ReplacementMatrix: a web server for maximum-likelihood estimation of amino acid replacement rate matrices.

PubMed

Dang, Cuong Cao; Lefort, Vincent; Le, Vinh Sy; Le, Quang Si; Gascuel, Olivier

2011-10-01

Amino acid replacement rate matrices are an essential basis of protein studies (e.g. in phylogenetics and alignment). A number of general purpose matrices have been proposed (e.g. JTT, WAG, LG) since the seminal work of Margaret Dayhoff and co-workers. However, it has been shown that matrices specific to certain protein groups (e.g. mitochondrial) or life domains (e.g. viruses) differ significantly from general average matrices, and thus perform better when applied to the data to which they are dedicated. This Web server implements the maximum-likelihood estimation procedure that was used to estimate LG, and provides a number of tools and facilities. Users upload a set of multiple protein alignments from their domain of interest and receive the resulting matrix by email, along with statistics and comparisons with other matrices. A non-parametric bootstrap is performed optionally to assess the variability of replacement rate estimates. Maximum-likelihood trees, inferred using the estimated rate matrix, are also computed optionally for each input alignment. Finely tuned procedures and up-to-date ML software (PhyML 3.0, XRATE) are combined to perform all these heavy calculations on our clusters. http://www.atgc-montpellier.fr/ReplacementMatrix/ olivier.gascuel@lirmm.fr Supplementary data are available at http://www.atgc-montpellier.fr/ReplacementMatrix/

Mortality risk disparities in children receiving chronic renal replacement therapy for the treatment of end-stage renal disease across Europe: an ESPN-ERA/EDTA registry analysis.

PubMed

Chesnaye, Nicholas C; Schaefer, Franz; Bonthuis, Marjolein; Holman, Rebecca; Baiko, Sergey; Baskın, Esra; Bjerre, Anna; Cloarec, Sylvie; Cornelissen, Elisabeth A M; Espinosa, Laura; Heaf, James; Stone, Rosário; Shtiza, Diamant; Zagozdzon, Ilona; Harambat, Jérôme; Jager, Kitty J; Groothoff, Jaap W; van Stralen, Karlijn J

2017-05-27

We explored the variation in country mortality rates in the paediatric population receiving renal replacement therapy across Europe, and estimated how much of this variation could be explained by patient-level and country-level factors. In this registry analysis, we extracted patient data from the European Society for Paediatric Nephrology/European Renal Association-European Dialysis and Transplant Association (ESPN/ERA-EDTA) Registry for 32 European countries. We included incident patients younger than 19 years receiving renal replacement therapy. Adjusted hazard ratios (aHR) and the explained variation were modelled for patient-level and country-level factors with multilevel Cox regression. The primary outcome studied was all-cause mortality while on renal replacement therapy. Between Jan 1, 2000, and Dec 31, 2013, the overall 5 year renal replacement therapy mortality rate was 15·8 deaths per 1000 patient-years (IQR 6·4-16·4). France had a mortality rate (9·2) of more than 3 SDs better, and Russia (35·2), Poland (39·9), Romania (47·4), and Bulgaria (68·6) had mortality rates more than 3 SDs worse than the European average. Public health expenditure was inversely associated with mortality risk (per SD increase, aHR 0·69, 95% CI 0·52-0·91) and explained 67% of the variation in renal replacement therapy mortality rates between countries. Child mortality rates showed a significant association with renal replacement therapy mortality, albeit mediated by macroeconomics (eg, neonatal mortality reduced from 1·31 [95% CI 1·13-1·53], p=0·0005, to 1·21 [0·97-1·51], p=0·10). After accounting for country distributions of patient age, the variation in renal replacement therapy mortality rates between countries increased by 21%. Substantial international variation exists in paediatric renal replacement therapy mortality rates across Europe, most of which was explained by disparities in public health expenditure, which seems to limit the availability and quality of paediatric renal care. Differences between countries in their ability to accept and treat the youngest patients, who are the most complex and costly to treat, form an important source of disparity within this population. Our findings can be used by policy makers and health-care providers to explore potential strategies to help reduce these health disparities. ERA-EDTA and ESPN. Copyright © 2017 Elsevier Ltd. All rights reserved.

Antibiotic Dosing in Continuous Renal Replacement Therapy.

PubMed

Shaw, Alexander R; Mueller, Bruce A

2017-07-01

Appropriate antibiotic dosing is critical to improve outcomes in critically ill patients with sepsis. The addition of continuous renal replacement therapy makes achieving appropriate antibiotic dosing more difficult. The lack of continuous renal replacement therapy standardization results in treatment variability between patients and may influence whether appropriate antibiotic exposure is achieved. The aim of this study was to determine if continuous renal replacement therapy effluent flow rate impacts attaining appropriate antibiotic concentrations when conventional continuous renal replacement therapy antibiotic doses were used. This study used Monte Carlo simulations to evaluate the effect of effluent flow rate variance on pharmacodynamic target attainment for cefepime, ceftazidime, levofloxacin, meropenem, piperacillin, and tazobactam. Published demographic and pharmacokinetic parameters for each antibiotic were used to develop a pharmacokinetic model. Monte Carlo simulations of 5000 patients were evaluated for each antibiotic dosing regimen at the extremes of Kidney Disease: Improving Global Outcomes guidelines recommended effluent flow rates (20 and 35 mL/kg/h). The probability of target attainment was calculated using antibiotic-specific pharmacodynamic targets assessed over the first 72 hours of therapy. Most conventional published antibiotic dosing recommendations, except for levofloxacin, reach acceptable probability of target attainment rates when effluent rates of 20 or 35 mL/kg/h are used. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Central line replacement following infection does not improve reinfection rates in pediatric pulmonary hypertension patients receiving intravenous prostanoid therapy.

PubMed

McCarthy, Elisa K; Ogawa, Michelle T; Hopper, Rachel K; Feinstein, Jeffrey A; Gans, Hayley A

2018-01-01

Treatment of pediatric pulmonary hypertension (PH) with IV prostanoids has greatly improved outcomes but requires a central line, posing inherent infection risk. This study examines the types of infections, infection rates, and importantly the effect of line management strategies on reinfection in children receiving IV prostanoids for PH. This study is a retrospective review of all pediatric PH patients receiving intravenous epoprostenol (EPO) or treprostinil (TRE) at one academic tertiary care center between 2000 and 2014. No patients declined participation in the study or were otherwise excluded. Infectious complications were characterized by organism(s), infection rates, time to next infection, and line management decisions (salvage vs. replace). Of the 40 patients followed, 13 sustained 38 infections involving 49 pathogens, with a predominance of gram-positive (GP) organisms (n = 35). The pooled infection rate was 1.06 per 1000 prostanoid days with no difference between EPO and TRE. No significant difference in reinfection rate was observed when comparing line salvage to replacement, regardless of organism type. Both overall and organism-type comparisons suggest longer time between line infections following line salvage compared with line replacement (732 vs. 410 days overall; 793 vs. 363 days for GP; 611 vs. 581 days for gram-negative [GN]; P > 0.05 for all comparisons). Central line replacement following blood stream infections in pediatric PH patients does not improve subsequent infection rates or time to next infection, and may lead to unnecessary risks associated with line replacement, including potential loss of vascular access. A revised approach to central line infections in pediatric PH is proposed.

CardiaMed mechanical valve: mid-term results of a multicenter clinical trial.

PubMed

Nazarov, Vladimir M; Zheleznev, Sergey I; Bogachev-Prokophiev, Alexandr V; Afanasyev, Alexandr V; Nemchenko, Eugene V; Jeltovskiy, Yuri V; Lavinyukov, Sergey O

2014-01-01

Prosthesis choice is a major concern in valvular surgery. A multicenter clinical trial was performed to assess the efficacy and safety of the CardiaMed prosthetic heart valve. The study enrolled 420 patients who underwent mitral (209) or aortic (211) valve replacement from 2003 to 2004 at 7 institutions in Russia, and who were followed up from 2006 to 2011. The mean age was 52.2 ± 10.2 years (range, 12-78 years), 47.4% were female, and 99.05% completed the study. The maximum observation term was 7.5 years (2188.5 patient-years); 1081.6 patient-years for aortic and 1106.9 patient-years for mitral valve replacement. The overall 7-year survival rate was 85.1%  ± 3.7%; 86.1%  ± 4.8% and 84.4%  ± 5.4% for aortic and mitral valve replacement, respectively. The 7-year freedom from valve-related death was 93.9%  ± 3.7% and 94.5%  ± 3.2% for aortic and mitral valve replacement, respectively. When early mortality (<30 days) was excluded, these rates were 94.8%  ± 3.1% and 93.8%  ± 3.82%, respectively. Linearized valve-dependent complication rates were determined for structural valve failure (0%/patient-year overall), thrombosis (0.63%/patient-year, all for mitral valve replacement), thromboembolic complications including transient neurologic deficits (0.13%/patient-year overall, 0.5%/patient-year for aortic valve replacement, 0.8%/patient-year for mitral valve replacement), hemorrhagic bleeding (0.64%/patient-year overall, 0.55%/patient-year for aortic valve replacement, 0.09%/patient-year for mitral valve replacement), prosthetic endocarditis (0.28%/patient-year overall, 0.28%/patient-year for aortic valve replacement, 0%/patient-year for mitral valve replacement), and hemolysis (0%/patient-year overall). The CardiaMed mechanical heart valve prostheses meets world standards of safety and efficacy.

Enamel formation and growth in non-mammalian cynodonts

PubMed Central

Dirks, Wendy; Martinelli, Agustín G.

2018-01-01

The early evolution of mammals is associated with the linked evolutionary origin of diphyodont tooth replacement, rapid juvenile growth and determinate adult growth. However, specific relationships among these characters during non-mammalian cynodont evolution require further exploration. Here, polarized light microscopy revealed incremental lines, resembling daily laminations of extant mammals, in histological sections of enamel in eight non-mammalian cynodont species. In the more basal non-probainognathian group, enamel extends extremely rapidly from cusp to cervix. By contrast, the enamel of mammaliamorphs is gradually accreted, with slow rates of crown extension, more typical of the majority of non-hypsodont crown mammals. These results are consistent with the reduction in dental replacement rate across the non-mammalian cynodont lineage, with greater rates of crown extension required in most non-probainognathians, and slower crown extension rates permitted in mammaliamorphs, which have reduced patterns of dental replacement in comparison with many non-probainognathians. The evolution of mammal-like growth patterns, with faster juvenile growth and more abruptly terminating adult growth, is linked with this reduction in dental replacement rates and may provide an additional explanation for the observed pattern in enamel growth rates. It is possible that the reduction in enamel extension rates in mammaliamorphs reflects an underlying reduction in skeletal growth rates at the time of postcanine formation, due to a more abruptly terminating pattern of adult growth in these more mammal-like, crownward species. PMID:29892415

46 CFR 565.10 - Suspension procedures, period of suspension, and replacement rates.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 9 2010-10-01 2010-10-01 false Suspension procedures, period of suspension, and replacement rates. 565.10 Section 565.10 Shipping FEDERAL MARITIME COMMISSION REGULATIONS AND ACTIONS TO ADDRESS RESTRICTIVE FOREIGN MARITIME PRACTICES CONTROLLED CARRIERS § 565.10 Suspension procedures, period...

Development of an approach to facilitate optimal equipment replacement : technical summary.

DOT National Transportation Integrated Search

1999-10-01

The objective of the study was to determine a way or ways to assign an urgency rating to equipment that was currently in service but in need of replacement. This urgency rating must in some manner took into account the various costs associated with r...

What is the evidence behind the evidence-base? The premature death of block-replace antithyroid drug regimens for Graves' disease.

PubMed

Razvi, Salman; Vaidya, Bijay; Perros, Petros; Pearce, Simon H S

2006-06-01

Block-replace and titration antithyroid drug regimens both give similar rates of medium- to long-term remission of hyperthyroid Graves' disease. Recent meta-analysis, however, has suggested that titration regimens may be preferable owing to a higher rate of adverse events seen in the block-replace arms of published comparative studies. This article critically re-evaluates the evidence upon which these meta-analyses were based. We suggest that there is little objective evidence that is pertinent to current clinical practice to separate block-replace from titration antithyroid drug regimens and that both remain satisfactory approaches to the medical management of hyperthyroid Graves' disease.

Catheter replacement structure in home medical care settings and regional characteristics in Tokyo and three adjoining prefectures.

PubMed

Kimura, Takuma; Yoshie, Satoru; Tsuchiya, Rumiko; Kawagoe, Shohei; Hirahara, Satoshi; Iijima, Katsuya; Akahoshi, Toru; Tsuji, Tetsuo

2017-04-01

The present study investigated the association between the structure of catheter replacement services in home medical care settings and regional characteristics. An anonymous self-administered questionnaire was carried out from August to September 2013. Participants were physicians from 5338 clinics that provided medical care services at home, and nurses from 1619 home-visit nursing stations in Tokyo and three adjoining prefectures. The questionnaire covered catheter replacement (gastrostomy tubes, nasogastric tubes, tracheal cannulas) during home medical care, and the professions of those who replaced urethral catheters for male and female patients. Regions were divided into two groups (higher- and lower-density regions) based on the number of clinics, number of home-visit nursing stations and the ratio of the population aged ≥65 years. The rates of respondents that reported catheter replacement was usually executed, and those who reported catheters were replaced by "physicians in principle" were compared between the groups. Responses were received from 842 clinics (16.3%) and 499 home-visit nursing stations (31.4%). In the higher-density regions, the rate of physicians who reported urethral catheters for male patients were replaced by "physicians in principle" was significantly higher than in the lower-density regions (P < 0.001). In the lower-density regions, the rate of nurses who reported urethral catheters for male patients were replaced by "nurses in principle" was significantly higher compared with the higher-density regions (P < 0.016). In home medical care settings, urethral catheters for male patients are replaced by nurses in regions where physician resources are limited. Geriatr Gerontol Int 2017; 17: 628-636. © 2016 Japan Geriatrics Society.

Cell cycle- and chaperone-mediated regulation of H3K56ac incorporation in yeast.

PubMed

Kaplan, Tommy; Liu, Chih Long; Erkmann, Judith A; Holik, John; Grunstein, Michael; Kaufman, Paul D; Friedman, Nir; Rando, Oliver J

2008-11-01

Acetylation of histone H3 lysine 56 is a covalent modification best known as a mark of newly replicated chromatin, but it has also been linked to replication-independent histone replacement. Here, we measured H3K56ac levels at single-nucleosome resolution in asynchronously growing yeast cultures, as well as in yeast proceeding synchronously through the cell cycle. We developed a quantitative model of H3K56ac kinetics, which shows that H3K56ac is largely explained by the genomic replication timing and the turnover rate of each nucleosome, suggesting that cell cycle profiles of H3K56ac should reveal most first-time nucleosome incorporation events. However, since the deacetylases Hst3/4 prevent use of H3K56ac as a marker for histone deposition during M phase, we also directly measured M phase histone replacement rates. We report a global decrease in turnover rates during M phase and a further specific decrease in turnover at several early origins of replication, which switch from rapidly replaced in G1 phase to stably bound during M phase. Finally, by measuring H3 replacement in yeast deleted for the H3K56 acetyltransferase Rtt109 and its two co-chaperones Asf1 and Vps75, we find evidence that Rtt109 and Asf1 preferentially enhance histone replacement at rapidly replaced nucleosomes, whereas Vps75 appears to inhibit histone turnover at those loci. These results provide a broad perspective on histone replacement/incorporation throughout the cell cycle and suggest that H3K56 acetylation provides a positive-feedback loop by which replacement of a nucleosome enhances subsequent replacement at the same location.

A randomized trial of nicotine-replacement therapy patches in pregnancy.

PubMed

Coleman, Tim; Cooper, Sue; Thornton, James G; Grainge, Matthew J; Watts, Kim; Britton, John; Lewis, Sarah

2012-03-01

Nicotine-replacement therapy is effective for smoking cessation outside pregnancy and its use is widely recommended during pregnancy. We investigated the efficacy and safety of nicotine patches during pregnancy. We recruited participants from seven hospitals in England who were 16 to 50 years of age with pregnancies of 12 to 24 weeks' gestation and who smoked five or more cigarettes per day. Participants received behavioral cessation support and were randomly assigned to 8 weeks of treatment with active nicotine patches (15 mg per 16 hours) or matched placebo patches. The primary outcome was abstinence from the date of smoking cessation until delivery, as validated by measurement of exhaled carbon monoxide or salivary cotinine. Safety was assessed by monitoring for adverse pregnancy and birth outcomes. Of 1050 participants, 521 were randomly assigned to nicotine-replacement therapy and 529 to placebo. There was no significant difference in the rate of abstinence from the quit date until delivery between the nicotine-replacement and placebo groups (9.4% and 7.6%, respectively; unadjusted odds ratio with nicotine-replacement therapy, 1.26; 95% confidence interval, 0.82 to 1.96), although the rate was higher at 1 month in the nicotine-replacement group than in the placebo group (21.3% vs. 11.7%). Compliance was low; only 7.2% of women assigned to nicotine-replacement therapy and 2.8% assigned to placebo used patches for more than 1 month. Rates of adverse pregnancy and birth outcomes were similar in the two groups. Adding a nicotine patch (15 mg per 16 hours) to behavioral cessation support for women who smoked during pregnancy did not significantly increase the rate of abstinence from smoking until delivery or the risk of adverse pregnancy or birth outcomes. However, low compliance rates substantially limited the assessment of safety. (Funded by the National Institute for Health Research Health Technology Assessment Programme; Current Controlled Trials number, ISRCTN07249128.).

Calculating evidence-based renal replacement therapy - Introducing an excel-based calculator to improve prescribing and delivery in renal replacement therapy - A before and after study.

PubMed

Cottle, Daniel; Mousdale, Stephen; Waqar-Uddin, Haroon; Tully, Redmond; Taylor, Benjamin

2016-02-01

Transferring the theoretical aspect of continuous renal replacement therapy to the bedside and delivering a given "dose" can be difficult. In research, the "dose" of renal replacement therapy is given as effluent flow rate in ml kg -1  h -1 . Unfortunately, most machines require other information when they are initiating therapy, including blood flow rate, pre-blood pump flow rate, dialysate flow rate, etc. This can lead to confusion, resulting in patients receiving inappropriate doses of renal replacement therapy. Our aim was to design an excel calculator which would personalise patient's treatment, deliver an effective, evidence-based dose of renal replacement therapy without large variations in practice and prolong filter life. Our calculator prescribes a haemodialfiltration dose of 25 ml kg -1  h -1 whilst limiting the filtration fraction to 15%. We compared the episodes of renal replacement therapy received by a historical group of patients, by retrieving their data stored on the haemofiltration machines, to a group where the calculator was used. In the second group, the data were gathered prospectively. The median delivered dose reduced from 41.0 ml kg -1  h -1 to 26.8 ml kg -1  h -1 with reduced variability that was significantly closer to the aim of 25 ml kg -1 .h -1 ( p  < 0.0001). The median treatment time increased from 8.5 h to 22.2 h ( p  = 0.00001). Our calculator significantly reduces variation in prescriptions of continuous veno-venous haemodiafiltration and provides an evidence-based dose. It is easy to use and provides personal care for patients whilst optimizing continuous veno-venous haemodiafiltration delivery and treatment times.

Projecting the need for hip replacement over the next three decades: influence of changing demography and threshold for surgery

PubMed Central

Birrell, F.; Johnell, O.; Silman, A.

1999-01-01

OBJECTIVES—To estimate the requirement for total hip replacement in the United Kingdom over the next three decades
METHODS—Projection of age and sex specific hip replacements in the UK over 10 year intervals taking account of demographic change and the extrapolation of arthroplasty rates from Sweden; a country with recently introduced guidelines.
RESULTS—Assuming no change in the age and sex specific arthroplasty rates, the estimated number of hip replacements will increase by 40% over the next 30 year period because of demographic change alone. The proportionate change will be substantially higher in men (51%) than women (33%), with a doubling of the number of male hip replacements in those aged over 85. Changes in the threshold for surgery may increase this further—up to double the current number.
CONCLUSION—A sharp rise in hip replacements will be needed to satisfy needs in the UK population over the next 30 years.

 PMID:10460191

[Meta-analysis of internal fixation versus hip replacement in the treatment of trochanteric fractures].

PubMed

Dong, Jian-Bin; Wang, Zhi-Yong; Lu, Hao; Tian, Yuan; Wang, Xin-Rui; Zhang, Zhi-Qiang

2015-03-01

To compare the efficacy of internal fixation (including PFNA and PFN) versus hip replacement (including FHR or THA) in the treatment of trochanteric fractures in adults. Reports of studies using randomized controlled trials (RCT) to compare internal fixationg with hip replacement in the management of intertrochanteric fractures were retrieved (up to January 1, 2013) from the Cochrane Library, PUBMED Data, CNKI (China National Knowledge infrastructure), Elsevier, the Chinese Biomedical Database, Wanfang Data, and manually. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software RevMan 5.0 was used for data-analysis. Seven articles were included in the meta-analysis. The results showed that,compared internal fixation with hip replacement,there were statistical significance in the duration of surgery time [WMD = -2.66, 95% CI (-5.25,-0.06), P = 0.05], intra-operative blood loss [WMD = -24.20, 95% CI (-30.38, -18.02), P < 0.000 01], hospital stays time [WMD = -4.72, 95% CI (-5.18, -4.25), P < 0.000 01], bearing load time [WMD = -29.54, 95% CI (-30.77, -28.31), P < 0.000 01], total complications rate [WMD = 0.15, 95% CI (0.11, 0.22), P < 0.000 01], the good rate of Harris scores [WMD = 1.09, 95% CI (0.54,1.32), P < 0.05]. However, there were no statistical significance in the rate of deep venous thrombosis [WMD = 1.09, 95% CI (0.47, 2.55), P > 0.05]. CON- CLUSION: Hip replacement (containing FHR or THA) for the treatment of intertrochanteric fractures is superior to internal fixa- tion in regards to the duration of surgery time, the mean duration of hosipital stays, mean post-operative down time, intra-opera- tive blood loss, the rate of post-operative good Harris scores. But there is not enough evidence to show any difference between hip replacement (containing THA or FHR) and internal fixation in regards to the rate of deep venous thrombosis. However, internal fixation for the treatment of intertrochanteric fractures is superior to hip replacement (containing FHR or THA) in regards to total complications rate.

Script Reforms--Are They Necessary?

ERIC Educational Resources Information Center

James, Gregory

Script reform, the modification of an existing writing system, is often confused with script replacement of one writing system with another. Turkish underwent the replacement of Arabic script by an adaptation of Roman script under Kamel Ataturk, but a similar replacement in Persian was rejected because of the high rate of existing literacy in…

The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study.

PubMed

Bayliss, Lee E; Culliford, David; Monk, A Paul; Glyn-Jones, Sion; Prieto-Alhambra, Daniel; Judge, Andrew; Cooper, Cyrus; Carr, Andrew J; Arden, Nigel K; Beard, David J; Price, Andrew J

2017-04-08

Total joint replacements for end-stage osteoarthritis of the hip and knee are cost-effective and demonstrate significant clinical improvement. However, robust population based lifetime-risk data for implant revision are not available to aid patient decision making, which is a particular problem in young patient groups deciding on best-timing for surgery. We did implant survival analysis on all patients within the Clinical Practice Research Datalink who had undergone total hip replacement or total knee replacement. These data were adjusted for all-cause mortality with data from the Office for National Statistics and used to generate lifetime risks of revision surgery based on increasing age at the time of primary surgery. We identified 63 158 patients who had undergone total hip replacement and 54 276 who had total knee replacement between Jan 1, 1991, and Aug 10, 2011, and followed up these patients to a maximum of 20 years. For total hip replacement, 10-year implant survival rate was 95·6% (95% CI 95·3-95·9) and 20-year rate was 85·0% (83·2-86·6). For total knee replacement, 10-year implant survival rate was 96·1% (95·8-96·4), and 20-year implant survival rate was 89·7% (87·5-91·5). The lifetime risk of requiring revision surgery in patients who had total hip replacement or total knee replacement over the age of 70 years was about 5% with no difference between sexes. For those who had surgery younger than 70 years, however, the lifetime risk of revision increased for younger patients, up to 35% (95% CI 30·9-39·1) for men in their early 50s, with large differences seen between male and female patients (15% lower for women in same age group). The median time to revision for patients who had surgery younger than age 60 was 4·4 years. Our study used novel methodology to investigate and offer new insight into the importance of young age and risk of revision after total hip or knee replacement. Our evidence challenges the increasing trend for more total hip replacements and total knee replacements to be done in the younger patient group, and these data should be offered to patients as part of the shared decision making process. Oxford Musculoskeletal Biomedical Research Unit, National Institute for Health Research. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

High renesting rates in arctic-breeding Dunlin (Calidris alpina): A clutch-removal experiment

USGS Publications Warehouse

Gates, H. River; Lanctot, Richard B.; Powell, Abby N.

2013-01-01

The propensity to replace a clutch is a complex component of avian reproduction and poorly understood. We experimentally removed clutches from an Arctic-breeding shorebird, the Dunlin (Calidris alpina arcticola), during early and late stages of incubation to investigate replacement clutch rates, renesting interval, and mate and site fidelity between nesting attempts. In contrast to other Arctic studies, we documented renesting by radiotracking individuals to find replacement clutches. We also examined clutch size and mean egg volume to document changes in individual females’ investment in initial and replacement clutches. Finally, we examined the influence of adult body mass, clutch volume, dates of clutch initiation and nest loss, and year on the propensity to renest. We found high (82–95%) and moderate (35–50%) rates of renesting for early and late incubation treatments. Renesting intervals averaged 4.7–6.8 days and were not different for clutches removed early or late in incubation. Most pairs remained together for renesting attempts. Larger females were more likely to replace a clutch; female body mass was the most important parameter predicting propensity to renest. Clutches lost later in the season were less likely to be replaced. We present evidence that renesting is more common in Arctic-breeding shorebirds than was previously thought, and suggest that renesting is constrained by energetic and temporal factors as well as mate availability. Obtaining rates of renesting in species breeding at different latitudes will help determine when this behavior is likely to occur; such information is necessary for demographic models that include individual and population-level fecundity estimates.

Influence of white plastic and water replacement rates on pomegranate orchard phenology, fruit yield and quality

USDA-ARS?s Scientific Manuscript database

Currently, 98% of domestic commercial pomegranate fruit (Punica granatum L.) are produced in California on over 13,000 ha. In 2013, a pomegranate orchard, established in 2010 with a density of 558 trees/ha, was irrigated at water replacement rates of 35, 50 and 100% based on rainfall, tree water r...

Long-Term Mortality Effect of Early Pacemaker Implantation After Surgical Aortic Valve Replacement.

PubMed

Greason, Kevin L; Lahr, Brian D; Stulak, John M; Cha, Yong-Mei; Rea, Robert F; Schaff, Hartzell V; Dearani, Joseph A

2017-10-01

The need for pacemaker implantation is a well-described complication of aortic valve replacement. Not so well described is the effect such an event has on long-term outcome. This study reviewed a 21-year experience at the Mayo Clinic (Rochester, Minnesota) with aortic valve replacement to understand the influence of early postoperative pacemaker implantation on long-term mortality rates more clearly. This study retrospectively reviewed the records of 5,842 patients without previous pacemaker implantation who underwent surgical aortic valve replacement from January 1993 through June 2014. The median age of these patients was 73 years (range, 65 to 79 years), the median ejection fraction was 62% (range, 53% to 68%), 3,853 patients were male (66%), and coronary artery bypass graft operation was performed in 2,553 (44%) of the patients studied. Early pacemaker implantation occurred in 146 patients (2.5%) within 30 days of surgical aortic valve replacement. The median follow-up of patients was 11.1 years (range, 5.8 to 16.5 years), and all-cause mortality rates were 2.4% at 30 days, 6.4% at 1 year, 23.1% at 5 years, 48.3% at 10 years, and 67.9% at 15 years postoperatively. Early pacemaker implantation was associated with an increased risk of death after multivariable adjustment for baseline patients' characteristics (hazard ratio, 1.49; 95% confidence interval, 1.20, 1.84; p < 0.001). Early pacemaker implantation as a complication of surgical aortic valve replacement is associated with an increased risk of long-term death. Valve replacement-related pacemaker implantation rates should be important considerations with respect to new valve replacement paradigms, especially in younger and lower-risk patients. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Mortality rates at 10 years after metal-on-metal hip resurfacing compared with total hip replacement in England: retrospective cohort analysis of hospital episode statistics

PubMed Central

Kendal, Adrian R; Prieto-Alhambra, Daniel; Arden, Nigel K; Judge, Andrew

2013-01-01

Objectives To compare 10 year mortality rates among patients undergoing metal-on-metal hip resurfacing and total hip replacement in England. Design Retrospective cohort study. Setting English hospital episode statistics database linked to mortality records from the Office for National Statistics. Population All adults who underwent primary elective hip replacement for osteoarthritis from April 1999 to March 2012. The exposure of interest was prosthesis type: cemented total hip replacement, uncemented total hip replacement, and metal-on-metal hip resurfacing. Confounding variables included age, sex, Charlson comorbidity index, rurality, area deprivation, surgical volume, and year of operation. Main outcome measures All cause mortality. Propensity score matching was used to minimise confounding by indication. Kaplan-Meier plots estimated the probability of survival up to 10 years after surgery. Multilevel Cox regression modelling, stratified on matched sets, described the association between prosthesis type and time to death, accounting for variation across hospital trusts. Results 7437 patients undergoing metal-on-metal hip resurfacing were matched to 22 311 undergoing cemented total hip replacement; 8101 patients undergoing metal-on-metal hip resurfacing were matched to 24 303 undergoing uncemented total hip replacement. 10 year rates of cumulative mortality were 271 (3.6%) for metal-on-metal hip resurfacing versus 1363 (6.1%) for cemented total hip replacement, and 239 (3.0%) for metal-on-metal hip resurfacing versus 999 (4.1%) for uncemented total hip replacement. Patients undergoing metal-on-metal hip resurfacing had an increased survival probability (hazard ratio 0.51 (95% confidence interval 0.45 to 0.59) for cemented hip replacement; 0.55 (0.47 to 0.65) for uncemented hip replacement). There was no evidence for an interaction with age or sex. Conclusions Patients with hip osteoarthritis undergoing metal-on-metal hip resurfacing have reduced mortality in the long term compared with those undergoing cemented or uncemented total hip replacement. This difference persisted after extensive adjustment for confounding factors available in our data. The study results can be applied to matched populations, which exclude patients who are very old and have had complex total hip replacements. Although residual confounding is possible, the observed effect size is large. These findings require validation in external cohorts and randomised clinical trials. PMID:24284336

Distinct developmental genetic mechanisms underlie convergently evolved tooth gain in sticklebacks

PubMed Central

Ellis, Nicholas A.; Glazer, Andrew M.; Donde, Nikunj N.; Cleves, Phillip A.; Agoglia, Rachel M.; Miller, Craig T.

2015-01-01

Teeth are a classic model system of organogenesis, as repeated and reciprocal epithelial and mesenchymal interactions pattern placode formation and outgrowth. Less is known about the developmental and genetic bases of tooth formation and replacement in polyphyodonts, which are vertebrates with continual tooth replacement. Here, we leverage natural variation in the threespine stickleback fish Gasterosteus aculeatus to investigate the genetic basis of tooth development and replacement. We find that two derived freshwater stickleback populations have both convergently evolved more ventral pharyngeal teeth through heritable genetic changes. In both populations, evolved tooth gain manifests late in development. Using pulse-chase vital dye labeling to mark newly forming teeth in adult fish, we find that both high-toothed freshwater populations have accelerated tooth replacement rates relative to low-toothed ancestral marine fish. Despite the similar evolved phenotype of more teeth and an accelerated adult replacement rate, the timing of tooth number divergence and the spatial patterns of newly formed adult teeth are different in the two populations, suggesting distinct developmental mechanisms. Using genome-wide linkage mapping in marine-freshwater F2 genetic crosses, we find that the genetic basis of evolved tooth gain in the two freshwater populations is largely distinct. Together, our results support a model whereby increased tooth number and an accelerated tooth replacement rate have evolved convergently in two independently derived freshwater stickleback populations using largely distinct developmental and genetic mechanisms. PMID:26062935

Randomized comparative trial of nicotine polacrilex, a transdermal patch, nasal spray, and an inhaler.

PubMed

Hajek, P; West, R; Foulds, J; Nilsson, F; Burrows, S; Meadow, A

1999-09-27

There are several nicotine replacement products on the market, and physicians are likely to be asked with increasing frequency about which of these products their patients should use. To provide a basis for rational advice by comparing nicotine polacrilex (gum), a transdermal patch, nasal spray, and an inhaler. Randomized trial with assessments at the quit date and 1, 4, and 12 weeks later. Hospital smokers' clinic. Male and female community volunteers (N = 504) smoking 10 or more cigarettes per day and seeking help to stop smoking. Patients were given brief advice, and purchased their nicotine replacement treatment at approximately half the regular retail price. Nicotine replacement treatment use, ratings of withdrawal symptoms, ratings of product characteristics and helpfulness, and biochemically validated continuous lapse-free abstinence. The products did not differ in their effects on withdrawal discomfort, urges to smoke, or rates of abstinence. The continuous validated 12-week abstinence rates were 20%, 21%, 24%, and 24% in the gum, patch, spray, and inhaler groups, respectively. Compliance with recommended nicotine replacement treatment use was high for the patch, low for gum, and very low for the spray and the inhaler. The spray was underused because of adverse effects more often than the other products. In the subjects using the spray, the level of use among abstainers at week 1 predicted outcome at week 12. The inhaler was rated as more embarrassing to use than the other products, but provided at least as much nicotine as the gum. When asked about nicotine replacement treatment products available, physicians should note that, despite low compliance with the recommended dose of the spray and inhaler and differences in product ratings, overall, there are no notable differences between the products in their effects on withdrawal discomfort, perceived helpfulness, or general efficacy.

Analyzing Systems Integration Best Practices and Assessment in DoD Space Systems Acquisition

DTIC Science & Technology

2009-12-01

satellite  Insufficient stress relief and insulation caused abrasion of wiring harness. C Product–Product: stress relief and insulation – wiring...delaminated during firing . This problem escaped qualification since slow heating rates (0.1–deg F/sec) used in the lab test provided time for the gas...to escape. Faster rates would have revealed the issue. E Product–Process: material – replace, firing ; rate – test B Process–Process: replace

The economics of using prophylactic antibiotic-loaded bone cement in total knee replacement.

PubMed

Gutowski, C J; Zmistowski, B M; Clyde, C T; Parvizi, J

2014-01-01

The rate of peri-prosthetic infection following total joint replacement continues to rise, and attempts to curb this trend have included the use of antibiotic-loaded bone cement at the time of primary surgery. We have investigated the clinical- and cost-effectiveness of the use of antibiotic-loaded cement for primary total knee replacement (TKR) by comparing the rate of infection in 3048 TKRs performed without loaded cement over a three-year period versus the incidence of infection after 4830 TKRs performed with tobramycin-loaded cement over a later period of time of a similar duration. In order to adjust for confounding factors, the rate of infection in 3347 and 4702 uncemented total hip replacements (THR) performed during the same time periods, respectively, was also examined. There were no significant differences in the characteristics of the patients in the different cohorts. The absolute rate of infection increased when antibiotic-loaded cement was used in TKR. However, this rate of increase was less than the rate of increase in infection following uncemented THR during the same period. If the rise in the rate of infection observed in THR were extrapolated to the TKR cohort, 18 additional cases of infection would have been expected to occur in the cohort receiving antibiotic-loaded cement, compared with the number observed. Depending on the type of antibiotic-loaded cement that is used, its cost in all primary TKRs ranges between USD $2112.72 and USD $112 606.67 per case of infection that is prevented.

Sensory evaluation ratings and melting characteristics show that okra gum is an acceptable milk-fat ingredient substitute in chocolate frozen dairy dessert.

PubMed

Romanchik-Cerpovicz, Joelle E; Costantino, Amanda C; Gunn, Laura H

2006-04-01

Reducing dietary fat intake may lower the risk of developing coronary heart disease. This study examined the feasibility of substituting okra gum for 25%, 50%, 75%, or 100% milk fat in frozen chocolate dairy dessert. Fifty-six consumers evaluated the frozen dairy desserts using a hedonic scale. Consumers rated color, smell, texture, flavor, aftertaste, and overall acceptability characteristics of all products as acceptable. All ratings were similar among the products except for the aftertaste rating, which was significantly lower for chocolate frozen dairy dessert containing 100% milk-fat replacement with okra gum compared with the control (0% milk-fat replacement) (P<0.05). Whereas melting points of all products were similar, melting rates slowed significantly as milk-fat replacement with okra gum increased, suggesting that okra gum may increase the stability of frozen dairy desserts (P<0.05). Overall, this study shows that okra gum is an acceptable milk-fat ingredient substitute in chocolate frozen dairy dessert.

Hip and knee replacement in Germany and the USA: analysis of individual inpatient data from German and US hospitals for the years 2005 to 2011.

PubMed

Wengler, Annelene; Nimptsch, Ulrike; Mansky, Thomas

2014-06-09

The number of hip and knee replacement operations is rising in many industrialized countries. To evaluate the current situation in Germany, we analyzed the frequency of procedures in Germany compared to the USA, with the aid of similar case definitions and taking demographic differences into account. We used individual inpatient data from Germany (DRG statistics) and the USA (Nationwide Inpatient Sample) to study differences in the age- and sex-adjusted rates of hip and knee replacement surgery and the determinants of trends in case numbers over the years 2005 to 2011. In 2011, hip replacement surgery was performed 1.4 times as frequently in Germany as in the USA (284 vs. 204 cases per 100 000 population per year; the American figures have been adjusted to the age and sex structure of the German population). On the other hand, knee replacement surgery was performed 1.5 times as frequently in the USA as in Germany (304 [standardized] vs. 206 cases per 100,000 population per year). Over the period of observation, the rates of both procedures increased in both countries. The number of elective primary hip replacement operations in Germany grew by 11%, from 140,000 to 155 300 (from 170 to 190 per 100,000 persons); after correction for demographic changes, a 3% increase remained. At the same time, the rate of elective primary hip replacement surgery in the USA rose by 28%, from 79 to 96 per 100 000 population, with a 13% increase remaining after correction for demographic changes. There are major differences between Germany and the USA in the frequency of these operations. The observed upward trend in elective primary hip replacement operations was mostly due to demographic changes in Germany; non-demographic factors exerted a stronger influence in the USA than in Germany. With respect to primary knee replacement surgery, non-demographic factors exerted a comparably strong influence in both countries.

Faster Blood Flow Rate Does Not Improve Circuit Life in Continuous Renal Replacement Therapy: A Randomized Controlled Trial.

PubMed

Fealy, Nigel; Aitken, Leanne; du Toit, Eugene; Lo, Serigne; Baldwin, Ian

2017-10-01

To determine whether blood flow rate influences circuit life in continuous renal replacement therapy. Prospective randomized controlled trial. Single center tertiary level ICU. Critically ill adults requiring continuous renal replacement therapy. Patients were randomized to receive one of two blood flow rates: 150 or 250 mL/min. The primary outcome was circuit life measured in hours. Circuit and patient data were collected until each circuit clotted or was ceased electively for nonclotting reasons. Data for clotted circuits are presented as median (interquartile range) and compared using the Mann-Whitney U test. Survival probability for clotted circuits was compared using log-rank test. Circuit clotting data were analyzed for repeated events using hazards ratio. One hundred patients were randomized with 96 completing the study (150 mL/min, n = 49; 250 mL/min, n = 47) using 462 circuits (245 run at 150 mL/min and 217 run at 250 mL/min). Median circuit life for first circuit (clotted) was similar for both groups (150 mL/min: 9.1 hr [5.5-26 hr] vs 10 hr [4.2-17 hr]; p = 0.37). Continuous renal replacement therapy using blood flow rate set at 250 mL/min was not more likely to cause clotting compared with 150 mL/min (hazards ratio, 1.00 [0.60-1.69]; p = 0.68). Gender, body mass index, weight, vascular access type, length, site, and mode of continuous renal replacement therapy or international normalized ratio had no effect on clotting risk. Continuous renal replacement therapy without anticoagulation was more likely to cause clotting compared with use of heparin strategies (hazards ratio, 1.62; p = 0.003). Longer activated partial thromboplastin time (hazards ratio, 0.98; p = 0.002) and decreased platelet count (hazards ratio, 1.19; p = 0.03) were associated with a reduced likelihood of circuit clotting. There was no difference in circuit life whether using blood flow rates of 250 or 150 mL/min during continuous renal replacement therapy.

Description of the rates, trends and surgical burden associated with revision for prosthetic joint infection following primary and revision knee replacements in England and Wales: an analysis of the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man.

PubMed

Lenguerrand, Erik; Whitehouse, Michael R; Beswick, Andrew D; Toms, Andrew D; Porter, Martyn L; Blom, Ashley W

2017-07-10

To describe the prevalence rates of revision surgery for the treatment of prosthetic joint infection (PJI) for patients undergoing knee replacement, their time trends, the cumulative incidence function of revision for PJI and estimate the burden of PJI at health service level. We analysed revision knee replacements performed due to a diagnosis of PJI and the linked index procedures recorded in the National Joint Registry from 2003 to 2014 for England and Wales. The cohort analysed consisted of 679 010 index primary knee replacements, 33 920 index revision knee replacements and 8247 revision total knee replacements performed due to a diagnosis of PJI. The prevalence rates, their time trends investigated by time from index surgery to revision for PJI, cumulative incidence functions and the burden of PJI (total procedures) were calculated. Overall linear trends were investigated with log-linear regression. The incidence of revision total knee replacement due to PJI at 2 years was 3.2/1000 following primary and 14.4/1000 following revision knee replacement, respectively. The prevalence of revision due to PJI in the 3 months following primary knee replacement has risen by 2.5-fold (95% CI 1.2 to 5.3) from 2005 to 2013 and 7.5-fold (95% CI 1.0 to 56.1) following revision knee replacement. Over 1000 procedures per year are performed as a consequence of knee PJI, an increase of 2.8 from 2005 to 2013. Overall, 75% of revisions were two-stage with an increase in use of single-stage from 7.9% in 2005 to 18.8% in 2014. Although the risk of revision due to PJI following knee replacement is low, it is rising, and coupled with the established and further predicted increased incidence of both primary and revision knee replacements, this represents an increasing and substantial treatment burden for orthopaedic service delivery in England and Wales. This has implications for future service design and the funding of individual and specialist centres. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Description of the rates, trends and surgical burden associated with revision for prosthetic joint infection following primary and revision knee replacements in England and Wales: an analysis of the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man

PubMed Central

Lenguerrand, Erik; Whitehouse, Michael R; Beswick, Andrew D; Toms, Andrew D; Porter, Martyn L; Blom, Ashley W

2017-01-01

Objectives To describe the prevalence rates of revision surgery for the treatment of prosthetic joint infection (PJI) for patients undergoing knee replacement, their time trends, the cumulative incidence function of revision for PJI and estimate the burden of PJI at health service level. Design We analysed revision knee replacements performed due to a diagnosis of PJI and the linked index procedures recorded in the National Joint Registry from 2003 to 2014 for England and Wales. The cohort analysed consisted of 679 010 index primary knee replacements, 33 920 index revision knee replacements and 8247 revision total knee replacements performed due to a diagnosis of PJI. The prevalence rates, their time trends investigated by time from index surgery to revision for PJI, cumulative incidence functions and the burden of PJI (total procedures) were calculated. Overall linear trends were investigated with log-linear regression. Results The incidence of revision total knee replacement due to PJI at 2 years was 3.2/1000 following primary and 14.4/1000 following revision knee replacement, respectively. The prevalence of revision due to PJI in the 3 months following primary knee replacement has risen by 2.5-fold (95% CI 1.2 to 5.3) from 2005 to 2013 and 7.5-fold (95% CI 1.0 to 56.1) following revision knee replacement. Over 1000 procedures per year are performed as a consequence of knee PJI, an increase of 2.8 from 2005 to 2013. Overall, 75% of revisions were two-stage with an increase in use of single-stage from 7.9% in 2005 to 18.8% in 2014. Conclusions Although the risk of revision due to PJI following knee replacement is low, it is rising, and coupled with the established and further predicted increased incidence of both primary and revision knee replacements, this represents an increasing and substantial treatment burden for orthopaedic service delivery in England and Wales. This has implications for future service design and the funding of individual and specialist centres. PMID:28698316

Contemporary results of open aortic arch surgery.

PubMed

Thomas, Mathew; Li, Zhuo; Cook, David J; Greason, Kevin L; Sundt, Thoralf M

2012-10-01

The success of endovascular therapies for descending thoracic aortic disease has turned attention toward stent graft options for repair of aortic arch aneurysms. Defining the role of such techniques demands understanding of contemporary results of open surgery. The outcomes of open arch procedures performed on a single surgical service from July 1, 2001 to August 30, 2010, were examined as defined per The Society of Thoracic Surgeons national database. During the study period, 209 patients (median age, 65 years; range, 26-88) underwent arch operations, of which 159 were elective procedures. In 65 the entire arch was replaced, 22 of whom had portions of the descending thoracic aorta simultaneously replaced via bilateral thoracosternotomy. Antegrade cerebral perfusion was used in 78 patients and retrograde cerebral perfusion in 1. Operative mortality was 2.5% in elective circumstances and 10% in emergency cases (P = .04). The stroke rate was 5.0% when procedures were performed electively and 11.8% when on an emergency basis (P = .11). Procedure-specific mortality rates were 5.5% for elective and 10% for emergency procedures with total arch replacement, and 1.0% for elective and 10% for emergency procedures with hemiarch replacement. Stratified by extent, neurologic event rates were 5.5% for elective and 10% for emergency procedures with total arch and 4.8% for elective and 12.5% for emergency procedures with hemiarch replacement. Open aortic arch replacement can be performed with low operative mortality and stroke rates, especially in elective circumstances, by a team with particular focus on the procedure. The results of novel endovascular therapies should be benchmarked against contemporary open series performed in such a setting. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients.

PubMed

Leon, Martin B; Smith, Craig R; Mack, Michael J; Makkar, Raj R; Svensson, Lars G; Kodali, Susheel K; Thourani, Vinod H; Tuzcu, E Murat; Miller, D Craig; Herrmann, Howard C; Doshi, Darshan; Cohen, David J; Pichard, Augusto D; Kapadia, Samir; Dewey, Todd; Babaliaros, Vasilis; Szeto, Wilson Y; Williams, Mathew R; Kereiakes, Dean; Zajarias, Alan; Greason, Kevin L; Whisenant, Brian K; Hodson, Robert W; Moses, Jeffrey W; Trento, Alfredo; Brown, David L; Fearon, William F; Pibarot, Philippe; Hahn, Rebecca T; Jaber, Wael A; Anderson, William N; Alu, Maria C; Webb, John G

2016-04-28

Previous trials have shown that among high-risk patients with aortic stenosis, survival rates are similar with transcatheter aortic-valve replacement (TAVR) and surgical aortic-valve replacement. We evaluated the two procedures in a randomized trial involving intermediate-risk patients. We randomly assigned 2032 intermediate-risk patients with severe aortic stenosis, at 57 centers, to undergo either TAVR or surgical replacement. The primary end point was death from any cause or disabling stroke at 2 years. The primary hypothesis was that TAVR would not be inferior to surgical replacement. Before randomization, patients were entered into one of two cohorts on the basis of clinical and imaging findings; 76.3% of the patients were included in the transfemoral-access cohort and 23.7% in the transthoracic-access cohort. The rate of death from any cause or disabling stroke was similar in the TAVR group and the surgery group (P=0.001 for noninferiority). At 2 years, the Kaplan-Meier event rates were 19.3% in the TAVR group and 21.1% in the surgery group (hazard ratio in the TAVR group, 0.89; 95% confidence interval [CI], 0.73 to 1.09; P=0.25). In the transfemoral-access cohort, TAVR resulted in a lower rate of death or disabling stroke than surgery (hazard ratio, 0.79; 95% CI, 0.62 to 1.00; P=0.05), whereas in the transthoracic-access cohort, outcomes were similar in the two groups. TAVR resulted in larger aortic-valve areas than did surgery and also resulted in lower rates of acute kidney injury, severe bleeding, and new-onset atrial fibrillation; surgery resulted in fewer major vascular complications and less paravalvular aortic regurgitation. In intermediate-risk patients, TAVR was similar to surgical aortic-valve replacement with respect to the primary end point of death or disabling stroke. (Funded by Edwards Lifesciences; PARTNER 2 ClinicalTrials.gov number, NCT01314313.).

Medical Surveillance Monthly Report (MSMR). Volume 22, Number 5, May 2015

DTIC Science & Technology

2015-05-01

aTotal column equals one joint replacement per person per period. bAn individual could be counted once in each of the types of joint replacements. cRate...Percentages of joint replace- ment cases who remained in service or had left service, 2 years post-joint replacement, by gender , active component...Musculoskeletal-related disability in US Army personnel: prevalence, gender and military occupational specialties. J Occup Environ Med. 1997;39(1):68–78

Extent of tooth decay in the mouth and increased need for replacement of dental restorations: the New England Children's Amalgam Trial.

PubMed

Trachtenberg, Felicia; Maserejian, Nancy Nairi; Tavares, Mary; Soncini, Jennifer Ann; Hayes, Catherine

2008-01-01

The purpose of this study was to assess the relationship between baseline caries experience and the restoration replacement rate in children. The 5-year New England Children's Amalgam Trial recruited 534 6- to 10-year-old children with 2 or more carious posterior teeth. The association between decoy and longevity of restorations was assessed. Restorations with no follow-up (N = 391) were excluded from analysis. The average follow-up was 3.0 +/- 1.6 years in 489 children. Restorations with follow-up (N = 3,604) were placed in mouths with a median of 15 dfs/DFS and 8 dft/DFT. The need for replacement increased significantly (P < or = .001) with increasing numbers of dfs/DFS and dft/DFT. After 5 years of follow-up, at least 15% of restorations in a mouth with > or = 14 dfs/DFS needed replacement, compared to 9% for 2 to 5 dfs/DFS. Comparing dft/DFT after 5 years of follow-up, there was a 23% replacement rate for > or = 12 dft/DFT compared to 10% for 2 to 3 dft/DFT. Decoy in the mouth had a greater association with the need for replacement due to new caries compared to replacement due to recurrent caries. Children with more decoy at the time of restoration placement were at higher risk for replacement of restorations.

A2-3: Impact of Mild Chronic Kidney Disease Stage on Outcomes after Total Hip or Knee Arthroplasty

PubMed Central

Graham, Jove; Deegan, Brian; Bowen, Thomas; Richard, Raveesh; Perkins, Robert; Foltzer, Michael

2014-01-01

Background/Aims Dialysis and kidney transplantation adversely impact outcomes of total hip or knee arthroplasty (THA, TKA), but complication rates have not been reported for patients with less advanced stages of chronic kidney disease (CKD). Surgeons lack the data necessary to have informed discussions regarding anticipated outcomes of joint replacement for these patients. Methods We retrospectively reviewed electronic health records of 779 adults with stages 1, 2, and 3 CKD not requiring dialysis or transplantation who underwent THA or TKA from 2004–2011, to assess infection, revision, 90-day readmission and mortality rates. Patients with less than 12 months follow-up, open fracture, prior joint surgery, pregnancy, or acute kidney injury were excluded. Chi-square analysis and Cox survival analysis compared these outcomes between the stage 1–2 and stage 3 groups, stratified by joint replaced (THA vs TKA). All models adjusted for age, sex and BMI at surgery. Results No statistically different rates of revision or infection between Stage 3 vs. Stages 1–2 were seen, although there was a trend toward increased infections in Stage 3. THA patients with Stage 3 showed a significantly increased mortality rate compared to Stage 1–2 THA patients (HR 3.40, 95% CI = 1.25–9.23, P = 0.02). Conclusions CKD affects nearly 15% of the U.S. population many of whom undergo joint replacement. End stage kidney disease (patients post-transplant or on hemodialysis) has been consistently associated with increased rates of infection and revision in excess of our observed outcomes, but the overall rate of infection/revision in our study population was only slightly higher than reported rates in the general population (2–7% vs. 1–2%, respectively). CKD should not preclude joint replacement, but these data can help clinicians engage in meaningful informed discussions with patients with mild kidney disease regarding risks for infection, revision and death following joint replacement.

