Science.gov

Sample records for pressure risk model

  1. From pore pressure modeling to seismic risk assessment - a fully-integrated modeling approach

    NASA Astrophysics Data System (ADS)

    Layland-Bachmann, C. E.; Foxall, W.; Doughty, C.; Savy, J. B.; Hutchings, L. J.

    2016-12-01

    Increased subsurface fluid injection accompanying oil, gas, and geothermal exploitation and carbon dioxide sequestration, among other fluid injection applications, has increased the potential impact of injection-induced seismicity over the last few years, escalating the need to model the underlying physical processes and to assess potential seismic hazard and risks. We are developing a method to assess the seismic impact of proposed fluid injection projects that combines fluid flow modeling and earthquake simulation with probabilistic seismic hazard analysis. We use the multi-phase, multi-component flow and transport model TOUGH2 code, which enables complex pore-pressure time histories on specific faults and fractures resulting from injection to be calculated. A recent addition to RSQSim, the code used for physics-based earthquake simulations, enables such pressure histories to be treated as external stressing factors added to stresses due to tectonic loading. Earthquake catalogs generated by RSQSim are used as input to the RiskCat code, which performs probabilistic seismic hazard and risk calculations based on time- and space-dependent seismicity frequency-magnitude distributions. We present an application of this integrated approach to hypothetical CO2 sequestration injection scenarios based on a simplified model of a faulted reservoir at King Island in the northern Sacramento Valley, California. Multiple pore-pressure distributions calculated by TOUGH2 for different injection scenarios are used as external stress inputs to RSQsim. By varying fault and other properties, we generate the multiple realizations of the seismic catalogs required by RiskCat to carry out probabilistic seismic hazard assessments that fully incorporate both epistemic and aleatory uncertainty distributions. We propose that simulation-based methods like this can be used during the pre-injection design phase of planned projects.

  2. Validation of a Model for Predicting Pressure Injury Risk in Patients With Vascular Diseases.

    PubMed

    Moyse, Tonya; Bates, Jacqueline; Karafa, Matthew; Whitman, Angela; Albert, Nancy M

    The purpose of this study was to validate a 10-factor model of risk factors for hospital-acquired pressure injury (HAPI) risk in patients with vascular disease. Medical reviews identified 800 patients from a 1063 admissions to a 1400 bed quarternary care hospital in the midwestern United States. Retrospective review of medical records. Medical records of consecutive patients treated during an 18-month period on a medical-surgical vascular progressive care unit were reviewed. Ten previously identified risk factors for HAPI-(1) lower right ankle-brachial index, (2) low Braden Scale for Pressure Sore Risk score, (3) cared for in intensive care unit, (4) low serum hematocrit values, (4) elevated serum hematocrit levels (5) female gender, (6) nonwhite individual, (7) atherosclerosis, (8) diabetes mellitus, (9) elevated blood urea nitrogen levels, and (10) high body mass index-were compared to determine their ability to predict development of HAPI. Logistic regression model was used to validate the model. One hundred forty-six (16.1%) out of 800 patients developed an HAPI. The 10-factor risk model produced a concordance index of predicted to actual risk of 0.851, and the likelihood of developing an HAPI based on the model was significant (P < .001). A 10-factor model of HAPI risk was developed for patients with vascular disease. Routine assessment of risk factors is crucial in planning individualized interventions to diminish the risk of HAPI occurrences.

  3. Physics-Based Fragment Acceleration Modeling for Pressurized Tank Burst Risk Assessments

    NASA Technical Reports Server (NTRS)

    Manning, Ted A.; Lawrence, Scott L.

    2014-01-01

    As part of comprehensive efforts to develop physics-based risk assessment techniques for space systems at NASA, coupled computational fluid and rigid body dynamic simulations were carried out to investigate the flow mechanisms that accelerate tank fragments in bursting pressurized vessels. Simulations of several configurations were compared to analyses based on the industry-standard Baker explosion model, and were used to formulate an improved version of the model. The standard model, which neglects an external fluid, was found to agree best with simulation results only in configurations where the internal-to-external pressure ratio is very high and fragment curvature is small. The improved model introduces terms that accommodate an external fluid and better account for variations based on circumferential fragment count. Physics-based analysis was critical in increasing the model's range of applicability. The improved tank burst model can be used to produce more accurate risk assessments of space vehicle failure modes that involve high-speed debris, such as exploding propellant tanks and bursting rocket engines.

  4. Modeling the relationship between propagule pressure and invasion risk to inform policy and management.

    PubMed

    Wonham, Marjorie J; Byers, James E; Grosholz, Edwin D; Leung, Brian

    2013-10-01

    Predicting population establishment based on initial population size is a theoretically and empirically challenging problem whose resolution informs a multitude of applications. Indeed, it is a central problem in the management of introduced, endangered, harvested, and pathogenic organisms. We focus here on introduced species. We synthesize the current state of modeling in this predictive enterprise and outline future directions in the application of these models to developing regulations intended to prevent the establishment of invaders. Descriptive and mechanistic models of single-population introductions are fairly well developed and have provided insight into invasion risk in laboratory and field conditions. However, many invasions stem from large-scale and repeated releases of a multitude of species from relatively indiscriminate invasion vectors associated with international trade and travel. Vector-scale models of invasion risk are less well developed and are characterized largely by the use of untested proxy variables for propagule pressure. We illustrate the problems associated with proxy variables and introduce a more mechanistic theoretical formulation characterizing vector-scale invasion pressure in terms of propagule pressure (number of introduced individuals) and colonization pressure (number of introduced species). We outline key questions to be addressed in applying both single-population and vector-scale models to the development of threshold-based invasion regulations. We illustrate these ecological and applied questions using examples from terrestrial, aquatic, and marine systems. We develop in detail examples from ballast-water transport that, as one of the best-characterized global invasion vectors and one that is subject to emerging international threshold-based biosecurity regulations, provides a rich case study.

  5. Dynamic prediction model and risk assessment chart for cardiovascular disease based on on-treatment blood pressure and baseline risk factors.

    PubMed

    Teramukai, Satoshi; Okuda, Yasuyuki; Miyazaki, Shigeru; Kawamori, Ryuzo; Shirayama, Masayuki; Teramoto, Tamio

    2016-02-01

    For patients with hypertension, an individual risk prediction tool for cardiovascular disease based on on-treatment blood pressure is needed and would be useful. The objective of this study was to establish a 3-year risk prediction model for cardiovascular disease based on data from 13 052 patients with no history of cardiovascular disease in the Olmesartan Mega study to determine the relationship between Cardiovascular Endpoints and Blood Pressure Goal Achievement study. To develop dynamic prediction models including on-treatment blood pressure, a Cox proportional hazard model using the sliding landmarking method with three landmark points (6, 12 and 18 months from baseline) was used. The prediction model included blood pressure (<130/85 mm Hg, ⩾130/85  to <140/90 mm Hg, ⩾140/90 to <160/100 mm Hg and ⩾160/100 mm Hg) as a time-dependent covariate and well-known baseline risk factors (sex, age, smoking, family history of coronary artery disease and diabetes) as covariates. The 3-year risk assessment chart was constructed using the combination of all risk factors in the prediction model, and six different colors were displayed on each chart corresponding to the predicted probability of cardiovascular disease. Judging from the chart, if an elderly man with diabetes and other risk factors had a blood pressure of <130/85 mm Hg at 6 months, the risk of cardiovascular disease would be 8.0%, whereas the risk would be 8.6% if he had a blood pressure of ⩾130/85 to <140/90 mm Hg. The risk assessment chart developed from the large-scale observational study data would help physicians to more easily assess the cardiovascular disease risk for hypertensive patients on antihypertensive treatments.

  6. Recording pressure ulcer risk assessment and incidence.

    PubMed

    Plaskitt, Anne; Heywood, Nicola; Arrowsmith, Michaela

    2015-07-15

    This article reports on the introduction of an innovative computer-based system developed to record and report pressure ulcer risk and incidence at an acute NHS trust. The system was introduced to ensure that all patients have an early pressure ulcer risk assessment, which prompts staff to initiate appropriate management if a pressure ulcer is detected, thereby preventing further patient harm. Initial findings suggest that this electronic process has helped to improve the timeliness and accuracy of data on pressure ulcer risk and incidence. In addition, it has resulted in a reduced number of reported hospital-acquired pressure ulcers.

  7. Pressure sore risk assessment in palliative care.

    PubMed

    Chaplin, J

    2000-01-01

    Pressure sore prevention in palliative care is recognized as being an essential element of holistic care, with the primary goal of promoting quality of life for patient and family. Little is known about the incidence of pressure sore development and the use of pressure sore risk assessment tools in palliative care settings. The development of a risk assessment tool specifically for palliative care patients in a 41-bedded specialist palliative care unit is described. The risk assessment tool was developed as part of a tissue viability practice development initiative. The approach adopted in the validation of the Hunters Hill Marie Curie Centre pressure sore risk assessment tool was the comparative analysis of professional judgment of experienced palliative care nurses with the numerical scores achieved during the assessment of risk on 291 patients (529 risk assessment events). This comparative analysis identified the threshold for different degrees of risk for the patient group involved: low risk, medium risk, high risk and very high risk. Further work is being undertaken to evaluate the inter-rater reliability of the new tool. A number of issues are explored in this paper in relation to pressure sore prevention in palliative care: the role of risk assessment tools, the sometimes conflicting aims of trying to ensure comfort and prevent pressure sore damage, and the uncertainties faced by palliative care nurses when they are trying to maintain quality of life for the dying.

  8. Visual Impairment/Intracranial Pressure Risk Assessment

    NASA Technical Reports Server (NTRS)

    Fogarty, Jennifer A.; Durham, T.; Otto, C.; Grounds, D.; Davis, J. R.

    2010-01-01

    Since 2006 there have been 6 reported cases of altered visual acuity and intracranial pressure (ICP) in long duration astronauts. In order to document this risk and develop an integrated approach to its mitigation, the NASA Space Life Sciences Directorate (SLSD) and Human Research Program (HRP) have chosen to use the Human System Risk Board (HSRB) and the risk management analysis tool (RMAT). The HSRB is the venue in which the stakeholders and customers discuss and vet the evidence and the RMAT is the tool that facilitates documentation and comparison of the evidence across mission profiles as well as identification of risk factors, and documentation of mitigation strategies. This process allows for information to be brought forward and dispositioned so that it may be properly incorporated into the RMAT and contribute to the design of the research and mitigation plans. The evidence thus far has resulted in the identification of a visual impairment/intracranial pressure (VIIP) project team, updating of both short and long duration medical requirements designed to assess visual acuity, and a research plan to characterize this issue further. In order to understand this issue more completely, a plan to develop an Accelerated Research Collaboration (ARC) has been approved by the HSRB. The ARC is a novel research model pioneered by the Myelin Repair Foundation. It is a patient centered research model that brings together researchers and clinicians, under the guidance of a scientific advisory panel, to collaborate and produce results much quickly than accomplished through traditional research models. The data and evidence from the updated medical requirements and the VIIP ARC will be reviewed at the HSRB on a regular basis. Each review package presented to the HSRB will include an assessment and recommendation with respect to continuation of research, countermeasure development, occupational surveillance modalities, selection criteria, etc. This process will determine the

  9. Pressure sore risk assessment in children.

    PubMed

    Waterlow, J A

    1997-07-01

    A multi-centred study was undertaken involving 300 children ranging from neonates to children aged 16 years. The purpose of the study was to investigate the possibility of designing a pressure sore risk assessment scoring system suitable for the paediatric area of care. It was found that the following conclusions can be drawn: (i) Children are at risk of developing pressure sores; (ii) A version of the adult Waterlow card was not appropriate, especially at the younger end of the scale; (iii) There are identifiable situations and treatments which do pose a risk of pressure sore development. Admission documentation and a care plan within a hospital policy is recommended as the best method of drawing nurses' attention to the risk factors involved and the measures which need to be taken to alleviate the risk of tissue damage.

  10. Comparison of the Framingham Heart Study Hypertension Model with Blood Pressure Alone in the Prediction of Risk of Hypertension: The Multi-Ethnic Study of Atherosclerosis (MESA)

    PubMed Central

    Muntner, Paul; Woodward, Mark; Mann, Devin; Shimbo, Daichi; Michos, Erin D.; Blumenthal, Roger S.; Carson, April P; Chen, Haiying; Arnett, Donna K.

    2010-01-01

    A prediction model, developed in the Framingham Heart Study (FHS), has been proposed for use in estimating a given individual’s risk of hypertension. We compared this model with systolic blood pressure (SBP) alone and age-specific diastolic blood pressure (DBP) categories for the prediction of hypertension. Participants in the Multi-Ethnic Study of Atherosclerosis, without hypertension or diabetes (n=3013), were followed for the incidence of hypertension (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg and/or the initiation of antihypertensive medication). The predicted probability of developing hypertension between four adjacent study examinations, with a median of 1.6 years between examinations, was determined. The mean (standard deviation) age of participants was 58.5 (9.7) years and 53% were women. During follow-up, 849 incident cases of hypertension occurred. The c-statistic for the FHS model was 0.788 (95% CI: 0.773, 0.804) compared with 0.768 (95% CI: 0.751, 0.785; p=0.096 compared to the FHS model) for SBP alone and 0.699 (95% CI: 0.681, 0.717; p<0.001 compared to the FHS model) for age-specific DBP categories. The relative integrated discrimination improvement index for the FHS model versus SBP alone was 10.0% (95% CI: −1.7%, 22.7%) and versus age-specific DBP categories was 146% (95% CI: 116%, 181%). Using the FHS model, there were significant differences between observed and predicted hypertension risk (Hosmer-Lemeshow goodness of fit p<0.001); re-calibrated and best-fit models produced a better model fit (p=0.064 and 0.245, respectively). In this multi-ethnic cohort of U.S. adults, the FHS model was not substantially better than SBP alone for predicting hypertension. PMID:20439822

  11. Patient repositioning and pressure ulcer risk--monitoring interface pressures of at-risk patients.

    PubMed

    Peterson, Matthew J; Gravenstein, Nikolaus; Schwab, Wilhelm K; van Oostrom, Johannes H; Caruso, Lawrence J

    2013-01-01

    Repositioning patients regularly to prevent pressure ulcers and reduce interface pressures is the standard of care, yet prior work has found that standard repositioning does not relieve all areas of at-risk tissue in nondisabled subjects. To determine whether this holds true for high-risk patients, we assessed the effectiveness of routine repositioning in relieving at-risk tissue of the perisacral area using interface pressure mapping. Bedridden patients at risk for pressure ulcer formation (n = 23, Braden score <18) had their perisacral skin-bed interface pressures recorded every 30 s while they received routine repositioning care for 4-6 h. All participants had specific skin areas (206 +/- 182 cm(2)) that exceeded elevated pressure thresholds for >95% of the observation period. Thirteen participants were observed in three distinct positions (supine, turned left, turned right), and all had specific skin areas (166 +/- 184 cm(2)) that exceeded pressure thresholds for >95% of the observation period. At-risk patients have skin areas that are likely always at risk throughout their hospital stay despite repositioning. Healthcare providers are unaware of the actual tissue-relieving effectiveness (or lack thereof) of their repositioning interventions, which may partially explain why pressure ulcer mitigation strategies are not always successful. Relieving at-risk tissue is a necessary part of pressure ulcer prevention, but the repositioning practice itself needs improvement.

  12. Designing trials for pressure ulcer risk assessment research: methodological challenges.

    PubMed

    Balzer, K; Köpke, S; Lühmann, D; Haastert, B; Kottner, J; Meyer, G

    2013-08-01

    For decades various pressure ulcer risk assessment scales (PURAS) have been developed and implemented into nursing practice despite uncertainty whether use of these tools helps to prevent pressure ulcers. According to current methodological standards, randomised controlled trials (RCTs) are required to conclusively determine the clinical efficacy and safety of this risk assessment strategy. In these trials, PURAS-aided risk assessment has to be compared to nurses' clinical judgment alone in terms of its impact on pressure ulcer incidence and adverse outcomes. However, RCTs evaluating diagnostic procedures are prone to specific risks of bias and threats to the statistical power which may challenge their validity and feasibility. This discussion paper critically reflects on the rigour and feasibility of experimental research needed to substantiate the clinical efficacy of PURAS-aided risk assessment. Based on reflections of the methodological literature, a critical appraisal of available trials on this subject and an analysis of a protocol developed for a methodologically robust cluster-RCT, this paper arrives at the following conclusions: First, available trials do not provide reliable estimates of the impact of PURAS-aided risk assessment on pressure ulcer incidence compared to nurses' clinical judgement alone due to serious risks of bias and insufficient sample size. Second, it seems infeasible to assess this impact by means of rigorous experimental studies since sample size would become extremely high if likely threats to validity and power are properly taken into account. Third, means of evidence linkages seem to currently be the most promising approaches for evaluating the clinical efficacy and safety of PURAS-aided risk assessment. With this kind of secondary research, the downstream effect of use of PURAS on pressure ulcer incidence could be modelled by combining best available evidence for single parts of this pathway. However, to yield reliable modelling

  13. Hurricane risk mitigation - High Pressure Gas Facility

    NASA Technical Reports Server (NTRS)

    2008-01-01

    A worker pours concrete as part of a nitrogen risk mitigation project at the High Pressure Gas Facility at Stennis Space Center. The concrete slab will provide the foundation needed to place new pumps at the site and is part of ongoing hurricane-related mitigation work at Stennis.

  14. Hurricane risk mitigation - High Pressure Gas Facility

    NASA Image and Video Library

    2008-07-29

    A worker pours concrete as part of a nitrogen risk mitigation project at the High Pressure Gas Facility at Stennis Space Center. The concrete slab will provide the foundation needed to place new pumps at the site and is part of ongoing hurricane-related mitigation work at Stennis.

  15. Effectiveness of amlodipine-valsartan single-pill combinations: hierarchical modeling of blood pressure and total cardiovascular disease risk outcomes (the EXCELLENT study).

    PubMed

    Lins, Robert; Aerts, Ann; Coen, Nicolas; Hermans, Christine; MacDonald, Karen; Brié, Heidi; Lee, Christopher; Shen, Yu-Ming; Vancayzeele, Stefaan; Mecum, Natalie; Abraham, Ivo

    2011-06-01

    Both patient- and physician-related factors have been shown to explain variability in the outcomes of antihypertensive treatment. Total cardiovascular risk (TCVR) is increasingly used as a determinant of treatment effectiveness but has also been proposed as a treatment outcome. To our knowledge, no studies have reported how antihypertensive treatment impacts blood pressure and TCVR outcomes. To examine in patients treated with a regimen including single-pill combinations (SPCs) of amlodipine/valsartan (1) blood pressure (BP) reduction and control, total cardiovascular risk (TCVR) change, and TCVR reduction of 1 class or more; (2) hierarchical patient- and physician-level determinants of these outcomes; and (3) predictors of uncontrolled BP and improved TCVR classification. A prospective (90 days), multicenter, multilevel pharmacoepidemiologic study was conducted in 3546 patients with hypertension treated with SPC amlodipine/valsartan by 698 general practitioners. Statistical analysis included hierarchical linear and logistic modeling of BP and TCVR outcomes. Mean (SD) systolic BP (SBP) reductions were 20.1 (15.5) mm Hg and diastolic BP (DBP) reductions were 9.8 (10.3) mm Hg, with higher reductions among high-risk patients. SBP, DBP, and SBP/DBP control rates were 33.3%, 45.3%, and 25.5%, respectively, with lower rates among high-risk patients. Mean TCVR improvement was a reduction of 0.73 (0.96) classes (-4 [best] to +4 [worst]), with higher reductions for high-risk patients; 58.2% of patients achieved a TCVR reduction of 1 or more classes, with lower percentages for high-risk patients. Twenty-two percent of systolic variability and 26% of diastolic variability in 90-day BP values were attributable to a physician class effect, as was 16% of TCVR change. Regimens that include SPC amlodipine/valsartan formulations are effective in reducing BP and TCVR in a real-world observational setting. Hierarchical modeling identified patient- and physician-related determinants

  16. [Elevated blood pressure as cardiovascular risk factor].

    PubMed

    Kowalewski, Wiesław; Hebel, Kazimiera

    2013-01-01

    Cardiovascular diseases for decades have been and still are the main and current health problem of the Polish society and there are many reasons for these diseases. Hypertension is one of the major risk factors for developing cardiovascular disease. The factors significantly increasing risk the of cardiovascular disease are in addition to high blood pressure, smoking (also passive), high blood fats (cholesterol and its HDL, LDL fractions as well as triglyceride levels, obesity, lack of exercise, diabetes and hereditary features. Other important factors which play an important role are external factors such as e.g. environmental pollution, lifestyle, stress. Prediction of cardiovascular disease should start from the evaluation of the fetal period because low birth weight may be a risk of coronary heart disease, hypertension, obesity or diabetes in adulthood. The authors of the referred tests showed that the level of blood pressure observed during childhood is closely associated with the level of blood pressure in adults and is also dependent on the body weight. Since the issue of the effects of high pressure on the cardiovascular system is inherent in the issue of the metabolic syndrome, it should be mentioned also that another causative factor may be an irregularity in the removal of urine from the body and the amount of insulin. The control of hypertension is a complex problem, at least in view of the wide range of adverse factors affecting the human body: hypertension is often either a constituent of other lesions. Therefore, it is difficult to treat high blood pressure in the strict sense; more often it is a combination therapy based on pharmacology caused for other reasons.

  17. Exercise May Help Black Americans Lower Blood Pressure Risk

    MedlinePlus

    ... html Exercise May Help Black Americans Lower Blood Pressure Risk Recommended 150 minutes of moderate activity weekly ... may lower black Americans' risk of high blood pressure, a new study finds. The new research included ...

  18. Credit Risk Models

    NASA Astrophysics Data System (ADS)

    Sobehart, Jorge

    2003-03-01

    The conventional method for developing credit risk models is to determine the probability of occurrence of credit events that can contribute to business failure. Unfortunately, most of the quantitative approaches to credit risk modeling found in the literature do not accurately portray the situation when the model inputs contain a significant degree of subjectivity or the relationships between inputs are inexact. In practice, data are often sparse, unreliable or nonexistent and the relationships between the model variables are often based on expert judgment. This means that credit risk models often depend on significant subjective expertise as opposed to models derived from first principles. Because of the continuous development of complex derivatives structures and debt instruments, and also because investors are becoming increasingly sophisticated and more reluctant to accept overly simplistic credit risk analysis, it is important to understand the basic limitations of the available credit risk models.

  19. ``Swiss cheese'' models with pressure

    NASA Astrophysics Data System (ADS)

    Bona, C.; Stela, J.

    1987-11-01

    Local spherically symmetric inhomogeneities are matched to a spatially flat Robertson-Walker background with pressure. In the cases in which the background evolves to an Einstein-de Sitter dust universe, the interior metrics tend with time either to the vacuum Schwarzschild solution or to the spatially flat Tolman dust metrics. The whole construction may be interpreted as the history of the dust-filled ``Swiss cheese'' models.

  20. High Blood Pressure, Afib and Your Risk of Stroke

    MedlinePlus

    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More High Blood Pressure, AFib and Your Risk of Stroke Updated:Aug ... have a stroke for the first time have high blood pressure . And an irregular atrial heart rhythm — a condition ...

  1. High Blood Pressure, Afib and Your Risk of Stroke

    MedlinePlus

    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More High Blood Pressure, Afib and Your Risk of Stroke Updated:Sep ... have a stroke for the first time have high blood pressure . And an irregular atrial heart rhythm — a condition ...

  2. General Pressurization Model in Simscape

    NASA Technical Reports Server (NTRS)

    Servin, Mario; Garcia, Vicky

    2010-01-01

    System integration is an essential part of the engineering design process. The Ares I Upper Stage (US) is a complex system which is made up of thousands of components assembled into subsystems including a J2-X engine, liquid hydrogen (LH2) and liquid oxygen (LO2) tanks, avionics, thrust vector control, motors, etc. System integration is the task of connecting together all of the subsystems into one large system. To ensure that all the components will "fit together" as well as safety and, quality, integration analysis is required. Integration analysis verifies that, as an integrated system, the system will behave as designed. Models that represent the actual subsystems are built for more comprehensive analysis. Matlab has been an instrument widely use by engineers to construct mathematical models of systems. Simulink, one of the tools offered by Matlab, provides multi-domain graphical environment to simulate and design time-varying systems. Simulink is a powerful tool to analyze the dynamic behavior of systems over time. Furthermore, Simscape, a tool provided by Simulink, allows users to model physical (such as mechanical, thermal and hydraulic) systems using physical networks. Using Simscape, a model representing an inflow of gas to a pressurized tank was created where the temperature and pressure of the tank are measured over time to show the behavior of the gas. By further incorporation of Simscape into model building, the full potential of this software can be discovered and it hopefully can become a more utilized tool.

  3. Risk Factors for High Blood Pressure

    MedlinePlus

    ... to achieve target blood pressure goals with treatment. Overweight You are more likely to develop prehypertension or high blood pressure if you’re overweight or obese . The terms “overweight” and “obese” refer ...

  4. Evaluating Health Risk Models

    PubMed Central

    2010-01-01

    SUMMARY Interest in targeted disease prevention has stimulated development of models that assign risks to individuals, using their personal covariates. We need to evaluate these models and quantify the gains achieved by expanding a model to include additional covariates. This paper reviews several performance measures and shows how they are related. Examples are used to show that appropriate performance criteria for a risk model depend upon how the model is used. Application of the performance measures to risk models for hypothetical populations and for US women at risk of breast cancer illustrate two additional points. First, model performance is constrained by the distribution of risk-determining covariates in the population. This complicates the comparison of two models when applied to populations with different covariate distributions. Second, all summary performance measures obscure model features of relevance to its utility for the application at hand, such as performance in specific subgroups of the population. In particular, the precision gained by adding covariates to a model can be small overall, but large in certain subgroups. We propose new ways to identify these subgroups and to quantify how much they gain by measuring the additional covariates. Those with largest gains could be targeted for cost-efficient covariate assessment. PMID:20623821

  5. Melanoma Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing melanoma cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  6. Blood Pressure and Global Risk Assessment in a Swedish Population

    PubMed Central

    Eckner, Jenny; Larsson, Charlotte A.; Råstam, Lennart; Lindblad, Ulf

    2012-01-01

    This study investigated the association between SCORE and the 2007 ESH-ESC blood pressure categories and explored achievements of blood pressure goals considering global risk. In 2001–2005, a random sample of inhabitants aged 30–74 years in southwestern Sweden was invited to a survey of cardiovascular risk factors. The study enrolled 2816 participants (participation rate 76%). Blood pressure was categorized according to the 2007 ESH-ESC guidelines. Global risk of 10-year CVD death was estimated using the Swedish SCORE chart also accounting for additional risk from diabetes (SCORE-DM). SCORE-DM increased in both sexes from optimal blood pressure to manifest hypertension but did not differ between the normal blood pressure categories. However, SCORE-DM became significantly higher among those with temporarily high blood pressure (men 3.3 SD (1.7), women 1.1 (1.8)) and hypertension (3.6 (2.0), 2.0 (2.0)), compared to optimal blood pressure (1.6 (2.9), 0.6 (1.9)). In the presence of both hypertension and diabetes, high-risk subjects dominated (men 76%, women 61%), and correspondingly a major proportion of patients with known hypertension were at high risk at a blood pressure ≥160/100 mm Hg. These findings have strong implications on blood pressure evaluation in clinical practice and support the use of SCORE to evaluate global risk. PMID:22991653

  7. Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors.

    PubMed

    Cornelissen, Véronique A; Fagard, Robert H

    2005-10-01

    Previous meta-analyses of randomized controlled trials on the effects of chronic dynamic aerobic endurance training on blood pressure reported on resting blood pressure only. Our aim was to perform a comprehensive meta-analysis including resting and ambulatory blood pressure, blood pressure-regulating mechanisms, and concomitant cardiovascular risk factors. Inclusion criteria of studies were: random allocation to intervention and control; endurance training as the sole intervention; inclusion of healthy sedentary normotensive or hypertensive adults; intervention duration of > or =4 weeks; availability of systolic or diastolic blood pressure; and publication in a peer-reviewed journal up to December 2003. The meta-analysis involved 72 trials, 105 study groups, and 3936 participants. After weighting for the number of trained participants and using a random-effects model, training induced significant net reductions of resting and daytime ambulatory blood pressure of, respectively, 3.0/2.4 mm Hg (P<0.001) and 3.3/3.5 mm Hg (P<0.01). The reduction of resting blood pressure was more pronounced in the 30 hypertensive study groups (-6.9/-4.9) than in the others (-1.9/-1.6; P<0.001 for all). Systemic vascular resistance decreased by 7.1% (P<0.05), plasma norepinephrine by 29% (P<0.001), and plasma renin activity by 20% (P<0.05). Body weight decreased by 1.2 kg (P<0.001), waist circumference by 2.8 cm (P<0.001), percent body fat by 1.4% (P<0.001), and the homeostasis model assessment index of insulin resistance by 0.31 U (P<0.01); HDL cholesterol increased by 0.032 mmol/L(-1) (P<0.05). In conclusion, aerobic endurance training decreases blood pressure through a reduction of vascular resistance, in which the sympathetic nervous system and the renin-angiotensin system appear to be involved, and favorably affects concomitant cardiovascular risk factors.

  8. Pore pressure propagation in a permeable thin-layer coal seam based on a dual porosity model: A case of risk prediction of water inrush in coalmines

    NASA Astrophysics Data System (ADS)

    Zhu, B.; Gao, F.; Yang, J. W.; Zhou, G. Q.

    2016-08-01

    Thin-layer coal seams, a type of filling coal rock body, are considered aquifer systems made up of dual porosity medium with immediate floor. A numerical simulation for the pore pressure propagation along a thin-layer coal seam was carried out for the case of the Zhaogezhuang coalmine in China. By valuing the permeability (Kf ) of the thin-layer coal seam, pore pressure variation with time was simulated and compared to the analytical solutions of a dual porosity model (DPM). The main conclusions were drawn as follow: (1) Seepage in the thin-layer coal seam was predominant in the whole process, and the distance of seepage was lengthened and the pore pressure decreased with increased Kf , (2) A series of simulated hydraulic graphs demonstrated that the pore pressure characteristics of peak-occurring and time-lag effects agreed with the analytical solutions of DPM; (3) By adjusting the parameters of DPM, two results of analytical solutions and numerical solutions fit well, particularly in the thin-layer coal seam, (4) The power law relationship between the peak-values and lag time of pore pressure were derived statistically under consideration of the Kf parameter in the range of 10-8 to 10-10 m2/pa-s orders, and it was reasonable that the Kf of the thin-layer coal seam was in the range of 10-8 m2/pa-s orders. The results were significantly helpful in decision-making for mining water prevention and prediction in practice.

  9. Biosafety Risk Assessment Model

    SciTech Connect

    Daniel Bowen, Susan Caskey

    2011-05-27

    Software tool based on a structured methodology for conducting laboratory biosafety risk assessments by biosafety experts. Software is based upon an MCDA scheme and uses peer reviewed criteria and weights. The software was developed upon Microsoft's .net framework. The methodology defines likelihood and consequence of a laboratory exposure for thirteen unique scenarios and provides numerical relative risks for each of the relevant thirteen. The software produces 2-d graphs reflecting the relative risk and a sensitivity analysis which highlights the overall importance of each factor. The software works as a set of questions with absolute scales and uses a weighted additive model to calculate the likelihood and consequence.

  10. Biosafety Risk Assessment Model

    SciTech Connect

    Daniel Bowen, Susan Caskey

    2011-05-27

    Software tool based on a structured methodology for conducting laboratory biosafety risk assessments by biosafety experts. Software is based upon an MCDA scheme and uses peer reviewed criteria and weights. The software was developed upon Microsoft’s .net framework. The methodology defines likelihood and consequence of a laboratory exposure for thirteen unique scenarios and provides numerical relative risks for each of the relevant thirteen. The software produces 2-d graphs reflecting the relative risk and a sensitivity analysis which highlights the overall importance of each factor. The software works as a set of questions with absolute scales and uses a weighted additive model to calculate the likelihood and consequence.

  11. Risk assessment scales for pressure ulcer prevention: a systematic review.

    PubMed

    Pancorbo-Hidalgo, Pedro L; Garcia-Fernandez, Francisco Pedro; Lopez-Medina, Isabel Ma; Alvarez-Nieto, Carmen

    2006-04-01

    This paper reports a systematic review conducted to determine the effectiveness of the use of risk assessment scales for pressure ulcer prevention in clinical practice, degree of validation of risk assessment scales, and effectiveness of risk assessment scales as indicators of risk of developing a pressure ulcer. Pressure ulcers are an important health problem. The best strategy to avoid them is prevention. There are several risk assessment scales for pressure ulcer prevention which complement nurses' clinical judgement. However, some of these have not undergone proper validation. A systematic bibliographical review was conducted, based on a search of 14 databases in four languages using the keywords pressure ulcer or pressure sore or decubitus ulcer and risk assessment. Reports of clinical trials or prospective studies of validation were included in the review. Thirty-three studies were included in the review, three on clinical effectiveness and the rest on scale validation. There is no decrease in pressure ulcer incidence was found which might be attributed to use of an assessment scale. However, the use of scales increases the intensity and effectiveness of prevention interventions. The Braden Scale shows optimal validation and the best sensitivity/specificity balance (57.1%/67.5%, respectively); its score is a good pressure ulcer risk predictor (odds ratio = 4.08, CI 95% = 2.56-6.48). The Norton Scale has reasonable scores for sensitivity (46.8%), specificity (61.8%) and risk prediction (OR = 2.16, CI 95% = 1.03-4.54). The Waterlow Scale offers a high sensitivity score (82.4%), but low specificity (27.4%); with a good risk prediction score (OR = 2.05, CI 95% = 1.11-3.76). Nurses' clinical judgement (only considered in three studies) gives moderate scores for sensitivity (50.6%) and specificity (60.1%), but is not a good pressure ulcer risk predictor (OR = 1.69, CI 95% = 0.76-3.75). There is no evidence that the use of risk assessment scales decreases pressure

  12. Modeling Cyclic Variation of Intracranial Pressure

    DTIC Science & Technology

    2001-10-25

    with increasing vascular dilation induced by increasing the level of the partial pressure of carbon dioxide (PCO2) within the arterial blood ...ventilation. Simulated model recordings demonstrated that the correlation index between arterial blood pressure and ICP progressively increased... blood pressure (ABP) recording, the ICP Figure 1. Experimental Recordings of ABP and ICP during Normocapnia and Hypercapnia. a) Normocapnia with

  13. [Role of pulse pressure, systolic blood pressure, and diastolic blood pressure in the prediction of cardiovascular risk. Cohort study].

    PubMed

    Baena-Díez, José Miguel; Bermúdez-Chillida, Noemí; García-Lareo, Manel; Olivia Byram, Alice; Vidal-Solsona, Marc; Vilató-García, Mónica; Gómez-Fernández, Claudia; Vásquez-Lazo, Javier Ernesto

    2008-03-22

    To analize the role of pulse pressure (PP), systolic (SBP) and diastolic blood pressure (DBP), in the prediction of cardiovascular risk. A prospective cohort study carried out in 2 primary care center, including 932 patients aged between 35-84 years old, without cardiovascular events, selected by simple random sampling, and with an 8 year follow-up. PP, SBP, and DBP were categorized in tertiles, comparing the upper with the 2 lowers. First cardiovascular event, whether fatal or not, such as coronary heart disease, cerebrovascular disease, and peripheral arterial disease was recorded as a composite variable. Results were studied according to Cox models, adjusting for age, sex, smoking, total cholesterol, high density lipoprotein cholesterol, and diabetes mellitus. We studied the correlation between PP with SBP, DBP, and cardiovascular risk factors. We registered 85 cardiovascular events: 43 cases of coronary heart disease, 27 cerebrovascular disease, and 17 peripheral arterial disease. The adjusted hazard ratios for composite variable were: upper PP tertile (>/= 59 mmHg) = 1.3 (95% confidence interval [CI], 0.8-2.1); upper SBP tertile (>/= 140 mmHg) = 1.5 (95% CI, 1.0-2.5); upper DBP tertile (>/= 84 mmHg) = 1.1 (95% CI, 0.7-1.8). Results were similar for specific cardiovascular events. PP was correlated with SBP (r = 0.825; p < 0.001), age (r = 0.422; p < 0.001), diabetes mellitus (r = 0.242; p < 0.001), and smoking (r = -0.158; p = 0.01), with adjusted hazard ratio for these variables of 1.0 (95% CI, 0.6-1.9). PP is an arterial pressure component very correlated with SBP and other factors, but is not a better cardiovascular risk predictor than SBP.

  14. Melanoma risk prediction models.

    PubMed

    Nikolić, Jelena; Loncar-Turukalo, Tatjana; Sladojević, Srdan; Marinković, Marija; Janjić, Zlata

    2014-08-01

    The lack of effective therapy for advanced stages of melanoma emphasizes the importance of preventive measures and screenings of population at risk. Identifying individuals at high risk should allow targeted screenings and follow-up involving those who would benefit most. The aim of this study was to identify most significant factors for melanoma prediction in our population and to create prognostic models for identification and differentiation of individuals at risk. This case-control study included 697 participants (341 patients and 356 controls) that underwent extensive interview and skin examination in order to check risk factors for melanoma. Pairwise univariate statistical comparison was used for the coarse selection of the most significant risk factors. These factors were fed into logistic regression (LR) and alternating decision trees (ADT) prognostic models that were assessed for their usefulness in identification of patients at risk to develop melanoma. Validation of the LR model was done by Hosmer and Lemeshow test, whereas the ADT was validated by 10-fold cross-validation. The achieved sensitivity, specificity, accuracy and AUC for both models were calculated. The melanoma risk score (MRS) based on the outcome of the LR model was presented. The LR model showed that the following risk factors were associated with melanoma: sunbeds (OR = 4.018; 95% CI 1.724-9.366 for those that sometimes used sunbeds), solar damage of the skin (OR = 8.274; 95% CI 2.661-25.730 for those with severe solar damage), hair color (OR = 3.222; 95% CI 1.984-5.231 for light brown/blond hair), the number of common naevi (over 100 naevi had OR = 3.57; 95% CI 1.427-8.931), the number of dysplastic naevi (from 1 to 10 dysplastic naevi OR was 2.672; 95% CI 1.572-4.540; for more than 10 naevi OR was 6.487; 95%; CI 1.993-21.119), Fitzpatricks phototype and the presence of congenital naevi. Red hair, phototype I and large congenital naevi were only present in melanoma patients and thus

  15. Pressure ulcer risk of patient handling sling use.

    PubMed

    Peterson, Matthew J; Kahn, Julie A; Kerrigan, Michael V; Gutmann, Joseph M; Harrow, Jeffrey J

    2015-01-01

    Patient handling slings and lifts reduce the risk of musculoskeletal injuries for healthcare providers. However, no published evidence exists of their safety with respect to pressure ulceration for vulnerable populations, specifically persons with spinal cord injury, nor do any studies compare slings for pressure distribution. High-resolution interface pressure mapping was used to describe and quantify risks associated with pressure ulceration due to normal forces and identify at-risk anatomical locations. We evaluated 23 patient handling slings with 4 nondisabled adults. Sling-participant interface pressures were recorded while participants lay supine on a hospital bed and while suspended during typical patient transfers. Sling-participant interface pressures were greatest while suspended for all seated and supine slings and exceeded 200 mm Hg for all seated slings. Interface pressures were greatest along the sling seams (edges), regardless of position or sling type. The anatomical areas most at risk while participants were suspended in seated slings were the posterior upper and lower thighs. For supine slings, the perisacral area, ischial tuberosities, and greater trochanters were most at risk. The duration of time spent in slings, especially while suspended, should be limited.

  16. Pressure sores in intensive care: defining their incidence and associated factors and assessing the utility of two pressure sore risk assessment tools.

    PubMed

    Boyle, M; Green, M

    2001-02-01

    Patients in intensive care units (ICU) are at high risk of developing pressure sores and the use of pressure sore risk tools has been advocated as a means of identifying patients at risk. A prospective multi-site observational study was conducted to define the incidence of pressure sores, assess two pressure sore risk scales and to define risk factors relevant to intensive care. Patients (n = 534) were assessed for the presence of pressure sores. The Waterlow and Jackson/Cubbin risk scales were completed each day for 314 and 188 of these patients respectively. A total of 75 pressure sores were recorded. Of these, 34 were present on admission. Of the remaining 41, 16 were classified as Grade 1 and 24 as Grade 2 sores. The pressure sore (PS) incidence was 5.2 per cent. Expressed as PS/1000 patient days there were 18.48 pressure sores per 1000 patient days. The ability of the risk scores to predict pressure sores was tested using a Receiver Operating Characteristic (ROC) analysis. The association of risk score with pressure sores was analysed using a survival function (Kaplan Meier) and variables compared using a logrank test (Mantel-Cox). Factors associated with pressure sore occurrence were developed and tested using a survival regression model. Both risk scales were poor predictors of pressure sores (ROC curve area approximately 70 per cent for both). The factors, coma/unresponsiveness/paralysed & sedated and cardiovascular instability were significantly associated with pressure sores with relative risks of 4.2 and 2.5 respectively. Risk increased as a function of time such that the cumulative risk was 50 per cent at 20 days.

  17. Clustering-based limb identification for pressure ulcer risk assessment.

    PubMed

    Baran Pouyan, M; Nourani, M; Pompeo, M

    2015-01-01

    Bedridden patients have a high risk of developing pressure ulcers. Risk assessment for pressure ulceration is critical for preventive care. For a reliable assessment, we need to identify and track the limbs continuously and accurately. In this paper, we propose a method to identify body limbs using a pressure mat. Three prevalent sleep postures (supine, left and right postures) are considered. Then, predefined number of limbs (body parts) are identified by applying Fuzzy C-Means (FCM) clustering on key attributes. We collected data from 10 adult subjects and achieved average accuracy of 93.2% for 10 limbs in supine and 7 limbs in left/right postures.

  18. Modeling the Effects of Moisture-Related Skin-Support Friction on the Risk for Superficial Pressure Ulcers during Patient Repositioning in Bed

    PubMed Central

    Shaked, Eliav; Gefen, Amit

    2013-01-01

    Patient repositioning when the skin is moist, e.g., due to sweat or urine may cause skin breakdown since wetness increases the skin-support coefficient of friction (COF) and hence also the shear stresses that are generated in the skin when the patient is being moved. This everyday hospital scenario was never studied systematically however. The aim of this study was to simulate such interactions using a biomechanical computational model which is the first of its kind, in order to quantitatively describe the effects of repositioning on the pathomechanics of moisture-related tissue damage. We designed a finite element model to analyze skin stresses under a weight-bearing bony prominence while this region of interest slides frictionally over the support surface, as occurs during repositioning. Our results show, expectedly, that maximal effective stresses in the skin increase as the moisture-contents-related COF between the skin and the mattress rises. Interestingly however, the rise in stresses for a wet interface became more prominent when the skin tissue was stiffer – which represented aging or diabetes. This finding demonstrates how the aged/diabetic skin is more fragile than a young-adult skin when repositioning in a moist environment. The modeling used herein can now be extended to test effects of different moisturizers, creams, lubricants, or possibly other interventions at the skin-support interface for testing their potential in protecting the skin from superficial pressure ulcers in a standard, objective, and quantitative manner. PMID:25022867

  19. Modeling systolic pressure variation due to positive pressure ventilation.

    PubMed

    Messerges, Joanne

    2006-01-01

    Although many clinical techniques have been proposed to assess blood volume none have been established as an undisputed standard practice, Volume studies suggest systolic pressure variation (SPV) as a promising volume indicator but underlying influences on SPV are not well understood. Successful modeling of SPV will reveal the major SPV influencers, guide algorithm development to accommodate these influencers, and potentially lead to a more clinically relevant interpretation of SPV values, thus improving upon current clinical methods for assessing blood volume. This study takes a first step towards identifying SPV influencers by investigating three variations of an existing pressure-flow cardiovascular model. Each successive version introduces an additional modification in attempt to model SPV under normovolemic and hypovolemic conditions, where the last model accounts for positive pressure ventilation, venous compression, and a rightward septum shift. Under normovolemic conditions, each model yields SPV values of 5.8, 6.4, and 6.7 mmHg, respectively. Under hypovolemic conditions the results do not agree with clinical findings, suggesting these three mechanisms alone do not dictate the clinical SPV response to a decrease in volume. Model results are used to suggest improvements for future work.

  20. Pressure Systems Stored-Energy Threshold Risk Analysis

    SciTech Connect

    Paulsen, Samuel S.

    2009-08-25

    Federal Regulation 10 CFR 851, which became effective February 2007, brought to light potential weaknesses regarding the Pressure Safety Program at the Pacific Northwest National Laboratory (PNNL). The definition of a pressure system in 10 CFR 851 does not contain a limit based upon pressure or any other criteria. Therefore, the need for a method to determine an appropriate risk-based hazard level for pressure safety was identified. The Laboratory has historically used a stored energy of 1000 lbf-ft to define a pressure hazard; however, an analytical basis for this value had not been documented. This document establishes the technical basis by evaluating the use of stored energy as an appropriate criterion to establish a pressure hazard, exploring a suitable risk threshold for pressure hazards, and reviewing the methods used to determine stored energy. The literature review and technical analysis concludes the use of stored energy as a method for determining a potential risk, the 1000 lbf-ft threshold, and the methods used by PNNL to calculate stored energy are all appropriate. Recommendations for further program improvements are also discussed

  1. Modeling Scala Media as a Pressure Vessel

    NASA Astrophysics Data System (ADS)

    Lepage, Eric; Olofsson, A.˚Ke

    2011-11-01

    The clinical condition known as endolymphatic hydrops is the swelling of scala media and may result in loss in hearing sensitivity consistent with other forms of low-frequency biasing. Because outer hair cells (OHCs) are displacement-sensitive and hearing levels tend to be preserved despite large changes in blood pressure and CSF pressure, it seems unlikely that the OHC respond passively to changes in static pressures in the chambers. This suggests the operation of a major feedback control loop which jointly regulates homeostasis and hearing sensitivity. Therefore the internal forces affecting the cochlear signal processing amplifier cannot be just motile responses. A complete account of the cochlear amplifier must include static pressures. To this end we have added a third, pressure vessel to our 1-D 140-segment, wave-digital filter active model of cochlear mechanics, incorporating the usual nonlinear forward transduction. In each segment the instantaneous pressure is the sum of acoustic pressure and global static pressure. The object of the model is to maintain stable OHC operating point despite any global rise in pressure in the third chamber. Such accumulated pressure is allowed to dissipate exponentially. In this first 3-chamber implementation we explore the possibility that acoustic pressures are rectified. The behavior of the model is critically dependent upon scaling factors and time-constants, yet by initial assumption, the pressure tends to accumulate in proportion to sound level. We further explore setting of the control parameters so that the accumulated pressure either stays within limits or may rise without bound.

  2. A risk tertiles model for predicting mortality in patients with acute respiratory distress syndrome: age, plateau pressure, and P(aO(2))/F(IO(2)) at ARDS onset can predict mortality.

    PubMed

    Villar, Jesús; Pérez-Méndez, Lina; Basaldúa, Santiago; Blanco, Jesús; Aguilar, Gerardo; Toral, Darío; Zavala, Elizabeth; Romera, Miguel A; González-Díaz, Gumersindo; Nogal, Frutos Del; Santos-Bouza, Antonio; Ramos, Luís; Macías, Santiago; Kacmarek, Robert M

    2011-04-01

    Predicting mortality has become a necessary step for selecting patients for clinical trials and defining outcomes. We examined whether stratification by tertiles of respiratory and ventilatory variables at the onset of acute respiratory distress syndrome (ARDS) identifies patients with different risks of death in the intensive care unit. We performed a secondary analysis of data from 220 patients included in 2 multicenter prospective independent trials of ARDS patients mechanically ventilated with a lung-protective strategy. Using demographic, pulmonary, and ventilation data collected at ARDS onset, we derived and validated a simple prediction model based on a population-based stratification of variable values into low, middle, and high tertiles. The derivation cohort included 170 patients (all from one trial) and the validation cohort included 50 patients (all from a second trial). Tertile distribution for age, plateau airway pressure (P(plat)), and P(aO(2))/F(IO(2)) at ARDS onset identified subgroups with different mortalities, particularly for the highest-risk tertiles: age (> 62 years), P(plat) (> 29 cm H(2)O), and P(aO(2))/F(IO(2)) (< 112 mm Hg). Risk was defined by the number of coexisting high-risk tertiles: patients with no high-risk tertiles had a mortality of 12%, whereas patients with 3 high-risk tertiles had 90% mortality (P < .001). A prediction model based on tertiles of patient age, P(plat), and P(aO(2))/F(IO(2)) at the time the patient meets ARDS criteria identifies patients with the lowest and highest risk of intensive care unit death.

  3. Carotid Stenosis and Ocular Blood Pressure Modelling

    PubMed Central

    Jullian, M.; Kinsner, W.

    1984-01-01

    A model of the human carotid vascular system was developed to study the effects of carotid stenosis on ocular blood pressure and ocular pulse waveform. The model incorporates a non-linear element representing a stenosis. A state variable representation of a reduced model is used in a computer simulation. Results show that carotid stenosis as low as 20% are detectable in the ocular blood pressure waveform.

  4. Acute radiation risk models

    NASA Astrophysics Data System (ADS)

    Smirnova, Olga

    Biologically motivated mathematical models, which describe the dynamics of the major hematopoietic lineages (the thrombocytopoietic, lymphocytopoietic, granulocytopoietic, and erythropoietic systems) in acutely/chronically irradiated humans are developed. These models are implemented as systems of nonlinear differential equations, which variables and constant parameters have clear biological meaning. It is shown that the developed models are capable of reproducing clinical data on the dynamics of these systems in humans exposed to acute radiation in the result of incidents and accidents, as well as in humans exposed to low-level chronic radiation. Moreover, the averaged value of the "lethal" dose rates of chronic irradiation evaluated within models of these four major hematopoietic lineages coincides with the real minimal dose rate of lethal chronic irradiation. The demonstrated ability of the models of the human thrombocytopoietic, lymphocytopoietic, granulocytopoietic, and erythropoietic systems to predict the dynamical response of these systems to acute/chronic irradiation in wide ranges of doses and dose rates implies that these mathematical models form an universal tool for the investigation and prediction of the dynamics of the major human hematopoietic lineages for a vast pattern of irradiation scenarios. In particular, these models could be applied for the radiation risk assessment for health of astronauts exposed to space radiation during long-term space missions, such as voyages to Mars or Lunar colonies, as well as for health of people exposed to acute/chronic irradiation due to environmental radiological events.

  5. Fiber bundle model under fluid pressure

    NASA Astrophysics Data System (ADS)

    Amitrano, David; Girard, Lucas

    2016-03-01

    Internal fluid pressure often plays an important role in the rupture of brittle materials. This is a major concern for many engineering applications and for natural hazards. More specifically, the mechanisms through which fluid pressure, applied at a microscale, can enhance the failure at a macroscale and accelerate damage dynamics leading to failure remains unclear. Here we revisit the fiber bundle model by accounting for the effect of fluid under pressure that contributes to the global load supported by the fiber bundle. Fluid pressure is applied on the broken fibers, following Biot's theory. The statistical properties of damage avalanches and their evolution toward macrofailure are analyzed for a wide range of fluid pressures. The macroscopic strength of the new model appears to be strongly controlled by the action of the fluid, particularly when the fluid pressure becomes comparable with the fiber strength. The behavior remains consistent with continuous transition, i.e., second order, including for large pressure. The main change concerns the damage acceleration toward the failure that is well modeled by the concept of sweeping of an instability. When pressure is increased, the exponent β characterizing the power-law distribution avalanche sizes significantly decreases and the exponent γ characterizing the cutoff divergence when failure is approached significantly increases. This proves that fluid pressure plays a key role in failure process acting as destabilization factor. This indicates that macrofailure occurs more readily under fluid pressure, with a behavior that becomes progressively unstable as fluid pressure increases. This may have considerable consequences on our ability to forecast failure when fluid pressure is acting.

  6. Pressure ulcer prevalence and risk factors during prolonged surgical procedures.

    PubMed

    Primiano, Mike; Friend, Michael; McClure, Connie; Nardi, Scott; Fix, Lisa; Schafer, Marianne; Savochka, Kathlyn; McNett, Molly

    2011-12-01

    Pressure ulcer formation related to positioning while in the OR increases the length of hospital stay and hospital costs, but there is little evidence documenting how positioning devices used in the OR influence pressure ulcer development when examined with traditional risk factors. The aim of this prospective cohort study was to identify the prevalence of and risk factors associated with pressure ulcer development among patients undergoing surgical procedures lasting longer than three hours. Participants included all adult same-day admission patients scheduled for a three-hour surgical procedure during an eight-month period (N = 258). Data were gathered preoperatively, intraoperatively, and postoperatively on pressure ulcer risk factors. Bivariate analyses indicated that the type of positioning (ie, heels elevated) (χ(2) = 7.897, P = .048), OR bed surface (ie, foam table pad) (χ(2) = 15.848, P = .000), skin assessment in the postanesthesia care unit (χ(2) = 41.652, P = .000), and male gender (χ(2) = 6.984, P = .030) were associated with pressure ulcer development. Logistic regression analyses indicated that the use of a foam pad (β = 2.691, P = .024) and a lower day-one Braden score (β = .244, P = .003) were predictive of pressure ulcers.

  7. A Retrospective Analysis of Pressure Ulcer Incidence and Modified Braden Scale Score Risk Classifications.

    PubMed

    Chen, Hong-Lin; Cao, Ying-Juan; Wang, Jing; Huai, Bao-Sha

    2015-09-01

    The Braden Scale is the most widely used pressure ulcer risk assessment in the world, but the currently used 5 risk classification groups do not accurately discriminate among their risk categories. To optimize risk classification based on Braden Scale scores, a retrospective analysis of all consecutively admitted patients in an acute care facility who were at risk for pressure ulcer development was performed between January 2013 and December 2013. Predicted pressure ulcer incidence first was calculated by logistic regression model based on original Braden score. Risk classification then was modified based on the predicted pressure ulcer incidence and compared between different risk categories in the modified (3-group) classification and the traditional (5-group) classification using chi-square test. Two thousand, six hundred, twenty-five (2,625) patients (mean age 59.8 ± 16.5, range 1 month to 98 years, 1,601 of whom were men) were included in the study; 81 patients (3.1%) developed a pressure ulcer. The predicted pressure ulcer incidence ranged from 0.1% to 49.7%. When the predicted pressure ulcer incidence was greater than 10.0% (high risk), the corresponding Braden scores were less than 11; when the predicted incidence ranged from 1.0% to 10.0% (moderate risk), the corresponding Braden scores ranged from 12 to 16; and when the predicted incidence was less than 1.0% (mild risk), the corresponding Braden scores were greater than 17. In the modified classification, observed pressure ulcer incidence was significantly different between each of the 3 risk categories (P less than 0.05). However, in the traditional classification, the observed incidence was not significantly different between the high-risk category and moderate-risk category (P less than 0.05) and between the mild-risk category and no-risk category (P less than 0.05). If future studies confirm the validity of these findings, pressure ulcer prevention protocols of care based on Braden Scale scores can

  8. Managing risks from virus intrusion into water distribution systems due to pressure transients.

    PubMed

    Yang, Jian; LeChevallier, Mark W; Teunis, Peter F M; Xu, Minhua

    2011-06-01

    Low or negative pressure transients in water distribution systems, caused by unexpected events (e.g. power outages) or routine operation/maintenance activities, are usually brief and thus are rarely monitored or alarmed. Previous studies have shown connections between negative pressure events in water distribution systems and potential public health consequences. Using a quantitative microbial risk assessment (QMRA) model previously developed, various factors driving the risk of viral infection from intrusion were evaluated, including virus concentrations external to the distribution system, maintenance of a disinfectant residual, leak orifice sizes, the duration and the number of nodes drawing negative pressures. The most sensitive factors were the duration and the number of nodes drawing negative pressures, indicating that mitigation practices should be targeted to alleviate the severity of low/negative pressure transients. Maintaining a free chlorine residual of 0.2 mg/L or above is the last defense against the risk of viral infection due to negative pressure transients. Maintaining a chloramine residual did not appear to significantly reduce the risk. The effectiveness of ensuring separation distances from sewer mains to reduce the risk of infection may be system-specific. Leak detection/repair and cross-connection control should be prioritized in areas vulnerable to negative pressure transients.

  9. Blood pressure and risk of prostate cancer: Cohort Norway (CONOR).

    PubMed

    Martin, Richard M; Vatten, Lars; Gunnell, David; Romundstad, Pål

    2010-03-01

    Some studies suggest that raised blood pressure may increase prostate cancer risk. We investigated associations of blood pressure with prostate cancer within the CONOR collaborative cohorts of Norway. Between 1994 and 2003, 82,098 men from ten population-based cohorts in Norway completed standardised questionnaires and physical examinations, including resting blood pressure. The unique 11-digit identification number of Norwegian citizens allowed linkage with the Cancer Registry of Norway. A total of 78,768 (96%) men who were cancer-free at baseline and average age of 50.3 years (standard deviation, SD: 15.2) were followed up for a mean of 9.15 years. 11.4% of these men used antihypertensive drugs at baseline. During follow-up (1994-2006), 1,974 incident prostate cancers were diagnosed. We found a 4% (95% confidence interval, CI = 0-9%) increased risk of prostate cancer per one SD (18.3 mmHg) increase in systolic blood pressure and similar findings for diastolic blood pressure (hazard ratio, HR: 1.05 per SD; 95% CI = 1.01-1.10). The association was stronger for advanced (HR: 1.16 per SD increase in systolic blood pressure; 95% CI = 1.05-1.27) compared with localised (1.01; 0.95-1.08) prostate cancer (p for heterogeneity in hazard ratios = 0.02). Raised blood pressure was associated with an increased risk of prostate cancer, particularly advanced cancers at diagnosis. Understanding the mechanisms underlying these findings may provide biological insights into prostate carcinogenesis. Even if the association was causal, our data suggest that raised blood pressure would account for only 3% of prostate cancers, so the public health impact of this association may be limited.

  10. Risk Associated with Pulse Pressure on Out-of-Office Blood Pressure Measurement

    PubMed Central

    Gu, Yu-Mei; Aparicio, Lucas S.; Liu, Yan-Ping; Asayama, Kei; Hansen, Tine W.; Niiranen, Teemu J.; Boggia, José; Thijs, Lutgarde; Staessen, Jan A.

    2014-01-01

    Background Longitudinal studies have demonstrated that the risk of cardiovascular disease increases with pulse pressure (PP). However, PP remains an elusive cardiovascular risk factor with findings being inconsistent between studies. The 2013 ESH/ESC guideline proposed that PP is useful in stratification and suggested a threshold of 60 mm Hg, which is 10 mm Hg higher compared to that in the 2007 guideline; however, no justification for this increase was provided. Methodology Published thresholds of PP are based on office blood pressure measurement and often on arbitrary categorical analyses. In the International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) and the International Database on HOme blood pressure in relation to Cardiovascular Outcome (IDHOCO), we determined outcome-driven thresholds for PP based on ambulatory or home blood pressure measurement, respectively. Results The main findings were that for people aged <60 years, PP did not refine risk stratification, whereas in older people the thresholds were 64 and 76 mm Hg for the ambulatory and home PP, respectively. However, PP provided little added predictive value over and beyond classical risk factors. PMID:26587443

  11. What patient characteristics guide nurses' clinical judgement on pressure ulcer risk? A mixed methods study.

    PubMed

    Balzer, K; Kremer, L; Junghans, A; Halfens, R J G; Dassen, T; Kottner, J

    2014-05-01

    Nurses' clinical judgement plays a vital role in pressure ulcer risk assessment, but evidence is lacking which patient characteristics are important for nurses' perception of patients' risk exposure. To explore which patient characteristics nurses employ when assessing pressure ulcer risk without use of a risk assessment scale. Mixed methods design triangulating observational data from the control group of a quasi-experimental trial and data from semi-structured interviews with nurses. Two traumatological wards at a university hospital. Quantitative data: A consecutive sample of 106 patients matching the eligibility criteria (age ≥ 18 years, no pressure ulcers category ≥ 2 at admission and ≥ 5 days expected length of stay). Qualitative data: A purposive sample of 16 nurses. Quantitative data: Predictor variables for pressure ulcer risk were measured by study assistants at the bedside each second day. Concurrently, nurses documented their clinical judgement on patients' pressure ulcer risk by means of a 4-step global judgement scale. Bivariate correlations between predictor variables and nurses' risk estimates were established. Qualitative data: In interviews, nurses were asked to assess fictitious patients' pressure ulcer risk and to justify their risk estimates. Patient characteristics perceived as relevant for nurses' judements were thematically clustered. Triangulation: Firstly, predictors of nurses' risk estimates identified in bivariate analysis were cross-mapped with interview findings. Secondly, three models to predict nurses' risk estimates underwent multiple linear regression analysis. Nurses consider multiple patient characteristics for pressure ulcer risk assessment, but regard some conditions more important than others. Triangulation showed that these are measures reflecting patients' exposure to pressure or overall care dependency. Qualitative data furthermore indicate that nurses are likely to trade off risk-enhancing conditions against

  12. SAPPIRE: a prototype mobile tool for pressure ulcer risk assessment.

    PubMed

    Kim, Hyeoneui; Chung, Heejoon; Wang, Shuang; Jiang, Xiaoqian; Choi, Jeeyae

    2014-01-01

    Accurate assessment and documentation of skin conditions facilitate communication among care providers and are critical to effective prevention and mitigation of pressure ulcer. We report developing a prototype mobile system called SAPPIRE (Skin Assessment for Pressure Ulcer Prevention, an Integrated Recording Environment) for an android device to assist nurses with skin assessment and documentation at bedside. SAPPIRE demonstrates (1) data documentation conforming to the relevant terminology standards, (2) data exchange using Continuity of Care Records (CCR) standard and (3) smart display of patient data relevant to risk parameters to promote accurate pressure ulcer risk assessment with the Braden scale. Challenges associated standardizing assessment data faced during this development and the approaches that SAPPIRE took to overcome them are described.

  13. Model-based setting of inspiratory pressure and respiratory rate in pressure-controlled ventilation.

    PubMed

    Schranz, C; Becher, T; Schädler, D; Weiler, N; Möller, K

    2014-03-01

    Mechanical ventilation carries the risk of ventilator-induced-lung-injury (VILI). To minimize the risk of VILI, ventilator settings should be adapted to the individual patient properties. Mathematical models of respiratory mechanics are able to capture the individual physiological condition and can be used to derive personalized ventilator settings. This paper presents model-based calculations of inspiration pressure (pI), inspiration and expiration time (tI, tE) in pressure-controlled ventilation (PCV) and a retrospective evaluation of its results in a group of mechanically ventilated patients. Incorporating the identified first order model of respiratory mechanics in the basic equation of alveolar ventilation yielded a nonlinear relation between ventilation parameters during PCV. Given this patient-specific relation, optimized settings in terms of minimal pI and adequate tE can be obtained. We then retrospectively analyzed data from 16 ICU patients with mixed pathologies, whose ventilation had been previously optimized by ICU physicians with the goal of minimization of inspiration pressure, and compared the algorithm's 'optimized' settings to the settings that had been chosen by the physicians. The presented algorithm visualizes the patient-specific relations between inspiration pressure and inspiration time. The algorithm's calculated results highly correlate to the physician's ventilation settings with r = 0.975 for the inspiration pressure, and r = 0.902 for the inspiration time. The nonlinear patient-specific relations of ventilation parameters become transparent and support the determination of individualized ventilator settings according to therapeutic goals. Thus, the algorithm is feasible for a variety of ventilated ICU patients and has the potential of improving lung-protective ventilation by minimizing inspiratory pressures and by helping to avoid the build-up of clinically significant intrinsic positive end-expiratory pressure.

  14. Modelling pressure rolling of asymmetric rolling process

    NASA Astrophysics Data System (ADS)

    Alexa, V.; Ratiu, S. A.; Kiss, I.; Cioata, V. G.

    2017-05-01

    The paper presents a comparative analysis between experimental results and modelling in order to interpret the value of the contact pressure on the asymmetric longitudinal rolling. It is also intended action and the different behaviour of upper cylinder compared to the lower cylinder action in situations when both are driven, or only one operates. In the modelling will be presented on the basis of boundary conditions imposed rolling pressure variation in the degree of reduction and also re size arc length of contact. Determining a curve is also important to determine the locus of points which characterize symmetry conditions partial rolling process between unequal diameters cylinders.

  15. Biological correlates of blood pressure variability in elderly at high risk of cardiovascular disease.

    PubMed

    Poortvliet, Rosalinde K E; Lloyd, Suzanne M; Ford, Ian; Sattar, Naveed; de Craen, Anton J M; Wijsman, Liselotte W; Mooijaart, Simon P; Westendorp, Rudi G J; Jukema, J Wouter; de Ruijter, Wouter; Gussekloo, Jacobijn; Stott, David J

    2015-04-01

    Visit-to-visit variability in blood pressure is an independent predictor of cardiovascular disease. This study investigates biological correlates of intra-individual variability in blood pressure in older persons. Nested observational study within the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) among 3,794 male and female participants (range 70-82 years) with a history of, or risk factors for cardiovascular disease. Individual visit-to-visit variability in systolic and diastolic blood pressure and pulse pressure (expressed as 1 SD in mm Hg) was assessed using nine measurements over 2 years. Correlates of higher visit-to-visit variability were examined at baseline, including markers of inflammation, endothelial function, renal function and glucose homeostasis. Over the first 2 years, the mean intra-individual variability (1 SD) was 14.4mm Hg for systolic blood pressure, 7.7mm Hg for diastolic blood pressure, and 12.6mm Hg for pulse pressure. After multivariate adjustment a higher level of interleukin-6 at baseline was consistently associated with higher intra-individual variability of blood pressure, including systolic, diastolic, and pulse pressure. Markers of endothelial function (Von Willebrand factor, tissue plasminogen activator), renal function (glomerular filtration rate) and glucose homeostasis (blood glucose, homeostatic model assessment index) were not or to a minor extent associated with blood pressure variability. In an elderly population at risk of cardiovascular disease, inflammation (as evidenced by higher levels of interleukin-6) is associated with higher intra-individual variability in systolic, diastolic, and pulse pressure. © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  16. New Zealand Seismic Risk Model

    NASA Astrophysics Data System (ADS)

    Molas, G.; Aslani, H.; Bryngelson, J.; Khan, Z.

    2006-12-01

    A seismic risk model for New Zealand has been developed to assisted insurers and reinsurers in assessing their financial risk posed by earthquakes. This presentation summarizes the methodology and data within the model and includes a discussion of the key results from the hazard and risk perspectives. The earthquake, risk-model framework has four components. First, the stochastic event set is determined, as well as its associated event probabilities. A ground-motion model including geotechnical data is added to complete the seismic hazard model. To determine risk, regional building vulnerability curves and a financial model are incorporated. An insurer property exposure database was developed to determine the insured seismic risk in these countries. Using this model, examination of resulting hazard maps (200, 475, 1000 and 2500 years) and of city-level, hazard-curves gives insight to the key drivers of risk across the region. Hazard de-aggregation allow for examination of key drivers of risk in terms of seismic sources, event magnitude and events types. Examination of loss costs for residential and commercial (short and mid-rise) structures gives insight into the risk perspective for these various lines of business. Finally, incorporation of the insurer property exposure allows for an examination of the insured risk across the region and between exposure concentrations including Wellington, Auckland and Christchurch.

  17. Postprandial Glucose as a Risk Factor for Elevated Intraocular Pressure

    PubMed Central

    Wu, Chen-Jung; Fang, Wen-Hui; Kao, Tung-Wei; Chen, Ying-Jen; Liaw, Fang-Yih; Chang, Yaw-Wen; Wang, Gia-Chi; Peng, Tao-Chun; Chen, Wei-Liang

    2016-01-01

    The aim of this study was to investigate the association between postprandial glucose and intraocular pressure in a relatively healthy population. We examined 1,439 adults getting a health check-up in a health promotion center at Tri-Service General Hospital (TSGH) in Taiwan between 2012 and 2013. All participants underwent examinations to measure metabolic variables and intraocular pressure. Multiple linear regression analyses were performed to assess the relationship between postprandial glucose and intraocular pressure. The levels of postprandial glucose were divided into quartiles with subjects in the lowest quartile being regarded as the reference group to perform quartile-based analysis. Covariate adjustment was designed for three models for further analysis. Subjects with higher quartiles of postprandial glucose level had a higher systolic blood pressure, a greater waist circumference and an elevated fasting glucose level (all p < 0.001). The β coefficient with adjusted covariates showed a significant positive association between postprandial glucose and intraocular pressure. The trends of intraocular pressure across increasing quartiles of postprandial glucose were statistically significant (all p for trend < 0.001). Thus, higher levels of postprandial glucose positively correlated with elevated intraocular pressure. PMID:27977733

  18. Modeling steam pressure under martian lava flows

    USGS Publications Warehouse

    Dundas, Colin M.; Keszthelyi, Laszlo P.

    2013-01-01

    Rootless cones on Mars are a valuable indicator of past interactions between lava and water. However, the details of the lava–water interactions are not fully understood, limiting the ability to use these features to infer new information about past water on Mars. We have developed a model for the pressurization of a dry layer of porous regolith by melting and boiling ground ice in the shallow subsurface. This model builds on previous models of lava cooling and melting of subsurface ice. We find that for reasonable regolith properties and ice depths of decimeters, explosive pressures can be reached. However, the energy stored within such lags is insufficient to excavate thick flows unless they draw steam from a broader region than the local eruption site. These results indicate that lag pressurization can drive rootless cone formation under favorable circumstances, but in other instances molten fuel–coolant interactions are probably required. We use the model results to consider a range of scenarios for rootless cone formation in Athabasca Valles. Pressure buildup by melting and boiling ice under a desiccated lag is possible in some locations, consistent with the expected distribution of ice implanted from atmospheric water vapor. However, it is uncertain whether such ice has existed in the vicinity of Athabasca Valles in recent history. Plausible alternative sources include surface snow or an aqueous flood shortly before the emplacement of the lava flow.

  19. Layzer type models for pressure driven shells

    SciTech Connect

    Hurricane, O A

    2004-09-16

    Models for the nonlinear instability of finite thickness shells driven by pressure are constructed in the style of Layzer. Equations for both Cartesian and cylindrically convergent/divergent geometries are derived. The resulting equations are appropriate for incompressible shells with unity Atwood number. Predictions from the equations compare well with two-dimensional simulations.

  20. Layzer type models for pressure driven shells

    SciTech Connect

    Hurricane, O.A.

