three patients had already had implantable cardioverter-defibrillator (ICD) therapy. Procedures were on-pump coronary artery bypass grafting (CABG) and mitral valvuloplasty (MVP) [case 1], on-pump CABG, MVP, left ventricular restoration (LVR) and cryoablation (case 2), and off-pump CABG (case 3-5). Case 5 necessitated conversion to on-pump for electrical storm during left circumflex artery (LCx) anastomosis. Case 3 suddenly died on the 2nd postoperative day due to electrical storm. Case 1 had recurrent attack of electrical storm postoperatively, treated by ICD, overdrive pacing, repeated intraaortic balloon pumping (IABP), deep sedation with endotracheal intubation, and finally catheter ablation. Four patients have survived 2 years (mean) postoperatively without any arrhythmia, and are all in good condition [New York Heart Association (NYHA) I] now. It was concluded that off-pump procedure was not suitable for subacute myocardial ischemia with electrical storm and that LVR with surgical cryoablation would be effective if indicated.

Fuel Delivery System.

DTIC Science & Technology

1996-07-24

to fuel tank 27 aboard 23 test torpedo 26. Pressure switch 19B operates to close solenoid 24 valve 22A and concurrently open solenoid valve 22D...leading to a pump explosion. The boost pump 4 is driven by its 11 motor 14B and positive displacement pump 1 by its respective 12 motor 14A. Pressure ... switch 19A monitors the head pressure 13 created by the boost pump 4 and it will shut off the motor 14A of 14 the positive displacement pump 1 if

Hemodynamic changes during displacement of the beating heart using epicardial stabilization for off-pump coronary artery bypass graft surgery.

PubMed

Mishra, Manisha; Malhotra, Rajneesh; Mishra, Anil; Meharwal, Zile Singh; Trehan, Naresh

2002-12-01

To evaluate the hemodynamic alterations during off-pump coronary artery bypass graft surgery to determine the degree of impairment caused and the techniques to rectify them. Prospective, observational cohort study performed from January 2000 through September 2000. Patients (n = 500) with coronary artery disease undergoing multivessel off-pump coronary artery bypass graft surgery using the Octopus tissue stabilizer (Medtronic, Inc, Minneapolis, MN). Unstable patients with ongoing ischemia were excluded from the study. All patients were monitored with radial artery and pulmonary artery catheters and continuous transesophageal echocardiography monitoring with a multiplane transducer. The perioperative requirement of an intracoronary shunt, inotropes, or an intra-aortic balloon pump was noted. The effect of the Trendelenburg position and fluids on hemodynamics was observed. The need for defibrillation and institution of emergency cardiopulmonary bypass were major endpoints to determine the inability of the patient to tolerate displacement of the heart. Mean patient age was 59.3 +/- 11.6 years. There were 204 (40%) patients in the high-risk category; 54 (10.8%) patients had left ventricular ejection fraction <25%. The mean number of grafts was 2.7 +/- 0.8. Vertical displacement of the heart to access the lateral and inferior walls decreased the mean arterial pressure by 18 +/- 4% (p < 0.01), with a concomitant increase in central venous pressure of 66 +/- 18% (p < 0.001). The stroke volume and the cardiac index were reduced by 35.7 +/- 11% (p < 0.001) and 45 +/- 13% (p < 0.001). On transesophageal echocardiography, there was development of new regional wall motion abnormalities in 59.2% and a decrease in global left ventricular functions in 61.2%. The use of inotropes was highest during anastomosis on the posterior wall-78.4% compared with 21.9% for the anterior wall. An intra-aortic balloon pump was used in 55 (11.2%) patients, and 7 (0.71 %) patients had to be put on emergency CPB. The in-hospital mortality was 1.2%. Most patients had hemodynamic changes easily correctable by fluids and inotropes. Monitoring of left ventricular and right ventricular function by transesophageal echocardiography enhances safety of the procedure and is recommended. The use of the Octopus II tissue stabilizer proved to be a safe and versatile means to stabilize the heart during off-pump coronary artery bypass procedures, especially in high-risk patients. Copyright 2002, Elsevier Science (USA). All rights reserved.

Aspirin plus clopidogrel for optimal platelet inhibition following off-pump coronary artery bypass surgery: results from the CRYSSA (prevention of Coronary arteRY bypaSS occlusion After off-pump procedures) randomised study.

PubMed

Mannacio, Vito Antonio; Di Tommaso, Luigi; Antignan, Anita; De Amicis, Vincenzo; Vosa, Carlo

2012-12-01

To determine the individual variability in the response to aspirin and/or clopidogrel and its impact on graft patency after off-pump coronary artery bypass grafting. A single-centre prospective randomised controlled study designed according to the Consolidated Standards of Reporting Trials statement. Randomisation was obtained by a computer-generated algorithm. University medical school in Italy. 300 patients who underwent off-pump coronary artery bypass grafting were randomised to receive aspirin (n=150) or aspirin plus clopidogrel (n=150). Aspirin 100 mg or aspirin 100 mg plus clopidogrel 75 mg daily was initiated when postoperative chest tube drainage was ≤ 50 ml/h for 2 h and patients were followed up for 12 months. Qualitative and quantitative assessment of platelet function, angiographic evaluation of coronary revascularisation by 64-slice CT and clinical outcome. In the aspirin group, 49 patients (32.6%) were aspirin resistant and, in the aspirin-clopidogrel group, 19 patients (12.6%) were aspirin and clopidogrel resistant. The platelet response to aspirin was similar in all aspirin responders despite the study arm (Aspirin Reaction Units 313.2 ± 44.8 vs 323.6 ± 53.6; p=0.07). The platelet response to clopidogrel was enhanced by aspirin in patients responsive to both aspirin and clopidogrel (synergistic effect) compared with responders to clopidogrel only (P2Y12 Reaction Units 139.9 ± 15.5 vs 179.4 ± 18.5; p<0.001). Combined therapy was associated with a reduced vein graft occlusion rate (7.4% vs 13.1%; p=0.04). Antiplatelet resistance was a predictor of graft occlusion (RR 3.6, 95% CI 2.5 to 6.9; p<0.001). Synergistic aspirin and clopidogrel activity was a strong predictor of vein graft patency (RR 5.1, 95% CI 1.4 to 16.3; p<0.01). Combined clopidogrel and aspirin overcome single drug resistances, are safe for bleeding and improve venous graft patency.

LASER APPLICATIONS AND OTHER TOPICS IN QUANTUM ELECTRONICS: Study of thermooptic distortions of a Nd:YVO4 active element at different methods of its mounting

NASA Astrophysics Data System (ADS)

Kijko, V. V.; Ofitserov, Evgenii N.

2006-05-01

Thermooptic distortions of the active element of an axially diode-pumped Nd:YVO4 solid-state laser are studied at different methods of its mounting. The study was performed by the Hartmann method. A mathematical model for calculating the optical power of a thermal lens produced in the crystal upon pumping is developed and verified experimentally. It is shown that the optical power of a thermal lens produced upon axial pumping of the convectively cooled active element sealed off in a copper heat sink is half the optical power observed upon convective cooling of the active element without heat sink. The experimental and theoretical results are in good agreement.

Pathway-related modules involved in the application of sevoflurane or propofol in off-pump coronary artery bypass graft surgery.

PubMed

Bu, Xiangmei; Wang, Bo; Wang, Yaoqi; Wang, Zhigang; Gong, Chunzhi; Qi, Feng; Zhang, Caixia

2017-07-01

Off-pump coronary artery bypass graft (CABG) surgery has recently emerged as a means to avoid the sequelae of extracorporeal circulation, including the whole-body inflammatory response, coagulation disorders and multiple organ dysfunction. At present, gas anesthesia, sevoflurane and intravenous anesthesia and propofol have been widely used during the CABG. To further understand the underlying mechanisms of these anesthetics on the gene level, the present study conducted pathway-related module analysis based on a co-expression network. This was performed in order to identify significant pathways in coronary artery disease patients who had undergone off-pump CABG surgery before and after applying sevoflurane or propofol. A total of 269 and 129 differentially expressed genes were obtained in the sevoflurane and propofol groups, respectively. In total, eight and seven pathways (P<0.05) in the sevoflurane and propofol groups were separately obtained via Kyoto Encyclopedia of Genes and Genome pathway analysis. Finally, eight and seven pathway-related modules in the sevoflurane and propofol groups were obtained, respectively. Furthermore, the mean degree of complement and coagulation cascades pathway-related module in both of the groups was the highest. It was predicted that during the CABG, the anesthetics might activate the complement and coagulation systems in order to possess some cardioprotective properties.

Factors associated with postoperative requirement of renal replacement therapy following off-pump coronary bypass surgery.

PubMed

Kato, Tomoko S; Machida, Yoichiro; Kuwaki, Kenji; Yamamoto, Taira; Amano, Atsushi

2017-02-01

Cardiopulmonary bypass usage provokes a systemic inflammatory response resulting in deterioration of renal function. However, risk factors for requiring renal replacement therapy (RRT) following off-pump coronary artery bypass graft surgery (CABG) have not yet been fully elucidated. We reviewed 718 consecutive patients undergoing elective off-pump CABG at our institution, excluding patients on chronic hemodialysis preoperatively. Sub-analysis of patients with preserved renal function, defined as a creatinine level below a cut-off value of 1.12 mg/dL (obtained by receiver operating characteristic curve), was also performed. Of the 718 patients, 41 (5.7 %) required RRT. There were 556 patients (77.4 %) with preserved renal function preoperatively, and 13 (2.4 %) of these required postoperative RRT. Multivariate analysis revealed that age (years) and preoperative serum creatinine (mg/dL) and brain natriuretic peptide (BNP) levels (pg/dL) were associated with RRT [odds ratios (OR) 1.052, 95 % confidence interval (CI) 9.064 and 1.001, respectively, all p < 0.05] in the total population, whereas low albumin concentration was the only independent predictor for RRT in patients with preserved renal function (OR 0.062, p < 0.0001). When creatinine levels were below 1.5 mg/dL, the predictive power of hypoalbuminemia for RRT requirement overwhelmed that of creatinine or BNP levels. Older age, preoperative elevated creatinine and BNP levels were associated with a requirement for RRT following off-pump CABG. In patients with preserved renal function, hypoalbuminemia was most significantly related to the RRT requirement.

Tretinoin microsphere gel 0.04% pump for treating acne vulgaris in preadolescents: a randomized, controlled study.

PubMed

Eichenfield, Lawrence F; Hebert, Adelaide A; Schachner, Lawrence; Paller, Amy S; Rossi, Ana Beatris; Lucky, Anne W

2012-01-01

Although acne vulgaris is common in preadolescents (<13 yrs), few acne treatments are currently approved for children. This study assessed the safety and efficacy of tretinoin microsphere gel (TMG) 0.04% pump in children aged 9-11 with acne vulgaris. In this multicenter, randomized, double-blind, vehicle-controlled pilot study, patients applied TMG 0.04% pump or vehicle once daily to the face for 12 weeks. Efficacy measures were changes in facial lesion counts, Investigator Global Evaluation of acne severity using two scales, and Investigator Global Assessment of Improvement from baseline to week 12. Of the 110 patients enrolled, 55 received TMG 0.04% pump, and 55 received vehicle. At week 12, there was significantly greater improvement in the least-squares mean change in noninflammatory lesions with TMG 0.04% than with vehicle (-19.9 vs -9.7, p = 0.04) and a significant difference in Investigator Global Assessment of improvement at week 12 between the children treated with TMG 0.04% pump and those treated with vehicle (p = 0.02), but there were no discernible differences in static acne severity scales. Change from baseline in signs and symptoms of cutaneous irritation were similar between the active and vehicle arms at week 12. This study demonstrated statistically significant differences in the reduction of noninflammatory lesions between TMG 0.04% pump and vehicle in patients aged 9-11 with acne vulgaris. Additional studies are warranted to further characterize the safety and efficacy of TMG 0.04% pump for the treatment of acne in the preadolescent population. © 2012 Wiley Periodicals, Inc.

Lasing in strongly scattering dielectric microstructures

NASA Astrophysics Data System (ADS)

Florescu, Lucia

In the first part of this thesis, a detailed analysis of lasing in random multiple-light-scattering media with gain is presented. Random laser emission is analyzed using a time-dependent diffusion model for light propagating in the medium containing active atoms. We demonstrate the effects of scatterers to narrow the emission spectral linewidth and to shorten the emitted pulse duration at a specific threshold pump intensity. This threshold pump intensity decreases with scatterer density and excitation spot diameter, in excellent agreement with experimental results. The coherence properties of the random laser are studied using a generalized master equation. The random laser medium is treated as a collection of low quality-factor cavities, coupled by random photon diffusion. Laser-like coherence, on average, is demonstrated above a specific pumping threshold. We demonstrate that with stronger scattering, the pumping threshold for the transition from chaotic to isotropic coherent light emission decreases and enhanced optical coherence for the emitted light is achieved above threshold. The second part of this thesis presents a study of lasing in photonic crystals (PCs). The emission from an incoherently pumped atomic system in interaction with the electro-magnetic reservoir of a PC is analyzed using a set of generalized semiclassical Maxwell-Bloch equations. We demonstrate that the photonic band edge facilitates the enhancement of stimulated emission and the reduction of internal losses, leading to an important lowering of the laser threshold. In addition, an increase of the laser output at a photonic band edge is demonstrated. We next develop a detailed quantum theory of a coherently pumped two-level atom in a photonic band gap material, coupled to both a multi-mode wave-guide channel and a high-quality micro-cavity embedded within the PC. The cavity field characteristics are highly distinct from that of a corresponding high-Q cavity in ordinary vacuum. We demonstrate enhanced, inversionless, and nearly coherent light generation when the photon density of states (DOS) jump between the Mollow spectral components of atomic resonance fluorescence is large. In the case of a vanishing photon DOS on the lower Mollow sideband and no dipolar dephasing, the emitted photon statistics is Poissonian and the cavity field exhibits quadrature coherence.

Rare case-series of electrocautery burn following off-pump coronary artery bypass grafting

PubMed Central

Sabzi, Feridoun; Niazi, Mojtaba; Ahmadi, Alireza

2014-01-01

Abstract: With an increasing number of off-pump coronary artery surgery procedures in high-risk patients with coagulopathy, including renal failure, hepatic failure and anticoagulant drug-using patients, the frequency of related complications such as repeated exploration for bleeding is also increasing. The associated co-morbidity and repeated use of electrocautery in postoperative bleeding leaves patients susceptible to electrocautery ulcers. In this case series, rare cases of cautery burn with unique causative mechanisms are described. PMID:23669602

Nonselective carotid artery ultrasound screening in patients undergoing coronary artery bypass grafting: Is it necessary?

PubMed Central

Masabni, Khalil; Sabik, Joseph F.; Raza, Sajjad; Carnes, Theresa; Koduri, Hemantha; Idrees, Jay J.; Beach, Jocelyn; Riaz, Haris; Shishehbor, Mehdi H.; Gornik, Heather L.; Blackstone, Eugene H.

2016-01-01

Objectives To determine whether nonselective preoperative carotid artery ultrasound screening alters management of patients scheduled for coronary artery bypass grafting (CABG), and whether such screening affects neurologic outcomes. Methods From March 2011 to September 2013, preoperative carotid artery ultrasound screening was performed on 1236 of 1382 patients (89%) scheduled to undergo CABG. Carotid artery stenosis (CAS) was classified as none or mild (any type 0%–59% stenosis), moderate (unilateral 60%-79% stenosis), or severe (bilateral 60%-79% stenosis or unilateral 80%–100% stenosis). Results A total of 1069 (86%) had

Nonselective carotid artery ultrasound screening in patients undergoing coronary artery bypass grafting: Is it necessary?

PubMed

Masabni, Khalil; Sabik, Joseph F; Raza, Sajjad; Carnes, Theresa; Koduri, Hemantha; Idrees, Jay J; Beach, Jocelyn; Riaz, Haris; Shishehbor, Mehdi H; Gornik, Heather L; Blackstone, Eugene H

2016-02-01

To determine whether nonselective preoperative carotid artery ultrasound screening alters management of patients scheduled for coronary artery bypass grafting (CABG), and whether such screening affects neurologic outcomes. From March 2011 to September 2013, preoperative carotid artery ultrasound screening was performed on 1236 of 1382 patients (89%) scheduled to undergo CABG. Carotid artery stenosis (CAS) was classified as none or mild (any type 0%-59% stenosis), moderate (unilateral 60%-79% stenosis), or severe (bilateral 60%-79% stenosis or unilateral 80%-100% stenosis). A total of 1069 (86%) had

Does transfusion of residual cardiopulmonary bypass circuit blood increase postoperative bleeding? A prospective randomized study in patients undergoing on pump cardiopulmonary bypass

PubMed Central

Duara, Rajnish; Misra, Manoranjan; Bhuyan, Ritwick Raj; Sarma, P. Sankara; Jayakumar, Karunakaran

2008-01-01

Objective: Homologous blood transfusion after open heart surgery puts a tremendous load on the blood banks. This prospective randomized study evaluates the efficacy of infusing back residual cardiopulmonary bypass (CPB) circuit i.e., pump blood as a means to reduce homologous transfusion after coronary artery bypass surgery (CABG) and whether its use increases postoperative drainage. Materials and Methods: Sixty-seven consecutive patients who underwent elective CABGs under CPB were randomized into 2 groups: (1) cases where residual pump blood was used and (2) controls where residual pump blood was not used. Patients were monitored for hourly drainage on the day of surgery and the 1st postoperative day and the requirements of homologous blood and its products. Data were matched regarding change in Hemoglobin, Packed Cell Volume and coagulation parameters till 1st postoperative day. All cases were followed up for three years. Results: There was a marginal reduction in bleeding pattern in the early postoperative period in the cases compared to controls. The requirement of homologous blood and its products were also reduced in the cases. Conclusions: The use of CPB circuit blood is safe in the immediate postoperative period. The requirement of homologous blood transfusion can come down if strict transfusion criteria are maintained. PMID:20041077

Time-resolved orbital angular momentum spectroscopy

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

Noyan, Mehmet A.; Kikkawa, James M.

We introduce pump-probe magneto-orbital spectroscopy, wherein Laguerre-Gauss optical pump pulses impart orbital angular momentum to the electronic states of a material and subsequent dynamics are studied with 100 fs time resolution. The excitation uses vortex modes that distribute angular momentum over a macroscopic area determined by the spot size, and the optical probe studies the chiral imbalance of vortex modes reflected off the sample. First observations in bulk GaAs yield transients that evolve on time scales distinctly different from population and spin relaxation, as expected, but with surprisingly large lifetimes.

Assessment of cardiac autonomic regulation and ventricular repolarization after off-pump coronary artery bypass grafting.

PubMed

Kalisnik, Jurij M; Avbelj, Viktor; Trobec, Roman; Ivaskovic, Daroslav; Vidmar, Gaj; Troise, Giovanni; Gersak, Borut

2006-01-01

Altered autonomic regulation precipitates cardiac arrhythmias and increases the risk of sudden cardiac death. This risk is further increased by changes in ventricular repolarization. Autonomic regulation is deranged in patients after myocardial on-pump revascularization. We aimed to clarify how off-pump coronary artery bypass grafting (CABG) affects postoperative cardiac autonomic regulation and ventricular repolarization within 4 weeks after CABG. Forty-two patients (mean age, 61.9 +/- 9.3 years; mean EURO score 2.6 +/- 1.9) were electively admitted for off-pump CABG. The electrocardiographic and respiratory waveform recordings were performed in the afternoon in the supine position for 10 minutes. Autonomic modulation was assessed using heart rate variability analysis. Power spectra were computed from 5-minute stable RR intervals using Fourier Transform analysis. Total power of spectra was defined in the range of 0.01 to 0.40 Hz, high-frequency power within 0.15 to 0.40 Hz, and low-frequency power within 0.04 to 0.15 Hz. Normalized power was defined as a ratio of power in each band/total power. The high- and low-frequency power as well as their normalized values indicated cardiac vagal and sympathetic modulation, respectively. Ventricular repolarization was assessed using QT interval, QT interval variability, and QT-RR interdependence analysis. QT intervals were determined from the beginning of the 5-minute segments. QT interval variability was evaluated by a T-wave template-matching algorithm. Pearson correlation between length of RR and QT interval was applied to study QT-RR characteristics. The results were tested for significance using the Fisher exact test, nonpaired t test, and analysis of variance; a P <.05 was considered significant. The frequency of arrhythmic events and heart rate increased from the fourth to the seventh postoperative day and returned to preoperative levels 4 weeks after CABG. Heart rate variability measures indicating autonomic modulation remained depressed even 4 weeks after the procedure. QT variability index increased from -1.2 +/- 0.5 to -0.8 +/- 0.4 on the fourth day after the operation (P <.05) and returned to -1.0 +/- 0.5 4 weeks after CABG (P = not significant). QT-RR correlation decreased from 0.41 to 0.23 (P <.05) and remained significantly impaired as long as 4 weeks after CABG. Observed faster heart rates until 1 week after off-pump CABG imply excessive adrenergic activation, which is comparable to on-pump CABG procedure rates. The results indicate profound autonomic derangement and loss of rate-dependent regulation after off-pump CABG even 4 weeks after operation. Restituted repolarization as assessed by QT variability index 4 weeks postoperatively corresponded with decreased frequency of rhythm disturbances 4 weeks after CABG. The loss of coupling between QT and RR intervals shows increased electrical instability postoperatively, which may serve as an additional promoter for postoperative arrhythmias, especially at higher heart rates.

Adiabatic quantum pump in a zigzag graphene nanoribbon junction

NASA Astrophysics Data System (ADS)

Zhang, Lin

2015-11-01

The adiabatic electron transport is theoretically studied in a zigzag graphene nanoribbon (ZGNR) junction with two time-dependent pumping electric fields. By modeling a ZGNR p-n junction and applying the Keldysh Green’s function method, we find that a pumped charge current is flowing in the device at a zero external bias, which mainly comes from the photon-assisted tunneling process and the valley selection rule in an even-chain ZGNR junction. The pumped charge current and its ON and OFF states can be efficiently modulated by changing the system parameters such as the pumping frequency, the pumping phase difference, and the Fermi level. A ferromagnetic ZGNR device is also studied to generate a pure spin current and a fully polarized spin current due to the combined spin pump effect and the valley valve effect. Our finding might pave the way to manipulate the degree of freedom of electrons in a graphene-based electronic device. Project supported by the National Natural Science Foundation of China (Grant No. 110704033), the Natural Science Foundation of Jiangsu Province, China (Grant No. BK2010416), and the Natural Science Foundation for Colleges and Universities in Jiangsu Province, China (Grant No. 13KJB140005).

Stable donutlike vortex beam generation from lasers with controlled Ince-Gaussian modes

NASA Astrophysics Data System (ADS)

Chu, Shu-Chun; Otsuka, Kenju

2007-11-01

This study proposes a three-lens configuration for generating a stable donutlike vortex laser beam with controlled Ince-Gaussian mode (IGM) operation in the model of laser-diode (LD)-pumped solid-state lasers. Simply controlling the lateral off-axis position of the pump beam's focus on the laser crystal can generate a desired donutlike vortex beam from the proposed simple and easily made three-lens configuration, a proposed astigmatic mode converter assembled into one body with a concave-convex laser cavity.

Variational and WKB Descriptions of Laterally Localized Eigenmodes in Non-Collinear Optical Parametric Amplifiers

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

Afeyan, Bedros; Charbonneau-Lefort, Mathieu; Fejer, Martin

With a finite lateral width pump, non-collinear interactions result in metastable or stable laterally localized bound states. The physical processes involved are group velocity walk-off, diffraction, chirped QPM gratings and different pump shapes.

Hourly simulation of a Ground-Coupled Heat Pump system

NASA Astrophysics Data System (ADS)

Naldi, C.; Zanchini, E.

2017-01-01

In this paper, we present a MATLAB code for the hourly simulation of a whole Ground-Coupled Heat Pump (GCHP) system, based on the g-functions previously obtained by Zanchini and Lazzari. The code applies both to on-off heat pumps and to inverter-driven ones. It is employed to analyse the effects of the inverter and of the total length of the Borehole Heat Exchanger (BHE) field on the mean seasonal COP (SCOP) and on the mean seasonal EER (SEER) of a GCHP system designed for a residential house with 6 apartments in Bologna, North-Center Italy, with dominant heating loads. A BHE field with 3 in line boreholes is considered, with length of each BHE either 75 m or 105 m. The results show that the increase of the BHE length yields a SCOP enhancement of about 7%, while the SEER remains nearly unchanged. The replacement of the on-off heat pump by an inverter-driven one yields a SCOP enhancement of about 30% and a SEER enhancement of about 50%. The results demonstrate the importance of employing inverter-driven heat pumps for GCHP systems.

Random lasing actions in self-assembled perovskite nanoparticles

NASA Astrophysics Data System (ADS)

Liu, Shuai; Sun, Wenzhao; Li, Jiankai; Gu, Zhiyuan; Wang, Kaiyang; Xiao, Shumin; Song, Qinghai

2016-05-01

Solution-based perovskite nanoparticles have been intensively studied in the past few years due to their applications in both photovoltaic and optoelectronic devices. Here, based on the common ground between solution-based perovskite and random lasers, we have studied the mirrorless lasing actions in self-assembled perovskite nanoparticles. After synthesis from a solution, discrete lasing peaks have been observed from optically pumped perovskites without any well-defined cavity boundaries. We have demonstrated that the origin of the random lasing emissions is the scattering between the nanostructures in the perovskite microplates. The obtained quality (Q) factors and thresholds of random lasers are around 500 and 60 μJ/cm2, respectively. Both values are comparable to the conventional perovskite microdisk lasers with polygon-shaped cavity boundaries. From the corresponding studies on laser spectra and fluorescence microscope images, the lasing actions are considered random lasers that are generated by strong multiple scattering in random gain media. In additional to conventional single-photon excitation, due to the strong nonlinear effects of perovskites, two-photon pumped random lasers have also been demonstrated for the first time. We believe this research will find its potential applications in low-cost coherent light sources and biomedical detection.

Numerical modeling of nonlinear modulation of coda wave interferometry in a multiple scattering medium with the presence of a localized micro-cracked zone

NASA Astrophysics Data System (ADS)

Chen, Guangzhi; Pageot, Damien; Legland, Jean-Baptiste; Abraham, Odile; Chekroun, Mathieu; Tournat, Vincent

2018-04-01

The spectral element method is used to perform a parametric sensitivity study of the nonlinear coda wave interferometry (NCWI) method in a homogeneous sample with localized damage [1]. The influence of a strong pump wave on a localized nonlinear damage zone is modeled as modifications to the elastic properties of an effective damage zone (EDZ), depending on the pump wave amplitude. The local change of the elastic modulus and the attenuation coefficient have been shown to vary linearly with respect to the excitation amplitude of the pump wave as in previous experimental studies of Zhang et al. [2]. In this study, the boundary conditions of the cracks, i.e. clapping effects is taken into account in the modeling of the damaged zone. The EDZ is then modeled with random cracks of random orientations, new parametric studies are established to model the pump wave influence with two new parameters: the change of the crack length and the crack density. The numerical results reported constitute another step towards quantification and forecasting of the nonlinear acoustic response of a cracked material, which proves to be necessary for quantitative non-destructive evaluation.

Self-regenerating Nanotips: Indestructable Field-emission Cathodes for Low-power Electric Propulsion

DTIC Science & Technology

2010-09-27

Field Emission Scanning Electron Microscope. The chamber was evacuated using a series of three ion pumps and vacuum pressure of 10-7 Torr was...backed by a 110-L/min dry scroll pump . The chamber is also equipped with a 300-L/s combination ion/sublimation pump that can maintain pressure of...Torr for 2 to 24 hours and then the ion pump was turned off to let the vacuum pressure slowly increase while observing the electron emission

Metabolic control after years of completing a clinical trial on sensor-augmented pump therapy.

PubMed

Quirós, Carmen; Giménez, Marga; Orois, Aida; Conget, Ignacio

2015-11-01

Sensor-augmented pump (SAP) therapy has been shown to be effective and safe for improving metabolic control in patients with type 1 diabetes mellitus (T1DM) in a number of trials. Our objective was to assess glycemic control in a group of T1DM patients on insulin pump or SAP therapy after years of participating in the SWITCH (Sensing With Insulin pump Therapy To Control HbA1c) trial and their return to routine medical monitoring. A retrospective, observational study of 20 patients who participated in the SWITCH trial at our hospital from 2008 to 2010. HbA1c values were compared at the start, during (at the end of the periods with/without SAP use - Sensor On/Sensor Off period respectively - of the cross-over design), and 3 years after study completion. HbA1c values of patients who continued SAP therapy (n=6) or only used insulin pump (n=14) were also compared. Twenty patients with T1DM (44.4±9.3 years, 60% women, baseline HbA1c level 8.43±0.55%) were enrolled into the SWITCH study). Three years after study completion, HbA1c level was 7.79±0.77 in patients on pump alone, with no significant change from the value at the end of the Off period of the study (7.85±0.57%; p=0.961). As compared to the end of the On period, HbA1c worsened less in patients who remained on SAP than in those on pump alone (0.18±0.42 vs. 0.55±0.71%; p=0.171), despite the fact that levels were similar at study start (8.41±0.60 vs. 8.47±0.45; p=0.831) and at the end of the On period (7.24±0.48 vs. 7.38±0.61; p=0.566). Frequency of CGM use in patients who continued SAP therapy was high (61.2% of the time in the last 3 months). Our study suggests that the additional benefit of SAP therapy achieved in a clinical trial may persist in the long term in routine clinical care of patients with T1DM. Copyright © 2015 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

Myocardial protection by glucose-insulin-potassium in acute coronary syndrome patients undergoing urgent multivessel off-pump coronary artery bypass surgery.

PubMed

Shim, J-K; Yang, S-Y; Yoo, Y-C; Yoo, K-J; Kwak, Y-L

2013-01-01

The aim of this randomized and controlled trial was to investigate the effect of a glucose-insulin-potassium (GIK) solution on myocardial protection in acute coronary syndrome (ACS) patients undergoing urgent multivessel off-pump coronary artery bypass (OPCAB) surgery. Sixty-six patients were randomly allocated either to receive 0.3 ml kg(-1) h(-2) GIK solution (potassium 80 mEq and regular insulin 325 IU in 500 ml of 50% glucose) or equivalent volume of normal saline (control) upon anaesthetic induction until 6 h after reperfusion. The primary endpoints were to compare the concentrations of creatine kinase-MB (CK-MB) and troponin-T between the groups after reperfusion. The secondary endpoints were to compare the incidences of postoperative troponin-T >0.8 ng ml(-1) and myocardial infarction (MI) between the groups. Highest CK-MB [8.7 (4.4) vs 13.1 (7.9) ng ml(-1), P=0.006] and troponin-T [0.20 (0.13-0.49) vs 0.48 (0.18-0.91) ng ml(-1), P<0.0001] values after reperfusion were significantly lower in the GIK group compared with the control group. The area under the curve of serially measured troponin-T was also significantly smaller in the GIK group compared with the control group [0.83 (0.43-1.81) vs 0.46 (0.31-1.00), P=0.036]. Significantly fewer patients in the GIK group showed troponin-T >0.8 ng ml(-1) after reperfusion compared with the control group (3 vs 11, P=0.033). The incidence of postoperative MI was similar between the groups. GIK administration in ACS patients undergoing urgent multivessel OPCAB significantly attenuated the degree of ensuing myocardial injury without complications related to glycaemic control. Clinical Trial Registry. URL: http://clinicaltrials.gov/ct2/show/NCT01384656?term=GIK+AND+OPCAB&rank=1. Unique identification number NCT01384656.

Miniaturized extracorporeal circulation versus off-pump coronary artery bypass grafting: a meta-analysis of randomized controlled trials.

PubMed

Benedetto, Umberto; Ng, Colin; Frati, Giacomo; Biondi-Zoccai, Giuseppe; Vitulli, Piergiusto; Zeinah, Mohamed; Raja, Shahzad G

2015-02-01

Controversies exist whether off-pump coronary artery bypass (OPCAB) is superior to miniaturized extracorporeal circulation (MECC) in reducing deleterious effects of cardiopulmonary bypass as only a number of smaller randomized controlled trials (RCT) currently provide a limited evidence base. The main purpose of conducting the present meta-analysis was to overcome the expected low power in RCTs in an attempt to establish whether MECC is comparable to OPCAB. A MEDLINE/PubMed search was conducted to identify eligible RCTs. A pooled summary effect estimate was calculated by means of Mantel-Haenszel method. The search yielded 7 RCTs included in this meta-analysis enrolling 271 patients in the OPCAB group and 279 in the MECC group. The OPCAB and MECC groups were comparable in terms of incidence of in-hospital mortality (Risk Difference [RD] 0.01; 95%CI -0.02, 0.03; P = 0.55; I(2) = 0%), stroke (RD -0.01; 95%CI -0.05, 0.04; P = 0.69; I(2) = 0%), need for renal replacement therapy (RD 0.00; -0.06, 0.06; P = 1; I(2) = 0%), postoperative atrial fibrillation (RD -0.03; -0.17, 0.10; P = 0.64; I(2) = 0%), re-exploration for bleeding (RD -0.01; 95%CI -0.03, 0.02; P = 0.65; I(2) = 0%), transfusion rate (RD -0.01; 95%CI -0.03, 0.02; P = 0.65; I(2) = 0%) and the amount of blood loss (weighted mean difference -25 mL; 95%CI -71, 21; P = 0.28; I(2) = 0%). Using a meta-analytic approach, MECC achieves clinical results comparable to OPCAB including postoperative blood loss and blood transfusion requirement. On the basis of our findings, MECC should be considered as a valid alternative to OPCAB in order to reduce surgical morbidity of conventional cardiopulmonary bypass. Copyright © 2015 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Remotely Adjustable Hydraulic Pump

NASA Technical Reports Server (NTRS)

Kouns, H. H.; Gardner, L. D.

1987-01-01

Outlet pressure adjusted to match varying loads. Electrohydraulic servo has positioned sleeve in leftmost position, adjusting outlet pressure to maximum value. Sleeve in equilibrium position, with control land covering control port. For lowest pressure setting, sleeve shifted toward right by increased pressure on sleeve shoulder from servovalve. Pump used in aircraft and robots, where hydraulic actuators repeatedly turned on and off, changing pump load frequently and over wide range.

In reply to: "Intra-aortic balloon pump protects against hydrostatic pulmonary oedema during peripheral venoarterial-extracorporeal membrane oxygenation".

PubMed

Privratsky, Jamie R; Diaz, Sebastian; Nicoara, Alina; Daneshmand, Mani A

2018-05-01

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an increasingly utilized life-saving measure. However, left-ventricular distention from inadequate left-ventricular off-loading can lead to unwanted pulmonary and cardiac complications. We are writing to indicate our agreement with a recent article by Brechot et al. published in the June 2017 issue where the authors demonstrated that intra-aortic balloon pump provides mechanical support to off-load the left ventricle during VA-ECMO, which prevents pulmonary edema.

Coherent random lasing from liquid waveguide gain channels with biological scatters

NASA Astrophysics Data System (ADS)

Zhang, Hong; Feng, Guoying; Wang, Shutong; Yang, Chao; Yin, Jiajia; Zhou, Shouhuan

2014-12-01

A unidirectional coherent random laser based on liquid waveguide gain channels with biological scatters is demonstrated. The optical feedback of the random laser is provided by both light scattering and waveguide confinement. This waveguide-scattering-feedback scheme not only reduces the pump threshold but also makes the output of random laser directional. The threshold of our random laser is about 11 μJ. The emission spectra can be sensitively tuned by changing pump position due to the micro/nano-scale randomness of butterfly wings. It shows the potential applications of optofluidic random lasers for bio-chemical sensors on-chip.

Experimental demonstration of spatially coherent beam combining using optical parametric amplification.

PubMed

Kurita, Takashi; Sueda, Keiichi; Tsubakimoto, Koji; Miyanaga, Noriaki

2010-07-05

We experimentally demonstrated coherent beam combining using optical parametric amplification with a nonlinear crystal pumped by random-phased multiple-beam array of the second harmonic of a Nd:YAG laser at 10-Hz repetition rate. In the proof-of-principle experiment, the phase jump between two pump beams was precisely controlled by a motorized actuator. For the demonstration of multiple-beam combining a random phase plate was used to create random-phased beamlets as a pump pulse. Far-field patterns of the pump, the signal, and the idler indicated that the spatially coherent signal beams were obtained on both cases. This approach allows scaling of the intensity of optical parametric chirped pulse amplification up to the exa-watt level while maintaining diffraction-limited beam quality.

Quantum theory of the far-off-resonance continuous-wave Raman laser: Heisenberg-Langevin approach

NASA Astrophysics Data System (ADS)

Roos, P. A.; Murphy, S. K.; Meng, L. S.; Carlsten, J. L.; Ralph, T. C.; White, A. G.; Brasseur, J. K.

2003-07-01

We present the quantum theory of the far-off-resonance continuous-wave Raman laser using the Heisenberg-Langevin approach. We show that the simplified quantum Langevin equations for this system are mathematically identical to those of the nondegenerate optical parametric oscillator in the time domain with the following associations: pump ↔ pump, Stokes ↔ signal, and Raman coherence ↔ idler. We derive analytical results for both the steady-state behavior and the time-dependent noise spectra, using standard linearization procedures. In the semiclassical limit, these results match with previous purely semiclassical treatments, which yield excellent agreement with experimental observations. The analytical time-dependent results predict perfect photon statistics conversion from the pump to the Stokes and nonclassical behavior under certain operational conditions.

Oxygen uptake on-kinetics during six-minute walk test predicts short-term outcomes after off-pump coronary artery bypass surgery.

PubMed

Rocco, Isadora Salvador; Viceconte, Marcela; Pauletti, Hayanne Osiro; Matos-Garcia, Bruna Caroline; Marcondi, Natasha Oliveira; Bublitz, Caroline; Bolzan, Douglas William; Moreira, Rita Simone Lopes; Reis, Michel Silva; Hossne, Nelson Américo; Gomes, Walter José; Arena, Ross; Guizilini, Solange

2017-12-26

We aimed to investigate the ability of oxygen uptake kinetics to predict short-term outcomes after off-pump coronary artery bypass grafting. Fifty-two patients aged 60.9 ± 7.8 years waiting for off-pump coronary artery bypass surgery were evaluated. The 6-min walk test distance was performed pre-operatively, while simultaneously using a portable cardiopulmonary testing device. The transition of oxygen uptake kinetics from rest to exercise was recorded to calculate oxygen uptake kinetics fitting a monoexponential regression model. Oxygen uptake at steady state, constant time, and mean response time corrected by work rate were analysed. Short-term clinical outcomes were evaluated during the early post-operative of off-pump coronary artery bypass surgery. Multivariate analysis showed body mass index, surgery time, and mean response time corrected by work rate as independent predictors for short-term outcomes. The optimal mean response time corrected by work rate cut-off to estimate short-term clinical outcomes was 1.51 × 10 -3  min 2 /ml. Patients with slower mean response time corrected by work rate demonstrated higher rates of hypertension, diabetes, EuroSCOREII, left ventricular dysfunction, and impaired 6-min walk test parameters. The per cent-predicted distance threshold of 66% in the pre-operative was associated with delayed oxygen uptake kinetics. Pre-operative oxygen uptake kinetics during 6-min walk test predicts short-term clinical outcomes after off-pump coronary artery bypass surgery. From a clinically applicable perspective, a threshold of 66% of pre-operative predicted 6-min walk test distance indicated slower kinetics, which leads to longer intensive care unit and post-surgery hospital length of stay. Implications for rehabilitation Coronary artery bypass grafting is a treatment aimed to improve expectancy of life and prevent disability due to the disease progression; The use of pre-operative submaximal functional capacity test enabled the identification of patients with high risk of complications, where patients with delayed oxygen uptake kinetics exhibited worse short-term outcomes; Our findings suggest the importance of the rehabilitation in the pre-operative in order to "pre-habilitate" the patients to the surgical procedure; Faster oxygen uptake on-kinetics could be achieved by improving the oxidative capacity of muscles and cardiovascular conditioning through rehabilitation, adding better results following cardiac surgery.

Method to improve optical parametric oscillator beam quality

DOEpatents

Smith, Arlee V.; Alford, William J.; Bowers, Mark S.

2003-11-11

A method to improving optical parametric oscillator (OPO) beam quality having an optical pump, which generates a pump beam at a pump frequency greater than a desired signal frequency, a nonlinear optical medium oriented so that a signal wave at the desired signal frequency and a corresponding idler wave are produced when the pump beam (wave) propagates through the nonlinear optical medium, resulting in beam walk off of the signal and idler waves, and an optical cavity which directs the signal wave to repeatedly pass through the nonlinear optical medium, said optical cavity comprising an equivalently even number of non-planar mirrors that produce image rotation on each pass through the nonlinear optical medium. Utilizing beam walk off where the signal wave and said idler wave have nonparallel Poynting vectors in the nonlinear medium and image rotation, a correlation zone of distance equal to approximately .rho.L.sub.crystal is created which, through multiple passes through the nonlinear medium, improves the beam quality of the OPO output.

Optical parametric osicllators with improved beam quality

DOEpatents

Smith, Arlee V.; Alford, William J.

2003-11-11

An optical parametric oscillator (OPO) having an optical pump, which generates a pump beam at a pump frequency greater than a desired signal frequency, a nonlinear optical medium oriented so that a signal wave at the desired signal frequency and a corresponding idler wave are produced when the pump beam (wave) propagates through the nonlinear optical medium, resulting in beam walk off of the signal and idler waves, and an optical cavity which directs the signal wave to repeatedly pass through the nonlinear optical medium, said optical cavity comprising an equivalently even number of non-planar mirrors that produce image rotation on each pass through the nonlinear optical medium. Utilizing beam walk off where the signal wave and said idler wave have nonparallel Poynting vectors in the nonlinear medium and image rotation, a correlation zone of distance equal to approximately .rho.L.sub.crystal is created which, through multiple passes through the nonlinear medium, improves the beam quality of the OPO output.

The off-pump technique in redo coronary artery bypass grafting reduces mortality and major morbidities: propensity score analysis of data from the Japan Cardiovascular Surgery Database†.

PubMed

Dohi, Masahiro; Miyata, Hiroaki; Doi, Kiyoshi; Okawa, Kazunari; Motomura, Noboru; Takamoto, Shinichi; Yaku, Hitoshi

2015-02-01

The benefits of off-pump coronary artery grafting (OPCAB) have been demonstrated. Especially in patients with a high number of comorbidities, redo coronary artery bypass grafting (CABG) remains a difficult entity of CABG, because patients are likely to have multiple risk factors and often have diseased patent grafts with adhesions. The aim of the present study was to evaluate the effects of the OPCAB technique in redo CABG on mortality and morbidity using data from the Japan Cardiovascular Surgery Database (JCVSD). We analysed 34 980 patients who underwent isolated CABG between 2008 and 2011, as reported in the JCVSD. Of these, 1.8% of patients (n = 617/34980) had undergone redo CABG, including those who underwent OPCAB (n = 364; 69%) and on-pump CABG (n = 253; 41%). We used propensity score (PS) matching with 13 preoperative risk factors to adjust for differences in baseline characteristics between the redo OPCAB and on-pump redo CABG groups. By one-to-one PS matching, we selected 200 pairs from each group. There were no significant differences in patient background between the redo OPCAB and on-pump redo CABG groups after PS matching. There was no significant difference in the mean number of distal anastomoses after matching (2.41 ± 1.00 vs 2.21 ± 1.04, P = 0.074); nevertheless, the mean operation time was significantly shorter in the redo OPCAB than the on-pump redo CABG group (353.7 vs 441.3 min, P < 0.00010). Patients in the redo OPCAB group had a lower 30-day mortality rate (3.5 vs 7.0%, P = 0.18), a significantly lower rate of composite mortality or major morbidities (11.0 vs 21.5%, P = 0.0060), a significantly lower rate of prolonged ventilation (>24 h) (7.0 vs 15.0%, P = 0.016), a significantly shorter duration of intensive care unit (ICU) stay (ICU stay ≥ 8 days) (7.0 vs 14.5%, P = 0.023) and a significantly decreased need for blood transfusions (71.5 vs 94.0%, P < 0.00010) than patients in the on-pump redo CABG group. The off-pump technique reduced early operative mortality and the incidences of major complications in redo CABG. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Systematic off-pump coronary artery revascularization in multivessel disease: experience of three hundred cases.

PubMed

Cartier, R; Brann, S; Dagenais, F; Martineau, R; Couturier, A

2000-02-01

We sought to report our recent experience with off-pump coronary artery revascularization in multivessel disease. Between October 1996 and December 1998, 300 off-pump beating heart operations were performed at the Montreal Heart Institute by a single surgeon, representing 94% of all procedures undertaken during this same time frame (97% for 1998). This cohort of patients was compared with 1870 patients operated on with cardiopulmonary bypass from 1995 to 1996. Mean age, sex distribution, and preoperative risk factors were comparable for the two groups. On average, 2.92 +/- 0.8 and 2.84 +/- 0.6 grafts per patient were completed in the beating heart and cardiopulmonary bypass groups, respectively. A majority of patients (70%) had either a triple or quadruple bypass. Coronary anastomoses were achieved with myocardial mechanical stabilization and heart "verticalization." Ischemic time was shorter in the beating heart group (29.8 +/- 0.9 vs 45 +/- 0.4 minutes, P <.05). Similarly, the need for transfusion was significantly less in the beating heart group (beating heart operations, 34%; cardiopulmonary bypass, 66%; P <.005). Reduced use of postoperative intra-aortic counterpulsation, as well as a lower rise in creatine kinase MB isoenzyme, was observed in the beating heart group. Operative mortality rates (beating heart operations, 1. 3%; cardiopulmonary bypass, 2%) and perioperative myocardial infarction (beating heart operations, 3.6%; cardiopulmonary bypass, 4.2%) were comparable for the two groups. In a majority of patients, off-pump complete coronary artery revascularization is an acceptable alternative to conventional operations, yielding good results given progressive experience, rigorous technique, and adequate coronary artery stabilization.

Hybrid coronary revascularization in the era of drug-eluting stents.

PubMed

Murphy, Gavin J; Bryan, Alan J; Angelini, Gianni D

2004-11-01

Left internal mammary artery to left anterior descending coronary artery bypass grafting integrated with percutaneous coronary angioplasty (hybrid procedure) offers multivessel revascularization with minimal morbidity in high-risk patients. This is caused in part by the avoidance of cardiopulmonary bypass-related morbidity and manipulation of the aorta coupled with minimally invasive techniques. Hybrid revascularization is currently reserved for particularly high-risk patients or those with favorable anatomic variants however, largely because of the emergence of off-pump coronary artery bypass grafting, which permits more complete multivessel revascularization, with low morbidity in high-risk groups. The wider introduction of hybrid revascularization is limited chiefly by the high number of repeat interventions compared with off-pump coronary artery bypass grafting, which occurs because of the target vessel failure rate of percutaneous coronary intervention. Other demerits are the costs and logistic problems associated with performing two procedures with differing periprocedural management protocols. Recently, drug-eluting stents have reduced the need for repeat intervention after percutaneous coronary intervention, and this has raised the possibility that the results of hybrid revascularization may now equal or even better those of off-pump coronary artery bypass grafting. Although undoubtedly effective at reducing in-stent restenosis, drug-eluting stents will not address the issues of incomplete revascularization or the logistic problems associated with hybrid. Uncertainty regarding the long-term effectiveness of drug-eluting stents in many patients, as well as their high cost when compared with those of off-pump coronary artery bypass grafting surgery, also militates against the wider introduction of hybrid revascularization.

Groundwater withdrawal in randomly heterogeneous coastal aquifers

NASA Astrophysics Data System (ADS)

Siena, Martina; Riva, Monica

2018-05-01

We analyze the combined effects of aquifer heterogeneity and pumping operations on seawater intrusion (SWI), a phenomenon which is threatening coastal aquifers worldwide. Our investigation is set within a probabilistic framework and relies on a numerical Monte Carlo approach targeting transient variable-density flow and solute transport in a three-dimensional randomly heterogeneous porous domain. The geological setting is patterned after the Argentona river basin, in the Maresme region of Catalonia (Spain). Our numerical study is concerned with exploring the effects of (a) random heterogeneity of the domain on SWI in combination with (b) a variety of groundwater withdrawal schemes. The latter have been designed by varying the screen location along the vertical direction and the distance of the wellbore from the coastline and from the location of the freshwater-saltwater mixing zone which is in place prior to pumping. For each random realization of the aquifer permeability field and for each pumping scheme, a quantitative depiction of SWI phenomena is inferred from an original set of metrics characterizing (a) the inland penetration of the saltwater wedge and (b) the width of the mixing zone across the whole three-dimensional system. Our results indicate that the stochastic nature of the system heterogeneity significantly affects the statistical description of the main features of the seawater wedge either in the presence or in the absence of pumping, yielding a general reduction of toe penetration and an increase of the width of the mixing zone. Simultaneous extraction of fresh and saltwater from two screens along the same wellbore located, prior to pumping, within the freshwater-saltwater mixing zone is effective in limiting SWI in the context of groundwater resources exploitation.

Details of the Construction and Production of Fuel Pumps and Fuel Nozzles for the Airplane Diesel Engine

NASA Technical Reports Server (NTRS)

Lubenetsky, W S

1936-01-01

This report presents investigations into the design and construction of fuel pumps for diesel engines. The results of the pump tests on the engines showed that, with a good cut-off, accurate injection, assured by the proper adjustment of the pump elements, there is a decrease in the consumption of fuel and hence an increase in the rated power of the engine. Some of the aspects investigated include: cam profile, coefficient of discharge, and characteristics of the injection system.

Glass-wool study of laser-induced spin currents en route to hyperpolarized Cs salt

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

Ishikawa, Kiyoshi

2011-07-15

The nuclear spin polarization of optically pumped Cs atoms flows to the surface of Cs hydride in a vapor cell. A fine glass wool lightly coated with the salt helps greatly increase the surface area in contact with the pumped atoms and enhance the spin polarization of the salt nuclei. Even though the glass wool randomly scatters the pump light, the atomic vapor can be polarized with unpolarized light in a magnetic field. The measured enhancement in the salt enables study of the polarizations of light and atomic nuclei very near the salt surface.

Preoperative intra-aortic balloon pump improves the clinical outcomes of off-pump coronary artery bypass grafting in left ventricular dysfunction patients

PubMed Central

Yang, Feng; Wang, Jinhong; Hou, Dengbang; Xing, Jialin; Liu, Feng; Xing, Zhi chen; Jiang, Chunjing; Hao, Xing; Du, Zhongtao; Yang, Xiaofang; Zhao, Yanyan; Miao, Na; Jiang, Yu; Dong, Ran; Gu, Chengxiong; Sun, Lizhong; Wang, Hong; Hou, Xiaotong

2016-01-01

Severe left ventricular (LV) dysfunction patients undergoing off-pump coronary artery bypass grafting (OPCAB) are often associated with a higher mortality. The efficacy and safety of the preoperative prophylactic intra-aortic balloon pump (IABP) insertion is not well established. 416 consecutive patients with severe LV dysfunction (ejection fraction ≤35%) undergoing isolated OPCAB were enrolled in a retrospective observational study. 191 patients was enrolled in the IABP group; the remaining 225 patients was in control group. A total of 129 pairs of patients were propensity-score matched. No significant differences in demographic and preoperative risk factors were found between the two groups. The postoperative 30-day mortality occurred more frequently in the control group compared with the IABP group (8.5% vs. 1.6%, p = 0.02). There was a significant reduction of low cardiac output syndrome in the IABP group compared with the control group (14% vs. 6.2%, p = 0.04). Prolonged mechanical ventilation (≥48 h) occurred more frequently in the control group (34.9% vs. 20.9%, p = 0.02). IABP also decreased the postoperative length of stay. Preoperative IABP was associated with a lower 30-day mortality, suggesting that it is effective in patients with severe LV dysfunction undergoing OPCAB. PMID:27279591

Generation of Multiple Vortex Beams with Specified Vortex Number from Lasers with Controlled Ince-Gaussian Modes

NASA Astrophysics Data System (ADS)

Chu, Shu-Chun

2008-07-01

This study proposes a systematic method of selecting excitations of part of Ince-Gaussian modes (IGMs) and a three-lens configuration for generating multiple vortex beams with forced IGMs in the model of laser-diode (LD)-pumped solid-state lasers. Simply changing the lateral off-axis position of the tight pump beam focus on the laser crystal can produce the desired multiple optical vortex beam from the laser in a well-controlled manner using a proposed astigmatic mode converter assembled into one body with the laser cavity.

Meta-Analysis of Aspirin Versus Dual Antiplatelet Therapy Following Coronary Artery Bypass Grafting.

PubMed

Agarwal, Nayan; Mahmoud, Ahmed N; Patel, Nimesh Kirit; Jain, Ankur; Garg, Jalaj; Mojadidi, Mohammad Khalid; Agrawal, Sahil; Qamar, Arman; Golwala, Harsh; Gupta, Tanush; Bhatia, Nirmanmoh; Anderson, R David; Bhatt, Deepak L

2018-01-01

Although aspirin monotherapy is considered the standard of care after coronary artery bypass grafting (CABG), more recent evidence has suggested a benefit with dual antiplatelet therapy (DAPT) after CABG. We performed a meta-analysis of observational studies and randomized controlled trials comparing outcomes of aspirin monotherapy with DAPT in patients after CABG. Subgroup analyses were conducted according to surgical technique (i.e., on vs off pump) and clinical presentation (acute coronary syndrome vs no acute coronary syndrome). Random effects overall risk ratios (RR) were calculated using the DerSimonian and Laird model. Eight randomized control trials and 9 observational studies with a total of 11,135 patients were included. At a mean follow-up of 23 months, major adverse cardiac events (10.3% vs 12.1%, RR 0.84, confidence interval [CI] 0.71 to 0.99), all-cause mortality (5.7% vs 7.0%, RR 0.67, CI 0.48 to 0.94), and graft occlusion (11.3% vs 14.2%, RR 0.79, CI 0.63 to 0.98) were less with DAPT than with aspirin monotherapy. There was no difference in myocardial infarction, stroke, or major bleeding between the 2 groups. In conclusion, DAPT appears to be associated with a reduction in graft occlusion, major adverse cardiac events, and all-cause mortality, without significantly increasing major bleeding compared with aspirin monotherapy in patients undergoing CABG. Copyright © 2017 Elsevier Inc. All rights reserved.

Transapical aortic valve implantation and minimally invasive off-pump bypass surgery

PubMed Central

Ahad, Samir; Baumbach, Hardy; Hill, Stephan; Franke, Ulrich F. W.

2014-01-01

Transcatheter aortic valve implantation (TAVI) has gained increasing popularity for high-risk patients with symptomatic aortic valve stenosis. A concomitant coronary artery disease leads to a complicated management and an increased perioperative risk. This case report describes the successful total arterial coronary revascularization of the left anterior descending and the left marginal branch of the circumflex artery utilizing the left internal mammary artery (LIMA) and left radial artery in off-pump technique in combination with the transapical transcatheter aortic valve implantation via minimally invasive anterolateral access in the fifth intercostal space. PMID:24221960

Current status of cardiovascular surgery in Japan, 2013 and 2014: A report based on the Japan Cardiovascular Surgery Database 3. Coronary artery bypass surgery.

PubMed

Saito, Aya; Hirahara, Norimichi; Motomura, Noboru; Miyata, Hiroaki; Takamoto, Shinichi

2018-01-01

Data on isolated coronary artery bypass grafting (CABG) performed in 2013 and 2014, and registered in the Japan Cardiovascular Surgery Database were reviewed for preoperative characteristics, postoperative outcomes, and choice of graft material for the left anterior descending artery (LAD). Isolated CABG was performed off-pump in 54.7% of cases, and graft material for the LAD was left internal thoracic artery in 74.3% and right internal thoracic artery in 15.6%. Operative mortality was 2.0% in elective cases, 8.2% in emergency cases, and 3.0% overall. In elective cases, operative mortality was 1.1% for off-pump CABG compared with 3.0% for on-pump CABG. Clinical results of our isolated CABG were reasonable and acceptable.