Sex inequality in kidney transplantation rates.

PubMed

Schaubel, D E; Stewart, D E; Morrison, H I; Zimmerman, D L; Cameron, J I; Jeffery, J J; Fenton, S S

Men in the United States undergoing renal replacement therapy are more likely than women to receive a kidney transplant. However, the ability to pay may, in part, be responsible for this finding. To compare adult male and female transplantation rates in a setting in which equal access to medical treatment is assumed. Using data from the Canadian Organ Replacement Register, the rate of first transplantations was computed for the 20, 131 men and the 13,458 women aged 20 years or older who initiated renal replacement therapy between January 1, 1981, and December 31, 1996. Poisson regression analysis was used to estimate the male-female transplantation rate ratio, adjusting for age, race, province, calendar period, underlying disease leading to renal failure, and dialytic modality. Actuarial survival methods were used to compare transplantation probability for covariable-matched cohorts of men and women. Men experienced 20% greater covariable-adjusted kidney transplantation rates relative to women (rate ratio, 1.20; 95% confidence interval, 1.13-1.27). The sex disparity was stronger for cadaveric transplants (rate ratio, 1.23) compared with those from living donors (rate ratio, 1.10). The 5-year probability of receiving a transplant was 47% for men and 39% for women within covariable-matched cohorts (P<.001). The sex disparity in transplantation rates increased with increasing age. The sex effect was weaker among whites and Oriental persons (Chinese, Japanese, Vietnamese, Cambodian, Laotian, Filipino, Malaysian, Indonesian, and Korean) and stronger among blacks, Asian Indians (Indian, Pakistani, and Sri Lankan), and North American Indians (aboriginal). Since survival probability and quality of life are superior for patients who undergo transplantation relative to those who undergo dialysis, an increased effort should be made to distribute kidneys available for transplantation more equitably by sex among patients undergoing renal replacement therapy.

Peach Bottom Atomic Power Station recirc pipe dose rates with zinc injection and condenser replacement

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

DiCello, D.C.; Odell, A.D.; Jackson, T.J.

1995-03-01

Peach Bottom Atomic Power Station (PBAPS) is located near the town of Delta, Pennsylvania, on the west bank of the Susquehanna River. It is situated approximately 20 miles south of Lancaster, Pennsylvania. The site contains two boiling water reactors of General Electric design and each rated at 3,293 megawatts thermal. The units are BWR 4s and went commercial in 1977. There is also a decommissioned high temperature gas-cooled reactor on site, Unit 1. PBAPS Unit 2 recirc pipe was replaced in 1985 and Unit 3 recirc pipes replaced in 1988 with 326 NGSS. The Unit 2 replacement pipe was electropolished,more » and the Unit 3 pipe was electropolished and passivated. The Unit 2 brass condenser was replaced with a Titanium condenser in the first quarter of 1991, and the Unit 3 condenser was replaced in the fourth quarter of 1991. The admiralty brass condensers were the source of natural zinc in both units. Zinc injection was initiated in Unit 2 in May 1991, and in Unit 3 in May 1992. Contact dose rate measurements were made in standard locations on the 28-inch recirc suction and discharge lines to determine the effectiveness of zinc injection and to monitor radiation build-up in the pipe. Additionally, HPGe gamma scans were performed to determine the isotopic composition of the oxide layer inside the pipe. In particular, the specific ({mu}Ci/cm{sup 2}) of Co-60 and Zn-65 were analyzed.« less

Seasonality of service provision in hip and knee surgery: a possible contributor to waiting times? A time series analysis.

PubMed

Upshur, Ross E G; Moineddin, Rahim; Crighton, Eric J; Mamdani, Muhammad

2006-03-01

The question of how best to reduce waiting times for health care, particularly surgical procedures such as hip and knee replacements is among the most pressing concern of the Canadian health care system. The objective of this study was to test the hypothesis that significant seasonal variation exists in the performance of hip and knee replacement surgery in the province of Ontario. We performed a retrospective, cross-sectional time series analysis examining all hip and knee replacement surgeries in people over the age of 65 in the province of Ontario, Canada between 1992 and 2002. The main outcome measure was monthly hospitalization rates per 100,000 population for all hip and knee replacements. There was a marked increase in the rate of hip and knee replacement surgery over the 10-year period as well as an increasing seasonal variation in surgeries. Highly significant (Fisher Kappa = 16.05, p < 0.01; Bartlett-Kolmogorov-Smirnov Test = 0.31, p < 0.01) and strong (R2Autoreg = 0.85) seasonality was identified in the data. Holidays and utilization caps appear to exert a significant influence on the rate of service provision. It is expected that waiting times for hip and knee replacement could be reduced by reducing seasonal fluctuations in service provision and benchmarking services to peak delivery. The results highlight the importance of system behaviour in seasonal fluctuation of service delivery.

Seasonality of service provision in hip and knee surgery: A possible contributor to waiting times? A time series analysis

PubMed Central

Upshur, Ross EG; Moineddin, Rahim; Crighton, Eric J; Mamdani, Muhammad

2006-01-01

Background The question of how best to reduce waiting times for health care, particularly surgical procedures such as hip and knee replacements is among the most pressing concern of the Canadian health care system. The objective of this study was to test the hypothesis that significant seasonal variation exists in the performance of hip and knee replacement surgery in the province of Ontario. Methods We performed a retrospective, cross-sectional time series analysis examining all hip and knee replacement surgeries in people over the age of 65 in the province of Ontario, Canada between 1992 and 2002. The main outcome measure was monthly hospitalization rates per 100 000 population for all hip and knee replacements. Results There was a marked increase in the rate of hip and knee replacement surgery over the 10-year period as well as an increasing seasonal variation in surgeries. Highly significant (Fisher Kappa = 16.05, p < 0.01; Bartlett-Kolmogorov-Smirnov Test = 0.31, p < 0.01) and strong (R2Autoreg = 0.85) seasonality was identified in the data. Conclusion Holidays and utilization caps appear to exert a significant influence on the rate of service provision. It is expected that waiting times for hip and knee replacement could be reduced by reducing seasonal fluctuations in service provision and benchmarking services to peak delivery. The results highlight the importance of system behaviour in seasonal fluctuation of service delivery. PMID:16509992

Quality and Safety in Health Care, Part XXX: Transcatheter Aortic Valve Therapy.

PubMed

Harolds, Jay A

2017-12-01

Initially, the transcatheter aortic valve replacement procedure was approved only for patients with aortic stenosis that was both severe and symptomatic who either also had too high a risk of aortic valve replacement surgery to have the surgery or who had a high risk for the surgery. Between the years 2012 and 2015, the death rate at 30 days declined from an initial rate of 7.5% to 4.6%. There has also been more use of the transfemoral approach over the years. In 2016, the transcatheter aortic valve replacement was approved for patients with aortic stenosis at intermediate risk of surgery.

Segmental Aortic Stiffness in Children and Young Adults With Connective Tissue Disorders: Relationships With Age, Aortic Size, Rate of Dilation, and Surgical Root Replacement.

PubMed

Prakash, Ashwin; Adlakha, Himanshu; Rabideau, Nicole; Hass, Cara J; Morris, Shaine A; Geva, Tal; Gauvreau, Kimberlee; Singh, Michael N; Lacro, Ronald V

2015-08-18

Aortic diameter is an imperfect predictor of aortic complications in connective tissue disorders (CTDs). Novel indicators of vascular phenotype severity such as aortic stiffness and vertebral tortuosity index have been proposed. We assessed the relation between aortic stiffness by cardiac MRI, surgical root replacement, and rates of aortic root dilation in children and young adults with CTDs. Retrospective analysis of cardiac MRI data on children and young adults with a CTD was performed to derive aortic stiffness measures (strain, distensibility, and β-stiffness index) at the aortic root, ascending aorta, and descending aorta. Vertebral tortuosity index was calculated as previously described. Rate of aortic root dilation before cardiac MRI was calculated as change in echocardiographic aortic root diameter z score per year. In 83 CTD patients (median age, 24 years; range, 1-55; 17% <18 years of age; 60% male), ascending aorta distensibility was reduced in comparison with published normative values: median z score, -1.93 (range, -8.7 to 1.3; P<0.0001 versus normals). Over a median follow-up period of 2.7 years, there were no aortic dissections or deaths, but 16 of 83 (19%) patients underwent surgical aortic root replacement. In multivariable analysis, lower aortic root strain (P=0.05) and higher vertebral tortuosity index (P=0.01) were independently associated with aortic root replacement. Lower ascending aorta strain (P=0.02) was associated with a higher rate of aortic root dilation. Higher aortic stiffness is associated with higher rates of surgical aortic replacement and aortic root dilation in children and young adults with CTDs. © 2015 American Heart Association, Inc.

Trends in Aortic Valve Replacement Procedures Between 2009 and 2015: Has Transcatheter Aortic Valve Replacement Made a Difference?

PubMed

Culler, Steven D; Cohen, David J; Brown, Phillip P; Kugelmass, Aaron D; Reynolds, Matthew R; Ambrose, Karen; Schlosser, Michael L; Simon, April W; Katz, Marc R

2018-04-01

This study reports trends in volume and adverse events associated with isolated aortic valve procedures performed in Medicare beneficiaries between 2009 and 2015. This retrospective study used the annual fiscal year Medicare Provider Analysis and Review file to identify all Medicare beneficiaries undergoing an isolated aortic valve procedure. Outcome measures included three mortality rates and nine in-hospital adverse events. The final study population consisted of 233,660 hospitalizations. During the study period, Medicare beneficiaries undergoing an aortic valve procedure increased from 22,076 to 49,362, for an average annual growth rate of 14.45%. Transcatheter aortic valve replacement (TAVR) procedures per 100,000 Medicare beneficiaries grew from 10.7 in 2012 to 41.1 in 2015. Overall, in-hospital mortality rates, cumulative 30-day mortality rates, and 90-day postdischarge mortality rates declined annually during the study period. However, the 90-day mortality rate for TAVR was nearly double the rate for the tissue surgical aortic valve replacement group. Nearly 68% of Medicare beneficiaries experienced at least one in-hospital adverse event during their index hospitalization. Medicare beneficiaries undergoing TAVR had the lowest observed adverse events rates among the aortic valve procedures in 2015. The total number of Medicare beneficiaries undergoing isolated aortic valve procedures increased from 47.5 to 88.9 per 100,000 Medicare beneficiaries during the study period. Aortic valve procedures increased significantly during this study period primarily due to the increase in TAVR, with clinical outcomes improving as well. Although long-term outcomes of TAVR are still under investigation, these results are promising. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Liquid and Solid Meal Replacement Products Differentially Affect Postprandial Appetite and Food Intake in Older Adults

PubMed Central

Stull, April J.; Apolzan, John W.; Thalacker-Mercer, Anna E.; Iglay, Heidi B.; Campbell, Wayne W.

2008-01-01

Liquid and solid foods are documented to elicit differential appetitive and food intake responses. This study was designed to assess the influences of liquid vs solid meal replacement products on postprandial appetite ratings and subsequent food intake in healthy older adults. This study used a randomized and crossover design with two 1-day trials (1 week between trials), and 24 adults (12 men and 12 women) aged 50 to 80 years with body mass index (calculated as kg/m2) between 22 and 30 participated. After an overnight fast, the subjects consumed meal replacement products as either a beverage (liquid) or a bar (solid). The meal replacement products provided 25% of each subject's daily estimated energy needs with comparable macro-nutrient compositions. Subjects rated their appetite on a 100 mm quasilogarithmic visual analog scale before and 15, 30, 45, 60, 90, 120, and 150 minutes after consuming the meal replacement product. At minute 120, each subject consumed cooked oatmeal ad libitum to a “comfortable level of fullness.” Postprandial composite (area under the curve from minute 15 to minute 120) hunger was higher (P=0.04) for the liquid vs solid meal replacement products and desire to eat (P=0.15), preoccupation with thoughts of food (P=0.07), and fullness (P=0.25) did not differ for the liquid vs solid meal replacement products. On average, the subjects consumed 13.4% more oatmeal after the liquid vs solid (P=0.006) meal replacement product. These results indicate that meal replacement products in liquid and solid form do not elicit comparable appetitive and ingestive behavior responses and that meal replacement products in liquid form blunt the postprandial decline in hunger and increase subsequent food intake in older adults. PMID:18589034

Kinetic-rheological insights uncovered by the self-accelerating brucite-for-periclase replacement - but only if adjusted on volume. The blind spot of geochemists

NASA Astrophysics Data System (ADS)

Merino, E.

2013-12-01

Geochemists of weathering, metamorphism, dolomitization, etc., have long adjusted mineral reactions conserving one or another component among the minerals, but paying no attention to whether the volumetric consequences of such adjustments are consistent with independent petrographic evidence. In fact the widespread occurrence of replacement in all types of water-rock interaction implies that the mineral reactions involved did conserve solid volume, not a component. The conflict has been hidden in a blind spot that geochemists appear to be unaware of having. Characteristically, replacement preserves both volume and morphological details of the host. It originates not by dissolution-precipitation, but by guest-growth-driven pressure solution of host by guest (Merino/Dewers 1998; Merino/Canals 2011) The replacement of periclase by brucite common in magnesian marbles is attributed (Turner 1965; Ferry 2000) to: MgO(per) + H2O = Mg(OH)2(bruc), (EQ 1), which conserves Mg between the two minerals. But with formula volumes of pericl & bruc ~11 & 25 cm3, this reaction cannot preserve mineral volume; it conflicts with excellent petrographic evidence that mineral volume was preserved. However, by adjusting the local mass balance on volume, as observed, 2.2MgO(per) + 2.4H+ = Mg(OH)2(bruc) + 1.2Mg++ + 0.2H2O (EQ 2), we gain striking dynamic/geochemical insights: (I) Seeing that Mg++ is locally released to the pore fluid, we suddenly grasp why the brucite is typically surrounded by a rim of dolomite replacing matrix calcite. As it is released, the Mg++ reacts with calcite and produces dolomite that replaces calcite, also isovolumetrically, as observed. (II) The second replacement (dolo-for-calc) was simultaneous and thus adjacent to the first, and must have happened at the same T,P, and at the same rate, as the first. (In the conventional view, the dolomite rim is attributed, ad hoc, to the reaction bruc + calc + CO2 = dolo + water, which necessarily happens later and at different T,P; which doesn't preserve volume; and which tells us nothing about rates.) (III) The Mg++ released by each increment of bruc-for-pericl replacement must increase the local ion-activity product for brucite growth from its ions, and thus the growth rate of the next increment of replacement, and so on: The bruc-for-pericl replacement is self-accelerating. This is why it always reaches completion - the brucite keeps replacing periclase faster and faster until all the periclase is gone. (Also self-accelerating are the dolo-for-calc replacement in dolomitization [Merino/Canals, 2011], and the serp-for-oliv replacement in serpentinization.) (IV) A dramatic feedback arises: As a self-accelerating replacement takes place in a non-newtonian rock of the strain-rate-softening kind (as crystalline carbonates and dunites are), it must reduce the local rock viscosity more and more, and, unless a needed reactant is used up first, the viscosity may become low enough for the growth of the guest mineral to gradually pass by itself from replacive to displacive (both régimes being driven by the guest-growth induced stress). This is how thin, displacive zebra veins form routinely in burial dolomitization (Merino/Canals 2006, 2011) and in serpentinization of dunite.

Regulation of intramembranous absorption and amniotic fluid volume by constituents in fetal sheep urine

PubMed Central

Jonker, Sonnet S.; Louey, Samantha; Cheung, Cecilia Y.; Brace, Robert A.

2013-01-01

Our objective was to test the hypothesis that fetal urine contains a substance(s) that regulates amniotic fluid volume by altering the rate of intramembranous absorption of amniotic fluid. In late gestation ovine fetuses, amniotic fluid volumes, urine, and lung liquid production rates, swallowed volumes and intramembranous volume and solute absorption rates were measured over 2-day periods under control conditions and when urine was removed and continuously replaced at an equal rate with exogenous fluid. Intramembranous volume absorption rate decreased by 40% when urine was replaced with lactated Ringer solution or lactated Ringer solution diluted 50% with water. Amniotic fluid volume doubled under both conditions. Analysis of the intramembranous sodium and chloride fluxes suggests that the active but not passive component of intramembranous volume absorption was altered by urine replacement, whereas both active and passive components of solute fluxes were altered. We conclude that fetal urine contains an unidentified substance(s) that stimulates active intramembranous transport of amniotic fluid across the amnion into the underlying fetal vasculature and thereby functions as a regulator of amniotic fluid volume. PMID:23824958

Conference considers low fertility.

PubMed

1997-01-01

At present, at least 51 countries--representing 44% of the world's population--are showing below-replacement fertility rates. In some of these countries, where the number of new births is not adequate to replace aging populations, this trend is problematic. In other countries, most notably China, declining fertility has conferred significant benefits. At an Economic and Social Commission for Asia and the Pacific (ESCAP) Population Commission meeting held in New York in 1997, staff from China's State Statistical Bureau reported the country has a current total fertility rate of 1.8. The birth rate remains high, however, because of the large numbers of Chinese women in the 15-49 year reproductive age group (336 million in 1997). Also buffering the impact of a low fertility rate is a large labor surplus (130 million excess workers in rural China). To keep fertility below the replacement level, China plans to improve the quality of its family planning service, enhance poverty alleviation programs, and increase incentives for small families in rural areas. China's low fertility rate has provided an important impetus for economic development.

A prospective randomised study comparing the jubilee dressing method to a standard adhesive dressing for total hip and knee replacements.

PubMed

Burke, Neil G; Green, Connor; McHugh, Gavin; McGolderick, Niall; Kilcoyne, Carol; Kenny, Patrick

2012-08-01

It is important to reduce potential wound complications in total hip and total knee arthroplasty procedures. The purpose of this study was to compare the jubilee dressing method to a standard adhesive dressing. 124 patients (62 total hip replacements and 62 total knee replacements) were randomly selected to have either a standard adhesive dressing or jubilee method dressing. The number of dressing changes, incidence of blistering, leakage, appearance of inflammation, infection rate and the average stay in hospital was recorded for each patient. The jubilee dressing significantly reduced the rate of blistering, leakage and number of dressing changes when compare to a traditional adhesive dressing (p < 0.05). The rate of inflammation and average length of stay in hospital was not significantly different between the two groups. The authors recommend the use of this dressing for total hip and total knee arthroplasty procedures due to the associated lower complication rate. Copyright © 2012 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

Frequency and impact of informant replacement in Alzheimer disease research.

PubMed

Grill, Joshua D; Zhou, Yan; Karlawish, Jason; Elashoff, David

2015-01-01

Informants serve an essential role in Alzheimer disease research. Were an informant to be replaced during a longitudinal study, this could have negative implications. We used data from the National Alzheimer's Coordinating Center Uniform Data Set to examine the frequency of informant replacement among Alzheimer disease dementia participants, whether patient and informant characteristics were associated with replacement, and how replacement affected research outcome measures. Informant replacement was common (15.5%) and typically occurred after the first or the second research visit. Adult child (24%) and other (38%) informants were more frequently replaced than spouse informants (10%). Older spouse informant age and younger adult child informant age were associated with replacement. The between-visit change in Functional Assessment Questionnaire scores was greater in patients who replaced informants than in those with stable informants. Clinical Dementia Rating-Sum of Boxes, Functional Assessment Questionnaire, and Neuropsychiatric Inventory scores showed greater variability in between-visit change in patients who replaced informants compared with those with stable informants. These findings suggest that informant replacement is relatively common, may have implications to study analyses, and warrant further examination in the setting of clinical trials.

Exponential approximation for daily average solar heating or photolysis. [of stratospheric ozone layer

NASA Technical Reports Server (NTRS)

Cogley, A. C.; Borucki, W. J.

1976-01-01

When incorporating formulations of instantaneous solar heating or photolytic rates as functions of altitude and sun angle into long range forecasting models, it may be desirable to replace the time integrals by daily average rates that are simple functions of latitude and season. This replacement is accomplished by approximating the integral over the solar day by a pure exponential. This gives a daily average rate as a multiplication factor times the instantaneous rate evaluated at an appropriate sun angle. The accuracy of the exponential approximation is investigated by a sample calculation using an instantaneous ozone heating formulation available in the literature.

Frequency of pacemaker malfunction associated with monopolar electrosurgery during pulse generator replacement or upgrade surgery.

PubMed

Lin, Yun; Melby, Daniel P; Krishnan, Balaji; Adabag, Selcuk; Tholakanahalli, Venkatakrishna; Li, Jian-Ming

2017-08-01

The aim of this study is to investigate the frequency of electrosurgery-related pacemaker malfunction. A retrospective study was conducted to investigate electrosurgery-related pacemaker malfunction in consecutive patients undergoing pulse generator (PG) replacement or upgrade from two large hospitals in Minneapolis, MN between January 2011 and January 2014. The occurrence of this pacemaker malfunction was then studied by using MAUDE database for all four major device vendors. A total of 1398 consecutive patients from 2 large tertiary referral centers in Minneapolis, MN undergoing PG replacement or upgrade surgery were retrospectively studied. Four patients (0.3% of all patients), all with pacemakers from St Jude Medical (2.8%, 4 of 142) had output failure or inappropriately low pacing rate below 30 bpm during electrosurgery, despite being programmed in an asynchronous mode. During the same period, 1174 cases of pacemaker malfunctions were reported on the same models in MAUDE database, 37 of which (3.2%) were electrosurgery-related. Twenty-four cases (65%) had output failure or inappropriate low pacing rate. The distribution of adverse events was loss of pacing (59.5%), reversion to backup pacing (32.4%), inappropriate low pacing rate (5.4%), and ventricular fibrillation (2.7%). The majority of these (78.5%) occurred during PG replacement at ERI or upgrade surgery. No electrosurgery-related malfunction was found in MAUDE database on 862 pacemaker malfunction cases during the same period from other vendors. Electrosurgery during PG replacement or upgrade surgery can trigger output failure or inappropriate low pacing rate in certain models of modern pacemakers. Cautions should be taken for pacemaker-dependent patients.

Survival of dental implants placed in sites of previously failed implants.

PubMed

Chrcanovic, Bruno R; Kisch, Jenö; Albrektsson, Tomas; Wennerberg, Ann

2017-11-01

To assess the survival of dental implants placed in sites of previously failed implants and to explore the possible factors that might affect the outcome of this reimplantation procedure. Patients that had failed dental implants, which were replaced with the same implant type at the same site, were included. Descriptive statistics were used to describe the patients and implants; survival analysis was also performed. The effect of systemic, environmental, and local factors on the survival of the reoperated implants was evaluated. 175 of 10,096 implants in 98 patients were replaced by another implant at the same location (159, 14, and 2 implants at second, third, and fourth surgeries, respectively). Newly replaced implants were generally of similar diameter but of shorter length compared to the previously placed fixtures. A statistically significant greater percentage of lost implants were placed in sites with low bone quantity. There was a statistically significant difference (P = 0.032) in the survival rates between implants that were inserted for the first time (94%) and implants that replaced the ones lost (73%). There was a statistically higher failure rate of the reoperated implants for patients taking antidepressants and antithrombotic agents. Dental implants replacing failed implants had lower survival rates than the rates reported for the previous attempts of implant placement. It is suggested that a site-specific negative effect may possibly be associated with this phenomenon, as well as the intake of antidepressants and antithrombotic agents. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Patient and implant survival following joint replacement because of metastatic bone disease

PubMed Central

2013-01-01

Background Patients suffering from a pathological fracture or painful bony lesion because of metastatic bone disease often benefit from a total joint replacement. However, these are large operations in patients who are often weak. We examined the patient survival and complication rates after total joint replacement as the treatment for bone metastasis or hematological diseases of the extremities. Patients and methods 130 patients (mean age 64 (30–85) years, 76 females) received 140 joint replacements due to skeletal metastases (n = 114) or hematological disease (n = 16) during the period 2003–2008. 21 replaced joints were located in the upper extremities and 119 in the lower extremities. Clinical and survival data were extracted from patient files and various registers. Results The probability of patient survival was 51% (95% CI: 42–59) after 6 months, 39% (CI: 31–48) after 12 months, and 29% (CI: 21–37) after 24 months. The following surgical complications were seen (8 of which led to additional surgery): 2–5 hip dislocations (n = 8), deep infection (n = 3), peroneal palsy (n = 2), a shoulder prosthesis penetrating the skin (n = 1), and disassembly of an elbow prosthesis (n = 1). The probability of avoiding all kinds of surgery related to the implanted prosthesis was 94% (CI: 89–99) after 1 year and 92% (CI: 85–98) after 2 years. Conclusion Joint replacement operations because of metastatic bone disease do not appear to have given a poorer rate of patient survival than other types of surgical treatment, and the reoperation rate was low. PMID:23530874

LED traffic signal replacement schedules : facilitating smooth freight flows.

DOT National Transportation Integrated Search

2011-11-01

This research details a field study of LED traffic signals in Missouri and develops a replacement schedule based on key findings. : Rates of degradation were statistically analyzed using Analysis of Variance (ANOVA). Results of this research will pro...

Survey of IUD replacing status in Sichuan, PR China.

PubMed

Xiaoqin, Chen; Li, Xie; Xiaoping, Pan; Chuanrong, Zhang; Shiyuan, Luo

2003-05-01

To investigate the status of copper-bearing intrauterine device (IUD) replacing inert IUD in Sichuan Province, cluster random sampling method was adopted for the survey. Questionnaires were completed and IUD were inspected through ultrasound among 12,804 subjects of 15 counties, who were inserted an IUD from 1994 to 1998. The insertion rate of copper-bearing IUD was 42.1%, in a gradually increasing trend; it was lower in mountain areas than in plain and hilly areas and increased after induced abortion and previous IUD failure. Some factors, such as lower pregnancy rate, lower expulsion rate and easy removal, etc., contributed to copper-bearing IUD use. On the other hand, other factors like longer contraception period, lower side effects and lower cost contributed to inert IUD use. The results show that the adoption of copper-bearing IUD is increasing, but those factors influencing copper-bearing IUD replacement should not be neglected.

Potential of Bacillus cereus strain RS87 for partial replacement of chemical fertilisers in the production of Thai rice cultivars.

PubMed

Jetiyanon, Kanchalee; Plianbangchang, Pinyupa

2012-03-30

There is increasing interest in the development of technologies which can reduce the requirement for chemical fertilisers in rice production. The objective of this study was to investigate the efficacy of Bacillus cereus strain RS87 for the partial replacement of chemical fertiliser in rice production. A greenhouse experiment was designed using different fertiliser regimes, with and without strain RS87. Six Thai rice cultivars were tested separately. Maximum rice growth and yield were obtained in rice receiving the full recommended fertiliser rate in combination with the strain RS87. Interestingly, all rice cultivars which were treated with strain RS87 and 50% recommended fertiliser rate provided equivalent plant growth and yield to that receiving the full recommended fertiliser rate only. A paired comparison between rice treated with 50% of the recommended fertiliser rate with the bacterial inoculant and the full fertiliser rate alone was further examined in small experimental rice paddy fields. Growth and yield of all rice cultivars which received the 50% fertiliser rate supplemented with strain RS87 gave a similar yield to that receiving the full fertiliser rate alone. Bacterial strain RS87 showed the potential to replace 50% of the recommended fertiliser rate for yield production. Integration of plant growth-promoting rhizobacterial inoculants with reduced application rates of chemical fertiliser appears promising for future agriculture. Copyright © 2012 Society of Chemical Industry.

Pain measurement and brain activity: will neuroimages replace pain ratings?

PubMed

Robinson, Michael E; Staud, Roland; Price, Donald D

2013-04-01

Arguments made for the advantages of replacing pain ratings with brain-imaging data include assumptions that pain ratings are less reliable and objective and that brain image data would greatly benefit the measurement of treatment efficacy. None of these assumptions are supported by available evidence. Self-report of pain is predictable and does not necessarily reflect unreliability or error. Because pain is defined as an experience, magnitudes of its dimensions can be estimated by well-established methods, including those used to validate brain imaging of pain. Brain imaging helps to study pain mechanisms and might be used as proxy measures of pain in persons unable to provide verbal reports. Yet eliminating pain ratings or replacing them with neuroimaging data is misguided because brain images only help explain pain if they are used in conjunction with self-report. There is no objective readout mechanism of pain (pain thermometer) that is unaffected by psychological factors. Benefits from including neuroimaging data might include increased understanding of underlying neural mechanisms of treatment efficacy, discovery of new treatment vectors, and support of conclusions derived from self-report. However, neither brain imaging nor self-report data are privileged over the other. The assumption that treatment efficacy is hampered by self-report has not been shown; there is a plethora of treatment studies showing that self-report is sensitive to treatment. Dismissal of patients' self-reports (pain ratings) by brain-imaging data is potentially harmful. The aim of replacing self-report with brain-imaging data is misguided and has no scientific or philosophical foundation. Although brain imaging may offer considerable insight into the neural mechanisms of pain, including relevant causes and correlations, brain images cannot and should not replace self-report. Only the latter assesses the experience of pain, which is not identical to neural activity. Brain imaging may help to explain pain, but replacing self-report with brain-imaging data would be philosophically and scientifically misguided and potentially harmful to pain patients. Copyright © 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.

Management of Microcircuit Obsolescence in a Pre-Production ACAT-ID Missile Program

DTIC Science & Technology

2002-12-01

and Engineering Center ASIC Application Specific Integrated Circuit AVCOM Avionics Component Obsolescence Management BRU Battery Replaceable Unit...then just a paper qualification, e.g. Board or Battery Replaceable Unit ( BRU ) testing. 5 After-market Package The Die is Available and Can Be...Encapsulated Microcircuits (PEM), speed change, failure rate) 8 Emulation Manufacture or re-engineering of a FFF Replacement 9 CCA or BRU Redesign Board

Methods for removing concrete decks from bridge girders : [tech transfer summary].

DOT National Transportation Integrated Search

2014-08-01

Although bridges are typically designed to last for 75 years (AWS 2012), : bridge decks deteriorate at a faster rate (Flowers et al. 2010). Full-depth : replacement of bridge decks that can be performed without replacing the : bridge superstructures ...

SU-D-209-01: Can Fluoroscopic Air-Kerma Rates Be Reliably Measured with Solid-State Meters?

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

Feng, C; Thai, L; Wagner, L

Purpose: Ionization chambers remain the standard for calibration of air-kerma rate measuring devices. Despite their strong energy-dependent response, solid state radiation detectors are increasingly used, primarily due to their efficiency in making standardized measurements. To test the reliability of these devices in measuring air-kerma rates, we compared ion chambers measurements with solid-state measurements for various mobile fluoroscopes operated at different beam qualities and air-kerma rates. Methods: Six mobile fluoroscopes (GE OEC models 9800 and 9900) were used to generate test beams. Using various field sizes and dose rate controls, copper attenuators and a lead attenuator were placed at the imagemore » receptor in varying combinations to generate a range of air-kerma rates. Air-kerma rates at 30 centimeters from the image receptors were measured using two 6-cm{sup 3} ion chambers with electrometers (Radcal, models 1015 and 9015) and two with solid state detectors (Unfors Xi and Raysafe X2). No error messages occurred during measurements. However, about two months later, one solid-state device stopped working and was replaced by the manufacturer. Two out of six mobile fluoroscopic units were retested with the replacement unit. Results: Generally, solid state and ionization chambers agreed favorably well, with two exceptions. Before replacement of the detector, the Xi meter when set in the “RF High” mode deviated from ion chamber readings by factors of 2 and 10 with no message indicating error in measurement. When set in the “RF Low” mode, readings were within −4% to +3%. The replacement Xi detector displayed messages alerting the user when settings were not compatible with air-kerma rates. Conclusion: Air-kerma rates can be measured favorably well using solid-state devices, but users must be aware of the possibility that readings can be grossly in error with no discernible indication for the deviation.« less

1992 five year battery forecast

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

Amistadi, D.

1992-12-01

Five-year trends for automotive and industrial batteries are projected. Topic covered include: SLI shipments; lead consumption; automotive batteries (5-year annual growth rates); industrial batteries (standby power and motive power); estimated average battery life by area/country for 1989; US motor vehicle registrations; replacement battery shipments; potential lead consumption in electric vehicles; BCI recycling rates for lead-acid batteries; US average car/light truck battery life; channels of distribution; replacement battery inventory end July; 2nd US battery shipment forecast.

Prescription, Dispensation, and Generic Medicine Replacement Ratios: Influence on Japanese Medicine Costs

PubMed Central

Yokoi, Masayuki; Tashiro, Takao

2016-01-01

This study used publicly available data to examine the effect of the separation of dispensing and prescribing medicines between pharmacists in pharmacies and doctors in medical institutions (the separation system) and the generic medicine replacement ratio on the cost of various medicines in Japanese prefectures. For Japanese medical institutions, participation in the separation system is optional. Consequently, the expansion rate of the separation system for each administrative district is highly variable. In our multiple regression analysis, the dependent variables were the costs of daily medicines, specifically, total, internal, external, and injection medicines, as well as medical devices, and the independent variables were the expansion rate of the separation system and generic medicine replacement ratio. The expansion rate of the separation system showed a significant negative partial correlation with the daily costs of total, internal, and injection medicines as well as medical devices. Moreover, the rate of replacing brand name medicines with generic medicines showed a significant negative partial correlation with the daily costs of total and internal medicines. However, external and injection medicines and medical devices did not because only a few or no generic products of these types were sold in the Japanese market. Otherwise, expansion of the separation system was effective in reducing medicine costs, except in the case of external medicines. This suggests that the cost efficiency effect of the separation system does not function all the time. PMID:26234979

Long-term outcome on renal replacement therapy in patients who previously received a keto acid-supplemented very-low-protein diet.

PubMed

Chauveau, Philippe; Couzi, Lionel; Vendrely, Benoit; de Précigout, Valérie; Combe, Christian; Fouque, Denis; Aparicio, Michel

2009-10-01

The consequences of a supplemented very-low-protein diet remain a matter of debate with regard to patient outcome before or after the onset of renal replacement therapy. We evaluated the long-term clinical outcome during maintenance dialysis and/or transplantation in patients who previously received a supplemented very-low-protein diet. We assessed the outcome of 203 patients who received a supplemented very-low-protein diet for >3 mo (inclusion period: 1985-2000) and started dialysis after a mean diet duration of 33.1 mo (4-230 mo). The survival rate in the whole cohort was 79% and 63% at 5 and 10 y, respectively. One hundred two patients continued with chronic dialysis during the entire follow-up, and 101 patients were grafted at least once. Patient outcomes were similar to those of the French Dialysis Registry patients for the dialysis group and similar to the 865 patients who were transplanted in Bordeaux during the same period for the transplant group. There was no correlation between death rate and duration of diet. The lack of correlation between death rate and duration of diet and the moderate mortality rate observed during the first 10 y of renal replacement therapy confirm that a supplemented very-low-protein diet has no detrimental effect on the outcome of patients with chronic kidney disease who receive renal replacement therapy.

Life expectancy evaluation and development of a replacement schedule for LED traffic signals.

DOT National Transportation Integrated Search

2011-03-01

This research details a field study of LED traffic signals in Missouri and develops a replacement schedule : based on key findings. Rates of degradation were statistically analyzed using Analysis of Variance : (ANOVA). Results of this research will p...

Employment, gender, and smoking cessation outcomes in low-income smokers using nicotine replacement therapy.

PubMed

Burgess, Diana J; Fu, Steven S; Noorbaloochi, Siamak; Clothier, Barbara A; Ricards, Jennifer; Widome, Rachel; van Ryn, Michelle

2009-12-01

This study examines the presence and correlates of gender disparities in smoking cessation among lower income smokers prescribed nicotine replacement medication. We examined quit rates (7-day abstinence point prevalence) among a cohort of smokers who filled prescriptions for nicotine replacement (N = 1,782), using Minnesota Health Care Programs' (e.g., Medicaid) pharmacy claims databases (2005-2006) and mixed-mode survey protocols. A cohort of smokers who recently filled a prescription for nicotine replacement was stratified by race, and then subjects were selected by simple random sample from each race, oversampling the nonWhite groups (N = 1,782). The primary outcome was point prevalence of 7-day abstinence, and outcomes were assessed about 8 months after the nicotine replacement therapy (NRT) index prescription fill date using a mixed-mode survey protocol. Final interaction models were constructed using backward elimination. Abstinence rates were 11.4% among women and 19.2% among men (p = .02) and remained marginally significant after controlling for demographics, mental and physical health, period of cigarette abstinence, social environment, religious attendance, perceived stress, and NRT prescription type (p = .08). There was a significant Gender x Employment interaction (p = .02). Among men, quit rates were higher among the employed (26%) compared with the unemployed (16%); among women, quit rates were lower among those who were employed (8%) compared with those who were unemployed (14%). Results suggest the need for research on factors specific to women's work roles or workplaces that inhibit cessation as well as cessation programs tailored to low-income, employed female smokers. On-site workplace interventions and flexible counseling programs may be especially beneficial.

A Retrospective Analysis of Dental Implants Replacing Failed Implants in Grafted Maxillary Sinus: A Case Series.

PubMed

Manor, Yifat; Chaushu, Gavriel; Lorean, Adi; Mijiritzky, Eithan

2015-01-01

To evaluate the survival rate of dental implants replacing failed implants in grafted maxillary sinuses using the lateral approach vs nongrafted posterior maxillae. A retrospective analysis was conducted to study the survival of secondary dental implants inserted in the posterior maxilla in previously failed implant sites between the years 2000 and 2010. The study group consisted of patients who had also undergone maxillary sinus augmentation, and the control group consisted of patients in whom implants in the posterior maxilla had failed. Clinical and demographic data were analyzed using a structured form. Seventy-five patients with a total of 75 replaced implants were included in the study. The study group comprised 40 patients and the control group, 35 patients. None of the replaced implants in the study group failed, resulting in an overall survival of 100%; three replaced implants in the control group failed (92% survival). The main reason for the primary implant removal was lack of osseointegration (35 [87.5%] of 40 study group implants and 23 [65.7%] of 35 control group implants [P = .027]). The difference between the groups with regard to the timing of primary implant failure was statistically significant. The study group had more early failures of the primary implant than did the control group (77% vs 62%; P = .038). Dental implants replaced in the posterior maxilla had a high survival rate. A higher rate of survival was found in augmented maxillary sinus sites. Within the limits of the present study, it can be concluded that previous implant failures in the grafted maxillary sinus should not discourage practitioners from a second attempt.

Readmission Patterns Over 90-Day Episodes of Care Among Medicare Fee-for-Service Beneficiaries Discharged to Post-acute Care.

PubMed

Middleton, Addie; Kuo, Yong-Fang; Graham, James E; Karmarkar, Amol; Lin, Yu-Li; Goodwin, James S; Haas, Allen; Ottenbacher, Kenneth J

2018-04-21

Examine readmission patterns over 90-day episodes of care in persons discharged from hospitals to post-acute settings. Retrospective cohort study. Acute care hospitals. Medicare fee-for-service enrollees (N = 686,877) discharged from hospitals to post-acute care in 2013-2014. The cohort included beneficiaries >65 years of age hospitalized for stroke, joint replacement, or hip fracture and who survived for 90 days following discharge. 90-day unplanned readmissions. The cohort included 127,680 individuals with stroke, 442,195 undergoing joint replacement, and 117,002 with hip fracture. Thirty-day readmission rates ranged from 3.1% for knee replacement patients discharged to home health agencies (HHAs) to 14.4% for hemorrhagic stroke patients discharged to skilled nursing facilities (SNFs). Ninety-day readmission rates ranged from 5.0% for knee replacement patients discharged to HHAs to 26.1% for hemorrhagic stroke patients discharged to SNFs. Differences in readmission rates decreased between stroke subconditions (hemorrhagic and ischemic) and increased between joint replacement subconditions (knee, elective hip, and nonelective hip) from 30 to 90 days across all initial post-acute discharge settings. We observed clear patterns in readmissions over 90-day episodes of care across post-acute discharge settings and subconditions. Our findings suggest that patients with hemorrhagic stroke may be more vulnerable than those with ischemic over the first 30 days after hospital discharge. For patients receiving nonelective joint replacements, readmission prevention efforts should start immediately after discharge and continue, or even increase, over the 90-day episode of care. Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Healthcare Utilization and Costs of Knee or Hip Replacements versus Pain-Relief Injections

PubMed Central

Pasquale, Margaret K.; Louder, Anthony M.; Cheung, Raymond Y.; Reiners, Andrew T.; Mardekian, Jack; Sanchez, Robert J.; Goli, Veerainder

2015-01-01

Background Given the dramatic increase in total knee and hip replacement procedures among the US population aged 45 years and older, there is a need to compare the downstream healthcare utilization and costs between patients who undergo joint replacement and those who receive intraarticular injections as a low-cost alternative. Objective To compare changes in osteoarthritis (OA)-related healthcare utilization and costs for Medicare members with OA who underwent knee or hip replacement versus those receiving steroid or viscosupplementation injections. Methods Medicare members aged ≥45 years diagnosed with OA were identified for this retrospective longitudinal study. Data were compared for patients who underwent primary knee or hip replacement surgery between July 1, 2007, and June 30, 2012, and those receiving injection of pain-relief medication during the same period. The date of joint replacement surgery was considered the index date. For the comparison cohort, the index date was 180 days postinjection of the first intraarticular injection. Medical and pharmacy claims were examined longitudinally in 90-day increments, from 180 days preindex until 360 days postindex. Difference-in-difference analyses were conducted to compare the change in OA-related healthcare costs, postindex versus preindex, between the study cohorts. Time-to-event analyses were used to measure rates of readmissions and venous thromboembolism (VTE). Results The mean age was 70.7 years for patients with knee replacement, 71.7 years for those with hip replacement, and 71.1 years for those receiving pain-relief injection (P <.0001). The RxRisk-V comorbidity index scores were 4.7, 4.4, and 4.8, respectively (P <.0001). Difference-in-difference analyses indicated that decreases in OA-related costs were greater for the joint replacement cohorts (coefficient for knee replacement*time: −0.603; hip replacement*time: −0.438; P <.001 for both) than for the comparison cohort. The VTE rates were 5.6% (knee) and 5.1% (hip) postsurgery versus 1.4% (knee) and 1.3% (hip) presurgery. Conclusion The overall difference-in-difference results showed a greater decrease in healthcare utilization and costs for the members with joint replacement than for those receiving injection. PMID:26557232

Triple valve surgery: a 25-year experience.

PubMed

Yilmaz, Mustafa; Ozkan, Murat; Böke, Erkmen

2004-09-01

Surgical treatment of rheumatic valvular disease still constitutes a significant number of cardiac operations in developing countries. Despite improvements in myocardial protection and cardiopulmonary bypass techniques, triple valve operations (aortic, mitral and tricuspid valves) are still challenging because of longer duration of cardiopulmonary bypass and higher degree of myocardial decompensation. This study was instituted in order to assess results of triple valve surgery. Between 1977 and 2002, 34 patients underwent triple valve surgery in our clinic by the same surgeon (EB). Eleven patients underwent triple valve replacement (32.4%) and 23 underwent tricuspid valve annuloplasty with aortic and mitral valve replacements (67.6%). There was no significant difference between the two groups of patients who underwent triple valve replacement and aortic and mitral valve replacement with tricuspid valve annuloplasty. There were 4 hospital deaths (11.8%) occurring within 30 days. The duration of follow-up for 30 survivors ranged from 6 to 202 months (mean 97 months). The actuarial survival rates were 85%, 72%, and 48% at 5, 10, and 15 years respectively. Actuarial freedom from reoperation rates at 5, 10, and 15 years was 86.3%, 71.9%, and 51.2%, respectively. Freedom from cerebral thromboembolism and anticoagulation-related hemorrhage rates, expressed in actuarial terms was 75.9% and 62.9% at 5 and 10 years. Major cerebral complications occurred in 10 of the 30 patients. We prefer replacing, if repairing is not possible, the tricuspid valve, with a bileaflet mechanical prosthesis in a patient with valve replacement of the left heart who will be anticoagulated in order to avoid unfavorable properties of bioprosthesis like degeneration and of old generation mechanical prosthesis like thrombosis and poor hemodynamic function. In recent years, results of triple valve surgery either with tricuspid valve conservation or valve replacement in suitable cases have become encouraging with improvements in surgical techniques and myocardial preservation methods.

Analysis of factors affecting failure of glass cermet tunnel restorations in a multi-center study.

PubMed

Pilebro, C E; van Dijken, J W

2001-06-01

The aim of this study was to analyze factors influencing the failures of tunnel restorations performed with a glass cermet cement (Ketac Silver). Caries activity, lesion size, tunnel cavity opening size, partial or total tunnel, composite lamination or operating time showed no significant correlation to failure rate. Twelve dentists in eight clinics clinically experienced and familiar with the tunnel technique placed 374 restorations. The occlusal sections of fifty percent of the restorations were laminated with hybrid resin composite. The results of the yearly clinical and radiographic evaluations over the course of 3 years were correlated to factors that could influence the failure rate using logistic regression analysis. At the 3-year recall a cumulative number of 305 restorations were available. The cumulative replacement rate was 20%. The main reasons for replacement were marginal ridge fracture (14%) and dentin caries (3%). Another 7% of the restorations which had not been replaced were classified as failures because of untreated dentin caries. The only significant variable observed was the individual failure rate of the participating dentists varying between 9 and 50% (p=0.013).

Mitral-valve repair versus replacement for severe ischemic mitral regurgitation.

PubMed

Acker, Michael A; Parides, Michael K; Perrault, Louis P; Moskowitz, Alan J; Gelijns, Annetine C; Voisine, Pierre; Smith, Peter K; Hung, Judy W; Blackstone, Eugene H; Puskas, John D; Argenziano, Michael; Gammie, James S; Mack, Michael; Ascheim, Deborah D; Bagiella, Emilia; Moquete, Ellen G; Ferguson, T Bruce; Horvath, Keith A; Geller, Nancy L; Miller, Marissa A; Woo, Y Joseph; D'Alessandro, David A; Ailawadi, Gorav; Dagenais, Francois; Gardner, Timothy J; O'Gara, Patrick T; Michler, Robert E; Kron, Irving L

2014-01-02

Ischemic mitral regurgitation is associated with a substantial risk of death. Practice guidelines recommend surgery for patients with a severe form of this condition but acknowledge that the supporting evidence for repair or replacement is limited. We randomly assigned 251 patients with severe ischemic mitral regurgitation to undergo either mitral-valve repair or chordal-sparing replacement in order to evaluate efficacy and safety. The primary end point was the left ventricular end-systolic volume index (LVESVI) at 12 months, as assessed with the use of a Wilcoxon rank-sum test in which deaths were categorized below the lowest LVESVI rank. At 12 months, the mean LVESVI among surviving patients was 54.6±25.0 ml per square meter of body-surface area in the repair group and 60.7±31.5 ml per square meter in the replacement group (mean change from baseline, -6.6 and -6.8 ml per square meter, respectively). The rate of death was 14.3% in the repair group and 17.6% in the replacement group (hazard ratio with repair, 0.79; 95% confidence interval, 0.42 to 1.47; P=0.45 by the log-rank test). There was no significant between-group difference in LVESVI after adjustment for death (z score, 1.33; P=0.18). The rate of moderate or severe recurrence of mitral regurgitation at 12 months was higher in the repair group than in the replacement group (32.6% vs. 2.3%, P<0.001). There were no significant between-group differences in the rate of a composite of major adverse cardiac or cerebrovascular events, in functional status, or in quality of life at 12 months. We observed no significant difference in left ventricular reverse remodeling or survival at 12 months between patients who underwent mitral-valve repair and those who underwent mitral-valve replacement. Replacement provided a more durable correction of mitral regurgitation, but there was no significant between-group difference in clinical outcomes. (Funded by the National Institutes of Health and the Canadian Institutes of Health; ClinicalTrials.gov number, NCT00807040.).

Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021.

PubMed

Kurtz, Steven M; Ong, Kevin L; Lau, Edmund; Bozic, Kevin J

2014-04-16

Few studies have explored the role of the National Health Expenditure and macroeconomics on the utilization of total joint replacement. The economic downturn has raised questions about the sustainability of growth for total joint replacement in the future. Previous projections of total joint replacement demand in the United States were based on data up to 2003 using a statistical methodology that neglected macroeconomic factors, such as the National Health Expenditure. Data from the Nationwide Inpatient Sample (1993 to 2010) were used with United States Census and National Health Expenditure data to quantify historical trends in total joint replacement rates, including the two economic downturns in the 2000s. Primary and revision hip and knee arthroplasty were identified using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. Projections in total joint replacement were estimated using a regression model incorporating the growth in population and rate of arthroplasties from 1993 to 2010 as a function of age, sex, race, and census region using the National Health Expenditure as the independent variable. The regression model was used in conjunction with government projections of National Health Expenditure from 2011 to 2021 to estimate future arthroplasty rates in subpopulations of the United States and to derive national estimates. The growth trend for the incidence of joint arthroplasty, for the overall United States population as well as for the United States workforce, was insensitive to economic downturns. From 2009 to 2010, the total number of procedures increased by 6.0% for primary total hip arthroplasty, 6.1% for primary total knee arthroplasty, 10.8% for revision total hip arthroplasty, and 13.5% for revision total knee arthroplasty. The National Health Expenditure model projections for primary hip replacement in 2020 were higher than a previously projected model, whereas the current model estimates for total knee arthroplasty were lower. Economic downturns in the 2000s did not substantially influence the national growth trends for hip and knee arthroplasty in the United States. These latest updated projections provide a basis for surgeons, hospitals, payers, and policy makers to plan for the future demand for total joint replacement surgery.

Role of monovalent cations in fluid secretion from the exocrine rabbit pancreas.

PubMed

Kuijpers, G A; Van Nooy, I G; De Pont, J J

1989-08-21

The role of Na+ in fluid secretion by the isolated rabbit pancreas was investigated. The fluid secretion rate is reduced upon replacement of Na+ in the bathing medium by Li+, K+ or choline. The inhibition depends on the nature of the substituting cation, and is largest with choline. Upon replacement, the substituent cation appears in the secreted fluid, and the Na+ concentration in the secreted fluid is decreased in a mirror-like fashion. When Na+ is replaced by Li+ or choline, the secretory Na+ concentration is decreased, although less than in the bathing medium, and the K+ concentration is increased. When Na+ is replaced by K+, the Na+ and the K+ concentration in the secreted fluid are approximately equal to their bathing medium concentrations. In the Li+ and choline medium, stimulation of the pancreas by carbachol or CCK-8 increases the fluid secretion rate. In addition, it increases the Li+ or choline concentration, and decreases the Na+ and K+ concentrations in the secreted fluid. In normal and K+ medium, stimulation causes only a slight increase in fluid secretion rate, with no change in the secretory Na+ concentration. In normal medium, stimulation leads to a decrease in the secretory K+ concentration. The effects of replacing Na+ appear to be the result of a direct inhibition of the active HCO3- transport underlying secretion, and an indirect inhibition related to the permeability of the pancreas for the various cations. The stimulants are likely to act by increasing the permeability of the tight junctions.