    2005-05-01

    Models for the nonlinear instability of finite thickness shells driven by pressure are constructed in the style of Layzer. Equations for both Cartesian and cylindrically convergent/divergent geometries are derived. The resulting equations are appropriate for incompressible shells with unity Atwood number. Predictions from the equations compare well with two-dimensional simulations.

  1. Chagas disease, a risk factor for high blood pressure.

    PubMed

    Vicco, Miguel Hernán; Rodeles, Luz; Yódice, Agustina; Marcipar, Iván

    2014-12-01

    Chagas disease is a parasite infection caused by the protozoan Trypanosoma cruzi. Its most common complications is chronic Chagas heart disease but impairments of the systemic vasculature also has been observed. Although the different mechanisms that regulate blood pressure are disrupted, to our knowledge data on the association of hypertension and chronic Chagas disease are scarce. In this regard we evaluate whether Chagas disease constitutes a high blood pressure risk factor. We recruited 200 individuals, half of them with positive serology for T. cruzi. They were subjected to a complete clinical examination. The mean age of sampled individuals was 46.7 ± 12.3, and the mean of systolic and diastolic blood pressure were 124 ± 12 mmHg and 82 ± 10 mmHg, respectively. There were no between-group differences regarding age, sex distribution or body mass index. Chagas disease contributed significantly to high blood pressure (OR = 4, 95% CI 1.8323-7.0864, p = 0.0002). Our results reveal an important association between Chagas disease and high blood pressure, which should be contemplated by physicians in order to promote preventive cardiovascular actions in patients with Chagas disease.

  2. Tank Pressure Control Experiment and Theoretical Modeling

    NASA Astrophysics Data System (ADS)

    Albayyari, Jihad M.

    1995-01-01

    Future space systems such as Space Station Freedom, and space defense systems will require storage of cryogenic fluids in a low-gravity environment for extended periods of time. Heat leaks to the containment vessel lead to an increase in the temperature and pressure of the fluid. The absence of natural convection results in a non-uniform temperature which exacerbates the pressure increase. Therefore a re-circulating liquid jet is necessary to mix the fluid. Therefore the Tank Pressure Control Experiment (TPCE) was designed. This experiment has been flown twice on the Space Shuttle (STS 43-1991 and STS 52-1992). The experiments used Freon-113 at near saturation conditions to simulate cryogenic fluids in space, with relatively low ullage volume (84 percent liquid fill). The TPCE results showed that low-velocity mixing is effective for pressure control in a nearly full tank. Multiple-burn missions using a single set of cryogenic propellant tanks, however, will consume 50 to 60 percent of the propellant during the first burn. The University of Cincinnati was awarded an In-Space Technology Experiment (IN-STEP) contract to re-fly the TPCE with a 40 percent liquid fill using Freon-113, and to theoretically model the heating and the mixing process inside the tank. Due to the absence of natural convection during the heating phase, a conduction model is needed to determine the temperature increase inside the tank. The heating model determined the time required for the pressure inside the tank to start increasing due to nucleate pool boiling at the heater surface. The mixing model consists of a non-penetrating laminar jet directed toward the liquid-vapor interface in the tank to induce condensation. The mixing model numerically solved the two-dimensional Navier-Stokes, and the energy equations. The model will predict the velocity, pressure, and temperature inside the tank. The model also predicted condensation rate at the interface, which will reduce the pressure in the tank.

  3. Mid- to Late-Life Trajectories of Blood Pressure and the Risk of Stroke: The Rotterdam Study.

    PubMed

    Portegies, Marileen L P; Mirza, Saira Saeed; Verlinden, Vincentius J A; Hofman, Albert; Koudstaal, Peter J; Swanson, Sonja A; Ikram, M Arfan

    2016-06-01

    Hypertension is a major modifiable risk factor for stroke. Associations of blood pressure with incident stroke are mostly based on single or average blood pressure levels. However, this approach does not take into account long-term trajectories of blood pressure, which can vary considerably in the elderly. Within the population-based Rotterdam Study, we examined trajectories of systolic blood pressure in 6745 participants (60.0% women) over an age-range from 55 to 106 years and jointly modeled their risk of stroke and competing causes of death using joint latent class mixed modeling. Four trajectories were identified. Class 1 was characterized by blood pressure increasing gradually from on average 120 to 160 mm Hg over 5 decades (n=4938). Compared with this class, class 2, characterized by a similar midlife blood pressure, but a steep increase (n=822, increasing from 120 to 200 mm Hg), and class 4, characterized by a high midlife blood pressure (n=115; average 160 mm Hg) and had a higher risk of stroke and death. Class 3, characterized by a moderate midlife blood pressure (n=870; average 140 mm Hg), had a similar risk of death as class 1, but the highest risk of stroke. Assessing trajectories of blood pressure provides a more nuanced understanding of the associations between blood pressure, stroke, and mortality. In particular, high blood pressure and rapidly increasing blood pressure patterns are associated with a high risk of stroke and death, whereas moderately high blood pressure is only related to an increased risk of stroke. Future studies should explore the potential pathogenic significance of these patterns. © 2016 American Heart Association, Inc.

  4. Pressure ulcers: effectiveness of risk-assessment tools. A randomised controlled trial (the ULCER trial).

    PubMed

    Webster, Joan; Coleman, Kerrie; Mudge, Alison; Marquart, Louise; Gardner, Glenn; Stankiewicz, Monica; Kirby, Julie; Vellacott, Catherine; Horton-Breshears, Margaret; McClymont, Alice

    2011-04-01

    To evaluate the effectiveness of two pressure-ulcer screening tools against clinical judgement in preventing pressure ulcers. A single blind randomised controlled trial. A large metropolitan tertiary hospital. 1231 patients admitted to internal medicine or oncology wards. Patients were excluded if their hospital stay was expected to be 2 days or less. Participants allocated to either a Waterlow (n=410) or Ramstadius (n=411) screening tool group or to a clinical judgement group (n=410) where no formal risk screening instrument was used. Incidence of hospital acquired pressure ulcers ascertained by regular direct observation. Use of any devices for the prevention of pressure ulcers, documentation of a pressure plan and any dietetic or specialist skin integrity review were recorded. On admission, 71 (5.8%) patients had an existing pressure ulcer. The incidence of hospital-acquired pressure ulcers was similar between groups (clinical judgement 28/410 (6.8%); Waterlow 31/411 (7.5%); Ramstadius 22/410 (5.4%), p=0.44). Significant associations with pressure injury in regression modelling included requiring a dietetic referral, being admitted from a location other than home and age over 65 years. The authors found no evidence to show that two common pressure-ulcer risk-assessment tools are superior to clinical judgement to prevent pressure injury. Resources associated with use of these tools might be better spent on careful daily skin inspection and improving management targetted at specific risks. The trial was registered with the Australian and New Zealand Clinicat Trials Registry (ACTRN 12608000541303).

  5. Combined impact of lead, cadmium, polychlorinated biphenyls and non-chemical risk factors on blood pressure in NHANES

    SciTech Connect

    Peters, Junenette L. Patricia Fabian, M. Levy, Jonathan I.

    2014-07-15

    High blood pressure is associated with exposure to multiple chemical and non-chemical risk factors, but epidemiological analyses to date have not assessed the combined effects of both chemical and non-chemical stressors on human populations in the context of cumulative risk assessment. We developed a novel modeling approach to evaluate the combined impact of lead, cadmium, polychlorinated biphenyls (PCBs), and multiple non-chemical risk factors on four blood pressure measures using data for adults aged ≥20 years from the National Health and Nutrition Examination Survey (1999–2008). We developed predictive models for chemical and other stressors. Structural equation models were applied to account for complex associations among predictors of stressors as well as blood pressure. Models showed that blood lead, serum PCBs, and established non-chemical stressors were significantly associated with blood pressure. Lead was the chemical stressor most predictive of diastolic blood pressure and mean arterial pressure, while PCBs had a greater influence on systolic blood pressure and pulse pressure, and blood cadmium was not a significant predictor of blood pressure. The simultaneously fit exposure models explained 34%, 43% and 52% of the variance for lead, cadmium and PCBs, respectively. The structural equation models were developed using predictors available from public data streams (e.g., U.S. Census), which would allow the models to be applied to any U.S. population exposed to these multiple stressors in order to identify high risk subpopulations, direct intervention strategies, and inform public policy. - Highlights: • We evaluated joint impact of chemical and non-chemical stressors on blood pressure. • We built predictive models for lead, cadmium and polychlorinated biphenyls (PCBs). • Our approach allows joint evaluation of predictors from population-specific data. • Lead, PCBs and established non-chemical stressors were related to blood pressure.

  6. Longitudinal Patterns of Change in Systolic Blood Pressure and Incidence of Cardiovascular Disease: The Atherosclerosis Risk in Communities Study.

    PubMed

    Petruski-Ivleva, Natalia; Viera, Anthony J; Shimbo, Daichi; Muntner, Paul; Avery, Christy L; Schneider, Andrea L C; Couper, David; Kucharska-Newton, Anna

    2016-06-01

    Elevated blood pressure in midlife contributes significantly to the risk of cardiovascular disease. However, patterns of blood pressure increase may differ among individuals and may result in differential risk. Our goal was to examine the contribution of longitudinal patterns of blood pressure change to incidence of heart failure, coronary heart disease, stroke, and cardiovascular disease mortality. Latent class growth models were used to identify patterns of change in blood pressure across 4 clinical examinations (1987-1998) among 9845 Atherosclerosis Risk in Communities (ARIC) cohort participants (mean age, 53.7 [SD 5.7] years). Patterns of change in systolic blood pressure included slowly and steeply increasing, a decreasing and a sustained elevated blood pressure. Changes in diastolic and mid-blood pressure (½ systolic+½ diastolic) were less pronounced. The association of blood pressure pattern group membership with incidence of clinical outcomes was examined in follow-up from the fourth clinical examination (1996-1998) to December 31, 2011, using Poisson regression models adjusted for demographic and metabolic characteristics, and hypertension medication use. A gradient of rates of all events was observed across the identified patterns. Associations were attenuated after adjustment for covariates. Cumulative systolic blood pressure load, rather than the temporal pattern of change in systolic blood pressure itself, plays a role in determining the risk of cardiovascular disease, in particular, of heart failure and cardiovascular disease mortality, independent of blood pressure level measured at one point in time. © 2016 American Heart Association, Inc.

  7. Developing a pressure ulcer risk factor minimum data set and risk assessment framework.

    PubMed

    Coleman, Susanne; Nelson, E Andrea; Keen, Justin; Wilson, Lyn; McGinnis, Elizabeth; Dealey, Carol; Stubbs, Nikki; Muir, Delia; Farrin, Amanda; Dowding, Dawn; Schols, Jos M G A; Cuddigan, Janet; Berlowitz, Dan; Jude, Edward; Vowden, Peter; Bader, Dan L; Gefen, Amit; Oomens, Cees W J; Schoonhoven, Lisette; Nixon, Jane

    2014-10-01

    To agree a draft pressure ulcer risk factor Minimum Data Set to underpin the development of a new evidenced-based Risk Assessment Framework. A recent systematic review identified the need for a pressure ulcer risk factor Minimum Data Set and development and validation of an evidenced-based pressure ulcer Risk Assessment Framework. This was undertaken through the Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056), funded by the National Institute for Health Research and incorporates five phases. This article reports phase two, a consensus study. Consensus study. A modified nominal group technique based on the Research and Development/University of California at Los Angeles appropriateness method. This incorporated an expert group, review of the evidence and the views of a Patient and Public Involvement service user group. Data were collected December 2010-December 2011. The risk factors and assessment items of the Minimum Data Set (including immobility, pressure ulcer and skin status, perfusion, diabetes, skin moisture, sensory perception and nutrition) were agreed. In addition, a draft Risk Assessment Framework incorporating all Minimum Data Set items was developed, comprising a two stage assessment process (screening and detailed full assessment) and decision pathways. The draft Risk Assessment Framework will undergo further design and pre-testing with clinical nurses to assess and improve its usability. It will then be evaluated in clinical practice to assess its validity and reliability. The Minimum Data Set could be used in future for large scale risk factor studies informing refinement of the Risk Assessment Framework. © 2014 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

  8. Developing a pressure ulcer risk factor minimum data set and risk assessment framework

    PubMed Central

    Coleman, Susanne; Nelson, E Andrea; Keen, Justin; Wilson, Lyn; McGinnis, Elizabeth; Dealey, Carol; Stubbs, Nikki; Muir, Delia; Farrin, Amanda; Dowding, Dawn; Schols, Jos MGA; Cuddigan, Janet; Berlowitz, Dan; Jude, Edward; Vowden, Peter; Bader, Dan L; Gefen, Amit; Oomens, Cees WJ; Schoonhoven, Lisette; Nixon, Jane

    2014-01-01

    Aim To agree a draft pressure ulcer risk factor Minimum Data Set to underpin the development of a new evidenced-based Risk Assessment Framework. Background A recent systematic review identified the need for a pressure ulcer risk factor Minimum Data Set and development and validation of an evidenced-based pressure ulcer Risk Assessment Framework. This was undertaken through the Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056), funded by the National Institute for Health Research and incorporates five phases. This article reports phase two, a consensus study. Design Consensus study. Method A modified nominal group technique based on the Research and Development/University of California at Los Angeles appropriateness method. This incorporated an expert group, review of the evidence and the views of a Patient and Public Involvement service user group. Data were collected December 2010–December 2011. Findings The risk factors and assessment items of the Minimum Data Set (including immobility, pressure ulcer and skin status, perfusion, diabetes, skin moisture, sensory perception and nutrition) were agreed. In addition, a draft Risk Assessment Framework incorporating all Minimum Data Set items was developed, comprising a two stage assessment process (screening and detailed full assessment) and decision pathways. Conclusion The draft Risk Assessment Framework will undergo further design and pre-testing with clinical nurses to assess and improve its usability. It will then be evaluated in clinical practice to assess its validity and reliability. The Minimum Data Set could be used in future for large scale risk factor studies informing refinement of the Risk Assessment Framework. PMID:24845398

  9. Multidimensional Gravitational Model with Anisotropic Pressure

    NASA Astrophysics Data System (ADS)

    Grigorieva, O. A.; Sharov, G. S.

    2013-08-01

    We consider the gravitational model with additional spatial dimensions and anisotropic pressure which is nonzero only in these dimensions. Cosmological solutions of the Einstein equations in this model include accelerated expansion of the universe at late stage of its evolution and dynamical compactification of extra dimensions. This model describes observational data for Type Ia supernovae on the level or better than the ΛCDM model. We analyze two equations of state resulting in different predictions for further evolution, but in both variants the acceleration epoch is finite.

  10. Concordance of Shape Risk Scale, a new pressure ulcer risk tool, with Braden Scale.

    PubMed

    Soppi, Esa T; Iivanainen, Ansa K; Korhonen, Pasi A

    2014-12-01

    The occurrence of pressure ulcers was examined in a cross-sectional study in 23 health care facilities and in home care involving 548 patients. The screening of pressure ulcer risk was assessed simultaneously using the Braden Scale and the new Shape Risk Scale (SRS), and the results were compared. The overall prevalence of pressure ulcers in the study population was 15·5% (85/548). The Braden Scale was performed as described in the literature. The direct concordance of the Braden and SRS scales was 46%. In more than 90% of cases, the SRS classified patients as well as or better than the Braden Scale. The SRS allocates patients significantly different from the Braden Scale into the risk categories, especially the difference is significant between the low and medium-risk categories. The greatest advantage of SRS to Braden Scale is that it correctly identifies patients with low risk of pressure ulcers. It is interesting that the two risk scores, taking into consideration the basically different pathophysiological factors, can still give rather similar results. The users considered that both scales are easy to use.

  11. Engineering Model of High Pressure Moist Air

    NASA Astrophysics Data System (ADS)

    Hyhlík, Tomáš

    The article deals with the moist air equation of state. There are equations of state discussed in the article, i.e. the model of an ideal mixture of ideal gases, the model of an ideal mixture of real gases and the model based on the virial equation of state. The evaluation of sound speed based on the ideal mixture concept is mentioned. The sound speed calculated by the model of an ideal mixture of ideal gases is compared with the sound speed calculated by using the model based on the concept of an ideal mixture of real gases. The comparison of enthalpy end entropy based on the model of an ideal mixture of ideal gases and the model of an ideal mixture of real gases is performed. It is shown that the model of an ideal mixture of real gases deviates from the model of an ideal mixture of ideal gases only in the case of high pressure. An impossibility of the definition of partial pressure in the mixture of real gases is discussed, where the virial equation of state is used.

  12. Common Carotid Intima-Media Thickness Measurements Do Not Improve Cardiovascular Risk Prediction in Individuals With Elevated Blood Pressure

    PubMed Central

    Bots, Michiel L.; Groenewegen, Karlijn A.; Anderson, Todd J.; Britton, Annie R.; Dekker, Jacqueline M.; Engström, Gunnar; Evans, Greg W.; de Graaf, Jacqueline; Grobbee, Diederick E.; Hedblad, Bo; Hofman, Albert; Holewijn, Suzanne; Ikeda, Ai; Kavousi, Maryam; Kitagawa, Kazuo; Kitamura, Akihiko; Ikram, M. Arfan; Lonn, Eva M.; Lorenz, Matthias W.; Mathiesen, Ellisiv B.; Nijpels, Giel; Okazaki, Shuhei; O’Leary, Daniel H.; Polak, Joseph F.; Price, Jacqueline F.; Robertson, Christine; Rembold, Christopher M.; Rosvall, Maria; Rundek, Tatjana; Salonen, Jukka T.; Sitzer, Matthias; Stehouwer, Coen D.A.; Franco, Oscar H.; Peters, Sanne A.E.; den Ruijter, Hester M.

    2015-01-01

    Carotid intima-media thickness (CIMT) is a marker of cardiovascular risk. It is unclear whether measurement of mean common CIMT improves 10-year risk prediction of first-time myocardial infarction or stroke in individuals with elevated blood pressure. We performed an analysis among individuals with elevated blood pressure (ie, a systolic blood pressure ≥140 mm Hg and a diastolic blood pressure ≥ 90 mm Hg) in USE-IMT, a large ongoing individual participant data meta-analysis. We refitted the risk factors of the Framingham Risk Score on asymptomatic individuals (baseline model) and expanded this model with mean common CIMT (CIMT model) measurements. From both models, 10-year risks to develop a myocardial infarction or stroke were estimated. In individuals with elevated blood pressure, we compared discrimination and calibration of the 2 models and calculated the net reclassification improvement (NRI). We included 17 254 individuals with elevated blood pressure from 16 studies. During a median follow-up of 9.9 years, 2014 first-time myocardial infarctions or strokes occurred. The C-statistics of the baseline and CIMT models were similar (0.73). NRI with the addition of mean common CIMT was small and not significant (1.4%; 95% confidence intervals, −1.1 to 3.7). In those at intermediate risk (n=5008, 10-year absolute risk of 10% to 20%), the NRI was 5.6% (95% confidence intervals, 1.6–10.4). There is no added value of measurement of mean common CIMT in individuals with elevated blood pressure for improving cardiovascular risk prediction. For those at intermediate risk, the addition of mean common CIMT to an existing cardiovascular risk score is small but statistically significant. PMID:24614213

  13. Analytic Modeling of Pressurization and Cryogenic Propellant

    NASA Technical Reports Server (NTRS)

    Corpening, Jeremy H.

    2010-01-01

    An analytic model for pressurization and cryogenic propellant conditions during all mission phases of any liquid rocket based vehicle has been developed and validated. The model assumes the propellant tanks to be divided into five nodes and also implements an empirical correlation for liquid stratification if desired. The five nodes include a tank wall node exposed to ullage gas, an ullage gas node, a saturated propellant vapor node at the liquid-vapor interface, a liquid node, and a tank wall node exposed to liquid. The conservation equations of mass and energy are then applied across all the node boundaries and, with the use of perfect gas assumptions, explicit solutions for ullage and liquid conditions are derived. All fluid properties are updated real time using NIST Refprop.1 Further, mass transfer at the liquid-vapor interface is included in the form of evaporation, bulk boiling of liquid propellant, and condensation given the appropriate conditions for each. Model validation has proven highly successful against previous analytic models and various Saturn era test data and reasonably successful against more recent LH2 tank self pressurization ground test data. Finally, this model has been applied to numerous design iterations for the Altair Lunar Lander, Ares V Core Stage, and Ares V Earth Departure Stage in order to characterize Helium and autogenous pressurant requirements, propellant lost to evaporation and thermodynamic venting to maintain propellant conditions, and non-uniform tank draining in configurations utilizing multiple LH2 or LO2 propellant tanks. In conclusion, this model provides an accurate and efficient means of analyzing multiple design configurations for any cryogenic propellant tank in launch, low-acceleration coast, or in-space maneuvering and supplies the user with pressurization requirements, unusable propellants from evaporation and liquid stratification, and general ullage gas, liquid, and tank wall conditions as functions of time.

  14. Association of blood pressure and hypertension with the risk of Parkinson disease: the National FINRISK Study.

    PubMed

    Qiu, Chengxuan; Hu, Gang; Kivipelto, Miia; Laatikainen, Tiina; Antikainen, Riitta; Fratiglioni, Laura; Jousilahti, Pekka; Tuomilehto, Jaakko

    2011-06-01

    Cardiovascular risk factors, such as diabetes mellitus and central obesity, have been associated with Parkinson disease (PD), but data on blood pressure and PD are lacking. We sought to examine the association of blood pressure and hypertension with the risk of PD among men and women. This study consisted of 7 surveys (1972-2002) on representative samples of the general population in Finland (National FINRISK Study). A total number of 59 540 participants (age 25 to 74 years; 51.8% women) who were free of PD and stroke at baseline were prospectively followed until December 31, 2006, to identify incident PD cases using the National Social Insurance Register database. Cox proportional hazards models were constructed to estimate the hazard ratio of PD associated with blood pressure. During a mean follow-up period of 18.8 years (SD: 10.2 years), 423 men and 371 women were ascertained to have developed PD. In women, compared with normotensive subjects (<130/80 mm Hg), the multivariable-adjusted hazard ratios of PD associated with high-normal blood pressure (130 to 139/80 to 89 mm Hg) and hypertension (≥140/90 mm Hg or use of antihypertensive agents) were 1.63 (95% CI: 1.07 to 2.47) and 1.62 (95% CI: 1.09 to 2.42). There was no significant association between blood pressure and PD risk in men. The multivariable-adjusted hazard ratios of PD associated with use of antihypertensive agents were 1.08 (95% CI: 0.79 to 1.48) in men and 1.03 (95% CI: 0.76 to 1.38) in women. This study suggests that, in women, above-optimal blood pressure, including high-normal blood pressure and hypertension, is associated with an increased risk of PD. Optimal control of blood pressure in women may reduce the incidence of PD.

  15. [Analysis of risk assessment scales for pressure ulcer].

    PubMed

    Moreno-Pina, Josefa Patricia; Richart-Martínez, Miguel; Guirao-Goris, Josef Adolf; Duarte-Climents, Gonzalo

    2007-01-01

    To perform a literature review of the scales and instruments used to assess the risk of developing a pressure ulcer (RPU) in the adult and elderly population and to analyze whether these scales meet the criteria of validity and reliability. To determine whether a specific scale has been developed for use in the domiciliary care setting and adapted to the Spanish environment. We performed a descriptive study with a search of the CUIDEN, IME, CINAHL and MEDLINE databases between January 1990 and December 2005. A specifically-designed form was used to register the variables. Data extraction was performed by a single person. The key words used were pressure ulcer, decubitus ulcer, pressure sore, risk evaluation scales, validity, sensitivity, specificity and reliability and their equivalents in Spanish. Complete descriptions of 22 instruments and studies of the validity and/or reliability of 15 instruments were found. At present, and based on the results of this review, the RPU scale that has shown the greatest validity and reliability is the Braden-Bergstrom scale.

  16. RISK 0301 - MOLECULAR MODELING

    EPA Science Inventory

    Risk assessment practices, in general, for a range of diseases now encourages the use of mechanistic data to enhance the ability to predict responses at low, environmental exposures. In particular, the pathway from normal biology to pathologic state can be dcscribed by a set of m...

  17. RISK 0301 - MOLECULAR MODELING

    EPA Science Inventory

    Risk assessment practices, in general, for a range of diseases now encourages the use of mechanistic data to enhance the ability to predict responses at low, environmental exposures. In particular, the pathway from normal biology to pathologic state can be dcscribed by a set of m...

  18. Home Blood Pressure Variability as Cardiovascular Risk Factor in the Population of Ohasama

    PubMed Central

    Asayama, Kei; Kikuya, Masahiro; Schutte, Rudolph; Thijs, Lutgarde; Hosaka, Miki; Satoh, Michihiro; Hara, Azusa; Obara, Taku; Inoue, Ryusuke; Metoki, Hirohito; Hirose, Takuo; Ohkubo, Takayoshi; Staessen, Jan A.; Imai, Yutaka

    2013-01-01

    Blood pressure variability based on office measurement predicts outcome in selected patients. We explored whether novel indices of blood pressure variability derived from the self-measured home blood pressure predicted outcome in a general population. We monitored mortality and stroke in 2421 Ohasama residents (Iwate Prefecture, Japan). At enrollment (1988–1995), participants (mean age, 58.6 years; 60.9% women; 27.1% treated) measured their blood pressure at home, using an oscillometric device. In multivariable-adjusted Cox models, we assessed the independent predictive value of the within-subject mean systolic blood pressure (SBP) and corresponding variability as estimated by variability independent of the mean, difference between maximum and minimum blood pressure, and average real variability. Over 12.0 years (median), 412 participants died, 139 of cardiovascular causes, and 223 had a stroke. In models including morning SBP, variability independent of the mean and average real variability (median, 26 readings) predicted total and cardiovascular mortality in all of the participants (P≤0.044); variability independent of the mean predicted cardiovascular mortality in treated (P=0.014) but not in untreated (P=0.23) participants; and morning maximum and minimum blood pressure did not predict any end point (P≥0.085). In models already including evening SBP, only variability independent of the mean predicted cardiovascular mortality in all and in untreated participants (P≤0.046). The R2 statistics, a measure for the incremental risk explained by adding blood pressure variability to models already including SBP and covariables, ranged from <0.01% to 0.88%. In a general population, new indices of blood pressure variability derived from home blood pressure did not incrementally predict outcome over and beyond mean SBP. PMID:23172933

  19. Leisure-Time Exercise Could Lower Your Risk of High Blood Pressure

    MedlinePlus

    ... Leisure-time exercise could lower your risk of high blood pressure American Heart Association Rapid Access Journal Report September ... copyright American Heart Association Download (1.4 MB) High Blood Pressure A high blood pressure reading. copyright American Heart ...

  20. Biomechanical modeling to prevent ischial pressure ulcers.

    PubMed

    Luboz, Vincent; Petrizelli, Marion; Bucki, Marek; Diot, Bruno; Vuillerme, Nicolas; Payan, Yohan

    2014-07-18

    With 300,000 paraplegic persons only in France, ischial pressure ulcers represent a major public health issue. They result from the buttocks׳ soft tissues compression by the bony prominences. Unfortunately, the current clinical techniques, with - in the best case - embedded pressure sensor mats, are insufficient to prevent them because most are due to high internal strains which can occur even with low pressures at the skin surface. Therefore, improving prevention requires using a biomechanical model to estimate internal strains from skin surface pressures. However, the buttocks׳ soft tissues׳ stiffness is still unknown. This paper provides a stiffness sensitivity analysis using a finite element model. Different layers with distinct Neo Hookean materials simulate the skin, fat and muscles. With Young moduli in the range [100-500 kPa], [25-35 kPa], and [80-140 kPa] for the skin, fat, and muscles, respectively, maximum internal strains reach realistic 50 to 60% values. The fat and muscle stiffnesses have an important influence on the strain variations, while skin stiffness is less influent. Simulating different sitting postures and changing the muscle thickness also result in a variation in the internal strains. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Low diastolic pressure and risk of dementia in very old people: a longitudinal study.

    PubMed

    Qiu, Chengxuan; Winblad, Bengt; Fratiglioni, Laura

    2009-01-01

    Midlife high blood pressure is linked to late-life dementia. We sought to investigate the temporal relation of blood pressure to the risk of dementia and Alzhei-mer's disease (AD) among older adults. A dementia-free cohort (n = 422) aged > or =81 years was followed for 3 years to detect dementia and AD cases (Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised criteria). The blood pressure was measured 4 times over a 9-year period starting from > or =75 years of age. The data were analyzed with Cox models controlling for potential confounders. During the 954 person-years of follow- up, 89 subjects developed dementia (72 AD cases). Low diastolic pressure (<70 vs. 70-89 mm Hg) was associated with a multiadjusted hazard ratio of 2.13 [95% confidence interval (CI) = 1.05-4.32] for dementia and 2.16 (95% CI = 0.98-4.73) for AD occurring over a 6-to 9-year period, whereas high diastolic pressure (> or =90 mm Hg) was marginally related to a decreased hazard ratio of 0.58 (95% CI = 0.33-1.02) for dementia and 0.57 (95% CI = 0.30-1.09) for AD. Systolic pressure was not significantly related to dementia risk. Subjects who developed dementia had a greater decline in blood pressure than persons who did not, mainly during the 3-year period before dementia diagnosis. Low diastolic pressure predicts the risk of dementia among very old people, and the blood pressure exhibits a substantial decline over around 3 years before the dementia syndrome becomes clinically evident. Copyright 2009 S. Karger AG, Basel.

  2. [Using the 'Driving Force - Pressure - State - Exposure - Effects - Action' (DPSEEA) model of the World Health Organization (WHO) for the analysis of risks related to the use of pesticides in agricultural activities in the state of Rio de Janeiro].

    PubMed

    Araújo-Pinto, Mariana de; Peres, Frederico; Moreira, Josino Costa

    2012-06-01

    This paper seeks to apply the DPSEEA model (WHO) to identify major health risks to rural workers and the environment associated with the intensive use of pesticides in the State of Rio de Janeiro, based on an analysis of official public documents and a review of the (national and international) literature. It emphasizes the two main representative branches of agriculture in the state: family farming in the mountain region and the monoculture of sugarcane in the flatlands. Results show that the bulk of the determinants identified in the DPSEEA Matrix are related to deficiencies in actions for monitoring and surveillance of pesticide use, as well as a lack of technical assistance provided by the Public Sector in Rio de Janeiro State. Most of the actions developed in the state address the effects of pesticide exposure and, to a lesser extent, exposure to these chemicals, failing to focus on the higher levels of the matrix (such as driving forces and pressure). These are considered, by several authors, as the most appropriate when tackling the complex and systemic issues, such as the scope of this paper. By means of this study, an attempt was made to enable the application of the DPSEEA Model to assist in environmental and occupational health surveillance initiatives.

  3. Choking under pressure: theoretical models and interventions.

    PubMed

    Mesagno, Christopher; Beckmann, Juergen

    2017-08-01

    In sport, choking under pressure is a major concern for athletes, coaches and sport psychologists because athletes fail to meet self-imposed performance expectations in critical situations (when it counts the most), which is devastating and embarrassing. Researchers have debated choking under pressure definitions, identified personality characteristics that exacerbate choking outcomes, and examined models to determine mechanisms for choking. Based on these investigations, several interventions to prevent choking have been developed and tested. In this review, we specifically discuss current self-presentation and attention models and theory-driven interventions that help to alleviate choking in order to facilitate the understanding of this complex phenomenon by athletes, sport psychologists and researchers. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Genome-wide association analysis identifies novel blood pressure loci and offers biological insights into cardiovascular risk.

    PubMed

    Warren, Helen R; Evangelou, Evangelos; Cabrera, Claudia P; Gao, He; Ren, Meixia; Mifsud, Borbala; Ntalla, Ioanna; Surendran, Praveen; Liu, Chunyu; Cook, James P; Kraja, Aldi T; Drenos, Fotios; Loh, Marie; Verweij, Niek; Marten, Jonathan; Karaman, Ibrahim; Lepe, Marcelo P Segura; O'Reilly, Paul F; Knight, Joanne; Snieder, Harold; Kato, Norihiro; He, Jiang; Tai, E Shyong; Said, M Abdullah; Porteous, David; Alver, Maris; Poulter, Neil; Farrall, Martin; Gansevoort, Ron T; Padmanabhan, Sandosh; Mägi, Reedik; Stanton, Alice; Connell, John; Bakker, Stephan J L; Metspalu, Andres; Shields, Denis C; Thom, Simon; Brown, Morris; Sever, Peter; Esko, Tõnu; Hayward, Caroline; van der Harst, Pim; Saleheen, Danish; Chowdhury, Rajiv; Chambers, John C; Chasman, Daniel I; Chakravarti, Aravinda; Newton-Cheh, Christopher; Lindgren, Cecilia M; Levy, Daniel; Kooner, Jaspal S; Keavney, Bernard; Tomaszewski, Maciej; Samani, Nilesh J; Howson, Joanna M M; Tobin, Martin D; Munroe, Patricia B; Ehret, Georg B; Wain, Louise V

    2017-03-01

    Elevated blood pressure is the leading heritable risk factor for cardiovascular disease worldwide. We report genetic association of blood pressure (systolic, diastolic, pulse pressure) among UK Biobank participants of European ancestry with independent replication in other cohorts, and robust validation of 107 independent loci. We also identify new independent variants at 11 previously reported blood pressure loci. In combination with results from a range of in silico functional analyses and wet bench experiments, our findings highlight new biological pathways for blood pressure regulation enriched for genes expressed in vascular tissues and identify potential therapeutic targets for hypertension. Results from genetic risk score models raise the possibility of a precision medicine approach through early lifestyle intervention to offset the impact of blood pressure-raising genetic variants on future cardiovascular disease risk.

  5. Exercise blood pressure and the risk of future hypertension.

    PubMed

    Holmqvist, L; Mortensen, L; Kanckos, C; Ljungman, C; Mehlig, K; Manhem, K

    2012-12-01

    The aim of this prospective cohort study was to identify which blood pressure measurement during exercise is the best predictor of future hypertension. Further we aimed to create a risk chart to facilitate the evaluation of blood pressure reaction during exercise testing. A number (n=1047) of exercise tests by bicycle ergometry, performed in 1996 and 1997 were analysed. In 2007-2008, 606 patients without hypertension at the time of the exercise test were sent a questionnaire aimed to identify current hypertension. The response rate was 58% (n=352). During the 10-12 years between exercise test and questionnaire, 23% developed hypertension. The strongest predictors of future hypertension were systolic blood pressure (SBP) before exercise (odds ratios (OR) 1.63 (1.31-2.01) for 10 mm Hg difference) in combination with the increase of SBP over time during exercise testing (OR 1.12 (1.01-1.24) steeper increase for every 1 mm Hg min(-1)). A high SBP before exercise and a steep rise in SBP over time represented a higher risk of developing hypertension. A risk chart based on SBP before exercise, increase of SBP over time and body mass index was created. SBP before exercise, maximal SBP during exercise and SBP at 100 W were significant single predictors of future hypertension and the prediction by maximal SBP was improved by adjusting for time/power at which SBP max was reached during exercise testing. Recovery ratio (maximal SBP/SBP 4 min after exercise) was not predictive of future hypertension.

  6. Cervical Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing cervical cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  7. Prostate Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing prostate cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  8. Esophageal Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing esophageal cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  9. Liver Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing liver cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  10. Testicular Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of testicular cervical cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  11. Breast Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing breast cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  12. Bladder Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing bladder cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  13. Lung Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing lung cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  14. Colorectal Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing colorectal cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  15. Pancreatic Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing pancreatic cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  16. Ovarian Cancer Risk Prediction Models

    Cancer.gov

    Developing statistical models that estimate the probability of developing ovarian cancer over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

  17. Multilevel joint competing risk models

    NASA Astrophysics Data System (ADS)

    Karunarathna, G. H. S.; Sooriyarachchi, M. R.

    2017-09-01

    Joint modeling approaches are often encountered for different outcomes of competing risk time to event and count in many biomedical and epidemiology studies in the presence of cluster effect. Hospital length of stay (LOS) has been the widely used outcome measure in hospital utilization due to the benchmark measurement for measuring multiple terminations such as discharge, transferred, dead and patients who have not completed the event of interest at the follow up period (censored) during hospitalizations. Competing risk models provide a method of addressing such multiple destinations since classical time to event models yield biased results when there are multiple events. In this study, the concept of joint modeling has been applied to the dengue epidemiology in Sri Lanka, 2006-2008 to assess the relationship between different outcomes of LOS and platelet count of dengue patients with the district cluster effect. Two key approaches have been applied to build up the joint scenario. In the first approach, modeling each competing risk separately using the binary logistic model, treating all other events as censored under the multilevel discrete time to event model, while the platelet counts are assumed to follow a lognormal regression model. The second approach is based on the endogeneity effect in the multilevel competing risks and count model. Model parameters were estimated using maximum likelihood based on the Laplace approximation. Moreover, the study reveals that joint modeling approach yield more precise results compared to fitting two separate univariate models, in terms of AIC (Akaike Information Criterion).

  18. Pressure ulcers in palliative ward patients: hyponatremia and low blood pressure as indicators of risk

    PubMed Central

    Sternal, Danuta; Wilczyński, Krzysztof; Szewieczek, Jan

    2017-01-01

    Background Prevention strategies for pressure ulcer formation remain critical in patients with an advanced illness. We analyzed factors associated with the development of pressure ulcers in patients hospitalized in a palliative care ward setting. Patients and methods This study was a retrospective analysis of 329 consecutive patients with a mean age (± standard deviation) of 70.4±11.8 years (range: 30–96 years, median 70.0 years; 55.3% women), who were admitted to the Palliative Care Department between July 2012 and May 2014. Results Patients were hospitalized for mean of 24.8±31.4 days (1–310 days, median 14 days). A total of 256 patients (77.8%) died in the ward and 73 patients (22.2%) were discharged. Two hundred and six patients (62.6%) did not develop pressure ulcers during their stay in the ward, 84 patients (25.5%) were admitted with pressure ulcers, and 39 patients (11.9%) developed pressure ulcers in the ward. Four factors assessed at admission appear to predict the development of pressure ulcers in the multivariate logistic regression model: Waterlow score (odds ratio [OR] =1.140, 95% confidence interval [CI] =1.057–1.229, P=0.001), transfer from other hospital wards (OR =2.938, 95% CI =1.339–6.448, P=0.007), hemoglobin level (OR =0.814, 95% CI =0.693–0.956, P=0.012), and systolic blood pressure (OR =0.976, 95% CI =0.955–0.997, P=0.023). Five other factors assessed during hospitalization appear to be associated with pressure ulcer development: mean evening body temperature (OR =3.830, 95% CI =1.729–8.486, P=0.001), mean Waterlow score (OR =1.194, 95% CI =1.092–1.306, P<0.001), the lowest recorded sodium concentration (OR =0.880, 95% CI =0.814–0.951, P=0.001), mean systolic blood pressure (OR =0.956, 95% CI =0.929–0.984, P=0.003), and the lowest recorded hemoglobin level (OR =0.803, 95% CI =0.672–0.960, P=0.016). Conclusion Hyponatremia and low blood pressure may contribute to the formation of pressure ulcers in patients with an

  19. Pressure ulcers in palliative ward patients: hyponatremia and low blood pressure as indicators of risk.

    PubMed

    Sternal, Danuta; Wilczyński, Krzysztof; Szewieczek, Jan

    2017-01-01

    Prevention strategies for pressure ulcer formation remain critical in patients with an advanced illness. We analyzed factors associated with the development of pressure ulcers in patients hospitalized in a palliative care ward setting. This study was a retrospective analysis of 329 consecutive patients with a mean age (± standard deviation) of 70.4±11.8 years (range: 30-96 years, median 70.0 years; 55.3% women), who were admitted to the Palliative Care Department between July 2012 and May 2014. Patients were hospitalized for mean of 24.8±31.4 days (1-310 days, median 14 days). A total of 256 patients (77.8%) died in the ward and 73 patients (22.2%) were discharged. Two hundred and six patients (62.6%) did not develop pressure ulcers during their stay in the ward, 84 patients (25.5%) were admitted with pressure ulcers, and 39 patients (11.9%) developed pressure ulcers in the ward. Four factors assessed at admission appear to predict the development of pressure ulcers in the multivariate logistic regression model: Waterlow score (odds ratio [OR] =1.140, 95% confidence interval [CI] =1.057-1.229, P=0.001), transfer from other hospital wards (OR =2.938, 95% CI =1.339-6.448, P=0.007), hemoglobin level (OR =0.814, 95% CI =0.693-0.956, P=0.012), and systolic blood pressure (OR =0.976, 95% CI =0.955-0.997, P=0.023). Five other factors assessed during hospitalization appear to be associated with pressure ulcer development: mean evening body temperature (OR =3.830, 95% CI =1.729-8.486, P=0.001), mean Waterlow score (OR =1.194, 95% CI =1.092-1.306, P<0.001), the lowest recorded sodium concentration (OR =0.880, 95% CI =0.814-0.951, P=0.001), mean systolic blood pressure (OR =0.956, 95% CI =0.929-0.984, P=0.003), and the lowest recorded hemoglobin level (OR =0.803, 95% CI =0.672-0.960, P=0.016). Hyponatremia and low blood pressure may contribute to the formation of pressure ulcers in patients with an advanced illness.

  20. Ambulatory Blood Pressure Phenotypes and the Risk for Hypertension

    PubMed Central

    Viera, Anthony J.; Shimbo, Daichi

    2014-01-01

    Ambulatory blood pressure (BP) monitoring provides valuable information on a person’s BP phenotype. Abnormal ambulatory BP phenotypes include white-coat hypertension, masked hypertension, nocturnal nondipping, nocturnal hypertension, and high BP variability. Compared to people with sustained normotension (normal BP in the clinic and on ambulatory BP monitoring), the limited research available suggests that the risk of developing sustained hypertension (abnormal BP in the clinic and on ambulatory BP monitoring) over 5 to 10 years is approximately two to three times greater for people with white-coat or masked hypertension. More limited data suggest that nondipping might predate hypertension, and no studies, to our knowledge, have examined whether nocturnal hypertension or high ambulatory BP variability predict hypertension. Ambulatory BP monitoring may be useful in identifying people at increased risk of developing sustained hypertension, but the clinical utility for such use would need to be further examined. PMID:25139779

  1. Blood pressure and cardiovascular risk: what about cocoa and chocolate?

    PubMed

    Grassi, Davide; Desideri, Giovambattista; Ferri, Claudio

    2010-09-01

    Cocoa flavonoids are able to reduce cardiovascular risk by improving endothelial function and decreasing blood pressure (BP). Interest in the biological activities of cocoa is daily increasing. A recent meta-analysis shows flavanol-rich cocoa administration decreases mean systolic (-4.5mm Hg; p<0.001) and diastolic (-2.5mm Hg; p<0.001) BP. A 3-mm Hg systolic BP reduction has been estimated to decrease the risk of cardiovascular and all-cause mortality. This paper summarizes new findings concerning cocoa effects on cardiovascular health focusing on putative mechanisms of action and nutritional and "pharmacological" viewpoints. Cocoa consumption could play a pivotal role in human health.

  2. Risk modelling in portfolio optimization

    NASA Astrophysics Data System (ADS)

    Lam, W. H.; Jaaman, Saiful Hafizah Hj.; Isa, Zaidi

    2013-09-01

    Risk management is very important in portfolio optimization. The mean-variance model has been used in portfolio optimization to minimize the investment risk. The objective of the mean-variance model is to minimize the portfolio risk and achieve the target rate of return. Variance is used as risk measure in the mean-variance model. The purpose of this study is to compare the portfolio composition as well as performance between the optimal portfolio of mean-variance model and equally weighted portfolio. Equally weighted portfolio means the proportions that are invested in each asset are equal. The results show that the portfolio composition of the mean-variance optimal portfolio and equally weighted portfolio are different. Besides that, the mean-variance optimal portfolio gives better performance because it gives higher performance ratio than the equally weighted portfolio.

  3. Models for Pesticide Risk Assessment

    EPA Pesticide Factsheets

    EPA considers the toxicity of the pesticide as well as the amount of pesticide to which a person or the environments may be exposed in risk assessment. Scientists use mathematical models to predict pesticide concentrations in exposure assessment.

  4. Predictive models for pressure ulcers from intensive care unit electronic health records using Bayesian networks.

    PubMed

    Kaewprag, Pacharmon; Newton, Cheryl; Vermillion, Brenda; Hyun, Sookyung; Huang, Kun; Machiraju, Raghu

    2017-07-05

    We develop predictive models enabling clinicians to better understand and explore patient clinical data along with risk factors for pressure ulcers in intensive care unit patients from electronic health record data. Identifying accurate risk factors of pressure ulcers is essential to determining appropriate prevention strategies; in this work we examine medication, diagnosis, and traditional Braden pressure ulcer assessment scale measurements as patient features. In order to predict pressure ulcer incidence and better understand the structure of related risk factors, we construct Bayesian networks from patient features. Bayesian network nodes (features) and edges (conditional dependencies) are simplified with statistical network techniques. Upon reviewing a network visualization of our model, our clinician collaborators were able to identify strong relationships between risk factors widely recognized as associated with pressure ulcers. We present a three-stage framework for predictive analysis of patient clinical data: 1) Developing electronic health record feature extraction functions with assistance of clinicians, 2) simplifying features, and 3) building Bayesian network predictive models. We evaluate all combinations of Bayesian network models from different search algorithms, scoring functions, prior structure initializations, and sets of features. From the EHRs of 7,717 ICU patients, we construct Bayesian network predictive models from 86 medication, diagnosis, and Braden scale features. Our model not only identifies known and suspected high PU risk factors, but also substantially increases sensitivity of the prediction - nearly three times higher comparing to logistical regression models - without sacrificing the overall accuracy. We visualize a representative model with which our clinician collaborators identify strong relationships between risk factors widely recognized as associated with pressure ulcers. Given the strong adverse effect of pressure ulcers

  5. Pressure Distribution over Thick Airfoils - Model Tests

    NASA Technical Reports Server (NTRS)

    Norton, F H; Bacon, D L

    1923-01-01

    This investigation was undertaken to study the distribution of loading over thick wings of various types. The unloading on the wing was determined by taking the pressure at a number of holes on both the upper and lower surfaces of a model wing in the wind tunnel. The results from these tests show, first, that the distribution of pressure over a thick wing of uniform section is very little different from that over a thin wing; second, that wings tapering either in chord or thickness have the lateral center of pressure, as would be expected, slightly nearer the center of the wings; and, third, that wings tapering in plan form and with a section everywhere proportional to the center section may be considered to have a loading at any point which is proportional to the chord when compared to a wing with a similar constant section. These tests confirm the belief that wings tapering both in thickness and plan form are of considerable structural value because the lateral center of pressure is thereby moved toward the center of the span.

  6. Association of uric acid genetic risk score with blood pressure: the Rotterdam study.

    PubMed

    Sedaghat, Sanaz; Pazoki, Raha; Uitterlinden, Andre G; Hofman, Albert; Stricker, Bruno H Ch; Ikram, M Arfan; Franco, Oscar H; Dehghan, Abbas

    2014-11-01

    High levels of serum uric acid are associated with hypertension in observational studies. The aim of this study was to investigate the association of uric acid gene variants with blood pressure. We studied 5791 participants aged ≥55 years from the Rotterdam Study. Thirty gene variants identified for serum uric acid level were used to compile genetic risk score (GRS). We used linear regression models to investigate the association of the uric acid GRS with systolic and diastolic blood pressure in the whole study population and separately in participants with and without comorbidities and medication use. In the age- and sex-adjusted model, each SD increase in uric acid GRS was associated with 0.75 mm Hg lower systolic blood pressure (95% confidence interval, -1.31 to -0.19) and 0.42 mm Hg lower diastolic blood pressure (95% confidence interval, -0.72 to -0.13). The association did not attenuate after further adjustment for antihypertensive medication use and conventional cardiovascular risk factors. In subgroup analysis, the association of uric acid GRS with systolic blood pressure was significantly stronger in participants (n=885) on diuretic treatment (P for interaction, 0.007). In conclusion, we found that higher uric acid GRS is associated with lower systolic and diastolic blood pressure. Diuretics treatment may modify the association of uric acid genetic risk score and systolic blood pressure. Our study suggests that genome wide association study's findings can be associated with an intermediate factor or have a pleiotropic role and, therefore, should be applied for Mendelian Randomization with caution. © 2014 American Heart Association, Inc.

  7. The potential for health risks from intrusion of contaminants into the distribution system from pressure transients.

    PubMed

    LeChevallier, Mark W; Gullick, Richard W; Karim, Mohammad R; Friedman, Melinda; Funk, James E

    2003-03-01

    The potential for public health risks associated with intrusion of contaminants into water supply distribution systems resulting from transient low or negative pressures is assessed. It is shown that transient pressure events occur in distribution systems; that during these negative pressure events pipeline leaks provide a potential portal for entry of groundwater into treated drinking water; and that faecal indicators and culturable human viruses are present in the soil and water exterior to the distribution system. To date, all observed negative pressure events have been related to power outages or other pump shutdowns. Although there are insufficient data to indicate whether pressure transients are a substantial source of risk to water quality in the distribution system, mitigation techniques can be implemented, principally the maintenance of an effective disinfectant residual throughout the distribution system, leak control, redesign of air relief venting, and more rigorous application of existing engineering standards. Use of high-speed pressure data loggers and surge modelling may have some merit, but more research is needed.

  8. Cardiovascular Risk in Hypertension in Relation to Achieved Blood Pressure Using Automated Office Blood Pressure Measurement.

    PubMed

    Myers, Martin G; Kaczorowski, Janusz; Dolovich, Lisa; Tu, Karen; Paterson, J Michael

    2016-10-01

    The SPRINT (Systolic Blood Pressure Intervention Trial) reported that some older, higher risk patients might benefit from a target systolic blood pressure (BP) of <120 versus <140 mm Hg. However, it is not yet known how the BP target and measurement methods used in SPRINT relate to cardiovascular outcomes in real-world practice. SPRINT used the automated office BP technique, which requires the patient to be resting quietly and alone, with multiple readings being recorded automatically using an electronic oscillometric sphygmomanometer. We studied the relationship between achieved automated office BP at baseline and cardiovascular events in 6183 community-dwelling residents of Ontario aged ≥66 years who were receiving antihypertensive therapy and followed for a mean of 4.6 years. Adjusted hazard ratios (95% confidence intervals) were computed for 10 mm Hg increments in achieved automated office BP at baseline using Cox proportional hazards regression and the BP category with the lowest event rate as the reference category. Based on 904 fatal and nonfatal cardiovascular events, the nadir of cardiovascular events was at the systolic pressure category of 110 to 119 mm Hg, which was lower than the next highest category of 120 to 129 mm Hg (hazard ratio 1.30 [1.01, 1.66]). The hazard ratio for diastolic pressure was relatively unchanged above 60 mm Hg. Pulse pressure exhibited an increase in hazard ratio (1.33 [1.02, 1.72]) at ≥80 mm Hg. These results using automated office BP measurement in a usual treatment setting extend the finding in SPRINT of an optimum target systolic BP of <120 mm Hg to routine clinical practice. © 2016 American Heart Association, Inc.

  9. Formation risk of toxic and other unwanted compounds in pressure-assisted thermally processed foods.

    PubMed

    Bravo, K Segovia; Ramírez, R; Durst, R; Escobedo-Avellaneda, Z J; Welti-Chanes, J; Sanz, P D; Torres, J A

    2012-01-01

    Consumers demand, in addition to excellent eating quality, high standards of microbial and chemical safety in shelf-stable foods. This requires improving conventional processing technologies and developing new alternatives such as pressure-assisted thermal processing (PATP). Studies in PATP foods on the kinetics of chemical reactions at temperatures (approximately 100 to 120 °C) inactivating bacterial spores in low-acid foods are severely lacking. This review focuses on a specific chemical safety risk in PATP foods: models predicting if the activation volume value (V(a) ) of a chemical reaction is positive or negative, and indicating if the reaction rate constant will decrease or increase with pressure, respectively, are not available. Therefore, the pressure effect on reactions producing toxic compounds must be determined experimentally. A recent model solution study showed that acrylamide formation, a potential risk in PATP foods, is actually inhibited by pressure (that is, its V(a) value must be positive). This favorable finding was not predictable and still needs to be confirmed in food systems. Similar studies are required for other reactions producing toxic compounds including polycyclic aromatic hydrocarbons, heterocyclic amines, N-nitroso compounds, and hormone like-peptides. Studies on PATP inactivation of prions, and screening methods to detect the presence of other toxicity risks of PATP foods, are also reviewed.

  10. The Risk of Intraocular Pressure Elevation in Pediatric Noninfectious Uveitis.

    PubMed

    Kothari, Srishti; Foster, C Stephen; Pistilli, Maxwell; Liesegang, Teresa L; Daniel, Ebenezer; Sen, H Nida; Suhler, Eric B; Thorne, Jennifer E; Jabs, Douglas A; Levy-Clarke, Grace A; Nussenblatt, Robert B; Rosenbaum, James T; Lawrence, Scott D; Kempen, John H

    2015-10-01

    To characterize the risk and risk factors for intraocular pressure (IOP) elevation in pediatric noninfectious uveitis. Multicenter retrospective cohort study. Nine hundred sixteen children (1593 eyes) younger than 18 years at presentation with noninfectious uveitis followed up between January 1978 and December 2007 at 5 academic uveitis centers in the United States. Medical records review by trained, certified experts. Prevalence and incidence of IOP of 21 mmHg or more and 30 mmHg or more and incidence of a rise in IOP by 10 mmHg or more. To avoid underascertainment, outcomes were counted as present when IOP-lowering therapies were in use. Initially, 251 (15.8%) and 46 eyes (2.9%) had IOP ≥21 mmHg and ≥30 mmHg, respectively. Factors significantly associated with presenting IOP elevation included age of 6 to 12 years (versus other pediatric ages), prior cataract surgery, pars plana vitrectomy, duration of uveitis ≥6 months, contralateral IOP elevation, presenting visual acuity worse than 20/40, and topical corticosteroid use (in a dose-response relationship). The median follow-up was 1.25 years (interquartile range, 0.4-3.66). The estimated incidence of any observed IOP elevation to ≥21 mmHg, to ≥30 mmHg, and increase in IOP by ≥10 mmHg was 33.4%, 14.8%, and 24.4%, respectively, within 2 years. Factors associated with IOP elevation included pars plana vitrectomy, contralateral IOP elevation (adjusted hazard ratio [aHR], up to 9.54; P < 0.001), and the use of topical (aHR, up to 8.77 that followed a dose-response relationship; P < 0.001), periocular (aHR, up to 7.96; P < 0.001), and intraocular (aHR, up to 19.7; P < 0.001) corticosteroids. Intraocular pressure elevation affects a large minority of children with noninfectious uveitis. Statistically significant risk factors include IOP elevation or use of IOP-lowering treatment in the contralateral eye and local corticosteroid use that demonstrated a dose-and route of administration-dependent relationship

  11. Pressure ulcer risk assessment and prevention: what difference does a risk scale make? A comparison between Norway and Ireland.

    PubMed

    Johansen, E; Moore, Z; van Etten, M; Strapp, H

    2014-07-01

    To explore similarities and differences in nurses' views on risk assessment practices and preventive care activities in a context where patients' risk of developing pressure ulcers is assessed using clinical judgment (Norway) and a context where patients' risk of developing pressure ulcers is assessed using a formal structured risk assessment combined with clinical judgement (Ireland). A descriptive, qualitative design was employed across two different care settings with a total of 14 health care workers, nine from Norway and five from Ireland. Regardless of whether risk assessment was undertaken using clinical judgment or formal structured risk assessment, identified risk factors, at risk patients and appropriate preventive initiatives discussed by participant were similar across care settings. Furthermore, risk assessment did not necessarily result in the planning and implementation of appropriate pressure ulcer prevention initiatives. Thus, in this instance, use of a formal risk assessment tool does not seem to make any difference to the planning, initiation and evaluation of pressure ulcer prevention strategies. Regardless of the method of risk assessment, patients at risk of developing pressure ulcers are detected, suggesting that the practice of risk assessment should be re-evaluated. Moreover, appropriate preventive interventions were described. However, the missing link between risk assessment and documented care planning is of concern and barriers to appropriate pressure ulcer documentation should be explored further. This work is partly funded by a research grant from the Norwegian Nurses Organisation (NNO) (Norsk Sykepleierforbund NSF) in 2012. The authors have no conflict of interest to declare.

  12. Communicating Health Risks under Pressure: Homeland Security Applications

    SciTech Connect

    Garrahan, K.G.; Collie, S.L.

    2006-07-01

    The U.S. Environmental Protection Agency's (EPA) Office of Research and Development (ORD) Threat and Consequence Assessment Division (TCAD) within the National Homeland Security Research Center (NHSRC) has developed a tool for rapid communication of health risks and likelihood of exposure in preparation for terrorist incidents. The Emergency Consequence Assessment Tool (ECAT) is a secure web-based tool designed to make risk assessment and consequence management faster and easier for high priority terrorist threat scenarios. ECAT has been designed to function as 'defensive play-book' for health advisors, first responders, and decision-makers by presenting a series of evaluation templates for priority scenarios that can be modified for site-specific applications. Perhaps most importantly, the risk communication aspect is considered prior to an actual release event, so that management or legal advisors can concur on general risk communication content in preparation for press releases that can be anticipated in case of an actual emergency. ECAT serves as a one-stop source of information for retrieving toxicological properties for agents of concern, estimating exposure to these agents, characterizing health risks, and determining what actions need to be undertaken to mitigate the risks. ECAT has the capability to be used at a command post where inputs can be checked and communicated while the response continues in real time. This front-end planning is intended to fill the gap most commonly identified during tabletop exercises: a need for concise, timely, and informative risk communication to all parties. Training and customization of existing chemical and biological release scenarios with modeling of exposure to air and water, along with custom risk communication 'messages' intended for public, press, shareholders, and other partners enable more effective communication during times of crisis. For DOE, the ECAT could serve as a prototype that would be amenable to

  13. Malnutrition and pressure ulcer risk in adults in Australian health care facilities.

    PubMed

    Banks, Merrilyn; Bauer, Judith; Graves, Nicholas; Ash, Susan

    2010-09-01

    To determine the effect of nutritional status on the presence and severity of pressure ulcer. A multicenter, cross-sectional audit of nutritional status of a convenience sample of subjects was carried out as part of a large audit of pressure ulcers in a sample of Queensland, Australia, public healthcare facilities in 2002 and 2003. Dietitians in 20 hospitals and 6 residential aged care facilities conducted single-day nutritional status audits of 2208 acute and 839 aged care subjects using the Subjective Global Assessment. The effect of nutritional status on the presence and severity (highest stage and number of pressure ulcers) was determined by logistic regression in a model controlling for age, gender, medical specialty, and facility location. The potential clustering effect of facility was accounted for in the model using an analysis of correlated data approach. Subjects with malnutrition had adjusted odds ratios of 2.6 (95% confidence interval 1.8-3.5, P<0.001) of having a pressure ulcer in acute care facilities and 2.0 (95% confidence interval 1.5-2.7, P<0.001) for residential aged care facilities. There was also increased odds ratio of having a pressure ulcer, and having a more severe pressure ulcer (higher stage pressure ulcer and/or a higher number) with increased severity of malnutrition. Malnutrition was associated with at least twice the odds ratio of having a pressure ulcer of in public health care facilities in Queensland. Action must be taken to identify, prevent, and treat malnutrition, especially in patients at risk of pressure ulcer. (c) 2010. Published by Elsevier Inc. All rights reserved.

  14. Multifractal Value at Risk model

    NASA Astrophysics Data System (ADS)

    Lee, Hojin; Song, Jae Wook; Chang, Woojin

    2016-06-01

    In this paper new Value at Risk (VaR) model is proposed and investigated. We consider the multifractal property of financial time series and develop a multifractal Value at Risk (MFVaR). MFVaR introduced in this paper is analytically tractable and not based on simulation. Empirical study showed that MFVaR can provide the more stable and accurate forecasting performance in volatile financial markets where large loss can be incurred. This implies that our multifractal VaR works well for the risk measurement of extreme credit events.

  15. Command Process Modeling & Risk Analysis

    NASA Technical Reports Server (NTRS)

    Meshkat, Leila

    2011-01-01

    Commanding Errors may be caused by a variety of root causes. It's important to understand the relative significance of each of these causes for making institutional investment decisions. One of these causes is the lack of standardized processes and procedures for command and control. We mitigate this problem by building periodic tables and models corresponding to key functions within it. These models include simulation analysis and probabilistic risk assessment models.

  16. Command Process Modeling & Risk Analysis

    NASA Technical Reports Server (NTRS)

    Meshkat, Leila

    2011-01-01

    Commanding Errors may be caused by a variety of root causes. It's important to understand the relative significance of each of these causes for making institutional investment decisions. One of these causes is the lack of standardized processes and procedures for command and control. We mitigate this problem by building periodic tables and models corresponding to key functions within it. These models include simulation analysis and probabilistic risk assessment models.

  17. Information risk and security modeling

    NASA Astrophysics Data System (ADS)

    Zivic, Predrag

    2005-03-01

    This research paper presentation will feature current frameworks to addressing risk and security modeling and metrics. The paper will analyze technical level risk and security metrics of Common Criteria/ISO15408, Centre for Internet Security guidelines, NSA configuration guidelines and metrics used at this level. Information IT operational standards view on security metrics such as GMITS/ISO13335, ITIL/ITMS and architectural guidelines such as ISO7498-2 will be explained. Business process level standards such as ISO17799, COSO and CobiT will be presented with their control approach to security metrics. Top level, the maturity standards such as SSE-CMM/ISO21827, NSA Infosec Assessment and CobiT will be explored and reviewed. For each defined level of security metrics the research presentation will explore the appropriate usage of these standards. The paper will discuss standards approaches to conducting the risk and security metrics. The research findings will demonstrate the need for common baseline for both risk and security metrics. This paper will show the relation between the attribute based common baseline and corporate assets and controls for risk and security metrics. IT will be shown that such approach spans over all mentioned standards. The proposed approach 3D visual presentation and development of the Information Security Model will be analyzed and postulated. Presentation will clearly demonstrate the benefits of proposed attributes based approach and defined risk and security space for modeling and measuring.

  18. Cabin Environment Physics Risk Model

    NASA Technical Reports Server (NTRS)

    Mattenberger, Christopher J.; Mathias, Donovan Leigh

    2014-01-01

    This paper presents a Cabin Environment Physics Risk (CEPR) model that predicts the time for an initial failure of Environmental Control and Life Support System (ECLSS) functionality to propagate into a hazardous environment and trigger a loss-of-crew (LOC) event. This physics-of failure model allows a probabilistic risk assessment of a crewed spacecraft to account for the cabin environment, which can serve as a buffer to protect the crew during an abort from orbit and ultimately enable a safe return. The results of the CEPR model replace the assumption that failure of the crew critical ECLSS functionality causes LOC instantly, and provide a more accurate representation of the spacecraft's risk posture. The instant-LOC assumption is shown to be excessively conservative and, moreover, can impact the relative risk drivers identified for the spacecraft. This, in turn, could lead the design team to allocate mass for equipment to reduce overly conservative risk estimates in a suboptimal configuration, which inherently increases the overall risk to the crew. For example, available mass could be poorly used to add redundant ECLSS components that have a negligible benefit but appear to make the vehicle safer due to poor assumptions about the propagation time of ECLSS failures.

  19. Combined impact of lead, cadmium, polychlorinated biphenyls and non-chemical risk factors on blood pressure in NHANES.

    PubMed

    Peters, Junenette L; Fabian, M Patricia; Levy, Jonathan I

    2014-07-01

    High blood pressure is associated with exposure to multiple chemical and non-chemical risk factors, but epidemiological analyses to date have not assessed the combined effects of both chemical and non-chemical stressors on human populations in the context of cumulative risk assessment. We developed a novel modeling approach to evaluate the combined impact of lead, cadmium, polychlorinated biphenyls (PCBs), and multiple non-chemical risk factors on four blood pressure measures using data for adults aged ≥ 20 years from the National Health and Nutrition Examination Survey (1999-2008). We developed predictive models for chemical and other stressors. Structural equation models were applied to account for complex associations among predictors of stressors as well as blood pressure. Models showed that blood lead, serum PCBs, and established non-chemical stressors were significantly associated with blood pressure. Lead was the chemical stressor most predictive of diastolic blood pressure and mean arterial pressure, while PCBs had a greater influence on systolic blood pressure and pulse pressure, and blood cadmium was not a significant predictor of blood pressure. The simultaneously fit exposure models explained 34%, 43% and 52% of the variance for lead, cadmium and PCBs, respectively. The structural equation models were developed using predictors available from public data streams (e.g., U.S. Census), which would allow the models to be applied to any U.S. population exposed to these multiple stressors in order to identify high risk subpopulations, direct intervention strategies, and inform public policy. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Pressure ulcers and risk assessment in severe burns.

    PubMed

    Lewis, Giavonni M; Pham, Tam N; Robinson, Ellen; Otto, Andrew; Honari, Shari; Heimbach, David M; Klein, Matthew B; Gibran, Nicole S

    2012-01-01

    Risk and incidence of pressure ulcers (PUs) in the burn population remain poorly understood. The purpose of this study was to determine the timing and incidence of PUs at our regional burn center and to identify early risk factors for PU development in burn patients. A retrospective review of 40 charts was performed from among the 1489 patients admitted to our regional burn center between January 2008 and December 2009. Twenty patients acquired PUs during their admission and were identified on the basis of International Classification of Diseases, ninth revision, designation, hospital stay >7 days, and thermal injury (excluding toxic epidermal necrolysis and purpura fulminans). The remaining 20 patients were matched controls based on ±5 years in age and ±8% TBSA. Patient, injury, and outcome characteristics were compared among patient groups using χ for categorical variables and Mann-Whitney for continuous variables. The incidence of PU was 1.3% of all admissions. PU most commonly occurred at the sacrum/coccyx (eight), lower extremity (seven), and occiput (six). A majority of PU presented at stage 2 (33%), stage 3 (26%), and unstageable (30%). Thirteen were splint or device related and reportable. Ninety percent of patients with PUs presented with a Braden score of 16 or less (P = .03), although 60% of controls also had admission Braden scores less than 16. On an average, PUs were acquired within 17 days of admission. Data suggest burn patients are particularly at risk of developing PU based on admission Braden scores. However, low Braden scores do not necessarily correlate with eventual development of PU. Therefore, early and aggressive PU prevention and risk assessment tools must be used to diagnose PUs at an early and reversible stage.

  1. Pressurization Risk Assessment of CO2 Reservoirs Utilizing Design of Experiments and Response Surface Methods

    NASA Astrophysics Data System (ADS)

    Guyant, E.; Han, W. S.; Kim, K. Y.; Park, E.; Han, K.

    2015-12-01

    Monitoring of pressure buildup can provide explicit information on reservoir integrity and is an appealing tool, however pressure variation is dependent on a variety of factors causing high uncertainty in pressure predictions. This work evaluated pressurization of a reservoir system in the presence of leakage pathways as well as exploring the effects of compartmentalization of the reservoir utilizing design of experiments (Definitive Screening, Box Behnken, Central Composite, and Latin Hypercube designs) and response surface methods. Two models were developed, 1) an idealized injection scenario in order to evaluate the performance of multiple designs, and 2) a complex injection scenario implementing the best performing design to investigate pressurization of the reservoir system. A holistic evaluation of scenario 1, determined that the Central Composite design would be used for the complex injection scenario. The complex scenario evaluated 5 risk factors: reservoir, seal, leakage pathway and fault permeabilities, and horizontal position of the pathway. A total of 60 response surface models (RSM) were developed for the complex scenario with an average R2 of 0.95 and a NRMSE of 0.067. Sensitivity to the input factors was dynamic through space and time; at the earliest time (0.05 years) the reservoir permeability was dominant, and for later times (>0.5 years) the fault permeability became dominant for all locations. The RSM's were then used to conduct a Monte Carlo Analysis to further analyze pressurization risks, identifying the P10, P50, P90 values. This identified the in zone (lower) P90 values as 2.16, 1.77, and 1.53 MPa and above zone values of 1.35, 1.23, 1.09 MPa for monitoring locations 1, 2, and 3, respectively. In summary, the design of experiments and response surface methods allowed for an efficient sensitivity and uncertainty analysis to be conducted permitting a complete evaluation of the pressurization across the entire parameter space.

  2. Risk Modelling of Agricultural Products

    NASA Astrophysics Data System (ADS)

    Nugrahani, E. H.

    2017-03-01

    In the real world market, agricultural commodity are imposed with fluctuating prices. This means that the price of agricultural products are relatively volatile, which means that agricultural business is a quite risky business for farmers. This paper presents some mathematical models to model such risks in the form of its volatility, based on certain assumptions. The proposed models are time varying volatility model, as well as time varying volatility with mean reversion and with seasonal mean equation models. Implementation on empirical data show that agricultural products are indeed risky.

  3. Pressure Ulcers in the Hospitalized Neonate: Rates and Risk Factors

    PubMed Central

    Visscher, Marty; Taylor, Teresa

    2014-01-01

    Pressure ulcers (PU) are serious, reportable events causing pain, infection and prolonged hospitalization, particularly among critically ill patients. The literature on PUs in neonates is limited. The objective was to determine the etiology, severity and influence of gestational age on PUs among hospitalized infants. A two-year prospective study was conducted among 741 neonatal intensive care patients over 31,643 patient-days. Risk factors were determined by comparing the characteristics of infants who developed PUs with those who did not. There were 1.5 PUs per 1000 patient days with 1.0 PU per 1000 days in premature infants and 2.7 per 1000 days in term infants. The number of PUs associated with devices was nearly 80% overall and over 90% in premature infants. Infants with PUs had longer hospitalizations and weighed more than those who did not. Infants with device-related PUs were younger, of lower gestational age and developed the PU earlier than patients with PUs due to conventional pressure. The time to PU development was longer in prematurely born versus term infants. Hospitalized neonates are susceptible to device-related injury and the rate of stage II injury is high. Strategies for early detection and mitigation of device-related injury are essential to prevent PUs. PMID:25502955

  4. Become the PPUPET Master: Mastering Pressure Ulcer Risk Assessment With the Pediatric Pressure Ulcer Prediction and Evaluation Tool (PPUPET).