Characterization of light-control-light system using graphene oxide coated optical waveguide

NASA Astrophysics Data System (ADS)

Ahmad, Harith; Soltani, Soroush; Faizal Ismail, Mohammad; Thambiratnam, Kavintheran; Yi, Chong Wu; Yasin, Moh

2018-07-01

An optical waveguide was coated with graphene oxide (GO) using the drop-casting technique to increase the interaction between the waveguide’s evanescent field and the GO layer. Subsequently, a 1550 nm tunable laser source and 980 nm pump laser is used to study the potential of the GO-film to control the flow of light through the waveguide by altering the state of the waveguide between transparent (ON) and opaque (OFF). The GO layer has a thickness of 0.40 µm and allows a 1550 nm signal with a peak power of  ‑7.0 dBm and average output power of 0 dBm to pass through at a maximum pump power of 60 mW. The waveguide has a responsivity of ~0.1 dB mW‑1, with the time to switch between the ON and OFF states being about 3 ms.

Systematic review: proton pump inhibitors (PPIs) for the healing of reflux oesophagitis - a comparison of esomeprazole with other PPIs.

PubMed

Edwards, S J; Lind, T; Lundell, L

2006-09-01

No randomized controlled trial has compared all the licensed standard dose proton pump inhibitors in the healing of reflux oesophagitis. To compare the effectiveness of esomeprazole with licensed standard dose proton pump inhibitors for healing of reflux oesophagitis (i.e. lansoprazole 30 mg, omeprazole 20 mg, pantoprazole 40 mg and rabeprazole 20 mg). Systematic review of CENTRAL, BIOSIS, EMBASE and MEDLINE for randomized controlled trials in patients with reflux oesophagitis. Searching was completed in February 2005. Data on endoscopic healing rates at 4 and 8 weeks were extracted and re-analysed if not analysed by intention-to-treat. Meta-analysis was conducted using a fixed effects model. Of 133 papers identified in the literature search, six were of sufficient quality to be included in the analysis. No studies were identified comparing rabeprazole with esomeprazole. A meta-analysis of healing rates of esomeprazole 40 mg compared with standard dose proton pump inhibitors gave the following results: at 4 weeks [relative risk (RR) 0.92; 95% CI: 0.90, 0.94; P < 0.00001], and 8 weeks (RR 0.95; 95% CI: 0.94, 0.97; P < 0.00001). Publication bias did not have a significant impact on the results. The results were robust to changes in the inclusion/exclusion criteria and using a random effects model. Esomeprazole consistently demonstrates higher healing rates when compared with standard dose proton pump inhibitors.

Tretinoin microsphere gel pump 0.04% versus tazarotene cream 0.05% in the treatment of mild-to-moderate facial acne vulgaris.

PubMed

Kircik, Leon H

2009-07-01

This 12-week, single-center, investigator-blinded, randomized, parallel-design study assessed the safety and efficacy of tretinoin microsphere gel 0.04% delivered by pump (TMG PUMP) to tazarotene cream 0.05% (TAZ) in mild-to-moderate facial acne vulgaris. Efficacy measurements included investigator global assessment (IGA), lesion counts, and subject self-assessment of acne signs and symptoms. Efficacy was generally comparable between treatment groups, although TMG PUMP provided more rapid results in several parameters. IGA showed a more rapid mean change from baseline at week 4 in the TMG PUMP group (-0.18 versus -0.05 in the TAZ subjects). TMG PUMP yielded more rapid improvement in papules. At week 4, the mean percentage change from baseline in open comedones was statistically significant at -64% in the TMG PUMP group (P=0.0039, within group) versus -19% in the TAZ group (not statistically significant within the group; P=0.1875). Skin dryness, peeling and pruritus were significantly less in the TMG PUMP group as early as week 4. Adverse events related to study treatment were rare in both groups and all resolved upon discontinuation of study medication.

Representations and evolutionary operators for the scheduling of pump operations in water distribution networks.

PubMed

López-Ibáñez, Manuel; Prasad, T Devi; Paechter, Ben

2011-01-01

Reducing the energy consumption of water distribution networks has never had more significance. The greatest energy savings can be obtained by carefully scheduling the operations of pumps. Schedules can be defined either implicitly, in terms of other elements of the network such as tank levels; or explicitly, by specifying the time during which each pump is on/off. The traditional representation of explicit schedules is a string of binary values with each bit representing pump on/off status during a particular time interval. In this paper, we formally define and analyze two new explicit representations based on time-controlled triggers, where the maximum number of pump switches is established beforehand and the schedule may contain fewer than the maximum number of switches. In these representations, a pump schedule is divided into a series of integers with each integer representing the number of hours for which a pump is active/inactive. This reduces the number of potential schedules compared to the binary representation, and allows the algorithm to operate on the feasible region of the search space. We propose evolutionary operators for these two new representations. The new representations and their corresponding operations are compared with the two most-used representations in pump scheduling, namely, binary representation and level-controlled triggers. A detailed statistical analysis of the results indicates which parameters have the greatest effect on the performance of evolutionary algorithms. The empirical results show that an evolutionary algorithm using the proposed representations is an improvement over the results obtained by a recent state of the art hybrid genetic algorithm for pump scheduling using level-controlled triggers.

Tapered fiber based Brillouin random fiber laser and its application for linewidth measurement.

PubMed

Gao, Song; Zhang, Liang; Xu, Yanping; Lu, Ping; Chen, Liang; Bao, Xiaoyi

2016-12-12

A one-end pumping Brillouin random fiber laser (BRFL) based on a 5-km tapered fiber (TF) is demonstrated. The enhanced Rayleigh scattering and the increased power density from tapering in the TF provide good directionality and a high degree of coherent feedback. Both the transmitting and TF enhanced Rayleigh scattered pump lights formed effective bi-direction pumping for the Brillouin gain in the standing cavity configuration in the distributed way as the gain and random feedback in the same fiber. The linewidth of the laser shows ~1.17 kHz while the relative intensity noise (RIN) has been verified to be suppressed comparing with that of the two-end pumping of the standard single mode fiber (SMF). Furthermore, utilizing the proposed laser, a high-resolution (~kHz) linewidth measurement method is demonstrated without long delay fiber (>100km) and extra frequency shifter thanks to the acoustic frequency shift from fiber itself.

Theoretical study and design of third-order random fiber laser

NASA Astrophysics Data System (ADS)

Xie, Zhaoxin; Shi, Wei; Fu, Shijie; Sheng, Quan; Yao, Jianquan

2018-02-01

We present result of achieving a random fiber laser at a working wavelength of 1178nm while pumping at 1018nm. The laser power is realized by 200m long cavity which includes three high reflectivity fiber Bragg gratings. This simple and efficient random fiber laser could provide a novel approach to realize low-threshold and high-efficiency 1178nm long wavelength laser. We theoretically analyzed the laser power in random fiber lasers at different pump power by changing three high reflectivity fiber Bragg gratings. We also calculated the forward and backward power of 1st-order stokes, 2nd-order stokes, 3rd-order stokes. With the theoretical analysis, we optimize the cavity's reflectivity to get higher laser power output. The forward random laser exhibits larger gain, the backward random laser has lower gain. By controlling the value of angle-cleaved end fiber's reflectivity to 3×10-7, when the high reflectivity increases from 0.01 to 0.99, the laser power increases, using this proposed configuration, the 1178nm random laser can be generated easily and stably.

Hybrid Multilayered Plasmonic Nanostars for Coherent Random Lasing.

PubMed

Munkhbat, Battulga; Ziegler, Johannes; Pöhl, Hannes; Wörister, Christian; Sivun, Dmitry; Scharber, Markus C; Klar, Thomas A; Hrelescu, Calin

2016-10-20

Here, we report that hybrid multilayered plasmonic nanostars can be universally used as feedback agents for coherent random lasing in polar or nonpolar solutions containing gain material. We show that silver-enhancement of gold nanostars reduces the pumping threshold for coherent random lasing substantially for both a typical dye (R6G) and a typical fluorescent polymer (MEH-PPV). Further, we reveal that the lasing intensity and pumping threshold of random lasers based on silver-enhanced gold nanostars are not influenced by the silica coating, in contrast to gold nanostar-based random lasers, where silica-coated gold nanostars support only amplified spontaneous emission but no coherent random lasing.

Do Perceptions of Insulin Pump Usability Impact Attitudes Toward Insulin Pump Therapy? A Pilot Study of Individuals With Type 1 and Insulin-Treated Type 2 Diabetes

PubMed Central

Gilgen, Emily

2014-01-01

Background: We assessed the impact of perceived insulin pump usability on attitudes toward insulin pump therapy in diabetic individuals currently treated with multiple daily insulin injections (MDI). Method: This comparative, single-arm study recruited 28 adults with type 1 (n = 16) and insulin-treated type 2 diabetes (n = 12) to evaluate 2 current insulin pumps: Medtronic Revel 723 (Pump 1), Asante Snap Insulin Pump (Pump 2). Participants were randomized 1:1 to 1 of 2 assessment sequences: Pump 1 followed by Pump 2; and Pump 2 followed by Pump 1. Structured observational protocols were utilized to assess participants’ ability and time required to learn/perform common tasks associated with pump setup/use. Participants used a modified version of the System Usability Scale (SUS) and investigator-developed questionnaires to rate pump usability and task difficulty; pre-post questionnaires assessed changes in attitudes toward insulin pump therapy. Results: All participants completed the study. SUS scores showed Pump 2 to be more usable than Pump 1 on all usability attributes. Participants rated Pump 2 more positively than Pump 1, overall mean SUS scores of 5.7 versus 4.1 respectively, F(1, 52) = 32.7, P < .001, and SUS scores were higher if participants used the Pump 2 last, 5.3 versus 4.4 for Pump 1 last, F(1, 52) = 10.8, P < .01. Pump 2 was preferred for all tasks: manual bolus (86%), bolus calculation (71%), managing basal rates (93%), interpreting alarms (96%), transferring settings (100%), changing insulin and infusion sets (93%), all P < .05. Conclusions: Perceptions of pump usability can directly impact acceptance and use of features that may benefit those who wear them. Simpler pump devices that decrease perceptions of complexity may encourage broader use of this technology. PMID:25269659

Lift-Off Performance in Flexure Pivot Pad and Hybrid Bearings

DTIC Science & Technology

2008-12-01

and Dawson, M. P., 1998, "Experience in the Use of Flexure Pivot Tilt Pad Bearings in Boiler Feed Water Pumps ," Proc. of the 15th International...freely. Test Procedure 1) Turn on the pump to buffer water to the test bearing. 2) Turn on air to the air seal that prevents water flowing... Pump Users Symposium, Turbomachinery Laboratory, College Station, Texas, pp. 77-84. [6] Rodriguez, L., 2004, “Experimental Frequency-Dependent

Effect of sensor-augmented insulin pump therapy and automated insulin suspension vs standard insulin pump therapy on hypoglycemia in patients with type 1 diabetes: a randomized clinical trial.

PubMed

Ly, Trang T; Nicholas, Jennifer A; Retterath, Adam; Lim, Ee Mun; Davis, Elizabeth A; Jones, Timothy W

2013-09-25

Hypoglycemia is a critical obstacle to the care of patients with type 1 diabetes. Sensor-augmented insulin pump with automated low-glucose insulin suspension has the potential to reduce the incidence of major hypoglycemic events. To determine the incidence of severe and moderate hypoglycemia with sensor-augmented pump with low-glucose suspension compared with standard insulin pump therapy. A randomized clinical trial involving 95 patients with type 1 diabetes, recruited from December 2009 to January 2012 in Australia. Patients were randomized to insulin pump only or automated insulin suspension for 6 months. The primary outcome was the combined incidence of severe (hypoglycemic seizure or coma) and moderate hypoglycemia (an event requiring assistance for treatment). In a subgroup, counterregulatory hormone responses to hypoglycemia were assessed using the hypoglycemic clamp technique. Of the 95 patients randomized, 49 were assigned to the standard-pump (pump-only) therapy and 46 to the low-glucose suspension group. The mean (SD) age was 18.6 (11.8) years; duration of diabetes, 11.0 (8.9) years; and duration of pump therapy, 4.1 (3.4) years. The baseline rate of severe and moderate hypoglycemic events in the pump-only group was 20.7 vs 129.6 events per 100 patient months in the low-glucose suspension group. After 6 months of treatment, the event rates decreased from 28 to 16 in the pump-only group vs 175 to 35 in the low-glucose suspension group. The adjusted incidence rate per 100 patient-months was 34.2 (95% CI, 22.0-53.3) for the pump-only group vs 9.5 (95% CI, 5.2-17.4) for the low-glucose suspension group. The incidence rate ratio was 3.6 (95% CI, 1.7-7.5; P <.001). There was no change in glycated hemoglobin in either group: mean, 7.4 (95% CI, 7.2-7.6) to 7.4 (95% CI, 7.2-7.7) in the pump-only group vs mean, 7.6 (95%, CI, 7.4-7.9) to 7.5 (95% CI, 7.3-7.7) in the low-glucose suspension group. Counterregulatory hormone responses to hypoglycemia were not changed. There were no episodes of diabetic ketoacidosis or hyperglycemia with ketosis. Sensor-augmented pump therapy with automated insulin suspension reduced the combined rate of severe and moderate hypoglycemia in patients with type 1 diabetes. anzctr.org.au Identifier: ACTRN12610000024044.

Mid-infrared optical parametric oscillator pumped by an amplified random fiber laser

NASA Astrophysics Data System (ADS)

Shang, Yaping; Shen, Meili; Wang, Peng; Li, Xiao; Xu, Xiaojun

2017-01-01

Recently, the concept of random fiber lasers has attracted a great deal of attention for its feature to generate incoherent light without a traditional laser resonator, which is free of mode competition and insure the stationary narrow-band continuous modeless spectrum. In this Letter, we reported the first, to the best of our knowledge, optical parametric oscillator (OPO) pumped by an amplified 1070 nm random fiber laser (RFL), in order to generate stationary mid-infrared (mid-IR) laser. The experiment realized a watt-level laser output in the mid-IR range and operated relatively stable. The use of the RFL seed source allowed us to take advantage of its respective stable time-domain characteristics. The beam profile, spectrum and time-domain properties of the signal light were measured to analyze the process of frequency down-conversion process under this new pumping condition. The results suggested that the near-infrared (near-IR) signal light `inherited' good beam performances from the pump light. Those would be benefit for further develop about optical parametric process based on different pumping circumstances.

Random distributed feedback fiber laser at 2.1  μm.

PubMed

Jin, Xiaoxi; Lou, Zhaokai; Zhang, Hanwei; Xu, Jiangming; Zhou, Pu; Liu, Zejin

2016-11-01

We demonstrate a random distributed feedback fiber laser at 2.1 μm. A high-power pulsed Tm-doped fiber laser operating at 1.94 μm with a temporal duty ratio of 30% was employed as a pump laser to increase the equivalent incident pump power. A piece of 150 m highly GeO₂-doped silica fiber that provides a strong Raman gain and random distributed feedbacks was used to act as the gain medium. The maximum output power reached 0.5 W with the optical efficiency of 9%, which could be further improved by more pump power and optimized fiber length. To the best of our knowledge, this is the first demonstration of random distributed feedback fiber laser at 2 μm band based on Raman gain.

Clopidogrel use After Myocardial Revascularization: Prevalence, Predictors, and One-Year Survival Rate

PubMed Central

Prates, Paulo Roberto L.; Williams, Judson B.; Mehta, Rajendra H.; Stevens, Susanna R.; Thomas, Laine; Smith, Peter K.; Newby, L. Kristin; Kalil, Renato A. K.; Alexander, John H.; Lopes, Renato D.

2016-01-01

Introduction Antiplatelet therapy after coronary artery bypass graft (CABG) has been used. Little is known about the predictors and efficacy of clopidogrel in this scenario. Objective Identify predictors of clopidogrel following CABG. Methods We evaluated 5404 patients who underwent CABG between 2000 and 2009 at Duke University Medical Center. We excluded patients undergoing concomitant valve surgery, those who had postoperative bleeding or death before discharge. Postoperative clopidogrel was left to the discretion of the attending physician. Adjusted risk for 1-year mortality was compared between patients receiving and not receiving clopidogrel during hospitalization after undergoing CABG. Results At hospital discharge, 931 (17.2%) patients were receiving clopidogrel. Comparing patients not receiving clopidogrel at discharge, users had more comorbidities, including hyperlipidemia, hypertension, heart failure, peripheral arterial disease and cerebrovascular disease. Patients who received aspirin during hospitalization were less likely to receive clopidogrel at discharge (P≤0.0001). Clopidogrel was associated with similar 1-year mortality compared with those who did not use clopidogrel (4.4% vs. 4.5%, P=0.72). There was, however, an interaction between the use of cardiopulmonary bypass and clopidogrel, with lower 1-year mortality in patients undergoing off-pump CABG who received clopidogrel, but not those undergoing conventional CABG (2.6% vs 5.6%, P Interaction = 0.032). Conclusion Clopidogrel was used in nearly one-fifth of patients after CABG. Its use was not associated with lower mortality after 1 year in general, but lower mortality rate in those undergoing off-pump CABG. Randomized clinical trials are needed to determine the benefit of routine use of clopidogrel in CABG. PMID:27556308

A randomized study of rotigotine dose response on 'off' time in advanced Parkinson's disease.

PubMed

Nicholas, Anthony P; Borgohain, Rupam; Chaná, Pedro; Surmann, Erwin; Thompson, Emily L; Bauer, Lars; Whitesides, John; Elmer, Lawrence W

2014-01-01

Previous phase III studies in patients with advanced Parkinson's disease (PD) not adequately controlled on levodopa demonstrated significant reduction of 'off' time with rotigotine transdermal system up to 16 mg/24 h. However, the minimal effective dose has not been established. This international, randomized, double-blind, placebo-controlled study (SP921; NCT00522379) investigated rotigotine dose response up to 8 mg/24 h. Patients with advanced idiopathic PD (≥2.5 h of daily 'off' time on stable doses of levodopa) were randomized 1:1:1:1:1 to receive rotigotine 2, 4, 6, or 8 mg/24 h or placebo, titrated over 4 weeks and maintained for 12 weeks. The primary efficacy variable was change from baseline to end of maintenance in absolute time spent 'off'. 409/514 (80%) randomized patients completed maintenance. Mean (±SD) baseline daily 'off' times (h/day) were placebo: 6.4 (±2.5), rotigotine 2-8 mg/24 h: 6.4 (±2.6). Rotigotine 8 mg/24 h was the minimal dose to significantly reduce 'off' time versus placebo. LS mean (±SE) absolute change in daily 'off' time (h/day) from baseline was -2.4 (±0.28) with rotigotine 8 mg/24 h, and -1.5 (±0.26) with placebo; absolute change in 'off' time in the 8 mg/24 h group compared with placebo was -0.85 h/day (95% CI -1.59, -0.11; p = 0.024). There was an apparent dose-dependent trend. Adverse events (AEs) reported at a higher incidence in the rotigotine 8 mg/24 h group versus placebo included application site reactions, nausea, dry mouth, and dyskinesia; there was no worsening of insomnia, somnolence, orthostatic hypotension, confusional state or hallucinations, even in patients ≥75 years of age. The minimal statistically significant effective dose of rotigotine to reduce absolute 'off' time was 8 mg/24 h. The AE profile was similar to previous studies.

Microchip solid-state cylindrical vector lasers with orthogonally polarized dual laser-diode end pumping.

PubMed

Otsuka, Kenju; Chu, Shu-Chun

2013-05-01

We report a simple method for generating cylindrical vector beams directly from laser-diode (LD)-pumped microchip solid-state lasers by using dual end-pumping beams. Radially as well as azimuthally polarized vector field emissions have been generated from the common c-cut Nd:GdVO4 laser cavity merely by controlling the focus positions of orthogonally polarized LD off-axis pump beams. Hyperbolically polarized vector fields have also been observed, in which the cylindrical symmetry of vector fields is broken. Experimental results have been well reproduced by numerical simulations.

A stable submillimeter laser local oscillator for heterodyne radiometry and spectroscopy

NASA Technical Reports Server (NTRS)

Koepf, G. A.; Fetterman, H. R.; Mcavoy, N.

1980-01-01

A submillimeter laser with off-axis pump beam injection is described. This design concept achieves complete isolation of the pump laser with respect to the pump radiation reflected from the submillimeter resonator. Active line independent stabilization of the pump laser is obtained by the use of an external tunable etalon as a frequency reference. The submillimeter output power is constant to within 4% over periods of hours. Mean frequency drifts of less than 2 parts in 100 million per minute were measured by mixing with very high harmonics of an X-band synthesizer in a planar Schottky diode.

Erbium Doped GaN Lasers by Optical Pumping

DTIC Science & Technology

2016-07-13

obtained via growth by hydride vapor phase epitaxy (HVPE) in conjunction with a laser-lift-off (LLO) process. An Er doping level of 1.4 × 10^20 atoms/cm3... conjunction with a laser-lift-off (LLO) 2 process. An Er doping level

Controlling signal transport in a carbon nanotube opto-transistor

NASA Astrophysics Data System (ADS)

Li, Jinjin; Chu, Yanhui; Zhu, Ka-Di

2016-11-01

With the highly competitive development of communication technologies, modern information manufactures place high importance on the ability to control the transmitted signal using easy miniaturization materials. A controlled and miniaturized optical information device is, therefore, vital for researchers in information and communication fields. Here we propose a controlled signal transport in a doubly clamped carbon nanotube system, where the transmitted signal can be controlled by another pump beam. Pump off results in the transmitted signal off, while pump on results in the transmitted signal on. The more pump, the more amplified output signal transmission. Analogous with traditional cavity optomechanical system, the role of optical cavity is played by a localized exciton in carbon nanotube while the role of the mechanical element is played by the nanotube vibrations, which enables the realization of an opto-transistor based on carbon nanotube. Since the signal amplification and attenuation have been observed in traditional optomechanical system, and the nanotube optomechanical system has been realized in laboratory, the proposed carbon nanotube opto-transistor could be implemented in current experiments and open the door to potential applications in modern optical networks and future quantum networks.

Resonantly cladding-pumped Yb-free Er-doped LMA fiber laser with record high power and efficiency.

PubMed

Zhang, Jun; Fromzel, Viktor; Dubinskii, Mark

2011-03-14

We report the results of our power scaling experiments with resonantly cladding-pumped Er-doped eye-safe large mode area (LMA) fiber laser. While using commercial off-the-shelf LMA fiber we achieved over 88 W of continuous-wave (CW) single transverse mode power at ~1590 nm while pumping at 1532.5 nm. Maximum observed optical-to-optical efficiency was 69%. This result presents, to the best of our knowledge, the highest power reported from resonantly-pumped Yb-free Er-doped LMA fiber laser, as well as the highest efficiency ever reported for any cladding-pumped Er-doped laser, either Yb-co-doped or Yb-free.

Infrared x-ray pump-probe spectroscopy of the NO molecule

NASA Astrophysics Data System (ADS)

Guimarães, F. F.; Kimberg, V.; Felicíssimo, V. C.; Gel'Mukhanov, F.; Cesar, A.; Ågren, H.

2005-07-01

Two color infrared x-ray pump-probe spectroscopy of the NO molecule is studied theoretically and numerically in order to obtain a deeper insight of the underlying physics and of the potential of this suggested technology. From the theoretical investigation a number of conclusions could be drawn: It is found that the phase of the infrared field strongly influences the trajectory of the nuclear wave packet, and hence, the x-ray spectrum. The trajectory experiences fast oscillations with the vibrational frequency with a modulation due to the anharmonicity of the potential. The dependences of the x-ray spectra on the delay time, the duration, and the shape of the pulses are studied in detail. It is shown that the x-ray spectrum keep memory about the infrared phase after the pump field left the system. This memory effect is sensitive to the time of switching-off the pump field and the Rabi frequency. The phase effect takes maximum value when the duration of the x-ray pulse is one-fourth of the infrared field period, and can be enhanced by a proper control of the duration and intensity of the pump pulse. The manifestation of the phase is different for oriented and disordered molecules and depends strongly on the intensity of the pump radiation.

A study with pharyngeal and esophageal 24-hour pH-impedance monitoring in patients with laryngopharyngeal symptoms refractory to proton pump inhibitors.

PubMed

Dulery, C; Lechot, A; Roman, S; Bastier, P-L; Stoll, D; de Gabory, L; Zerbib, F

2017-01-01

The role of gastroesophageal reflux in chronic laryngeal symptoms is difficult to establish. The aim of this study was to characterize pharyngeal and esophageal pH-impedance reflux patterns in a group of patients with suspected laryngopharyngeal reflux and to determine predictive factors of response to proton pump inhibitors. Patients with chronic pharyngolaryngeal symptoms were evaluated with a symptom score questionnaire, laryngoscopy, and 24-hour pharyngeal and esophageal pH-impedance monitoring at baseline and after 8-week treatment with esomeprazole 40 mg b.i.d. Response to treatment was defined by a diminution of more than 50% of the score for the primary symptom. Reflux patterns and baseline impedance values were compared to those obtained in 46 healthy subjects. Twenty-four patients were included (17 women, median age 54 years), all previously refractory to antisecretory therapy. Symptom scores were 46 (32-62) and 40 (27-76) off and on therapy, respectively (P=.1). There was no significant difference between patients and controls for pH-impedance reflux parameters and baseline values off and on therapy in distal and proximal esophagus and in the pharynx. Median numbers of pharyngeal reflux were 0 and 0 off and on therapy, respectively. Only two patients were responders to treatment, both with excessive distal reflux but no pharyngeal reflux. Only one patient had abnormal pharyngeal reflux but did not respond to proton pump inhibitors. Patients with suspected laryngopharyngeal reflux refractory to therapy do not exhibit abnormal pharyngeal or esophageal pH-impedance reflux. In these patients, laryngopharyngeal reflux is unlikely. © 2016 John Wiley & Sons Ltd.

Suggested techniques, equipment, and standards for the testing of hand insecticide-spraying equipment

PubMed Central

Hall, Lawrence B.

1955-01-01

The new demands placed upon application equipment by the introduction of modern insecticides have revealed the deficiencies of this equipment when required for continuous use on a large scale. If adequate equipment is to be produced, specifications must be based not only on basic materials tests but also on “use” tests, in which the conditions of field use are simulated. The author outlines suggested techniques to be followed and standards to be adopted in testing the performance of compression sprayers and allied equipment, with reference to the following features: compression-sprayer tank fatigue; tank impact; pump resistance to bursting; pump resistance to collapse; pump friction; cut-off valve durability; constant-pressure valves; cut-off valve actuation; hose flexure; hose tension and bursting-pressure; hose friction; gaskets, valve faces, and similar non-metallic parts; nozzle-orifice erosion; and nozzle pattern. ImagesFIG. 1FIG. 14FIG. 20 PMID:14364189

Analysis of Dual-Order Backward Pumping Schemes in Distributed Raman Amplification System

NASA Astrophysics Data System (ADS)

Singh, Kulwinder; Patterh, Manjeet Singh; Bhamrah, Manjit Singh

2018-04-01

Backward pumping in fiber Raman amplifiers has been investigated in this paper in terms of on-off Raman gain, noise figure and optical signal-to-noise ratio. The results exhibit that with four first-order pumps and one second-order pump scheme can be employed to achieve 8.2 dB noise figure in 64 channel fiber optic communication system. It has also been reported that 2.65 dB gain ripple, 0.87 dB noise figure tilt and 2.02 dB OSNR tilt can be attained with the second-order pumping in fiber Raman amplifiers. The main advantage of the scheme is that only 50 mW second-order pump shows appreciable improvement in the system performance. It shows that further increase in first-order and second-order pump powers increase system noise implications.

Two-color pump-probe laser spectroscopy instrument with picosecond time-resolved electronic delay and extended scan range

NASA Astrophysics Data System (ADS)

Yu, Anchi; Ye, Xiong; Ionascu, Dan; Cao, Wenxiang; Champion, Paul M.

2005-11-01

An electronically delayed two-color pump-probe instrument was developed using two synchronized laser systems. The instrument has picosecond time resolution and can perform scans over hundreds of nanoseconds without the beam divergence and walk-off effects that occur using standard spatial delay systems. A unique picosecond Ti :sapphire regenerative amplifier was also constructed without the need for pulse stretching and compressing optics. The picosecond regenerative amplifier has a broad wavelength tuning range, which suggests that it will make a significant contribution to two-color pump-probe experiments. To test this instrument we studied the rotational correlation relaxation of myoglobin (τr=8.2±0.5ns) in water as well as the geminate rebinding kinetics of oxygen to myoglobin (kg1=1.7×1011s-1, kg2=3.4×107s-1). The results are consistent with, and improve upon, previous studies.

Observation of random lasing in gold-silica nanoshell/water solution

NASA Astrophysics Data System (ADS)

Kang, Jin U.

2006-11-01

The author reports experimental observation of resonant surface plasmon enhanced random lasing in gold-silica nanoshells in de-ionized water. The gold-silica nanoshell/water solution with concentration of 8×109particles/ml was pumped above the surface plasmon resonance frequency using 514nm argon-krypton laser. When pumping power was above the lasing threshold, sharp random lasing peaks occurred near and below the plasmon peak from 720to860nm with a lasing linewidth less than 1nm.

Effect of intra-aortic balloon pump on coronary blood flow during different balloon cycles support: A computer study.

PubMed

Aye, Thin Pa Pa; Htet, Zwe Lin; Singhavilai, Thamvarit; Naiyanetr, Phornphop

2015-01-01

Intra-aortic balloon pump (IABP) has been used in clinical treatment as a mechanical circulatory support device for patients with heart failure. A computer model is used to study the effect on coronary blood flow (CBF) with different balloon cycles under both normal and pathological conditions. The model of cardiovascular and IABP is developed by using MATLAB SIMULINK. The effect on coronary blood flow has been studied under both normal and pathological conditions using different balloon cycles (balloon off; 1:4; 1:2; 1:1). A pathological heart is implemented by reducing the left ventricular contractility. The result of this study shows that the rate of balloon cycles is related to the level of coronary blood flow.

Wide sternal retraction may impede internal mammary artery graft flow and reduce myocardial function during off-pump coronary artery bypass grafting: presentation of two cases

PubMed Central

Espinoza, Andreas; Bergsland, Jacob; Lundblad, Runar; Fosse, Erik

2012-01-01

The internal mammary artery (IMA) is routinely used for grafting of the left anterior descending coronary artery (LAD), providing good flow to the anterior left ventricle (LV) wall. Impeded IMA-to-LAD flow may result in myocardial ischaemia and haemodynamic deterioration. From a study population, we describe two incidents where myocardial ischaemia was observed during off-pump coronary artery bypass surgery (CABG), with a confirmed reduction in the IMA-to-LAD flow in one patient. In patient no. 1, normal IMA flow was assessed by transit-time flow measurement after a complete IMA-to-LAD anastomosis. The anterior LV wall thickening was monitored continuously by epicardial ultrasonic transducers. Normal wall thickening was confirmed after IMA grafting. During a wide sternal opening for circumflex grafting the anterior wall motion displayed an ischaemic pattern, with reduced systolic and increased post-systolic wall thickening. IMA flow was reduced simultaneously. When easing the sternal opening, IMA flow normalized, as did the motion pattern in the anterior LV wall. In patient no. 2, similar changes in wall thickening occurred during a wide sternal opening after IMA-to-LAD grafting. When easing the retractor, the wall thickening normalized. It is important for the surgeon to be aware of this possible cause of myocardial ischaemia, with a risk of subsequent haemodynamic deterioration. This may not only be of great importance during off-pump CABG, but can also be significant for successful weaning from the cardiopulmonary bypass machine. PMID:22499803

Multiwavelength ytterbium-Brillouin random Rayleigh feedback fiber laser

NASA Astrophysics Data System (ADS)

Wu, Han; Wang, Zinan; Fan, Mengqiu; Li, Jiaqi; Meng, Qingyang; Xu, Dangpeng; Rao, Yunjiang

2018-03-01

In this letter, we experimentally demonstrate the multiwavelength ytterbium-Brillouin random fiber laser for the first time, in the half-open cavity formed by a fiber loop mirror and randomly distributed Rayleigh mirrors. With a cladding-pumped ytterbium-doped fiber and a long TrueWave fiber, the narrow linewidth Brillouin pump can generate multiple Brillouin Stokes lines with hybrid ytterbium-Brillouin gain. Up to six stable channels with a spacing of about 0.06 nm are obtained. This work extends the operation wavelength of the multiwavelength Brillouin random fiber laser to the 1 µm band, and has potential in various applications.

Random Mutagenesis of the Multidrug Transporter AcrB from Escherichia coli for Identification of Putative Target Residues of Efflux Pump Inhibitors

PubMed Central

Kohler, Samay; Buck, Annika; Dambacher, Christine; König, Armin; Bohnert, Jürgen A.; Kern, Winfried V.

2014-01-01

Efflux is an important mechanism of bacterial multidrug resistance (MDR), and the inhibition of MDR pumps by efflux pump inhibitors (EPIs) could be a promising strategy to overcome MDR. 1-(1-Naphthylmethyl)-piperazine (NMP) and phenylalanine-arginine-β-naphthylamide (PAβN) are model EPIs with activity in various Gram-negative bacteria expressing AcrB, the major efflux pump of Escherichia coli, or similar homologous pumps of the resistance-nodulation-cell division class. The aim of the present study was to generate E. coli AcrB mutants resistant to the inhibitory action of the two model EPIs and to identify putative EPI target residues in order to better understand mechanisms of pump inhibition. Using an in vitro random mutagenesis approach focusing on the periplasmic domain of AcrB, we identified the double mutation G141D N282Y, which substantially compromised the synergistic activity of NMP with linezolid, was associated with similar intracellular linezolid concentrations in the presence and absence of NMP, and did not impair the intrinsic MICs of various pump substrates and dye accumulation. We propose that these mutations near the outer face of the distal substrate binding pocket reduce NMP trapping. Other residues found to be relevant for efflux inhibition by NMP were G288 and A279, but mutations at these sites also changed the susceptibility to several pump substrates. Unlike with NMP, we were unable to generate AcrB periplasmic domain mutants with resistance or partial resistance to the EPI activity of PAβN, which is consistent with the modes of action of PAβN differing from those of NMP. PMID:25182653

Fluid sample collection and distribution system. [qualitative analysis of aqueous samples from several points

NASA Technical Reports Server (NTRS)

Brooks, R. L. (Inventor)

1979-01-01

A multipoint fluid sample collection and distribution system is provided wherein the sample inputs are made through one or more of a number of sampling valves to a progressive cavity pump which is not susceptible to damage by large unfiltered particles. The pump output is through a filter unit that can provide a filtered multipoint sample. An unfiltered multipoint sample is also provided. An effluent sample can be taken and applied to a second progressive cavity pump for pumping to a filter unit that can provide one or more filtered effluent samples. The second pump can also provide an unfiltered effluent sample. Means are provided to periodically back flush each filter unit without shutting off the whole system.

Quantitative analysis of backflow of reversible pump-turbine in generating mode

NASA Astrophysics Data System (ADS)

Liu, K. H.; Zhang, Y. N.; Li, J. W.; Xian, H. Z.

2016-05-01

Significant vibration and pressure fluctuations are usually observed when pump- turbine is operated during the off-design conditions, especially turbine brake and runaway. The root cause of these instability phenomena is the abnormal unsteady flow (especially the backflow) inside the pump-turbine. In the present paper, numerical simulation method is adopted to investigate the characteristics of the flow inside the whole passage of pump-turbine with two guide vane openings (6° and 21° respectively) and three kinds of operating conditions (turbine, runaway and turbine braking respectively). A quantitative analysis of backflow is performed in both the axial and radial directions and the generation and development of backflow in the pump turbine are revealed with great details.

High-power ultralong-wavelength Tm-doped silica fiber laser cladding-pumped with a random distributed feedback fiber laser

PubMed Central

Jin, Xiaoxi; Du, Xueyuan; Wang, Xiong; Zhou, Pu; Zhang, Hanwei; Wang, Xiaolin; Liu, Zejin

2016-01-01

We demonstrated a high-power ultralong-wavelength Tm-doped silica fiber laser operating at 2153 nm with the output power exceeding 18 W and the slope efficiency of 25.5%. A random distributed feedback fiber laser with the center wavelength of 1173 nm was employed as pump source of Tm-doped fiber laser for the first time. No amplified spontaneous emissions or parasitic oscillations were observed when the maximum output power reached, which indicates that employing 1173 nm random distributed feedback fiber laser as pump laser is a feasible and promising scheme to achieve high-power emission of long-wavelength Tm-doped fiber laser. The output power of this Tm-doped fiber laser could be further improved by optimizing the length of active fiber, reflectivity of FBGs, increasing optical efficiency of pump laser and using better temperature management. We also compared the operation of 2153 nm Tm-doped fiber lasers pumped with 793 nm laser diodes, and the maximum output powers were limited to ~2 W by strong amplified spontaneous emission and parasitic oscillation in the range of 1900–2000 nm. PMID:27416893

High-power ultralong-wavelength Tm-doped silica fiber laser cladding-pumped with a random distributed feedback fiber laser.

PubMed

Jin, Xiaoxi; Du, Xueyuan; Wang, Xiong; Zhou, Pu; Zhang, Hanwei; Wang, Xiaolin; Liu, Zejin

2016-07-15

We demonstrated a high-power ultralong-wavelength Tm-doped silica fiber laser operating at 2153 nm with the output power exceeding 18 W and the slope efficiency of 25.5%. A random distributed feedback fiber laser with the center wavelength of 1173 nm was employed as pump source of Tm-doped fiber laser for the first time. No amplified spontaneous emissions or parasitic oscillations were observed when the maximum output power reached, which indicates that employing 1173 nm random distributed feedback fiber laser as pump laser is a feasible and promising scheme to achieve high-power emission of long-wavelength Tm-doped fiber laser. The output power of this Tm-doped fiber laser could be further improved by optimizing the length of active fiber, reflectivity of FBGs, increasing optical efficiency of pump laser and using better temperature management. We also compared the operation of 2153 nm Tm-doped fiber lasers pumped with 793 nm laser diodes, and the maximum output powers were limited to ~2 W by strong amplified spontaneous emission and parasitic oscillation in the range of 1900-2000 nm.

Femtosecond Nonlinearities in Indium Gallium Arsenic Phosphide Diode Lasers

NASA Astrophysics Data System (ADS)

Hall, Katherine Lavin

Semiconductor optical amplifiers are receiving increasing attention for possible applications to broadband optical communication and switching systems. In this thesis we report the results of an extensive experimental study of the ultrafast gain and refractive index nonlinearities in 1.5 μm InGaAsP laser diode amplifiers. The temporal resolution afforded by the femtosecond optical pulses used in these experiments allows us to study carrier interactions with other carriers as well as carrier interactions with the lattice. The 100-200 fs optical pulses used in the pump -probe experiments are generated by an Additive Pulse Modelocked color center laser. The measured group velocity dispersion in the diodes ranged from -0.6 to -0.95 mu m^{-1 }. Differences in the group velocity for TE - and TM-polarized pulses suggested that cross-polarized pump-probe pulses walk off from each other in the diode. This walk-off can diminish the time resolution of some experiments. A novel heterodyne pump-probe technique was developed to distinguish collinear, copolarized, pump and probe pulses that were nominally at the same wavelength. Comparing cross-polarized and copolarized pump-probe results yielded new information about the physical mechanisms responsible for nonlinear gain in the diodes. We observed a gain compression across the entire bandwidth of the diode, associated with carrier heating. The hot carrier distribution cooled back to the lattice temperature with a 0.6 to 1.0 ps time constant, depending on the device structure. In addition, we observed a 0.1 to 0.25 ps delay in onset of carrier heating. Large gain compression due to two photon absorption was also observed. A small portion of the nonlinear gain is attributed to spectral hole burning. Pulsewidth-dependent output saturation energies were explained by a rate equation model that included the effect of carrier heating. Measurements of pump-induced probe phase changes revealed index nonlinearities due to delayed carrier heating and an instantaneous electronic, or virtual process. (Copies available exclusively from MIT Libraries, Rm. 14-0551, Cambridge, MA 02139-4307. Ph. 617 -253-5668; Fax 617-253-1690.).

Local anesthetic infusion pump for pain management following total knee arthroplasty: a meta-analysis.

PubMed

Zhang, Yeying; Lu, Ming; Chang, Cheng

2017-01-23

We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) were to evaluate the effect and safety of local anesthetic infusion pump versus placebo for pain management following total knee arthroplasty (TKA). In September 2016, a systematic computer-based search was conducted in the Pubmed, ISI Web of Knowledge, Embase, Cochrane Database of Systematic Reviews. Randomized controlled trials of patients prepared for primary TKA that compared local anesthetic infusion pump versus placebo for pain management following TKA were retrieved. The primary endpoint was the visual analogue scale (VAS) with rest or mobilization at 24, 48 and 72 h and morphine consumption at 24 and 48 h. The second outcomes are range of motion, length of hospital stay (LOS) and complications (infection, deep venous thrombosis (DVT), prolonged drainage and postoperative nausea and vomiting (PONV)). Seven clinical studies with 587 patients were included and for meta-analysis. Local anesthetic infusion pump are associated with less pain scores with rest or mobilization at 24 and 48 h with significant difference. However, the difference was likely no clinical significance. There were no significant difference between the LOS, the occurrence of DVT, prolonged drainage and PONV. However, local anesthetic infusion pump may be associated with more infection. Based on the current meta-analysis, we found no evidence to support the routine use of local anesthetic infusion pump in the management of acute pain following TKA. More RCTs are still need to identify the pain control effects and optimal dose and speed of local anesthetic pain pump.

Sequential compression pump effect on hypotension due to spinal anesthesia for cesarean section: A double blind clinical trial.

PubMed

Zadeh, Fatemeh Javaherforoosh; Alqozat, Mostafa; Zadeh, Reza Akhond

2017-05-01

Spinal anesthesia (SA) is a standard technique for cesarean section. Hypotension presents an incident of 80-85% after SA in pregnant women. To determine the effect of intermittent pneumatic compression of lower limbs on declining spinal anesthesia induced hypotension during cesarean section. This double-blind clinical prospective study was conducted on 76 non-laboring parturient patients, aged 18-45 years, with the American Society of Anesthesiologist physical status I or II who were scheduled for elective cesarean section at Razi Hospital, Ahvaz, Iran from December 21, 2015 to January 20, 2016. Patients were divided into treatment mechanical pump (Group M) or control group (Group C) with simple random sampling. Fetal presentation, birth weight, Apgar at 1 and 5 min, time taken for pre-hydration (min), pre-hydration to the administration of spinal anesthesia (min), initiation of spinal to the delivery (min) and total volume of intravenous fluids, total dose of ephedrine and metoclopramide were recorded. Data were analyzed by SPSS version 19, using repeated measures of ANOVA and Chi square test. Heart rate, MPA, DAP and SAP changes were significantly higher in off-pump group in the baseline and 1st-minute (p<0.05), and in the other times, this change was significantly different with control groups. This research showed the suitability of the use of Sequential Compression Device (SCD) in reducing hypotension after spinal anesthesia for cesarean section, also this method can cause reducing vasopressor dosage for increased blood pressure, but the approval of its effectiveness requires repetition of the study with a larger sample size. The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the IRCT ID: IRCT2015011217742N3. The authors received no financial support for the research, authorship, and/or publication of this article.

Sequential compression pump effect on hypotension due to spinal anesthesia for cesarean section: A double blind clinical trial

PubMed Central

Zadeh, Fatemeh Javaherforoosh; Alqozat, Mostafa; Zadeh, Reza Akhond

2017-01-01

Background Spinal anesthesia (SA) is a standard technique for cesarean section. Hypotension presents an incident of 80–85% after SA in pregnant women. Objective To determine the effect of intermittent pneumatic compression of lower limbs on declining spinal anesthesia induced hypotension during cesarean section. Methods This double-blind clinical prospective study was conducted on 76 non-laboring parturient patients, aged 18–45 years, with the American Society of Anesthesiologist physical status I or II who were scheduled for elective cesarean section at Razi Hospital, Ahvaz, Iran from December 21, 2015 to January 20, 2016. Patients were divided into treatment mechanical pump (Group M) or control group (Group C) with simple random sampling. Fetal presentation, birth weight, Apgar at 1 and 5 min, time taken for pre-hydration (min), pre-hydration to the administration of spinal anesthesia (min), initiation of spinal to the delivery (min) and total volume of intravenous fluids, total dose of ephedrine and metoclopramide were recorded. Data were analyzed by SPSS version 19, using repeated measures of ANOVA and Chi square test. Results Heart rate, MPA, DAP and SAP changes were significantly higher in off-pump group in the baseline and 1st-minute (p<0.05), and in the other times, this change was significantly different with control groups. Conclusion This research showed the suitability of the use of Sequential Compression Device (SCD) in reducing hypotension after spinal anesthesia for cesarean section, also this method can cause reducing vasopressor dosage for increased blood pressure, but the approval of its effectiveness requires repetition of the study with a larger sample size. Trial registration The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the IRCT ID: IRCT2015011217742N3. Funding The authors received no financial support for the research, authorship, and/or publication of this article. PMID:28713516

A randomised controlled trial of active chronic otitis media comparing courses of eardrops versus one-off topical treatments suitable for primary, secondary and tertiary healthcare settings.

PubMed

Loock, J W

2012-08-01

Primary: to compare one-off administration of boric acid powder with courses of 1% acetic acid and ciprofloxacin eardrops in treating active chronic otitis media. Secondary: to evaluate the effectiveness of Quadriderm® cream in resistant active chronic otitis media; and to document side effects of these treatments, especially hearing loss. Randomised controlled trial. Outpatient department of a tertiary ENT unit. Hundred and fifty-nine patients over 6 years old with active chronic mucosal (without cholesteatoma) otitis media randomised to receive one of the three primary agents. All techniques employed were suitable for primary healthcare givers as well as specialists. After confirming eligibility, patients were randomly allocated to treatment. All ears underwent toilet with irrigation using clean water, a syringe and ambient light, with or without dry mopping, until the perforation was visible. The randomised solution was flushed through the middle ear and eustachian tube using a 'tragal pump' technique: saline was used as the solution for flushing in the boric acid powder arm. Patients allocated topical ear medication were given a bottle of eardrops to administer (six drops twice daily, 'pumped in') until finished. Those allocated boric acid powder had the external ear canals filled as a one-off treatment. Patients were followed up monthly thereafter. Primary: Dry (inactive) middle ears as assessed by the doctor. Secondary: Patient assessment of success; microbiologic culture and sensitivity; audiologic changes because of treatment; complications of treatment; costs of therapies. Ciprofloxacin eardrops and boric acid powder were statistically superior to 1% acetic acid eardrops in rendering active chronic otitis media inactive (73% dry ears for ciprofloxacin; 67% for boric acid powder; and 24% for acetic acid). There was no difference between the success rates of ciprofloxacin eardrops and boric acid powder. Quadriderm cream was effective in 85% of patients failing first-line therapy. No agent caused significant complications and specifically no hearing loss. This study showed a single application of boric acid powder following external auditory canal irrigation until the perforation was visible to be as effective as the current best practice of topical quinolone eardrops in active chronic otitis media. Boric acid powder is inexpensive and does not require patient compliance. Boric acid powder is a viable, less costly alternative to topical antibiotic/steroid ear drops in the developing world for active chronic otitis media. Acetic acid eardrops 1% are ineffective. Quadriderm cream, given as a one-off therapy, also appears to be effective. © 2012 Blackwell Publishing Ltd.

Optimization and Performance Study of Select Heating Ventilation and Air Conditioning Technologies for Commercial Buildings

NASA Astrophysics Data System (ADS)

Kamal, Rajeev

Buildings contribute a significant part to the electricity demand profile and peak demand for the electrical utilities. The addition of renewable energy generation adds additional variability and uncertainty to the power system. Demand side management in the buildings can help improve the demand profile for the utilities by shifting some of the demand from peak to off-peak times. Heating, ventilation and air-conditioning contribute around 45% to the overall demand of a building. This research studies two strategies for reducing the peak as well as shifting some demand from peak to off-peak periods in commercial buildings: 1. Use of gas heat pumps in place of electric heat pumps, and 2. Shifting demand for air conditioning from peak to off-peak by thermal energy storage in chilled water and ice. The first part of this study evaluates the field performance of gas engine-driven heat pumps (GEHP) tested in a commercial building in Florida. Four GEHP units of 8 Tons of Refrigeration (TR) capacity each providing air-conditioning to seven thermal zones in a commercial building, were instrumented for measuring their performance. The operation of these GEHPs was recorded for ten months, analyzed and compared with prior results reported in the literature. The instantaneous COPunit of these systems varied from 0.1 to 1.4 during typical summer week operation. The COP was low because the gas engines for the heat pumps were being used for loads that were much lower than design capacity which resulted in much lower efficiencies than expected. The performance of equivalent electric heat pump was simulated from a building energy model developed to mimic the measured building loads. An economic comparison of GEHPs and conventional electrical heat pumps was done based on the measured and simulated results. The average performance of the GEHP units was estimated to lie between those of EER-9.2 and EER-11.8 systems. The performance of GEHP systems suffers due to lower efficiency at part load operation. The study highlighted the need for optimum system sizing for GEHP/HVAC systems to meet the building load to obtain better performance in buildings. The second part of this study focusses on using chilled water or ice as thermal energy storage for shifting the air conditioning load from peak to off-peak in a commercial building. Thermal energy storage can play a very important role in providing demand-side management for diversifying the utility demand from buildings. Model of a large commercial office building is developed with thermal storage for cooling for peak power shifting. Three variations of the model were developed and analyzed for their performance with 1) ice storage, 2) chilled water storage with mixed storage tank and 3) chilled water storage with stratified tank, using EnergyPlus 8.5 software developed by the US Department of Energy. Operation strategy with tactical control to incorporate peak power schedule was developed using energy management system (EMS). The modeled HVAC system was optimized for minimum cost with the optimal storage capacity and chiller size using JEPlus. Based on the simulation, an optimal storage capacity of 40-45 GJ was estimated for the large office building model along with 40% smaller chiller capacity resulting in higher chiller part-load performance. Additionally, the auxiliary system like pump and condenser were also optimized to smaller capacities and thus resulting in less power demand during operation. The overall annual saving potential was found in the range of 7-10% for cooling electricity use resulting in 10-17% reduction in costs to the consumer. A possible annual peak shifting of 25-78% was found from the simulation results after comparing with the reference models. Adopting TES in commercial buildings and achieving 25% peak shifting could result in a reduction in peak summer demand of 1398 MW in Tampa.

Sustained efficacy of insulin pump therapy compared with multiple daily injections in type 2 diabetes: 12-month data from the OpT2mise randomized trial.

PubMed

Aronson, R; Reznik, Y; Conget, I; Castañeda, J A; Runzis, S; Lee, S W; Cohen, O

2016-05-01

To compare insulin pump therapy and multiple daily injections (MDI) in patients with type 2 diabetes receiving basal and prandial insulin analogues. After a 2-month dose-optimization period, 331 patients with glycated haemoglobin (HbA1c) levels ≥8.0% and ≤12% were randomized to pump therapy or continued MDI for 6 months [randomization phase (RP)]. The MDI group was subsequently switched to pump therapy during a 6-month continuation phase (CP). The primary endpoint was the between-group difference in change in mean HbA1c from baseline to the end of the RP. The mean HbA1c at baseline was 9% in both groups. At the end of the RP, the reduction in HbA1c was significantly greater with pump therapy than with MDI (-1.1 ± 1.2% vs -0.4 ± 1.1%; p < 0.001). The pump therapy group maintained this improvement to 12 months while the MDI group, which was switched to pump therapy, showed a 0.8% reduction: the final HbA1c level was identical in both arms. In the RP, total daily insulin dose (TDD) was 20.4% lower with pump therapy than with MDI and remained stable in the CP. The MDI-pump group showed a 19% decline in TDD, such that by 12 months TDD was equivalent in both groups. There were no differences in weight gain or ketoacidosis between groups. In the CP, one patient in each group experienced severe hypoglycaemia. Pump therapy has a sustained durable effect on glycaemic control in uncontrolled type 2 diabetes. © 2016 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

Sustained efficacy of insulin pump therapy compared with multiple daily injections in type 2 diabetes: 12‐month data from the OpT2mise randomized trial

PubMed Central

Reznik, Y.; Conget, I.; Castañeda, J. A.; Runzis, S.; Lee, S. W.; Cohen, O.

2016-01-01

Aims To compare insulin pump therapy and multiple daily injections (MDI) in patients with type 2 diabetes receiving basal and prandial insulin analogues. Methods After a 2‐month dose‐optimization period, 331 patients with glycated haemoglobin (HbA1c) levels ≥8.0% and ≤12% were randomized to pump therapy or continued MDI for 6 months [randomization phase (RP)]. The MDI group was subsequently switched to pump therapy during a 6‐month continuation phase (CP). The primary endpoint was the between‐group difference in change in mean HbA1c from baseline to the end of the RP. Results The mean HbA1c at baseline was 9% in both groups. At the end of the RP, the reduction in HbA1c was significantly greater with pump therapy than with MDI (−1.1 ± 1.2% vs −0.4 ± 1.1%; p < 0.001). The pump therapy group maintained this improvement to 12 months while the MDI group, which was switched to pump therapy, showed a 0.8% reduction: the final HbA1c level was identical in both arms. In the RP, total daily insulin dose (TDD) was 20.4% lower with pump therapy than with MDI and remained stable in the CP. The MDI–pump group showed a 19% decline in TDD, such that by 12 months TDD was equivalent in both groups. There were no differences in weight gain or ketoacidosis between groups. In the CP, one patient in each group experienced severe hypoglycaemia. Conclusions Pump therapy has a sustained durable effect on glycaemic control in uncontrolled type 2 diabetes. PMID:26854123

Sutureless Technique to Fix the Great Saphenous Vein along the Atrioventricular Groove Using Fibrin Glue in Off-Pump Coronary Artery Bypass Grafting.

PubMed

Ohira, Suguru; Doi, Kiyoshi; Yaku, Hitoshi

2016-04-05

We describe a simple method to fix the great saphenous vein graft (SVG) to the right coronary artery along the atrioventricular groove using fibrin glue in off-pump coronary artery bypass grafting (OPCAB). After completion of the proximal anastomosis, the SVG was placed along the atrioventricular groove to the acute margin. Fibrin glue was sprayed using pressurized carbon dioxide gas. A distal anastomosis was subsequently performed after rotating the heart to expose the posterior descending artery. It is a straightforward and reproducible technique to determine the optimal length of the SVG and prevent kinking or stretching of the graft, especially in OPCAB.

FMR-driven spin pumping in Y3Fe5O12-based structures

NASA Astrophysics Data System (ADS)

Yang, Fengyuan; Hammel, P. Chris

2018-06-01

Ferromagnetic resonance driven spin pumping, a topic of steadily increasing interest since its emergence over two decades ago, remains one of the most exciting research fields in condensed matter physics. Among the many materials that have been explored for spin pumping, yttrium iron garnet (YIG) is one of the most extensively studied because of its exceptionally low magnetic damping and insulating nature. There is a great amount of literature in the spin pumping and related research fields, too broad for this review to cover. In this Topical Review, we focus on the YIG-based spin pumping results carried out by our groups, including: the mechanism and technical details of our off-axis sputtering technique for the growth of single-crystalline YIG epitaxial films with a high degree ordering, experimental evidence for the high quality of the YIG films, spin pumping results from YIG into various transition metals and their heterostructures, dynamic spin transport in YIG/antiferromagnet hybrid structures, intralayer spin pumping by localized spin wave modes confined by a micromagnetic probe, dynamic spin coupling between YIG and nitrogen-vacancy centers in diamond, parametric spin pumping from high-wavevector spin waves in YIG, and localized spin wave mode behavior in broadly tunable spatially complex magnetic configurations. These results build on the power and versatility of YIG spin pumping to improve our understanding of spin dynamics, spin currents, spin Hall physics, spin–orbit coupling, dynamic magnetic coupling, and the relationship between these phenomena in a broad range of materials, geometries, and settings.

Off-pump coronary bypass surgery adversely affects alveolar gas exchange.