Optimizing model: insemination, replacement, seasonal production, and cash flow.

PubMed

DeLorenzo, M A; Spreen, T H; Bryan, G R; Beede, D K; Van Arendonk, J A

1992-03-01

Dynamic programming to solve the Markov decision process problem of optimal insemination and replacement decisions was adapted to address large dairy herd management decision problems in the US. Expected net present values of cow states (151,200) were used to determine the optimal policy. States were specified by class of parity (n = 12), production level (n = 15), month of calving (n = 12), month of lactation (n = 16), and days open (n = 7). Methodology optimized decisions based on net present value of an individual cow and all replacements over a 20-yr decision horizon. Length of decision horizon was chosen to ensure that optimal policies were determined for an infinite planning horizon. Optimization took 286 s of central processing unit time. The final probability transition matrix was determined, in part, by the optimal policy. It was estimated iteratively to determine post-optimization steady state herd structure, milk production, replacement, feed inputs and costs, and resulting cash flow on a calendar month and annual basis if optimal policies were implemented. Implementation of the model included seasonal effects on lactation curve shapes, estrus detection rates, pregnancy rates, milk prices, replacement costs, cull prices, and genetic progress. Other inputs included calf values, values of dietary TDN and CP per kilogram, and discount rate. Stochastic elements included conception (and, thus, subsequent freshening), cow milk production level within herd, and survival. Validation of optimized solutions was by separate simulation model, which implemented policies on a simulated herd and also described herd dynamics during transition to optimized structure.

[Panhypopituitarism in one identical twin: the effect of hormone replacement].

PubMed

Del Canho, Harrij; van Alfen-van der Velden, Janiëlle; del Canho, Riwka; Otten, Barto

2011-01-01

Panhypopituitarism in childhood is rare. It is even rarer if the disorder appears in a boy with an identical but healthy twin brother. In such a patient it is useful to study the consequences of the hormone disorder and the effect of hormone replacement. A 6-year-old boy saw a paediatrician because of short stature. He was much shorter than his identical twin brother and he had more abdominal fat mass and a smaller penis. Laboratory tests identified hypothyroidism of central origin, in combination with hypocortisolism and growth hormone deficiency. Hormonal replacement resulted in an improvement in growth rate. At the age of 15 years, testosterone therapy was introduced because puberty had not occurred and his growth rate was low. Finally the patient grew a few centimetres taller than his twin brother. In the first year of life, panhypopituitarism has no negative consequences for growth. After this point, growth is clearly delayed. With sufficient replacement growth can completely catch up.

Impact of intravenous magnesium infusion rate during ambulatory replacements on serum magnesium concentrations after allogeneic stem cell transplant.

PubMed

Snyder, Matthew; Shillingburg, Alexandra; Newton, Michael; Hamadani, Mehdi; Kanate, Abraham S; Craig, Michael; Cumpston, Aaron

2016-10-01

For an outpatient cancer center to operate efficiently, optimizing the use of chair time is essential. Allogeneic hematopoietic cell transplant (allo-HCT) recipients are seen frequently in this setting after hospital discharge and regularly for several months thereafter. Aggressive electrolyte replacement is commonly required in these patients, primarily due to renal wasting with calcineurin inhibitor use. Frequent intravenous (IV) magnesium repletion, requiring several hours of infusion time, is often needed in these patients to adequately manage their magnesium deficiencies. The purpose of this study is to explore the impact of extending the infusion rate of intravenous magnesium sulfate on the frequency and degree of IV magnesium replacements required in allo-HCT recipients. We conducted a retrospective study to compare two cohorts of patients administered IV magnesium sulfate at a rate of 4 g/1 h versus 4 g/2 h. A total of 103 continuous patients were assessed in two groups as cohort 1 at the 4 g/1 h rate and cohort 2 at the 4 g/2 h rate. Cohort 1 required less IV magnesium per outpatient visit (median 2.2 vs. 2.9 g/visit, P = 0.0211) and less total IV magnesium replacement through day +100 (median 68 vs. 85 g, P = 0.0479) than cohort 2. These data suggest that there is no apparent benefit of prolonging magnesium infusion from 1 to 2 h in our outpatient allo-HCT population.

Graded replacement of maize grain with molassed sugar beet pulp modulated ruminal microbial community and fermentation profile in vitro.

PubMed

Münnich, Matthias; Khol-Parisini, Annabella; Klevenhusen, Fenja; Metzler-Zebeli, Barbara U; Zebeli, Qendrim

2018-02-01

Molassed sugar beet pulp (Bp) is a viable alternative to grains in cattle nutrition for reducing human edible energy input. Yet little is known about the effects of high inclusion rates of Bp on rumen microbiota. This study used an in vitro approach and the quantitative polymerase chain reaction technique to establish the effects of a graded replacement of maize grain (MG) by Bp on the ruminal microbial community, fermentation profile and nutrient degradation. Six different amounts of Bp (0-400 g kg -1 ), which replaced MG in the diet, were tested using the in vitro semi-continuous rumen simulation technique. The increased inclusion of Bp resulted in greater dietary content and degradation of neutral detergent fibre (P < 0.01). Further, Bp feeding enhanced (P < 0.01) the abundance of genus Prevotella and shifted (P < 0.01) the short-chain fatty acid patterns in favour of acetate and propionate and at the expense of butyrate. A total replacement of MG with Bp resulted in an increased daily methane production (P < 0.01). Results suggest positive effects of the replacement of MG by Bp especially in terms of stimulating ruminal acetate and propionate fermentation. However, high replacement rates of Bp resulted in lowered utilization of ammonia and higher ruminal methane production. © 2017 Society of Chemical Industry. © 2017 Society of Chemical Industry.

Quality and Safety in Health Care, Part XXXII: Additional Outcome Predictors for Transcatheter Aortic Valve Replacement.

PubMed

Harolds, Jay A

2018-02-01

Mortality 12 months after a transcatheter aortic valve replacement (TAVR) is partly due to a number of reasons in addition to the usual preprocedural medical patient risk factors. In patients who need a permanent pacemaker placed after the procedure, the mortality risk goes up. The death rate following a TAVR varies considerably at different institutions, and the past death rate of TAVR patients at an institution is predictive of the mortality rate of new patients having this procedure. In addition, the quality of life of the individual before the procedure is predictive of the 12-month mortality outcome after the TAVR is done.

[Late complications following Björk-Shiley and St. Jude Medical heart valve replacement].

PubMed

Horstkotte, D; Körfer, R; Budde, T; Haerten, K; Schulte, H D; Bircks, W; Loogen, F

1983-05-01

Valve-related complications after Björk-Shiley mitral (n = 475), aortic (n = 424), or mitral-aortic implantation (n = 119) were compared to complications after St. Jude mitral (n = 173), aortic (n = 152), and St. Jude mitral and aortic (n = 63) replacements. The 1,018 consecutive patients with Björk-Shiley valves had been operated upon between 1974 and 1982, those with St. Jude valves between 1978 and 1982. All patients were placed on anticoagulant therapy with phenprocoumon early after operation and no significant intergroup differences in the effectiveness of the anticoagulant therapy were found. At a comparable follow-up time of approximately 23 months, 24 major thromboembolic episodes were observed after Björk-Shiley mitral (BSM) and 3 after St. Jude mitral valve implantation (SJM), corresponding to a thromboembolic rate of 2.82/100 patient years with BSM and 0.93/100 patient years with SJM. After aortic valve replacements, 1.93 events in 100 patient years occurred after Björk-Shiley aortic (BSA) and 0.73 after St. Jude aortic implantation (SJA). In patients with double valve replacements, these rates were 3.2 (BSM + BSA) and 0.88 (SJM + SJA), respectively. The cerebral vessels were involved in 52% and the arteries of the extremities in 22% of these major events. Six Björk-Shiley prostheses had to be replaced because of valve thrombosis. The overall incidence of severe hemorrhagic complications was 2.94/100 patient years in BSM and 1.79 in SJM. After aortic valve replacement, we found rates of 1.80/100 patient years (BSA) and 2.57/100 patient years (SJA), respectively. Intravascular hemolysis no longer seems to be a significant clinical problem. However, indications of red cell damage after heart valve replacement were significantly greater in patients with perivalvular leakage, valve thrombosis, or dysfunction than in those with normally functioning prostheses. Reoperations were necessary because of valve thrombosis (0.46%), perivalvular leakage (2.2%), or prosthetic valve endocarditis with concomitant perivalvular regurgitation (0.46%). One valve had to be replaced because of fracture of the outlet strut of a BSM prosthesis. Hemorrhage due to the anticoagulant treatment was thus the most frequent complication, without significant intergroup differences, while thromboembolic complications were significantly more frequent after Björk-Shiley mitral, aortic, and double valve replacements than after St. Jude implantation. This may lead to the consideration of a change in the prophylaxis of thrombus formations with the St. Jude valve, especially in aortic valve replacements with sinus rhythm.

Associations between socioeconomic status and primary total knee joint replacements performed for osteoarthritis across Australia 2003-10: data from the Australian Orthopaedic Association National Joint Replacement Registry.

PubMed

Brennan, Sharon L; Lane, Stephen E; Lorimer, Michelle; Buchbinder, Rachelle; Wluka, Anita E; Page, Richard S; Osborne, Richard H; Pasco, Julie A; Sanders, Kerrie M; Cashman, Kara; Ebeling, Peter R; Graves, Stephen E

2014-10-28

Relatively little is known about the social distribution of total knee joint replacement (TKR) uptake in Australia. We examine associations between socioeconomic status (SES) and TKR performed for diagnosed osteoarthritis 2003-10 for all Australian males and females aged ≥ 30 yr. Data of primary TKR (n=213,018, 57.4% female) were ascertained from a comprehensive national joint replacement registry. Residential addresses were matched to Australian Census data to identify area-level social disadvantage, and categorised into deciles. Estimated TKR rates were calculated. Poisson regression was used to model the relative risk (RR) of age-adjusted TKR per 1,000py, stratified by sex and SES. A negative relationship was observed between TKR rates and SES deciles. Females had a greater rate of TKR than males. Surgery utilisation was greatest for all adults aged 70-79 yr. In that age group differences in estimated TKR per 1,000py between deciles were greater for 2010 than 2003 (females: 2010 RR 4.32 and 2003 RR 3.67; males: 2010 RR 2.04 and 2003 RR 1.78). Identifying factors associated with TKR utilisation and SES may enhance resource planning and promote surgery utilisation for end-stage osteoarthritis.

Reproducing Italians: contested biopolitics in the age of 'replacement anxiety'.

PubMed

Marchesi, Milena

2012-01-01

In national and international discourses, Italians are often represented as a greying population failing to reproduce itself. Italian women are targeted for their very low birth rates, while migrant women are scrutinized for their 'excessive' fertility and abortion rates. These demographic concerns over differential reproduction reflect 'replacement anxiety' about the below-replacement rates of Italians and the replacement of Italians by immigrants. Demographic anxieties coalesce with the intensifying of Catholic 'vitapolitics' manifesting in the paradox of pro-natalist interventions coexisting with the curtailment of fertility-enhancing reproductive technologies. The children of migrants emerge in some population discourses as a threat rather than a contribution to the reproduction of the nation. Drawing on multi-sited ethnographic research in Milan, this paper examines how reproduction in contemporary Italy has emerged as a contested social, political, and moral issue that invests Italian and migrant women in different ways, engendering different forms and terms of resistance and contestation. On what terms are subjects governed and called upon to govern themselves to be more 'rational' and 'responsible' reproducers of the nation? What subjectivities and local responses are engendered by the politics of reproduction in Italy? As different rationalities and notions of responsible reproduction circulate, ethnographic research sheds light on how anxieties over low birth rates are reappropriated and redeployed against the state, suggesting that subjects are not so easily governable by population and reproductive discourses. This research contributes to the literature on critical demography and the politics of reproduction and migration in the new Europe.

Review of Evidence for Adult Diabetic Ketoacidosis Management Protocols.

PubMed

Tran, Tara T T; Pease, Anthony; Wood, Anna J; Zajac, Jeffrey D; Mårtensson, Johan; Bellomo, Rinaldo; Ekinci, Elif I I

2017-01-01

Diabetic ketoacidosis (DKA) is an endocrine emergency with associated risk of morbidity and mortality. Despite this, DKA management lacks strong evidence due to the absence of large randomised controlled trials (RCTs). To review existing studies investigating inpatient DKA management in adults, focusing on intravenous (IV) fluids; insulin administration; potassium, bicarbonate, and phosphate replacement; and DKA management protocols and impact of DKA resolution rates on outcomes. Ovid Medline searches were conducted with limits "all adult" and published between "1973 to current" applied. National consensus statements were also reviewed. Eligibility was determined by two reviewers' assessment of title, abstract, and availability. A total of 85 eligible articles published between 1973 and 2016 were reviewed. The salient findings were (i) Crystalloids are favoured over colloids though evidence is lacking. The preferred crystalloid and hydration rates remain contentious. (ii) IV infusion of regular human insulin is preferred over the subcutaneous route or rapid acting insulin analogues. Administering an initial IV insulin bolus before low-dose insulin infusions obviates the need for supplemental insulin. Consensus-statements recommend fixed weight-based over "sliding scale" insulin infusions although evidence is weak. (iii) Potassium replacement is imperative although no trials compare replacement rates. (iv) Bicarbonate replacement offers no benefit in DKA with pH > 6.9. In severe metabolic acidosis with pH < 6.9, there is lack of both data and consensus regarding bicarbonate administration. (v) There is no evidence that phosphate replacement offers outcome benefits. Guidelines consider replacement appropriate in patients with cardiac dysfunction, anaemia, respiratory depression, or phosphate levels <0.32 mmol/L. (vi) Upon resolution of DKA, subcutaneous insulin is recommended with IV insulin infusions ceased with an overlap of 1-2 h. (vii) DKA resolution rates are often used as end points in studies, despite a lack of evidence that rapid resolution improves outcome. (viii) Implementation of DKA protocols lacks strong evidence for adherence but may lead to improved clinical outcomes. There are major deficiencies in evidence for optimal management of DKA. Current practice is guided by weak evidence and consensus opinion. All aspects of DKA management require RCTs to affirm or redirect management and formulate consensus evidence-based practice to improve patient outcomes.

Stand-replacing wildfires increase nitrification for decades in southwestern ponderosa pine forests.

PubMed

Kurth, Valerie J; Hart, Stephen C; Ross, Christopher S; Kaye, Jason P; Fulé, Peter Z

2014-05-01

Stand-replacing wildfires are a novel disturbance within ponderosa pine (Pinus ponderosa) forests of the southwestern United States, and they can convert forests to grasslands or shrublands for decades. While most research shows that soil inorganic N pools and fluxes return to pre-fire levels within a few years, we wondered if vegetation conversion (ponderosa pine to bunchgrass) following stand-replacing fires might be accompanied by a long-term shift in N cycling processes. Using a 34-year stand-replacing wildfire chronosequence with paired, adjacent unburned patches, we examined the long-term dynamics of net and gross nitrogen (N) transformations. We hypothesized that N availability in burned patches would become more similar to those in unburned patches over time after fire as these areas become re-vegetated. Burned patches had higher net and gross nitrification rates than unburned patches (P < 0.01 for both), and nitrification accounted for a greater proportion of N mineralization in burned patches for both net (P < 0.01) and gross (P < 0.04) N transformation measurements. However, trends with time-after-fire were not observed for any other variables. Our findings contrast with previous work, which suggested that high nitrification rates are a short-term response to disturbance. Furthermore, high nitrification rates at our site were not simply correlated with the presence of herbaceous vegetation. Instead, we suggest that stand-replacing wildfire triggers a shift in N cycling that is maintained for at least three decades by various factors, including a shift from a woody to an herbaceous ecosystem and the presence of fire-deposited charcoal.

Generator exchange is associated with an increased rate of Sprint Fidelis lead failure.

PubMed

Lovelock, Joshua D; Patel, Ayesha; Mengistu, Andenet; Hoskins, Michael; El-Chami, Mikhael; Lloyd, Michael S; Leon, Angel; DeLurgio, David; Langberg, Jonathan J

2012-10-01

The Medtronic Sprint Fidelis defibrillator lead is at an increased risk for failure and was recalled in October 2007. Approximately 268,000 leads were implanted, and more than 100,000 patients still have active Fidelis leads. A number of studies have examined the rate and clinical predictors of lead failure, but none has addressed the effect of an implantable cardioverter-defibrillator generator exchange on subsequent lead failure. Although the manufacturer asserts that "Sprint Fidelis performance after device change-out is similar to lead performance without device change-out," published data are lacking. To assess the effect of implantable cardioverter-defibrillator generator exchange on the rate of Fidelis lead failure. A chart review was conducted in patients who underwent implantation of a Fidelis lead. Patients with a functioning Fidelis lead at generator exchange were compared with controls with leads implanted for a comparable amount of time not undergoing ICD replacement. A total of 1366 patients received a Fidelis lead prior to the recall, of which 479 were still actively followed. Seventy-two patients with a functioning lead underwent generator exchange without lead replacement. Following generator replacement, 15 leads failed. Sixty percent of the Fidelis leads failed within 3 months. Generator exchange increased the rate of lead failure compared with matched controls (20.8% vs 2.54%; P < .001). Generator exchange is associated with a higher than expected rate of Fidelis lead failure, often within 3 months. The risk-benefit ratio of Fidelis lead replacement at the time of generator exchange may be greater than appreciated. Copyright © 2012 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Inorganic nitrogen availability after severe stand-replacing fire in the Greater Yellowstone ecosystem

PubMed Central

Turner, Monica G.; Smithwick, Erica A. H.; Metzger, Kristine L.; Tinker, Daniel B.; Romme, William H.

2007-01-01

Understanding ecosystem processes as they relate to wildfire and vegetation dynamics is of growing importance as fire frequency and extent increase throughout the western United States. However, the effects of severe, stand-replacing wildfires are poorly understood. We studied inorganic nitrogen pools and mineralization rates after stand-replacing wildfires in the Greater Yellowstone Ecosystem, Wyoming. After fires that burned in summer 2000, soil ammonium concentration peaked in 2001 (33 mg NH4-N· kgsoil−1); soil nitrate increased subsequently (2.7 mg NO3-N·kgsoil−1 in 2003) but was still low. However, annual net ammonification rates were largely negative from 2001 to 2004, indicating ammonium depletion. Thus, although net nitrification rates were positive, annual net nitrogen mineralization (net ammonification plus net nitrification) remained low. Aboveground net primary production (ANPP) increased from 0.25 to 1.6 Mg·ha−1·yr−1 from 2001 to 2004, but variation in ANPP among stands was not related to net nitrogen mineralization rates. Across a broader temporal gradient (stand age zero to >250 yr), negative rates of net annual ammonification were especially pronounced in the first postfire year. Laboratory incubations using 15N isotope pool dilution revealed that gross production of ammonium was reduced and ammonium consumption greatly exceeded gross production during the initial postfire years. Our results suggest a microbial nitrogen sink for several years after severe, stand-replacing fire, confirming earlier hypotheses about postdisturbance succession and nutrient cycling in cold, fire-dominated coniferous forests. Postfire forests in Yellowstone seem to be highly conservative for nitrogen, and microbial immobilization of ammonium plays a key role during early succession. PMID:17360349

Rating and analysis of continuous girder bridges.

DOT National Transportation Integrated Search

1980-01-01

Federal regulations prompted as a result of bridge failures require the rating of bridge structures for which federal funds will be utilized for rehabilitation and replacement. The large number of bridges in Virginia subject to being rated makes such...

Thermal Characterization of Epoxy Adhesive by Hotfire Testing

NASA Technical Reports Server (NTRS)

Spomer, Ken A.; Haddock, M. Reed; McCool, Alex (Technical Monitor)

2001-01-01

This paper describes subscale solid-rocket motor hot-fire testing of epoxy adhesives in flame surface bondlines to evaluate heat-affected depth, char depth and ablation rate. Hot-fire testing is part of an adhesive down-selection program on the Space Shuttle Solid Rocket Motor Nozzle to provide additional confidence in the down-selected adhesives. The current nozzle structural adhesive bond system is being replaced due to obsolescence. Prior to hot-fire testing, adhesives were tested for chemical, physical and mechanical properties, which resulted in the selection of two potential replacement adhesives, Resin Technology Group's TIGA 321 and 3M's EC2615XLW. Hot-fire testing consisted of four forty-pound charge (FPC) motors fabricated in configurations that would allow side-by-side comparison testing of the candidate replacement adhesives with the current RSRM adhesives. Results of the FPC motor testing show that: 1) the phenolic char depths on radial bondlines is approximately the same and vary depending on the position in the blast tube regardless of which adhesive was used, 2) the replacement candidate adhesive char depths are equivalent to the char depths of the current adhesives, 3) the heat-affected depths of the candidate and current adhesives are equivalent, and 4) the ablation rates for both replacement adhesives were equivalent to the current adhesives.

Optimal Surgical Management of Severe Ischemic Mitral Regurgitation: To Repair or to Replace?

PubMed Central

Perrault, Louis P.; Moskowitz, Alan J.; Kron, Irving L.; Acker, Michael A.; Miller, Marissa A.; Horvath, Keith A.; Thourani, Vinod H.; Argenziano, Michael; D'Alessandro, David A.; Blackstone, Eugene H.; Moy, Claudia S.; Mathew, Joseph P.; Hung, Judy; Gardner, Timothy J.; Parides, Michael K.

2013-01-01

Background Ischemic mitral regurgitation (MR), a complication of myocardial infarction and coronary artery disease more generally, is associated with a high mortality rate and estimated to affect 2.8 million Americans. With 1-year mortality rates as high as 40%, recent practice guidelines of professional societies recommend repair or replacement, but there remains a lack of conclusive evidence supporting either intervention. The choice between therapeutic options is characterized by the trade-off between reduced operative morbidity and mortality with repair versus a better long-term correction of mitral insufficiency with replacement. The long-term benefits of repair versus replacement remain unknown, which has led to significant variation in surgical practice. Methods and Results This paper describes the design of a prospective randomized clinical trial to evaluate the safety and effectiveness of mitral valve repair and replacement in patients with severe ischemic mitral regurgitation. This trial is being conducted as part of the Cardiothoracic (CT) Surgical Trials Network. This paper addresses challenges in selecting a feasible primary endpoint, characterizing the target population (including the degree of MR), and analytical challenges in this high mortality disease. Conclusions The paper concludes by discussing the importance of information on functional status, survival, neurocognition, quality of life and cardiac physiology in therapeutic decision-making. PMID:22054660

[Retrospective study about periodontal ligament healing of replanted permanent teeth in children].

PubMed

Bai, J; Zhao, Y M; Qin, M

2015-04-18

To analyze the prognosis about periodontal ligament healing of replanted permanent teeth in children and to examine the associated factors. The sample consisted of 49 children with 61 avulsed permanent teeth, whose injuries had been managed in the period from 2000 to 2012. The clinical data of replanted teeth were collected, and the follow-up period was no less than 12 months. The factors were analyzed in relation to postoperative outcomes, classified as functional periodontal healing (FH), infection-related (inflammatory) resorption (IRR) and replacement resorption (RR). The functional healing rate was 23.0%, while replacement resorption rate was 72.1%. The replacement resorption (ankylosis) was usually observed earlier by clinical examination than by radiographic examination. 86.0% (40/47) resorptive processes were diagnosed within the first year. Physiological storages, such as milk, saline and saliva were significantly better to periodontal ligament healing than nonphysiological storages, such as tap water and sterilizing solutions (chloramine and alcohol). Functional healing was found significantly more frequent in canines and premolars. The factor significantly affecting periodontal ligament healing is storage medium. Replacement resorption is the most common type of root resorption. The replacement resorption diagnosis must combine the radiographic examination with the clinical examination. It is better to follow up more than 1 year after tooth replantation.

76 FR 51344 - Notice of Funds Availability for Section 514 Farm Labor Housing Loans and Section 516 Farm Labor...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-18

...). Replacement of heating, ventilation and air conditioning (HVAC) equipment with Energy Star qualified heating, HVAC equipment. (3 points). Replacement of windows and doors with Energy Star qualified windows and... the third-party program's rating and verification systems. (2 points). Dated: August 11, 2011. Robert...

Cue-Provoked Craving and Nicotine Replacement Therapy in Smoking Cessation

ERIC Educational Resources Information Center

Waters, Andrew J.; Shiffman, Saul; Sayette, Michael A.; Paty, Jean A.; Gwaltney, Chad J.; Balabanis, Mark H.

2004-01-01

Cue exposure paradigms have been used to examine reactivity to smoking cues. However, it is not known whether cue-provoked craving is associated with smoking cessation outcomes or whether cue reactivity can be attenuated by nicotine replacement therapy (NRT) in clinical samples. Cue-provoked craving ratings and reaction time responses were…

Wide Field Camera 3 Accommodations for HST Robotics Servicing Mission

NASA Technical Reports Server (NTRS)

Ginyard, Amani

2005-01-01

This slide presentation discusses the objectives of the Hubble Space Telescope (HST) Robotics Servicing and Deorbit Mission (HRSDM), reviews the Wide Field Camera 3 (WFC3), and also reviews the contamination accomodations for the WFC3. The objectives of the HRSDM are (1) to provide a disposal capability at the end of HST's useful life, (2) to upgrade the hardware by installing two new scientific instruments: replace the Corrective Optics Space Telescope Axial Replacement (COSTAR) with the Cosmic Origins Spectrograph (COS), and to replace the Wide Field/Planetary Camera-2 (WFPC2) with Wide Field Camera-3, and (3) Extend the Scientific life of HST for a minimum of 5 years after servicing. Included are slides showing the Hubble Robotic Vehicle (HRV) and slides describing what the HRV contains. There are also slides describing the WFC3. One of the mechanisms of the WFC3 is to serve partially as replacement gyroscopes for HST. There are also slides that discuss the contamination requirements for the Rate Sensor Units (RSUs), that are part of the Rate Gyroscope Assembly on the WFC3.

Early testosterone replacement attenuates intracellular calcium dyshomeostasis in the heart of testosterone-deprived male rats.

PubMed

Weerateerangkul, Punate; Shinlapawittayatorn, Krekwit; Palee, Siripong; Apaijai, Nattayaporn; Chattipakorn, Siriporn C; Chattipakorn, Nipon

2017-11-01

Testosterone deficiency in elderly men increases the risk of cardiovascular disease. In bilateral orchiectomized (ORX) animals, impaired cardiac Ca 2+ regulation was observed, and this impairment could be improved by testosterone replacement, indicating the important role of testosterone in cardiac Ca 2+ regulation. However, the temporal changes of Ca 2+ dyshomeostasis in testosterone-deprived conditions are unclear. Moreover, the effects of early vs. late testosterone replacement are unknown. We hypothesized that the longer the deprivation of testosterone, the greater the impairment of cardiac Ca 2+ homeostasis, and that early testosterone replacement can effectively reduce this adverse effect. Male Wistar rats were randomly divided into twelve groups, four sets of three. The first set were ORX for 2, 4 and 8 weeks, the second set were sham-operated groups of the same periods, the third set were ORX for 8 weeks coupled with a subcutaneous injection of vehicle (control), testosterone during weeks 1-8 (early replacement) or testosterone during weeks 5-8 (late replacement), and finally the 12-week sham-operated, ORX and ORX treated with testosterone groups. Cardiac Ca 2+ transients (n=4-5/group), L-type calcium current (I Ca-L ) (n=4/group), Ca 2+ regulatory proteins (n=6/group) and cardiac function (n=5/group) were determined. In the ORX rats, impaired cardiac Ca 2+ transients and reduced I Ca-L were observed initially 4 weeks after ORX as shown by decreased Ca 2+ transient amplitude, rising rate and maximum and average decay rates. No alteration of Ca 2+ regulatory proteins such as the L-type Ca 2+ channels, ryanodine receptor type 2, Na + -Ca 2+ exchangers and SERCA2a were observed. Early testosterone replacement markedly improved cardiac Ca 2+ transients, whereas late testosterone replacement did not. The cardiac contractility was also improved after early testosterone replacement. Impaired cardiac Ca 2+ homeostasis is time-dependent after testosterone deprivation. Early testosterone replacement improves cardiac Ca 2+ transient regulation and contractility, suggesting the necessity of early intervention in conditions of testosterone-deprivation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Transcatheter aortic-valve replacement with a self-expanding prosthesis.

PubMed

Adams, David H; Popma, Jeffrey J; Reardon, Michael J; Yakubov, Steven J; Coselli, Joseph S; Deeb, G Michael; Gleason, Thomas G; Buchbinder, Maurice; Hermiller, James; Kleiman, Neal S; Chetcuti, Stan; Heiser, John; Merhi, William; Zorn, George; Tadros, Peter; Robinson, Newell; Petrossian, George; Hughes, G Chad; Harrison, J Kevin; Conte, John; Maini, Brijeshwar; Mumtaz, Mubashir; Chenoweth, Sharla; Oh, Jae K

2014-05-08

We compared transcatheter aortic-valve replacement (TAVR), using a self-expanding transcatheter aortic-valve bioprosthesis, with surgical aortic-valve replacement in patients with severe aortic stenosis and an increased risk of death during surgery. We recruited patients with severe aortic stenosis who were at increased surgical risk as determined by the heart team at each study center. Risk assessment included the Society of Thoracic Surgeons Predictor Risk of Mortality estimate and consideration of other key risk factors. Eligible patients were randomly assigned in a 1:1 ratio to TAVR with the self-expanding transcatheter valve (TAVR group) or to surgical aortic-valve replacement (surgical group). The primary end point was the rate of death from any cause at 1 year, evaluated with the use of both noninferiority and superiority testing. A total of 795 patients underwent randomization at 45 centers in the United States. In the as-treated analysis, the rate of death from any cause at 1 year was significantly lower in the TAVR group than in the surgical group (14.2% vs. 19.1%), with an absolute reduction in risk of 4.9 percentage points (upper boundary of the 95% confidence interval, -0.4; P<0.001 for noninferiority; P = 0.04 for superiority). The results were similar in the intention-to-treat analysis. In a hierarchical testing procedure, TAVR was noninferior with respect to echocardiographic indexes of valve stenosis, functional status, and quality of life. Exploratory analyses suggested a reduction in the rate of major adverse cardiovascular and cerebrovascular events and no increase in the risk of stroke. In patients with severe aortic stenosis who are at increased surgical risk, TAVR with a self-expanding transcatheter aortic-valve bioprosthesis was associated with a significantly higher rate of survival at 1 year than surgical aortic-valve replacement. (Funded by Medtronic; U.S. CoreValve High Risk Study ClinicalTrials.gov number, NCT01240902.).

Smoking cessation in primary care clinics.

PubMed

Sippel, J M; Osborne, M L; Bjornson, W; Goldberg, B; Buist, A S

1999-11-01

To document smoking cessation rates achieved by applying the 1996 Agency for Health Care Policy and Research (AHCPR) smoking cessation guidelines for primary care clinics, compare these quit rates with historical results, and determine if quit rates improve with an additional motivational intervention that includes education as well as spirometry and carbon monoxide measurements. Randomized clinical trial. Two university-affiliated community primary care clinics. Two hundred five smokers with routinely scheduled appointments. All smokers were given advice and support according to AHCPR guidelines. Half of the subjects received additional education with spirometry and carbon monoxide measurements. Quit rate was evaluated at 9-month follow-up. Eleven percent of smokers were sustained quitters at follow-up. Sustained quit rate was no different for intervention and control groups (9% vs 14%; [OR] 0.6; 95% [CI] 0.2, 1.4). Nicotine replacement therapy was strongly associated with sustained cessation (OR 6.7; 95% CI 2.3, 19.6). Subjects without insurance were the least likely to use nicotine replacement therapy ( p =.05). Historical data from previously published studies showed that 2% of smokers quit following physician advice, and additional support similar to AHCPR guidelines increased the quit rate to 5%. The sustained smoking cessation rate achieved by following AHCPR guidelines was 11% at 9 months, which compares favorably with historical results. Additional education with spirometry did not improve the quit rate. Nicotine replacement therapy was the strongest predictor of cessation, yet was used infrequently owing to cost. These findings support the use of AHCPR guidelines in primary care clinics, but do not support routine spirometry for motivating patients similar to those studied here.

4-Year Cohort Graduation Rate: Overview

ERIC Educational Resources Information Center

Pennsylvania Department of Education, 2010

2010-01-01

Federal law requires Pennsylvania, and all other states, to transition to a new calculation method for determining high school graduation rates. Beginning in 2012, using graduation data from the Classes of 2010 and 2011, the "4-Year Cohort Graduation Rate" calculation will replace the "4-Year Leaver Graduation Rate"…

Concomitant replacement of the dilated ascending aorta during aortic valve replacement; does it increase the perioperative morbidity and mortality risks?

PubMed

Lim, Ju Y; Jung, Sung H; Kim, Joon B; Kim, Dong K; Chung, Cheol H; Song, Hyun; Lee, Jae W; Choo, Suk J

2013-05-01

Concerns of increased surgical risks with ascending aortic replacement have led surgeons to manage post-stenotic aortic dilatation more conservatively during aortic valve replacement (AVR). The present study aimed to assess the prognostic implications and surgical risks of replacing the dilated aorta during AVR. Between January 1999 and March 2010, 134 patients who received surgery for aortic stenosis and post-stenotic dilatation (aorta size ≥40 mm) were included in the present study. AVR was performed in 92 patients (AVR group) while aortic valve and ascending aorta replacement (AVR + aorta group) were performed in 42 patients. Overall survival was compared between the two groups using Cox proportional hazard model after adjustment with inverse-probability-of-treatment weighting. The mean follow-up duration was 3.5 ± 3 years. There were no significant differences in the operative mortality and morbidity between the two groups. The late cardiac deaths were also not significantly different between the two groups (p = 1.00). In the AVR group, the ascending aortic expansion rate which was 0.18 mm/year over a mean follow-up duration of 2.3 ± 2.2 years by echocardiography showed a positive correlation with time (r = 0.3, p = 0.08). A relatively greater aortic expansion rate was identified as a risk factor for late mortality (p = 0.015, HR 1.08 (CI: 1.02 to 1.15). Concomitant replacement of the dilated ascending aorta during AVR did not increase the immediate postoperative morbidity or mortality risks and tended to exert a long-term beneficial effect on the risk of late mortality. © 2013 Wiley Periodicals, Inc.

Outcomes in Patients with Vasodilatory Shock and Renal Replacement Therapy Treated with Intravenous Angiotensin II.

PubMed

Tumlin, James A; Murugan, Raghavan; Deane, Adam M; Ostermann, Marlies; Busse, Laurence W; Ham, Kealy R; Kashani, Kianoush; Szerlip, Harold M; Prowle, John R; Bihorac, Azra; Finkel, Kevin W; Zarbock, Alexander; Forni, Lui G; Lynch, Shannan J; Jensen, Jeff; Kroll, Stew; Chawla, Lakhmir S; Tidmarsh, George F; Bellomo, Rinaldo

2018-06-01

Acute kidney injury requiring renal replacement therapy in severe vasodilatory shock is associated with an unfavorable prognosis. Angiotensin II treatment may help these patients by potentially restoring renal function without decreasing intrarenal oxygenation. We analyzed the impact of angiotensin II on the outcomes of acute kidney injury requiring renal replacement therapy. Post hoc analysis of the Angiotensin II for the Treatment of High-Output Shock 3 trial. ICUs. Patients with acute kidney injury treated with renal replacement therapy at initiation of angiotensin II or placebo (n = 45 and n = 60, respectively). IV angiotensin II or placebo. Primary end point: survival through day 28; secondary outcomes included renal recovery through day 7 and increase in mean arterial pressure from baseline of ≥ 10 mm Hg or increase to ≥ 75 mm Hg at hour 3. Survival rates through day 28 were 53% (95% CI, 38%-67%) and 30% (95% CI, 19%-41%) in patients treated with angiotensin II and placebo (p = 0.012), respectively. By day 7, 38% (95% CI, 25%-54%) of angiotensin II patients discontinued RRT versus 15% (95% CI, 8%-27%) placebo (p = 0.007). Mean arterial pressure response was achieved in 53% (95% CI, 38%-68%) and 22% (95% CI, 12%-34%) of patients treated with angiotensin II and placebo (p = 0.001), respectively. In patients with acute kidney injury requiring renal replacement therapy at study drug initiation, 28-day survival and mean arterial pressure response were higher, and rate of renal replacement therapy liberation was greater in the angiotensin II group versus the placebo group. These findings suggest that patients with vasodilatory shock and acute kidney injury requiring renal replacement therapy may preferentially benefit from angiotensin II.

Feasibility of partial replacement of fishmeal with proteins from different sources in diets of Korean rockfish ( Sebastes schlegeli)

NASA Astrophysics Data System (ADS)

Yan, Quangen; Zhu, Xiaoming; Yang, Yunxia; Han, Dong; Xie, Shouqi

2014-12-01

An 8-week feeding experiment was conducted in an indoor recirculation seawater system to investigate the effects of partial replacement of dietary fishmeal with proteins from five sources on the growth performance and feed utilization of Sebastes schlegeli. Six isonitrogenous and isoenergetic diets were formulated using fishmeal (FM, the control) as sole protein source, or proteins from five sources including poultry by-product meal (PBM), meat and bone meal (MBM), soybean meal (SBM), cottonseed meal (CSM) and canola meal (CNM). Fifteen percent of the crude protein provided by fish meal was replaced, respectively. The results showed that the differences in specific growth rate (SGR) and survival rate (SR) among fish fed PBM, MBM, SBM, CSM and whole FM diets were not significant. However, SGR and SR of fish fed CNM diet was significantly lower than that of other treatments. Feeding rate, feed conversion, nutrient retention showed similar patterns to that of growth. Fish fed CSM and CNM showed significantly lower apparent digestibility coefficient (ADC) of dry matter and gross energy than those fed others while fish fed CNM showed lower ADC of crude protein than those fed others ( P<0.05). These results suggested that it was feasible to substitute 15% dietary protein provided by fishmeal with PBM, MBM, SBM and CSM, respectively, but not with CNM as the replacement with CNM reduced fish growth and feed utilization.

Parameters of infection in replacement and voluntary donors in the western part of Turkey.

PubMed

Uzun, Berrin; Gungor, Serdar; Demirci, Mustafa

2014-08-01

According to our center's experiences familial/replacement donors (FRDs) frequently donate blood for the first time in their lives. Therefore, results of infection parameters are expected to be different voluntary donors (VDs), at similar rates to the population. The present study aimed to investigate if there were any difference in VDs and FRDs in terms of infection parameters. The blood donation records over 6 years (2004-2010) were reviewed, retrospectively. HBsAg, anti-HCV, anti-HIV screening tests were performed by ELISA and syphilis screening was performed by the RPR method. Out of 71.217, 16.727 donors donated whole blood as FRD. Among the whole blood donated by FRD, the positives for HBsAg, anti-HCV and RPR were 1.23%, 0.37%, and 0.07%, respectively. Confirmed anti-HIV screening test was not observed in this group. Positivities for HBsAg, anti-HCV, anti-HIV and RPR in VD were 1.36%, 0.42%, 0.004%, and 0.04%, respectively. When FRD and VD were analyzed statistically, HBsAg rates were significantly higher among FRD in the years 2004, 2007 and 2008, whereas they were significantly high among VD in year 2005. HBsAg rates stated in the years 2006-2009 were insignificant. Significantly high results were observed in HCV rates in the year 2005 among VD, whereas insignificant levels were observed in other years. HIV rates were insignificant among VD in the years 2004 and 2005, confirmed positivity was established in only one patient. Values in all years in RPR rates were statistically insignificant. Grouping donors as replacement and voluntary has no importance in infection parameters. Grouping donors as replacement and voluntary has no importance in infection parameters. Appropriate donor inquiries and screening of infection parameters by reliable proven tests preserve their significances. Copyright © 2014 Elsevier Ltd. All rights reserved.

Transcatheter Heart Valve Selection and Permanent Pacemaker Implantation in Patients With Pre-Existent Right Bundle Branch Block.

PubMed

van Gils, Lennart; Tchetche, Didier; Lhermusier, Thibault; Abawi, Masieh; Dumonteil, Nicolas; Rodriguez Olivares, Ramón; Molina-Martin de Nicolas, Javier; Stella, Pieter R; Carrié, Didier; De Jaegere, Peter P; Van Mieghem, Nicolas M

2017-03-03

Right bundle branch block is an established predictor for new conduction disturbances and need for a permanent pacemaker (PPM) after transcatheter aortic valve replacement. The aim of the study was to evaluate the absolute rates of transcatheter aortic valve replacement related PPM implantations in patients with pre-existent right bundle branch block and categorize for different transcatheter heart valves. We pooled data on 306 transcatheter aortic valve replacement patients from 4 high-volume centers in Europe and selected those with right bundle branch block at baseline without a previously implanted PPM. Logistic regression was used to evaluate whether PPM rate differed among transcatheter heart valves after adjustment for confounders. Mean age was 83±7 years and 63% were male. Median Society of Thoracic Surgeons score was 6.3 (interquartile range, 4.1-10.2). The following transcatheter valve designs were used: Medtronic CoreValve (n=130; Medtronic, Minneapolis, MN); Edwards Sapien XT (ES-XT; n=124) and Edwards Sapien 3 (ES-3; n=32; Edwards Lifesciences, Irvine, CA); and Boston Scientific Lotus (n=20; Boston Scientific Corporation, Marlborough, MA). Overall permanent pacemaker implantation rate post-transcatheter aortic valve replacement was 41%, and per valve design: 75% with Lotus, 46% with CoreValve, 32% with ES-XT, and 34% with ES-3. The indication for PPM implantation was total atrioventricular block in 98% of the cases. Lotus was associated with a higher PPM rate than all other valves. PPM rate did not differ between ES-XT and ES-3. Ventricular paced rhythm at 30-day and 1-year follow-up was present in 81% at 89%, respectively. Right bundle branch block at baseline is associated with a high incidence of PPM implantation for all transcatheter heart valves. PPM rate was highest for Lotus and lowest for ES-XT and ES-3. Pacemaker dependency remained high during follow-up. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Sustainability, Eco-Point and Engineering Performance of Different Workability OPC Fly-Ash Mortar Mixes.

PubMed

Razi, Putri Zulaiha; Abdul Razak, Hashim; Khalid, Nur Hafizah A

2016-05-06

This study investigates the engineering performance and CO₂ footprint of mortar mixers by replacing Portland cement with 10%, 20%, 40% and 60% fly ash, a common industrial waste material. Samples of self-compacting mortar (SCM) were prepared with four different water/binder ratios and varying dosages of superplasticizer to give three ranges of workability, i.e. , normal, high and self-compacting mortar mix. The engineering performance was assessed in term of compressive strength after designated curing periods for all mixes. CO₂ footprint was the environmental impact indicator of each production stage. The optimum mix obtained was at 10% replacement rate for all mixes. Total production emission reduced by 56% when the fly ash replacement rate increased from 0% to 60% (maximum). This is translated to a reduction of 80% in eco-points (assuming that the energy consumption rate of production with 0% fly ash is at 100%). Such re-utilization is encouraged since it is able to reduce possible soil toxicity due to sulfur leaching by 5% to 27% and landfill area by 15% to 91% on average.

Sustainability, Eco-Point and Engineering Performance of Different Workability OPC Fly-Ash Mortar Mixes

PubMed Central

Razi, Putri Zulaiha; Abdul Razak, Hashim; Khalid, Nur Hafizah A.

2016-01-01

This study investigates the engineering performance and CO2 footprint of mortar mixers by replacing Portland cement with 10%, 20%, 40% and 60% fly ash, a common industrial waste material. Samples of self-compacting mortar (SCM) were prepared with four different water/binder ratios and varying dosages of superplasticizer to give three ranges of workability, i.e., normal, high and self-compacting mortar mix. The engineering performance was assessed in term of compressive strength after designated curing periods for all mixes. CO2 footprint was the environmental impact indicator of each production stage. The optimum mix obtained was at 10% replacement rate for all mixes. Total production emission reduced by 56% when the fly ash replacement rate increased from 0% to 60% (maximum). This is translated to a reduction of 80% in eco-points (assuming that the energy consumption rate of production with 0% fly ash is at 100%). Such re-utilization is encouraged since it is able to reduce possible soil toxicity due to sulfur leaching by 5% to 27% and landfill area by 15% to 91% on average. PMID:28773465

Heart valve replacement with the Sorin tilting-disc prosthesis. A 10-year experience.

PubMed

Milano, A; Bortolotti, U; Mazzucco, A; Mossuto, E; Testolin, L; Thiene, G; Gallucci, V

1992-02-01

From 1978 to 1988, 697 patients with a mean age of 48 +/- 11 years (range 5 to 75 years) received a Sorin tilting-disc prosthesis; 358 had had aortic valve replacement, 247 mitral valve replacement, and 92 mitral and aortic valve replacement. Operative mortality rates were 7.8%, 11.3%, and 10.8%, respectively, in the three groups. Cumulative duration of follow-up is 1650 patient-years for aortic valve replacement (maximum follow-up 11.4 years), 963 patient-years for mitral valve replacement (maximum follow-up 9.9 years) and 328 patient-years for mitral and aortic valve replacement (maximum follow-up 9.4 years). Actuarial survival at 9 years is 72% +/- 4% after mitral valve replacement, 70% +/- 3% after aortic valve replacement, and 50% +/- 12% after mitral and aortic valve replacement, and actuarial freedom from valve-related deaths is 97% +/- 2% after mitral valve replacement, 92% +/- 2% after aortic valve replacement, and 62% +/- 15% after mitral and aortic valve replacement. Thromboembolic events occurred in 21 patients with aortic valve replacement (1.3% +/- 0.2%/pt-yr), in 12 with mitral valve replacement (1.2% +/- 0.3% pt-yr), and in seven with mitral and aortic valve replacement (2.1% +/- 0.8%), with one case of prosthetic thrombosis in each group; actuarial freedom from thromboembolism at 9 years is 92% +/- 3% after mitral valve replacement, 91% +/- 3% after aortic valve replacement, and 74% +/- 16% after mitral and aortic valve replacement. Anticoagulant-related hemorrhage was observed in 15 patients after aortic valve replacement (0.9% +/- 0.2%/pt-yr), in 9 after mitral valve replacement (0.9% +/- 0.3%/pt-yr), and in 6 with mitral and aortic valve replacement (0.9% +/- 0.5%/pt-yr); actuarial freedom from this complication at 9 years is 94% +/- 2% after aortic valve replacement, 91% +/- 4% after mitral valve replacement, and 68% +/- 16% after mitral and aortic valve replacement. Actuarial freedom from reoperation at 9 years is 97% +/- 2% after mitral and aortic valve replacement, 92% +/- 4% after mitral valve replacement, and 89% +/- 3% after aortic valve replacement, with no cases of mechanical fracture. The Sorin valve has shown a satisfactory long-term overall performance, comparable with other mechanical prostheses, and an excellent durability that renders it a reliable heart valve substitute for the mitral and aortic positions.

Success of smoking cessation interventions during pregnancy.

PubMed

Bérard, Anick; Zhao, Jin-Ping; Sheehy, Odile

2016-11-01

Smoking during pregnancy is a modifiable risk factor associated with adverse pregnancy outcomes. Smoking during pregnancy has been shown to increase the risk of spontaneous abortion, prematurity, low birthweight, congenital malformations, and sudden infant death syndrome. Despite the fact that it is well known that smoking can lead to adverse pregnancy outcomes, 13-25% of pregnant women overall continue to smoke during this critical period. The objective of the study was to evaluate the effect of gestational use of bupropion and nicotine patch replacement therapy on the risk of the following: (1) smoking cessation, (2) prematurity, and (3) small for gestational age. Women included in the Quebec Pregnancy Cohort who filled the annual autoadministered questionnaire between Jan. 1, 1998, and June 30, 2009, were studied. Smokers before gestation with a pregnancy resulting in a live birth comprised the study population. Three mutually exclusive study groups were formed among those who smoked at the beginning of pregnancy: gestational users of nicotine patch replacement therapy, bupropion, and smokers who did not use nicotine patch replacement therapy or bupropion. Rate of smoking cessation during pregnancy as well as the risk of prematurity and small for gestational age were studied. Of the 1288 women who met inclusion criteria, 900 were smokers, 72 were bupropion users, and 316 were nicotine patch replacement therapy users. Bupropion and nicotine patch replacement therapy use during pregnancy were associated with higher rates of smoking cessation: 81% in the bupropion group; 79% for nicotine patch replacement therapy; and 0% in those not using buproprion or nicotine patch replacement therapy. After discontinuing smoking cessation medications, 60% of bupropion users and 68% of nicotine patch replacement therapy users did not smoke again during and after pregnancy. Adjusting for potential confounders, nicotine patch replacement therapy use was associated with a lower risk of prematurity (adjusted odds ratio, 0.21, 95% confidence interval, 0.13-0.34), and small-for-gestational-age (adjusted odds ratio, 0.61, 95% confidence interval, 0.41-0.90) compared to smoking. Bupropion was associated with a lower risk of prematurity only (adjusted odds ratio, 0.12, 95% confidence interval, 0.03-0.50). Bupropion and nicotine patch replacement therapy have an impact on smoking cessation during and after pregnancy. Nicotine patch replacement therapy also decreased the risk of prematurity and small for gestational age. Copyright © 2016 Elsevier Inc. All rights reserved.

Effect on smoking cessation of switching nicotine replacement therapy to over-the-counter status.

PubMed

Thorndike, Anne N; Biener, Lois; Rigotti, Nancy A

2002-03-01

This study examined whether the change in nicotine replacement therapy sales from prescription to over the counter (OTC) status affected smoking cessation. We used the 1993-1999 Massachusetts Tobacco Surveys to compare data from adult current smokers and recent quitters before and after the OTC switch. No significant change over time occurred in the proportion of smokers who used nicotine replacement therapy at a quit attempt in the past year (20.1% pre-OTC vs 21.4% post-OTC), made a quit attempt in the past year (48.1% vs 45.2%), or quit smoking in the past year (8.1% vs 11.1%). Fewer non-Whites used nicotine replacement therapy after the switch (20.7% pre-OTC vs 3.2% post-OTC, P =.002), but the proportion of Whites using nicotine replacement therapy did not change significantly (20.6% vs 24.0%). We observed no increase in Massachusetts smokers' rates of using nicotine replacement therapy, making a quit attempt, or stopping smoking after nicotine replacement therapy became available for OTC sale. There appear to be other barriers to the use of nicotine replacement therapy besides visiting a physician, especially among minority smokers.

Variant surface glycoprotein density defines an immune evasion threshold for African trypanosomes undergoing antigenic variation.

PubMed

Pinger, Jason; Chowdhury, Shanin; Papavasiliou, F Nina

2017-10-10

Trypanosoma brucei is a protozoan parasite that evades its host's adaptive immune response by repeatedly replacing its dense variant surface glycoprotein (VSG) coat from its large genomic VSG repertoire. While the mechanisms regulating VSG gene expression and diversification have been examined extensively, the dynamics of VSG coat replacement at the protein level, and the impact of this process on successful immune evasion, remain unclear. Here we evaluate the rate of VSG replacement at the trypanosome surface following a genetic VSG switch, and show that full coat replacement requires several days to complete. Using in vivo infection assays, we demonstrate that parasites undergoing coat replacement are only vulnerable to clearance via early IgM antibodies for a limited time. Finally, we show that IgM loses its ability to mediate trypanosome clearance at unexpectedly early stages of coat replacement based on a critical density threshold of its cognate VSGs on the parasite surface. Trypanosoma brucei evades the host immune system through replacement of a variant surface glycoprotein (VSG) coat. Here, the authors show that VSG replacement takes several days to complete, and the parasite is vulnerable to the host immune system for a short period of time during the process.