    PubMed

    Sterken, David J; Mooney, JoAnn; Ropele, Diana; Kett, Alysha; Vander Laan, Karen J

    2015-01-01

    Hospital acquired pressure ulcers (HAPU) are serious, debilitating, and preventable complications in all inpatient populations. Despite evidence of the development of pressure ulcers in the pediatric population, minimal research has been done. Based on observations gathered during quarterly HAPU audits, bedside nursing staff recognized trends in pressure ulcer locations that were not captured using current pressure ulcer risk assessment tools. Together, bedside nurses and nursing leadership created and conducted multiple research studies to investigate the validity and reliability of the Pediatric Pressure Ulcer Prediction and Evaluation Tool (PPUPET). Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Approach for Mitigating Pressure Garment Design Risks in a Mobile Lunar Surface Systems Architecture

    NASA Technical Reports Server (NTRS)

    Aitchison, Lindsay

    2009-01-01

    The stated goals of the 2004 Vision for Space Exploration focus on establishing a human presence throughout the solar system beginning with the establishment of a permanent human presence on the Moon. However, the precise objectives to be accomplished on the lunar surface and the optimal system architecture to achieve those objectives have been a topic of much debate since the inception of the Constellation Program. There are two basic styles of system architectures being traded at the Programmatic level: a traditional large outpost that would focus on techniques for survival off our home planet and a greater depth of exploration within one area, or a mobile approach- akin to a series of nomadic camps- that would allow greater breadth of exploration opportunities. The traditional outpost philosophy is well within the understood pressure garment design space with respect to developing interfaces and operational life cycle models. The mobile outpost, however, combines many unknowns with respect to pressure garment performance and reliability that could dramatically affect the cost and schedule risks associated with the Constellation space suit system. This paper provides an overview of the concepts being traded for a mobile architecture from the operations and hardware implementation perspective, describes the primary risks to the Constellation pressure garment associated with each of the concepts, and summarizes the approach necessary to quantify the pressure garment design risks to enable the Constellation Program to make informed decisions when deciding on an overall lunar surface systems architecture.

  6. Approach for Mitigating Pressure Garment Design Risks in a Mobile Lunar Surface Systems Architecture

    NASA Technical Reports Server (NTRS)

    Aitchison, Lindsay

    2009-01-01

    The stated goals of the 2004 Vision for Space Exploration focus on establishing a human presence throughout the solar system beginning with the establishment of a permanent human presence on the Moon. However, the precise objectives to be accomplished on the lunar surface and the optimal system architecture to achieve those objectives have been a topic of much debate since the inception of the Constellation Program. There are two basic styles of system architectures being traded at the Programmatic level: a traditional large outpost that would focus on techniques for survival off our home planet and a greater depth of exploration within one area, or a mobile approach- akin to a series of nomadic camps- that would allow greater breadth of exploration opportunities. The traditional outpost philosophy is well within the understood pressure garment design space with respect to developing interfaces and operational life cycle models. The mobile outpost, however, combines many unknowns with respect to pressure garment performance and reliability that could dramatically affect the cost and schedule risks associated with the Constellation space suit system. This paper provides an overview of the concepts being traded for a mobile architecture from the operations and hardware implementation perspective, describes the primary risks to the Constellation pressure garment associated with each of the concepts, and summarizes the approach necessary to quantify the pressure garment design risks to enable the Constellation Program to make informed decisions when deciding on an overall lunar surface systems architecture.

  7. A Corrosion Risk Assessment Model for Underground Piping

    NASA Technical Reports Server (NTRS)

    Datta, Koushik; Fraser, Douglas R.

    2009-01-01

    The Pressure Systems Manager at NASA Ames Research Center (ARC) has embarked on a project to collect data and develop risk assessment models to support risk-informed decision making regarding future inspections of underground pipes at ARC. This paper shows progress in one area of this project - a corrosion risk assessment model for the underground high-pressure air distribution piping system at ARC. It consists of a Corrosion Model of pipe-segments, a Pipe Wrap Protection Model; and a Pipe Stress Model for a pipe segment. A Monte Carlo simulation of the combined models provides a distribution of the failure probabilities. Sensitivity study results show that the model uncertainty, or lack of knowledge, is the dominant contributor to the calculated unreliability of the underground piping system. As a result, the Pressure Systems Manager may consider investing resources specifically focused on reducing these uncertainties. Future work includes completing the data collection effort for the existing ground based pressure systems and applying the risk models to risk-based inspection strategies of the underground pipes at ARC.

  8. Pressure ulcers in the intensive care unit: the relationship between nursing workload, illness severity and pressure ulcer risk.

    PubMed

    Cremasco, Mariana F; Wenzel, Fernanda; Zanei, Suely S V; Whitaker, Iveth Y

    2013-08-01

    Aims and objective.  To verify association between PU development with nursing workload and illness severity and to verify whether nursing workload and illness severity are related with Braden Scale scores. Background.  Critically ill patients are more susceptible to treatment complications because of the severity of their clinical condition. Design.  Prospective descriptive study. Methods.  Patients consecutively admitted to three intensive care units (ICUs) of a public university hospital located in Sao Paulo, Brazil and without pressure ulcer (PU) at admission and a minimum stay of 24 hours were included in the sample. Prospective data collection included demographic, clinical and hospitalisation data, Nursing Activities Score (NAS), Simplified Acute Physiology Score (SAPSII) and Braden Scale. Multivariate linear regression analysis was applied to verify whether nursing workload and illness severity are related with Braden Scale scores. Multivariate logistic regression analysis was used to verify whether nursing workload and illness severity were risk factors associated with PU development. Results.  The study sample included 160 patients. The mean Braden score was 12·0 and PU incidence was 34·4%. Multivariate linear regression analysis identified as factors related to variation of Braden scores: illness severity (SAPSII), nursing workload (NAS) and age. Multivariate logistic regression showed a model with risk factors associated with PU development: sex, length of ICU stay, illness severity and nursing workload. Conclusion.  Nursing workload, severity of illness, sex and length of ICU stay were identified as risk factors associated with PU development. However, nursing workload acted as a protective factor. Illness severity, nursing workload and age were related to Braden scores. Relevance to clinical practice.  Accurate identification of risk factors and the use of clinical judgment in skin assessment are prerequisites for determining

  9. Lunar Landing Operational Risk Model

    NASA Technical Reports Server (NTRS)

    Mattenberger, Chris; Putney, Blake; Rust, Randy; Derkowski, Brian

    2010-01-01

    Characterizing the risk of spacecraft goes beyond simply modeling equipment reliability. Some portions of the mission require complex interactions between system elements that can lead to failure without an actual hardware fault. Landing risk is currently the least characterized aspect of the Altair lunar lander and appears to result from complex temporal interactions between pilot, sensors, surface characteristics and vehicle capabilities rather than hardware failures. The Lunar Landing Operational Risk Model (LLORM) seeks to provide rapid and flexible quantitative insight into the risks driving the landing event and to gauge sensitivities of the vehicle to changes in system configuration and mission operations. The LLORM takes a Monte Carlo based approach to estimate the operational risk of the Lunar Landing Event and calculates estimates of the risk of Loss of Mission (LOM) - Abort Required and is Successful, Loss of Crew (LOC) - Vehicle Crashes or Cannot Reach Orbit, and Success. The LLORM is meant to be used during the conceptual design phase to inform decision makers transparently of the reliability impacts of design decisions, to identify areas of the design which may require additional robustness, and to aid in the development and flow-down of requirements.

  10. Blood pressure and risk of cancer incidence and mortality in the Metabolic Syndrome and Cancer Project.

    PubMed

    Stocks, Tanja; Van Hemelrijck, Mieke; Manjer, Jonas; Bjørge, Tone; Ulmer, Hanno; Hallmans, Göran; Lindkvist, Björn; Selmer, Randi; Nagel, Gabriele; Tretli, Steinar; Concin, Hans; Engeland, Anders; Jonsson, Håkan; Stattin, Pär

    2012-04-01

    Observational studies have shown inconsistent results for the association between blood pressure and cancer risk. We investigated the association in 7 cohorts from Norway, Austria, and Sweden. In total, 577799 adults with a mean age of 44 years were followed for, on average, 12 years. Incident cancers were 22184 in men and 14744 in women, and cancer deaths were 8724 and 4525, respectively. Cox regression was used to calculate hazard ratios of cancer per 10-mmHg increments of midblood pressure, which corresponded with 0.7 SDs and, for example, an increment of systolic/diastolic blood pressure of 130/80 to 142/88 mmHg. All of the models used age as the time scale and were adjusted for possible confounders, including body mass index and smoking status. In men, midblood pressure was positively related to total incident cancer (hazard ratio per 10 mmHg increment: 1.07 [95% CI: 1.04-1.09]) and to cancer of the oropharynx, colon, rectum, lung, bladder, kidney, malignant melanoma, and nonmelanoma skin cancer. In women, midblood pressure was not related to total incident cancer but was positively related to cancer of the liver, pancreas, cervix, uterine corpus, and malignant melanoma. A positive association was also found for cancer mortality, with HRs per 10-mmHg increment of 1.12 (95% CI: 1.08-1.15) for men and 1.06 (95% CI: 1.02-1.11) for women. These results suggest a small increased cancer risk overall in men with elevated blood pressure level and a higher risk for cancer death in men and women.

  11. Risk perception in epidemic modeling

    NASA Astrophysics Data System (ADS)

    Bagnoli, Franco; Liò, Pietro; Sguanci, Luca

    2007-12-01

    We investigate the effects of risk perception in a simple model of epidemic spreading. We assume that the perception of the risk of being infected depends on the fraction of neighbors that are ill. The effect of this factor is to decrease the infectivity, that therefore becomes a dynamical component of the model. We study the problem in the mean-field approximation and by numerical simulations for regular, random, and scale-free networks. We show that for homogeneous and random networks, there is always a value of perception that stops the epidemics. In the “worst-case” scenario of a scale-free network with diverging input connectivity, a linear perception cannot stop the epidemics; however, we show that a nonlinear increase of the perception risk may lead to the extinction of the disease. This transition is discontinuous, and is not predicted by the mean-field analysis.

  12. Thermal Modelling In Pressure Die Casting

    NASA Astrophysics Data System (ADS)

    Rasgado, M. T. Alonso; Davey, K.; Watari, H.

    2004-06-01

    The pressure die casting process is cyclic and the temperature levels in the die are principally dictated by the total energy received from the casting. It is thus extremely important that any solidification model for the casting is able to predict energy extraction rates to a high degree of accuracy. In this paper an efficient three dimensional hybrid thermal model for the pressure die casting process is described. The finite element method (FEM) is used for modelling heat transfer in the casting, coupled to a boundary element (BE) model for the die. The FEM can efficiently account for the non-linearity introduced by the release of latent heat on solidification, whereas the BEM is ideally suited for modelling linear heat conduction in the die, as surface temperatures are of principal importance. The FE formulation for the casting is based on a control volume capacitance method, which is shown to provide high accuracy and stability. This method is similar to the apparent and effective heat capacitance methods, which are popular approaches used where conduction predominates over other heat transfer mechanisms. These methods involve the specification of element or nodal capacitances to accommodate for the release of latent heat. Unfortunately they suffer from a major drawback in that energy is not correctly transported through elements and so providing a source of inaccuracy. The control volume capacitance method allows for the transport of mass arising from volumetric shrinkage and ensures that energy is correctly transported. The BE model caters for surface phenomena such as boiling in the cooling channels, which is important, as this effectively controls the manner in which energy is extracted. The die temperature is decomposed into two components, one a steady-state part and the other a time-dependent perturbation. This approach enables the transient die temperatures to be calculated in an efficient way, since only die surfaces close to the die cavity are

  13. Ecological risk assessment of water environment for Luanhe River Basin based on relative risk model.

    PubMed

    Liu, Jingling; Chen, Qiuying; Li, Yongli

    2010-11-01

    The relative risk model (RRM) was applied in regional ecological risk assessments successfully. In this study, the RRM was developed through increasing the data of risk source and introducing the source-stressor-habitat exposure filter (SSH), the endpoint-habitat exposure filter (EH) and the stressor-endpoint effect filter (SE) to reflect the meaning of exposure and effect more explicit. Water environment which include water quality, water quantity and aquatic ecosystems was selected as the ecological risk assessment endpoints. The Luanhe River Basin located in the North China was selected as model case. The results showed that there were three low risk regions, one medium risk region and two high risk regions in the Luanhe River Basin. The results also indicated habitat destruction was the largest stressor with the risk scores as high as 11.87 for the Luanhe water environment, the second was oxygen consuming organic pollutants (9.28) and the third was nutrients (7.78). So these three stressors were the main influencing factors of the ecological pressure in the study area. Furthermore, animal husbandry was the biggest source with the risk scores as high as 20.38, the second was domestic sewage (14.00), and the third was polluting industry (9.96). For habitats, waters and farmland were enduring the bigger pressure and should be taken considerable attention. Water deterioration and ecological service values damaged were facing the biggest risk pressure, and secondly was biodiversity decreased and landscape fragmentation.

  14. Animal Models in Pressure Ulcer Research

    PubMed Central

    Salcido, Richard; Popescu, Adrian; Ahn, Chulhyun

    2007-01-01

    Background/Objective: Research targeting the pathophysiology, prevention, and treatment of pressure ulcers (PrUs) continue to be a significant priority for clinical and basic science research. Spinal cord injury patients particularly benefit from PrU research, because the prevalence of chronic wounds in this category is increasing despite standardized medical care. Because of practical, ethical, and safety considerations, PrUs in the human environment are limited to studies involving patients with pre-existing ulcers. Therefore, we are limited in our basic knowledge pertaining to the development, progression, and healing environment in this devastating disease. Methods: This review provides a synopsis of literature and a discussion of techniques used to induce PrUs in animal models. The question of what animal model best mimics the human PrU environment has been a subject of debate by investigators, peer review panels, and editors. The similarities in wound development and healing in mammalian tissue make murine models a relevant model for understanding the causal factors as well as the wound healing elements. Although we are beginning to understand some of the mechanisms of PrU development, a key dilemma of what makes an apparently healthy tissue develop a PrU waits to be solved. Results and Conclusions: No single method of induction and exploring PrUs in animals can address all the aspects of the pathology of chronic wounds. Each model has its particular strengths and weaknesses. Certain types of models can selectively identify specific aspects of wound development, quantify the extent of lesions, and assess outcomes from interventions. The appropriate interpretation of these methods is significant for proper study design, an understanding of the results, and extrapolation to clinical relevance. PMID:17591222

  15. Model of current enhancement at high pressure

    SciTech Connect

    Yu, S.S.; Melendez, R.E.

    1983-04-05

    A model is proposed to account for the phenomenon of net current enhancement at high pressures recently observed on the Experimental Test Accelerator. The proposed mechanism involves energetic secondary electrons (delta rays) which are pushed forward by the self-magnetic field of the electron beam. For high current beams, the forward delta ray current can build up to a significant fraction of the beam current. Analytic calculations of the steady-state solution as well as the rate of buildup of the delta ray current are presented in this paper. In addition, numerical results from a nonlocal Boltzmann code, NUTS, are presented. The analytic and numerical results have many features which are in qualitative agreement with the experiments, but quantitative discrepancies still exist.

  16. Pressurized Cadaver Model in Cardiothoracic Surgical Simulation.

    PubMed

    Greene, Christina L; Minneti, Michael; Sullivan, Maura E; Baker, Craig J

    2015-09-01

    Simulation is increasingly recognized as an integral aspect of thoracic surgery education. A number of simulators have been introduced to teach component cardiothoracic skills; however, no good model exists for numerous essential skills including redo sternotomy and internal mammary artery takedown. These procedures are often relegated to thoracic surgery residents but have significant negative implications if performed incorrectly. Fresh tissue dissection is recognized as the gold standard for surgical simulation, but the lack of circulating blood volume limits surgical realism. Our aim is to describe the technique of the pressurized cadaver for use in cardiothoracic surgical procedures, focusing on internal mammary artery takedown. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Modeling the Extreme-Pressure Lubricating Interface

    NASA Astrophysics Data System (ADS)

    Kaltchev, Matey; Gao, Feng; Lara-Romero, Javier; Tysoe, Wilfred

    2005-04-01

    Extreme-pressure lubricants are currently widely used in various areas of applications. However, despite of their common use, the fundamental aspects of the mechanism in which these lubricants reduce the friction coefficient are not clear yet. Earlier macrotribological experiments using chlorinated hydrocarbons have shown remarkable effectiveness. It has been proven that thin films that resemble those formed under tribological conditions can also be synthesized in ultrahigh vacuum when beams of chlorinated hydrocarbons are directed onto a clean iron surface. Here results obtained using X-ray photoelectron spectroscopy, temperature programmed desorption, atomic force microscopy and microtribological measurements of these films are presented. Substantial information about the fundamental properties and structure of this model lubricating interface is revealed. A mechanism of the formation of the interface under tribological conditions is also suggested.

  18. Quantile uncertainty and value-at-risk model risk.

    PubMed

    Alexander, Carol; Sarabia, José María

    2012-08-01

    This article develops a methodology for quantifying model risk in quantile risk estimates. The application of quantile estimates to risk assessment has become common practice in many disciplines, including hydrology, climate change, statistical process control, insurance and actuarial science, and the uncertainty surrounding these estimates has long been recognized. Our work is particularly important in finance, where quantile estimates (called Value-at-Risk) have been the cornerstone of banking risk management since the mid 1980s. A recent amendment to the Basel II Accord recommends additional market risk capital to cover all sources of "model risk" in the estimation of these quantiles. We provide a novel and elegant framework whereby quantile estimates are adjusted for model risk, relative to a benchmark which represents the state of knowledge of the authority that is responsible for model risk. A simulation experiment in which the degree of model risk is controlled illustrates how to quantify Value-at-Risk model risk and compute the required regulatory capital add-on for banks. An empirical example based on real data shows how the methodology can be put into practice, using only two time series (daily Value-at-Risk and daily profit and loss) from a large bank. We conclude with a discussion of potential applications to nonfinancial risks. © 2012 Society for Risk Analysis.

  19. Hypertension risk status and effect of caffeine on blood pressure.

    PubMed

    Hartley, T R; Sung, B H; Pincomb, G A; Whitsett, T L; Wilson, M F; Lovallo, W R

    2000-07-01

    We compared the acute effects of caffeine on arterial blood pressure (BP) in 5 hypertension risk groups composed of a total of 182 men. We identified 73 men with optimal BP, 28 with normal BP, 36 with high-normal BP, and 27 with stage 1 hypertension on the basis of resting BP; in addition, we included 18 men with diagnosed hypertension from a hypertension clinic. During caffeine testing, BP was measured after 20 minutes of rest and again at 45 to 60 minutes after the oral administration of caffeine (3.3 mg/kg or a fixed dose of 250 mg for an average dose of 260 mg). Caffeine raised both systolic and diastolic BP (SBP and DBP, respectively; P<0.0001 for both) in all groups. However, an ANCOVA revealed that the strongest response to caffeine was observed among diagnosed men, followed by the stage 1 and high-normal groups and then by the normal and optimal groups (SBP F(4),(175)=5.06, P<0.0001; DBP F(4,175)=3.02, P<0.02). Indeed, diagnosed hypertensive men had a pre-to-postdrug change in BP that was >1.5 times greater than the optimal group. The potential clinical relevance of caffeine-induced BP changes is seen in the BPs that reached the hypertensive range (SBP >/=140 mm Hg or DBP >/=90 mm Hg) after caffeine. During the predrug baseline, 78% of diagnosed hypertensive men and 4% of stage 1 men were hypertensive, whereas no others were hypertensive. After caffeine ingestion, 19% of the high-normal, 15% of the stage 1, and 89% of the diagnosed hypertensive groups fell into the hypertensive range. All subjects from the optimal and normal groups remained normotensive. We conclude that hypertension risk status should take priority in future research regarding pressor effects of dietary intake of caffeine.

  20. Walking speed and high blood pressure mortality risk in a Spanish elderly population.

    PubMed

    Gutiérrez-Misis, A; Sánchez-Santos, M T; Banegas, J R; Castell, M V; González-Montalvo, J I; Otero, A

    2015-09-01

    This study analyzed the relationship between blood pressure and all-cause mortality according to objectively measured walking speed in a Mediterranean population-based sample of older persons. We used data from the longitudinal 'Peñagrande' Cohort Study, initiated in 2008 in a sex- and age-stratified random sample of 1250 people aged ⩾65 years living in Madrid (Spain). A total of 814 individuals participated in the first study wave. The average of two standardized blood pressure readings was used. Walking speed was measured over a 3-m walk and classified as faster (⩾0.8 m s(-1)) or slower. A total of 314 individuals were slower walkers, 475 were faster walkers and 25 did not complete the walk test. Cox proportional hazards models stratified by walking speed were used to assess the association between blood pressure and all-cause death. Non-linear relationship between BP and mortality was explored by a restricted cubic spline analysis. There were 171 deaths from study entry through 31 March 2013. Systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mmHg were associated with higher mortality than blood pressure values above 140 and 90 mm Hg, respectively, but this association reached statistical significance only for systolic blood pressure and only in the slower walkers. In conclusion, systolic blood pressure levels <140 mm Hg were found associated with higher risk of total mortality among slower walkers in an old Spaniard population cohort.

  1. Blood pressure components and the risk for proteinuria in Japanese men: The Kansai Healthcare Study.

    PubMed

    Shibata, Mikiko; Sato, Kyoko Kogawa; Uehara, Shinichiro; Koh, Hideo; Kinuhata, Shigeki; Oue, Keiko; Kambe, Hiroshi; Morimoto, Michio; Hayashi, Tomoshige

    2017-11-01

    We examined prospectively which of the four blood pressure (BP) components (systolic BP [SBP], diastolic BP [DBP], pulse pressure [PP], and mean arterial pressure [MAP]) was best in predicting the risk of proteinuria. This prospective study included 9341 non-diabetic Japanese middle-aged men who had no proteinuria and an estimated glomerular filtration rate ≥60 mL/min/1.73 m(2) and were not taking antihypertensive medications at entry. Persistent proteinuria was defined if proteinuria was detected two or more times consecutively and persistently at the annual examination until the end of follow-up. We calculated the difference in values of Akaike's information criterion (ΔAIC) in comparison of the BP components-added model to the model without them in a Cox proportional hazards model. During the 84,587 person-years follow-up period, we confirmed 151 cases of persistent proteinuria. In multiple-adjusted models that included a single BP component, the hazard ratios for persistent proteinuria for the highest quartile of SBP, PP, and MAP were 3.11 (95% confidence interval [CI], 1.79-5.39), 1.87 (95% CI, 1.18-2.94), and 2.21 (95% CI, 1.33-3.69) compared with the lowest quartile of SBP, PP, and MAP, respectively. The hazard ratio for the highest quartile of DBP was 2.69 (95% CI, 1.65-4.38) compared with the second quartile of DBP. Of all models that included a single BP component, those that included SBP alone or DBP alone had the highest values of ΔAIC (14.0 and 13.1, respectively) in predicting the risk of persistent proteinuria. Of all BP components, SBP and DBP were best in predicting the risk of persistent proteinuria in middle-aged Japanese men. Copyright © 2017 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

  2. Fluid dynamic modelling of renal pelvic pressure during endoscopic stone removal

    NASA Astrophysics Data System (ADS)

    Oratis, Alexandros; Subasic, John; Bird, James; Eisner, Brian

    2015-11-01

    Endoscopic kidney stone removal procedures are known to increase internal pressure in the renal pelvis, the kidney's urinary collecting system. High renal pelvic pressure incites systemic absorption of irrigation fluid, which can increase the risk of postoperative fever and sepsis or the unwanted absorption of electrolytes. Urologists choose the appropriate surgical procedure based on patient history and kidney stone size. However, no study has been conducted to compare the pressure profiles of each procedure, nor is there a precise sense of how the renal pelvic pressure scales with various operational parameters. Here we develop physical models for the flow rates and renal pelvic pressure for various procedures. We show that the results of our models are consistent with existing urological data on each procedure and that the models can predict pressure profiles where data is unavailable.

  3. Sex Difference in Cardiovascular Risk: Role of Pulse Pressure Amplification

    PubMed Central

    Regnault, Véronique; Thomas, Frédérique; Safar, Michel E.; Osborne-Pellegrin, Mary; Khalil, Raouf A.; Pannier, Bruno; Lacolley, Patrick

    2013-01-01

    Objectives Our aim was to explore whether the carotid/brachial pulse pressure (C/B-PP) ratio selectively predicts the gender difference in age-related cardiovascular death. Background Hypertension and cardiovascular complications are more severe in men and post-menopausal women than in pre-menopausal women. C-PP is lower than B-PP, and the C/B-PP ratio is a physiological marker of PP amplification between C and B arteries which tends toward 1.0 with age. Methods The study involved 72,437 men (aged 41.0±11.1 years, mean±SD) and 52,714 women (39.5±11.6 years). C-PP was calculated for each gender by a multiple regression analysis including B-PP, age, height and risk factors, a method validated beforehand in a subgroup of 834 subjects. During the 12 years of follow-up, 3028 men and 969 women died. Results In the total population, the adjusted hazard ratios (HR, 95% CI) of C/B-PP ratio were: (i) for all cause mortality: men, 1.51 (1.47–1.56), women, 2.46 (2.27–2.67) (p<0.0001); (ii) for cardiovascular mortality: men, 1.81 (1.70–1.93), women, 4.46 (3.66–5.45) (p<0.0001). The C/B-PP impact on mortality did not significantly increase from younger men to those over 55, from: 1.44 (1.31–1.58) to 1.65 (1.48–1.84), but increased significantly with age in women: 3.19 (2.08–4.89) vs 5.60 (4.17–7.50) (p<0.01). Thus the mortality impact of C/B-PP ratio was 3-fold higher in women than in men over 55. Conclusions The C/B amplification is highly predictive of differences in cardiovascular risk between men and women. In post-menopausal women, the attenuation of PP amplification, mainly related to increased aortic stiffness, contributes to the significant increase in cardiovascular risk. PMID:22575315

  4. The Nursing Diagnosis of risk for pressure ulcer: content validation.

    PubMed

    Santos, Cássia Teixeira Dos; Almeida, Miriam de Abreu; Lucena, Amália de Fátima

    2016-06-14

    to validate the content of the new nursing diagnosis, termed risk for pressure ulcer. the content validation with a sample made up of 24 nurses who were specialists in skin care from six different hospitals in the South and Southeast of Brazil. Data collection took place electronically, through an instrument constructed using the SurveyMonkey program, containing a title, definition, and 19 risk factors for the nursing diagnosis. The data were analyzed using Fehring's method and descriptive statistics. The project was approved by a Research Ethics Committee. title, definition and seven risk factors were validated as "very important": physical immobilization, pressure, surface friction, shearing forces, skin moisture, alteration in sensation and malnutrition. Among the other risk factors, 11 were validated as "important": dehydration, obesity, anemia, decrease in serum albumin level, prematurity, aging, smoking, edema, impaired circulation, and decrease in oxygenation and in tissue perfusion. The risk factor of hyperthermia was discarded. the content validation of these components of the nursing diagnosis corroborated the importance of the same, being able to facilitate the nurse's clinical reasoning and guiding clinical practice in the preventive care for pressure ulcers. validar o conteúdo do novo diagnóstico de enfermagem, denominado risco de úlcera por pressão. trata-se de uma validação de conteúdo, com amostra composta por 24 enfermeiros especialistas no cuidado à pele, procedentes de seis diferentes hospitais do Sul e Sudeste brasileiro. A coleta de dados ocorreu por meio eletrônico, em instrumento construído pelo programa SurveyMonkey, que continha título, definição e 19 fatores de risco para o diagnóstico de enfermagem. Os dados foram analisados pelo método de Fehring e pela estatística descritiva. O projeto foi aprovado em Comitê de Ética em Pesquisa. título, definição e sete fatores de risco foram validados como "muito importante

  5. Spatiotemporal Modeling of Community Risk

    DTIC Science & Technology

    2016-03-01

    intensity of their point data. They developed a spatial visualization of fire distribution against a random sampling of non-affected buildings, effectively ...risk, spatiotemporal, spatial , temporal, quantitative analysis, deployment model 15. NUMBER OF PAGES 115 16. PRICE CODE 17. SECURITY... effects of asthma and summer heat. Surprisingly, the monthly trends of EMS call volume depicted a stable call volume across the months with no apparent

  6. Strict blood pressure control associates with decreased mortality risk by APOL1 genotype.

    PubMed

    Ku, Elaine; Lipkowitz, Michael S; Appel, Lawrence J; Parsa, Afshin; Gassman, Jennifer; Glidden, David V; Smogorzewski, Miroslaw; Hsu, Chi-Yuan

    2017-02-01

    Although APOL1 high-risk genotype partially accounts for the increased susceptibility of blacks to chronic kidney disease (CKD), whether APOL1 associates differentially with mortality risk remains controversial. Here we evaluate the association between APOL1 genotype and risk of death and determine whether APOL1 status modifies the association between strict versus usual blood pressure control and mortality risk. We performed a retrospective analysis of the African American Study of Kidney Disease and Hypertension trial that randomized black participants with CKD to strict versus usual blood pressure control from 1995 to 2001. This included 682 participants with known APOL1 genotype (157 with high-risk genotype) previously assigned to either strict (mean arterial pressure [MAP] 92 mm Hg or less) versus usual blood pressure control (MAP 102-107 mm Hg) during the trial. During a median follow-up of 14.5 years, risk of death did not differ between individuals with high- versus low-risk APOL1 genotypes (unadjusted hazard ratio 1.00 [95% confidence interval 0.76-1.33]). However, a significant interaction was detected between the APOL1 risk group and blood pressure control strategy. In the APOL1 high-risk group, the risk of death was 42% lower comparing strict versus usual blood pressure control (0.58 [0.35-0.97]). In the APOL1 low-risk group, the risk of death comparing strict versus usual blood pressure control was not significantly different (1.09 [0.84-1.43]). Thus, strict blood pressure control during CKD associates with a lower risk of death in blacks with the high-risk CKD APOL1 genotype. Knowledge of APOL1 status could inform selection of blood pressure treatment targets in black CKD patients. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

  7. A Study of the Factors Associated with Risk for Development of Pressure Ulcers: A Longitudinal Analysis

    PubMed Central

    Thomas, Elizebeth; Vinodkumar, Sudhaya; Mathew, Silvia; Setia, Maninder Singh

    2015-01-01

    Background: Pressure ulcers (PUs) are prevalent in hospitalized patients; they may cause clinical, psychological, and economic problems in these patients. Previous studies are cross-sectional, have used pooled data, or cox-regression models to assess the risk for developing PU. However, PU risk scores change over time and models that account for time varying variables are useful for cohort analysis of data. Aims and Objectives: The present longitudinal study was conducted to compare the risk of PU between surgical and nonsurgical patients, and to evaluate the factors associated with the development of these ulcers over a period of time. Materials and Methods: We evaluated 290 hospitalized patients over a 4 months period. The main outcomes for our analysis were: (1) Score on the pressure risk assessment scale; and (2) the proportion of individuals who were at severe risk for developing PUs. We used random effects models for longitudinal analysis of the data. Results: The mean PU score was significantly higher in the nonsurgical patients compared with surgical patients at baseline (15.23 [3.86] vs. 9.33 [4.57]; P < 0.01). About 7% of the total patients had a score of >20 at baseline and were considered as being at high-risk for PU; the proportion was significantly higher among the nonsurgical patients compared with the surgical patients (14% vs. 4%, P = 0.003). In the adjusted models, there was no difference for severe risk for PU between surgical and nonsurgical patients (odds ratios [ORs]: 0.37, 95% confidence interval [CI]: 0.01–12.80). An additional day in the ward was associated with a significantly higher likelihood of being at high-risk for PU (OR: 1.47, 95% CI: 1.16–1.86). Conclusion: There were no significant differences between patients who were admitted for surgery compared with those who were not. An additional day in the ward, however, is important for developing a high-risk score for PU on the monitoring scale, and these patients require active

  8. Intraglottal velocity and pressure measurements in a hemilarynx model.

    PubMed

    Oren, Liran; Gutmark, Ephraim; Khosla, Sid

    2015-02-01

    Determining the mechanisms of self-sustained oscillation of the vocal folds requires characterization of the pressures produced by intraglottal aerodynamics. Because most of the intraglottal aerodynamic forces cannot be measured in a tissue model of the larynx, current understanding of vocal fold vibration mechanism is derived from mechanical, analytical, and computational models. Previous studies have computed intraglottal pressures from measured intraglottal velocity fields and intraglottal geometry; however, this technique for determining pressures is not yet validated. In this study, intraglottal pressure measurements taken in a hemilarynx model are compared with pressure values that are computed from simultaneous velocity measurements. The results showed that significant negative pressure formed near the superior aspect of the folds during closing, which agrees with previous measurements in other hemilarynx models. Intraglottal velocity measurements show that the flow near the superior aspect separates from the glottal wall during closing and may develop into a vortex, which further augments the magnitude of negative pressure. Intraglottal pressure distributions, computed by solving the pressure Poisson equation, showed good agreement with pressure measurements. The match between the pressure computations and its measurements validates the current technique, which was previously used to estimate intraglottal pressure distribution in a full larynx model.

  9. Nursing Home Work Environment and the Risk of Pressure Ulcers and Incontinence

    PubMed Central

    Temkin-Greener, Helena; Cai, Shubing; Zheng, Nan Tracy; Zhao, Hongwei; Mukamel, Dana B

    2012-01-01

    Objective To examine the association between nursing home (NH) work environment attributes such as teams, consistent assignment and staff cohesion, and the risk of pressure ulcers and incontinence. Data Sources/Setting Minimum dataset for 46,044 residents in 162 facilities in New York State, for June 2006–July 2007, and survey responses from 7,418 workers in the same facilities. Study Design For each individual and facility, primary and secondary data were linked. Random effects logistic models were used to develop/validate outcome measures. Generalized estimating equation models with robust standard errors and probability weights were employed to examine the association between outcomes and work environment attributes. Key independent variables were staff cohesion, percent staff in daily care teams, and percent staff with consistent assignment. Other facility factors were also included. Principal Findings Residents in facilities with worse staff cohesion had significantly greater odds of pressure ulcers and incontinence, compared with residents in facilities with better cohesion scores. Residents in facilities with greater penetration of self-managed teams had lower risk of pressure ulcers, but not of incontinence. Prevalence of consistent assignment was not significantly associated with the outcome measures. Conclusions NH environments and management practices influence residents’ health outcomes. These findings provide important lessons for administrators and regulators interested in promoting NH quality improvement. PMID:22098384

  10. [Cardiovascular risk stratification. Systolic, diastolic or pulse pressure?].

    PubMed

    Pede, S; Lombardo, M

    2001-04-01

    It is well known that hypertension is a highly prevalent condition in the population, carries a significant risk of adverse cardiovascular events and is therapeutically difficult to control. These factors render it "a major unsolved - but soluble - mass public health problem". One of the present-day aspects of the complexity of managing patients with high blood pressure (BP) derives from clinical and epidemiological data that have emerged over the past 10 years: the growing importance of the clinical significance of systolic and pulse BP. The pathophysiological basis of these data is based, on the one hand, on a better articulated definition of the components of BP, and on the other, on precise information concerning age-related modifications. The common definition of BP does not take into account pressure fluctuations occurring during the cardiac cycle; in fact, systolic and diastolic BP denote the extreme values of continuous variations in differential pressure. Diastolic BP reflects, to a greater extent, the trend of arterial resistances and mean BP (usually calculated as diastolic BP plus one third of the differential BP, and considered the "stable component" of the arterial sphygmogram) and has long been used as a diagnostic and therapeutic target. Systolic BP is more closely linked to variations in pulse BP (given from the difference between systolic and diastolic BP and considered the "dynamic component" of the arterial sphygmogram) and is produced by a group of factors including left ventricular ejection and the reflection of the sphygmic wave. As age increases, the walls of the aorta and the large elastic arteries progressively harden due to senile degenerative phenomena and the loss of elasticity as well as the progressive diffusion of atherosdclerotic lesions. This leads to the reduced capacity of the arterial wall to distend during the systole with a consequent increase in both systolic and pulse BP. These pathophysiological data have important clinical

  11. Twenty-four hour ocular perfusion pressure fluctuation and risk of normal-tension glaucoma progression.

    PubMed

    Sung, Kyung Rim; Lee, Suhwan; Park, Seong Bae; Choi, Jaewan; Kim, Soon Tae; Yun, Sung-Cheol; Kang, Sung Yong; Cho, Jung Woo; Kook, Michael S

    2009-11-01

    To investigate the relationship between clinical factors including 24-hour mean ocular perfusion pressure (MOPP, (2/3) x mean arterial pressure [MAP] - intraocular pressure [IOP]) and visual field (VF) progression in eyes with medically treated normal-tension glaucoma (NTG). One hundred one eyes of 101 NTG patients followed up for more than 4 years (mean follow-up, 6.2 years +/- 12.1 months) were included after retrospective chart review. Several clinical factors including demographic, systemic, ocular risk factors, and 24-hour MOPP were explored for associations with decreasing VF. Kaplan-Meier analyses were performed to compare outcomes with reference to four risk factors (age, myopia, and elevated MAP and MOPP fluctuation) for VF deterioration. Hazard ratios (HRs) for the association between potential risk factors and glaucoma progression were obtained using Cox proportional hazards models. Overall VF progression was detected in 29 (28.7%) eyes. There were significant differences between progressors and nonprogressors in nocturnal MAP and MOPP fluctuations (both P < 0.0001), 24-hour MAP, and MOPP fluctuations (both P < 0.0001), initial mean deviation (P = 0.0034), and pattern standard deviation (PSD) score (P < 0.0001). Both elevated 24-hour MAP and MOPP fluctuations were associated with greater VF progression probabilities based on Kaplan-Meier analyses. Among all risk factors investigated, the Cox proportional hazards model indicated that VF progression was significantly associated with 24-hour MOPP fluctuation and initial PSD score. Clinical factors other than IOP were associated with VF progression in our series of medically treated NTG eyes. Twenty-four-hour MOPP fluctuation was the most consistent prognostic factor for glaucoma progression.

  12. The incidence of pressure ulcer in patients on mechanical ventilation andeffects of selected risk factors on pressure ulcer development.

    PubMed

    Karayurt, Özgül; Akyol, Özay; Kılıçaslan, Necmiye; Akgün, Nuray; Sargın, Ümran; Kondakçı, Melike; Ekinci, Hanım; Sarı, Neslihan

    2016-11-17

    This study aimed to determine the incidence of pressure ulcers in patients on mechanical ventilation and selected risk factors likely to play a role in pressure ulcer development. The study included 110 patients recruited from an anesthesia critical care unit of a university hospital. Data were collected with a demographic and clinical characteristics form. The form was composed of questions about demographic characteristics and clinical features including diagnosis, duration of mechanical ventilation, general well-being, oxygenation, perfusion, and skin condition. The incidence of pressure ulcer was 15.5%. Duration of mechanical ventilation was longer and the body mass index was higher in patients developing pressure ulcers than in those without pressure ulcers. Additionally, 90.11% of patients with pressure ulcers had edema and 82.35% of patients with pressure ulcers received vasopressin. The patients with pressure ulcers had higher PH levels, lower PaO2 levels, higher PCO2 levels, lower SaO2 levels, and higher urine output. It can be recommended that nurses and other health professionals should be aware of factors playing a role in pressure ulcer development and should be able to conduct appropriate interventions to prevent pressure ulcers.

  13. Daily exercise attenuates the development of arterial blood pressure related cardiovascular risk factors in hypertensive rats.

    PubMed

    Collins, H L; Rodenbaugh, D W; DiCarlo, S E

    2000-02-01

    This study was designed to test the hypothesis that daily spontaneous running (DSR) attenuates the development of blood pressure-related cardiovascular disease risk factors (BP-related CVD risk factors) in spontaneously hypertensive rats (SHR). After 8 weeks of DSR or sedentary control, rats were chronically instrumented with arterial catheters. Daily exercise attenuated the development of all measures of BP-related CVD risk factors. Specifically DSR attenuated the increase in systolic blood pressure (delta--22 mmHg), systolic blood pressure variability (delta--2.5 mmHg), and systolic blood pressure load (delta--27%). Similarly, DSR attenuated the increase in diastolic blood pressure (delta--15 mmHg), diastolic blood pressure variability (delta--1.19 mmHg), and diastolic blood pressure load (delta--17%). Finally, DSR attenuated the development of tachycardia (delta--63 bpm). These data demonstrate that daily exercise attenuates the development of hypertension and tachycardia in animals predisposed to hypertension.

  14. Genetic predisposition to higher blood pressure increases risk of incident hypertension and cardiovascular diseases in Chinese.

    PubMed

    Lu, Xiangfeng; Huang, Jianfeng; Wang, Laiyuan; Chen, Shufeng; Yang, Xueli; Li, Jianxin; Cao, Jie; Chen, Jichun; Li, Ying; Zhao, Liancheng; Li, Hongfan; Liu, Fangcao; Huang, Chen; Shen, Chong; Shen, Jinjin; Yu, Ling; Xu, Lihua; Mu, Jianjun; Wu, Xianping; Ji, Xu; Guo, Dongshuang; Zhou, Zhengyuan; Yang, Zili; Wang, Renping; Yang, Jun; Yan, Weili; Gu, Dongfeng

    2015-10-01

    Although multiple genetic markers associated with blood pressure have been identified by genome-wide association studies, their aggregate effect on risk of incident hypertension and cardiovascular disease is uncertain, particularly among East Asian who may have different genetic and environmental exposures from Europeans. We aimed to examine the association between genetic predisposition to higher blood pressure and risk of incident hypertension and cardiovascular disease in 26 262 individuals in 2 Chinese population-based prospective cohorts. A genetic risk score was calculated based on 22 established variants for blood pressure in East Asian. We found the genetic risk score was significantly and independently associated with linear increases in blood pressure and risk of incident hypertension and cardiovascular disease (P range from 4.57×10(-3) to 3.10×10(-6)). In analyses adjusted for traditional risk factors including blood pressure, individuals carrying most blood pressure-related risk alleles (top quintile of genetic score distribution) had 40% (95% confidence interval, 18-66) and 26% (6-45) increased risk for incident hypertension and cardiovascular disease, respectively, when compared with individuals in the bottom quintile. The genetic risk score also significantly improved discrimination for incident hypertension and cardiovascular disease and led to modest improvements in risk reclassification for cardiovascular disease (all the P<0.05). Our data indicate that genetic predisposition to higher blood pressure is an independent risk factor for blood pressure increase and incident hypertension and cardiovascular disease and provides modest incremental information to cardiovascular disease risk prediction. The potential clinical use of this panel of blood pressure-associated polymorphisms remains to be determined. © 2015 American Heart Association, Inc.

  15. Intelligent adversary risk analysis: a bioterrorism risk management model.

    PubMed

    Parnell, Gregory S; Smith, Christopher M; Moxley, Frederick I

    2010-01-01

    The tragic events of 9/11 and the concerns about the potential for a terrorist or hostile state attack with weapons of mass destruction have led to an increased emphasis on risk analysis for homeland security. Uncertain hazards (natural and engineering) have been successfully analyzed using probabilistic risk analysis (PRA). Unlike uncertain hazards, terrorists and hostile states are intelligent adversaries who can observe our vulnerabilities and dynamically adapt their plans and actions to achieve their objectives. This article compares uncertain hazard risk analysis with intelligent adversary risk analysis, describes the intelligent adversary risk analysis challenges, and presents a probabilistic defender-attacker-defender model to evaluate the baseline risk and the potential risk reduction provided by defender investments. The model includes defender decisions prior to an attack; attacker decisions during the attack; defender actions after an attack; and the uncertainties of attack implementation, detection, and consequences. The risk management model is demonstrated with an illustrative bioterrorism problem with notional data.

  16. Calculating osmotic pressure according to nonelectrolyte Wilson nonrandom factor model.

    PubMed

    Li, Hui; Zhan, Tingting; Zhan, Xiancheng; Wang, Xiaolan; Tan, Xiaoying; Guo, Yiping; Li, Chengrong

    2014-08-01

    Abstract The osmotic pressure of NaCl solutions was determined by the air humidity in equilibrium (AHE) method. The relationship between the osmotic pressure and the concentration was explored theoretically, and the osmotic pressure was calculated according to the nonelectrolyte Wilson nonrandom factor (N-Wilson-NRF) model from the concentration. The results indicate that the calculated osmotic pressure is comparable to the measured one.

  17. Behavior modification in primary care: the pressure system model.

    PubMed

    Katz, D L

    2001-01-01

    The leading causes of death in the United States are predominantly attributable to modifiable behaviors. Patients with behavioral risk factors for premature death and disability, including dietary practices; sexual practices; level of physical activity; motor vehi cle use patterns; and tobacco, alcohol, and illicit sub stance use, are seen far more consistently by primary care providers than by mental health specialists. Yet models of behavior modification are reported, debated, and revised almost exclusively in the psychology literature. While the Stages of Change Model, or Transtheo retical Model, has won application in a broadening array of clinical settings, its application in the primary care setting is apparently quite limited despite evidence of its utility [Prochaska J, Velicer W. Am J Health Promot 1997;12:38-48]. The lack of a rigorous behavioral model developed for application in the primary care setting is an impediment to the accomplishment of public health goals specified in the Healthy People objectives and in the reports of the U.S. Preventive Services Task Force. The Pressure System Model reported here synthesizes elements of established behavior modification theories for specific application under the constraints of the primary care setting. Use of the model in both clinical and research settings, with outcome evaluation, is encouraged as part of an effort to advance public health.

  18. A Quantitative Software Risk Assessment Model

    NASA Technical Reports Server (NTRS)

    Lee, Alice

    2002-01-01

    This slide presentation reviews a risk assessment model as applied to software development. the presentation uses graphs to demonstrate basic concepts of software reliability. It also discusses the application to the risk model to the software development life cycle.

  19. Pressure Sensitive Paint Applied to Flexible Models Project

    NASA Technical Reports Server (NTRS)

    Schairer, Edward T.; Kushner, Laura Kathryn

    2014-01-01

    One gap in current pressure-measurement technology is a high-spatial-resolution method for accurately measuring pressures on spatially and temporally varying wind-tunnel models such as Inflatable Aerodynamic Decelerators (IADs), parachutes, and sails. Conventional pressure taps only provide sparse measurements at discrete points and are difficult to integrate with the model structure without altering structural properties. Pressure Sensitive Paint (PSP) provides pressure measurements with high spatial resolution, but its use has been limited to rigid or semi-rigid models. Extending the use of PSP from rigid surfaces to flexible surfaces would allow direct, high-spatial-resolution measurements of the unsteady surface pressure distribution. Once developed, this new capability will be combined with existing stereo photogrammetry methods to simultaneously measure the shape of a dynamically deforming model in a wind tunnel. Presented here are the results and methodology for using PSP on flexible surfaces.

  20. REPEATED MEASUREMENTS OF BLOOD PRESSURE AND CHOLESTEROL IMPROVES CARDIOVASCULAR DISEASE RISK PREDICTION: AN INDIVIDUAL-PARTICIPANT-DATA META-ANALYSIS.

    PubMed

    Paige, Ellie; Barrett, Jessica; Pennells, Lisa; Sweeting, Michael; Willeit, Peter; Di Angelantonio, Emanuele; Gudnason, Vilmundur; Nordestgaard, Børge G; Psaty, Bruce M; Goldbourt, Uri; Best, Lyle G; Assmann, Gerd; Salonen, Jukka T; Nietert, Paul J; Verschuren, Wm Monique; Brunner, Eric J; Kronmal, Richard A; Salomaa, Veikko; Bakker, Stephan Jl; Dagenais, Gilles R; Sato, Shinichi; Jansson, Jan-Håkan; Willeit, Johann; Onat, Altan; de la Cámara, Agustin Gómez; Roussel, Ronan; Völzke, Henry; Dankner, Rachel; Tipping, Robert W; Meade, Tom W; Donfrancesco, Chiara; Kuller, Lewis H; Peters, Annette; Gallacher, John; Kromhout, Daan; Iso, Hiroyasu; Knuiman, Matthew; Casiglia, Edoardo; Kavousi, Maryam; Palmieri, Luigi; Sundström, Johan; Davis, Barry R; Njølstad, Inger; Couper, David; Danesh, John; Thompson, Simon G; Wood, Angela

    2017-05-26

    The added value of incorporating information from repeated measurements of blood pressure and cholesterol for cardiovascular disease (CVD) risk prediction has not been rigorously assessed. We used data from the Emerging Risk Factors Collaboration on 191,445 adults (38 cohorts from across 17 countries with data from 1962-2014) with > 1 million measurements of systolic blood pressure, total cholesterol and high-density lipoprotein cholesterol; over a median 12 years of follow-up, 21,170 CVD events occurred. Risk prediction models using cumulative means of repeated measurements and summary measures from longitudinal modelling of the repeated measurements were compared to models using measurements from a single time point. Risk discrimination (C-index) and net reclassification were calculated, and changes in C-indices were meta-analysed across studies. Compared to the single time point model, the cumulative means and the longitudinal models increased the C-index by 0.0040 (95% CI: 0.0023, 0.0057) and 0.0023 (0.0005, 0.0042), respectively. Reclassification was also improved in both models; compared to the single time point model, overall net reclassification improvements were 0.0369 (0.0303, 0.0436) for the cumulative means model and 0.0177 (0.0110, 0.0243) for the longitudinal model. In conclusion, incorporating repeated measurements of blood pressure and cholesterol into CVD risk prediction models slightly improves risk prediction. © The Author 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.

  1. Pressure in an exactly solvable model of active fluid

    NASA Astrophysics Data System (ADS)

    Marini Bettolo Marconi, Umberto; Maggi, Claudio; Paoluzzi, Matteo

    2017-07-01

    We consider the pressure in the steady-state regime of three stochastic models characterized by self-propulsion and persistent motion and widely employed to describe the behavior of active particles, namely, the Active Brownian particle (ABP) model, the Gaussian colored noise (GCN) model, and the unified colored noise approximation (UCNA) model. Whereas in the limit of short but finite persistence time, the pressure in the UCNA model can be obtained by different methods which have an analog in equilibrium systems, in the remaining two models only the virial route is, in general, possible. According to this method, notwithstanding each model obeys its own specific microscopic law of evolution, the pressure displays a certain universal behavior. For generic interparticle and confining potentials, we derive a formula which establishes a correspondence between the GCN and the UCNA pressures. In order to provide explicit formulas and examples, we specialize the discussion to the case of an assembly of elastic dumbbells confined to a parabolic well. By employing the UCNA we find that, for this model, the pressure determined by the thermodynamic method coincides with the pressures obtained by the virial and mechanical methods. The three methods when applied to the GCN give a pressure identical to that obtained via the UCNA. Finally, we find that the ABP virial pressure exactly agrees with the UCNA and GCN results.

  2. NGNP Risk Management Database: A Model for Managing Risk

    SciTech Connect

    John Collins; John M. Beck

    2011-11-01

    The Next Generation Nuclear Plant (NGNP) Risk Management System (RMS) is a database used to maintain the project risk register. The RMS also maps risk reduction activities to specific identified risks. Further functionality of the RMS includes mapping reactor suppliers Design Data Needs (DDNs) to risk reduction tasks and mapping Phenomena Identification Ranking Table (PIRTs) to associated risks. This document outlines the basic instructions on how to use the RMS. This document constitutes Revision 1 of the NGNP Risk Management Database: A Model for Managing Risk. It incorporates the latest enhancements to the RMS. The enhancements include six new custom views of risk data - Impact/Consequence, Tasks by Project Phase, Tasks by Status, Tasks by Project Phase/Status, Tasks by Impact/WBS, and Tasks by Phase/Impact/WBS.

  3. A Prediction Model of the Capillary Pressure J-Function

    PubMed Central

    Xu, W. S.; Luo, P. Y.; Sun, L.; Lin, N.

    2016-01-01

    The capillary pressure J-function is a dimensionless measure of the capillary pressure of a fluid in a porous medium. The function was derived based on a capillary bundle model. However, the dependence of the J-function on the saturation Sw is not well understood. A prediction model for it is presented based on capillary pressure model, and the J-function prediction model is a power function instead of an exponential or polynomial function. Relative permeability is calculated with the J-function prediction model, resulting in an easier calculation and results that are more representative. PMID:27603701

  4. Drivers of extinction risk in African mammals: the interplay of distribution state, human pressure, conservation response and species biology.

    PubMed

    Di Marco, Moreno; Buchanan, Graeme M; Szantoi, Zoltan; Holmgren, Milena; Grottolo Marasini, Gabriele; Gross, Dorit; Tranquilli, Sandra; Boitani, Luigi; Rondinini, Carlo

    2014-01-01

    Although conservation intervention has reversed the decline of some species, our success is outweighed by a much larger number of species moving towards extinction. Extinction risk modelling can identify correlates of risk and species not yet recognized to be threatened. Here, we use machine learning models to identify correlates of extinction risk in African terrestrial mammals using a set of variables belonging to four classes: species distribution state, human pressures, conservation response and species biology. We derived information on distribution state and human pressure from satellite-borne imagery. Variables in all four classes were identified as important predictors of extinction risk, and interactions were observed among variables in different classes (e.g. level of protection, human threats, species distribution ranges). Species biology had a key role in mediating the effect of external variables. The model was 90% accurate in classifying extinction risk status of species, but in a few cases the observed and modelled extinction risk mismatched. Species in this condition might suffer from an incorrect classification of extinction risk (hence require reassessment). An increased availability of satellite imagery combined with improved resolution and classification accuracy of the resulting maps will play a progressively greater role in conservation monitoring.

  5. Drivers of extinction risk in African mammals: the interplay of distribution state, human pressure, conservation response and species biology

    PubMed Central

    Di Marco, Moreno; Buchanan, Graeme M.; Szantoi, Zoltan; Holmgren, Milena; Grottolo Marasini, Gabriele; Gross, Dorit; Tranquilli, Sandra; Boitani, Luigi; Rondinini, Carlo

    2014-01-01

    Although conservation intervention has reversed the decline of some species, our success is outweighed by a much larger number of species moving towards extinction. Extinction risk modelling can identify correlates of risk and species not yet recognized to be threatened. Here, we use machine learning models to identify correlates of extinction risk in African terrestrial mammals using a set of variables belonging to four classes: species distribution state, human pressures, conservation response and species biology. We derived information on distribution state and human pressure from satellite-borne imagery. Variables in all four classes were identified as important predictors of extinction risk, and interactions were observed among variables in different classes (e.g. level of protection, human threats, species distribution ranges). Species biology had a key role in mediating the effect of external variables. The model was 90% accurate in classifying extinction risk status of species, but in a few cases the observed and modelled extinction risk mismatched. Species in this condition might suffer from an incorrect classification of extinction risk (hence require reassessment). An increased availability of satellite imagery combined with improved resolution and classification accuracy of the resulting maps will play a progressively greater role in conservation monitoring. PMID:24733953

  6. Predictive Validity of Pressure Ulcer Risk Assessment Tools for Elderly: A Meta-Analysis.

    PubMed

    Park, Seong-Hi; Lee, Young-Shin; Kwon, Young-Mi

    2016-04-01

    Preventing pressure ulcers is one of the most challenging goals existing for today's health care provider. Currently used tools which assess risk of pressure ulcer development rarely evaluate the accuracy of predictability, especially in older adults. The current study aimed at providing a systemic review and meta-analysis of 29 studies using three pressure ulcer risk assessment tools: Braden, Norton, and Waterlow Scales. Overall predictive validities of pressure ulcer risks in the pooled sensitivity and specificity indicated a similar range with a moderate accuracy level in all three scales, while heterogeneity showed more than 80% variability among studies. The studies applying the Braden Scale used five different cut-off points representing the primary cause of heterogeneity. Results indicate that commonly used screening tools for pressure ulcer risk have limitations regarding validity and accuracy for use with older adults due to heterogeneity among studies. © The Author(s) 2015.

  7. Casting Stainless-Steel Models Around Pressure Tubes

    NASA Technical Reports Server (NTRS)

    Vasquez, Peter; Micol, John R.

    1992-01-01

    Survivability of thin-wall stainless-steel tubing increased to nearly 100 percent. Improves state of art in pressure-model castings and reduces cost associated with machining complete model from stainless-steel blank.

  8. Casting Stainless-Steel Models Around Pressure Tubes

    NASA Technical Reports Server (NTRS)

    Vasquez, Peter; Micol, John R.

    1992-01-01

    Survivability of thin-wall stainless-steel tubing increased to nearly 100 percent. Improves state of art in pressure-model castings and reduces cost associated with machining complete model from stainless-steel blank.

  9. Intraoperative testing of opening and closing pressure predicts risk of low intraocular pressure after Ahmed glaucoma valve implantation

    PubMed Central

    Bochmann, F; Kipfer, A; Tarantino, J; Kaufmann, C; Bachmann, L; Thiel, M

    2014-01-01

    Purpose The aim of this study was to assess whether intraoperative testing of silicone Ahmed glaucoma valves (AGVs) would identify valves with an increased risk of low postoperative intraocular pressure (IOP). Methods In 30 consecutive cases of glaucoma surgery with AGV implantation, after priming the AGV, we intraoperatively measured the opening pressure A, closing pressure B, and re-opening pressure C using the active infusion pump of a phako-machine. IOP was checked postoperatively on the same day. Low IOP was defined as <5 mm Hg. Intraoperatively measured pressure characteristics of the valve function were analysed for their ability to predict postoperative IOP outcomes. Results Opening A, closing B, and re-opening C pressures (mean, (SD)) were 18.4 (5.1), 8.3 (4.7), and 11.7 (4.8)mm Hg, respectively. Ten patients (33.3%) had low IOP. An opening pressure of ≤18 mm Hg predicted low postoperative IOP with a sensitivity (10/10) of 100% (95% CI, 69.2–100) and a specificity (13/20) of 65.0% (95% CI, 40.8–84.6). Conclusions AGVs have a high variability of opening, closing, and re-opening pressures. An opening pressure of ≤18 mm Hg, a closing pressure of ≤10 mm Hg, or a re-opening pressure of ≤11 mm Hg identified all patients with low postoperative IOP. PMID:25060848

  10. Blood Pressure Fluctuations Tied to Dementia Risk in Study

    MedlinePlus

    ... for dementia or Alzheimer's disease, new research from Japan suggests. People whose systolic blood pressure (the top ... School of Medical Sciences, Kyushu University, Fukuoka City, Japan; Costantino Iadecola, M.D., professor, neurology, director, Feil ...

  11. Thermodynamic models for bounding pressurant mass requirements of cryogenic tanks

    NASA Technical Reports Server (NTRS)

    Vandresar, Neil T.; Haberbusch, Mark S.

    1994-01-01

    Thermodynamic models have been formulated to predict lower and upper bounds for the mass of pressurant gas required to pressurize a cryogenic tank and then expel liquid from the tank. Limiting conditions are based on either thermal equilibrium or zero energy exchange between the pressurant gas and initial tank contents. The models are independent of gravity level and allow specification of autogenous or non-condensible pressurants. Partial liquid fill levels may be specified for initial and final conditions. Model predictions are shown to successfully bound results from limited normal-gravity tests with condensable and non-condensable pressurant gases. Representative maximum collapse factor maps are presented for liquid hydrogen to show the effects of initial and final fill level on the range of pressurant gas requirements. Maximum collapse factors occur for partial expulsions with large final liquid fill fractions.

  12. Predictive capacity of risk assessment scales and clinical judgment for pressure ulcers: a meta-analysis.

    PubMed

    García-Fernández, Francisco Pedro; Pancorbo-Hidalgo, Pedro L; Agreda, J Javier Soldevilla

    2014-01-01

    A systematic review with meta-analysis was completed to determine the capacity of risk assessment scales and nurses' clinical judgment to predict pressure ulcer (PU) development. Electronic databases were searched for prospective studies on the validity and predictive capacity of PUs risk assessment scales published between 1962 and 2010 in English, Spanish, Portuguese, Korean, German, and Greek. We excluded gray literature sources, integrative review articles, and retrospective or cross-sectional studies. The methodological quality of the studies was assessed according to the guidelines of the Critical Appraisal Skills Program. Predictive capacity was measured as relative risk (RR) with 95% confidence intervals. When 2 or more valid original studies were found, a meta-analysis was conducted using a random-effect model and sensitivity analysis. We identified 57 studies, including 31 that included a validation study. We also retrieved 4 studies that tested clinical judgment as a risk prediction factor. Meta-analysis produced the following pooled predictive capacity indicators: Braden (RR = 4.26); Norton (RR = 3.69); Waterlow (RR = 2.66); Cubbin-Jackson (RR = 8.63); EMINA (RR = 6.17); Pressure Sore Predictor Scale (RR = 21.4); and clinical judgment (RR = 1.89). Pooled analysis of 11 studies found adequate risk prediction capacity in various clinical settings; the Braden, Norton, EMINA (mEntal state, Mobility, Incontinence, Nutrition, Activity), Waterlow, and Cubbin-Jackson scales showed the highest predictive capacity. The clinical judgment of nurses was found to achieve inadequate predictive capacity when used alone, and should be used in combination with a validated scale.

  13. Incidence and risk factors for pressure ulcers in the intensive care unit.

    PubMed

    Nijs, Nele; Toppets, Adinda; Defloor, Tom; Bernaerts, Kris; Milisen, Koen; Van Den Berghe, Greet

    2009-05-01

    To determine the incidence of pressure ulcers occurring at least 48 hours after admission and risk factors for pressure ulcers grade 2-4 in a long-stay surgical Intensive Care Unit (ICU) population. The incidence of pressure ulcers in intensive care units is larger than in non-intensive environments. Prospective descriptive research design. Using pressure ulcers grade 2-4 as an outcome measure, a multivariate logistic regression analysis was used to identify the risk factors. Data were obtained on a daily basis in a surgical intensive care unit of the University Hospital Leuven between November 2003-March 2004. A total of 520 long-stay (>or= 24 hours) intensive care patients were included. Cumulative incidence of pressure ulcers grade 2-4 was 20.1%. The following variables were positively associated with pressure ulcers grade 2-4: history of vascular disease, treatment with Dopamine or Dobutamine, intermittent haemodialysis (IHD) or continuous veno-venous haemofiltration (CVVH), mechanical ventilation. Also preventive measures were statistically positively associated with pressure ulcers grade 2-4: turning, floating heels, alternating mattresses, adequate prevention. The use of sedatives, body temperature above 38.5 degrees C and sitting in chair where negatively associated with pressure ulcers. Pressure ulcers are statistically associated with different risk factors and preventive measures. The identified risk factors are eligible to be included in a new risk assessment scale for patients admitted to intensive care units. The novel insights have implications for risk assessment for patients in intensive care units. Patients admitted to intensive care units have other risk factors for pressure ulcers which are eligible to be included in a new risk assessment scale.

  14. Mechanical Modeling of a WIPP Drum Under Pressure

    SciTech Connect

    Smith, Jeffrey A.

    2014-11-25

    Mechanical modeling was undertaken to support the Waste Isolation Pilot Plant (WIPP) technical assessment team (TAT) investigating the February 14th 2014 event where there was a radiological release at the WIPP. The initial goal of the modeling was to examine if a mechanical model could inform the team about the event. The intention was to have a model that could test scenarios with respect to the rate of pressurization. It was expected that the deformation and failure (inability of the drum to contain any pressure) would vary according to the pressurization rate. As the work progressed there was also interest in using the mechanical analysis of the drum to investigate what would happen if a drum pressurized when it was located under a standard waste package. Specifically, would the deformation be detectable from camera views within the room. A finite element model of a WIPP 55-gallon drum was developed that used all hex elements. Analyses were conducted using the explicit transient dynamics module of Sierra/SM to explore potential pressurization scenarios of the drum. Theses analysis show similar deformation patterns to documented pressurization tests of drums in the literature. The calculated failure pressures from previous tests documented in the literature vary from as little as 16 psi to 320 psi. In addition, previous testing documented in the literature shows drums bulging but not failing at pressures ranging from 69 to 138 psi. The analyses performed for this study found the drums failing at pressures ranging from 35 psi to 75 psi. When the drums are pressurized quickly (in 0.01 seconds) there is significant deformation to the lid. At lower pressurization rates the deformation of the lid is considerably less, yet the lids will still open from the pressure. The analyses demonstrate the influence of pressurization rate on deformation and opening pressure of the drums. Analyses conducted with a substantial mass on top of the closed drum demonstrate that the

  15. High pressure common rail injection system modeling and control.

    PubMed

    Wang, H P; Zheng, D; Tian, Y

    2016-07-01

    In this paper modeling and common-rail pressure control of high pressure common rail injection system (HPCRIS) is presented. The proposed mathematical model of high pressure common rail injection system which contains three sub-systems: high pressure pump sub-model, common rail sub-model and injector sub-model is a relative complicated nonlinear system. The mathematical model is validated by the software Matlab and a virtual detailed simulation environment. For the considered HPCRIS, an effective model free controller which is called Extended State Observer - based intelligent Proportional Integral (ESO-based iPI) controller is designed. And this proposed method is composed mainly of the referred ESO observer, and a time delay estimation based iPI controller. Finally, to demonstrate the performances of the proposed controller, the proposed ESO-based iPI controller is compared with a conventional PID controller and ADRC.

  16. Relationship between blood lead levels and blood pressure and its cardiovascular risk implications

    SciTech Connect

    Pirkle, J.L.; Schwartz, J.; Landis, J.R.; Harlan, W.R.

    1985-02-01

    The relationship between blood pressure and blood lead levels in the second National Health and Nutrition Examination Survey (1976-1980) has been examined for white males aged 40-59 years. After adjustment for age, body mass index, nutritional factors, and blood biochemistries in a multiple linear regression model, the relationship of systolic and diastolic blood pressures to blood lead levels was statistically significant (p < 0.01). There was no evidence of a threshold blood lead level for this relationship. Although these data alone do not prove a causal relationship between low blood lead levels and blood pressure, the findings are consistent with current epidemiologic and animal studies, indicating that a causal reationship is probable. To examine the potential health risks, the multiple logistic risk factor coefficients from the Pooling Project and Framingham studies were used to predict the impact of the 37% decrease in mean blood lead levels which occurred in adult white males from 1976 to 1980. As a result of this blood lead decrease, the calculations predicted a 4.7% decrease in the incidence of fatal and nonfatal myocardial infarction over 10 years, a 6.7% decrease in the incidence of fatal and nonfatal strokes over 10 years, and a 5.5% decrease in the incidence of death from all causes over 11.5 years. In addition, as a result of this blood lead decrease, the predicted number of white males in this age group with hypertension (diastolic blood pressure greater than or equal to 90 mmHg) decreased by 17.5%.

  17. Reswick and Rogers pressure-time curve for pressure ulcer risk. Part 2.

    PubMed

    Gefen, A

    In part one of this article, the concepts of an injury threshold were explained and it was shown that the Reswick and Rogers pressure-time curve is inaccurate at the extremes of the timescale. It was also shown that their curve cannot be used for studying deep tissue injuries, and that it is likely to be irrelevant for studying most pressure ulcers. The second part of this article describes recent research work focusing on tissue injury thresholds as related to pressure ulcers, with particular emphasis on thresholds that are specific for deep tissue injuries. Clinical implications are also discussed, with particular reference to patients who are obese and those with muscle atrophy.

  18. Common carotid intima-media thickness measurements do not improve cardiovascular risk prediction in individuals with elevated blood pressure: the USE-IMT collaboration.

    PubMed

    Bots, Michiel L; Groenewegen, Karlijn A; Anderson, Todd J; Britton, Annie R; Dekker, Jacqueline M; Engström, Gunnar; Evans, Greg W; de Graaf, Jacqueline; Grobbee, Diederick E; Hedblad, Bo; Hofman, Albert; Holewijn, Suzanne; Ikeda, Ai; Kavousi, Maryam; Kitagawa, Kazuo; Kitamura, Akihiko; Ikram, M Arfan; Lonn, Eva M; Lorenz, Matthias W; Mathiesen, Ellisiv B; Nijpels, Giel; Okazaki, Shuhei; O'Leary, Daniel H; Polak, Joseph F; Price, Jacqueline F; Robertson, Christine; Rembold, Christopher M; Rosvall, Maria; Rundek, Tatjana; Salonen, Jukka T; Sitzer, Matthias; Stehouwer, Coen D A; Franco, Oscar H; Peters, Sanne A E; den Ruijter, Hester M

    2014-06-01

    Carotid intima-media thickness (CIMT) is a marker of cardiovascular risk. It is unclear whether measurement of mean common CIMT improves 10-year risk prediction of first-time myocardial infarction or stroke in individuals with elevated blood pressure. We performed an analysis among individuals with elevated blood pressure (i.e., a systolic blood pressure ≥140 mm Hg and a diastolic blood pressure ≥ 90 mm Hg) in USE-IMT, a large ongoing individual participant data meta-analysis. We refitted the risk factors of the Framingham Risk Score on asymptomatic individuals (baseline model) and expanded this model with mean common CIMT (CIMT model) measurements. From both models, 10-year risks to develop a myocardial infarction or stroke were estimated. In individuals with elevated blood pressure, we compared discrimination and calibration of the 2 models and calculated the net reclassification improvement (NRI). We included 17 254 individuals with elevated blood pressure from 16 studies. During a median follow-up of 9.9 years, 2014 first-time myocardial infarctions or strokes occurred. The C-statistics of the baseline and CIMT models were similar (0.73). NRI with the addition of mean common CIMT was small and not significant (1.4%; 95% confidence intervals, -1.1 to 3.7). In those at intermediate risk (n=5008, 10-year absolute risk of 10% to 20%), the NRI was 5.6% (95% confidence intervals, 1.6-10.4). There is no added value of measurement of mean common CIMT in individuals with elevated blood pressure for improving cardiovascular risk prediction. For those at intermediate risk, the addition of mean common CIMT to an existing cardiovascular risk score is small but statistically significant.

  19. A model of psychosocial and cultural antecedents of blood pressure control.

    PubMed Central

    Bosworth, Hayden B.; Oddone, Eugene Z.