PubMed

Gasparović, Hrvoje; Unić, Daniel; Sutlić, Zeljko; Husedzinović, Ino; Biocina, Bojan; Rudez, Igor; Nikić, Nada; Jelić, Ivan

2008-03-01

While the introduction of off-pump myocardial revascularization (OPCAB) has initially shown promise in reducing respiratory complications inherent to conventional coronary surgery, it has failed to eradicate them. Our study focused on quantifying the lactate release from the lungs and the dysfunction at the level of the alveolar-capillary membrane precipitated by OPCAB at different time points after the insult. Furthermore, we aimed to determine the impact of pulmonary lactate production on systemic lactic acid concentrations. The study was conducted in a prospective observational fashion. Forty consecutive patients undergoing OPCAB were analyzed. The mean patient age was 60 +/- 10 years. The mean EUROScore was 3.8 +/- 2.9. The alveolar-arterial O2 gradient increased from 19 [range 9 to 30] to 26 [range 20 to 34] kPa (P < 0.001) and remained elevated up to 6 hours after surgery. It rapidly declined again by 18 hours postoperatively. The observed increase in the pulmonary lactate release (PLR) from a baseline value of 0.022 [range -0.074 to 0.066] to 0.089 [range 0.016 to 0.209] mmol/min/m2 at six hours postoperatively did not reach statistical significance (P = 0.105). The systemic arterial lactate (Ls) concentration increased from 0.94 [range 0.78 to 1.06] to 1.39 [range 0.97 to 2.81] mmol/L (P < 0.001). The venoarterial pCO2 difference showed no significant change in comparison to baseline values. The mortality in the studied group was 2.5% (1/40). The pulmonary lactate production showed a statistically significant correlation with the systemic lactate concentration (R = 0.46; P = 0.003). Pulmonary injury following off pump myocardial revascularization was evidenced by a prompt increase in the alveolar-arterial oxygen gradient. The alveolar-arterial O2 gradient correlated with the duration of mechanical ventilation.

Effect of Impeller Geometry on Lift-Off Characteristics and Rotational Attitude in a Monopivot Centrifugal Blood Pump.

PubMed

Nishida, Masahiro; Nakayama, Kento; Sakota, Daisuke; Kosaka, Ryo; Maruyama, Osamu; Kawaguchi, Yasuo; Kuwana, Katsuyuki; Yamane, Takashi

2016-06-01

The effect of the flow path geometry of the impeller on the lift-off and tilt of the rotational axis of the impeller against the hydrodynamic force was investigated in a centrifugal blood pump with an impeller supported by a single-contact pivot bearing. Four types of impeller were compared: the FR model with the flow path having both front and rear cutouts on the tip, the F model with the flow path having only a front cutout, the R model with only a rear cutout, and the N model with a straight flow path. First, the axial thrust and the movement about the pivot point, which was loaded on the surface of the impeller, were calculated using computational fluid dynamics (CFD) analysis. Next, the lift-off point and the tilt of the rotational axis of the impeller were measured experimentally. The CFD analysis showed that the axial thrust increased gently in the FR and R models as the flow rate increased, whereas it increased drastically in the F and N models. This difference in axial thrust was likely from the higher pressure caused by the smaller circumferential velocity in the gap between the top surface of the impeller and the casing in the FR and R models than in the F and N models, which was caused by the rear cutout. These results corresponded with the experimental results showing that the impellers lifted off in the F and N models as the flow rate increased, whereas it did not in the FR and R models. Conversely, the movement about the pivot point increased in the direction opposite the side with the pump outlet as the flow rate increased. However, the tilt of the rotational axis of the impeller, which oriented away from the pump outlet, was less than 0.8° in any model under any conditions, and was considered to negligibly affect the rotational attitude of the impeller. These results confirm that a rear cutout prevents lift-off of the impeller caused by a decrease in the axial thrust. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

ANTISECRETORY TREATMENT FOR PEDIATRIC GASTROESOPHAGEAL REFLUX DISEASE - A SYSTEMATIC REVIEW.

PubMed

Mattos, Ângelo Zambam de; Marchese, Gabriela Meirelles; Fonseca, Bárbara Brum; Kupski, Carlos; Machado, Marta Brenner

2017-12-01

Proton pump inhibitors and histamine H2 receptor antagonists are two of the most commonly prescribed drug classes for pediatric gastroesophageal reflux disease, but their efficacy is controversial. Many patients are treated with these drugs for atypical manifestations attributed to gastroesophageal reflux, even that causal relation is not proven. To evaluate the use of proton pump inhibitors and histamine H2 receptor antagonists in pediatric gastroesophageal reflux disease through a systematic review. A systematic review was performed, using MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials databases. The search was limited to studies published in English, Portuguese or Spanish. There was no limitation regarding date of publication. Studies were considered eligible if they were randomized-controlled trials, evaluating proton pump inhibitors and/or histamine H2 receptor antagonists for the treatment of pediatric gastroesophageal reflux disease. Studies published only as abstracts, studies evaluating only non-clinical outcomes and studies exclusively comparing different doses of the same drug were excluded. Data extraction was performed by independent investigators. The study protocol was registered at PROSPERO platform (CRD42016040156). After analyzing 735 retrieved references, 23 studies (1598 randomized patients) were included in the systematic review. Eight studies demonstrated that both proton pump inhibitors and histamine H2 receptor antagonists were effective against typical manifestations of gastroesophageal reflux disease, and that there was no evidence of benefit in combining the latter to the former or in routinely prescribing long-term maintenance treatments. Three studies evaluated the effect of treatments on children with asthma, and neither proton pump inhibitors nor histamine H2 receptor antagonists proved to be significantly better than placebo. One study compared different combinations of omeprazole, bethanechol and placebo for the treatment of children with cough, and there is no clear definition on the best strategy. Another study demonstrated that omeprazole performed better than ranitidine for the treatment of extraesophageal reflux manifestations. Ten studies failed to demonstrate significant benefits of proton pump inhibitors or histamine H2 receptor antagonists for the treatment of unspecific manifestations attributed to gastroesophageal reflux in infants. Proton pump inhibitors or histamine H2 receptor antagonists may be used to treat children with gastroesophageal reflux disease, but not to treat asthma or unspecific symptoms.

STAR 3 randomized controlled trial to compare sensor-augmented insulin pump therapy with multiple daily injections in the treatment of type 1 diabetes: research design, methods, and baseline characteristics of enrolled subjects.

PubMed

Davis, Stephen N; Horton, Edward S; Battelino, Tadej; Rubin, Richard R; Schulman, Kevin A; Tamborlane, William V

2010-04-01

Sensor-augmented pump therapy (SAPT) integrates real-time continuous glucose monitoring (RT-CGM) with continuous subcutaneous insulin infusion (CSII) and offers an alternative to multiple daily injections (MDI). Previous studies provide evidence that SAPT may improve clinical outcomes among people with type 1 diabetes. Sensor-Augmented Pump Therapy for A1c Reduction (STAR) 3 is a multicenter randomized controlled trial comparing the efficacy of SAPT to that of MDI in subjects with type 1 diabetes. Subjects were randomized to either continue with MDI or transition to SAPT for 1 year. Subjects in the MDI cohort were allowed to transition to SAPT for 6 months after completion of the study. SAPT subjects who completed the study were also allowed to continue for 6 months. The primary end point was the difference between treatment groups in change in hemoglobin A1c (HbA1c) percentage from baseline to 1 year of treatment. Secondary end points included percentage of subjects with HbA1c < or =7% and without severe hypoglycemia, as well as area under the curve of time spent in normal glycemic ranges. Tertiary end points include percentage of subjects with HbA1c < or =7%, key safety end points, user satisfaction, and responses on standardized assessments. A total of 495 subjects were enrolled, and the baseline characteristics similar between the SAPT and MDI groups. Study completion is anticipated in June 2010. Results of this randomized controlled trial should help establish whether an integrated RT-CGM and CSII system benefits patients with type 1 diabetes more than MDI.

Spill-Detector-and-Shutoff Device

NASA Technical Reports Server (NTRS)

Jarvis, M. R.; Fulton, D. S.

1985-01-01

Overflow in liquid chromatography systems rapidly detected and stopped. Spill-detector-and-shutoff device incorporated into liquid-chromatography system. When liquid from output nozzle spills on liquid sensor, device automatically shuts off pump and releases solenoid to pinch off flow in tube. Device uses common type of alarm circuit reset manually before normal operation resumes.

Steady-state, cavityless, multimode superradiance in a cold vapor

NASA Astrophysics Data System (ADS)

Greenberg, Joel A.; Gauthier, Daniel J.

2012-07-01

We demonstrate steady-state, mirrorless superradiance in a cold vapor pumped by weak optical fields. Beyond a critical pump intensity of 1 mW/cm2, the vapor spontaneously transforms into a spatially self-organized state: a density grating forms. Scattering of the pump beams off this grating generates a pair of new, intense optical fields that act back on the vapor to enhance the atomic organization. We map out experimentally the superradiant phase transition boundary and show that it is well described by our theoretical model. The resulting superradiant emission is nearly coherent, persists for several seconds, displays strong temporal correlations between the various modes, and has a coherence time of several hundred μs. This system therefore has applications in fundamental studies of many-body physics with long-range interactions as well as all-optical and quantum information processing.

Theoretical and experimental study of a laser-diode-pumped actively Q-switched Yb:NaY(WO4)2 laser with acoustic-optic modulator

NASA Astrophysics Data System (ADS)

Zhang, Haikun; Xia, Wei; Song, Peng; Wang, Jing; Li, Xin

2018-03-01

A laser-diode-pumped actively Q-switched Yb:NaY(WO4)2 laser operating at around 1040 nm is presented for the first time with acoustic-optic modulator. The dependence of pulse width on incident pump power for different pulse repetition rates is measured. By considering the Guassian spatial distribution of the intracavity photon density and the initial population-inversion density as well as the longitudinal distribution of the photon density along the cavity axis and the turn off time of the acoustic-optic Q-switch, the coupled equations of the actively Q-switched Yb:NaY(WO4)2 laser are given. The coupled rate equations are used to simulate the Q-switched process of laser, and the numerical solutions agree with the experimental results.

Pulsed and cw laser oscillations in LiF:F-2 color center crystal under laser diode pumping.

PubMed

Basiev, Tasoltan T; Vassiliev, Sergey V; Konjushkin, Vasily A; Gapontsev, Valentin P

2006-07-15

Continuous-wave laser oscillations in LiF:F-2 crystal optically pumped by a laser diode at 970 nm were demonstrated for what is believed to be the first time. The slope efficiency of 14% and conversion efficiency of 5.5% were achieved for 80 micros pump pulse duration and 5 Hz pulse repetition rate. An efficiency twice as low was measured at a 6.25 kHz pulse repetition rate (50% off-duty factor) and in cw mode of laser operation.

Off-Pump Versus On-Pump Coronary Artery Bypass Grafting-A Systematic Review and Analysis of Clinical Outcomes.

PubMed

Shaefi, Shahzad; Mittel, Aaron; Loberman, Dan; Ramakrishna, Harish

2018-04-04

Surgical coronary artery bypass grafting (CABG) is the standard of care for revascularization of left main or three-vessel coronary artery disease. The off-pump coronary artery bypass graft (OPCAB) procedure avoids the use of cardiopulmonary bypass. Theoretically, OPCAB may improve long-term outcomes by reducing the rates of perioperative myocardial injury, stroke, neurocognitive impairment, and cardiac-related mortality. Several high-quality clinical trials have been conducted since OPCAB became popular in the 1990s and have demonstrated no benefit of OPCAB over traditional CABG with respect to these outcomes despite favorable short-term reductions in transfusion requirements and other postoperative complications. Ultimately, OPCAB is associated with less effective myocardial revascularization and does not entirely prevent complications traditionally associated with cardiopulmonary bypass. This article reviews major high-quality trials of OPCAB versus traditional CABG with respect to both short- and long-term clinical outcomes. Copyright © 2018 Elsevier Inc. All rights reserved.

Centaur liquid oxygen boost pump vibration test

NASA Technical Reports Server (NTRS)

Tang, H. M.

1975-01-01

The Centaur LOX boost pump was subjected to both the simulated Titan Centaur proof flight and confidence demonstration vibration test levels. For each test level, both sinusoidal and random vibration tests were conducted along each of the three orthogonal axes of the pump and turbine assembly. In addition to these tests, low frequency longitudinal vibration tests for both levels were conducted. All tests were successfully completed without damage to the boost pump.

Influence of body size on outcomes of off-pump coronary artery bypass surgery.

PubMed

Yap, Alexander; Baladi, Naoum; Zapolanski, Alex; Pliam, Michael B; Shaw, Richard E

2005-01-01

Patients of small physical stature may be more likely selected for an on-pump coronary artery surgery (ONCAB) rather than an off-pump procedure (OPCAB). Small patients who do have OPCAB may do poorly. Our hospital demographics afford a unique opportunity to examine a group of small patients. Information was available over the past 4 years on 1015 patients who had isolated CABG and a calculable body surface area. Sixty-one patients had a body surface area of less than 1.5 m2 (SMALL). The 954 remaining patients were classed as larger (LARGER). Patients were compared with respect to preoperative risk factors, operative procedures, and postoperative results. Among SMALL patients, 59% were Asian, 89% female, averaged slightly older, had higher STS risk scores, lower hematocrits, more severe NYHA class ratings, and less elective surgical status (P < .05) than LARGER patients. Fifty-one percent of SMALL patients had OPCAB, 44.3% received blood, 90% had an event-free course, and 4.9% died postop (versus 1.2%, P < .05). OPCAB mortality was lower than ONCAB for both SMALL and nonsmall (P < .05). Blood use was greater for SMALL than for LARGER (44% versus 20%, P < .05) but less for SMALL OPCAB than SMALL ONCAB (27% versus 62%, P < .05). No differences were noted in postop MI, CVA, or length of stay, but 30-day readmission was lower for SMALL patients (5.0% versus 7.4%). Patients with small physical stature can be safely operated upon using off-pump techniques with good revascularization and postop results, despite apparently higher preop STS risk scores.

Numerical simulation of hydrodynamics in a pump-turbine at off-design operating conditions in turbine mode

NASA Astrophysics Data System (ADS)

Yan, J. P.; Seidel, U.; Koutnik, J.

2012-11-01

The hydrodynamics of a reduced-scaled model of a radial pump-turbine is investigated under off-design operating conditions, involving runaway and "S-shape" turbine brake curve at low positive discharge. It is a low specific speed pump-turbine machine of Francis type with 9 impeller blades and 20 stay vanes as well as 20 guide vanes. The computational domain includes the entire water passage from the spiral casing inlet to the draft tube outlet. Completely structured hexahedral meshes generated by the commercial software ANSYS-ICEM are employed. The unsteady incompressible simulations are performed using the commercial code ANSYS-CFX13. For turbulence modeling the standard k-ε model is applied. The numerical results at different operating points are compared to the experimental results. The predicted pressure amplitude is in good agreement with the experimental data and the amplitude of normal force on impeller is in reasonable range. The detailed analysis reveals the onset of the flow instabilities when the machine is brought from a regular operating condition to runaway and turbine break mode. Furthermore, the rotating stall phenomena are well captured at runaway condition as well as low discharge operating condition with one stall cell rotating inside and around the impeller with about 70% of its frequency. Moreover, the rotating stall is found to be the effect of rotating flow separations developed in several consecutive impeller channels which lead to their blockage. The reliable simulation of S-curve characteristics in pump-turbines is a basic requirement for design and optimization at off-design operating conditions.

Proton Pump Inhibitors Decrease Phlebotomy Need in HFE Hemochromatosis: Double-Blind Randomized Placebo-Controlled Trial.

PubMed

Vanclooster, Annick; van Deursen, Cees; Jaspers, Reggy; Cassiman, David; Koek, Ger

2017-09-01

Phlebotomy constitutes the established treatment for HFE-related hemochromatosis. Retrospective studies have suggested proton pump inhibitors (PPIs) reduce the need for phlebotomy in this population. We conducted a randomized controlled trial to prove this. Thirty p.C282Y homozygous patients were randomly allocated to PPI (pantoprazole 40 mg/day) or placebo for 12 months. Phlebotomies were performed when serum ferritin was > 100 μg/L. Phlebotomy need turned out to be significantly lower in patients taking PPI (P = .0052). PPI treatment significantly reduces the need for phlebotomies in p.C282Y homozygous patients. In view of the known long-term safety profile of PPI, they can be a valuable addition to standard therapy. Clinicaltrials.gov: NCT01524757. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Physiological uncoupling of mitochondrial oxidative phosphorylation. Studies in different yeast species.

PubMed

Guerrero-Castillo, Sergio; Araiza-Olivera, Daniela; Cabrera-Orefice, Alfredo; Espinasa-Jaramillo, Juan; Gutiérrez-Aguilar, Manuel; Luévano-Martínez, Luís A; Zepeda-Bastida, Armando; Uribe-Carvajal, Salvador

2011-06-01

Under non-phosphorylating conditions a high proton transmembrane gradient inhibits the rate of oxygen consumption mediated by the mitochondrial respiratory chain (state IV). Slow electron transit leads to production of reactive oxygen species (ROS) capable of participating in deleterious side reactions. In order to avoid overproducing ROS, mitochondria maintain a high rate of O(2) consumption by activating different exquisitely controlled uncoupling pathways. Different yeast species possess one or more uncoupling systems that work through one of two possible mechanisms: i) Proton sinks and ii) Non-pumping redox enzymes. Proton sinks are exemplified by mitochondrial unspecific channels (MUC) and by uncoupling proteins (UCP). Saccharomyces. cerevisiae and Debaryomyces hansenii express highly regulated MUCs. Also, a UCP was described in Yarrowia lipolytica which promotes uncoupled O(2) consumption. Non-pumping alternative oxido-reductases may substitute for a pump, as in S. cerevisiae or may coexist with a complete set of pumps as in the branched respiratory chains from Y. lipolytica or D. hansenii. In addition, pumps may suffer intrinsic uncoupling (slipping). Promising models for study are unicellular parasites which can turn off their aerobic metabolism completely. The variety of energy dissipating systems in eukaryote species is probably designed to control ROS production in the different environments where each species lives.

Engineering microbial biofuel tolerance and export using efflux pumps

PubMed Central

Dunlop, Mary J; Dossani, Zain Y; Szmidt, Heather L; Chu, Hou Cheng; Lee, Taek Soon; Keasling, Jay D; Hadi, Masood Z; Mukhopadhyay, Aindrila

2011-01-01

Many compounds being considered as candidates for advanced biofuels are toxic to microorganisms. This introduces an undesirable trade-off when engineering metabolic pathways for biofuel production because the engineered microbes must balance production against survival. Cellular export systems, such as efflux pumps, provide a direct mechanism for reducing biofuel toxicity. To identify novel biofuel pumps, we used bioinformatics to generate a list of all efflux pumps from sequenced bacterial genomes and prioritized a subset of targets for cloning. The resulting library of 43 pumps was heterologously expressed in Escherichia coli, where we tested it against seven representative biofuels. By using a competitive growth assay, we efficiently distinguished pumps that improved survival. For two of the fuels (n-butanol and isopentanol), none of the pumps improved tolerance. For all other fuels, we identified pumps that restored growth in the presence of biofuel. We then tested a beneficial pump directly in a production strain and demonstrated that it improved biofuel yields. Our findings introduce new tools for engineering production strains and utilize the increasingly large database of sequenced genomes. PMID:21556065

Mechanical ventilation and thoracic artificial lung assistance during mechanical circulatory support with PUCA pump: in silico study.

PubMed

De Lazzari, Claudio; Genuini, Igino; Quatember, Bernhard; Fedele, Francesco

2014-02-01

Patients assisted with left ventricular assist device (LVAD) may require prolonged mechanical ventilatory assistance secondary to postoperative respiratory failure. The goal of this work is the study of the interdependent effects LVAD like pulsatile catheter (PUCA) pump and mechanical ventilatory support or thoracic artificial lung (TAL), by the hemodynamic point of view, using a numerical simulator of the human cardiovascular system. In the simulator, different circulatory sections are described using lumped parameter models. Lumped parameter models have been designed to describe the hydrodynamic behavior of both PUCA pump and thoracic artificial lung. Ventricular behavior atrial and septum functions were reproduced using variable elastance model. Starting from simulated pathological conditions we studied the effects produced on some hemodynamic variables by simultaneous PUCA pump, thoracic artificial lung or mechanical ventilation assistance. Thoracic artificial lung was applied in parallel or in hybrid mode. The effects of mechanical ventilation have been simulated by changing mean intrathoracic pressure value from -4 mmHg to +5 mmHg. The hemodynamic variables observed during the simulations, in different assisted conditions, were: left and right ventricular end systolic (diastolic) volume, systolic/diastolic aortic pressure, mean pulmonary arterial pressure, left and right mean atrial pressure, mean systemic venous pressure and the total blood flow. Results show that the application of PUCA (without mechanical ventilatory assistance) increases the total blood flow, reduces the left ventricular end systolic volume and increases the diastolic aortic pressure. Parallel TAL assistance increases the right ventricular end diastolic (systolic) volume reduction both when PUCA is switched "ON" and both when PUCA is switched "OFF". By switching "OFF" the PUCA pump, it seems that parallel thoracic artificial lung assistance produces a greater cardiac output (respect to hybrid TAL assistance). Results concerning PUCA and TAL interaction produced by simulations cannot be compared with "in vivo" results since they are not presented in literature. But results concerning the effects produced by LVAD and mechanical ventilation have a trend consistent with those presented in literature. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Effect of increasing pump speed during exercise on peak oxygen uptake in heart failure patients supported with a continuous-flow left ventricular assist device. A double-blind randomized study.

PubMed

Jung, Mette Holme; Hansen, Peter Bo; Sander, Kaare; Olsen, Peter Skov; Rossing, Kasper; Boesgaard, Soeren; Russell, Stuart D; Gustafsson, Finn

2014-04-01

Continuous-flow left ventricular assist device (CF-LVAD) implantation is associated with improved quality of life, but the effect on exercise capacity is less well documented. It is uncertain whether a fixed CF-LVAD pump speed, which allows for sufficient circulatory support at rest, remains adequate during exercise. The aim of this study was to evaluate the effects of fixed versus incremental pump speed on peak oxygen uptake (peak VO2) during a maximal exercise test. In CF-LVAD (HeartMate II) patients exercise testing measuring peak oxygen uptake (VO2) was performed on an ergometer bike twice in one day: once with fixed pump speed (testfix) and once with incremental pump speed (testinc). The order of testfix and testinc in each patient was determined by randomization. During testinc pump speed was increased from the baseline value by 400 rpm/2 min. Fourteen patients (aged 23–69 years) were included with a mean support duration of 465±483 days. Baseline CF-LVAD speed was 9357±238 rpm and during testinc speed was increased by a mean of 1486±775 rpm. Mean peak VO2 was significantly higher in testinc compared with testfix (15.4±5.9 mL/kg/min vs. 14.1±6.3 mL/kg/min; P=0.012), corresponding to a 9.2% increase. All exercise tests (n=28) were adequately performed with RER>1. Increasing pump speed during exercise augments peak VO2 in patients supported with CF-LVADs. An automatic speed-change function in future generations of CF-LVADs might improve functional capacity. © 2014 The Authors. European Journal of Heart Failure © 2014 European Society of Cardiology.

Disposable magnetically levitated centrifugal blood pump: design and in vitro performance.

PubMed

Hoshi, Hideo; Asama, Junichi; Shinshi, Tadahiko; Ohuchi, Katsuhiro; Nakamura, Makoto; Mizuno, Tomohiro; Arai, Hirokuni; Shimokohbe, Akira; Takatani, Setsuo

2005-07-01

A magnetically levitated (MagLev) centrifugal blood pump (CBP) with a disposable pump head has been designed to realize a safe, easy-to-handle, reliable, and low-cost extracorporeal blood pump system. It consisted of a radial magnetic-coupled driver with a magnetic bearing having a two-degree freedom control and a disposable pump head unit with a priming volume of 24 mL. The easy on-off disposable pump head unit was made into a three-piece system consisting of the top and bottom housings, and the impeller-rotor assembly. The size and weight of the disposable pump unit were 75 mm x 45 mm and 100 g, respectively. Because the structure of the pump head unit is easily attachable and removable, the gap between the electromagnets of the stator and the target material in the rotor increased to 1.8 mm in comparison to the original integrated bearing system of 1.0 mm. The pump performance, power requirements, and controllability of the magnetic bearing revealed that from 1400 to 2400 rpm, the pump performance remained fairly unchanged. The amplitudes of the X- and Y-axis rotor oscillation increased to +/- 24 microm. The axial displacement of the rotor, 0.4 mm, toward the top housing was also observed at the pump rpm between 1400 and 2400. The axial and rotational stiffness of the bearing were 15.9 N/mm and 4.4 Nm/rad, respectively. The MagLev power was within 0.7 Watts. This study demonstrated the feasibility of a disposable, magnetically suspended CBP as the safe, reliable, easy-to-handle, low-cost extracorporeal circulation support device.

Assessment of techniques of massage and pumping in the treatment of breast engorgement by thermography

PubMed Central

Heberle, Anita Batista dos Santos; de Moura, Marcos Antônio Muniz; de Souza, Mauren Abreu; Nohama, Percy

2014-01-01

Objective to evaluate techniques of massage and pumping in the treatment of postpartum breast engorgement through thermography. Method the study was conducted in the Human Milk Bank of a hospital in Curitiba, Brazil. We randomly selected 16 lactating women with engorgement with the classification lobar, ampullary and glandular, moderate and intense. We compared the differential patterns of temperature, before and after the treatment by means of massage and pumping. Results we found a negative gradient of 0.3°C of temperature between the pre- and post-treatment in the experimental group. Breasts with intense engorgement were 0.7°C warmer when compared with moderate engorgement. Conclusion massage and electromechanical pumping were superior to manual methods when evaluated by thermography. REBEC: U1111-1136-9027. PMID:26107836

Lubricating Oil Burn-Off in Coast Guard Power Plants

DTIC Science & Technology

1975-02-01

of the in-line fuel filters and wear of the fuel pumps . The overwhelming majority of tests performed by others in L• lube oil burn-off programs...February 1975 IAJBRICATING OIL BURN-OFF IN 6. perfarming Organization Code COAST GUARD POWER PLANTS ___________A. Performing Organization Report No. 7...Authorls) J.R. Hobbs and R. A. WalterDOTC-JC76 9. Performing Organization Name and Address 10. Work Unit No. (TRAIS) U.S. Department of Transportation

Correlation between proton pump inhibitors and risk of pyogenic liver abscess.

PubMed

Lin, Hsien-Feng; Liao, Kuan-Fu; Chang, Ching-Mei; Lin, Cheng-Li; Lai, Shih-Wei

2017-08-01

Little is known about the relationship between proton pump inhibitors use and pyogenic liver abscess. The objective of this study was to evaluate the correlation between proton pump inhibitors use and pyogenic liver abscess in Taiwan. This was a population-based case-control study using the database of the Taiwan National Health Insurance Program since 2000 to 2011. Subjects aged 20 to 84 who experienced their first episode of pyogenic liver abscess were enrolled as the case group (n = 1372). Randomly selected subjects aged 20 to 84 without pyogenic liver abscess were enrolled as the control group (n = 1372). Current use, early use, and late use of proton pump inhibitors was defined as subjects whose last one tablet for proton pump inhibitors was noted ≤30 days, between 31 to 90 days and ≥91 days before the date of admission for pyogenic liver abscess. Subjects who never received a prescription for proton pump inhibitors were defined as nonusers of proton pump inhibitors. A multivariable unconditional logistic regression model was used to measure the odds ratio and 95% confidence interval to evaluate the correlation between proton pump inhibitors use and pyogenic liver abscess. After adjusting for confounders, the adjusted odds ratio of pyogenic liver abscess was 7.59 for subjects with current use of proton pump inhibitors (95% confidence interval 5.05, 11.4), when compared with nonusers. Current use of proton pump inhibitors is associated with a greater risk of pyogenic liver abscess.

Representing pump-capacity relations in groundwater simulation models

USGS Publications Warehouse

Konikow, Leonard F.

2010-01-01

The yield (or discharge) of constant-speed pumps varies with the total dynamic head (or lift) against which the pump is discharging. The variation in yield over the operating range of the pump may be substantial. In groundwater simulations that are used for management evaluations or other purposes, where predictive accuracy depends on the reliability of future discharge estimates, model reliability may be enhanced by including the effects of head-capacity (or pump-capacity) relations on the discharge from the well. A relatively simple algorithm has been incorporated into the widely used MODFLOW groundwater flow model that allows a model user to specify head-capacity curves. The algorithm causes the model to automatically adjust the pumping rate each time step to account for the effect of drawdown in the cell and changing lift, and will shut the pump off if lift exceeds a critical value. The algorithm is available as part of a new multinode well package (MNW2) for MODFLOW.

Representing pump-capacity relations in groundwater simulati on models

USGS Publications Warehouse

Konikow, Leonard F.

2010-01-01

The yield (or discharge) of constant-speed pumps varies with the total dynamic head (or lift) against which the pump is discharging. The variation in yield over the operating range of the pump may be substantial. In groundwater simulations that are used for management evaluations or other purposes, where predictive accuracy depends on the reliability of future discharge estimates, model reliability may be enhanced by including the effects of head-capacity (or pump-capacity) relations on the discharge from the well. A relatively simple algorithm has been incorporated into the widely used MODFLOW groundwater flow model that allows a model user to specify head-capacity curves. The algorithm causes the model to automatically adjust the pumping rate each time step to account for the effect of drawdown in the cell and changing lift, and will shut the pump off if lift exceeds a critical value. The algorithm is available as part of a new multinode well package (MNW2) for MODFLOW. ?? 2009 National Ground Water Association.

Theoretical and experimental analysis of a multiphase screw pump, handling gas-liquid mixtures with very high gas volume fractions

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

Raebiger, K.; Faculty of Advanced Technology, University of Glamorgan, Pontypridd, Wales; Maksoud, T.M.A.

In the investigation of the pumping behaviour of multiphase screw pumps, handling gas-liquid mixtures with very high gas volume fractions, theoretical and experimental analyses were performed. A new theoretical screw pump model was developed, which calculates the time-dependent conditions inside the several chambers of a screw pump as well as the exchange of mass and energy between these chambers. By means of the performed experimental analysis, the screw pump model was verified, especially at very high gas volume fractions from 90% to 99%. The experiments, which were conducted with the reference fluids water and air, can be divided mainly intomore » the determination of the steady state pumping behaviour on the one hand and into the analysis of selected transient operating conditions on the other hand, whereas the visualisation of the leakage flows through the circumferential gaps was rounded off the experimental analysis. (author)« less

Dual-channel current valve in a three terminal zigzag graphene nanoribbon junction

NASA Astrophysics Data System (ADS)

Zhang, L.

2017-02-01

We theoretically propose a dual-channel current valve based on a three terminal zigzag graphene nanoribbon (ZGNR) junction driven by three asymmetric time-dependent pumping potentials. By means of the Keldysh Green’s function method, we show that two asymmetric charge currents can be pumped in the different left-right terminals of the device at a zero bias, which mainly stems from the single photon-assisted pumping approximation and the valley valve effect in a ZGNR p-n junction. The ON and OFF states of pumped charge currents are crucially dependent on the even-odd chain widths of the three electrodes, the pumping frequency, the lattice potential and the Fermi level. Two-tunneling spin valves are also considered to spatially separate and detect 100% polarized spin currents owing to the combined spin pump effect and the valley selective transport in a three terminal ZGNR ferromagnetic junction. Our investigations might be helpful to control the spatial and spin degrees of freedom of electrons in graphene pumping devices.

Simulation of the ground-water flow system at Naval Submarine Base Bangor and vicinity, Kitsap County, Washington

USGS Publications Warehouse

Heeswijk, Marijke van; Smith, Daniel T.

2002-01-01

An evaluation of the interaction between ground-water flow on Naval Submarine Base Bangor and the regional-flow system shows that for selected alternatives of future ground-water pumping on and near the base, the risk is low that significant concentrations of on-base ground-water contamination will reach off-base public-supply wells and hypothetical wells southwest of the base. The risk is low even if worst-case conditions are considered ? no containment and remediation of on-base contamination. The evaluation also shows that future saltwater encroachment of aquifers below sea level may be possible, but this determination has considerable uncertainty associated with it. The potential effects on the ground-water flow system resulting from four hypothetical ground-water pumping alternatives were considered, including no change in 1995 pumping rates, doubling the rates, and 2020 rates estimated from population projections with two different pumping distributions. All but a continuation of 1995 pumping rates demonstrate the possibility of future saltwater encroachment in the Sea-level aquifer on Naval Submarine Base Bangor. The amount of time it would take for encroachment to occur is unknown. For all pumping alternatives, future saltwater encroachment in the Sea-level aquifer also may be possible along Puget Sound east and southeast of the base. Future saltwater encroachment in the Deep aquifer also may be possible throughout large parts of the study area. Projections of saltwater encroachment are least certain outside the boundaries of Naval Submarine Base Bangor. The potential effects of the ground-water pumping alternatives were evaluated by simulating the ground-water flow system with a three-dimensional uniform-density ground-water flow model. The model was calibrated by trial-and-error by minimizing differences between simulated and measured or estimated variables. These included water levels from prior to January 17, 1977 (termed 'predevelopment'), water-level drawdowns since predevelopment until April 15, 1995, ground-water discharge to streams in water year 1995, and residence times of ground water in different parts of the flow system that were estimated in a separate but related study. Large amounts of ground water were pumped from 1977 through 1980 from the Sea-level aquifer on Naval Submarine Base Bangor to enable the construction of an off-shore drydock. Records of the flow-system responses to the applied stresses were used to help calibrate the model. Errors in the calibrated model were significant. The poor agreement between simulated and measured values could be improved by making many local changes to hydraulic parameters but these changes were not supported by other data. Model errors may have resulted in errors in the simulated effects of ground-water pumping alternatives.

Impact of Spatial Pumping Patterns on Groundwater Management

NASA Astrophysics Data System (ADS)

Yin, J.; Tsai, F. T. C.

2017-12-01

Challenges exist to manage groundwater resources while maintaining a balance between groundwater quantity and quality because of anthropogenic pumping activities as well as complex subsurface environment. In this study, to address the impact of spatial pumping pattern on groundwater management, a mixed integer nonlinear multi-objective model is formulated by integrating three objectives within a management framework to: (i) maximize total groundwater withdrawal from potential wells; (ii) minimize total electricity cost for well pumps; and (iii) attain groundwater level at selected monitoring locations as close as possible to the target level. Binary variables are used in the groundwater management model to control the operative status of pumping wells. The NSGA-II is linked with MODFLOW to solve the multi-objective problem. The proposed method is applied to a groundwater management problem in the complex Baton Rouge aquifer system, southeastern Louisiana. Results show that (a) non-dominated trade-off solutions under various spatial distributions of active pumping wells can be achieved. Each solution is optimal with regard to its corresponding objectives; (b) operative status, locations and pumping rates of pumping wells are significant to influence the distribution of hydraulic head, which in turn influence the optimization results; (c) A wide range of optimal solutions is obtained such that decision makers can select the most appropriate solution through negotiation with different stakeholders. This technique is beneficial to finding out the optimal extent to which three objectives including water supply concern, energy concern and subsidence concern can be balanced.

Ring-Down Spectroscopy for Characterizing a CW Raman Laser

NASA Technical Reports Server (NTRS)

Matsko, Andrey; Savchenkov, Anatoliy; Maleki, Lute

2007-01-01

.A relatively simple technique for characterizing an all-resonant intracavity continuous-wave (CW) solid-state Raman laser involves the use of ring-down spectroscopy. As used here, characterizing signifies determining such parameters as threshold pump power, Raman gain, conversion efficiency, and quality factors (Q values) of the pump and Stokes cavity modes. Heretofore, in order to characterize resonant-cavity-based Raman lasers, it has usually been necessary to manipulate the frequencies and power levels of pump lasers and, in each case, to take several sets of measurements. In cases involving ultra-high-Q resonators, it also has been desirable to lock pump lasers to resonator modes to ensure the quality of measurement data. Simpler techniques could be useful. In the present ring-down spectroscopic technique, one infers the parameters of interest from the decay of the laser out of its steady state. This technique does not require changing the power or frequency of the pump laser or locking the pump laser to the resonator mode. The technique is based on a theoretical analysis of what happens when the pump laser is abruptly switched off after the Raman generation reaches the steady state. The analysis starts with differential equations for the evolution of the amplitudes of the pump and Stokes electric fields, leading to solutions for the power levels of the pump and Stokes fields as functions of time and of the aforementioned parameters. Among other things, these solutions show how the ring-down time depends, to some extent, on the electromagnetic energy accumulated in the cavity. The solutions are readily converted to relatively simple equations for the parameters as functions of quantities that can be determined from measurements of the time-dependent power levels. For example, the steady-state intracavity conversion efficiency is given by G1/G2 1 and the threshold power is given by Pin(G2/G1)2, where Pin is the steady-state input pump power immediately prior to abrupt switch-off, G1 is the initial rate of decay of the pump field, and G2 is the final rate of decay of the pump field. Hence, it is possible to determine all the parameters from a single ring-down scan, provided that the measurements taken in that scan are sufficiently accurate and complete.

Biventricular support with the Jarvik 2000 axial flow pump: a feasibility study.

PubMed

Radovancevic, Branislav; Gregoric, Igor D; Tamez, Daniel; Vrtovec, Bojan; Tuzun, Egemen; Chee, Hyun Keun; Moore, Sheila; Jarvik, Robert K; Frazier, O H

2003-01-01

Patients with congestive heart failure who are supported with a left ventricular assist device (LVAD) may experience right ventricular dysfunction or failure that requires support with a right ventricular assist device (RVAD). To determine the feasibility of using a clinically available axial flow ventricular assist device as an RVAD, we implanted Jarvik 2000 pumps in the left ventricle and right atrium of two Corriente crossbred calves (approximately 100 kg each) by way of a left thoracotomy and then analyzed the hemodynamic effects in the mechanically fibrillated heart at various LVAD and RVAD speeds. Right atrial implantation of the device required no modification of either the device or the surgical technique used for left ventricular implantation. Satisfactory biventricular support was achieved during fibrillation as evidenced by an increase in mean aortic pressure from 34 mm Hg with the pumps off to 78 mm Hg with the pumps generating a flow rate of 4.8 L/min. These results indicate that the Jarvik 2000 pump, which can provide chronic circulatory support and can be powered by external batteries, is a feasible option for right ventricular support after LVAD implantation and is capable of completely supporting the circulation in patients with global heart failure.

Concentration and Velocity Gradients in Fluidized Beds

NASA Technical Reports Server (NTRS)

McClymer, James P.

2003-01-01

In this work we focus on the height dependence of particle concentration, average velocity components, fluctuations in these velocities and, with the flow turned off, the sedimentation velocity. The latter quantities are measured using Particle Imaging Velocimetry (PIV). The PIV technique uses a 1-megapixel camera to capture two time-displaced images of particles in the bed. The depth of field of the imaging system is approximately 0.5 cm. The camera images a region with characteristic length of 2.6 cm for the small particles and 4.7 cm. for the large particles. The local direction of particle flow is determined by calculating the correlation function for sub-regions of 32 x 32 pixels. The velocity vector map is created from this correlation function using the time between images (we use 15 to 30 ms). The software is sensitive variations of 1/64th of a pixel. We produce velocity maps at various heights, each consisting of 3844 velocities. We break this map into three vertical zones for increased height information. The concentration profile is measured using an expanded (1 cm diameter) linearly polarized HeNe Laser incident on the fluidized bed. A COHU camera (gamma=1, AGC off) with a lens and a polarizer images the transmitted linearly polarized light to minimize the effects of multiply scattered light. The intensity profile (640 X 480 pixels) is well described by a Gaussian fit and the height of the Gaussian is used to characterize the concentration. This value is compared to the heights found for known concentrations. The sedimentation velocity is estimated using by imaging a region near the bottom of the bed and using PIV to measure the velocity as a function of time. With a nearly uniform concentration profile, the time can be converted to height information. The stable fluidized beds are made from large pseudo-monodisperse particles (silica spheres with radii (250-300) microns and (425-500) microns) dispersed in a glycerin/water mix. The Peclet number is sufficiently large that Brownian motion of the particles can be ignored and the Reynolds number sufficiently small that particle inertia is negligible. A packed particle bed is used to randomize and disperse the flowing fluid introduced by a peristaltic pump. The bed itself is a rectangular glass cell 8 cm wide (x), 0.8 cm deep and a height of 30.5 cm (z). The depth of field of the camera is approximately 0.5 cm so depth information is averaged. Over flow fluid is returned to the reservoir making a closed loop system. In these experiments the particles form a sediment approximately 5.7 cm high with the pump off and expand to 22 cm with the pump on. For the smaller particles the pump velocity is .5 millimeters per second and 1.1 millimeters per second for the large particles. At this concentration the bed has a very well defined top where particle concentration rapidly drops to zero.

High power tunable mid-infrared optical parametric oscillator enabled by random fiber laser.

PubMed

Wu, Hanshuo; Wang, Peng; Song, Jiaxin; Ye, Jun; Xu, Jiangming; Li, Xiao; Zhou, Pu

2018-03-05

Random fiber laser, as a kind of novel fiber laser that utilizes random distributed feedback as well as Raman gain, has become a research focus owing to its advantages of wavelength flexibility, modeless property and output stability. Herein, a tunable optical parametric oscillator (OPO) enabled by a random fiber laser is reported for the first time. By exploiting a tunable random fiber laser to pump the OPO, the central wavelength of idler light can be continuously tuned from 3977.34 to 4059.65 nm with stable temporal average output power. The maximal output power achieved is 2.07 W. So far as we know, this is the first demonstration of a continuous-wave tunable OPO pumped by a tunable random fiber laser, which could not only provide a new approach for achieving tunable mid-infrared (MIR) emission, but also extend the application scenarios of random fiber lasers.

Phase analysis of coherent radial-breathing-mode phonons in carbon nanotubes: Implications for generation and detection processes

NASA Astrophysics Data System (ADS)

Shimura, Akihiko; Yanagi, Kazuhiro; Yoshizawa, Masayuki

2018-01-01

In time-resolved pump-probe spectroscopy of carbon nanotubes, the fundamental understanding of the optical generation and detection processes of radial-breathing-mode (RBM) phonons has been inconsistent among the previous reports. In this study, the tunable-pumping/broadband-probing scheme was used to fully reveal the amplitude and phase of the phonon-modulated signals. We observed that signals detected off resonantly to excitonic transitions are delayed by π /2 radians with respect to resonantly detected signals, which demonstrates that RBM phonons are detected through dynamically modulating the linear response, not through adiabatically modulating the light absorption. Furthermore, we found that the initial phases are independent of the pump detuning across the first (E11) and the second (E22) excitonic resonances, evidencing that the RBM phonons are generated by the displacive excitation rather than stimulated Raman process.

User oriented end-station on VUV pump-probe magneto-optical ellipsometry at ELI beamlines

NASA Astrophysics Data System (ADS)

Espinoza, Shirly; Neuber, Gerd; Brooks, Christopher D.; Besner, Bastian; Hashemi, Maryam; Rübhausen, Michael; Andreasson, Jakob

2017-11-01

A state of the art ellipsometer for user operations is being implemented at ELI Beamlines in Prague, Czech Republic. It combines three of the most promising and exotic forms of ellipsometry: VUV, pump-probe and magneto-optical ellipsometry. This new ellipsometer covers a spectral operational range from the NIR up to the VUV, with high through-put between 1 and 40 eV. The ellipsometer also allows measurements of magneto-optical spectra with a 1 kHz switchable magnetic field of up to 1.5 T across the sample combining ellipsometry and Kerr spectroscopy measurements in an unprecedented spectral range. This form of generalized ellipsometry enables users to address diagonal and off-diagonal components of the dielectric tensor within one measurement. Pump-probe measurements enable users to study the dynamic behaviour of the dielectric tensor in order to resolve the time-domain phenomena in the femto to 100 ns range.

A Secure and High-Fidelity Live Animal Model for Off-Pump Coronary Bypass Surgery Training.

PubMed

Liu, Xiaopeng; Yang, Yan; Meng, Qiang; Sun, Jiakang; Luo, Fuliang; Cui, Yongchun; Zhang, Hong; Zhang, Dong; Tang, Yue

2016-01-01

Existing simulators for off-pump coronary artery (CA) bypass grafting training are unable to provide cardiac surgery residents all necessary skills they need entering the operation room. In this study, we introduced a secure and high-fidelity live animal model to supplement the in vitro simulators for off-pump CA bypass grafting training. The left internal thoracic artery (ITA) of 3 Chinese miniature pigs was grafted to the left anterior descending CA using an end-to-side anastomosis. The free segment of the ITA was fixed on the ventricle surface, making it a simulative CA beating in synchrony with the heart. A total of 6 to 8 training anastomoses were made on each ITA. Animal Experiment Center in Fuwai Hospital. In total, 19 resident surgeons with at least 3 years of cardiac surgery work experience were trained using the new model. Their performances were recorded and reviewed. Simulative coronary arteries were successfully constructed in all 3 animals with no adverse event observed. A total of 19 anastomoses were then completed, 1 pig of 7 anastomoses and the other 2 animals of 6 anastomoses. Time consumption for the anastomosis was 782 ± 107 seconds. Anastomotic leakage was observed in 10/19 procedures. The most frequency site (7/10) was at the toe of the anastomosis. Further, the most common cause was uneven spacing or small margin of the stitches or both. Emergencies occurred during the training process included hypotension (7 procedures), tachyarrhythmia (4 procedures), and low blood oxygen saturation (1 procedure). This study demonstrated the safety and feasibility of our new live pig model in training resident surgeons. The simulative arteries can be easily accomplished and were long enough to place at least 6 anastomoses. Both on lumen diameter and motion status, they were proven to be a good substitution of the CA. Copyright © 2016. Published by Elsevier Inc.

Transcatheter aortic valve implantation and off-pump coronary artery bypass surgery: an effective hybrid procedure in selected patients.

PubMed

Mayr, Benedikt; Firschke, Christian; Erlebach, Magdalena; Bleiziffer, Sabine; Krane, Markus; Joner, Michael; Herold, Ulf; Nöbauer, Christian; Lange, Rüdiger; Deutsch, Marcus-André

2018-02-26

Simultaneous surgical off-pump coronary revascularization and transcatheter aortic valve implantation (TAVI) as a hybrid procedure may be a therapeutic option for patients with a TAVI indication who are not suitable for percutaneous coronary intervention and for patients who have an indication for combined surgical aortic valve implantation and coronary artery bypass grafting but present with a porcelain aorta. Early outcomes of these patients are analysed in this study. From February 2011 to April 2017, hybrid TAVI/off-pump coronary artery bypass (OPCAB) was performed in 12 (60%) patients, hybrid TAVI/minimally invasive direct coronary artery bypass in 6 (30%) patients and staged TAVI/OPCAB in 2 (10%) patients. Endpoints of this study were 30-day mortality, device success and postoperative adverse events as defined by the updated Valve Academic Research Consortium (VARC-2). The median age at the time of surgery was 77 years [interquartile range (IQR), 70-81] with a median logistic EuroSCORE and Society of Thoracic Surgeons' Predicted Risk score of 16.1% (IQR, 9.3-28.1) and 3.9% (IQR, 2.2-5.6), respectively. The median Synergy between PCI with Taxus and Cardiac Surgery score was 16.5 (IQR, 9.8-22.8). TAVI implantation routes were transaortic in 9 (45%) patients, transapical and transfemoral in 5 (25%) patients each and transsubclavian in 1 (5%) patient. Complete myocardial revascularization was achieved in 75% of patients. Device success rate was 100%. Paravalvular aortic regurgitation did not exceed mild in any patient. Stroke/transient ischaemic attack, vascular complications and myocardial infarction were not observed. Re-exploration for bleeding was required in 1 (5%) patient. Thirty-day mortality was 0%. Hybrid OPCAB/MIDCAB and TAVI prove to be a safe and effective alternative treatment option in selected higher risk patients.

Hydrogen-Fuel Engine Component Tests Near Completion

NASA Technical Reports Server (NTRS)

2003-01-01

Gaseous hydrogen is burned off at the E1 Test Stand the night of Oct. 7 during a cold-flow test of the fuel turbopump of the Integrated Powerhead Demonstrator (IPD) at NASA Stennis Space Center (SSC). The gaseous hydrogen spins the pump's turbine during the test, which was conducted to verify the pump's performance. Engineers plan one more test before sending the pump to The Boeing Co. for inspection. It will then be returned to SSC for engine system assembly. The IPD is the first reusable hydrogen-fueled advanced engine in development since the Space Shuttle Main Engine.

Hydrogen-Fuel Engine Component Tests Near Completion

NASA Image and Video Library

2003-11-05

Gaseous hydrogen is burned off at the E1 Test Stand the night of Oct. 7 during a cold-flow test of the fuel turbopump of the Integrated Powerhead Demonstrator (IPD) at NASA Stennis Space Center (SSC). The gaseous hydrogen spins the pump's turbine during the test, which was conducted to verify the pump's performance. Engineers plan one more test before sending the pump to The Boeing Co. for inspection. It will then be returned to SSC for engine system assembly. The IPD is the first reusable hydrogen-fueled advanced engine in development since the Space Shuttle Main Engine.

Determination of pump flow rate during cardiopulmonary bypass in obese patients avoiding hemodilution.

PubMed

Santambrogio, Luisa; Leva, Cristian; Musazzi, Giorgio; Bruno, Piergiorgio; Vailati, Andrea; Zecchillo, Franco; Di Credico, Germano

2009-01-01

During cardiopulmonary bypass the pump flow is usually set on 2.4 L/min/m(2) of body surface area (BSA) to guarantee adequate tissue perfusion without differences for patient constitutional type. The present study attempts to evaluate the adequacy of pump flow rate in obese patients, considering the ideal weight instead of the real one, avoiding the overflow side effects and hemodilution. Obese patients with body mass index (BMI) > 30 presented for cardiac surgery were randomized in two groups: in one the cardiopulmonary bypass was led traditionally, in the other, pump flow rate was calculated on ideal BMI of 25. Demographics, preoperative tests, and monitoring data were registered. Mortality at hospital discharge and 30 days after were analyzed. The pump flow rate between the groups was different (4.46 vs. 4.87; p = 0.004); there were no differences in organ perfusion (SvO(2); diuresis) and mortality, but the study group presented fewer complications and blood transfusions. The BSA is widely used as the biometric unit to normalize physiologic parameters included pump flow rate, but it is disputable if this practice is correct also in obese patients. The study group, in which pump flow rate was set on ideal BSA, presented no difference in diuresis and mixed venous saturation but fewer complications and fewer perioperative blood transfusions.

Laser Diode Pumped Solid State Lasers

DTIC Science & Technology

1987-01-01

Report N66001-83-C-0071, 17 April 1986, prepared for NOSC. 4.6 W.T. Welford, R. Winston , "The Option of Nonimaging Concentrators ," Academic Press, 1978...by non-imac optics such as reflective or refractive flux concentrators . Simple considerations regarding the optimum pumping configuration, high marks...reduced if the arrays can stand-off from the Nd:YAG laser. As mentioned before, compound parabolic concentrators or refractive optics cat employed to

Heart bypass surgery

MedlinePlus

Off-pump coronary artery bypass; OPCAB; Beating heart surgery; Bypass surgery - heart; CABG; Coronary artery bypass graft; Coronary artery bypass surgery; Coronary bypass surgery; Coronary artery disease - CABG; CAD - CABG; Angina - ...

Optical parametric oscillation in a random poly-crystalline medium: ZnSe ceramic

NASA Astrophysics Data System (ADS)

Ru, Qitian; Kawamori, Taiki; Lee, Nathaniel; Chen, Xuan; Zhong, Kai; Mirov, Mike; Vasilyev, Sergey; Mirov, Sergey B.; Vodopyanov, Konstantin L.

2018-02-01

We demonstrate an optical parametric oscillator (OPO) based on random phase matching in a polycrystalline χ(2) material, ZnSe. The subharmonic OPO utilized a 1.5-mm-long polished ZnSe ceramic sample placed at the Brewster's angle and was synchronously pumped by a Kerr-lens mode-locked Cr:ZnS laser with a central wavelength of 2.35 μm, a pulse duration of 62 fs, and a repetition frequency of 79 MHz. The OPO had a 90-mW pump threshold, and produced an ultrabroadband spectrum spanning 3-7.5 μm. The observed pump depletion was as high as 79%. The key to success in achieving the OPO action was choosing the average grain size of the ZnSe ceramic to be close to the coherence length ( 100 μm) for our 3-wave interaction. This is the first OPO that uses random polycrystalline material with quadratic nonlinearity and the first OPO based on ZnSe. Very likely, random phase matching in ZnSe and similar random polycrystalline materials (ZnS, CdS, CdSe, GaP) represents a viable route for generating few-cycle pulses and multi-octave frequency combs, thanks to a very broadband nonlinear response.

Effect of Compression Devices on Preventing Deep Vein Thrombosis Among Adult Trauma Patients: A Systematic Review.

PubMed

Ibrahim, Mona; Ahmed, Azza; Mohamed, Warda Yousef; El-Sayed Abu Abduo, Somaya

2015-01-01

Trauma is the leading cause of death in Americans up to 44 years old each year. Deep vein thrombosis (DVT) is a significant condition occurring in trauma, and prophylaxis is essential to the appropriate management of trauma patients. The incidence of DVT varies in trauma patients, depending on patients' risk factors, modality of prophylaxis, and methods of detection. However, compression devices and arteriovenous (A-V) foot pumps prophylaxis are recommended in trauma patients, but the efficacy and optimal use of it is not well documented in the literature. The aim of this study was to review the literature on the effect of compression devices in preventing DVT among adult trauma patients. We searched through PubMed, CINAHL, and Cochrane Central Register of Controlled Trials for eligible studies published from 1990 until June 2014. Reviewers identified all randomized controlled trials that satisfied the study criteria, and the quality of included studies was assessed by Cochrane risk of bias tool. Five randomized controlled trials were included with a total of 1072 patients. Sequential compression devices significantly reduced the incidence of DVT in trauma patients. Also, foot pumps were more effective in reducing incidence of DVT compared with sequential compression devices. Sequential compression devices and foot pumps reduced the incidence of DVT in trauma patients. However, the evidence is limited to a small sample size and did not take into account other confounding variables that may affect the incidence of DVT in trauma patients. Future randomized controlled trials with larger probability samples to investigate the optimal use of mechanical prophylaxis in trauma patients are needed.

"Intact" Carrier Doping by Pump-Pump-Probe Spectroscopy in Combination with Interfacial Charge Transfer: A Case Study of CsPbBr3 Nanocrystals.

PubMed

Wang, Junhui; Ding, Tao; Leng, Jing; Jin, Shengye; Wu, Kaifeng

2018-06-21

Carrier doping is important for semiconductor nanocrystals (NCs) as it offers a new knob to tune NCs' functionalities, in addition to size and shape control. Also, extensive studies on NC devices have revealed that under operating conditions NCs are often unintentionally doped with electrons or holes. Thus, it is essential to be able to control the doping of NCs and study the carrier dynamics of doped NCs. The extension of previously reported redox-doping methods to chemically sensitive materials, such as recently introduced perovskite NCs, has remained challenging. We introduce an "intact" carrier-doping method by performing pump-pump-probe transient absorption spectroscopy on NC-acceptor complexes. The first pump pulse is used to trigger charge transfer from the NC to the acceptor, leading to NCs doped with a band edge carrier; the following pump-probe pulses measure the dynamics of carrier-doped NCs. We performed this measurement on CsPbBr 3 NCs and deduced positive and negative trion lifetimes of 220 ± 50 and 150 ± 40 ps, respectively, for 10 nm diameter NCs, both dominated by Auger recombination. It also allowed us to identify randomly photocharged excitons in CsPbBr 3 NCs as positive trions.

Off-stream Pumped Storage Hydropower plant to increase renewable energy penetration in Santiago Island, Cape Verde

NASA Astrophysics Data System (ADS)

Barreira, Inês; Gueifão, Carlos; Ferreira de Jesus, J.

2017-04-01

In order to reduce the high dependence on imported fuels and to meet the ongoing growth of electricity demand, Cape Verde government set the goal to increase renewable energy penetration in Santiago Island until 2020. To help maximize renewable energy penetration, an off-stream Pumped Storage Hydropower (PSH) plant will be installed in Santiago, in one of the following locations: Chã Gonçalves, Mato Sancho and Ribeira dos Picos. This paper summarizes the studies carried out to find the optimal location and connection point of the PSH plant in Santiago’s electricity network. This goal was achieved by assessing the impact of the PSH plant, in each location, on power system stability. The simulation tool PSS/E of Siemens was used to study the steady-state and dynamic behavior of the future (2020) Santiago MV grid. Different scenarios of demand and renewable resources were created. Each hydro unit of the PSH plant was modeled as an adjustable speed reversible turbine employing a DFIM. The results show that Santiago’s grid with the PSH plant in Chã Gonçalves is the one that has the best performance.