Long-Term Behavior of Simulated Partial Lead Service Line Replacements

PubMed Central

St. Clair, Justin; Cartier, Clement; Triantafyllidou, Simoni; Clark, Brandi; Edwards, Marc

2016-01-01

Abstract In this 48-month pilot study, long-term impacts of copper:lead galvanic connections on lead release to water were assessed without confounding differences in pipe exposure prehistory or disturbances arising from cutting lead pipe. Lead release was tracked from three lead service line configurations, including (1) 100% lead, (2) traditional partial replacement with 50% copper upstream of 50% lead, and (3) 50% lead upstream of 50% copper as a function of flow rate, connection types, and sampling methodologies. Elevated lead from galvanic corrosion worsened with time, with 140% more lead release from configurations representing traditional partial replacement configurations at 14 months compared to earlier data in the first 8 months. Even when sampled consistently at moderate flow rate (8 LPM) and collecting all water passing through service lines, conditions representing traditional partial service line configurations were significantly worse (≈40%) when compared to 100% lead pipe. If sampled at a high flow rate (32 LPM) and collecting 2 L samples from service lines, 100% of samples collected from traditional partial replacement configurations exceeded thresholds posing an acute health risk versus a 0% risk for samples from 100% lead pipe. Temporary removal of lead accumulations near Pb:Cu junctions and lead deposits from other downstream plastic pipes reduced risk of partial replacements relative to that observed for 100% lead. When typical brass compression couplings were used to connect prepassivated lead pipes, lead release spiked up to 10 times higher, confirming prior concerns raised at bench and field scale regarding adverse impacts of crevices and service line disturbances on lead release. To quantify semirandom particulate lead release from service lines in future research, whole-house filters have many advantages compared to other approaches. PMID:26989344

Satisfaction with joint replacement in public versus private hospitals: a cohort study.

PubMed

Adie, Sam; Dao, Alan; Harris, Ian A; Naylor, Justine M; Mittal, Rajat

2012-09-01

In Australia, the majority of total knee and hip replacement surgeries occur in the private sector. Outcome-based research needs to be inclusive of this sector if the findings are intended to reflect the broader picture. This study compares outcomes up to 1 year post knee and hip replacement between patients treated in the public and private sectors. A prospective, observational study was performed in four high-volume joint replacement centres: two public, two private. Experienced orthopaedic surgeons contributed via their public and private practices. Knee and hip patients were recruited preoperatively. Self-reported questionnaires were completed preoperatively and at 6 and 12 months post-operatively. The primary outcome was satisfaction with surgery. Secondary outcomes included Oxford score, and SF-36 physical and mental component summary scores. Regression modelling was performed to adjust for potential confounders. Three hundred and thirty-one patients (184 public, 147 private; 215 knees, 116 hips) were recruited, with 6- and 12-month follow-up rates of 95% and 89%, respectively. Satisfaction rates were high in both public and private patients (approximately 90%) at 6 and 12 months, but private patients were less likely to be satisfied after adjusting for the strong effect of patient expectation. For both hip and knee cohorts, no between-sector differences were found in either the magnitude or rate of improvement in Oxford score or quality of life post-operatively. Joint replacement outcomes are similar for patients treated in public and private hospitals. Surgeons should manage patient expectation prior to surgery, particularly in private patients. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

WEIGHTED LIKELIHOOD ESTIMATION UNDER TWO-PHASE SAMPLING

PubMed Central

Saegusa, Takumi; Wellner, Jon A.

2013-01-01

We develop asymptotic theory for weighted likelihood estimators (WLE) under two-phase stratified sampling without replacement. We also consider several variants of WLEs involving estimated weights and calibration. A set of empirical process tools are developed including a Glivenko–Cantelli theorem, a theorem for rates of convergence of M-estimators, and a Donsker theorem for the inverse probability weighted empirical processes under two-phase sampling and sampling without replacement at the second phase. Using these general results, we derive asymptotic distributions of the WLE of a finite-dimensional parameter in a general semiparametric model where an estimator of a nuisance parameter is estimable either at regular or nonregular rates. We illustrate these results and methods in the Cox model with right censoring and interval censoring. We compare the methods via their asymptotic variances under both sampling without replacement and the more usual (and easier to analyze) assumption of Bernoulli sampling at the second phase. PMID:24563559

Mate replacement entails a fitness cost for a socially monogamous seabird.

PubMed

Ismar, Stefanie M H; Daniel, Claire; Stephenson, Brent M; Hauber, Mark E

2010-01-01

Studies of the selective advantages of divorce in socially monogamous bird species have unravelled extensive variation among different lineages with diverse ecologies. We quantified the reproductive correlates of mate retention, mate loss and divorce in a highly philopatric, colonially breeding biparental seabird, the Australasian gannet Morus serrator. Estimates of annual divorce rates varied between 40-43% for M. serrator and were high in comparison with both the closely related Morus bassanus and the range of divorce rates reported across monogamous avian breeding systems. Mate retention across seasons was related to consistently higher reproductive success compared with mate replacement, while divorce per se contributed significantly to lower reproductive output only in one of two breeding seasons. Prior reproductive success was not predictive of mate replacement overall or divorce in particular. These patterns are in accordance with the musical chairs hypothesis of adaptive divorce theory, which operates in systems characterised by asynchronous territorial establishment.

Population ageing: what should we worry about?

PubMed Central

Turner, Adair

2009-01-01

Approximately half the world's population now has replacement-level fertility or below. The UK experience in accommodating to a changing dependency ratio provides some generalizable insights. A mechanistic approach assuming a fixed retirement age and a need to raise fertility or increase immigration in order to maintain pensions at a fixed proportion of the gross domestic product (GDP) is overstated and wrong. It needs to be replaced by a welfare optimizing model, which takes into account the increasing years of healthy life, a slow rise in the pensionable age, capital inheritance and wider welfare considerations of population density that are not reflected in GDP measures. A combined replacement ratio (CRR) is suggested for developed countries combining the impact of the fertility rate and immigration rate. A CRR above 2 implies continued population growth. The current UK CRR of 2.48 is higher than needed for pension reasons, and it is suggested that it exceeds the welfare maximizing level. PMID:19770152

Mate replacement entails a fitness cost for a socially monogamous seabird

NASA Astrophysics Data System (ADS)

Ismar, Stefanie M. H.; Daniel, Claire; Stephenson, Brent M.; Hauber, Mark E.

2010-01-01

Studies of the selective advantages of divorce in socially monogamous bird species have unravelled extensive variation among different lineages with diverse ecologies. We quantified the reproductive correlates of mate retention, mate loss and divorce in a highly philopatric, colonially breeding biparental seabird, the Australasian gannet Morus serrator. Estimates of annual divorce rates varied between 40-43% for M. serrator and were high in comparison with both the closely related Morus bassanus and the range of divorce rates reported across monogamous avian breeding systems. Mate retention across seasons was related to consistently higher reproductive success compared with mate replacement, while divorce per se contributed significantly to lower reproductive output only in one of two breeding seasons. Prior reproductive success was not predictive of mate replacement overall or divorce in particular. These patterns are in accordance with the musical chairs hypothesis of adaptive divorce theory, which operates in systems characterised by asynchronous territorial establishment.

Energy dissipation rate as a determiner of Langmuir Wave turbulence in Stimulated Raman Scattering

NASA Astrophysics Data System (ADS)

Rose, Harvey A.

1998-11-01

In the steady state, the Manley Rowe relation relates the spatial growth of backscattered SRS to the local rate of Langmuir wave (LW) energy dissipation, ɛ. Past some threshold, the beating of the laser and the backscatter generates LW turbulence (LWT). Numerical simulations of SRS support the thesis that the LWT properties, such as various energy densities and enhanced LW decay rate, ν _eff, are determined primarily by ɛ, in the "inertial regime", where ν _eff>>ν_0, the linear rate, thus providing the basis for an SRS-LWT model. Energy conservation and turbulent stabilization of the SRS daughter LW against the decay instability imply that (ν_eff)^2>ω _pɛ /(16ν_ianT_e). Simulations reveal that, qualitatively, the inequality may be replaced by equality if the factor of 16 is replaced by 8.

Roguing with replacement in perennial crops: conditions for successful disease management.

PubMed

Sisterson, Mark S; Stenger, Drake C

2013-02-01

Replacement of diseased plants with healthy plants is commonly used to manage spread of plant pathogens in perennial cropping systems. This strategy has two potential benefits. First, removing infected plants may slow pathogen spread by eliminating inoculum sources. Second, replacing infected plants with uninfected plants may offset yield losses due to disease. The extent to which these benefits are realized depends on multiple factors. In this study, sensitivity analyses of two spatially explicit simulation models were used to evaluate how assumptions concerning implementation of a plant replacement program and pathogen spread interact to affect disease suppression. In conjunction, effects of assumptions concerning yield loss associated with disease and rates of plant maturity on yields were simultaneously evaluated. The first model was used to evaluate effects of plant replacement on pathogen spread and yield on a single farm, consisting of a perennial crop monoculture. The second model evaluated effects of plant replacement on pathogen spread and yield in a 100 farm crop growing region, with all farms maintaining a monoculture of the same perennial crop. Results indicated that efficient replacement of infected plants combined with a high degree of compliance among farms effectively slowed pathogen spread, resulting in replacement of few plants and high yields. In contrast, inefficient replacement of infected plants or limited compliance among farms failed to slow pathogen spread, resulting in replacement of large numbers of plants (on farms practicing replacement) with little yield benefit. Replacement of infected plants always increased yields relative to simulations without plant replacement provided that infected plants produced no useable yield. However, if infected plants produced useable yields, inefficient removal of infected plants resulted in lower yields relative to simulations without plant replacement for perennial crops with long maturation periods in some cases.

Improving the Estimates of International Space Station (ISS) Induced K-Factor Failure Rates for On-Orbit Replacement Unit (ORU) Supportability Analyses

NASA Technical Reports Server (NTRS)

Anderson, Leif F.; Harrington, Sean P.; Omeke, Ojei, II; Schwaab, Douglas G.

2009-01-01

This is a case study on revised estimates of induced failure for International Space Station (ISS) on-orbit replacement units (ORUs). We devise a heuristic to leverage operational experience data by aggregating ORU, associated function (vehicle sub -system), and vehicle effective' k-factors using actual failure experience. With this input, we determine a significant failure threshold and minimize the difference between the actual and predicted failure rates. We conclude with a discussion on both qualitative and quantitative improvements the heuristic methods and potential benefits to ISS supportability engineering analysis.

Irrigant flow within a prepared root canal using various flow rates: a Computational Fluid Dynamics study.

PubMed

Boutsioukis, C; Lambrianidis, T; Kastrinakis, E

2009-02-01

To study using computer simulation the effect of irrigant flow rate on the flow pattern within a prepared root canal, during final irrigation with a syringe and needle. Geometrical characteristics of a side-vented endodontic needle and clinically realistic flow rate values were obtained from previous and preliminary studies. A Computational Fluid Dynamics (CFD) model was created using FLUENT 6.2 software. Calculations were carried out for five selected flow rates (0.02-0.79 mL sec(-1)) and velocity and turbulence quantities along the domain were evaluated. Irrigant replacement was limited to 1-1.5 mm apical to the needle tip for all flow rates tested. Low-Reynolds number turbulent flow was detected near the needle outlet. Irrigant flow rate affected significantly the flow pattern within the root canal. Irrigation needles should be placed to within 1 mm from working length to ensure fluid exchange. Turbulent flow of irrigant leads to more efficient irrigant replacement. CFD represents a powerful tool for the study of irrigation.

Experimental investigation of photocatalytic effects of concrete in air purification adopting entire concrete waste reuse model.

PubMed

Xu, Yidong; Chen, Wei; Jin, Ruoyu; Shen, Jiansheng; Smallbone, Kirsty; Yan, Chunyang; Hu, Lei

2018-07-05

This research investigated the capacities of recycled aggregate concrete adopting entire concrete waste reuse model in degrading NO 2. Two major issues within environmental sustainability were addressed: concrete waste reuse rate and mitigation of hazards substances in the polluted air. The study consisted of two stages: identification of proper replacement rates of recycled concrete wastes in new concrete mixture design, and the evaluation of photocatalytic performance of recycled aggregate concrete in degrading NO 2 . It was found that replacement rates up to 3%, 30%, and 50% for recycled power, recycled fine aggregate, and recycled coarse aggregate respectively could be applied in concrete mixture design without deteriorating concrete strength. Recycled aggregates contained both positive attributes ("internal curing") and negative effects (e.g., lower hardness) to concrete properties. It was found that 30%-50% of natural coarse aggregate replaced by recycled coarse aggregates coated with TiO 2 would significantly improve the photocatalytic performance of concrete measured by degradation rate of NO 2 . Micro-structures of recycled aggregates observed under microscope indicated that soaking recycled aggregates in TiO 2 solution resulted in whiskers that filled the porosity within recycled aggregates which enhanced concrete strength. Copyright © 2018 Elsevier B.V. All rights reserved.

Estimating ages of white-tailed deer: Age and sex patterns of error using tooth wear-and-replacement and consistency of cementum annuli

USGS Publications Warehouse

Samuel, Michael D.; Storm, Daniel J.; Rolley, Robert E.; Beissel, Thomas; Richards, Bryan J.; Van Deelen, Timothy R.

2014-01-01

The age structure of harvested animals provides the basis for many demographic analyses. Ages of harvested white-tailed deer (Odocoileus virginianus) and other ungulates often are estimated by evaluating replacement and wear patterns of teeth, which is subjective and error-prone. Few previous studies however, examined age- and sex-specific error rates. Counting cementum annuli of incisors is an alternative, more accurate method of estimating age, but factors that influence consistency of cementum annuli counts are poorly known. We estimated age of 1,261 adult (≥1.5 yr old) white-tailed deer harvested in Wisconsin and Illinois (USA; 2005–2008) using both wear-and-replacement and cementum annuli. We compared cementum annuli with wear-and-replacement estimates to assess misclassification rates by sex and age. Wear-and-replacement for estimating ages of white-tailed deer resulted in substantial misclassification compared with cementum annuli. Age classes of females were consistently underestimated, while those of males were underestimated for younger age classes but overestimated for older age classes. Misclassification resulted in an impression of a younger age-structure than actually was the case. Additionally, we obtained paired age-estimates from cementum annuli for 295 deer. Consistency of paired cementum annuli age-estimates decreased with age, was lower in females than males, and decreased as age estimates became less certain. Our results indicated that errors in the wear-and-replacement techniques are substantial and could impact demographic analyses that use age-structure information. 

Polyethylene damage and deformation on fixed-bearing, non-conforming unicondylar knee replacements corresponding to progressive changes in alignment and fixation.

PubMed

Harman, Melinda K; Schmitt, Sabine; Rössing, Sven; Banks, Scott A; Sharf, Hans-Peter; Viceconti, Marco; Hodge, W Andrew

2010-07-01

Deviations from nominal alignment of unicondylar knee replacements impact knee biomechanics, including the load and stress distribution at the articular contact surfaces. This study characterizes relationships between the biomechanical environment, distinguished by progressive changes in alignment and fixation, and articular damage and deformation in a consecutive series of retrieved unicondylar knee replacements. Twenty seven fixed-bearing, non-conforming unicondylar knee replacements of one design were retrieved after 2 to 13 years of in vivo function. The in vivo biomechanical environment was characterized by grading component migration measured from full-length radiographs and grading component fixation based on intraoperative manual palpation. Articular damage patterns and linear deformation on the polyethylene inserts were measured using optical photogrammetry and contact point digitization. Articular damage patterns and surface deformation on the explanted polyethylene inserts corresponded to progressive changes in component alignment and fixation. Component migration produced higher deformation rates, whereas loosening contributed to larger damage areas but lower deformation rates. Migration and loosening of the femoral component, but not the tibial component, were factors contributing to large regions of abrasion concentrated on the articular periphery. Classifying component migration and fixation at revision proved useful for distinguishing common biomechanical conditions associated with the varied polyethylene damage patterns and linear deformation for this fixed-bearing, non-conforming design. Pre-clinical evaluations of unicondylar knee replacements that are capable of reproducing variations in clinical alignment and predicting the observed wear mechanisms are necessary to better understand the impact of knee biomechanics and design on unicondylar knee replacement longevity. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Replacement of RNA hairpins by in vitro selected tetranucleotides.

PubMed Central

Dichtl, B; Pan, T; DiRenzo, A B; Uhlenbeck, O C

1993-01-01

An in vitro selection method based on the autolytic cleavage of yeast tRNA(Phe) by Pb2+ was applied to obtain tRNA derivatives with the anticodon hairpin replaced by four single-stranded nucleotides. Based on the rates of the site-specific cleavage by Pb2+ and the presence of a specific UV-induced crosslink, certain tetranucleotide sequences allow proper folding of the rest of the tRNA molecule, whereas others do not. One such successful tetramer sequence was also used to replace the acceptor stem of yeast tRNA(Phe) and the anticodon hairpin of E.coli tRNA(Phe) without disrupting folding. These experiments suggest that certain tetramers may be able to replace structurally nonessential hairpins in any RNA. Images PMID:7680121

Does early return to theatre add value to rates of revision at 3 years in assessing surgeon performance for elective hip and knee arthroplasty? National observational study.

PubMed

Bottle, Alex; Chase, Helen E; Aylin, Paul P; Loeffler, Mark

2018-05-01

Joint replacement revision is the most widely used long-term outcome measure in elective hip and knee surgery. Return to theatre (RTT) has been proposed as an additional outcome measure, but how it compares with revision in its statistical performance is unknown. National hospital administrative data for England were used to compare RTT at 90 days (RTT90) with revision rates within 3 years by surgeon. Standard power calculations were run for different scenarios. Funnel plots were used to count the number of surgeons with unusually high or low rates. From 2006 to 2011, there were 297 650 hip replacements (HRs) among 2952 surgeons and 341 226 knee replacements (KRs) among 2343 surgeons. RTT90 rates were 2.1% for HR and 1.5% for KR; 3-year revision rates were 2.1% for HR and 2.2% for KR. Statistical power to detect surgeons with poor performance on either metric was particularly low for surgeons performing 50 cases per year for the 5 years. The correlation between the risk-adjusted surgeon-level rates for the two outcomes was +0.51 for HR and +0.20 for KR, both p<0.001. There was little agreement between the measures regarding which surgeons had significantly high or low rates. RTT90 appears to provide useful and complementary information on surgeon performance and should be considered alongside revision rates, but low case loads considerably reduce the power to detect unusual performance on either metric. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The Relationship between Job Satisfaction and Educational Leadership among Teachers in Secondary Education

ERIC Educational Resources Information Center

Stevens, Jessica Ann

2013-01-01

The increase in teacher attrition rates within the state of California since 2000 is of concern to the California Department of Education and districts throughout the state because of a myriad of issues created by the loss of qualified teachers. The cost of replacing qualified teachers and recruiting and training new teachers to replace those who…

Effects of Reiki on Pain, Anxiety, and Blood Pressure in Patients Undergoing Knee Replacement: A Pilot Study.

PubMed

Baldwin, Ann Linda; Vitale, Anne; Brownell, Elise; Kryak, Elizabeth; Rand, William

This blinded, controlled pilot study investigated the effects of Reiki on 46 patients undergoing knee replacement surgery. Of the 3 groups, Reiki, Sham Reiki, and Standard of Care, only the Reiki group showed significant reductions in pain, blood pressure, respiration rate, and state anxiety, which provides evidence for a full-scale clinical study.

Mitral valve replacement with preservation of the subvalvular apparatus.

PubMed

Reardon, M J; David, T E

1999-03-01

The introduction of the Starr-Edwards valve allowed complete replacement of diseased left-sided heart valves. With improved cardiopulmonary bypass, myocardial protection, and surgical techniques the mortality rate from aortic valve replacement decreased substantially, whereas the mortality rate from mitral valve replacement remained high, largely because of low cardiac output syndrome. Increasing use of mitral valve repair techniques resulted in a marked decrease in short-term and long-term morbidity and mortality when treating patients with mitral regurgitation. Some believed that this resulted from maintenance of the mitral annular papillary muscle continuity during mitral valve repair. Subsequent experimental and clinical studies have validated the positive short-term and long-term effects of maintaining the integrity of the mitral valve subvalvular apparatus. This article considers the history of the clinical use of preservation of the subvalvular apparatus, the physiologic studies examining this concept, and the clinical data available on its use. It also examines the following: 1) mitral stenosis versus mitral regurgitation and the preservation of the subvalvular apparatus; 2) whether the anterior, posterior, or both areas of the subvalvular apparatus should be preserved; and 3) the surgical techniques for the preservation of the subvalvular apparatus and valve implantation.

Servo-control of water and sodium homeostasis during renal clearance measurements in conscious rats.

PubMed

Thomsen, Klaus; Shirley, David G

2007-01-01

Servo-controlled fluid and sodium replacement during clearance studies is used in order to prevent loss of body fluid and sodium following diuretic/natriuretic procedures. However, even under control conditions, the use of this technique is sometimes associated with increases in proximal tubular fluid output (assessed by lithium clearance) and excretion rates. The present study examined the reason for these increases. The first series of experiments showed that one cause is volume overloading. This can occur if the servo system is activated from the start, i.e., during the establishment of a suitably high urine flow rate by constant infusion of hypotonic glucose solution. The second series of experiments showed that replacement of blood samples with donor blood can also lead to increases in fractional lithium excretion and accompanying increases in water and sodium excretion, a problem not seen when blood samples are replaced with the animal's own red blood cells resuspended in isotonic saline. When these pitfalls are avoided, servo-controlled sodium and fluid replacement is a reliable technique that makes it possible to study the effects of natriuretic and/or diuretic stimuli without interference from unwanted changes in extracellular volume. 2007 S. Karger AG, Basel

The Impact of the Medicaid Health Care-Associated Condition Program on Mediastinitis Following Coronary Artery Bypass Graft

PubMed Central

Hsu, Heather; Kawai, Alison Tse; Wang, Rui; Jentzsch, Maximilian S.; Rhee, Chanu; Horan, Kelly; Jin, Robert; Goldmann, Donald; Lee, Grace M.

2018-01-01

Objective In 2012, the Centers for Medicare and Medicaid Services expanded a 2008 program that eliminated additional Medicare payment for mediastinitis following coronary artery bypass graft (CABG) to include Medicaid. We aimed to evaluate the impact of this Medicaid program on mediastinitis rates reported by the National Healthcare Safety Network (NHSN) compared with rates of a condition not targeted by the program (deep space surgical site infection [SSI] after knee replacement). Design interrupted time series with comparison group. Methods We included surveillance data from non-federal acute care hospitals participating in NHSN and reporting CABG or knee replacement outcomes from 1/2009–6/2017. We examined the Medicaid program’s impact on NHSN-reported infection rates, adjusting for secular trends. Data analysis used generalized estimating equations with robust sandwich variance estimators. Results During the study period, 196 study hospitals reported 273,984 CABGs to NHSN, resulting in 970 mediastinitis cases (0.35%); 294 hospitals reported 555,395 knee replacements, with 1,751 resultant deep space SSIs (0.32%). There were no significant changes in incidence of either condition during the study. Mediastinitis models showed no effect of the 2012 Medicaid program on either secular trend during the post- vs. pre-program time periods (p-value=0.70) or immediate program effect (p-value=0.83). Results were similar in sensitivity analyses when adjusting for hospital characteristics, restricting to hospitals with consistent NHSN reporting, or incorporating a program implementation roll-in period. Knee replacement models also showed no program effect. Conclusions The 2012 Medicaid program to eliminate additional payments for mediastinitis following CABG had no impact on reported mediastinitis rates. PMID:29669607

Research on the Value Evaluation of Used Pure Electric Car Based on the Replacement Cost Method

NASA Astrophysics Data System (ADS)

Tan, zhengping; Cai, yun; Wang, yidong; Mao, pan

2018-03-01

In this paper, the value evaluation of the used pure electric car is carried out by the replacement cost method, which fills the blank of the value evaluation of the electric vehicle. The basic principle of using the replacement cost method, combined with the actual cost of pure electric cars, puts forward the calculation method of second-hand electric car into a new rate based on the use of AHP method to construct the weight matrix comprehensive adjustment coefficient of related factors, the improved method of value evaluation system for second-hand car

Charges on Strange Quark Nuggets in Space

NASA Technical Reports Server (NTRS)

Teplitz, V.; Bhatia, A.; Abers, E.; Dicus, D.; Repko, W.; Rosenbaum, D.

2008-01-01

This viewgraph presentation reviews the work done in calculations to find ZN such that the rate of ambient photons ionize the strange quark nuggets (SQNs) Electrons are equal to the rate of ambient e's to replace them.

Russia’s Demographic Trend: A Population in Steady Decline

DTIC Science & Technology

2009-03-26

epidemic, but a combination of demographic factors that are irreversible in the short term: birth rates well below replacement level, abnormally high death ... rates , and lowered life expectancies. Exacerbating the trend in the future will be the high rate of HIV/AIDS infection Russia is experiencing. This

Effect on Smoking Cessation of Switching Nicotine Replacement Therapy to Over-the-Counter Status

PubMed Central

Thorndike, Anne N.; Biener, Lois; Rigotti, Nancy A.

2002-01-01

Objectives. This study examined whether the change in nicotine replacement therapy sales from prescription to over the counter (OTC) status affected smoking cessation. Methods. We used the 1993–1999 Massachusetts Tobacco Surveys to compare data from adult current smokers and recent quitters before and after the OTC switch. Results. No significant change over time occurred in the proportion of smokers who used nicotine replacement therapy at a quit attempt in the past year (20.1% pre-OTC vs 21.4% post-OTC), made a quit attempt in the past year (48.1% vs 45.2%), or quit smoking in the past year (8.1% vs 11.1%). Fewer non-Whites used nicotine replacement therapy after the switch (20.7% pre-OTC vs 3.2% post-OTC, P = .002), but the proportion of Whites using nicotine replacement therapy did not change significantly (20.6% vs 24.0%). Conclusions. We observed no increase in Massachusetts smokers' rates of using nicotine replacement therapy, making a quit attempt, or stopping smoking after nicotine replacement therapy became available for OTC sale. There appear to be other barriers to the use of nicotine replacement therapy besides visiting a physician, especially among minority smokers. (Am J Public Health. 2002;92:437–442) PMID:11867326

The impact of changes in LVEF and renal function on the prognosis of ICD patients after elective device replacement.

PubMed

Vandenberk, Bert; Robyns, Tomas; Garweg, Christophe; Floré, Vincent; Foulon, Stefaan; Voros, Gabor; Ector, Joris; Willems, Rik

2017-10-01

A proportion of patients with an implantable cardioverter-defibrillator (ICD) in prevention of sudden cardiac death will only receive their first appropriate ICD therapy (AT) after device replacement. Clinical reassessment at the time of replacement could be helpful to guide the decision to replace or not in the future. All patients with an ICD for primary or secondary prevention in ischemic (ICM) or nonischemic cardiomyopathy were included in a single-center retrospective registry. The association of changes in left ventricular ejection fraction (LVEF; cut-off at 35%), worsening renal function (decrease in estimated glomerular filtration rate > 15 mL/min), and worsening New York Heart Association class at elective device replacement with mortality and AT was analyzed using adjusted Cox regression analysis. A total of 238 (33%) out of 727 patients received elective device replacement (86.1% male, 74.4% ICM, 42.9% primary prevention). During this replacement 20.2% received a device upgrade. The mean time to replacement was 6.4 ± 2.0 years and mean follow-up after replacement was 3.4 ± 3.0 years. Of patients who did not receive AT before replacement 23.1% received their first AT after replacement. Worsening renal function (hazard ratio [HR] 2.79, 95% confidence interval [CI] 1.50-5.18) and a consistently LVEF ≤35% compared to a consistently LVEF >35% (HR 2.15, 95% CI 1.10-4.19) at the time of replacement were independent predictors of mortality. Independent predictors of first AT after replacement could not be identified. Although reassessment of LVEF and renal function at replacement can be helpful in predicting total mortality, the clinical utility to guide reimplantation seemed limited. Our experience indicates that approximately 25% of patients received their first AT only after replacement. © 2017 Wiley Periodicals, Inc.

Pilot-in-the-Loop Evaluation of a Yaw Rate to Throttle Feedback Control with Enhanced Engine Response

NASA Technical Reports Server (NTRS)

Litt, Jonathan S.; Guo, Ten-Huei; Sowers, T. Shane; Chicatelli, Amy K.; Fulton, Christopher E.; May, Ryan D.; Owen, A. Karl

2012-01-01

This paper describes the implementation and evaluation of a yaw rate to throttle feedback system designed to replace a damaged rudder. It can act as a Dutch roll damper and as a means to facilitate pilot input for crosswind landings. Enhanced propulsion control modes were implemented to increase responsiveness and thrust level of the engine, which impact flight dynamics and performance. Piloted evaluations were performed to determine the capability of the engines to substitute for the rudder function under emergency conditions. The results showed that this type of implementation is beneficial, but the engines' capability to replace the rudder is limited.

State funding for higher education and RN replacement rates by state: a case for nursing by the numbers in state legislatures.

PubMed

Bargagliotti, L Antoinette

2009-01-01

Amid an enduring nursing shortage and state budget shortfalls, discerning how the percentage of state funding to higher education and other registered nurse (RN) workforce variables may be related to the RN replacement rates (RNRR) in states has important policy implications. Regionally, the age of RNs was inversely related to RNRR. State funding in 2000 significantly predicted the 2004 RNRR, with the percentage of LPNs in 2004 adding to the model. The stability of the model using 2000 and 2004 funding data suggests that state funding creates a climate for RNRR.

Wheat products as acceptable substitutes for rice.

PubMed

Yu, B H; Kies, C

1993-07-01

The objective of the study was to compare the acceptability to semi-trained US American and Asian palatability panelist, of four wheat products processed to be possible replacers of rice in human diets. Products evaluated using rice as the control standard of excellence were steamed whole wheat, couscous (steamed, extracted wheat flour semolina), rosamarina (rice shaped, extracted wheat flour pasta), and bulgar (steamed, pre-cooked partly debranned, cracked wheat). Using a ten point hedonic rating scale, both groups of panelists gave rosamarina closely followed by couscous, most favorable ratings although these ratings were somewhat lower than that of the positive control, steamed polished rice. Bulgar wheat was given the lowest evaluation and was, in general, found to be an unacceptable replacement for rice by both American and Asian judges because of its dark, 'greasy' color and distinctive flavor. In their personal dietaries, judges included rice from 0.25 to 18 times per week with the Asian judges consuming rice significantly more times per week than did the American judges (10.8 +/- 4.71 vs 1.75 +/- 1.65, p < 0.01). However, rice consumption patterns, nationality, race, or sex of the judges was not demonstrated to affect scoring of the wheat products as rice replacers.

Assessing the guidelines for potassium replacement in pediatric oncology patients receiving amphotericin B.

PubMed

Lafreniere, Janet A; Hamilton, Donald P; Carr, Roxane R

2006-10-01

To examine the practice of potassium chloride (KCl) replacement in pediatric oncology patients receiving amphotericin B (amp-B). A retrospective observational chart review was conducted of patients who received amp-B on the oncology unit between August 2000 and May 2001. A survey was distributed to pediatric oncology pharmacists at other pediatric institutions to assess KCl infusion guidelines across North America. Twenty hypokalemic episodes were identified within 22 patient admissions. Fifty-five percent used KCl replacement (by all combined routes) at rates exceeding the institution's guidelines. Other pediatric institutions varied with respect to the maximum rates and concentration of KCl permitted on non-intensive care units. Based on the data from this review, the KCl administration guidelines for our hospital were changed. We now allow a maximum peripheral line concentration of 60 mEq/L, a maximum central line concentration of 120 mEq/L and a maximum KCl infusion rate of 0.4 mEq/kg/hr without the requirement of a heart monitor. Parenteral Nutrition is now restricted to maximum potassium concentration of 80 mEq/L and fluid-restricted patients are restricted to a maximum concentration of 150 mEq/L.

Joint Tactical Radio System Handheld, Manpack, and Small Form Fit Radios (JTRS HMS)

DTIC Science & Technology

2013-12-01

requisitions through the Standard Army Supply System ( SASS ). All radios procured under the Full Rate Production (FRP) phase that become unserviceable...will be turned-in to TYAD through the SASS . Radios will be returned to the original equipment manufacturer vendor for warranty repair, or replacement...procure sustainment spares to replace unserviceable radios and ancillary items requisitioned through SASS , operations, maintenance, training

The Role of New Removable Complete Dentures in Stimulated Salivary Flow and Taste Perception.

PubMed

Tango, Rubens Nisie; Arata, Anelyse; Borges, Alexandre Luiz Souto; Costa, Anna K F; Pereira, Luciano Jose; Kaminagakura, Estela

2018-04-01

To evaluate the effect of replacement of inadequate complete dentures on salivary flow and taste perception in geriatric patients. Thirty-three patients, 13 males and 20 females, with a mean age of 64.4 years were submitted to stimulated and unstimulated salivary flow rate and salivary pH measurements, and sense of taste evaluation. Tests were performed 3 months before complete denture substitution and 3 weeks after denture insertion. The mean for unstimulated saliva (USS) was 2.1 ml before and 2.7 ml after replacement (p = 0.003). The mean volume of stimulated saliva was 6.3 ml before and 8.2 ml after replacement (p = 0.004). The pH mean of USS was 7.8 ± 0.44 before and 8.02 ± 0.41 after replacement (p = 0.005). No statistically significant difference was determined in the sense of taste before and 3 weeks after complete denture replacement. The replacement of inadequate complete dentures increases saliva flow; however, it does not improve taste perception. © 2016 by the American College of Prosthodontists.

The use of autologous concentrated growth factors to promote syndesmosis fusion in the Agility total ankle replacement. A preliminary study.

PubMed

Coetzee, J Chris; Pomeroy, Gregory C; Watts, J David; Barrow, Craig

2005-10-01

The Agility (DePuy, Warsaw, Indiana) total ankle replacement has been in use since 1984. One of the most common complications continues to be delayed union or nonunions of the distal tibiofibular syndesmosis. In the reported studies on the Agility ankle the delayed union and nonunion rate can be as high as 38%. Since 1999, 114 Agility total ankle replacements were done at two centers in the United States without the use of autologous concentrated growth factors. Since July of 2001, 66 Agility ankles were implanted with Symphony (DePuy, Warsaw, Indiana) augmented bone grafting. The standard operative technique was followed in all the patients. Prospective data was collected on all patients. The standard ankle radiographs were taken preoperatively and postoperative at 8 weeks, 12 weeks, 16 weeks, 6 months, and yearly. CT scans were obtained at 6 months if fusion at the syndesmosis was questionable. The Graphpad Instat software (Graphpad Software Inc., San Diego, CA) was used for statistical analysis. The two-tailed unpaired t-test was used, and the value <0.05 was considered significant. There was no statistical difference in the demographic data for the two groups. In 114 ankle replacements without autologous concentrated growth factors 70 fused at 8 weeks (61%), 14 fused at 12 weeks (12%), 13 fused at 6 months (12%). There were 17 nonunions (15%); delayed unions (3 to 6 months) and nonunions, therefore, equaled 27%. The syndesmosis fused in 50 of the 66 ankle replacements (76%) that had autologous concentrated growth fractures at 8 weeks (76%); 12 fused at 3 months (18%), 2 fused at 6 months (3%), 2 had nonunions (3%). Delayed unions (3 to 6 months) and nonunions equaled 6%. There was a statistically significant improvement in the 8- and 12-week fusion rates, and a statistically significant reduction in delayed unions and nonunions. Autologous concentrated growth factors appear to make a significant positive difference in the syndesmosis union rate in total ankle replacements.

[Short and long term results of aortic valve replacement in patients 80 years of age and older].

PubMed

Mortasawi, A; Gehle, S; Yaghmaie, M; Schröder, T; Ennker, I C; Rosendahl, U; Albert, A; Ennker, J

2001-03-01

Due to demographic changes in average life expectancy the age of patients undergoing cardiac surgery is increasing as well. We have reviewed the short- and long-term outcome in patients over 80 years of age after aortic valve replacement with or without concomitant coronary grafting. From 1.1.1995 until 31.12.1999, 126 patients (93 women, 33 men between 80 and 89 years, 82.8 +/- 2.4) underwent aortic valve replacement. 64 patients (group A) received isolated valve replacement, 62 (group B) underwent myocardial revascularization as well. The 30-day hospital mortality rate was 6.3% for group A and 14.5% for group B. The follow-up time ranged between 3 and 63 months (32 +/- 16). None of the patients had to be reoperated for prosthetic valve dysfunction or endocarditis. Bleeding complications due to anticoagulation therapy were observed by one patient from group A 3 years after the operation. Of the 15 deaths during the follow-up period seven (47%) were cardiac in nature and two (13%) related to stroke. Acturial survival rates for group A were 89%, 85% and 77% at 1, 2 and 3 years, and for group B 76%, 72% and 70%. Permanent nursing care was not required 1 year after the operation by 100% of patients in group A (2 years: 98%, 3 years 95%) and by 100% of patients in group B (2 years: 93%, 3 years: 90%). At an interval of 1 year after the operation 96% of patients in group A had not been hospitalized as a result of cardiac disorders (2 years: 96%, 3 years: 94%). The rates for group B were 88%, 81% and 75%. Compared with younger age groups, aortic valve replacement in patients 80 years of age and older is associated with a distinctly increased mortality and morbidity. However, our data suggest that considering the poor prognosis of conservative therapy of symptomatic aortic valve disease, functional status as well as life expectancy in this age group seem to be positively influenced by aortic valve replacement.

Spontaneous transition of replacive to displacive growth of dolomite in burial dolomitization, and of serpentine in serpentinization

NASA Astrophysics Data System (ADS)

Merino, E.; Canals, A.

2011-12-01

Burial dolostones consist of huge volumes of dolomite that has replaced limestone volume for volume, with patches < 10 meters across of thin, equidistant "zebra" veins that are displacive. Characteristically, the contact between the two dolomite types is, under the microscope, seamless. This has long puzzled carbonate petrologists, who have mistaken the displacive dolomite veins for "void-filling cements" and therefore expect a sharp contact between the two dolomite types. The replacive dolomite forms not by dissolution-precipitation as usually assumed, but by dolomite-growth-driven pressure solution of the host calcite -- if the host is sufficiently viscous, or rigid. The local stress induced by the dolomite growth self-adjusts automatically so as to force the rates of dolomite growth and calcite pressure-solution to be mutually equal at each moment of the replacement. That is why replacement is always isovolumetric. But the dolomite-for-calcite replacement is self-accelerating via Ca2+ (each replacement increment releases Ca2+, which increases the activity product for dolomite and thus the rate of the next replacement increment, and so on), and crystalline carbonates are non-newtonian solids of the softening kind (as shown experimentally, Heard & Raleigh 1972). Thus, when the dolomite-for-calcite replacement becomes fast enough to reduce the local rock viscosity sufficiently, and if aqueous Mg2+ has not run out by then, the replacive growth will inevitably, and seamlessly, transition to displacive growth. This is when incipient zebra veins start to form. Each vein interacts with its neighbors via the induced stress they exert on each other, which leads to a "weeding" feedback that pressure dissolves some veins (the ones that find themselves too close to their neighbors), leaving the surviving ones more equidistant than before. Dolomitic zebra veins, or "rhythmites", are a good example of syntaxial veins. The same process and feedbacks, via Mg2+ instead of via Ca2+, take place in the serpentinization of ultrabasic rocks, leading also to displacive zebra veins of serpentine in seamless contact with the host, replacive serpentine. The origin of the dolomite zebra veins above turns out to have a serendipitous proof. The same feedback that causes the dolomite-for-calcite replacement to self-accelerate exponentially, raises the pore-fluid Ca2+ concentration also exponentially. Consequently, when the rheological replacement-to-displacement transition takes place, the displacive dolomite is growing under such a huge Ca2+ concentration that some Ca2+, even as submicroscopic calcitic slivers, is forced to substitute for Mg2+ in the structure of the growing dolomite, deforming and curving it. This is why the displacive zebra veins always consist of dolomite crystals that are curved, called saddle dolomite. It also explains why some calcite forms right after the dolomite veins stop growing, as a cement and/or back-replacing dolomite.

Influence of growth rate and onset of boar contact on puberty attainment of replacement gilts raised in Thailand.

PubMed

Roongsitthichai, Atthaporn; Olanratmanee, Em-On; Tummaruk, Padet

2014-10-01

This study aimed to investigate the influence of growth rate and onset of boar contact on age at first observed estrus of the replacement gilts raised in Thailand. In total, 766 gilts were measured for body weight and backfat thickness prior to insemination. Body weight was further calculated for growth rate. Estrus detection was performed twice a day by back pressure test with an existence of mature boars with high libido. The first date of boar exposure and that of first observed estrus were individually recorded. Due to growth rate, they were classified into three groups: high (>700 g/day), moderate (600-700 g/day), and low (<600 g/day). According to onset of boar contact, the gilts were grouped into two categories: early (<150 days) and late (≥150 days). The results revealed that the gilts expressed first observed estrus, averagely, at age 205.1 ± 34.1 days, had a growth rate of 615.5 ± 57.6 g/day, and first contact with boars at 160.7 ± 19.9 days of age. The gilts with low growth rate expressed first estrus later than those with moderate (208.6 ± 2.0 vs 198.0 ± 3.2 days, P = 0.033) and high growth rate (208.6 ± 2.0 vs 193.9 ± 6.7 days, P = 0.005) groups. Together with the influence of boar exposure, the gilts contacted boar earlier with high growth rate showed first estrus at age 180.3 ± 10.1 days, whereas those with later boar contact with low growth rate showed first estrus at age 197.9 ± 3.2 days. In summary, the replacement gilts should have high growth rate and contact boar early to attain puberty faster and possess decent subsequent reproductive performance.

Early and 1-year outcomes of aortic root surgery in patients with Marfan syndrome: a prospective, multicenter, comparative study.

PubMed

Coselli, Joseph S; Volguina, Irina V; LeMaire, Scott A; Sundt, Thoralf M; Connolly, Heidi M; Stephens, Elizabeth H; Schaff, Hartzell V; Milewicz, Dianna M; Vricella, Luca A; Dietz, Harry C; Minard, Charles G; Miller, D Craig

2014-06-01

To compare the 1-year results after aortic valve-sparing (AVS) or valve-replacing (AVR) aortic root replacement from a prospective, international registry of 316 patients with Marfan syndrome (MFS). Patients underwent AVS (n = 239, 76%) or AVR (n = 77, 24%) aortic root replacement at 19 participating centers from 2005 to 2010. One-year follow-up data were complete for 312 patients (99%), with imaging findings available for 293 (94%). The time-to-events were compared between groups using Kaplan-Meier curves and Cox proportional hazards models. Two patients (0.6%)--1 in each group--died within 30 days. No significant differences were found in early major adverse valve-related events (MAVRE; P = .6). Two AVS patients required early reoperation for coronary artery complications. The 1-year survival rates were similar in the AVR (97%) and AVS (98%) groups; the procedure type was not significantly associated with any valve-related events. At 1 year and beyond, aortic regurgitation of at least moderate severity (≥2+) was present in 16 patients in the AVS group (7%) but in no patients in the AVR group (P = .02). One AVS patient required late AVR. AVS aortic root replacement was not associated with greater 30-day mortality or morbidity rates than AVR root replacement. At 1 year, no differences were found in survival, valve-related morbidity, or MAVRE between the AVS and AVR groups. Of concern, 7% of AVS patients developed grade ≥2+ aortic regurgitation, emphasizing the importance of 5 to 10 years of follow-up to learn the long-term durability of AVS versus AVR root replacement in patients with MFS. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Impact of treatment on Pb release from full and partially replaced harvested Lead Service Lines (LSLs).

PubMed

Cartier, Clément; Doré, Evelyne; Laroche, Laurent; Nour, Shokoufeh; Edwards, Marc; Prévost, Michèle

2013-02-01

Release of lead from 80% partially replaced service lines was compared to full lead service lines using harvested-stabilized lead pipes and field brass connectors. After more than a year of stabilization, lead release was consistent with field samples. Over the relatively short duration partial replacement of lead pipe by copper pipe (3 months), generated high lead release, attributed to galvanic corrosion, resulting in a final outcome for lead release that was even worse than for a full lead pipe. Increased lead release was especially evident at higher flow rates. Orthophosphate reduced lead release from full lead pipes by 64%. For partially replaced samples with copper, lead concentrations were unchanged by phosphate dosing at moderate flow (103 ± 265 vs 169 ± 349 μg/L) and were increased to very high levels when sampled at high flow rates (1001 ± 1808 vs 257 ± 224 μg/L). The increase lead release was in the form of particulate lead (>90%). In comparison to the condition without treatment, increased sulfate treatment had little impact on lead release from 100%-Pb rigs but reduced lead release from partially replaced lead pipes with copper. Our results also raise questions concerning protocols based on short 30 min stagnation (as those used in Canada) due to their incapacity to consider particulate lead release generated mostly after longer stagnation. Copyright © 2012 Elsevier Ltd. All rights reserved.

Proteaceae from severely phosphorus-impoverished soils extensively replace phospholipids with galactolipids and sulfolipids during leaf development to achieve a high photosynthetic phosphorus-use-efficiency.

PubMed

Lambers, Hans; Cawthray, Gregory R; Giavalisco, Patrick; Kuo, John; Laliberté, Etienne; Pearse, Stuart J; Scheible, Wolf-Rüdiger; Stitt, Mark; Teste, François; Turner, Benjamin L

2012-12-01

Proteaceae species in south-western Australia occur on severely phosphorus (P)-impoverished soils. They have very low leaf P concentrations, but relatively fast rates of photosynthesis, thus exhibiting extremely high photosynthetic phosphorus-use-efficiency (PPUE). Although the mechanisms underpinning their high PPUE remain unknown, one possibility is that these species may be able to replace phospholipids with nonphospholipids during leaf development, without compromising photosynthesis. For six Proteaceae species, we measured soil and leaf P concentrations and rates of photosynthesis of both young expanding and mature leaves. We also assessed the investment in galactolipids, sulfolipids and phospholipids in young and mature leaves, and compared these results with those on Arabidopsis thaliana, grown under both P-sufficient and P-deficient conditions. In all Proteaceae species, phospholipid levels strongly decreased during leaf development, whereas those of galactolipids and sulfolipids strongly increased. Photosynthetic rates increased from young to mature leaves. This shows that these species extensively replace phospholipids with nonphospholipids during leaf development, without compromising photosynthesis. A considerably less pronounced shift was observed in A. thaliana. Our results clearly show that a low investment in phospholipids, relative to nonphospholipids, offers a partial explanation for a high photosynthetic rate per unit leaf P in Proteaceae adapted to P-impoverished soils. © 2012 The Authors. New Phytologist © 2012 New Phytologist Trust.

The Replacement Rate: An Imperfect Indicator of Pension Adequacy in Cross-Country Analyses.

PubMed

Chybalski, Filip; Marcinkiewicz, Edyta

Pension systems are usually evaluated from the perspective of two basic criteria: pension adequacy and financial sustainability. The first criterion concerns the level of pension benefits and protection of the elderly from poverty. The second criterion applies to financial liquidity. This paper is primarily of methodological nature. We discuss the problem of measuring pension adequacy, focusing mainly on the replacement rate, which, defined in a number of ways, is the most common measure of pension adequacy. However, as we argue in this paper, it covers only one of its dimensions, namely consumption smoothing. Meanwhile, an equally important dimension, often discussed in the literature and included in most definitions of pension adequacy, is protection of old-age pensioners from poverty. Accordingly, we have proved the thesis that the replacement rate is not a sufficient measure of broadly understood pension adequacy in cross-country studies. Consequently, we have proposed alternative (or possibly complementary) measures called the synthetic pension adequacy indicators (SPAI1-3), defined in basic form as a quotient of relative median income and the at-risk-of-poverty rate. These indicators provide for both the above-mentioned dimensions of adequacy and, according to statistical analysis, also represent them very well. Moreover, the indicators, calculated separately for men and for women, enables evaluation of the third dimension of pension adequacy, namely gender-related differences in pension adequacy.

A Phenomenological Study of Mentoring Policies and Practices on Special Education Teachers

ERIC Educational Resources Information Center

Smith-Washington, Vannessa A.

2017-01-01

High teacher attrition rates adversely affect beginning special education teachers remaining on the job many of whom lack teaching experience. With high rates, replacements are needed, especially in the field of special education where new teachers leave at higher rates than general education teachers. The general problem is that limited…

MRI change metrics of facioscapulohumeral muscular dystrophy: Stir and T1.

PubMed

Ferguson, Mark R; Poliachik, Sandra L; Budech, Christopher B; Gove, Nancy E; Carter, Gregory T; Wang, Leo H; Miller, Daniel G; Shaw, Dennis W W; Friedman, Seth D

2018-06-01

MRI evaluation in facioscapulohumeral muscular dystrophy (FSHD) demonstrates fatty replacement and inflammation/edema in muscle. Our previous work demonstrated short T1 inversion recovery (STIR)-hyperintense (STIR+) signal in muscle 2 years before fatty replacement. We evaluated leg muscle STIR changes and fatty replacement within 14 months. FSHD subjects received 2 MRI scans of thigh and calf over a 6.9- to 13.8-month interval. Quality of life measures were collected. One Radiologist rated muscle changes on a semi-quantitative scale. Fifteen subjects completed longitudinal imaging. Four STIR + muscles and 3 STIR-normal (STIR-) muscles were rated as progressing to fatty tissue over the study period. STIR + muscles with confluent regions of fat at baseline increased more in fat, while STIR- muscles had increases in septal-fat over the study period. These changes may reflect two phases of FSHD, demonstrating MRI sensitivity is weighted toward gross pathological phases of the disease. Muscle Nerve 57: 905-912, 2018. © 2017 Wiley Periodicals, Inc.

Systematic bacterialization of yeast genes identifies a near-universally swappable pathway

PubMed Central

Kachroo, Aashiq H; Laurent, Jon M; Akhmetov, Azat; Szilagyi-Jones, Madelyn; McWhite, Claire D; Zhao, Alice; Marcotte, Edward M

2017-01-01

Eukaryotes and prokaryotes last shared a common ancestor ~2 billion years ago, and while many present-day genes in these lineages predate this divergence, the extent to which these genes still perform their ancestral functions is largely unknown. To test principles governing retention of ancient function, we asked if prokaryotic genes could replace their essential eukaryotic orthologs. We systematically replaced essential genes in yeast by their 1:1 orthologs from Escherichia coli. After accounting for mitochondrial localization and alternative start codons, 31 out of 51 bacterial genes tested (61%) could complement a lethal growth defect and replace their yeast orthologs with minimal effects on growth rate. Replaceability was determined on a pathway-by-pathway basis; codon usage, abundance, and sequence similarity contributed predictive power. The heme biosynthesis pathway was particularly amenable to inter-kingdom exchange, with each yeast enzyme replaceable by its bacterial, human, or plant ortholog, suggesting it as a near-universally swappable pathway. DOI: http://dx.doi.org/10.7554/eLife.25093.001 PMID:28661399

Replacing intrusive thoughts: investigating thought control in relation to OCD symptoms.