    2002-01-01

    Hypertension is a major modifiable risk factor for stroke, congestive heart failure, and end-stage renal disease. Hypertension is particularly prevalent and deadly among African Americans. Effective treatment for hypertension has been available for decades, yet only one fourth of all individuals have their blood pressure under control. Despite the potential impact of hypertension, interventions to improve control have had limited success. We present a model of how to understand antecedents of blood pressure control according to three interrelated categories: patient characteristics, social and cultural environment, and medical environment. This theoretical paper was conducted using a literature review and a model to explain psychosocial antecedents of blood pressure control is presented. We conclude that improved understanding of important antecedents of blood pressure control coupled with technological advances, such as tailored interventions, provide clinicians with a tool that may lead to improved blood pressure control. These interventions will require the involvement of clinicians and consideration of sociocultural factors to be successful. PMID:11991336

  20. Foot Modeling and Smart Plantar Pressure Reconstruction from Three Sensors

    PubMed Central

    Ghaida, Hussein Abou; Mottet, Serge; Goujon, Jean-Marc

    2014-01-01

    In order to monitor pressure under feet, this study presents a biomechanical model of the human foot. The main elements of the foot that induce the plantar pressure distribution are described. Then the link between the forces applied at the ankle and the distribution of the plantar pressure is established. Assumptions are made by defining the concepts of a 3D internal foot shape, which can be extracted from the plantar pressure measurements, and a uniform elastic medium, which describes the soft tissues behaviour. In a second part, we show that just 3 discrete pressure sensors per foot are enough to generate real time plantar pressure cartographies in the standing position or during walking. Finally, the generated cartographies are compared with pressure cartographies issued from the F-SCAN system. The results show 0.01 daN (2% of full scale) average error, in the standing position. PMID:25400713

  1. High blood pressure and related factors among individuals at high risk of HIV/sexually transmitted infections

    PubMed Central

    Nam, Soohyun; Whittemore, Robin; Jeon, Sangchoon; Davey-Rothwell, Melissa A.; Latkin, Carl

    2015-01-01

    Data from a social network-based HIV/STI prevention study with a total of 330 men and women at high risk of HIV/STIs were used to examine the relationships of substance use, depressive symptoms, general health, cardiovascular disease risk factors, sociodemographic characteristics, and systolic/diastolic blood pressure (SBP/DBP). Approximately 60% of the participants had prehypertension to stage 2 hypertension. In the base model, older subjects (p<.0001), men (p=.003), and with poorer self-reported health (p=.029) were significantly associated with high SBP, whereas older age (p<.001) and higher body mass index (p<.001) were significantly associated with higher DBP. After adjusting for the base model, high frequency of alcohol drinking and high frequency of binge drinking remained significant for high SBP and DBP. Our data suggest that future cardiovascular disease programs should target moderate alcohol consumption to improve blood pressure among individuals at high risk of HIV/STIs. PMID:26514661

  2. Modeling High Pressure Micro Hollow Cathode Discharges

    DTIC Science & Technology

    2007-11-02

    calculations in glow discharge in argon and neon . A Monte Carlo simulation of the ions and Grant 033083 – Final report 7 the fast neutrals generated...in high pressure xenon or in rare gas mixtures containing xenon are of interest in the context of UV and VUV generation. Numerical experiments on...The shape of the calculated characteristic is similar to those measured by Schoenbach et al1 in argon and by Moselhy and Schoenbach9 in xenon . There

  3. Multisite Web-based training in using the Braden Scale to predict pressure sore risk.

    PubMed

    Magnan, Morris A; Maklebust, JoAnn

    2008-03-01

    To evaluate the effect of a Web-based Braden Scale training module on nurses' knowledge of pressure-ulcer risk assessment and prevention. Pre-experimental, posttest-only design. Web-based learning environment. Registered nurses (N=1391) working at 3 medical centers in the Midwest. Primary outcomes of interest were reliability and competence associated with using the Braden Scale for pressure-ulcer risk assessment. Secondary outcomes of interest focused on program evaluation, specifically nurses' perceptions of program adequacy and ease of use. After training, nurses correctly rated Braden Scale level of risk 82.6% of the time. Numeric ratings for Braden subscales were generally more reliable when case-study data indicated extreme risk levels (generally not at-risk level, high-risk level, and very high level) than when data indicated midlevels of risk (mild-risk level and moderate-risk level). Nurses' knowledge of appropriate risk-based preventive interventions was high, but correlated poorly with the ability to correctly assign numeric ratings to Braden subscales. Web-based training alone may not ensure reliable, competent estimates of pressure-ulcer risk for patients at all risk levels. Other strategies, such as clinical practice with expert supervision, should be considered. Further research is needed to clarify the links between scoring Braden subscales correctly and selecting appropriate risk-based preventive interventions.

  4. Probabilistic Modeling of Intracranial Pressure Effects on Optic Nerve Biomechanics

    NASA Technical Reports Server (NTRS)

    Ethier, C. R.; Feola, Andrew J.; Raykin, Julia; Myers, Jerry G.; Nelson, Emily S.; Samuels, Brian C.

    2016-01-01

    Altered intracranial pressure (ICP) is involved/implicated in several ocular conditions: papilledema, glaucoma and Visual Impairment and Intracranial Pressure (VIIP) syndrome. The biomechanical effects of altered ICP on optic nerve head (ONH) tissues in these conditions are uncertain but likely important. We have quantified ICP-induced deformations of ONH tissues, using finite element (FE) and probabilistic modeling (Latin Hypercube Simulations (LHS)) to consider a range of tissue properties and relevant pressures.

  5. Kinetic modelling of pressure filtration of ceramic powder suspensions

    SciTech Connect

    Correia, L.A.; Salomoni, A.; Hey, A.W.

    1995-09-01

    A kinetic model developed for radial pressure filtration is described and used to study the casting behaviour of an Alumina (Al6SG) and a Zirconia (TZ3Ys) slip stabilized with Dolapix CE64. For the Zirconia slip no influence of pressure and curvature is found. The casting behaviour of the Alumina slip seems to be influenced by both the pressure and the curvature of the filtrating surface.

  6. The evaluation of daily living activities, pressure sores and risk factors.

    PubMed

    Aydın, Gökçen; Mucuk, Salime

    2015-01-01

    This study was conducted to assess daily living activities, pressure sores and risk factors. This was a descriptive study. The study was conducted at a rehabilitation center with 188 individuals participating in the study. Data were collected with a questionnaire form, Activities of Daily Living Scale (ADLS), Instrumental Activities of Daily Living Scale (IADLS) and Braden Risk Assessment Scale (BRAS). Among the participants, 48.9% were dependent according to activities of daily living and 71.8% were dependent on instrumental activities of daily living. It was noted that 4.8% had pressure sores and 38.8% were at high risk. A strong and positive correlation was found among ADLS, IADLS, and BRAS scores (p < .001). Participants who had a low body mass index, had lived at the rehabilitation center for a long time, and were fed on regime 1 or 2, had a higher risk of developing pressure sores (p < .001). Individuals who were dependent according to ADLS and IADLS were at increased risk for the development of pressure sores. Individuals who are treated at rehabilitation centers should be periodically assessed in terms of risk. Pressure sore development can be prevented with appropriate nursing interventions. To reduce the risk of developing pressure sores, nurses should describe the individual's degree of dependency according to ADLS and IADLS and initiate preventive nursing care. © 2014 Association of Rehabilitation Nurses.

  7. High-normal blood pressure and the risk of cardiovascular disease.

    PubMed

    Kokubo, Yoshihiro; Kamide, Kei

    2009-08-01

    The guidelines of the Joint National Committee 7 from the USA on hypertension have unified the normal and high-normal blood pressure categories into a single entity termed ;prehypertension'. In contrast, The European Guidelines for the management of hypertension in 2007 considered ;prehypertensive' to be divided into normal and high-normal blood pressure. These patients with high-normal blood pressure or prehypertension might progress to hypertension over time. Previous studies have shown that high-normal blood pressure is a risk factor for cardiovascular disease (CVD) in Western countries and Japan. The combination of high-normal blood pressure and other cardiovascular risk factors increases the risks of CVD. Recently, metabolic syndrome has also been shown to be a risk factor for CVD. In Japan, the association between metabolic syndrome and CVD was also found to be significant. The risks for CVD incidence were similar among participants who had the same number of components, regardless of the presence of abdominal obesity. In the Japanese guidelines for the management of hypertension published in 2009, patients are considered to be in a high-risk group if they have diabetes, chronic kidney disease, 3 or more risk factors, target organ damage or CVD, even if they have only high-normal blood pressure, and appropriate antihypertensive therapy should be initiated.

  8. Is atmospheric pressure change an Independent risk factor for hemoptysis?

    PubMed

    Araz, Omer; Ucar, Elif Yilmazel; Akgun, Metin; Aydin, Yener; Meral, Mehmet; Saglam, Leyla; Kaynar, Hasan; Gorguner, Ali Metin

    2014-05-01

    Hemoptysis is one of the most important and challenging symptoms in pulmonary medicine. Because of the increased number of patients with hemoptysis in certain periods of the year, we aimed to investigate whether atmospheric changes have an effect on the development of hemoptysis with or without a secondary cause. The data of patients presenting with hemoptysis between January 2006 and December 2011 were analyzed. Data on the daily atmospheric pressure (hectopascal, hPa), relative humidity (%), and temperature ((o) C) during that time were obtained. A total of 232 patients with hemoptysis, 145 male (62.5%) and 87 female (37.5%) with an average age of 48.1(±17.6), were admitted to our hospital between 2006 and 2011. The highest admission rates were in the spring season, the highest in May (n=37, 15.9%), and the lowest admission rates were in December (n=10, 4.3%). A statistically significant negative correlation was found between the number of hemoptysis cases and mean atmospheric pressure but no relative humidity or outdoor temperature. Hemoptysis is very much influenced by weather factors; in particular, low atmospheric pressures significantly affect the development of hemoptysis. Fluctuations in atmospheric pressure may also play a role in hemoptysis.

  9. Risks assessment of water pollution by pesticides at local scale (PESTEAUX project): study of polluting pressure.

    PubMed

    Noel, Stéphanie; Billo Bah, Boubacar

    2009-01-01

    Pollution of water resources (surface waters and ground waters) by pesticide uses is one of the key point of the European policy with the implementation of the Water Frame Work Directive (2000/60/EC) and the thematic Strategy on the Sustainable use of pesticides. According to this legislation, the Member States must initiate measures to limit environmental and toxicological effects caused by pesticide uses. The Agricultural Research Centre of Wallonia (CRA-W) emphasized the need of a tool for spatial risk analysis and develOPs it within the framework of PESTEAUX project. The originality of the approach proposed by the CRA-W is to generate maps to identify the risk of pollution at locale scale (agricultural parcel). The risk will be assessed according to the study of different factors, grouped under 3 data's layers: polluting pressure, vulnerability of the physical environment (soil) and meteorological data. This approach is directly based on the risk's definition which takes into account the polluting pressure, linked to the human activities, and the vulnerability of the soil, defined by factors of physical environment which characterize the water flow in the parcel. Moreover, meteorological data influence the intensity and likelihood flow of water, and indirectly pesticide by leaching or runoff. The PESTEAUX's approach to study the pollution is based on the model "source-vector-target". The source is the polluting pressure, in other words, the pesticides which could reach the targets. The main vector is the water which vehicles the pesticide on and trough the soil until the target which are the surface waters or ground waters. In this paper we introduce the factors contributing to the polluting pressure. These factors are linking to the human activities and more precisely, to the pesticide uses. The factors considered have an influence on pesticide's transport by water (in its solid state or in dissolved state by leaching, run-off, or erosion) but also on a set of

  10. Blood Pressure, Carotid Flow Pulsatility, and the Risk of Stroke: A Community-Based Study.

    PubMed

    Chuang, Shao-Yuan; Cheng, Hao-Min; Bai, Chyi-Huey; Yeh, Wen-Ting; Chen, Jiunn-Rong; Pan, Wen-Harn

    2016-09-01

    High blood pressure is a major cause of cardiovascular events, and carotid flow pulsatility may be associated with cardiovascular events. However, the combined effect of blood pressure and flow pulsatility on the development of stroke remains unclear. Therefore, we investigated the combined influence of central blood pressure and pulsatility index (PI) on the incidence of stroke. Baseline data from 2033 adults (≥30 years) without stroke history in the Cardiovascular Disease Risk Factor Two-Township Study were linked to incident stroke. Common carotid flow PI was calculated by peak systolic velocity, end-diastolic velocity, and mean vessel velocity, which were measured in the common carotid artery. Hazard ratios for the risk of total stroke resulting from high central systolic blood pressure (CSBP) and high PI were calculated with Cox proportional hazard models. Over a median follow-up of 9.81 years, 132 people incurred stroke events. The incidence rates of stroke were 1.3, 6.4, and 13.2 per 1000 person-years for tertile groups of CSBP (P for trend<0.05) and 4.3, 7.0, and 9.4 per 1000 person-years for tertile groups of PI (P for trend<0.05). Compared with the first tertile of CSBP, hazard ratios were 4.88 (95% confidence interval, 2.29-10.43) for the second tertile and 10.42 (5.05-21.53) for the third tertile. Hazard ratios of PI were 2.18 (1.39-3.42; third tertile) and 1.64 (1.02-2.63; second tertile) compared with the first tertile. The individuals with a high CSBP and high PI had a 13-fold higher stroke risk compared with those with low CSBP and low PI (13.2; 1.75-99.71) after adjusting for age, sex, and traditional cardiovascular risk. CSBP and common carotid PI jointly and independently predicted future stroke. Carotid flow pulsatility may play an important role in the development of stroke. © 2016 American Heart Association, Inc.

  11. Stroke Risk Can Rise with Pregnancy-Linked High Blood Pressure

    MedlinePlus

    ... history of high blood pressure puts women with preeclampsia in jeopardy, study says To use the sharing ... risk of pregnancy-related stroke in women with preeclampsia, a new study suggests. Preeclampsia is a condition ...

  12. Dairy consumption, systolic blood pressure, and risk of hypertension: Mendelian randomization study

    USDA-ARS?s Scientific Manuscript database

    Objective: To examine whether previous observed inverse associations of dairy intake with systolic blood pressure and risk of hypertension were causal. Design: Mendelian randomization study using the single nucleotide polymorphism rs4988235 related to lactase persistence as an instrumental variable...

  13. Day-to-Day Blood Pressure Variability and Risk of Dementia in a General Japanese Elderly Population: The Hisayama Study.

    PubMed

    Oishi, Emi; Ohara, Tomoyuki; Sakata, Satoko; Fukuhara, Masayo; Hata, Jun; Yoshida, Daigo; Shibata, Mao; Ohtsubo, Toshio; Kitazono, Takanari; Kiyohara, Yutaka; Ninomiya, Toshiharu

    2017-08-08

    Several observational studies have reported that higher visit-to-visit blood pressure variability is a risk factor for cognitive impairment and dementia. However, no studies have investigated the association of day-to-day blood pressure variability assessed by home blood pressure measurement with the development of dementia. A total of 1674 community-dwelling Japanese elderly without dementia, ≥60 years of age, were followed up for 5 years (2007-2012). Home blood pressure was measured 3 times every morning for a median of 28 days. Day-to-day systolic (SBP) and diastolic blood pressure variabilities, calculated as coefficients of variation (CoV) of home SBP and diastolic blood pressure, were categorized into quartiles. The hazard ratios and their 95% confidence intervals of the CoV levels of home blood pressure on the development of all-cause dementia, vascular dementia (VaD), and Alzheimer disease (AD) were computed with a Cox proportional hazards model. During the follow-up, 194 subjects developed all-cause dementia; of these, 47 had VaD and 134 had AD. The age- and sex-adjusted incidences of all-cause dementia, VaD, and AD increased significantly with increasing CoV levels of home SBP (all P for trend <0.05). These associations remained unchanged after adjustment for potential confounding factors, including home SBP. Compared with subjects in the first quartile of CoV levels of home SBP, the risks of the development of all-cause dementia, VaD, and AD were significantly higher in those in the fourth quartile (hazard ratio=2.27, 95% confidence interval=1.45-3.55, P<0.001 for all-cause dementia; hazard ratio=2.79, 95% confidence interval=1.04-7.51, P=0.03 for VaD; hazard ratio=2.22, 95% confidence interval=1.31-3.75, P<0.001 for AD). Similar associations were observed for CoV levels of home diastolic blood pressure. Meanwhile, home SBP levels were significantly associated with the risk of VaD but not with the risks of all-cause dementia and AD. There was no

  14. Personalized modeling for real-time pressure ulcer prevention in sitting posture.

    PubMed

    Luboz, Vincent; Bailet, Mathieu; Boichon Grivot, Christelle; Rochette, Michel; Diot, Bruno; Bucki, Marek; Payan, Yohan

    2017-06-15

    Ischial pressure ulcer is an important risk for every paraplegic person and a major public health issue. Pressure ulcers appear following excessive compression of buttock's soft tissues by bony structures, and particularly in ischial and sacral bones. Current prevention techniques are mainly based on daily skin inspection to spot red patches or injuries. Nevertheless, most pressure ulcers occur internally and are difficult to detect early. Estimating internal strains within soft tissues could help to evaluate the risk of pressure ulcer. A subject-specific biomechanical model could be used to assess internal strains from measured skin surface pressures. However, a realistic 3D non-linear Finite Element buttock model, with different layers of tissue materials for skin, fat and muscles, requires somewhere between minutes and hours to compute, therefore forbidding its use in a real-time daily prevention context. In this article, we propose to optimize these computations by using a reduced order modeling technique (ROM) based on proper orthogonal decompositions of the pressure and strain fields coupled with a machine learning method. ROM allows strains to be evaluated inside the model interactively (i.e. in less than a second) for any pressure field measured below the buttocks. In our case, with only 19 modes of variation of pressure patterns, an error divergence of one percent is observed compared to the full scale simulation for evaluating the strain field. This reduced model could therefore be the first step towards interactive pressure ulcer prevention in a daily set-up. Copyright © 2017 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  15. Blood pressure level impacts risk of death among HIV seropositive adults in Kenya: a retrospective analysis of electronic health records.

    PubMed

    Bloomfield, Gerald S; Hogan, Joseph W; Keter, Alfred; Holland, Thomas L; Sang, Edwin; Kimaiyo, Sylvester; Velazquez, Eric J

    2014-05-22

    Mortality among people with human immunodeficiency virus (HIV) infection is increasingly due to non-communicable causes. This has been observed mostly in developed countries and the routine care of HIV infected individuals has now expanded to include attention to cardiovascular risk factors. Cardiovascular risk factors such as high blood pressure are often overlooked among HIV seropositive (+) individuals in sub-Saharan Africa. We aimed to determine the effect of blood pressure on mortality among HIV+ adults in Kenya. We performed a retrospective analysis of electronic medical records of a large HIV treatment program in western Kenya between 2005 and 2010. All included individuals were HIV+. We excluded participants with AIDS, who were <16 or >80 years old, or had data out of acceptable ranges. Missing data for key covariates was addressed by inverse probability weighting. Primary outcome measures were crude mortality rate and mortality hazard ratio (HR) using Cox proportional hazards models adjusted for potential confounders including HIV stage. There were 49,475 (74% women) HIV+ individuals who met inclusion and exclusion criteria. Mortality rates for men and women were 3.8 and 1.8/100 person-years, respectively, and highest among those with the lowest blood pressures. Low blood pressure was associated with the highest mortality incidence rate (IR) (systolic <100 mmHg IR 5.2 [4.8-5.7]; diastolic <60 mmHg IR 9.2 [8.3-10.2]). Mortality rate among men with high systolic blood pressure without advanced HIV (3.0, 95% CI: 1.6-5.5) was higher than men with normal systolic blood pressure (1.1, 95% CI: 0.7-1.7). In weighted proportional hazards regression models, men without advanced HIV disease and systolic blood pressure ≥140 mmHg carried a higher mortality risk than normotensive men (HR: 2.39, 95% CI: 0.94-6.08). Although there has been little attention paid to high blood pressure among HIV+ Africans, we show that blood pressure level among HIV+ patients in Kenya

  16. Risk evaluation on the basis of pressure rate measured by automatic pressure tracking adiabatic calorimeter.

    PubMed

    Iwata, Yusaku; Koseki, Hiroshi

    2008-11-15

    An automatic pressure tracking adiabatic calorimeter (APTAC) had been employed to obtain the thermokinetic and the vapor pressure data during runaway reactions. The APTAC is an adiabatic calorimeter with a large-scale sample mass and low thermal inertia, and is an extremely useful tool for assessing thermal hazards of reactive chemicals. The data obtained by the APTAC are important information for the design of the safe industrial process. The thermodynamics parameters and the gas production were discussed on the basis of the experimental data of various concentrations and weights of di-tert-butyl peroxide (DTBP)/toluene solution for the purpose of investigating the properties of the APTAC data. The thermal decomposition of DTBP was studied on the basis of the temperature data and the pressure data obtained by the APTAC. The activation energy and the frequency factor of DTBP are nearly constant and the same as the literature values in the concentrations between 20 and 60 wt.%. The pressure rise due to gas production is important data for designing the relief vent of a reactor. The time history of the gas production was investigated with various weights and concentrations. The total gas production index, which had the vapor pressure correction, was 1.0 in the decomposition of DTBP.

  17. Effect of model design, cushion construction, and interface pressure mats on interface pressure and immersion.

    PubMed

    Pipkin, Leigh; Sprigle, Stephen

    2008-01-01

    Measuring interface pressure (IP) is one way to characterize cushion performance in the clinic and laboratory. This study explored how the presence of four commercially available IP mats affected IP on and immersion of two buttocks models. We loaded seven cushions with each buttocks model and captured pressure data using FSA sensors (Vista Medical Ltd; Winnipeg, Manitoba, Canada). Analysis was performed to compare pressure magnitude and immersion. Overall, both pressure magnitude and immersion changed after mat introduction. A significant interaction existed between cushion and mat condition and cushion and model for all variables. Introducing an IP mat to the model-cushion interface alters the loading on the cushion. The mats bridged the contours of the model, causing a change in IP at the locations studied. Although immersion was statistically different between mat conditions, the magnitude of the difference was less than 1 mm once we accounted for the thickness of the mats. The significance of the cushion-mat interaction indicates that the mat effect differed across cushion design. Clinical and research users of pressure mats should consider the effect of mat presence, the effect of model design, and mat and buttocks interactions with cushions for successful use.

  18. Empirical Model of the Pressure in the Earth's Ring Current

    NASA Astrophysics Data System (ADS)

    Sotirelis, T.; Gkioulidou, M.; Ukhorskiy, A. Y.; MacDonald, E.

    2014-12-01

    Plasma in the inner magnetosphere produces the Earth's ring current through its pressure. Changes in the plasma pressure dramatically effects the ring current, and the magnetic field which guides particle motion. Here, the pressure in the inner magnetosphere is empirically modeled using Van Allen Probes observations by the RBSPICE and ECT-HOPE instruments. The radial and local-time dependence of both the parallel and perpendicular components of plasma pressure are assessed and the contributions of Helium and Oxygen are measured. Correlation studies are used to further understand the causal roles played by various drivers. Simultaneous observations from the two Van Allen Probes permit an understanding of global versus local variations.

  19. Motivating patients to exercise: translating high blood pressure into equivalent risk of inactivity.

    PubMed

    Li, Chu-Shiu; Liu, Chwen-Chi; Tsai, Min-Kuang; Tai, Ya-Ping; Wai, Jackson Pui Man; Tsao, Chwen-Keng; Wen, Chi-Pang

    2015-02-01

    Even with the 2008 physical activity guidelines for Americans and the strong epidemiological evidence, physicians are not routinely emphasizing the importance of exercise. We try to explore an innovative way to communicate the benefits of physical activity in a term familiar to patients. A cohort of 470, 163 adults from a medical screening program in Taiwan were recruited between 1994 and 2008. Their vital status was followed up by matching with the National Death File. Individuals were classified as 'inactive', 'low active', or 'fully active', with 'fully active' meeting the current exercise recommendation of 150  min per week or more. Cox proportional model was used to calculate the hazard ratio. More than one-half of the cohort was inactive (54%), with one-quarter fully active (24%). One in seven was hypertensive (14%), defined as SBP at least 140  mmHg. Among the hypertensive individuals, mortality risks were increased by 37% for the inactive. Inactive individuals had higher all-cause mortality than active ones across all blood pressure (BP) levels. At 110-119  mmHg, the inactive had a risk as high as the risk at 155  mmHg, an increased mortality risk equivalent to a risk of BP increase of 41.2 mmHg. The mortality risk of being inactive was equivalent to an increase of around 40  mmHg in SBP or 20  mmHg in DBP, a number relevant to hypertensive patients. Appreciating this relationship may convince the inactive to start exercising, a behavior as important as controlling BP.

  20. Pressure Ulcer Risk in the Incontinent Patient: Analysis of Incontinence and Hospital-Acquired Pressure Ulcers From the International Pressure Ulcer Prevalence™ Survey.

    PubMed

    Lachenbruch, Charlie; Ribble, David; Emmons, Kirsten; VanGilder, Catherine

    2016-01-01

    To measure the prevalence of incontinence in the 2013-2014 International Pressure Ulcer Prevalence (IPUP) surveys and determine the relative risk of developing a facility-acquired pressure ulcers (FAPUs) by stage and by Braden Scale score groupings. The IPUP survey is an observational, cross-sectional cohort database designed to determine the frequency and severity of pressure ulcers in various populations. The survey includes acute care (91.4%), long-term acute care (1.7%), rehabilitation patients (1.7%) and long-term care residents (5.2%). Geographic distribution included 182,832 patients in the United States, 22,282 patients in Canada, and the rest of the world, primarily in Europe and the Middle East. We analyzed data from the 2013 and 2014 IPUP surveys to better understand the relationship between incontinence and the frequency and severity of FAPUs. The IPUP survey is an annual voluntary survey of patients who are hospitalized or who reside in long-term care facilities. Data were collected over a 24-hour period within each participating facility. Data collection included limited demographics, presence and stage of pressure ulcers, and pressure ulcer risk assessment score (Braden Scale for Pressure Sore Risk, Braden Q, Norton, Waterlow, and others). In addition, data were collected on pertinent pressure ulcer risk factors including the number of linen layers, use of a pressure redistributing surface, adherence to repositioning schedule, and whether moisture management was provided in the last 24 hours. We aggregated data by urinary, urinary catheter, fecal, fecal management system, double (urinary and fecal), and ostomy incontinence category. If patients were managed by indwelling urinary catheter or fecal management systems, they were considered incontinent in this analysis. In order to analyze ulcers likely to be affected by incontinence, we defined a subset of ulcers as Relevant Pressure Ulcers, which are ulcers that are facility-acquired, non

  1. Modeling Research Project Risks with Fuzzy Maps

    ERIC Educational Resources Information Center

    Bodea, Constanta Nicoleta; Dascalu, Mariana Iuliana

    2009-01-01

    The authors propose a risks evaluation model for research projects. The model is based on fuzzy inference. The knowledge base for fuzzy process is built with a causal and cognitive map of risks. The map was especially developed for research projects, taken into account their typical lifecycle. The model was applied to an e-testing research…

  2. Modeling flow in a pressure-sensitive, heterogeneous medium

    SciTech Connect

    Vasco, Donald W.; Minkoff, Susan E.

    2009-06-01

    Using an asymptotic methodology, including an expansion in inverse powers of {radical}{omega}, where {omega} is the frequency, we derive a solution for flow in a medium with pressure dependent properties. The solution is valid for a heterogeneous medium with smoothly varying properties. That is, the scale length of the heterogeneity must be significantly larger then the scale length over which the pressure increases from it initial value to its peak value. The resulting asymptotic expression is similar in form to the solution for pressure in a medium in which the flow properties are not functions of pressure. Both the expression for pseudo-phase, which is related to the 'travel time' of the transient pressure disturbance, and the expression for pressure amplitude contain modifications due to the pressure dependence of the medium. We apply the method to synthetic and observed pressure variations in a deforming medium. In the synthetic test we model one-dimensional propagation in a pressure-dependent medium. Comparisons with both an analytic self-similar solution and the results of a numerical simulation indicate general agreement. Furthermore, we are able to match pressure variations observed during a pulse test at the Coaraze Laboratory site in France.

  3. Choice of the Effective Light Pressure Model for Glonass Satellites

    NASA Astrophysics Data System (ADS)

    Aleksandrova, A. G.; Chuvashov, I. N.

    2017-06-01

    The application of four light pressure models, including the standard model, two empirical models with different degrees of complexity, and physical-empirical model taking into account the optical properties of the spacecraft (SC) surface for prediction of SC motion and determination of its orbits is analyzed. The accuracy of these models used to determine the orbits of the GLONASS satellite system and the stability of the model parameters are estimated.

  4. Pressurized water reactor fuel crud and corrosion modeling

    NASA Astrophysics Data System (ADS)

    Deshon, Jeff; Hussey, Dennis; Kendrick, Brian; McGurk, John; Secker, Jeff; Short, Michael

    2011-08-01

    Pressurized water reactors circulate high-temperature water that slowly corrodes Inconel and stainless steel system surfaces, and the nickel/iron based corrosion products deposit in regions of the fuel where sub-cooled nucleate boiling occurs. The deposited corrosion products, called `crud', can have an adverse impact on fuel performance. Boron can concentrate within the crud in the boiling regions of the fuel leading to a phenomenon known as axial offset anomaly (AOA). In rare cases, fuel clad integrity can be compromised because of crud-induced localized corrosion (CILC) of the zirconium-based alloy. Westinghouse and the Electric Power Research Institute have committed to understanding the crud transport process and develop a risk assessment software tool called boron-induced offset anomaly (BOA) to avoid AOA and CILC. This paper reviews the history of the BOA model development and new efforts to develop a micro-scale model called MAMBA for use in the Consortium for Advanced Light Water Reactor Simulation (CASL) program.

  5. Pupils' Pressure Models and Their Implications for Instruction.

    ERIC Educational Resources Information Center

    Kariotoglou, P.; Psillos, D.

    1993-01-01

    Discusses a study designed to investigate pupils' conceptions about fluids and particularly liquids in equilibrium, with reference to the concept of pressure. Based upon the results obtained, several mental models of how pupils understand liquids in equilibrium were proposed. (ZWH)

  6. Low temperature ablation models made by pressure/vacuum application

    NASA Technical Reports Server (NTRS)

    Fischer, M. C.; Heier, W. C.

    1970-01-01

    Method developed employs high pressure combined with strong vacuum force to compact ablation models into desired conical shape. Technique eliminates vapor hazard and results in high material density providing excellent structural integrity.

  7. Reswick and Rogers pressure-time curve for pressure ulcer risk. Part 1.

    PubMed

    Gefen, Amit

    Pressure ulcers are one of the most potentially devastating complications in individuals confined to a bed or a wheelchair for an extended period. Severe pressure ulcers may form in deep tissues overlying bony prominences, and only at a later stage become visible, or may even induce a full-thickness breakdown of the soft tissues at the affected site. A new type of pressure ulcer known as'deep tissue injury' has therefore been defined internationally. To understand the aetiology of deep tissue injury, health professionals should be able to predict whether or not a certain state of internal mechanical loads in deep tissues, such as tissue deformations and forces per unit area of tissue, would lead to localised irreversible cell damage. Part one of this article explains the concepts of injury thresholds as related to deep tissue injury. Some serious flaws in the classical, commonly used Reswick and Rogers pressure-time curve are analysed, and an alternative contemporary tissue injury threshold, the sigmoid threshold, is suggested. Part two of this article describes recent and ongoing work aimed at defining injury thresholds that are specific for deep tissue injury, standardised and therefore suitable for use with different patients. Clinical implications of current injury thresholds are also discussed, in relation to obese patients and patients with muscle atrophy.

  8. Risk Models to Predict Hypertension: A Systematic Review

    PubMed Central

    Echouffo-Tcheugui, Justin B.; Batty, G. David; Kivimäki, Mika; Kengne, Andre P.

    2013-01-01

    Background As well as being a risk factor for cardiovascular disease, hypertension is also a health condition in its own right. Risk prediction models may be of value in identifying those individuals at risk of developing hypertension who are likely to benefit most from interventions. Methods and Findings To synthesize existing evidence on the performance of these models, we searched MEDLINE and EMBASE; examined bibliographies of retrieved articles; contacted experts in the field; and searched our own files. Dual review of identified studies was conducted. Included studies had to report on the development, validation, or impact analysis of a hypertension risk prediction model. For each publication, information was extracted on study design and characteristics, predictors, model discrimination, calibration and reclassification ability, validation and impact analysis. Eleven studies reporting on 15 different hypertension prediction risk models were identified. Age, sex, body mass index, diabetes status, and blood pressure variables were the most common predictor variables included in models. Most risk models had acceptable-to-good discriminatory ability (C-statistic>0.70) in the derivation sample. Calibration was less commonly assessed, but overall acceptable. Two hypertension risk models, the Framingham and Hopkins, have been externally validated, displaying acceptable-to-good discrimination, and C-statistic ranging from 0.71 to 0.81. Lack of individual-level data precluded analyses of the risk models in subgroups. Conclusions The discrimination ability of existing hypertension risk prediction tools is acceptable, but the impact of using these tools on prescriptions and outcomes of hypertension prevention is unclear. PMID:23861760

  9. Cancer risk modelling and radiological protection.

    PubMed

    Wakeford, Richard

    2012-03-01

    Statistical models describing how the radiation-related risks of particular types of cancer vary with the doses of radiation received by specific tissues are derived from data gathered in epidemiological studies of exposed groups of people, guided by an incomplete understanding of radiobiological mechanisms gleaned from experimental studies. Cancer risk models have been developed for a dozen or so different types of cancer, and take account of the effect of important risk modifying factors such as age at exposure and time since exposure. Of primary importance in the development of cancer risk models is the experience of the Japanese atomic bomb survivors, but other exposed groups contribute information, including those exposed to radiation from internally deposited radioactive material, such as inhaled radon. Cancer risk models predict that at low doses or low dose rates the excess risk of cancer is directly proportional to the dose of radiation received, with no threshold dose--the linear no threshold (LNT) dose-response model--and the inferred summary estimate of the overall average lifetime excess risk of developing a serious cancer is ∼ 5%/Sv. It is these cancer risk models and this inferred nominal risk estimate that provide the technical basis of radiological protection. Although it is difficult to definitively test the LNT model at low doses or low dose rates, because the predicted excess risk is small compared with fluctuations in the baseline risk, evidence exists that a small risk of cancer results from low-level exposure to radiation and that the excess risk is around that predicted by current risk models.

  10. Computer-based testing of the Braden Scale for Predicting Pressure Sore Risk.

    PubMed

    Maklebust, JoAnn; Sieggreen, Mary Y; Sidor, Deborah; Gerlach, Mary A; Bauer, Carole; Anderson, Carol

    2005-04-01

    The Detroit Medical Center nursing documentation system requires all staff nurses to complete the Braden Scale for Predicting Pressure Sore Risk on an Acute Care Flow Record or Critical Care Flow Sheet on every patient, every day. An audit of these records raised concern as to whether staff nurses accurately used the Braden Scale to calculate pressure sore risk. Advanced Practice and ET Nurses noted that staff nurses were rating patients at lower levels of pressure sore risk than was warranted by the patient condition. In response, a computer-based learning module with case study examples was developed and tested to teach nursing staff to accurately evaluate pressure ulcer risk by using the Braden Scale and its subscales and to identify preventive interventions based on the patient's Braden subscale scores. Following revisions of those case study example narratives that were found to be problematic, the learning/assessment module was instituted in 2002. More than 2,500 nurses at the facility were tested regarding their knowledge of pressure ulcer risk assessment and prevention using this program. On average, nurses correctly rated the Braden Scale level of risk 75.6% of the time. The percentage of correct responses was highest for very high (92%) and very low (78%) levels of risk. This finding is consistent with the observation that most nosocomial pressure ulcers in this facility occur in patients who are rated in the "mild risk" level on the Braden scale. Subscales with the lowest percentage of correct answers were moisture and sensory perception. Correct clinical identification of a Stage I pressure ulcer as it was described in writing occurred only 53% of the time. These results indicate that training and practice are needed to use an assessment scale accurately. The Detroit Medical Center plans to include the Braden Scale in annual nursing education and competency testing.

  11. Relative risk regression models with inverse polynomials.

    PubMed

    Ning, Yang; Woodward, Mark

    2013-08-30

    The proportional hazards model assumes that the log hazard ratio is a linear function of parameters. In the current paper, we model the log relative risk as an inverse polynomial, which is particularly suitable for modeling bounded and asymmetric functions. The parameters estimated by maximizing the partial likelihood are consistent and asymptotically normal. The advantages of the inverse polynomial model over the ordinary polynomial model and the fractional polynomial model for fitting various asymmetric log relative risk functions are shown by simulation. The utility of the method is further supported by analyzing two real data sets, addressing the specific question of the location of the minimum risk threshold.

  12. Modelling oxygen self-diffusion in UO2 under pressure

    DOE PAGES

    Cooper, Michael William D.; Grimes, R. W.; Fitzpatrick, M. E.; ...

    2015-10-22

    Access to values for oxygen self-diffusion over a range of temperatures and pressures in UO2 is important to nuclear fuel applications. Here, elastic and expansivity data are used in the framework of a thermodynamic model, the cBΩ model, to derive the oxygen self-diffusion coefficient in UO2 over a range of pressures (0–10 GPa) and temperatures (300–1900 K). Furthermore, the significant reduction in oxygen self-diffusion as a function of increasing hydrostatic pressure, and the associated increase in activation energy, is identified.

  13. Characterization of a Murine Pressure Ulcer Model to Assess Efficacy of Adipose-derived Stromal Cells.

    PubMed

    Strong, Amy L; Bowles, Annie C; MacCrimmon, Connor P; Lee, Stephen J; Frazier, Trivia P; Katz, Adam J; Gawronska-Kozak, Barbara; Bunnell, Bruce A; Gimble, Jeffrey M

    2015-03-01

    As the world's population lives longer, the number of individuals at risk for pressure ulcers will increase considerably in the coming decades. In developed countries, up to 18% of nursing home residents suffer from pressure ulcers and the resulting hospital costs can account for up to 4% of a nation's health care budget. Although full-thickness surgical skin wounds have been used as a model, preclinical rodent studies have demonstrated that repeated cycles of ischemia and reperfusion created by exposure to magnets most closely mimic the human pressure ulcer condition. This study uses in vivo and in vitro quantitative parameters to characterize the temporal kinetics and histology of pressure ulcers in young, female C57BL/6 mice exposed to 2 or 3 ischemia-reperfusion cycles. This pressure ulcer model was validated further in studies examining the efficacy of adipose-derived stromal/stem cell administration. Optimal results were obtained with the 2-cycle model based on the wound size, histology, and gene expression profile of representative angiogenic and reparative messenger RNAs. When treated with adipose-derived stromal/stem cells, pressure ulcer wounds displayed a dose-dependent and significant acceleration in wound closure rates and improved tissue histology. These findings document the utility of this simplified preclinical model for the evaluation of novel tissue engineering and medical approaches to treat pressure ulcers in humans.

  14. Incidence and risk factors for surgically acquired pressure ulcers: a prospective cohort study investigators.

    PubMed

    Webster, Joan; Lister, Carolyn; Corry, Jean; Holland, Michelle; Coleman, Kerrie; Marquart, Louise

    2015-01-01

    To assess the incidence of hospital-acquired, surgery-related pressure injury (ulcers) and identify risk factors for these injuries. We used a prospective cohort study to investigate the research question. The study was conducted at a major metropolitan hospital in Brisbane, Australia. Five hundred thirty-four adult patients booked for any surgical procedure expected to last more than 30 minutes were eligible for inclusion. Patients who provided informed consent for study participation were assessed for pressure ulcers, using the European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel Guidelines, before entering the operating room and again in the post-anesthetic care unit (PACU). Research nurses and all PACU nurses were trained in skin assessment and in pressure ulcer staging. Patients were not assessed again after their discharge from the PACU. Seven patients (1.3%) had existing pressure injuries (ulcers) and a further 6 (1.3%) developed a surgery-related pressure ulcer. Risk factors associated with surgery-related pressure injuries were similar to non-surgically related risks and included older age, skin condition, and being admitted from a location other than one's own home. Length of surgery was not associated with pressure ulcer development in this cohort. Perioperative nurses play an important role in identifying existing or new pressure injuries. However, many of these nurses are unfamiliar with pressure ulcer classification, so education in this area is essential. Although the incidence of surgically acquired pressure ulcers was low in this cohort, careful skin inspection before and after surgery provides an opportunity for early treatment and may prevent existing lesions progressing to higher stages.

  15. Ultra-High Pressure Modeling and Experiments Review

    SciTech Connect

    Costantino, M; Darnell, I

    2004-06-01

    The RDHWT/MARIAH II energy addition, run time, and mass flow rate requirement simply large air and nitrogen fluid volumes at the highest practicable static enthalpy. The objective of the gas supply concept development is the satisfaction of ultra-high pressure (UHP), high temperature thermodynamic requirements in a facility with acceptable safety and economic risks. The primary challenges for the mechanical design are connecting multiple volumes at pressures greater than 1,400MPa and temperatures greater than 500 K; fabricating high strength steel sections approximately 2 m in typical dimension, and reacting the pressure-related forces in the system. In the 'octahedral module' concept, four UHP intensifiers and two UHP manifolds are arranged in an 'octahedral' geometry that results in acceptable deviatoric stresses at cross bores. Multiple modules join to provide the required UHP volume at a stagnation pressure of 2100MPa and stagnation temperature of 750 K.

  16. Improved Solar-Radiation-Pressure Models for GPS Satellites

    NASA Technical Reports Server (NTRS)

    Bar-Sever, Yoaz; Kuang, Da

    2006-01-01

    A report describes a series of computational models conceived as an improvement over prior models for determining effects of solar-radiation pressure on orbits of Global Positioning System (GPS) satellites. These models are based on fitting coefficients of Fourier functions of Sun-spacecraft- Earth angles to observed spacecraft orbital motions.

  17. Blood pressure values and depression in hypertensive individuals at high cardiovascular risk.

    PubMed

    Mejia-Lancheros, Cilia; Estruch, Ramón; Martínez-González, Miguel Angel; Salas-Salvadó, Jordi; Corella, Dolores; Gómez-Gracia, Enrique; Fiol, Miquel; Santos, José Manuel; Fitó, Montse; Arós, Fernando; Serra-Majem, Lluis; Pintó, Xavier; Basora, Josep; Sorlí, José Vicente; Muñoz, Miguel-Angel

    2014-08-26

    Hypertension and depression are both important risk factors for cardiovascular diseases. Nevertheless, the association of blood pressure on and depression has not been completely established. This study aims to analyze whether depression may influence the control of blood pressure in hypertensive individuals at high cardiovascular risk. Cross-sectional study, embedded within the PREDIMED clinical trial, of 5954 hypertensive patients with high cardiovascular risk factor profiles. The relationship between blood pressure control and depression was analyzed. A multivariate analysis (logistic and log-linear regression), adjusting for potential confounders (socio-demographic factors, body mass index, lifestyle, diabetes, dyslipidemia, and antihypertensive treatment), was performed. Depressive patients, with and without antidepressant treatment, had better blood pressure control (OR: 1.28, CI 95%: 1.06-1.55, and OR: 1.30, CI 95%: 1.03-1.65, respectively) than non-depressive ones. Regarding blood pressure levels, systolic blood pressure values (mmHg) were found to be lower in both treated and untreated depressive patients (Log coefficient Beta: -1.59, 95% CI: -0.50 to -2.69 and Log coefficient Beta: -3.49, 95% CI: -2.10 to -4.87, respectively). Among hypertensive patients at high cardiovascular risk, the control of blood pressure was better in those diagnosed with depression. Unique identifier: ISRCTN35739639.

  18. Giving in to Group Pressure: The Impact of Socialization and Risk on Perceived Outcomes

    ERIC Educational Resources Information Center

    McIntyre, Katharine A.; Platania, Judith

    2009-01-01

    The current study applies the perspective of decision theory to understanding how choices are made in an in-group setting involving social pressure and risk. Two hundred sixty-one undergraduate students provided assessments of consequences associated with illegally consuming alcohol in different environments with differing degrees of risk. In…

  19. Giving in to Group Pressure: The Impact of Socialization and Risk on Perceived Outcomes

    ERIC Educational Resources Information Center

    McIntyre, Katharine A.; Platania, Judith

    2009-01-01

    The current study applies the perspective of decision theory to understanding how choices are made in an in-group setting involving social pressure and risk. Two hundred sixty-one undergraduate students provided assessments of consequences associated with illegally consuming alcohol in different environments with differing degrees of risk. In…

  20. Childhood Risk Factors for Thin Body Preoccupation and Social Pressure to Be Thin

    ERIC Educational Resources Information Center

    Agras, W. Stewart; Bryson, Susan; Hammer, Lawrence D.; Kraemer, Helena C.

    2007-01-01

    Objective: Thin body preoccupation and social pressure to be thin (TBPSP) in adolescence are risk factors for the development of full and partial bulimia nervosa and binge eating disorder. This study examined precursors of these potent risk factors. Method: A prospective study followed 134 children from birth to 11.0 years and their parents.…

  1. Childhood Risk Factors for Thin Body Preoccupation and Social Pressure to Be Thin

    ERIC Educational Resources Information Center

    Agras, W. Stewart; Bryson, Susan; Hammer, Lawrence D.; Kraemer, Helena C.

    2007-01-01

    Objective: Thin body preoccupation and social pressure to be thin (TBPSP) in adolescence are risk factors for the development of full and partial bulimia nervosa and binge eating disorder. This study examined precursors of these potent risk factors. Method: A prospective study followed 134 children from birth to 11.0 years and their parents.…

  2. An asperity-deformation model for effective pressure

    NASA Astrophysics Data System (ADS)

    Gangi, Anthony F.; Carlson, Richard L.

    1996-05-01

    Variations of the mechanical and transport properties of cracked and/or porous rocks under isotropic stress depend on both the confining pressure ( Pc) and the pore-fluid pressure ( Pp). To a first approximation, these rock properties are functions of the differential pressure, Pd = Pc - Pp; at least for low differential pressures. However, at higher differential pressures, the properties depend in a more complicated way upon the two pressures. The concept of effective pressure, Pe, is used to denote this variation and it is defined as Pe( Pc, Pp) = Pc - n( Pc, Pp) Pp. If n = 1 (and therefore, is independent of Pc and Pp), the effective pressure is just the differential pressure. We have used an asperity-deformation model and a force-balance equation to derive expressions for the effective pressure. We equate the total external force (in one direction), Fc, to the total force on the asperities, Fa, and the force of the fluid, Fp, acting in that same direction. The fluid force, Fp, acts only on the parts of the crack (or pore-volume) faces which are not in contact. Then, the asperity pressure, Pa, is the average force per unit area acting on the crack (or grain) contacts P a = {F a}/{A} = {F c}/{A} - {F p}/{A} = P c - (1 - {A c}/{A})P p, where A is the total area over which Fc acts and Ac is the area of contact of the crack asperities or the grains. Thus, the asperity pressure, Pa, is greater than the differential pressure, Pd, because Pp acts on a smaller area, A- Ac, than the total area, A. For elastic asperities, the area of contact Ac and the strain (e.g., crack and pore openings) remain the same, to a high degree of approximation, at constant asperity pressure. Therefore, transport properties such as permeability, resistivity, thermal conductivity, etc. are constant, to the same degree of approximation, at constant asperity pressure. For these properties, the asperity pressure is, very accurately, the effective pressure, Pc. Using this model, we find that the

  3. Psychometric Properties of the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) for Pressure Ulcer Risk Assessment During Inpatient Rehabilitation.

    PubMed

    Delparte, Jude J; Scovil, Carol Y; Flett, Heather M; Higgins, Johanne; Laramée, Marie-Thérèse; Burns, Anthony S

    2015-11-01

    To assess the psychometric properties of the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) for pressure ulcer (PU) risk assessment during inpatient rehabilitation. Prospective cohort. Tertiary rehabilitation centers. Individuals (N=759) participating in inpatient spinal cord injury rehabilitation between January 3, 2012, and April 23, 2014. Not applicable. Admission SCIPUS scores and the corresponding risk stratification, PU incidence, intraclass correlation coefficient (ICC) for interrater reliability, sensitivity, specificity, and likelihood ratios (LRs). Receiver operating characteristic analysis was performed to calculate the area under the curve (AUC). Mean SCIPUS scores were higher for individuals who developed PUs than for those who did not (mean SCIPUS score, 9.8±2.5 vs 8.5±2.6). Interrater reliability was excellent for SCIPUS composite scores (ICC=.91) and very good for risk stratification (ICC=.86). Using the existing cutoff value of ≥6 for "high risk" category, sensitivity and specificity were estimated to be .97 and .12, respectively, with an LR of 1.1. A cutoff value of ≥8 yielded a better balance between sensitivity and specificity (.85 and .38, respectively). The AUC equaled .64 with an LR of 1.4. Results were similar when the analysis was confined to PUs of stage II or greater. The psychometric properties of the SCIPUS do not currently support its routine use as a measure of PU risk in individuals with spinal cord injury undergoing inpatient rehabilitation. LRs of <2 indicate that stratification as high risk or very high risk does not substantially increase the likelihood of identifying individuals who develop PUs beyond chance alone. AUCs were also below the desired cutoff value of 0.7. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  4. A pressure-deformation analytical model for rectangular diaphragm of MEMS pressure sensors

    NASA Astrophysics Data System (ADS)

    Zhou, Wu; Wang, Dong; Yu, Huijun; Peng, Bei

    2017-02-01

    Rectangular diaphragm is commonly used as a pressure sensitive component in MEMS pressure sensors. Its deformation under applied pressure directly determines the performance of micro-devices, accurately acquiring the pressure-deflection relationship, therefore, plays a significant role in pressure sensor design. This paper analyzes the deflection of an isotropic rectangular diaphragm under combined effects of loads. The model is regarded as a clamped plate with full surface uniform load and partially uniform load applied on its opposite sides. The full surface uniform load stands for the external measured pressure. The partial load is used to approximate the opposite reaction of the silicon island which is planted on the diaphragm to amplify the deformation displacement, thus to improve the sensitivity of the pressure sensor. Superposition method is proposed to calculate the diaphragm deflections. This method considers separately the actions of loads applied on the simple supported plate and moments distributed on edges. Considering the boundary condition of all edges clamped, the moments are constructed to eliminate the boundary rotations caused by lateral load. The diaphragm’s deflection is computed by superposing deflections which produced by loads applied on the simple supported plate and moments distributed on edges. This method provides higher calculation accuracy than Galerkin variational method, and it is used to analyze the influence factors of the diaphragm’s deflection, includes aspect ratio, thickness and the applied force area of the diaphragm.

  5. Ambulatory blood pressure improves prediction of cardiovascular risk: implications for better antihypertensive management.

    PubMed

    Krakoff, Lawrence R

    2013-04-01

    Accurate measurement of arterial pressure is necessary for diagnosis of hypertension and for assessment of its therapy. The development and growing application of ambulatory blood pressure monitoring (ABPM) furthers these goals. Use of ABPM has defined white coat hypertension (WCH) and masked hypertension (MH), important prognostic diagnoses. ABPM categorizes blood pressure in several ways that increase accuracy for diagnosis and prediction of cardiovascular risk. Measurements of blood pressure throughout the day, at night during sleep, during the morning surge, and, in some instances selected intervals can be especially valuable for both research and clinical management. ABPM is being explored for its value in measuring pulse pressure and a derived index of arterial stiffness. ABPM has also shown to be valuable for defining the effects of antihypertensive drugs therapy. Results of such studies are crucial for advancing antihypertensive management. This review will summarize the important and emerging role of ABPM in defining risk for cardiovascular disease.

  6. Constructing high-pressure thermodynamic models: problems and possible solutions

    NASA Astrophysics Data System (ADS)

    Brosh, E.

    2013-12-01

    Conventional thermodynamic databases (e.g. Fabrichnaya et al. 2004, Holland and Powell 1998, 2011) consist of expressions for the Gibbs energy at ambient pressure, extended to higher pressures through the integration of some EOS (Equation Of State). While this is simple and straight-forward, such thermodynamic models are prone to produce manifestly unphysical predictions of negative thermal expansion and even negative heat capacity at high pressure. It has been shown (Brosh et al. 2007) that these errors arise not only from problems the EOS itself but also from incompatibilities between the EOS and the models used for extrapolations of the heat capacity at ambient pressure. One solution is a radical restructuring of thermodynamic databases. Instead of modelling the Gibbs energy, new databases can be based on modelling the Helmholtz energy using Debye-Mie-Grüneisen EOS. This approach is very successful for modelling solid substances (Jacobs 2009, 2010, Dorogokupets et al. 2007, 2012) but the Debye-Mie-Grüneisen equations of state are not easily applicable to liquids. Other difficulties stem from the treatment of the predicted mechanical instability above the normal melting point. However, the most severe difficulty with the utilization of the Debye-Mie-Grüneisen approach is that it is incompatible with the current ambient-pressure thermodynamic databases and one will not be able to use them as a basis for high pressure modelling. Another approach (Brosh et al. 2007) is based on an interpolation of the thermophysical properties between the ambient pressure models given in conventional databases and the Debye-Mie-Grüneisen model at extreme pressures. This avoids most of the spurious anomalies of conventional models. The limitations of the interpolation scheme are the inclusion of several model parameters whose physical essence is not well-defined and an underestimation of the heat capacity at high pressures. In this presentation, the predictions of the

  7. Pressure and velocity profiles in a static mechanical hemilarynx model.

    PubMed

    Alipour, Fariborz; Scherer, Ronald C

    2002-12-01

    This study examined pressure and velocity profiles in a hemilarynx mechanical model of phonation. The glottal section had parallel walls and was fabricated from hard plastic. Twelve pressure taps were created in the vocal fold surface and connected to a differential pressure transducer through a pressure switch. The glottal gap was measured with feeler gauges and the uniform glottal duct was verified by use of a laser system. Eight pressure transducers were placed in the flat wall opposite the vocal fold. Hot-wire anemometry was used to obtain velocity profiles upstream and downstream of the glottis. The results indicate that the pressure distribution on the vocal fold surface was consistent with pressure change along a parallel duct, whereas the pressures on the opposite flat wall typically were lower (by 8%-40% of the transglottal pressure just past mid-glottis). The upstream velocity profiles were symmetric regardless of the constriction shape and size. The jet flow downstream of the glottis was turbulent even for laminar upstream conditions. The front of the jet was consistently approximately 1.5 mm from the flat wall for glottal gaps of 0.4, 0.8 and 1.2 mm. The turbulence intensity also remained approximately at the same location of about 4 mm from the flat wall for the two larger gaps.

  8. Blood pressure change and risk of hypertension associated with parental hypertension: the Johns Hopkins Precursors Study.

    PubMed

    Wang, Nae-Yuh; Young, J Hunter; Meoni, Lucy A; Ford, Daniel E; Erlinger, Thomas P; Klag, Michael J

    2008-03-24

    Parental hypertension is used to classify hypertension risk in young adults, but the long-term association of parental hypertension with blood pressure (BP) change and risk of hypertension over the adult life span has not been well studied. We examined the association of parental hypertension with BP change and hypertension risk from young adulthood through the ninth decade of life in a longitudinal cohort of 1160 male former medical students with 54 years of follow-up. In mixed-effects models using 29 867 BP measurements, mean systolic and diastolic BP readings were significantly higher at baseline among participants with parental hypertension. The rate of annual increase was slightly higher for systolic (0.03 mm Hg, P= .04), but not diastolic, BP in those with parental hypertension. After adjustment for baseline systolic and diastolic BP and time-dependent covariates--body mass index, alcohol consumption, coffee drinking, physical activity, and cigarette smoking--the hazard ratio (95% confidence interval [CI]) of hypertension development was 1.5 (1.2-2.0) for men with maternal hypertension only, 1.8 (1.4-2.4) for men with paternal hypertension only, and 2.4 (1.8-3.2) for men with hypertension in both parents compared with men whose parents never developed hypertension. Early-onset (at age risk (95% CI, 3.6-10.7) for the development of hypertension throughout adult life and a 20.0-fold higher adjusted risk (95% CI, 8.4-47.9) at the age of 35 years. Hypertension in both mothers and fathers has a strong independent association with elevated BP levels and incident hypertension over the course of adult life.

  9. Assessment of the risk of pressure ulcer development among hospitalized HIV/Aids patients.

    PubMed

    Cidral, Silvana; Silva, Waldirene Fernandes; Visentin, Angelita; Borghi, Angela Cristina da Silva; Mantovani, Maria de Fátima; Hey, Ana Paula

    2016-01-01

    to assess the risk of pressure ulcer development among hospitalized HIV/Aids. Metod: study quantitative descriptive with 35 patients admitted to an infectious diseases hospital in Curitiba-PR-BR. Characterized clinical and epidemiological of patients using a data collection instrument and the Braden Scale. Data was compiled using Excel® and a simple descriptive analysis. two patients were found to have pressure ulcers and the most common comorbidities associated with HIV/Aids were pneumocystis pneumonia, caused by pneumocisti cariini (16), and pulmonary tuberculosis (13). The lowest scores were obtained in the friction and shear subscale, followed by the activity, nutrition, mobility and moisture subscales. The highest score was obtained in the sensory perception subscale. Two patients were classified as 'very high risk', six as 'high risk', three as 'low risk', and the rest as 'no risk'. risk assessment using scales provides objective information to assist with systemized and targeted nursing decision-making.

  10. Is It Daily, Monthly, or Yearly Blood Pressure Variability that Enhances Cardiovascular Risk?

    PubMed

    Dolan, Eamon; O'Brien, Eoin

    2015-11-01

    Variability is a phenomenon common to most biological processes that we can measure and is a particular feature of blood pressure (BP). Variability causes concern for many physicians regarding its clinical meaning and potential impact on cardiovascular risk. In this review, we assess the role of different time periods of blood pressure variability (BPV) in cardiovascular risk stratification. We review the indices of BPV derived from ambulatory blood pressure measurement (ABPM), home blood pressure measurement (HBPM), or at the clinic setting with the intention of providing a clear message for clinical practice. BPV, either derived from ABPM or HBPM, does not consistently augment cardiovascular risk prediction over and beyond that of average BP, particularly in low-risk individuals. That said, it would seem that certain medications such as calcium channel blockers may have a beneficial effect on visit-to-visit BPV and perhaps reduce the associated cardiovascular risk. This highlights the benefits in using combination therapy which might couple a number of therapeutic benefits such as the reductions of mean blood pressure and BPV. Overall, we should remain aware that the average BP level remains the main modifiable risk factor derived from BP measurements and continue to improve the control of hypertension and adverse health outcomes.

  11. Cryogenic Pressure Control Modeling for Ellipsoidal Space Tanks

    NASA Technical Reports Server (NTRS)

    Lopez, Alfredo; Grayson, Gary D.; Chandler, Frank O.; Hastings, Leon J.; Heyadat, Ali

    2007-01-01

    A computational fluid dynamics (CFD) model is developed to simulate pressure control of an ellipsoidal-shaped liquid hydrogen tank under external heating in normal gravity. Pressure control is provided by an axial jet thermodynamic vent system (TVS) centered within the vessel that injects cooler liquid into the tank, mixing the contents and reducing tank pressure. The two-phase cryogenic tank model considers liquid hydrogen in its own vapor with liquid density varying with temperature only and a fully compressible ullage. The axisymmetric model is developed using a custom version of the commercially available FLOW-31) software. Quantitative model validation is ,provided by engineering checkout tests performed at Marshall Space Flight Center in 1999 in support of the Solar Thermal Upper Stage_ Technology Demonstrator (STUSTD) program. The engineering checkout tests provide cryogenic tank self-pressurization test data at various heat leaks and tank fill levels. The predicted self-pressurization rates, ullage and liquid temperatures at discrete locations within the STUSTD tank are in good agreement with test data. The work presented here advances current CFD modeling capabilities for cryogenic pressure control and helps develop a low cost CFD-based design process for space hardware.

  12. Modelling and Analysis of High Pressure Peaking Switch

    NASA Astrophysics Data System (ADS)

    S, Bindu; Parekh, Mrunal; Mangalvedekar, H. A.; Sharma, Archana; Chakravarthy, D. P.

    2012-07-01

    This paper presents modelling and analysis of peaking switch used in Marx generator, such that the rise time of the pulse produced by the Marx generator is reduced substantially. Towards this FEMM (Finite Element Methods Magnetics) software is used for the field modelling of the switch and MATLAB for circuit modelling to observe the rise time. The switch has to produce pulse with sub-nanosecond rise time, hence the electrode distance has to be minimum. This switch can withstand high voltage only under high pressure. A mathematical model is simulated in MATLAB to see the performance under high pressure.

  13. Effect of e-learning program on risk assessment and pressure ulcer classification - A randomized study.

    PubMed

    Bredesen, Ida Marie; Bjøro, Karen; Gunningberg, Lena; Hofoss, Dag

    2016-05-01

    Pressure ulcers (PUs) are a problem in health care. Staff competency is paramount to PU prevention. Education is essential to increase skills in pressure ulcer classification and risk assessment. Currently, no pressure ulcer learning programs are available in Norwegian. Develop and test an e-learning program for assessment of pressure ulcer risk and pressure ulcer classification. Forty-four nurses working in acute care hospital wards or nursing homes participated and were assigned randomly into two groups: an e-learning program group (intervention) and a traditional classroom lecture group (control). Data was collected immediately before and after training, and again after three months. The study was conducted at one nursing home and two hospitals between May and December 2012. Accuracy of risk assessment (five patient cases) and pressure ulcer classification (40 photos [normal skin, pressure ulcer categories I-IV] split in two sets) were measured by comparing nurse evaluations in each of the two groups to a pre-established standard based on ratings by experts in pressure ulcer classification and risk assessment. Inter-rater reliability was measured by exact percent agreement and multi-rater Fleiss kappa. A Mann-Whitney U test was used for continuous sum score variables. An e-learning program did not improve Braden subscale scoring. For pressure ulcer classification, however, the intervention group scored significantly higher than the control group on several of the categories in post-test immediately after training. However, after three months there were no significant differences in classification skills between the groups. An e-learning program appears to have a greater effect on the accuracy of pressure ulcer classification than classroom teaching in the short term. For proficiency in Braden scoring, no significant effect of educational methods on learning results was detected. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Under Pressure: Response Urgency Modulates Striatal and Insula Activity during Decision-Making under Risk

    PubMed Central

    Jones, Catherine L.; Minati, Ludovico; Harrison, Neil A.; Ward, Jamie; Critchley, Hugo D.

    2011-01-01

    When deciding whether to bet in situations that involve potential monetary loss or gain (mixed gambles), a subjective sense of pressure can influence the evaluation of the expected utility associated with each choice option. Here, we explored how gambling decisions, their psychophysiological and neural counterparts are modulated by an induced sense of urgency to respond. Urgency influenced decision times and evoked heart rate responses, interacting with the expected value of each gamble. Using functional MRI, we observed that this interaction was associated with changes in the activity of the striatum, a critical region for both reward and choice selection, and within the insula, a region implicated as the substrate of affective feelings arising from interoceptive signals which influence motivational behavior. Our findings bridge current psychophysiological and neurobiological models of value representation and action-programming, identifying the striatum and insular cortex as the key substrates of decision-making under risk and urgency. PMID:21677769

  15. Genetic risks and genetic model specification.

    PubMed

    Zheng, Gang; Zhang, Wei; Xu, Jinfeng; Yuan, Ao; Li, Qizhai; Gastwirth, Joseph L

    2016-08-21

    Genetic risks and genetic models are often used in design and analysis of genetic epidemiology studies. A genetic model is defined in terms of two genetic risk measures: genotype relative risk and odds ratio. The impacts of choosing a risk measure on the resulting genetic models are studied in the power to detect association and deviation from Hardy-Weinberg equilibrium in cases using genetic relative risk. Extensive simulations demonstrate that the power of a study to detect associations using odds ratio is lower than that using relative risk with the same value when other parameters are fixed. When the Hardy-Weinberg equilibrium holds in the general population, the genetic model can be inferred by the deviation from Hardy-Weinberg equilibrium in only cases. Furthermore, it is more efficient than that based on the deviation from Hardy-Weinberg equilibrium in all cases and controls. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Genetic variants in novel pathways influence blood pressure and cardiovascular disease risk.

    PubMed

    Ehret, Georg B; Munroe, Patricia B; Rice, Kenneth M; Bochud, Murielle; Johnson, Andrew D; Chasman, Daniel I; Smith, Albert V; Tobin, Martin D; Verwoert, Germaine C; Hwang, Shih-Jen; Pihur, Vasyl; Vollenweider, Peter; O'Reilly, Paul F; Amin, Najaf; Bragg-Gresham, Jennifer L; Teumer, Alexander; Glazer, Nicole L; Launer, Lenore; Zhao, Jing Hua; Aulchenko, Yurii; Heath, Simon; Sõber, Siim; Parsa, Afshin; Luan, Jian'an; Arora, Pankaj; Dehghan, Abbas; Zhang, Feng; Lucas, Gavin; Hicks, Andrew A; Jackson, Anne U; Peden, John F; Tanaka, Toshiko; Wild, Sarah H; Rudan, Igor; Igl, Wilmar; Milaneschi, Yuri; Parker, Alex N; Fava, Cristiano; Chambers, John C; Fox, Ervin R; Kumari, Meena; Go, Min Jin; van der Harst, Pim; Kao, Wen Hong Linda; Sjögren, Marketa; Vinay, D G; Alexander, Myriam; Tabara, Yasuharu; Shaw-Hawkins, Sue; Whincup, Peter H; Liu, Yongmei; Shi, Gang; Kuusisto, Johanna; Tayo, Bamidele; Seielstad, Mark; Sim, Xueling; Nguyen, Khanh-Dung Hoang; Lehtimäki, Terho; Matullo, Giuseppe; Wu, Ying; Gaunt, Tom R; Onland-Moret, N Charlotte; Cooper, Matthew N; Platou, Carl G P; Org, Elin; Hardy, Rebecca; Dahgam, Santosh; Palmen, Jutta; Vitart, Veronique; Braund, Peter S; Kuznetsova, Tatiana; Uiterwaal, Cuno S P M; Adeyemo, Adebowale; Palmas, Walter; Campbell, Harry; Ludwig, Barbara; Tomaszewski, Maciej; Tzoulaki, Ioanna; Palmer, Nicholette D; Aspelund, Thor; Garcia, Melissa; Chang, Yen-Pei C; O'Connell, Jeffrey R; Steinle, Nanette I; Grobbee, Diederick E; Arking, Dan E; Kardia, Sharon L; Morrison, Alanna C; Hernandez, Dena; Najjar, Samer; McArdle, Wendy L; Hadley, David; Brown, Morris J; Connell, John M; Hingorani, Aroon D; Day, Ian N M; Lawlor, Debbie A; Beilby, John P; Lawrence, Robert W; Clarke, Robert; Hopewell, Jemma C; Ongen, Halit; Dreisbach, Albert W; Li, Yali; Young, J Hunter; Bis, Joshua C; Kähönen, Mika; Viikari, Jorma; Adair, Linda S; Lee, Nanette R; Chen, Ming-Huei; Olden, Matthias; Pattaro, Cristian; Bolton, Judith A Hoffman; Köttgen, Anna; Bergmann, Sven; Mooser, Vincent; Chaturvedi, Nish; Frayling, Timothy M; Islam, Muhammad; Jafar, Tazeen H; Erdmann, Jeanette; Kulkarni, Smita R; Bornstein, Stefan R; Grässler, Jürgen; Groop, Leif; Voight, Benjamin F; Kettunen, Johannes; Howard, Philip; Taylor, Andrew; Guarrera, Simonetta; Ricceri, Fulvio; Emilsson, Valur; Plump, Andrew; Barroso, Inês; Khaw, Kay-Tee; Weder, Alan B; Hunt, Steven C; Sun, Yan V; Bergman, Richard N; Collins, Francis S; Bonnycastle, Lori L; Scott, Laura J; Stringham, Heather M; Peltonen, Leena; Perola, Markus; Vartiainen, Erkki; Brand, Stefan-Martin; Staessen, Jan A; Wang, Thomas J; Burton, Paul R; Soler Artigas, Maria; Dong, Yanbin; Snieder, Harold; Wang, Xiaoling; Zhu, Haidong; Lohman, Kurt K; Rudock, Megan E; Heckbert, Susan R; Smith, Nicholas L; Wiggins, Kerri L; Doumatey, Ayo; Shriner, Daniel; Veldre, Gudrun; Viigimaa, Margus; Kinra, Sanjay; Prabhakaran, Dorairaj; Tripathy, Vikal; Langefeld, Carl D; Rosengren, Annika; Thelle, Dag S; Corsi, Anna Maria; Singleton, Andrew; Forrester, Terrence; Hilton, Gina; McKenzie, Colin A; Salako, Tunde; Iwai, Naoharu; Kita, Yoshikuni; Ogihara, Toshio; Ohkubo, Takayoshi; Okamura, Tomonori; Ueshima, Hirotsugu; Umemura, Satoshi; Eyheramendy, Susana; Meitinger, Thomas; Wichmann, H-Erich; Cho, Yoon Shin; Kim, Hyung-Lae; Lee, Jong-Young; Scott, James; Sehmi, Joban S; Zhang, Weihua; Hedblad, Bo; Nilsson, Peter; Smith, George Davey; Wong, Andrew; Narisu, Narisu; Stančáková, Alena; Raffel, Leslie J; Yao, Jie; Kathiresan, Sekar; O'Donnell, Christopher J; Schwartz, Stephen M; Ikram, M Arfan; Longstreth, W T; Mosley, Thomas H; Seshadri, Sudha; Shrine, Nick R G; Wain, Louise V; Morken, Mario A; Swift, Amy J; Laitinen, Jaana; Prokopenko, Inga; Zitting, Paavo; Cooper, Jackie A; Humphries, Steve E; Danesh, John; Rasheed, Asif; Goel, Anuj; Hamsten, Anders; Watkins, Hugh; Bakker, Stephan J L; van Gilst, Wiek H; Janipalli, Charles S; Mani, K Radha; Yajnik, Chittaranjan S; Hofman, Albert; Mattace-Raso, Francesco U S; Oostra, Ben A; Demirkan, Ayse; Isaacs, Aaron; Rivadeneira, Fernando; Lakatta, Edward G; Orru, Marco; Scuteri, Angelo; Ala-Korpela, Mika; Kangas, Antti J; Lyytikäinen, Leo-Pekka; Soininen, Pasi; Tukiainen, Taru; Würtz, Peter; Ong, Rick Twee-Hee; Dörr, Marcus; Kroemer, Heyo K; Völker, Uwe; Völzke, Henry; Galan, Pilar; Hercberg, Serge; Lathrop, Mark; Zelenika, Diana; Deloukas, Panos; Mangino, Massimo; Spector, Tim D; Zhai, Guangju; Meschia, James F; Nalls, Michael A; Sharma, Pankaj; Terzic, Janos; Kumar, M V Kranthi; Denniff, Matthew; Zukowska-Szczechowska, Ewa; Wagenknecht, Lynne E; Fowkes, F Gerald R; Charchar, Fadi J; Schwarz, Peter E H; Hayward, Caroline; Guo, Xiuqing; Rotimi, Charles; Bots, Michiel L; Brand, Eva; Samani, Nilesh J; Polasek, Ozren; Talmud, Philippa J; Nyberg, Fredrik; Kuh, Diana; Laan, Maris; Hveem, Kristian; Palmer, Lyle J; van der Schouw, Yvonne T; Casas, Juan P; Mohlke, Karen L; Vineis, Paolo; Raitakari, Olli; Ganesh, Santhi K; Wong, Tien Y; Tai, E Shyong; Cooper, Richard S; Laakso, Markku; Rao, Dabeeru C; Harris, Tamara B; Morris, Richard W; Dominiczak, Anna F; Kivimaki, Mika; Marmot, Michael G; Miki, Tetsuro; Saleheen, Danish; Chandak, Giriraj R; Coresh, Josef; Navis, Gerjan; Salomaa, Veikko; Han, Bok-Ghee; Zhu, Xiaofeng; Kooner, Jaspal S; Melander, Olle; Ridker, Paul M; Bandinelli, Stefania; Gyllensten, Ulf B; Wright, Alan F; Wilson, James F; Ferrucci, Luigi; Farrall, Martin; Tuomilehto, Jaakko; Pramstaller, Peter P; Elosua, Roberto; Soranzo, Nicole; Sijbrands, Eric J G; Altshuler, David; Loos, Ruth J F; Shuldiner, Alan R; Gieger, Christian; Meneton, Pierre; Uitterlinden, Andre G; Wareham, Nicholas J; Gudnason, Vilmundur; Rotter, Jerome I; Rettig, Rainer; Uda, Manuela; Strachan, David P; Witteman, Jacqueline C M; Hartikainen, Anna-Liisa; Beckmann, Jacques S; Boerwinkle, Eric; Vasan, Ramachandran S; Boehnke, Michael; Larson, Martin G; Järvelin, Marjo-Riitta; Psaty, Bruce M; Abecasis, Gonçalo R; Chakravarti, Aravinda; Elliott, Paul; van Duijn, Cornelia M; Newton-Cheh, Christopher; Levy, Daniel; Caulfield, Mark J; Johnson, Toby

    2011-09-11

    Blood pressure is a heritable trait influenced by several biological pathways and responsive to environmental stimuli. Over one billion people worldwide have hypertension (≥140 mm Hg systolic blood pressure or  ≥90 mm Hg diastolic blood pressure). Even small increments in blood pressure are associated with an increased risk of cardiovascular events. This genome-wide association study of systolic and diastolic blood pressure, which used a multi-stage design in 200,000 individuals of European descent, identified sixteen novel loci: six of these loci contain genes previously known or suspected to regulate blood pressure (GUCY1A3-GUCY1B3, NPR3-C5orf23, ADM, FURIN-FES, GOSR2, GNAS-EDN3); the other ten provide new clues to blood pressure physiology. A genetic risk score based on 29 genome-wide significant variants was associated with hypertension, left ventricular wall thickness, stroke and coronary artery disease, but not kidney disease or kidney function. We also observed associations with blood pressure in East Asian, South Asian and African ancestry individuals. Our findings provide new insights into the genetics and biology of blood pressure, and suggest potential novel therapeutic pathways for cardiovascular disease prevention.