Apparatus for the conversion of power strokes of a random sequence and of random lengths of strokes into potential energy

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

Elkuch, E.

1984-01-17

The apparatus comprises at least one positive displacement pump, which is driven by the sea waves. The quantity of delivery of this pump is adjustable in accordance with the lengths of strokes made by the ocean waves. This is made possible in that the positive displacement pump comprises pistons having different volume displacements. The height of the incoming waves is measured by a membrane box connected to a transducer which generates signals such that only that piston of the plurality of pistons is made to operate, which has by design a volume displacement which gives the optimal recovery of themore » energy of the ocean waves. The or these pistons pump a working fluid into a storage vessel, which allows the generation of peak load as well as base load electrical energy.« less

Development of stable, narrow spectral line-width, fiber delivered laser source for spin exchange optical pumping

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

Liu, Bo; Tong, Xin; Jiang, Chenyang

2015-06-05

In this study, we developed a stable, narrow spectral line-width, fiber delivered laser source for spin exchange optical pumping. An optimized external cavity equipped with an off-the-shelf volume holographic grating narrowed the spectral line-width of a 100 W high-power diode laser and stabilized the laser spectrum. The laser spectrum showed a high side mode suppression ratio of >30 dB and good long-term stability (center wavelength drifting within ±0.002 nm during 220 h of operation). Finally, our laser is delivered by a multimode fiber with power ~70 W, center wavelength of 794.77 nm, and spectral bandwidth of ~0.12 nm.

Brightness enhancement limits in pulsed cladding-pumped fiber Raman amplifiers

NASA Astrophysics Data System (ADS)

Ji, Junhua; Codemard, Christophe A.; Nilsson, Johan

2010-02-01

We analyze theoretically limitations on brightness enhancement of a multimode pump beam into a diffraction-limited Stokes beam in efficient cladding-pumped fiber Raman amplifiers. Firstly, the power-scaling of the 1st Stokes (hence the brightness enhancement) is limited by the generation of the 2nd order Stokes. Thus using a spectral waveguide filter such as a W-type fiber core, it is possible to improve this limit to nearly five times that of a normal fiber without spectral filter. Secondly, we analyze limits set by glass damage, propagation loss, and pump-signal pulse walk-off in the multimode fiber. We show that a well-designed fiber with a propagation loss of 3.5 dB/km allows for a pump-to-signal brightness improvement of over 1000 times for pulses longer than 40 ns and up to 3500 times in the cw regime.

Rabeprazole test for the diagnosis of gastro-oesophageal reflux disease: Results of a study in a primary care setting

PubMed Central

des Varannes, Stanislas Bruley; Sacher-Huvelin, Sylvie; Vavasseur, Fabienne; Masliah, Claude; Rhun, Marc Le; Aygalenq, Philippe; Bonnot-Marlier, Sylvie; Lequeux, Yves; Galmiche, Jean Paul

2006-01-01

AIM: To determine the diagnostic value of the rabeprazole test in patients seen by general practitioners. METHODS: Eighty-three patients with symptoms suggestive of GERD were enrolled by general practitioners in this multi-centre, randomized and double-blind study. All patients received either rabeprazole (20 mg bid) or a placebo for one week. The diagnosis of GERD was established on the presence of mucosal breaks at endoscopy and/or an abnormal esophageal 24-h pH test. The test was considered to be positive if patients reported at least a “clear improvement” of symptoms on a 7-point Likert scale. RESULTS: The sensitivities of the test for rabeprazole and the placebo were 83% and 40%, respectively. The corresponding specificity, positive and negative predictive values were 45% and 67%, 71% and 71%, and 62% and 35%, respectively. A receiver operating characteristics (ROC) analysis confirmed that the best discriminatory cut-off corresponded to description of “clear improvement”. CONCLUSION: The poor specificity of the proton-pump inhibitor (PPI) test does not support such an approach to establish a diagnosis of GERD in a primary care setting. PMID:16688803

Recognition and processing of randomly fluctuating electric signals by Na,K-ATPase.

PubMed Central

Xie, T. D.; Marszalek, P.; Chen, Y. D.; Tsong, T. Y.

1994-01-01

Previous work has shown that Na,K-ATPase of human erythrocytes can extract free energy from sinusoidal electric fields to pump cations up their respective concentration gradients. Because regularly oscillating waveform is not a feature of the transmembrane electric potential of cells, questions have been raised whether these observed effects are biologically relevant. Here we show that a random-telegraph fluctuating electric field (RTF) consisting of alternating square electric pulses with random lifetimes can also stimulate the Rb(+)-pumping mode of the Na,K-ATPase. The net RTF-stimulated, ouabain-sensitive Rb+ pumping was monitored with 86Rb+. The tracer-measured, Rb+ influx exhibited frequency and amplitude dependencies that peaked at the mean frequency of 1.0 kHz and amplitude of 20 V/cm. At 4 degrees C, the maximal pumping activity under these optimal conditions was 28 Rb+/RBC-hr, which is approximately 50% higher than that obtained with the sinusoidal electric field. These findings indicate that Na,K-ATPase can recognize an electric signal, either regularly oscillatory or randomly fluctuating, for energy coupling, with high fidelity. The use of RTF for activation also allowed a quantitative theoretical analysis of kinetics of a membrane transport model of any complexity according to the theory of electroconformational coupling (ECC) by the diagram methods. A four-state ECC model was shown to produce the amplitude and the frequency windows of the Rb(+)-pumping if the free energy of interaction of the transporter with the membrane potential was to include a nonlinear quadratic term. Kinetic constants for the ECC model have been derived. These results indicate that the ECC is a plausible mechanism for the recognition and processing of electric signals by proteins of the cell membrane. PMID:7811939

Resonance energy transfer process in nanogap-based dual-color random lasing

NASA Astrophysics Data System (ADS)

Shi, Xiaoyu; Tong, Junhua; Liu, Dahe; Wang, Zhaona

2017-04-01

The resonance energy transfer (RET) process between Rhodamine 6G and oxazine in the nanogap-based random systems is systematically studied by revealing the variations and fluctuations of RET coefficients with pump power density. Three working regions stable fluorescence, dynamic laser, and stable laser are thus demonstrated in the dual-color random systems. The stable RET coefficients in fluorescence and lasing regions are generally different and greatly dependent on the donor concentration and the donor-acceptor ratio. These results may provide a way to reveal the energy distribution regulars in the random system and to design the tunable multi-color coherent random lasers for colorful imaging.

Head-to-head comparison of H2-receptor antagonists and proton pump inhibitors in the treatment of erosive esophagitis: A meta-analysis

PubMed Central

Wang, Wei-Hong; Huang, Jia-Qing; Zheng, Ge-Fan; Xia, Harry Hua-Xiang; Wong, Wai-Man; Lam, Shiu-Kum; Wong, Benjamin Chun-Yu

2005-01-01

AIM: To systematically evaluate the efficacy of H2-receptor antagonists (H2RAs) and proton pump inhibitors in healing erosive esophagitis (EE). METHODS: A meta-analysis was performed. A literature search was conducted in PubMed, Medline, Embase, and Cochrane databases to include randomized controlled head-to-head comparative trials evaluating the efficacy of H2RAs or proton pump inhibitors in healing EE. Relative risk (RR) and 95% confidence interval (CI) were calculated under a random-effects model. RESULTS: RRs of cumulative healing rates for each comparison at 8 wk were: high dose vs standard dose H2RAs, 1.17 (95%CI, 1.02-1.33); standard dose proton pump inhibitors vs standard dose H2RAs, 1.59 (95%CI, 1.44-1.75); standard dose other proton pump inhibitors vs standard dose omeprazole, 1.06 (95%CI, 0.98-1.06). Proton pump inhibitors produced consistently greater healing rates than H2RAs of all doses across all grades of esophagitis, including patients refractory to H2RAs. Healing rates achieved with standard dose omeprazole were similar to those with other proton pump inhibitors in all grades of esophagitis. CONCLUSION: H2RAs are less effective for treating patients with erosive esophagitis, especially in those with severe forms of esophagitis. Standard dose proton pump inhibitors are significantly more effective than H2RAs in healing esophagitis of all grades. Proton pump inhibitors given at the recommended dose are equally effective for healing esophagitis. PMID:15996033

76 FR 12634 - Airworthiness Directives; The Boeing Company Model 737-600, -700, -700C, -800, and -900 Series...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-08

... left-hand fuel pump of the center wing tank (CWT) to shut off after being selected ``OFF'' by the... original NPRM will not be extended to the main wing tanks, as discussed in meetings between Boeing and the... wing tanks on Model 737-600, -700, -700C, -800, and -900 series airplanes to support the proposed AD...

Two-stage optical parametric chirped-pulse amplifier using sub-nanosecond pump pulse generated by stimulated Brillouin scattering compression

NASA Astrophysics Data System (ADS)

Ogino, Jumpei; Miyamoto, Sho; Matsuyama, Takahiro; Sueda, Keiichi; Yoshida, Hidetsugu; Tsubakimoto, Koji; Miyanaga, Noriaki

2014-12-01

We demonstrate optical parametric chirped-pulse amplification (OPCPA) based on two-beam pumping, using sub-nanosecond pulses generated by stimulated Brillouin scattering compression. Seed pulse energy, duration, and center wavelength were 5 nJ, 220 ps, and ˜1065 nm, respectively. The 532 nm pulse from a Q-switched Nd:YAG laser was compressed to ˜400 ps in heavy fluorocarbon FC-40 liquid. Stacking of two time-delayed pump pulses reduced the amplifier gain fluctuation. Using a walk-off-compensated two-stage OPCPA at a pump energy of 34 mJ, a total gain of 1.6 × 105 was obtained, yielding an output energy of 0.8 mJ. The amplified chirped pulse was compressed to 97 fs.

Impact of Temporally Variable and Uniform Pumping Regimes on Contaminant Transport in Heterogeneous Aquifers

NASA Astrophysics Data System (ADS)

Libera, A.; de Barros, F.; Guadagnini, A.

2015-12-01

We study and compare the effect of temporally variable and uniform pumping regimes on key features of contaminant transport in a randomly heterogeneous aquifer. Pumping wells are used for groundwater supply in the context of urban, agricultural, and industrial activities. Groundwater management agencies typically schedule groundwater extraction through a predefined sequence of pumping periods to balance benefits to anthropogenic activities and environmental needs. The impact of the spatial variability of aquifer hydraulic properties, such as hydraulic conductivity, on contaminant transport and associated solute residence times are widely studied. Only a limited number of studies address the way a given pumping schedule affects contaminant plume behavior in heterogeneous aquifers. In this context, the feedback between a transient pumping regime and contaminant breakthrough curves is largely unexplored. Our goal is to investigate the way diverse groundwater extraction strategies affect the history of solute concentration recovered at the well while accounting for the natural variability of the geological system, in the presence of incomplete information on hydraulic conductivity distribution. Considering the joint effects of spatially heterogeneous hydraulic conductivity and temporally varying well pumping rates, this work offers a realistic evaluation of groundwater contamination risk. The latter is here considered in the context of human health and is quantified in terms of the probability that harm will result from exposure to a contaminant found in groundwater. Two scenarios are considered: a pumping well that extracts a given amount of water operating (a) at a constant pumping rate and (b) under transient conditions. The analysis is performed within a numerical Monte Carlo framework. We probe the impact of diverse geostatistical structures to describe aquifer heterogeneity on solute breakthrough curves and the statistics of target environmental performance metrics, including, e.g., peak concentration and the time at which peak breakthrough at well occurs.

[Clinical research of minimal extracorporeal circulation in perioperative blood conservation of coronary artery bypass graft].

PubMed

Liu, Yan; Cui, Hu-jun; Tao, Liang; Chen, Xu-fa

2011-04-01

To analyze the clinical effect of minimal extracorporeal circulation (MECC) in blood conservation perioperatively coronary artery bypass graft (CABG). The data of 120 cases received simple CABG since August 2006 to October 2009 was analyzed retrospectively. All the patients were divided to three groups according to the mode of circulation support in-operation: MECC, conventional extracorporeal circulation (cECC) or off-pump, 40 cases in each group. Jostra MECC system with normal temperature was used in MECC group, and common membrane oxygenator with moderate hypo-temperature was used in cECC group. Collect the data of coagulation and the blood cytological examination perioperatively, the draining volume during the first 24 h after operation, and consumption of blood products perioperatively. Standard and logistic EuroSCORE were higher in MECC group than the others (P < 0.01). The operative time and the number of distal anastomosis of off-pump group were less than MECC and cECC groups (P < 0.05), while no difference between MECC group and cECC group. Intrinsic coagulation (activated partial thromboplastin time) were much more prolonged early postoperatively in cECC group, and higher than in MECC group and off-pump group at 2 h, 6 h and 12 h postoperatively (P < 0.05), but no difference in extrinsic coagulation (prothrombin time) among three group. Adjusted by hematocrit of the same sample, free hemoglobin level rose up during the ECC procedure and reached the maximum at the end of ECC in cECC group and MECC group, but the levels were more higher in cECC group than in MECC group (P < 0.05). The draining volume during the first 24 h after operation of cECC group was larger than MECC group and off-pump group (P < 0.05). Although the decreased platelet count perioperatively and more consumed of the blood products in cECC group, but no difference among the three groups. MECC could reduce the ruin to blood cell and interfere to coagulation function during the conventional ECC procedure, decrease the postoperative draining volume and requirement of blood products.

Sleep quality in nurses: a randomized clinical trial of day and night shift workers.

PubMed

Niu, Shu-Fen; Chu, Hsin; Chung, Min-Huey; Lin, Chun-Chieh; Chang, Yu-Shiun; Chou, Kuei-Ru

2013-07-01

The study investigated the number of days off nurses working night shifts need to recover their sleep quality to the level of daytime workers during their days off. This study included 30 day-shift nurses and 32 night-shift nurses. It was conducted as a randomized clinical trial in the medical and surgical wards of a medical center in northern Taiwan in May and June 2010 using sleep diaries and sleep parameters collected by actigraphy on different workdays and days off. On workdays, the night-shift group had significantly less total sleep time (TST) on Day 5 and significantly lower sleep efficiency (SE) on Day 3 than the day-shift group. TSTs of the two groups on days off were higher than those on workdays. On the 4th consecutive day off, higher TST, a decrease in WASO, and an increase in SE suggests that the night-shift group had recovered their sleep quality to the level of the day-shift group on their days off. The SE of the night-shift group exceeded that of the day-shift group after the 4th consecutive day off, though the difference was not statistically significant in the present study. Based on these data, it is recommended that night-shift workers arrange a period of at least 4 days off after 5 consecutive night shifts and at least 5 days off if the staff who have previously worked night shifts are being assigned a set of different shifts.

Effects of mobile phone use on specific intensive care unit devices.

PubMed

Hans, Nidhi; Kapadia, Farhad N

2008-10-01

To observe the effects of mobile phone use in the vicinity of medical devices used in a critical care setting. Electromagnetic interference (EMI) was tested by using two types of mobile phones - GSM and CDMA. Mobile phones were placed at a distance of one foot from three medical devices - syringe pump, mechanical ventilator, and the bedside monitor - in switch off, standby, and talking modes of the phone. Medical devices were observed for any interference caused by the electromagnetic radiations (EMR) from the mobile phones. Out of the three medical devices that were tested, EMI occurred while using the mobile phone in the vicinity of the syringe pump, in the 'talk mode.' The mean variation observed in the calculated and delivered volume of the syringe pump was 2.66 ml. Mechanical ventilator did not show any specific adverse effects with mobile phone use in the one-foot vicinity. No other adverse effects or unexplained malfunctions or shutdown of the syringe pump, mechanical ventilator, or the bedside monitor was noted during the study period of 36 hours. EMI from mobile phones have an adverse effect on the medical devices used in critical care setup. They should be used at least one foot away from the diameter of the syringe pump.

Random Assignment within Schools: Lessons Learned from the Teach for America Experiment

ERIC Educational Resources Information Center

Glazerman, Steven

2012-01-01

Randomized trials are a common way to provide rigorous evidence on the impacts of education programs. This article discusses the trade-offs associated with study designs that involve random assignment of students within schools and describes the experience from one such study of Teach for America (TFA). The TFA experiment faced challenges with…

High-speed off-axis holographic cinematography with a copper-vapor-pumped dye laser.

PubMed

Lauterborn, W; Judt, A; Schmitz, E

1993-01-01

A series of coherent light pulses is generated by pumping a dye laser with the pulsed output of a copper-vapor laser at rates of as much as 20 kHz. Holograms are recorded at this pulse rate on a rotating holographic plate. This technique of high-speed holographic cinematography is demonstrated by viewing the bubble filaments that appear in water under the action of a sound field of high intensity.

Process Options for Nominal 2-K Helium Refrigeration System Designs

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

Peter Knudsen, Venkatarao Ganni

Nominal 2-K helium refrigeration systems are frequently used for superconducting radio frequency and magnet string technologies used in accelerators. This paper examines the trade-offs and approximate performance of four basic types of processes used for the refrigeration of these technologies; direct vacuum pumping on a helium bath, direct vacuum pumping using full or partial refrigeration recovery, cold compression, and hybrid compression (i.e., a blend of cold and warm sub-atmospheric compression).

Hydraulic Fracture Growth in a Layered Formation based on Fracturing Experiments and Discrete Element Modeling

NASA Astrophysics Data System (ADS)

Yushi, Zou; Xinfang, Ma; Tong, Zhou; Ning, Li; Ming, Chen; Sihai, Li; Yinuo, Zhang; Han, Li

2017-09-01

Hydraulic fracture (HF) height containment tends to occur in layered formations, and it significantly influences the entire HF geometry or the stimulated reservoir volume. This study aims to explore the influence of preexisting bedding planes (BPs) on the HF height growth in layered formations. Laboratory fracturing experiments were performed to confirm the occurrence of HF height containment in natural shale that contains multiple weak and high-permeability BPs under triaxial stresses. Numerical simulations were then conducted to further illustrate the manner in which vertical stress, BP permeability, BP density(or spacing), pump rate, and fluid viscosity control HF height growth using a 3D discrete element method-based fracturing model. In this model, the rock matrix was considered transversely isotropic and multiple BPs can be explicitly represented. Experimental and numerical results show that the vertically growing HF tends to be limited by multi-high-permeability BPs, even under higher vertical stress. When the vertically growing HF intersects with the multi-high-permeability BPs, the injection pressure will be sharply reduced. If a low pumping rate or a low-viscosity fluid is used, the excess fracturing fluid leak-off into the BPs obviously decreases the rate of pressure build up, which will then limit the growth of HF. Otherwise, a higher pumping rate and/or a higher viscosity will reduce the leak-off time and fluid volume, but increase the injection pressure to drive the HF to grow and to penetrate through the BPs.

Drug utilization and off-label drug use in Spanish pediatric gastroenterology outpatients.

PubMed

Ruíz-Antorán, Belén; Piñeiro, Roi; Avendaño, Cristina; Román, Enriqueta; Cilleruelo, María Luz; Gutiérrez-Junquera, Carolina; Centeno, Gustavo; Cilleruelo, María José

2013-02-01

The clinical use of medicines outside the conditions authorized in their Summary of Product Characteristics (SPC) (off-label use) is a common practice in pediatrics. The aim of the present study was to describe and quantify the medicines received by children attended in the pediatric gastroenterology department, their off-label use, and compliance with accepted rules for said use. A retrospective observational study was performed on all of the patients who had their first consultation in pediatric gastroenterology between January 1 and October 31, 2010. All of the clinical information and medicines prescribed were analyzed. Off-label use was defined as the use of medicines in indications not included in the officially approved SPC or in ages not included or recommended in the SPC as well as the use of doses, intervals, or administration routes different from those considered in the SPC. A total of 695 patients (52.8% male) were included, 48.2% younger than 2 years. Two-hundred seven patients (29.8%) received 331 prescriptions. The most commonly used medicines were anti-H2 and proton pump inhibitors. Of all the prescriptions, 33.2% were considered off-label, and up to 47.3% of the prescribed patients had at least 1 medicine under off-label conditions. The medical records contained no documentation on information given to the parents regarding off-label use. The study found a high percentage of off-label use of medicines in the Pediatric Gastroenterology outpatient setting, especially in children younger than 2 years. Several initiatives were derived from the present study and implemented in our hospital.

Micro-osmotic pumps for continuous release of the tyrosine kinase inhibitor bosutinib in juvenile rats and its impact on bone growth.

PubMed

Tauer, Josephine Tabea; Hofbauer, Lorenz C; Jung, Rolang; Erben, Reinhold G; Suttorp, Meinolf

2013-11-04

Bosutinib is a third-generation dual tyrosine kinase inhibitor (TKI) inhibiting Abl and Src kinases. It was developed to act on up-regulated tyrosine kinases (TKs) like BCR-ABL in Philadelphia chromosome positive (Ph+) chronic myeloid leukemia (CML) when resistance to first- and second-generation TKIs developed. However, first- and second-generation TKIs show off-target effects on bone metabolism, whereas studies on skeletal adverse effects of bosutinib are still lacking. Therefore, it was the aim of this study to continuously expose juvenile rats to bosutinib and to analyze its influence on the growing bone. Starting after weaning, 4-week-old Wistar rats were chronically exposed over a 28-day period to varying concentrations of bosutinib, which were continuously administered subcutaneously via implanted Alzet® micro-osmotic pumps. After necropsy, the length of the femora and tibiae were analyzed. Continuous administration of bosutinib by micro-osmotic pumps led to serum drug levels in the lower therapeutic range, was well tolerated, and exhibited only minor adverse effects on the growing skeleton. Micro-osmotic pumps represent a convenient system for continuous TKI release in young growing rats. Compared to first- and second-generation TKIs, bosutinib seems to exert fewer adverse effects on the growing bone.

Lactobacillus paracasei F19 versus placebo for the prevention of proton pump inhibitor-induced bowel symptoms: a randomized clinical trial.

PubMed

Compare, Debora; Rocco, Alba; Sgamato, Costantino; Coccoli, Pietro; Campo, Salvatore Maria Antonio; Nazionale, Immacolata; Larussa, Tiziana; Luzza, Francesco; Chiodini, Paolo; Nardone, Gerardo

2015-04-01

Proton pump inhibitors may foster intestinal dysbiosis and related bowel symptoms. To evaluate the effect of Lactobacillus paracasei F19 on bowel symptom onset in patients on long-term proton pump inhibitors. In this randomized, double-blind, placebo-controlled study, patients with typical gastroesophageal reflux disease symptoms receiving pantoprazole 40 mg/d for six months were randomly assigned to receive: (A) Lactobacillus paracasei F19 bid for three days/week for six months; (B) placebo bid for three days/week for six months; (C) Lactobacillus paracasei F19 bid for three days/week for three months and placebo bid for three days/week for the following three months; (D) placebo bid for three days/week for three months and Lactobacillus paracasei F19 bid for three days/week for the following three months. Bloating, flatulence, abdominal pain and bowel habit were assessed monthly. 100/312 patients were enrolled. In the parallel groups, the treatment-by-time interaction affected bloating (p = 0.015), while Lactobacillus paracasei F19 treatment alone affected flatulence (p = 0.011). Moreover, the treatment-by-time interaction significantly affected the mean score of bloating (p = 0.01) and flatulence (p < 0.0001), the mean stool form (p = 0.03) and mean stool frequency/week (p = 0.016). Analysis of the cross-over groups, limited to the first three months because of carry-over effect, confirmed these results. Lactobacillus paracasei F19 supplementation prevents bowel symptom onset in patients on long-term proton pump inhibitors. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Remediation System Evaluation, Raymark Superfund Site (PDF)

EPA Pesticide Factsheets

The Raymark site occupies 7 acres off Jacksonville Road in an industrial part of Hatboro, Pennsylvania.The pump-and-treat system addresses groundwater contamination, primarily trichloroethylene (TCE),associated with the operations of various ...

[Systemic coronary surgery in the beating heart. Experience in 250 cases].

PubMed

Cartier, R; Bouchard, D; Martineau, R; Couturier, A

1999-01-01

To report our recent experience with off-pump coronary artery revascularization in multi-vessel disease. Between October 1996 and August 1998, 250 off-pump (OP) procedures were completed at the Montreal Heart Institute, representing more than 90% of all procedures done during the same time frame (97% for 1998). These patients have been compared to 1870 patients operated upon under cardiopulmonary bypass during the years 1995-1996 (CPB). Mean age, sexe distribution, and preoperative risk factors were comparable for both groups. On average 2.89 +/- 0.8 and 2.84 +/- 0.6 grafts/patient were completed in OP and CPB groups respectively. A majority (70%) of patients had either a triple or quadruple bypass. Coronary anastomoses were achieved with myocardial mechanical stabilization and heart "verticalization". Ischemic time was shorter in the OP group (29.8 +/- 0.9 vs 45 +/- 0.4 min, p < 0.05). Similarly, need for transfusion was significantly less (OP: 34 vs CPB: 66%, p < 0.005). Use of postoperative intra-aortic counterpulsation as well as the raise of CK-MB were lesser in the OP group. Operative mortality (OP: 1.6%, vs CPB: 2%, p = ns) and perioperative myocardial infarction rate (OP: 3.6% vs CPB: 4.2) were comparable for both groups. Off-pump complete coronary artery revascularization is an acceptable alternative to conventional surgery in a majority of patients with good results given progressive experience, rigorous technique, and adequate coronary artery stabilization.

Transapical off-pump mitral valve repair. First experience with the NeoChord system in Poland (report of two cases).

PubMed

Wróbel, Krzysztof; Kurnicka, Katarzyna; Zygier, Marcin; Dyk, Wojciech; Wojdyga, Ryszard; Zieliński, Dariusz; Jarzębska, Małgorzata; Juraszyński, Zbigniew; Lichodziejewska, Barbara; Pruszczyk, Piotr; Biederman, Andrzej; Speziali, Giovanni; Kasten, Uwe

2017-01-01

Artificial chord implantation to repair a flail or prolapsing mitral valve leaflet requires open heart surgery and cardiopulmonary bypass. Transapical off-pump artificial chordae implantation is a new surgical technique proposed to treat degenerative mitral valve regurgitation. The procedure is performed using the NeoChord DS1000 system (NeoChord, Inc., St. Louis Park, MN, USA), which facilitates both implantation and lenght adjustment of the artificial chordae under two (2D)- and three (3D)-dimensional transoesophageal echocardiographic (TEE) guidance on a beating heart. Two male patients aged 60 and 55 years with severe mitral regurgitation due to posterior leaflet prolapse underwent transapical off-pump artificial chordae implantation on September 3, 2015. The procedure was performed by left minithoracotomy under general anaesthesia in a cardiac surgical theatre, using 2D and 3D TEE guidance. Early procedural success as confirmed by 3D TEE was achieved in both patients, with implantation of 6 artificial chordae in the first patient and 3 artificial chordae in the second patient. Both procedures were uneventful, and no postoperative complications were noted. The patients were discharged home on the 8th and 6th postoperative day, respectively. The NeoChord DS1000 system allows both implantation and lenght adjustment of artificial chordae under 2D and 3D TEE guidance on a beating heart. Our initial experience in 2 patients with posterior mitral leaflet prolapse indicates that the procedure is feasible and safe.

A randomized controlled trial of laparoscopic nissen fundoplication versus proton pump inhibitors for treatment of patients with chronic gastroesophageal reflux disease: One-year follow-up.

PubMed

Anvari, Mehran; Allen, Christopher; Marshall, John; Armstrong, David; Goeree, Ron; Ungar, Wendy; Goldsmith, Charles

2006-12-01

A randomized controlled trial conducted in patients with gastroesophageal reflux disease compared optimized medical therapy using proton pump inhibitor (n = 52) with laparoscopic Nissen fundoplication (n = 52). Patients were monitored for 1 year. The primary end point was frequency of gastroesophageal reflux dis-ease symptoms. Surgical patients had improved symptoms, pH control, and overall quality of life health index after surgery at 1 year compared with the medical group. The overall gastroesophageal reflux disease symptom score at 1 year was unchanged in the medical patients, but improved in the surgical patients. Fourteen patients in the medical arm experienced symptom relapse requiring titration of the proton pump inhibitor dose, but 6 had satisfactory symptom remission. No surgical patients required additional treatment for symptom control. Patients controlled on long-term proton pump inhibitor therapy for chronic gastroesophageal reflux disease are excellent surgical candidates and should experience improved symptom control after surgery at 1 year.

Numerical Simulation of Tubular Pumping Systems with Different Regulation Methods

NASA Astrophysics Data System (ADS)

Zhu, Honggeng; Zhang, Rentian; Deng, Dongsheng; Feng, Xusong; Yao, Linbi

2010-06-01

Since the flow in tubular pumping systems is basically along axial direction and passes symmetrically through the impeller, most satisfying the basic hypotheses in the design of impeller and having higher pumping system efficiency in comparison with vertical pumping system, they are being widely applied to low-head pumping engineering. In a pumping station, the fluctuation of water levels in the sump and discharge pool is most common and at most time the pumping system runs under off-design conditions. Hence, the operation of pump has to be flexibly regulated to meet the needs of flow rates, and the selection of regulation method is as important as that of pump to reduce operation cost and achieve economic operation. In this paper, the three dimensional time-averaged Navier-Stokes equations are closed by RNG κ-ɛ turbulent model, and two tubular pumping systems with different regulation methods, equipped with the same pump model but with different designed system structures, are numerically simulated respectively to predict the pumping system performances and analyze the influence of regulation device and help designers make final decision in the selection of design schemes. The computed results indicate that the pumping system with blade-adjusting device needs longer suction box, and the increased hydraulic loss will lower the pumping system efficiency in the order of 1.5%. The pumping system with permanent magnet motor, by means of variable speed regulation, obtains higher system efficiency partly for shorter suction box and partly for different structure design. Nowadays, the varied speed regulation is realized by varied frequency device, the energy consumption of which is about 3˜4% of output power of the motor. Hence, when the efficiency of variable frequency device is considered, the total pumping system efficiency will probably be lower.

Sustained multi-kHz flamefront and 3-component velocity-field measurements for the study of turbulent flames

NASA Astrophysics Data System (ADS)

Boxx, I.; Stöhr, M.; Carter, C.; Meier, W.

2009-04-01

We describe an approach of imaging the dynamic interaction of the flamefront and flowfield. Here, a diode-pumped Nd:YLF laser operating at 5 kHz is used to pump a dye laser, which is then frequency doubled to 283 nm to probe flamefront OH, while a dual cavity diode-pumped Nd:YAG system produces pulse-pairs for particle image velocimetry (PIV). CMOS digital cameras are used to detect both planar laser-induced fluorescence (PLIF) and particle scattering (in a stereo arrangement) such that a 5 kHz measurement frequency is attained. This diagnostic is demonstrated in lifted-jet and swirl-stabilized flames, wherein the dynamics of the flame stabilization processes are seen. Nonperiodic effects such as local ignition and/or extinction, lift-off and flashback events, and their histories can be captured by this technique. As such, this system has the potential to significantly extend our understanding of nonstationary combustion processes relevant to industrial and technical applications.

Parallel pumping of a ferromagnetic nanostripe: Confinement quantization and off-resonant driving

NASA Astrophysics Data System (ADS)

Yarbrough, P. M.; Livesey, K. L.

2018-01-01

The parametric excitation of spin waves in a rectangular, ferromagnetic nanowire in the parallel pump configuration and with an applied field along the long axis of the wire is studied theoretically, using a semi-classical and semi-analytic Hamiltonian approach. We find that as a function of static applied field strength, there are jumps in the pump power needed to excite thermal spin waves. At these jumps, there is the possibility to non-resonantly excite spin waves near kz = 0. Spin waves with negative or positive group velocity and with different standing wave structures across the wire width can be excited by tuning the applied field. By using a magnetostatic Green's function that depends on both the nanowire's width and thickness—rather than just its aspect ratio—we also find that the threshold field strength varies considerably for nanowires with the same aspect ratio but of different sizes. Comparisons between different methods of calculations are made and the advantages and disadvantages of each are discussed.

Controllable optical bistability in a three-mode optomechanical system with atom-cavity-mirror couplings

NASA Astrophysics Data System (ADS)

Chen, Bin; Wang, Xiao-Fang; Yan, Jia-Kai; Zhu, Xiao-Fei; Jiang, Cheng

2018-01-01

We theoretically investigate the optical bistable behavior in a three-mode optomechanical system with atom-cavity-mirror couplings. The effects of the cavity-pump detuning and the pump power on the bistable behavior are discussed detailedly, the impacts of the atom-pump detuning and the atom-cavity coupling strength on the bistability of the system are also explored, and the influences of the cavity-resonator coupling strength and the cavity decay rate are also taken into consideration. The numerical results demonstrate that by tuning these parameters the bistable behavior of the system can be freely switched on or off, and the threshold of the pump power for the bistability as well as the bistable region width can also be effectively controlled. These results can find potential applications in optical bistable switch in the quantum information processing.

Random lasing action in a polydimethylsiloxane wrinkle induced disordered structure

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

Shen, Zhenhua; Wu, Leilei; Zhu, Shu

This paper presents a chip-scale random lasing action utilizing polydimethylsiloxane (PDMS) wrinkles with random periods as disordered medium. Nanoscale wrinkles with long range disorder structures are formed on the oxidized surface of a PDMS slab and confirmed by atomic force microscopy. Light multiply scattered at each PDMS wrinkle-dye interfaces is optically amplified in the presence of pump gain. The shift of laser emission wavelength when pumping at different regions indicates the randomness of the winkle period. In addition, a relatively low threshold of about 27 μJ/mm{sup 2} is realized, which is comparable with traditional optofluidic dye laser. This is due tomore » the unique sinusoidal Bragg-grating-like random structure. Contrast to conventional microfluidic dye laser that inevitably requires the accurate design and implementation of microcavity to provide optical feedback, the convenience in both fabrication and operation makes PDMS wrinkle based random laser a promising underlying element in lab-on-a-chip systems and integrated microfluidic networks.« less

Architecture and Bloch-Maxwell modelling of multi-mJ 100 fs fully-coherent soft X-ray laser based on X-ray CPA

NASA Astrophysics Data System (ADS)

Zeitoun, Ph.; Oliva, E.; Fajardo, M.; Cheriaux, G.; Le, T. T. T.; Li, L.; Pitman, M.; Ros, D.; Sebban, S.; Velarde, P.

2012-07-01

By seeding amplifying plasmas pumped with the so-called Transient collisionnal excitation scheme, the amplified pulse seems to be limited to an energy of several 10's of μJ. Aiming to attain several mJ, we study the seeding of plasma pumped by long laser pulse. Thanks to our time-dependent Maxwell-Bloch code, we demonstrate that direct seeding with femtosecond pulse is inefficient. We also study the amplification of pulse train with the drawback of re-synchronizing the pulses. We proposed and studied the amplification of high harmonic seed stretched by a grating pair, amplified finally compressed. We consider off-axis diffraction on the gratings for maximizing their efficiency. Considering the phase deformation induced by the amplification and the spectral narrowing the final pulse is 230 fs in duration and 5 mJ.

Architecture and Bloch-Maxwell modelling of multi-mJ 100 fs fully-coherent soft X-ray laser based on X-ray CPA

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

Zeitoun, Ph.; Oliva, E.; Fajardo, M.

2012-07-09

By seeding amplifying plasmas pumped with the so-called Transient collisionnal excitation scheme, the amplified pulse seems to be limited to an energy of several 10's of {mu}J. Aiming to attain several mJ, we study the seeding of plasma pumped by long laser pulse. Thanks to our time-dependent Maxwell-Bloch code, we demonstrate that direct seeding with femtosecond pulse is inefficient. We also study the amplification of pulse train with the drawback of re-synchronizing the pulses. We proposed and studied the amplification of high harmonic seed stretched by a grating pair, amplified finally compressed. We consider off-axis diffraction on the gratings formore » maximizing their efficiency. Considering the phase deformation induced by the amplification and the spectral narrowing the final pulse is 230 fs in duration and 5 mJ.« less

An advanced molecule-surface scattering instrument for study of vibrational energy transfer in gas-solid collisions.

PubMed

Ran, Qin; Matsiev, Daniel; Wodtke, Alec M; Auerbach, Daniel J

2007-10-01

We describe an advanced and highly sensitive instrument for quantum state-resolved molecule-surface energy transfer studies under ultrahigh vacuum (UHV) conditions. The apparatus includes a beam source chamber, two differential pumping chambers, and a UHV chamber for surface preparation, surface characterization, and molecular beam scattering. Pulsed and collimated supersonic molecular beams are generated by expanding target molecule mixtures through a home-built pulsed nozzle, and excited quantum state-selected molecules were prepared via tunable, narrow-band laser overtone pumping. Detection systems have been designed to measure specific vibrational-rotational state, time-of-flight, angular and velocity distributions of molecular beams coming to and scattered off the surface. Facilities are provided to clean and characterize the surface under UHV conditions. Initial experiments on the scattering of HCl(v = 0) from Au(111) show many advantages of this new instrument for fundamental studies of the energy transfer at the gas-surface interface.

Presentation of a quality management program in off-pump coronary bypass surgery.

PubMed

Bougioukakis, Petros; Kluegl, Stefan J; Babin-Ebell, Joerg; Tagarakis, Giorgios I; Mandewirth, Martin; Zacher, Michael; Diegeler, Anno

2014-01-01

To increase the number of off-pump coronary procedures at our institution, a new surgical team was formed. The first 3 years of "learning period" were accompanied by a quality management program aimed to control and adjust the surgical process and to ensure the safety and quality of the procedure. All patients were operated on by the same surgeon between January 2004 and December 2006; all procedures were performed under the following quality management protocol. First, a flow chart regulated surgical and anesthetic details. Second, an online file, named "disturbance file," was used to report work flow interruption, disturbance, and intraoperative events, that is, myocardial ischemia, hypotension, conversion to cardiopulmonary bypass, and any violation of the protocol. Each event was coded with 1 point and added to a score (the higher the score is, the greater the disturbance). Outcome parameters known as major events-major cardiac and cerebral events: mortality within 30 days/myocardial infarction confirmed by electrocardiogram or significantly high levels of total creatine kinase-myocardial muscle creatine kinase/reintervention within 30 days/stroke--and new-onset dialysis were also measured. Success was defined as freedom from any of those events and depicted in a cumulative sum control (CUSUM) chart. Outcome data and CUSUM were correlated with the intraoperative Disturbance Index. In total, 490 off-pump coronary bypass operations were performed by the named surgeon during the study period. The 30-day mortality was reduced from 4.0% to 1.9%. Disturbance Index score of greater than 1 declined from 41.6% to 23.3%. All major cardiac and cerebral events declined. The CUSUM chart showed two critical periods during the learning period, which made an adjustment of the protocol necessary. Quality management control is efficient in improving the postoperative results of a surgical procedure. A learning period is of cardinal importance for any new team wishing to engage in a novel surgical technique.

Release of serum S-100β protein and neuron-specific enolase after off-pump coronary artery bypass grafting with and without intracranial and cervical artery stenosis.

PubMed

Tamura, Atsushi; Imamaki, Mizuho; Shimura, Hitoshi; Niitsuma, Yuriko; Miyazaki, Masaru

2011-01-01

The aim of this study was to quantify the amount of brain damage suffered by patients who underwent off-pump coronary artery bypass grafting (OPCAB) in which S-100β protein and neuron-specific enolase were used. Thirty-four patients undergoing scheduled OPCAB were enrolled in the study. The patients were divided into two groups according to the results of their magnetic resonance angiography (MRA) and cervical ultrasonography: 13 patients had cervical or intracranial arterial stenosis (Group A), and 21 patients did not (Group B). Blood samples were collected from the arterial catheters immediately before surgery, upon arrival to the intensive care unit, and 6 and 24 hours after surgery. In blood samples collected from patients upon arrival to the intensive care unit, the maximum concentration of serum s-100β protein in Group A was significantly higher than that of Group B (p = 0.029). Though patients in Group A tended to have higher maximum neuron-specific enolase (NSE) concentrations, there were no significant differences in NSE concentrations at any point between the two groups. Our findings show a correlation between the stenosis detected by MRA or cervical ultrasonography and brain damage after OPCAB.

Comprehensive experimental and numerical analysis of instability phenomena in pump turbines

NASA Astrophysics Data System (ADS)

Gentner, Ch; Sallaberger, M.; Widmer, Ch; Bobach, B.-J.; Jaberg, H.; Schiffer, J.; Senn, F.; Guggenberger, M.

2014-03-01

The changes in the electricity market have led to changed requirements for the operation of pump turbines. Utilities need to change fast and frequently between pumping and generating modes and increasingly want to operate at off-design conditions for extended periods. Operation of the units in instable areas of the machine characteristic is not acceptable and may lead to self-excited vibration of the hydraulic system. In turbine operation of pump turbines unstable behaviour can occur at low load off-design operation close to runaway conditions (S-shape of the turbine characteristic). This type of instability may impede the synchronization of the machine in turbine mode and thus increase start-up and switch over times. A pronounced S-shaped instability can also lead to significant drop of discharge in the event of load rejection. Low pressure on the suction side and in the tail-race tunnel could cause dangerous separation of the water column. Understanding the flow features that lead to the instable behaviour of pump turbines is a prerequisite to the design of machines that can fulfil the growing requirements relating to operational flexibility. Flow simulation in these instability zones is demanding due to the complex and highly unsteady flow patterns. Only unsteady simulation methods are able to reproduce the governing physical effects in these operating regions. ANDRITZ HYDRO has been investigating the stability behaviour of pump turbines in turbine operation in cooperation with several universities using simulation and measurements. In order to validate the results of flow simulation of unstable operating points, the Graz University of Technology (Austria) performed detailed experimental investigations. Within the scope of a long term research project, the operating characteristics of several pump turbine runners have been measured and flow patterns in the pump turbine at speed no load and runaway have been examined by 2D Laser particle image velocimetry (PIV). For several wicket gate positions, the flow fields in the vane-less space at runner inlet observed in the experiment are compared with the results of unsteady CFD flow simulations. Physical phenomena are visualized and insight to flow phenomena is given. Analyses using both results of simulation and measurement allow deriving a consistent explanation of the fluid mechanical mechanisms leading to the S-shaped instability of pump turbines.

Stress Introduction Rate Alters the Benefit of AcrAB-TolC Efflux Pumps.

PubMed

Langevin, Ariel M; Dunlop, Mary J

2018-01-01

Stress tolerance studies are typically conducted in an all-or-none fashion. However, in realistic settings-such as in clinical or metabolic engineering applications-cells may encounter stresses at different rates. Therefore, how cells tolerate stress may depend on its rate of appearance. To address this, we studied how the rate of stress introduction affects bacterial stress tolerance by focusing on a key stress response mechanism. Efflux pumps, such as AcrAB-TolC of Escherichia coli , are membrane transporters well known for the ability to export a wide variety of substrates, including antibiotics, signaling molecules, and biofuels. Although efflux pumps improve stress tolerance, pump overexpression can result in a substantial fitness cost to the cells. We hypothesized that the ideal pump expression level would involve a rate-dependent trade-off between the benefit of pumps and the cost of their expression. To test this, we evaluated the benefit of the AcrAB-TolC pump under different rates of stress introduction, including a step, a fast ramp, and a gradual ramp. Using two chemically diverse stresses, the antibiotic chloramphenicol and the jet biofuel precursor pinene, we assessed the benefit provided by the pumps. A mathematical model describing these effects predicted the benefit as a function of the rate of stress introduction. Our findings demonstrate that as the rate of introduction is lowered, stress response mechanisms provide a disproportionate benefit to pump-containing strains, allowing cells to survive beyond the original inhibitory concentrations. IMPORTANCE Efflux pumps are ubiquitous in nature and provide stress tolerance in the cells of species ranging from bacteria to mammals. Understanding how pumps provide tolerance has far-reaching implications for diverse fields, from medicine to biotechnology. Here, we investigated how the rate of stressor appearance impacts tolerance. We focused on two distinct substrates of AcrAB-TolC efflux pumps, the antibiotic chloramphenicol and the biofuel precursor pinene. Interestingly, tolerance is highly dependent on the rate of stress introduction. Therefore, it is important to consider not only the total quantity of a stressor but also the rate at which it is applied. The implications of this work are significant because environments are rarely static; antibiotic concentrations change during dosing, and metabolic engineering processes change with time. Copyright © 2017 American Society for Microbiology.

Nonlinear Optics Technology, Area 1: FWM (Four Wave Mixing) Technology

DTIC Science & Technology

1986-09-22

41 0 u Q)Co o 0 0. >1- o 0 41 -A $4 P4 38 paths to insure a high degree of copolarization at the Na cell. Turning mirrors (M) were visible dielectric...or MAXBRIte coated Zerodur substrate optics with twentieth wave or better surface figures. A 50-50 beamsplitter (BSl) served to generate the two pump...retroreflecting mirror . The signal beam, which essentially constituted a very bright glint, was split off of the pump leg by a beamsplitter and directed to a

AAFES Gas Station at Creech Air Force Base Environmental Assessment

DTIC Science & Technology

2009-07-01

Creech AFB with modern fuel refilling services. The AAFES Gas Station would include a one pump two hose filling station, a concrete slab, a 12,000...at both end of each hose , a shear valve at the base of the pump, and an electronic sensor in the dispenser to detect fuel leakage. In order to add...designed and built with leak prevention safety equipment. Shut- off valves would be installed at both ends of each hose . A shear valve would be

Development of a system for off-peak electrical energy use by air conditioners and heat pumps

NASA Astrophysics Data System (ADS)

Russell, L. D.

1980-05-01

Investigation and evaluation of several alternatives for load management for the TVA system are described. Specific data for the TVA system load characteristics were studied to determine the typical peak and off peak periods for the system. The alternative systems investigated for load management included gaseous energy storage, phase change materials energy storage, zeolite energy storage, variable speed controllers for compressors, and weather sensitive controllers. After investigating these alternatives, system design criteria were established; then, the gaseous and PCM energy storage systems were analyzed. The system design criteria include economic assessment of all alternatives. Handbook data were developed for economic assessment. A liquid/PCM energy storage system was judged feasible.

[Critical infusion incident caused by incorrect use of a patient-controlled analgesia pump].

PubMed

Steffen, M; von Hintzenstern, U; Obermayer, A

2002-01-01

We report on the case of a 17-year-old male patient who received a PCA pump after nephrectomy for postoperative analgesia. The syringe of the PCA pump was filled with 50 mg morphine and positioned about 25 cm above the heart. Since the piston of the syringe was not bolted while the pump was switched off, an unnoticed accidental evacuation of the whole content of the syringe into the intravenous line of the patient occurred because of gravity. This problem exists not only with PCA pumps, but can happen with syringe pumps in general. The incident, which can only be explained by strongly reduced venous pressure, was detected by chance. No harm resulted for the patient, but under different conditions it could have been lethal. This critical incident was caused by various factors: incorrect application in combination with insufficient experience or training, stress, inadequate handing-over of the patient and a lack of arrangements and instructions for procedures in routine situations. Suggestions for preventing such dangerous critical incidents are made and discussed. In particular, an algorithm for the correct procedure when inserting or changing the syringe of a syringe pump is presented.

Treatment of Parkinson's disease could be regulated by movement sensors: subcutaneous infusion of varying apomorphine doses according to the intensity of motor activity.

PubMed

Rodríguez-Molinero, Alejandro; Pérez-Martínez, David A; Català, Andreu; Cabestany, Joan; Yuste, Antonio

2009-04-01

Most recent therapeutic solutions to treat Parkinson's disease seek continuous administration of dopaminergic agonists, as for example rigotine patches or apomorphine infusion pumps. Such drug-delivery devices are aimed at preventing fluctuations in drug plasma levels, which could cause certain symptoms such as wearing-off periods or dyskinesia. However, we postulate that drug plasma levels should not keep constant, but rather adjust to the varying intensity of the different user's activities. The rationale behind this is that the drug amount appropriate to treat a patient at rest is lower than that required to treat the same patient when engaged in physical activity. We propose dynamic real-time dose adjustment, so that the doses increase as the patient starts performing physical activity, thus preventing off periods such as "freeze" phenomenon, and the doses reduce during the resting periods, thus preventing adverse effects. Small portable movement sensors are currently available, which detect the amount and type of activity in a continuous way. Combining such technology with infusion pumps to produce modified pumps capable of adjusting the infusion rate to the user's activity, seems to be feasible in the short-term.

Modeling and design of light powered biomimicry micropump utilizing transporter proteins

NASA Astrophysics Data System (ADS)

Liu, Jin; Sze, Tsun-Kay Jackie; Dutta, Prashanta

2014-11-01

The creation of compact micropumps to provide steady flow has been an on-going challenge in the field of microfluidics. We present a mathematical model for a micropump utilizing Bacteriorhodopsin and sugar transporter proteins. This micropump utilizes transporter proteins as method to drive fluid flow by converting light energy into chemical potential. The fluid flow through a microchannel is simulated using the Nernst-Planck, Navier-Stokes, and continuity equations. Numerical results show that the micropump is capable of generating usable pressure. Designing parameters influencing the performance of the micropump are investigated including membrane fraction, lipid proton permeability, illumination, and channel height. The results show that there is a substantial membrane fraction region at which fluid flow is maximized. The use of lipids with low membrane proton permeability allows illumination to be used as a method to turn the pump on and off. This capability allows the micropump to be activated and shut off remotely without bulky support equipment. This modeling work provides new insights on mechanisms potentially useful for fluidic pumping in self-sustained bio-mimic microfluidic pumps. This work is supported in part by the National Science Fundation Grant CBET-1250107.

Fluid dynamic characteristics of the VentrAssist rotary blood pump.

PubMed

Tansley, G; Vidakovic, S; Reizes, J

2000-06-01

The VentrAssist pump has no shaft or seal, and the device is unique in design because the rotor is suspended passively by hydrodynamic forces, and urging is accomplished by an integrated direct current motor rotor that also acts as the pump impeller. This device has led to many challenges in its fluidic design, namely large flow-blockage from impeller blades, low stiffness of bearings with concomitant impeller displacement under pulsatile load conditions, and very small running clearances. Low specific speed and radial blade off-flow were selected in order to minimize the hemolysis. Pulsatile and steady-flow tests show the impeller is stable under normal operating conditions. Computational fluid dynamics (CFD) has been used to optimize flow paths and reduce net axial force imbalance to acceptably small values. The latest design of the pump achieved a system efficiency of 18% (in 30% hematocrit of red blood cells suspended in phosphate-buffered saline), and efficiency was optimized over the range of operating conditions. Parameters critical to improving pump efficiency were investigated.

Oilwell Power Controller (OPC)

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

Not Available

1993-08-01

The Oil Well Power Controller (OPC) prototype units is nearing completion. This device is an oilwell beam pump controller and data logger. Applications for this device have been for an electrical power saving device, pump off control, parafffin detection, demand power load control, chemical treatment data, dynamometer and pump efficiency data. Preliminary results appear vary promising. A total of ten OPC rod pump controllers were assembled and installed on oilwells in several areas of Central and Western United States. Data was analyzed on these wells and forwarded to the participating oil companies. Cost savings on each individual oil well participatingmore » in the OPC testing vary considerably, savings on some situations have been outstanding. In situations where the pump efficiency was determined to be low, the cost savings have been considerable. Cost savings due to preventive maintenance are also present, but are difficult to pin point an exact dollar amount at the present time. A break out of actual cost data obtained on some of the oilwells controlled and monitored with the oilwell power controller.« less

Electron particle transport and turbulence studies in the T-10 tokamak

NASA Astrophysics Data System (ADS)

Vershkov, V. A.; Borisov, M. A.; Subbotin, G. F.; Shelukhin, D. A.; Dnestrovskii, Yu. N.; Danilov, A. V.; Cherkasov, S. V.; Gorbunov, E. P.; Sergeev, D. S.; Grashin, S. A.; Krylov, S. V.; Kuleshin, E. O.; Myalton, T. B.; Skosyrev, Yu. V.; Chistiakov, V. V.

2013-08-01

The goals of this paper are to compare the results of electron particle transport measurements in ohmic (OH) plasmas by means of a small perturbation technique, high-level gas puff and gas switch off, investigate the phenomenon of ‘density pump out’ during electron cyclotron resonance heating (ECRH) and to correlate density behaviour with turbulence. Two approaches for plasma particle transport studies were compared: the low perturbation technique of periodic puff (δn/ne = 0.3%) and strong density variations (δn/ne < 50%), including density ramp-up by gas puff and ramp-down with gas switch off. The model with constant in time diffusion coefficients and pinch velocities could describe the core density perturbations but failed at the edge. In the case of strong puff three stages were distinguished. Degraded energy confinement and, respectively, low turbulence frequencies were observed during density ramp-up and ramp-down, while enhanced confinement and higher turbulence frequencies were typical for the intermediate stage. Density profile variation during this intermediate phase could be described in the framework of the transport model with constant in time coefficients. The application of ECRH at the density ramp-up phase provided the possibility of postponing the ‘density pump out’. The increase in the low-frequency modes in turbulence spectra was observed at the ‘density pump out’ phase during central ECRH. Although the high- and low-frequency bands of turbulence spectra behaved as trapped electron mode and ion temperature gradient, respectively, they both rotated at the same angular velocity as a rigid body together with magnetohydrodynamic mode m/n = 2/1 and [E × B] plasma rotation.

The impact of hybrid coronary revascularization on hospital costs and reimbursements.

PubMed

Halkos, Michael E; Ford, Lauren; Peterson, Dane; Bluestein, Sheryl M; Liberman, Henry A; Kilgo, Patrick; Puskas, John D; Guyton, Robert A; Chowdhury, Ritam

2014-05-01

Hybrid coronary revascularization (HCR) combines a minimally invasive, left internal mammary artery-left anterior descending coronary artery (LAD) bypass with percutaneous intervention of non-LAD vessels for patients with multivessel coronary disease. The financial implications of HCR have not been compared with off-pump coronary artery bypass (OPCAB) through sternotomy. The contribution margin is a fiduciary calculation (best hospital payment estimate--total variable costs) used by hospitals to determine fiscal viability of services. From 2010 to 2011, 26 Medicare patients underwent HCR at a single United States institution and were compared with 28 randomly selected, contemporaneous Medicare patients undergoing multivessel OPCAB. All HCR patients underwent a robotic-assisted, sternal-sparing, off-pump, left internal mammary artery-LAD anastomosis plus percutaneous intervention to non-LAD vessels. A linear regression model was used to compare fiscal and utilization outcomes of HCR to OPCAB adjusted for hospital length of stay and The Society of Thoracic Surgeons Predicted Risk of Mortality score. On regression analysis controlling for overall length of stay and Predicted Risk of Mortality score, the contribution margin (+$8,771, p<0.0001) was greater for HCR than for OPCAB. Despite higher total cost for HCR compared with OPCAB (+$7,026, p=0.001), the total variable cost (+$2,281, p=0.07) was not significantly different. Best payment estimates (+11,031, p<0.0001) and Medicare reimbursements (+$8,992, p=0.002) were higher for HCR than for OPCAB, and there was a reduction in blood transfusion (-1.5 units, p<0.0001), ventilator time (-10 hours, p=0.001), and postoperative length of stay (-1.2 days, p=0.002) for the HCR group. Compared with OPCAB, HCR results in a greater contribution margin for hospitals. This may result from higher reimbursement as well as improved resource utilization postoperatively, which may offset more expensive procedural costs associated with HCR. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Tunable random lasing behavior in plasmonic nanostructures

NASA Astrophysics Data System (ADS)

Yadav, Ashish; Zhong, Liubiao; Sun, Jun; Jiang, Lin; Cheng, Gary J.; Chi, Lifeng

2017-01-01

Random lasing is desired in plasmonics nanostructures through surface plasmon amplification. In this study, tunable random lasing behavior was observed in dye molecules attached with Au nanorods (NRs), Au nanoparticles (NPs) and Au@Ag nanorods (NRs) respectively. Our experimental investigations showed that all nanostructures i.e., Au@AgNRs, AuNRs & AuNPs have intensive tunable spectral effects. The random lasing has been observed at excitation wavelength 532 nm and varying pump powers. The best random lasing properties were noticed in Au@AgNRs structure, which exhibits broad absorption spectrum, sufficiently overlapping with that of dye Rhodamine B (RhB). Au@AgNRs significantly enhance the tunable spectral behavior through localized electromagnetic field and scattering. The random lasing in Au@AgNRs provides an efficient coherent feedback for random lasers.