PubMed

Ólafsson, Ragnar P; Snorrason, Ívar; Bjarnason, Reynar K; Emmelkamp, Paul M G; Ólason, Daníel Þ; Kristjánsson, Árni

2014-12-01

Control of obsessive thoughts in Obsessive Compulsive Disorder (OCD) involves both avoidance and removal of undesirable intrusive thoughts. Thought suppression tasks tap both of these processes but experimental results have been inconsistent. Experimental tasks allowing more focused study of the processes involved in controlling intrusive thoughts may be needed. In two experiments, control over neutral, standardized intrusive and personal intrusive thoughts was investigated as participants attempted to replace them with neutral thoughts. Non-selected university students (Experiment 1: N = 61) and university students scoring high and low on self-report measure of OC symptoms (Experiment 2: N = 40) performed a computerized thought replacement task. In experiment 1 replacing personal intrusive thoughts took longer than replacing neutral thoughts. Self-reports showed that intrusive thoughts were rated more difficult to replace and were associated with greater thought reoccurrence during replacement, larger emotional reaction and more discomfort. These results were largely replicated in experiment 2. Furthermore, the high OC symptom group experienced greater overall difficulty controlling thoughts on the replacement task, experienced more reoccurrences of personal intrusive thoughts, larger emotional reactions and discomfort associated with them, and felt a greater urge to remove them. All participants were non-clinical university students, and older adults with OCD should be tested. The findings are in line with cognitive behavioural theories of OCD. They support the usefulness of thought replacement as a research paradigm to study thought control in OCD and possibly other psychological conditions characterized by repetitive thoughts. Copyright © 2014 Elsevier Ltd. All rights reserved.

Preimplantation genetic diagnosis and screening by array comparative genomic hybridisation: experience of more than 100 cases in a single centre.

PubMed

Chow, J Fc; Yeung, W Sb; Lee, V Cy; Lau, E Yl; Ho, P C; Ng, E Hy

2017-04-01

Preimplantation genetic screening has been proposed to improve the in-vitro fertilisation outcome by screening for aneuploid embryos or blastocysts. This study aimed to report the outcome of 133 cycles of preimplantation genetic diagnosis and screening by array comparative genomic hybridisation. This study of case series was conducted in a tertiary assisted reproductive centre in Hong Kong. Patients who underwent preimplantation genetic diagnosis for chromosomal abnormalities or preimplantation genetic screening between 1 April 2012 and 30 June 2015 were included. They underwent in-vitro fertilisation and intracytoplasmic sperm injection. An embryo biopsy was performed on day-3 embryos and the blastomere was subject to array comparative genomic hybridisation. Embryos with normal copy numbers were replaced. The ongoing pregnancy rate, implantation rate, and miscarriage rate were studied. During the study period, 133 cycles of preimplantation genetic diagnosis for chromosomal abnormalities or preimplantation genetic screening were initiated in 94 patients. Overall, 112 cycles proceeded to embryo biopsy and 65 cycles had embryo transfer. The ongoing pregnancy rate per transfer cycle after preimplantation genetic screening was 50.0% and that after preimplantation genetic diagnosis was 34.9%. The implantation rates after preimplantation genetic screening and diagnosis were 45.7% and 41.1%, respectively and the miscarriage rates were 8.3% and 28.6%, respectively. There were 26 frozen-thawed embryo transfer cycles, in which vitrified and biopsied genetically transferrable embryos were replaced, resulting in an ongoing pregnancy rate of 36.4% in the screening group and 60.0% in the diagnosis group. The clinical outcomes of preimplantation genetic diagnosis and screening using comparative genomic hybridisation in our unit were comparable to those reported internationally. Genetically transferrable embryos replaced in a natural cycle may improve the ongoing pregnancy rate and implantation rate when compared with transfer in a stimulated cycle.

Contemporary experience with surgical treatment of aortic valve disease in children.

PubMed

Khan, Muhammad S; Samayoa, Andres X; Chen, Diane W; Petit, Christopher J; Fraser, Charles D

2013-09-01

Surgical treatment of aortic valve (AoV) disease in childhood involves complex decisions particularly in very small patients. There is no consensus regarding the optimum surgical option. The objective of this review was to analyze a contemporary experience of AoV surgery in a large children's hospital. A retrospective review of children (aged ≤ 18 years) undergoing AoV repair or replacement from June 1995 to December 2011 was carried out. A total of 285 AoV operations (97 repairs, 188 replacements) were performed on 241 patients. Hospital survival for repair was 98% and for replacements was 97%. At follow-up of repairs, there were 16 (17%) reoperations and 3 (3%) late deaths. Follow-up of AoV replacements demonstrated 31 (16%) reoperations (homograft 27, autograft 3, mechanical 1) and 8 (4%) late deaths (homograft 5, autograft 2, mechanical 1). Freedom from reintervention or death (FRD) was found to be lower in repairs for infants (P = .048) and truncal valves (P < .05). For AoV replacements, infants and patients who had concomitant CHD or homografts (P < .0001) had lower FRD. Cox regression analysis for AoV replacements identified infants and homograft root replacements at a higher risk for death/reoperation. AoV repairs and replacements were generally found to be associated with low death and reoperation rates at long-term follow-up. Infants had a lower freedom from reintervention or death after either an AoV repair or replacement, although truncal valve repairs and AoV replacement in patients with concomitant CHD were associated with lower valve survival. Among the valve options, homograft root replacement had a higher risk of death/reoperation and lowest freedom from reintervention or death. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Prevalence of Total Hip and Knee Replacement in the United States.

PubMed

Maradit Kremers, Hilal; Larson, Dirk R; Crowson, Cynthia S; Kremers, Walter K; Washington, Raynard E; Steiner, Claudia A; Jiranek, William A; Berry, Daniel J

2015-09-02

Descriptive epidemiology of total joint replacement procedures is limited to annual procedure volumes (incidence). The prevalence of the growing number of individuals living with a total hip or total knee replacement is currently unknown. Our objective was to estimate the prevalence of total hip and total knee replacement in the United States. Prevalence was estimated using the counting method by combining historical incidence data from the National Hospital Discharge Survey and the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases from 1969 to 2010 with general population census and mortality counts. We accounted for relative differences in mortality rates between those who have had total hip or knee replacement and the general population. The 2010 prevalence of total hip and total knee replacement in the total U.S. population was 0.83% and 1.52%, respectively. Prevalence was higher among women than among men and increased with age, reaching 5.26% for total hip replacement and 10.38% for total knee replacement at eighty years. These estimates corresponded to 2.5 million individuals (1.4 million women and 1.1 million men) with total hip replacement and 4.7 million individuals (3.0 million women and 1.7 million men) with total knee replacement in 2010. Secular trends indicated a substantial rise in prevalence over time and a shift to younger ages. Around 7 million Americans are living with a hip or knee replacement, and consequently, in most cases, are mobile, despite advanced arthritis. These numbers underscore the substantial public health impact of total hip and knee arthroplasties. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Note: Modified anvil design for improved reliability in DT-Cup experiments.

PubMed

Hunt, Simon A; Dobson, David P

2017-12-01

The Deformation T-Cup (DT-Cup) is a modified 6-8 multi-anvil apparatus capable of controlled strain-rate deformation experiments at pressures greater than 18 GPa. Controlled strain-rate deformation was enabled by replacing two of the eight cubic "second-stage" anvils with hexagonal cross section deformation anvils and modifying the "first-stage" wedges. However, with these modifications approximately two-thirds of experiments end with rupture of the hexagonal anvils. By replacing the hexagonal anvils with cubic anvils and, split, deformation wedge extensions, we restore the massive support to the deformation anvils that were inherent in the original multi-anvil design and prevent deformation anvil failure. With the modified parts, the DT-Cup has an experimental success rate that is similar to that of a standard hydrostatic 6-8 multi-anvil apparatus.

A Procedure for Determining the Resource Utilization Potential of Coal Ash.

DTIC Science & Technology

1981-09-01

48 V Chapter Page Lime Replacement for Flue - Gas Desulfurization Ujnits . .. .. .. .. .. .. .. .. .. .. . .48 Refuse Pile Fire Abatemnent...exceeds the capability of a vacuum system to attain a satisfactory conveying rate. If thenfy ash is removed from the flue gas stream by a wet collector...the mixture some fertilizer value (21:44-45). Lime Replacement for Flue - Gas Desulfurization Units For conventional SO, lime-based removal systems

Bioactive titan cage Implaspin in treatment of degenerative disease of the cervcal spine--the results from 2007 till 2008.

PubMed

Filip, Michal; Linzer, Petr; Sámal, Filip; Jurek, Patrik; Strnad, Zdenek; Strnad, Jakub

2010-01-01

The authors present results of surgical treatment of cervical spine degenerative disease via Implaspin biotitanium replacement. Surgery was indicated for a group of 24 patients with symptoms of cervical spondylogenic myelopathy or the irritation decay root syndrome non-reacting to conservative treatment. Pre-surgery X-ray and MRI examinations showed spinal canal stenosis caused by the intervertebral disk osteochondrosis combined with prolapse or dorsal osteophytes. Clinical problems of the group of patients were evaluated through the JOA classification before surgery and during the 2nd, the 6th and month 12th after surgery. The surgery rate of success was evaluated in percentages during post-surgery examinations that took place in the 12th month. Based on the JOA classification, that rate of success falls into the good surgery results zone. The post-surgery X-ray examinations showed two sank replacements by 1/3 of its height into the surrounding vertebral bodies. In these cases we performed the control MRI. No signs of the new spinal compression were found and the spinal canal was free in the operated site. Based on our short-term experiences, the Implaspin bioactive replacement seems to be a suitable alternative to the other types of replacements designed for intervertebral fusion in the lower cervical spine area.

Monitoring the quality of total hip replacement in a tertiary care department using a cumulative summation statistical method (CUSUM).

PubMed

Biau, D J; Meziane, M; Bhumbra, R S; Dumaine, V; Babinet, A; Anract, P

2011-09-01

The purpose of this study was to define immediate post-operative 'quality' in total hip replacements and to study prospectively the occurrence of failure based on these definitions of quality. The evaluation and assessment of failure were based on ten radiological and clinical criteria. The cumulative summation (CUSUM) test was used to study 200 procedures over a one-year period. Technical criteria defined failure in 17 cases (8.5%), those related to the femoral component in nine (4.5%), the acetabular component in 32 (16%) and those relating to discharge from hospital in five (2.5%). Overall, the procedure was considered to have failed in 57 of the 200 total hip replacements (28.5%). The use of a new design of acetabular component was associated with more failures. For the CUSUM test, the level of adequate performance was set at a rate of failure of 20% and the level of inadequate performance set at a failure rate of 40%; no alarm was raised by the test, indicating that there was no evidence of inadequate performance. The use of a continuous monitoring statistical method is useful to ensure that the quality of total hip replacement is maintained, especially as newer implants are introduced.

[A project to provide instruction in the nursing of elderly patients with total hip replacement (T.H.R.)].

PubMed

Ting, Chao-Fong; Chou, Hsiu-Ling; Chen, Ming-Mie

2006-02-01

This project was aimed at improving the nursing of patients who have undergone total hip replacements. Investigation showed the following problems with existing nursing instruction in this area: lack of standard instruction, outdated educational materials, a 33.75% rate of completion of instruction lack of familiarity with instruction materials, and an average satisfaction score of 2.56 among nurses who have undergone instruction; The reading for patient's satisfaction with the guidance of nurses was 2.04. After site investigation, status analysis and reference check, we proposed the following program. (1) Establish standards and monitor tools for instruction for nursing total hip replacement patients, including "Caring standard", "Guidance for nursing instruction", "Nursing instruction sheet", "Notes at nursing instruction", "Satisfaction scoring system for nursing instruction"; (2) Carry out a training course to enhance nursing staff's knowledge about caring for patients with total hip replacement. After program had been implemented, a completion rate of 88.56% was achieved, and the satisfaction scores among nursing staff and patients were 4.3 and 4.36 respectively. This result shows that when we undertake reform at various different levels--including systemic structure, processing and monitoring--this can radically improve the quality of nursing instruction.

Pedogenic replacement of aluminosilicate grains by CaCO3 in Ustollic Haplargids, south-central Montana, U.S.A.

USGS Publications Warehouse

Reheis, M.C.

1988-01-01

A chronosequence of calcic soils formed on granitic glaciofluvial terrace deposits of Rock Creek and the Clarks Fork in south-central Montana shows progressive replacement of aluminosilicate parent-material grains by calcium-magnesium carbonate. The terraces range from late Pliocene to Holocene in age as dated by tephrochronology, correlation, and stream incision rates. Replacement is first seen in soils that are as old as 120,000 yr; the amount and degree of replacement increase in soils older than 120,000 yr along with the development of calcic horizons. Under the petrographic microscope, carbonate replacement of quartz, feldspars, and the groundmass of andesite grains in Rock Creek soils is shown by embayed grains, networks of carbonate along cracks and between parts of polycrystalline grains and optically aligned grain fragments within carbonate masses. Microprobe data suggest that silica is released by replacement because it is absent from carbonate-filled spaces and is depleted in corrosion pits. Little microscopic evidence exists to support displacement of framework grains by carbonate because fragments of a single grain are rarely rotated out of optical alignment. In the calcic soils of Rock Creek, K-fabric (grains floating in a carbonate matrix) may form by both replacement and displacement. ?? 1988.

Replacing zoledronic acid with denosumab is a risk factor for developing osteonecrosis of the jaw.

PubMed

Higuchi, Tomoko; Soga, Yoshihiko; Muro, Misato; Kajizono, Makoto; Kitamura, Yoshihisa; Sendo, Toshiaki; Sasaki, Akira

2018-06-01

Intravenous zoledronic acid (ZA) is often replaced with subcutaneous denosumab in patients with bone metastatic cancer. Despite their different pharmacologic mechanisms of action, both denosumab and ZA are effective in bone metastasis but cause osteonecrosis of the jaw (ONJ) as a side effect. ZA persists in the body almost indefinitely, whereas denosumab does not persist for long periods. This study evaluated the risks of developing ONJ when replacing ZA with denosumab. In total, 161 Japanese patients administered ZA for bone metastatic cancer were enrolled in this single-center, retrospective, observational study. The risk of developing ONJ was evaluated by logistic regression analysis using the following factors: age, gender, cancer type, angiogenesis inhibitors, steroids, and replacement of ZA with denosumab. Seventeen patients (10.6%) developed ONJ. Multiple regression analysis indicated a significant difference in rate of ONJ associated with replacement of ZA with denosumab (odds ratio = 3.81; 95% confidence interval 1.04-13.97; P = .043). Replacing ZA with denosumab is a risk factor for the development of ONJ. Both binding of bisphosphonate to bone and receptor activator of nuclear factor-κ B ligand inhibition could additively increase the risk of ONJ. We bring the replacement of ZA with denosumab to the attention of clinical oncologists. Copyright © 2018 Elsevier Inc. All rights reserved.

Late complications in patients with Björk-Shiley and St. Jude Medical heart valve replacement.

PubMed

Horstkotte, D; Körfer, R; Seipel, L; Bircks, W; Loogen, F

1983-09-01

Valve-related complications after Björk-Shiley mitral valve implantation (n = 475), aortic valve implantation (n = 424), or mitral-aortic valve implantation (n = 119) were compared with those after St. Jude Medical mitral valve replacement (n = 173), aortic valve replacement (n = 152), or mitral-aortic valve replacement (n = 69). All patients were placed on anticoagulant therapy with phenprocoumon early after operation. All patients had a comparable follow-up time of approximately 23 months, which showed that cumulative thromboembolic rates were significantly higher after St. Jude valve implantation than after Björk-Shiley valve implantation. Reoperations were necessary because of valve thrombosis (0.46%), perivalvular leakage (2.2%), or prosthetic valve endocarditis with perivalvular regurgitation (0.46%). One Björk-Shiley mitral valve prosthesis had to be replaced because of fracture of the outlet strut. Without significant intergroup differences, hemorrhage due to anticoagulant treatment was the most frequent complication. Thromboembolic complications were significantly more frequent after Björk-Shiley mitral, aortic, and double valve replacements than after St. Jude valve implantation. This may lead to consideration of changes in the prophylaxis of thrombus formations in the St. Jude valve, especially in aortic valve replacements, in patients with sinus rhythm.

Prioritization methodology for chemical replacement

NASA Technical Reports Server (NTRS)

Cruit, Wendy; Goldberg, Ben; Schutzenhofer, Scott

1995-01-01

Since United States of America federal legislation has required ozone depleting chemicals (class 1 & 2) to be banned from production, The National Aeronautics and Space Administration (NASA) and industry have been required to find other chemicals and methods to replace these target chemicals. This project was initiated as a development of a prioritization methodology suitable for assessing and ranking existing processes for replacement 'urgency.' The methodology was produced in the form of a workbook (NASA Technical Paper 3421). The final workbook contains two tools, one for evaluation and one for prioritization. The two tools are interconnected in that they were developed from one central theme - chemical replacement due to imposed laws and regulations. This workbook provides matrices, detailed explanations of how to use them, and a detailed methodology for prioritization of replacement technology. The main objective is to provide a GUIDELINE to help direct the research for replacement technology. The approach for prioritization called for a system which would result in a numerical rating for the chemicals and processes being assessed. A Quality Function Deployment (QFD) technique was used in order to determine numerical values which would correspond to the concerns raised and their respective importance to the process. This workbook defines the approach and the application of the QFD matrix. This technique: (1) provides a standard database for technology that can be easily reviewed, and (2) provides a standard format for information when requesting resources for further research for chemical replacement technology. Originally, this workbook was to be used for Class 1 and Class 2 chemicals, but it was specifically designed to be flexible enough to be used for any chemical used in a process (if the chemical and/or process needs to be replaced). The methodology consists of comparison matrices (and the smaller comparison components) which allow replacement technology to be quantitatively compared in several categories, and a QFD matrix which allows process/chemical pairs to be rated against one another for importance (using consistent categories). Depending on the need for application, one can choose the part(s) needed or have the methodology completed in its entirety. For example, if a program needs to show the risk of changing a process/chemical one may choose to use part of Matrix A and Matrix C. If a chemical is being used, and the process must be changed; one might use the Process Concerns part of Matrix D for the existing process and all possible replacement processes. If an overall analysis of a program is needed, one may request the QFD to be completed.

Conversion tables for use with the National Fire-Danger Rating System in the Intermountain area

Treesearch

Dwight S. Stockstad; Richard J. Barney

1964-01-01

Two tables prepared for use with the National Fire-Danger Rating System replace 10 tables previously used with the Model-8 Fire-Danger Rating System. They provide for the conversion of Spread Index values at various altitudes, aspects, and times of day. A rate of spread table facilitates converting Spread Index values to chains per hour of perimeter increase for...

Estimation of hydrocarbon biodegradation rates in gasoline-contaminated sediment from measured respiration rates

USGS Publications Warehouse

Baker, R.J.; Baehr, A.L.; Lahvis, M.A.

2000-01-01

An open microcosm method for quantifying microbial respiration and estimating biodegradation rates of hydrocarbons in gasoline-contaminated sediment samples has been developed and validated. Stainless-steel bioreactors are filled with soil or sediment samples, and the vapor-phase composition (concentrations of oxygen (O2), nitrogen (N2), carbon dioxide (CO2), and selected hydrocarbons) is monitored over time. Replacement gas is added as the vapor sample is taken, and selection of the replacement gas composition facilitates real-time decision-making regarding environmental conditions within the bioreactor. This capability allows for maintenance of field conditions over time, which is not possible in closed microcosms. Reaction rates of CO2 and O2 are calculated from the vapor-phase composition time series. Rates of hydrocarbon biodegradation are either measured directly from the hydrocarbon mass balance, or estimated from CO2 and O2 reaction rates and assumed reaction stoichiometries. Open microcosm experiments using sediments spiked with toluene and p-xylene were conducted to validate the stoichiometric assumptions. Respiration rates calculated from O2 consumption and from CO2 production provide estimates of toluene and p- xylene degradation rates within about ??50% of measured values when complete mineralization stoichiometry is assumed. Measured values ranged from 851.1 to 965.1 g m-3 year-1 for toluene, and 407.2-942.3 g m-3 year-1 for p- xylene. Contaminated sediment samples from a gasoline-spill site were used in a second set of microcosm experiments. Here, reaction rates of O2 and CO2 were measured and used to estimate hydrocarbon respiration rates. Total hydrocarbon reaction rates ranged from 49.0 g m-3 year-1 in uncontaminated (background) to 1040.4 g m-3 year-1 for highly contaminated sediment, based on CO2 production data. These rate estimates were similar to those obtained independently from in situ CO2 vertical gradient and flux determinations at the field site. In these experiments, aerobic conditions were maintained in the microcosms by using air as the replacement gas, thus preserving the ambient aerobic environment of the subsurface near the capillary zone. This would not be possible with closed microcosms.

Frequency of word-use predicts rates of lexical evolution throughout Indo-European history.

PubMed

Pagel, Mark; Atkinson, Quentin D; Meade, Andrew

2007-10-11

Greek speakers say "omicronupsilonrho", Germans "schwanz" and the French "queue" to describe what English speakers call a 'tail', but all of these languages use a related form of 'two' to describe the number after one. Among more than 100 Indo-European languages and dialects, the words for some meanings (such as 'tail') evolve rapidly, being expressed across languages by dozens of unrelated words, while others evolve much more slowly--such as the number 'two', for which all Indo-European language speakers use the same related word-form. No general linguistic mechanism has been advanced to explain this striking variation in rates of lexical replacement among meanings. Here we use four large and divergent language corpora (English, Spanish, Russian and Greek) and a comparative database of 200 fundamental vocabulary meanings in 87 Indo-European languages to show that the frequency with which these words are used in modern language predicts their rate of replacement over thousands of years of Indo-European language evolution. Across all 200 meanings, frequently used words evolve at slower rates and infrequently used words evolve more rapidly. This relationship holds separately and identically across parts of speech for each of the four language corpora, and accounts for approximately 50% of the variation in historical rates of lexical replacement. We propose that the frequency with which specific words are used in everyday language exerts a general and law-like influence on their rates of evolution. Our findings are consistent with social models of word change that emphasize the role of selection, and suggest that owing to the ways that humans use language, some words will evolve slowly and others rapidly across all languages.

Tip Design of Hemodialysis Catheters Influences Thrombotic Events and Replacement Rate.

PubMed

Petridis, C; Nitschke, M; Lehne, W; Smith, E; Goltz, J P; Lehnert, H; Meier, M

2017-02-01

Central venous tunnelled hemodialysis catheters (CVTC) are used for initial vascular access in patients with renal failure. Tip design of the CVTC may play an important role in catheter function and complication rates, influencing adequate hemodialysis treatment of these patients. This prospective, observational cohort study compared the function and complication rates of two CVTCs in patients with end stage renal disease (ESRD) within a follow-up period of 24 months. The study included patients with ESRD who received either a CVTC with a split tip (ST) or a shotgun tip (SG). All patients underwent dialysis within 24 h of intervention. Blood flow was documented initially (Qb 0 ) and was followed up after 6 (Qb 6 ), 12 (Qb 12 ), and 24 (Qb 24 ) months. Analysis of blood flow and complication rates within the follow-up period was performed by questionnaires. In total, 185 patients were included, of whom 93 received a ST CVTC and 92 a SG CVTC. Baseline parameters did not differ significantly between groups. CVTC blood flow was not significantly different between the two devices. Thrombolytic therapy with Alteplase was used significantly more often in the ST group (29%) than in the SG group (16%) (p < 0.05). The CVTC replacement rate was significantly higher in the ST group (19.3%) compared with the SG group (8.7%) (p < 0.05). The tip design of CVTC (split or shotgun) appears to be irrelevant for long-term blood flow during dialysis treatment. However, patients may benefit from SG catheters over ST catheters where replacement rates and thrombolytic treatment are concerned. Copyright © 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

[ANALYSIS OF IMPLANT-RELATED COMPLICATIONS AFTER HINGE KNEE REPLACEMENT FOR TUMORS AROUND THE KNEE].

PubMed

Li, Dong; Ma, Huanzhi; Zhang, Wei; Sun, Chengliang; Lu, Xiaoyong; Gao, Yutong; Zhou, Dongsheng

2015-08-01

To investigate the reasons and managements of implant-related complications after hinge knee replacement for tumors around the knee. A retrospective analysis was made on the clinical data of 96 patients undergoing hinge knee replacement between January 2000 and December 2012. There were 64 males and 32 females with the mean age of 31.0 years (range, 15-72 years). The most common tumor type was osteosarcoma (72 cases), and the second was giant cell tumor (15 cases). The tumor located at the distal femurs in 52 cases and at the proximal tibias in 44 cases. Fifteen hinge and 81 rotating hinge prostheses were used. The recurrence, metastasis, and survival were recorded. The implant-related complications were observed. The median follow-up time was 43.5 months (range, 10-156 months). Complications were observed in 21 patients (25 implant-related complications); 13 complications located at the femur and 12 complications at the tibia. The complications included aseptic loosening (8 cases), deep infection (7 cases), prosthetic breakage (4 cases), peri-prosthetic fracture (2 cases), and dislocation (4 cases). Most deep infection occurred within 12 months after operation (6/7), and most aseptic loosening after 40 months of operation (6/8). The rate of limb salvage was 90.6% (87/96) and the amputation rate was 9.4% (9/96). The overall survival rate of the prosthesis was 76.7% (5-year) and 47.2% (10-year). The 5-year survival rate was 82.9% for femoral prosthesis and 71.0% for tibial prosthesis, showing no significant difference (P = 0.954). Hinge knee prosthesis still has a high rate of complications. Deep infection is main reason to decrease short-term prosthetic survival rate, and aseptic loosening shortens the long-short prosthetic survival time.

A Pedagogical Note on the Superiority of Price-Cap Regulation to Rate-of-Return Regulation

ERIC Educational Resources Information Center

Currier, Kevin M.; Jackson, Brian K.

2008-01-01

The two forms of natural monopoly regulation that are typically discussed in intermediate microeconomics textbooks are marginal cost pricing and average cost pricing (rate-of-return regulation). However, within the last 20 years, price-cap regulation has largely replaced rate-of-return regulation because of the former's potential to generate more…

Short communication: Effects of increasing protein and energy in the milk replacer with or without direct-fed microbial supplementation on growth and performance of preweaned Holstein calves.

PubMed

Geiger, A J; Ward, S H; Williams, C C; Rude, B J; Cabrera, C J; Kalestch, K N; Voelz, B E

2014-11-01

Forty-four Holstein calves were fed a direct-fed microbial (DFM) and 1 of 2 milk replacers to evaluate calf performance and growth. Treatments were (1) a control milk replacer [22:20; 22% crude protein (CP) and 20% fat], (2) an accelerated milk replacer (27:10; 27% CP and 10% fat), (3) the control milk replacer with added DFM (22:20+D), and (4) the accelerated milk replacer with added DFM (27:10+D). Dry matter intake, rectal temperatures, respiration scores and rates, and fecal scores were collected daily. Body weight, hip and withers height, heart girth, blood, and rumen fluid samples were collected weekly. Effects of treatment, sex, week, and their interactions were analyzed. Calves fed an accelerated milk replacer, regardless of DFM supplementation, consumed more CP and metabolizable energy in the milk replacer. No treatment differences were found for starter intake or intake of neutral detergent fiber or acid detergent fiber in the starter. Calves fed the accelerated milk replacer had greater preweaning and weaning body weight compared with calves fed the control milk replacer. Average daily gain was greater during the preweaning period for calves fed the accelerated milk replacer, but the same pattern did not hold true during the postweaning period. Feed efficiency did not differ among treatments. Hip height tended to be and withers height and heart girth were greater at weaning for calves fed the accelerated milk replacer compared with calves fed the control milk replacer. Fecal scores were greatest in calves fed DFM. Overall acetate, propionate, butyrate, and n-valerate concentrations were lower in calves fed the accelerated milk replacer, but DFM did not have an effect. Rumen pH was not different. Blood metabolites were unaffected by DFM supplementation, but calves fed the accelerated milk replacer had increased partial pressure of CO2, bicarbonate, and total bicarbonate in the blood. Direct-fed microbial supplementation did not appear to benefit the calf in this trial. Copyright © 2014 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Diminished disease progression rate in a chronic kidney disease population following the replacement of dietary water source with quality drinking water: A pilot study.

PubMed

Siriwardhana, Edirisinghe Arachchige Ranga Iroshanie Edirisinghe; Perera, Ponnamperuma Aratchige Jayasumana; Sivakanesan, Ramiah; Abeysekara, Tilak; Nugegoda, Danaseela Bandara; Weerakoon, Kosala; Siriwardhana, Dunusingha Asitha Surandika

2018-05-01

Environmental toxin/s is alleged to be the contributory factor for the chronic kidney disease of unknown aetiology (CKDu) in Sri Lanka. The potential of drinking water as a medium for the nephrotoxic agents in the affected subjects has been comprehensively discoursed in the recent past. The present study was aimed to assess the effect of replacing the habitual drinking water on the kidney function of CKDu patients residing in the North Central Province of Sri Lanka: METHODS: An interventional study was carried out to assess the disease progression rate of a CKDu population whose habitual drinking water was replaced by bottled spring water certified by Sri Lanka Standard (SLS) for a period of 18 month along with a population of CKDu patients who continued with their usual drinking water. Kidney function of subjects in both groups were monitored in terms of blood pressure, serum creatinine, serum calcium, serum phosphorus, hemoglobin, estimated glomerular filtration rate and urinary protein at 6 months intervals during the intervention and follow up periods. Diminished disease progression rate was observed in CKDu patients in the intervention group when compared with the non- intervention group based on serum creatinine, Hb, estimated glomerular filtration rate and urinary protein levels. Extensive interventional studies are required to generalize effect of drinking water on CKDu population. The habitual drinking water is likely to be a contributory factor towards the progression of the disease. © 2017 Asian Pacific Society of Nephrology.

The frequency of replacement of dental restorations may vary based on a number of variables, including type of material, size of the restoration, and caries risk of the patient.

PubMed

Roumanas, Eleni D

2010-03-01

The authors analyzed the dental records of 2780 Navy (cohort 1 = 1078 entered the Navy in 1997) and US Marine Corps recruits (cohort 2 =1053 entered the USMC in 1999-2000; cohort 3 = 649 entered the USMC in 2002-2005). The records were reviewed at 16 US Navy dental treatment facilities at the following time periods: cohort 1, 2001; cohort 2, 2002-2003; and cohort 3, 2005-2006. The mean age of the subjects was 20 years, and 85% were men. Only posterior teeth (not third molars) with amalgam or resin-based composite (including glass ionomer restorations) were evaluated. Teeth that had been restored with more than one material and restorations that did not involve the occlusal surface were excluded. The minimum follow-up time was 2 years with at least 2 periodic exams following the initial exam. The primary factor of interest was the type of restorative material (amalgam versus resin-based composite). Secondary factors included tooth number, number of restored surfaces (single or multiple), and caries risk of the patient. Caries risk status was defined using the Navy Dental Corps Oral Disease Risk Management protocol. The primary outcome measure of interest was the determination of the relative risk of replacement of an initially intact restoration during the subject's first years of military service. Restorations were classified as clinically acceptable or requiring replacement either as a result of new primary caries, secondary caries, defective restorations, or endodontic therapy. At the initial exam, 964 (15.2%) of the amalgam restorations and 199 (17.4%) of the resin-based composites required replacement and were excluded from further analysis. Of the remaining restorations, an additional 14.2% of the amalgam and 16.7% of the composite restorations required replacement during the observation period. The mean follow-up time was 3.0 years (cohort 1, 3.4 years; cohort 2, 3.1 years; cohort 3, 2.3 years). Replacement rates for resin-based composite restorations compared with amalgam were significantly higher owing to all causes (adjusted hazard ratio [HR], 1.28; P < .05) and for replacement owing to restoration failure (adjusted HR, 1.64; P < .01). Multiple surface restorations demonstrated higher rates of replacement than single surface restorations from all causes (adjusted HR, 1.39; P < .01) and for replacement of existing restorations (adjusted HR, 1.82; P < .01). High-caries-risk subjects experienced more than twice the risk of retreatment than did low-caries-risk subjects when considering all replacements (adjusted HR, 2.04; P < .01) and 50% higher risk of replacement of previously restored surfaces (adjusted HR, 1.48; P<.01) Approximately 30% of all posterior restorations required replacement either at the initial or subsequent exams during the observation period. The number of resin-based composite restorations requiring replacement was significantly higher than amalgam restorations. The authors concluded that because of the extra cost, time, and potential for increased frequency of replacement, posterior composite restorations should be limited to restorations of appropriate size and placed under meticulous restorative technique with strict adherence to manufacturer's instructions.

Potentially conflicting metabolic demands of diving and exercise in seals.

PubMed

Castellini, M A; Murphy, B J; Fedak, M; Ronald, K; Gofton, N; Hochachka, P W

1985-02-01

Metabolic replacement rates (Ra) for glucose and free fatty acids (FFA) were determined during rest, exercise, and diving conditions in the gray seal using bolus injections of radiotracers. In the exercise experiments the seal swam at a metabolic rate elevated twofold over resting Ra for glucose and FFA while resting were similar to values found in terrestrial mammals and other marine mammal species. During exercise periods glucose turnover increased slightly while FFA turnover changes were variable. However, the energetic demands of exercise could not be met by the increase in the replacement rates of glucose or FFA even if both were completely oxidized. Under diving conditions the tracer pool displayed radically different specific activity curves indicative of the changes in perfusion and metabolic rate associated with a strong dive response. Since the radiotracer curves during exercise and diving differed qualitatively and quantitatively, it is possible that similar studies on freely diving animals can be used to assess the role of the diving response during underwater swimming in nature.

Long-term Outcomes of Mitral Valve Repair Versus Replacement for Degenerative Disease: A Systematic Review

PubMed Central

McNeely, Christian A; Vassileva, Christina M

2015-01-01

The short-term advantage of mitral valve repair versus replacement for degenerative disease has been extensively documented. These advantages include lower operative mortality, improved survival, better preservation of left-ventricular function, shorter post-operative hospital stay, lower total costs, and fewer valve-related complications, including thromboembolism, anticoagulation-related bleeding events and late prosthetic dysfunction. More recent written data are available indicating the long-term advantage of repair versus replacement. While at some institutions, the repair rate for degenerative disease may exceed 90%, the national average in 2007 was only 69%. Making direct comparisons between mitral valve repair and replacement using the available studies does present some challenges however, as there are often differences in baseline characteristics between patient groups as well as other dissimilarities between studies. The purpose of this review is to systematically summarize the long-term survival and reoperation data of mitral valve repair versus replacement for degenerative disease. A PubMed search was done and resulted in 12 studies that met our study criteria for comparing mitral valve repair versus replacement for degenerative disease. A systematic review was then conducted abstracting survival and reoperation data. PMID:25158683

Thermal Characterization of Adhesive

NASA Technical Reports Server (NTRS)

Spomer, Ken A.

1999-01-01

The current Space Shuttle Reusable Solid Rocket Motor (RSRM) nozzle adhesive bond system is being replaced due to obsolescence. Down-selection and performance testing of the structural adhesives resulted in the selection of two candidate replacement adhesives, Resin Technology Group's Tiga 321 and 3M's EC2615XLW. This paper describes rocket motor testing of these two adhesives. Four forty-pound charge motors were fabricated in configurations that would allow side by side comparison testing of the candidate replacement adhesives and the current RSRM adhesives. The motors provided an environment where the thermal performance of adhesives in flame surface bondlines was compared. Results of the FPC testing show that: 1) The phenolic char depths on radial bond lines is approximately the same and vary depending on the position in the blast tube regardless of which adhesive was used; 2) The adhesive char depth of the candidate replacement adhesives is less than the char depth of the current adhesives; 3) The heat-affected depth of the candidate replacement adhesives is less than the heat-affected depth of the current adhesives; and 4) The ablation rates for both replacement adhesives are slower than that of the current adhesives.

A systematic review of endoprosthetic replacement for non-tumour indications around the knee joint.

PubMed

Korim, Muhammad T; Esler, Colin N A; Reddy, Venuthurla R M; Ashford, Robert U

2013-12-01

Endoprosthetic replacement (EPR) for limb salvage is an established treatment modality for orthopaedic malignancies around the knee. Increasingly, they are being used for non-tumour indications such as fractures, bone loss associated with aseptic loosening, septic loosening and ligament insufficiencies. We reviewed the evolution and biomechanics of knee EPRs. MEDLINE was searched using the PubMed interface to identify relevant studies pertaining to the use of knee EPRs in non-tumour conditions. Failures, mortality and knee scores were the main outcome measures. Subgroup analysis in the non-tumour conditions was also performed. There were nine studies with an average follow-up of 3.3years (Range 1-5years) describing 241 EPRs used in non-tumour conditions. Re-operation for any reason occurred in 17% (41/241) of cases. The most common complication was infection (15%) followed by aseptic loosening (5%) and periprosthetic fractures (5%). The mortality rate averaged 22%. Infected knee arthroplasties were less likely to have a successful outcome when salvaged with an EPR with failure rates up to 33%. Endoprosthetic replacement is a limb salvage option when other surgical options are unfeasible, especially in low demand elderly patients with limited life expectancy. They have low rates of failure in the medium term. Level 1. Copyright © 2013 Elsevier B.V. All rights reserved.

Machine Learned Replacement of N-Labels for Basecalled Sequences in DNA Barcoding.

PubMed

Ma, Eddie Y T; Ratnasingham, Sujeevan; Kremer, Stefan C

2018-01-01

This study presents a machine learning method that increases the number of identified bases in Sanger Sequencing. The system post-processes a KB basecalled chromatogram. It selects a recoverable subset of N-labels in the KB-called chromatogram to replace with basecalls (A,C,G,T). An N-label correction is defined given an additional read of the same sequence, and a human finished sequence. Corrections are added to the dataset when an alignment determines the additional read and human agree on the identity of the N-label. KB must also rate the replacement with quality value of in the additional read. Corrections are only available during system training. Developing the system, nearly 850,000 N-labels are obtained from Barcode of Life Datasystems, the premier database of genetic markers called DNA Barcodes. Increasing the number of correct bases improves reference sequence reliability, increases sequence identification accuracy, and assures analysis correctness. Keeping with barcoding standards, our system maintains an error rate of percent. Our system only applies corrections when it estimates low rate of error. Tested on this data, our automation selects and recovers: 79 percent of N-labels from COI (animal barcode); 80 percent from matK and rbcL (plant barcodes); and 58 percent from non-protein-coding sequences (across eukaryotes).

Effects of a high milk intake during the pre-weaning period on nutrient metabolism and growth rate in Japanese Black cattle.

PubMed

Matsubara, Atsuko; Takahashi, Hideyuki; Saito, Akira; Nomura, Aoi; Sithyphone, Khounsaknalath; Mcmahon, Christopher D; Fujino, Ryoichi; Shiotsuka, Yuji; Etoh, Tetsuji; Furuse, Mitsuhiro; Gotoh, Takafumi

2016-09-01

This study aimed to determine the effects of feeding an increased volume of high-fat milk during the early post-natal life on metabolite concentrations in the blood, the expression of key genes regulating intermediary metabolism in the skeletal muscles, and the rate of growth of Japanese Black cattle. All calves were fed a high-fat milk replacer (crude protein, 26%; crude fat, 25.5%; total dissolved nitrogen, 116%). Control calves (n = 4) were nursed with 500 g milk replacer until 3 months of age, whereas calves in the experimental group (n = 4) were nursed with 1800 g milk replacer until 3 months, and then the volume was gradually reduced until 5 months. Body weight was significantly higher in the experimental group than in the control group at 7 months. Plasma glucose concentrations were significantly lower in the experimental group. Expression of glucose-transporter-4 messenger RNA (mRNA) was lower, whereas that of glucose transporter 1, cluster of differentiation 36, and carnitine palmitoyltransferase-1b mRNA was significantly higher in the Longissimus thoracis of the experimental group. Nutritional status during early post-natal life appears to strongly influence the growth rate and glucose and lipid metabolism in Japanese Black cattle. © 2015 Japanese Society of Animal Science.

Suboptimal Herd Performance Amplifies the Spread of Infectious Disease in the Cattle Industry

PubMed Central

Gates, M. Carolyn; Woolhouse, Mark E. J.

2014-01-01

Farms that purchase replacement breeding cattle are at increased risk of introducing many economically important diseases. The objectives of this analysis were to determine whether the total number of replacement breeding cattle purchased by individual farms could be reduced by improving herd performance and to quantify the effects of such reductions on the industry-level transmission dynamics of infectious cattle diseases. Detailed information on the performance and contact patterns of British cattle herds was extracted from the national cattle movement database as a case example. Approximately 69% of beef herds and 59% of dairy herds with an average of at least 20 recorded calvings per year purchased at least one replacement breeding animal. Results from zero-inflated negative binomial regression models revealed that herds with high average ages at first calving, prolonged calving intervals, abnormally high or low culling rates, and high calf mortality rates were generally more likely to be open herds and to purchase greater numbers of replacement breeding cattle. If all herds achieved the same level of performance as the top 20% of herds, the total number of replacement beef and dairy cattle purchased could be reduced by an estimated 34% and 51%, respectively. Although these purchases accounted for only 13% of between-herd contacts in the industry trade network, they were found to have a disproportionately strong influence on disease transmission dynamics. These findings suggest that targeting extension services at herds with suboptimal performance may be an effective strategy for controlling endemic cattle diseases while simultaneously improving industry productivity. PMID:24671129

Comparing Alternatives For Replacing Harmful Chemicals

NASA Technical Reports Server (NTRS)

Cruit, W.; Schutzenhofer, S.; Goldberg, B.; Everhart, K.

1995-01-01

Methodology developed to provide guidance for replacement of industrial chemicals that must be phased out by law because they are toxic and/or affect environment adversely. Chemicals and processes ranked numerically. Applies mostly to chemicals contributing to depletion of ozone in upper atmosphere; some other harmful chemicals included. Quality function deployment matrix format provides convenient way to compare alternative processes and chemicals. Overall rating at bottom of each process-and-chemical column indicates relative advantage.

Short communication: Effect of inclusion rate of microencapsulated sodium butyrate in starter mixture for dairy calves.

PubMed

Wanat, P; Górka, P; Kowalski, Z M

2015-04-01

The aim of this study was to determine the effect of different inclusion rates of microencapsulated sodium butyrate (M-SB) in the starter mixture (SM) on performance of dairy calves. Forty female Holstein calves with a mean (± SD) age of 12.8 (± 1.5) d were allocated to 1 of 4 treatments (10 calves/treatment) and fed SM without (M-SB-0) or with 0.3% (M-SB-0.3), 0.6% (M-SB-0.6), or 0.9% (M-SB-0.9) of M-SB (as fed) during a 49-d period of milk replacer feeding. The milk replacer was fed at 670 g/d divided into 2 equal meals. Starter mixture with or without M-SB was offered for ad libitum consumption beginning on the first day of the trial. Body weight of calves was recorded weekly, whereas intakes of milk replacer and SM and fecal fluidity were recorded daily. Intake of SM decreased linearly with increasing M-SB inclusion rate. Average daily gain decreased and body weight gain tended to decrease linearly with increasing amounts of M-SB in SM, but feed efficiency was not affected. Fecal score and number of days with diarrhea increased cubically with increasing M-SB inclusion rate in SM. Under the conditions of the current study, supplementation of SM with M-SB had a negative effect on performance of calves. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Effects of music on psychophysiological responses and opioid dosage in patients undergoing total knee replacement surgery.

PubMed

Chen, Hsin-Ji; Chen, Tsung-Ying; Huang, Chiung-Yu; Hsieh, Yuan-Mei; Lai, Hui-Ling

2015-10-01

The present authors examined the effects of listening to music on psychophysiological parameters (blood pressure, heart rate, and respiratory rate) during preoperative and postoperative days and determined whether listening to music could lower pain intensity and opioid dosage during postoperative days in patients who underwent total knee replacements. This was a two group repeated measures design for 30 subjects aged 53-85 years who were scheduled for total knee replacement. Subjects were randomly assigned to either a music group or a control group. Psychophysiological parameters were obtained from patients' monitors. A visual analog scale was used to assess postoperative pain. Opioid dosage was recorded and converted to standardized units. Mann-Whitney U-test and generalized estimating equation analysis were used to compare groups. Respiratory rates while in the surgical waiting area were lower for the music group than for the control group (P = 0.02). There was no significant difference between these groups for blood pressure, heart rate, pain intensity, or opioid dosage. However, a within-group comparison showed that systolic blood pressure in the music group was significantly and consistently decreased during postoperative recovery (Wald = 9.21, P = 0.007). These results suggest that listening to music stabilized systolic blood pressure in patients during postoperative recovery. However, the effects of music on psychophysiological parameters, pain intensity, and opioid dosage in a surgical setting require further research. © 2015 The Authors. Japan Journal of Nursing Science © 2015 Japan Academy of Nursing Science.

Costs and outcomes associated with alternative discharge strategies following joint replacement surgery: analysis of an observational study using a propensity score.

PubMed

Coyte, P C; Young, W; Croxford, R

2000-11-01

We estimated the impact of alternative discharge strategies, following joint replacement (JR) surgery, on acute care readmission rates and the total cost of a continuum of care. Following surgery, patients were discharged to one of four destinations. Propensity scores were used to adjust costs and outcomes for potential bias in the assignment of discharge destinations. We demonstrated that the use of rehabilitation hospitals may lower readmission rates, but at a prohibitive incremental cost of each saved readmission, that patients discharged with home care had longer acute care stays than other patients, that the provision of home care services increased health system costs, and that acute care readmission rates were greatest among patients discharged with home care. Our study should be seen as one important stepping stone towards a full economic evaluation of the continuum of care for patients.

Mitral valve replacement with the Hancock stabilized glutaraldehyde valve. Clinical and laboratory evaluation.

PubMed

Buch, W S; Pipkin, R D; Hancock, W D; Fogarty, T J

1975-11-01

From March 1971 through April 1975, one hundred twenty patients underwent mitral valve replacement with a Hancock "stabilized glutaraldehyde process" porcine aortic xenograft. A simultaneous canine experimental series was also carried out. In the clinical series, the early mortality was 8.3%. Actuarial analyses of all patients predicts survival at two years of 81.0% and at four years of 70.0%. The predicted survival for patients without coronary disease or prior prosthetic valve replacement is 87.5% at two years and 77.5% at four years. There were four thromboembolic episodes, a rate of 2.4% per patient-year. None were fatal. No valve failure were noted. Histologic examination and shrink temperature analysis of recovered valves show excellent tissue preservation at 40 months. The data indicate that the Hancock valve is durable, enjoys a low incidence of thromboembolism, and may be the valve of choice for mitral valve replacement.

Is methicillin-resistant Staphylococcus aureus replacing methicillin-susceptible S. aureus?

PubMed Central

Mostofsky, Elizabeth; Lipsitch, Marc; Regev-Yochay, Gili

2011-01-01

Despite extensive research on the emergence of and treatments for methicillin-resistant Staphylococcus aureus (MRSA), prior studies have not rigorously evaluated the impact of methicillin resistance on the overall incidence of S. aureus infections. Yet, there are direct clinical and research implications of determining whether methicillin-susceptible S. aureus (MSSA) infection rates remain stable in the face of increasing MRSA prevalence or whether MSSA will be replaced over time. A synthesis of prior studies indicates that the emergence of healthcare-associated MRSA (HA-MRSA) and community-associated MRSA (CA-MRSA) has led to an increase in the overall incidence of S. aureus infections, with MRSA principally adding to, rather than replacing, MSSA. However, colonization with CA-MRSA may at least partially replace colonization with MSSA. So far, evidence indicates that MSSA still accounts for many infections. Therefore, eradication of MRSA alone is not sufficient to address the public health burden of S. aureus. PMID:21737459

Pessimistic Determination of Mechanical Conditions and Micro/macroeconomic Evaluation of Mine Pillar Replacement

NASA Astrophysics Data System (ADS)

Chen, Qingfa; Zhao, Fuyu

2017-12-01

Numerous pillars are left after mining of underground mineral resources using the open stope method or after the first step of the partial filling method. The mineral recovery rate can, however, be improved by replacement recovery of pillars. In the present study, the relationships among the pillar type, minimum pillar width, and micro/macroeconomic factors were investigated from two perspectives, namely mechanical stability and micro/macroeconomic benefit. Based on the mechanical stability formulas for ore and artificial pillars, the minimum width for a specific pillar type was determined using a pessimistic criterion. The microeconomic benefit c of setting an ore pillar, the microeconomic benefit w of artificial pillar replacement, and the economic net present value (ENPV) of the replacement process were calculated. The values of c and w were compared with respect to ENPV, based on which the appropriate pillar type and economical benefit were determined.

International Comparison of Adult Height in Children with Growth Hormone Deficiency and Limitations of Growth Hormone Treatment in Japan.

PubMed

Tanaka, Toshiaki

2017-03-01

The approved therapeutic dose of growth hormone (GH) for growth hormone deficiency (GHD) varies depending on the country. Japan has the lowest therapeutic dose globally, with a single dose of 0.175 mg/kg/week. GH treatment for GHD is considered as a replacement therapy and in fact, a dose of 0.175 mg/kg/week is slightly higher than GH secretion in prepubertal healthy children but nearly the same as that of pubertal children. Although the same growth rate as that of healthy children is expected in response to replacement therapy, the catch-up growth observed for the first 1 to 2 years of GH treatment was misinterpreted as an effect of the GH replacement therapy. The real effect of the GH replacement therapy was the growth rate appeared after more than 3 years of GH therapy, when patients showed nearly the same growth rate as healthy children. Therefore, children with GHD can have a higher growth rate than healthy children only for the first 1 to 2 years of GH therapy, after which their growth rate begins to wane. In the United States and Europe, the various therapeutic doses and high-dose treatment are accepted and the SD score of adult height after treatment is higher than that in Japan. The improvement degree of the height SD score and the adult height SD score with GH therapy are lower in Japan compared with other countries that administer a similar therapeutic dose. This suggests that the response to GH can be affected by race. Actual comparison of the response to GH between Japanese and Caucasian patients using KIGS (Pharmacia International Growth Database) data showed that both the short-term response and the effect on adult height were reduced in Japanese patients. As there is a strong positive correlation between adult height and height at the onset of puberty, treatment methods that can increase pubertal growth will be considered in the future for patients with GDH who enter puberty with short stature. Copyright© of YS Medical Media ltd.

Carbon monoxide oxidation rates computed for automobile thermal reactor conditions

NASA Technical Reports Server (NTRS)

Brokaw, R. S.; Bittker, D. A.

1972-01-01

Carbon monoxide oxidation rates in thermal reactors for exhaust manifolds are computed by integrating differential equations for system of twenty-nine reversible chemical reactions. Reactors are noncatalytic replacements for conventional exhaust manifolds and are a system for reducing carbon monoxide and hydrocarbons in automobile exhausts.

The role of interest and inflation rates in life-cycle cost analysis

NASA Technical Reports Server (NTRS)

Eisenberger, I.; Remer, D. S.; Lorden, G.

1978-01-01

The effect of projected interest and inflation rates on life cycle cost calculations is discussed and a method is proposed for making such calculations which replaces these rates by a single parameter. Besides simplifying the analysis, the method clarifies the roles of these rates. An analysis of historical interest and inflation rates from 1950 to 1976 shows that the proposed method can be expected to yield very good projections of life cycle cost even if the rates themselves fluctuate considerably.

Comparison of intramedullary nailing and external fixation knee arthrodesis for the infected knee replacement.

PubMed

Mabry, Tad M; Jacofsky, David J; Haidukewych, George J; Hanssen, Arlen D

2007-11-01

We analyzed knee arthrodesis for the infected total knee replacement (TKR) using two different fixation techniques. Patients undergoing knee arthrodesis for infected TKR were identified and rates of successful fusion and recurrence of infection were compared using Cox proportional hazard models. Eighty-five consecutive patients who underwent knee arthrodesis were followed until union, nonunion, amputation, or death. External fixation achieved successful fusion in 41 of 61 patients and was associated with a 4.9% rate of deep infection. Fusion was successful in 23 of 24 patients with intramedullary (IM) nailing and was associated with an 8.3% rate of deep infection. We observed similar fusion and infection rates with the two techniques. Thirty-four patients (40%) had complications. Knee arthrodesis remains a reasonable salvage alternative for the difficult infected TKR. Complication rates are high irrespective of the technique, and one must consider the risks of both nonunion and infection when choosing the fixation method in this setting. IM nailing appears to have a higher rate of successful union but a higher risk of recurrent infection when compared with external fixation knee arthrodesis. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Estradiol replacement enhances fear memory formation, impairs extinction and reduces COMT expression levels in the hippocampus of ovariectomized female mice.