  17. Variability of blood pressure in dialysis patients: a new marker of cardiovascular risk.

    PubMed

    Di Iorio, Biagio; Di Micco, Lucia; Torraca, Serena; Sirico, Maria Luisa; Guastaferro, Pasquale; Chiuchiolo, Luigi; Nigro, Filippo; De Blasio, Antonietta; Romano, Paolo; Pota, Andrea; Rubino, Roberto; Morrone, Luigi; Lopez, Teodoro; Casino, Francesco Gaetano

    2013-01-01

    Hemodialysis patients have a high cardiovascular mortality, and hypertension is the most prevalent treatable risk factor. We aimed to assess the predictive significance of dialysis-to-dialysis variability in blood pressure in hemodialysis patients. We performed a historical cohort study in 1,088 prevalent hemodialysis patients, followed up for 5 years. The risk of cardiovascular death was determined in relation to dialysis-to-dialysis variability in blood pressure, maximum blood pressure and pulse pressure. Variability in blood pressure was a predictor of cardiovascular death (hazard ratio [HR] = 1.242; 95% confidence interval [95% CI], 1.004-1.537; p=0.046). Also age (HR=1.021; 95% CI, 1.011-1.048; p=0.049), diabetes (HR=1.134; 95% CI, 1.128-1.451; p=0.035), creatinine (HR=0.837; 95% CI, 0.717-0.977; p=0.024) and albumin (HR=0.901; 95% CI, 0.821-0.924; p=0.022) influenced mortality. Maximum blood pressure and pulse pressure did not show any effect on cardiovascular death. Dialysis-to-dialysis variability in blood pressure is a predictor of cardiovascular mortality in hemodialysis patients, and blood pressure variability may be used in managing hypertension and predicting outcomes in dialysis patients.

  18. Chronotherapy improves blood pressure control and reduces vascular risk in CKD.

    PubMed

    Hermida, Ramón C; Ayala, Diana E; Smolensky, Michael H; Mojón, Artemio; Fernández, José R; Crespo, Juan J; Moyá, Ana; Ríos, María T; Portaluppi, Francesco

    2013-06-01

    In patients with chronic kidney disease (CKD), the prevalence of increased blood pressure during sleep and blunted sleep-time-relative blood pressure decline (a nondipper pattern) is very high and increases substantially with disease severity. Elevated blood pressure during sleep is the major criterion for the diagnoses of hypertension and inadequate therapeutic ambulatory blood pressure control in these patients. Substantial, clinically meaningful ingestion-time-dependent differences in the safety, efficacy, duration of action and/or effects on the 24 h blood pressure pattern of six different classes of hypertension medications and their combinations have been substantiated. For example, bedtime ingestion of angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers is more effective than morning ingestion in reducing blood pressure during sleep and converting the 24 h blood pressure profile into a dipper pattern. We have identified a progressive reduction in blood pressure during sleep--a novel therapeutic target best achieved by ingestion of one or more hypertension medications at bedtime--as the most significant predictor of decreased cardiovascular risk in patients with and without CKD. Recent findings suggest that in patients with CKD, ambulatory blood pressure monitoring should be used for the diagnosis of hypertension and assessment of cardiovascular disease risk, and that therapeutic strategies given at bedtime rather than on awakening are preferable for the management of hypertension.

  19. Requirements based system risk modeling

    NASA Technical Reports Server (NTRS)

    Meshkat, Leila; Cornford, Steven; Feather, Martin

    2004-01-01

    The problem that we address in this paper is assessing the expected degree of success of the system or mission based on the degree to which each requirement is satisfied and the relative weight of the requirements. We assume a complete list of the requirements, the relevant risk elements and their probability of occurrence and the quantified effect of the risk elements on the requirements. In order to assess the degree to which each requirement is satisfied, we need to determine the effect of the various risk elements on the requirement.

  20. Pressure transient modeling of a fractured geothermal reservior

    SciTech Connect

    Robinson, B.A.

    1990-01-01

    A fracture network model has been developed to simulate transient fluid flow behavior in a fractured rock mass. Included is a pressure-dependent aperture submodel to simulate behavior often seen in fractured systems. The model is used to simulate data from the Fenton Hill Hot Dry Rock (HDR) geothermal reservoir. Both low-pressure/low-flow-rate and high-pressure/high-flow-rate transient data are adequately simulated. The model parameters obtained suggest ways in which the model can be refined to achieve even more realistic fits to the data. The model is then used to demonstrate more efficient operating modes than the two-well circulating mode usually proposed for HDR reservoirs. 11 refs., 9 figs., 1 tab.

  1. Microscopic pressure-cooker model for studying molecules in confinement

    NASA Astrophysics Data System (ADS)

    Santamaria, Ruben; Adamowicz, Ludwik; Rosas-Acevedo, Hortensia

    2015-04-01

    A model for a system of a finite number of molecules in confinement is presented and expressions for determining the temperature, pressure, and volume of the system are derived. The present model is a generalisation of the Zwanzig-Langevin model because it includes pressure effects in the system. It also has general validity, preserves the ergodic hypothesis, and provides a formal framework for previous studies of hydrogen clusters in confinement. The application of the model is illustrated by an investigation of a set of prebiotic compounds exposed to varying pressure and temperature. The simulations performed within the model involve the use of a combination of molecular dynamics and density functional theory methods implemented on a computer system with a mixed CPU-GPU architecture.

  2. CFD Modeling of Helium Pressurant Effects on Cryogenic Tank Pressure Rise Rates in Normal Gravity

    NASA Technical Reports Server (NTRS)

    Grayson, Gary; Lopez, Alfredo; Chandler, Frank; Hastings, Leon; Hedayat, Ali; Brethour, James

    2007-01-01

    A recently developed computational fluid dynamics modeling capability for cryogenic tanks is used to simulate both self-pressurization from external heating and also depressurization from thermodynamic vent operation. Axisymmetric models using a modified version of the commercially available FLOW-3D software are used to simulate actual physical tests. The models assume an incompressible liquid phase with density that is a function of temperature only. A fully compressible formulation is used for the ullage gas mixture that contains both condensable vapor and a noncondensable gas component. The tests, conducted at the NASA Marshall Space Flight Center, include both liquid hydrogen and nitrogen in tanks with ullage gas mixtures of each liquid's vapor and helium. Pressure and temperature predictions from the model are compared to sensor measurements from the tests and a good agreement is achieved. This further establishes the accuracy of the developed FLOW-3D based modeling approach for cryogenic systems.

  3. A human cadaver fascial compartment pressure measurement model.

    PubMed

    Messina, Frank C; Cooper, Dylan; Huffman, Gretchen; Bartkus, Edward; Wilbur, Lee

    2013-10-01

    Fresh human cadavers provide an effective model for procedural training. Currently, there are no realistic models to teach fascial compartment pressure measurement. We created a human cadaver fascial compartment pressure measurement model and studied its feasibility with a pre-post design. Three faculty members, following instructions from a common procedure textbook, used a standard handheld intra-compartment pressure monitor (Stryker(®), Kalamazoo, MI) to measure baseline pressures ("unembalmed") in the anterior, lateral, deep posterior, and superficial posterior compartments of the lower legs of a fresh human cadaver. The right femoral artery was then identified by superficial dissection, cannulated distally towards the lower leg, and connected to a standard embalming machine. After a 5-min infusion, the same three faculty members re-measured pressures ("embalmed") of the same compartments on the cannulated right leg. Unembalmed and embalmed readings for each compartment, and baseline readings for each leg, were compared using a two-sided paired t-test. The mean baseline compartment pressures did not differ between the right and left legs. Using the embalming machine, compartment pressure readings increased significantly over baseline for three of four fascial compartments; all in mm Hg (±SD): anterior from 40 (±9) to 143 (±44) (p = 0.08); lateral from 22 (±2.5) to 160 (±4.3) (p < 0.01); deep posterior from 34 (±7.9) to 161 (±15) (p < 0.01); superficial posterior from 33 (±0) to 140 (±13) (p < 0.01). We created a novel and measurable fascial compartment pressure measurement model in a fresh human cadaver using a standard embalming machine. Set-up is minimal and the model can be incorporated into teaching curricula. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Model of a stationary microwave argon discharge at atmospheric pressure

    SciTech Connect

    Zhelyazkov, I.; Pencheva, M.; Benova, E.

    2008-03-19

    The many applications of microwave gas discharges at atmospheric pressure in various fields of science, technology and medicine require an adequate model of these discharges. Such a model is based on the electromagnetic wave's propagation properties and on the elementary processes in the discharge bulk. In contrast to the microwave discharges at low-gas pressures, where many elementary processes might be ignored because of their negligible contribution to the electron and heavy particle's balance equations, for such discharges at atmospheric pressure the consideration of a large number of collisional processes is mandatory. For the build of a successful discharge-column model one needs three important quantities, notably the power {theta} necessary for sustaining an electron - ion pair, electron - neutral collision frequency for momentum transfer v{sub en}, and gas temperature T{sub g}. The first two key parameters are obtained by a collisional-radiative model of the argon at atmospheric pressure, while the microwave frequency {omega}/2{pi} = 2.45 GHz, plasma column radius R, gas pressure p and gas temperature T{sub g} are fixed external parameters determined by the experimental conditions. Here, we present a model of a capillary argon microwave plasma column with a length L {approx_equal} 14 cm, sustained by wave power of 110 W - the model yields the longitudinal distributions of the plasma density, expended wave power, wave electric field magnitude, and complex wave number.

  5. Computation of eigenfrequencies for equilibrium models including turbulent pressure

    NASA Astrophysics Data System (ADS)

    Sonoi, T.; Belkacem, K.; Dupret, M.-A.; Samadi, R.; Ludwig, H.-G.; Caffau, E.; Mosser, B.

    2017-03-01

    Context. The space-borne missions CoRoT and Kepler have provided a wealth of highly accurate data. However, our inability to properly model the upper-most region of solar-like stars prevents us from making the best of these observations. This problem is called "surface effect" and a key ingredient to solve it is turbulent pressure for the computation of both the equilibrium models and the oscillations. While 3D hydrodynamic simulations help to include properly the turbulent pressure in the equilibrium models, the way this surface effect is included in the computation of stellar oscillations is still subject to uncertainties. Aims: We aim at determining how to properly include the effect of turbulent pressure and its Lagrangian perturbation in the adiabatic computation of the oscillations. We also discuss the validity of the gas-gamma model and reduced gamma model approximations, which have been used to compute adiabatic oscillations of equilibrium models including turbulent pressure. Methods: We use a patched model of the Sun with an inner part constructed by a 1D stellar evolution code (CESTAM) and an outer part by the 3D hydrodynamical code (CO5BOLD). Then, the adiabatic oscillations are computed using the ADIPLS code for the gas-gamma and reduced gamma model approximations and with the MAD code imposing the adiabatic condition on an existing time-dependent convection formalism. Finally, all those results are compared to the observed solar frequencies. Results: We show that the computation of the oscillations using the time-dependent convection formalism in the adiabatic limit improves significantly the agreement with the observed frequencies compared to the gas-gamma and reduced gamma model approximations. Of the components of the perturbation of the turbulent pressure, the perturbation of the density and advection term is found to contribute most to the frequency shift. Conclusions: The turbulent pressure is certainly the dominant factor responsible for the

  6. Braden Scale risk assessments and pressure ulcer prevention planning: what's the connection?

    PubMed

    Magnan, Morris A; Maklebust, Joann

    2009-01-01

    To investigate the relationship between risk assessment scores on Braden subscales and nurses' selection of 10 commonly used best-practice pressure ulcer (PU) preventive interventions. Exploratory secondary data analysis, using a descriptive correlational design. A total of 377 Braden Scale PU risk assessments were made on 102 patients at different levels of risk. Assessments were made by RNs working at 3 different acute care hospitals. RNs making risk assessments also used an intervention checklist to select from 10 commonly used preventive interventions that should be implemented based on patient level of risk on each Braden subscale. The Braden Scale for Predicting Pressure Sore Risk was used to guide risk assessments. The Registered Nurses Intervention Checklist was used to identify PU preventive interventions that should be implemented. Braden subscale ratings influenced nurses' endorsement of preventive interventions in 2 distinct ways. First, endorsement of most (9 out of 10) preventive interventions was influenced by risk information embedded in unique combinations of Braden subscale assessments. Second, there appears to be a predictable pattern of increase in the likelihood of endorsing an intervention as Braden subscale scores decreased and the level of risk increased. Variability in Braden subscale ratings differentially predicts nurses' endorsements of selected PU-prevention interventions. Also, there is a predictable pattern of increase in the likelihood of endorsing a preventive intervention as PU risk levels increase, a pattern that may be related to the timing of risk assessment and PU-prevention planning activities.

  7. 3He Neutron Detector Pressure Effect and Comparison to Models

    SciTech Connect

    Kouzes, Richard T.; Ely, James H.; Lintereur, Azaree T.; Siciliano, Edward R.; Stromswold, David C.; Woodring, Mitchell L.

    2010-01-14

    Reported here are the results of measurements performed to determine the efficiency of 3He filled proportional counters as a function of gas pressure in the SAIC system. Motivation for these measurements was largely to validate the current model of the SAIC system. Those predictions indicated that the neutron detection efficiency plotted as a function of pressure has a simple, logarithmic shape. As for absolute performance, the model results indicated the 3He pressure in the current SAIC system could not be reduced appreciably while meeting the current required level of detection sensitivity. Thus, saving 3He by reducing its pressure was predicted not to be a viable option in the current SAIC system.

  8. Unsteady pressure loads in a generic high speed engine model

    NASA Technical Reports Server (NTRS)

    Parrott, Tony L.; Jones, Michael G.; Thurlow, Ernie M.

    1992-01-01

    Unsteady pressure loads were measured along the top interior wall of a generic high-speed engine (GHSE) model undergoing performance tests in the combustion-Heated Scramjet Test Facility at the Langley Research Center. Flow to the model inlet was simulated at 72000 ft and a flight Mach number of 4. The inlet Mach number was 3.5 with a total temperature and pressure of 1640 R and 92 psia. The unsteady pressure loads were measured with 5 piezoresistive gages, recessed into the wall 4 to 12 gage diameters to reduce incident heat flux to the diaphragms, and distributed from the inlet to the combustor. Contributors to the unsteady pressure loads included boundary layer turbulence, combustion noise, and transients generated by unstart loads. Typical turbulent boundary layer rms pressures in the inlet ranged from 133 dB in the inlet to 181 dB in the combustor over the frequency range from 0 to 5 kHz. Downstream of the inlet exist, combustion noise was shown to dominate boundary layer turbulence noise at increased heat release rates. Noise levels in the isolator section increased by 15 dB when the fuel-air ratio was increased from 0.37 to 0.57 of the stoichiometric ratio. Transient pressure disturbances associated with engine unstarts were measured in the inlet and have an upstream propagation speed of about 7 ft/sec and pressure jumps of at least 3 psia.

  9. Length of surgery and pressure ulcers risk in cardiovascular surgical patients: a dose-response meta-analysis.

    PubMed

    Chen, Hong-Lin; Shen, Wang-Qin; Liu, Peng; Liu, Kun

    2017-03-02

    The aim of this study was to assess the relationship between length of surgery (LOS) and pressure ulcer (PU) risk in cardiovascular surgery patients. PubMed and Web of Science were systematically searched. We compared LOS difference between PU (+) group and PU (-) group. We also examined the dose-response effect of this relationship. The mean LOS in the PU(+) groups ranged from 252·5 to 335·7 minutes, compared with 233·0 to 298·3 minutes in PU(-) groups. The LOS was higher in PU(+) groups compared with PU(-) groups [weighted mean difference (WMD) = 36·081 minutes; 95% CI: 21·640-50·522 minutes; Z = 4·90, P = 0·000]. The funnel plot showed no publication bias. A significant dose-response association was also found between the LOS and the risk of surgery-related pressure ulcers (SRPU, model χ(2)  = 9·29, P = 0·000). In the linear model, the PU OR was 1·296 (95% CI 1·097-1·531) for a 60-minute increase in the LOS intervals and 13·344 (95% CI 2·521-70·636) for a 600-minute increase. In a spline model, the OR of PU increased almost linearly along with the LOS. Our meta-analysis indicated that LOS was an important risk factor for pressure ulcers in cardiovascular surgical patients.

  10. Acute-Phase Blood Pressure Levels Correlate With a High Risk of Recurrent Strokes in Young-Onset Ischemic Stroke.

    PubMed

    Mustanoja, Satu; Putaala, Jukka; Gordin, Daniel; Tulkki, Lauri; Aarnio, Karoliina; Pirinen, Jani; Surakka, Ida; Sinisalo, Juha; Lehto, Mika; Tatlisumak, Turgut

    2016-06-01

    High blood pressure (BP) in acute stroke has been associated with a poor outcome; however, this has not been evaluated in young adults. The relationship between BP and long-term outcome was assessed in 1004 consecutive young, first-ever ischemic stroke patients aged 15 to 49 years enrolled in the Helsinki Young Stroke Registry. BP parameters included systolic (SBP) and diastolic BP, pulse pressure, and mean arterial pressure at admission and 24 hours. The primary outcome measure was recurrent stroke in the long-term follow-up. Adjusted for demographics and preexisting comorbidities, Cox regression models were used to assess independent BP parameters associated with outcome. Of our patients (63% male), 393 patients (39%) had prestroke hypertension and 358 (36%) used antihypertensive treatment. The median follow-up period was 8.9 years (interquartile range 5.7-13.2). Patients with a recurrent stroke (n=142, 14%) had significantly higher admission SBP, diastolic BP, pulse pressure, and mean arterial pressure (P<0.001) and 24-h SBP, diastolic BP, and mean arterial pressure compared with patients without the recurrent stroke. Patients with SBP ≥160 mm Hg compared with those with SBP <160 mm Hg had significantly more recurrent strokes (hazard ratio 3.3 [95% confidence interval, 2.05-4.55]; P<0.001) occurring earlier (13.9 years [13.0-14.6] versus 16.2 [15.8-16.6]; P<0.001) within the follow-up period. In multivariable analyses, higher admission SBP, diastolic BP, pulse pressure, and mean arterial pressure were independently associated with the risk of recurrent stroke, while the 24-hour BP levels were not. In young ischemic stroke patients, high acute phase BP levels are independently associated with a high risk of recurrent strokes. © 2016 American Heart Association, Inc.

  11. Accurate pressure gradient calculations in hydrostatic atmospheric models

    NASA Technical Reports Server (NTRS)

    Carroll, John J.; Mendez-Nunez, Luis R.; Tanrikulu, Saffet

    1987-01-01

    A method for the accurate calculation of the horizontal pressure gradient acceleration in hydrostatic atmospheric models is presented which is especially useful in situations where the isothermal surfaces are not parallel to the vertical coordinate surfaces. The present method is shown to be exact if the potential temperature lapse rate is constant between the vertical pressure integration limits. The technique is applied to both the integration of the hydrostatic equation and the computation of the slope correction term in the horizontal pressure gradient. A fixed vertical grid and a dynamic grid defined by the significant levels in the vertical temperature distribution are employed.

  12. A Modified Pressure-Impulse Blast Damage Model

    DTIC Science & Technology

    1977-01-01

    rndldontffy by b!ock number) ComputerSimulation Iso -DamageModeling StructuralDamageModeling Overpressure Blast Damage ZO.ABSTRACT(==@nJ*UMr-W- ti+~f~ -fd.tuf...11 2. Pressure-Impulse Iso -Damage Model . . . . . . . . . . . . . 13 3. Representation of Youngdahl’s Model...and REPSIL Computer Codes . , . . 29 II. Single Degree-of-Freedom Iso -Damage Data . . . . . . . . 32 III. Five Degree-of-FreedomIso-Damage Data

  13. Blood Pressure Variability and Cardiovascular Risk in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER)

    PubMed Central

    Poortvliet, Rosalinde K. E.; Ford, Ian; Lloyd, Suzanne M.; Sattar, Naveed; Mooijaart, Simon P.; de Craen, Anton J. M.; Westendorp, Rudi G. J.; Jukema, J. Wouter; Packard, Christopher J.; Gussekloo, Jacobijn; de Ruijter, Wouter; Stott, David J.

    2012-01-01

    Variability in blood pressure predicts cardiovascular disease in young- and middle-aged subjects, but relevant data for older individuals are sparse. We analysed data from the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) study of 5804 participants aged 70–82 years with a history of, or risk factors for cardiovascular disease. Visit-to-visit variability in blood pressure (standard deviation) was determined using a minimum of five measurements over 1 year; an inception cohort of 4819 subjects had subsequent in-trial 3 years follow-up; longer-term follow-up (mean 7.1 years) was available for 1808 subjects. Higher systolic blood pressure variability independently predicted long-term follow-up vascular and total mortality (hazard ratio per 5 mmHg increase in standard deviation of systolic blood pressure = 1.2, 95% confidence interval 1.1–1.4; hazard ratio 1.1, 95% confidence interval 1.1–1.2, respectively). Variability in diastolic blood pressure associated with increased risk for coronary events (hazard ratio 1.5, 95% confidence interval 1.2–1.8 for each 5 mmHg increase), heart failure hospitalisation (hazard ratio 1.4, 95% confidence interval 1.1–1.8) and vascular (hazard ratio 1.4, 95% confidence interval 1.1–1.7) and total mortality (hazard ratio 1.3, 95% confidence interval 1.1–1.5), all in long-term follow-up. Pulse pressure variability was associated with increased stroke risk (hazard ratio 1.2, 95% confidence interval 1.0–1.4 for each 5 mmHg increase), vascular mortality (hazard ratio 1.2, 95% confidence interval 1.0–1.3) and total mortality (hazard ratio 1.1, 95% confidence interval 1.0–1.2), all in long-term follow-up. All associations were independent of respective mean blood pressure levels, age, gender, in-trial treatment group (pravastatin or placebo) and prior vascular disease and cardiovascular disease risk factors. Our observations suggest variability in diastolic blood pressure is more strongly associated

  14. Visual Impairment/lntracranial Pressure Risk Clinical Care Data Tools

    NASA Technical Reports Server (NTRS)

    Van Baalen, Mary; Mason, Sara S.; Taiym, Wafa; Wear, Mary L.; Moynihan, Shannan; Alexander, David; Hart, Steve; Tarver, William

    2014-01-01

    Prior to 2010, several ISS crewmembers returned from spaceflight with changes to their vision, ranging from a mild hyperopic shift to frank disc edema. As a result, NASA expanded clinical vision testing to include more comprehensive medical imaging, including Optical Coherence Tomography and 3 Tesla Brain and Orbit MRIs. The Space and Clinical Operations (SCO) Division developed a clinical practice guideline that classified individuals based on their symptoms and diagnoses to facilitate clinical care. For the purposes of clinical surveillance, this classification was applied retrospectively to all crewmembers who had sufficient testing for classification. This classification is also a tool that has been leveraged for researchers to identify potential risk factors. In March 2014, driven in part by a more comprehensive understanding of the imaging data and increased imaging capability on orbit, the SCO Division revised their clinical care guidance to outline in-flight care and increase post-flight follow up. The new clinical guidance does not include a classification scheme

  15. Modelling Unsteady Wall Pressures Beneath Turbulent Boundary Layers

    NASA Technical Reports Server (NTRS)

    Ahn, B-K.; Graham, W. R.; Rizzi, S. A.

    2004-01-01

    As a structural entity of turbulence, hairpin vortices are believed to play a major role in developing and sustaining the turbulence process in the near wall region of turbulent boundary layers and may be regarded as the simplest conceptual model that can account for the essential features of the wall pressure fluctuations. In this work we focus on fully developed typical hairpin vortices and estimate the associated surface pressure distributions and their corresponding spectra. On the basis of the attached eddy model, we develop a representation of the overall surface pressure spectra in terms of the eddy size distribution. Instantaneous wavenumber spectra and spatial correlations are readily derivable from this representation. The model is validated by comparison of predicted wavenumber spectra and cross-correlations with existing emperical models and experimental data.

  16. The incidence, risk factors and characteristics of pressure ulcers in hospitalized patients in China

    PubMed Central

    Jiang, Qixia; Li, Xiaohua; Qu, Xiaolong; Liu, Yun; Zhang, Liyan; Su, Chunyin; Guo, Xiujun; Chen, Yuejuan; Zhu, Yajun; Jia, Jing; Bo, Suping; Liu, Li; Zhang, Rui; Xu, Ling; Wu, Leyan; Wang, Hai; Wang, Jiandong

    2014-01-01

    Pressure ulcers are very common in hospital patients. Though many studies have been reported in many countries, the large-scale benchmarking prevalence of pressure ulcers in China is not available. The aim of this study is to quantify the prevalence of pressure ulcers and the incidence of hospital-acquired pressure ulcers and analyze risk factors in hospitalized patients in China. A multi-central cross-sectional survey was conducted in one university hospital and 11 general hospitals in China. The Minimum Data Set (MDS) recommended by European Pressure Ulcer Advisory Panel (EUPAP) was used to collect information of inpatients. All patients stayed in hospital more than 24 hours and older than 18 years signed consent form and were included. Data from 39952 out of 40415 (98.85%) inpatients were analyzed. Of the 39952 patients, 631 patients (including 1024 locations) had pressure ulcers. The prevalence rate of pressure ulcers in 12 hospitals was 1.58% (0.94-2.97%). The incidence of hospital-acquired pressure ulcers (HAPU) was 0.63% (0.20-1.20%). The most common locations developed pressure ulcers were sacrum, heels, and iliac crests. The common stages of pressure ulcers were stage I and II. Patients in Intensive Care Unit, Geriatric and Neurological Department were easier to develop pressure ulcers. The prevalence and incidence of pressure ulcers in China was lower than that reported in European and other countries. The stages of pressure ulcers in China were different than that reported in European countries. Our study provides with a baseline value for intensive research on pressure ulcer in China. PMID:24966973

  17. The incidence, risk factors and characteristics of pressure ulcers in hospitalized patients in China.

    PubMed

    Jiang, Qixia; Li, Xiaohua; Qu, Xiaolong; Liu, Yun; Zhang, Liyan; Su, Chunyin; Guo, Xiujun; Chen, Yuejuan; Zhu, Yajun; Jia, Jing; Bo, Suping; Liu, Li; Zhang, Rui; Xu, Ling; Wu, Leyan; Wang, Hai; Wang, Jiandong

    2014-01-01

    Pressure ulcers are very common in hospital patients. Though many studies have been reported in many countries, the large-scale benchmarking prevalence of pressure ulcers in China is not available. The aim of this study is to quantify the prevalence of pressure ulcers and the incidence of hospital-acquired pressure ulcers and analyze risk factors in hospitalized patients in China. A multi-central cross-sectional survey was conducted in one university hospital and 11 general hospitals in China. The Minimum Data Set (MDS) recommended by European Pressure Ulcer Advisory Panel (EUPAP) was used to collect information of inpatients. All patients stayed in hospital more than 24 hours and older than 18 years signed consent form and were included. Data from 39952 out of 40415 (98.85%) inpatients were analyzed. Of the 39952 patients, 631 patients (including 1024 locations) had pressure ulcers. The prevalence rate of pressure ulcers in 12 hospitals was 1.58% (0.94-2.97%). The incidence of hospital-acquired pressure ulcers (HAPU) was 0.63% (0.20-1.20%). The most common locations developed pressure ulcers were sacrum, heels, and iliac crests. The common stages of pressure ulcers were stage I and II. Patients in Intensive Care Unit, Geriatric and Neurological Department were easier to develop pressure ulcers. The prevalence and incidence of pressure ulcers in China was lower than that reported in European and other countries. The stages of pressure ulcers in China were different than that reported in European countries. Our study provides with a baseline value for intensive research on pressure ulcer in China.

  18. Clinical Evaluation of a New Pressure Ulcer Risk Assessment Instrument, the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE T).

    PubMed

    Coleman, Susanne; Smith, Isabelle L; McGinnis, Elizabeth; Keen, Justin; Muir, Delia; Wilson, Lyn; Stubbs, Nikki; Dealey, Carol; Brown, Sarah; Nelson, E Andrea; Nixon, Jane

    2017-08-23

    To test the psychometric properties and clinical usability of a new Pressure Ulcer Risk Assessment Instrument including inter-rater and test-retest reliability, convergent validity and data completeness. Methodological and practical limitations associated with traditional Pressure Ulcer Risk Assessment Instruments, prompted a programme to work to develop a new instrument, as part of the National Institute for Health Research funded, Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056). Observational field test. For this clinical evaluation 230 patients were purposefully sampled across four broad levels of pressure ulcer risk with representation from 4 secondary care and 4 community NHS Trusts in England. Blinded and simultaneous paired (ward/community nurse and expert nurse) PURPOSE-T assessments were undertaken. Follow-up retest was undertaken by the expert nurse. Field notes of PURPOSE-T use were collected. Data were collected October 2012-Jan 2013. The clinical evaluation demonstrated 'very good' (kappa) inter-rater and test-retest agreement for PURPOSE-T assessment decision overall. The percentage agreement for 'problem/no problem' was over 75% for the main risk factors. Convergent validity demonstrated moderate to high associations with other measures of similar constructs. The PURPOSE-T evaluation facilitated the initial validation and clinical usability of the instrument and demonstrated that PURPOSE-T is suitable of use in clinical practice. Further study is needed to evaluate the impact of using the instrument on care processes and outcomes. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  19. Association Between Blood Pressure Control and Risk of Recurrent Intracerebral Hemorrhage.

    PubMed

    Biffi, Alessandro; Anderson, Christopher D; Battey, Thomas W K; Ayres, Alison M; Greenberg, Steven M; Viswanathan, Anand; Rosand, Jonathan

    2015-09-01

    Intracerebral hemorrhage (ICH) is the most severe form of stroke. Survivors are at high risk of recurrence, death, and worsening functional disability. To investigate the association between blood pressure (BP) after index ICH and risk of recurrent ICH. Single-site, tertiary care referral center observational study of 1145 of 2197 consecutive patients with ICH presenting from July 1994 to December 2013. A total of 1145 patients with ICH survived at least 90 days and were followed up through December 2013 (median follow-up of 36.8 months [minimum, 9.8 months]). Blood pressure measurements at 3, 6, 9, and 12 months, and every 6 months thereafter, obtained from medical personnel (inpatient hospital or outpatient clinic medical or nursing staff) or via patient self-report. Exposure was characterized in 3 ways: (1) recorded systolic and diastolic measurements; (2) classification as adequate or inadequate BP control based on American Heart Association/American Stroke Association recommendations; and (3) stage of hypertension based on Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 7 criteria. Recurrent ICH and its location within the brain (lobar vs nonlobar). There were 102 recurrent ICH events among 505 survivors of lobar ICH and 44 recurrent ICH events among 640 survivors of nonlobar ICH. During follow-up adequate BP control was achieved on at least 1 measurement by 625 patients (54.6% of total [range, 49.2%-58.7%]) and consistently (ie, at all available time points) by 495 patients (43.2% of total [range, 34.5%-51.0%]). The event rate for lobar ICH was 84 per 1000 person-years among patients with inadequate BP control compared with 49 per 1000 person-years among patients with adequate BP control. For nonlobar ICH the event rate was 52 per 1000 person-years with inadequate BP control compared with 27 per 1000 person-years for patients with adequate BP control. In analyses modeling BP control as a time

  20. Association Between Blood Pressure Control and Risk of Recurrent Intracerebral Hemorrhage

    PubMed Central

    Biffi, Alessandro; Anderson, Christopher D.; Battey, Thomas W. K.; Ayres, Alison M.; Greenberg, Steven M.; Viswanathan, Anand; Rosand, Jonathan

    2016-01-01

    IMPORTANCE Intracerebral hemorrhage (ICH) is the most severe form of stroke. Survivors are at high risk of recurrence, death, and worsening functional disability. OBJECTIVE To investigate the association between blood pressure (BP) after index ICH and risk of recurrent ICH. DESIGN, SETTING, AND PARTICIPANTS Single-site, tertiary care referral center observational study of 1145 of 2197 consecutive patients with ICH presenting from July 1994 to December 2013. A total of 1145 patients with ICH survived at least 90 days and were followed up through December 2013 (median follow-up of 36.8 months [minimum, 9.8 months]). EXPOSURES Blood pressure measurements at 3, 6, 9, and 12 months, and every 6 months thereafter, obtained from medical personnel (inpatient hospital or outpatient clinic medical or nursing staff) or via patient self-report. Exposure was characterized in 3 ways: (1) recorded systolic and diastolic measurements; (2) classification as adequate or inadequate BP control based on American Heart Association/American Stroke Association recommendations; and (3) stage of hypertension based on Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 7 criteria. MAIN OUTCOMES AND MEASURES Recurrent ICH and its location within the brain (lobar vs nonlobar). RESULTS There were 102 recurrent ICH events among 505 survivors of lobar ICH and 44 recurrent ICH events among 640 survivors of nonlobar ICH. During follow-up adequate BP control was achieved on at least 1 measurement by 625 patients (54.6% of total [range, 49.2%-58.7%]) and consistently (ie, at all available time points) by 495 patients (43.2% of total [range, 34.5%-51.0%]). The event rate for lobar ICH was 84 per 1000 person-years among patients with inadequate BP control compared with 49 per 1000 person-years among patients with adequate BP control. For nonlobar ICH the event rate was 52 per 1000 person-years with inadequate BP control compared with 27 per 1000 person

  1. Peripheral Edema, Central Venous Pressure, and Risk of AKI in Critical Illness

    PubMed Central

    Chen, Kenneth P.; Cavender, Susan; Lee, Joon; Feng, Mengling; Mark, Roger G.; Celi, Leo Anthony; Mukamal, Kenneth J.

    2016-01-01

    Background and objectives Although venous congestion has been linked to renal dysfunction in heart failure, its significance in a broader context has not been investigated. Design, setting, participants, & measurements Using an inception cohort of 12,778 critically ill adult patients admitted to an urban tertiary medical center between 2001 and 2008, we examined whether the presence of peripheral edema on admission physical examination was associated with an increased risk of AKI within the first 7 days of critical illness. In addition, in those with admission central venous pressure (CVP) measurements, we examined the association of CVPs with subsequent AKI. AKI was defined using the Kidney Disease Improving Global Outcomes criteria. Results Of the 18% (n=2338) of patients with peripheral edema on admission, 27% (n=631) developed AKI, compared with 16% (n=1713) of those without peripheral edema. In a model that included adjustment for comorbidities, severity of illness, and the presence of pulmonary edema, peripheral edema was associated with a 30% higher risk of AKI (95% confidence interval [95% CI], 1.15 to 1.46; P<0.001), whereas pulmonary edema was not significantly related to risk. Peripheral edema was also associated with a 13% higher adjusted risk of a higher AKI stage (95% CI, 1.07 to 1.20; P<0.001). Furthermore, levels of trace, 1+, 2+, and 3+ edema were associated with 34% (95% CI, 1.10 to 1.65), 17% (95% CI, 0.96 to 1.14), 47% (95% CI, 1.18 to 1.83), and 57% (95% CI, 1.07 to 2.31) higher adjusted risk of AKI, respectively, compared with edema-free patients. In the 4761 patients with admission CVP measurements, each 1 cm H2O higher CVP was associated with a 2% higher adjusted risk of AKI (95% CI, 1.00 to 1.03; P=0.02). Conclusions Venous congestion, as manifested as either peripheral edema or increased CVP, is directly associated with AKI in critically ill patients. Whether treatment of venous congestion with diuretics can modify this risk will require

  2. Modeling a Transient Pressurization with Active Cooling Sizing Tool

    NASA Technical Reports Server (NTRS)

    Guzik, Monica C.; Plachta, David W.; Elchert, Justin P.

    2011-01-01

    As interest in the area of in-space zero boil-off cryogenic propellant storage develops, the need to visualize and quantify cryogen behavior during ventless tank self-pressurization and subsequent cool-down with active thermal control has become apparent. During the course of a mission, such as the launch ascent phase, there are periods that power to the active cooling system will be unavailable. In addition, because it is not feasible to install vacuum jackets on large propellant tanks, as is typically done for in-space cryogenic applications for science payloads, instances like the launch ascent heating phase are important to study. Numerous efforts have been made to characterize cryogenic tank pressurization during ventless cryogen storage without active cooling, but few tools exist to model this behavior in a user-friendly environment for general use, and none exist that quantify the marginal active cooling system size needed for power down periods to manage tank pressure response once active cooling is resumed. This paper describes the Transient pressurization with Active Cooling Tool (TACT), which is based on a ventless three-lump homogeneous thermodynamic self-pressurization model1 coupled with an active cooling system estimator. TACT has been designed to estimate the pressurization of a heated but unvented cryogenic tank, assuming an unavailable power period followed by a given cryocooler heat removal rate. By receiving input data on the tank material and geometry, propellant initial conditions, and passive and transient heating rates, a pressurization and recovery profile can be found, which establishes the time needed to return to a designated pressure. This provides the ability to understand the effect that launch ascent and unpowered mission segments have on the size of an active cooling system. A sample of the trends found show that an active cooling system sized for twice the steady state heating rate would results in a reasonable time for tank

  3. The effect of nimodipine on intracranial pressure. Volume-pressure studies in a primate model.

    PubMed

    Hadley, M N; Spetzler, R F; Fifield, M S; Bichard, W D; Hodak, J A

    1987-09-01

    Nimodipine was administered by intravenous infusion to six male baboons before, during, and after 6 hours of middle cerebral artery occlusion. Intracranial pressure (ICP) and systemic blood pressure were monitored continuously. An epidural balloon was inflated at regular intervals at three levels of arterial CO2 tension (25, 35, and 50 mm Hg) before and after the administration of nimodipine, and volume-pressure curves were generated. In every case, curves generated after intravenous nimodipine infusion were lower and shifted more to the right than the same set of curves generated before nimodipine administration, regardless of the baseline ICP. The reduction in ICP following nimodipine infusion was not due to a reduction in mean arterial blood pressure and was statistically significant at all three levels of pCO2 (p less than 0.01). These results suggest that, in the presence of elevated ICP due to cerebral infarction, there is no increased risk of exacerbating intracranial hypertension with the addition of nimodipine.

  4. Justification pressure in risky decision making: search for risk defusing operators.

    PubMed

    Huber, Oswald; Bär, Arlette S; Huber, Odilo W

    2009-01-01

    Under justification pressure, the decision maker knows in advance that the decision has to be justified to somebody afterwards. The effect of justification pressure on the search for risk defusing operators (RDOs) and the role of RDOs in the justification texts were investigated. An RDO is an action intended by the decision maker to be performed in addition to an otherwise attractive alternative to decrease the risk. As predicted, in Experiment 1 participants (60 non-students) under justification pressure searched more RDOs. Additionally, in Experiment 2 (80 non-students) RDO search success was varied. Under justification pressure, persistence of RDO search was higher when no RDO could be detected. In the justification texts, the existence or non-existence of RDOs played a prominent role. Searching for RDOs supports people in their goal to make a good decision and in their attempt to convince the addressee of their justification that the decision was good.

  5. The relationship among pressure ulcer risk factors, incidence and nursing documentation in hospital-acquired pressure ulcer patients in intensive care units.

    PubMed

    Li, Dan

    2016-08-01

    To explore the quality/comprehensiveness of nursing documentation of pressure ulcers and to investigate the relationship between the nursing documentation and the incidence of pressure ulcers in four intensive care units. Pressure ulcer prevention requires consistent assessments and documentation to decrease pressure ulcer incidence. Currently, most research is focused on devices to prevent pressure ulcers. Studies have rarely considered the relationship among pressure ulcer risk factors, incidence and nursing documentation. Thus, a study to investigate this relationship is needed to fill this information gap. A retrospective, comparative, descriptive, correlational study. A convenience sample of 196 intensive care units patients at the selected medical centre comprised the study sample. All medical records of patients admitted to intensive care units between the time periods of September 1, 2011 through September 30, 2012 were audited. Data used in the analysis included 98 pressure ulcer patients and 98 non-pressure ulcer patients. The quality and comprehensiveness of pressure ulcer documentation were measured by the modified European Pressure Ulcer Advisory Panel Pressure Ulcers Assessment Instrument and the Comprehensiveness in Nursing Documentation instrument. The correlations between quality/comprehensiveness of pressure ulcer documentation and incidence of pressure ulcers were not statistically significant. Patients with pressure ulcers had longer length of stay than patients without pressure ulcers stay. There were no statistically significant differences in quality/comprehensiveness scores of pressure ulcer documentation between dayshift and nightshift. This study revealed a lack of quality/comprehensiveness in nursing documentation of pressure ulcers. This study demonstrates that staff nurses often perform poorly on documenting pressure ulcer appearance, staging and treatment. Moreover, nursing documentation of pressure ulcers does not provide a complete

  6. Root Caries Risk Indicators: A Systematic Review of Risk Models

    PubMed Central

    Ritter, André V.; Shugars, Daniel A.; Bader, James D.

    2010-01-01

    Objective To identify risk indicators that are associated with root caries incidence in published predictive risk models. Methods Abstracts (n=472) identified from a MEDLINE, EMBASE, and Cochrane registry search were screened independently by two investigators to exclude articles not in English (n=39), published prior to 1970 (none), or containing no information on either root caries incidence, risk indicators, or risk models (n=209). A full-article duplicate review of the remaining articles (n=224) selected those reporting predictive risk models based on original/primary longitudinal root caries incidence studies. The quality of the included articles was assessed based both on selected criteria of methodological standards for observational studies and on the statistical quality of the modeling strategy. Data from these included studies were extracted and compiled into evidence tables, which included information about the cohort location, incidence period, sample size, age of the study participants, risk indicators included in the model, root caries incidence, modeling strategy, significant risk indicators/predictors, and parameter estimates and statistical findings. Results Thirteen articles were selected for data extraction. The overall quality of the included articles was poor to moderate. Root caries incidence ranged fro m 12%–77% (mean±SD=45%±17%); follow-up time of the published studies was ≤10 years (range=9; median=3); sample size ranged from 23–723 (mean±SD=264±203; median=261); person-years ranged from 23–1540 (mean±SD=760±556; median=746). Variables most frequently tested and significantly associated with root caries incidence were (times tested; % significant; directionality): baseline root caries (12; 58%; positive); number of teeth (7; 71%; 3 times positive, twice negative), and plaque index (4; 100%; positive). Ninety-two other clinical and non-clinical variables were tested: 27 were tested 3 times or more and were significant between 9

  7. Home, automated office, and conventional office blood pressure as predictors of cardiovascular risk.

    PubMed

    Andreadis, Emmanuel A; Papademetriou, Vasilios; Geladari, Charalampia V; Kolyvas, George N; Angelopoulos, Epameinondas T; Aronis, Konstantinos N

    2017-02-03

    Automated office blood pressure (AOBP) has recently been shown to closely predict cardiovascular (CV) events in the elderly. Home blood pressure (HBP) has also been accepted as a valuable method in the prediction of CV disease. This study aimed to compare conventional office BP (OBP), HBP, and AOBP in order to evaluate their value in predicting CV events and deaths in hypertensives. We assessed 236 initially treatment naïve hypertensives, examined between 2009 and 2013. The end points were any CV and non-CV event including mortality, myocardial infarction, coronary heart disease, hospitalization for heart failure, severe arrhythmia, stroke, and intermittent claudication. We fitted proportional hazards models using the different modalities as predictors and evaluated their predictive performance using three metrics: time-dependent receiver operating characteristics curves, the Akaike's Information Criterion, and Harrell's C-index. After a mean follow-up of 7 years, 23 participants (39% women) had experienced ≥1 CV event. Conventional office systolic (hazard ratio [HR] per 1 mm Hg increase in BP, 1.028; 95% confidence interval [CI], 1.009-1.048), automated office systolic (HR per 1 mm Hg increase in BP, 1.031; 95% CI, 1.008-1.054), and home systolic (HR, 1.025; 95% CI, 1.003-1.047) were predictive of CV events. All systolic BP measurements were predictive after adjustment for other CV risk factors (P < .05). The predictive performance of the different modalities was similar. Conventional OBP was significantly higher than AOBP and average HBP. AOBP predicts equally well to OBP and HBP CV events. It appears to be comparable to HBP in the assessment of CV risk, and therefore, its introduction into guidelines and clinical practice as the reference method for assessing BP in the office seems reasonable after verification of these findings by randomized trials.

  8. Modeling conductive heat transfer during high-pressure thawing processes: determination of latent heat as a function of pressure.

    PubMed

    Denys, S; Van Loey, A M; Hendrickx, M E

    2000-01-01

    A numerical heat transfer model for predicting product temperature profiles during high-pressure thawing processes was recently proposed by the authors. In the present work, the predictive capacity of the model was considerably improved by taking into account the pressure dependence of the latent heat of the product that was used (Tylose). The effect of pressure on the latent heat of Tylose was experimentally determined by a series of freezing experiments conducted at different pressure levels. By combining a numerical heat transfer model for freezing processes with a least sum of squares optimization procedure, the corresponding latent heat at each pressure level was estimated, and the obtained pressure relation was incorporated in the original high-pressure thawing model. Excellent agreement with the experimental temperature profiles for both high-pressure freezing and thawing was observed.

  9. Analytical model for non-thermal pressure in galaxy clusters

    NASA Astrophysics Data System (ADS)

    Shi, Xun; Komatsu, Eiichiro

    2014-07-01

    Non-thermal pressure in the intracluster gas has been found ubiquitously in numerical simulations, and observed indirectly. In this paper we develop an analytical model for intracluster non-thermal pressure in the virial region of relaxed clusters. We write down and solve a first-order differential equation describing the evolution of non-thermal velocity dispersion. This equation is based on insights gained from observations, numerical simulations, and theory of turbulence. The non-thermal energy is sourced, in a self-similar fashion, by the mass growth of clusters via mergers and accretion, and dissipates with a time-scale determined by the turnover time of the largest turbulence eddies. Our model predicts a radial profile of non-thermal pressure for relaxed clusters. The non-thermal fraction increases with radius, redshift, and cluster mass, in agreement with numerical simulations. The radial dependence is due to a rapid increase of the dissipation time-scale with radii, and the mass and redshift dependence comes from the mass growth history. Combing our model for the non-thermal fraction with the Komatsu-Seljak model for the total pressure, we obtain thermal pressure profiles, and compute the hydrostatic mass bias. We find typically 10 per cent bias for the hydrostatic mass enclosed within r500.

  10. A simplified model of high pressure spray combustion

    NASA Technical Reports Server (NTRS)

    Mao, C.-P.; Wakamatsu, Y.; Faeth, G. M.

    1981-01-01

    A simplified model of high-pressure spray combustion is examined. The analysis relies on a kappa-epsilon-g turbulence model in conjunction with the locally homogeneous flow (LHF) approximation of two-phase flow, which implies infinitely fast transport rates between the phases. High-pressure phenomena near the thermodynamic critical point are treated using the Redlich-Kwong equation of state. Predictions are compared with existing measurements of spray boundaries in a pressure-atomized n-pentane spray (Sauter mean diameter, approximately 30 microns) burning in stagnant air at 3, 6, and 9 MPa. The LHF model overestimates the rate of development of the flow, yielding spray lengths roughly 20% shorter than measured. Calibrated drop-life-history calculations suggest that finite interphase transport rates are the primary cause of the discrepancy.

  11. Understanding the risk factors of trauma center closures: do financial pressure and community characteristics matter?

    PubMed

    Shen, Yu-Chu; Hsia, Renee Y; Kuzma, Kristen

    2009-09-01

    We analyze whether hazard rates of shutting down trauma centers are higher due to financial pressures or in areas with vulnerable populations (such as minorities or the poor). This is a retrospective study of all hospitals with trauma center services in urban areas in the continental US between 1990 and 2005, identified from the American Hospital Association Annual Surveys. These data were linked with Medicare cost reports, and supplemented with other sources, including the Area Resource File. We analyze the hazard rates of trauma center closures among several dimensions of risk factors using discrete-time proportional hazard models. The number of trauma center closures increased from 1990 to 2005, with a total of 339 during this period. The hazard rate of closing trauma centers in hospitals with a negative profit margin is 1.38 times higher than those hospitals without the negative profit margin (P < 0.01). Hospitals receiving more generous Medicare reimbursements face a lower hazard of shutting down trauma centers (ratio: 0.58, P < 0.01) than those receiving below average reimbursement. Hospitals in areas with higher health maintenance organizations penetration face a higher hazard of trauma center closure (ratio: 2.06, P < 0.01). Finally, hospitals in areas with higher shares of minorities face a higher risk of trauma center closure (ratio: 1.69, P < 0.01). Medicaid load and uninsured populations, however, are not risk factors for higher rates of closure after we control for other financial and community characteristics. Our findings give an indication on how the current proposals to cut public spending could exacerbate the trauma closure particularly among areas with high shares of minorities. In addition, given the negative effect of health maintenance organizations on trauma center survival, the growth of Medicaid managed care population should be monitored. Finally, high shares of Medicaid or uninsurance by themselves are not independent risk factors for

  12. A methodology for modeling regional terrorism risk.

    PubMed

    Chatterjee, Samrat; Abkowitz, Mark D

    2011-07-01

    Over the past decade, terrorism risk has become a prominent consideration in protecting the well-being of individuals and organizations. More recently, there has been interest in not only quantifying terrorism risk, but also placing it in the context of an all-hazards environment in which consideration is given to accidents and natural hazards, as well as intentional acts. This article discusses the development of a regional terrorism risk assessment model designed for this purpose. The approach taken is to model terrorism risk as a dependent variable, expressed in expected annual monetary terms, as a function of attributes of population concentration and critical infrastructure. This allows for an assessment of regional terrorism risk in and of itself, as well as in relation to man-made accident and natural hazard risks, so that mitigation resources can be allocated in an effective manner. The adopted methodology incorporates elements of two terrorism risk modeling approaches (event-based models and risk indicators), producing results that can be utilized at various jurisdictional levels. The validity, strengths, and limitations of the model are discussed in the context of a case study application within the United States.

  13. A prediction model of blood pressure for telemedicine.

    PubMed

    Kwong, Enid Wai-Yung; Wu, Hao; Pang, Grantham Kwok-Hung

    2016-08-04

    This paper presents a new study based on a machine learning technique, specifically an artificial neural network, for predicting systolic blood pressure through the correlation of variables (age, BMI, exercise level, alcohol consumption level, smoking status, stress level, and salt intake level). The study was carried out using a database containing a variety of variables/factors. Each database of raw data was split into two parts: one part for training the neural network and the remaining part for testing the performance of the network. Two neural network algorithms, back-propagation and radial basis function, were used to construct and validate the prediction system. According to the experiment, the accuracy of our predictions of systolic blood pressure values exceeded 90%. Our experimental results show that artificial neural networks are suitable for modeling and predicting systolic blood pressure. This new method of predicting systolic blood pressure helps to give an early warning to adults, who may not get regular blood pressure measurements that their blood pressure might be at an unhealthy level. Also, because an isolated measurement of blood pressure is not always very accurate due to daily fluctuations, our predictor can provide the predicted value as another figure for medical staff to refer to. © The Author(s) 2016.

  14. Using the Care Dependency Scale for identifying patients at risk for pressure ulcer.

    PubMed

    Dijkstra, Ate; Kazimier, Hetty; Halfens, Ruud J G

    2015-11-01

    The aim of this study was to evaluate risk screening for pressure ulcer by using the Care Dependency Scale (CDS) for patients receiving home care or admitted to a residential or nursing home in the Netherlands. Pressure ulcer is a serious and persistent problem for patients throughout the Western world. Pressure ulcer is among the most common adverse events in nursing practice and when a pressure ulcer occurs it has many consequences for patients and healthcare professionals. Cross-sectional design. The convenience sample consisted of 13,633 study participants, of whom 2639 received home care from 15 organisations, 4077 were patients from 67 residential homes and 6917 were admitted in 105 nursing homes. Data were taken from the Dutch National Prevalence Survey of Care Problems that was carried out in April 2012 in Dutch healthcare settings. For the three settings, cut-off points above 80% sensitivity were established, while in the residential home sample an almost 60% combined specificity score was identified. The CDS items 'Body posture' (home care), 'Getting dressed and undressed' (residential homes) and 'Mobility' (nursing homes) were the most significant variables which affect PU. The CDS is able to distinguish between patients at risk for pressure ulcer development and those not at risk in both home care and residential care settings. In nursing homes, the usefulness of the CDS for pressure ulcer detection is limited. © 2015 John Wiley & Sons Ltd.

  15. Pressure Ulcer Prevalence and Risk Factors among Prolonged Surgical Procedures in the OR

    PubMed Central

    Primiano, Mike; Friend, Michael; McClure, Connie; Nardi, Scott; Fix, Lisa; Schafer, Marianne; Savochka, Kathlyn; McNett, Molly

    2015-01-01

    Pressure ulcer formation related to positioning in the OR increases length of hospital stay and hospital costs, but there is little evidence documenting how positioning devices used in the OR influence pressure ulcer development when examined with traditional risk factors. The aim of this prospective cohort study was to identify prevalence of and risk factors associated with pressure ulcer development among patients undergoing surgical procedures lasting longer than three hours. Participants included all adult same-day admit patients scheduled for a three-hour surgical procedure during an eight-month period (N = 258). Data were gathered preoperatively, intraoperatively, and postoperatively on pressure ulcer risk factors. Bivariate analyses indicated that the type of positioning (ie, heels elevated) (χ2 = 7.897, P = .048), OR bed surface (ie, foam table pad) (χ2 15.848, P = .000), skin assessment in the postanesthesia care unit (χ2 = 41.652, P = .000), and male gender (χ2 = 6.984, P = .030) were associated with pressure ulcer development. Logistic regression analyses indicated that use of foam pad (B = 2.691, P = .024) and a lower day-one Braden score (B = .244, P = .003) were predictive of pressure ulcers. PMID:22118201

  16. Blood pressure and associated cardiovascular risk factors in adolescents of Mexico City.

    PubMed

    Juárez-Rojas, Juan Gabriel; Cardoso-Saldaña, Guillermo C; Posadas-Sánchez, Rosalinda; Medina-Urrutia, Aída Xochitl; Yamamoto-Kimura, Liria; Posadas-Romero, Carlos

    2008-01-01

    To determine the prevalence of high blood pressure and associated cardiovascular risk factors in Mexican adolescents. A cross-sectional study was conducted in 770 male and 1076 female students (12 to 16 years old) from eight randomly selected high schools in Mexico City. Anthropometry, blood pressure and fasting lipids and lipoproteins were measured. Blood pressure levels were adjusted for age, gender, and height. The prevalence rates of hypertension (systolic blood pressure (SBP) and/or diastolic (DBP) > or =95th percentile), and pre-hypertension (SBP or DBP > or =90th but <95th percentile) were 10.6 and 10%, respectively. Compared to normotensive subjects, those with high blood pressure showed a significantly higher prevalence of obesity, overweight, and dyslipidemia. A stepwise multiple regression analysis showed that waist (18.3%), Tanner stage (4.7%), age (2.1%), gender (0.6%), and body mass index (BMI, 0.3%) accounted for 26% of the variance in SBP; whereas BMI (8.7%), age (4.8%), Tanner stage (1.7%), waist (0.4%), and gender (0.4%) accounted for 15.9% of the variance in DBP. These results reveal a high prevalence of high blood pressure in adolescents living in Mexico City. Prehypertensive and hypertensive subjects showed a higher prevalence of cardiovascular risk factors, suggesting that, as adults, these adolescents will be at a higher risk of developing cardiovascular disease.

  17. An interrater reliability study of the assessment of pressure ulcer risk using the Braden scale and the classification of pressure ulcers in a home care setting.

    PubMed

    Kottner, Jan; Halfens, Ruud; Dassen, Theo

    2009-10-01

    Measurement error can seriously affect the validity of pressure ulcer risk assessment and of pressure ulcer classification. Determination of interrater reliability and agreement of pressure ulcer risk and pressure ulcers using the Braden scale and the EPUAP system. Duplicate assessments by trained nurses during two nationwide pressure ulcer prevalence surveys in the years 2007 and 2008 in The Netherlands in the home care setting. Home care clients which participated in 2007 (n=352) and 2008 (n=339) in the pressure ulcer prevalence surveys. The Braden scale was used to assess pressure ulcer risk. Skin examination was conducted to detect pressure related tissue damages and to classify them according to the EPUAP. In 2007 and 2008, Intraclass Correlation Coefficients for Braden scale sum scores were 0.90 (95% CI: 0.88-0.92) and 0.88 (95% CI: 0.85-0.91) respectively, and corresponding Standard Errors of Measurement were 1.00 and 0.98. 95% limits of agreement were -2.8 to 2.8 and -2.7 to 2.7 respectively. The items "moisture", "sensory perception" and "nutrition" contained largest amounts of measurement error. Proportions of agreement for the classification of pressure ulcers were 96% and interrater reliability was 0.81 and 0.79. Most disagreements were observed for the classification of grade 1 pressure ulcers. The standardized study procedure applied in the annual nationwide pressure ulcer prevalence surveys leads to reliable and reproducible results regarding pressure ulcer risk and pressure ulcer prevalence in the home care setting. Researchers and practitioners should be careful when drawing inferences from single pressure ulcer risk factors included in the Braden scale. Descriptions of the items "moisture", "sensory perception" and "nutrition" should be made more clearly and unambiguous.

  18. Tyre pressure monitoring using a dynamical model-based estimator

    NASA Astrophysics Data System (ADS)

    Reina, Giulio; Gentile, Angelo; Messina, Arcangelo

    2015-04-01

    In the last few years, various control systems have been investigated in the automotive field with the aim of increasing the level of safety and stability, avoid roll-over, and customise handling characteristics. One critical issue connected with their integration is the lack of state and parameter information. As an example, vehicle handling depends to a large extent on tyre inflation pressure. When inflation pressure drops, handling and comfort performance generally deteriorate. In addition, it results in an increase in fuel consumption and in a decrease in lifetime. Therefore, it is important to keep tyres within the normal inflation pressure range. This paper introduces a model-based approach to estimate online tyre inflation pressure. First, basic vertical dynamic modelling of the vehicle is discussed. Then, a parameter estimation framework for dynamic analysis is presented. Several important vehicle parameters including tyre inflation pressure can be estimated using the estimated states. This method aims to work during normal driving using information from standard sensors only. On the one hand, the driver is informed about the inflation pressure and he is warned for sudden changes. On the other hand, accurate estimation of the vehicle states is available as possible input to onboard control systems.

  19. Importance of sustained and "tight" blood pressure control in patients with high cardiovascular risk.

    PubMed

    Meredith, Peter A; Lloyd, Suzanne M; Ford, Ian; Elliott, Henry L

    2016-01-01

    A retrospective further analysis of the ACTION database evaluated the relationship between cardiovascular outcomes and the "quality" of the control of blood pressure (BP). The study population (n = 6287) comprised those patients with four BP measurements during year 1 subdivided according to the proportion of visits in which BP was controlled in relation to two BP targets: < 140/90mmHg and < 130/80 mmHg. Differences between the BP control groups for the major prespecified ACTION outcomes were investigated with Cox proportional hazards models. For all the prespecified cardiovascular endpoints the incidence declined as the proportion of visits with BP control increased. The greatest differences in outcomes between the different BP control groups were observed for the risk of stroke but were still apparent for all the other endpoints. For example, the risks for the primary outcome [hazard ratio (HR) 0.78; 95% confidence interval (CI) 0.67 to 0.90] were significantly less in the group with >_75% of visits with BP control than in the group with < 25% of visits with BP control. There were no significant treatment-related differences. Retrospective analyses are not definitive but these results highlight the importance of the attainment of BP control targets and the consistency of BP control during long-term follow-up.

  20. Predictive risk models for proximal aortic surgery

    PubMed Central

    Díaz, Rocío; Pascual, Isaac; Álvarez, Rubén; Alperi, Alberto; Rozado, Jose; Morales, Carlos; Silva, Jacobo; Morís, César

    2017-01-01

    Predictive risk models help improve decision making, information to our patients and quality control comparing results between surgeons and between institutions. The use of these models promotes competitiveness and led to increasingly better results. All these virtues are of utmost importance when the surgical operation entails high-risk. Although proximal aortic surgery is less frequent than other cardiac surgery operations, this procedure itself is more challenging and technically demanding than other common cardiac surgery techniques. The aim of this study is to review the current status of predictive risk models for patients who undergo proximal aortic surgery, which means aortic root replacement, supracoronary ascending aortic replacement or aortic arch surgery. PMID:28616348

  1. Predictive risk models for proximal aortic surgery.

    PubMed

    Hernandez-Vaquero, Daniel; Díaz, Rocío; Pascual, Isaac; Álvarez, Rubén; Alperi, Alberto; Rozado, Jose; Morales, Carlos; Silva, Jacobo; Morís, César

    2017-05-01

    Predictive risk models help improve decision making, information to our patients and quality control comparing results between surgeons and between institutions. The use of these models promotes competitiveness and led to increasingly better results. All these virtues are of utmost importance when the surgical operation entails high-risk. Although proximal aortic surgery is less frequent than other cardiac surgery operations, this procedure itself is more challenging and technically demanding than other common cardiac surgery techniques. The aim of this study is to review the current status of predictive risk models for patients who undergo proximal aortic surgery, which means aortic root replacement, supracoronary ascending aortic replacement or aortic arch surgery.

  2. Model-Based, Noninvasive Monitoring of Intracranial Pressure

    DTIC Science & Technology

    2013-07-01

    are twice as good as in our earlier validation studies. 15. SUBJECT TERMS Intracranial pressure (ICP), noninvasive monitoring, cerebrovascular model...of these waveforms exploits a simplified dynamic model of cerebrovascular physiology that relates the measured signals to ICP [1, 2, 3]. Validation...aggregated mechanistic model of the cerebrovascular space. Figure 2.2.1 shows successive abstractions of the relevant physiology, resulting in the circuit

  3. Study on Calculation Model of Culvert Soil Pressure

    NASA Astrophysics Data System (ADS)

    Liu, Jing; Tian, Xiao-yan; Gao, Xiao-mei

    2017-09-01

    Culvert diseases are prevalent in highway engineering. There are many factors involved in the occurrence of the disease, and the problem is complex. However, the design cannot accurately determine the role of the soil pressure on the culvert is the main reason to the disease. Based on the theoretical analysis and field test, this paper studies the characteristics of the stress and deformation of the culvert-soil structure. According to the theory of soil mechanics, the calculation model of vertical soil pressure at the top of culvert is determined, and the formula of vertical soil pressure at the top of culvert is deduced. Through the field test of the vertical soil pressure at the top of culvert of several engineering examples, the calculation formula of this paper is verified, which can provide reference for future practical engineering.

  4. Nonlinear model predictive control of managed pressure drilling.

    PubMed

    Nandan, Anirudh; Imtiaz, Syed

    2017-07-01

    A new design of nonlinear model predictive controller (NMPC) is proposed for managed pressure drilling (MPD) system. The NMPC is based on output feedback control architecture and employs offset-free formulation proposed in [1]. NMPC uses active set method for computing control inputs. The controller implements an automatic switching from constant bottom hole pressure (CBHP) regulation to flow control mode in the event of a reservoir kick. In the flow control mode the controller automatically raises the bottom hole pressure setpoint, and thereby keeps the reservoir fluid flow to the surface within a tunable threshold. This is achieved by exploiting constraint handling capability of NMPC. In addition to kick mitigation the controller demonstrated good performance in containing the bottom hole pressure (BHP) during the pipe connection sequence. The controller also delivered satisfactory performance in the presence of measurement noise and uncertainty in the system. Copyright © 2017 ISA. Published by Elsevier Ltd. All rights reserved.

  5. Systolic blood pressure, arterial rigidity, and risk of stroke. The Framingham study.

    PubMed

    Kannel, W B; Wolf, P A; McGee, D L; Dawber, T R; McNamara, P; Castelli, W P

    1981-03-27

    Based on prospective data from the Framingham study relating systolic pressure, diastolic pressure, age, and pulse-wave configuration to future stroke incidence, it would appear that isolated systolic hypertension predisposes to stroke independent of arterial rigidity. The prevalence of isolated systolic hypertension increased with age and with the degree of blunting of the dicrotic notch in the pulse wave. Subjects with isolated systolic hypertension experienced two to four times as many strokes as did normotensive persons. While diastolic pressure is related to stroke incidence, in the subject with systolic hypertension, the diastolic component adds little to risk assessment and in men, in this subgroup, appears unrelated to stroke incidence.

  6. PRISM: a planned risk information seeking model.

    PubMed

    Kahlor, LeeAnn

    2010-06-01

    Recent attention on health-related information seeking has focused primarily on information seeking within specific health and health risk contexts. This study attempts to shift some of that focus to individual-level variables that may impact health risk information seeking across contexts. To locate these variables, the researcher posits an integrated model, the Planned Risk Information Seeking Model (PRISM). The model, which treats risk information seeking as a deliberate (planned) behavior, maps variables found in the Theory of Planned Behavior (TPB; Ajzen, 1991) and the Risk Information Seeking and Processing Model (RISP; Griffin, Dunwoody, & Neuwirth, 1999), and posits linkages among those variables. This effort is further informed by Kahlor's (2007) Augmented RISP, the Theory of Motivated Information Management (Afifi & Weiner, 2004), the Comprehensive Model of Information Seeking (Johnson & Meischke, 1993), the Health Information Acquisition Model (Freimuth, Stein, & Kean, 1989), and the Extended Parallel Processing Model (Witte, 1998). The resulting integrated model accounted for 59% of the variance in health risk information-seeking intent and performed better than the TPB or the RISP alone.

  7. Adversarial risk analysis for counterterrorism modeling.

    PubMed

    Rios, Jesus; Rios Insua, David

    2012-05-01

    Recent large-scale terrorist attacks have raised interest in models for resource allocation against terrorist threats. The unifying theme in this area is the need to develop methods for the analysis of allocation decisions when risks stem from the intentional actions of intelligent adversaries. Most approaches to these problems have a game-theoretic flavor although there are also several interesting decision-analytic-based proposals. One of them is the recently introduced framework for adversarial risk analysis, which deals with decision-making problems that involve intelligent opponents and uncertain outcomes. We explore how adversarial risk analysis addresses some standard counterterrorism models: simultaneous defend-attack models, sequential defend-attack-defend models, and sequential defend-attack models with private information. For each model, we first assess critically what would be a typical game-theoretic approach and then provide the corresponding solution proposed by the adversarial risk analysis framework, emphasizing how to coherently assess a predictive probability model of the adversary's actions, in a context in which we aim at supporting decisions of a defender versus an attacker. This illustrates the application of adversarial risk analysis to basic counterterrorism models that may be used as basic building blocks for more complex risk analysis of counterterrorism problems.

  8. Clustering of cardiovascular behavioral risk factors and blood pressure among people diagnosed with hypertension: a nationally representative survey in China

    PubMed Central

    Li, Yichong; Feng, Xiaoqi; Zhang, Mei; Zhou, Maigeng; Wang, Ning; Wang, Limin

    2016-01-01

    This study aimed to examine association between the number of behavioral risk factors and blood pressure (BP) level among a nationally representative sample of Chinese people diagnosed with hypertension. A total of 31,694 respondents aged 18+ years with diagnosed hypertension were extracted from the 2013–2014 China Chronic Disease and Risk Factor Surveillance. BP of each respondent was classified into six levels according to criteria in 2007 Guidelines for the Management of Arterial Hypertension. Information for smoking, alcohol drinking, fruit and vegetables consumption, physical inactivity, and overweight and obesity were obtained. The average number of risk factors was determined by BP level to explore potential risk factor clustering. Ten generalized proportional odds models were used to examine association between clustering of behavioral risk factors and BP level. A clear gradient between the number of behavioral risk factors and BP level was observed for men and women (P < 0.05 for both genders). BP level for men and women was much likely to upgrade as number of risk factors accumulated (P < 0.01 for 10 models). Behavioral modifications may decrease BP, and combinations of two or more behavioral interventions could potentially result in even better BP management among people diagnosed with hypertension. PMID:27279273

  9. Risk, prevention and treatment of pressure ulcers--nursing staff knowledge and documentation.

    PubMed

    Gunningberg, L; Lindholm, C; Carlsson, M; Sjödén, P O

    2001-01-01

    The aims were to investigate (i) registered nurses' and nursing assistants' knowledge of risk, prevention and treatment of pressure ulcer before implementing a system for risk assessment and pressure ulcer classification for patients with hip fracture (ii) interventions documented in the patient's records by registered nurses, and (iii) to what extent reported and documented interventions accord with the Swedish quality guidelines. Nursing staff (n=85) completed a questionnaire, and patient's records (n=55) were audited retrospectively. The majority of the nursing staff reported that they performed risk assessment when caring for a patient with hip fracture. These risk assessments were, however, not comprehensive. The most frequently reported preventive interventions were repositioning, use of lotion, mattresses/overlays and cushions for the heels. These interventions were to some extent documented in the patient's records. Nutritional support, reduction of shear and friction, hygiene and skin moisture, and patient's education were reported to a small extent and not documented at all. The Swedish quality guidelines regarding prevention and treatment of pressure ulcers were not fully implemented in clinical practice. It was concluded that nursing staff's knowledge and documentation of risk, prevention and treatment of pressure ulcers for patients with hip fractures could be improved.