Conflicting results between randomized trials and observational studies on the impact of proton pump inhibitors on cardiovascular events when coadministered with dual antiplatelet therapy: systematic review.

PubMed

Melloni, Chiara; Washam, Jeffrey B; Jones, W Schuyler; Halim, Sharif A; Hasselblad, Victor; Mayer, Stephanie B; Heidenfelder, Brooke L; Dolor, Rowena J

2015-01-01

Discordant results have been reported on the effects of concomitant use of proton pump inhibitors (PPIs) and dual antiplatelet therapy (DAPT) for cardiovascular outcomes. We conducted a systematic review comparing the effectiveness and safety of concomitant use of PPIs and DAPT in the postdischarge treatment of unstable angina/non-ST-segment-elevation myocardial infarction patients. We searched for clinical studies in MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews, from 1995 to 2012. Reviewers screened and extracted data, assessed applicability and quality, and graded the strength of evidence. We performed meta-analyses of direct comparisons when outcomes and follow-up periods were comparable. Thirty-five studies were eligible. Five (4 randomized controlled trials and 1 observational) assessed the effect of omeprazole when added to DAPT; the other 30 (observational) assessed the effect of PPIs as a class when compared with no PPIs. Random-effects meta-analyses of the studies assessing PPIs as a class consistently reported higher event rates in patients receiving PPIs for various clinical outcomes at 1 year (composite ischemic end points, all-cause mortality, nonfatal MI, stroke, revascularization, and stent thrombosis). However, the results from randomized controlled trials evaluating omeprazole compared with placebo showed no difference in ischemic outcomes, despite a reduction in upper gastrointestinal bleeding with omeprazole. Large, well-conducted observational studies of PPIs and randomized controlled trials of omeprazole seem to provide conflicting results for the effect of PPIs on cardiovascular outcomes when coadministered with DAPT. Prospective trials that directly compare pharmacodynamic parameters and clinical events among specific PPI agents in patients with unstable angina/non-ST-segment-elevation myocardial infarction treated with DAPT are warranted. © 2015 American Heart Association, Inc.

Seventeen-year Outcome of a Randomized Clinical Trial Comparing Laparoscopic and Conventional Nissen Fundoplication: A Plea for Patient Counseling and Clarification.

PubMed

Oor, Jelmer E; Roks, David J; Broeders, Joris A; Hazebroek, Eric J; Gooszen, Hein G

2017-07-01

To analyze long-term outcome of a randomized clinical trial comparing laparoscopic Nissen fundoplication (LNF) and conventional Nissen fundoplication (CNF) for the treatment of gastroesophageal reflux disease (GERD). LNF has replaced CNF, based on positive short and mid-term outcome. Studies with a follow-up of over 15 years are scarce, but are desperately needed for patient counselling. Between 1997 and 1999, 177 patients with proton pump inhibitor (PPI)-refractory GERD were randomized to CNF or LNF. Data regarding the presence of reflux symptoms, dysphagia, general health, PPI use, and need for surgical reintervention at 17 years are reported. A total of 111 patients (60 LNF, 51 CNF) were included. Seventeen years after LNF and CNF, 90% and 95% of the patients reported symptom relief, with no differences in GERD symptoms or dysphagia. Forty-three and 49% of the patients used PPIs (NS). Both groups demonstrated significant improvement in general health (77% vs 71%; NS) and quality of life (75.3 vs 74.7; NS). Surgical reinterventions were more frequent after CNF (18% vs 45%; P = 0.002), mainly due to incisional hernia corrections (3% vs 14%; P = 0.047). The effects of LNF and CNF on symptomatic outcome and general state of health remain for up to 17 years after surgery, with no differences between the 2 procedures. CNF carries a higher risk of surgical reintervention, mainly due to incisional hernia corrections. Patients should be informed that 17 years after Nissen fundoplication, 60% of the patients are off PPIs, and 16% require reoperation for recurrent GERD and/or dysphagia.

Assessment of the effect of off-pump coronary artery bypass (OPCAB) surgery on right ventricle function using strain and strain rate imaging.

PubMed

Khani, Mohammad; Hosseintash, Mahsa; Foroughi, Mahnoosh; Naderian, Mohammadreza; Khaheshi, Isa

2016-04-01

Right ventricle function significantly decreases after coronary artery bypass surgery; as one of the likely causes, such a condition is attributed to the use of cardiopulmonary pump (CPB). Because nowadays there is a tendency toward increasing use of off-pump coronary artery bypass (OPCAB) surgery, this study was conducted to evaluate the right ventricle function after this type of surgery using strain and strain rate imaging (SRI) echocardiography. This study was conducted on 30 patients, candidate for elective OPCAB surgery, between 2011 and 2012. Standard echocardiography was performed before the surgery and the right ventricle function was examined using strain and SRI echocardiography. Then patient underwent surgery, 6 days and 3 months after surgery they underwent echocardiography again and the results obtained from the three stages were compared with each other. Participants included 30 patients (23 males and 7 females) with a mean age of 66±11 years. Compared to the prior of the surgery, 6 days and 3 months after the surgery there was a significant decrease in tricuspid annular plane systolic excursion (TAPSE), tissue Doppler imaging (TDI) at the lateral annulus of tricuspid valve, and strain and SRI of right ventricle. However, the values obtained 3 months after surgery were significantly higher than those obtained after 6 days. In other words, the right ventricle function 6 days after the surgery had dropped, however some of the values recovered 3 months after the surgery. The findings of this study are consistent with other studies in this field and showed that after coronary artery surgery a decline occurs in right ventricular function. However, more detailed quantitative strain and SRI parameters which were measured in our study showed that at the early days after the OPCAB surgery there is a decline in the right ventricle function which is relatively reversible at longer intervals (3 months after surgery).

Particle Tracking on the BNL Relativistic Heavy Ion Collider

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

Dell, G. F.

1986-08-07

Tracking studies including the effects of random multipole errors as well as the effects of random and systematic multipole errors have been made for RHIC. Initial results for operating at an off diagonal working point are discussed.

Goal-directed therapy improves the outcome of high-risk cardiac patients undergoing off-pump coronary artery bypass.

PubMed

Kapoor, Poonam Malhotra; Magoon, Rohan; Rawat, Rajinder Singh; Mehta, Yatin; Taneja, Sameer; Ravi, R; Hote, Milind P

2017-01-01

There has been a constant emphasis on developing management strategies to improve the outcome of high-risk cardiac patients undergoing surgical revascularization. The performance of coronary artery bypass surgery on an off-pump coronary artery bypass (OPCAB) avoids the risks associated with extra-corporeal circulation. The preliminary results of goal-directed therapy (GDT) for hemodynamic management of high-risk cardiac surgical patients are encouraging. The present study was conducted to study the outcome benefits with the combined use of GDT with OPCAB as compared to the conventional hemodynamic management. Patients with the European System for Cardiac Operative Risk Evaluation ≥3 scheduled for OPCAB were randomly divided into two groups; the control and GDT groups. The GDT group included the monitoring and optimization of advanced parameters, including cardiac index (CI), systemic vascular resistance index, oxygen delivery index, stroke volume variation; continuous central venous oxygen saturation (ScVO 2 ), global end-diastolic volume, and extravascular lung water (EVLW), using FloTrac™ , PreSep™ , and EV-1000 ® monitoring panels, in addition to the conventional hemodynamic management in the control group. The hemodynamic parameters were continuously monitored for 48 h in Intensive Care Unit (ICU) and corrected according to GDT protocol. A total of 163 patients consented for the study. Seventy-five patients were assigned to the GDT group and 88 patients were in the control group. In view of 9 exclusions from the GDT group and 12 exclusions from control group, 66 patients in the GDT group and 76 patients in control group completed the study. The length of stay in hospital (LOS-H) (7.42 ± 1.48 vs. 5.61 ± 1.11 days, P < 0.001) and ICU stay (4.2 ± 0.82 vs. 2.53 ± 0.56 days, P < 0.001) were significantly lower in the GDT group as compared to control group. The duration of inotropes (3.24 ± 0.73 vs. 2.89 ± 0.68 h, P = 0.005) was also significantly lower in the GDT group. The two groups did not differ in duration of ventilated hours, mortality, and other complications. The parameters such as ScVO 2 , CI, and EVLW had a strong negative and positive correlation with the LOS-H with r values of - 0.331, -0.319, and 0.798, respectively. The study elucidates the role of a goal-directed hemodynamic optimization for improved outcome in high-risk cardiac patients undergoing OPCAB.

Procedure Training Aid for the SH-3D/H Normal Start Checklist.

DTIC Science & Technology

1982-02-01

1 Engine .... START Pupoe: To make a Normal Start of No. 1 engine. :4 14. Action Pilot/Copilot verify lite -off by noting rapid rise in T5 and Nq and...Nf increasinq 15. Note Normal starts are characterized by 7 0-75D0 T5 in I seconds after lite -off 16. If T5 is incrasinn too rapidlyv or appears to...Pumps 206 NORMAL START CHECKLIST ITEM NO. 23. No. I Ergine ... TART 14. Action Pilot/Copilot verify lite -off by noting ra ’pid rise in and Ng and Nf

Experimental analysis of the flow pattern of a pump turbine model in pump mode

NASA Astrophysics Data System (ADS)

Guggenberger, Mark; Senn, Florian; Jaberg, Helmut; Gehrer, Arno; Sallaberger, Manfred; Widmer, Christian

2016-11-01

Reversible pump turbines are the only means to store primary energy in an highly efficient way. Within a short time their operation can be switched between the different operational regimes thus enhancing the stabilization of the electric grid. These qualities in combination with the operation even at off-design conditions offer a high flexibility to the energy market. However, pump turbines pass through operational regimes where their behaviour becomes unstable. One of these effects occurs when the flowrate is decreased continuously down to a minimum. This point is the physical limitation of the pump operation and is very difficult to predict properly by numerical design without a model test. The purpose of the present study is to identify the fluid mechanical phenomena leading to the occurrence of instabilities of pump turbines in pump mode. A reduced scale model of a ANDRITZ pump turbine was installed on a 4-quadrant test rig for the experimental investigation of unstable conditions in pump mode. The performed measurements are based on the IEC60193-standard. Characteristic measurements at a single guide vane opening were carried out to get a detailed insight into the instabilities in pump mode. The interaction between runner and guide vane was analysed by Particle Image Velocimetry. Furthermore, high-speed visualizations of the suction side part load flow and the suction recirculation were performed. Like never before the flow pattern in the draft tube cone became visible with the help of a high-speed camera by intentionally caused cavitation effects which allow a qualitative view on the flow pattern in the draft tube cone. Suction recirculation is observed in form of single vortices separating from each runner blade and stretching into the draft tube against the main flow direction. To find an explanation for the flow phenomena responsible for the appearance of the unstable head curve also characteristic velocity distributions on the pressure side were combined with high-speed visualizations on the suction side of the pump turbine model. The results enhance the comprehension of the physical background leading to the instability and improve the numerical predictability of the instability in pump mode.

The evaluation of off-loading using a new removable oRTHOsis in DIABetic foot (ORTHODIAB) randomized controlled trial: study design and rational.

PubMed

Mohammedi, Kamel; Potier, Louis; François, Maud; Dardari, Dured; Feron, Marilyne; Nobecourt-Dupuy, Estelle; Dolz, Manuel; Ducloux, Roxane; Chibani, Abdelkader; Eveno, Dominique-François; Crea Avila, Teresa; Sultan, Ariane; Baillet-Blanco, Laurence; Rigalleau, Vincent; Velho, Gilberto; Tubach, Florence; Roussel, Ronan; Dupré, Jean-Claude; Malgrange, Dominique; Marre, Michel

2016-01-01

Off-loading is essential for diabetic foot management, but remains understudied. The evaluation of Off-loading using a new removable oRTHOsis in DIABetic foot (ORTHODIAB) trial aims to evaluate the efficacy of a new removable device "Orthèse Diabète" in the healing of diabetic foot. ORTHODIAB is a French multi-centre randomized, open label trial, with a blinded end points evaluation by an adjudication committee according to the Prospective Randomized Open Blinded End-point. Main endpoints are adjudicated based on the analysis of diabetic foot photographs. Orthèse Diabète is a new removable off-loading orthosis (PROTEOR, France) allowing innovative functions including real-time evaluation of off-loading and estimation of patients' adherence. Diabetic patients with neuropathic plantar ulcer or amputation wounds (toes or transmetatarsal) are assigned to one of 2 parallel-groups: Orthèse Diabète or control group (any removable device) according to a central computer-based randomization. Study visits are scheduled for 6 months (days D7 and D14, and months M1, M2, M3, and M6). The primary endpoint is the proportion of patients whose principal ulcer is healed at M3. Secondary endpoints are: the proportion of patients whose principal ulcer is healed at M1, M2 and M6; the proportion of patients whose initial ulcers are all healed at M1, M2, M3, and M6; principal ulcer area reduction; time-related ulcer-free survival; development of new ulcers; new lower-extremity amputation; infectious complications; off-loading adherence; and patient satisfaction. The study protocol was approved by the French National Agency for Medicines and Health Products Safety, and by the ethics committee of Saint-Louis Hospital (Paris). Comprehensive study information including a Patient Information Sheet has been provided to each patient who must give written informed consent before enrolment. Monitoring, data management, and statistical analyses are providing by UMANIS Life Science (Paris), independently to the sponsor. Since 27/10/2013, 13 centres have agreed to participate in this study, 117 participants were included, and 70 have achieved the study schedules. The study completion is expected for the end of 2016, and the main results will be published in 2017. ORTHODIAB trial evaluates an innovating removable off-loading device, seeking to improve diabetic foot healing (ClinicalTrials.gov identifier: NCT01956162).

Performance of a solar augmented heat pump

NASA Astrophysics Data System (ADS)

Bedinger, A. F. G.; Tomlinson, J. J.; Reid, R. L.; Chaffin, D. J.

Performance of a residential size solar augmented heat pump is reported for the 1979-1980 heating season. The facility located in Knoxville, Tennessee, has a measured heat load coefficient of 339.5 watt/C (644 BTU/hr- F). The solar augmented heat pump system consists of 7.4 cu m of one inch diameter crushed limestone. The heat pump is a nominal 8.8 KW (2 1/2 ton) high efficiency unit. The system includes electric resistance heaters to give the option of adding thermal energy to the pebble bed storage during utility off-peak periods, thus offering considerable load management capability. A 15 KW electric resistance duct heater is used to add thermal energy to the pebble bin as required during off-peak periods. Hourly thermal performance and on site weather data was taken for the period November 1, 1979, to April 13, 1980. Thermal performance data consists of heat flow summations for all modes of the system, pebble bed temperatures, and space temperature. Weather data consists of dry bulb temperature, dew point temperature, total global insolation (in the plane of the collector), and wind speed and direction. An error analysis was performed and the least accurate of the measurements was determined to be the heat flow at 5%. Solar system thermal performance factor was measured to be 8.77. The heat pump thermal performance factor was 1.64. Total system seasonal performance factor was measured to be 1.66. Using a modified version of TRNSYS, the thermal performance of this system was simulated. When simulation results were compared with data collected onsite, the predicted heat flow and power consumption generally were within experimental accuracy.

Analysis of energy requirement in the irrigation sector and its application in groundwater over-pumping control at a local scale - A case study in the North China Plain

NASA Astrophysics Data System (ADS)

Wang, L.; Kinzelbach, W.; Yao, H.; Hagmann, A.; Li, N.; Steiner, J. F.

2017-12-01

The North China Plain is one of the most important agricultural regions which relies heavily on groundwater pumping for irrigation powered by electric energy. This region is also facing a severe problem of groundwater over-pumping. Stopping groundwater depletion by controlling pumping for irrigation may harm the agricultural production and affect the interests of the electricity utility who is a direct participant in the irrigation management. Water-saving infrastructures such as sprinklers can be effective means for water conservation but are often difficult to implement due to farmers' unwillingness to pay for the additional electricity consumption. Understanding this food-energy-water nexus is fundamental to implement effective and practical strategies for groundwater over-pumping control in the North China Plain. However, this understanding can be obscured by the missing groundwater pumping monitoring and a lack of access to specific energy data for irrigation use as well as the field observations of pump efficiency. Taking the example of a typical agricultural county (Guantao) in the North China Plain with irrigation pumps generally powered by electricity, this study is focused on the analysis of the energy requirement in the irrigation sector and its application in developing strategies for groundwater over-pumping control at the county scale. 1) Field measurements from pumping tests are used to adjust the pumps' theoretical characteristics. A simple empirical equation is derived to estimate the energy use rate for irrigation given the depth of the groundwater table. Field measurements show that pump efficiency is around 30% in the tested region. 2) We hypothesize that the inter-annual variability of rural energy consumption is caused by the randomness in annual precipitation. This assumption is examined and then applied to separate the energy consumption for irrigation from the total rural energy consumption. 3) Based on the groundwater pumping rate reconstructed from the energy use, the interaction of agricultural production, groundwater resources and energy requirement is analysed and will help in developing practical strategies for groundwater over-pumping control in Guantao County.

Role of phase matching in pulsed second-harmonic generation: Walk-off and phase-locked twin pulses in negative-index media

NASA Astrophysics Data System (ADS)

Roppo, Vito; Centini, Marco; Sibilia, Concita; Bertolotti, Mario; de Ceglia, Domenico; Scalora, Michael; Akozbek, Neset; Bloemer, Mark J.; Haus, Joseph W.; Kosareva, Olga G.; Kandidov, Valery P.

2007-09-01

The present investigation is concerned with the study of pulsed second-harmonic generation under conditions of phase and group velocity mismatch, and generally low conversion efficiencies and pump intensities. In positive-index, nonmetallic materials, we generally find qualitative agreement with previous reports regarding the presence of a double-peaked second harmonic signal, which comprises a pulse that walks off and propagates at the nominal group velocity one expects at the second-harmonic frequency, and a second pulse that is “captured” and propagates under the pump pulse. We find that the origin of the double-peaked structure resides in a phase-locking mechanism that characterizes not only second-harmonic generation, but also χ(3) processes and third-harmonic generation. The phase-locking mechanism that we describe occurs for arbitrarily small pump intensities, and so it is not a soliton effect, which usually relies on a threshold mechanism, although multicolor solitons display similar phase locking characteristics. Thus, in second harmonic generation a phase-matched component is always generated, even under conditions of material phase mismatch: This component is anomalous, because the material does not allow energy exchange between the pump and the second-harmonic beam. On the other hand, if the material is phase matched, phase locking and phase matching are indistinguishable, and the conversion process becomes efficient. We also report a similar phase-locking phenomenon in negative index materials. A spectral analysis of the pump and the generated signals reveals that the phase-locking phenomenon causes the forward moving, phase-locked second-harmonic pulse to experience the same negative index as the pump pulse, even though the index of refraction at the second-harmonic frequency is positive. Our analysis further shows that the reflected second-harmonic pulse generated at the interface and the forward-moving, phase-locked pulse appear to be part of the same pulse initially generated at the surface, part of which is immediately back-reflected, while the rest becomes trapped and dragged along by the pump pulse. These pulses thus constitute twin pulses generated at the interface, having the same negative wave vector, but propagating in opposite directions. Almost any break of the longitudinal symmetry, even an exceedingly small χ(2) discontinuity, releases the trapped pulse which then propagates in the backward direction. These dynamics are indicative of very rich and intricate interactions that characterize ultrashort pulse propagation phenomena.

Role of phase matching in pulsed second-harmonic generation: Walk-off and phase-locked twin pulses in negative-index media

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

Roppo, Vito; Centini, Marco; Sibilia, Concita

The present investigation is concerned with the study of pulsed second-harmonic generation under conditions of phase and group velocity mismatch, and generally low conversion efficiencies and pump intensities. In positive-index, nonmetallic materials, we generally find qualitative agreement with previous reports regarding the presence of a double-peaked second harmonic signal, which comprises a pulse that walks off and propagates at the nominal group velocity one expects at the second-harmonic frequency, and a second pulse that is 'captured' and propagates under the pump pulse. We find that the origin of the double-peaked structure resides in a phase-locking mechanism that characterizes not onlymore » second-harmonic generation, but also {chi}{sup (3)} processes and third-harmonic generation. The phase-locking mechanism that we describe occurs for arbitrarily small pump intensities, and so it is not a soliton effect, which usually relies on a threshold mechanism, although multicolor solitons display similar phase locking characteristics. Thus, in second harmonic generation a phase-matched component is always generated, even under conditions of material phase mismatch: This component is anomalous, because the material does not allow energy exchange between the pump and the second-harmonic beam. On the other hand, if the material is phase matched, phase locking and phase matching are indistinguishable, and the conversion process becomes efficient. We also report a similar phase-locking phenomenon in negative index materials. A spectral analysis of the pump and the generated signals reveals that the phase-locking phenomenon causes the forward moving, phase-locked second-harmonic pulse to experience the same negative index as the pump pulse, even though the index of refraction at the second-harmonic frequency is positive. Our analysis further shows that the reflected second-harmonic pulse generated at the interface and the forward-moving, phase-locked pulse appear to be part of the same pulse initially generated at the surface, part of which is immediately back-reflected, while the rest becomes trapped and dragged along by the pump pulse. These pulses thus constitute twin pulses generated at the interface, having the same negative wave vector, but propagating in opposite directions. Almost any break of the longitudinal symmetry, even an exceedingly small {chi}{sup (2)} discontinuity, releases the trapped pulse which then propagates in the backward direction. These dynamics are indicative of very rich and intricate interactions that characterize ultrashort pulse propagation phenomena.« less

Assessing the potential for using wetlands as intermediary storages to conjunctively maintain ecological values and support agricultural demands.

PubMed

Ning, Nathan S P; Watkins, Susanne C; Gawne, Ben; Nielsen, Daryl L

2012-09-30

Water sharing to meet both agricultural and environmental demands is a critical issue affecting the health of many floodplain river systems around the world. This study explored the potential for using wetlands as temporary off-river storages to conjunctively maintain ecological values and support agricultural demands by assessing the effects of artificial drawdown on wetland aquatic plant communities. An initial experiment was undertaken in outdoor mesocosms in which four different treatments were compared over a 131 day duration: (1) natural drawdown where the water was left to drawdown naturally via evaporation; (2) partial drawdown where approximately half of the volume of water was pumped out after 42 days; (3) stepped drawdown where approximately half of the volume of water pumped out after 42 days, and then the remaining volume of water was pumped out after 117 days; and (4) total drawdown where all of the of water was pumped out after 117 days. A complementary field study was subsequently undertaken where two wetlands were left to drawdown naturally and two were partially drawn down artificially (i.e. had approximately half of their volume removed by pumping). Results from both of these studies indicated that neither aquatic plant abundance nor taxon richness were adversely affected by partial drawdown. Rather, both studies showed that aquatic plant communities subjected to a partial drawdown treatment became more species rich and diverse than communities subjected to a natural drawdown treatment. This suggests that it may be possible to use wetlands as intermediary storages for the dual purposes of maintaining ecological values and supporting agricultural demands. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

Q-switched oscillation in thulium-doped fiber lasers using preloaded dynamic microbending technique

NASA Astrophysics Data System (ADS)

Sakata, H.; Takahashi, N.; Ushiro, Y.

2018-01-01

We demonstrate Q-switched pulse generation in thulium-doped fiber lasers by introducing piezoelectric-driven microbend with preloaded stress. We employed a pair of corrugated chips each attached on piezoelectric actuators (PAs) to clamp the fiber in a ring laser resonator. The thulium-doped fiber is pumped by a laser diode emitting at 1.63 μm and generates the Q-switched laser pulses at around 1.9 μm by switching off the PAs. The laser pulse performance is improved by optimizing the preload and switch-off period for the PAs. The Q-switched pulses with a peak power of 2.8 W and a pulsewidth of 900 ns are observed for a launched pump power of 161 mW. We expect that the in-fiber Q-switching technique will provide efficient laser systems for environmental sensing and medical applications.

Enhanced broadband near-IR luminescence and gain spectra of bismuth/erbium co-doped fiber by 830 and 980 nm dual pumping

NASA Astrophysics Data System (ADS)

Zhao, Qiancheng; Luo, Yanhua; Wang, Wenyu; Canning, John; Peng, Gang-Ding

2017-04-01

A dual 830 and 980 nm pumping scheme is proposed aiming at broadening and flattening the spectral performance of bismuth/erbium codoped multicomponent fiber (BEDF). The spectral properties of distinct Bi active centers (BACs) associated with germanium (BAC-Ge), aluminium (BAC-Al), phosphorus (BAC-P) and silicon (BAC-Si) are characterized under single pumping of 830 and 980 nm, respectively. Based on the emission slope efficiencies of BAC-Al (˜1100 nm) and BAC-Si (˜1430 nm) under single pumping of 830 and 980 nm, the dual pumping scheme with the optimal pump power ratio of 25 (980 nm VS 830 nm) is determined to achieve flat, ultrabroadband luminescence spectra covering the wavelength range 950-1600 nm. The dual pumping scheme is further demonstrated on the on-off gain performance of BEDF. It is found under the pump power ratio of ˜8 (980 VS 830 nm), The gain spectrum has been flattened and broadened over 300 nm (1300-1600 nm) with an average gain coefficient of ˜1.5 dBm-1. The spectral coverage is approximately 1.5 and 3 times wider compared to single pumping of 830 and 980 nm pumping, respectively. The energy level diagrams of 830 and 980 nm are also constructed separately in view of the optical characteristic, which further clarifies the advantage for dual pumping. The proposed dual 830 and 980 nm pumping scheme with the multicomponent BEDF shows great potential in various broadband optical applications such as uniform ASE source, broadband amplifier and tuneable laser in NIR band.

BEWARE: Body awareness training in the treatment of wearing-off related anxiety in patients with Parkinson's disease: study protocol for a randomized controlled trial.

PubMed

Ghielen, Ires; van den Heuvel, Odile A; de Goede, Cees J T; Houniet-de Gier, Marieke; Collette, Emma H; Burgers-Bots, Ingrid A L; Rutten, Sonja; Kwakkel, Gert; Vermunt, Kees; van Vliet, Bep; Berendse, Henk W; van Wegen, Erwin E H

2015-06-23

The wearing-off phenomenon in patients with Parkinson's disease (PD) is a complication of prolonged levodopa usage. During this phenomenon, motor symptoms such as rigidity and freezing re-emerge. This is often accompanied by non-motor symptoms, including anxiety, the so-called wearing-off related anxiety (WRA). Current treatment options are limited and typically focus on either the physical or mental aspects of wearing-off. An integrated approach seems warranted in order to optimally address the complex reciprocal interactions between these aspects. Also, because wearing-off is eventually inescapable, treatment needs to focus on coping, acceptance, and self-efficacy. We therefore developed an integrated body awareness intervention, combining principles from physical therapy with acceptance and commitment therapy to teach patients to deal with WRA. This study will investigate whether this new intervention, named BEWARE, is more effective than treatment as usual in increasing self-efficacy. This is a single-blinded randomized controlled trial in 36 PD patients who experience WRA. Subjects will be recruited from the outpatient clinic for movement disorders of the VU University Medical Center. After providing written informed consent, patients will be randomly assigned to an experimental (BEWARE) or treatment-as-usual (physical therapy) group. Clinical assessments will be performed prior to the intervention, directly after the 6-week intervention period, and at 3-month naturalistic follow-up by a blinded investigator not involved in the study. The primary outcome measure is self-efficacy, and secondary outcomes focus on mobility, daily functioning, anxiety, and quality of life. Because wearing-off is an inevitable consequence of levodopa therapy and current treatment options are insufficient, a multidisciplinary intervention that addresses both physical and mental aspects of wearing-off in PD may foster additional benefits for treating WRA in PD patients over mono-disciplinary care alone. ClinicalTrials.gov identifier: NCT02054845. Date of registration: 30 January 2014.

Conducting Causal Effects Studies in Science Education: Considering Methodological Trade-Offs in the Context of Policies Affecting Research in Schools

ERIC Educational Resources Information Center

Taylor, Joseph; Kowalski, Susan; Wilson, Christopher; Getty, Stephen; Carlson, Janet

2013-01-01

This paper focuses on the trade-offs that lie at the intersection of methodological requirements for causal effect studies and policies that affect how and to what extent schools engage in such studies. More specifically, current federal funding priorities encourage large-scale randomized studies of interventions in authentic settings. At the same…

Design and modeling of a light powered biomimicry micropump

NASA Astrophysics Data System (ADS)

Sze, Tsun-kay Jackie; Liu, Jin; Dutta, Prashanta

2015-06-01

The design of compact micropumps to provide steady flow has been an on-going challenge in the field of microfluidics. In this work, a novel micropump concept is introduced utilizing bacteriorhodopsin and sugar transporter proteins. The micropump utilizes light energy to activate the transporter proteins, which create an osmotic pressure gradient and drive the fluid flow. The capability of the bio inspired micropump is demonstrated using a quasi 1D numerical model, where the contributions of bacteriorhodopsin and sugar transporter proteins are taken care of by appropriate flux boundary conditions in the flow channel. Proton flux created by the bacteriorhodopsin proteins is compared with experimental results to obtain the appropriate working conditions of the proteins. To identify the pumping capability, we also investigate the influences of several key parameters, such as the membrane fraction of transporter proteins, membrane proton permeability and the presence of light. Our results show that there is a wide bacteriorhodopsin membrane fraction range (from 0.2 to 10%) at which fluid flow stays nearly at its maximum value. Numerical results also indicate that lipid membranes with low proton permeability can effectively control the light source as a method to turn on/off fluid flow. This capability allows the micropump to be activated and shut off remotely without bulky support equipment. In comparison with existing micropumps, this pump generates higher pressures than mechanical pumps. It can produce peak fluid flow and shutoff head comparable to other non-mechanical pumps.

Building America Case Study: Impact of Improved Duct Insulation on Fixed-Capacity (SEER 13) and Variable-Capacity (SEER 22) Heat Pumps, Cocoa, Florida

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

C. Withers, J. Cummings, B. Nigusse, E. Martin

A new generation of central, ducted variable-capacity heat pump systems has come on the market, promising very high cooling and heating efficiency. Instead of cycling on at full capacity and then cycling off when the thermostat is satisfied, they vary their cooling and heating output over a wide range (approximately 40 to 118% of nominal full capacity); thus, staying 'on' for 60% to 100% more hours per day compared to fixed-capacity systems. Current Phase 4 experiments in an instrumented lab home with simulated occupancy evaluate the impact of duct R-value enhancement on the overall operating efficiency of the variable-capacity systemmore » compared to the fixed-capacity system.« less

Broadband and tunable optical parametric generator for remote detection of gas molecules in the short and mid-infrared.

PubMed

Lambert-Girard, Simon; Allard, Martin; Piché, Michel; Babin, François

2015-04-01

The development of a novel broadband and tunable optical parametric generator (OPG) is presented. The OPG properties are studied numerically and experimentally in order to optimize the generator's use in a broadband spectroscopic LIDAR operating in the short and mid-infrared. This paper discusses trade-offs to be made on the properties of the pump, crystal, and seeding signal in order to optimize the pulse spectral density and divergence while enabling energy scaling. A seed with a large spectral bandwidth is shown to enhance the pulse-to-pulse stability and optimize the pulse spectral density. A numerical model shows excellent agreement with output power measurements; the model predicts that a pump having a large number of longitudinal modes improves conversion efficiency and pulse stability.

Highly nonlinear organic crystal OHQ-T for efficient ultra-broadband terahertz wave generation beyond 10 THz.

PubMed

Kang, Bong Joo; Baek, In Hyung; Lee, Seung-Heon; Kim, Won Tae; Lee, Seung-Jun; Jeong, Young Uk; Kwon, O-Pil; Rotermund, Fabian

2016-05-16

We report on efficient generation of ultra-broadband terahertz (THz) waves via optical rectification in a novel nonlinear organic crystal with acentric core structure, i.e. 2-(4-hydroxystyryl)-1-methylquinolinium 4-methylbenzenesulfonate (OHQ-T), which possesses an ideal molecular structure leading to a maximized nonlinear optical response for near-infrared-pumped THz wave generation. By systematic studies on wavelength-dependent phase-matching conditions in OHQ-T crystals of different thicknesses we are able to generate coherent THz waves with a high peak-to-peak electric field amplitude of up to 650 kV/cm and an upper cut-off frequency beyond 10 THz. High optical-to-THz conversion efficiency of 0.31% is achieved by efficient index matching with a selective pumping at 1300 nm.

Bose-Einstein condensation in an ultra-hot gas of pumped magnons.

PubMed

Serga, Alexander A; Tiberkevich, Vasil S; Sandweg, Christian W; Vasyuchka, Vitaliy I; Bozhko, Dmytro A; Chumak, Andrii V; Neumann, Timo; Obry, Björn; Melkov, Gennadii A; Slavin, Andrei N; Hillebrands, Burkard

2014-03-11

Bose-Einstein condensation of quasi-particles such as excitons, polaritons, magnons and photons is a fascinating quantum mechanical phenomenon. Unlike the Bose-Einstein condensation of real particles (like atoms), these processes do not require low temperatures, since the high densities of low-energy quasi-particles needed for the condensate to form can be produced via external pumping. Here we demonstrate that such a pumping can create remarkably high effective temperatures in a narrow spectral region of the lowest energy states in a magnon gas, resulting in strikingly unexpected transitional dynamics of Bose-Einstein magnon condensate: the density of the condensate increases immediately after the external magnon flow is switched off and initially decreases if it is switched on again. This behaviour finds explanation in a nonlinear 'evaporative supercooling' mechanism that couples the low-energy magnons overheated by pumping with all the other thermal magnons, removing the excess heat, and allowing Bose-Einstein condensate formation.

Far infrared maser communications technology

NASA Technical Reports Server (NTRS)

Claspy, P. C.; Pao, Y. H.

1975-01-01

An optically pumped FIR laser was constructed and tested. Optimum operating conditions were determined with CH3OH as the lasing medium. The laser was found to operate equally well with flowing gas or in a sealed off configuration. The FIR cavity stability and pump laser stability were found to have significant problems. The absorption coefficient per unit pressure of 1-1 difluoroethylene at the P(22) and P(24) lines of the 10.4 micron CO2 band was measured. The FIR line pumped by P(22) occurs at approximately 890 microns, which may be in an atmospheric transmission window. It was found that significant Stark tuning of absorption lines of methanol and 1-1 difluoroethylene can be accomplished, even at the usual 100 to 300 mTorr operating pressures of FIR lasers. This means that the use of Stark tuning may enable more effective use of pump laser output.

Five-order SRSs and supercontinuum generation from a tapered tellurite microstructured fiber with longitudinally varying dispersion.

PubMed

Liao, Meisong; Yan, Xin; Gao, Weiqing; Duan, Zhongchao; Qin, Guanshi; Suzuki, Takenobu; Ohishi, Yasutake

2011-08-01

We try to obtain stable supercontinuum (SC) generation with broad bandwidth under relative simple pump conditions. We use a 1.3-m-long highly nonlinear tellurite microstructured fiber and pump it by a 15 ps 1064 nm fiber laser. One segment of the fiber is tapered from a core diameter of 3.4 μm to 1.3 μm. For the first time five-order stimulated Raman scatterings (SRSs) are observed for soft glass fibers. SC covering 730-1700 nm is demonstrated with the pump-pulse-energy of several nJ. The mechanisms of SC broadening are mainly SRS, self-phase modulation (SPM) and cross phase modulation (XPM). The tapered segment has two advantages. Firstly it increases the nonlinearity of fiber by several times. Secondly, it acts as a compensation for the dispersion of the untapered segment, and mitigates the walk-off between pump pulse and SRS peaks.

Design of a high-pressure circulating pump for viscous liquids.

PubMed

Seifried, Bernhard; Temelli, Feral

2009-07-01

The design of a reciprocating dual action piston pump capable of circulating viscous fluids at pressures of up to 34 MPa (5000 psi) and temperatures up to 80 degrees C is described. The piston of this pump is driven by a pair of solenoids energized alternatively by a 12 V direct current power supply controlled by an electronic controller facilitating continuously adjustable flow rates. The body of this seal-less pump is constructed using off-the-shelf parts eliminating the need for custom made parts. Both the electronic controller and the pump can be assembled relatively easily. Pump performance has been evaluated at room temperature (22 degrees C) and atmospheric pressure using liquids with low and moderately high viscosities, such as ethanol and corn oil, respectively. At ambient conditions, the pump delivered continuous flow of ethanol and corn oil at a flow rate of up to 170 and 17 cm3/min, respectively. For pumping viscous fluids comparable to corn oil, an optimum reciprocation frequency was ascertained to maximize flow rate. For low viscosity liquids such as ethanol, a linear relationship between the flow rate and reciprocation frequency was determined up to the maximum reciprocation frequency of the pump. Since its fabrication, the pump has been used in our laboratory for circulating triglycerides in contact with supercritical carbon dioxide at pressures of up to 25 MPa (3600 psi) and temperatures up to 70 degrees C on a daily basis for a total of more than 1500 h of operation functioning trouble free.

Effect of the colloids gelatin and HES 130/0.4 on blood coagulation in cardiac surgery patients: a randomized controlled trial.

PubMed

Kimenai, D M; Bastianen, G W; Daane, C R; Megens-Bastiaanse, C M; van der Meer, N J M; Scohy, T V; Gerritse, B M

2013-11-01

The choice of the prime solution for cardiopulmonary bypass can play an important role in limiting the effect on blood coagulation, but it is still unclear what the effect of colloids on blood coagulation is. The aim of this study was to investigate the effect of synthetic colloids on blood loss and blood coagulation in patients after on-pump coronary artery bypass graft (CABG) procedures. Sixty elective, on-pump CABG patients were randomly assigned to receive the prime solutions lactated Ringer's solution combined with hydroxyethyl starch 130/0.4 (HES, 6% Volulyte, Fresenius Kabi Nederland BV, Zeist, the Netherlands) (HES group) or gelatin (Gelofusin(®), B Braun Melsung AG, Melsungen, Germany) (Gelo group). Blood loss was assessed using post-operative chest tube output; secondary endpoints were number of blood component transfusions, routine coagulation test values and rotation thromboelastometry values (Rotem(®) delta, Pentapharm GmbH, Munich, Germany). Total post-operative chest tube output was 500 ± 420 ml in the HES group versus 465 ± 390 ml in the Gelo group (p = 0.48). No significant differences were observed in any of the routine coagulation tests values, thromboelastometry parameters or number of blood component transfusions between the groups. In this randomized, controlled trial of adults after on-pump CABG procedures, there was no significant difference in blood loss or blood coagulation between the HES group and the Gelo group.

The feasibility and safety of off-pump coronary bypass surgery in emergency revascularization

PubMed Central

Joo, Hyun-Chel; Youn, Young-Nam; Chang, Byung-Chul

2018-01-01

Background The efficacy and safety of off-pump coronary artery bypass grafting (OPCAB) in emergency revascularization remains controversial despite its widespread use. The aim of our study was to examine the applicability and safety of OPCAB in patients who were indicated for emergency surgery. Methods This single-center study reviewed the indication, operative data, and early and long-term outcomes of 113 patients (mean age, 67.2±9.0 years; logistic EuroSCORE, 14.3±13.5) who underwent emergency OPCAB from January 2003 to December 2014 and were followed up (94.6% completion rate) for a mean 51.1±40.3 (range, 1–135) months. Results Emergency OPCAB was associated with favorable surgical outcomes (number of distal anastomoses per patient, 3.04±0.87; internal thoracic artery (IMA) use, 98.2%; complete revascularization, 79.6%) and in-hospital outcomes (mortality, 5.3%; low cardiac output syndrome, 5.3%; stroke, 2.7%; pulmonary complications, 8.8%; renal failure, 11.5%). Only five patients (4.4%) required on-pump conversion. The 10-year outcomes were also acceptable (survival, 75.4%±5.6%; major cerebral and cardiovascular events, 52.1%±1.8%). The multivariate risk factors for late mortality were peripheral vascular disease (HR 2.95, 95% CI: 1.11–11.83), cardiogenic shock (HR 3.67, 95% CI: 1.35–9.96), and incomplete revascularization (HR 3.41, 95% CI: 1.06–14.26). When patients were separated by whether the procedure was performed early (<2010) or late (≥2010) in the study period, the late period cohort had better outcomes despite containing higher-risk patients. Conclusions Our study suggests that emergency OPCAB can be performed safely and effectively with good hospital outcomes and adequate long-term results. OPCAB strategy can be considered as a good option in emergency revascularization. PMID:29850131

Sensor-Augmented Insulin Pumps and Hypoglycemia Prevention in Type 1 Diabetes.

PubMed

Steineck, Isabelle; Ranjan, Ajenthen; Nørgaard, Kirsten; Schmidt, Signe

2017-01-01

Hypoglycemia can lead to seizures, unconsciousness, or death. Insulin pump treatment reduces the frequency of severe hypoglycemia compared with multiple daily injections treatment. The addition of a continuous glucose monitor, so-called sensor-augmented pump (SAP) treatment, has the potential to further limit the duration and severity of hypoglycemia as the system can detect and in some systems act on impending and prevailing low blood glucose levels. In this narrative review we summarize the available knowledge on SAPs with and without automated insulin suspension, in relation to hypoglycemia prevention. We present evidence from randomized trials, observational studies, and meta-analyses including nonpregnant individuals with type 1 diabetes mellitus. We also outline concerns regarding SAPs with and without automated insulin suspension. There is evidence that SAP treatment reduces episodes of moderate and severe hypoglycemia compared with multiple daily injections plus self-monitoring of blood glucose. There is some evidence that SAPs both with and without automated suspension reduces the frequency of severe hypoglycemic events compared with insulin pumps without continuous glucose monitoring.

Understanding the C-pulse device and its potential to treat heart failure.

PubMed

Sales, Virna L; McCarthy, Patrick M

2010-03-01

The Sunshine Heart C-Pulse (C-Pulse; Sunshine Heart Inc., Tustin, CA) device is an extra-aortic implantable counterpulsation pump designed as a non-blood contacting ambulatory heart assist device, which may provide relief from symptoms for class II-III congestive heart failure patients. It has a comparable hemodynamic augmentation to intra-aortic balloon counterpulsation devices. The C-Pulse cuff is implanted through a median sternotomy, secured around the ascending aorta, and pneumatically driven by an external system controller. Pre-clinical studies in the acute pig model, and initial temporary clinical studies in patients undergoing off-pump coronary bypass surgery have shown substantial increase in diastolic perfusion of the coronary vessels, which translated to a favorable improvement in ventricular function. A U.S. prospective multi-center trial to evaluate the safety and efficacy of the C-Pulse in class III patients with moderate heart failure is now in progress.

Evaluation of CGP 39393 as the anticoagulant in cardiopulmonary bypass operation in a dog model.

PubMed

Walenga, J M; Koza, M J; Park, S J; Terrell, M R; Pifarré, R

1994-12-01

Recombinant desulphatohirudin HV1 (CGP 39393), a specific and potent peptidic inhibitor of thrombin, was evaluated as the sole anticoagulant in a dog model of cardiopulmonary bypass. CGP 39393 was administered as a bolus plus infusion for a 1-hour pump period at doses of 1.0 mg/kg + 0.75 mg.kg-1.h-1, 1.0 mg/kg + 1.50 mg.kg-1.h-1, 1.0 mg/kg + 2.25 mg.kg-1.h-1, or 1.0 mg/kg + 3.0 mg.kg-1.h-1 (n = 5 per group). The lowest dose was ineffective, as a high degree of clot formation (314 +/- 160 mg) occurred as determined by quantitation of protein deposits in the pump line filter. The three higher doses inhibited clot formation (35 to 44 mg) but did not reveal a dose-dependent effect (p = 0.308 between groups). All four doses produced the same amount of postoperative blood loss (6.5 to 10 g/kg over 2 hours; p = 0.215 between groups) and no oozing of blood from cut tissues (sternum, muscle, skin) during or after operation. No adverse hemodynamic or hematologic effects were observed. Animals were physiologically stable coming off pump, requiring minimal fluid replacement or other cardiovascular supportive measures. The chromogenic anti-IIa assay could be used to monitor CGP 39393. Some activated partial thromboplastin time and all activated clotting time values were off scale on pump, but they fell immediately after cardiopulmonary bypass, typically reaching near-normal levels within 30 to 60 minutes. No reversal of CGP 39393 was used, as blood levels declined rapidly after cessation of the infusion. This study in a dog model shows that CGP 39393 administered as a bolus plus infusion (minimum dose, 1.0 mg/kg + 1.50 mg.kg-1.h-1) can be used safely and effectively during cardiopulmonary bypass for cardiac operation.

Magnetic heat pumping near room temperature

NASA Technical Reports Server (NTRS)

Brown, G. V.

1976-01-01

It is shown that magnetic heat pumping can be made practical at room temperature by using a ferromagnetic material with a Curie point at or near operating temperature and an appropriate regenerative thermodynamic cycle. Measurements are performed which show that gadolinium is a resonable working material and it is found that the application of a 7-T magnetic field to gadolinium at the Curie point (293 K) causes a heat release of 4 kJ/kg under isothermal conditions or a temperature rise of 14 K under adiabatic conditions. A regeneration technique can be used to lift the load of the lattice and electronic heat capacities off the magnetic system in order to span a reasonable temperature difference and to pump as much entropy per cycle as possible

Pumping Performance or RBCC Engine under Sea Level Static Condition

NASA Astrophysics Data System (ADS)

Kouchi, Toshinori; Tomioka, Sadatake; Kanda, Takeshi

Numerical simulations were conducted to predict the ejector pumping performance of a rocket-ramjet combined-cycle engine under a take-off condition. The numerical simulations revealed that the suction airflow was chocked at the exit of the engine throat when the ejector rocket was driven by cold N2 gas at the chamber pressure of 3MPa. When the ejector-driving gas was changed from cold N2 gas to hot combustion gas, the suction performance decreased remarkably. Mach contours in the engine revealed that the rocket plume constricted when the driving gas was the hot combustion gas. The change of the area of the stream tube area seemed to induce the pressure rise in the duct and decreasing in the pumping performance.

Affordable Hybrid Heat Pump Clothes Dryer

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

TeGrotenhuis, Ward E.; Butterfield, Andrew; Caldwell, Dustin D.

This project was successful in demonstrating the feasibility of a step change in residential clothes dryer energy efficiency by demonstrating heat pump technology capable of 50% energy savings over conventional standard-size electric dryers with comparable drying times. A prototype system was designed from off-the-shelf components that can meet the project’s efficiency goals and are affordable. An experimental prototype system was built based on the design that reached 50% energy savings. Improvements have been identified that will reduce drying times of over 60 minutes to reach the goal of 40 minutes. Nevertheless, the prototype represents a step change in efficiency overmore » heat pump dryers recently introduced to the U.S. market, with 30% improvement in energy efficiency at comparable drying times.« less

Bidirectional superior cavopulmonary anastomosis with or without cardiopulmonary bypass: A randomized study.

PubMed

Talwar, Sachin; Gupta, Anish; Nehra, Ashima; Makhija, Neeti; Kapoor, Poonam Malhotra; Sreenivas, Vishnubhatla; Choudhary, Shiv Kumar; Airan, Balram

2017-06-01

This study aims to compare the bidirectional superior cavopulmonary anastomosis (BDG) with or without cardiopulmonary bypass (CPB). 100 patients undergoing BDG were randomized into two groups: Off-CPB or on-CPB groups. All patients underwent near-infrared spectrophotometry (NIRS) and bispectral index (BIS) monitoring and pre- and postoperative serum 100 beta protein measurements (Sβ100) and neuro-cognitive evaluation. Postoperative intensive care unit (ICU) parameters were also studied. The median age of patients in the on-CPB and off-CPB group were 42 and 48 months, respectively (p = 0.11). Median weights in the on-CPB group and off-CPB group were 13.5 (5-50) kg and 15 (7-36) kg, respectively (p = 0.927). There was a significant rise in superior vena cava (SVC) pressure on SVC clamping in the off-CPB group (23.12 ± 6.84 vs 2.98 ± 2.22 mmHg) on-CPB group (p < 0.001). There was a significant fall in NIRS and BIS values from baseline in the off-CPB group during the anastomosis but there was no statistically significant change in serum Sβ100from pre-clamp to post-clamp in either group. Inotropic support, duration of ventilation, ICU stay, and hospital stay were significantly less in the off-CPB group (p < 0.001). Assessment of Social Adaptive Functioning revealed no adverse sequelae. There were significant cost savings if surgery was performed off-CPB (p < 0.001). Off CPB-BDG is an economical and safe procedure. Duration of inotropic and mechanical ventilatory support, ICU, and hospital stay is significantly less. We did not observe any early adverse neurologic sequelae in patients undergoing off-CPB BDG. © 2017 Wiley Periodicals, Inc.

Comparison on electrically pumped random laser actions of hydrothermal and sputtered ZnO films

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

Wang, Canxing; Jiang, Haotian; Li, Yunpeng

2013-10-07

Random lasing (RL) in polycrystalline ZnO films is an intriguing research subject. Here, we have comparatively investigated electrically pumped RL behaviors of two metal-insulator-semiconductor structured devices using the hydrothermal and sputtered ZnO films as the semiconductor components, i.e., the light-emitting layers, respectively. It is demonstrated that the device using the hydrothermal ZnO film exhibits smaller threshold current and larger output optical power of the electrically pumped RL. The morphological characterization shows that the hydrothermal ZnO film is somewhat porous and is much rougher than the sputtered one, suggesting that in the former stronger multiple light scattering can occur. Moreover, themore » photoluminescence characterization indicates that there are fewer defects in the hydrothermal ZnO film than in the sputtered one, which means that the photons can pick up larger optical gain through stimulated emission in the hydrothermal ZnO film. Therefore, it is believed that the stronger multiple light scattering and larger optical gain contribute to the improved performance of the electrically pumped RL from the device using the hydrothermal ZnO film.« less

Miniaturised medium pressure capillary liquid chromatography system with flexible open platform design using off-the-shelf microfluidic components.

PubMed

Li, Yan; Dvořák, Miloš; Nesterenko, Pavel N; Stanley, Roger; Nuchtavorn, Nantana; Krčmová, Lenka Kujovská; Aufartová, Jana; Macka, Mirek

2015-10-08

Trends towards portable analytical instrumentation of the last decades have not been equally reflected in developments of portable liquid chromatography (LC) instrumentation for rapid on-site measurements. A miniaturised medium pressure capillary LC (MPLC) system with gradient elution capability has been designed based on a flexible modular microfluidic system using primarily off-the-shelf low cost components to ensure wide accessibility to other analysts. The microfluidic platform was assembled on a breadboard and contained microsyringe pumps and switch valves, complemented with an injection valve and on-capillary detectors, all controlled by a PC. Four miniaturised microsyringe pumps, with 5, 20 and 100 μL syringe volume options, formed the basis of the pumping system. Two pairs of pumps were used for each mobile phase to create gradient elution capability. The two microsyringe pumps in each pairs were linked by two electrically operated microfluidic switching valves and both pairs of pumps were connected through a zero void volume cross-connector, thus providing a low hold-up volume for gradient formation. Sample was injected by a 20 nL nano-LC sampling valve, directly connected to a 18 cm long 100 μm i.d. Chromolith CapRod RP-18 monolithic capillary column. On-capillary LED-based UV-vis photometric detection was conducted through a piece of equal diameter fused silica capillary connected after the column. The performance of the portable LC system was evaluated theoretically and experimentally, including the maximum operating pressure, gradient mixing performance, and the performance of the detectors. The 5 μL microsyringe pump offered the best performance, with typical maximum operating pressures up to 11.4 ± 0.4 MPa (water) and gradient pumping repeatability of between 4 and 9% for gradients between 0.10% s(-1) and 0.33% s(-1). Test analytes of charged and uncharged dyes and pharmaceuticals of varying hydrophobicity showed typical RSD values of 0.7-1.4% and 3.3-4.8% in isocratic mode and 1.2-4.6% and 3.2-6.4% in gradient mode, respectively for retention time and peak area repeatability. Crown Copyright © 2015. Published by Elsevier B.V. All rights reserved.

Meta-analysis: comparative efficacy of different proton-pump inhibitors in triple therapy for Helicobacter pylori eradication.

PubMed

Vergara, M; Vallve, M; Gisbert, J P; Calvet, X

2003-09-15

It is not known whether certain proton-pump inhibitors are more efficacious than others when used in triple therapy for Helicobacter pylori eradication. To compare the efficacy of different proton-pump inhibitors in triple therapy by performing a meta-analysis. A MEDLINE search was performed. Abstracts of the European Helicobacter pylori Study Group and the American Gastroenterological Association congresses from 1996 to 2002 were also examined. Randomized studies with at least two branches of triple therapy that differed only in terms of type of proton-pump inhibitor were included in a meta-analysis using Review Manager 4.1. Fourteen studies were included. Intention-to-treat cure rates were similar for omeprazole and lansoprazole: 74.7% vs. 76%, odds ratio (OR) 0.91 [95% confidence interval (CI) 0.69-1.21] in a total of 1085 patients; for omeprazole and rabeprazole: 77.9% vs. 81.2%, OR 0.81 (95% CI 0.58-1.15) in a total of 825 patients; for omeprazole and esomeprazole: 87.7% vs. 89%, OR 0.89 (95% CI 0.58-1.35) in 833 patients; and for lansoprazole and rabeprazole: 81% vs. 85.7%, OR 0.77 (95% CI 0.48-1.22) in 550 patients. The efficacy of various proton-pump inhibitors seems to be similar when used for H. pylori eradication in standard triple therapy.

Novel core-shell (TiO2@Silica) nanoparticles for scattering medium in a random laser: higher efficiency, lower laser threshold and lower photodegradation.

PubMed

Jimenez-Villar, Ernesto; Mestre, Valdeci; de Oliveira, Paulo C; de Sá, Gilberto F

2013-12-21

There has been growing interest in scattering media in recent years, due to their potential applications as solar collectors, photocatalyzers, random lasers and other novel optical devices. Here, we have introduced a novel core-shell scattering medium for a random laser composed of TiO2@Silica nanoparticles. Higher efficiency, lower laser threshold and long photobleaching lifetime in random lasers were demonstrated. This has introduced a new method or parameter (fraction of absorbed pumping), which opens a new avenue to characterize and study the scattering media. Optical chemical and colloidal stabilities were combined by coating a suitable silica shell onto TiO2 nanoparticles.

Ultra-fast all-optical plasmonic switching in near infra-red spectrum using a Kerr nonlinear ring resonator

NASA Astrophysics Data System (ADS)

Nurmohammadi, Tofiq; Abbasian, Karim; Yadipour, Reza

2018-03-01

In this paper, an all-optical plasmonic switch based on metal-insulator-metal (MIM) nanoplasmonic waveguide with a Kerr nonlinear ring resonator is introduced and studied. Two-dimensional simulations utilizing the finite-difference time-domain algorithm are used to demonstrate an apparent optical bistability and significant switching mechanisms (in enabled-low condition: T(ON/OFF) =21.9 and in enabled-high condition: T(ON/OFF) =24.9) of the signal light arisen by altering the pump-light intensity. The proposed all-optical switching demonstrates femtosecond-scale feedback time (90 fs) and then ultra-fast switching can be achieved. The offered all-optical switch may recognize potential significant applications in integrated optical circuits.

Two-photon Anderson localization in a disordered quadratic waveguide array

NASA Astrophysics Data System (ADS)

Bai, Y. F.; Xu, P.; Lu, L. L.; Zhong, M. L.; Zhu, S. N.

2016-05-01

We theoretically investigate two-photon Anderson localization in a χ (2) waveguide array with off-diagonal disorder. The nonlinear parametric down-conversion process would enhance both the single-photon and the two-photon Anderson localization. In the strong disorder regime, the two-photon position correlation exhibits a bunching distribution around the pumped waveguides, which is independent of pumping conditions and geometrical structures of waveguide arrays. Quadratic nonlinearity can be supplied as a new ingredient for Anderson localization. Also, our results pave the way for engineering quantum states through nonlinear quantum walks.

New concepts and new design of permanent maglev rotary artificial heart blood pumps.