PubMed

McDermott, Carmel M; Liu, Dan; Ade, Catherine; Schrader, Laura A

2015-02-01

Females experience depression, posttraumatic stress disorder (PTSD), and anxiety disorders at approximately twice the rate of males, but the mechanisms underlying this difference remain undefined. The effect of sex hormones on neural substrates presents a possible mechanism. We investigated the effect of ovariectomy at two ages, before puberty and in adulthood, and 17β-estradiol (E2) replacement administered chronically in drinking water on anxiety level, fear memory formation, and extinction. Based on previous studies, we hypothesized that estradiol replacement would impair fear memory formation and enhance extinction rate. Females, age 4 weeks and 10 weeks, were divided randomly into 4 groups; sham surgery, OVX, OVX+low E2 (200nM), and OVX+high E2 (1000nM). Chronic treatment with high levels of E2 significantly increased anxiety levels measured in the elevated plus maze. In both age groups, high levels of E2 significantly increased contextual fear memory but had no effect on cued fear memory. In addition, high E2 decreased the rate of extinction in both ages. Finally, catechol-O-methyltransferase (COMT) is important for regulation of catecholamine levels, which play a role in fear memory formation and extinction. COMT expression in the hippocampus was significantly reduced by high E2 replacement, implying increased catecholamine levels in the hippocampus of high E2 mice. These results suggest that estradiol enhanced fear memory formation, and inhibited fear memory extinction, possibly stabilizing the fear memory in female mice. This study has implications for a neurobiological mechanism for PTSD and anxiety disorders. Copyright © 2014 Elsevier Inc. All rights reserved.

Replacing Alpha-Fetoprotein With Alpha-Fetoprotein-L3 Increases the Sensitivity of Prenatal Screening for Trisomy 21.

PubMed

Huai, Lei; Leng, Jianhang; Ma, Shenglin; Huang, Fang; Shen, Junya; Ding, Yu

This study aimed to investigate the serum concentration of alpha-fetoprotein (AFP)-L3 in midterm pregnancies and its potential application in prenatal trisomy screening. The serum samples from 27 women with trisomy 21 fetuses and 800 women with normal fetuses were examined to measure the concentrations of AFP, AFP-L3, human chorionic gonadotropin (hCG), unconjugated estriol (uE3), and inhibin-A. The screening results of various tests consisting of these markers were analyzed. In normal pregnancies within 15-20 weeks of gestation, the medians of serum AFP-L3 were 4.63, 5.70, 5.78, 6.58, 7.03, and 7.25 pg/mL. The median of AFP-L3 MoM in the trisomy 21 group was 0.46, which was significantly lower than the value of 1 in the normal group (P < 0.05). When using a cutoff value of 1/270, the sensitivity of the triple marker test (AFP, hCG, uE3) was improved from 74% to 81% by replacing AFP with AFP-L3, with the false-positive rate slightly increased from 5.4% to 6.8%. Similarly, the sensitivity of the quad marker test (AFP, hCG, uE3, inhibin-A) was improved from 81% to 89% by replacing AFP with AFP-L3, with the false-positive rate slightly increased from 4.6% to 5.6%. Serum AFP-L3 concentration increases along with more weeks of gestation in the midterm pregnancies. Trisomy 21 screening tests with AFP replaced by AFP-L3 have higher sensitivities at the expense of slightly increased false-positive rates. This improvement in screening may help to better prepare the parents and caregivers for the special needs of newborns with trisomy 21.

Infection after pacemaker implantation: infection rates and risk factors associated with infection in a population-based cohort study of 46299 consecutive patients

PubMed Central

Johansen, Jens Brock; Jørgensen, Ole Dan; Møller, Mogens; Arnsbo, Per; Mortensen, Peter Thomas; Nielsen, Jens Cosedis

2011-01-01

Aims Infection is a serious complication of pacemaker (PM) systems. Although the rate of infection has been debated, the figures are largely unknown. We therefore studied the incidence of PM infection and its associated risk factors in the Danish population. Methods and results Since 1982, all PM implantation and removal procedures performed in Denmark have been prospectively recorded in the Danish Pacemaker Register. All patients (n = 46299) who underwent implantation between 1982 and 2007 were included. The total length of surveillance was 236 888 PM-years. The incidence of infection was calculated according to the total number of PM-years. The incidence of surgical site infection (≤365 days after PM implantation) was compared with later infection in first implant and replacement procedures. Multiple-record and multiple-event-per-subject proportional hazards analyses were used to identify the independent risk factors of PM infection. Surgical site infection occurred in 192 cases after first implantation (incidence rate 4.82/1000 PM-years), and in 133 cases after replacement (12.12/1000 PM-years). Infections occurring more than 365 days after the first implantation occurred in 153 cases (1.02/1000 PM-years), and in 118 cases after replacement (3.26/1000 PM-years). Independent factors associated with an increased risk of PM infection were a greater number of PM operations (including replacements), male sex, younger age, implantation during the earliest part of the study period, and absence of antibiotics (P< 0.001). Conclusion The overall risk of infection after PM implantation was low. A greater number of operations augmented the risk of infection. This should be taken into account when considering revisions of PM systems. PMID:21252172

Telemedicine support shortens length of stay after fast-track hip replacement.

PubMed

Vesterby, Martin Svoldgaard; Pedersen, Preben Ulrich; Laursen, Malene; Mikkelsen, Søren; Larsen, Jens; Søballe, Kjeld; Jørgensen, Lene Bastrup

2017-02-01

Background and purpose - Telemedicine could allow patients to be discharged more quickly after surgery and contribute to improve fast-track procedures without compromising quality, patient safety, functionality, anxiety, or other patient-perceived parameters. We investigated whether using telemedicine support (TMS) would permit hospital discharge after 1 day without loss of self-assessed quality of life, loss of functionality, increased anxiety, increased rates of re-admission, or increased rates of complications after hip replacement. Patients and methods - We performed a randomized controlled trial involving 72 Danish patients in 1 region who were referred for elective fast-track total hip replacement between August 2009 and March 2011 (654 were screened for eligibility). Half of the patients received a telemedicine solution connected to their TV. The patients were followed until 1 year after surgery. Results - Length of stay was reduced from 2.1 days (95% CI: 2.0-2.3) to 1.1 day (CI: 0.9-1.4; p < 0.001) with the TMS intervention. Health-related quality of life increased in both groups, but there were no statistically significant differences between groups. There were also no statistically significant differences between groups regarding timed up-and-go test and Oxford hip score at 3-month follow-up. At 12-month follow-up, the rates of complications and re-admissions were similar between the groups, but the number of postoperative hospital contacts was lower in the TMS group. Interpretation - Length of postoperative stay was shortened in patients with the TMS solution, without compromising patient-perceived or clinical parameters in patients undergoing elective fast-track surgery. These results indicate that telemedicine can be of value in fast-track treatment of patients undergoing total hip replacement.

Importance of milk replacer intake and composition in rearing orphan foals

PubMed Central

Cymbaluk, Nadia F.; Smart, Marion E.; Bristol, Frank M.; Pouteaux, Victor A.

1993-01-01

Effects of milk replacer composition and intake on the growth of orphan foals were evaluated. Twenty foals were assigned to four treatments: 1) mare-nursed, 2) commercial foal milk replacer at recommended intakes (standard), 3) commercial foal milk replacer at high intakes (high), and 4) acidified replacer at recommended intakes (acidified). Foals fed milk replacer diets were weaned at 12-24 hours postpartum and fed milk replacer for 50 days. Mare-nursed foals were weaned between 52 and 56 days of age. Foals fed replacer diets gained 12% to 28% less weight than mare-nursed foals up to two weeks of age. However, by four months of age, weights of replacer-fed foals were similar to those of mare-nursed foals and 32 other mare-nursed foals at the farm weaned between three and four months postparium. Foals drank 10 to 12 L/100 kg body weight (BW) in fluid replacer daily over the trial period. During the first week, high intake foals consumed 26% more replacer (p<0.05) than foals fed acidified or standard diets. This higher intake resulted in diarrhea earlier (6-11 days vs 11-22 days) and for a longer time (6.3 days vs 2.5-3.6 days) than in foals fed recommended amounts. Mare-nursed foals developed “foal heat scours” in the second week postpartum. After the first week, foals fed high replacer diet voluntarily consumed the same volume of fluid replacer as foals fed the standard intake. Foals ate less than 1 kg grain mix/100 kg BW daily to one month of age, then increased intake to 1.5-2 kg/ 100 kg BW to weaning. Water intake was 20-40% of daily fluid intake and was correlated (r = 0.85) to dry matter intake. Foals in the high intake group ate less (p<0.05) solid feed and drank less water than foals fed the standard and acidified diets. The foal's stomach capacity appears to limit meal size and thus replacer intake. If recommended feeding intervals are used, replacer intakes by foals are less than 15% BW daily. High volume intakes appeared to prolong diarrhea. Normal growth rates occur when replacer and good-quality feeds are fed concurrently. PMID:17424268

The future of hemodialysis membranes.

PubMed

Humes, H D; Fissell, W H; Tiranathanagul, K

2006-04-01

Hemodialytic treatment of patients with either acute or chronic renal failure has had a dramatic impact on the mortality rates of these patients. Unfortunately, this membrane-based therapy is still incomplete renal replacement, as the mortality and morbidity of these patients remain unacceptably high. Much progress must be made to improve the biocompatibility of hemodialysis membranes as well as their hydraulic and permselective properties to remove small solutes and 'middle molecules' in compact cartridges. The next directions of development will leverage materials and mechanical engineering technology, including microfluidics and nanofabrication, to further improve the clearance functions of the kidney to replicate glomerular permselectivity while retaining high rates of hydraulic permeability. The extension of membrane technology to biohybrid devices utilizing progenitor/stem cells will be another substantive advance for renal replacement therapy. The ability to not only replace solute and water clearance but also active reabsorptive transport and metabolic activity will add additional benefit to the therapy of patients suffering from renal failure. This area of translational research is rich in creative opportunities to improve the unmet medical needs of patients with either chronic or acute renal failure.

Aggressive Treatment of Life-Threatening Hypophosphatemia During Recovery From Fulminant Hepatic Failure: A Case Report.

PubMed

Bissell, Brittany D; Davis, Jason E; Flannery, Alexander H; Adkins, David A; Thompson Bastin, Melissa L

2018-06-01

Acute liver failure secondary to acetaminophen overdose can be a life-threatening condition, characterized by severe electrolyte derangements. Hepatocyte regeneration is associated with phosphorous utilization and is a known complication of liver recovery following injury. We report the case of profound, life-threatening hypophosphatemia following recovery from acute fulminant liver failure. As the liver enzymes normalized, serum phosphorous levels plummeted. Our patient required an aggressive, individualized phosphorus replacement regimen, which resulted in a continuous infusion of intravenous (IV) sodium phosphate, titrated to a maximum rate of 30 mmol/h or 0.5 mmol/kg/h. The patient required over 400 mmol of total IV and oral phosphorous over the course of 48 hours. An aggressive approach to phosphorous replacement was done safely and effectively. Traditional replacement protocols are not adequate to sustain patients with this degree of hypophosphatemia. This is the first report to utilize a continuous infusion of phosphate with a maximum reported rate (0.5 mmol/kg/h). Our report summarizes a novel and safe approach for clinicians to maximally support these patients through high-dose, continuous infusion phosphorous administration.

A note on the effects of replenishment of depleted cells on HIV infection dynamics: A graph-theoretic approach

NASA Astrophysics Data System (ADS)

Mukwembi, Simon

2008-02-01

We study the effects of the rate of replacement of dead cells by either healthy cells or by infected cells on HIV infection dynamics through a graph-theoretic approach. Our framework takes into account a reasonable amount of the immune action to any pathogen and the local cell interactions that occur in the lymph nodes. Our results, in an extremal case where dead cells are highly likely to be replaced by healthy cells, show that all cells become healthy in a finite number of steps of given order and infection stops propagating. Further, for this extremal case, we give an algebraic formula for the number of infected cells at any given time in the HIV progression. We also find a sufficient condition, determined by dead cell replacement rate, which guarantees that an infected patient is continually positive, and give bounds on the number of infected, healthy and dead cells at any given time. We apply our theoretical results to a recently proposed model of the HIV infection dynamics.

When It's Time to Retire: Notes From the Afterlife.

PubMed

Loxterkamp, David

2018-03-01

At the end of the Second World War, the US birth rate peaked at nearly 27 births per 1,000 population-a rate unparalleled in the previous 3 decades, and one that would not be repeated. That Boomer generation is now retiring. How do those of us caught in the wave feel about stepping back? Who will step in to replace us? And how will we replace the loss of purpose and fulfillment that comes from a career in medicine? A lengthening life expectancy has challenged many of us to consider the "second act" to our adult life. This essay describes the emotional turbulence of ending one career and contemplating the next. © 2018 Annals of Family Medicine, Inc.

Glaucoma after corneal replacement.

PubMed

Baltaziak, Monika; Chew, Hall F; Podbielski, Dominik W; Ahmed, Iqbal Ike K

Glaucoma is a well-known complication after corneal transplantation surgery. Traditional corneal transplantation surgery, specifically penetrating keratoplasty, has been slowly replaced by the advent of new corneal transplantation procedures: primarily lamellar keratoplasties. There has also been an emergence of keratoprosthesis implants for eyes that are high risk of failure with penetrating keratoplasty. Consequently, there are different rates of glaucoma, pathogenesis, and potential treatment in the form of medical, laser, or surgical therapy. Copyright © 2017 Elsevier Inc. All rights reserved.

On the Suitability of Tcl/Tk for SYS

DTIC Science & Technology

2003-02-01

database design, or user interface. CMU/SEI-2003-TN-001 7 4.4 Legacy Systems SYS is not now complete. The system it replaced interfaced with a dozen...a database maintained by a parent organization. Before SYS was released, many of its current users interacted directly with JSYS, so that system...rating. Rather than shades of blue, the full rainbow is exploited. Rather than window proliferation, the usual result of an action is to replace the

Oxygen enhanced switching to combustion of lower rank fuels

DOEpatents

Kobayashi, Hisashi; Bool, III, Lawrence E.; Wu, Kuang Tsai

2004-03-02

A furnace that combusts fuel, such as coal, of a given minimum energy content to obtain a stated minimum amount of energy per unit of time is enabled to combust fuel having a lower energy content, while still obtaining at least the stated minimum energy generation rate, by replacing a small amount of the combustion air fed to the furnace by oxygen. The replacement of oxygen for combustion air also provides reduction in the generation of NOx.

Is Low Fertility a Twenty-First-Century Demographic Crisis?*

PubMed Central

Morgan, S. Philip

2010-01-01

Nearly half of the world's population in 2000 lived in countries with fertility rates at or below replacement level, and nearly all countries will reach low fertility levels in the next two decades. Concerns about low fertility, fertility that is well below replacement, are widespread. But there are both persistent rationales for having children and institutional adjustments that can make the widespread intentions for two children attainable, even in increasingly individualistic and egalitarian societies. PMID:14686132

Flow-induced vibration testing of replacement thermowell designs

NASA Astrophysics Data System (ADS)

Haslinger, K. H.

2003-09-01

Inconel 600 Primary Water Stress Corrosion Cracking (PWSCC) in Nuclear Pressurized Water Reactors (PWRs) has necessitated the repair/replacement of various small bore nozzles. These repairs/replacements must be designed to avoid unwanted vibrations. So, to this end, new RTD-Thermowell-Nozzle replacement designs were developed and subjected to flow testing over a velocity range from 9.14 to 33.53m/s (30-110ft/s), and temperatures ranging from 121°C to 316°C (250-600°F). The replacement nozzles are welded on the pipe OD, rather than on the pipe ID. A split, tapered ferrule is used to support the nozzle tip inside the pipe bore. This maintains high thermowell tip-resonance frequencies with the objective of avoiding self-excitation from vortex shedding that is believed to have caused failures in an earlier design during initial, precritical plant startup testing. The flow testing was complicated by the small size of the thermowell tips (5.08mm or 0.2in ID), which necessitated use of a complement of low temperature and high temperature instrumentation. Since the high temperature device had an internal resonance (750Hz) within the frequency range of interest (0-2500Hz), adequate sensor correlations had to be derived from low temperature tests. The current nozzle/thermowell design was tested concurrently with two slight variations of the replacement design. The acceleration signals were acquired during incremental and continuous flow sweeps, nominally at 5kHz sampling rates and for time domain processing as high as 25kHz. Whereas vortex-shedding frequencies were predicted to prevail between 400 and 1500Hz, no such response was observed at these frequencies. Rather, the thermowell tips responded due to turbulent buffeting with a peak response that was related directly to flow velocity. Lift direction response was always larger than drag direction response. The thermowell tips also responded at their natural tip frequencies in a narrow band random fashion. At the higher flow rates, one replacement design experienced an instability mode leading to high tip stresses. Although this instability did not repeat, this particular design was eliminated from consideration. The second replacement design performed almost identically to the current in-plant design. The experimental data were used to extract forcing functions and thermowell responses that were used as input into the design calculations.

Accuracy of intravenous infusion pumps in continuous renal replacement therapies.

PubMed

Jenkins, R; Harrison, H; Chen, B; Arnold, D; Funk, J

1992-01-01

Most extracorporeal continuous renal replacement therapies (CRRT) require inflow pumping of either dialysate, filtrate replacement solution, or both. Outflow of spent dialysate and ultrafiltrate can be accomplished by gravity drainage or pump. Intravenous infusion pumps have been commonly used for these purposes, although little is known about the accuracy of these pumps. To evaluate accuracy of two different types of intravenous infusion pumps used in CRRT, we studied flow rates at nine different pressure variations in three piston type and three linear peristaltic pumps. The results showed that error of either pump was not different for flow rates of 4 and 16 ml/min. Both types of pumps were affected by fluid circuit pressures, although pressure conditions under which error was low were different for each pump type. The linear peristaltic pumps were most accurate under conditions of low pump inlet pressure, whereas piston pumps were most accurate under conditions of low pump pressure gradient (outlet minus inlet) of 0 or -100 mmHg. The magnitude of error outside these conditions was substantial, reaching 12.5% for the linear peristaltic pump when inlet pressure was -100 mmHg and outlet pressure was 100 mmHg. Error may be minimized in the clinical setting by choosing the pump type best suited for the pressure conditions expected for the renal replacement modality in use.

The dependence of the action potential of the frog's heart on the external and intracellular sodium concentration

PubMed Central

Niedergerke, R.; Orkand, R. K.

1966-01-01

1. The overshoot of the action potential of the frog's heart was reduced when external sodium chloride was replaced by sucrose. However, the potential decrement was only 17·3 mV for a 10-fold reduction of sodium as compared with 58 mV expected on the basis of the sodium hypothesis of excitation. 2. Replacement of up to 75% of the external sodium by choline did not reduce the overshoot, provided atropine was present in sufficient concentrations to suppress any parasympathomimetic action. 3. The maximum rate of rise of the action potential markedly declined in low sodium fluids whether sucrose or choline chloride was used to replace sodium chloride. 4. The maximum rate of rise was reduced to only a small extent when external sodium was replaced by lithium. 5. Increasing the intracellular sodium concentration in exchange for lost potassium caused overshoots to decline. The effects resembled those obtained in similar experiments with skeletal muscle fibres (Desmedt, 1953). 6. Action potentials occurring under certain conditions even in the presence of very low external sodium concentrations (≤ 5% normal) also declined in height when the intracellular sodium concentration was increased. 7. The behaviour of the action potential in low external sodium concentrations may be explained by an action of calcium on the excitable membrane. PMID:5921833

40 CFR 1065.1107 - Sample media and sample system preparation; sample system assembly.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) For capturing PM, we recommend using pure quartz filters with no binder. Select the filter diameter to minimize filter change intervals, accounting for the expected PM emission rate, sample flow rate, and... filter without replacing the sorbent or otherwise disassembling the batch sampler. In those cases...

18 CFR 300.11 - Technical support for the rate schedule.

Code of Federal Regulations, 2011 CFR

2011-04-01

... historic period or are expected to produce revenue during the rate test period; (B) Capitalized deferred...) Whether the investment is an initial investment, an addition, a replacement, or a capitalized deferred..., Maintenance and Other Annual Expenses. Statement E must contain, for the last five years of the historic...

18 CFR 300.11 - Technical support for the rate schedule.

Code of Federal Regulations, 2010 CFR

2010-04-01

... historic period or are expected to produce revenue during the rate test period; (B) Capitalized deferred...) Whether the investment is an initial investment, an addition, a replacement, or a capitalized deferred..., Maintenance and Other Annual Expenses. Statement E must contain, for the last five years of the historic...

18 CFR 300.11 - Technical support for the rate schedule.

Code of Federal Regulations, 2014 CFR

2014-04-01

... historic period or are expected to produce revenue during the rate test period; (B) Capitalized deferred...) Whether the investment is an initial investment, an addition, a replacement, or a capitalized deferred..., Maintenance and Other Annual Expenses. Statement E must contain, for the last five years of the historic...

18 CFR 300.11 - Technical support for the rate schedule.

Code of Federal Regulations, 2012 CFR

2012-04-01

... historic period or are expected to produce revenue during the rate test period; (B) Capitalized deferred...) Whether the investment is an initial investment, an addition, a replacement, or a capitalized deferred..., Maintenance and Other Annual Expenses. Statement E must contain, for the last five years of the historic...

18 CFR 300.11 - Technical support for the rate schedule.

Code of Federal Regulations, 2013 CFR

2013-04-01

... historic period or are expected to produce revenue during the rate test period; (B) Capitalized deferred...) Whether the investment is an initial investment, an addition, a replacement, or a capitalized deferred..., Maintenance and Other Annual Expenses. Statement E must contain, for the last five years of the historic...

'Benefits cycle' replacing premium cycle as consumerism takes hold.

PubMed

2002-05-01

The traditional premium cycle of ups and downs in rates is giving way to a new phenomenon--driven by the advent of consumerism in health care--termed the "benefits cycle" by one consultant. Rather than shifts in rates, he argues, the future will see shifts in benefits packages.

FORECASTING REGIONAL TO GLOBAL PLANT MIGRATION IN RESPONSE TO CLIMATE CHANGE

EPA Science Inventory

The rate of future climate change is likely to exceed the migration rates of most plant species. The replacement of dominant species by locally rare species may require decades, and extinctions may occur when plant species cannot migrate fast enough to escape the consequences of...

Babies Bottom Out--A 'Maybe Boom'

ERIC Educational Resources Information Center

Science News, 1977

1977-01-01

Data for the period September 1976 through April 1977 indicate a rise in the United States birth rate; however, the rate is still below the replacement level. It is speculated that the increase is an "echo" effect to the post-World War II baby boom which peaked in 1957. (SL)

[Electroacupuncture intervention combined with general anesthesia for 80 cases of heart valve replacement surgery under cardiopulmonary bypass].

PubMed

Chi, Hao; Zhou, Wen-Xiong; Wu, Yao-Yao; Chen, Tong-Yu; Ge, Wen; Yuan, Lan; Shen, Wei-Dong; Zhou, Jia

2014-02-01

To determine whether electroacupuncture (EA) intervention combined with general anesthesia (GA) strategy can reduce early post-operative morbidity and medical costs in patients undergoing heart valve replacement operation under cardiopulmonary bypass. A total of 160 heart valve replacement surgery patients undergoing cardiopulmonary bypass were randomly divided into GA and EA + GA groups (n = 80 in each group). Patients of the GA group were given with intravenous injection of Fentanyl, Midazolam, Vecuronium Bromide, etc. and routine tracheal intubation. EA (3-4 Hz, 2.0-2.2 mA) was applied to bilateral Zhongfu (LU 1), Chize (LU 5) and Ximen (PC 4) beginning about 20 mm before the surgery in the EA + GA group. Endotracheal intubation was not employed but only prepared as a standby for patients of the EA + GA group. The dosage of narcotic drugs, duration of surgery, duration of aertic blockage, rate of cardiac re-beating, volumes of post-operative blood transfusion, discharge volume, cases of post-operative pulmonary infection, vocal cord injury, and the time of first bed-off, first eating and duration in intensive care unit (IOU) residence. etc. were recorded. The successful rates of heart valve replacement surgery were similar in both GA and EA + GA groups. Compared with the GA group, the dosages of Fentanyl, Midazolam and Vecuronium of the EA + GA group were significantly lower (P < 0.05, P < 0.01), the numbers of patients needing blood-transfusion, antibiotics treatment, and suffering from pulmonary infection were fewer, the time of first bed-off and duration of hospitalizetion and IOU residence were considerably shorter (P < 0.05, P < 0.01) and the total medical cost was obviously lower (P < 0.05) in the EA + GA group. EA combined with general anesthesia strategy for heart valve replacement surgery without endotracheal intubation is safe and can reduce post-operative morbidity and medical costs in patients undergoing heart valve replacement surgery under cardiopulmonary bypass.

Pacemaker replacement in nonagenarians: Procedural safety and long-term follow-up.

PubMed

Loirat, Aurélie; Fénéon, Damien; Behaghel, Albin; Behar, Nathalie; Le Helloco, Alain; Mabo, Philippe; Daubert, Jean-Claude; Leclercq, Christophe; Martins, Raphaël P

2015-01-01

The rate of pacemaker implantation is rising. Given that the life expectancy of the population is projected to increase, a large number of elderly patients are likely to be implanted in the future. As pacemaker batteries can last for 8-10years, an increasing number of pacemaker recipients will require replacement of their devices when they become nonagenarians. To analyse the short- and long-term outcomes after device replacement in nonagenarians. Patients aged≥90years referred to a tertiary centre for pacemaker replacement from January 2004 to July 2014 were included retrospectively. Clinical follow-up data were obtained from clinical visits or telephone interviews with patients or their families. The primary clinical endpoint was total mortality. Secondary endpoints included early and delayed procedure-related complications and predictive risk factors for total mortality. Sixty-two patients were included (mean age 93.3±2.9years at time of pacemaker replacement). Mean procedure duration was 35.7±17.2minutes. Mean hospital stay was 2.2±1.1days. One patient died from a perioperative complication. Thirty-seven patients (59.7%) died during a median follow-up of 22.1months (interquartile range, 11.8-39.8months). Survival rates were 84.2% (95% confidence interval [CI] 71.8-91.5%) at 1year, 66.9% (95% CI 51.8-78.2%) at 2years and 22.7% (95% CI 10.6-37.7%) at 5years. Atrial fibrillation (hazard ratio 2.47, 95% CI 1.1-5.6) and non-physiological pacing (i.e. VVI pacing in patients in sinus rhythm) (hazard ratio 2.20, 95% CI 1.0-4.9) were predictors of mortality. Pacemaker replacement in nonagenarians is a safe and straightforward procedure. These data suggest that procedures can be performed securely in this old and frail population, with patients living for a median of 30months afterwards. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Kinetically Controlled Alteration of the Chemical Record During Diagenesis: An Experimental Study on Hydrothermal Carbonate Replacement

NASA Astrophysics Data System (ADS)

Mueller, T.; Dohmen, R.; Jonas, L.; Immenhauser, A.

2016-12-01

The geological record stored in the geochemical composition of carbonates provides a direct source of information on the Earth systems. However, the robustness and accuracy of these key records can be compromised by post-depositional alteration of sediments, such as dolomitization during diagenesis or low temperature metamorphism. Hence, knowledge on the mechanisms and rates of these processes hold the key to evaluate the robustness of proxies or to evaluate the extent of geochemical alteration. Previously, we presented experimental results of hydrothermal alteration of single calcite crystals and aragonitic coral fragments leading to replacement of the original carbonate by a Ca-Mg carbonate phase of variable composition. The experiments revealed the formation of a multiphase reaction rim with multiple replacement fronts [1]. Here, the reaction rate as well as composition of the reaction products is controlled by element transport in the pore fluid. In this study we focus on the reaction path of the replacement reaction and its effect on the recorded Mg-isotope composition. XRD diffraction patterns suggest the initial precipitation of non-ordered protodolomite that is subsequently continuously recrystallizing over the duration of the experiments to form an ordered, albeit non-stoichiometric dolomite. These observations are in agreement with Mg-isotope composition measured of the bulk reaction rim showing a systematic evolution over time that cannot be explained by simple Rayleigh or equilibrium fractionation. We interpret these findings as additional, but delayed reaction fronts affecting the microstructure and chemical composition of the newly formed carbonate rim that are essentially decoupled from the initial replacement front. Our results highlight the need to quantitatively understand alteration processes during diagenesis in order to accurately interpret the preserved geochemical record stored in element and isotope ratios of carbonates. [1] Jonas L., Mueller T., Dohmen R., Baumgartner L., and Putlitz B. (2015): Transport-controlled hydrothermal replacement of calcite by Mg-carbonates, Geology, 43, 779-782.

Comparison of survival analysis and palliative care involvement in patients aged over 70 years choosing conservative management or renal replacement therapy in advanced chronic kidney disease.

PubMed

Hussain, Jamilla A; Mooney, Andrew; Russon, Lynne

2013-10-01

There are limited data on the outcomes of elderly patients with chronic kidney disease undergoing renal replacement therapy or conservative management. We aimed to compare survival, hospital admissions and palliative care access of patients aged over 70 years with chronic kidney disease stage 5 according to whether they chose renal replacement therapy or conservative management. Retrospective observational study. Patients aged over 70 years attending pre-dialysis clinic. In total, 172 patients chose conservative management and 269 chose renal replacement therapy. The renal replacement therapy group survived for longer when survival was taken from the time estimated glomerular filtration rate <20 mL/min (p < 0.0001), <15 mL/min (p < 0.0001) and <12 mL/min (p = 0.002). When factors influencing survival were stratified for both groups independently, renal replacement therapy failed to show a survival advantage over conservative management, in patients older than 80 years or with a World Health Organization performance score of 3 or more. There was also a significant reduction in the effect of renal replacement therapy on survival in patients with high Charlson's Comorbidity Index scores. The relative risk of an acute hospital admission (renal replacement therapy vs conservative management) was 1.6 (p < 0.05; 95% confidence interval = 1.14-2.13). A total of 47% of conservative management patients died in hospital, compared to 69% undergoing renal replacement therapy (Renal Registry data). Seventy-six percent of the conservative management group accessed community palliative care services compared to 0% of renal replacement therapy patients. For patients aged over 80 years, with a poor performance status or high co-morbidity scores, the survival advantage of renal replacement therapy over conservative management was lost at all levels of disease severity. Those accessing a conservative management pathway had greater access to palliative care services and were less likely to be admitted to or die in hospital.

Effect of fat replacement by inulin or lupin-kernel fibre on sausage patty acceptability, post-meal perceptions of satiety and food intake in men.

PubMed

Archer, Bridie J; Johnson, Stuart K; Devereux, Helen M; Baxter, Amynta L

2004-04-01

The present study examined whether replacing fat with inulin or lupin-kernel fibre influenced palatability, perceptions of satiety, and food intake in thirty-three healthy men (mean age 52 years, BMI 27.4 kg/m(2)), using a within-subject design. On separate occasions, after fasting overnight, the participants consumed a breakfast consisting primarily of either a full-fat sausage patty (FFP) or a reduced-fat patty containing inulin (INP) or lupin-kernel fibre (LKP). Breakfast variants were alike in mass, protein and carbohydrate content; however the INP and LKP breakfasts were 36 and 37 % lower in fat and 15 and 17 % lower in energy density respectively compared with the FFP breakfast. The participants rated their satiety before breakfast then evaluated patty acceptability. Satiety was rated immediately after consuming the breakfast, then over the subsequent 4.5 h whilst fasting. Food consumed until the end of the following day was recorded. All patties were rated above 'neither acceptable or unacceptable', however the INP rated lower for general acceptability (P=0.039) and the LKP lower for flavour (P=0.023) than the FFP. The LKP breakfast rated more satiating than the INP (P=0.010) and FFP (P=0.016) breakfasts. Total fat intake was 18 g lower on the day of the INP (P=0.035) and 26 g lower on the day of the LKP breakfast (P=0.013) than the FFP breakfast day. Energy intake was lower (1521 kJ) only on the day of the INP breakfast (P=0.039). Both inulin and lupin-kernel fibre appear to have potential as fat replacers in meat products and for reducing fat and energy intake in men.

[Short-term curative effects of Tantalum rod treatment in early avascular necrosis].

PubMed

Ye, Fu-Sheng; Ni, Zhe-Ji; Chu, Xiao-Bing; He, Bang-Jian; Li, Ju; Tong, Pei-Jian

2013-08-01

To explore the recent clinical curative effect of Tantalum rod in treating the early avascular necrosis. From January 2008 to November 2008, the 25 patients (39 hips) with early avascular necrosis accepted tantalum rod placement and included 9 males (11 hips) and 16 females (28 hips) with an average age of 37 years old ranging from 18 to 74 years old. Four patients (6 hips) caused by Alcoholic, 6 patients (8 hips) by hormone, 2 cases (2 hips) by traumatic, 13 cases (23 hips) by idiopathic. Steinberg preoperative stage involved 7 hips in period I, 24 hips in period II, 8 hips in period III. Curative effect analysis included preoperative and postoperative Harris score, radiographic changes and hip replacement for follow-up to accept the end of the femoral head survival rate. All patients were followed up for 6 to 47 months (averaged 37.4 months). All 12 hips imaging appeard progress,including tantalum rod exit in 1 hip, hip hemiarthroplasty collapse in 3 hips, the area increased to avascular necrosis in 8 hips. Six hips accepted total hip replacement, including imaging progress in 5 hips (41.7%, 5/12), no imaging progress in 1 hip (3.7%,1/27). All hips' Kaplan-Meier survival curves showed 6-month survival rate was (97.4 +/- 2.5)% after tantalum stick insertion, 1-year survival rate was (94.7 +/- 3.6), and 2-year survival rate was (88.6 +/- 5.4)%, 3-year survival rate was (72.5 +/- 11.2). It is effective for treatment of avascular necrosis of femoral head in Steinberg I and II by Tantalum rod, and it can effectively relieve femoral head replacement time.

pH regulation in barnacle muscle fibers: dependence on extracellular sodium and bicarbonate.

PubMed

Boron, W F; McCormick, W C; Roos, A

1981-01-01

Intracellular pH (pHi) regulation was studied in barnacle muscle fibers with pH-sensitive microelectrodes. The cells were acid loaded, and the subsequent recovery of pHi was monitored. The rate of recovery was reduced by one-third when external Na+ ([Na+]o) was replaced by Li+, but recovery was completely abolished when Na+ was replaced by choline or N-methyl-D-glucamine. In other experiments, varying amounts of Na+ were replaced by choline, and the acid extrusion rate, derived from the recovery rate of pHi, was calculated at a single value of pHi, 6.80. The dependence of the acid extrusion rate on [Na+]o could be described by Michaelis-Menten kinetics; at pHo (extracellular) = 8.0 and [HCO3-]o (extracellular) = 10 mM, the apparent Km and Vmax were 59 mM and 1.3 mmol x l(-1) x min-1. When [HCO3-]o was reduced to 2.5 mM at the same pHo, Km did not change significantly, but Vmax was substantially reduced. On the other hand, when pHo was reduced to 7.4 at constant [HCO3-]o, Vmax changed only slightly, but Km increased substantially. In similar experiments, we examined the dependence of the acid extrusion rate on [HCO3-]o. At pHo = 8.0 and [Na+]o = 440 mM, the apparent Km and Vmax were 4.1 mM and 2.1 mmol x 1-1 x min-1. When pHo was reduced to 7.4, Vmax was not altered, but Km substantially increased. The kinetic data are discussed in terms of the role of pHo, [Na+]o, and [HCO3-]o in the pHi-regulating system.

Vagaries of the molecular clock

PubMed Central

Ayala, Francisco J.

1997-01-01

The hypothesis of the molecular evolutionary clock asserts that informational macromolecules (i.e., proteins and nucleic acids) evolve at rates that are constant through time and for different lineages. The clock hypothesis has been extremely powerful for determining evolutionary events of the remote past for which the fossil and other evidence is lacking or insufficient. I review the evolution of two genes, Gpdh and Sod. In fruit flies, the encoded glycerol-3-phosphate dehydrogenase (GPDH) protein evolves at a rate of 1.1 × 10−10 amino acid replacements per site per year when Drosophila species are compared that diverged within the last 55 million years (My), but a much faster rate of ≈4.5 × 10−10 replacements per site per year when comparisons are made between mammals (≈70 My) or Dipteran families (≈100 My), animal phyla (≈650 My), or multicellular kingdoms (≈1100 My). The rate of superoxide dismutase (SOD) evolution is very fast between Drosophila species (16.2 × 10−10 replacements per site per year) and remains the same between mammals (17.2) or Dipteran families (15.9), but it becomes much slower between animal phyla (5.3) and still slower between the three kingdoms (3.3). If we assume a molecular clock and use the Drosophila rate for estimating the divergence of remote organisms, GPDH yields estimates of 2,500 My for the divergence between the animal phyla (occurred ≈650 My) and 3,990 My for the divergence of the kingdoms (occurred ≈1,100 My). At the other extreme, SOD yields divergence times of 211 My and 224 My for the animal phyla and the kingdoms, respectively. It remains unsettled how often proteins evolve in such erratic fashion as GPDH and SOD. PMID:9223263

Can end-of-day reports replace momentary assessment of pain and fatigue?

PubMed Central

Broderick, Joan E.; Schwartz, Joseph E.; Schneider, Stefan; Stone, Arthur A.

2009-01-01

This study evaluated the ability of end-of-day (EOD) ratings to accurately reflect momentary (EMA) ratings on 10 widely used pain and fatigue items. Rheumatology patients (N=105) completed ≥5 randomly scheduled EMA assessments of each item per day as well as EOD ratings. Correlations were high between EOD and EMA ratings of the five pain items (r= .90-.92) and somewhat lower for the five fatigue/energy items (r= .71-.86). To examine the ability of EOD ratings to represent a week of EMA ratings, 7 EOD ratings were averaged and correlated with EMA (r ≥ .95 for pain items, r = .88-.95 for fatigue/energy items). Further, averaging only 3-5 EOD ratings achieved very high correlations with a week of EMA ratings. Within-subject correlations of EOD with mean daily EMA across 7 days confirmed patients’ ability to provide daily ratings that accurately reflect their day-to-day variation in symptom levels. These EOD results were compared to traditional recall ratings collected in the same protocol. It was concluded (1) that EOD ratings were a better representation of EMA than were recall ratings, and (2) that EOD ratings across a reporting period can replace EMA for studies targeting average levels of pain or fatigue. Perspective This study in chronic pain patients demonstrated that end-of-day ratings of pain are highly accurate representations of average levels of pain experience across a day; Ratings of fatigue were somewhat less accurate, though still at a level that would be valid. PMID:19070550

Complex patterns of tooth replacement revealed in the fruit bat (Eidolon helvum).

PubMed

Popa, Elena M; Anthwal, Neal; Tucker, Abigail S

2016-12-01

How teeth are replaced during normal growth and development has long been an important question for comparative and developmental anatomy. Non-standard model animals have become increasingly popular in this field due to the fact that the canonical model laboratory mammal, the mouse, develops only one generation of teeth (monophyodonty), whereas the majority of mammals possess two generations of teeth (diphyodonty). Here we used the straw-coloured fruit bat (Eidolon helvum), an Old World megabat, which has two generations of teeth, in order to observe the development and replacement of tooth germs from initiation up to mineralization stages. Our morphological study uses 3D reconstruction of histological sections to uncover differing arrangements of the first and second-generation tooth germs during the process of tooth replacement. We show that both tooth germ generations develop as part of the dental lamina, with the first generation detaching from the lamina, leaving the free edge to give rise to a second generation. This separation was particularly marked at the third premolar locus, where the primary and replacement teeth become positioned side by side, unconnected by a lamina. The position of the replacement tooth, with respect to the primary tooth, varied within the mouth, with replacements forming posterior to or directly lingual to the primary tooth. Development of replacement teeth was arrested at some tooth positions and this appeared to be linked to the timing of tooth initiation and the subsequent rate of development. This study adds an additional species to the growing body of non-model species used in the study of tooth replacement, and offers a new insight into the development of the diphyodont condition. © 2016 Anatomical Society.

Comparison of blood loss between using non central part cutting knee prosthesis and distal central part cutting.

PubMed

Malairungsakul, Anan

2014-12-01

Patients who undergo knee replacement surgery may need to receive a blood transfusion due to blood loss during the operation. Therefore it was important to improve the design of knee implant operative procedures in an attempt to reduce the rate of blood loss. The present study aimed to compare the blood loss between two types of knee replacement surgery. This is a retrospective study in which 78 patients received cemented knee replacements in Phayao Hospital between October 2010 and March 2012. There were two types of surgical procedure: 1) using an implant position covering the end of the femoral bone without cutting into the central part of the distal femoral, 2) using an implant position covering the end of the femoral bone cutting the central part of the distal femoral. Blood loss, blood transfusion, hemoglobin and hematocrit were recorded preoperatively, immediately postsurgery and 48 hours after surgery. Findings revealed that the knee replacement surgery using the implant position covering the end of the femoral bone without cutting the central part of the distal femoral significantly lowered the rate of blood loss when compared to using the implant position covering the end of the femoral bone with central cutting of the distal femor. The average blood loss during the operation without cutting at the central part of distal femoral was 49.50 ± 11.11 mL; whereas the operation cutting the central part of the distal femoral was 58.50 ± 11.69 mL. As regards blood loss, the knee replacement surgery using the implant position covering the end ofthefemoral bone without cutting the central part of distal femor was better than using the implant position covering the end of the femoral bone cutting at the central part of the distal femor.

The influence of simulator input conditions on the wear of total knee replacements: An experimental and computational study

PubMed Central

Brockett, Claire L; Abdelgaied, Abdellatif; Haythornthwaite, Tony; Hardaker, Catherine; Fisher, John; Jennings, Louise M

2016-01-01

Advancements in knee replacement design, material and sterilisation processes have provided improved clinical results. However, surface wear of the polyethylene leading to osteolysis is still considered the longer-term risk factor. Experimental wear simulation is an established method for evaluating the wear performance of total joint replacements. The aim of this study was to investigate the influence of simulation input conditions, specifically input kinematic magnitudes, waveforms and directions of motion and position of the femoral centre of rotation, on the wear performance of a fixed-bearing total knee replacement through a combined experimental and computational approach. Studies were completed using conventional and moderately cross-linked polyethylene to determine whether the influence of these simulation input conditions varied with material. The position of the femoral centre of rotation and the input kinematics were shown to have a significant influence on the wear rates. Similar trends were shown for both the conventional and moderately cross-linked polyethylene materials, although lower wear rates were found for the moderately cross-linked polyethylene due to the higher level of cross-linking. The most important factor influencing the wear was the position of the relative contact point at the femoral component and tibial insert interface. This was dependent on the combination of input displacement magnitudes, waveforms, direction of motion and femoral centre of rotation. This study provides further evidence that in order to study variables such as design and material in total knee replacement, it is important to carefully control knee simulation conditions. This can be more effectively achieved through the use of displacement control simulation. PMID:27160561

Retrospective study of long-term outcomes of enzyme replacement therapy in Fabry disease: Analysis of prognostic factors

PubMed Central

Biegstraaten, Marieke; Hughes, Derralynn A.; Mehta, Atul; Elliott, Perry M.; Oder, Daniel; Watkinson, Oliver T.; Vaz, Frédéric M.; van Kuilenburg, André B. P.; Wanner, Christoph; Hollak, Carla E. M.

2017-01-01

Despite enzyme replacement therapy, disease progression is observed in patients with Fabry disease. Identification of factors that predict disease progression is needed to refine guidelines on initiation and cessation of enzyme replacement therapy. To study the association of potential biochemical and clinical prognostic factors with the disease course (clinical events, progression of cardiac and renal disease) we retrospectively evaluated 293 treated patients from three international centers of excellence. As expected, age, sex and phenotype were important predictors of event rate. Clinical events before enzyme replacement therapy, cardiac mass and eGFR at baseline predicted an increased event rate. eGFR was the most important predictor: hazard ratios increased from 2 at eGFR <90 ml/min/1.73m2 to 4 at eGFR <30, compared to patients with an eGFR >90. In addition, men with classical disease and a baseline eGFR <60 ml/min/1.73m2 had a faster yearly decline (-2.0 ml/min/1.73m2) than those with a baseline eGFR of >60. Proteinuria was a further independent risk factor for decline in eGFR. Increased cardiac mass at baseline was associated with the most robust decrease in cardiac mass during treatment, while presence of cardiac fibrosis predicted a stronger increase in cardiac mass (3.36 gram/m2/year). Of other cardiovascular risk factors, hypertension significantly predicted the risk for clinical events. In conclusion, besides increasing age, male sex and classical phenotype, faster disease progression while on enzyme replacement therapy is predicted by renal function, proteinuria and to a lesser extent cardiac fibrosis and hypertension. PMID:28763515

Is human chorionic gonadotropin supplementation beneficial for frozen and thawed embryo transfer in estrogen/progesterone replacement cycles?: A randomized clinical trial.

PubMed

Shiotani, Masahide; Matsumoto, Yukiko; Okamoto, Eri; Yamada, Satoshi; Mizusawa, Yuri; Furuhashi, Kohyu; Ogata, Hiromi; Ogata, Seiji; Kokeguchi, Shoji

2017-04-01

Human chorionic gonadotropin (hCG) is used frequently for luteal support in fresh in vitro fertilization cycles as it induces progesterone secretion from the ovaries after oocyte retrieval and modulates the endometrium for implantation in fresh cycles. In contrast, hCG is not usually used for the transfer of cryopreserved-thawed embryos in estrogen/progesterone replacement cycles because ovulation is suppressed. However, several studies have shown that luteinizing hormone and hCG receptors are present in the human endometrium and that hCG can directly induce the decidualization of endometrial stromal cells in vitro. Thus, this study evaluated whether hCG supplementation can be beneficial for cryopreserved-thawed embryo transfer in estrogen/progesterone replacement cycles. One-hundred-and seventy-three cryopreserved-thawed embryo transfer cycles with estrogen/progesterone replacement were divided randomly into two groups. Transdermal oestradiol was used in combination with vaginal progesterone suppositories for HR. The embryo transfer was performed on day 17 and/or day 20 of the HR therapy cycle in both groups. In Group A, 3000 IU of hCG was administered on days 17, 20, and 23. In Group B, hCG was not used. There was no significant difference in the average age of the patients, the average number of previous assisted reproductive technology cycles, or the average number of embryo transfers between the two groups. The rates of pregnancy and implantation per embryo were 37.2% and 25.3%, respectively, in Group A and 35.6% and 21.7%, respectively, in Group B. The pregnancy and implantation rates were similar in both groups. Supplementation with hCG is not beneficial for cryopreserved-thawed embryo transfer in estrogen/progesterone replacement cycles.

Antibacterial Envelope Is Associated With Low Infection Rates After Implantable Cardioverter-Defibrillator and Cardiac Resynchronization Therapy Device Replacement: Results of the Citadel and Centurion Studies.

PubMed

Henrikson, Charles A; Sohail, M Rizwan; Acosta, Helbert; Johnson, Eric E; Rosenthal, Lawrence; Pachulski, Roman; Dan, Dan; Paladino, Walter; Khairallah, Farhat S; Gleed, Kent; Hanna, Ibrahim; Cheng, Alan; Lexcen, Daniel R; Simons, Grant R

2017-10-01

This study sought to determine whether the nonabsorbable TYRX Antibacterial Envelope (TYRX) reduces major cardiovascular implantable electronic device (CIED) infections 12 months after implant. TYRX is a monofilament polypropylene mesh impregnated with minocycline and rifampin specifically designed to hold a CIED in place and elute antimicrobials over time. There are limited data on its ability to reduce CIED infections. We prospectively enrolled patients who underwent generator replacement with an implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy device (CRT), treated with TYRX. The primary endpoints were major CIED infection and CIED mechanical complications. Given the differences in infection rates among ICD and CRT patients, 3 different control populations were used: a published benchmark rate for ICD patients, and both site-matched and comorbidity-matched controls groups for CRT patients. Overall, a major CIED infection occurred in 5 of 1,129 patients treated with TYRX (0.4%; 95% confidence interval: 0.0% to 0.9%), significantly lower than the 12-month benchmark rate of 2.2% (p = 0.0023). Among the TYRX-treated CRT cohort, the major CIED infection rate was 0.7% compared with an infection rate of 1.0% and 1.3% (p = 0.38 and p = 0.02) in site-matched and comorbidity-matched control groups, respectively. Among the ICD group, the 12-month infection rate was 0.2% compared with the published benchmark of 2.2% (p = 0.0052). The most common CIED mechanical complication in study patients was pocket hematoma, which occurred in 18 of the 1,129 patients (1.6%; 95% confidence interval: 0.8 to 2.5), which is comparable with a published rate of 1.6%. Use of TYRX was associated with a lower major CIED infection rate. (TYRX™ Envelope for Prevention of Infection Following Replacement With a CRT or ICD; [Centurion]; NCT01043861/NCT01043705). Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Relating hybrid advantage and genome replacement in unisexual salamanders.

PubMed

Charney, Noah D

2012-05-01

Unisexual vertebrates are model systems for understanding the evolution of sex. Many predominantly clonal lineages allow occasional genetic recombination, which may be sufficient to avoid the accumulation of deleterious mutations and parasites. Introgression of paternal DNA into an all-female lineage represents a one-way flow of genetic material. Over many generations, this could result in complete replacement of the unisexual genomes by those of the donor species. The process of genome replacement may be counteracted by contemporary dispersal or by positive selection on hybrid nuclear genomes in ecotones. I present a conceptual model that relates nuclear genome replacement, positive selection on hybrids and biogeography in unisexual systems. I execute an individual-based simulation of the fate of hybrid genotypes in contact with a single host species. I parameterize these models for unisexual salamanders in the Ambystoma genus, for which the frequency of genome replacement has been a source of ongoing debate. I find that, if genome replacement occurs at a rate greater than 1/10,000 in Ambystoma, then there must be compensating positive selection in order to maintain observed levels of hybrid nuclei. Future researchers studying unisexual systems may use this framework as a guide to evaluating the hybrid superiority hypothesis. © 2011 The Author. Evolution© 2011 The Society for the Study of Evolution.

Tibio-talo-calcaneal arthrodesis with retrograde compression intramedullary nail fixation for salvage of failed total ankle replacement: a systematic review.

PubMed

Donnenwerth, Michael P; Roukis, Thomas S

2013-04-01

Failed total ankle replacement is a complex problem that should only be treated by experienced foot and ankle surgeons. Significant bone loss can preclude revision total ankle replacement and obligate revision though a complex tibio-talo-calcaneal arthrodesis. A systematic review of the world literature reveals a nonunion rate of 24.2%. A weighted mean of modified American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Scale demonstrated fair patient outcomes of 58.1 points on an 86-point scale (67.6 points on a 100-point scale). Complications were observed in 38 of 62 (62.3%) patients reviewed, with the most common complication being nonunion. Copyright © 2013 Elsevier Inc. All rights reserved.

Total elbow arthroplasty in primary osteoarthritis of the elbow.