  10. Thresholds for Diagnosing Hypertension Based on Automated Office Blood Pressure Measurements and Cardiovascular Risk.

    PubMed

    Myers, Martin G; Kaczorowski, Janusz; Paterson, J Michael; Dolovich, Lisa; Tu, Karen

    2015-09-01

    The risk of cardiovascular events in relation to blood pressure is largely based on readings taken with a mercury sphygmomanometer in populations which differ from those of today in terms of hypertension severity and drug therapy. Given replacement of the mercury sphygmomanometer with electronic devices, we sought to determine the blood pressure threshold for a significant increase in cardiovascular risk using a fully automated device, which takes multiple readings with the subject resting quietly alone. Participants were 3627 community-dwelling residents aged >65 years untreated for hypertension. Automated office blood pressure readings were obtained in a community pharmacy with subjects seated and undisturbed. This method for recording blood pressure produces similar readings in different settings, including a pharmacy and family doctor's office providing the above procedures are followed. Subjects were followed for a mean (SD) of 4.9 (1.0) years for fatal and nonfatal cardiovascular events. Adjusted hazard ratios (95% confidence intervals) were computed for 10 mm Hg increments in blood pressure (mm Hg) using Cox proportional hazards regression and the blood pressure category with the lowest event rate as the reference category. A total of 271 subjects experienced a cardiovascular event. There was a significant (P=0.02) increase in the hazard ratio of 1.66 (1.09, 2.54) at a systolic blood pressure of 135 to 144 and 1.72 (1.21, 2.45; P=0.003) at a diastolic blood pressure of 80 to 89. A significant (P=0.03) increase in hazard ratio of 1.73 (1.04, 2.86) occurred with a pulse pressure of 80 to 89. These findings are consistent with a threshold of 135/85 for diagnosing hypertension in older subjects using automated office blood pressure. © 2015 American Heart Association, Inc.

  11. Modelling suicide risk in later life.

    PubMed

    Lo, C F; Kwok, Cordelia M Y

    2006-08-01

    Affective disorder is generally regarded as the prominent risk factor for suicide in the old age population. Despite the large number of empirical studies available in the literature, there is no attempt in modelling the dynamics of an individual's level of suicide risk theoretically yet. In particular, a dynamic model which can simulate the time evolution of an individual's level of risk for suicide and provide quantitative estimates of the probability of suicide risk is still lacking. In the present study we apply the contingent claims analysis of credit risk modelling in the field of quantitative finance to derive a theoretical stochastic model for estimation of the probability of suicide risk in later life in terms of a signalling index of affective disorder. Our model is based upon the hypothesis that the current state of affective disorder of a patient can be represented by a signalling index and exhibits stochastic movement and that a threshold of affective disorder, which signifies the occurrence of suicide, exists. According to the numerical results, the implications of our model are consistent with the clinical findings. Hence, we believe that such a dynamic model will be essential to the design of effective suicide prevention strategies in the target population of older adults, especially in the primary care setting.

  12. Blood Pressure Variability: Can Nonlinear Dynamics Enhance Risk Assessment During Cardiovascular Surgery? A Feasibility Study

    PubMed Central

    Subramaniam, Balachundhar; Khabbaz, Kamal R.; Heldt, Thomas; Lerner, Adam B.; Mittleman, Murray A.; Davis, Roger B.; Goldberger, Ary L.; Costa, Madalena D.

    2014-01-01

    Brief Summary We propose that complex (nonlinear) fluctuations of hemodynamic variables (including systemic blood pressure parameters) during cardiovascular surgery contain information relevant to risk assessment and intraoperative management. Preliminary analysis of a pilot study supports the feasibility and potential merits of performing a larger, prospective study to assess the clinical utility of such new dynamical measures and to evaluate their potential role in enhancing contemporary approaches to risk assessment of major adverse events. PMID:24508020

  13. Risk factors for pressure injuries among critical care patients: A systematic review.

    PubMed

    Alderden, Jenny; Rondinelli, June; Pepper, Ginette; Cummins, Mollie; Whitney, JoAnne

    2017-06-01

    To identify risk factors independently predictive of pressure injury (also known as pressure ulcer) development among critical-care patients. We undertook a systematic review of primary research based on standardized criteria set forth by the Institute of Medicine. We searched the following databases: CINAHL (EBSCOhost), the Cochrane Library (Wilson), Dissertations & Theses Global (ProQuest), PubMed (National Library of Medicine), and Scopus. There was no language restriction. A research librarian coordinated the search strategy. Articles that potentially met inclusion criteria were screened by two investigators. Among the articles that met selection criteria, one investigator extracted data and a second investigator reviewed the data for accuracy. Based on a literature search, we developed a tool for assessing study quality using a combination of currently available tools and expert input. We used the method developed by Coleman et al. in 2014 to generate evidence tables and a summary narrative synthesis by domain and subdomain. Of 1753 abstracts reviewed, 158 were identified as potentially eligible and 18 fulfilled eligibility criteria. Five studies were classified as high quality, two were moderate quality, nine were low quality, and two were of very low quality. Age, mobility/activity, perfusion, and vasopressor infusion emerged as important risk factors for pressure injury development, whereas results for risk categories that are theoretically important, including nutrition, and skin/pressure injury status, were mixed. Methodological limitations across studies limited the generalizability of the results, and future research is needed, particularly to evaluate risk conferred by altered nutrition and skin/pressure injury status, and to further elucidate the effects of perfusion-related variables. Results underscore the importance of avoiding overinterpretation of a single study, and the importance of taking study quality into consideration when reviewing risk

  14. Integrated Environmental Modeling: Quantitative Microbial Risk Assessment

    EPA Science Inventory

    The presentation discusses the need for microbial assessments and presents a road map associated with quantitative microbial risk assessments, through an integrated environmental modeling approach. A brief introduction and the strengths of the current knowledge are illustrated. W...

  15. Integrated Environmental Modeling: Quantitative Microbial Risk Assessment

    EPA Science Inventory

    The presentation discusses the need for microbial assessments and presents a road map associated with quantitative microbial risk assessments, through an integrated environmental modeling approach. A brief introduction and the strengths of the current knowledge are illustrated. W...

  16. Quantifying fatigue risk in model-based fatigue risk management.

    PubMed

    Rangan, Suresh; Van Dongen, Hans P A

    2013-02-01

    The question of what is a maximally acceptable level of fatigue risk is hotly debated in model-based fatigue risk management in commercial aviation and other transportation modes. A quantitative approach to addressing this issue, referred to by the Federal Aviation Administration with regard to its final rule for commercial aviation "Flightcrew Member Duty and Rest Requirements," is to compare predictions from a mathematical fatigue model against a fatigue threshold. While this accounts for duty time spent at elevated fatigue risk, it does not account for the degree of fatigue risk and may, therefore, result in misleading schedule assessments. We propose an alternative approach based on the first-order approximation that fatigue risk is proportional to both the duty time spent below the fatigue threshold and the distance of the fatigue predictions to the threshold--that is, the area under the curve (AUC). The AUC approach is straightforward to implement for schedule assessments in commercial aviation and also provides a useful fatigue metric for evaluating thousands of scheduling options in industrial schedule optimization tools.

  17. Modeling Oxygen Prebreathe Protocols for Exploration Extravehicular Activities Using Variable Pressure Suits

    NASA Technical Reports Server (NTRS)

    Abercromby, Andrew F. J.; Conkin, Johnny; Gernhardt, Michael L.

    2017-01-01

    Exploration missions are expected to use variable pressure extravehicular activity (EVA) spacesuits as well as a spacecraft "exploration atmosphere" of 56.5 kPa (8.2 psia), 34% O2, both of which provide the possibility of reducing the oxygen prebreathe times necessary to reduce decompression sickness (DCS) risk. Previous modeling work predicted 8.4% DCS risk for an EVA beginning at the exploration atmosphere, followed by 15 minutes of in-suit O2 prebreathe, and 6 hours of EVA at 29.6 kPa (4.3 psia). In this study we model notional prebreathe protocols for a variable pressure suit where the exploration atmosphere is unavailable.

  18. [Validation of abdominal wound dehiscence's risk model].

    PubMed

    Gómez Díaz, Carlos Javier; Rebasa Cladera, Pere; Navarro Soto, Salvador; Hidalgo Rosas, José Manuel; Luna Aufroy, Alexis; Montmany Vioque, Sandra; Corredera Cantarín, Constanza

    2014-02-01

    The aim of this study is to determine the usefulness of the risk model developed by van Ramshorst et al., and a modification of the same, to predict the abdominal wound dehiscence's risk in patients who underwent midline laparotomy incisions. Observational longitudinal retrospective study. Patients who underwent midline laparotomy incisions in the General and Digestive Surgery Department of the Sabadell's Hospital-Parc Taulí's Health and University Corporation-Barcelona, between January 1, 2010 and June 30, 2010. Dependent variable: Abdominal wound dehiscence. Global risk score, preoperative risk score (postoperative variables were excluded), global and preoperative probabilities of developing abdominal wound dehiscence. 176 patients. Patients with abdominal wound dehiscence: 15 (8.5%). The global risk score of abdominal wound dehiscence group (mean: 4.97; IC 95%: 4.15-5.79) was better than the global risk score of No abdominal wound dehiscence group (mean: 3.41; IC 95%: 3.20-3.62). This difference is statistically significant (P<.001). The preoperative risk score of abdominal wound dehiscence group (mean: 3.27; IC 95%: 2.69-3.84) was better than the preoperative risk score of No abdominal wound dehiscence group (mean: 2.77; IC 95%: 2.64-2.89), also a statistically significant difference (P<.05). The global risk score (area under the ROC curve: 0.79) has better accuracy than the preoperative risk score (area under the ROC curve: 0.64). The risk model developed by van Ramshorst et al. to predict the abdominal wound dehiscence's risk in the preoperative phase has a limited usefulness. Additional refinements in the preoperative risk score are needed to improve its accuracy. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

  19. Genetic and BMI risks for predicting blood pressure in three generations of West African Dogon women.

    PubMed

    Taylor, Jacquelyn Y; Sampson, Deborah; Taylor, Andre D; Caldwell, Dennis; Sun, Yan V

    2013-01-01

    The study of genetic polymorphisms and body mass index (BMI) among African women in Africa and in the United States contributes to our understanding of the genetic and environmental risk factors for hypertension. African American women have the highest prevalence of hypertension and obesity compared to other ethnic groups in the United States. Using a cross-sectional research design, we examined the effects of genetic and environmental risks of single nucleotide polymorphisms (SNPs) and BMI on blood pressure (BP) among three generations of West African Dogon women (N = 199). We genotyped six SNPs located in the candidate genes known to be related to hypertension. We tested the associations between these SNPs and systolic BP (SBP) and diastolic BP (DBP) with Fisher's exact tests, chi-square tests for independence, and multivariable linear mixed models. The SNP rs8179526 (SLC4A5) was significantly associated with SBP adjusted for age, age(2), and BMI (p = .02). The "C" allele variant of rs8179526 (allele frequency of 0.445) was associated with higher SBP. This SNP did not deviate from the Hardy-Weinberg equilibrium (HWE) with p value of .772. The SNP × BMI interaction effects associated with SBP and DBP were not significant. rs8179526 is located on the SLC4A5 gene on chromosome 2. SLC4A5 encodes a protein that transports sodium and bicarbonate across cell membranes while regulating cellular pH and contains several SNPs linked to elevated BP. Knowledge of the SNP's effect on hypertension among West African women can help health practitioners educate their patients about genetic risks of developing hypertension.

  20. Genetic and BMI Risks for Predicting Blood Pressure in Three Generations of West African Dogon Women

    PubMed Central

    Taylor, Jacquelyn Y.; Sampson, Deborah; Taylor, Andre D.; Caldwell, Dennis; Sun, Yan V.

    2011-01-01

    The study of genetic polymorphisms and body mass index (BMI) among African women in Africa and in the United States contributes to our understanding of the genetic and environmental risk factors for hypertension. African American women have the highest prevalence of hypertension and obesity compared to other ethnic groups in the United States. Using a crosssectional research design, we examined the effects of genetic and environmental risks of single nucleotide polymorphisms (SNPs) and BMI on blood pressure (BP) among three generations of West African Dogon women (N = 199). We genotyped six SNPs located in the candidate genes known to be related to hypertension. We tested the associations between these SNPs and systolic BP (SBP) and diastolic BP (DBP) with Fisher’s exact tests, chi-square tests for independence, and multivariable linear mixed models. The SNP rs8179526 (SLC4A5) was significantly associated with SBP adjusted for age, age2, and BMI (p = .02). The “C” allele variant of rs8179526 (allele frequency of 0.445) was associated with higher SBP. This SNP did not deviate from the Hardy-Weinberg equilibrium (HWE) with p value of .772. The SNP × BMI interaction effects associated with SBP and DBP were not significant. rs8179526 is located on the SLC4A5 gene on chromosome 2. SLC4A5 encodes a protein that transports sodium and bicarbonate across cell membranes while regulating cellular pH and contains several SNPs linked to elevated BP. Knowledge of the SNP’s effect on hypertension among West African women can help health practitioners educate their patients about genetic risks of developing hypertension. PMID:21859746

  1. Modeling risk in distributed healthcare information systems.

    PubMed

    Maglogiannis, Ilias; Zafiropoulos, Elias

    2006-01-01

    This paper presents a modeling approach for performing a risk analysis study of networked healthcare information systems. The proposed method is based on CRAMM for studying the assets, threats and vulnerabilities of the distributed information system, and models their interrelationships using Bayesian networks. The most critical events are identified and prioritized, based on "what - if" studies of system operation. The proposed risk analysis framework has been applied to a healthcare information network operating in the North Aegean Region in Greece.

  2. Risk Factors Involved in Central-to-Radial Arterial Pressure Gradient During Cardiac Surgery.

    PubMed

    Fuda, Giuseppe; Denault, André; Deschamps, Alain; Bouchard, Denis; Fortier, Annik; Lambert, Jean; Couture, Pierre

    2016-03-01

    A central-to-radial arterial pressure gradient may occur after cardiopulmonary bypass (CPB), which, in some patients, may last for a prolonged time after CPB. Whenever there is a pressure gradient, the radial artery pressure measure may underestimate a more centrally measured systemic pressure, which may result in a misguided therapeutic strategy. It is clinically important to identify the risk factors that may predict the appearance of a central-to-radial pressure gradient, because more central sites of measurements might then be considered to monitor systemic arterial pressure in high-risk patients. The objective of this study was to assess preoperative and intraoperative risk factors for central-to-radial pressure gradient. Seventy-three patients undergoing cardiac surgery using CPB were included in this prospective observational study. A significant central-to-radial arterial pressure gradient was defined as a difference of 25 mm Hg in systolic pressure or 10 mm Hg in mean arterial pressure for a minimum of 5 minutes. Preoperative data included demographics, presence of comorbidities, and medications. Intraoperative data included type of surgery, CPB and aortic clamping time, use of inotropic drugs, and vasodilators or vasopressors agents. The diameter of the radial and femoral artery was measured before the induction of anesthesia using B-mode ultrasonography. Thirty-three patients developed a central-to-radial arterial pressure gradient (45%). Patients with a significant pressure gradient had a smaller weight (71.0 ± 16.9 vs 79.3 ± 17.3 kg, P = 0.041), a smaller height (162.0 ± 9.6 vs 166.3 ± 8.6 cm, P = 0.047), a smaller radial artery diameter (0.24 ± 0.03 vs 0.29 ± 0.05 cm, P < 0.001), and were at a higher risk as determined by the Parsonnet score (30.3 ± 24.9 vs 17.0 ± 10.9, P = 0.007). In addition, a longer aortic clamping time (85.8 ± 51.0 vs 64.2 ± 29.3 minutes, P = 0.036), mitral and complex surgery (P = 0.007 and P = 0.017, respectively

  3. Plantar pressure asymmetry and risk of stress injuries in the foot of young soccer players.

    PubMed

    Azevedo, Renato R; da Rocha, Emmanuel S; Franco, Pedro S; Carpes, Felipe P

    2017-03-01

    Asymmetries in the magnitude of plantar pressure are considered a risk factor for stress fracture of the fifth metatarsal in soccer athletes. To investigate the presence of plantar pressure asymmetries among young soccer athletes. Observational. Laboratory. Thirty young adolescents divided into a soccer player group (n = 15) or a matched control group (n = 15). Mean plantar pressure was determined for seven different regions of the foot. Data were compared between the preferred and non-preferred foot, and between the groups, during barefoot standing on a pressure mat system. Higher pressure was found in the hallux, 5th metatarsal and medial rearfoot of the non-preferred foot in the young soccer players. These asymmetries were not observed in the control group. Magnitudes of plantar pressure did not differ between the groups. Young soccer players present asymmetries in plantar pressure in the hallux, 5th metatarsal and medial rearfoot, with higher pressure observed in the non-preferred foot. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Postural effects on intracranial pressure: modeling and clinical evaluation.

    PubMed

    Qvarlander, Sara; Sundström, Nina; Malm, Jan; Eklund, Anders

    2013-11-01

    The physiological effect of posture on intracranial pressure (ICP) is not well described. This study defined and evaluated three mathematical models describing the postural effects on ICP, designed to predict ICP at different head-up tilt angles from the supine ICP value. Model I was based on a hydrostatic indifference point for the cerebrospinal fluid (CSF) system, i.e., the existence of a point in the system where pressure is independent of body position. Models II and III were based on Davson's equation for CSF absorption, which relates ICP to venous pressure, and postulated that gravitational effects within the venous system are transferred to the CSF system. Model II assumed a fully communicating venous system, and model III assumed that collapse of the jugular veins at higher tilt angles creates two separate hydrostatic compartments. Evaluation of the models was based on ICP measurements at seven tilt angles (0-71°) in 27 normal pressure hydrocephalus patients. ICP decreased with tilt angle (ANOVA: P < 0.01). The reduction was well predicted by model III (ANOVA lack-of-fit: P = 0.65), which showed excellent fit against measured ICP. Neither model I nor II adequately described the reduction in ICP (ANOVA lack-of-fit: P < 0.01). Postural changes in ICP could not be predicted based on the currently accepted theory of a hydrostatic indifference point for the CSF system, but a new model combining Davson's equation for CSF absorption and hydrostatic gradients in a collapsible venous system performed well and can be useful in future research on gravity and CSF physiology.

  5. [A model list of high risk drugs].

    PubMed

    Cotrina Luque, J; Guerrero Aznar, M D; Alvarez del Vayo Benito, C; Jimenez Mesa, E; Guzman Laura, K P; Fernández Fernández, L

    2013-12-01

    «High-risk drugs» are those that have a very high «risk» of causing death or serious injury if an error occurs during its use. The Institute for Safe Medication Practices (ISMP) has prepared a high-risk drugs list applicable to the general population (with no differences between the pediatric and adult population). Thus, there is a lack of information for the pediatric population. The main objective of this work is to develop a high-risk drug list adapted to the neonatal or pediatric population as a reference model for the pediatric hospital health workforce. We made a literature search in May 2012 to identify any published lists or references in relation to pediatric and/or neonatal high-risk drugs. A total of 15 studies were found, from which 9 were selected. A model list was developed mainly based on the ISMP one, adding strongly perceived pediatric risk drugs and removing those where the pediatric use was anecdotal. There is no published list that suits pediatric risk management. The list of pediatric and neonatal high-risk drugs presented here could be a «reference list of high-risk drugs » for pediatric hospitals. Using this list and training will help to prevent medication errors in each drug supply chain (prescribing, transcribing, dispensing and administration). Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  6. Risk factors for high blood pressure in low income children aged 3-4 years.

    PubMed

    Vitolo, Márcia Regina; da Costa Louzada, Maria Laura; Rauber, Fernanda; Campagnolo, Paula Dal Bó

    2013-08-01

    This study aimed to evaluate the effect of dietary sodium intake on blood pressure among low income children aged 3-4 years. Data were collected during a randomized trial conducted in São Leopoldo, Brazil, with 500 mother-child pairs recruited from the maternity ward of a local hospital. Breastfeeding data were obtained during the children's first year of life. At 3 to 4 years of age, children's anthropometric, dietary, and blood pressure assessments were obtained. Sodium intake was estimated from two multiple-pass 24-h dietary recalls. Systolic blood pressure > 90th percentile for age, sex, and height was classified as high systolic blood pressure, according to the population-based percentiles provided by the Task Force on Hypertension Control in Children and Adolescents. Blood pressure data were obtained from 331 children at 3 to 4 years. The mean value of systolic blood pressure was 91.31 mmHg (SD = 8.30 mmHg) and 5.2% (n = 17) presented high systolic blood pressure. The results of the multivariable analyses showed that children who consumed more than 1,200 mg of sodium/day and with waist-to-height ratio higher than 0.5 presented, respectively, 3.32 (95%CI 0.98-11.22) and 8.81 (95%CI 2.13-36.31) greater risk of having high systolic blood pressure. Exclusive breastfeeding, child overweight and change in body mass index z score during the first year of life were not associated with the outcome. The results of this study suggest that at preschool age sodium intake and high waist-to-height ratio are risk factors for high systolic blood pressure.

  7. Unsteady Pressure Measurements on Oscillating Models in European Wind Tunnels.

    DTIC Science & Technology

    1980-03-01

    AO-AUB3 24B AIR FORCE WRIGHT AERONAUTICAL LABS WRIGHT-PATTERSON APR OH F/B 20/41 UNSTEADY PRESSURE MEASUREMENTS ON OSCILLATING MODELS IN EUROPEA -ETC...A. The Netherlands The state-of-the- art of unsteady aerodynamic testing has been accel- erated by the contributions from the Netherlands. An

  8. The coefficient of restitution of pressurized balls: a mechanistic model

    NASA Astrophysics Data System (ADS)

    Georgallas, Alex; Landry, Gaëtan

    2016-01-01

    Pressurized, inflated balls used in professional sports are regulated so that their behaviour upon impact can be anticipated and allow the game to have its distinctive character. However, the dynamics governing the impacts of such balls, even on stationary hard surfaces, can be extremely complex. The energy transformations, which arise from the compression of the gas within the ball and from the shear forces associated with the deformation of the wall, are examined in this paper. We develop a simple mechanistic model of the dependence of the coefficient of restitution, e, upon both the gauge pressure, P_G, of the gas and the shear modulus, G, of the wall. The model is validated using the results from a simple series of experiments using three different sports balls. The fits to the data are extremely good for P_G > 25 kPa and consistent values are obtained for the value of G for the wall material. As far as the authors can tell, this simple, mechanistic model of the pressure dependence of the coefficient of restitution is the first in the literature. *%K Coefficient of Restitution, Dynamics, Inflated Balls, Pressure, Impact Model

  9. Assessing Predictive Validity of Pressure Ulcer Risk Scales- A Systematic Review and Meta-Analysis

    PubMed Central

    PARK, Seong-Hi; LEE, Hea Shoon

    2016-01-01

    Background: The purpose of this study was to present a scientific reason for pressure ulcer risk scales: Cubbin& Jackson modified Braden, Norton, and Waterlow, as a nursing diagnosis tool by utilizing predictive validity of pressure sores. Methods: Articles published between 1966 and 2013 from periodicals indexed in the Ovid Medline, Embase, CINAHL, KoreaMed, NDSL, and other databases were selected using the key word “pressure ulcer”. QUADAS-II was applied for assessment for internal validity of the diagnostic studies. Selected studies were analyzed using meta-analysis with MetaDisc 1.4. Results: Seventeen diagnostic studies with high methodological quality, involving 5,185 patients, were included. In the results of the meta-analysis, sROC AUC of Braden, Norton, and Waterflow scale was over 0.7, showing moderate predictive validity, but they have limited interpretation due to significant differences between studies. In addition, Waterlow scale is insufficient as a screening tool owing to low sensitivity compared with other scales. Conclusion: The contemporary pressure ulcer risk scale is not suitable for uninform practice on patients under standardized criteria. Therefore, in order to provide more effective nursing care for bedsores, a new or modified pressure ulcer risk scale should be developed upon strength and weaknesses of existing tools. PMID:27114977

  10. A Raster Based Approach To Solar Pressure Modeling

    NASA Technical Reports Server (NTRS)

    Wright, Theodore

    2014-01-01

    The impact of photons upon a spacecraft introduces small forces and moments. The magnitude and direction of the forces depend on the material properties of the spacecraft components being illuminated. Which components are being lit depends on the orientation of the craft with respect to the Sun as well as the gimbal angles for any significant moving external parts (solar arrays, typically). Some components may shield others from the Sun.To determine solar pressure in the presence overlapping components, a 3D model can be used to determine which components are illuminated. A view (image) of the model as seen from the Sun shows the only contributors to solar pressure. This image can be decomposed into pixels, each of which can be treated as a non-overlapping flat plate as far as solar pressure calculations are concerned. The sums of the pressures and moments on these plates approximate the solar pressure and moments on the entire vehicle.The image rasterization technique can also be used to compute other spacecraft attributes that are dependent on attitude and geometry, including solar array power generation capability and free molecular flow drag.

  11. Validated Analytical Model of a Pressure Compensation Drip Irrigation Emitter

    NASA Astrophysics Data System (ADS)

    Shamshery, Pulkit; Wang, Ruo-Qian; Taylor, Katherine; Tran, Davis; Winter, Amos

    2015-11-01

    This work is focused on analytically characterizing the behavior of pressure-compensating drip emitters in order to design low-cost, low-power irrigation solutions appropriate for off-grid communities in developing countries. There are 2.5 billion small acreage farmers worldwide who rely solely on their land for sustenance. Drip, compared to flood, irrigation leads to up to 70% reduction in water consumption while increasing yields by 90% - important in countries like India which are quickly running out of water. To design a low-power drip system, there is a need to decrease the pumping pressure requirement at the emitters, as pumping power is the product of pressure and flow rate. To efficiently design such an emitter, the relationship between the fluid-structure interactions that occur in an emitter need to be understood. In this study, a 2D analytical model that captures the behavior of a common drip emitter was developed and validated through experiments. The effects of independently changing the channel depth, channel width, channel length and land height on the performance were studied. The model and the key parametric insights presented have the potential to be optimized in order to guide the design of low-pressure, clog-resistant, pressure-compensating emitters.

  12. Two criteria for evaluating risk prediction models.

    PubMed

    Pfeiffer, R M; Gail, M H

    2011-09-01

    We propose and study two criteria to assess the usefulness of models that predict risk of disease incidence for screening and prevention, or the usefulness of prognostic models for management following disease diagnosis. The first criterion, the proportion of cases followed PCF (q), is the proportion of individuals who will develop disease who are included in the proportion q of individuals in the population at highest risk. The second criterion is the proportion needed to follow-up, PNF (p), namely the proportion of the general population at highest risk that one needs to follow in order that a proportion p of those destined to become cases will be followed. PCF (q) assesses the effectiveness of a program that follows 100q% of the population at highest risk. PNF (p) assess the feasibility of covering 100p% of cases by indicating how much of the population at highest risk must be followed. We show the relationship of those two criteria to the Lorenz curve and its inverse, and present distribution theory for estimates of PCF and PNF. We develop new methods, based on influence functions, for inference for a single risk model, and also for comparing the PCFs and PNFs of two risk models, both of which were evaluated in the same validation data.

  13. High Temperature High Pressure Thermodynamic Measurements for Coal Model Compounds

    SciTech Connect

    John C. Chen; Vinayak N. Kabadi

    1998-11-12

    The overall objective of this project is to develop a better thermodynamic model for predicting properties of high-boiling coal derived liquids, especially the phase equilibria of different fractions at elevated temperatures and pressures. The development of such a model requires data on vapor-liquid equilibria (VLE), enthalpy, and heat capacity which would be experimentally determined for binary systems of coal model compounds and compiled into a database. The data will be used to refine existing models such as UNIQUAC and UNIFAC. The flow VLE apparatus designed and built for a previous project was upgraded and recalibrated for data measurements for thk project. The modifications include better and more accurate sampling technique and addition of a digital recorder to monitor temperature, pressure and liquid level inside the VLE cell. VLE data measurements for system benzene-ethylbenzene have been completed. The vapor and liquid samples were analysed using the Perkin-Elmer Autosystem gas chromatography.

  14. Technology for pressure-instrumented thin airfoil models

    NASA Technical Reports Server (NTRS)

    Wigley, David A.

    1988-01-01

    A novel method of airfoil model construction was developed. This Laminated Sheet technique uses 0.8 mm thick sheets of A286 containing a network of pre-formed channels which are vacuum brazed together to form the airfoil. A 6.25 percent model of the X29A canard, which has a 5 percent thick section, was built using this technique. The model contained a total of 96 pressure orifices, 56 in three chordwise rows on the upper surface and 37 in three similar rows on the lower surface. It was tested in the NASA Langley 0.3 m Transonic Cryogenic Tunnel. Unique aerodynamic data was obtained over the full range of temperature and pressure. Part of the data was at transonic Mach numbers and flight Reynolds number. A larger two dimensional model of the NACA 64a-105 airfoil section was also fabricated. Scale up presented some problems, but a testable airfoil was fabricated.

  15. Construct validity of the moisture subscale of the Braden Scale for Predicting Pressure Sore Risk.

    PubMed

    Omolayo, Tolulope; Brown, Kilty; Rapp, Mary Pat; Li, Jing; Barrett, Ryan; Horn, Susan; Bergstrom, Nancy

    2013-03-01

    In this study, the construct validity of the moisture subscale of the Braden Scale for Predicting Pressure Sore Risk is partially supported by the significant inverse relationships between moisture subscale scores, the number of wet observations and soiled observations, brief changes, and differences among the moisture subscale score groups.

  16. Dairy consumption, systolic blood pressure, and risk of hypertension: Mendelian randomization study

    USDA-ARS?s Scientific Manuscript database

    This study examined whether previous observed inverse associations of dairy intake with systolic blood pressure and risk of hypertension were causal. A Mendelian randomization study was employed, using the single nucleotide polymorphism rs4988235 related to lactase persistence as an instrumental var...

  17. Awareness and Knowledge of Cardiovascular Risk through Blood Pressure and Cholesterol Testing in College Freshmen

    ERIC Educational Resources Information Center

    Melnyk, J. A.; Panza, G.; Zaleski, A.; Taylor, B.

    2015-01-01

    Background: Cardiovascular disease (CVD) is the leading cause of death in the United States, yet knowledge of CVD risk factors is surprisingly low in college students. Purpose: The purpose of this study was to determine the effectiveness of an individualized blood pressure, cholesterol, and CVD education intervention on college freshmen. Methods:…

  18. Awareness and Knowledge of Cardiovascular Risk through Blood Pressure and Cholesterol Testing in College Freshmen

    ERIC Educational Resources Information Center

    Melnyk, J. A.; Panza, G.; Zaleski, A.; Taylor, B.

    2015-01-01

    Background: Cardiovascular disease (CVD) is the leading cause of death in the United States, yet knowledge of CVD risk factors is surprisingly low in college students. Purpose: The purpose of this study was to determine the effectiveness of an individualized blood pressure, cholesterol, and CVD education intervention on college freshmen. Methods:…

  19. Optimal Blood Pressure Goals in Patients With Hypertension at High Risk for Cardiovascular Events.

    PubMed

    Aronow, Wilbert S

    2016-01-01

    Existing epidemiologic and clinical trial data suggest that the blood pressure in patients with hypertension at high risk for cardiovascular events because of coronary artery disease, diabetes mellitus, chronic kidney disease, stroke, or heart failure should be reduced to <140/90 mm Hg in patients younger than 80 years and the systolic blood pressure be reduced to 140-145 mm Hg if tolerated in patients aged 80 years and older. Studies from patients with coronary artery disease, diabetes mellitus, chronic kidney disease, stroke, and heart failure will be discussed that support a blood pressure goal of <140/90 mm Hg in patients younger than 80 years at high risk for cardiovascular events.

  20. Modelling wall pressure fluctuations under a turbulent boundary layer

    NASA Astrophysics Data System (ADS)

    Doisy, Yves

    2017-07-01

    The derivation of the wave vector-frequency (w-f) spectrum of wall pressure fluctuations below a turbulent boundary layer developed over a rigid flat plate is re-considered. The Lighthill's equation for pressure fluctuations is derived in a frame of reference fix with respect to the plate, at low Mach numbers, and transformed into the convected frame moving with the flow. To model the source terms of the Lighthill equation, it is assumed that in the inertial range, the turbulence is locally isotropic in the convected frame. The w-f spectrum of isotropic turbulence is obtained from symmetry considerations by extending the isotropy to space time, based on the concept of sweeping velocity. The resulting solution for the pressure w-f spectrum contains a term (the mean shear-turbulence term) which does not fulfill the Kraichnan Philipps theorem, due to the form of the selected turbulent velocity spectrum. The viscous effects are accounted for by a cut-off depending on wall distance; this procedure allows extending the model beyond the inertial range contribution. The w-f pressure spectrum is derived and compared to the experimental low wavenumber data of Farabee and Geib (1991) [8] and Bonness et al. (2010) [5], for which a good agreement is obtained. The derived expression is also compared to Chase theoretical model Chase (1987) [6] and found to agree well in the vicinity of the convective ridge of the subsonic domain and to differ significantly both in supersonic and subsonic low wavenumber limits. The pressure spectrum derived from the model and its scaling are discussed and compared to experimental data and to the empirical model of Goody (2002) [23], which results from the compilation of a large set of experimental data. Very good agreement is obtained, except at vanishing frequencies where it is claimed that the experimental results lack of significance due to the limited size of the experimental facilities. This hypothesis supported by the results obtained from

  1. Ensemble Risk Model of Emergency Admissions (ERMER).

    PubMed

    Mesgarpour, Mohsen; Chaussalet, Thierry; Chahed, Salma

    2017-07-01

    About half of hospital readmissions can be avoided with preventive interventions. Developing decision support tools for identification of patients' emergency readmission risk is an important area of research. Because, it remains unclear how to design features and develop predictive models that can adjust continuously to a fast-changing healthcare system and population characteristics. The objective of this study was to develop a generic ensemble Bayesian risk model of emergency readmission. We produced a decision support tool that predicts risk of emergency readmission using England's Hospital Episode Statistics inpatient database. Firstly, we used a framework to develop an optimal set of features. Then, a combination of Bayes Point Machine (BPM) models for different cohorts was considered to create an optimised ensemble model, which is stronger than the individual generative and non-linear classifications. The developed Ensemble Risk Model of Emergency Admissions (ERMER) was trained and tested using three time-frames: 1999-2004, 2000-05 and 2004-09, each of which includes about 20% of patients in England during the trigger year. Comparisons are made for different time-frames, sub-populations, risk cut-offs, risk bands and top risk segments. The precision was 71.6-73.9%, the specificity was 88.3-91.7% and the sensitivity was 42.1-49.2% across different time-frames. Moreover, the Area Under the Curve was 75.9-77.1%. The decision support tool performed considerably better than the previous modelling approaches, and it was robust and stable with high precision. Moreover, the framework and the Bayesian model allow the model to continuously adjust it to new significant features, different population characteristics and changes in the system. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. On modeling pressure diffusion in non-homogeneous shear flows

    NASA Technical Reports Server (NTRS)

    Demuren, A. O.; Rogers, M. M.; Durbin, P.; Lele, S. K.

    1996-01-01

    New models are proposed for the 'slow and 'rapid' parts of the pressure diffusive transport based on the examination of DNS databases for plane mixing layers and wakes. The model for the 'slow' part is non-local, but requires the distribution of the triple-velocity correlation as a local source. The latter can be computed accurately for the normal component from standard gradient diffusion models, but such models are inadequate for the cross component. More work is required to remedy this situation.

  3. Explicit Pore Pressure Material Model in Carbon-Cloth Phenolic

    NASA Technical Reports Server (NTRS)

    Gutierrez-Lemini, Danton; Ehle, Curt

    2003-01-01

    An explicit material model that uses predicted pressure in the pores of a carbon-cloth phenolic (CCP) composite has been developed. This model is intended to be used within a finite-element model to predict phenomena specific to CCP components of solid-fuel-rocket nozzles subjected to high operating temperatures and to mechanical stresses that can be great enough to cause structural failures. Phenomena that can be predicted with the help of this model include failures of specimens in restrained-thermal-growth (RTG) tests, pocketing erosion, and ply lifting

  4. Can noise cause high blood pressure? Occupational risk in paper industry.

    PubMed

    Sancini, A; Caciari, T; Rosati, M V; Samperi, I; Iannattone, G; Massimi, R; Loreti, B; Scala, B; Sacco, C; Tomei, F; Tomei, G

    2014-01-01

    The authors hypothesize cardiovascular effects in paper industry workers exposed to noise. The study included 72 paper industry workers exposed to noise and two control groups not exposed to noise. The workers completed a questionnaire and underwent a medical examination, measurement of blood pressure, electrocardiogram, blood tests, audiometry and measurement of noise exposure. The workers exposed to noise, all hearing impaired, were compared with not exposed and showed: significant increase of mean systolic and diastolic blood pressure values (p<0.001), higher frequency of hypertension, systolic and diastolic blood pressure (p<0.01 and p<0.001) and electrocardiografic abnormalities (p<0.05), significant reduction of blood pressure response in orthostatism (p<0.005). Our results suggest that for the workers of the paper industry the noise is an occupational risk factor for cardiovascular effects.

  5. Hydrodynamic model of advanced pressurized fluidized bed combustion

    SciTech Connect

    Horio, Masayuki; Lei, H.W.

    1997-12-31

    A hydrodynamic model was developed for the advanced pressurized fluidized bed combustion (A-PFBC) process. The particular system investigated here is composed of a pressurized circulating fluidized bed (PCFB) for coal gasification/desulfurization and a PCFB for combustion with the gas-solid counter-current flow through the two PCFBs. One of the most important parameters may be the material seal height (MSH) in the downcomer connecting the gasifier/desulfurizer and the combustor, which is thought to strongly influence the safe and stable operation of the process. In this mode, MSH was determined according to the pressure balance between the gasifier/desulfurizer and the combustor. The solid flux in the lower dense region of the two PCFBs was estimated by considering the clustering suspension and core-annulus flow. The mean cluster size and voidage in the cluster phase were predicted by the cluster size model of Horio-Ito (1996). Solid flux of the gasifier and combustor was calculated based on mass balances of limestone, char and ash in the system. Based on this model, the whole pressure profile loop in the system was predicted, and the effects of operating conditions on MSH between the gasifier and the combustor were investigated. The feasibility of the A-PCFB system with PCFBs both for the gasifier/desulfurizer and for the combustor was successfully confirmed.

  6. Modeling the pressure pulse shape of piezoelectric lithotripters

    NASA Astrophysics Data System (ADS)

    Dreyer, Thomas; Riedlinger, Rainer

    2002-11-01

    Piezoelectric focusing transducers are widely used in extracorporeal lithotripsy. To optimize the therapeutically relevant focal pressure pulse it is necessary to affect the generated pulse shape at the transducer surface. Therefore a modeling approach is required containing the acousto-mechanical properties of the transducer structure as well as the influence of the electrical drive. The procedure presented here uses three dimensional transient finite element simulations to calculate an electro-acoustical impulse response of the transducer structure and linear systems theory to model the influence of the driving circuit on the emitted acoustical signal. Applying a short electrical pulse an acoustical impulse response can be simulated under plane wave conditions, which is valid at sufficiently large distances from the transducer. Focal pressures are estimated rapidly by linear calculations or accurately by a nonlinear propagation model. The influence of electrical drive conditions on the emitted acoustical signal is investigated very efficiently by a convolution with the desired electrical input, avoiding FEM simulations for each case. Reverting this process the required driving voltage course for a given pressure signal is determined. Alterations of the pressure signal in terms of pulse width and tensile components are demonstrated theoretically, varying the design parameters of the transducer.

  7. Yoga lifestyle intervention reduces blood pressure in HIV-infected adults with cardiovascular disease risk factors.

    PubMed

    Cade, W T; Reeds, D N; Mondy, K E; Overton, E T; Grassino, J; Tucker, S; Bopp, C; Laciny, E; Hubert, S; Lassa-Claxton, S; Yarasheski, K E

    2010-07-01

    People living with HIV infection are at increased risk for developing cardiovascular disease (CVD). Safe and effective interventions for lowering CVD risk in HIV infection are high priorities. We conducted a prospective, randomized, controlled study to evaluate whether a yoga lifestyle intervention improves CVD risk factors, virological or immunological status, or quality of life (QOL) in HIV-infected adults relative to standard of care treatment in a matched control group. Sixty HIV-infected adults with mild-moderate CVD risk were assigned to 20 weeks of supervised yoga practice or standard of care treatment. Baseline and week 20 measures were: 2-h oral glucose tolerance test with insulin monitoring, body composition, fasting serum lipid/lipoprotein profile, resting blood pressures, CD4 T-cell count and plasma HIV RNA, and the Medical Outcomes Study Short Form (SF)-36 health-related QOL inventory. Resting systolic and diastolic blood pressures improved more (P=0.04) in the yoga group (-5 +/- 2 and -3 +/- 1 mmHg, respectively) than in the standard of care group (+1 +/- 2 and+2 +/- 2 mmHg, respectively). However, there was no greater reduction in body weight, fat mass or proatherogenic lipids, or improvements in glucose tolerance or overall QOL after yoga. Immune and virological status was not adversely affected. Among traditional lifestyle modifications, yoga is a low-cost, simple to administer, nonpharmacological, popular behavioural intervention that can lower blood pressure in pre-hypertensive HIV-infected adults with mild-moderate CVD risk factors.

  8. The Nursing Diagnosis of risk for pressure ulcer: content validation 1

    PubMed Central

    dos Santos, Cássia Teixeira; Almeida, Miriam de Abreu; Lucena, Amália de Fátima

    2016-01-01

    Abstract Objective: to validate the content of the new nursing diagnosis, termed risk for pressure ulcer. Method: the content validation with a sample made up of 24 nurses who were specialists in skin care from six different hospitals in the South and Southeast of Brazil. Data collection took place electronically, through an instrument constructed using the SurveyMonkey program, containing a title, definition, and 19 risk factors for the nursing diagnosis. The data were analyzed using Fehring's method and descriptive statistics. The project was approved by a Research Ethics Committee. Results: title, definition and seven risk factors were validated as "very important": physical immobilization, pressure, surface friction, shearing forces, skin moisture, alteration in sensation and malnutrition. Among the other risk factors, 11 were validated as "important": dehydration, obesity, anemia, decrease in serum albumin level, prematurity, aging, smoking, edema, impaired circulation, and decrease in oxygenation and in tissue perfusion. The risk factor of hyperthermia was discarded. Conclusion: the content validation of these components of the nursing diagnosis corroborated the importance of the same, being able to facilitate the nurse's clinical reasoning and guiding clinical practice in the preventive care for pressure ulcers. PMID:27305182

  9. Calibrated predictions for multivariate competing risks models.

    PubMed

    Gorfine, Malka; Hsu, Li; Zucker, David M; Parmigiani, Giovanni

    2014-04-01

    Prediction models for time-to-event data play a prominent role in assessing the individual risk of a disease, such as cancer. Accurate disease prediction models provide an efficient tool for identifying individuals at high risk, and provide the groundwork for estimating the population burden and cost of disease and for developing patient care guidelines. We focus on risk prediction of a disease in which family history is an important risk factor that reflects inherited genetic susceptibility, shared environment, and common behavior patterns. In this work family history is accommodated using frailty models, with the main novel feature being allowing for competing risks, such as other diseases or mortality. We show through a simulation study that naively treating competing risks as independent right censoring events results in non-calibrated predictions, with the expected number of events overestimated. Discrimination performance is not affected by ignoring competing risks. Our proposed prediction methodologies correctly account for competing events, are very well calibrated, and easy to implement.

  10. Risk terrain modeling predicts child maltreatment.

    PubMed

    Daley, Dyann; Bachmann, Michael; Bachmann, Brittany A; Pedigo, Christian; Bui, Minh-Thuy; Coffman, Jamye

    2016-12-01

    As indicated by research on the long-term effects of adverse childhood experiences (ACEs), maltreatment has far-reaching consequences for affected children. Effective prevention measures have been elusive, partly due to difficulty in identifying vulnerable children before they are harmed. This study employs Risk Terrain Modeling (RTM), an analysis of the cumulative effect of environmental factors thought to be conducive for child maltreatment, to create a highly accurate prediction model for future substantiated child maltreatment cases in the City of Fort Worth, Texas. The model is superior to commonly used hotspot predictions and more beneficial in aiding prevention efforts in a number of ways: 1) it identifies the highest risk areas for future instances of child maltreatment with improved precision and accuracy; 2) it aids the prioritization of risk-mitigating efforts by informing about the relative importance of the most significant contributing risk factors; 3) since predictions are modeled as a function of easily obtainable data, practitioners do not have to undergo the difficult process of obtaining official child maltreatment data to apply it; 4) the inclusion of a multitude of environmental risk factors creates a more robust model with higher predictive validity; and, 5) the model does not rely on a retrospective examination of past instances of child maltreatment, but adapts predictions to changing environmental conditions. The present study introduces and examines the predictive power of this new tool to aid prevention efforts seeking to improve the safety, health, and wellbeing of vulnerable children.

  11. Validation of a Finite Element Humeroradial Joint Model of Contact Pressure Using Fuji Pressure Sensitive Film.

    PubMed

    Kim, Sunghwan; Carl Miller, Mark

    2016-01-01

    A finite element (FE) elbow model was developed to predict the contact stress and contact area of the native humeroradial joint. The model was validated using Fuji pressure sensitive film with cadaveric elbows for which axial loads of 50, 100, and 200 N were applied through the radial head. Maximum contact stresses ranged from 1.7 to 4.32 MPa by FE predictions and from 1.34 to 3.84 MPa by pressure sensitive film measurement while contact areas extended from 39.33 to 77.86 mm2 and 29.73 to 83.34 mm2 by FE prediction and experimental measurement, respectively. Measurements from cadaveric testing and FE predictions showed the same patterns in both the maximum contact stress and contact area, as another demonstration of agreement. While measured contact pressures and contact areas validated the FE predictions, computed maximum stresses and contact area tended to overestimate the maximum contact stress and contact area.

  12. Numerical Modeling of Pressurization of a Propellant Tank

    NASA Technical Reports Server (NTRS)

    Majumdar, Alok; Steadman, Todd

    1998-01-01

    An unsteady finite volume procedure has been developed to predict the history of pressure, temperature and mass flow rate of the pressurant and propellant during the expulsion of the propellant from a tank. The time dependent mass, momentum and energy conservation equations are solved at the ullage space. The model accounts for the change in the ullage volume due to expulsion of the propellant. It also accounts for the heat transfer from the tank wall and propellant to the ullage gas. The procedure was incorporated in the Generalized Fluid System Simulation Program (GFSSP). The results of several test cases were then compared with a published correlation of pressurant requirements for a given displacement of propellant. The agreement between the predictions and the correlation was found to be satisfactory.

  13. Numerical Modeling of Pressurization of a Propellant Tank

    NASA Technical Reports Server (NTRS)

    Majumdar, Alok; Steadman, Todd

    1999-01-01

    An unsteady finite volume procedure has been developed to predict the history o pressure, temperature and mass flow rate of the pressurant and propellant during the expulsion of the propellant from a tan. The time dependent mass, momentum and energy conservation equations are solved at the ullage space. The model accounts for the change in the ullage volume due to expulsion of the propellant. It also accounts for the heat transfer from the tank wall and propellant to the ullage gas. The procedure was incorporated in the Generalized Fluid System Simulation Program (GFSSP). The results of several test cases were then compared with a published correlation of pressurant requirements for a given displacement of propellant. The agreement between the predictions and the correlation was found to be satisfactory.

  14. Evaluating the risk of eye injuries: intraocular pressure during high speed projectile impacts.

    PubMed

    Duma, Stefan M; Bisplinghoff, Jill A; Senge, Danielle M; McNally, Craig; Alphonse, Vanessa D

    2012-01-01

    To evaluate the risk of eye injuries by determining intraocular pressure during high speed projectile impacts. A pneumatic cannon was used to impact eyes with a variety of projectiles at multiple velocities. Intraocular pressure was measured with a small pressure sensor inserted through the optic nerve. A total of 36 tests were performed on 12 porcine eyes with a range of velocities between 6.2 m/s and 66.5 m/s. Projectiles selected for the test series included a 6.35  mm diameter metal ball, a 9.25  mm diameter aluminum rod, and an 11.16  mm diameter aluminum rod. Experiments were designed with velocities in the range of projectile consumer products such as toy guns. A range of intraocular pressures ranged between 2017 mmHg to 26,426 mmHg (39 psi-511 psi). Four of the 36 impacts resulted in globe rupture. Intraocular pressures dramatically above normal physiological pressure were observed for high speed projectile impacts. These pressure data provide critical insight to chronic ocular injuries and long-term complications such as glaucoma and cataracts.

  15. Blood pressure increases during a simulated night shift in persons at risk for hypertension.

    PubMed

    McCubbin, James A; Pilcher, June J; Moore, D DeWayne

    2010-12-01

    Shift work with sleep disruption is a systemic stressor that may possibly be associated with blood pressure dysregulation and hypertension. We hypothesize that rotation to a simulated night shift with sleep deprivation will produce blood pressure elevations in persons at risk for development of hypertension. We examined the effects of a simulated night shift on resting blood pressure in 51 diurnal young adults without current hypertension. Resting blood pressure was monitored throughout a 24-h period of total sleep deprivation with sustained cognitive work. Twelve participants (23.5%) reported one or more parents with a diagnosis of hypertension. Ten participants were classified as prehypertensive by JNC-7 criteria. Only two prehypertensive subjects reported parental hypertension. Results indicate that, as the night shift progressed, participants with a positive family history of hypertension showed significantly higher resting diastolic blood pressure than those with a negative family history of hypertension (p = 0.007). Prehypertensive participants showed elevated blood pressure throughout the study. These data suggest that rotation to a simulated night shift with sleep deprivation may contribute to blood pressure dysregulation in persons with a positive family history of hypertension.

  16. Body forces and pressures in elastic models of the myocardium.

    PubMed Central

    Pierce, W H

    1981-01-01

    Tension strands are introduced to represent active myocardial fibers. They create one body force proportional to the divergence of the tension-direction vector, and a second equal to the tension divided by the radius of curvature. Explicit solutions to isotropic linearly elastic tensor equations with these body forces are found for the radially-symmetric, linearly-isotropic, elastic spherical heart with arbitrary radial body force. They confirm experiments showing supraluminal intramural pressures. Such pressures may affect coronary perfusion. A tension strand model which is a reasonable compromise between actual myofibrillar geometry and analytical simplicity is the iso-oblique, terminating, nonintersecting model. The body force from that or any other axially symmetric body force can be the forcing term for equations in which the heart is modeled as a thin, ellipsoidal, elastic membrane. PMID:7213931

  17. Jet fire consequence modeling for high-pressure gas pipelines

    NASA Astrophysics Data System (ADS)

    Coccorullo, Ivano; Russo, Paola

    2016-12-01

    A simple and reliable approach for sizing the hazard area potentially affected by a jet fire as consequence of the failure of high-pressure pipeline is proposed. A release rate model, taking pipeline operation properties and source release properties into account, is coupled with SLAB dispersion model and point source radiation model to calculate the hazard distance. The hazard distance is set beyond the distance at which a low chance of fatality can occur to people exposed and a wooden structure is not expected to burn due to radiation heat of jet fire. The comparison between three gases with different physico-chemical properties (i.e. natural gas, hydrogen, ethylene) is shown. The influence of pipeline operating parameters, such as: pressure, pipeline diameter and length, hole size, on the hazard area for the three gases is evaluated. Finally, a simple correlation is proposed for calculating the hazard distance as function of these parameters.

  18. Modeling of the pressurized xenon gamma ray scintillation detector

    NASA Astrophysics Data System (ADS)

    Meek, Romney; Barzilov, Alexander; Novikov, Ivan

    2011-10-01

    We are developing a high pressure xenon detector for photon measurements. Xenon produces electroluminescence (EL) scintillation emission that we use as the primary signal in our strategy to acquire information. The detector consists of a high pressure chamber, a thin radiation input window with the supporting grid of collimator ribs and electrode grids to create the electric field, and a photo sensor -- the large area silicon avalanche photodiode. The electrode grids are made of thin wire. The modeling of the electric field is a crucial step in developing a working prototype. It has been previously shown that the uniform electric field divided by the number density of xenon gas needs to be above approximately 3 Td to give enough energy to ionize the xenon atoms, but less than 16 Td to prevent electron avalanches from occurring. The electric field was modeled using Comsol Multiphysics. This presentation discusses the results of electric field modeling for the detector (absorption, drift, and EL regions).

  19. A Simplified Model for Detonation Based Pressure-Gain Combustors

    NASA Technical Reports Server (NTRS)

    Paxson, Daniel E.

    2010-01-01

    A time-dependent model is presented which simulates the essential physics of a detonative or otherwise constant volume, pressure-gain combustor for gas turbine applications. The model utilizes simple, global thermodynamic relations to determine an assumed instantaneous and uniform post-combustion state in one of many envisioned tubes comprising the device. A simple, second order, non-upwinding computational fluid dynamic algorithm is then used to compute the (continuous) flowfield properties during the blowdown and refill stages of the periodic cycle which each tube undergoes. The exhausted flow is averaged to provide mixed total pressure and enthalpy which may be used as a cycle performance metric for benefits analysis. The simplicity of the model allows for nearly instantaneous results when implemented on a personal computer. The results compare favorably with higher resolution numerical codes which are more difficult to configure, and more time consuming to operate.

  20. Remote monitoring of blood pressure to reduce the risk of preeclampsia related complications with an innovative use of mobile technology.

    PubMed

    Ganapathy, R; Grewal, A; Castleman, J S

    2016-10-01

    Assess suitability of remote self-monitoring of blood pressure with an innovative use of technology in detecting raised blood pressure in pregnancy. Assess ease of use and safety of the newly developed kit which included a Bluetooth enabled blood pressure machine and an android based mobile phone. The phone was modified to have only one application in it which showed the blood pressure readings with a traffic light system. The study was a proof of concept for wider use of the kit. We provided 50 women who were admitted with the kit. We assessed ease of use of the blood pressure machine and accuracy of readings including remote transfer to a computer. Technological feasibility and acceptance by women. The technology provides accurate data and visual cues including safe remote transfer instantaneously. 90% of the women agreed that the Kit was simple to use and 78% would prefer this model of testing at home. In a relatively resource rich setting the machine can reduce the number of patient visits for women who are at risk for preeclampsia. In resource poor settings it helps to triage resources to women who need it the most. It also is a valuable tool for research. Studies of the Kit in both developed and developing world will be needed to show reduction in perinatal and maternal morbidity or mortality secondary to preeclampsia. Copyright © 2016 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.

  1. Earthquake Risk Modelling - Opening the black box

    NASA Astrophysics Data System (ADS)

    Alarcon, John E.; Simic, Milan; Franco, Guillermo; Shen-Tu, Bingming

    2010-05-01

    Assessing the risk from natural catastrophes such as earthquakes involves the detailed study of the seismic sources and site conditions that contribute to the earthquake hazard in the region of interest, the distribution and particular characteristics of the exposures through the study of building stock and its vulnerabilities, and the application of specific financial terms for particular portfolios. The catastrophe modelling framework encompasses these relatively complex considerations while also including a measure of uncertainty. This paper describes succinctly the structure and modules included in a probabilistic catastrophe risk model and presents several examples of risk modelling for realistic scenarios such as the expected earthquakes in the Marmara Sea region of Turkey and the results from modelling the 2009 L'Aquila (Abruzzo) earthquake.

  2. Dry skin and pressure ulcer risk: A multi-center cross-sectional prevalence study in German hospitals and nursing homes.

    PubMed

    Lechner, Anna; Lahmann, Nils; Neumann, Konrad; Blume-Peytavi, Ulrike; Kottner, Jan

    2017-05-18

    Pressure ulcers are a serious health problem in medical and nursing care. Therefore, effective prevention is crucial. Major pressure ulcer risk factors have been identified but the particular role of dry skin (xerosis cutis) is unclear. To investigate possible associations between dry skin and pressure ulcers focusing on the sacrum/trochanter and at heel/ankle skin areas. Two multicenter cross-sectional studies. In 2014 and 2015 thirty nursing homes and thirteen hospitals in Germany participated. In total 3837 participants were included. Mean age was 76.1 (SD 15.5) years. Skin assessments and data collection were performed by trained nurses based on a standardized data collection form. Descriptive comparisons and multilevel logistic regressions predicting pressure ulcers at sacrum/trochanter and ankle/heel were conducted. The prevalence of skin dryness at the trunk was significantly higher for subjects with pressure ulcers category 2+ at the sacral area compared to without (39.0% vs. 24.4%, p=0.010). Adjusted to demographic variables, mobility and type of institution dry skin at the trunk was no longer associated with pressure ulceration (OR 1.11 (95% CI 0.62-2.00)). 71.9% of patients with heel/ankle pressure ulcers category 2+ were affected by dry skin at legs or feet, compared to 42.8% of subjects without pressure ulcers (p<0.001). In the adjusted analysis the OR was 1.85 (95% CI 0.83-4.14). Study results indicate that dry skin at the feet may be considered as a risk factor for heel pressure ulcer development. Skin dryness may be less important for sacral pressure ulcers. Therefore, the variable skin status should be better defined in future studies and pressure ulcer risk models. Results further support differences in pressure ulcer aetiologies between anatomical locations. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Long range Ising model for credit risk modeling

    NASA Astrophysics Data System (ADS)

    Molins, Jordi; Vives, Eduard

    2005-07-01

    Within the framework of maximum entropy principle we show that the finite-size long-range Ising model is the adequate model for the description of homogeneous credit portfolios and the computation of credit risk when default correlations between the borrowers are included. The exact analysis of the model suggest that when the correlation increases a first-order-like transition may occur inducing a sudden risk increase.

  4. A Risk Model for Lung Cancer Incidence

    PubMed Central

    Hoggart, Clive; Brennan, Paul; Tjonneland, Anne; Vogel, Ulla; Overvad, Kim; Østergaard, Jane Nautrup; Kaaks, Rudolf; Canzian, Federico; Boeing, Heiner; Steffen, Annika; Trichopoulou, Antonia; Bamia, Christina; Trichopoulos, Dimitrios; Johansson, Mattias; Palli, Domenico; Krogh, Vittorio; Tumino, Rosario; Sacerdote, Carlotta; Panico, Salvatore; Boshuizen, Hendriek; Bueno-de-Mesquita, H. Bas; Peeters, Petra H.M.; Lund, Eiliv; Gram, Inger Torhild; Braaten, Tonje; Rodríguez, Laudina; Agudo, Antonio; Sanchez-Cantalejo, Emilio; Arriola, Larraitz; Chirlaque, Maria-Dolores; Barricarte, Aurelio; Rasmuson, Torgny; Khaw, Kay-Tee; Wareham, Nicholas; Allen, Naomi E.; Riboli, Elio; Vineis, Paolo

    2015-01-01

    Risk models for lung cancer incidence would be useful for prioritizing individuals for screening and participation in clinical trials of chemoprevention. We present a risk model for lung cancer built using prospective cohort data from a general population which predicts individual incidence in a given time period. We build separate risk models for current and former smokers using 169,035 ever smokers from the multicenter European Prospective Investigation into Cancer and Nutrition (EPIC) and considered a model for never smokers. The data set was split into independent training and test sets. Lung cancer incidence was modeled using survival analysis, stratifying by age started smoking, and for former smokers, also smoking duration. Other risk factors considered were smoking intensity, 10 occupational/environmental exposures previously implicated with lung cancer, and single-nucleotide polymorphisms at two loci identified by genome-wide association studies of lung cancer. Individual risk in the test set was measured by the predicted probability of lung cancer incidence in the year preceding last follow-up time, predictive accuracy was measured by the area under the receiver operator characteristic curve (AUC). Using smoking information alone gave good predictive accuracy: the AUC and 95% confidence interval in ever smokers was 0.843 (0.810–0.875), the Bach model applied to the same data gave an AUC of 0.775 (0.737–0.813). Other risk factors had negligible effect on the AUC, including never smokers for whom prediction was poor. Our model is generalizable and straightforward to implement. Its accuracy can be attributed to its modeling of lifetime exposure to smoking. PMID:22496387

  5. Facial pressure zones of an oronasal interface for noninvasive ventilation: a computer model analysis* **

    PubMed Central

    Barros, Luana Souto; Talaia, Pedro; Drummond, Marta; Natal-Jorge, Renato

    2014-01-01

    OBJECTIVE: To study the effects of an oronasal interface (OI) for noninvasive ventilation, using a three-dimensional (3D) computational model with the ability to simulate and evaluate the main pressure zones (PZs) of the OI on the human face. METHODS: We used a 3D digital model of the human face, based on a pre-established geometric model. The model simulated soft tissues, skull, and nasal cartilage. The geometric model was obtained by 3D laser scanning and post-processed for use in the model created, with the objective of separating the cushion from the frame. A computer simulation was performed to determine the pressure required in order to create the facial PZs. We obtained descriptive graphical images of the PZs and their intensity. RESULTS: For the graphical analyses of each face-OI model pair and their respective evaluations, we ran 21 simulations. The computer model identified several high-impact PZs in the nasal bridge and paranasal regions. The variation in soft tissue depth had a direct impact on the amount of pressure applied (438-724 cmH2O). CONCLUSIONS: The computer simulation results indicate that, in patients submitted to noninvasive ventilation with an OI, the probability of skin lesion is higher in the nasal bridge and paranasal regions. This methodology could increase the applicability of biomechanical research on noninvasive ventilation interfaces, providing the information needed in order to choose the interface that best minimizes the risk of skin lesion. PMID:25610506

  6. Understanding the external pressure and behavior of commercial banks' environmental risk management: an empirical study undertaken in the Yangtze River delta of China.

    PubMed

    Liu, Yong; Lin, Zhongguo

    2014-04-01

    The present study employed a quantitative survey to ascertain whether the external pressure of environmental risk management (ERM) on commercial banks was a contributing factor to their ERM behavior. Data was obtained using questionnaires from 204 branches of commercial banks located in the Yangtze River Delta of China. The relationship between external pressure and behavior was tested using a linear structural relations model through path analysis. The results revealed that external pressure of ERM was significantly and positively related to the behavior and that pressure from governmental regulations was the most important contributing factor in the passive feedback behavior and preventive behavior of commercial banks. The pressure from markets was the most important contributing factor in banks' active participation behavior; the pressure from community and NGOs was the most important contributing factor in their enthusiastic behavior.

  7. Cortisol, heart rate, and blood pressure as early markers of PTSD risk: A systematic review and meta-analysis.

    PubMed

    Morris, Matthew C; Hellman, Natalie; Abelson, James L; Rao, Uma

    2016-11-01

    Individuals with posttraumatic stress disorder (PTSD) typically exhibit altered hypothalamic-pituitary-adrenal (HPA) function and sympathetic nervous system (SNS) activity. The goals of this study were to determine whether HPA and SNS alterations in the immediate aftermath of trauma predict subsequent PTSD symptom development and whether inconsistencies observed between studies can be explained by key demographic and methodological factors. This work informs secondary prevention of PTSD by identifying subgroups of trauma survivors at risk for PTSD. This meta-analysis (26 studies, N=5186 individuals) revealed that higher heart rate measured soon after trauma exposure was associated with higher PTSD symptoms subsequently (r=0.13). Neither cortisol (r=-0.07) nor blood pressure (diastolic: r=-0.01; systolic: r=0.02) were associated with PTSD symptoms which may be influenced by methodological limitations. Associations between risk markers (heart rate, cortisol, systolic blood pressure) and PTSD symptoms were in the positive direction for younger samples and negative direction for older samples. These findings extend developmental traumatology models of PTSD by revealing an age-related shift in the presentation of early risk markers. More work will be needed to identify risk markers and pathways to PTSD while addressing methodological limitations in order to shape and target preventive interventions. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Nursing care missed in patients at risk of or having pressure ulcers

    PubMed Central

    Valles, Jonathan Hermayn Hernández; Monsiváis, María Guadalupe Moreno; Guzmán, Ma. Guadalupe Interial; Arreola, Leticia Vázquez

    2016-01-01

    ABSTRACT Objective: to determine the nursing care missed as perceived by the nursing staff and its relation with the nursing care missed identified in the assessment of patients at risk of or having pressur ulcers. Method: descriptive correlation study. The participants were 161 nurses and 483 patients from a public hospital. The MISSCARE survey was used in combination with a Nursing Care Assessment Form for Patients at Risk of or having pressure ulcers. For the analysis, descriptive and inferential statistics were used. Results: the nursing staff indicated greater omission in skin care (38.5%), position change (31.1%) and the registration of risk factors for the development of pressure ulcers (33.5%). The nursing care missed identified in the assessment related to the use of pressure relief on bony prominences and drainage tubes interfering in the patient's movements (both with 58.6%) and the use of pneumatic mattresses (57.6%). Conclusion: a high percentage of nursing care missed was found according to the staff's perception. Nevertheless, the assessment of the nursing care missed was much higher. No significant relation was found between both. Therefore, it is a priority to reflect on the importance of objective patient assessments. PMID:27878218

  9. Risk factors for pressure ulcer development in Intensive Care Units: A systematic review.

    PubMed

    Lima Serrano, M; González Méndez, M I; Carrasco Cebollero, F M; Lima Rodríguez, J S

    Pressure ulcers represent a significant problem for patients, professionals and health systems. Their reported incidence and prevalence are significant worldwide. Their character iatrogenic states that its appearance is preventable and its incidence is an indicator of scientific and technical quality both in primary care and specialized care. The aim of this review was to identify risk factors associated with the occurrence of pressure ulcers in critically ill patients. The PRISMA Declaration recommendations have been followed and adapted to studies identifying risk factors. A qualitative systematic review of primary studies has been performed and a search was conducted of the PubMed, The Cochrane Library, Scopus and Web of Science databases. Methodological limitations in observational studies have been considered. From 200 references, 17 fulfilled the eligibility criteria. These studies included 19,363 patients admitted to intensive care units. Six studies were classified as high quality and 11 were classified as moderate quality. Risk factors that emerged as predictive of pressure ulcers development more frequently included age, length of ICU stay, diabetes, time of MAP <60-70mmHg, mechanical ventilation, length of mechanical ventilation, intermittent haemodialysis or continuous veno-venous haemofiltration therapy, vasopressor support, sedation and turning. There is no single factors which can explain the occurrence of pressure ulcers. Rather, it is an interplay of factors that increase the probability of its development. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  10. Modeling of an implantable device for remote arterial pressure measurement

    NASA Astrophysics Data System (ADS)

    Miguel, J. A.; Lechuga, Y.; Mozuelos, R.; Martinez, M.

    2013-05-01

    Cardiovascular diseases are the leading causes of illness and death in Europe, having a major impact on healthcare costs. An intelligent stent (e-stent), capable of obtaining and transmitting measurements of physiological parameters, can be a useful tool for real-time monitorization of arterial blockage without patient hospitalization. In this paper, a behavioral model of a pressure sensing-based e-stent is proposed and simulated under several restenosis conditions. Special attention has been given to the need of an accurate fault model, obtained from realistic finite-element simulations, to ensure long-term reliability; particularly for those faults whose behavior cannot be described by usual analytical models.

  11. Risk factors associated with newly diagnosed high blood pressure in men and women.

    PubMed

    Carlsson, Axel C; Wändell, Per E; de Faire, Ulf; Hellénius, Mai-Lis

    2008-07-01

    Hypertension is a major risk factor for cardiovascular diseases. Early diagnosis and prevention of hypertension are of great importance in reducing overall mortality. The objective was to determine which potential risk factors are associated with newly diagnosed high blood pressure in women and men. This study is part of a population-based, cross-sectional study including 4,228 women and men aged 60 years in Stockholm County, Sweden. Newly diagnosed high blood pressure was defined as systolic and/or diastolic blood pressure exceeding 140/90 measured on one occasion. Subjects with known hypertension were excluded, leaving 3,156 individuals. Waist circumference > or =95 cm (quintiles 3-5) in men and > or =88.5 cm (quintiles 4-5) in women was associated with newly diagnosed high blood pressure. Secondary school was a protective factor in men (odds ratio (OR), men = 0.73, 95% confidence interval (CI) = 0.54-0.99) and university education was protective in both men (OR = 0.66, 95% CI = 0.52-0.85) and women (OR = 0.45, 95% CI = 0.34-0.59). Regular physical activity was negatively associated in women (OR = 0.77, 95% CI = 0.61-0.99), and high alcohol consumption (>30 g/day) was positively associated in men (OR = 1.60, 95% CI = 1.22-2.09). Women were negatively associated with newly diagnosed high blood pressure (OR = 0.50, 95% CI = 0.41-0.61). An interaction between college/university and gender was found in multivariate analysis (OR = 0.67, 95% CI = 0.47-0.97). Gender differences in risk profile for newly diagnosed high blood pressure might explain part of the differences in hypertension found between men and women. These findings should be considered when planning preventive actions against hypertension at the community level.