PubMed

Qian, K X; Zeng, P; Ru, W M; Yuan, H Y

2006-05-01

According to tradition, permanent maglev cannot achieve stable equilibrium. The authors have developed, to the contrary, two stable permanent maglev impeller blood pumps. The first pump is an axially driven uni-ventricular assist pump, in which the rotor with impeller is radially supported by two passive magnetic bearings, but has one point contact with the stator axially at standstill. As the pump raises its rotating speed, the increasing hydrodynamic force of fluid acting on the impeller will make the rotor taking off from contacting point and disaffiliate from the stator. Then the rotor becomes fully suspended. The second pump is a radially driven bi-ventricular assist pump, i.e., an impeller total artificial heart. Its rotor with two impellers on both ends is supported by two passive magnetic bearings, which counteract the attractive force between rotor magnets and stator coil iron core. The rotor is affiliated to the stator radially at standstill and becomes levitated during rotation. Therefore, the rotor keeps concentric with stator during rotation but eccentric at standstill, as is confirmed by rotor position detection with Honeywell sensors. It concludes that the permanent maglev needs action of a non-magnetic force to achieve stability but a rotating magnetic levitator with high speed and large inertia can maintain its stability merely with passive magnetic bearings.

Quantum Glass of Interacting Bosons with Off-Diagonal Disorder

NASA Astrophysics Data System (ADS)

Piekarska, A. M.; Kopeć, T. K.

2018-04-01

We study disordered interacting bosons described by the Bose-Hubbard model with Gaussian-distributed random tunneling amplitudes. It is shown that the off-diagonal disorder induces a spin-glass-like ground state, characterized by randomly frozen quantum-mechanical U(1) phases of bosons. To access criticality, we employ the "n -replica trick," as in the spin-glass theory, and the Trotter-Suzuki method for decomposition of the statistical density operator, along with numerical calculations. The interplay between disorder, quantum, and thermal fluctuations leads to phase diagrams exhibiting a glassy state of bosons, which are studied as a function of model parameters. The considered system may be relevant for quantum simulators of optical-lattice bosons, where the randomness can be introduced in a controlled way. The latter is supported by a proposition of experimental realization of the system in question.

Enhanced photoluminescence intensity by modifying the surface nanostructure of Nd3+-doped (Pb, La)(Zr, Ti)O3 ceramics.

PubMed

Xu, Long; Zhang, Jingwen; Zhao, Hua; Sun, Haibin; Xu, Caixia

2017-09-01

Quasi-period cylindrical nanostructures with both diameters and intervals of about 100 nm are manufactured on the surfaces of Nd 3+ -doped lanthanum lead zirconate titanate ceramics by femtosecond laser irradiation under SF 6 atmosphere. A light-emission enhancement of more than 20 times is investigated, accompanied by an extremely long trailing-off time of light emission and lower threshold. A specific polarization state of the light emission is achieved and tuned by changing the incident regions of the pumping source. The increased absorption coefficient of the specimen is discussed based on multiple scattering and weak localization of light. In addition, both the scatterers provided by the laser-machined nanostructure and the recurrent photoinduced trapping and re-excitation process participated in the enhancement of the light emission. This Letter offers new insight to improve the luminescence property of laser materials, as well as to broaden the range of exploring the weak localization of light and random lasers.

Randomised trial comparing hand expression with breast pumping for mothers of term newborns feeding poorly.

PubMed

Flaherman, Valerie J; Gay, Barbara; Scott, Cheryl; Avins, Andrew; Lee, Kathryn A; Newman, Thomas B

2012-01-01

Breast pumping or hand expression may be recommended when newborns latch or suck poorly. A recent trial found worse outcomes among mothers who used a breast pump in the early postpartum period. The objective of this study was to compare bilateral electric breast pumping to hand expression among mothers of healthy term infants feeding poorly at 12-36 h after birth. Randomised controlled trial. Well-baby nursery and postpartum unit. 68 mothers of newborns 12-36 h old who were latching or sucking poorly were randomly assigned to either 15 min of bilateral electric pumping or 15 min of hand expression. Milk transfer, maternal pain, breastfeeding confidence and breast milk expression experience (BMEE) immediately after the intervention, and breastfeeding rates at 2 months after birth. The median volume of expressed milk (range) was 0.5 (0-5) ml for hand expressing mothers and 1 (0-40) ml for pumping mothers (p=0.07). Maternal pain, breastfeeding confidence and BMEE did not differ by intervention. At 2 months, mothers assigned to hand expression were more likely to be breastfeeding (96.1%) than mothers assigned to breast pumping (72.7%) (p=0.02). Hand expression in the early postpartum period appears to improve eventual breastfeeding rates at 2 months after birth compared with breast pumping, but further research is needed to confirm this. However, in circumstances where either pumping or hand expression would be appropriate for healthy term infants 12-36 h old feeding poorly, providers should consider recommending hand expression.

Preoperative factors affecting cost and length of stay for isolated off-pump coronary artery bypass grafting: hierarchical linear model analysis.

PubMed

Shinjo, Daisuke; Fushimi, Kiyohide

2015-11-17

To determine the effect of preoperative patient and hospital factors on resource use, cost and length of stay (LOS) among patients undergoing off-pump coronary artery bypass grafting (OPCAB). Observational retrospective study. Data from the Japanese Administrative Database. Patients who underwent isolated, elective OPCAB between April 2011 and March 2012. The primary outcomes of this study were inpatient cost and LOS associated with OPCAB. A two-level hierarchical linear model was used to examine the effects of patient and hospital characteristics on inpatient costs and LOS. The independent variables were patient and hospital factors. We identified 2491 patients who underwent OPCAB at 268 hospitals. The mean cost of OPCAB was $40 665 ±7774, and the mean LOS was 23.4±8.2 days. The study found that select patient factors and certain comorbidities were associated with a high cost and long LOS. A high hospital OPCAB volume was associated with a low cost (-6.6%; p=0.024) as well as a short LOS (-17.6%, p<0.001). The hospital OPCAB volume is associated with efficient resource use. The findings of the present study indicate the need to focus on hospital elective OPCAB volume in Japan in order to improve cost and LOS. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

78 FR 23546 - Proposed Extension of Approval of Information Collection; Comment Request: Virginia Graeme Baker...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-19

..., 2011. In addition to the anti-entrapment devices or systems, each public pool and spa in the United... release system; suction-limiting vent system; gravity drainage system; automatic pump shut-off system or...

Energo- and exergo-technical assessment of ground-source heat pump systems for geothermal energy production from underground mines.

PubMed

Amiri, Leyla; Madadian, Edris; Hassani, Ferri P

2018-06-08

The objective of this study is to perform the energy and exergy analysis of an integrated ground-source heat pump (GSHP) system, along with technical assessment, for geothermal energy production by deployment of Engineering Equation Solver (EES). The system comprises heat pump cycle and ground heat exchanger for extracting geothermal energy from underground mine water. A simultaneous energy and exergy analysis of the system is brought off. These analyses provided persuasive outcomes due to the use of an economic and green source of energy. The energetic coefficient of performance (COP) of the entire system is 2.33 and the exergy efficiency of the system is 28.6%. The exergetic efficiencies of the compressor, ground heat exchanger, evaporator, expansion valve, condenser and fan are computed to be 38%, 42%, 53%, 55%, 60% and 64%, respectively. In the numerical investigation, different alteration such as changing the temperature and pressure of the condenser show promising potential for further application of GSHPs. The outcomes of this research can be used for developing and designing novel coupled heat and power systems.

Temporal patterns of physical activity in Olympic dinghy racing.

PubMed

Legg, S; Mackie, H; Smith, P

1999-12-01

The objective of the present study was to determine the temporal patterns of physical activity in four classes of Olympic racing dinghy. Descriptive. A field (on-water) study. Nineteen elite New Zealand sailors (fifteen male and four female). Not applicable. The temporal pattern (duration and frequency) and nature of the physical activities of each sailor during each leg of simulated races were recorded on video tape and subsequently systematically quantified and categorised using notational analysis. The accumulated percentage of total leg time spent sitting (upright or leaning backwards), hiking (upright or fully extended) whilst trimming and whilst pumping the mainsheet and for the time spent on rig adjustments, tacking and gybing were calculated for both up-wind and off-wind sailing. When sailing up-wind, the most time was spent hiking upright (average 29-66% of total leg time) while trimming the mainsheet. During off-wind sailing, sailors spent the most time sitting upright while trimming the mainsheet (average 29-55% total leg time). Hiking upright while trimming the mainsheet was executed the greatest number of times (average 15.8-23.9) when sailing up-wind and sitting upright while trimming was executed the most times (average 3.5-7.4) when sailing off-wind. The most lengthy continuous activity was hiking upright while trimming the mainsheet when sailing up-wind (9-18 seconds) and sitting upright while trimming the mainsheet when sailing off-wind (17-34 seconds). The most physically demanding aspect of Olympic yacht racing is hiking. It occurs for the majority of up-wind legs when the wind starts to exceed approximately 8 knots. The only respite that the sailor gets from hiking is during tacking, rig adjustments or sitting in-board for brief periods when the wind is low. Sustained hiking tends to last for no more than approximately 20 seconds before the sailor changes to either a more extended or more upright hiking posture. The physical demands during off-wind sailing are generally less, except for a greater requirement for power in the arms and shoulders to pump the mainsheet in order to assist the dinghy in accelerating down waves. The findings of the present study are directly applicable to the design of sailing specific physical conditioning programmes for Olympic class sailors.

Low amplified spontaneous emission threshold and suppression of electroluminescence efficiency roll-off in layers doped with ter(9,9'-spirobifluorene)

NASA Astrophysics Data System (ADS)

Inoue, Munetomo; Matsushima, Toshinori; Adachi, Chihaya

2016-03-01

We demonstrate that ter(9,9'-spirobifluorene) (TSBF) doped in a host matrix layer of 4,4'-bis(carbazol-9-yl)biphenyl (CBP) shows a low amplified spontaneous emission (ASE) threshold (Eth = 1.0 μJ cm-2) and suppressed electroluminescence efficiency roll-off at high current densities (no roll-off up to 100 mA cm-2). One origin of the low ASE threshold is that the TSBF-doped CBP layer possesses a very large radiative decay constant (kr = 1.1 × 109 s-1). Singlet-triplet annihilation is almost suppressed in the TSBF-doped CBP layer, which can be ascribed to the small overlap between the emission and triplet absorption of TSBF. Also, the small energy level difference between TSBF and CBP minimizes carrier trapping in TSBF, leading to the suppression of singlet-polaron annihilation. TSBF showed one of the lowest Eth and the most suppressed efficiency roll-off among organic laser dyes investigated in this study and, therefore, is believed to be a promising candidate to realize electrically pumped organic semiconductor laser diodes in the future.

Corrective Feedback, Spoken Accuracy and Fluency, and the Trade-Off Hypothesis

ERIC Educational Resources Information Center

Chehr Azad, Mohammad Hassan; Farrokhi, Farahman; Zohrabi, Mohammad

2018-01-01

The current study was an attempt to investigate the effects of different corrective feedback (CF) conditions on Iranian EFL learners' spoken accuracy and fluency (AF) and the trade-off between them. Consequently, four pre-intermediate intact classes were randomly selected as the control, delayed explicit metalinguistic CF, extensive recast, and…

Significance of off-pump coronary artery bypass grafting compared with percutaneous coronary intervention: a propensity score analysis.

PubMed

Marui, Akira; Kimura, Takeshi; Tanaka, Shiro; Furukawa, Yutaka; Kita, Toru; Sakata, Ryuzo

2012-01-01

Although there have been several studies that compared the efficacy of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), the impact of off-pump CABG (OPCAB) has not been well elucidated. The objective of the present study was to compare the outcomes after PCI, on-pump CABG (ONCAB), and OPCAB in patients with multivessel and/or left main disease. Among the 9877 patients undergoing first PCI using bare-metal stents or CABG who were enrolled in the CREDO-Kyoto Registry, 6327 patients with multivessel and/or left main disease were enrolled into the present study (67.9±9.8 years old). Among them, 3877 patients received PCI, 1388 ONCAB, and 1069 OPCAB. Median follow-up was 3.5 years. Comparing PCI with all CABG (ONCAB and OPCAB), propensity-score-adjusted all-cause mortality after PCI was higher than that CABG (hazard ratio (95% confidence interval): 1.37 (1.15-1.63), p<0.01). The incidence of stroke was lower after PCI than that after CABG (0.75 (0.59-0.96), p=0.02). CABG was associated with better survival outcomes than PCI in the elderly (interaction p=0.04). Comparing OPCAB with PCI or ONCAB, propensity-score-adjusted all-cause mortality after PCI was higher than that after OPCAB (1.50 (1.20-1.86), p<0.01). Adjusted mortality was similar between ONCAB and OPCAB (1.18 (0.93-1.51), p=0.33). The incidence of stroke after OPCAB was similar to that after PCI (0.98 (0.71-1.34), p>0.99), but incidence of stroke after ONCAB was higher than that after OPCAB (1.59 (1.16-2.18), p<0.01). In patients with multivessel and/or left main disease, CABG, particularly OPCAB, is associated with better survival outcomes than PCI using bare-metal stents. Survival outcomes are similar between ONCAB and OPCAB.

View from southeast to northwest of administration building. Community center ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

View from southeast to northwest of administration building. Community center can be seen in far left background - Stanley R. Mickelsen Safeguard Complex, Administrative Headquarters Building, In Controlled Area just off Avenue A & East of Pump House, Nekoma, Cavalier County, ND

Ultra-long fiber Raman lasers: design considerations

NASA Astrophysics Data System (ADS)

Koltchanov, I.; Kroushkov, D. I.; Richter, A.

2015-03-01

In frame of the European Marie Currie project GRIFFON [http://astonishgriffon.net/] the usage of a green approach in terms of reduced power consumption and maintenance costs is envisioned for long-span fiber networks. This shall be accomplished by coherent transmission in unrepeatered links (100 km - 350 km) utilizing ultra-long Raman fiber laser (URFL)-based distributed amplification, multi-level modulation formats, and adapted Digital Signal Processing (DSP) algorithms. The URFL uses a cascaded 2-order pumping scheme where two (co- and counter-) ˜ 1365 nm pumps illuminate the fiber. The URFL oscillates at ˜ 1450 nm whereas amplification is provided by stimulated Raman scattering (SRS) of the ˜ 1365 nm pumps and the optical feedback is realized by two Fiber Bragg gratings (FBGs) at the fiber ends reflecting at 1450 nm. The light field at 1450 nm provides amplification for signal waves in the 1550 nm range due to SRS. In this work we present URFL design studies intended to characterize and optimize the power and noise characteristics of the fiber links. We use a bidirectional fiber model describing propagation of the signal, pump and noise powers along the fiber length. From the numerical solution we evaluate the on/off Raman gain and its bandwidth, the signal excursion over the fiber length, OSNR spectra, and the accumulated nonlinearities. To achieve best performance for these characteristics the laser design is optimized with respect to the forward/backward pump powers and wavelengths, input/output signal powers, reflectivity profile of the FBGs and other parameters.

Electrochemical oxidation coupled with liquid chromatography and mass spectrometry to study the oxidative stability of active pharmaceutical ingredients in solution: A comparison of off-line and on-line approaches.

PubMed

Torres, Susana; Brown, Roland; Zelesky, Todd; Scrivens, Garry; Szucs, Roman; Hawkins, Joel M; Taylor, Mark R

2016-11-30

Stability studies of pharmaceutical drug products and pharmaceutical active substances are important to research and development in order to fully understand and maintain product quality and safety throughout its shelf-life. Oxidative forced degradation studies are among the different types of stability studies performed by the pharmaceutical industry in order to understand the intrinsic stability of drug molecules. We have been comparing the use of electrochemistry as an alternative oxidative forced degradation method to traditional forced degradation and accelerated stability studies. Using the electrochemical degradation approach the substrate oxidation takes place in a commercially available electrochemical cell and the effluent of the cell can be either a) directly infused into the mass spectrometer or b) injected in a chromatographic column for separation of the different products formed prior to the mass spectrometry analysis. To enable the study of large numbers of different experimental conditions and molecules we developed a new dual pump automated electrochemical screening platform. This system used a HPLC pump and autosampler to load and wash the electrochemical cell and deliver the oxidized sample plug to a second injection loop. This system enabled the automatic sequential analyses of large numbers of different solutions under varied experimental conditions without need for operator intervention during the run sequence. Here we describe the system and evaluate its performance using a test molecule with well characterized stability and compare results to those obtained using an off-line electrochemistry approach. Copyright © 2016 Elsevier B.V. All rights reserved.

Stimulated Raman scattering of sub-millimeter waves in bismuth

NASA Astrophysics Data System (ADS)

Kumar, Pawan; Tripathi, V. K.

2007-12-01

A high-power sub-millimeter wave propagating through bismuth, a semimetal with non-spherical energy surfaces, parametrically excites a space-charge mode and a back-scattered electromagnetic wave. The free carrier density perturbation associated with the space-charge wave couples with the oscillatory velocity due to the pump to derive the scattered wave. The scattered and pump waves exert a pondermotive force on electrons and holes, driving the space-charge wave. The collisional damping of the decay waves determines the threshold for the parametric instability. The threshold intensity for 20 μm wavelength pump turns out to be ˜2×1012 W/cm2. Above the threshold, the growth rate scales increase with ωo, attain a maximum around ωo=6.5ωp, and, after this, falls off.

Saturation of low-threshold two-plasmon parametric decay leading to excitation of one localized upper hybrid wave

NASA Astrophysics Data System (ADS)

Gusakov, E. Z.; Popov, A. Yu.; Saveliev, A. N.

2018-06-01

We analyze the saturation of the low-threshold absolute parametric decay instability of an extraordinary pump wave leading to the excitation of two upper hybrid (UH) waves, only one of which is trapped in the vicinity of a local maximum of the plasma density profile. The pump depletion and the secondary decay of the localized daughter UH wave are treated as the most likely moderators of a primary two-plasmon decay instability. The reduced equations describing the nonlinear saturation phenomena are derived. The general analytical consideration is accompanied by the numerical analysis performed under the experimental conditions typical of the off-axis X2-mode ECRH experiments at TEXTOR. The possibility of substantial (up to 20%) anomalous absorption of the pump wave is predicted.

Maintenance of valvular integrity with Impella left heart support: Results from the multicenter PROTECT II randomized study.

PubMed

Goldstein, James A; Dixon, Simon R; Douglas, Pamela S; Ohman, E Magnus; Moses, Jeffrey; Popma, Jeffrey J; O'Neill, William W

2017-10-08

The Impella 2.5 axial flow pump, which is positioned across the aortic valve, is widely employed for hemodynamic support. The present study compared structural and functional integrity of the left heart valves in patients undergoing Impella vs intra-aortic balloon pump in the randomized PROTECT II trial. Transthoracic echocardiograms were performed at baseline, 1 and 3 months in 445 patients in the PROTECT II trial. Serial studies were analyzed by an independent echocardiography core laboratory for aortic and mitral valve structure and function, and left ventricular ejection fraction (LVEF). During Impella support there was no appreciable change in the degree of baseline valvular regurgitation. There were no cases of structural derangement of the mitral or aortic valve after use of the Impella device. At 90-day follow-up, there was an average 22% relative increase in LVEF from baseline (27% ± 9 vs. 33% ± 11, P < 0.001). The present echocardiographic analysis of the PROTECT II study confirms prior observations regarding the safety of the Impella 2.5 device with respect to mitral and aortic valve function. © 2017 Wiley Periodicals, Inc.

ASPIRE In-Home: rationale, design, and methods of a study to evaluate the safety and efficacy of automatic insulin suspension for nocturnal hypoglycemia.

PubMed

Klonoff, David C; Bergenstal, Richard M; Garg, Satish K; Bode, Bruce W; Meredith, Melissa; Slover, Robert H; Ahmann, Andrew; Welsh, John B; Lee, Scott W

2013-07-01

Nocturnal hypoglycemia is a barrier to therapy intensification efforts in diabetes. The Paradigm® Veo™ system may mitigate nocturnal hypoglycemia by automatically suspending insulin when a prespecified sensor glucose threshold is reached. ASPIRE (Automation to Simulate Pancreatic Insulin REsponse) In-Home (NCT01497938) was a multicenter, randomized, parallel, adaptive study of subjects with type 1 diabetes. The control arm used sensor-augmented pump therapy. The treatment arm used sensor-augmented pump therapy with threshold suspend, which automatically suspends the insulin pump in response to a sensor glucose value at or below a prespecified threshold. To be randomized, subjects had to have demonstrated ≥2 episodes of nocturnal hypoglycemia, defined as >20 consecutive minutes of sensor glucose values ≤65 mg/dl starting between 10:00 PM and 8:00 AM in the 2-week run-in phase. The 3-month study phase evaluated safety by comparing changes in glycated hemoglobin (A1C) values and evaluated efficacy by comparing the mean area under the glucose concentration time curves for nocturnal hypoglycemia events in the two groups. Other outcomes included the rate of nocturnal hypoglycemia events and the distribution of sensor glucose values. Data from the ASPIRE In-Home study should provide evidence on the safety of the threshold suspend feature with respect to A1C and its efficacy with respect to severity and duration of nocturnal hypoglycemia when used at home over a 3-month period. © 2013 Diabetes Technology Society.

Rabeprazole: the role of proton pump inhibitors in Helicobacter pylori eradication.

PubMed

Sharara, Ala I

2005-12-01

Proton pump inhibitors have become one of the cornerstones in the treatment of Helicobacter pylori infection. Rabeprazole (Pariet) is a substituted benzimidazole proton pump inhibitor with potent gastric acid suppression properties. Its high acid-base dissociation constant allows activation over a broader pH range, resulting in quick, irreversible binding to the H+/K+-ATPase pump, and a more rapid onset of action compared with omeprazole, lansoprazole and pantoprazole. Unlike other proton pump inhibitors, the metabolism of rabeprazole is primarily via a nonenzymatic reduction to the thioether derivative, and the cytochrome P450 isoenzyme 2C19 is only partly involved in its metabolism. The effect of genetic polymorphism in cytochrome P450 isoenzyme 2C19 on the pharmacokinetics and pharmacodynamics of rabeprazole is therefore limited. In humans, once-daily dosing of 5-40 mg of rabeprazole inhibits gastric acid secretion in a dose-dependent manner. In vitro studies have shown that rabeprazole possesses more potent antibacterial properties against the growth of H. pylori than other proton pump inhibitors. Furthermore, its thioether derivative has more potent inhibitory in vitro activity against the growth and motility of clarithromycin-resistant H. pylori than other proton pump inhibitors or commonly used antimicrobials. Despite these inherent favorable characteristics of rabeprazole, randomized controlled trials have largely shown equivalence amongst proton pump inhibitors when used with two antibiotics in the eradication of H. pylori, with cure rates of 75-89% on an intent-to-treat basis. However, rabeprazole appears to consistently achieve such comparable eradication rates even when used at reduced doses (10 mg twice daily) as part of clarithromycin-based triple therapy.

Giant pseudoaneurysm from Vieussens' arterial ring.

PubMed

Kocica, Mladen J; Vranes, Mile R; Djukic, Petar L; Mikic, Aleksandar Dj; Velinovic, Milos M; Havelka, Marija; Kanjuh, Vladimir I

2004-11-01

A giant coronary pseudoaneurysm of uncertain cause, arising from Vieussens' arterial ring, was preoperatively diagnosed in an oligosymptomatic female patient. Successful off-pump surgical excision without additional bypass grafting was performed. Difficulties in diagnostic algorithm, as well as possible cause and extremely rare localization were discussed.

Recent development on high-power tandem-pumped fiber laser

NASA Astrophysics Data System (ADS)

Zhou, Pu; Xiao, Hu; Leng, Jinyong; Zhang, Hanwei; Xu, Jiangmin; Wu, Jian

2016-11-01

High power fiber laser is attracting more and more attention due to its advantage in excellent beam quality, high electricto- optical conversion efficiency and compact system configuration. Power scaling of fiber laser is challenged by the brightness of pump source, nonlinear effect, modal instability and so on. Pumping active fiber by using high-brightness fiber laser instead of common laser diode may be the solution for the brightness limitation. In this paper, we will present the recent development of various kinds of high power fiber laser based on tandem pumping scheme. According to the absorption property of Ytterbium-doped fiber, Thulium-doped fiber and Holmium-doped fiber, we have theoretically studied the fiber lasers that operate at 1018 nm, 1178 nm and 1150 nm, respectively in detail. Consequently, according to the numerical results we have optimized the fiber laser system design, and we have achieved (1) 500 watt level 1018nm Ytterbium-doped fiber laser (2) 100 watt level 1150 nm fiber laser and 100 watt level random fiber laser (3) 30 watt 1178 nm Ytterbium-doped fiber laser, 200 watt-level random fiber laser. All of the above-mentioned are the record power for the corresponded type of fiber laser to the best of our knowledge. By using the high-brightness fiber laser operate at 1018 nm, 1178 nm and 1150 nm that we have developed, we have achieved the following high power fiber laser (1) 3.5 kW 1090 nm Ytterbium-doped fiber amplifier (2) 100 watt level Thulium-doped fiber laser and (3) 50 watt level Holmium -doped fiber laser.

Cerebral hemodynamics with intra-aortic balloon pump: business as usual?

PubMed

Caldas, J R; Panerai, R B; Bor-Seng-Shu, E; Almeida, J P; Ferreira, G S R; Camara, L; Nogueira, R C; Oliveira, M L; Jatene, F B; Robinson, T G; Hajjar, L A

2017-06-22

Intra-aortic balloon pump (IABP) is commonly used as mechanical support after cardiac surgery or cardiac shock. Although its benefits for cardiac function have been well documented, its effects on cerebral circulation are still controversial. We hypothesized that transfer function analysis (TFA) and continuous estimates of dynamic cerebral autoregulation (CA) provide consistent results in the assessment of cerebral autoregulation in patients with IABP. Continuous recordings of blood pressure (BP, intra-arterial line), end-tidal CO 2 , heart rate and cerebral blood flow velocity (CBFV, transcranial Doppler) were obtained (i) 5 min with IABP ratio 1:3, (ii) 5 min, starting 1 min with the IABP-ON, and continuing for another 4 min without pump assistance (IABP-OFF). Autoregulation index (ARI) was estimated from the CBFV response to a step change in BP derived by TFA and as a function of time using an autoregressive moving-average model during removal of the device (ARI t ). Critical closing pressure and resistance area-product were also obtained. ARI with IABP-ON (4.3  ±  1.2) were not different from corresponding values at IABP-OFF (4.7  ±  1.4, p  =  0.42). Removal of the balloon had no effect on ARI t , CBFV, BP, cerebral critical closing pressure or resistance area-product. IABP does not disturb cerebral hemodynamics. TFA and continuous estimates of dynamic CA can be used to assess cerebral hemodynamics in patients with IABP. These findings have important implications for the design of studies of critically ill patients requiring the use of different invasive support devices.

Long-term Effects of Off-Pump Coronary Bypass Versus Conventional Coronary Bypass Grafting on Renal Function.

PubMed

Hynes, Conor F; Colo, Sanchez; Amdur, Richard L; Chawla, Lakhmir S; Greenberg, Michael D; Trachiotis, Gregory D

2016-01-01

This study aimed to evaluate the short- and long-term effects of conventional on-pump coronary bypass grafting (cCABG) compared with off-pump coronary artery bypass (OPCAB) on renal function. A retrospective review of patients undergoing coronary bypass grafting from 2004 through 2013 at a single center was conducted. Preoperative renal function, perioperative acute kidney injury, and long-term glomerular filtration were evaluated. Multivariable analyses were used to determine factors contributing to short- and long-term renal impairment. A total of 234 patients underwent cCABG, and 582 underwent OPCAB. Patients undergoing OPCAB were significantly older, had greater preoperative renal dysfunction, had greater functional dependence, and took more hypertension medications. Multivariable analyses found that 30-day acute kidney injury was an independent risk factor for a 10% decline in glomerular filtration rate at 1 and 5 years (P < 0.0001 and 0.002, respectively). However, the use of cardiopulmonary bypass was not found to influence long-term renal function (P = 0.78 at 1 year, P = 0.76 at 5 years). The percentage of patients experiencing a 10% drop in renal function from baseline at 1 year (33% OPCAB, 35% cCABG; P = 0.73) and 5 years (16% OPCAB, 16% cCABG; P = 0.93) were not significantly different. Independent predictors of acute kidney injury included baseline kidney function (P = 0.04) and age (P < 0.0001), whereas cardiopulmonary bypass did not affect the incidence (P = 0.17). A propensity-matched analysis confirmed these findings. Acute kidney injury is a risk factor for long-term renal dysfunction after either bypass method and was not greater after cCABG compared with OPCAB. Patients undergoing OPCAB did not experience greater decrease in long-term kidney function despite having worse baseline kidney function.

Benefits of off-pump coronary artery bypass grafting in high-risk patients.

PubMed

Marui, Akira; Okabayashi, Hitoshi; Komiya, Tatsuhiko; Tanaka, Shiro; Furukawa, Yutaka; Kita, Toru; Kimura, Takeshi; Sakata, Ryuzo

2012-09-11

The benefits of off-pump coronary artery bypass graft (OPCAB) compared with conventional on-pump coronary artery bypass graft (CCAB) remain controversial. Thus, it is important to investigate which patient subgroups may benefit the most from OPCAB rather than CCAB. Among the patients undergoing first coronary revascularization enrolled in the CREDO-Kyoto Registry (a registry of first-time percutaneous coronary intervention and coronary artery bypass graft patients in Japan), 2468 patients undergoing coronary artery bypass graft were entered into the study (mean age, 67 ± 9 years). Predicted risk of operative mortality (PROM) of each patient was calculated by logistic EuroSCORE. Patients were divided into tertile based on their PROM. Mortality rates and the incidences of cardiovascular events were compared between CCAB and OPCAB within each PROM tertile using propensity score analysis. A total of 1377 patients received CCAB whereas 1091 received OPCAB. Adjusted 30-day mortality was not significantly different between CCAB and OPCAB patients regardless of their PROM range. However, the odds ratio of 30-day stroke in CCAB compared with OPCAB in the high-risk tertile was 8.30 (95% confidence interval, 2.25-30.7; P<0.01). Regarding long-term outcomes, hazard ratio of stroke in CCAB compared with OPCAB in the high-risk tertile was 1.80 (95% confidence interval, 1.07-3.02; P=0.03). Nevertheless, hazard ratio of overall mortality in the high-risk tertile was 1.44 (95% confidence interval, 0.98-2.11; P=0.06), indicating no statistically significant difference between the 2 procedures. OPCAB as opposed to CCAB is associated with short-term and long-term benefits in stroke prevention in patients at higher risk as estimated by EuroSCORE. No survival benefit of OPCAB was shown regardless of preoperative risk level.

Successful resuscitation of cardiac arrest caused by CO2 embolism with intra-aortic injection of epinephrine during off-pump coronary bypass surgery -a case report-.

PubMed

Lee, Choon Soo; Yoon, Yeo Sam; Shim, Jae-Kwang; Lim, Hyun Kyoung

2013-12-01

Although compressed gas (CO2) blowers have been used safely to aid accurate grafting during off-pump coronary bypass surgery, hemodynamic collapse due to gas embolism into the right coronary artery may occur. Supportive measures to facilitate gas clearance by increasing the coronary perfusion pressure have been reported to be successful in restoring hemodynamic stability. However, right ventricular dysfunction and atrioventricular nodal ischemia may hinder effective systemic delivery of the vasoactive medications, even when performing resuscitative measures such as direct cardiac massage. We herein report a case of cardiac arrest that was caused by a right coronary gas embolism and that could not be restored by cardiac resuscitation. When supportive measures fail, direct aortic injection of epinephrine to increase the coronary perfusion pressure can be attempted before initiating cardiopulmonary bypass, and this approach may be life-saving in situations that limit systemic drug delivery from the venous side despite the performance of direct cardiac massage.

Successful resuscitation of cardiac arrest caused by CO2 embolism with intra-aortic injection of epinephrine during off-pump coronary bypass surgery -a case report-

PubMed Central

Lee, Choon Soo; Yoon, Yeo Sam; Shim, Jae-Kwang

2013-01-01

Although compressed gas (CO2) blowers have been used safely to aid accurate grafting during off-pump coronary bypass surgery, hemodynamic collapse due to gas embolism into the right coronary artery may occur. Supportive measures to facilitate gas clearance by increasing the coronary perfusion pressure have been reported to be successful in restoring hemodynamic stability. However, right ventricular dysfunction and atrioventricular nodal ischemia may hinder effective systemic delivery of the vasoactive medications, even when performing resuscitative measures such as direct cardiac massage. We herein report a case of cardiac arrest that was caused by a right coronary gas embolism and that could not be restored by cardiac resuscitation. When supportive measures fail, direct aortic injection of epinephrine to increase the coronary perfusion pressure can be attempted before initiating cardiopulmonary bypass, and this approach may be life-saving in situations that limit systemic drug delivery from the venous side despite the performance of direct cardiac massage. PMID:24427464

Controlled in-situ dissolution of an alkali metal

DOEpatents

Jones, Jeffrey Donald; Dooley, Kirk John; Tolman, David Donald

2012-09-11

A method for the controllable dissolution of one or more alkali metals from a vessel containing a one or more alkali metals and/or one or more partially passivated alkali metals. The vessel preferably comprising a sodium, NaK or other alkali metal-cooled nuclear reactor that has been used. The alkali metal, preferably sodium, potassium or a combination thereof, in the vessel is exposed to a treatment liquid, preferably an acidic liquid, more preferably citric acid. Preferably, the treatment liquid is maintained in continuous motion relative to any surface of unreacted alkali metal with which the treatment liquid is in contact. The treatment liquid is preferably pumped into the vessel containing the one or more alkali metals and the resulting fluid is extracted and optionally further processed. Preferably, the resulting off-gases are processed by an off-gas treatment system and the resulting liquids are processed by a liquid disposal system. In one preferred embodiment, an inert gas is pumped into the vessel along with the treatment liquid.

Integration of InGaAs MOSFETs and GaAs/ AlGaAs lasers on Si Substrate for advanced opto-electronic integrated circuits (OEICs).

PubMed

Kumar, Annie; Lee, Shuh-Ying; Yadav, Sachin; Tan, Kian Hua; Loke, Wan Khai; Dong, Yuan; Lee, Kwang Hong; Wicaksono, Satrio; Liang, Gengchiau; Yoon, Soon-Fatt; Antoniadis, Dimitri; Yeo, Yee-Chia; Gong, Xiao

2017-12-11

Lasers monolithically integrated with high speed MOSFETs on the silicon (Si) substrate could be a key to realize low cost, low power, and high speed opto-electronic integrated circuits (OEICs). In this paper, we report the monolithic integration of InGaAs channel transistors with electrically pumped GaAs/AlGaAs lasers on the Si substrate for future advanced OEICs. The laser and transistor layers were grown on the Si substrate by molecular beam epitaxy (MBE) using direct epitaxial growth. InGaAs n-FETs with an I ON /I OFF ratio of more than 10 6 with very low off-state leakage and a low subthreshold swing with a minimum of 82 mV/decade were realized. Electrically pumped GaAs/AlGaAs quantum well (QW) lasers with a lasing wavelength of 795 nm at room temperature were demonstrated. The overall fabrication process has a low thermal budget of no more than 400 °C.

Observer-based perturbation extremum seeking control with input constraints for direct-contact membrane distillation process

NASA Astrophysics Data System (ADS)

Eleiwi, Fadi; Laleg-Kirati, Taous Meriem

2018-06-01

An observer-based perturbation extremum seeking control is proposed for a direct-contact membrane distillation (DCMD) process. The process is described with a dynamic model that is based on a 2D advection-diffusion equation model which has pump flow rates as process inputs. The objective of the controller is to optimise the trade-off between the permeate mass flux and the energy consumption by the pumps inside the process. Cases of single and multiple control inputs are considered through the use of only the feed pump flow rate or both the feed and the permeate pump flow rates. A nonlinear Lyapunov-based observer is designed to provide an estimation for the temperature distribution all over the designated domain of the DCMD process. Moreover, control inputs are constrained with an anti-windup technique to be within feasible and physical ranges. Performance of the proposed structure is analysed, and simulations based on real DCMD process parameters for each control input are provided.

Continued advances in high brightness fiber-coupled laser modules for efficient pumping of fiber and solid-state lasers

NASA Astrophysics Data System (ADS)

Hemenway, M.; Chen, Z.; Urbanek, W.; Dawson, D.; Bao, L.; Kanskar, M.; DeVito, M.; Martinsen, R.

2018-02-01

Both the fibber laser and diode-pumped solid-state laser market continue to drive advances in pump diode module brightness. We report on the continued progress by nLIGHT to develop and deliver the highest brightness diode-laser pumps using single-emitter technology. Continued advances in multimode laser diode technology [13] and fiber-coupling techniques have enabled higher emitter counts in the element packages, enabling us to demonstrate 305 W into 105 μm - 0.16 NA. This brightness improvement is achieved by leveraging our prior-reported package re-optimization, allowing an increase in the emitter count from two rows of nine emitters to two rows of twelve emitters. Leveraging the two rows off twelve emitter architecture,, product development has commenced on a 400 W into 200 μm - 00.16 NA package. Additionally, the advances in pump technology intended for CW Yb-doped fiber laser pumping has been leveraged to develop the highest brightness 793 nm pump modules for 2 μm Thulium fiber laser pumping, generating 150 W into 200 μm - 0.18 NA and 100 W into 105 μm - 0.15 NA. Lastly, renewed interest in direct diode materials processing led us to experiment with wavelength multiplexing our existing state of the art 200 W, 105 μm - 00.15 NA package into a combined output of 395 WW into 105 μm - 0.16 NA.

Single-Centre Experience of Off-Pump Multi-Vessel Coronary Artery Bypass Grafting Using Proximal Suture Device.

PubMed

Ohira, Suguru; Doi, Kiyoshi; Numata, Satoshi; Yamazaki, Sachiko; Itatani, Keiichi; Kawajiri, Hidetake; Morimoto, Kazuki; Yaku, Hitoshi

2017-10-01

To investigate the results of off-pump coronary artery grafting (OPCAB) with the proximal suture device (PSD) regarding postoperative stroke and graft patency. The PSD was used in 376 patients (32.0%), aorta-no-touch OPCAB was performed in 523 patients (45.2%), on-pump beating coronary artery bypass surgery (CABG) (on-beat group) in 125 patients (10.6%) including 51 conversions (conversion rate: 5.4%), and CABG with aortic clamp use (clamp group) in 152 patients. In the PSD group, Enclose II was used in 267 patients (71.0%). The hospital mortality rate was 1.95%. There was no early stroke in the OPCAB group, whereas the early-stroke rate was 0.8% in the on-beat group and 2.6% in the clamp group. The incidences of stroke at one month were: PSD group, 1.6%; no-touch group, 1.1%; on-beat group, 1.6%; and clamp group, 4.6% (p=0.014). The rates of complete revascularisation were higher in the PSD and clamp groups (94.7 and 94.0%, respectively) compared with the no-touch and on-beat groups (81.5 and 84.9%, respectively; p<0.001). The vein graft patency rates were comparable between the PSD and clamp groups. In multiple logistic regression analysis, OPCAB using the PSD did not increase the risk of stroke compared with the no-touch group (adjusted odds ratio [AOR]: 1.40; p=0.594) or on-beat group (AOR: 0.99; p=0.206), but reduced the risk of stroke compared with the clamp group (AOR: 0.19; p=0.005). Off-pump coronary artery grafting using the PSD was a safe and effective procedure. It led to lower incidences of postoperative stroke and excellent rates of graft patency and complete revascularisation compared with conventional CABG. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Continuous subcutaneous delivery of medications for home care palliative patients-using an infusion set or a pump?

PubMed

Menahem, Sasson; Shvartzman, Pesach

2010-09-01

The purpose of this study was to evaluate safety, feasibility, and efficacy of continuous drug delivery by the subcutaneous route through a solution bag connected to an infusion set compared with an infusion pump in a home palliative care setting. Patients in need of continuous subcutaneous medication delivery for pain control, nausea, and/or vomiting were recruited. The study was designed as a double-blind, crossover study. The patient was connected to two parallel subcutaneous lines running simultaneously, connected together to a line entering the subcutaneous tissue. One line is connected to an infusion set and the other to a pump. The infusion set included a 500-cc solution bag connected to a 1.5-m plastic tube containing a drip chamber controlled by a roller clamp that is gravity driven without hyaluronidase. Active medications were randomly assigned to start in either administration method and switched after 24 h. An independent research assistant evaluated symptom control and side effects at baseline and every 24 h for 2 days using a structured questionnaire. Another independent research assistant connected the lines after adding medications and evaluated technical and clinical failures. Twenty-seven patients were recruited, and of them, 18 completed the study. Incidents in fluid administration were more common through the infusion set (18 times) compared to the pump (only twice). On the other hand, no clinical significant change was noted in the average symptom levels and side effects when medications were given through the infusion set versus the pump. No local edema or irritation was observed in either way of administration. In a home palliative care setting with a medical staff on call for 24 h, using medications for symptom control can be considered to be infused to a fluid solution bag through an infusion set instead of using a syringe driver or a pump when there is a responsible caregiver to follow up on the fluid. Subcutaneous constant drug delivery through a pump is more accurate.

Experimental and numerical investigation of centrifugal pumps with asymmetric inflow conditions

NASA Astrophysics Data System (ADS)

Mittag, Sten; Gabi, Martin

2015-11-01

Most of the times pumps operate off best point states. Reasons are changes of operating conditions, modifications, pollution and wearout or erosion. As consequences non-rotational symmetric flows, transient operational conditions, increased risk of cavitation, decrease of efficiency and unpredictable wearout can appear. Especially construction components of centrifugal pumps, in particular intake elbows, contribute to this matter. Intake elbows causes additional losses and secondary flows, hence non-rotational velocity distributions as intake profile to the centrifugal pump. As a result the impeller vanes experience permanent changes of the intake flow angle and with it transient flow conditions in the blade channels. This paper presents the first results of a project, experimentally and numerically investigating the consequences of non-rotational inflow to leading edge flow conditions of a centrifugal pump. Therefore two pumpintake- elbow systems are compared, by only altering the intake elbow geometry: a common single bended 90° elbow and a numerically optimized elbow (improved regarding rotational symmetric inflow conditions and friction coefficient). The experiments are carried out, using time resolved stereoscopic PIV on a full acrylic pump with refractions index matched (RIM) working fluid. This allows transient investigations of the flow field simultaneously for all blade leading edges. Additional CFD results are validated and used to further support the investigation i.e. for comparing an analog pump system with ideal inflow conditions.

Coronagraphic Notch Filter for Raman Spectroscopy

NASA Technical Reports Server (NTRS)

Cohen, David; Stirbl, Robert

2004-01-01

A modified coronagraph has been proposed as a prototype of improved notch filters in Raman spectrometers. Coronagraphic notch filters could offer alternatives to both (1) the large and expensive double or triple monochromators in older Raman spectrometers and (2) holographic notch filters, which are less expensive but are subject to environmental degradation as well as to limitations of geometry and spectral range. Measurement of a Raman spectrum is an exercise in measuring and resolving faint spectral lines close to a bright peak: In Raman spectroscopy, a monochromatic beam of light (the pump beam) excites a sample of material that one seeks to analyze. The pump beam generates a small flux of scattered light at wavelengths slightly greater than that of the pump beam. The shift in wavelength of the scattered light from the pump wavelength is known in the art as the Stokes shift. Typically, the flux of scattered light is of the order of 10 7 that of the pump beam and the Stokes shift lies in the wave-number range of 100 to 3,000 cm 1. A notch filter can be used to suppress the pump-beam spectral peak while passing the nearby faint Raman spectral lines. The basic principles of design and operation of a coronagraph offer an opportunity for engineering the spectral transmittance of the optics in a Raman spectrometer. A classical coronagraph may be understood as two imaging systems placed end to end, such that the first system forms an intermediate real image of a nominally infinitely distant object and the second system forms a final real image of the intermediate real image. If the light incident on the first telescope is collimated, then the intermediate image is a point-spread function (PSF). If an appropriately tailored occulting spot (e.g., a Gaussian-apodized spot with maximum absorption on axis) is placed on the intermediate image plane, then the instrument inhibits transmission of light from an on-axis source. However, the PSFs of off-axis light sources are formed off axis - that is, away from the occulting spot - so that they become refocused onto the final image plane.

Synchronization modulation of Na/K pumps on Xenopus oocytes

NASA Astrophysics Data System (ADS)

Liang, Pengfei; Mast, Jason; Chen, Wei

We developed a new technique named synchronization modulation to electrically synchronize and modulate the Na/K pump molecules by a specially designed oscillating electric field. This technique is based on the theory of energy-trap in quantum physics as well as the concept of electronic synchrotron accelerator. As a result, the Na-transports are all entrapped into the positive half-cycle of the applied electric field and consequently, all of the K-transports are entrapped into the negative half cycle of the field. To demonstrate the process of the pump synchronization and modulation, we use Xenopus oocytes as a platform and introduce two-electrode whole-cell voltage clamp in measurement of pump current. Practically, we first synchronize the pump molecules running at the same pace (rate and phase) by a specially designed oscillation electric field. Then, we carefully maintain the pump synchronization status and gradually change the field frequency (decrease and increase) to modulate the pump molecules to newer pumping rate. The result shows a separation of the inward K current from the outward Na current, and about 10 time increase of the total (inward plus outward) pump current from the net outward current from the random paced pump molecules. Also, the ratio of the modulated total pump current with synchronized total pump current is consistent with the ratio of their field frequencies.

Astigmatism transfer phenomena in the optical parametric amplification process

NASA Astrophysics Data System (ADS)

Li, Wenkai; Chen, Yun; Li, Yanyan; Xu, Yi; Guo, Xiaoyang; Lu, Jun; Leng, Yuxin

2017-01-01

We numerically and experimentally investigate the astigmatism transfer phenomena in femtosecond optical parametric amplification (OPA). We model the OPA process based on the coupled second-order three-wave nonlinear propagation equations. The numerical and experimental results support that the input pump pulse astigmatism can be transferred into the idler pulse but not the signal pulse, and the idler pulse astigmatism originating from spatial walk-off is less than the idler pulse astigmatism received from the pump. Thus, we can provide a clear understanding of astigmatism transfer mechanisms in the OPA process, and make better use of broadband tunable OPA sources.

Efficient, high power, Q-switched Nd:YLF slab laser end-pumped by diode stack

NASA Astrophysics Data System (ADS)

Zhang, Hengli; Li, Daijun; Shi, Peng; Diart, Rober; Shell, Alexander; Haas, Claus R.; Du, Keming

2005-06-01

A high power diode stack end-pumped electro-optically Q-switched Nd:YLF slab laser with a stable and off-axis negative-branch confocal unstable hybrid resonator was demonstrated. By using a cylindrical lens in the stable direction the thermal lens effect was compensated. Pulse energy of 25 mJ was obtained with a pulse width of 22.4 ns at repetition rates of 500 Hz and a conversion efficiency of 22%. The stability was better than 0.8% and the beam propagation M2 factor was about 1.2.

Practical and efficient magnetic heat pump

NASA Technical Reports Server (NTRS)

Brown, G. V.

1978-01-01

Method for pumping heat magnetically at room temperature is more economical than existing refrigeration systems. Method uses natural magneto-thermal effect of gadolinium metal to establish temperature gradient across length of tube. Regenerative cyclic process in which gadolinium sample is magnetized and gives off heat at one end of tube, and then is demagnetized at other end to absorb heat has established temperature gradients of 144 degrees F in experiments near room temperature. Other materials with large magnetothermal effects can be used below room temperature. Possible commercial applications include freeze-drying and food processing, cold storage, and heating and cooling of buildings, plants, and ships.

Hydrologic trade-offs in conjunctive use management.

PubMed

Bredehoeft, John

2011-01-01

An aquifer, in a stream/aquifer system, acts as a storage reservoir for groundwater. Groundwater pumping creates stream depletion that recharges the aquifer. As wells in the aquifer are moved away from the stream, the aquifer acts to filter out annual fluctuations in pumping; with distance the stream depletion tends to become equal to the total pumping averaged as an annual rate, with only a small fluctuation. This is true for both a single well and an ensemble of wells. A typical growing season in much of the western United States is 3 to 4 months. An ensemble of irrigation wells spread more or less uniformly across an aquifer several miles wide, pumping during the growing season, will deplete the stream by approximately one-third of the total amount of water pumped during the growing season. The remaining two-thirds of stream depletion occurs outside the growing season. Furthermore, it takes more than a decade of pumping for an ensemble of wells to reach a steady-state condition in which the impact on the stream is the same in succeeding years. After a decade or more of pumping, the depletion is nearly constant through the year, with only a small seasonal fluctuation: ±10%. Conversely, stream depletion following shutting down the pumping from an ensemble of wells takes more than a decade to fully recover from the prior pumping. Effectively managing a conjunctive groundwater and surface water system requires integrating the entire system into a single management institution with a long-term outlook. Copyright © 2010 The Author(s). Journal compilation © 2010 National Ground Water Association.

Research on the performance of low-lift diving tubular pumping system by CFD and Test

NASA Astrophysics Data System (ADS)

Xia, Chenzhi; Cheng, Li; Liu, Chao; Zhou, Jiren; Tang, Fangping; Jin, Yan

2016-11-01

Post-diving tubular pump is always used in large-discharge & low-head irrigation or storm drainage pumping station, its impeller and motor share the same shaft. Considering diving tubular pump system's excellent hydraulic performance, compact structure, good noise resistance and low operating cost, it is used in Chinese pump stations. To study the hydraulic performance and pressure fluctuation of inlet and outlet passage in diving tubular pump system, both of steady and unsteady full flow fields are numerically simulated at three flow rate conditions by using CFD commercial software. The asymmetry of the longitudinal structure of inlet passage affects the flow pattern on outlet. Especially at small flow rate condition, structural asymmetry will result in the uneven velocity distribution on the outlet of passage inlet. The axial velocity distribution uniformity increases as the flow rate increases on the inlet of passage inlet, and there is a positive correlation between hydraulic loss in the passage inlet and flow rate's quadratic. The axial velocity distribution uniformity on the outlet of passage inlet is 90% at design flow rate condition. The predicted result shows the same trend with test result, and the range of high efficiency area between predicted result and test result is almost identical. The dominant frequency of pressure pulsation is low frequency in inlet passage at design condition. The dominant frequency is high frequency in inlet passage at small and large flow rate condition. At large flow rate condition, the flow pattern is significantly affected by the rotation of impeller in inlet passage. At off-design condition, the pressure pulsation is strong at outlet passage. At design condition, the dominant frequency is 35.57Hz, which is double rotation frequency.

Initial in vitro testing of a paediatric continuous-flow total artificial heart.

PubMed

Fukamachi, Kiyotaka; Karimov, Jamshid H; Horvath, David J; Sunagawa, Gengo; Byram, Nicole A; Kuban, Barry D; Moazami, Nader

2018-06-01

Mechanical circulatory support has become standard therapy for adult patients with end-stage heart failure; however, in paediatric patients with congenital heart disease, the options for chronic mechanical circulatory support are limited to paracorporeal devices or off-label use of devices intended for implantation in adults. Congenital heart disease and cardiomyopathy often involve both the left and right ventricles; in such cases, heart transplantation, a biventricular assist device or a total artificial heart is needed to adequately sustain both pulmonary and systemic circulations. We aimed to evaluate the in vitro performance of the initial prototype of our paediatric continuous-flow total artificial heart. The paediatric continuous-flow total artificial heart pump was downsized from the adult continuous-flow total artificial heart configuration by a scale factor of 0.70 (1/3 of total volume) to enable implantation in infants. System performance of this prototype was evaluated using the continuous-flow total artificial heart mock loop set to mimic paediatric circulation. We generated maps of pump performance and atrial pressure differences over a wide range of systemic vascular resistance/pulmonary vascular resistance and pump speeds. Performance data indicated left pump flow range of 0.4-4.7 l/min at 100 mmHg delta pressure. The left/right atrial pressure difference was maintained within ±5 mmHg with systemic vascular resistance/pulmonary vascular resistance ratios between 1.4 and 35, with/without pump speed modulation, verifying expected passive self-regulation of atrial pressure balance. The paediatric continuous-flow total artificial heart prototype met design requirements for self-regulation and performance; in vivo pump performance studies are ongoing.

Sensor-Augmented Insulin Pumps and Hypoglycemia Prevention in Type 1 Diabetes

PubMed Central

Steineck, Isabelle; Ranjan, Ajenthen; Nørgaard, Kirsten; Schmidt, Signe

2016-01-01

Hypoglycemia can lead to seizures, unconsciousness, or death. Insulin pump treatment reduces the frequency of severe hypoglycemia compared with multiple daily injections treatment. The addition of a continuous glucose monitor, so-called sensor-augmented pump (SAP) treatment, has the potential to further limit the duration and severity of hypoglycemia as the system can detect and in some systems act on impending and prevailing low blood glucose levels. In this narrative review we summarize the available knowledge on SAPs with and without automated insulin suspension, in relation to hypoglycemia prevention. We present evidence from randomized trials, observational studies, and meta-analyses including nonpregnant individuals with type 1 diabetes mellitus. We also outline concerns regarding SAPs with and without automated insulin suspension. There is evidence that SAP treatment reduces episodes of moderate and severe hypoglycemia compared with multiple daily injections plus self-monitoring of blood glucose. There is some evidence that SAPs both with and without automated suspension reduces the frequency of severe hypoglycemic events compared with insulin pumps without continuous glucose monitoring. PMID:28264173

Competing power-generating technologies for the 21st century

NASA Astrophysics Data System (ADS)

Troost, G. K.

1994-04-01

Several new and advanced power-generating systems are presently being developed, e.g., fuel cells, advanced heat pumps, high-performance gas turbines. An analysis of these systems is presented and is based on projections of comparative studies and relevant trends. For advanced systems, a trade-off between efficiency gain and projected development cost is crucial. Projections for market conditions in the 21st century and, in particular, environmental issues are made in order to assess market-entry opportunities. Results from various case studies indicate challenging opportunities in process and metallurgical industries; several process-integrated configurations are being studied.

Inactivation of Pol θ and C-NHEJ eliminates off-target integration of exogenous DNA.

PubMed

Zelensky, Alex N; Schimmel, Joost; Kool, Hanneke; Kanaar, Roland; Tijsterman, Marcel

2017-07-07

Off-target or random integration of exogenous DNA hampers precise genomic engineering and presents a safety risk in clinical gene therapy strategies. Genetic definition of random integration has been lacking for decades. Here, we show that the A-family DNA polymerase θ (Pol θ) promotes random integration, while canonical non-homologous DNA end joining plays a secondary role; cells double deficient for polymerase θ and canonical non-homologous DNA end joining are devoid of any integration events, demonstrating that these two mechanisms define random integration. In contrast, homologous recombination is not reduced in these cells and gene targeting is improved to 100% efficiency. Such complete reversal of integration outcome, from predominately random integration to exclusively gene targeting, provides a rational way forward to improve the efficacy and safety of DNA delivery and gene correction approaches.Random off-target integration events can impair precise gene targeting and poses a safety risk for gene therapy. Here the authors show that repression of polymerase θ and classical non-homologous recombination eliminates random integration.

A multicenter, randomized, prospective study of 14-day ranitidine bismuth citrate- vs. lansoprazole-based triple therapy for the eradication of Helicobacter pylori in dyspeptic patients.

PubMed

Avşar, Erol; Tiftikçi, Arzu; Poturoğlu, Sule; Erzin, Yusuf; Kocakaya, Ozan; Dinçer, Dinç; Yıldırım, Bulut; Güliter, Sefa; Türkay, Cansel; Yılmaz, Uğur; Onuk, Mehmet Derya; Bölükbaş, Cengiz; Ellidokuz, Ender; Bektaş, Ahmet; Taşan, Güralp; Aytuğ, Necip; Ateş, Yüksel; Kaymakoğlu, Sabahattin

2013-01-01

Proton-pump inhibitor and ranitidine bismuth citrate-based triple regimens are the two recommended first line treatments for the eradication of Helicobacter pylori. We aimed to compare the effectiveness and tolerability of these two treatments in a prospective, multicentric, randomized study. Patients with dyspeptic complaints were recruited from 15 study centers. Presence of Helicobacter pylori was investigated by both histology and rapid urease test. The patients were randomized to either ranitidine bismuth citrate 400 mg bid plus amoxicillin 1 g bid plus clarithromycin 500 mg bid (n=149) or lansoprazole 30 mg bid plus amoxicillin 1 g bid plus clarithromycin 500 mg bid (n=130) treatment arm for 14 days. Adverse events have been recorded during the treatment phase. A 13 C urea breath test was performed 6 weeks after termination of treatment to assess the efficacy of the therapy. Eradication rate was calculated by intention-to-treat and per-protocol analysis. Two hundred seventy-nine patients (123 male, 156 female) were eligible for randomization. In per-protocol analysis (n=247), Helicobacter pylori was eradicated with ranitidine bismuth citrate- and lansoprazole-based regimens in 74,6% and 69,2% of cases, respectively (p>0,05). Intention-to-treat analysis (n=279) revealed that eradication rates were 65,1% and 63,6% in ranitidine bismuth citrate and in lansoprazole-based regimens, respectively (p>0,05). Both regimes were well-tolerated, and no serious adverse event was observed during the study. Ranitidine bismuth citrate-based regimen is at least as effective and tolerable as the classical proton-pump inhibitor-based regimen, but none of the therapies could achieve the recommendable eradication rate.