PubMed

Kozak, T K; Adams, R A; Morrey, B F

1998-10-01

Primary osteoarthritis of the elbow is an infrequent condition typically managed by some form of debridement. There is no comment in the literature regarding prosthetic replacement for this condition. We report 5 patients (mean age, 68), with a minimum assessment of 3 years (range, 37-125 years) after total elbow arthroplasty. Complications in 4 patients included subluxation, fracture of a humeral component with particulate synovitis, heterotopic ossification, recurrent osteophyte formation, and transient ulnar neuropathy. Although revision was required in 2 of the 5, currently all experience had satisfactory outcomes. While replacement has proven ultimately to be a successful option for this high-demand patient group because of the high complication rate, we do not recommend replacement unless alternate operative options are deemed unacceptable.

Mitochondrial Replacement Therapy in Reproductive Medicine

PubMed Central

Wolf, Don P.; Mitalipov, Nargiz; Mitalipov, Shoukhrat

2015-01-01

Mitochondrial dysfunction is implicated in disease and in age-related infertility. Mitochondrial replacement therapies (MRT) in oocytes or zygotes such as pronuclear (PNT), spindle (ST) or polar body (PBT) transfer could prevent second generation transmission of mitochondrial DNA (mtDNA) defects. PNT, associated with high levels of mtDNA carryover in mice but low levels in human embryos, carries ethical issues secondary to donor embryo destruction. ST, developed in primates, supports normal development to adults and low mtDNA carryover. PBT in mice, coupled with PN or ST, may increase the yield of reconstructed embryos with low mtDNA carryover. MRT also offers replacement of the deficient cytoplasm in oocytes from older patients, with the expectation of high pregnancy rates following in vitro fertilization. PMID:25573721

Forecasting invasive pneumococcal disease trends after the introduction of 13-valent pneumococcal conjugate vaccine in the United States, 2010-2020.

PubMed

Link-Gelles, Ruth; Taylor, Thomas; Moore, Matthew R

2013-05-24

Pneumococcal vaccines are highly effective at preventing invasive pneumococcal disease (IPD), a leading cause of global morbidity. Because pneumococcal vaccines can be expensive, it is useful to estimate what impact might be expected from their introduction. Our objective was to develop a statistical model that could predict rates of IPD following introduction of 13-valent pneumococcal conjugate vaccine (PCV13) in the U.S. We used active surveillance data to design and validate a Poisson model forecasting the reductions in IPD observed after U.S. introduction of 7-valent pneumococcal conjugate vaccine (PCV7) in 2000. We used this model to forecast rates of IPD from 2010 to 2020 in the presence of PCV13. Because increases in non-PCV7-type IPD were evident following PCV7 introduction, we evaluated varying levels of increase in non-PCV13-type IPD ("serotype replacement") by sensitivity analyses. A total of 43,507 cases of IPD were identified during 1998-2009; cases from this period were used to develop the model, which accurately predicted indirect effects of PCV7 in adults, as well as serotype replacement. Assuming that PCV13 provides similar protection against PCV13 serotypes as PCV7 did against PCV7 serotypes, the base-case model predicted approximately 168,000 cases of IPD prevented from 2011 to 2020. When serotype replacement was varied in sensitivity analyses from 0 to levels comparable to that seen with serotype 19A (the most common replacement serotype since PCV7 was introduced), the model predicted 167,000-170,000 cases prevented. The base-case model predicted rates of IPD in children under five years of age decreasing from 21.9 to 9.3 cases per 100,000 population. This model provides a "benchmark" for assessing progress in the prevention of IPD in the years after PCV13 introduction. The amount of serotype replacement is unlikely to greatly affect the overall number of cases prevented by PCV13. Published by Elsevier Ltd.

Dependence of flow and transport through the Williamson River Delta, Upper Klamath Lake, Oregon, on wind, river inflow, and lake elevation

USGS Publications Warehouse

Wood, Tamara M.

2012-01-01

The hydrodynamic model of Upper Klamath and Agency Lakes, Oregon, was used to run 384 realizations of a numerical tracer experiment in order to understand the relative effects of wind, lake elevation, and Williamson River inflow on flow and transport (the movement of water and passively transported constituents) through the Williamson River Delta. Significant findings from this study include: * The replacement rate of water increased in Tulana and Goose Bay with increasing lake elevation, Williamson River inflow, and wind speed. * The fraction of Williamson River inflow passing through either side of the Delta increased with lake elevation and Williamson River inflow. * The partial replacement rate of water in Goose Bay with water from the Williamson River increased with wind speed. * The partial replacement rate of water in Tulana with water from the Williamson River decreased with wind speed. * Strong wind forcing at the water surface caused more of the Williamson River inflow to pass through Goose Bay than through Tulana. * Westerly to northwesterly winds result in more of the Williamson River inflow passing through the Goose Bay side of the Delta than through the Tulana side. * Regression models developed from the tracer experiments can be used to quantify the dependencies between transport and the independent variables to obtain rough estimates of useful quantities such as residence time and steady-state solute concentrations.

Mannose-Binding Lectin Protein Deficiency Among Patients with Primary Immunodeficiency Disease Receiving IVIG Therapy.

PubMed

Azizi, Gholamreza; Kiaee, Fatemeh; Yaslianifard, Somaye; Rafiemanesh, Hosein; Mohammadikhajehdehi, Sara; Mohammadi, Hamed; Miresmaeeli, Seyed Sakineh; Pour, Leila H; Poor Heravi, Sina Abdolrahim; Sharifi, Laleh; Yazdani, Reza; Abolhassani, Hassan; Aghamohammadi, Asghar

2018-02-13

Primary immunodeficiencies (PIDs) are inherited disorders in which one or several components of the immune system are defective. Immunoglobulin replacement therapy is the mainstay of treatment for patients with impaired antibody production. However, recurrent infections would continue to occur in some patients due to the other high frequent concomitant defects, such as mannose-binding lectin (MBL) deficiency. A total of 51 PID patients participated in this cross-sectional study. A detailed questionnaire was completed by interviewing patients in order to record demographic, clinical and laboratory data. The levels of MBL were determined in the serums of patients by a sandwich enzyme-linked immunosorbent assay (ELISA) technique. MBL deficiency was found in 29.4% of cases; 11.8% patients had mild, 3.9% patients had moderate and 13.7% patients had severe MBL deficiency. In patients with MBL deficiency, the rate of meningitis, sepsis, pneumonia, and otitis media was higher than patients with normal MBL levels. Immunoglobulin replacement therapy reduced the rate of infectious complications in PID patients; however, these reductions were more apparent in patients with normal MBL levels than patients with MBL deficiency. Antibody deficient patients with a concomitant immune defect in MBL production have higher rates of recurrent infections despite receiving Immunoglobulin replacement therapy. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Maternal cfDNA screening for Down syndrome--a cost sensitivity analysis.

PubMed

Cuckle, Howard; Benn, Peter; Pergament, Eugene

2013-07-01

This study aimed to determine the principal factors contributing to the cost of avoiding a birth with Down syndrome by using cell-free DNA (cfDNA) to replace conventional screening. A range of unit costs were assigned to each item in the screening process. Detection rates were estimated by meta-analysis and modeling. The marginal cost associated with the detection of additional cases using cfDNA was estimated from the difference in average costs divided by the difference in detection. The main factor was the unit cost of cfDNA testing. For example, replacing a combined test costing $150 with 3% false-positive rate and invasive testing at $1000, by cfDNA tests at $2000, $1500, $1000, and $500, the marginal cost is $8.0, $5.8, $3.6, and $1.4m, respectively. Costs were lower when replacing a quadruple test and higher for a 5% false-positive rate, but the relative importance of cfDNA unit cost was unchanged. A contingent policy whereby 10% to 20% women were selected for cfDNA testing by conventional screening was considerably more cost-efficient. Costs were sensitive to cfDNA uptake. Universal cfDNA screening for Down syndrome will only become affordable by public health purchasers if costs fall substantially. Until this happens, the contingent use of cfDNA is recommended. © 2013 John Wiley & Sons, Ltd.

What is the impact of a clinically related readmission measure on the assessment of hospital performance?

PubMed

Khouri, Roger K; Hou, Hechuan; Dhir, Apoorv; Andino, Juan J; Dupree, James M; Miller, David C; Ellimoottil, Chad

2017-11-28

The Hospital Readmission Reduction Program (HRRP) penalizes hospitals for high all-cause unplanned readmission rates. Many have expressed concern that hospitals serving patient populations with more comorbidities, lower incomes, and worse self-reported health status may be disproportionately penalized by readmissions that are not clinically related to the index admission. The impact of including clinically unrelated readmissions on hospital performance is largely unknown. We sought to determine if a clinically related readmission measure would significantly alter the assessment of hospital performance. We analyzed Medicare claims for beneficiaries in Michigan admitted for pneumonia and joint replacement from 2011 to 2013. We compared each hospital's 30-day readmission rate using specifications from the HRRP's all-cause unplanned readmission measure to values calculated using a clinically related readmission measure. We found that the mean 30-day readmission rates were lower when calculated using the clinically related readmission measure (joint replacement: all-cause 5.8%, clinically related 4.9%, p < 0.001; pneumonia: all cause 12.5%, clinically related 11.3%, p < 0.001)). The correlation of hospital ranks using both methods was strong (joint replacement: 0.95 (p < 0.001), pneumonia: 0.90 (p < 0.001)). Our findings suggest that, while greater specificity may be achieved with a clinically related measure, clinically unrelated readmissions may not impact hospital performance in the HRRP.

Comparative outcomes of transcatheter aortic valve replacement in African American and Caucasian patients with severe aortic stenosis.

PubMed

Alqahtani, Fahad; Aljohani, Sami; Almustafa, Ahmad; Alhijji, Mohammed; Ali, Oluseun; Holmes, David R; Alkhouli, Mohamad

2018-04-01

Racial disparities in cardiovascular care have been extensively investigated. The introduction of transcatheter aortic valve replacement (TAVR) revolutionized the treatment of aortic stenosis (AS) in the last decade. Whether a racial disparity in the utilization and outcome of TAVR exists is unknown. We utilized the nationwide inpatient sample (NIS) to compare utilization rates, and in-hospital outcomes of Caucasians and African American (AA) patients who underwent TAVR between August 2011 and December 2014. A total of 7,176 patients (6870 Caucasians, 95.7%) and (306 AAs, 4.3%) were included in this analysis. Among patients who underwent aortic valve replacement between 2011 and 2014, the rates of TAVR utilization increased from 0.32% to 7.6% in AAs and from 0.4% to 8.8% in Caucasians. In propensity-matched cohorts of patients (n = 300 Caucasians and n = 300 AAs), in-hospital mortality was similar (3.7% and 3.3%, respectively, P = 0.99). Also, rates of key complications including stroke, permanent pacemaker implantation (PPMI), vascular complications, acute kidney injury, new dialysis, blood transfusion, and tamponade were similar in both races. There was also no significant difference between Caucasians and AAs with regards to length of stay, cost of hospitalization, and intermediate care facility utilization. There was no significant difference in the utilization rates, in-hospital outcomes, and cost of TAVR between Caucasians and AA patients in contemporary US practice. Further comparative studies of surgical and TAVR in AAs and other racial minorities are warranted. © 2017 Wiley Periodicals, Inc.

Comparison of group-based outpatient physiotherapy with usual care after total knee replacement: a feasibility study for a randomized controlled trial.

PubMed

Artz, Neil; Dixon, Samantha; Wylde, Vikki; Marques, Elsa; Beswick, Andrew D; Lenguerrand, Erik; Blom, Ashley W; Gooberman-Hill, Rachael

2017-04-01

To evaluate the feasibility of conducting a randomized controlled trial comparing group-based outpatient physiotherapy with usual care in patients following total knee replacement. A feasibility study for a randomized controlled trial. One secondary-care hospital orthopaedic centre, Bristol, UK. A total of 46 participants undergoing primary total knee replacement. The intervention group were offered six group-based exercise sessions after surgery. The usual care group received standard postoperative care. Participants were not blinded to group allocation. Feasibility was assessed by recruitment, reasons for non-participation, attendance, and completion rates of study questionnaires that included the Lower Extremity Functional Scale and Knee Injury and Osteoarthritis Outcome Score. Recruitment rate was 37%. Five patients withdrew or were no longer eligible to participate. Intervention attendance was high (73%) and 84% of group participants reported they were 'very satisfied' with the exercises. Return of study questionnaires at six months was lower in the usual care (75%) than in the intervention group (100%). Mean (standard deviation) Lower Extremity Functional Scale scores at six months were 45.0 (20.8) in the usual care and 57.8 (15.2) in the intervention groups. Recruitment and retention of participants in this feasibility study was good. Group-based physiotherapy was acceptable to participants. Questionnaire return rates were lower in the usual care group, but might be enhanced by telephone follow-up. The Lower Extremity Functional Scale had high responsiveness and completion rates. Using this outcome measure, 256 participants would be required in a full-scale randomized controlled trial.

75 FR 28602 - Corning Natural Gas Corporation; Notice of Compliance Filing

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-21

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. PR09-30-003] Corning Natural Gas Corporation; Notice of Compliance Filing May 17, 2010. Take notice that on May 10, 2010, Corning Natural Gas Corporation, (Corning) filed a corrected rate sheet to replace the rate sheet filed with its...

Incorporating molecular breeding values with variable call rates into genetic evaluations

USDA-ARS?s Scientific Manuscript database

A partial genotype for an animal can result from panels with low call rates used to calculate a molecular breeding value. A molecular breeding value can still be calculated using a partial genotype by replacing the missing marker covariates with their mean value. This approach is expected to chang...

Technology Transience and the Challenges It Poses to Higher Education

ERIC Educational Resources Information Center

Amirault, Ray J.

2015-01-01

Today's technologies come and go at an alarming rate, and the length of time any one technology, either software or hardware, exists before being supplanted by a newer technology is growing ever shorter. For anyone working within the field of instructional technology, this rapid replacement rate of technologies can hold immense implications for…

76 FR 59592 - Government Securities Act Regulations; Replacement of References to Credit Ratings and Technical...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-27

...://www.treasurydirect.gov . Paper Comments Send paper comments to Bureau of the Public Debt, Government... includes commercial paper, which, in order to receive the more favorable haircut treatment of Treasury..., each in regard to commercial paper. NRSROs are credit rating agencies that are subject to Securities...

76 FR 11164 - Removing References to Credit Ratings in Regulations; Proposing Alternatives to the Use of Credit...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-01

... of the regulations governing the investment activities of natural person Federal credit unions (FCUs..., investment activities, and capital risk-weighting of corporate credit unions. 12 CFR part 704. There is also... regulations. For investments, the proposal generally replaces the minimum credit rating requirement with a...

Wear characteristics of an unconstrained lumbar total disc replacement under a range of in vitro test conditions

PubMed Central

Fisher, John; Hall, Richard M.

2015-01-01

Abstract The effect of kinematics, loading and centre of rotation on the wear of an unconstrained total disc replacement have been investigated using the ISO 18192‐1 standard test as a baseline. Mean volumetric wear rate and surface morphological effects were reported. Changing the phasing of the flexions to create a low (but finite) amount of crossing path motion at the bearing surfaces resulted in a significant fall in wear volume. However, the rate of wear was still much larger than previously reported values under zero cross shear conditions. Reducing the load did not result in a significant change in wear rate. Moving the centre of rotation of the disc inferiorly did significantly increase wear rate. A phenomenon of debris re‐attachment on the UHMWPE surface was observed and hypothesised to be due to a relatively harsh tribological operating regime in which lubricant replenishment and particle migration out of the bearing contact zone were limited. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 46–52, 2017. PMID:26411540

Does the obesity paradox apply to early postoperative complications after hip surgery? A retrospective chart review.

PubMed

Shaparin, Naum; Widyn, James; Nair, Singh; Kho, Irene; Geller, David; Delphin, Ellise

2016-08-01

There is evidence that very obese patients (body mass index [BMI] >40 kg/m(2)) undergoing hip replacement have longer average hospital stays, as well as higher rates of complications and readmission compared with patients with normal BMI. However, there are sparse data describing how overweight and obese patients fare in the period immediately after hip replacement surgery compared with patients with low or normal BMI. In this study, we sought to explore the association of BMI with the rate of early postoperative complications in patients undergoing total hip arthroplasty. A proprietary hospital software program, Clinical Looking Glass was used to query the Montefiore Medical Center database and create a list of patients with International Classification of Diseases, Ninth Revision code 81.51 (hip replacement) from the period of January 1, 2010, through December 31, 2012. The medical records of patients with length of stay 5 or more days were reviewed to evaluate the reason for the extended stay. The primary outcome studied was the association between BMI and occurrence of early complications in patients who had undergone total hip replacement surgery. Logistic regression was used to calculate adjusted odds ratio (OR) and 95% confidence interval (CI) for the association of BMI and early postoperative complications. Of the 802 patients undergoing hip replacement surgery within our time frame, 142 patient medical records were reviewed due to their length of stay of ≥5 days. Overall complication rate in the analyzed patients demonstrated a J-curve distribution pattern, with the highest morbidity being 23.5% in the underweight group, the second highest in the normal-weight group (17.3%), and decreasing to nadir in the overweight (8.0%) and obese class I (10.0%) and then higher again in classes II (14.3%) and III (16.7%). Adjusted ORs demonstrated the same J distribution pattern similar to the pattern observed in the univariate analysis. Of the variables studied, Charlson score (OR, 1.1; 95% CI, 1.1-1.2; P = .03), diagnosis of hip fracture (OR, 5.2; 95% CI, 2.8-9.8; P = .01), normal weight (OR, 1.9; 95% CI, 1.1-3.8; P = .04), and obese class III (OR, 2.5; 95% CI, 1.1-6.3; P = .04) were the factors associated with the highest odds of early complications after hip replacement surgery. In this retrospective review of hip replacement surgery patients, BMI classification was a predictor of early postoperative complications. Although the exact underlying mechanisms are still not clear, these results are consistent with the obesity paradox, in which obesity or its correlates provide some form of protection. Copyright © 2016 Elsevier Inc. All rights reserved.

Local infiltration analgesia versus continuous interscalene brachial plexus block for shoulder replacement pain: a randomized clinical trial.

PubMed

Bjørnholdt, Karen T; Jensen, Jan M; Bendtsen, Thomas F; Søballe, Kjeld; Nikolajsen, Lone

2015-12-01

Shoulder replacement involves significant post-operative pain, which is often managed by continuous interscalene brachial plexus block. Catheter displacement and complications limit the beneficial effect of the block. Local infiltration analgesia (LIA) has provided good results in knee replacement. We aimed to assess the effectiveness of LIA for pain after shoulder replacement. Patients scheduled for primary shoulder replacement under general anaesthesia were randomized to receive either local infiltration analgesia (LIA) (150 ml ropivacaine 0.2 % with epinephrine intra-operatively) or interscalene brachial plexus catheter (ISC) (ropivacaine 0.75 %, 7 ml bolus followed by 48-h 5 ml/h infusion). The primary outcome was opioid consumption during the first 24 post-operative hours. Secondary outcomes were pain ratings, supplementary analgesics, and side effects for 3 days, and complications until 3 months after surgery. Data were analysed for 61 patients (LIA 30, ISC 31). Twenty-four-hour opioid consumption was higher in the LIA group compared with the ISC group: median (IQR) 95 mg (70-150 mg) versus 40 mg (8-76 mg) (P = 0.0001). No significant difference in opioid consumption was found between groups during the following 3 days. The LIA group had higher pain scores at 0, 2, 4, and 8 h. Two patients in the ISC group had long-lasting complications. The LIA technique cannot be recommended for shoulder replacement unless substantially modified. Occurrence of inadequate analgesia and complications following interscalene brachial plexus block prompt further studies into pain management after shoulder replacement.

75 FR 7580 - Proposed Rate Adjustment for Kerr-Philpott System

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-22

..., CP&L-1-A, CP&L-2-A, CP&L-3-A, CP&L-4-A, AP-1-A, AP-2-A, AP-3-A, AP-4-A, NC-1-A, Replacement-2, and... transmission arrangement. Rate Schedule CP&L-1-B Available to public bodies and cooperatives in North Carolina... Carolina Power & Light (also known as Progress Energy Carolinas). Rate Schedule CP&L-2-B Available to...

Intramedullary knee arthrodesis as a salvage procedure after failed total knee replacement.

PubMed

Panagiotopoulos, E; Kouzelis, A; Matzaroglou, Ch; Saridis, A; Lambiris, E

2006-12-01

Septic and aseptic loosening with or without extensive bone loss after total knee replacement are the most common indications for knee fusion. Both external fixation and intramedullary nailing can be used for the treatment, though the latter appears to be the method of choice for most patients. Nine patients were treated after a total knee replacement failure using intramedullary nailing. A long intramedullary nail with a proximal interlocking screw was used in five cases, and a customised nail was used in four cases. Successful fusion occurred in eight of nine patients (89%). Average time for the joint union was 6.5 months, and average operative blood loss was 860 ml. In two patients, iliac crest and patellar bone graft were also used. In conclusion, intramedullary nailing can give excellent results in achieving knee fusion after a failed knee replacement as it allows early weight bearing and at the same time offers stability, pain relief, and a high rate of union, even though the surgical technique is demanding.

Optimum random and age replacement policies for customer-demand multi-state system reliability under imperfect maintenance

NASA Astrophysics Data System (ADS)

Chen, Yen-Luan; Chang, Chin-Chih; Sheu, Dwan-Fang

2016-04-01

This paper proposes the generalised random and age replacement policies for a multi-state system composed of multi-state elements. The degradation of the multi-state element is assumed to follow the non-homogeneous continuous time Markov process which is a continuous time and discrete state process. A recursive approach is presented to efficiently compute the time-dependent state probability distribution of the multi-state element. The state and performance distribution of the entire multi-state system is evaluated via the combination of the stochastic process and the Lz-transform method. The concept of customer-centred reliability measure is developed based on the system performance and the customer demand. We develop the random and age replacement policies for an aging multi-state system subject to imperfect maintenance in a failure (or unacceptable) state. For each policy, the optimum replacement schedule which minimises the mean cost rate is derived analytically and discussed numerically.

Economic trade-offs between genetic improvement and longevity in dairy cattle.

PubMed

De Vries, A

2017-05-01

Genetic improvement in sires used for artificial insemination (AI) is increasing faster compared with a decade ago. The genetic merit of replacement heifers is also increasing faster and the genetic lag with older cows in the herd increases. This may trigger greater cow culling to capture this genetic improvement. On the other hand, lower culling rates are often viewed favorably because the costs and environmental effects of maintaining herd size are generally lower. Thus, there is an economic trade-off between genetic improvement and longevity in dairy cattle. The objective of this study was to investigate the principles, literature, and magnitude of these trade-offs. Data from the Council on Dairy Cattle Breeding show that the estimated breeding value of the trait productive life has increased for 50 yr but the actual time cows spend in the herd has not increased. The average annual herd cull rate remains at approximately 36% and cow longevity is approximately 59 mo. The annual increase in average estimated breeding value of the economic index lifetime net merit of Holstein sires is accelerating from $40/yr when the sire entered AI around 2002 to $171/yr for sires that entered AI around 2012. The expectation is therefore that heifers born in 2015 are approximately $50 more profitable per lactation than heifers born in 2014. Asset replacement theory shows that assets should be replaced sooner when the challenging asset is technically improved. Few studies have investigated the direct effects of genetic improvement on optimal cull rates. A 35-yr-old study found that the economically optimal cull rates were in the range of 25 to 27%, compared with the lowest possible involuntary cull rate of 20%. Only a small effect was observed of using the best surviving dams to generate the replacement heifer calves. Genetic improvement from sires had little effect on the optimal cull rate. Another study that optimized culling decisions for individual cows also showed that the effect of changes in genetic improvement of milk revenue minus feed cost on herd longevity was relatively small. Reduced involuntary cull rates improved profitability, but also increased optimal voluntary culling. Finally, an economically optimal culling model with prices from 2015 confirmed that optimal annual cull rates were insensitive to heifer prices and therefore insensitive to genetic improvement in heifers. In conclusion, genetic improvement is important but does not warrant short cow longevity. Economic cow longevity continues to depends more on cow depreciation than on accelerated genetic improvements in heifers. This is confirmed by old and new studies. Copyright © 2017 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Brief Report: Valued Life Activities and Readiness to Quit Smoking among Mobility Impaired Smokers

PubMed Central

Busch, Andrew M.; Borrelli, Belinda

2011-01-01

Objective People with physical disabilities smoke at a higher rate than their non-disabled peers, with rates as high as 28–40% among non-elderly adults with functional impairments. One possible explanation for these findings is that restriction of valued life activities (social, professional, pleasurable or otherwise meaningful) due to mobility impairment interferes with smoking cessation. Methods Forty-seven smokers (48.9% female; Mage = 48.91) with chronic mobility impairments (i.e., regularly use equipment to ambulate) were interviewed over the telephone. We assessed demographics, self-efficacy to quit smoking, stage of change, current engagement in valued activities, current restriction of valued activities due to physical limitations, and efforts to replace restricted valued activities in a cross sectional design. Results Bivariate results indicate that 74% of those in the preparation stage had satisfactory replacements for their most valued restricted activity, while only 27% in the contemplation stage and 17% in the pre-contemplation stage had such satisfactory replacements. Multinomial ordinal regression analyses revealed that (a) having satisfactory replacements for activities restricted due to physical disability was significantly associated with higher stage of change and (b) more current valued activities and, to a lesser extent, fewer restricted activities were significantly associated with higher levels of self-efficacy to quit smoking. Conclusions These results support the need for the development of treatments for smoking cessation that aim to increase engagement in valued activities, such as Behavioral Activation. PMID:21875204

Effects of brown fish meal replacement with fermented soybean meal on growth performance, feed efficiency and enzyme activities of Chinese soft-shelled turtle, Pelodiscus sinensis

NASA Astrophysics Data System (ADS)

Zou, Yurong; Ai, Qinghui; Mai, Kangsen; Zhang, Wenbing; Zhang, Yanjiao; Xu, Wei

2012-06-01

A 120-day feeding experiment was conducted to investigate the effects of partial replacement of brown fish meal (BFM) by fermented soybean meal (FSBM) in diets of Chinese soft-shelled turtle ( Pelodiscus sinensis). The turtles (initial mean body weight, (115.52 ± 1.05) g) were fed with three experimental diets, in which 0%, 4.72% and 9.44% BFM protein was replaced by 0%, 3% and 6% FSBM, respectively. Results showed that the feeding rate (FR), specific growth rate (SGR) and feed efficiency ratio (FER) of turtles fed with the diet containing 3% FSBM were not significantly different from the control group (0% FSBM) ( P > 0.05). However, FR, SGR and FER of turtles fed with the diet containing 6% FSBM were significantly lower than those of the control group ( P < 0.05). No significant differences were observed in the activities of serum glutamic-oxalacetic transaminase and glutamic-pyruvic transaminase among dietary treatments ( P > 0.05). However, the uric acid concentration in turtles fed with the diet containing 3% or 6% FSBM was significantly lower than that in the control group ( P < 0.05). There were no significant differences in the activities of lysozyme, alkaline phosphatase and total superoxide dismutase among dietary treatments ( P > 0.05). The results suggested that FSBM could replace 4.72% BFM protein in turtle diets without exerting adverse effects on turtle growth, feed utilization and measured immune parameters.

Comparing The Effects Of Reference Pricing And Centers-Of-Excellence Approaches To Value-Based Benefit Design.

PubMed

Zhang, Hui; Cowling, David W; Facer, Matthew

2017-12-01

Various health insurance benefit designs based on value-based purchasing have been promoted to steer patients to high-value providers, but little is known about the designs' relative effectiveness and underlying mechanisms. We compared the impact of two designs implemented by the California Public Employees' Retirement System on inpatient hospital total hip or knee replacement: a reference-based pricing design for preferred provider organizations (PPOs) and a centers-of-excellence design for health maintenance organizations (HMOs). Payment and utilization data for the procedures in the period 2008-13 were evaluated using pre-post and quasi-experimental designs at the system and health plan levels, adjusting for demographic characteristics, case-mix, and other confounders. We found that both designs prompted higher use of designated low-price high-quality facilities and reduced average replacement expenses per member at the plan and system levels. However, the designs used different routes: The reference-based pricing design reduced average replacement payments per case in PPOs by 26.7 percent in the first year, compared to HMOs, but did not lower PPO members' utilization rates. In contrast, the centers-of-excellence design lowered HMO members' utilization rates by 29.2 percent in the first year, compared to PPOs, but did not reduce HMO average replacement payments per case. The reference-based pricing design appears more suitable for reducing price variation, and the centers-of-excellence design for addressing variation in use.

Professional and lay people perceptions of anterior maxillary esthetics

NASA Astrophysics Data System (ADS)

Roslan, Husniyati; Lillywhite, Graeme

2016-12-01

Achieving esthetic outcomes with implant-based restorations in the esthetic zone is a challenge due to the difficulty in replacing lost papillae. This study aimed to assess the influence of contact point position on the overall perception of esthetics as assessed by dental professionals and lay people. A cross-sectional study using self-administered questionnaire was distributed among 300 prosthodontists, general dentists and lay people in the United Kingdom. The questionnaire consisted of photographic images of a smile, intentionally altered using image manipulation software. Variations in contact length between maxillary central incisors were created to mimic the clinical situation when missing teeth were replaced with implant-supported crowns. These images were rated using VAS. One-way and two-way ANOVAs, and Tukey's test were used to analyze the data. The overall response rate by the three groups was 72%. Lay people and general dentists were more critical than prosthodontists in all VAS ratings (p < 0.000). Overall, all the groups perceived that the esthetic value reduced as the contact point increased in its length.

Reliability and performance experience with flat-plate photovoltaic modules

NASA Technical Reports Server (NTRS)

Ross, R. G., Jr.

1982-01-01

Statistical models developed to define the most likely sources of photovoltaic (PV) array failures and the optimum method of allowing for the defects in order to achieve a 20 yr lifetime with acceptable performance degradation are summarized. Significant parameters were the cost of energy, annual power output, initial cost, replacement cost, rate of module replacement, the discount rate, and the plant lifetime. Acceptable degradation allocations were calculated to be 0.0001 cell failures/yr, 0.005 module failures/yr, 0.05 power loss/yr, a 0.01 rate of power loss/yr, and a 25 yr module wear-out length. Circuit redundancy techniques were determined to offset cell failures using fault tolerant designs such as series/parallel and bypass diode arrangements. Screening processes have been devised to eliminate cells that will crack in operation, and multiple electrical contacts at each cell compensate for the cells which escape the screening test and then crack when installed. The 20 yr array lifetime is expected to be achieved in the near-term.

Fixed-bed biosorption of cadmium using immobilized Scenedesmus obliquus CNW-N cells on loofa (Luffa cylindrica) sponge.

PubMed

Chen, Bor-Yann; Chen, Chun-Yen; Guo, Wan-Qian; Chang, Hao-Wei; Chen, Wen-Ming; Lee, Duu-Jong; Huang, Chieh-Chen; Ren, Nan-Qi; Chang, Jo-Shu

2014-05-01

A continuous fixed-bed biosorption process was established for cadmium (Cd) removal by Scenedesmus obliquus CNW-N (isolated from southern Taiwan) cells immobilized onto loofa sponge. This immobilized-cell biosorption process allows better recovery and reusability of the microalgal biomass. The growth of microalgae on the matrix support with appropriate nutrient supplementation could enhance the overall metal removal activity. Major operating parameters (e.g., feeding flow rate, cycle number of medium replacement, and particle diameter of the sponge) were studied for treatability evaluation. The most promising cell growth on the sponge support was obtained at a flow rate of 0.284 bed volume (BV)/min, sponge particle diameter of 1 cm, and with one cycle of medium replacement. The performance of fixed-bed biosorption (adsorption capacity of 38.4 mg, breakthrough time at 15.5 h) was achieved at a flow rate of 5 ml/min with an influent concentration of 7.5 mg Cd/l. Copyright © 2014 Elsevier Ltd. All rights reserved.

Potential for worldwide displacement of fossil-fuel electricity by nuclear energy in three decades based on extrapolation of regional deployment data.

PubMed

Qvist, Staffan A; Brook, Barry W

2015-01-01

There is an ongoing debate about the deployment rates and composition of alternative energy plans that could feasibly displace fossil fuels globally by mid-century, as required to avoid the more extreme impacts of climate change. Here we demonstrate the potential for a large-scale expansion of global nuclear power to replace fossil-fuel electricity production, based on empirical data from the Swedish and French light water reactor programs of the 1960s to 1990s. Analysis of these historical deployments show that if the world built nuclear power at no more than the per capita rate of these exemplar nations during their national expansion, then coal- and gas-fired electricity could be replaced worldwide in less than a decade. Under more conservative projections that take into account probable constraints and uncertainties such as differing relative economic output across regions, current and past unit construction time and costs, future electricity demand growth forecasts and the retiring of existing aging nuclear plants, our modelling estimates that the global share of fossil-fuel-derived electricity could be replaced within 25-34 years. This would allow the world to meet the most stringent greenhouse-gas mitigation targets.

Residual Renal Function in Children Treated with Chronic Peritoneal Dialysis

PubMed Central

Roszkowska-Blaim, Maria

2013-01-01

Residual renal function (RRF) in patients with end-stage renal disease (ESRD) receiving renal replacement therapy is defined as the ability of native kidneys to eliminate water and uremic toxins. Preserved RRF improves survival and quality of life in adult ESRD patients treated with peritoneal dialysis. In children, RRF was shown not only to help preserve adequacy of renal replacement therapy but also to accelerate growth rate, improve nutrition and blood pressure control, reduce the risk of adverse myocardial changes, facilitate treatment of anemia and calcium-phosphorus balance abnormalities, and result in reduced serum and dialysate fluid levels of advanced glycation end-products. Factors contributing to RRF loss in children treated with peritoneal dialysis include the underlying renal disease such as hemolytic-uremic syndrome and hereditary nephropathy, small urine volume, severe proteinuria at the initiation of renal replacement therapy, and hypertension. Several approaches can be suggested to decrease the rate of RRF loss in pediatric patients treated with chronic peritoneal dialysis: potentially nephrotoxic drugs (e.g., aminoglycosides), episodes of hypotension, and uncontrolled hypertension should be avoided, urinary tract infections should be treated promptly, and loop diuretics may be used to increase salt and water excretion. PMID:24376376

Association of Short-term Complications With Procedures Through Separate Incisions During Total Ankle Replacement.

PubMed

Criswell, Braden; Hunt, Kenneth; Kim, Todd; Chou, Loretta; Haskell, Andrew

2016-10-01

Surgeons disagree about the safety of adding adjuvant procedures requiring separate incisions during total ankle replacement (TAR). This study tested the hypothesis that complication rates for patients in the first year after TAR would be greater when combined with procedures through separate incisions. A retrospective review was performed on a consecutive series of 124 patients who underwent total ankle replacement between 2007 and 2013. Demographics, case-specific data, and postoperative complications over the first year were collected. A chi-square analysis was performed to compare differences in complication rates among patients with and without additional procedures requiring a separate incision. The average patient age was 67±10 years. Fourteen patients (11%) were diabetic and 2 patients (2%) were current smokers. Eighty-seven (70%) had prior trauma leading to arthritis. Ninety-seven (78%) cases used the Scandinavian Total Ankle Replacement (STAR), 16 (13%) Salto Talaris, and 11 (9%) In Bone implants. Ten (8%) cases were revisions. Excluding percutaneous Achilles lengthening, 35 of 124 patients (28%) had a total of 54 adjuvant procedures requiring a separate incision during TAR. These included 9 (7%) calcaneal osteotomies, 8 (6%) medial malleolar fixation, 6 (5%) subtalar fusions, 5 (4%) lateral ligament repair, 4 (3%) open Achilles lengthening, 4 (3%) removal of hardware, 2 (2%) first metatarsal osteotomy, and 8 other procedures. Overall, 32 (26%) of the 124 patients had a complication, including 15 (12%) delayed wound healing, 6 (5%) malleolar fracture, and 11 other complications. At 1 year, 24 (27%) of 89 patients without additional incisions and 8 (23%) of 35 patients with additional incisions, excluding percutaneous Achilles lengthening, had any complication (P = .64). This study did not demonstrate an association between additional procedures requiring a separate incision during TAR and early complications. Overall complication rates were similar to previously reported series of TAR. This study suggests that surgeons can add adjuvant procedures during TAR to improve alignment, stability, or treat adjacent segment arthritis without affecting short-term complication rates. The necessity or utility of these adjuvant procedures requires further study. Level III, comparative series. © The Author(s) 2016.

How do we use language? Shared patterns in the frequency of word use across 17 world languages

PubMed Central

Calude, Andreea S.; Pagel, Mark

2011-01-01

We present data from 17 languages on the frequency with which a common set of words is used in everyday language. The languages are drawn from six language families representing 65 per cent of the world's 7000 languages. Our data were collected from linguistic corpora that record frequencies of use for the 200 meanings in the widely used Swadesh fundamental vocabulary. Our interest is to assess evidence for shared patterns of language use around the world, and for the relationship of language use to rates of lexical replacement, defined as the replacement of a word by a new unrelated or non-cognate word. Frequencies of use for words in the Swadesh list range from just a few per million words of speech to 191 000 or more. The average inter-correlation among languages in the frequency of use across the 200 words is 0.73 (p < 0.0001). The first principal component of these data accounts for 70 per cent of the variance in frequency of use. Elsewhere, we have shown that frequently used words in the Indo-European languages tend to be more conserved, and that this relationship holds separately for different parts of speech. A regression model combining the principal factor loadings derived from the worldwide sample along with their part of speech predicts 46 per cent of the variance in the rates of lexical replacement in the Indo-European languages. This suggests that Indo-European lexical replacement rates might be broadly representative of worldwide rates of change. Evidence for this speculation comes from using the same factor loadings and part-of-speech categories to predict a word's position in a list of 110 words ranked from slowest to most rapidly evolving among 14 of the world's language families. This regression model accounts for 30 per cent of the variance. Our results point to a remarkable regularity in the way that human speakers use language, and hint that the words for a shared set of meanings have been slowly evolving and others more rapidly evolving throughout human history. PMID:21357232

The effect of replacing lactose by starch on protein and fat digestion in milk-fed veal calves.

PubMed

Pluschke, A M; Gilbert, M S; Williams, B A; van den Borne, J J G C; Schols, H A; Gerrits, W J J

2016-08-01

Replacing dairy components from milk replacer (MR) with vegetable products has been previously associated with decreased protein and fat digestibility in milk-fed calves resulting in lower live weight gain. In this experiment, the major carbohydrate source in MR, lactose, was partly replaced with gelatinized corn starch (GCS) to determine the effect on protein and fat digestibility in milk-fed calves. In total, 16 male Holstein-Friesian calves received either MR with lactose as the carbohydrate source (control) or 18% GCS at the expense of lactose. In the adaptation period, calves were exposed to an increasing dose of GCS for 14 weeks. The indigestible marker cobalt ethylenediaminetetraacetic acid was incorporated into the MR for calculating apparent nutrient digestibility, whereas a pulse dose of chromium (Cr) chloride was fed with the last MR meal 4 h before slaughter as an indicator of passage rates. The calves were anesthetized and exsanguinated at 30 weeks of age. The small intestine was divided in three; small intestine 1 and 2 (SI1 and SI2, respectively) and the terminal ileum (last ~100 cm of small intestine) and samples of digesta were collected. Small intestinal digesta was analysed for α-amylase, lipase and trypsin activity. Digestibility of protein was determined for SI1, SI2, ileum and total tract, whereas digestibility of fat was determined for SI1, SI2 and total tract. Apparent protein digestibility in the small intestine did not differ between treatments but was higher in control calves at total tract level. Apparent crude fat digestibility tended to be increased in SI1 and SI2 for GCS calves, but no difference was found at total tract level. Activity of α-amylase in SI2 and lipase in both SI1 and SI2 was higher in GCS calves. Activity of trypsin tended to be higher in control calves and was higher in SI1 compared with SI2. A lower recovery of Cr in SI2 and a higher recovery of Cr in the large intestine suggest an increased rate of passage for GCS calves. Including 18% of GCS in a milk replacer at the expense of lactose increased passage rate and decreased apparent total tract protein digestibility. In the small intestine, protein digestion did not decrease when feeding GCS and fat digestion even tended to increase. Overall, effects on digestion might be levelled when partially replacing lactose with GCS, because starch digestion is lower than that of lactose but fat digestion may be slightly increased when feeding GCS.

Plan demographics, participants' saving behavior, and target-date fund investments.

PubMed

Park, Youngkyun

2009-05-01

This analysis explores (1) whether plan demographic characteristics would affect individual participant contribution rates and target-date fund investments and (2) equity glide paths for participants in relation to plan demographics by considering target replacement income and its success rate. PLAN DEMOGRAPHIC CHARACTERISTICS IN PARTICIPANT CONTRIBUTION RATES: This study finds empirical evidence that 401(k) plan participants' contribution rates differ by plan demographics based on participants' income and/or tenure. In particular, participants in 401(k) plans dominated by those with low income and short tenure tend to contribute less than those in plans dominated by participants with high income and long tenure. Future research will explore how participant contribution behavior may also be influenced by incentives provided by employers through matching formulae. PLAN DEMOGRAPHIC CHARACTERISTICS IN TARGET-DATE FUND INVESTMENTS: The study also finds empirical evidence that participants' investments in target-date funds with different equity allocations differ by plan demographics based on participants' income and/or tenure. In particular, target-date fund users with 90 percent or more of their account balances in target-date funds who are in 401(k) plans dominated by low-income and short-tenure participants tend to hold target-date funds with lower equity allocations, compared with their counterparts in plans dominated by high-income and long-tenure participants. Future research will focus on the extent to which these characteristics might influence the selection of target-date funds by plan sponsors. EQUITY GLIDE PATHS: Several stylized equity glide paths as well as alternative asset allocations are compared for participants at various starting ages to demonstrate the interaction between plan demographics and equity glide paths/asset allocations in terms of success rates in meeting various replacement income targets. The equity glide path/asset allocation providing the highest success rate at a particular replacement rate target will vary with the assumed starting date of the participant (see Figure 17). Given the highly stylized nature of the simulations in this Issue Brief it is important to note that the results are not intended to provide a single equity glide path solution in relation to plan demographics. Instead, they serve as a framework to be considered when plan sponsors make a selection concerning which target-date funds to include in their plan. IMPORTANCE OF PARTICIPANT CONTRIBUTION RATES: This analysis finds that although target-date funds with different equity glide paths affect the retirement income replacement success rate, participant contribution rates corresponding to different plan demographic characteristics have a stronger impact. AUTO FEATURES OF THE PPA: This Issue Brief provides a stylized study using observed contribution rates as of the 2007 plan year. However, with the passage of the Pension Protection Act of 2006 and its likely impact on plan design in the future (increased utilization of automatic enrollment and automatic contribution escalations), it is likely that contribution rates among the participants may become more homogenous. In such a scenario, it may be more likely that a single equity glide path would meet a wide range of demographic profiles.

Earlier Pulmonary Valve Replacement in Down Syndrome Patients Following Tetralogy of Fallot Repair.

PubMed

Sullivan, Rachel T; Frommelt, Peter C; Hill, Garick D

2017-08-01

The association between Down syndrome and pulmonary hypertension could contribute to more severe pulmonary regurgitation after tetralogy of Fallot repair and possibly earlier pulmonary valve replacement. We compared cardiac magnetic resonance measures of pulmonary regurgitation and right ventricular dilation as well as timing of pulmonary valve replacement between those with and without Down syndrome after tetralogy of Fallot repair. Review of our surgical database from 2000 to 2015 identified patients with tetralogy of Fallot with pulmonary stenosis. Those with Down syndrome were compared to those without. The primary outcome of interest was time from repair to pulmonary valve replacement. Secondary outcomes included pulmonary regurgitation and indexed right ventricular volume on cardiac magnetic resonance imaging. The cohort of 284 patients included 35 (12%) with Down syndrome. Transannular patch repair was performed in 210 (74%). Down syndrome showed greater degree of pulmonary regurgitation (55 ± 14 vs. 37 ± 16%, p = 0.01) without a significantly greater rate of right ventricular dilation (p = 0.09). In multivariable analysis, Down syndrome (HR 2.3, 95% CI 1.2-4.5, p = 0.02) and transannular patch repair (HR 5.5, 95% CI 1.7-17.6, p = 0.004) were significant risk factors for valve replacement. Those with Down syndrome had significantly lower freedom from valve replacement (p = 0.03). Down syndrome is associated with an increased degree of pulmonary regurgitation and earlier pulmonary valve replacement after tetralogy of Fallot repair. These patients require earlier assessment by cardiac magnetic resonance imaging to determine timing of pulmonary valve replacement and evaluation for and treatment of preventable causes of pulmonary hypertension.

Hormone replacement therapy and risk of malignancy.

PubMed

Diamanti-Kandarakis, Evanthia

2004-02-01

The fact that today our concern is oriented towards the risks rather than the benefits of hormone replacement therapy could be the clearest message about our current position. The safety of hormone replacement therapy, an estrogen-progestin combination which has been sympathetic to and supportive of disturbing menopausal symptoms of women, is seriously challenged. Four randomized trials have now reported on the results of hormone replacement therapy in major potentially fatal conditions, in more than 20,000 women studied for about 5 years. The main concern regarding the increased risk of malignancy in healthy postmenopausal women in western countries has been breast cancer. It is estimated to cause an extra case in about six per 1000 users aged 50-59 and 12 per 1000 aged 60-69. Over the same period the estimated risk of endometrial cancer rates are not increased, with a relative risk of 0.76 per 1000 users aged 50-59. Overall, however, the increased incidence of malignancies is greater than any reduction, one per 230 users aged 50-59 and one per 150 aged 60-69. Randomized trials examining other important but rarer malignancies, like ovarian, gall bladder and urinary bladder cancer, are either nonexistent or too small to reliably describe any effects of hormone replacement therapy. Conclusively epidemiological evidence suggests that hormone replacement therapy is associated with a small but substantial increase in breast cancer risk and combined estrogen-progesterone regimens further increase this hazard. Additionally, the evidence from the recent double blind placebo controlled randomized trial on the slight increase in the incidence of adverse cardiovascular events, has turned our orientation away from hormone replacement therapy as a long term therapy in postmenopausal women. In this review, the effort is to approach comprehensively and globally the information on the risks of hormone replacement therapy on several cancer sites.

Structure, attachment, replacement and growth of teeth in bluefish, Pomatomus saltatrix (Linnaeus, 1776), a teleost with deeply socketed teeth.

PubMed

Bemis, William E; Giuliano, Anne; McGuire, Betty

2005-01-01

Tooth replacement poses many questions about development, pattern formation, tooth attachment mechanisms, functional morphology and the evolution of vertebrate dentitions. Although most vertebrate species have polyphyodont dentitions, detailed knowledge of tooth structure and replacement is poor for most groups, particularly actinopterygians. We examined the oral dentition of the bluefish, Pomatomus saltatrix, a pelagic and coastal marine predator, using a sample of 50 individuals. The oral teeth are located on the dentary and premaxillary bones, and we scored each tooth locus in the dentary and premaxillary bones using a four-part functional classification: absent (A), incoming (I), functional (F=fully ankylosed) or eroding (E). The homodont oral teeth of Pomatomus are sharp, deeply socketed and firmly ankylosed to the bone of attachment. Replacement is intraosseus and occurs in alternate tooth loci with long waves of replacement passing from rear to front. The much higher percentage of functional as opposed to eroding teeth suggests that replacement rates are low but that individual teeth are quickly lost once erosion begins. Tooth number increases ontogenetically, ranging from 15-31 dentary teeth and 15-39 premaxillary teeth in the sample studied. Teeth increase in size with every replacement cycle. Remodeling of the attachment bone occurs continuously to accommodate growth. New tooth germs originate from a discontinuous dental lamina and migrate from the lingual (dentary) or labial (premaxillary) epithelium through pores in the bone of attachment into the resorption spaces beneath the existing teeth. Pomatomus shares unique aspects of tooth replacement with barracudas and other scombroids and this supports the interpretation that Pomatomus is more closely related to scombroids than to carangoids.

Demographic trends in Claremont California’s street tree population

Treesearch

Natalie S. van Doorn; E. Gregory McPherson

2018-01-01

The aim of this study was to quantify street tree population dynamics in the city of Claremont, CA. A repeated measures survey (2000 and 2014) based on a stratified random sampling approach across size classes and for the most abundant 21 species was analyzed to calculate removal, growth, and replacement planting rates. Demographic rates were estimated using a...

Technical Report from Grant Recipient - City of Redlands

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

Giorgianni, Kathleen Margaret

2016-05-26

The goals and objectives of the HVAC upgrades are to replace equipment as old as twenty-three (23) years in five different facilities. The project will upgrade some facilities from SEER ratings of 9 to SEER ratings of 14 at a savings of 556 kilowatt hours per ton (savings depends on specific size of the system).

76 FR 47251 - Training and Employment Guidance (TEGL) Letter No. 17-06, Change 1, Special Procedures: Labor...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-04

...-based application process and made several substantive changes to the program, but retained the special... organizational changes, in addition to new regulatory and policy objectives. It rescinds and replaces previous... rate for that State based on the piece rate findings submitted by an adjoining or proximate SWA for the...

Telecommunications Policy Research Conference. Alternatives to Rate of Return Regulation Section. Papers.

ERIC Educational Resources Information Center

Telecommunications Policy Research Conference, Inc., Washington, DC.

The first of two papers presented in this section, "Price-Caps: Theory and Implementation" (Peter B. Linhart and Roy Radner) describes a proposed method of regulation involving price caps on core services and no price regulation of other services. This method is designed to replace rate-of-return regulation during a transition period to…

Short-Term Sediment Burial Effects on the Seagrass Phyllospadix scouleri

DTIC Science & Technology

2008-09-01

replacement (e.g., Cymodocea nodosa, Thalassia testudinum (Short and Duarte 2001) exhibited increased growth rates and leaf production rates when...thresholds of 10-13 cm for Syringodium isoetifolium, Cymodocea rotundata, Thalassia hemprichii, Cymodocea serrulata, Halodule uninervis, Halophila ovalis...Methods for study of growth and production of turtle grass, Thalassia -testudinum Konig. Aquaculture 42: 139-143

Society of Thoracic Surgeons 2008 cardiac risk models predict in-hospital mortality of heart valve surgery in a Chinese population: a multicenter study.

PubMed

Wang, Lv; Lu, Fang-Lin; Wang, Chong; Tan, Meng-Wei; Xu, Zhi-yun

2014-12-01

The Society of Thoracic Surgeons 2008 cardiac surgery risk models have been developed for heart valve surgery with and without coronary artery bypass grafting. The aim of our study was to evaluate the performance of Society of Thoracic Surgeons 2008 cardiac risk models in Chinese patients undergoing single valve surgery and the predicted mortality rates of those undergoing multiple valve surgery derived from the Society of Thoracic Surgeons 2008 risk models. A total of 12,170 patients underwent heart valve surgery from January 2008 to December 2011. Combined congenital heart surgery and aortal surgery cases were excluded. A relatively small number of valve surgery combinations were excluded. The final research population included the following isolated heart valve surgery types: aortic valve replacement, mitral valve replacement, and mitral valve repair. The following combined valve surgery types were included: mitral valve replacement plus tricuspid valve repair, mitral valve replacement plus aortic valve replacement, and mitral valve replacement plus aortic valve replacement and tricuspid valve repair. Evaluation was performed by using the Hosmer-Lemeshow test and C-statistics. Data from 9846 patients were analyzed. The Society of Thoracic Surgeons 2008 cardiac risk models showed reasonable discrimination and poor calibration (C-statistic, 0.712; P = .00006 in Hosmer-Lemeshow test). Society of Thoracic Surgeons 2008 models had better discrimination (C-statistic, 0.734) and calibration (P = .5805) in patients undergoing isolated valve surgery than in patients undergoing multiple valve surgery (C-statistic, 0.694; P = .00002 in Hosmer-Lemeshow test). Estimates derived from the Society of Thoracic Surgeons 2008 models exceeded the mortality rates of multiple valve surgery (observed/expected ratios of 1.44 for multiple valve surgery and 1.17 for single valve surgery). The Society of Thoracic Surgeons 2008 cardiac surgery risk models performed well when predicting the mortality for Chinese patients undergoing valve surgery. The Society of Thoracic Surgeons 2008 models were suitable for single valve surgery in a Chinese population; estimates of mortality for multiple valve surgery derived from the Society of Thoracic Surgeons 2008 models were less accurate. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Effect of plane of milk replacer intake and age on glucose and insulin kinetics and abomasal emptying in female Holstein Friesian dairy calves fed twice daily.