  12. Exaggerated blood pressure response during the exercise treadmill test as a risk factor for hypertension

    PubMed Central

    Lima, S.G.; Albuquerque, M.F.P.M.; Oliveira, J.R.M.; Ayres, C.F.J.; Cunha, J.E.G.; Oliveira, D.F.; Lemos, R.R.; Souza, M.B.R.; Silva, O. Barbosa e

    2013-01-01

    Exaggerated blood pressure response (EBPR) during the exercise treadmill test (ETT) has been considered to be a risk factor for hypertension. The relationship of polymorphisms of the renin-angiotensin system gene with hypertension has not been established. Our objective was to evaluate whether EBPR during exercise is a clinical marker for hypertension. The study concerned a historical cohort of normotensive individuals. The exposed individuals were those who presented EBPR. At the end of the observation period (41.7 months = 3.5 years), the development of hypertension was analyzed within the two groups. Genetic polymorphisms and blood pressure behavior were assessed as independent variables, together with the classical risk factors for hypertension. The I/D gene polymorphism of the angiotensin-converting enzyme and M235T of angiotensinogen were ruled out as risk factors for hypertension. EBPR during ETT is not an independent influence on the chances of developing hypertension. No differences were observed between the hypertensive and normotensive individuals regarding gender (P = 0.655), skin color (P = 0.636), family history of hypertension (P = 0.225), diabetes mellitus (P = 0.285), or hypertriglyceridemia (P = 0.734). The risk of developing hypertension increased with increasing body mass index (BMI) and advancing age. The risk factors, which independently influenced the development of hypertension, were age and BMI. EBPR did not constitute an independent risk factor for hypertension and is probably a preclinical phase in the spectrum of normotension and hypertension. PMID:23598646

  13. Tantalum strength model incorporating temperature, strain rate and pressure

    NASA Astrophysics Data System (ADS)

    Lim, Hojun; Battaile, Corbett; Brown, Justin; Lane, Matt

    Tantalum is a body-centered-cubic (BCC) refractory metal that is widely used in many applications in high temperature, strain rate and pressure environments. In this work, we propose a physically-based strength model for tantalum that incorporates effects of temperature, strain rate and pressure. A constitutive model for single crystal tantalum is developed based on dislocation kink-pair theory, and calibrated to measurements on single crystal specimens. The model is then used to predict deformations of single- and polycrystalline tantalum. In addition, the proposed strength model is implemented into Sandia's ALEGRA solid dynamics code to predict plastic deformations of tantalum in engineering-scale applications at extreme conditions, e.g. Taylor impact tests and Z machine's high pressure ramp compression tests, and the results are compared with available experimental data. Sandia National Laboratories is a multi program laboratory managed and operated by Sandia Corporation, a wholly owned subsidiary of Lockheed Martin Corporation, for the U.S. Department of Energy's National Nuclear Security Administration under contract DE-AC04-94AL85000.

  14. Relationship of anthropometric indicators with blood pressure levels and the risk of hypertension in Nigerian adults

    PubMed Central

    Adedoyin, Rufus A; Mbada, Chidozie E; Bisiriyu, Luqman A; Adebayo, Rasaaq A; Balogun, Michael O; Akintomide, Anthony O

    2008-01-01

    Background and purpose: Studies on cardiovascular risks in relation to anthropometric factors are limited in Sub-Sahara Africa. The aims of this study were to examine the relationship between anthropometric parameters and blood pressure; and to evaluate body mass index (BMI) across the range of underweight and obesity as a primary risk factor of hypertension in adult Nigerians. Material and methods: 2097 adults aged between 20 and 100 years consented and participated in this door-to-door survey. All participants underwent blood pressure and anthropometric measurements using standard procedures. The population study was separated in normotensive and hypertensive males and females and the possible risk for hypertension were categorized into different classes of value based on BMI definition. Results: The relative risks (odds ratio [OR] and 95% confidence interval [CI]) of developing hypertension among the obese compared with the underweight, normal weight, and overweight persons were (OR 5.75; CI 5.67–5.83), (OR 1.73; CI 1.65–1.81), and (OR 1.54; CI 1.46–1.62) for all the participants, respectively. Among obese (BMI ≥ 30.0 Kg/m2) males, the OR for hypertension was three times (OR 2.78; CI 2.76–2.80) that of normal weight (BMI ≥ 18.5–24.9 Kg/m2) males. Females with obesity had a risk of hypertension three times (OR 3.34; CI 3.33–3.35) that of normal weight females. Conclusion: Our results indicated that the there was a significant positive correlation of obesity indicator with blood pressure. In Nigeria, we found a strong gradient between higher BMI and increased risk of hypertension among all ages. Approaches to reduce the risk of hypertension may include prevention of overweight and obesity. PMID:20428404

  15. High Pressure Air Jet in the Endoscopic Preparation Room: Risk of Noise Exposure on Occupational Health

    PubMed Central

    Lu, Lung-Sheng; Wu, Cheng-Kun

    2015-01-01

    After high-level disinfection of gastrointestinal endoscopes, they are hung to dry in order to prevent residual water droplets impact on patient health. To allow for quick drying and clinical reuse, some endoscopic units use a high pressure air jet (HPAJ) to remove the water droplets on the endoscopes. The purpose of this study was to evaluate the excessive noise exposure with the use of HPAJ in endoscopic preparation room and to investigate the risk to occupational health. Noise assessment was taken during 7 automatic endoscopic reprocessors (AERs) and combined with/without HPAJ use over an 8-hour time-weighted average (TWA). Analytical procedures of the NIOSH and the ISO for noise-induced hearing loss were estimated to develop analytic models. The peak of the noise spectrum of combined HPAJ and 7 AERs was significantly higher than that of the 7 AERs alone (108.3 ± 1.36 versus 69.3 ± 3.93 dBA, P < 0.0001). The risk of hearing loss (HL > 2.5 dB) was 2.15% at 90 dBA, 11.6% at 95 dBA, and 51.3% at 100 dBA. The odds ratio was 49.1 (95% CI: 11.9 to 203.6). The noise generated by the HPAJ to work over TWA seriously affected the occupational health and safety of those working in an endoscopic preparation room. PMID:25710009

  16. Control of Blood Pressure and Risk Attenuation: Post Trial Follow-Up of Randomized Groups.

    PubMed

    Jafar, Tazeen H; Jehan, Imtiaz; Liang, Feng; Barbier, Sylvaine; Islam, Muhammad; Bux, Rasool; Khan, Aamir Hameed; Nadkarni, Nivedita; Poulter, Neil; Chaturvedi, Nish; Ebrahim, Shah

    2015-01-01

    Evidence on long term effectiveness of public health strategies for lowering blood pressure (BP) is scarce. In the Control of Blood Pressure and Risk Attenuation (COBRA) Trial, a 2 x 2 factorial, cluster randomized controlled trial, the combined home health education (HHE) and trained general practitioner (GP) intervention delivered over 2 years was more effective than no intervention (usual care) in lowering systolic BP among adults with hypertension in urban Pakistan. However, it was not clear whether the effect would be sustained after the cessation of intervention. We conducted 7 years follow-up inclusive of 5 years of post intervention period of COBRA trial participants to assess the effectiveness of the interventions on BP during extended follow-up. A total of 1341 individuals 40 years or older with hypertension (systolic BP 140 mm Hg or greater, diastolic BP 90 mm Hg or greater, or already receiving treatment) were followed by trained research staff masked to randomization status. BP was measured thrice with a calibrated automated device (Omron HEM-737 IntelliSense) in the sitting position after 5 minutes of rest. BP measurements were repeated after two weeks. Generalized estimating equations (GEE) were used to analyze the primary outcome of change in systolic BP from baseline to 7- year follow-up. The multivariable model was adjusted for clustering, age at baseline, sex, baseline systolic and diastolic BP, and presence of diabetes. After 7 years of follow-up, systolic BP levels among those randomised to combined HHE plus trained GP intervention were significantly lower (2.1 [4.1-0.1] mm Hg) compared to those randomised to usual care, (P = 0.04). Participants receiving the combined intervention compared to usual care had a greater reduction in LDL-cholesterol (2.7 [4.8 to 0.6] mg/dl. The benefit in systolic BP reduction observed in the original cohort assigned to the combined intervention was attenuated but still evident at 7- year follow-up. These findings

  17. Psychometric Testing of INTEGRARE, an Instrument for the Assesment of Pressure Ulcer Risk in Inpatients.

    PubMed

    Porcel-Gálvez, Ana María; Romero-Castillo, Rocío; Fernández-García, Elena; Barrientos-Trigo, Sergio

    2017-08-21

    The aim of this study is to evaluate the psychometric properties of INTEGRARE, an instrument based on Nursing Outcome Classification. A multicenter, cross-sectional, methodological design was used. The study included 3,835 patients. Internal consistency α = 0.86. Confirmatory factor analysis demonstrated the unidimensionality of the scale, indicating a good model fit (CMIN/DF = 4; GFI, CFI, NFI, IFI = 0.999; RMSEA = 0.028). INTEGRARE is a valid and reliable instrument with high sensitivity, specificity, and diagnostic accuracy in measuring pressure ulcer (PU) risk in inpatients. This instrument allows us to know the effectiveness of nursing interventions, providing evidence for the validation of the diagnosis Risk for pressure ulcer (00249) as well as on health outcomes, due to the fact that PUs are nursing-sensitive outcomes. Evaluar las propiedades psicométricas de INTEGRARE, un instrumento basado en la Clasificación de Resultados de Enfermería. MÉTODO: Se optó por un diseño transversal multicéntrico. El estudio incluyó a 3,835 pacientes. Consistencia interna α = 0.86. El análisis factorial confirmatorio demostró la unidimensionalidad de la escala, indicando un buen ajuste del modelo (CMIN/DF = 4; GFI, CFI, NFI, IFI = 0.999; RMSEA = 0.028). INTEGRARE es un instrumento válido y fiable con alta sensibilidad, especificidad y precisión diagnóstica en la medición de riesgo de úlcera por presión (UPP) en pacientes hospitalizados. IMPLICACIONES PARA LA PRÁCTICA ENFERMERA: Este instrumento nos permite conocer la efectividad de las intervenciones enfermeras, aportando evidencia para la validación del diagnóstico Riesgo de úlcera por presión (00249), así como sobre los resultados de salud, debido a que las UPP son resultados sensibles a la práctica enfermera. © 2017 NANDA International, Inc.

  18. Control of Blood Pressure and Risk Attenuation: Post Trial Follow-Up of Randomized Groups

    PubMed Central

    Jafar, Tazeen H.; Jehan, Imtiaz; Liang, Feng; Barbier, Sylvaine; Islam, Muhammad; Bux, Rasool; Khan, Aamir Hameed; Nadkarni, Nivedita; Poulter, Neil; Chaturvedi, Nish; Ebrahim, Shah

    2015-01-01

    Background Evidence on long term effectiveness of public health strategies for lowering blood pressure (BP) is scarce. In the Control of Blood Pressure and Risk Attenuation (COBRA) Trial, a 2 x 2 factorial, cluster randomized controlled trial, the combined home health education (HHE) and trained general practitioner (GP) intervention delivered over 2 years was more effective than no intervention (usual care) in lowering systolic BP among adults with hypertension in urban Pakistan. However, it was not clear whether the effect would be sustained after the cessation of intervention. We conducted 7 years follow-up inclusive of 5 years of post intervention period of COBRA trial participants to assess the effectiveness of the interventions on BP during extended follow-up. Methods A total of 1341 individuals 40 years or older with hypertension (systolic BP 140 mm Hg or greater, diastolic BP 90 mm Hg or greater, or already receiving treatment) were followed by trained research staff masked to randomization status. BP was measured thrice with a calibrated automated device (Omron HEM-737 IntelliSense) in the sitting position after 5 minutes of rest. BP measurements were repeated after two weeks. Generalized estimating equations (GEE) were used to analyze the primary outcome of change in systolic BP from baseline to 7- year follow-up. The multivariable model was adjusted for clustering, age at baseline, sex, baseline systolic and diastolic BP, and presence of diabetes. Findings After 7 years of follow-up, systolic BP levels among those randomised to combined HHE plus trained GP intervention were significantly lower (2.1 [4.1–0.1] mm Hg) compared to those randomised to usual care, (P = 0.04). Participants receiving the combined intervention compared to usual care had a greater reduction in LDL-cholesterol (2.7 [4.8 to 0.6] mg/dl. Conclusions The benefit in systolic BP reduction observed in the original cohort assigned to the combined intervention was attenuated but still

  19. High Blood Pressure and Related Factors Among Individuals at High Risk for HIV/Sexually Transmitted Infections.

    PubMed

    Nam, Soohyun; Whittemore, Robin; Jeon, Sangchoon; Davey-Rothwell, Melissa A; Latkin, Carl

    2016-06-01

    Data from a social network-based human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention study with a total of 330 men and women at high risk for HIV/STIs were used to examine the relationships between substance use, depressive symptoms, general health, cardiovascular disease risk factors, sociodemographic characteristics, and systolic/diastolic blood pressure (SBP/DBP). Approximately 60% of the participants had prehypertension to stage 2 hypertension. In the base model, older patients (P<.0001), men (P=.003), and patients with poorer self-reported health (P=.029) were significantly associated with high SBP, whereas older age (P<.001) and higher body mass index (P<.001) were significantly associated with higher DBP. After adjusting for the base model, high frequency of alcohol drinking and high frequency of binge drinking remained significant for high SBP and DBP. These data suggest that future cardiovascular disease programs should target moderate alcohol consumption to improve blood pressure among individuals at high risk for HIV/STIs. © 2015 Wiley Periodicals, Inc.

  20. Integral bubble and jet models with pressure forces

    NASA Astrophysics Data System (ADS)

    Vulfson, A. N.; Nikolaev, P. V.

    2017-07-01

    Modifications of integral bubble and jet models including the pressure force are proposed. Exact solutions are found for the modified model of a stationary convective jet from a point source of buoyancy and momentum. The exact solutions are compared against analytical solutions of the integral models for a stationary jet that are based on the approximation of the vertical boundary layer. It is found that the modified integral models of convective jets retain the power-law dependences on the altitude for the vertical velocity and buoyancy obtained in classical models. For a buoyant jet in a neutrally stratified atmosphere, the inclusion of the pressure force increases the amplitude of buoyancy and decreases the amplitude of vertical velocity. The total amplitude change is about 10%. It is shown that in this model there is a dynamic invariant expressing the law of a uniform distribution of the potential and kinetic energy along the jet axis. For a spontaneous jet rising in an unstably stratified atmosphere, the inclusion of the pressure force retains the amplitude of buoyancy and increases the amplitude of vertical velocity by about 15%. It is shown that in the model of a spontaneous jet there is a dynamic invariant expressing the law of a uniform distribution of the available potential and kinetic energy along the jet axis. The results are of interest for the problems of anthropogenic pollution diffusion in the air and water environments and the formulation of models for statistical and stochastic ensembles of thermals in a mass-flux parameterization of turbulent moments.

  1. 49 CFR 195.303 - Risk-based alternative to pressure testing older hazardous liquid and carbon dioxide pipelines.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... hazardous liquid and carbon dioxide pipelines. 195.303 Section 195.303 Transportation Other Regulations... Pressure Testing § 195.303 Risk-based alternative to pressure testing older hazardous liquid and carbon dioxide pipelines. (a) An operator may elect to follow a program for testing a pipeline on risk-based...

  2. 49 CFR 195.303 - Risk-based alternative to pressure testing older hazardous liquid and carbon dioxide pipelines.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... hazardous liquid and carbon dioxide pipelines. 195.303 Section 195.303 Transportation Other Regulations... Pressure Testing § 195.303 Risk-based alternative to pressure testing older hazardous liquid and carbon dioxide pipelines. (a) An operator may elect to follow a program for testing a pipeline on risk-based...

  3. 49 CFR 195.303 - Risk-based alternative to pressure testing older hazardous liquid and carbon dioxide pipelines.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... hazardous liquid and carbon dioxide pipelines. 195.303 Section 195.303 Transportation Other Regulations... Pressure Testing § 195.303 Risk-based alternative to pressure testing older hazardous liquid and carbon dioxide pipelines. (a) An operator may elect to follow a program for testing a pipeline on risk-based...

  4. 49 CFR 195.303 - Risk-based alternative to pressure testing older hazardous liquid and carbon dioxide pipelines.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... hazardous liquid and carbon dioxide pipelines. 195.303 Section 195.303 Transportation Other Regulations... Pressure Testing § 195.303 Risk-based alternative to pressure testing older hazardous liquid and carbon dioxide pipelines. (a) An operator may elect to follow a program for testing a pipeline on risk-based...

  5. 49 CFR 195.303 - Risk-based alternative to pressure testing older hazardous liquid and carbon dioxide pipelines.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... hazardous liquid and carbon dioxide pipelines. 195.303 Section 195.303 Transportation Other Regulations... Pressure Testing § 195.303 Risk-based alternative to pressure testing older hazardous liquid and carbon dioxide pipelines. (a) An operator may elect to follow a program for testing a pipeline on risk-based...

  6. [Baroreflex sensitivity: diagnostic importance, methods of determination and a model of baroreflex blood-pressure regulation].

    PubMed

    Svacinová, J; Moudr, J; Honzíková, N

    2013-01-01

    Baroreflex regulation of blood pressure primarily moderates its fluctuations and also affects mean blood pressure. Heart rate baroreflex sensitivity is described as changes of the inter-beat interval induced by a change of blood pressure of 1 mmHg (BRS). BRS is decreased in many cardiovascular diseases (hypertension, diabetes mellitus, obesity, cardiac failure, etc.). Decreased BRS in disposed individuals, especially after myocardial infarction, increases the risk of sudden cardiac death. Therefore, early diagnosis of BRS decrease gains in importance. This article describes different methods of determination of baroreflex sensitivity. The methods are based on evaluation of the spontaneous fluctuation of heart rate and blood pressure (spectral, sequential or nonlinear methods), or of primary changes of blood pressure induced by a vasoactive substance or a physiological manoeuvre and corresponding changes of cardiac intervals (Valsalva manoeuvre, phenylephrine administration). Each method has its advantages and disadvantages resulting from a different difficulty of calculation or from inclusion of different deviations in the results, which are not directly linked with baroreflex. Baroreflex regulating total peripheral resistance is less described. A mathematical model of baroreflex blood pressure regulation by fluctuation of heart rate and peripheral resistance is presented in this paper.

  7. Impact of Blood Pressure and Blood Pressure Change during Middle Age on the Remaining Lifetime Risk for Cardiovascular Disease: The Cardiovascular Lifetime Risk Pooling Project

    PubMed Central

    Allen, Norrina; Berry, Jarett D.; Ning, Hongyan; Van Horn, Linda; Dyer, Alan; Lloyd-Jones, Donald M.

    2012-01-01

    Background Prior estimates of lifetime risk (LTR) for cardiovascular disease (CVD) examined the impact of blood pressure at the index age and did not account for changes in blood pressure over time. We examined how changes in blood pressure during middle-age affect LTR for CVD, coronary heart disease (CHD) and stroke. Methods and Results Data from 7 diverse US cohort studies were pooled. Remaining LTR for CVD, CHD and stroke were estimated for White and Black men and women with death free of CVD as a competing event. LTR for CVD by blood pressure (BP) strata and by changes in BP over an average of 14 years were estimated. Starting at age 55, we followed 61,585 men and women for 700,000 person-years. LTR for CVD was 52.5% (95% CI 51.3–53.7) for men and 39.9% (38.7–41.0) for women. LTR for CVD was higher for Blacks and increased with increasing BP at index age. Individuals who maintained or decreased their BP to normal levels had the lowest remaining LTR for CVD, 22–41%, as compared to individuals who had or developed hypertension by the age of 55, 42–69%; suggesting a dose-response effect for the length of time at high BP levels Conclusions Individuals who experience increases or decreases in BP in middle age have associated higher and lower remaining LTR for CVD. Prevention efforts should continue to emphasize the importance of lowering BP and avoiding or delaying the incidence of hypertension in order to reduce the LTR for CVD. PMID:22184621

  8. Blood Pressure and Cardiovascular Disease Risk in the Veterans Affairs Diabetes Trial

    PubMed Central

    Anderson, Robert J.; Bahn, Gideon D.; Moritz, Thomas E.; Kaufman, Derrick; Abraira, Carlos; Duckworth, William

    2011-01-01

    OBJECTIVE Blood pressure ranges associated with cardiovascular disease (CVD) events in advanced type 2 diabetes are not clear. Our objective was to determine whether baseline and follow-up (On-Study) systolic blood pressure (SBP), diastolic blood pressure (DBP), and SBP combined with DBP predict CVD events in the Veterans Affairs Diabetes Trial (VADT). RESEARCH DESIGN AND METHODS Participants in the VADT (n = 1,791) with hypertension received stepped treatment to maintain blood pressure below the target of 130/80 mmHg in standard and intensive glycemic treatment groups. Blood pressure levels of all subjects at baseline and On-Study were analyzed to detect associations with CVD risk. The primary outcome was the time from randomization to the first occurrence of myocardial infarction, stroke, congestive heart failure, surgery for vascular disease, inoperable coronary disease, amputation for ischemic gangrene, or CVD death. RESULTS Separated SBP ≥140 mmHg had significant risk at baseline (hazards ratio [HR] 1.508, P < 0.001) and On-Study (HR 1.469, P = 0.002). DBP <70 mmHg increased CVD events at baseline (HR 1.482, P < 0.001) and On-Study (HR 1.491, P < 0.001). Combined blood pressure categories indicated high risk for CVD events for SBP ≥140 with DBP <70 mmHg at baseline (HR 1.785, P = 0.03) and On-Study (HR 2.042, P = 0.003) and nearly all SBP with DBP <70 mmHg. CONCLUSIONS Increased risk of CVD events with SBP ≥140 mmHg emphasizes the urgency for treatment of systolic hypertension. Increased risk with DBP <70 mmHg, even when combined with SBP in guideline-recommended target ranges, supports a new finding in patients with type 2 diabetes. The results emphasize that DBP <70 mmHg in these patients was associated with elevated CVD risk and may best be avoided. PMID:21059830

  9. Modeling food spoilage in microbial risk assessment.

    PubMed

    Koutsoumanis, Konstantinos

    2009-02-01

    In this study, I describe a systematic approach for modeling food spoilage in microbial risk assessment that is based on the incorporation of kinetic spoilage modeling in exposure assessment by combining data and models for the specific spoilage organisms (SSO: fraction of the total microflora responsible for spoilage) with those for pathogens. The structure of the approach is presented through an exposure assessment application for Escherichia coli O157:H7 in ground beef. The proposed approach allows for identifying spoiled products at the time of consumption by comparing the estimated level of SSO (pseudomonads) with the spoilage level (level of SSO at which spoilage is observed). The results of the application indicate that ignoring spoilage in risk assessment could lead to significant overestimations of risk.

  10. Modeling of low pressure plasma sources for microelectronics fabrication

    NASA Astrophysics Data System (ADS)

    Agarwal, Ankur; Bera, Kallol; Kenney, Jason; Likhanskii, Alexandre; Rauf, Shahid

    2017-10-01

    Chemically reactive plasmas operating in the 1 mTorr–10 Torr pressure range are widely used for thin film processing in the semiconductor industry. Plasma modeling has come to play an important role in the design of these plasma processing systems. A number of 3-dimensional (3D) fluid and hybrid plasma modeling examples are used to illustrate the role of computational investigations in design of plasma processing hardware for applications such as ion implantation, deposition, and etching. A model for a rectangular inductively coupled plasma (ICP) source is described, which is employed as an ion source for ion implantation. It is shown that gas pressure strongly influences ion flux uniformity, which is determined by the balance between the location of plasma production and diffusion. The effect of chamber dimensions on plasma uniformity in a rectangular capacitively coupled plasma (CCP) is examined using an electromagnetic plasma model. Due to high pressure and small gap in this system, plasma uniformity is found to be primarily determined by the electric field profile in the sheath/pre-sheath region. A 3D model is utilized to investigate the confinement properties of a mesh in a cylindrical CCP. Results highlight the role of hole topology and size on the formation of localized hot-spots. A 3D electromagnetic plasma model for a cylindrical ICP is used to study inductive versus capacitive power coupling and how placement of ground return wires influences it. Finally, a 3D hybrid plasma model for an electron beam generated magnetized plasma is used to understand the role of reactor geometry on plasma uniformity in the presence of E  ×  B drift.

  11. Uncertainty in surface water flood risk modelling

    NASA Astrophysics Data System (ADS)

    Butler, J. B.; Martin, D. N.; Roberts, E.; Domuah, R.

    2009-04-01

    Two thirds of the flooding that occurred in the UK during summer 2007 was as a result of surface water (otherwise known as ‘pluvial') rather than river or coastal flooding. In response, the Environment Agency and Interim Pitt Reviews have highlighted the need for surface water risk mapping and warning tools to identify, and prepare for, flooding induced by heavy rainfall events. This need is compounded by the likely increase in rainfall intensities due to climate change. The Association of British Insurers has called for the Environment Agency to commission nationwide flood risk maps showing the relative risk of flooding from all sources. At the wider European scale, the recently-published EC Directive on the assessment and management of flood risks will require Member States to evaluate, map and model flood risk from a variety of sources. As such, there is now a clear and immediate requirement for the development of techniques for assessing and managing surface water flood risk across large areas. This paper describes an approach for integrating rainfall, drainage network and high-resolution topographic data using Flowroute™, a high-resolution flood mapping and modelling platform, to produce deterministic surface water flood risk maps. Information is provided from UK case studies to enable assessment and validation of modelled results using historical flood information and insurance claims data. Flowroute was co-developed with flood scientists at Cambridge University specifically to simulate river dynamics and floodplain inundation in complex, congested urban areas in a highly computationally efficient manner. It utilises high-resolution topographic information to route flows around individual buildings so as to enable the prediction of flood depths, extents, durations and velocities. As such, the model forms an ideal platform for the development of surface water flood risk modelling and mapping capabilities. The 2-dimensional component of Flowroute employs

  12. Modeling plasma pressure anisotropy's effect on Saturn's global magnetospheric dynamics

    NASA Astrophysics Data System (ADS)

    Tilley, M.; Harnett, E. M.; Winglee, R.

    2014-12-01

    A 3D multi-fluid, multi-scale plasma model with a complete treatment of plasma pressure anisotropy is employed to study global magnetospheric dynamics at Saturn. Cassini has observed anisotropies in the Saturnian magnetosphere, and analyses have showed correlations between anisotropy and plasma convection, ring current structure and intensity, confinement of plasma to the equatorial plane, as well as mass transport to the outer magnetosphere. The energization and transport of plasma within Saturn's magnetosphere is impactful upon the induced magnetic environments and atmospheres of potentially habitable satellites such as Enceladus and Titan. Recent efforts to couple pressure anisotropy with 3D multi-fluid plasma modeling have shown a significant move towards matching observations for simulations of Earth's magnetosphere. Our approach is used to study the effects of plasma pressure anisotropy on global processes of the Saturnian magnetosphere such as identifying the effect of pressure anisotropy on the centrifugal interchange instability. Previous simulation results have not completely replicated all aspects of the structure and formation of the interchange 'fingers' measured by Cassini at Saturn. The related effects of anisotropy, in addition to those mentioned above, include contribution to formation of MHD waves (e.g. reduction of Alfvén wave speed) and formation of firehose and mirror instabilities. An accurate understanding of processes such as the interchange instability is required if a complete picture of mass and energy transport at Saturn is to be realized. The results presented here will detail how the inclusion of a full treatment of pressure anisotropy for idealized solar wind conditions modifies the interchange structure and shape of the tail current sheet. Simulation results are compared to observations made by Cassini.

  13. Prevalence of pressure ulcer and associated risk factors in middle and older age medical inpatients in Norway.

    PubMed

    Børsting, Tove Elisabet; Tvedt, Christine Raaen; Skogestad, Ingrid Johansen; Granheim, Tove Irene; Gay, Caryl L; Lerdal, Anners

    2017-09-27

    The objectives of this study are to describe the prevalence of pressure ulcers among middle and older aged patients in a general medical hospital in Norway and to describe the associations between pressure ulcers and potential risk factors additional to the Braden risk score. Degrees of mobility, activity, perfusion and skin status are risk factors for development of pressure ulcer. Nurses' clinical judgements combined with risk assessments tools are effective to detect pressure ulcer risk. Cross-sectional study. The study was performed as part of a research project conducted between September 2012 and May 2014 in a general hospital in the capital of Norway. Registered nurses and nursing students collected data from all eligible patients on 10 days during the students' clinical practice studies. The Braden Scale was used to measure pressure ulcer risk, and skin examinations were performed to classify the skin area as normal or as indicative of pressure ulcer according to the definitions by the National Pressure Ulcer Advisory Panel. Comorbidities were collected by patient's self-report. This analysis focused on the 255 inpatients at the medical wards ≥ 52 years of age, most of whom had more than one comorbidity. The prevalence of pressure ulcers was 14.9% in this sample. Higher age, underweight, diabetes and worse Braden scores were factors associated with pressure ulcer, and pressure ulcer was most frequently sited at the sacrum or heel. Adding age, weight, and diabetes status to pressure ulcer risk assessment scales may improve identification of patients at risk for pressure ulcers. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  14. Development of a relative risk model for evaluating ecological risk of water environment in the Haihe River Basin estuary area.

    PubMed

    Chen, Qiuying; Liu, Jingling; Ho, Kin Chung; Yang, Zhifeng

    2012-03-15

    Ecological risk assessment for water environment is significant to water resource management of basin. Effective environmental management and systems restoration such as the Haihe River Basin require holistic understanding of the relative importance of various stressor-related impacts throughout the basin. As an effective technical tool for evaluating the ecological risk, relative risk model (RRM) was applied in regional scale successfully. In this study, the risk transfer from upstream of basin was considered and the RRM was developed through introducing the source-stressor-habitat exposure filter (SSH), the endpoint-habitat exposure filter (EH) and the stressor-endpoint effect filter (SE) to reflect the meaning of exposure and effect more explicit. Water environment which includes water quality, water quantity and aquatic ecosystems was selected as the assessment endpoints. We created a conceptual model which depicting potential and effect pathways from source to stressor to habitat to endpoint. The Haihe River Basin estuary (HRBE) was selected as the model case. The results showed that there were two low risk regions, one medium risk region and two high risk regions in the HRBE. The results also indicated that urbanization was the biggest source, the second was shipping and the third was industry, their risk scores are 5.65, 4.71 and 3.68 respectively. Furthermore, habitat destruction was the largest stressor with the risk scores (2.66), the second was oxygen consuming organic pollutants (1.75) and the third was pathogens (1.75). So these three stressors were the main influencing factors of the ecological pressure in the study area. For habitats, open waters (9.59) and intertidal mudflat were enduring the bigger pressure and should be taken considerable attention. Ecological service values damaged (30.54) and biodiversity decreased were facing the biggest risk pressure.

  15. Galileo's relativity principle, the concept of pressure, and complex characteristics, for the six-equation, one-pressure model

    SciTech Connect

    Makowitz, H.

    1992-10-01

    We have studied various formulations of the concept of pressure, in the context of the usual Six-Equation Model of thermal-hydraulics. A different concept of pressure, than the usual one, has been used. This new pressure concept is Galilean Invariant, and results for the One-Pressure Model with the same complex characteristic roots as the Basic III-Posed Model,'' discussed in the literature for the cases we have investigated. We have also examined several Two-Pressure formulations and shown that two pressures are a necessary but not sufficient condition for obtaining a Well-Posed system. Several counter examples are presented. We have shown that the standard theory is not Galilean Invariant and suggested that the origin of III-Posedness is due to our closure relationships. We also question whether the current theory can satisfy conservation principles for mass, energy, and momentum.

  16. Fuzzy risk stratification and risk assessment model for clinical monitoring in the ICU.

    PubMed

    Dervishi, Albion

    2017-08-01

    The decisions that clinicians make in intensive care units (ICUs) based on monitored parameters reflecting physiological deterioration are of major medical and biomedical engineering interest. These parameters have been investigated and assessed for their usefulness in risk assessment. Totally, 127 ICU adult patients were studied. They were selected from a MIMIC II Waveform Database Matched Subset and had continuous monitoring of heart rate, invasive blood pressure, and oxygen saturation. The monitored data were dimension reduced using deep learning autoencoders and then used to train a support vector machine model (SVM). A combination of methods including fuzzy c-means clustering (FCM), and a random forest (RF) was used to determine the risk levels. When classifying patients into stable or deteriorating groups the main performance parameter was the receiver operating characteristics (ROC). The area under the ROC (AUROC) was 93.2 (95% CI (92.9-93.4)) with sensitivity and specificity values of 0.80 and 0.89, respectively. The suggested fuzzy risk levels using the combined method of the FCM clustering and RF achieved an accuracy of 1 (0.9999, 1), with both sensitivity and specificity values equal to 1. The potential for using models in risk assessment to estimate a patient's physiological status, stable or deteriorating, within 4 h has been demonstrated. The study was based on retrospective analysis and further studies are needed to evaluate the impact on clinical outcomes using this model. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. High blood pressure, physical and cognitive function, and risk of stroke in the oldest old: the Leiden 85-plus Study.

    PubMed

    Sabayan, Behnam; van Vliet, Peter; de Ruijter, Wouter; Gussekloo, Jacobijn; de Craen, Anton J M; Westendorp, Rudi G J

    2013-01-01

    Epidemiological studies have shown mixed findings on the association between hypertension and stroke in the oldest old. Heterogeneity of the populations under study may underlie variation in outcomes. We examined whether the level of physical and cognitive function moderates the association between blood pressure and stroke. We included 513 subjects aged 85 years old from the population-based Leiden 85-plus Study. Systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pulse pressure were measured at baseline. Activities of daily living and Mini-Mental State Examination were assessed to estimate level of physical and cognitive function, respectively. Five-year risk of stroke was estimated with Cox regression analysis. In the entire cohort, there were no associations between various measures of blood pressure and risk of stroke except for the inverse relation between pulse pressure and stroke risk (hazard ratio [HR], 0.80 [95% confidence interval [CI], 0.66-0.98]). Among subjects with impaired physical functioning, higher systolic blood pressure (HR, 0.74 [95% CI, 0.59-0.92]), mean arterial pressure (HR: 0.68 [95% CI, 0.47-0.97]), and pulse pressure (HR, 0.71 [95% CI, 0.55-0.93]) were associated with reduced risk of stroke. Likewise, among subjects with impaired cognitive functioning, higher systolic blood pressure was associated with reduced risk of stroke (HR, 0.80 [95% CI, 0.65-0.98]). In subjects with unimpaired cognitive functioning, higher diastolic blood pressure (HR: 1.98 [95% CI, 1.21-3.22]) and mean arterial pressure (HR, 1.70 [95% CI, 1.08-2.68]) were associated with higher risk of stroke. Our findings suggest that impaired physical and cognitive function moderates the association between blood pressure and stroke.

  18. Relations of exercise blood pressure response to cardiovascular risk factors and vascular function in the Framingham Heart Study.

    PubMed

    Thanassoulis, George; Lyass, Asya; Benjamin, Emelia J; Larson, Martin G; Vita, Joseph A; Levy, Daniel; Hamburg, Naomi M; Widlansky, Michael E; O'Donnell, Christopher J; Mitchell, Gary F; Vasan, Ramachandran S

    2012-06-12

    Exercise blood pressure (BP) is an important marker of left ventricular hypertrophy, incident hypertension, and future cardiovascular events. Although impaired vascular function is hypothesized to influence the BP response during exercise, limited data exist on the association of vascular function with exercise BP in the community. Framingham Offspring cohort participants (n=2115, 53% women, mean age 59 years) underwent a submaximal exercise test (first 2 stages of the Bruce protocol), applanation tonometry, and brachial artery flow-mediated dilation testing. We related exercise systolic and diastolic BP at second stage of the Bruce protocol to standard cardiovascular risk factors and to vascular function measures. In multivariable linear regression models, exercise systolic BP was positively related to age, standing BP, standing heart rate, smoking, body mass index, and the total cholesterol-to-high-density cholesterol ratio (P≤0.01 for all). Similar associations were observed for exercise diastolic BP. Carotid-femoral pulse wave velocity (P=0.02), central pulse pressure (P<0.0001), mean arterial pressure (P=0.04), and baseline brachial flow (P=0.002) were positively associated with exercise systolic BP, whereas flow-mediated dilation was negatively associated (P<0.001). For exercise diastolic BP, forward pressure wave amplitude was negatively related (P<0.0001), whereas mean arterial pressure was positively related (P<0.0001). Increased arterial stiffness and impaired endothelial function are significant correlates of a higher exercise systolic BP response. Our findings suggest that impaired vascular function may contribute to exaggerated BP responses during daily living, resulting in repetitive increments in load on the heart and vessels and increased cardiovascular disease risk.

  19. Prevalence and risk of pressure ulcers in acute care following implementation of practice guidelines: annual pressure ulcer prevalence census 1994-2008.

    PubMed

    VanDenKerkhof, Elizabeth G; Friedberg, Elaine; Harrison, Margaret B

    2011-09-01

    Hospital-acquired pressure ulcers in the United States were estimated to cost US$2.2 to US$3.6 billion per year in 1999. In the early 1990s clinical practice guidelines for the prevention and treatment of pressure ulcers were introduced. The purpose of this study was to examine the epidemiology of pressure ulcers in acute care in Canada. The current study is based on 12,787 individuals who were inpatients during a 1-day annual census conducted in an acute care facility in Ontario between 1994 and 2008. The prevalence and incidence of pressure ulcer decreased slightly over time while the risk of pressure ulcer increased. The coccyx sacrum (~27%), heel (13%), ankle (~12%), and ischial tubersosity (~10%) were the most common ulcer sites. The implementation of clinical practice guidelines appears to have improved the quality of patient care, as demonstrated by increasing pressure ulcer risk while the prevalence and incidence of pressure ulcers has remained somewhat constant. From a policy perspective the importance of monitoring and tracking the risk and occurrence of this adverse event provides a general indicator of care, considering the many organizational aspects that may ameliorate risk. © 2011 National Association for Healthcare Quality.

  20. A model for pressurized hydrogen induced thin film blisters

    NASA Astrophysics Data System (ADS)

    van den Bos, R. A. J. M.; Reshetniak, V.; Lee, C. J.; Benschop, J.; Bijkerk, F.

    2016-12-01

    We introduce a model for hydrogen induced blister formation in nanometer thick thin films. The model assumes that molecular hydrogen gets trapped under a circular blister cap causing it to deflect elastically outward until a stable blister is formed. In the first part, the energy balance required for a stable blister is calculated. From this model, the adhesion energy of the blister cap, the internal pressure, and the critical H-dose for blister formation can be calculated. In the second part, the flux balance required for a blister to grow to a stable size is calculated. The model is applied to blisters formed in a Mo/Si multilayer after being exposed to hydrogen ions. From the model, the adhesion energy of the Mo/Si blister cap was calculated to be around 1.05 J/m2 with internal pressures in the range of 175-280 MPa. Based on the model, a minimum ion dose for the onset of blister formation was calculated to be d = 4.2 × 1018 ions/cm2. From the flux balance equations, the diffusion constant for the Mo/Si blister cap was estimated to be DH2=(10 ±1 )×10-18 cm2/s .

  1. Simulation modeling for microbial risk assessment.

    PubMed

    Cassin, M H; Paoli, G M; Lammerding, A M

    1998-11-01

    Quantitative microbial risk assessment implies an estimation of the probability and impact of adverse health outcomes due to microbial hazards. In the case of food safety, the probability of human illness is a complex function of the variability of many parameters that influence the microbial environment, from the production to the consumption of a food. The analytical integration required to estimate the probability of foodborne illness is intractable in all but the simplest of models. Monte Carlo simulation is an alternative to computing analytical solutions. In some cases, a risk assessment may be commissioned to serve a larger purpose than simply the estimation of risk. A Monte Carlo simulation can provide insights into complex processes that are invaluable, and otherwise unavailable, to those charged with the task of risk management. Using examples from a farm-to-fork model of the fate of Escherichia coli O157:H7 in ground beef hamburgers, this paper describes specifically how such goals as research prioritization, risk-based characterization of control points, and risk-based comparison of intervention strategies can be objectively achieved using Monte Carlo simulation.

  2. [Mapping the nursing care with the NIC for patients in risk for pressure ulcer].

    PubMed

    Pereira, Ana Gabriela Silva; Santos, Cássia Teixeira Dos; Menegon, Dóris Baratz; Mello, Bruna Schroeder; Azambuja, Fernanda; Lucena, Amália de Fátima

    2014-06-01

    To identify the nursing care prescribed for patients in risk for pressure ulcer (PU) and to compare those with the Nursing Interventions Classification (NIC) interventions. Cross mapping study conducted in a university hospital. The sample was composed of 219 adult patients hospitalized in clinical and surgical units. The inclusion criteria were: score ≤ 13 in the Braden Scale and one of the nursing diagnoses, Self-Care deficit syndrome, Impaired physical mobility, Impaired tissue integrity, Impaired skin integrity, Risk for impaired skin integrity. The data were collected retrospectively in a nursing prescription system and statistically analyzed by crossed mapping. It was identified 32 different nursing cares to prevent PU, mapped in 17 different NIC interventions, within them: Skin surveillance, Pressure ulcer prevention and Positioning. The cross mapping showed similarities between the prescribed nursing care and the NIC interventions.

  3. Modeling and Managing Risk in Billing Infrastructures

    NASA Astrophysics Data System (ADS)

    Baiardi, Fabrizio; Telmon, Claudio; Sgandurra, Daniele

    This paper discusses risk modeling and risk management in information and communications technology (ICT) systems for which the attack impact distribution is heavy tailed (e.g., power law distribution) and the average risk is unbounded. Systems with these properties include billing infrastructures used to charge customers for services they access. Attacks against billing infrastructures can be classified as peripheral attacks and backbone attacks. The goal of a peripheral attack is to tamper with user bills; a backbone attack seeks to seize control of the billing infrastructure. The probability distribution of the overall impact of an attack on a billing infrastructure also has a heavy-tailed curve. This implies that the probability of a massive impact cannot be ignored and that the average impact may be unbounded - thus, even the most expensive countermeasures would be cost effective. Consequently, the only strategy for managing risk is to increase the resilience of the infrastructure by employing redundant components.

  4. Risk considerations related to lung modeling

    SciTech Connect

    Masse, R.; Cross, F.T. )

    1989-01-01

    Improved lung models provide a more accurate assessment of dose from inhalation exposures and, therefore, more accurate dose-response relationships for risk evaluation and exposure limitation. Epidemiological data for externally irradiated persons indicate that the numbers of excess respiratory tract carcinomas differ in the upper airways, bronchi, and distal lung. Neither their histogenesis and anatomical location nor their progenitor cells are known with sufficient accuracy for accurate assessment of the microdosimetry. The nuclei of sensitive cells generally can be assumed to be distributed at random in the epithelium, beneath the mucus and tips of the beating cilia and cells. In stratified epithelia, basal cells may be considered the only cells at risk. Upper-airway tumors have been observed in both therapeutically irradiated patients and in Hiroshima-Nagasaki survivors. The current International Commission on Radiological Protection Lung-Model Task Group proposes that the upper airways and lung have a similar relative risk coefficient for cancer induction. The partition of the risk weighting factor, therefore, will be proportional to the spontaneous death rate from tumors, and 80% of the weighting factor for the respiratory tract should be attributed to the lung. For Weibel lung-model branching generations 0 to 16 and 17 to 23, the Task Group proposes an 80/20 partition of the risk, i.e., 64% and 16%, respectively, of the total risk. Regarding risk in animals, recent data in rats indicate a significantly lower effectiveness for lung-cancer induction at low doses from insoluble long-lived alpha-emitters than from Rn daughters. These findings are due, in part, to the fact that different regions of the lung are irradiated. Tumors in the lymph nodes are rare in people and animals exposed to radiation.44 references.

  5. Risk management model of winter navigation operations.

    PubMed

    Valdez Banda, Osiris A; Goerlandt, Floris; Kuzmin, Vladimir; Kujala, Pentti; Montewka, Jakub

    2016-07-15

    The wintertime maritime traffic operations in the Gulf of Finland are managed through the Finnish-Swedish Winter Navigation System. This establishes the requirements and limitations for the vessels navigating when ice covers this area. During winter navigation in the Gulf of Finland, the largest risk stems from accidental ship collisions which may also trigger oil spills. In this article, a model for managing the risk of winter navigation operations is presented. The model analyses the probability of oil spills derived from collisions involving oil tanker vessels and other vessel types. The model structure is based on the steps provided in the Formal Safety Assessment (FSA) by the International Maritime Organization (IMO) and adapted into a Bayesian Network model. The results indicate that ship independent navigation and convoys are the operations with higher probability of oil spills. Minor spills are most probable, while major oil spills found very unlikely but possible.

  6. Genetic risk models: Influence of model size on risk estimates and precision.

    PubMed

    Shan, Ying; Tromp, Gerard; Kuivaniemi, Helena; Smelser, Diane T; Verma, Shefali S; Ritchie, Marylyn D; Elmore, James R; Carey, David J; Conley, Yvette P; Gorin, Michael B; Weeks, Daniel E

    2017-05-01

    Disease risk estimation plays an important role in disease prevention. Many studies have found that the ability to predict risk improves as the number of risk single-nucleotide polymorphisms (SNPs) in the risk model increases. However, the width of the confidence interval of the risk estimate is often not considered in the evaluation of the risk model. Here, we explore how the risk and the confidence interval width change as more SNPs are added to the model in the order of decreasing effect size, using both simulated data and real data from studies of abdominal aortic aneurysms and age-related macular degeneration. Our results show that confidence interval width is positively correlated with model size and the majority of the bigger models have wider confidence interval widths than smaller models. Once the model size is bigger than a certain level, the risk does not shift markedly, as 100% of the risk estimates of the one-SNP-bigger models lie inside the confidence interval of the one-SNP-smaller models. We also created a confidence interval-augmented reclassification table. It shows that both more effective SNPs with larger odds ratios and less effective SNPs with smaller odds ratios contribute to the correct decision of whom to screen. The best screening strategy is selected and evaluated by the net benefit quantity and the reclassification rate. We suggest that individuals whose upper bound of their risk confidence interval is above the screening threshold, which corresponds to the population prevalence of the disease, should be screened. © 2017 WILEY PERIODICALS, INC.

  7. Validation of Reynolds Stress Transport Models with Velocity/Pressure-Gradient Models in Wall- Bounded Flows

    NASA Astrophysics Data System (ADS)

    Fernandez, Juan D. C.; Poroseva, Svetlana; Murman, Scott

    2014-11-01

    In the traditional formulation of Reynolds Stress Transport (RST) turbulence models, velocity/pressure-gradient correlations are decomposed into pressure-strain correlations and pressure diffusion terms that are modeled separately. In our study, a potential of a different modeling approach for improving simulation results in the near-wall area is investigated. No decomposition of velocity/pressure-gradient correlations is attempted. New linear models for such correlations have been recently developed and successfully validated against DNS data in two-dimensional incompressible turbulent flows such as a zero-pressure gradient boundary layer over a flat plate and a fully-developed channel flow. The models correctly reproduce DNS profiles of velocity/pressure-gradient correlations up to the wall with the same model coefficients in different geometries and at different Reynolds numbers. These models are currently implemented in transport equations for Reynolds stresses. The compatibility of models for such correlations with existing models for the dissipation tensor and turbulent diffusion is investigated. Simulations are conducted with open-source software OpenFOAM and in-house code in two-dimensional wall-bounded flows. A part of the material is based upon work supported by NASA under Award NNX12AJ61A.

  8. Numerical Investigation of Thermal Distribution and Pressurization Behavior in Helium Pressurized Cryogenic Tank by Introducing a Multi-component Model

    NASA Astrophysics Data System (ADS)

    Lei, Wang; Yanzhong, Li; Zhan, Liu; Kang, Zhu

    An improved CFD model involving a multi-component gas mixturein the ullage is constructed to predict the pressurization behavior of a cryogenic tank considering the existence of pressurizing helium.A temperature difference between the local fluid and its saturation temperature corresponding to the vapor partial pressure is taken as the phase change driving force. As practical application of the model, hydrogen and oxygen tanks with helium pressurization arenumerically simulated by using themulti-component gas model. The results presentthat the improved model produce higher ullage temperature and pressure and lower wall temperaturethan those without multi-component consideration. The phase change has a slight influence on thepressurization performance due to the small quantities involved.

  9. Modeling methods for merging computational and experimental aerodynamic pressure data

    NASA Astrophysics Data System (ADS)

    Haderlie, Jacob C.

    This research describes a process to model surface pressure data sets as a function of wing geometry from computational and wind tunnel sources and then merge them into a single predicted value. The described merging process will enable engineers to integrate these data sets with the goal of utilizing the advantages of each data source while overcoming the limitations of both; this provides a single, combined data set to support analysis and design. The main challenge with this process is accurately representing each data source everywhere on the wing. Additionally, this effort demonstrates methods to model wind tunnel pressure data as a function of angle of attack as an initial step towards a merging process that uses both location on the wing and flow conditions (e.g., angle of attack, flow velocity or Reynold's number) as independent variables. This surrogate model of pressure as a function of angle of attack can be useful for engineers that need to predict the location of zero-order discontinuities, e.g., flow separation or normal shocks. Because, to the author's best knowledge, there is no published, well-established merging method for aerodynamic pressure data (here, the coefficient of pressure Cp), this work identifies promising modeling and merging methods, and then makes a critical comparison of these methods. Surrogate models represent the pressure data for both data sets. Cubic B-spline surrogate models represent the computational simulation results. Machine learning and multi-fidelity surrogate models represent the experimental data. This research compares three surrogates for the experimental data (sequential--a.k.a. online--Gaussian processes, batch Gaussian processes, and multi-fidelity additive corrector) on the merits of accuracy and computational cost. The Gaussian process (GP) methods employ cubic B-spline CFD surrogates as a model basis function to build a surrogate model of the WT data, and this usage of the CFD surrogate in building the WT

  10. HIGH TEMPERATURE HIGH PRESSURE THERMODYNAMIC MEASUREMENTS FOR COAL MODEL COMPOUNDS

    SciTech Connect

    Vinayak N. Kabadi

    1999-02-24

    The enthalpy of a fluid measured with respect to some reference temperature and pressure (enthalpy increment or Cp) is required for many engineering designs. Different techniques for determining enthalpy increments include direct measurement, integration of heat capacity as a function of temperature at constant pressure, and calculation from accurate density measurements as a function of temperature and pressure with ideal-gas enthalpies. Techniques have been developed for measurement of heat capacities using differential scanning calorimeters, but routine measurements with a precision better than 3% are rare. For thermodynamic model development, excess enthalpies or enthalpies of mixing of binary and ternary systems are generally required. Although these data can be calculated from measured values of incremental enthalpies of mixtures and corresponding pure components, the method of calculation involves subtraction of large numbers, and it is impossible to obtain accurate results from relatively accurate incremental enthalpy data. Directly measured heats of mixing provide better data for model development. In what follows, we give a brief literature survey of experimental methods available for measurement of incremental enthalpies as well as heats of mixing.

  11. Constitutive modeling of human saphenous veins at overloading pressures.

    PubMed

    Veselý, J; Horný, L; Chlup, H; Adámek, T; Krajíček, M; Žitný, R

    2015-05-01

    In the present study, inflation tests with free axial extension of 15 human vena saphena magna were conducted ex vivo to obtain data suitable for multi-axial constitutive modeling at overloading conditions (pressures up to approximately 15kPa). Subsequently the data were fitted with a hyperelastic, nonlinear and anisotropic constitutive model based on the theory of the closed thick-walled tube. It was observed that initial highly deformable behavior (up to approximately 2.5kPa) in the pressure-circumferential stretch response is followed by progressive large strain stiffening. Contrary to that, samples were much stiffer in longitudinal direction, where the observed stretches were in the range 0.98-1.03 during the entire pressurization in most cases. The effect of possible residual stress was evaluated in a simulation of the intramural stress distribution with the opening angle prescribed to 0°, 10°, 20°, 30°, 40°, and 50°. The result suggests that the optimal opening angle making the stress distribution through the wall thickness uniform is about 40°. The material parameters presented here are suitable for use in mechanobiological simulations describing the adaptation of the autologous vein wall after bypass surgery. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Plantar Pressure as a Risk Assessment Tool for Diabetic Foot Ulceration in Egyptian Patients with Diabetes

    PubMed Central

    Fawzy, Olfat A; Arafa, Asmaa I; El Wakeel, Mervat A; Abdul Kareem, Shaimaa H

    2014-01-01

    BACKGROUND Diabetic foot ulceration is a preventable long-term complication of diabetes. In the present study, peak plantar pressures (PPP) and other characteristics were assessed in a group of 100 Egyptian patients with diabetes with or without neuropathy and foot ulcers. The aim was to study the relationship between plantar pressure (PP) and neuropathy with or without ulceration and trying to clarify the utility of pedobarography as an ulceration risk assessment tool in patients with diabetes. SUBJECTS AND METHODS A total of 100 patients having diabetes were selected. All patients had a comprehensive foot evaluation, including assessment for neuropathy using modified neuropathy disability score (MNDS), for peripheral vascular disease using ankle brachial index, and for dynamic foot pressures using the MAT system (Tekscan). The studied patients were grouped into: (1) diabetic control group (DC), which included 37 patients who had diabetes without neuropathy or ulceration and MNDS ≤2; (2) diabetic neuropathy group (DN), which included 33 patients who had diabetes with neuropathy and MNDS >2, without current or a history of ulceration; and (3) diabetic ulcer group (DU), which included 30 patients who had diabetes and current ulceration, seven of those patients also gave a history of ulceration. RESULTS PP parameters were significantly different between the studied groups, namely, forefoot peak plantar pressure (FFPPP), rearfoot peak plantar pressure (RFPPP), forefoot/rearfoot ratio (F/R), forefoot peak pressure gradient (FFPPG) rearfoot peak pressure gradient (RFPPG), and forefoot peak pressure gradient/rearfoot peak pressure gradient (FFPPG/RFPPG) (P < 0.05). FFPPP and F/R were significantly higher in the DU group compared to the DN and DC groups (P < 0.05), with no significant difference between DN and DC. FFPPG was significantly higher in the DU and DN groups compared to the DC group (P < 0.05). RFPPP and FFPPG/RFPPG were significantly higher in the DU and DN

  13. Malignancy risk models for oral lesions.

    PubMed

    Zarate, Ana-María; Brezzo, María-Magdalena; Secchi, Dante-Gustavo; Barra, José-Luis; Brunotto, Mabel

    2013-09-01

    The aim of this work was to assess risk habits, clinical and cellular phenotypes and TP53 DNA changes in oral mucosa samples from patients with Oral Potentially Malignant Disorders (OPMD), in order to create models that enable genotypic and phenotypic patterns to be obtained that determine the risk of lesions becoming malignant. Clinical phenotypes, family history of cancer and risk habits were collected in clinical histories. TP53 gene mutation and morphometric-morphological features were studied, and multivariate models were applied. Three groups were estabished: a) oral cancer (OC) group (n=10), b) oral potentially malignant disorders group (n=10), and c) control group (n=8). An average of 50% of patients with malignancy were found to have smoking and drinking habits. A high percentage of TP53 mutations were observed in OC (30%) and OPMD (average 20%) lesions (p=0.000). The majority of these mutations were GC TA transversion mutations (60%). However, patients with OC presented mutations in all the exons and introns studied. Highest diagnostic accuracy (p=0.0001) was observed when incorporating alcohol and tobacco habits variables with TP3 mutations. Our results prove to be statistically reliable, with parameter estimates that are nearly unbiased even for small sample sizes. Models 2 and 3 were the most accurate for assessing the risk of an OPMD becoming cancerous. However, in a public health context, model 3 is the most recommended because the characteristics considered are easier and less costly to evaluate.

  14. Impact of comprehensive cardiovascular risk reduction programme on risk factor clustering associated with elevated blood pressure in an Indian industrial population.

    PubMed

    Jeemon, Panniyammakal; Prabhakaran, Dorairaj; Goenka, Shifalika; Ramakrishnan, Lakshmy; Padmanabhan, Sandosh; Huffman, Mark; Joshi, Prashant; Sivasankaran, Sivasubramonian; Mohan, B V M; Ahmed, F; Ramanathan, Meera; Ahuja, R; Sinha, Nakul; Thankappan, K R; Reddy, K S

    2012-04-01

    Cardiovascular risk factors clustering associated with blood pressure (BP) has not been studied in the Indian population. This study was aimed at assessing the clustering effect of cardiovascular risk factors with suboptimal BP in Indian population as also the impact of risk reduction interventions. Data from 10543 individuals collected in a nation-wide surveillance programme in India were analysed. The burden of risk factors clustering with blood pressure and coronary heart disease (CHD) was assessed. The impact of a risk reduction programmme on risk factors clustering was prospectively studied in a sub-group. Mean age of participants was 40.9 ± 11.0 yr. A significant linear increase in number of risk factors with increasing blood pressure, irrespective of stratifying using different risk factor thresholds was observed. While hypertension occurred in isolation in 2.6 per cent of the total population, co-existence of hypertension and >3 risk factors was observed in 12.3 per cent population. A comprehensive risk reduction programme significantly reduced the mean number of additional risk factors in the intervention population across the blood pressure groups, while it continued to be high in the control arm without interventions (both within group and between group P<0.001). The proportion of 'low risk phenotype' increased from 13.4 to 19.9 per cent in the intervention population and it was decreased from 27.8 to 10.6 per cent in the control population (P<0.001). The proportion of individuals with hypertension and three more risk factors decreased from 10.6 to 4.7 per cent in the intervention arm while it was increased from 13.3 to 17.8 per cent in the control arm (P<0.001). Our findings showed that cardiovascular risk factors clustered together with elevated blood pressure and a risk reduction programme significantly reduced the risk factors burden.

  15. Impact of comprehensive cardiovascular risk reduction programme on risk factor clustering associated with elevated blood pressure in an Indian industrial population

    PubMed Central

    Jeemon, Panniyammakal; Prabhakaran, Dorairaj; Goenka, Shifalika; Ramakrishnan, Lakshmy; Padmanabhan, Sandosh; Huffman, Mark; Joshi, Prashant; Sivasankaran, Sivasubramonian; Mohan, B.V.M.; Ahmed, F.; Ramanathan, Meera; Ahuja, R.; Sinha, Nakul; Thankappan, K.R.; Reddy, K.S.

    2012-01-01

    Background & objectives: Cardiovascular risk factors clustering associated with blood pressure (BP) has not been studied in the Indian population. This study was aimed at assessing the clustering effect of cardiovascular risk factors with suboptimal BP in Indian population as also the impact of risk reduction interventions. Methods: Data from 10543 individuals collected in a nation-wide surveillance programme in India were analysed. The burden of risk factors clustering with blood pressure and coronary heart disease (CHD) was assessed. The impact of a risk reduction programmme on risk factors clustering was prospectively studied in a sub-group. Results: Mean age of participants was 40.9 ± 11.0 yr. A significant linear increase in number of risk factors with increasing blood pressure, irrespective of stratifying using different risk factor thresholds was observed. While hypertension occurred in isolation in 2.6 per cent of the total population, co-existence of hypertension and >3 risk factors was observed in 12.3 per cent population. A comprehensive risk reduction programme significantly reduced the mean number of additional risk factors in the intervention population across the blood pressure groups, while it continued to be high in the control arm without interventions (both within group and between group P<0.001). The proportion of ‘low risk phenotype’ increased from 13.4 to 19.9 per cent in the intervention population and it was decreased from 27.8 to 10.6 per cent in the control population (P<0.001). The proportion of individuals with hypertension and three more risk factors decreased from 10.6 to 4.7 per cent in the intervention arm while it was increased from 13.3 to 17.8 per cent in the control arm (P<0.001). Interpretation & conclusions: Our findings showed that cardiovascular risk factors clustered together with elevated blood pressure and a risk reduction programme significantly reduced the risk factors burden. PMID:22664495

  16. Crystal Plasticity Model of Reactor Pressure Vessel Embrittlement in GRIZZLY

    SciTech Connect

    Chakraborty, Pritam; Biner, Suleyman Bulent; Zhang, Yongfeng; Spencer, Benjamin Whiting

    2015-07-01

    The integrity of reactor pressure vessels (RPVs) is of utmost importance to ensure safe operation of nuclear reactors under extended lifetime. Microstructure-scale models at various length and time scales, coupled concurrently or through homogenization methods, can play a crucial role in understanding and quantifying irradiation-induced defect production, growth and their influence on mechanical behavior of RPV steels. A multi-scale approach, involving atomistic, meso- and engineering-scale models, is currently being pursued within the GRIZZLY project to understand and quantify irradiation-induced embrittlement of RPV steels. Within this framework, a dislocation-density based crystal plasticity model has been developed in GRIZZLY that captures the effect of irradiation-induced defects on the flow stress behavior and is presented in this report. The present formulation accounts for the interaction between self-interstitial loops and matrix dislocations. The model predictions have been validated with experiments and dislocation dynamics simulation.

  17. A Probabilistic Asteroid Impact Risk Model

    NASA Technical Reports Server (NTRS)

    Mathias, Donovan L.; Wheeler, Lorien F.; Dotson, Jessie L.

    2016-01-01

    Asteroid threat assessment requires the quantification of both the impact likelihood and resulting consequence across the range of possible events. This paper presents a probabilistic asteroid impact risk (PAIR) assessment model developed for this purpose. The model incorporates published impact frequency rates with state-of-the-art consequence assessment tools, applied within a Monte Carlo framework that generates sets of impact scenarios from uncertain parameter distributions. Explicit treatment of atmospheric entry is included to produce energy deposition rates that account for the effects of thermal ablation and object fragmentation. These energy deposition rates are used to model the resulting ground damage, and affected populations are computed for the sampled impact locations. The results for each scenario are aggregated into a distribution of potential outcomes that reflect the range of uncertain impact parameters, population densities, and strike probabilities. As an illustration of the utility of the PAIR model, the results are used to address the question of what minimum size asteroid constitutes a threat to the population. To answer this question, complete distributions of results are combined with a hypothetical risk tolerance posture to provide the minimum size, given sets of initial assumptions. Model outputs demonstrate how such questions can be answered and provide a means for interpreting the effect that input assumptions and uncertainty can have on final risk-based decisions. Model results can be used to prioritize investments to gain knowledge in critical areas or, conversely, to identify areas where additional data has little effect on the metrics of interest.

  18. Linking family economic pressure and supportive parenting to adolescent health behaviors: two developmental pathways leading to health promoting and health risk behaviors.

    PubMed

    Kwon, Josephine A; Wickrama, K A S

    2014-07-01

    Adolescent health behaviors, especially health risk behaviors, have previously been linked to distal (i.e., family economic pressure) and proximal (i.e., parental support) contributors. However, few studies have examined both types of contributors along with considering health promoting and health risk behaviors separately. The present study investigated the influences of family economic hardship, supportive parenting as conceptualized by self-determination theory, and individual psychosocial and behavioral characteristics (i.e., mastery and delinquency, respectively) on adolescents' health promoting and health risk behaviors. We used structural equation modeling to analyze longitudinal data from a sample of Caucasian adolescent children and their mothers and fathers (N = 407, 54 % female) to examine direct and indirect effects, as well as gender symmetry and asymmetry. Findings suggest that family economic pressure contributed to adolescent mastery and delinquency through supportive parenting. Further, supportive parenting indirectly affected adolescent health risk behaviors only through delinquency, whereas supportive parenting indirectly influenced health promoting behaviors only through mastery, suggesting different developmental pathways for adolescent health risk and health promoting behaviors. Testing for gender symmetry of the full model showed that maternal and paternal parenting contributed to females' health risk behaviors directly, while maternal and paternal parenting contributed to males' health risk behaviors through delinquency. Gender symmetry was largely unsupported. The study highlights key direct and indirect pathways to adolescent health risk and health promoting behaviors within a family stress model and self-determination theory framework, and also highlights important gender differences in these developmental pathways.

  19. Suicide risk assessment and suicide risk formulation: essential components of the therapeutic risk management model.

    PubMed

    Silverman, Morton M

    2014-09-01

    Suicide and other suicidal behaviors are often associated with psychiatric disorders and dysfunctions. Therefore, psychiatrists have significant opportunities to identify at-risk individuals and offer treatment to reduce that risk. Although a suicide risk assessment is a core competency requirement, many clinical psychiatrists lack the requisite training and skills to appropriately assess for suicide risk. Moreover, the standard of care requires psychiatrists to foresee the possibility that a patient might engage in suicidal behavior, hence to conduct a suicide risk formulation sufficient to guide triage and treatment planning. Based on data collected via a suicide risk assessment, a suicide risk formulation is a process whereby the psychiatrist forms a judgment about a patient's foreseeable risk of suicidal behavior in order to inform triage decisions, safety and treatment planning, and interventions to reduce risk. This paper addresses the components of this process in the context of the model for therapeutic risk management of the suicidal patient developed at the Veterans Integrated Service Network (VISN) 19 Mental Illness Research, Education and Clinical Center by Wortzel et al.

  20. Development of a Numerical Model of Hypervelocity Impact into a Pressurized Composite Overwrapped Pressure Vessel

    NASA Technical Reports Server (NTRS)

    Garcia, M. A.; Davis, B. A.; Miller, J. E.

    2017-01-01

    . Also seen in the figure is the eroded projectile that had passed into the COPV vessel with the generated shock wave in the pressurant propagating just ahead of the material. In this paper, pertinent experimental details and the development of the material constitutive models necessary for this work along with the efforts to validate their use are dis-cussed. The simulation results are presented and compared with the NASA experimental observations. While work is on-going from this effort, early observations pertinent to the failure threshold are presented.

  1. Value of reserve pulse pressure in improving the risk stratification of patients with normal myocardial perfusion imaging

    PubMed Central

    Thomas, Deepak; Al-Mallah, Mouaz; Govindarajulu, Usha; Forman, Daniel E.; Mora, Samia; Di Carli, Marcelo F.; Dorbala, Sharmila

    2013-01-01

    Aims To evaluate the incremental prognostic value of reserve-pulse pressure (reserve-PP: exercise-PP minus rest-PP) to standard risk factors among patients with suspected coronary artery disease (CAD) but normal exercise myocardial perfusion imaging (MPI). Methods and results We studied 4269 consecutive symptomatic patients without known CAD who were referred for exercise MPI but had normal MPI results (mean age 58 ± 12 years, 56% females, 84% referred for evaluation of chest pain or dyspnoea, 95% with intermediate pretest likelihood of CAD). There were 202 deaths over 5.1 ± 1.4 years of follow-up. Reserve-PP was abnormal (<44 mmHg increase in PP from rest) in 1894 patients (44%). Patients with an abnormal reserve-PP had a higher risk of death compared with patients with normal reserve-PP [hazard ratio (HR): 2.47, 95% CI, 1.8–3.3]. In multivariable models adjusting for age, sex, ejection fraction, medications, heart rate recovery, Duke treadmill score (DTS), and rest-PP, each 10 mmHg lower reserve-PP was associated with a 20.6% increase in risk-adjusted mortality (adjusted HR 0.83, 95% CI 0.76–0.91). Models incorporating reserve-PP significantly reclassified risk compared with models without these parameters (net reclassification index 14.3%, P = 0.0007; integrated discrimination index 0.69, P = 0.01). Conclusion In patients without a history of CAD and a normal MPI, an abnormal reserve-PP identified and reclassified those at higher risk of death independent of known risk factors and DTS. PMID:23539339

  2. Yoga lifestyle intervention reduces blood pressure in HIV-infected adults with cardiovascular disease risk factors

    PubMed Central

    Cade, Todd; Reeds, Dominic N.; Mondy, Kristin E.; Overton, Turner; Grassino, Joseph; Tucker, Shawn; Bopp, Coco; Laciny, Erin; Hubert, Sara; Lassa-Claxton, Sherry; Yarasheski, Kevin E.

    2009-01-01

    People living with human immunodeficiency virus infection (HIV) are at increased risk for developing cardiovascular disease (CVD). Safe and effective interventions for lowering CVD risk in HIV are high priorities. Objective We conducted a prospective, randomized, controlled study to evaluate whether a yoga lifestyle intervention improves CVD risk factors, virologic or immunologic status, or quality of life in HIV-infected adults more than in a matched control group. Methods Sixty HIV-infected adults with mild-moderate CVD risk were assigned to 20 wks of supervised yoga practice or standard of care treatment. Baseline and week 20 measures were; 2hr-oral glucose tolerance test with insulin monitoring, body composition, fasting serum lipid/lipoprotein profile, resting blood pressures, CD4+ T-cell number and plasma HIV RNA, and the Medical Outcomes Study SF-36 health-related quality of life inventory. Results Resting systolic and diastolic blood pressures were reduced more (p=0.04) in the yoga group (−5±2 and −3±1 mmHg) than in the standard of care group (+1±2 and +2±2 mmHg), despite no greater reduction in body weight, fat mass, proatherogenic lipids, or improvements in glucose tolerance or overall quality of life after yoga. Immune and virologic status was not adversely affected. Conclusion Among traditional lifestyle modifications, yoga is a low cost, simple to administer, non-pharmacological, popular behavioral intervention that can lower blood pressure in pre-hypertensive HIV-infected adults with mild-moderate CVD risk factors. PMID:20059570

  3. Improved model for window breakdown at low pressure

    SciTech Connect

    Chang, C.; Chen, H. B.; Liu, G. Z.; Zhu, X. X.; Fang, J. Y.

    2009-03-15

    An improved global model is proposed to analyze high power microwave dielectric window breakdown at low pressure. The effect of ionization on the average momentum and energy of electrons is taken into account and a Maxwellian electron energy distribution function is adopted. The plasma energy flow and density loss to dielectric, and partially secondary electrons returning plasma to compensate the density loss, have been analytically considered. Space charge potential drop and the generalized Bohm criterion are deduced analytically. After considering the energy and density loss as well as the secondary electron compensation, the breakdown time by using numerical calculation under low pressure gets shorter compared with that under no wall loss condition. In other words, the dielectric surface breakdown time is lower than plasma volume breakdown time.

  4. Cardiovascular risk factors and blood pressure in a primary care unit: Yugoslav Study of the Precursors of Atherosclerosis in School Children (YUSAD).

    PubMed

    Bajcetic, Milica; Ilic, Katarina; Singh, Nada Majkic; Novakovic, Ivana; Vukotic, Milija; Nedeljkovic, Srecko; Simeunovic, Slavko

    2006-01-01

    The presence of cardiovascular risk factors in children may be important in the development of atherosclerosis in adulthood. Adequate control of blood pressure is a cornerstone in atherosclerosis prevention. The aim of the Yugoslav Study of the Precursors of Atherosclerosis in School Children (YUSAD) was to identify risk factors for elevated blood pressure in school children. The YUSAD study is a multicentre follow-up study comprised of two cross-sectional surveys conducted five years apart. At baseline, 10-year-old children (3226 boys and 3074 girls [n=6300]) were randomly selected during periodical visits to primary health care centres. The risk factors measured were heart rate, weight, body mass index (BMI), waist-to-hip ratio, grade point average and current smoking status. Significant age and sex differences were identified in systolic blood pressure, diastolic blood pressure and all investigated independent variables. In a multivariate analysis, diastolic blood pressure in 10-year-old boys was directly and significantly related to total cholesterol and height, whereas it was inversely related to weight. At follow-up, in the multivariate model, only BMI was a significant predictor of diastolic blood pressure in boys. In girls at baseline in the multivariate regression analysis, the only significant predictor of diastolic blood pressure was total cholesterol. In 15-year-old girls, diastolic blood pressure was significantly and directly related to BMI and heart rate, whereas it was inversely related to weight. For both 10- and 15-year-old male and female participants, none of the variables by multivariate analysis were a significant predictor of systolic blood pressure. Age, sex, heart rate, cholesterol and weight are the most important predictors of blood pressure in school children.