78 FR 60275 - Alternative Method for Calculating Off-Cycle Credits for Mercedes-Benz Vehicles Under the Light...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-01

...., small/mid-size/large cars and light-duty trucks) (See Section II-III of Mercedes-Benz Application...-start effectiveness unless the vehicle possesses an electric heater circulation pump, or equivalent...-start system includes an electric [[Page 60278

Atomic defects in monolayer WSe2 tunneling FETs studied by systematic ab initio calculations

NASA Astrophysics Data System (ADS)

Wu, Jixuan; Fan, Zhiqiang; Chen, Jiezhi; Jiang, Xiangwei

2018-05-01

Atomic defects in monolayer WSe2 tunneling FETs (TFETs) are studied through systematic ab initio calculations aiming at performance predictions and enhancements. The effects of various defect positions and different passivation atoms are characterized in WSe2 TFETs by rigorous ab initio quantum transport simulations. It is suggested that the Se vacancy (VSe) defect located in the gate-controlled channel region tends to increase the OFF current (I off), whereas it can be well suppressed by oxygen passivation. It is demonstrated that chlorine (Cl) passivation at the source-side tunneling region can largely suppress I off, leading to an impressively improved on–off ratio (I on/I off) compared with that without any defect. However, it is also observed that randomly positioned atomic defects tend to induce significant fluctuation of the TFET output. Further discussions are made with focus on the performance-variability trade-off for robust circuit design.

Properties of excited states in organic light emitting diodes and lasers

NASA Astrophysics Data System (ADS)

Giebink, Noel C.

The field of organic semiconductors has grown rapidly over the past decade with the development of light emitting diodes, solar cells, and lasers that promise a new generation of low-cost, flexible optoelectronic devices. In each case, the behavior of molecular excited states, or excitons, is of fundamental importance. The present study explores the nature and interactions of such excited states in the attempt to develop an electrically pumped organic semiconductor laser, and to improve the performance and operational stability of organic light emitting diodes. We begin by investigating intrinsic loss processes in optically pumped organic semiconductor lasers and demonstrate that exciton annihilation implies a fundamental limit that will prevent lasing by electrical injection in currently known materials. Searching for an alternative approach to reach threshold leads us to study metastable geminate charge pairs, where we find that optically generated excitons can be accumulated over time in an external electric field via these intermediate states. Upon field turn-off, the excitons are immediately restored, leading to a sudden burst of excitation density over 30 times higher than that generated by the pump alone. Unfortunately, we identify limitations that have thus far prevented reaching laser threshold with this technique. In a parallel push toward high power density, we investigate the origins of quantum efficiency roll-off in organic light emitting diodes (OLEDs) and find that it is dominated by loss of charge balance in the majority of fluorescent and phosphorescent devices. The second major theme of this work involves understanding the intrinsic modes of OLED operational degradation. Based on extensive modeling and supported directly by experimental evidence, we identify exciton-charge carrier annihilation reactions as a principle degradation pathway. Exploiting the diffusion of triplet excitons, we show that fluorescence and phosphorescence can be combined to increase the operational lifetime of white OLEDs and still retain the potential for unity internal quantum efficiency.

All-optical switching in GaAs microdisk resonators by a femtosecond pump-probe technique through tapered-fiber coupling.

PubMed

Lin, Yen-Chih; Mao, Ming-Hua; Lin, You-Ru; Lin, Hao-Hsiung; Lin, Che-An; Wang, Lon A

2014-09-01

We demonstrate ultrafast all-optical switching in GaAs microdisk resonators using a femtosecond pump-probe technique through tapered-fiber coupling. The temporal tuning of the resonant modes resulted from the refractive index change due to photoexcited carrier density variation inside the GaAs microdisk resonator. Transmission through the GaAs microdisk resonator can be modulated by more than 10 dB with a switching time window of 8 ps in the switch-off operation using pumping pulses with energies as low as 17.5 pJ. The carrier lifetime was fitted to be 42 ps, much shorter than that of the bulk GaAs, typically of the order of nanoseconds. The above observation indicates that the surface recombination plays an important role in increasing the switching speed.

Large-Scale Coherent Vortex Formation in Two-Dimensional Turbulence

NASA Astrophysics Data System (ADS)

Orlov, A. V.; Brazhnikov, M. Yu.; Levchenko, A. A.

2018-04-01

The evolution of a vortex flow excited by an electromagnetic technique in a thin layer of a conducting liquid was studied experimentally. Small-scale vortices, excited at the pumping scale, merge with time due to the nonlinear interaction and produce large-scale structures—the inverse energy cascade is formed. The dependence of the energy spectrum in the developed inverse cascade is well described by the Kraichnan law k -5/3. At large scales, the inverse cascade is limited by cell sizes, and a large-scale coherent vortex flow is formed, which occupies almost the entire area of the experimental cell. The radial profile of the azimuthal velocity of the coherent vortex immediately after the pumping was switched off has been established for the first time. Inside the vortex core, the azimuthal velocity grows linearly along a radius and reaches a constant value outside the core, which agrees well with the theoretical prediction.

Are higher doses of proton pump inhibitors better in acute peptic bleeding?

PubMed

Villalón, Alejandro; Olmos, Roberto; Rada, Gabriel

2016-06-24

Although there is broad consensus about the benefits of proton pump inhibitors in acute upper peptic bleeding, there is still controversy over their optimal dosing. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified six systematic reviews including 27 randomized trials addressing this question. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded high-dose proton pump inhibitors probably result in little or no difference in re-bleeding rate or mortality. The risk/benefit and cost/benefit balance probably favor use of low-doses.

IDENTIFICATION OF OFF-FARM AGRICULTURAL OCCUPATIONS AND THE EDUCATION NEEDED FOR EMPLOYMENT IN THESE OCCUPATIONS IN DELAWARE.

ERIC Educational Resources Information Center

BARWICK, RALPH P.

THE PURPOSES OF THE STUDY WERE TO (1) IDENTIFY PRESENT AND EMERGING OFF-FARM AGRICULTURAL OCCUPATIONS, (2) ESTIMATE THE NUMBER EMPLOYED, (3) ESTIMATE THE NUMBER TO BE EMPLOYED IN THE FUTURE, AND (4) DETERMINE COMPETENCIES NEEDED IN SELECTED OCCUPATIONAL FAMILIES. A DISPROPORTIONATE RANDOM SAMPLE OF 267 BUSINESSES OR SERVICES WAS DRAWN FROM A LIST…

Sensor-augmented pump therapy lowers HbA(1c) in suboptimally controlled Type 1 diabetes; a randomized controlled trial.

PubMed

Hermanides, J; Nørgaard, K; Bruttomesso, D; Mathieu, C; Frid, A; Dayan, C M; Diem, P; Fermon, C; Wentholt, I M E; Hoekstra, J B L; DeVries, J H

2011-10-01

To investigate the efficacy of sensor-augmented pump therapy vs. multiple daily injection therapy in patients with suboptimally controlled Type 1 diabetes. In this investigator-initiated multi-centre trial (the Eurythmics Trial) in eight outpatient centres in Europe, we randomized 83 patients with Type 1 diabetes (40 women) currently treated with multiple daily injections, age 18-65 years and HbA(1c) ≥ 8.2% (≥ 66 mmol/mol) to 26 weeks of treatment with either a sensor-augmented insulin pump (n = 44) (Paradigm(®) REAL-Time) or continued with multiple daily injections (n = 39). Change in HbA(1c) between baseline and 26 weeks, sensor-derived endpoints and patient-reported outcomes were assessed. The trial was completed by 43/44 (98%) patients in the sensor-augmented insulin pump group and 35/39 (90%) patients in the multiple daily injections group. Mean HbA(1c) at baseline and at 26 weeks changed from 8.46% (SD 0.95) (69 mmol/mol) to 7.23% (SD 0.65) (56 mmol/mol) in the sensor-augmented insulin pump group and from 8.59% (SD 0.82) (70 mmol/mol) to 8.46% (SD 1.04) (69 mmol/mol) in the multiple daily injections group. Mean difference in change in HbA(1c) after 26 weeks was -1.21% (95% confidence interval -1.52 to -0.90, P < 0.001) in favour of the sensor-augmented insulin pump group. This was achieved without an increase in percentage of time spent in hypoglycaemia: between-group difference 0.0% (95% confidence interval -1.6 to 1.7, P = 0.96). There were four episodes of severe hypoglycaemia in the sensor-augmented insulin pump group and one episode in the multiple daily injections group (P = 0.21). Problem Areas in Diabetes and Diabetes Treatment Satisfaction Questionnaire scores improved in the sensor-augmented insulin pump group. Sensor augmented pump therapy effectively lowers HbA(1c) in patients with Type 1 diabetes suboptimally controlled with multiple daily injections. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.

Aerodynamics of electrically driven freight pipeline system

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

Lundgren, T.S.; Zhao, Y.

2000-06-01

This paper examines the aerodynamic characteristics of a freight pipeline system in which freight capsules are individually propelled by electrical motors. The fundamental difference between this system and the more extensively studied pneumatic capsule pipeline is the different role played by aerodynamic forces. In a driven system the propelled capsules are resisted by aerodynamic forces and, in reaction, pump air through the tube. In contrast, in a pneumatically propelled system external blowers pump air through the tubes, and this provides the thrust for the capsules. An incompressible transient analysis is developed to study the aerodynamics of multiple capsules in amore » cross-linked two-bore pipeline. An aerodynamic friction coefficient is used as a cost parameter to compare the effects of capsule blockage and headway and to assess the merits of adits and vents. The authors conclude that optimum efficiency for off-design operation is obtained with long platoons of capsules in vented or adit connected tubes.« less

The role of drug efflux pumps in Malassezia pachydermatis and Malassezia furfur defence against azoles.

PubMed

Iatta, Roberta; Puttilli, Maria Rita; Immediato, Davide; Otranto, Domenico; Cafarchia, Claudia

2017-03-01

This study aims to evaluate the effect of efflux pump modulators (EPMs) on the minimal inhibitory concentration (MIC) of fluconazole (FLZ) and voriconazole (VOR) in Malassezia furfur and Malassezia pachydermatis. The in vitro efficacy of azoles, in combination with EPMs (ie haloperidol-HAL, promethazine-PTZ and cyclosporine A-CYS), against 21 M. furfur from bloodstream infection patients and 14 M. pachydermatis from the skin of dogs with dermatitis, was assessed using a broth microdilution chequerboard analysis. Data were analysed using the model-fractional inhibitory concentration index (FICI) method. The MIC of FLZ and VOR of Malassezia spp. decreased in the presence of sub-inhibitory concentrations of HAL and/or PTZ. The synergic effect was observed only in strains with FLZ MIC≥128 μg/mL for M. furfur, FLZ MIC≥64 μg/mL for M. pachydermatis and VOR MIC≥4 μg/mL in both Malassezia spp. These results suggest that the drug efflux pumps are involved as defence mechanisms to azole drugs in Malassezia yeast. The synergism might be related to an increased expression of efflux pump genes, eventually resulting in azole resistance phenomena. Finally, the above FLZ and VOR MIC values might be considered the cut-off to discriminate susceptible and resistant strains. © 2016 Blackwell Verlag GmbH.

Shamba Maisha: A pilot study assessing impacts of a micro-irrigation intervention on the health and economic wellbeing of HIV patients

PubMed Central

2010-01-01

Background HIV/AIDS negatively impacts poverty alleviation and food security, which reciprocally hinder the rapid scale up and effectiveness of HIV care programs. Nyanza province has the highest HIV prevalence (15.3%), and is the third highest contributor (2.4 million people) to rural poverty in Kenya. Thus, we tested the feasibility of providing a micro-irrigation pump to HIV-positive farmers in order to evaluate its impact on health and economic advancement among HIV-positive patients and their families. Methods Thirty HIV-positive patients enrolled in the Family AIDS Care and Education Services (FACES) program in Kisumu, Kenya were provided a micro-financed loan to receive an irrigation pump and farming guidance from KickStart, the developer of the pump. Economic data, CD4 counts, household health and loan repayment history were collected 12 months after the pumps were distributed. Results Mean annual family income increased by $1,332 over baseline. CD4 counts did not change significantly. Though income increased, only three (10%) participants had paid off more than a quarter of the loan. Conclusions We demonstrated the feasibility of an income-generating micro-irrigation intervention among HIV-positive patients and the collection of health and economic data. While family income improved significantly, loan repayment rates were low- likely complicated by the drought that occurred in Kenya during the intervention period. PMID:20459841

Shamba Maisha: a pilot study assessing impacts of a micro-irrigation intervention on the health and economic wellbeing of HIV patients.

PubMed

Pandit, Jay A; Sirotin, Nicole; Tittle, Robin; Onjolo, Elijah; Bukusi, Elizabeth A; Cohen, Craig R

2010-05-11

HIV/AIDS negatively impacts poverty alleviation and food security, which reciprocally hinder the rapid scale up and effectiveness of HIV care programs. Nyanza province has the highest HIV prevalence (15.3%), and is the third highest contributor (2.4 million people) to rural poverty in Kenya. Thus, we tested the feasibility of providing a micro-irrigation pump to HIV-positive farmers in order to evaluate its impact on health and economic advancement among HIV-positive patients and their families. Thirty HIV-positive patients enrolled in the Family AIDS Care and Education Services (FACES) program in Kisumu, Kenya were provided a micro-financed loan to receive an irrigation pump and farming guidance from KickStart, the developer of the pump. Economic data, CD4 counts, household health and loan repayment history were collected 12 months after the pumps were distributed. Mean annual family income increased by $1,332 over baseline. CD4 counts did not change significantly. Though income increased, only three (10%) participants had paid off more than a quarter of the loan. We demonstrated the feasibility of an income-generating micro-irrigation intervention among HIV-positive patients and the collection of health and economic data. While family income improved significantly, loan repayment rates were low- likely complicated by the drought that occurred in Kenya during the intervention period.

The glassy random laser: replica symmetry breaking in the intensity fluctuations of emission spectra

PubMed Central

Antenucci, Fabrizio; Crisanti, Andrea; Leuzzi, Luca

2015-01-01

The behavior of a newly introduced overlap parameter, measuring the correlation between intensity fluctuations of waves in random media, is analyzed in different physical regimes, with varying amount of disorder and non-linearity. This order parameter allows to identify the laser transition in random media and describes its possible glassy nature in terms of emission spectra data, the only data so far accessible in random laser measurements. The theoretical analysis is performed in terms of the complex spherical spin-glass model, a statistical mechanical model describing the onset and the behavior of random lasers in open cavities. Replica Symmetry Breaking theory allows to discern different kinds of randomness in the high pumping regime, including the most complex and intriguing glassy randomness. The outcome of the theoretical study is, eventually, compared to recent intensity fluctuation overlap measurements demonstrating the validity of the theory and providing a straightforward interpretation of qualitatively different spectral behaviors in different random lasers. PMID:26616194

Evaluation of the horizontal-to-vertical spectral ratio (HVSR) seismic method to determine sediment thickness in the vicinity of the South Well Field, Franklin County, OH

USGS Publications Warehouse

Haefner, Ralph J.; Sheets, Rodney A.; Andrews, Robert E.

2011-01-01

The horizontal-to-vertical spectral ratio (HVSR) seismic method involves analyzing measurements of ambient seismic noise in three dimensions to determine the fundamental site resonance frequency. Resonance is excited by the interaction of surface waves (Rayleigh and Love) and body waves (vertically incident shear) with the high-contrast aconstic impedance boundary at the bedrock-sediment interface. Measurements were made to determine the method's utility for estimating thickness of unconsolidated glacial sediments at 18 locations at the South Well Field, Franklin County, OH, and at six locations in Pickaway County where sediment thickness was already known. Measurements also were made near a high-capacity production well (with pumping on and off) and near a highway and a limestone quarry to examine changes in resonance frequencies over a 20-hour period. Although the regression relation for resonance frequency and sediment thickness had a relatively low [r.sup.2] (0.322), estimates of sediment thickness were, on average, within 14 percent of known thicknesses. Resonance frequencies for pumping on and pumping off were identical, although the amplitude of the peak was nearly double under pumping conditions. Resonance frequency for the 20-hour period did not change, but the amplitude of the peak changed considerably, with a maximum amplitude in the early afternoon and minimum in the very early morning hours. Clay layers within unconsolidated sediments may influence resonance frequency and the resulting regression equation, resulting in underestimation of sediment thickness; however, despite this and other complicating factors, hydrogeologists should consider this method when thickness data are needed for unconsolidated sediments.

Evaluation of the horizontal-to-vertical spectral ratio (HVSR) seismic method to determine sediment thickness in the vicinity of the south well field, Franklin county, OH

USGS Publications Warehouse

Haefner, R.J.; Sheets, R.A.; Andrews, R.E.

2010-01-01

The horizontal-to-vertical spectral ratio (HVSR) seismic method involves analyzing measurements of ambient seismic noise in three dimensions to determine the fundamental site resonance frequency. Resonance is excited by the interaction of surface waves (Rayleigh and Love) and body waves (vertically incident shear) with the high-contrast acoustic impedance boundary at the bedrock-sediment interface. Measurements were made to determine the method's utility for estimating thickness of unconsolidated glacial sediments at 18 locations at the South Well Field, Franklin County, OH, and at six locations in Pickaway County where sediment thickness was already known. Measurements also were made near a high-capacity production well (with pumping on and off ) and near a highway and a limestone quarry to examine changes in resonance frequencies over a 20-hour period. Although the regression relation for resonance frequency and sediment thickness had a relatively low r 2(0.322), estimates of sediment thickness were, on average, within 14 percent of known thicknesses. Resonance frequencies for pumping on and pumping off were identical, although the amplitude of the peak was nearly double under pumping conditions. Resonance frequency for the 20-hour period did not change, but the amplitude of the peak changed considerably, with a maximum amplitude in the early afternoon and minimum in the very early morning hours. Clay layers within unconsolidated sediments may influence resonance frequency and the resulting regression equation, resulting in underestimation of sediment thickness; however, despite this and other complicating factors, hydrogeologists should consider this method when thickness data are needed for unconsolidated sediments. ?? 2011 by The Ohio Academy of Science. All Rights Reserved.

Limited Effect of Rebamipide in Addition to Proton Pump Inhibitor (PPI) in the Treatment of Post-Endoscopic Submucosal Dissection Gastric Ulcers: A Randomized Controlled Trial Comparing PPI Plus Rebamipide Combination Therapy with PPI Monotherapy.

PubMed

Nakamura, Kazuhiko; Ihara, Eikichi; Akiho, Hirotada; Akahoshi, Kazuya; Harada, Naohiko; Ochiai, Toshiaki; Nakamura, Norimoto; Ogino, Haruei; Iwasa, Tsutomu; Aso, Akira; Iboshi, Yoichiro; Takayanagi, Ryoichi

2016-11-15

The ability of endoscopic submucosal dissection (ESD) to resect large early gastric cancers (EGCs) results in the need to treat large artificial gastric ulcers. This study assessed whether the combination therapy of rebamipide plus a proton pump inhibitor (PPI) offered benefits over PPI monotherapy. In this prospective, randomized, multicenter, open-label, and comparative study, patients who had undergone ESD for EGC or gastric adenoma were randomized into groups receiving either rabeprazole monotherapy (10 mg/day, n=64) or a combination of rabeprazole plus rebamipide (300 mg/day, n=66). The Scar stage (S stage) ratio after treatment was compared, and factors independently associated with ulcer healing were identified by using multivariate analyses. The S stage rates at 4 and 8 weeks were similar in the two groups, even in the subgroups of patients with large amounts of tissue resected and regardless of CYP2C19 genotype. Independent factors for ulcer healing were circumferential location of the tumor and resected tissue size; the type of treatment did not affect ulcer healing. Combination therapy with rebamipide and PPI had limited benefits compared with PPI monotherapy in the treatment of post-ESD gastric ulcer (UMIN Clinical Trials Registry, UMIN000007435).

A study on the efficacy of rebamipide for patients with proton pump inhibitor-refractory non-erosive reflux disease.

PubMed

Adachi, Kyoichi; Furuta, Kenji; Miwa, Hiroto; Oshima, Tadayuki; Miki, Masaharu; Komazawa, Yoshinori; Iwakiri, Katsuhiko; Furuta, Takahisa; Koike, Tomoyuki; Shimatani, Tomohiko; Kinoshita, Yoshikazu

2012-06-01

Reflux symptoms in patients with non-erosive reflux disease (NERD) cannot be easily controlled by treatment with proton pump inhibitors (PPI). The anti-inflammatory function of rebamipide may be effective for protecting the esophageal mucosa. This prospective randomized multicenter placebo-controlled study was performed to clarify the efficacy of rebamipide for NERD patients whose reflux symptoms were refractory to PPI treatment. One hundred forty-nine patients were enrolled on the basis of a QUEST score of over 6 and absence of endoscopically proven esophageal mucosal breaks. All the patients were initially administered 15 mg of lansoprazole for 4 weeks, and the symptoms were then assessed using QUEST and GSRS. PPI-refractory patients were randomly assigned to administration of rebamipide or placebo t.i.d. for 4 weeks. Three of the 149 patients were lost to follow-up, and 60 among the remaining 146 patients were found to be PPI-refractory. Among these PPI-refractory patients, 31 were randomly assigned to a rebamipide group and 29 to a placebo group. At the end of drug administration, the QUEST and GSRS scores did not differ between the rebamipide and placebo groups, although a significantly higher proportion of patients in the rebamipide group showed amelioration of abdominal pain and diarrhea. Administration of rebamipide cannot effectively control reflux symptoms in NERD patients whose symptoms are refractory to PPI therapy.

Limited Effect of Rebamipide in Addition to Proton Pump Inhibitor (PPI) in the Treatment of Post-Endoscopic Submucosal Dissection Gastric Ulcers: A Randomized Controlled Trial Comparing PPI Plus Rebamipide Combination Therapy with PPI Monotherapy

PubMed Central

Nakamura, Kazuhiko; Ihara, Eikichi; Akiho, Hirotada; Akahoshi, Kazuya; Harada, Naohiko; Ochiai, Toshiaki; Nakamura, Norimoto; Ogino, Haruei; Iwasa, Tsutomu; Aso, Akira; Iboshi, Yoichiro; Takayanagi, Ryoichi

2016-01-01

Background/Aims The ability of endoscopic submucosal dissection (ESD) to resect large early gastric cancers (EGCs) results in the need to treat large artificial gastric ulcers. This study assessed whether the combination therapy of rebamipide plus a proton pump inhibitor (PPI) offered benefits over PPI monotherapy. Methods In this prospective, randomized, multicenter, open-label, and comparative study, patients who had undergone ESD for EGC or gastric adenoma were randomized into groups receiving either rabeprazole monotherapy (10 mg/day, n=64) or a combination of rabeprazole plus rebamipide (300 mg/day, n=66). The Scar stage (S stage) ratio after treatment was compared, and factors independently associated with ulcer healing were identified by using multivariate analyses. Results The S stage rates at 4 and 8 weeks were similar in the two groups, even in the subgroups of patients with large amounts of tissue resected and regardless of CYP2C19 genotype. Independent factors for ulcer healing were circumferential location of the tumor and resected tissue size; the type of treatment did not affect ulcer healing. Conclusions Combination therapy with rebamipide and PPI had limited benefits compared with PPI monotherapy in the treatment of post-ESD gastric ulcer (UMIN Clinical Trials Registry, UMIN000007435). PMID:27282261

A cost-effectiveness analysis of sensor-augmented insulin pump therapy and automated insulin suspension versus standard pump therapy for hypoglycemic unaware patients with type 1 diabetes.

PubMed

Ly, Trang T; Brnabic, Alan J M; Eggleston, Andrew; Kolivos, Athena; McBride, Margaret E; Schrover, Rudolf; Jones, Timothy W

2014-07-01

To assess the cost-effectiveness of sensor-augmented insulin pump therapy with "Low Glucose Suspend" (LGS) functionality versus standard pump therapy with self-monitoring of blood glucose in patients with type 1 diabetes who have impaired awareness of hypoglycemia. A clinical trial-based economic evaluation was performed in which the net costs and effectiveness of the two treatment modalities were calculated and expressed as an incremental cost-effectiveness ratio (ICER). The clinical outcome of interest for the evaluation was the rate of severe hypoglycemia in each arm of the LGS study. Quality-of-life utility scores were calculated using the three-level EuroQol five-dimensional questionnaire. Resource use costs were estimated using public sources. After 6 months, the use of sensor-augmented insulin pump therapy with LGS significantly reduced the incidence of severe hypoglycemia compared with standard pump therapy (incident rate difference 1.85 [0.17-3.53]; P = 0.037). Based on a primary randomized study, the ICER per severe hypoglycemic event avoided was $18,257 for all patients and $14,944 for those aged 12 years and older. Including all major medical resource costs (e.g., hospital admissions), the ICERs were $17,602 and $14,289, respectively. Over the 6-month period, the cost per quality-adjusted life-year gained was $40,803 for patients aged 12 years and older. Based on the Australian experience evaluating new interventions across a broad range of therapeutic areas, sensor-augmented insulin pump therapy with LGS may be considered a cost-effective alternative to standard pump therapy with self-monitoring of blood glucose in hypoglycemia unaware patients with type 1 diabetes. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Insulin appearance of subcutaneously infused insulin: influence of the basal rate pulse interval of the infusion pump.

PubMed

Birch, K; Hildebrandt, P; Jensen, B M; Kühl, C; Brange, J

1985-05-01

To compare the metabolic control and the pharmacokinetics of infused insulin using an insulin pump (Auto-Syringe AS 6C) which provides the basal rate in pulses every 2-10 min with a pump (Medix Syringe Driver 209) providing the basal rate in pulses every 15-60 min, 6 C-peptide negative diabetic patients received, in random order, identical, but individual, insulin treatment during one 4-day period using the Auto-Syringe pump and another 4-day period using the Medix pump. On the fourth day of each period, blood glucose and plasma-free insulin were estimated every 30 min for 7 hr and every 5 min for the next hour. Plasma-free insulin was significantly higher on 3 time points out of the 26 possible when using the Medix pump, but this was not reflected in the blood glucose concentrations which were similar in the 2 periods. The results indicate that, from a metabolic and pharmacokinetic point of view, insulin pumps working with larger intervals between the basal rate pulses are just as good as the more technically advanced and hence often more expensive pumps which provide the basal rate in more and smaller pulses.

A Modular Control Platform for a Diode Pumped Alkali Laser

NASA Astrophysics Data System (ADS)

Shapiro, J.; Teare, S.

Many of the difficulties of creating compact, high power laser systems can be overcome if the heat dissipating properties of chemical lasers can be combined with the efficiency of diode lasers. Recently, the novel idea of using solid state diode lasers to pump gaseous gain media, such as is done in diode pumped alkali lasers (DPALs), has been proposed and early experiments have shown promising results. However, a number of technical issues need to be overcome to realize high output power from these lasers. In order to achieve higher power, the efficiency of coupling between pump laser energy and the chemical cell must be increased, and eventually multiple high power diode pumps must be combined and synchronized so that their energy can pump the chemical cell. Additionally, an inter-cavity adaptive optics system may be a requirement to be able to propagate these lasers with high efficiency. DPAL systems are complex and require a significant amount of data fusion and active feedback to control and optimize their performance. There are a wide range of components including pump lasers, gain cells and monitoring points needed to study and refine the overall laser system. In support of this dynamic development environment, we have developed a hardware framework using commercial off the shelf (COTS) components which supports the rapid assembly of functional system blocks into a cohesive integrated system. Critical to this system are a simple communication protocol, industry standard communication pipes (USB, Bluetooth, etc), and flexible high level scripting. Simplifying the integration process has the benefit of allowing flexible "on the fly" modifications to adapt the system as needed and enhance available functionality. The modular nature of the architecture allows scalability and adaptability as more pieces are added to the system. Key components of this system are demonstrated for selected portions of a DPAL system using a USB backbone.

77 FR 29861 - Airworthiness Directives; Fokker Services B.V. Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-21

... an in-flight failure of the hydraulic control panel, which resulted in the absence of pressure and... absence of pressure and quantity indication of the hydraulic system and accompanying alerts for... shut-off of the engine driven hydraulic pumps, resulting in complete absence of hydraulic pressure...

Off-label prescription of antineoplastic drugs: an Italian prospective, observational, multicenter survey.

PubMed

Roila, Fausto; Ballatori, Enzo; Labianca, Roberto; De Braud, Filippo; Borgonovo, Karen; Martelli, Olga; Gallo, Ciro; Tinazzi, Angelo; Perrone, Francesco

2009-01-01

An appropriate use of drugs should follow the registered indications. Different reasons can induce oncologists to prescribe drugs off-label. The aim of this study was to describe incidence and characteristics of these prescriptions in Italy. Patients submitted to chemotherapy in 15 Italian oncology centers were evaluated for two randomized non-consecutive days of two weeks in May 2006. The study enrolled 644 patients receiving 1,053 drugs. Overall, 199 of 1053 (18.9%) prescriptions were off-label. In 92 of 199 cases (46.2%), the drugs were used for a neoplasm for which they were not approved, but there was scientific evidence (one or more randomized clinical trials or more phase II studies published in a major oncology journal) justifying the prescription. In 27 cases (13.6%), the drugs were prescribed for a rare neoplasm (cisplatin and gemcitabine in mesothelioma). In 20/21 cases (10.1%/10.5%), drugs were used in association/alone in contrast with the approved use (capecitabine in association in colorectal cancer). In 28/11 cases (14.0%/5.6%), the drugs were used in lines of chemotherapy subsequent/previous to that approved. Off-label use of antineoplastic drugs, in this observational survey, represents less than 20% of the prescriptions, and most of them are based on scientific evidence of efficacy.

Pump RIN-induced impairments in unrepeatered transmission systems using distributed Raman amplifier.

PubMed

Cheng, Jingchi; Tang, Ming; Lau, Alan Pak Tao; Lu, Chao; Wang, Liang; Dong, Zhenhua; Bilal, Syed Muhammad; Fu, Songnian; Shum, Perry Ping; Liu, Deming

2015-05-04

High spectral efficiency modulation format based unrepeatered transmission systems using distributed Raman amplifier (DRA) have attracted much attention recently. To enhance the reach and optimize system performance, careful design of DRA is required based on the analysis of various types of impairments and their balance. In this paper, we study various pump RIN induced distortions on high spectral efficiency modulation formats. The vector theory of both 1st and higher-order stimulated Raman scattering (SRS) effect using Jones-matrix formalism is presented. The pump RIN will induce three types of distortion on high spectral efficiency signals: intensity noise stemming from SRS, phase noise stemming from cross phase modulation (XPM), and polarization crosstalk stemming from cross polarization modulation (XPolM). An analytical model for the statistical property of relative phase noise (RPN) in higher order DRA without dealing with complex vector theory is derived. The impact of pump RIN induced impairments are analyzed in polarization-multiplexed (PM)-QPSK and PM-16QAM-based unrepeatered systems simulations using 1st, 2nd and 3rd-order forward pumped Raman amplifier. It is shown that at realistic RIN levels, negligible impairments will be induced to PM-QPSK signals in 1st and 2nd order DRA, while non-negligible impairments will occur in 3rd order case. PM-16QAM signals suffer more penalties compared to PM-QPSK with the same on-off gain where both 2nd and 3rd order DRA will cause non-negligible performance degradations. We also investigate the performance of digital signal processing (DSP) algorithms to mitigate such impairments.

Tapering off long-term opioid therapy in chronic non-cancer pain patients: a randomized clinical trial.

PubMed

Kurita, Geana Paula; Højsted, Jette; Sjøgren, Per

2018-05-13

The indications for initiating long-term opioid treatment (L-TOT) for chronic non-cancer pain (CNCP) are often unclear and associated with problematic use. This study aimed at evaluating the efficacy of stabilizing opioid therapy followed by a sequential opioid tapering off program in CNCP patients. A randomized clinical trial with a medications stabilization period (Phase 1) followed by a opioid tapering off program (Phase 2). In Phase 2, patients were randomized to Control Group (stable treatment) or Taper off Group (sequential opioid dose reduction) and assessed at baseline, after stabilization and up to six months. Primary outcomes: measures of cognitive function; secondary outcomes: pain, sleep, rest, quality of life, depression, anxiety, opioid misuse, and opioid withdrawal symptoms. Two hundred seventy-four patients were screened; 75 were included, out of which 40 dropped out before Phase 2. Those who succeeded Phase 1 (n=35) had weak/moderate improvements of psychomotor function (p=0.020), sleeping hours (p=0.031), opioid withdrawal symptoms (p=0.019), measures of quality of life (p≤0.043) and opioid misuse scores (p=0.003). In Phase 2, patients in Taper off Group (n=15) experienced stable pain intensity and felt significantly more rested at third assessment than the Control Group (n=20). The opioid tapering off program was not successful due to the vast number of dropouts. Phase 1 was associated with weak to moderate improvements on psychomotor function, sleeping, opioid withdrawal symptoms, quality of life, and reduced risk of opioid misuse. In the intervention group of Phase 2, pain intensity was stable and patients felt more rested. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Threshold-based insulin-pump interruption for reduction of hypoglycemia.

PubMed

Bergenstal, Richard M; Klonoff, David C; Garg, Satish K; Bode, Bruce W; Meredith, Melissa; Slover, Robert H; Ahmann, Andrew J; Welsh, John B; Lee, Scott W; Kaufman, Francine R

2013-07-18

The threshold-suspend feature of sensor-augmented insulin pumps is designed to minimize the risk of hypoglycemia by interrupting insulin delivery at a preset sensor glucose value. We evaluated sensor-augmented insulin-pump therapy with and without the threshold-suspend feature in patients with nocturnal hypoglycemia. We randomly assigned patients with type 1 diabetes and documented nocturnal hypoglycemia to receive sensor-augmented insulin-pump therapy with or without the threshold-suspend feature for 3 months. The primary safety outcome was the change in the glycated hemoglobin level. The primary efficacy outcome was the area under the curve (AUC) for nocturnal hypoglycemic events. Two-hour threshold-suspend events were analyzed with respect to subsequent sensor glucose values. A total of 247 patients were randomly assigned to receive sensor-augmented insulin-pump therapy with the threshold-suspend feature (threshold-suspend group, 121 patients) or standard sensor-augmented insulin-pump therapy (control group, 126 patients). The changes in glycated hemoglobin values were similar in the two groups. The mean AUC for nocturnal hypoglycemic events was 37.5% lower in the threshold-suspend group than in the control group (980 ± 1200 mg per deciliter [54.4 ± 66.6 mmol per liter] × minutes vs. 1568 ± 1995 mg per deciliter [87.0 ± 110.7 mmol per liter] × minutes, P<0.001). Nocturnal hypoglycemic events occurred 31.8% less frequently in the threshold-suspend group than in the control group (1.5 ± 1.0 vs. 2.2 ± 1.3 per patient-week, P<0.001). The percentages of nocturnal sensor glucose values of less than 50 mg per deciliter (2.8 mmol per liter), 50 to less than 60 mg per deciliter (3.3 mmol per liter), and 60 to less than 70 mg per deciliter (3.9 mmol per liter) were significantly reduced in the threshold-suspend group (P<0.001 for each range). After 1438 instances at night in which the pump was stopped for 2 hours, the mean sensor glucose value was 92.6 ± 40.7 mg per deciliter (5.1 ± 2.3 mmol per liter). Four patients (all in the control group) had a severe hypoglycemic event; no patients had diabetic ketoacidosis. This study showed that over a 3-month period the use of sensor-augmented insulin-pump therapy with the threshold-suspend feature reduced nocturnal hypoglycemia, without increasing glycated hemoglobin values. (Funded by Medtronic MiniMed; ASPIRE ClinicalTrials.gov number, NCT01497938.).

Type-curve estimation of statistical heterogeneity

NASA Astrophysics Data System (ADS)

Neuman, Shlomo P.; Guadagnini, Alberto; Riva, Monica

2004-04-01

The analysis of pumping tests has traditionally relied on analytical solutions of groundwater flow equations in relatively simple domains, consisting of one or at most a few units having uniform hydraulic properties. Recently, attention has been shifting toward methods and solutions that would allow one to characterize subsurface heterogeneities in greater detail. On one hand, geostatistical inverse methods are being used to assess the spatial variability of parameters, such as permeability and porosity, on the basis of multiple cross-hole pressure interference tests. On the other hand, analytical solutions are being developed to describe the mean and variance (first and second statistical moments) of flow to a well in a randomly heterogeneous medium. We explore numerically the feasibility of using a simple graphical approach (without numerical inversion) to estimate the geometric mean, integral scale, and variance of local log transmissivity on the basis of quasi steady state head data when a randomly heterogeneous confined aquifer is pumped at a constant rate. By local log transmissivity we mean a function varying randomly over horizontal distances that are small in comparison with a characteristic spacing between pumping and observation wells during a test. Experimental evidence and hydrogeologic scaling theory suggest that such a function would tend to exhibit an integral scale well below the maximum well spacing. This is in contrast to equivalent transmissivities derived from pumping tests by treating the aquifer as being locally uniform (on the scale of each test), which tend to exhibit regional-scale spatial correlations. We show that whereas the mean and integral scale of local log transmissivity can be estimated reasonably well based on theoretical ensemble mean variations of head and drawdown with radial distance from a pumping well, estimating the log transmissivity variance is more difficult. We obtain reasonable estimates of the latter based on theoretical variation of the standard deviation of circumferentially averaged drawdown about its mean.

Prophylactic intra-aortic balloon pump in high-risk patients undergoing coronary artery bypass surgery: a meta-analysis of randomized controlled trials.

PubMed

Sá, Michel Pompeu B O; Ferraz, Paulo E; Escobar, Rodrigo R; Martins, Wendell N; Nunes, Eliobas O; Vasconcelos, Frederico P; Lima, Ricardo C

2012-11-01

The aim of this study was to assess the efficacy of a prophylactic intra-aortic balloon pump (IABP) in high-risk patients undergoing coronary artery bypass graft surgery. MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar, and reference lists of relevant articles were searched. We included only randomized controlled trials. Assessments for eligibility, relevance, and study validity and data extraction were performed in duplicate using prespecified criteria. Meta-analysis was carried out using fixed-effect and random-effect models. Seven publications fulfilled our eligibility criteria. There was no important statistical heterogeneity or publication bias among included studies. In total, 177 patients received prophylactic IABP and 168 did not. Overall relative risk (RR) for hospital mortality in patients treated with prophylactic IABP was 0.255 [95% confidence interval (CI), 0.122-0.533; P<0.001; same results for both effect models]. Pooled RR for postoperative low cardiac output syndrome was 0.206 (95% CI, 0.109-0.389; P<0.001) for the fixed-effect model and 0.219 (95% CI, 0.095-0.504; P<0.001) for the random-effect model. Patients treated with prophylactic IABP presented an overall difference in means for length of intensive care unit stay and hospital stay, which was lower than that in the control group (P<0.001 for both effect models). Only 7.4% (13/177) of patients who received prophylactic IABP developed complications at an insertion site, with no IABP-related death. This meta-analysis supports the use of prophylactic IABP in high-risk patients to reduce hospital mortality. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Fiber Raman laser and amplifier pumped by Nd3+:YVO4 solid state laser

NASA Astrophysics Data System (ADS)

Liu, Deming; Zhang, Minming; Liu, Shuang; Nie, Mingju; Wang, Ying

2005-04-01

Pumping source is the key technology of fiber Raman amplifiers (FRA) which are important for ultra long haul and high bit rate dense wavelength division multiplexing (DWDM) systems. In this paper the research work of the project, "Fiber Raman Laser and Amplifier pumped by Nd3+:YVO4 Solid State Laser", supported by the National High-tech Program (863-program) of China is introduced, in which a novel 14xx nm pump module with fine characteristics of high efficiency, simplicity, compactness and low cost is researched and developed. A compact 1342 nm Nd3+:YVO4 diode pumped solid state laser (DPSSL) module is developed with the total laser power of 655mW and the slope efficiency of 42.6% pumped by a 2W 808nm laser diode (LD). A special C-lens fiber collimator is designed to couple the 1342nm laser beam into a piece of single mode fiber (SMF) and the coupling efficiency of 80% is reached. The specific 14xx nm output laser is generated from a single stage Raman resonator which includes a pair of fiber Bragg gratings and a piece of Germanic-silicate or Phospho-silicate fiber pumped by such DPSSL module. The slope efficiency for conversion from 1342 to 14xx nm radiation is 75% and the laser power is more than 300mW each. Finally, Raman gain experiments are carried out with 100km SMF. 100 nm bandwidth with 10dB on-off Raman gain and 1.1dB gain flatness is achieved by pumped at 1425, 1438, 1455 and 1490nm.

Preoperative intra-aortic balloon pump in patients undergoing coronary bypass surgery: a systematic review and meta-analysis.

PubMed

Dyub, Adel M; Whitlock, Richard P; Abouzahr, Labib L; Cinà, Claudio S

2008-01-01

To assess the effectiveness of preoperative intra-aortic balloon pump (IABP) placement in high-risk patients undergoing coronary bypass surgery (CABG). The primary outcome was hospital mortality and secondary outcomes were IABP-related complications (bleeding, leg ischemia, aortic dissection). MEDLINE, EMBASE, Cochrane registry of Controlled Trials, and reference lists of relevant articles were searched. We included randomized controlled trials (RCTs), and cohort studies that fulfilled our a priori inclusion criteria. Eligibility decisions, relevance, study validity, and data extraction were performed in duplicate using pre-specified criteria. Meta-analysis was conducted using a random effects model. Ten publications fulfilled our eligibility criteria, of which four were RCTs and six were cohort studies with controls. There were statistical as well as clinical heterogeneity among included studies. A total of 1034 patients received preoperative IABP and 1329 did not receive preoperative IABP. The pooled odds ratio (OR) for hospital mortality in patients treated with preoperative IABP was 0.41 (95% CI, 0.21-0.82, p = 0.01). The number needed to treat was 17. The pooled OR for hospital mortality from randomized trials was 0.18 (95% CI, 0.06-0.57, p = 0.003) and from cohort studies was 0.54 (95% CI, 0.24-1.2, p = 0.13). Overall, 3.7% (13 of 349) of patients who received preoperative IABP developed either limb ischemia or haematoma at the IABP insertion site, and most of these complications improved after discontinuation of IABP. Evidence from this meta-analysis support the use of preoperative IABP in high-risk patients to reduce hospital mortality.

Formation of the stimulated electromagnetic emission spectra near gyroharmonics for quasi-stationary and decaying striations

NASA Astrophysics Data System (ADS)

Grach, Savely; Norin, Lars; Sergeev, Evgeny; Thide, Bo; Leyser, Thomas

We present new results of the analysis of the stimulated electromagnetic emission (SEE) measurements performed with special diagnostic HF-pumping scheme, for pump wave frequencies f0 close to a multiple of the electron gyroharmonic nfce , n = 4, 5. The pumping scheme used was an alternation of quasi-continuous pumping (˜ 100-200 ms on, ˜ 20-30 ms off) during a few tens of seconds, and low duty cycle radiation (pulse duration 20-500 ms with 1-3 s interpulse period). The main attention is paid to the following: (i) The development of some spectral features of the SEE, such as the downshifted maximum (DM), the second downshifted maximum (2DM), the upshifted maximum (UM) and the broad upshifted maximum (BUM) in a preconditioned ionosphere such that stationary small-scale magnetic field-aligned irregularities (striations) are already present. In particular, we characterize a fast (3-15 ms) overshoot in the DM, 2DM and UM, and we study the properties of a transient BUM with a maximum intensity for 18 kHz < f - f0 < 25 kHz and the same lower cutoff at f - f0 ≈ 14 kHz as the stationary BUM. The transient BUM vanishes after 5 to 10 ms of the pump turn-on and does not reappear. (ii) The formation of SEE features caused by the pump wave after the transition to low duty cycle pumping (i.e. on the background of decaying striations). In particular we note, that the BUM growths exponentially with a characteristic time ˜ 15 ms while the DM grows much faster and later exhibits slower dynamics. (iii) A slow (from pulse to pulse) temporal evolution of the SEE after the changing the pump scheme to a low duty cycle pulse mode. We note a disappearance of the transient BUM 1-2 s after the change of pump scheme and we observe an overshoot of the DM and (part of) the BUM. Higher frequency components of the BUM decays much faster than its lower frequencies. The results allow us to investigate ponderomotive processes responsible for the formation of upper hybrid turbulence in the HP-pumped ionosphere and the comparative contribution of the striations with different scales to the generation of different SEE spectral components. The work was supported by the RFBR (grants No. 06-02-17334, 07-02-00464).

DPSSL pumped 20-TW Ti:sapphire laser system for DD fusion experiment

NASA Astrophysics Data System (ADS)

Sekine, T.; Hatano, Y.; Takeuchi, Y.; Kawashima, T.

2016-03-01

A diode-pumped solid-state laser (DPSSL) pumped 20-TW output Ti:sapphire laser system has been developed. A diode-pumped Nd:glass laser with output energy of 12.7 J in 527 nm was used as a pump source for a 20-TW Ti:sapphire amplifier. A CeLiB6O10 nonlinear optical crystal was used as a frequency doubler of the Nd:glass DPSSL[1]. Figure 1 shows typical output pulse energy of the 20-TW amplifier as a function of pumping energy and a near field pattern. A 1.65 J pulse energy was obtained by 4.5 J pump energy. The amplified seed pulse is compressed to typically 60 fs as shown in Fig. 1 by a vacuumed pulse compressor with 80% of transmissivity. Encircled energy ratio, into a circled with 8 μm diameter area, of far field pattern focused by off-axis parabolic mirror with F# of 3 is numerically evaluated to 40% at TW class output condition. Then focal intensity would reach to 1018W/cm2. This all- DPSSL system contributes for stable and continual investigation of laser induced plasma experiment. We have succeeded continual and high efficient generation of DD fusion neutron from CD nano-particles by cluster fusion scheme using the 20-TW laser. A yield of ∼105 neutrons per shot was stably observed during continuous 100 shots with repetition rate of 0.1Hz.

Estimating pumping time and ground-water withdrawals using energy- consumption data

USGS Publications Warehouse

Hurr, R.T.; Litke, D.W.

1989-01-01

Evaluation of the hydrology of an aquifer requires knowledge about the volume of groundwater in storage and also about the volume of groundwater withdrawals. Totalizer flow meters may be installed at pumping plants to measure withdrawals; however, it generally is impractical to equip all pumping plants in an area with meters. A viable alternative is the use of rate-time methods. Rate-time methods may be used at individual pumping plants to decrease the data collection necessary for determining withdrawals. At sites where pumping-time measurement devices are not installed, pumping time may be determined on the basis of energy consumption and power demand. At pumping plants where energy consumption is metered, data acquired by reading of meters is used to estimate pumping time. Care needs to be taken to read these meters correctly. At pumping plants powered by electricity, the calculations need to be modified if transformers are present. At pumping plants powered by natural gas, the effects of the pressure-correction factor need to be included in the calculations. At pumping plants powered by gasoline, diesel oil, or liquid petroleum gas, the geometry of storage tanks needs to be analyzed as part of the calculations. The relation between power demand and pumping rate at a pumping plant can be described through the use of the power-consumption coefficient. Where equipment and hydrologic conditions are stable, this coefficient can be applied to total energy consumption at a site to estimate total groundwater withdrawals. Random sampling of power consumption coefficients can be used to estimate area-wide groundwater withdrawal. (USGS)

Pathways of proton transfer in the light-driven pump bacteriorhodopsin

NASA Technical Reports Server (NTRS)

Lanyi, J. K.

1993-01-01

The mechanism of proton transport in the light-driven pump bacteriorhodopsin is beginning to be understood. Light causes the all-trans to 13-cis isomerization of the retinal chromophore. This sets off a sequential and directed series of transient decreases in the pKa's of a) the retinal Schiff base, b) an extracellular proton release complex which includes asp-85, and c) a cytoplasmic proton uptake complex which includes asp-96. The timing of these pKa changes during the photoreaction cycle causes sequential proton transfers which result in the net movement of a proton across the protein, from the cytoplasmic to the extracellular surface.

Oil/gas separator for installation at burning wells

DOEpatents

Alonso, C.T.; Bender, D.A.; Bowman, B.R.; Burnham, A.K.; Chesnut, D.A.; Comfort, W.J. III; Guymon, L.G.; Henning, C.D.; Pedersen, K.B.; Sefcik, J.A.; Smith, J.A.; Strauch, M.S.

1993-03-09

An oil/gas separator is disclosed that can be utilized to return the burning wells in Kuwait to production. Advantageously, a crane is used to install the separator at a safe distance from the well. The gas from the well is burned off at the site, and the oil is immediately pumped into Kuwait's oil gathering system. Diverters inside the separator prevent the oil jet coming out of the well from reaching the top vents where the gas is burned. The oil falls back down, and is pumped from an annular oil catcher at the bottom of the separator, or from the concrete cellar surrounding the well.

Oil/gas separator for installation at burning wells

DOEpatents

Alonso, Carol T.; Bender, Donald A.; Bowman, Barry R.; Burnham, Alan K.; Chesnut, Dwayne A.; Comfort, III, William J.; Guymon, Lloyd G.; Henning, Carl D.; Pedersen, Knud B.; Sefcik, Joseph A.; Smith, Joseph A.; Strauch, Mark S.

1993-01-01

An oil/gas separator is disclosed that can be utilized to return the burning wells in Kuwait to production. Advantageously, a crane is used to install the separator at a safe distance from the well. The gas from the well is burned off at the site, and the oil is immediately pumped into Kuwait's oil gathering system. Diverters inside the separator prevent the oil jet coming out of the well from reaching the top vents where the gas is burned. The oil falls back down, and is pumped from an annular oil catcher at the bottom of the separator, or from the concrete cellar surrounding the well.

Mesoscale eddies drive increased silica export in the subtropical Pacific Ocean.

PubMed

Benitez-Nelson, Claudia R; Bidigare, Robert R; Dickey, Tommy D; Landry, Michael R; Leonard, Carrie L; Brown, Susan L; Nencioli, Francesco; Rii, Yoshimi M; Maiti, Kanchan; Becker, Jamie W; Bibby, Thomas S; Black, Wil; Cai, Wei-Jun; Carlson, Craig A; Chen, Feizhou; Kuwahara, Victor S; Mahaffey, Claire; McAndrew, Patricia M; Quay, Paul D; Rappé, Michael S; Selph, Karen E; Simmons, Melinda P; Yang, Eun Jin

2007-05-18

Mesoscale eddies may play a critical role in ocean biogeochemistry by increasing nutrient supply, primary production, and efficiency of the biological pump, that is, the ratio of carbon export to primary production in otherwise nutrient-deficient waters. We examined a diatom bloom within a cold-core cyclonic eddy off Hawaii. Eddy primary production, community biomass, and size composition were markedly enhanced but had little effect on the carbon export ratio. Instead, the system functioned as a selective silica pump. Strong trophic coupling and inefficient organic export may be general characteristics of community perturbation responses in the warm waters of the Pacific Ocean.

All-optical switching application based on optical nonlinearity of Yb(3+) doped aluminosilicate glass fiber with a long-period fiber gratings pair.

PubMed

Kim, Yune; Kim, Nam; Chung, Youngjoo; Paek, Un-Chul; Han, Won-Taek

2004-02-23

We propose a new fiber-type all-optical switching device based on the optical nonlinearity of Yb(3+) doped fiber and a long-period fiber gratings(LPG) pair. The all-optical ON-OFF switching with the continuous wave laser signal at ~1556nm in the LPG pair including the 25.5cm long Yb(3+) doped fiber was demonstrated up to ~200Hz upon pumping with the modulated square wave pulses at 976nm, where a full optical switching with the ~18dB extinction ratio was obtained at the launched pump power of ~35mW.

Rotigotine transdermal patch in Chinese patients with advanced Parkinson's disease: A randomized, double-blind, placebo-controlled pivotal study.

PubMed

Zhang, Zhen-Xin; Liu, Chun-Feng; Tao, En-Xiang; Shao, Ming; Liu, Yi-Ming; Wang, Jian; Asgharnejad, Mahnaz; Xue, Hai-Bo; Surmann, Erwin; Bauer, Lars

2017-11-01

Rotigotine was demonstrated to be efficacious and well-tolerated in three placebo-controlled studies (CLEOPATRA-PD/PREFER/SP921) of patients with advanced-stage Parkinson's disease (PD), most of whom were Caucasian. This multicenter phase 3 study (SP1037; NCT01646255) was the first to investigate the efficacy and safety of rotigotine in Chinese patients with advanced-stage PD. Chinese patients with PD, inadequately controlled on levodopa (stable dose ≥200 mg/day), with ≥2.5 h/day "off" time, and Hoehn & Yahr stage 2-4, were randomized 1:1 to receive transdermal rotigotine or placebo, titrated over ≤7 weeks, maintained at optimal/maximum dose (4-16 mg/24 h) for 12 weeks. Primary efficacy variable: mean change in absolute "off" time (according to patient diaries) from baseline to end of maintenance. Safety variables included adverse events (AEs) and discontinuations due to AEs. 346 patients were randomized and 89.9% completed the study (87.8% placebo; 92.0% rotigotine). All were Chinese (58.7% male; mean ± SD age: 62.2 ± 8.9 years; mean ± SD time since PD diagnosis: 6.62 ± 3.70 years). Rotigotine significantly reduced "off" time vs placebo (LS mean [95% CI] treatment difference: -1.20 h/day [-1.83, -0.57]; p = 0.0002), and resulted in more responders (≥30% decrease in "off" time: 36.9% placebo; 48.8% rotigotine; p = 0.0269). AEs were reported for 86 (50.0%) placebo- and 103 (59.2%) rotigotine-treated patients; 15 discontinued due to AEs (placebo 7; rotigotine 8). The most common AEs (≥5%) were dizziness, nausea, pruritus, and dyskinesia. Rotigotine was efficacious in Chinese patients with advanced-stage PD as add-on therapy to levodopa, significantly reducing "off" time vs placebo; the treatment difference was similar to that observed in previous studies of mainly Caucasian patients. Rotigotine was generally well-tolerated and had a similar AE profile to those observed in previous studies. Copyright © 2017 Elsevier Ltd. All rights reserved.

Trade-off study and computer simulation for assessing spacecraft pointing accuracy and stability capabilities

NASA Astrophysics Data System (ADS)

Algrain, Marcelo C.; Powers, Richard M.

1997-05-01

A case study, written in a tutorial manner, is presented where a comprehensive computer simulation is developed to determine the driving factors contributing to spacecraft pointing accuracy and stability. Models for major system components are described. Among them are spacecraft bus, attitude controller, reaction wheel assembly, star-tracker unit, inertial reference unit, and gyro drift estimators (Kalman filter). The predicted spacecraft performance is analyzed for a variety of input commands and system disturbances. The primary deterministic inputs are the desired attitude angles and rate set points. The stochastic inputs include random torque disturbances acting on the spacecraft, random gyro bias noise, gyro random walk, and star-tracker noise. These inputs are varied over a wide range to determine their effects on pointing accuracy and stability. The results are presented in the form of trade- off curves designed to facilitate the proper selection of subsystems so that overall spacecraft pointing accuracy and stability requirements are met.

Rapid Speed Modulation of a Rotary Total Artificial Heart Impeller.