  5. Investigation of pressure gradient aware wall modeling in LES

    NASA Astrophysics Data System (ADS)

    Thiry, Olivier; Winckelmans, Gregoire; Duponcheel, Matthieu

    2015-11-01

    This work focuses on the investigation of various wall modeling strategies for the simulation of high Reynolds number wall-bounded turbulent flows with acceleration and/or deceleration. Our code is based on fourth order finite differences, is momentum conserving, and is energy conserving up to fourth order. We here use a ``channel flow'' set-up, with no slip and wall modeling at the bottom, with slip at the top, and with blowing and/or suction at the top in order to generate the desired acceleration-deceleration profile. Two strategies are investigated and compared. Pressure gradient corrected algebraic models are first considered, and we investigate various local averaging techniques so as to avoid imposing mean profile laws pointwise. RANS sub-layer models are then also considered, where the turbulent viscosity is corrected to account for pressure gradient effects and for resolved LES fluctuations effects. A wall-resolved LES was also performed to provide a reference solution. Research fellow (Ph.D. student) at the F.R.S. - FNRS (Belgium).

  6. Modeling of Propagation of Interacting Cracks Under Hydraulic Pressure Gradient

    SciTech Connect

    Huang, Hai; Mattson, Earl Douglas; Podgorney, Robert Karl

    2015-04-01

    A robust and reliable numerical model for fracture initiation and propagation, which includes the interactions among propagating fractures and the coupling between deformation, fracturing and fluid flow in fracture apertures and in the permeable rock matrix, would be an important tool for developing a better understanding of fracturing behaviors of crystalline brittle rocks driven by thermal and (or) hydraulic pressure gradients. In this paper, we present a physics-based hydraulic fracturing simulator based on coupling a quasi-static discrete element model (DEM) for deformation and fracturing with conjugate lattice network flow model for fluid flow in both fractures and porous matrix. Fracturing is represented explicitly by removing broken bonds from the network to represent microcracks. Initiation of new microfractures and growth and coalescence of the microcracks leads to the formation of macroscopic fractures when external and/or internal loads are applied. The coupled DEM-network flow model reproduces realistic growth pattern of hydraulic fractures. In particular, simulation results of perforated horizontal wellbore clearly demonstrate that elastic interactions among multiple propagating fractures, fluid viscosity, strong coupling between fluid pressure fluctuations within fractures and fracturing, and lower length scale heterogeneities, collectively lead to complicated fracturing patterns.

  7. Risk assessment of physiological effects of atmospheric composition and pressure in Constellation vehicles

    NASA Astrophysics Data System (ADS)

    Scheuring, Richard; Conkin, Johnny; Jones, Jeffrey A.; Gernhardt, Michael L.

    Introduction: To limit the risk of fire and reduce denitrogenation time to prevent decompression sickness to support frequent extravehicular activities on the Moon, a hypobaric (PB=414mmHg) and mildly hypoxic ( ppO2=132mmHg, 32% O2-68%N2) living environment is considered for the Crew Exploration Vehicle (CEV) and Lunar Surface Access Module (LSAM). With acute change in ppO2 from 145-178mmHg at standard vehicular operating pressure to less than 125mmHg at desired lunar surface vehicular operating pressures, there is the possibility that some crewmembers may develop symptoms of Acute Mountain Sickness (AMS). The signs and symptoms of AMS (headache plus nausea, dizziness, fatigue, or sleeplessness) could impact crew health and performance on lunar surface missions. Methods: We performed a literature review on the topic of the physiological effects of reduced ppO2 and absolute pressure. The results of nine studies were evaluated. Results: There is evidence for an absolute pressure effect per se on AMS, so the higher the altitude for a given hypoxic alveolar oxygen (O2) partial pressure (PAO2), the greater the AMS response is. Between 7% and 25% of adults may experience mild AMS near 2000 m altitude following a rapid ascent from sea level while breathing air (6500 ft, acute PAO2=75mmHg). The operational experience with the Shuttle staged denitrogenation protocol at 528mmHg (3048 m) while breathing 26.5% O2 (acute PAO2=85mmHg) in astronauts adapting to microgravity suggests a similar likely experience in the proposed CEV environment. Conclusions: We believe the risk of mild AMS is greater given a PAO2 of 77mmHg at 4876 m altitude while breathing 32% O2 than at 1828 m altitude while breathing 21% O2. Only susceptible astronauts would develop mild and transient AMS with prolonged exposure to 414 mmHg (4876 m) while breathing 32% O2 (acute PAO2=77mmHg). So the following may be employed for operational risk reduction: (1) develop procedures to increase PB as needed in the

  8. Absolute risk of cardiovascular disease events, and blood pressure- and lipid-lowering therapy in Australia.

    PubMed

    Banks, Emily; Crouch, Simon R; Korda, Rosemary J; Stavreski, Bill; Page, Karen; Thurber, Katherine A; Grenfell, Robert

    2016-05-02

    To quantify absolute cardiovascular disease (CVD) risk and treatment in Australian adults. Cross-sectional representative study of 9564 people aged 18 years or more who had participated in the 2011-12 Australian National Health Measures Survey (response rate for those aged 45-74 years: 46.5%). Prior CVD was ascertained and 5-year absolute risk of a primary CVD event calculated (using the Australian National Vascular Disease Prevention Alliance algorithm; categories: low [< 10%], moderate [10-15%], and high [> 15%] risk) on the basis of data on medical history, risk factors and medications, derived from interviews, physical measurements, and blood and urine samples. Absolute CVD risk increased with age and was higher among men than women. Overall, 19.9% (95% CI, 18.5-21.3%) of Australians aged 45-74 years had a high absolute risk of a future CVD event (an estimated 1 445 000 people): 8.7% (95% CI, 7.8-9.6%) had prior CVD (estimated 634 000 people) and 11.2% (95% CI, 10.2-12.2%) had high primary CVD risk (estimated 811 000 people). A further 8.6% (95% CI, 7.4-9.8%, estimated 625 000) were at moderate primary CVD risk. Among those with prior CVD, 44.2% (95% CI, 36.8-51.6%) were receiving blood pressure- and lipid-lowering medications, 35.4% (95% CI, 27.8-43.0%) were receiving only one of these, and 20.4% (95% CI, 13.9-26.9%) were receiving neither. Corresponding figures for high primary CVD risk were 24.3% (95% CI, 18.3-30.3%); 28.7% (95% CI, 22.7-34.7%); and 47.1% (95% CI, 39.9-54.3%). About one-fifth of the Australian population aged 45-74 years (about 1.4 million individuals) were estimated to have a high absolute risk of a future CVD event. Most (estimated 970 000) were not receiving currently recommended combination blood pressure- and lipid-lowering therapy, indicating substantial potential for health gains by increasing routine assessment and treatment according to absolute CVD risk.

  9. Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease.

    PubMed

    Lonn, Eva M; Bosch, Jackie; López-Jaramillo, Patricio; Zhu, Jun; Liu, Lisheng; Pais, Prem; Diaz, Rafael; Xavier, Denis; Sliwa, Karen; Dans, Antonio; Avezum, Alvaro; Piegas, Leopoldo S; Keltai, Katalin; Keltai, Matyas; Chazova, Irina; Peters, Ron J G; Held, Claes; Yusoff, Khalid; Lewis, Basil S; Jansky, Petr; Parkhomenko, Alexander; Khunti, Kamlesh; Toff, William D; Reid, Christopher M; Varigos, John; Leiter, Lawrence A; Molina, Dora I; McKelvie, Robert; Pogue, Janice; Wilkinson, Joanne; Jung, Hyejung; Dagenais, Gilles; Yusuf, Salim

    2016-05-26

    Antihypertensive therapy reduces the risk of cardiovascular events among high-risk persons and among those with a systolic blood pressure of 160 mm Hg or higher, but its role in persons at intermediate risk and with lower blood pressure is unclear. In one comparison from a 2-by-2 factorial trial, we randomly assigned 12,705 participants at intermediate risk who did not have cardiovascular disease to receive either candesartan at a dose of 16 mg per day plus hydrochlorothiazide at a dose of 12.5 mg per day or placebo. The first coprimary outcome was the composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke; the second coprimary outcome additionally included resuscitated cardiac arrest, heart failure, and revascularization. The median follow-up was 5.6 years. The mean blood pressure of the participants at baseline was 138.1/81.9 mm Hg; the decrease in blood pressure was 6.0/3.0 mm Hg greater in the active-treatment group than in the placebo group. The first coprimary outcome occurred in 260 participants (4.1%) in the active-treatment group and in 279 (4.4%) in the placebo group (hazard ratio, 0.93; 95% confidence interval [CI], 0.79 to 1.10; P=0.40); the second coprimary outcome occurred in 312 participants (4.9%) and 328 participants (5.2%), respectively (hazard ratio, 0.95; 95% CI, 0.81 to 1.11; P=0.51). In one of the three prespecified hypothesis-based subgroups, participants in the subgroup for the upper third of systolic blood pressure (>143.5 mm Hg) who were in the active-treatment group had significantly lower rates of the first and second coprimary outcomes than those in the placebo group; effects were neutral in the middle and lower thirds (P=0.02 and P=0.009, respectively, for trend in the two outcomes). Therapy with candesartan at a dose of 16 mg per day plus hydrochlorothiazide at a dose of 12.5 mg per day was not associated with a lower rate of major cardiovascular events than placebo among persons at

  10. Risk analysis: divergent models and convergent interpretations

    NASA Technical Reports Server (NTRS)

    Carnes, B. A.; Gavrilova, N.

    2001-01-01

    Material presented at a NASA-sponsored workshop on risk models for exposure conditions relevant to prolonged space flight are described in this paper. Analyses used mortality data from experiments conducted at Argonne National Laboratory on the long-term effects of external whole-body irradiation on B6CF1 mice by 60Co gamma rays and fission neutrons delivered as a single exposure or protracted over either 24 or 60 once-weekly exposures. The maximum dose considered was restricted to 1 Gy for neutrons and 10 Gy for gamma rays. Proportional hazard models were used to investigate the shape of the dose response at these lower doses for deaths caused by solid-tissue tumors and tumors of either connective or epithelial tissue origin. For protracted exposures, a significant mortality effect was detected at a neutron dose of 14 cGy and a gamma-ray dose of 3 Gy. For single exposures, radiation-induced mortality for neutrons also occurred within the range of 10-20 cGy, but dropped to 86 cGy for gamma rays. Plots of risk relative to control estimated for each observed dose gave a visual impression of nonlinearity for both neutrons and gamma rays. At least for solid-tissue tumors, male and female mortality was nearly identical for gamma-ray exposures, but mortality risks for females were higher than for males for neutron exposures. As expected, protracting the gamma-ray dose reduced mortality risks. Although curvature consistent with that observed visually could be detected by a model parameterized to detect curvature, a relative risk term containing only a simple term for total dose was usually sufficient to describe the dose response. Although detectable mortality for the three pathology end points considered typically occurred at the same level of dose, the highest risks were almost always associated with deaths caused by tumors of epithelial tissue origin.

  11. Risk analysis: divergent models and convergent interpretations

    NASA Technical Reports Server (NTRS)

    Carnes, B. A.; Gavrilova, N.

    2001-01-01

    Material presented at a NASA-sponsored workshop on risk models for exposure conditions relevant to prolonged space flight are described in this paper. Analyses used mortality data from experiments conducted at Argonne National Laboratory on the long-term effects of external whole-body irradiation on B6CF1 mice by 60Co gamma rays and fission neutrons delivered as a single exposure or protracted over either 24 or 60 once-weekly exposures. The maximum dose considered was restricted to 1 Gy for neutrons and 10 Gy for gamma rays. Proportional hazard models were used to investigate the shape of the dose response at these lower doses for deaths caused by solid-tissue tumors and tumors of either connective or epithelial tissue origin. For protracted exposures, a significant mortality effect was detected at a neutron dose of 14 cGy and a gamma-ray dose of 3 Gy. For single exposures, radiation-induced mortality for neutrons also occurred within the range of 10-20 cGy, but dropped to 86 cGy for gamma rays. Plots of risk relative to control estimated for each observed dose gave a visual impression of nonlinearity for both neutrons and gamma rays. At least for solid-tissue tumors, male and female mortality was nearly identical for gamma-ray exposures, but mortality risks for females were higher than for males for neutron exposures. As expected, protracting the gamma-ray dose reduced mortality risks. Although curvature consistent with that observed visually could be detected by a model parameterized to detect curvature, a relative risk term containing only a simple term for total dose was usually sufficient to describe the dose response. Although detectable mortality for the three pathology end points considered typically occurred at the same level of dose, the highest risks were almost always associated with deaths caused by tumors of epithelial tissue origin.

  12. Quantitative risk modelling for new pharmaceutical compounds.

    PubMed

    Tang, Zhengru; Taylor, Mark J; Lisboa, Paulo; Dyas, Mark

    2005-11-15

    The process of discovering and developing new drugs is long, costly and risk-laden. Faced with a wealth of newly discovered compounds, industrial scientists need to target resources carefully to discern the key attributes of a drug candidate and to make informed decisions. Here, we describe a quantitative approach to modelling the risk associated with drug development as a tool for scenario analysis concerning the probability of success of a compound as a potential pharmaceutical agent. We bring together the three strands of manufacture, clinical effectiveness and financial returns. This approach involves the application of a Bayesian Network. A simulation model is demonstrated with an implementation in MS Excel using the modelling engine Crystal Ball.

  13. Blood Pressure and Risk of Cardiovascular Events in Patients on Chronic Hemodialysis: The CRIC Study (Chronic Renal Insufficiency Cohort).

    PubMed

    Bansal, Nisha; McCulloch, Charles E; Lin, Feng; Alper, Arnold; Anderson, Amanda H; Cuevas, Magda; Go, Alan S; Kallem, Radhakrishna; Kusek, John W; Lora, Claudia M; Lustigova, Eva; Ojo, Akinlolu; Rahman, Mahboob; Robinson-Cohen, Cassianne; Townsend, Raymond R; Wright, Jackson; Xie, Dawei; Hsu, Chi-Yuan

    2017-08-01

    We recently reported a linear association between higher systolic blood pressure (SBP) and risk of mortality in hemodialysis patients when SBP is measured outside of the dialysis unit (out-of-dialysis-unit-SBP), despite there being a U-shaped association between SBP measured at the dialysis unit (dialysis-unit-SBP) with risk of mortality. Here, we explored the relationship between SBP with cardiovascular events, which has important treatment implications but has not been well elucidated. Among 383 hemodialysis participants enrolled in the prospective CRIC study (Chronic Renal Insufficiency Cohort), multivariable splines and Cox models were used to study the association between SBP and adjudicated cardiovascular events (heart failure, myocardial infarction, ischemic stroke, and peripheral artery disease), controlling for differences in demographics, cardiovascular disease risk factors, and dialysis parameters. Dialysis-unit-SBP and out-of-dialysis-unit-SBP were modestly correlated (r=0.34; P<0.001). We noted a U-shaped association of dialysis-unit-SBP and risk of cardiovascular events, with the nadir risk between 140 and 170 mm Hg. In contrast, there was a linear stepwise association between out-of-dialysis-unit-SBP with risk of cardiovascular events. Participants with out-of-dialysis-unit-SBP ≥128 mm Hg (top 2 quartiles) had >2-fold increased risk of cardiovascular events compared with those with out-of-dialysis-unit-SBP ≤112 mm Hg (3rd SBP quartile: adjusted hazard ratio, 2.08 [95% confidence interval, 1.12-3.87] and fourth SBP quartile: adjusted hazard ratio, 2.76 [95% confidence interval, 1.42-5.33]). In conclusion, among hemodialysis patients, although there is a U-shaped (paradoxical) association of dialysis-unit-SBP and risk of cardiovascular disease, there is a linear association of out-of-dialysis-unit-SBP with risk of cardiovascular disease. Out-of-dialysis-unit blood pressure provides key information and may be an important therapeutic target.

  14. Landslide risk mapping and modeling in China

    NASA Astrophysics Data System (ADS)

    Li, W.; Hong, Y.

    2015-12-01

    Under circumstances of global climate change, tectonic stress and human effect, landslides are among the most frequent and severely widespread natural hazards on Earth, as demonstrated in the World Atlas of Natural Hazards (McGuire et al., 2004). Every year, landslide activities cause serious economic loss as well as casualties (Róbert et al., 2005). How landslides can be monitored and predicted is an urgent research topic of the international landslide research community. Particularly, there is a lack of high quality and updated landslide risk maps and guidelines that can be employed to better mitigate and prevent landslide disasters in many emerging regions, including China (Hong, 2007). Since the 1950s, landslide events have been recorded in the statistical yearbooks, newspapers, and monographs in China. As disasters have been increasingly concerned by the government and the public, information about landslide events is becoming available from online news reports (Liu et al., 2012).This study presents multi-scale landslide risk mapping and modeling in China. At the national scale, based on historical data and practical experiences, we carry out landslide susceptibility and risk mapping by adopting a statistical approach and pattern recognition methods to construct empirical models. Over the identified landslide hot-spot areas, we further evaluate the slope-stability for each individual site (Sidle and Hirotaka, 2006), with the ultimate goal to set up a space-time multi-scale coupling system of Landslide risk mapping and modeling for landslide hazard monitoring and early warning.

  15. Risk management model in road transport systems

    NASA Astrophysics Data System (ADS)

    Sakhapov, R. L.; Nikolaeva, R. V.; Gatiyatullin, M. H.; Makhmutov, M. M.

    2016-08-01

    The article presents the results of a study of road safety indicators that influence the development and operation of the transport system. Road safety is considered as a continuous process of risk management. Authors constructed a model that relates the social risks of a major road safety indicator - the level of motorization. The model gives a fairly accurate assessment of the level of social risk for any given level of motorization. Authors calculated the dependence of the level of socio-economic costs of accidents and injured people in them. The applicability of the concept of socio-economic damage is caused by the presence of a linear relationship between the natural and economic indicators damage from accidents. The optimization of social risk is reduced to finding the extremum of the objective function that characterizes the economic effect of the implementation of measures to improve safety. The calculations make it possible to maximize the net present value, depending on the costs of improving road safety, taking into account socio-economic damage caused by accidents. The proposed econometric models make it possible to quantify the efficiency of the transportation system, allow to simulate the change in road safety indicators.

  16. Landslide risk models for decision making.

    PubMed

    Bonachea, Jaime; Remondo, Juan; de Terán, José Ramón Díaz; González-Díez, Alberto; Cendrero, Antonio

    2009-11-01

    This contribution presents a quantitative procedure for landslide risk analysis and zoning considering hazard, exposure (or value of elements at risk), and vulnerability. The method provides the means to obtain landslide risk models (expressing expected damage due to landslides on material elements and economic activities in monetary terms, according to different scenarios and periods) useful to identify areas where mitigation efforts will be most cost effective. It allows identifying priority areas for the implementation of actions to reduce vulnerability (elements) or hazard (processes). The procedure proposed can also be used as a preventive tool, through its application to strategic environmental impact analysis (SEIA) of land-use plans. The underlying hypothesis is that reliable predictions about hazard and risk can be made using models based on a detailed analysis of past landslide occurrences in connection with conditioning factors and data on past damage. The results show that the approach proposed and the hypothesis formulated are essentially correct, providing estimates of the order of magnitude of expected losses for a given time period. Uncertainties, strengths, and shortcomings of the procedure and results obtained are discussed and potential lines of research to improve the models are indicated. Finally, comments and suggestions are provided to generalize this type of analysis.

  17. Public sector risk management: a specific model.

    PubMed

    Lawlor, Ted

    2002-07-01

    Risk management programs for state mental health authorities are generally limited in scope and reactive in nature. Recent changes in how mental health care is provided render it necessary to redirect the risk management focus from its present institutional basis to a statewide, network-based paradigm that is integrated across public and private inpatient and community programs alike. These changes include treating an increasing number of individuals in less-secure settings and contracting for an increasing number of public mental health services with private providers. The model proposed here is closely linked to the Quality Management Process.

  18. Mathematical modelling of risk reduction in reinsurance

    NASA Astrophysics Data System (ADS)

    Balashov, R. B.; Kryanev, A. V.; Sliva, D. E.

    2017-01-01

    The paper presents a mathematical model of efficient portfolio formation in the reinsurance markets. The presented approach provides the optimal ratio between the expected value of return and the risk of yield values below a certain level. The uncertainty in the return values is conditioned by use of expert evaluations and preliminary calculations, which result in expected return values and the corresponding risk levels. The proposed method allows for implementation of computationally simple schemes and algorithms for numerical calculation of the numerical structure of the efficient portfolios of reinsurance contracts of a given insurance company.

  19. Nursing Intervention Classifications (NIC) validated for patients at risk of pressure ulcers.

    PubMed

    Bavaresco, Taline; Lucena, Amália de Fátima

    2012-01-01

    to validate the Nursing Intervention Classifications (NIC) for the diagnosis 'Risk of Impaired Skin Integrity' in patients at risk of pressure ulcers (PU). the sample comprised 16 expert nurses. The data was collected with an instrument about the interventions and their definitions were scored on a Likert scale by the experts. The data was analyzed statistically, using the calculation of weighted averages (WA). The study was approved by the Research Ethics Committee (56/2010). nine interventions were validated as 'priority' (WA ≥0.80), among them Prevention of PU (MP=0.92); 22 as 'suggested' (WA >0.50 and <0.80) and 20 were discarded (WA ≤0.50). the prevention of PU results from the implementation of specific interventions related to the risk factors for development of the lesion, with implications for nursing practice, teaching and research.

  20. Hypotension is a risk factor for new pressure ulcer occurrence in older patients after admission to an acute hospital.

    PubMed

    Man, Shiu-piu; Au-Yeung, Tung-wai

    2013-08-01

    Pressure ulcer occurrence in older patients admitted to hospital has not been studied thoroughly; yet, pressure ulcers frequently develop among the frail older patients who are hospitalized. Identifying risk factors for pressure ulcer occurrence is of utmost importance in preventing its development in this group of patients. Hypoperfusion, as manifested by hypotension, is theoretically important in the development of pressure ulcer. However, studies on this aspect are scarce. To examine whether a hypotensive episode (systolic blood pressure less than or equal to 90 mm Hg) is associated with pressure ulcer occurrence. This was a retrospective cohort study in a regional hospital. It recruited 259 patients aged 65 or older who were admitted to a convalescence ward and had a hospital stay for more than 5 days. Baseline clinical characteristics and the possible risk factors of pressure ulcer occurrence on admission and any episode of hypotension were recorded. The primary outcome measured was the incidence of pressure ulcer occurrence in the index admission. Hypotension was strongly associated with incident pressure ulcer occurrence (odds ratio 6.71, P = .001). Hypotension was an important risk factor for incident pressure ulcer occurrence during hospital stay. Every effort has to be taken to try to prevent hypotension. Precautions to prevent pressure ulcer development should be taken on patients who are hypotensive. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

  1. Malignancy Risk Models for Oral Lesions

    PubMed Central

    Zarate, Ana M.; Brezzo, María M.; Secchi, Dante G.; Barra, José L.

    2013-01-01

    Objectives: The aim of this work was to assess risk habits, clinical and cellular phenotypes and TP53 DNA changes in oral mucosa samples from patients with Oral Potentially Malignant Disorders (OPMD), in order to create models that enable genotypic and phenotypic patterns to be obtained that determine the risk of lesions becoming malignant. Study Design: Clinical phenotypes, family history of cancer and risk habits were collected in clinical histories. TP53 gene mutation and morphometric-morphological features were studied, and multivariate models were applied. Three groups were estabished: a) oral cancer (OC) group (n=10), b) OPMD group (n=10), and c) control group (n=8). Results: An average of 50% of patients with malignancy were found to have smoking and drinking habits. A high percentage of TP53 mutations were observed in OC (30%) and OPMD (average 20%) lesions (p=0.000). The majority of these mutations were GC ? TA transversion mutations (60%). However, patients with OC presented mutations in all the exons and introns studied. Highest diagnostic accuracy (p=0.0001) was observed when incorporating alcohol and tobacco habits variables with TP53 mutations. Conclusions: Our results prove to be statistically reliable, with parameter estimates that are nearly unbiased even for small sample sizes. Models 2 and 3 were the most accurate for assessing the risk of an OPMD becoming cancerous. However, in a public health context, model 3 is the most recommended because the characteristics considered are easier and less costly to evaluate. Key words:TP53, oral potentially malignant disorders, risk factors, genotype, phenotype. PMID:23722122

  2. Relating cardiovascular risk to out-of-office blood pressure and the importance of controlling blood pressure 24 hours a day.

    PubMed

    White, William B

    2008-08-01

    Blood pressure exhibits a natural circadian rhythm characterized by a decrease during sleep, then a steep increase in the early morning period followed by higher values throughout the active waking period. Because an excessive early morning surge in blood pressure is associated with an elevated risk for cardiovascular events, it represents a potential therapeutic target in patients with hypertension, especially those already at high risk for such events. Ambulatory blood pressure monitoring (ABPM) is an out-of-office technique that allows assessment of blood pressure control during a 24-hour period, including the morning surge. It is known that 24-hour control based on ABPM is a better predictor of hypertensive target-organ involvement and cardiovascular events than conventional in-office blood pressure measurement. ABPM also reveals that many antihypertensive drugs do not adequately control early morning blood pressure, particularly when given once daily in the morning. There are several effective ways to improve morning blood pressure control. These include using agents with a long pharmacologic half-life; prescribing drug formulations specifically designed to target the morning blood pressure surge when given at bedtime; or increasing dosages to twice daily that of conventional shorter-acting agents.

  3. Association of vitamin D status with arterial blood pressure and hypertension risk: a mendelian randomisation study.

    PubMed

    Vimaleswaran, Karani S; Cavadino, Alana; Berry, Diane J; Jorde, Rolf; Dieffenbach, Aida Karina; Lu, Chen; Alves, Alexessander Couto; Heerspink, Hiddo J Lambers; Tikkanen, Emmi; Eriksson, Joel; Wong, Andrew; Mangino, Massimo; Jablonski, Kathleen A; Nolte, Ilja M; Houston, Denise K; Ahluwalia, Tarunveer Singh; van der Most, Peter J; Pasko, Dorota; Zgaga, Lina; Thiering, Elisabeth; Vitart, Veronique; Fraser, Ross M; Huffman, Jennifer E; de Boer, Rudolf A; Schöttker, Ben; Saum, Kai-Uwe; McCarthy, Mark I; Dupuis, Josée; Herzig, Karl-Heinz; Sebert, Sylvain; Pouta, Anneli; Laitinen, Jaana; Kleber, Marcus E; Navis, Gerjan; Lorentzon, Mattias; Jameson, Karen; Arden, Nigel; Cooper, Jackie A; Acharya, Jayshree; Hardy, Rebecca; Raitakari, Olli; Ripatti, Samuli; Billings, Liana K; Lahti, Jari; Osmond, Clive; Penninx, Brenda W; Rejnmark, Lars; Lohman, Kurt K; Paternoster, Lavinia; Stolk, Ronald P; Hernandez, Dena G; Byberg, Liisa; Hagström, Emil; Melhus, Håkan; Ingelsson, Erik; Mellström, Dan; Ljunggren, Osten; Tzoulaki, Ioanna; McLachlan, Stela; Theodoratou, Evropi; Tiesler, Carla M T; Jula, Antti; Navarro, Pau; Wright, Alan F; Polasek, Ozren; Wilson, James F; Rudan, Igor; Salomaa, Veikko; Heinrich, Joachim; Campbell, Harry; Price, Jacqueline F; Karlsson, Magnus; Lind, Lars; Michaëlsson, Karl; Bandinelli, Stefania; Frayling, Timothy M; Hartman, Catharina A; Sørensen, Thorkild I A; Kritchevsky, Stephen B; Langdahl, Bente Lomholt; Eriksson, Johan G; Florez, Jose C; Spector, Tim D; Lehtimäki, Terho; Kuh, Diana; Humphries, Steve E; Cooper, Cyrus; Ohlsson, Claes; März, Winfried; de Borst, Martin H; Kumari, Meena; Kivimaki, Mika; Wang, Thomas J; Power, Chris; Brenner, Hermann; Grimnes, Guri; van der Harst, Pim; Snieder, Harold; Hingorani, Aroon D; Pilz, Stefan; Whittaker, John C; Järvelin, Marjo-Riitta; Hyppönen, Elina

    2014-09-01

    Low plasma 25-hydroxyvitamin D (25[OH]D) concentration is associated with high arterial blood pressure and hypertension risk, but whether this association is causal is unknown. We used a mendelian randomisation approach to test whether 25(OH)D concentration is causally associated with blood pressure and hypertension risk. In this mendelian randomisation study, we generated an allele score (25[OH]D synthesis score) based on variants of genes that affect 25(OH)D synthesis or substrate availability (CYP2R1 and DHCR7), which we used as a proxy for 25(OH)D concentration. We meta-analysed data for up to 108 173 individuals from 35 studies in the D-CarDia collaboration to investigate associations between the allele score and blood pressure measurements. We complemented these analyses with previously published summary statistics from the International Consortium on Blood Pressure (ICBP), the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium, and the Global Blood Pressure Genetics (Global BPGen) consortium. In phenotypic analyses (up to n=49 363), increased 25(OH)D concentration was associated with decreased systolic blood pressure (β per 10% increase, -0·12 mm Hg, 95% CI -0·20 to -0·04; p=0·003) and reduced odds of hypertension (odds ratio [OR] 0·98, 95% CI 0·97-0·99; p=0·0003), but not with decreased diastolic blood pressure (β per 10% increase, -0·02 mm Hg, -0·08 to 0·03; p=0·37). In meta-analyses in which we combined data from D-CarDia and the ICBP (n=146 581, after exclusion of overlapping studies), each 25(OH)D-increasing allele of the synthesis score was associated with a change of -0·10 mm Hg in systolic blood pressure (-0·21 to -0·0001; p=0·0498) and a change of -0·08 mm Hg in diastolic blood pressure (-0·15 to -0·02; p=0·01). When D-CarDia and consortia data for hypertension were meta-analysed together (n=142 255), the synthesis score was associated with a reduced odds of hypertension (OR per allele, 0

  4. Association of vitamin D status with arterial blood pressure and hypertension risk: a mendelian randomisation study

    PubMed Central

    Vimaleswaran, Karani S; Cavadino, Alana; Berry, Diane J; Jorde, Rolf; Dieffenbach, Aida Karina; Lu, Chen; Alves, Alexessander Couto; Heerspink, Hiddo J Lambers; Tikkanen, Emmi; Eriksson, Joel; Wong, Andrew; Mangino, Massimo; Jablonski, Kathleen A; Nolte, Ilja M; Houston, Denise K; Ahluwalia, Tarunveer Singh; van der Most, Peter J; Pasko, Dorota; Zgaga, Lina; Thiering, Elisabeth; Vitart, Veronique; Fraser, Ross M; Huffman, Jennifer E; de Boer, Rudolf A; Schöttker, Ben; Saum, Kai-Uwe; McCarthy, Mark I; Dupuis, Josée; Herzig, Karl-Heinz; Sebert, Sylvain; Pouta, Anneli; Laitinen, Jaana; Kleber, Marcus E; Navis, Gerjan; Lorentzon, Mattias; Jameson, Karen; Arden, Nigel; Cooper, Jackie A; Acharya, Jayshree; Hardy, Rebecca; Raitakari, Olli; Ripatti, Samuli; Billings, Liana K; Lahti, Jari; Osmond, Clive; Penninx, Brenda W; Rejnmark, Lars; Lohman, Kurt K; Paternoster, Lavinia; Stolk, Ronald P; Hernandez, Dena G; Byberg, Liisa; Hagström, Emil; Melhus, Håkan; Ingelsson, Erik; Mellström, Dan; Ljunggren, Östen; Tzoulaki, Ioanna; McLachlan, Stela; Theodoratou, Evropi; Tiesler, Carla M T; Jula, Antti; Navarro, Pau; Wright, Alan F; Polasek, Ozren; Hayward, Caroline; Wilson, James F; Rudan, Igor; Salomaa, Veikko; Heinrich, Joachim; Campbell, Harry; Price, Jacqueline F; Karlsson, Magnus; Lind, Lars; Michaëlsson, Karl; Bandinelli, Stefania; Frayling, Timothy M; Hartman, Catharina A; Sørensen, Thorkild I A; Kritchevsky, Stephen B; Langdahl, Bente Lomholt; Eriksson, Johan G; Florez, Jose C; Spector, Tim D; Lehtimäki, Terho; Kuh, Diana; Humphries, Steve E; Cooper, Cyrus; Ohlsson, Claes; März, Winfried; de Borst, Martin H; Kumari, Meena; Kivimaki, Mika; Wang, Thomas J; Power, Chris; Brenner, Hermann; Grimnes, Guri; van der Harst, Pim; Snieder, Harold; Hingorani, Aroon D; Pilz, Stefan; Whittaker, John C; Järvelin, Marjo-Riitta; Hyppönen, Elina

    2015-01-01

    Summary Background Low plasma 25-hydroxyvitamin D (25[OH]D) concentration is associated with high arterial blood pressure and hypertension risk, but whether this association is causal is unknown. We used a mendelian randomisation approach to test whether 25(OH)D concentration is causally associated with blood pressure and hypertension risk. Methods In this mendelian randomisation study, we generated an allele score (25[OH]D synthesis score) based on variants of genes that affect 25(OH)D synthesis or substrate availability (CYP2R1 and DHCR7), which we used as a proxy for 25(OH)D concentration. We meta-analysed data for up to 108 173 individuals from 35 studies in the D-CarDia collaboration to investigate associations between the allele score and blood pressure measurements. We complemented these analyses with previously published summary statistics from the International Consortium on Blood Pressure (ICBP), the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium, and the Global Blood Pressure Genetics (Global BPGen) consortium. Findings In phenotypic analyses (up to n=49 363), increased 25(OH)D concentration was associated with decreased systolic blood pressure (β per 10% increase, −0·12 mm Hg, 95% CI −0·20 to −0·04; p=0·003) and reduced odds of hypertension (odds ratio [OR] 0·98, 95% CI 0·97−0·99; p=0·0003), but not with decreased diastolic blood pressure (β per 10% increase, −0·02 mm Hg, −0·08 to 0·03; p=0·37). In meta-analyses in which we combined data from D-CarDia and the ICBP (n=146 581, after exclusion of overlapping studies), each 25(OH)D-increasing allele of the synthesis score was associated with a change of −0·10 mm Hg in systolic blood pressure (−0·21 to −0·0001; p=0·0498) and a change of −0·08 mm Hg in diastolic blood pressure (−0·15 to −0·02; p=0·01). When D-CarDia and consortia data for hypertension were meta-analysed together (n=142 255), the synthesis score was associated

  5. Identifying Individuals at Risk for Cardiovascular Events Across the Spectrum of Blood Pressure Levels

    PubMed Central

    Karmali, Kunal N; Ning, Hongyan; Goff, David C; Lloyd-Jones, Donald M

    2015-01-01

    Background We determined the proportion of atherosclerotic cardiovascular disease (ASCVD) events that occur across the spectrum of systolic blood pressure (SBP) and assessed whether multivariable risk assessment can identify persons who experience ASCVD events at all levels of SBP, including those with goal levels. Methods and Results Participants aged 45 to 64 years from the Framingham Offspring and Atherosclerosis Risk in Communities studies were stratified based on treated and untreated SBP levels (<120, 120 to 129, 130 to 139, 140 to 149, 150 to 159, ≥160 mm Hg). We determined the number of excess ASCVD events in each SBP stratum by calculating the difference between observed and expected events (ASCVD event rate in untreated SBP <120 mm Hg was used as the reference). We categorized participants into 10-year ASCVD risk groups using the Pooled Cohort risk equations. There were 18 898 participants (78% white; 22% black) who were followed for 10 years. We estimated 427 excess ASCVD events, of which 56% (109 of 197) and 50% (115 of 230), respectively, occurred among untreated and treated participants with elevated SBP who were not recommended for antihypertensive therapy. Among untreated participants, 10-year ASCVD risk ≥7.5% identified 64% of those who experienced an ASCVD at 10 years and 30% of those who did not. Multivariable risk assessment was less useful in baseline-treated participants. Conclusions Half of excess ASCVD events occurred in persons with elevated SBP who were not currently recommended for antihypertensive therapy. Multivariable risk assessment may help identify those likely to benefit from further risk-reducing therapies. These findings support consideration of multivariable risk in guiding prevention across the spectrum of SBP. PMID:26391134

  6. Aspects of Mathematical Modelling of Pressure Retarded Osmosis.

    PubMed

    Anissimov, Yuri G

    2016-02-03

    In power generating terms, a pressure retarded osmosis (PRO) energy generating plant, on a river entering a sea or ocean, is equivalent to a hydroelectric dam with a height of about 60 meters. Therefore, PRO can add significantly to existing renewable power generation capacity if economical constrains of the method are resolved. PRO energy generation relies on a semipermeable membrane that is permeable to water and impermeable to salt. Mathematical modelling plays an important part in understanding flows of water and salt near and across semipermeable membranes and helps to optimize PRO energy generation. Therefore, the modelling can help realizing PRO energy generation potential. In this work, a few aspects of mathematical modelling of the PRO process are reviewed and discussed.

  7. HIGH TEMPERATURE HIGH PRESSURE THERMODYNAMIC MEASUREMENTS FOR COAL MODEL COMPOUNDS

    SciTech Connect

    Vinayak N. Kabadi

    1999-02-20

    It is well known that the fluid phase equilibria can be represented by a number of {gamma}-models , but unfortunately most of them do not function well under high temperature. In this calculation, we mainly investigate the performance of UNIQUAC and NRTL models under high temperature, using temperature dependent parameters rather than using the original formulas. the other feature of this calculation is that we try to relate the excess Gibbs energy G{sup E}and enthalpy of mixing H{sup E}simultaneously. In other words, we will use the high temperature and pressure G{sup E} and H{sup E}data to regress the temperature dependant parameters to find out which model and what kind of temperature dependant parameters should be used.

  8. Active earth pressure model tests versus finite element analysis

    NASA Astrophysics Data System (ADS)

    Pietrzak, Magdalena

    2017-06-01

    The purpose of the paper is to compare failure mechanisms observed in small scale model tests on granular sample in active state, and simulated by finite element method (FEM) using Plaxis 2D software. Small scale model tests were performed on rectangular granular sample retained by a rigid wall. Deformation of the sample resulted from simple wall translation in the direction `from the soil" (active earth pressure state. Simple Coulomb-Mohr model for soil can be helpful in interpreting experimental findings in case of granular materials. It was found that the general alignment of strain localization pattern (failure mechanism) may belong to macro scale features and be dominated by a test boundary conditions rather than the nature of the granular sample.

  9. Aspects of Mathematical Modelling of Pressure Retarded Osmosis

    PubMed Central

    Anissimov, Yuri G.

    2016-01-01

    In power generating terms, a pressure retarded osmosis (PRO) energy generating plant, on a river entering a sea or ocean, is equivalent to a hydroelectric dam with a height of about 60 meters. Therefore, PRO can add significantly to existing renewable power generation capacity if economical constrains of the method are resolved. PRO energy generation relies on a semipermeable membrane that is permeable to water and impermeable to salt. Mathematical modelling plays an important part in understanding flows of water and salt near and across semipermeable membranes and helps to optimize PRO energy generation. Therefore, the modelling can help realizing PRO energy generation potential. In this work, a few aspects of mathematical modelling of the PRO process are reviewed and discussed. PMID:26848696

  10. Developing a pressure ulcer risk assessment scale for patients in long-term care.

    PubMed

    Lepisto, Mervi; Eriksson, Elina; Hietanen, Helvi; Lepisto, Jyri; Lauri, Sirkka

    2006-02-01

    Previous pressure ulcer risk assessment scales appear to have relied on opinions about risk factors and are based on care setting rather than research evidence. Utilizing 21 existing risk assessment scales and relevant risk factor literature, an instrument was developed by Finnish researchers that takes into account individual patient risk factors, devices and methods applied in nursing care, and organizational characteristics. The instrument underwent two pilot tests to assess the relevance and clarity of the instrument: the first involved 43 nurses and six patients; the second involved 50 nurses with expertise in wound care. Changes to questionnaire items deemed necessary as a result of descriptive analysis and agreement percentages were completed. After pilot testing, the final instrument addressed the following issues: 1) patient risks: activity, mobility in bed, mental status, nutrition, urinary incontinence, fecal incontinence, sensory perception, and skin condition; 2) devices and methods used in patient care: technical devices, bed type, mattress, overlay, seat cushions, and care methods; and 3) staff number and structure, maximum number of beds, and beds in use (the last group of questions were included to ensure participants understood the items; results were not analyzed). The phases of the study provided an expeditious means of data collection and a suitable opportunity to assess how the instrument would function in practice. Instrument reliability and validity were improved as a result of the pilot testing and can be enhanced further with continued use and assessment.

  11. Predicting abnormal pressure from 2-D seismic velocity modeling

    SciTech Connect

    Grauls, D.; Dunand, J.P.; Beaufort, D.

    1995-12-01

    Seismic velocities are the only data available, before drilling, on which to base a quantitative, present-day estimate of abnormal pressure. Recent advances in seismic velocity processing have enabled them to obtain, using an in-house approach, an optimized 2-D interval velocity field and consequently to better define the lateral extension of pressure regimes. The methodology, interpretation and quantification of overpressure-related anomalies are supported by case studies, selected in sand-shale dominated Tertiary basins, offshore West Africa. Another advantage of this approach is that it can also account for the presence of reservoir-potential intervals at great depth and thus provide significant insight, from a prospective standpoint, into very poorly explored areas. Although at the outset the 2-D seismic tool legitimately merits being favored, optimization of the final predictive pressure model, prior to drilling, will depend upon the success of its combined use with other concepts and approaches, pertaining to structural geology, sedimentology, rock mechanics and fluid dynamics.

  12. Raster-Based Approach to Solar Pressure Modeling

    NASA Technical Reports Server (NTRS)

    Wright, Theodore W. II

    2013-01-01

    An algorithm has been developed to take advantage of the graphics processing hardware in modern computers to efficiently compute high-fidelity solar pressure forces and torques on spacecraft, taking into account the possibility of self-shading due to the articulation of spacecraft components such as solar arrays. The process is easily extended to compute other results that depend on three-dimensional attitude analysis, such as solar array power generation or free molecular flow drag. The impact of photons upon a spacecraft introduces small forces and moments. The magnitude and direction of the forces depend on the material properties of the spacecraft components being illuminated. The parts of the components being lit depends on the orientation of the craft with respect to the Sun, as well as the gimbal angles for any significant moving external parts (solar arrays, typically). Some components may shield others from the Sun. The purpose of this innovation is to enable high-fidelity computation of solar pressure and power generation effects of illuminated portions of spacecraft, taking self-shading from spacecraft attitude and movable components into account. The key idea in this innovation is to compute results dependent upon complicated geometry by using an image to break the problem into thousands or millions of sub-problems with simple geometry, and then the results from the simpler problems are combined to give high-fidelity results for the full geometry. This process is performed by constructing a 3D model of a spacecraft using an appropriate computer language (OpenGL), and running that model on a modern computer's 3D accelerated video processor. This quickly and accurately generates a view of the model (as shown on a computer screen) that takes rotation and articulation of spacecraft components into account. When this view is interpreted as the spacecraft as seen by the Sun, then only the portions of the craft visible in the view are illuminated. The view as

  13. Solar Radiation Pressure and Attitude Modeling of GNSS Satellites

    NASA Astrophysics Data System (ADS)

    Rodriguez-Solano, C.; Hugentobler, U.; Steigenberger, P.

    2011-12-01

    The main non-gravitational orbit perturbation acting on GNSS satellites is the solar radiation pressure. There are two main approaches to model this force: 1) adjusting empirical parameters that fit best the GNSS tracking data, and 2) computing the a priori force from analytical models based on the detailed satellite structure and information available on ground. The first approach is not based on the physical interaction between solar radiation and the satellite, while the second one cannot be easily adjusted to the real on-orbit behaviour of the satellites, e.g., changes due to aging of optical properties or deviations from nominal attitude. We use here an intermediate approach, an analytical box-wing model based on the physical interaction between the solar radiation and a satellite consisting of a bus (box shape) and solar panels. Furthermore, some of the parameters of the box-wing model can be adjusted to fit the GNSS tracking data, namely the optical properties of the satellite surfaces. It was found that a pure box-wing model interacting with solar radiation is not sufficient for precise orbit determination. In particular a rotation lag angle of the solar panels was identified. This deviation of the solar panels from nominal attitude is a key factor to obtain precise GNSS orbits. Moreover, the yaw attitude of GNSS satellites during eclipse seasons deviates from nominal attitude due to maneuvers performed by the satellites. As mentioned in other studies, the phase measurements are degraded if these maneuvers are not taken into account since the modelled position of the navigation antenna may differ from the true position. In this study we focus on the impact of the yaw attitude on the solar radiation pressure parameters and the benefits for precise orbit determination and prediction.

  14. Circumferential pressure distributions in a model labyrinth seal

    NASA Technical Reports Server (NTRS)

    Leong, Y. M. M. S.; Brown, R. D.

    1982-01-01

    A research program to isolate and study leakage flow through labyrinth glands was initiated. Circumferential pressure distributions were measured in the labyrinth glands with geometry appropriate to the high pressure labyrinths in large steam turbines. Knowledge of this pressure distribution is essential as it is this unequal pressure field that results in the destabilizing force. Parameters that are likely to affect the pressure distributions are incorporated into the test rig. Some preliminary pressure profiles are presented.

  15. Enhanced solar radiation pressure modeling for Galileo satellites

    NASA Astrophysics Data System (ADS)

    Montenbruck, O.; Steigenberger, P.; Hugentobler, U.

    2015-03-01

    This paper introduces a new approach for modeling solar radiation pressure (SRP) effects on Global Navigation Satellite Systems (GNSSs). It focuses on the Galileo In-Orbit Validation (IOV) satellites, for which obvious SRP modeling deficits can be identified in presently available precise orbit products. To overcome these problems, the estimation of empirical accelerations in the Sun direction (D), solar panel axis (Y) and the orthogonal (B) axis is complemented by an a priori model accounting for the contribution of the rectangular spacecraft body. Other than the GPS satellites, which comprise an almost cubic body, the Galileo IOV satellites exhibit a notably rectangular shape with a ratio of about 2:1 for the main body axes. Use of the a priori box model allows to properly model the varying cross section exposed to the Sun during yaw-steering attitude mode and helps to remove systematic once-per-revolution orbit errors that have so far affected the Galileo orbit determination. Parameters of a simple a priori cuboid model suitable for the IOV satellites are established from the analysis of a long-term set of GNSS observations collected with the global network of the Multi-GNSS Experiment of the International GNSS Service. The model is finally demonstrated to reduce the peak magnitude of radial orbit errors from presently 20 cm down to 5 cm outside eclipse phases.

  16. Modeling of patient's blood pressure variation during ambulance transportation

    NASA Astrophysics Data System (ADS)

    Sakatani, Kenji; Ono, Takahiko; Kobayasi, Yasuhide; Hikita, Shinichi; Saito, Mitsuyuki

    2007-12-01

    In an emergency transportation by ambulance, a patient is transported in a supine position. In this position, a patient's blood pressure (BP) variation depending on an inertial force which occurs when an ambulance accelerates or decelerates. This BP variation causes a critical damage for a patent with brain disorder. In order to keep a patient stable during transportation, it is required to maintain small BP variation. To analyze the BP variation during transportation, a model of the BP variation has so far been made. But, it can estimate the BP variation only in braking. The purpose of this paper is to make a dynamical model of the BP variation which can simulate it in both braking and accelerating. First, to obtain the data to construct the model, we used a tilting bed to measure a head-to-foot acceleration and BP of fingertip. Based on this data, we build a mathematical model whose input is the head-to-foot acceleration and output is the Mean BP variation. It is a switched model which switches two models depending on the jerk. We add baroreceptor reflex to the model as a offset value.

  17. Simulation Assisted Risk Assessment: Blast Overpressure Modeling

    NASA Technical Reports Server (NTRS)

    Lawrence, Scott L.; Gee, Ken; Mathias, Donovan; Olsen, Michael

    2006-01-01

    A probabilistic risk assessment (PRA) approach has been developed and applied to the risk analysis of capsule abort during ascent. The PRA is used to assist in the identification of modeling and simulation applications that can significantly impact the understanding of crew risk during this potentially dangerous maneuver. The PRA approach is also being used to identify the appropriate level of fidelity for the modeling of those critical failure modes. The Apollo launch escape system (LES) was chosen as a test problem for application of this approach. Failure modes that have been modeled and/or simulated to date include explosive overpressure-based failure, explosive fragment-based failure, land landing failures (range limits exceeded either near launch or Mode III trajectories ending on the African continent), capsule-booster re-contact during separation, and failure due to plume-induced instability. These failure modes have been investigated using analysis tools in a variety of technical disciplines at various levels of fidelity. The current paper focuses on the development and application of a blast overpressure model for the prediction of structural failure due to overpressure, including the application of high-fidelity analysis to predict near-field and headwinds effects.

  18. Quantitative Risk Modeling of Fire on the International Space Station

    NASA Technical Reports Server (NTRS)

    Castillo, Theresa; Haught, Megan

    2014-01-01

    The International Space Station (ISS) Program has worked to prevent fire events and to mitigate their impacts should they occur. Hardware is designed to reduce sources of ignition, oxygen systems are designed to control leaking, flammable materials are prevented from flying to ISS whenever possible, the crew is trained in fire response, and fire response equipment improvements are sought out and funded. Fire prevention and mitigation are a top ISS Program priority - however, programmatic resources are limited; thus, risk trades are made to ensure an adequate level of safety is maintained onboard the ISS. In support of these risk trades, the ISS Probabilistic Risk Assessment (PRA) team has modeled the likelihood of fire occurring in the ISS pressurized cabin, a phenomenological event that has never before been probabilistically modeled in a microgravity environment. This paper will discuss the genesis of the ISS PRA fire model, its enhancement in collaboration with fire experts, and the results which have informed ISS programmatic decisions and will continue to be used throughout the life of the program.

  19. Risk Assessment of Physiological Effects of Atmospheric Composition and Pressure in Constellation Vehicles

    NASA Technical Reports Server (NTRS)

    Scheuring, Richard A.; Conkin, Johnny; Jones, Jeffrey A.; Gernhardt, Michael L.

    2007-01-01

    To reduce denitrogenation time to prevent decompression sickness to support frequent extravehicular activities on the Moon, and to limit the risk of fire, a hypobaric (P(sub B) = 414 mmHg) and mildly hypoxic (ppO2 = 132 mmHg, 32% O2 - 68% N2) living environment is being considered during lunar missions for the Crew Exploration Vehicle (CEV) and Lunar Surface Access Module (LSAM). If the vehicular ppO2 is acutely changed from 145-178 mmHg at standard vehicular operating pressure to less than 125 mmHg at desired lunar surface outpost operating pressures, there is the possibility that some crewmembers may develop symptoms of Acute Mountain Sickness (AMS). The signs and symptoms of AMS (headache plus nausea, dizziness, fatigue, or sleeplessness), could impact crew health and performance on lunar surface missions. Methods: An exhaustive literature review on the topic of the physiological effects of reduced ppO2 and absolute pressure as may contribute to the development of hypoxia and altitude symptoms or AMS. The results of the nine most rigorous studies were collated, analyzed and contents on the physiological concerns associated with hypobaric operations, AMS and hypoxia symptoms summarized. Results: Although space vehicles have operated in hypobaric conditions previously, they have not operated in a mildly hypoxic ppO2. There is evidence for an absolute pressure effect per se on AMS, such that the higher the altitude for a given hypoxic alveolar O2 partial pressure (P(sub A)O2), the greater the likelihood of an AMS response. About 25% of adults are likely to experience mild AMS near 2,000 m (xxx mmHg) altitude following a rapid ascent from sea level while breathing air (6,500 feet, acute (P(sub A)O2) = 75 mmHg). The operational experience with the Shuttle staged denitrogenation protocol at 528 mmHg (3,048 m) while breathing 26.5% O2 (acute (P(sub A)O2) = 85 mmHg) in astronauts adapting to microgravity suggests a similar likely experience in the proposed CEV

  20. Geomechanical modelling of induced seismicity using Coulomb stress and pore pressure changes

    NASA Astrophysics Data System (ADS)

    Zhao, B.; Shcherbakov, R.

    2016-12-01

    In recent years, there has been a dramatic increase in seismicity (earthquakes) due to anthropogenic activities related to the unconventional oil and gas exploration in the Western Canada Sedimentary Basin (WCSB). There are compelling evidences that hydraulic fracturing and wastewater injection operations play a key role in induced seismicity in the WCSB; however, their physical mechanisms are still not fully understood. Therefore, this study focuses on exploring the physical mechanisms of induced seismicity and developing a realistic geomechanical model by incorporating the past seismicity and well production data. In this work, we model the Coulomb stress changes due to past moderate (magnitude greater than 3 with known fault plane solutions) induced earthquakes and pore pressure changes due to wastewater injection in Alberta, specifically in Fox Creek and Fort St. John areas. Relationships between Coulombs stress changes, fault geometry and orientation and subsequent earthquake locations are tested. Subsurface flow due to injection well operations is studied to model the pore pressure changes in time and space, using known well production data, which include well types, well locations and water extraction and injection rates. By modelling the changes in pore pressure and Coulomb stress, we aim at constraining the time scale of occurrence of possible future earthquakes. The anticipating results can help to control the parameters of anthropogenic energy related operations such as hydraulic fracturing and wastewater injection in mitigating the risk due to induced seismicity.

  1. Preventing heel pressure ulcers and plantar flexion contractures in high-risk sedated patients.

    PubMed

    Meyers, Tina R

    2010-01-01

    An intervention using heel pressure ulcer and plantar flexion contracture prevention protocols for high-risk patients was established to promote earlier recognition of heel skin issues and provide effective prevention of both conditions. Fifty-three patients who were sedated, managed in an intensive care unit for 5 days or more, and had a Braden Scale score of 16 or less were treated with heel protector devices that maintained the foot in a neutral position and floated the heel off the bed. On admission to the intensive care unit, heel skin assessment and the Braden Scale were administered to all patients. Initial ankle range of motion was measured with a goniometer on admission and before the application of the heel protector. Goniometric measurements were documented every other day. Heel assessments and the Braden Scale for Predicting Pressure Sore Prevention and Ramsay Sedation Scale scores were recorded in every shift and recorded as part of the study every other day. Measurements continued until the patient was transferred, the heel protector boot was discontinued by the physician, or the patient's Braden Scale score rose above 16. Application of the heel protectors led to a 50% reduction in prevalence of abnormal heel position. No patients developed plantar flexion contractures or new heel ulcers. Patients with normal heels had significantly higher Braden Scale scores compared to those with abnormal heels (P 5 .0136). Despite their high risk, no patients using the heel protector device developed a heel pressure ulcer or plantar flexion contracture.

  2. Construction Safety Risk Modeling and Simulation.

    PubMed

    Tixier, Antoine J-P; Hallowell, Matthew R; Rajagopalan, Balaji

    2017-03-17

    By building on a genetic-inspired attribute-based conceptual framework for safety risk analysis, we propose a novel approach to define, model, and simulate univariate and bivariate construction safety risk at the situational level. Our fully data-driven techniques provide construction practitioners and academicians with an easy and automated way of getting valuable empirical insights from attribute-based data extracted from unstructured textual injury reports. By applying our methodology on a data set of 814 injury reports, we first show the frequency-magnitude distribution of construction safety risk to be very similar to that of many natural phenomena such as precipitation or earthquakes. Motivated by this observation, and drawing on state-of-the-art techniques in hydroclimatology and insurance, we then introduce univariate and bivariate nonparametric stochastic safety risk generators based on kernel density estimators and copulas. These generators enable the user to produce large numbers of synthetic safety risk values faithful to the original data, allowing safety-related decision making under uncertainty to be grounded on extensive empirical evidence. One of the implications of our study is that like natural phenomena, construction safety may benefit from being studied quantitatively by leveraging empirical data rather than strictly being approached through a managerial perspective using subjective data, which is the current industry standard. Finally, a side but interesting finding is that in our data set, attributes related to high energy levels (e.g., machinery, hazardous substance) and to human error (e.g., improper security of tools) emerge as strong risk shapers. © 2017 Society for Risk Analysis.

  3. GENETIC VARIANTS AND BLOOD PRESSURE IN A POPULATION-BASED COHORT: THE CARDIOVASCULAR RISK IN YOUNG FINNS STUDY

    PubMed Central

    Oikonen, Mervi; Tikkanen, Emmi; Juhola, Jonna; Tuovinen, Tarja; Seppälä, Ilkka; Juonala, Markus; Taittonen, Leena; Mikkilä, Vera; Kähönen, Mika; Ripatti, Samuli; Viikari, Jorma; Lehtimäki, Terho; Havulinna, Aki S; Kee, Frank; Newton-Cheh, Christopher; Peltonen, Leena; Schork, Nicholas J; Murray, Sarah S; Berenson, Gerald S; Chen, Wei; Srinivasan, Sathanur R; Salomaa, Veikko; Raitakari, Olli T

    2011-01-01

    Clinical relevance of a genetic predisposition to elevated blood pressure was quantified during the transition from childhood to adulthood in a population-based Finnish cohort (N=2,357). Blood pressure was measured at baseline in 1980 (age 3–18 years) and in follow-ups in 1983, 1986, 2001 and 2007. Thirteen single nucleotide polymorphisms associated with blood pressure were genotyped and three genetic risk scores associated with systolic and diastolic blood pressure and their combination were derived for all participants. Effects of the genetic risk score were 0.47 mmHg for systolic and 0.53 mmHg for diastolic blood pressure (both p<0.01). The combination genetic risk score was associated with diastolic blood pressure from age 9 onwards (β=0.68 mmHg, p=0.015). Replications in 1194 participants of the Bogalusa Heart Study showed essentially similar results. The participants in the highest quintile of the combination genetic risk score had a 1.82-fold risk of hypertension in adulthood (p<0.0001) compared with the lowest quintile, independent of a family history of premature hypertension. These findings show that genetic variants are associated with preclinical blood pressure traits in childhood, individuals with several susceptibility alleles have on average a 0.5 mmHg higher blood pressure and this trajectory continues from childhood to adulthood. PMID:22025373

  4. Structural equation modeling in environmental risk assessment.

    PubMed Central

    Buncher, C R; Succop, P A; Dietrich, K N

    1991-01-01

    Environmental epidemiology requires effective models that take individual observations of environmental factors and connect them into meaningful patterns. Single-factor relationships have given way to multivariable analyses; simple additive models have been augmented by multiplicative (logistic) models. Each of these steps has produced greater enlightenment and understanding. Models that allow for factors causing outputs that can affect later outputs with putative causation working at several different time points (e.g., linkage) are not commonly used in the environmental literature. Structural equation models are a class of covariance structure models that have been used extensively in economics/business and social science but are still little used in the realm of biostatistics. Path analysis in genetic studies is one simplified form of this class of models. We have been using these models in a study of the health and development of infants who have been exposed to lead in utero and in the postnatal home environment. These models require as input the directionality of the relationship and then produce fitted models for multiple inputs causing each factor and the opportunity to have outputs serve as input variables into the next phase of the simultaneously fitted model. Some examples of these models from our research are presented to increase familiarity with this class of models. Use of these models can provide insight into the effect of changing an environmental factor when assessing risk. The usual cautions concerning believing a model, believing causation has been proven, and the assumptions that are required for each model are operative. PMID:2050063

  5. Relationships between blood pressure, oral contraceptive use and metabolic risk markers for cardiovascular disease.

    PubMed

    Godsland, I F; Crook, D; Devenport, M; Wynn, V

    1995-09-01

    Data from a previous study, designed to compare metabolic risk markers for cardiovascular disease in non-users and oral contraceptive (OC) users, were analysed to evaluate the influence of OC composition on blood pressure. Healthy, female volunteers (1189 women) either not using OC (non-users) or currently using one of six different combined formulations (users) were compared. Combinations studied contained 30-40 micrograms ethinyl estradiol combined with the progestins levonorgestrel, norethindrone (at two and three different doses, respectively) or desogestrel. After statistical standardisation to account for the significantly greater age of the non-users and longer duration of OC use amongst the levonorgestrel combination users, mean blood pressure was higher, compared with non-users, in users of monophasic or triphasic levonorgestrel combinations (systolic: +4.3 mmHg (p < 0.001) and +2.7 mmHg (p < 0.001), respectively; diastolic: +2.6 mmHg (p < 0.001) and +2.3 mmHg (p < 0.05), respectively). Blood pressures in users of monophasic norethindrone and desogestrel combinations were not significantly raised and there was no increase in the proportion of women with abnormal values. Diastolic and systolic blood pressures were positively associated with oral glucose tolerance test insulin response (r = 0.11 (p < 0.01) and r = 0.15 (p < 0.001), respectively) in users but not in non-users. Currently used OC containing norethindrone or desogestrel progestins have little impact on blood pressure. Their correlated reduction in impact on insulin concentrations, though small, suggests common mechanisms through which OC affect blood pressure and insulin.

  6. Probabilistic Seismic Risk Model for Western Balkans

    NASA Astrophysics Data System (ADS)

    Stejskal, Vladimir; Lorenzo, Francisco; Pousse, Guillaume; Radovanovic, Slavica; Pekevski, Lazo; Dojcinovski, Dragi; Lokin, Petar; Petronijevic, Mira; Sipka, Vesna

    2010-05-01

    A probabilistic seismic risk model for insurance and reinsurance purposes is presented for an area of Western Balkans, covering former Yugoslavia and Albania. This territory experienced many severe earthquakes during past centuries producing significant damage to many population centres in the region. The highest hazard is related to external Dinarides, namely to the collision zone of the Adriatic plate. The model is based on a unified catalogue for the region and a seismic source model consisting of more than 30 zones covering all the three main structural units - Southern Alps, Dinarides and the south-western margin of the Pannonian Basin. A probabilistic methodology using Monte Carlo simulation was applied to generate the hazard component of the model. Unique set of damage functions based on both loss experience and engineering assessments is used to convert the modelled ground motion severity into the monetary loss.

  7. Soil Erosion Risk Assessment and Modelling

    NASA Astrophysics Data System (ADS)

    Fister, Wolfgang; Kuhn, Nikolaus J.; Heckrath, Goswin

    2013-04-01

    Soil erosion is a phenomenon with relevance for many research topics in the geosciences. Consequently, PhD students with many different backgrounds are exposed to soil erosion related questions during their research. These students require a compact, but detailed introduction to erosion processes, the risks associated with erosion, but also tools to assess and study erosion related questions ranging from a simple risk assessment to effects of climate change on erosion-related effects on geochemistry on various scales. The PhD course on Soil Erosion Risk Assessment and Modelling offered by the University of Aarhus and conducted jointly with the University of Basel is aimed at graduate students with degrees in the geosciences and a PhD research topic with a link to soil erosion. The course offers a unique introduction to erosion processes, conventional risk assessment and field-truthing of results. This is achieved by combing lectures, mapping, erosion experiments, and GIS-based erosion modelling. A particular mark of the course design is the direct link between the results of each part of the course activities. This ensures the achievement of a holistic understanding of erosion in the environment as a key learning outcome.

  8. Predictive power of the Braden scale for pressure sore risk in adult critical care patients: a comprehensive review.

    PubMed

    Cox, Jill

    2012-01-01

    Critical care is designed for managing the sickest patients within our healthcare system. Multiple factors associated with an increased likelihood of pressure ulcer development have been investigated in the critical care population. Nevertheless, there is a lack of consensus regarding which of these factors poses the greatest risk for pressure ulceration. While the Braden scale for pressure sore risk is the most commonly used tool for measuring pressure ulcer risk in the United States, research focusing on the cumulative Braden Scale score and subscale scores is lacking in the critical care population. This author conducted a literature review on pressure ulcer risk assessment in the critical care population, to include the predictive value of both the total score and the subscale scores. In this review, the subscales sensory perception, mobility, moisture, and friction/shear were found to be associated with an increased likelihood of pressure ulcer development; in contrast, the Activity and Nutrition subscales were not found to predict pressure ulcer development in this population. In order to more precisely quantify risk in the critically ill population, modification of the Braden scale or development of a critical care specific risk assessment tool may be indicated.

  9. [High-grade pressure sores in frail older high-risk persons. A retrospective postmortem case-control-study].

    PubMed

    Von Renteln-Kruse, W; Krause, T; Anders, J; Kühl, M; Heinemann, A; Püschel, K

    2004-04-01

    Some old persons at risk do develop, but others, at comparable risk, do not develop high-grade pressure sores. To evaluate potentially different risk factors, we performed a post mortem case-control study in old persons who developed high-grade pressure sores within six months until 14 days before death. Consecutive cases with pressure sores grade >/=3 and potential controls at comparably high risk for pressure sores were examined before cremation. After written informed consent had been obtained by the next relatives, all available nursing and medical records of the deceased were thoroughly evaluated. Cases and controls were matched according to age, gender, immobility, and cachexia.A total of 100 cases with 71 pressure sores grade 3 and 29 pressure sores grade 4 were compared to 100 controls with 27 pressure sores grade risk as assessed by the Norton scale. The mean age was 86 years, 80% were females, 86% were bedridden, and cachexia was found in 66%. The cases were more often seriously disabled, had more often contractions of joints, and were on more drugs with intended or unwanted depressive/sedative effects (neuroleptics, benzodiazepines, centrally acting analgesics). Patient's impaired ability or low intention to comply/cooperate with preventive and/or therapeutic measures was more often recorded in cases than controls.A high degree of disablement and immobility, in particular, are risk factors for high-grade pressure sores in frail older high-risk persons. Sedative drug effects and impaired patient compliance with preventive and therapeutic measures may also be associated with the development of high-grade pressure sores in old persons at high risk.

  10. Petri net modeling of fault analysis for probabilistic risk assessment

    NASA Astrophysics Data System (ADS)

    Lee, Andrew

    Fault trees and event trees have been widely accepted as the modeling strategy to perform Probabilistic Risk Assessment (PRA). However, there are several limitations associated with fault tree/event tree modeling. These include 1. It only considers binary events; 2. It assumes independence among basic events; and 3. It does not consider timing sequence of basic events. This thesis investigates Petri net modeling as a potential alternative for PRA modeling. Petri nets have mainly been used as a simulation tool for queuing and network systems. However, it has been suggested that they could also model failure scenarios, and thus could be a potential modeling strategy for PRA. In this thesis, the transformations required to model logic gates in a fault tree by Petri nets are explored. The gap between fault tree analysis and Petri net analysis is bridged through gate equivalency analysis. Methods for qualitative and quantitative analysis for Petri nets are presented. Techniques are developed and implemented to revise and tailor traditional Petri net modeling for system failure analysis. The airlock system and the maintenance cooling system of a CANada Deuterium Uranium (CANDU) reactor are used as case studies to demonstrate Petri nets ability to model system failure and provide a structured approach for qualitative and quantitative analysis. The minimal cutsets and the probability of the airlock system failing to maintain the pressure boundary are obtained. Furthermore, the case study is extended to non-coherent system analysis due to system maintenance.

  11. Pressure mapping to assess seated pressure distributions and the potential risk for skin ulceration in a population of sledge hockey players and control subjects.

    PubMed

    Berthold, Justin; Dicianno, Brad E; Cooper, Rory A

    2013-09-01

    Ice sledge (or sled) hockey is a fast-paced sport that enables individuals with physical disabilities to play ice hockey. As the attraction to the sport continues to rise, the need for developing better equipment and installing preventative measures for injury will become increasingly important. One such injury includes skin pressure ulceration. A total of 26 subjects including active controls and those with spinal cord injury, multiple sclerosis, limb amputation and traumatic brain injury were studied using a pressure mapping device at the 2012 National Disabled Veterans Winter Sports Clinic to determine the risk for skin pressure ulceration and the impact of cushioning and knee angle positioning on seated pressure distributions. Sledge hockey athletes may be at increased risk for skin pressure ulceration based on seated pressure distribution data. This experiment failed to demonstrate a benefit for specialty cushioning in either group. Interestingly, knee angle positioning, particularly, knee extension significantly lowered the average seated pressures. When considering the risk for skin pressure ulceration, knee angle positioning is of particular clinical importance. More research is warranted, specifically targeting novel cushion and sledge designs and larger groups of individuals with sensory loss and severe spinal deformities. Implications for Rehabilitation Ice sledge (or sled) hockey is a fast-paced and growing adaptive sport played at the Paralympic level. Rehabilitation professionals should consider the potential for skin ulceration in this population of athletes. The effects of cushioning used in the sledge design warrants further investigation. Knee angle positioning; particularly, knee extension significantly lowers seated pressures and may reduce the potential for skin ulceration.

  12. Development and validation of a cardiovascular risk prediction model for Japanese: the Hisayama study.

    PubMed

    Arima, Hisatomi; Yonemoto, Koji; Doi, Yasufumi; Ninomiya, Toshiharu; Hata, Jun; Tanizaki, Yumihiro; Fukuhara, Masayo; Matsumura, Kiyoshi; Iida, Mitsuo; Kiyohara, Yutaka

    2009-12-01

    The objective of this paper is to develop a new risk prediction model of cardiovascular disease and to validate its performance in a general population of Japanese. The Hisayama study is a population-based prospective cohort study. A total of 2634 participants aged 40 years or older were followed up for 14 years for incident cardiovascular disease (stroke and coronary heart disease (myocardial infarction, coronary revascularization and sudden cardiac death)). We used data among a random two-thirds (the derivation cohort, n=1756) to develop a new risk prediction model that was then tested to compare observed and predicted outcomes in the remaining one-third (the validation cohort, n=878). A multivariable cardiovascular risk prediction model was developed that incorporated age, sex, systolic blood pressure, diabetes, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and smoking. We assessed the performance of the model for predicting individual cardiovascular event among the validation cohort. The risk prediction model demonstrated good discrimination (c-statistic=0.81; 95% confidence interval, 0.77 to 0.86) and calibration (Hosmer-Lemeshow chi(2)-statistic=6.46; P=0.60). A simple risk score sheet based on the cardiovascular risk prediction model was also presented. We developed and validated a new cardiovascular risk pr