PubMed

Kleinheyer, Matthias; Timms, Daniel L; Tansley, Geoffrey D; Nestler, Frank; Greatrex, Nicholas A; Frazier, O Howard; Cohn, William E

2016-09-01

Unlike the earlier reciprocating volume displacement-type pumps, rotary blood pumps (RBPs) typically operate at a constant rotational speed and produce continuous outflow. When RBP technology is used in constructing a total artificial heart (TAH), the pressure waveform that the TAH produces is flat, without the rise and fall associated with a normal arterial pulse. Several studies have suggested that pulseless circulation may impair microcirculatory perfusion and the autoregulatory response and may contribute to adverse events such as gastrointestinal bleeding, arteriovenous malformations, and pump thrombosis. It may therefore be beneficial to attempt to reproduce pulsatile output, similar to that generated by the native heart, by rapidly modulating the speed of an RBP impeller. The choice of an appropriate speed profile and control strategy to generate physiologic waveforms while minimizing power consumption and blood trauma becomes a challenge. In this study, pump operation modes with six different speed profiles using the BiVACOR TAH were evaluated in vitro. These modes were compared with respect to: hemodynamic pulsatility, which was quantified as surplus hemodynamic energy (SHE); maximum rate of change of pressure (dP/dt); pulse power index; and motor power consumption as a function of pulse pressure. The results showed that the evaluated variables underwent different trends in response to changes in the speed profile shape. The findings indicated a possible trade-off between SHE levels and flow rate pulsatility related to the relative systolic duration in the speed profile. Furthermore, none of the evaluated measures was sufficient to fully characterize hemodynamic pulsatility. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Preliminary Design of the Vacuum System for FAIR Super FRS Quadrupole Magnet Cryostat

NASA Astrophysics Data System (ADS)

Akhter, J.; Pal, G.; Datta, A.; Sarma, P. R.; Bhunia, U.; Roy, S.; Bhattacharyya, S.; Nandi, C.; Mallik, C.; Bhandari, R. K.

2012-11-01

The Super-Conducting Fragment Separator (Super FRS) of the Facility for Antiproton and Ion Research (FAIR) at GSI Darmstadt is a large-acceptance superonducting fragment separator. The separator consists of large dipole, quadrupole and hexapole superconducting magnets. The long quadrupole magnet cryostat houses the helium chamber, which has the magnet iron and NbTi superconducting coil. The magnet weighs about 30 tons. The helium chamber is enclosed in vacuum inside the magnet cryostat. Multilayer Insulation (MLI) will be wrapped around the thermal shield to reduce radiation loss. Polyster of MLI comprises the major component responsible for outgassing. In order to reduce outgassing, pumping at elevated temperatures has to be carried out. In view of the large size and weight of the magnet, a seal off approach might not be operationally feasible. Continuous pumping of the cryostat has also been examined. Pump has been kept at a distance from the magnet considering the effect of stray magnetic fields. Oil free turbo molecular pump and scroll pump combination will be used to pump down the cryostat. The ultimate heat load of the cryostat will be highly dependent on the pressure attained. Radiation and conduction plays an important role in the heat transfer at low temperatures. This paper presents the vacuum design of the long quadrupole magnet cryostat and estimates the heat load of the cryostat.

Direct emission of chirality controllable femtosecond LG01 vortex beam

NASA Astrophysics Data System (ADS)

Wang, S.; Zhang, S.; Yang, H.; Xie, J.; Jiang, S.; Feng, G.; Zhou, S.

2018-05-01

Direct emission of a chirality controllable ultrafast LG01 mode vortex optical beam from a conventional z-type cavity design SESAM (SEmiconductor Saturable Absorber Mirror) mode locked LD pumped Yb:Phosphate laser has been demonstrated. A clean 360 fs vortex beam of ˜45.7 mW output power has been achieved. A radial shear interferometer has been built to determine the phase singularity and the wavefront helicity of the ultrafast output laser. Theoretically, it is found that the LG01 vortex beam is obtained via the combination effect of diagonal HG10 mode generation by off-axis pumping and the controllable Gouy phase difference between HG10 and HG01 modes in the sagittal and tangential planes. The chirality of the LG01 mode can be manipulated by the pump position to the original point of the laser cavity optical axis.

Relative phase noise induced impairment in CO-OFDM optical communication system with distributed fiber Raman amplifier.

PubMed

Wu, Jiadi; Cheng, Jingchi; Tang, Ming; Deng, Lei; Songnian, Fu; Shum, Perry Ping; Liu, Deming

2014-05-15

In this Letter, we demonstrate that the interplay between Raman pump relative intensity noise and cross-phase modulation leads to a relative phase noise (RPN) that brings non-negligible performance degradation to coherent optical orthogonal frequency-division multiplexing (CO-OFDM) transmission systems with co-pumped Raman amplification. By theoretical analysis and numerical simulation, we proved that RPN brings more system impairment in terms of Q-factor penalty than the single carrier system, and relatively larger walk-off between pump and signal helps to suppress the RPN induced impairment. A higher-order modulated signal is less tolerant to RPN than a lower-order signal. With the same spectral efficiency, the quadrature-amplitude modulation format shows better tolerance to RPN than phase-shift keying. The reported findings will be useful for the design and optimization of Raman amplified CO-OFDM multi-carrier transmission systems.

Device and method to relieve cordelle action in a chain driven pump

DOEpatents

Dysarz, Edward D.

1994-01-01

A cordelle action relief apparatus or device for use in sucker rod pumps in a petroleum or water well. The device is incorporated in a chain driven pump to prevent the chain from forming a bow or archlike configuration as the chain rolls off of the sprocket and down into the well. When the chain is allowed to form this bow or arch it could damage the well and well casing. The device includes a first rod on the side of the chain and a second rod on the second side of the chain that will allow the rollers of the chain to roll on the rod and further prevent the chain from bowing or arching and will further allow the rollers on the chain to roll on the rods which will further prevent damage to the well casing, the well, and the chain.

Application of fuzzy adaptive control to a MIMO nonlinear time-delay pump-valve system.

PubMed

Lai, Zhounian; Wu, Peng; Wu, Dazhuan

2015-07-01

In this paper, a control strategy to balance the reliability against efficiency is introduced to overcome the common off-design operation problem in pump-valve systems. The pump-valve system is a nonlinear multi-input-multi-output (MIMO) system with time delays which cannot be accurately measured but can be approximately modeled using Bernoulli Principle. A fuzzy adaptive controller is applied to approximate system parameters and achieve the control of delay-free model since the system model is inaccurate and the direct feedback linearization method cannot be applied. An extended Smith predictor is introduced to compensate time delays of the system using the inaccurate system model. The experiment is carried out to verify the effectiveness of the control strategy whose results show that the control performance is well achieved. Copyright © 2015 ISA. Published by Elsevier Ltd. All rights reserved.

Dual-wavelength vortex beam with high stability in a diode-pumped Yb:CaGdAlO4 laser

NASA Astrophysics Data System (ADS)

Shen, Yijie; Meng, Yuan; Fu, Xing; Gong, Mali

2018-05-01

We present a stable dual-wavelength vortex beam carrying orbital angular momentum (OAM) with two spectral peaks separated by a few terahertz in a diode-pumped Yb:CaGdAlO4 (CALGO) laser. The dual-wavelength spectrum is controlled by the pump power and off-axis loss in a laser resonator, arising from the broad emission bandwidth of Yb:CALGO. The OAM beam is obtained by a pair of cylindrical lenses serving as a π/2 convertor for high-order Hermite–Gaussian modes. The stability is verified by the fact that a 1\\hbar OAM beam with two spectral peaks at 1046.1 nm and 1057.2 nm (3.01 THz interval) can steadily operate for more than 3 h. It has great potential for scaling the application of OAM beams in terahertz spectroscopy, high-resolution interferometry, and so on.

Twenty-four-hour simultaneous subcutaneous basal-bolus administration of insulin and amylin in adolescents with type 1 diabetes decreases postprandial hyperglycemia

USDA-ARS?s Scientific Manuscript database

The purpose of this study was to examine the effect of continuous subcutaneous (sc) replacement of amylin and insulin for a 24-h period on glucose homeostasis in adolescents with type 1 diabetes. Thirteen adolescents with type 1 diabetes on insulin pump therapy participated in a randomized, controll...

Real-time monitoring of river water quality using in-line continuous acquisition of fluorescence excitation and emission matrices

NASA Astrophysics Data System (ADS)

Carstea, E.; Baker, A.; Johnson, R.; Reynolds, D. M.

2009-12-01

In-line fluorescence EEM monitoring has been performed over an eleven-day period for Bournbrook River, Birmingham, UK. River water was diverted to a portable laboratory via a continuous flow pump and filter system. Fluorescence excitation-emission matrices data was recorded every 3 minutes using a flow cell (1cm pathlength) coupled to a fiber optic probe. This real-time fluorescence EEM data (Excitation, 225-400 nm at 5 nm steps, emission, 280-500 nm at 2 nm steps) was collected 'in-line'and directly compared with the spectrophotometric properties and physical and chemical parameters of river water samples collected off-line at known time intervals. Over the monitoring period, minor pollution pulses from cross connections were detected and identified hourly along with a random diesel pollution event. This work addresses the practicalities of measuring and detecting fluorescence EEM in the field and discusses the potential of this technological approach for further understanding important hydrological and biogeochemical processes. Problems associated with fouling and system failure are also reported. Example of the data generated from the continuous fluorescence EEM monitoring.

Insulin pump therapy with automated insulin suspension in response to hypoglycemia: reduction in nocturnal hypoglycemia in those at greatest risk.

PubMed

Choudhary, Pratik; Shin, John; Wang, Yongyin; Evans, Mark L; Hammond, Peter J; Kerr, David; Shaw, James A M; Pickup, John C; Amiel, Stephanie A

2011-09-01

To evaluate a sensor-augmented insulin pump with a low glucose suspend (LGS) feature that automatically suspends basal insulin delivery for up to 2 h in response to sensor-detected hypoglycemia. The LGS feature of the Paradigm Veo insulin pump (Medtronic, Inc., Northridge, CA) was tested for 3 weeks in 31 adults with type 1 diabetes. There were 166 episodes of LGS: 66% of daytime LGS episodes were terminated within 10 min, and 20 episodes lasted the maximum 2 h. LGS use was associated with reduced nocturnal duration ≤2.2 mmol/L in those in the highest quartile of nocturnal hypoglycemia at baseline (median 46.2 vs. 1.8 min/day, P = 0.02 [LGS-OFF vs. LGS-ON]). Median sensor glucose was 3.9 mmol/L after 2-h LGS and 8.2 mmol/L at 2 h after basal restart. Use of an insulin pump with LGS was associated with reduced nocturnal hypoglycemia in those at greatest risk and was well accepted by patients.

Circulatory support for OPCAB procedures.

PubMed

Mueller, Xavier M; von Segesser, Ludwig K

2002-07-01

During off-pump coronary artery bypass grafting (OPCAB) which allows complete revascularization through a median sternotomy, revascularization of the lateral and posterior walls requires the verticalization of the heart, which may cause haemodynamic disturbance. This concern has stimulated the development of circulatory support with mini-pumps. Initially, these pumps were designed for the right side of the heart, which was found to be the main contributor to haemodynamic instability under experimental conditions. The three types of mini-pumps that have been developed so far - two for the right side of the heart and one for both sides - are reviewed as well as a new concept of integrated cardiopulmonary bypass (CPB) circuit with reduced surface and priming volume. However, with increasing experience and improved methods of exposition, OPCAB has become a procedure that can be performed without support in the majority of the cases. Nevertheless, the concept of miniaturization and the possibility to insert these devices through a peripheral access has opened the way to new indications, mainly short-term circulatory support for acute heart failure. This development is welcome in a field where available devices are invasive and plagued with a heavy morbidity.

Distributed parametric amplifier for RZ-DPSK signal transmission system.

PubMed

Xu, Xing; Zhang, Chi; Yuk, T I; Wong, Kenneth K Y

2012-08-13

We have experimentally demonstrated a single pump distributed parametric amplification (DPA) system for differential phase shift keying (DPSK) signal in a spool of dispersion-shifted fiber (DSF). The gain spectrum of single pump DPA is thoroughly investigated by both simulation and experiment, and a possible reference for optimal input pump power and fiber length relationship is provided to DPA based applications. Furthermore, DPSK format is compared with on-off keying (OOK) within DPA scheme. Eight WDM signal channels at 10-Gb/s are utilized, and approximately 0.5-dB power penalties at the bit-error rate (BER) of 10(-9) are achieved for return-to-zero DPSK (RZ-DPSK), comparing to larger than 1.5-dB with OOK format. In order to improve the system power efficiency, at the receiver, the pump is recycled by a photovoltaic cell and the converted energy can be used by potential low-power-consuming devices, i.e sensors or small-scale electronic circuits. Additionally, with suitable components, the whole DPA concept could be directly applied to the 1.3-μm telecommunication window along the most commonly used single-mode fiber (SMF).

Effects of intra-aortic balloon pump versus centrifugal pump on myocardial energetics and systemic circulation in a porcine model of rapidly worsening acute heart failure.

PubMed

Ntalianis, Argyrios S; Drakos, Stavros G; Charitos, Christos; Dolou, Paraskevi; Pierrakos, Charalampos N; Terrovitis, John V; Papaioannou, Theodoros; Charitos, Efstratios; Nanas, John N

2008-01-01

The present experimental study compared the effectiveness of counterpulsation provided by the intra-aortic balloon pump (IABP) versus that of a nonpulsatile, radial-flow centrifugal pump (CFP) in rapidly worsening acute heart failure (HF). Eighteen pigs were included in the study. After the induction of acute moderate HF, circulatory support was randomly provided with either the IABP or CFP. No significant change in cardiac output (CO) and mean aortic pressure (MAP) was observed with either pump. The IABP caused a significantly greater decrease than the CFP in 1) double product (13.138 +/- 2.476 mm Hg/min vs. 14.217 +/- 2.673 mm Hg/min, p = 0.023), 2) left ventricular systolic pressure (LVSP, 100 +/- 8 mm Hg vs. 106 +/- 10 mm Hg, p = 0.046), and 3) end-diastolic aortic pressure (EDAP, 70 +/- 6 mm Hg vs. 86 +/- 6 mm Hg, p = 0.000). The effects of both pumps on total tension time index and LAD flow were similar. After the induction of severe HF, the IABP had its main effects on afterload and decreased LVSP from 88 +/- 6 mm Hg to 78 +/- 9 mm Hg, (p = 0.008), and EDAP from 57 +/- 9 mm Hg to 49 +/- 14 mm Hg, (p = 0.044), whereas the CFP exerted its effects mainly on preload, lowering LV end-diastolic pressure from 19 +/- 5 mm Hg to 11 +/- 4 mm Hg, (p = 0.002). CO and MAP were similarly increased by both assist systems. The IABP (by lowering afterload) and CFP (by lowering preload) both offered significant mechanical support in acute HF. However, afterload reduction offered principally by the IABP seems preferable for the recovery of the acutely failing heart.

PREVENtion of HeartMate II Pump Thrombosis Through Clinical Management: The PREVENT multi-center study.

PubMed

Maltais, Simon; Kilic, Ahmet; Nathan, Sriram; Keebler, Mary; Emani, Sitaramesh; Ransom, John; Katz, Jason N; Sheridan, Brett; Brieke, Andreas; Egnaczyk, Gregory; Entwistle, John W; Adamson, Robert; Stulak, John; Uriel, Nir; O'Connell, John B; Farrar, David J; Sundareswaran, Kartik S; Gregoric, Igor

2017-01-01

Recommended structured clinical practices including implant technique, anti-coagulation strategy, and pump speed management (PREVENT [PREVENtion of HeartMate II Pump Thrombosis Through Clinical Management] recommendations) were developed to address risk of early (<3 months) pump thrombosis (PT) risk with HeartMate II (HMII; St. Jude Medical, Inc. [Thoratec Corporation], Pleasanton, CA). We prospectively assessed the HMII PT rate in the current era when participating centers adhered to the PREVENT recommendations. PREVENT was a prospective, multi-center, single-arm, non-randomized study of 300 patients implanted with HMII at 24 participating sites. Confirmed PT (any suspected PT confirmed visually and/or adjudicated by an independent assessor) was evaluated at 3 months (primary end-point) and at 6 months after implantation. The population included 83% men (age 57 years ± 13), 78% destination therapy, and 83% Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Profile 1-3. Primary end-point analysis showed a confirmed PT of 2.9% at 3 months and 4.8% at 6 months. Adherence to key recommendations included 78% to surgical recommendations, 95% to heparin bridging, and 79% to pump speeds ≥9,000 RPMs (92% >8,600 RPMs). Full adherence to implant techniques, heparin bridging, and pump speeds ≥9,000 RPMs resulted in a significantly lower risk of PT (1.9% vs 8.9%; p < 0.01) and lower composite risk of suspected thrombosis, hemolysis, and ischemic stroke (5.7% vs 17.7%; p < 0.01) at 6 months. Adoption of all components of a structured surgical implant technique and clinical management strategy (PREVENT recommendations) is associated with low rates of confirmed PT. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Raman dissipative soliton fiber laser pumped by an ASE source.

PubMed

Pan, Weiwei; Zhang, Lei; Zhou, Jiaqi; Yang, Xuezong; Feng, Yan

2017-12-15

The mode locking of a Raman fiber laser with an amplified spontaneous emission (ASE) pump source is investigated for performance improvement. Raman dissipative solitons with a compressed pulse duration of 1.05 ps at a repetition rate of 2.47 MHz are generated by utilizing nonlinear polarization rotation and all-fiber Lyot filter. A signal-to-noise ratio as high as 85 dB is measured in a radio-frequency spectrum, which suggests excellent temporal stability. Multiple-pulse operation with unique random static distribution is observed for the first time, to the best of our knowledge, at higher pump power in mode-locked Raman fiber lasers.

Vehicle fuel system

DOEpatents

Risse, John T.; Taggart, James C.

1976-01-01

A vehicle fuel system comprising a plurality of tanks, each tank having a feed and a return conduit extending into a lower portion thereof, the several feed conduits joined to form one supply conduit feeding fuel to a supply pump and using means, unused fuel being returned via a return conduit which branches off to the several return conduits.

Biological Aerosol Test Method and Personal Protective Equipment (PPE) Decon

DTIC Science & Technology

2011-05-01

supply to the porous tube diluter. This stops all air into the LSAT. 6. Power off the vacuum pump and the compressed air supply. 22 Distribution...Experiment from Template from the menu. 10. Scroll down the template list until you find APHL Flu Assay 04272009. 11. Highlight the test, then click

Warfighting and Logistic Support of Joint Forces from the Joint Sea Base

DTIC Science & Technology

2007-01-01

Intel- ligence Community. For more information on RAND’s Acquisition and Technology Policy Center, contact the Director, Philip Antón. He can be reached...This is similar to ships such as the 225-meter MV American Cor- morant , a float-on/float-off heavy lift semisubmersible vessel, and the pumping

76 FR 18105 - Energy Conservation Program for Consumer Products: Test Procedures for Residential Central Air...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-01

... the low-voltage transformer used when testing coil-only residential central air conditioners and heat... the Low-Voltage Transformer Used When Testing Coil- Only Central Air Conditioners and Heat Pumps and... metric, estimating off-mode energy consumption, and selecting the low- voltage transformer in the test...

Generation and detection of 80-Gbit/s return-to-zero differential phase-shift keying signals

NASA Astrophysics Data System (ADS)

Möller, Lothar; Su, Yikai; Xie, Chongjin; Liu, Xiang; Leuthold, Juerg; Gill, Douglas; Wei, Xing

2003-12-01

Nonlinear polarization rotation between a pump and a probe signal in a highly nonlinear fiber is used as a modulation process to generate 80-Gbit/s return-to-zero differential phase-shift keying signals. Its performance is analyzed and compared with a conventional on-off keying modulated signal.

78 FR 4160 - Federal Property Suitable as Facilities To Assist the Homeless

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-18

... use to assist the homeless. The properties were reviewed using information provided to HUD by Federal...-0801 Directions: fuel pump bldg.: 220 sf.; vehicle maint. bldg.: 1,526 sf. Comments: off-site removal only; vacant for 180 mons. or 15 yrs.; conditions unknown South Carolina Former US Vegetable Lab 2875...

A Randomized, Crossover Trial of a Novel Sound-to-Sleep Mattress Technology in Children with Autism and Sleep Difficulties.

PubMed

Frazier, Thomas W; Krishna, Jyoti; Klingemier, Eric; Beukemann, Mary; Nawabit, Rawan; Ibrahim, Sally

2017-01-15

This preliminary study investigated the tolerability and efficacy of a novel mattress technology-the Sound-To-Sleep (STS) system-in the treatment of sleep problems in children with autism. After screening, 45 children, ages 2.5 to 12.9 years, were randomized to order of mattress technology use (On-Off vs. Off-On). Treatment conditions (On vs. Off) lasted two weeks with immediate crossover. Tolerability, including study discontinuation and parent-report of mattress tolerance and ease of use, was tracked throughout the study. Efficacy assessments were obtained at baseline, prior to crossover, and end of study and included measures of autism traits, other psychopathology symptoms, sensory abnormalities, communication difficulties, quality of life, sleep diary parameters, and single-blinded actigraphy-derived sleep parameters. Statistical analyses evaluated differences in tolerability and efficacy when the STS system was on versus off. STS system use was well tolerated (n = 2, 4.4% dropout) and resulted in parent-reported sleep quality improvements (STS off mean = 4.3, 95% CI = 4.05-4.54 vs. on mean = 4.9, 95%CI = 4.67-5.14). The technology was described by parents as very easy to use and child tolerance was rated as good. Parent-diary outcomes indicated improvements in falling asleep and reduced daytime challenging behavior. Actigraphy-derived sleep parameters indicated improved sleep duration and sleep efficiency. Improvements in child and family quality of life were identified on parent questionnaires. A future large sample phase 2 trial of the STS system is warranted and would benefit from extended study duration, an objective primary efficacy outcome, and careful attention to methodological issues that promote compliance with the intervention and study procedures. © 2017 American Academy of Sleep Medicine

Significance of off-pump coronary artery bypass grafting compared with percutaneous coronary intervention: a propensity score analysis

PubMed Central

Marui, Akira; Kimura, Takeshi; Tanaka, Shiro; Furukawa, Yutaka; Kita, Toru; Sakata, Ryuzo

2012-01-01

OBJECTIVE Although there have been several studies that compared the efficacy of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), the impact of off-pump CABG (OPCAB) has not been well elucidated. The objective of the present study was to compare the outcomes after PCI, on-pump CABG (ONCAB), and OPCAB in patients with multivessel and/or left main disease. METHODS Among the 9877 patients undergoing first PCI using bare-metal stents or CABG who were enrolled in the CREDO-Kyoto Registry, 6327 patients with multivessel and/or left main disease were enrolled into the present study (67.9 ± 9.8 years old). Among them, 3877 patients received PCI, 1388 ONCAB, and 1069 OPCAB. Median follow-up was 3.5 years. RESULTS Comparing PCI with all CABG (ONCAB and OPCAB), propensity-score-adjusted all-cause mortality after PCI was higher than that CABG (hazard ratio (95% confidence interval): 1.37 (1.15–1.63), p < 0.01). The incidence of stroke was lower after PCI than that after CABG (0.75 (0.59–0.96), p = 0.02). CABG was associated with better survival outcomes than PCI in the elderly (interaction p = 0.04). Comparing OPCAB with PCI or ONCAB, propensity-score-adjusted all-cause mortality after PCI was higher than that after OPCAB (1.50 (1.20–1.86), p < 0.01). Adjusted mortality was similar between ONCAB and OPCAB (1.18 (0.93–1.51), p = 0.33). The incidence of stroke after OPCAB was similar to that after PCI (0.98 (0.71–1.34), p > 0.99), but incidence of stroke after ONCAB was higher than that after OPCAB (1.59 (1.16–2.18), p < 0.01). CONCLUSIONS In patients with multivessel and/or left main disease, CABG, particularly OPCAB, is associated with better survival outcomes than PCI using bare-metal stents. Survival outcomes are similar between ONCAB and OPCAB. PMID:21676626

Solar Pumped Laser

DTIC Science & Technology

1976-09-01

1 dB into 50 ohm load, output VSWR less than 1.5. Phase variation relative to the optical pulse train less than +A.5 Rod Temperature...design of the PSQM laser. All phases of design, mechanical, electronic and optical , borrowed heavily from the EFM lamp pumped laser...opnical power input change for the germanium device is twice that for the silicon device, its random phase noise for a typical in- put of 1 mW optical

On-pump Cardiac Surgery Enhances Platelet Renewal and Impairs Aspirin Pharmacodynamics: Effects of Improved Dosing Regimens.

PubMed

Cavalca, V; Rocca, B; Veglia, F; Petrucci, G; Porro, B; Myasoedova, V; De Cristofaro, R; Turnu, L; Bonomi, A; Songia, P; Cavallotti, L; Zanobini, M; Camera, M; Alamanni, F; Parolari, A; Patrono, C; Tremoli, E

2017-11-01

On-pump cardiac surgery may trigger inflammation and accelerate platelet cyclooxygenase-1 renewal, thereby modifying low-dose aspirin pharmacodynamics. Thirty-seven patients on standard aspirin 100 mg once-daily were studied before surgery and randomized within 36 hours postsurgery to 100 mg once-daily, 100 mg twice-daily, or 200 mg once-daily for 90 days. On day 7 postsurgery, immature and mature platelets, platelet mass, thrombopoietin, glycocalicin, leukocytes, C-reactive protein, and interleukin-6 significantly increased. Interleukin-6 significantly correlated with immature platelets. At day 7, patients randomized to 100 mg once-daily showed a significant increase in serum thromboxane (TX)B 2 within the 24-hour dosing interval and urinary TXA 2 metabolite (TXM) excretion. Aspirin 100 mg twice-daily lowered serum TXB 2 and prevented postsurgery TXM increase (P < 0.01), without affecting prostacyclin metabolite excretion. After cardiac surgery, shortening the dosing interval, but not doubling the once-daily dose, rescues the impaired antiplatelet effect of low-dose aspirin and prevents platelet activation associated with acute inflammation and enhanced platelet turnover. © 2017 American Society for Clinical Pharmacology and Therapeutics.

The effect of bacon pump retention levels following thermal processing on bacon slice composition and sensory characteristics.

PubMed

Sivendiran, T; Wang, L M; Huang, S; Bohrer, B M

2018-06-01

The objective was to evaluate the effect of belly pump uptake and cook yield during processing on bacon slice composition and sensory attributes. A total of forty-four bellies were commercially sourced and randomly assigned to two experiments. Each experiment consisted of one smokehouse cooking cycle. Within each experiment, bellies were separated at the medial point and one belly half was assigned to a high pump uptake treatment (HIGH; target of 30% uptake) and the remaining belly half was assigned to a normal pump uptake treatment (NORM; target of 15% uptake). In experiment-1, cook yields were 107.79% for the HIGH bellies and 101.52% for the NORM bellies. In experiment-2, cook yields were 97.41% for the HIGH bellies and 94.74% for the NORM bellies. Overall, bacon slice composition and sensory attributes of bacon from bellies with greater pump retention were largely unaffected, accordingly it was concluded that cook yields ranging in level of pump retention does not affect most attributes of bacon. Copyright © 2018 Elsevier Ltd. All rights reserved.

Impacts of mesoscale eddies on biogeochemical cycles in the South China Sea

NASA Astrophysics Data System (ADS)

Xiu, P.; Chai, F.; Guo, M.

2016-02-01

Biogeochemical cycles associated with mesoscale eddies in the South China Sea (SCS) are investigated by using satellite surface chlorophyll concentration, altimeter data, satellite sea surface temperature, and a coupled physical-biogeochemical Pacific Ocean model (ROMS-CoSiNE) simulation for the period from 1991 to 2007. Considering the annual mean, composite analysis reveals that cyclonic eddies are associated with higher concentrations of nutrients, phytoplankton and zooplankton while the anticyclonic eddies are with lower concentrations compared with surrounding waters, which is generally controlled by the eddy pumping mechanism. Dipole structures of vertical fluxes with net upward motion in cyclonic eddies and net downward motion in anticyclonic eddies are also revealed. During the lifetime of an eddy, the evolutions of physical, biological, and chemical structures are not linearly coupled at the eddy core where plankton grow and composition of the community depend not only on the physical and chemical processes but also on the adjustments by the predator-prey relationship. Considering the seasonal variability, we find eddy pumping mechanisms are generally dominant in winter and eddy advection effects are dominant in summer. Over the space, variability of chlorophyll to the west of Luzon Strait and off northwest of Luzon Island are mainly controlled by eddy pumping mechanism. In regions off the Vietnam coast, chlorophyll distributions are generally associated with horizontal eddy advection. This research highlights different mesoscale mechanisms affecting biological structures that can potentially disturb ocean biogeochemical cycling processes in the South China Sea.

Predicting performance of axial pump inducer of LOX booster turbo-pump of staged combustion cycle based rocket engine using CFD

NASA Astrophysics Data System (ADS)

Mishra, Arpit; Ghosh, Parthasarathi

2015-12-01

For low cost, high thrust, space missions with high specific impulse and high reliability, inert weight needs to be minimized and thereby increasing the delivered payload. Turbopump feed system for a liquid propellant rocket engine (LPRE) has the highest power to weight ratio. Turbopumps are primarily equipped with an axial flow inducer to achieve the high angular velocity and low suction pressure in combination with increased system reliability. Performance of the turbopump strongly depends on the performance of the inducer. Thus, for designing a LPRE turbopump, demands optimization of the inducer geometry based on the performance of different off-design operating regimes. In this paper, steady-state CFD analysis of the inducer of a liquid oxygen (LOX) axial pump used as a booster pump for an oxygen rich staged combustion cycle rocket engine has been presented using ANSYS® CFX. Attempts have been made to obtain the performance characteristic curves for the LOX pump inducer. The formalism has been used to predict the performance of the inducer for the throttling range varying from 80% to 113% of nominal thrust and for the different rotational velocities from 4500 to 7500 rpm. The results have been analysed to determine the region of cavitation inception for different inlet pressure.

Willingness to trade-off: An intermediate factor in patient decision-making regarding escalating care.

PubMed

Seng, Elizabeth K; Grinberg, Amy S; Fraenkel, Liana

2018-01-01

This study aimed to evaluate treatment necessity, treatment concern, and willingness to engage in decisional trade-offs in the context of treatment escalation decision-making. Participants ( n  = 147) recruited online were randomized to read a vignette about escalating care in psoriasis in a 2 (high treatment concern vs moderate treatment concern) × 2 (high perceived treatment necessity vs moderate perceived treatment necessity) design. High treatment concern was associated with choosing to defer treatment escalation and being unwilling to engage in decisional trade-offs if disease risk changed. Results highlight the importance of treatment concern and willingness trade-off in treatment escalation decision-making.

Willingness to trade-off: An intermediate factor in patient decision-making regarding escalating care

PubMed Central

Seng, Elizabeth K; Grinberg, Amy S; Fraenkel, Liana

2018-01-01

This study aimed to evaluate treatment necessity, treatment concern, and willingness to engage in decisional trade-offs in the context of treatment escalation decision-making. Participants (n = 147) recruited online were randomized to read a vignette about escalating care in psoriasis in a 2 (high treatment concern vs moderate treatment concern) × 2 (high perceived treatment necessity vs moderate perceived treatment necessity) design. High treatment concern was associated with choosing to defer treatment escalation and being unwilling to engage in decisional trade-offs if disease risk changed. Results highlight the importance of treatment concern and willingness trade-off in treatment escalation decision-making. PMID:29662681

Effect of different dosages of nitroglycerin infusion on arterial blood gas tensions in patients undergoing on- pump coronary artery bypass graft surgery.

PubMed

Masoumi, Gholamreza; Pour, Evaz Hidar; Sadeghpour, Ali; Ziayeefard, Mohsen; Alavi, Mostapha; Anbardan, Sanam Javid; Shirani, Shahin

2012-02-01

On-pump coronary artery bypass graft (CABG) surgery impairs gas exchange in the early postoperative period. The main object on this study was evaluation of changes in arterial blood gas values in patients underwent on pump CABG surgery receiving different dose of intravenous nitroglycerin (NTG). sixty-seven consecutive patients undergoing elective on-pump CABG randomly enrolled into three groups receiving NTG 50 μg/min (Group N1, n =67), 100 μg/min (Group N2, n = 67), and 150 μg/min (Group N3, n = 67). Arterial blood gas (ABG) tensions were evaluated just before induction of anesthesia, during anesthesia, at the end of warming up period, and 6 h after admission to the intensive care unit. Pao2 and PH had the highest value during surgery in Group N1, Group N2, and Group N3. No significant difference was noted in mean values of Pao2 and PH during surgery between three groups (P > 0.05). There was no significant difference in HCO3 values in different time intervals among three groups (P > 0.05). our results showed that infusing three different dosage of NTG (50, 100, and 150 μg/min) had no significant effect on ABG tensions in patients underwent on-pump CABG surgery.

Preference heterogeneity in a count data model of demand for off-highway vehicle recreation

Treesearch

Thomas P Holmes; Jeffrey E Englin

2010-01-01

This paper examines heterogeneity in the preferences for OHV recreation by applying the random parameters Poisson model to a data set of off-highway vehicle (OHV) users at four National Forest sites in North Carolina. The analysis develops estimates of individual consumer surplus and finds that estimates are systematically affected by the random parameter specification...

Insulin Pump and Continuous Glucose Monitor Initiation in Hospitalized Patients with Type 2 Diabetes Mellitus.

PubMed

Levitt, David L; Spanakis, Elias K; Ryan, Kathleen A; Silver, Kristi D

2018-01-01

Insulin pumps and continuous glucose monitoring (CGM) are commonly used by patients with diabetes mellitus in the outpatient setting. The efficacy and safety of initiating inpatient insulin pumps and CGM in the nonintensive care unit setting is unknown. In a prospective pilot study, inpatients with type 2 diabetes were randomized to receive standard subcutaneous basal-bolus insulin and blinded CGM (group 1, n = 5), insulin pump and blinded CGM (group 2, n = 6), or insulin pump and nonblinded CGM (group 3, n = 5). Feasibility, glycemic control, and patient satisfaction were evaluated among groups. Group 1 had lower mean capillary glucose levels, 144.5 ± 19.5 mg/dL, compared with groups 2 and 3, 191.5 ± 52.3 and 182.7 ± 59.9 mg/dL (P 1 vs. 2+3  = 0.05). CGM detected 19 hypoglycemic episodes (glucose <70 mg/dL) among all treatment groups, compared with 12 episodes detected by capillary testing, although not statistically significant. No significant differences were found for the total daily dose of insulin or percentage of time spent below target glucose range (<90 mg/dL), in target glucose range (90-180 mg/dL), or above target glucose range (>180 mg/dL). On the Diabetes Treatment Satisfaction Questionnaire-Change, group 3 reported increased hyperglycemia and decreased hypoglycemia frequency compared with the other two groups, although the differences did not reach statistical significance. Insulin pump and CGM initiation are feasible during hospitalization, although they are labor intensive. Although insulin pump initiation may not lead to improved glycemic control, there is a trend toward CGM detecting a greater number of hypoglycemic episodes. Larger studies are needed to determine whether use of this technology can lower inpatient morbidity and mortality.

Electrical characteristic fluctuation of 16-nm-gate high-κ/metal gate bulk FinFET devices in the presence of random interface traps

NASA Astrophysics Data System (ADS)

Hsu, Sheng-Chia; Li, Yiming

2014-11-01

In this work, we study the impact of random interface traps (RITs) at the interface of SiO x /Si on the electrical characteristic of 16-nm-gate high-κ/metal gate (HKMG) bulk fin-type field effect transistor (FinFET) devices. Under the same threshold voltage, the effects of RIT position and number on the degradation of electrical characteristics are clarified with respect to different levels of RIT density of state ( D it). The variability of the off-state current ( I off) and drain-induced barrier lowering (DIBL) will be severely affected by RITs with high D it varying from 5 × 1012 to 5 × 1013 eV-1 cm-2 owing to significant threshold voltage ( V th) fluctuation. The results of this study indicate that if the level of D it is lower than 1 × 1012 eV-1 cm-2, the normalized variability of the on-state current, I off, V th, DIBL, and subthreshold swing is within 5%.

Impact of left ventricular assist device speed adjustment on exercise tolerance and markers of wall stress.

PubMed

Hayward, Christopher S; Salamonsen, Robert; Keogh, Anne M; Woodard, John; Ayre, Peter; Prichard, Roslyn; Kotlyar, Eugene; Macdonald, Peter S; Jansz, Paul; Spratt, Phillip

2015-09-01

Left ventricular assist devices are crucial in rehabilitation of patients with end-stage heart failure. Whether cardiopulmonary function is enhanced with higher pump output is unknown. 10 patients (aged 39±16 years, mean±SD) underwent monitored adjustment of pump speed to determine minimum safe low speed and maximum safe high speed at rest. Patients were then randomized to these speed settings and underwent three 6-minute walk tests (6MWT) and symptom-limited cardiopulmonary stress tests (CPX) on separate days. Pump speed settings (low, normal and high) resulted in significantly different resting pump flows of 4.43±0.6, 5.03±0.94, and 5.72±1.2 l/min (P<.001). There was a significant enhancement of pump flows (greater at higher speed settings) with exercise (P<0.05). Increased pump speed was associated with a trend to increased 6MWT distance (P=.10); and CPX exercise time (p=.27). Maximum workload achieved and peak oxygen consumption were significantly different comparing low to high pump speed settings only (P<.05). N-terminal-pro-B-type natriuretic peptide release was significantly reduced at higher pump speed with exercise (P<.01). We have found that alteration of pump speed setting resulted in significant variation in estimated pump flow. The high-speed setting was associated with lower natriuretic hormone release consistent with lower myocardial wall stress. This did not, however, improve exercise tolerance.

Modeling variability in porescale multiphase flow experiments

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

Ling, Bowen; Bao, Jie; Oostrom, Mart

Microfluidic devices and porescale numerical models are commonly used to study multiphase flow in biological, geological, and engineered porous materials. In this work, we perform a set of drainage and imbibition experiments in six identical microfluidic cells to study the reproducibility of multiphase flow experiments. We observe significant variations in the experimental results, which are smaller during the drainage stage and larger during the imbibition stage. We demonstrate that these variations are due to sub-porescale geometry differences in microcells (because of manufacturing defects) and variations in the boundary condition (i.e.,fluctuations in the injection rate inherent to syringe pumps). Computational simulationsmore » are conducted using commercial software STAR-CCM+, both with constant and randomly varying injection rate. Stochastic simulations are able to capture variability in the experiments associated with the varying pump injection rate.« less

CARS Spectral Fitting with Multiple Resonant Species using Sparse Libraries

NASA Technical Reports Server (NTRS)

Cutler, Andrew D.; Magnotti, Gaetano

2010-01-01

The dual pump CARS technique is often used in the study of turbulent flames. Fast and accurate algorithms are needed for fitting dual-pump CARS spectra for temperature and multiple chemical species. This paper describes the development of such an algorithm. The algorithm employs sparse libraries, whose size grows much more slowly with number of species than a conventional library. The method was demonstrated by fitting synthetic "experimental" spectra containing 4 resonant species (N2, O2, H2 and CO2), both with noise and without it, and by fitting experimental spectra from a H2-air flame produced by a Hencken burner. In both studies, weighted least squares fitting of signal, as opposed to least squares fitting signal or square-root signal, was shown to produce the least random error and minimize bias error in the fitted parameters.

Blood transfusion and risk of atrial fibrillation after coronary artery bypass graft surgery

PubMed Central

Liu, Shengqun; Li, Zhanwen; Liu, Zhe; Hu, Zhenhua; Zheng, Gaifang

2018-01-01

Abstract The aim of this study was to systematically evaluate the effect of blood transfusion (BT) on postoperative atrial fibrillation (AF) in adult patients who had undergone coronary artery bypass grafting (CABG) surgery. PubMed, Embase, and Cochrane Library databases from inception to January 2017 were searched. Cohort studies were searched that evaluated the association between BT and the risk of postoperative AF in adult patients who had undergone CABG surgery. Study quality was assessed by using the Newcastle–Ottawa scale (NOS). A meta-analysis was performed with the random-effect model. Eight cohort studies involving 7401 AF cases and 31,069 participants were identified and included in our data analysis. The pooled odds ratio of postoperative AF in patients with BT was 1.45 (95% confidence interval, 1.26–1.67), with significant heterogeneity (P < .0001, I2 = 79%). Excluding one study that had an off-pump CABG did not significantly impact this result (odds ratio, 1.36; 95% confidence interval, 1.23–1.50; n = 7). To examine the stability of the primary results, we performed subgroup analyses. The association between BT and the risk of postoperative AF was similar, as determined in the stratified analyses conducted according to study design, type of surgery, and country. The findings of the present meta-analysis demonstrated a statistically significant increase in postoperative AF risk among adult patients with BT. Further prospective large-scale studies are needed to establish causality and to elucidate the underlying mechanisms. PMID:29517692

Attenuating the Systemic Inflammatory Response to Adult Cardiopulmonary Bypass: A Critical Review of the Evidence Base

PubMed Central

Landis, R. Clive; Brown, Jeremiah R.; Fitzgerald, David; Likosky, Donald S.; Shore-Lesserson, Linda; Baker, Robert A.; Hammon, John W.

2014-01-01

Abstract: A wide range of pharmacological, surgical, and mechanical pump approaches have been studied to attenuate the systemic inflammatory response to cardiopulmonary bypass, yet no systematically based review exists to cover the scope of anti-inflammatory interventions deployed. We therefore conducted an evidence-based review to capture “self-identified” anti-inflammatory interventions among adult cardiopulmonary bypass procedures. To be included, trials had to measure at least one inflammatory mediator and one clinical outcome, specified in the “Outcomes 2010” consensus statement. Ninety-eight papers satisfied inclusion criteria and formed the basis of the review. The review identified 33 different interventions and approaches to attenuate the systemic inflammatory response. However, only a minority of papers (35 of 98 [35.7%]) demonstrated any clinical improvement to one or more of the predefined outcome measures (most frequently myocardial protection or length of intensive care unit stay). No single intervention was supported by strong level A evidence (multiple randomized controlled trials [RCTs] or meta-analysis) for clinical benefit. Interventions at level A evidence included off-pump surgery, minimized circuits, biocompatible circuit coatings, leukocyte filtration, complement C5 inhibition, preoperative aspirin, and corticosteroid prophylaxis. Interventions at level B evidence (single RCT) for minimizing inflammation included nitric oxide donors, C1 esterase inhibition, neutrophil elastase inhibition, propofol, propionyl-L-carnitine, and intensive insulin therapy. A secondary analysis revealed that suppression of at least one inflammatory marker was necessary but not sufficient to confer clinical benefit. The most effective interventions were those that targeted multiple inflammatory pathways. These observations are consistent with a “multiple hit” hypothesis, whereby clinically effective suppression of the systemic inflammatory response requires hitting multiple inflammatory targets simultaneously. Further research is warranted to evaluate if combinations of interventions that target multiple inflammatory pathways are capable of synergistically reducing inflammation and improving outcomes after cardiopulmonary bypass. PMID:26357785

Sustainable Improvement of Urban River Network Water Quality and Flood Control Capacity by a Hydrodynamic Control Approach-Case Study of Changshu City

NASA Astrophysics Data System (ADS)

Xie, Chen; Yang, Fan; Liu, Guoqing; Liu, Yang; Wang, Long; Fan, Ziwu

2017-01-01

Water environment of urban rivers suffers degradation with the impacts of urban expansion, especially in Yangtze River Delta. The water area in cites decreased sharply, and some rivers were cut off because of estate development, which brings the problems of urban flooding, flow stagnation and water deterioration. The approach aims to enhance flood control capability and improve the urban river water quality by planning gate-pump stations surrounding the cities and optimizing the locations and functions of the pumps, sluice gates, weirs in the urban river network. These gate-pump stations together with the sluice gates and weirs guarantee the ability to control the water level in the rivers and creating hydraulic gradient artificially according to mathematical model. Therefore the flow velocity increases, which increases the rate of water exchange, the DO concentration and water body self-purification ability. By site survey and prototype measurement, the river problems are evaluated and basic data are collected. The hydrodynamic model of the river network is established and calibrated to simulate the scenarios. The schemes of water quality improvement, including optimizing layout of the water distribution projects, improvement of the flow discharge in the river network and planning the drainage capacity are decided by comprehensive Analysis. Finally the paper introduces the case study of the approach in Changshu City, where the approach is successfully implemented.

The Effects of Intra-Aortic Balloon Pumps on Mortality in Patients Undergoing High-Risk Coronary Revascularization: A Meta-Analysis of Randomized Controlled Trials of Coronary Artery Bypass Grafting and Stenting Era

PubMed Central

Wan, You-Dong; Sun, Tong-Wen; Kan, Quan-Cheng; Guan, Fang-Xia; Liu, Zi-Qi; Zhang, Shu-Guang

2016-01-01

Background Intra-aortic balloon pumps (IABP) have generally been used for patients undergoing high-risk mechanical coronary revascularization. However, there is still insufficient evidence to determine whether they can improve outcomes in reperfusion therapy patients, mainly by percutaneous coronary intervention (PCI) with stenting or coronary artery bypass graft (CABG). This study was designed to determine the difference between high-risk mechanical coronary revascularization with and without IABPs on mortality, by performing a meta-analysis on randomized controlled trials of the current era. Methods Pubmed and Embase databases were searched from inception to May 2015. Unpublished data were obtained from the investigators. Randomized clinical trials of IABP and non-IABP in high-risk coronary revascularization procedures (PCI or CABG) were included. In the case of PCI procedures, stents should be used in more than 80% of patients. Numbers of events at the short-term and long-term follow-up were extracted. Results A total of 12 randomized trials enrolling 2155 patients were included. IABPs did not significantly decrease short-term mortality (relative risk (RR) 0.66; 95% CI, 0.42–1.01), or long-term mortality (RR 0.79; 95% CI, 0.47–1.35), with low heterogeneity across the studies. The findings remained stable in patients with acute myocardial infarction with or without cardiogenic shock. But in high-risk CABG patients, IABP was associated with reduced mortality (71 events in 846 patients; RR 0.40; 95%CI 0.25–0.67). Conclusion In patients undergoing high-risk coronary revascularization, IABP did not significantly decrease mortality. But high-risk CABG patients may be benefit from IABP. Rigorous criteria should be applied to the use of IABPs. PMID:26784578

Novel pump head design for high energy 1064 nm oscillator amplifier system for lidar applications

NASA Astrophysics Data System (ADS)

Willis, Christina C. C.; Witt, Greg; Martin, Nigel; Albert, Michael; Culpepper, Charles; Burnham, Ralph

2017-02-01

Many scientific endeavors are benefitted by the development of increasingly high energy laser sources for lidar applications. Space-based applications for lidar require compact, efficient and high energy sources, and we have designed a novel gain head that is compatible with these requirements. The gain medium for the novel design consists of a composite Nd:YAG/Sm:YAG slab, wherein the Sm:YAG portion absorbs any parasitic 1064 nm oscillations that might occur in the main pump axis. A pump cavity is built around the slab, consisting of angled gold-coated reflectors which allow for five pump passes from each of the four pumping locations around the slab. Pumping is performed with off-axis diode bars, allowing for highly compact conductively cooled design. Optical and thermal modeling of this design was done to verify and predict its performance. In order to ultimately achieve 50 W average power at a repetition rate of 500 Hz, three heads of this design will be used in a MOPA configuration with two stages of amplification. To demonstrate the pump head we built it into a 1064 nm laser cavity and performed initial amplification experiments. Modeling and design of the system is presented along with the initial oscillator and amplifier results. The greatest pulse energy produced from the seeded q-switched linear oscillator was an output of 25 mJ at 500 Hz. With an input of 25 mJ and two planned stages of amplification, we expect to readily reach 100 mJ or more per pulse.

Therapy of stress (takotsubo) cardiomyopathy: present shortcomings and future perspectives.

PubMed

Brunetti, Natale Daniele; Santoro, Francesco; De Gennaro, Luisa; Correale, Michele; Kentaro, Hayashi; Gaglione, Antonio; Di Biase, Matteo

2016-09-01

Several therapeutic options are available for the treatment of the acute phase of stress cardiomyopathy, pharmacological (β-blockers, diuretics, anticoagulants, antiarrhythmics, noncatecholamine inotropics [levosimendan]), and nonpharmacological (intra-aortic balloon pumping, extracorporeal membrane oxygenation), according to the wide possible clinical presentation and course of the disease. However, there is a gap in evidence, and very few data come from randomized and adequately powered studies. Some evidence supports the use of β-blockers, in particular with a short half-life, in the case of left ventricular outflow tract obstruction, and angiotensin-converting enzyme inhibitors in secondary prevention. Future perspectives include the study of genetic basis of stress cardiomyopathy, role of miRNA and neurovegetative modulation. Randomized studies, however, are surely warranted.

Efficacy and safety of mini-dose glucagon for treatment of nonsevere hypoglycemia in adults with type 1 diabetes

USDA-ARS?s Scientific Manuscript database

The purpose of this study was to evaluate low-dose glucagon to treat mild hypoglycemia in ambulatory adults with type 1 diabetes (T1D). This was a randomized crossover trial (two 3-week periods) conducted at five U.S. diabetes clinics. Twenty adults with T1D using an insulin pump and continuous gluc...

Home Use of Day-and-Night Hybrid Closed-Loop Insulin Delivery in Suboptimally Controlled Adolescents With Type 1 Diabetes: A 3-Week, Free-Living, Randomized Crossover Trial.

PubMed

Tauschmann, Martin; Allen, Janet M; Wilinska, Malgorzata E; Thabit, Hood; Acerini, Carlo L; Dunger, David B; Hovorka, Roman

2016-11-01

This study evaluated the feasibility, safety, and efficacy of day-and-night hybrid closed-loop insulin delivery in adolescents with type 1 diabetes under free-living conditions. In an open-label randomized crossover study, 12 suboptimally controlled adolescents on insulin pump therapy (mean ± SD age 14.6 ± 3.1 years; HbA 1c 69 ± 8 mmol/mol [8.5 ± 0.7%]; duration of diabetes 7.8 ± 3.5 years) underwent two 21-day periods in which hybrid closed-loop insulin delivery was compared with sensor-augmented insulin pump therapy in random order. During the closed-loop intervention, a model predictive algorithm automatically directed insulin delivery between meals and overnight. Participants used a bolus calculator to administer prandial boluses. The proportion of time that sensor glucose was in the target range (3.9-10 mmol/L; primary end point) was increased during the closed-loop intervention compared with sensor-augmented insulin pump therapy by 18.8 ± 9.8 percentage points (mean ± SD; P < 0.001), the mean sensor glucose level was reduced by 1.8 ± 1.3 mmol/L (P = 0.001), and the time spent above target was reduced by 19.3 ± 11.3 percentage points (P < 0.001). The time spent with sensor glucose levels below 3.9 mmol/L was low and comparable between interventions (median difference 0.4 [interquartile range -2.2 to 1.3] percentage points; P = 0.33). Improved glucose control during closed-loop was associated with increased variability of basal insulin delivery (P < 0.001) and an increase in the total daily insulin dose (53.5 [39.5-72.1] vs. 51.5 [37.6-64.3] units/day; P = 0.006). Participants expressed positive attitudes and experience with the closed-loop system. Free-living home use of day-and-night closed-loop in suboptimally controlled adolescents with type 1 diabetes is safe, feasible, and improves glucose control without increasing the risk of hypoglycemia. Larger and longer studies are warranted. © 2016 by the American Diabetes Association.

Single-shot stand-off chemical identification of powders using random Raman lasing

PubMed Central

Hokr, Brett H.; Bixler, Joel N.; Noojin, Gary D.; Thomas, Robert J.; Rockwell, Benjamin A.; Yakovlev, Vladislav V.; Scully, Marlan O.

2014-01-01

The task of identifying explosives, hazardous chemicals, and biological materials from a safe distance is the subject we consider. Much of the prior work on stand-off spectroscopy using light has been devoted to generating a backward-propagating beam of light that can be used drive further spectroscopic processes. The discovery of random lasing and, more recently, random Raman lasing provide a mechanism for remotely generating copious amounts of chemically specific Raman scattered light. The bright nature of random Raman lasing renders directionality unnecessary, allowing for the detection and identification of chemicals from large distances in real time. In this article, the single-shot remote identification of chemicals at kilometer-scale distances is experimentally demonstrated using random Raman lasing. PMID:25114231

Analysis of user characteristics related to drop-off detection with long cane

PubMed Central

Kim, Dae Shik; Emerson, Robert Wall; Curtis, Amy

2010-01-01

This study examined how user characteristics affect drop-off detection with the long cane. A mixed-measures design with block randomization was used for the study, in which 32 visually impaired adults attempted to detect the drop-offs using different cane techniques. Younger cane users detected drop-offs significantly more reliably (mean +/− standard deviation = 74.2% +/− 11.2% of the time) than older cane users (60.9% +/− 10.8%), p = 0.009. The drop-off detection threshold of the younger participants (5.2 +/− 2.1 cm) was also statistically significantly smaller than that of the older participants (7.9 +/− 2.2 cm), p = 0.007. Those with early-onset visual impairment (78.0% +/− 9.0%) also detected drop-offs significantly more reliably than those with later-onset visual impairment (67.3% +/− 12.4%), p = 0.01. No interaction occurred between examined user characteristics (age and age at onset of visual impairment) and the type of cane technique used in drop-off detection. The findings of the study may help orientation and mobility specialists select appropriate cane techniques in accordance with the cane user’s age and onset of visual impairment. PMID:20665349

Unique Challenges of Type 1 Diabetes in the Preschool Population.

PubMed

Coshway, Loyal K; Hoffman, Robert P

2017-01-01

Extremely young children aged ≤6 years old represent a unique population among patients with type 1 diabetes in terms of glycemic variation, diabetes management and complications. We describe distinct features of diabetes care and outcomes in preschool age children. We searched PubMed, Google Scholar, and authors' bibliographies in order to extract articles specific to type 1 diabetes in preschool age children. The preschool age group is beset by many challenges to diabetes care, including more frequent hypo- and hyperglycemia, hypoglycemia unawareness, decreased residual beta cell function, and greater long-term neurocognitive effects from severe hypoglycemia and chronic hyperglycemia. Randomized controlled trials show that equally good metabolic control can be obtained with multiple daily injections or an insulin pump. Several non-randomized trials, including an 8 year longitudinal study, show lower hemoglobin A1C and decreased hypoglycemia on insulin pumps. Sensor augmented pump therapy resulted in superior A1C as long as sensors were used regularly. In contrast to adults, continuous glucose monitoring has little to no impact on A1C, although parents appreciate the improved monitoring for hypoglycemia. Children with onset of diabetes prior to age 5 are at risk for younger onset of microalbuminuria, however do not develop earlier onset retinopathy than children diagnosed after 5 years. Both severe hypoglycemia and chronic hyperglycemia have negative impact on neurocognition. Special knowledge about this young population is helpful for practitioners and parents. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Results of completion arteriography after minimally invasive off-pump coronary artery bypass.

PubMed

Hoff, Steven J; Ball, Stephen K; Leacche, Marzia; Solenkova, Natalia; Umakanthan, Ramanan; Petracek, Michael R; Ahmad, Rashid; Greelish, James P; Walker, Kristie; Byrne, John G

2011-01-01

The benefits of a minimally invasive approach to off-pump coronary artery bypass remain controversial. The value of completion arteriography in validating this technique has not been investigated. From April 2007 to October 2009, fifty-six patients underwent isolated minimally invasive coronary artery bypass grafting through a left thoracotomy without cardiopulmonary bypass. Forty-three of these patients underwent completion arteriography. Sixty-five grafts were performed in these 56 patients, (average, 1.2 grafts per patient; range, 1 to 3). Forty-eight grafts were studied in the 43 patients undergoing completion arteriography. There were 4 findings on arteriogram leading to further immediate intervention (8.3%). These included 3 grafts with anastomotic stenoses or spasm requiring stent placement, and 1 patient who had limited dissection in the left internal mammary artery graft and underwent placement of an additional vein graft. These findings were independent of electrocardiographic changes or hemodynamic instability. The remainder of the studies showed no significant abnormalities. There were no deaths. One patient who did not have a completion arteriogram suffered a postoperative myocardial infarction requiring stent placement for anastomotic stenosis. Patients were discharged home an average of 6.8 days postoperatively. There were no instances of renal dysfunction postoperatively attributable to catheterization. Minimally invasive coronary artery bypass is safe and effective. Findings of completion arteriography occasionally reveal previously under-recognized findings that, if corrected in a timely fashion, could potentially impact graft patency and clinical outcomes. Our experience validates this minimally invasive technique. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.