PubMed

MacPherson, J A R; Berends, H; Leal, L N; Cant, J P; Martín-Tereso, J; Steele, M A

2016-10-01

The objective of this study was to investigate how preweaning plane of milk replacer intake and age can affect insulin and glucose kinetics as well as abomasal emptying rate in dairy calves fed twice a day. A total of 12 female Holstein Friesian calves were blocked by cow parity, paired by colostrum origin, and were randomly assigned to a high plane of milk replacer intake (8 L/d, 1.2kg of milk replacer/d; n=6) or a low plane of nutrition (4 L/d, 0.6kg of milk replacer/d; n=6). All calves received 4 L of colostrum over 2 meals (1 and 6h after birth) and were then directly transferred to their assigned feeding plans until they were stepped-down from milk by 50% during wk 7 and weaned on wk 8. Milk replacer (24% crude protein, 18% crude fat) was fed at 150g/L twice daily (0700 and 1700h) and all calves had ad libitum access to pelleted calf starter, chopped wheat straw, and water. Jugular catheters were placed in all calves at 4, 7, and 10wk of age. Then, postprandial response to plasma glucose, insulin, and acetaminophen (supplied with the meal) were determined to measure abomasal emptying. The next day, a glucose tolerance test was conducted by infusing glucose via the jugular catheter. At 4 and 7wk of age, the rate constant (%/h) for abomasal emptying of the meal was lower in high calves (0.21±0.02 in wk 4; 0.27±0.02 in wk 7) compared with low (0.34±0.02 in wk 4; 0.47±0.02 in wk 7). The postprandial plasma insulin area under the curve over 420min was greater in high calves (18,443±7,329; low=5,834±739 µU/mL) compared with low. We found no differences in glucose tolerance test kinetics between the high and low dairy calves at 4, 7, or 10wk of age. The findings from this study suggest that feeding dairy calves an elevated plane of nutrition in 2 meals of milk replacer per day does not decrease insulin sensitivity. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Development of a vancomycin dosing approach for critically ill patients receiving hybrid hemodialysis using Monte Carlo simulation.

PubMed

Lewis, Susan J; Mueller, Bruce A

2018-01-01

Prolonged intermittent renal replacement therapy is an increasingly popular treatment for acute kidney injury in critically ill patients that runs at different flow rates and durations than conventional hemodialysis or continuous renal replacement therapies. Pharmacokinetic studies conducted in patients receiving prolonged intermittent renal replacement therapy are scarce; consequently, clinicians are challenged to dose antibiotics effectively. The purpose of this study was to develop vancomycin dosing recommendations for patients receiving prolonged intermittent renal replacement therapy. Monte Carlo simulations were performed in thousands of virtual patients derived from previously published demographic, pharmacokinetic, and dialytic information derived from critically ill patients receiving vancomycin and other forms of renal replacement therapy. We conducted "in silico" vancomycin pharmacokinetic/pharmacodynamics analyses in these patients receiving prolonged intermittent renal replacement therapy to determine what vancomycin dose would achieve vancomycin 24-h area under the curve (AUC 24h ) of 400-700 mg·h/L, a target associated with positive clinical outcomes. Nine different vancomycin dosing regimens were tested using four different, commonly used prolonged intermittent renal replacement therapy modalities. A dosing nomogram based on serum concentration data achieved after the third dose was developed to individualize vancomycin therapy. An initial vancomycin dose of 15 or 20 mg/kg immediately followed by 15 mg/kg after subsequent prolonged intermittent renal replacement therapy treatments achieved AUC 24h of ≥400 mg·h/L for ≥90% of patients regardless of prolonged intermittent renal replacement therapy duration, modality, or time of vancomycin dose relative to prolonged intermittent renal replacement therapy. Many patients experienced AUC 24h of ≥700 mg·h/L, but once the dosing nomogram was applied to serum concentrations obtained after the third vancomycin dose, 67%-88% of patients achieved AUC 24h of 400-700 mg·h/L. An initial loading dose of 15-20 mg/kg followed by a maintenance regimen of 15 mg/kg after every prolonged intermittent renal replacement therapy session coupled with serum concentration monitoring should be used to individualize vancomycin dosing. These predictions need clinical verification.

The High-efficiency LED Driver for Visible Light Communication Applications.

PubMed

Gong, Cihun-Siyong Alex; Lee, Yu-Chen; Lai, Jyun-Liang; Yu, Chueh-Hao; Huang, Li Ren; Yang, Chia-Yen

2016-08-08

This paper presents a LED driver for VLC. The main purpose is to solve the low data rate problem used to be in switching type LED driver. The GaN power device is proposed to replace the traditional silicon power device of switching LED driver for the purpose of increasing switching frequency of converter, thereby increasing the bandwidth of data transmission. To achieve high efficiency, the diode-connected GaN power transistor is utilized to replace the traditional ultrafast recovery diode used to be in switching type LED driver. This work has been experimentally evaluated on 350-mA output current. The results demonstrate that it supports the data of PWM dimming level encoded in the PPM scheme for VLC application. The experimental results also show that system's efficiency of 80.8% can be achieved at 1-Mb/s data rate.

Fluid resuscitation in acute pancreatitis

PubMed Central

Aggarwal, Aakash; Manrai, Manish; Kochhar, Rakesh

2014-01-01

Acute pancreatitis remains a clinical challenge, despite an exponential increase in our knowledge of its complex pathophysiological changes. Early fluid therapy is the cornerstone of treatment and is universally recommended; however, there is a lack of consensus regarding the type, rate, amount and end points of fluid replacement. Further confusion is added with the newer studies reporting better results with controlled fluid therapy. This review focuses on the pathophysiology of fluid depletion in acute pancreatitis, as well as the rationale for fluid replacement, the type, optimal amount, rate of infusion and monitoring of such patients. The basic goal of fluid epletion should be to prevent or minimize the systemic response to inflammatory markers. For this review, various studies and reviews were critically evaluated, along with authors’ recommendations, for predicted severe or severe pancreatitis based on the available evidence. PMID:25561779

A systematic review of the evidence for single stage and two stage revision of infected knee replacement

PubMed Central

2013-01-01

Background Periprosthetic infection about the knee is a devastating complication that may affect between 1% and 5% of knee replacement. With over 79 000 knee replacements being implanted each year in the UK, periprosthetic infection (PJI) is set to become an important burden of disease and cost to the healthcare economy. One of the important controversies in treatment of PJI is whether a single stage revision operation is superior to a two-stage procedure. This study sought to systematically evaluate the published evidence to determine which technique had lowest reinfection rates. Methods A systematic review of the literature was undertaken using the MEDLINE and EMBASE databases with the aim to identify existing studies that present the outcomes of each surgical technique. Reinfection rate was the primary outcome measure. Studies of specific subsets of patients such as resistant organisms were excluded. Results 63 studies were identified that met the inclusion criteria. The majority of which (58) were reports of two-stage revision. Reinfection rated varied between 0% and 41% in two-stage studies, and 0% and 11% in single stage studies. No clinical trials were identified and the majority of studies were observational studies. Conclusions Evidence for both one-stage and two-stage revision is largely of low quality. The evidence basis for two-stage revision is significantly larger, and further work into direct comparison between the two techniques should be undertaken as a priority. PMID:23895421

Characterization of mutants expressing thermostable D1 and D2 polypeptides of photosystem II in the cyanobacterium Synechococcus elongatus PCC 7942.

PubMed

Haraguchi, Norihisa; Kaseda, Jun; Nakayama, Yasumune; Nagahama, Kazuhiro; Ogawa, Takahira; Matsuoka, Masayoshi

2018-06-08

Photosystem II complex embedded in thylakoid membrane performs oxygenic photosynthesis where the reaction center D1/D2 heterodimer accommodates all components of the electron transport chain. To express thermostable D1/D2 heterodimer in a cyanobacterium Synechococcus elongatus PCC 7942, we constructed a series of mutant strains whose psbA1 and psbD1 genes encoding, respectively, the most highly expressed D1 and D2 polypeptides were replaced with those of a thermophilic strain, Thermosynechococcus vulcanus. Because the C-terminal 16 amino acid sequences of D1 polypeptides should be processed prior to maturation but diverge from each other, we also constructed the psbA1ΔC-replaced strain expressing a thermostable D1 polypeptide devoid of the C-terminal extension. The psbA1/psbD1-replaced strain showed decreased growth rate and oxygen evolution rate, suggesting inefficient photosystem II. Immunoblot analyses for thermostable D1, D2 polypeptides revealed that the heterologous D1 protein was absent in thylakoid membrane from any mutant strains with psbA1, psbA1ΔC, and psbA1/psbD1-replacements, whereas the heterologous D2 protein was present in thylakoid membrane as well as purified photosystem II complex from the psbA1/psbD1-replaced strain. In the latter strain, the compensatory expression of psbA3 and psbD2 genes was elevated. These data suggest that heterologous D2 polypeptide could be combined with the host D1 polypeptide to form chimeric D1/D2 heterodimer, whereas heterologous D1 polypeptide even without the C-terminal extension was unable to make complex with the host D2 polypeptide. Since the heterologous D1 could not be detected even in the whole cells of psbA1/psbD1-replaced strain, the rapid degradation of unprocessed or unassembled heterologous D1 was implicated. Copyright © 2018 The Society for Biotechnology, Japan. Published by Elsevier B.V. All rights reserved.

Growth versus metabolic tissue replacement in mouse tissues determined by stable carbon and nitrogen isotope analysis

NASA Astrophysics Data System (ADS)

Macavoy, S. E.; Jamil, T.; Macko, S. A.; Arneson, L. S.

2003-12-01

Stable isotope analysis is becoming an extensively used tool in animal ecology. The isotopes most commonly used for analysis in terrestrial systems are those of carbon and nitrogen, due to differential carbon fractionation in C3 and C4 plants, and the approximately 3‰ enrichment in 15N per trophic level. Although isotope signatures in animal tissues presumably reflect the local food web, analysis is often complicated by differential nutrient routing and fractionation by tissues, and by the possibility that large organisms are not in isotopic equilibrium with the foods available in their immediate environment. Additionally, the rate at which organisms incorporate the isotope signature of a food through both growth and metabolic tissue replacement is largely unknown. In this study we have assessed the rate of carbon and nitrogen isotopic turnover in liver, muscle and blood in mice following a diet change. By determining growth rates, we were able to determine the proportion of tissue turnover caused by growth versus that caused by metabolic tissue replacement. Growth was found to account for approximately 10% of observed tissue turnover in sexually mature mice (Mus musculus). Blood carbon was found to have the shortest half-life (16.9 days), followed by muscle (24.7 days). Liver carbon turnover was not as well described by the exponential decay equations as other tissues. However, substantial liver carbon turnover was observed by the 28th day after diet switch. Surprisingly, these tissues primarily reflect the carbon signature of the protein, rather than carbohydrate, source in their diet. The nitrogen signature in all tissues was enriched by 3 - 5‰ over their dietary protein source, depending on tissue type, and the isotopic turnover rates were comparable to those observed in carbon.

Low permanent pacemaker rates following Lotus device implantation for transcatheter aortic valve replacement due to modified implantation protocol.

PubMed

Krackhardt, Florian; Kherad, Behrouz; Krisper, Maximilian; Pieske, Burkert; Laule, Michael; Tschöpe, Carsten

2017-01-01

Conduction disturbances requiring permanent pacemaker implantation following transcatheter aortic valve replacement (TAVR) are a common problem. Pacemaker implantation rates after TAVR appear to be higher compared to conventional aortic valve replacement. The aim of this study was to analyze whether a high annulus implantation conveys the benefit of a decreased rate of permanent pacemaker implantation while being safe and successful according to Valve Academic Research Consortium 2 (VARC2)-criteria. A total of 23 patients with symptomatic severe aortic valve stenosis, an aortic annulus of 19-27 mm and at high risk for surgery were treated with the Lotus valve. In all patients the valve was implanted in a high annulus position via femoral access. The primary device performance endpoint was VARC2-defined device success after 30 days and the primary safety endpoint was the need for permanent pacemaker implantation. The mean age was 73.23 ± 7.65 years, 46% were female, 38% were New York Heart Association class III/IV at baseline. Thirty-day follow-up data were available for all patients. The VARC2-defined device success rate after 30 days was 22/23 (96%). 2/21 (10%) patients required a newly implanted pacemaker due to 3rd degree atrioventricular block. 25% of the patients developed a new left bundle branch block after valvuloplasty or device implantation. 21 of the 23 patients (96%) had no other signs of conduction disturbances after 30 days. The approach of the modified implantation technique of Lotus TAVR device was safe and effective. The incidence of need for a permanent pacemaker following TAVR could be significantly reduced due to adopted implantation protocol.

Economic evaluation of single-tooth replacement: dental implant versus fixed partial denture.

PubMed

Kim, Younhee; Park, Joo-Yeon; Park, Sun-Young; Oh, Sung-Hee; Jung, YeaJi; Kim, Ji-Min; Yoo, Soo-Yeon; Kim, Seong-Kyun

2014-01-01

This study assessed the cost-effectiveness from a societal perspective of a dental implant compared with a three-unit tooth-supported fixed partial denture (FPD) for the replacement of a single tooth in 2010. A decision tree was developed to estimate cost-effectiveness over a 10-year period. The survival rates of single-tooth implants and FPDs were extracted from a meta-analysis of single-arm studies. Medical costs included initial treatment costs, maintenance costs, and costs to treat complications. Patient surveys were used to obtain the costs of the initial single-tooth implant or FPD. Maintenance costs and costs to treat complications were based on surveys of seven clinical experts at dental clinics or hospitals. Transportation costs were calculated based on the number of visits for implant or FPD treatment. Patient time costs were estimated using the number of visits and time required, hourly wage, and employment rate. Future costs were discounted by 5% to convert to present values. The results of a 10-year period model showed that a single dental implant cost US $261 (clinic) to $342 (hospital) more than an FPD and had an average survival rate that was 10.4% higher. The incremental cost-effectiveness ratio was $2,514 in a clinic and $3,290 in a hospital for a prosthesis in situ for 10 years. The sensitivity analysis showed that initial treatment costs and survival rate influenced the cost-effectiveness. If the cost of an implant were reduced to 80% of the current cost, the implant would become the dominant intervention. Although the level of evidence for effectiveness is low, and some aspects of single-tooth implants or FPDs, such as satisfaction, were not considered, this study will help patients requiring single-tooth replacement to choose the best treatment option.

Replacing single frozen-thawed euploid embryos in a natural cycle in ovulatory women may increase live birth rates compared to medicated cycles in anovulatory women.

PubMed

Melnick, Alexis P; Setton, Robert; Stone, Logan D; Pereira, Nigel; Xu, Kangpu; Rosenwaks, Zev; Spandorfer, Steven D

2017-10-01

The goal of this study was to compare pregnancy outcomes between natural frozen embryo transfer (FET) cycles in ovulatory women and programmed FET cycles in anovulatory women after undergoing in vitro fertilization with preimplantation genetic screening (IVF-PGS). This was a retrospective cohort study performed at an academic medical center. Patients undergoing single FET IVF-PGS cycles between October 2011 and December 2014 were included. Patients were stratified by type of endometrial replacement: programmed cycles with estrogen/progesterone replacement and natural cycles. IVF-PGS with 24-chromosome screening was performed on all included patients. Those patients with euploid embryos had single embryo transfer in a subsequent FET. The primary study outcome was live birth/ongoing pregnancy rate. Secondary outcomes included implantation, biochemical pregnancy, and miscarriage rates. One hundred thirteen cycles met inclusion criteria: 65 natural cycles and 48 programmed cycles. The programmed FET group was younger (35.9 ± 4.5 vs. 37.5 ± 3.7, P = 0.03) and had a higher AMH (3.95 ± 4.2 vs. 2.37 ± 2.4, P = 0.045). The groups were similar for BMI, gravidity, parity, history of uterine surgery, and incidence of Asherman's syndrome. There was also no difference in embryo grade at biopsy or transfer, and proportion of day 5 and day 6 transfers. Implantation rates were higher in the natural FET group (0.66 ± 0.48 vs. 0.44 ± 0.50, P = 0.02). There was no difference in the rates of biochemical pregnancy or miscarriage. After controlling for age, live birth/ongoing pregnancy rate was higher in natural FETs with an adjusted odds ratio of 2.68 (95% CI 1.22-5.87). Natural FET in ovulatory women after IVF-PGS is associated with increased implantation and live birth rates compared to programmed FET in anovulatory women. Further investigation is needed to determine whether these findings hold true in other patient cohorts.

Rheological properties of reduced fat ice cream mix containing octenyl succinylated pearl millet starch.

PubMed

Sharma, Monika; Singh, Ashish K; Yadav, Deep N

2017-05-01

The octenyl succinyl anhydride (OSA) esterified pearl millet ( Pennisetum typhoides ) starch was evaluated as fat replacer in soft serve ice cream in comparison to other fat replacers viz. inulin, whey protein concentrate-70 and commercial starch. During temperature sweep test, the yield stress and flow behaviour index of un-pasteurized ice cream mixes increased as the temperature increased from 40 to 80 °C, while the consistency index decreased. Consistency index of aged ice cream mixes containing 2% fat replacer was higher as compared to mixes with 1% level. The aged ice cream mixes exhibited non-Newtonian behaviour as flow behaviour index values were less than one. Apparent viscosity (at 50 s -1 shear rate) of control as well as ice cream mix containing 1% OSA-esterified pearl millet starch samples was 417 and 415 mPas, respectively and did not differ significantly. The overrun of the ice cream (with 5 and 7.5% fat) containing 1 and 2% of above fat replacers ranged between 29.7 and 34.3% and was significantly lower than control (40.3%). The percent melted ice cream was also low for the ice creams containing 2% of above fat replacers at 5% fat content as compared to control. However, sensory acceptability and rheological characteristics of reduced fat ice creams containing 1.0 and 2.0% OSA-esterified pearl millet starch were at par with other fat replacers under the study. Thus, OSA-esterified pearl millet starch has potential to be used as fat replacer in reduced fat ice cream.

Aortic Root Replacement for Children With Loeys-Dietz Syndrome.

PubMed

Patel, Nishant D; Alejo, Diane; Crawford, Todd; Hibino, Narutoshi; Dietz, Harry C; Cameron, Duke E; Vricella, Luca A

2017-05-01

Loeys-Dietz syndrome (LDS) is an aggressive aortopathy with a proclivity for aortic aneurysm rupture and dissection at smaller diameters than other connective tissue disorders. We reviewed our surgical experience of children with LDS to validate our guidelines for prophylactic aortic root replacement (ARR). We reviewed all children (younger than 18 years) with a diagnosis of LDS who underwent ARR at our institution. The primary endpoint was mortality, and secondary endpoints included complications and the need for further interventions. Thirty-four children with LDS underwent ARR. Mean age at operation was 10 years, and 15 (44%) were female. Mean preoperative root diameter was 4 cm. Three children (9%) had composite ARR with a mechanical prosthesis, and 31 (91%) underwent valve-sparing ARR. Concomitant procedures included arch replacement in 2 (6%), aortic valve repair in 1 (3%), and patent foramen ovale closure in 16 (47%). There was no operative mortality. Two children (6%) required late replacement of the ascending aorta, 5 (15%) required arch replacement, 1 (3%) required mitral valve replacement, and 2 (6%) had coronary button aneurysms/pseudoaneurysms requiring repair. Three children required redo valve-sparing ARR after a Florida sleeve procedure, and 2 had progressive aortic insufficiency requiring aortic valve replacement after a valve-sparing procedure. There were 2 late deaths (6%). These data confirm the aggressive aortopathy of LDS. Valve-sparing ARR should be performed when feasible to avoid the risks of prostheses. Serial imaging of the arterial tree is critical, given the rate of subsequent intervention. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Repair or Replacement for Isolated Tricuspid Valve Pathology? Insights from a Surgical Analysis on Long-Term Survival

PubMed Central

Farag, Mina; Arif, Rawa; Sabashnikov, Anton; Zeriouh, Mohamed; Popov, Aron-Frederik; Ruhparwar, Arjang; Schmack, Bastian; Dohmen, Pascal M.; Szabó, Gábor; Karck, Matthias; Weymann, Alexander

2017-01-01

Background Long-term follow-up data concerning isolated tricuspid valve pathology after replacement or reconstruction is limited. Current American Heart Association guidelines equally recommend repair and replacement when surgical intervention is indicated. Our aim was to investigate and compare operative mortality and long-term survival in patients undergoing isolated tricuspid valve repair surgery versus replacement. Material/Methods Between 1995 and 2011, 109 consecutive patients underwent surgical correction of tricuspid valve pathology at our institution for varying structural pathologies. A total of 41 (37.6%) patients underwent tricuspid annuloplasty/repair (TAP) with or without ring implantation, while 68 (62.3%) patients received tricuspid valve replacement (TVR) of whom 36 (53%) were mechanical and 32 (47%) were biological prostheses. Results Early survival at 30 days after surgery was 97.6% in the TAP group and 91.1% in the TVR group. After 6 months, 89.1% in the TAP group and 87.8% in the TVR group were alive. In terms of long-term survival, there was no further mortality observed after one year post surgery in both groups (Log Rank p=0.919, Breslow p=0.834, Tarone-Ware p=0.880) in the Kaplan-Meier Survival analysis. The 1-, 5-, and 8-year survival rates were 85.8% for TAP and 87.8% for TVR group. Conclusions Surgical repair of the tricuspid valve does not show survival benefit when compared to replacement. Hence valve replacement should be considered generously in patients with reasonable suspicion that regurgitation after repair will reoccur. PMID:28236633

Protein and calorie prescription for children and young adults receiving continuous renal replacement therapy: a report from the Prospective Pediatric Continuous Renal Replacement Therapy Registry Group.

PubMed

Zappitelli, Michael; Goldstein, Stuart L; Symons, Jordan M; Somers, Michael J G; Baum, Michelle A; Brophy, Patrick D; Blowey, Douglas; Fortenberry, James D; Chua, Annabelle N; Flores, Francisco X; Benfield, Mark R; Alexander, Steven R; Askenazi, David; Hackbarth, Richard; Bunchman, Timothy E

2008-12-01

Few published reports describe nutrition provision for critically ill children and young adults with acute kidney injury receiving continuous renal replacement therapy. The goals of this study were to describe feeding practices in pediatric continuous renal replacement therapy and to evaluate factors associated with over- and under-prescription of protein and calories. Retrospective database study. Multicenter study in pediatric critical care units. Patients with acute kidney injury (estimated glomerular filtration rate < 75 mL/min/1.73 m at continuous renal replacement therapy initiation) enrolled in the Prospective Pediatric Continuous Renal Replacement Therapy Registry. None. Nutrition variables: initial and maximal protein (g/kg/day) and caloric (kcal/kg/day) prescription and predicted resting energy expenditure (kcal/kg/day). We determined factors predicting initial and maximal protein and caloric prescription by multivariate analysis. One hundred ninety-five patients (median [interquartile range] age = 8.1 [12.8] yrs, 56.9% men) were studied. Mean protein and caloric prescriptions at continuous renal replacement therapy initiation were 1.3 +/- 1.5 g/kg/day (median, 1.0; range, 0-10) and 37 +/- 27 kcal/kg/day (median, 32; range, 0-107). Mean maximal protein and caloric prescriptions during continuous renal replacement therapy were 2.0 +/- 1.5 g/kg/day (median, 1.7; range, 0-12) and 48 +/- 32 kcal/kg/day (median, 43; range, 0-117). Thirty-four percent of patients were initially prescribed < 1 g/kg/day protein; 23% never attained > 1 g/kg/day protein prescription. By continuous renal replacement therapy day 5, median protein prescribed was > 2 g/kg/day. Protein prescription practices differed substantially between medical centers with 5 of 10 centers achieving maximal protein prescription of > 2 g/kg/day in > or = 40% of patients. Caloric prescription exceeded predicted resting energy expenditure by 30%-100%. Factors independently associated with maximal protein and caloric prescription while on continuous renal replacement therapy were younger age, initial protein and caloric prescription and number of continuous renal replacement therapy treatment days (p < 0.05). Protein prescription in pediatric continuous renal replacement therapy may be inadequate. Inter-center variation exists with respect to nutrition prescription. Feeding practice standardization and research in pediatric acute kidney injury nutrition are essential to begin providing evidence-based feeding recommendations.

Mechanisms of starch digestion by α-amylase-Structural basis for kinetic properties.

PubMed

Dhital, Sushil; Warren, Frederick J; Butterworth, Peter J; Ellis, Peter R; Gidley, Michael J

2017-03-24

Recent studies of the mechanisms determining the rate and extent of starch digestion by α-amylase are reviewed in the light of current widely-used classifications for (a) the proportions of rapidly-digestible (RDS), slowly-digestible (SDS), and resistant starch (RS) based on in vitro digestibility, and (b) the types of resistant starch (RS 1,2,3,4…) based on physical and/or chemical form. Based on methodological advances and new mechanistic insights, it is proposed that both classification systems should be modified. Kinetic analysis of digestion profiles provides a robust set of parameters that should replace the classification of starch as a combination of RDS, SDS, and RS from a single enzyme digestion experiment. This should involve determination of the minimum number of kinetic processes needed to describe the full digestion profile, together with the proportion of starch involved in each process, and the kinetic properties of each process. The current classification of resistant starch types as RS1,2,3,4 should be replaced by one which recognizes the essential kinetic nature of RS (enzyme digestion rate vs. small intestinal passage rate), and that there are two fundamental origins for resistance based on (i) rate-determining access/binding of enzyme to substrate and (ii) rate-determining conversion of substrate to product once bound.

Polyethylene wear of mobile-bearing unicompartmental knee replacement at 20 years.

PubMed

Kendrick, B J L; Simpson, D J; Kaptein, B L; Valstar, E R; Gill, H S; Murray, D W; Price, A J

2011-04-01

The Oxford unicompartmental knee replacement (UKR) was designed to minimise wear utilising a fully-congruent, mobile, polyethylene bearing. Wear of polyethylene is a significant cause of revision surgery in UKR in the first decade, and the incidence increases in the second decade. Our study used model-based radiostereometric analysis to measure the combined wear of the upper and lower bearing surfaces in 13 medial-compartment Oxford UKRs at a mean of 20.9 years (17.2 to 25.9) post-operatively. The mean linear penetration of the polyethylene bearing was 1.04 mm (0.307 to 2.15), with a mean annual wear rate of 0.045 mm/year (0.016 to 0.099). The annual wear rate of the phase-2 bearings (mean 0.022 mm/year) was significantly less (p = 0.01) than that of phase-1 bearings (mean 0.07 mm/year). The linear wear rate of the Oxford UKR remains very low into the third decade. We believe that phase-2 bearings had lower wear rates than phase-1 implants because of the improved bearing design and surgical technique which decreased the incidence of impingement. We conclude that the design of the Oxford UKR gives low rates of wear in the long term.

Nicotine replacement therapy, tobacco products, and electronic cigarettes in pharmacies in St. Louis, Missouri.

PubMed

Barnoya, Joaquin; Jin, Linda; Hudmon, Karen Suchanek; Schootman, Mario

2015-01-01

To compare availability of nicotine replacement therapy (NRT), tobacco products, and electronic cigarettes (e-cigarettes) in pharmacies in St. Louis, MO. Cross-sectional study, on-site store audits of 322 pharmacies. St. Louis, MO. 242 eligible community pharmacies located in the study area. Pharmacies were visited by trained research assistants who conducted a 5- to 10-minute store audit using a paper-based data collection tool. Availability, accessibility, and pricing of NRT as a function of neighborhood poverty rate and proportion of black residents as well as availability of tobacco products and e-cigarettes. NRT availability decreased as neighborhood poverty rate increased (P = 0.02). Availability without pharmacy personnel assistance also decreased with increasing poverty rate (r = -0.19; 95% CI = -0.06, -0.31) and higher percentage of black residents (r = -0.18; 95% CI = -0.06, -0.31). Prices were lower in neighborhoods with higher poverty rates (P = 0.02) and a higher percentage of black residents (P = 0.03). E-cigarettes were available in 43% of pharmacies, and their availability and price did not differ by poverty rate or percentage of black residents. Low access to NRT might perpetuate smoking disparities in disadvantaged and racially diverse neighborhoods. Study data support policies to ensure equal NRT access to reduce disparities.

Effect of flow rate and lead/copper pipe sequence on lead release from service lines.

PubMed

Cartier, Clément; Arnold, Roger B; Triantafyllidou, Simoni; Prévost, Michèle; Edwards, Marc

2012-09-01

A pilot experiment examined lead leaching from four representative configurations of service lines including: (1) 100% lead (Pb), (2) 100% copper (Cu), (3) 50% Pb upstream of 50% Cu, and (4) 50% Pb-downstream of 50% Cu using a range of flow rates. The cumulative mass of lead release indicated that a typical partial replacement configuration (50% lead downstream of copper) did not provide a net reduction in lead when compared to 100% lead pipe (85 mg for 50% Pb-downstream versus 83 mg for 100%-Pb) due to galvanic and deposition corrosion. The partially replaced service line configuration also had a much greater likelihood of producing water with "spikes" of lead particulates at higher flow rates, while tending to produce lower levels of lead at very low flow rates. After the first 214 days the galvanic current between copper and lead was only reduced by 34%, proving that galvanic impacts can be highly persistent even in water with optimized corrosion control by dosing of zinc orthophosphate. Finally, this experiment raises concern about the low flow rates used during some prior home sampling events, which may underestimate exposure to lead during normal water use, especially when galvanic Pb:Cu connections are present. Copyright © 2012 Elsevier Ltd. All rights reserved.

The economic cost of upland and gully erosion on subsistence agriculture for a watershed in the Ethiopian highlands

USDA-ARS?s Scientific Manuscript database

This paper quantifies the cost of erosion; it uses nutrient replacement cost to value topsoil nutrient depletion, daily wage rate to monetize the opportunity cost of labour due to gully erosion and local market price to quantify the lost animal and cash crop trees. Soil erosion rate is estimated fro...

78 FR 4759 - Airworthiness Directives; Bell Helicopter Textron, Inc. (Bell) Helicopters

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-23

.... Reviewing the helicopter records and determining the total factored hours TIS will require about 3 work... inspection and MPI will require about 35 work hours at an average labor rate of $85 per work hour, for a... inspection cycle. To replace a yoke will require about 32 work hours at an average labor rate of $85 per hour...

Forecasting regional to global plant migration in response to climate change.

Treesearch

Ronald P. Neilson; Louis F. Pitelka; Allen M. Solomon; Ran Nathan; Guy F. Midgley; Jóse M. Fragoso; Heike Lischke; Ken Thompson

2005-01-01

The rate of future climate change is likely to exceed the migration rates of most plant species. The replacement of dominant species by locally rare species may require decades, and extinctions may occur when plant species cannot migrate fast enough to escape the consequences of climate change. Such lags may impair ecosystem services, such as carbon sequestration and...

Microbial processing of carbon in hydrothermal systems (Invited)

NASA Astrophysics Data System (ADS)

LaRowe, D.; Amend, J. P.

2013-12-01

Microorganisms are known to be active in hydrothermal systems. They catalyze reactions that consume and produce carbon compounds as a result of their efforts to gain energy, grow and replace biomass. However, the rates of these processes, as well as the size of the active component of microbial populations, are poorly constrained in hydrothermal environments. In order to better characterize biogeochemical processes in these settings, a quantitative relationship between rates of microbial catalysis, energy supply and demand and population size is presented. Within this formulation, rates of biomass change are determined as a function of the proportion of catabolic power that is converted into biomass - either new microorganisms or the replacement of existing cell components - and the amount of energy that is required to synthesize biomass. The constraints that hydrothermal conditions place on power supply and demand are explicitly taken into account. The chemical composition, including the concentrations of organic compounds, of diffuse and focused flow hydrothermal fluids, hydrothermally influenced sediment pore water and fluids from the oceanic lithosphere are used in conjunction with cell count data and the model described above to constrain the rates of microbial processes that influence the carbon cycle in the Juan de Fuca hydrothermal system.

What is the optimal bone-preserving strategy for patients with Addison's disease?

PubMed

Lee, Paul; Greenfield, Jerry R

2015-08-01

Addison's disease is associated with low bone mineral density and increased risk of hip fractures. Causes are multifactorial, contributed by underlying adrenocortical hormonal deficiency, associated autoimmune endocrinopathies, electrolyte disturbances and, in some patients, supraphysiologic glucocorticoid replacement. Recent realization of physiologic cortisol production rate has revised downwards glucocorticoid replacement dosages. Meanwhile, new research has emerged suggesting complex interplay between sodium and calcium homoeostasis under the influence of mineralocorticoid and parathyroid hormone that may impact bone health. As the prevalence of Addison's disease is rising, and osteoporosis and fractures are associated with significant morbidity and increased mortality, attention to bone preservation in Addison's disease is of clinical relevance and importance. We suggest an approach to bone health in Addison's disease integrating physiologic adrenocortical hormonal replacement with electrolyte and mineral homoeostasis optimization. © 2015 John Wiley & Sons Ltd.

Manipulation Detection and Preference Alterations in a Choice Blindness Paradigm

PubMed Central

Taya, Fumihiko; Gupta, Swati; Farber, Ilya; Mullette-Gillman, O'Dhaniel A.

2014-01-01

Objectives It is commonly believed that individuals make choices based upon their preferences and have access to the reasons for their choices. Recent studies in several areas suggest that this is not always the case. In choice blindness paradigms, two-alternative forced-choice in which chosen-options are later replaced by the unselected option, individuals often fail to notice replacement of their chosen option, confabulate explanations for why they chose the unselected option, and even show increased preferences for the unselected-but-replaced options immediately after choice (seconds). Although choice blindness has been replicated across a variety of domains, there are numerous outstanding questions. Firstly, we sought to investigate how individual- or trial-factors modulated detection of the manipulations. Secondly, we examined the nature and temporal duration (minutes vs. days) of the preference alterations induced by these manipulations. Methods Participants performed a computerized choice blindness task, selecting the more attractive face between presented pairs of female faces, and providing a typewritten explanation for their choice on half of the trials. Chosen-face cue manipulations were produced on a subset of trials by presenting the unselected face during the choice explanation as if it had been selected. Following all choice trials, participants rated the attractiveness of each face individually, and rated the similarity of each face pair. After approximately two weeks, participants re-rated the attractiveness of each individual face online. Results Participants detected manipulations on only a small proportion of trials, with detections by fewer than half of participants. Detection rates increased with the number of prior detections, and detection rates subsequent to first detection were modulated by the choice certainty. We show clear short-term modulation of preferences in both manipulated and non-manipulated explanation trials compared to choice-only trials (with opposite directions of effect). Preferences were altered in the direction that subjects were led to believe they selected. PMID:25247886

Pulse Generator Exchange Does Not Accelerate the Rate of Electrical Failure in a Recalled Small Caliber ICD Lead.

PubMed

Lovelock, Joshua D; Premkumar, Ajay; Levy, Mathew R; Mengistu, Andenet; Hoskins, Michael H; El-Chami, Mikhael F; Lloyd, Michael S; Leon, Angel R; Langberg, Jonathan J; Delurgio, David B

2015-12-01

St. Jude Riata/Riata ST defibrillator leads (St. Jude Medical, Sylmar, CA, USA) were recalled by the Food and Drug Administration in 2011 for an increased rate of failure. More than 227,000 leads were implanted and at least 79,000 patients still have active Riata leads. Studies have examined clinical predictors of lead failure in Riata leads, but none have addressed the effect of implantable cardioverter defibrillator (ICD) generator exchange on lead failure. The purpose of this study is to assess the effect of ICD generator exchange on the rate of electrical failure in the Riata lead at 1 year. A retrospective chart review was conducted in patients who underwent implantation of a Riata/Riata ST lead at one center. Patients with a functioning Riata lead (with/without externalized conductor) at the time of ICD exchange were compared to controls with Riata leads implanted for a comparable amount of time who did not undergo generator replacement. Riata leads were implanted in 1,042 patients prior to the recall and 153 of these patients underwent generator exchange without lead replacement. Conductor externalization was noted in 21.5% of Riata leads in the ICD exchange cohort, which was not different from the control group (19.2%; P = 0.32). Two leads failed in the first year after generator replacement (1.5%) which did not significantly differ from the control group (2.0%; P = 0.57). At change-out, 54% received a commanded shock (18.6 ± 0.9 J) that did not result in any change in the high-voltage lead impedance (46.1 ± 1.1 ohms). Conductor externalization was seen frequently in our cohort of patients. ICD generator exchange did not accelerate the rate of Riata lead failure at 1 year. Although both the control and the change-out cohorts failed at a rate much greater than nonrecalled leads, generator exchange did not appear to add to the problem. ©2015 Wiley Periodicals, Inc.

Estimated impacts of alternative Australian alcohol taxation structures on consumption, public health and government revenues.

PubMed

Doran, Christopher M; Byrnes, Joshua M; Cobiac, Linda J; Vandenberg, Brian; Vos, Theo

2013-11-04

To examine health and economic implications of modifying taxation of alcohol in Australia. Economic and epidemiological modelling of four scenarios for changing the current taxation of alcohol products, including: replacing the wine equalisation tax (WET) with a volumetric tax; applying an equal tax rate to all beverages equivalent to a 10% increase in the current excise applicable to spirits and ready-to-drink products; applying an excise tax rate that increases exponentially by 3% for every 1% increase in alcohol content above 3.2%; and applying a two-tiered volumetric tax. We used annual sales data and taxation rates for 2010 as the base case. Alcohol consumption, taxation revenue, disability-adjusted life-years (DALYs) averted and health care costs averted. In 2010, the Australian Government collected close to $8.6 billion from alcohol taxation. All four of the proposed variations to current rates of alcohol excise were shown to save money and more effectively reduce alcohol-related harm compared with the 2010 base case. Abolishing the WET and replacing it with a volumetric tax on wine would increase taxation revenue by $1.3 billion per year, reduce alcohol consumption by 1.3%, save $820 million in health care costs and avert 59 000 DALYs. The alternative scenarios would lead to even higher taxation receipts and greater reductions in alcohol use and harm. Our research findings suggest that any of the proposed variations to current rates of alcohol excise would be a cost-effective health care intervention; they thus reinforce the evidence that taxation is a cost-effective strategy. Of all the scenarios, perhaps the most politically feasible policy option at this point in time is to abolish the WET and replace it with a volumetric tax on wine. This analysis supports the recommendation of the National Preventative Health Taskforce and the Henry Review towards taxing alcohol according to alcohol content.

Infraclavicular versus axillary nerve catheters: A retrospective comparison of early catheter failure rate.

PubMed

Quast, Michaela B; Sviggum, Hans P; Hanson, Andrew C; Stoike, David E; Martin, David P; Niesen, Adam D

2018-05-01

Continuous brachial plexus catheters are often used to decrease pain following elbow surgery. This investigation aimed to assess the rate of early failure of infraclavicular (IC) and axillary (AX) nerve catheters following elbow surgery. Retrospective study. Postoperative recovery unit and inpatient hospital floor. 328 patients who received IC or AX nerve catheters and underwent elbow surgery were identified by retrospective query of our institution's database. Data collected included unplanned catheter dislodgement, catheter replacement rate, postoperative pain scores, and opioid administration on postoperative day 1. Catheter failure was defined as unplanned dislodging within 24 h of placement or requirement for catheter replacement and evaluated using a covariate adjusted model. 119 IC catheters and 209 AX catheters were evaluated. There were 8 (6.7%) failed IC catheters versus 13 (6.2%) failed AX catheters. After adjusting for age, BMI, and gender there was no difference in catheter failure rate between IC and AX nerve catheters (p = 0.449). These results suggest that IC and AX nerve catheters do not differ in the rate of early catheter failure, despite differences in anatomic location and catheter placement techniques. Both techniques provided effective postoperative analgesia with median pain scores < 3/10 for patients following elbow surgery. Reasons other than rate of early catheter failure should dictate which approach is performed. Copyright © 2018. Published by Elsevier Inc.

Eye bank tissue utilization between endothelial keratoplasty and penetrating keratoplasty.

PubMed

Croasdale, Christopher R; Barney, Erin; Warner, Evan J

2013-03-01

To determine rates of tissue use for corneal transplants via endothelial keratoplasty (EK) relative to penetrating keratoplasty (PK). Retrospective chart review of all cornea tissues (n = 3669) distributed from the Lions Eye Bank of Wisconsin for EK or PK from August 1, 2004 through July 31, 2009 (60 months). Rates of tissue use for EK relative to PK were determined both on a yearly basis and for the overall study period. Replacement frequency and time to subsequent surgery were established for each group. Donor tissue and recipient characteristics were compared between groups. Donor characteristics did not differ between the 2 groups; 11.9% of EK tissues failed and were replaced during the study period compared with 5.1% of PK tissues (P < 0.0001). Additional tissue for the same eye came at a mean of 174 days after an EK surgery compared with 558 days after a PK (P < 0.0001). Surgeons requesting tissue for EK increased each year, whereas the number of repeat tissue requests decreased over time. Additional tissues were required for recipients of EK more than twice as often as for recipients of PK, and replacement of EK grafts occurred at a mean of more than 1 year before replacement of PK grafts. This pattern of tissue utilization during the first 5 years of distribution for EK did not negatively affect the Lions Eye Bank of Wisconsin from meeting the surgeon demand for tissue in its service area. Eye banks may wish to monitor tissue utilization as part of their quality assurance program.

[Reconstruction and balance of soft tissue in hemi-shoulder replacement for patients with four-part fracture of the proximal humerus].

PubMed

Wu, Xing; Lou, Lie-ming; Chen, Zheng-rong; Zhang, Guang-jian

2008-10-01

To explore the effective skills of reconstruction and balance of soft tissue in hemi-shoulder replacement for patients with four-part fracture of the proximal humerus in order to avoid postoperative complications of joint instability and great tubercle displacement. From June 2002 to June 2006, 25 patients with Neer four-part fracture of the proximal humerus were adopted in the study which included 15 females and 10 males, with the mean age of 66 years (ranged from 56 years to 80 years). They were treated with humeral head replacement and should joint reparation simultaneously by modified operation approach and reconstruction and balance skills of soft tissue. The mean duration of follow-up was 2.3 years (ranged from 1 to 4.5 years). No infection, nerve damage and prosthesis loosing were found in all cases. Two cases of infra-forward dislocation or subluxation occurred due to affected limb placed on abduction splint postoperatively. One case occurred prosthesis upward displacement due to early active abduction exercise but no complains. Neither joint instability nor displacement and malunion of great tubercle were found in other patients. According to Neer scoring system, 6 cases were rated as excellent, 15 as good and 5 as fair. The good and excellent rate was 84%. In hemi-shoulder replacement for patients with Neer four-part fracture the modified operation approach and reconstruction and balance of soft tissue skills combined with rational rehabilitation exercise can prevent postoperative shoulder joint instability and displacement and malunion of great tubercle.

Developing Ultra Reliable Life Support for the Moon and Mars

NASA Technical Reports Server (NTRS)

Jones, Harry W.

2009-01-01

Recycling life support systems can achieve ultra reliability by using spares to replace failed components. The added mass for spares is approximately equal to the original system mass, provided the original system reliability is not very low. Acceptable reliability can be achieved for the space shuttle and space station by preventive maintenance and by replacing failed units, However, this maintenance and repair depends on a logistics supply chain that provides the needed spares. The Mars mission must take all the needed spares at launch. The Mars mission also must achieve ultra reliability, a very low failure rate per hour, since it requires years rather than weeks and cannot be cut short if a failure occurs. Also, the Mars mission has a much higher mass launch cost per kilogram than shuttle or station. Achieving ultra reliable space life support with acceptable mass will require a well-planned and extensive development effort. Analysis must define the reliability requirement and allocate it to subsystems and components. Technologies, components, and materials must be designed and selected for high reliability. Extensive testing is needed to ascertain very low failure rates. Systems design should segregate the failure causes in the smallest, most easily replaceable parts. The systems must be designed, produced, integrated, and tested without impairing system reliability. Maintenance and failed unit replacement should not introduce any additional probability of failure. The overall system must be tested sufficiently to identify any design errors. A program to develop ultra reliable space life support systems with acceptable mass must start soon if it is to produce timely results for the moon and Mars.

Genetic and economic analyses of female replacement rates in the dam-daughter pathway of a hierarchical swine breeding structure.

PubMed

Faust, M A; Robison, O W; Tess, M W

1992-07-01

A stochastic life-cycle swine production model was used to study the effect of female replacement rates in the dam-daughter pathway for a tiered breeding structure on genetic change and returns to the breeder. Genetic, environmental, and economic parameters were used to simulate characteristics of individual pigs in a system producing F1 female replacements. Evaluated were maximum culling ages for nucleus and multiplier tier sows. System combinations included one- and five-parity alternatives for both levels and 10-parity options for the multiplier tier. Yearly changes and average phenotypic levels were computed for performance and economic measures. Generally, at the nucleus level, responses to 10 yr of selection for sow and pig performance in five-parity herds were 70 to 85% of response in one-parity herds. Similarly, the highest selection responses in multiplier herds were from systems with one-parity nucleus tiers. Responses in these were typically greater than 115% of the response for systems with the smallest yearly change, namely, the five-parity nucleus and five- and 10-parity multiplier levels. In contrast, the most profitable multiplier tiers (10-parity) had the lowest replacement costs. Within a multiplier culling strategy, rapid genetic change was desirable. Differences between systems that culled after five or 10 parities were smaller than differences between five- and one-parity multiplier options. To recover production costs, systems with the lowest returns required 140% of market hog value for gilts available to commercial tiers, whereas more economically efficient systems required no premium.

Desulfurization of phosphorothioate oligonucleotides via the sulfur-by-oxygen replacement induced by the hydroxyl radical during negative electrospray ionization mass spectrometry.

PubMed

Wu, Lianming; White, David E; Ye, Connie; Vogt, Frederick G; Terfloth, Gerald J; Matsuhashi, Hayao

2012-07-01

While the occurrence of desulfurization of phosphorothioate oligonucleotides in solution is well established, this study represents the first attempt to investigate the basis of the unexpected desulfurization via the net sulfur-by-oxygen (S-O) replacement during negative electrospray ionization (ESI). The current work, facilitated by quantitative mass deconvolution, demonstrates that considerable desulfurization can take place even under common negative ESI operating conditions. The extent of desulfurization is dependent on the molar phosphorothioate oligonucleotide-to-hydroxyl radical ratio, which is consistent with the corona discharge-induced origin of the hydroxyl radical leading to the S-O replacement. This hypothesis is supported by the fact that an increase of the high-performance liquid chromatography (HPLC) flow rate and the on-column concentration of a phosphorothioate oligonucleotide, as well as a decrease of the electrospray voltage reduce the degree of desulfurization. Comparative LC-tandem mass spectrometry (MS/MS) sequencing of a phosphorothioate oligonucleotide and its corresponding desulfurization product revealed evidence that the S-O replacement occurs at multiple phosphorothioate internucleotide linkage sites. In practice, the most convenient and effective strategy for minimizing this P = O artifact is to increase the LC flow rate and the on-column concentration of phosphorothioate oligonucleotides. Another approach to mitigate possible detrimental effects of the undesired desulfurization is to operate the ESI source at a very low electrospray voltage to diminish the corona discharge; however this will significantly compromise sensitivity when analyzing the low-level P = O impurities in phosphorothioate oligonucleotides. Copyright © 2012 John Wiley & Sons, Ltd.

Longevity of implantable cardioverter-defibrillators for cardiac resynchronization therapy in current clinical practice: an analysis according to influencing factors, device generation, and manufacturer.

PubMed

Landolina, Maurizio; Curnis, Antonio; Morani, Giovanni; Vado, Antonello; Ammendola, Ernesto; D'onofrio, Antonio; Stabile, Giuseppe; Crosato, Martino; Petracci, Barbara; Ceriotti, Carlo; Bontempi, Luca; Morosato, Martina; Ballari, Gian Paolo; Gasparini, Maurizio

2015-08-01

Device replacement at the time of battery depletion of implantable cardioverter-defibrillators (ICDs) may carry a considerable risk of complications and engenders costs for healthcare systems. Therefore, ICD device longevity is extremely important both from a clinical and economic standpoint. Cardiac resynchronization therapy defibrillators (CRT-D) battery longevity is shorter than ICDs. We determined the rate of replacements for battery depletion and we identified possible determinants of early depletion in a series of patients who had undergone implantation of CRT-D devices. We retrieved data on 1726 consecutive CRT-D systems implanted from January 2008 to March 2010 in nine centres. Five years after a successful CRT-D implantation procedure, 46% of devices were replaced due to battery depletion. The time to device replacement for battery depletion differed considerably among currently available CRT-D systems from different manufacturers, with rates of batteries still in service at 5 years ranging from 52 to 88% (log-rank test, P < 0.001). Left ventricular lead output and unipolar pacing configuration were independent determinants of early depletion [hazard ratio (HR): 1.96; 95% 95% confidence interval (CI): 1.57-2.46; P < 0.001 and HR: 1.58, 95% CI: 1.25-2.01; P < 0.001, respectively]. The implantation of a recent-generation device (HR: 0.57; 95% CI: 0.45-0.72; P < 0.001), the battery chemistry and the CRT-D manufacturer (HR: 0.64; 95% CI: 0.47-0.89; P = 0.008) were additional factors associated with replacement for battery depletion. The device longevity at 5 years was 54%. High left ventricular lead output and unipolar pacing configuration were associated with early battery depletion, while recent-generation CRT-Ds displayed better longevity. Significant differences emerged among currently available CRT-D systems from different manufacturers. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

Short communication: Prediction of retention pay-off using a machine learning algorithm.

PubMed

Shahinfar, Saleh; Kalantari, Afshin S; Cabrera, Victor; Weigel, Kent

2014-05-01

Replacement decisions have a major effect on dairy farm profitability. Dynamic programming (DP) has been widely studied to find the optimal replacement policies in dairy cattle. However, DP models are computationally intensive and might not be practical for daily decision making. Hence, the ability of applying machine learning on a prerun DP model to provide fast and accurate predictions of nonlinear and intercorrelated variables makes it an ideal methodology. Milk class (1 to 5), lactation number (1 to 9), month in milk (1 to 20), and month of pregnancy (0 to 9) were used to describe all cows in a herd in a DP model. Twenty-seven scenarios based on all combinations of 3 levels (base, 20% above, and 20% below) of milk production, milk price, and replacement cost were solved with the DP model, resulting in a data set of 122,716 records, each with a calculated retention pay-off (RPO). Then, a machine learning model tree algorithm was used to mimic the evaluated RPO with DP. The correlation coefficient factor was used to observe the concordance of RPO evaluated by DP and RPO predicted by the model tree. The obtained correlation coefficient was 0.991, with a corresponding value of 0.11 for relative absolute error. At least 100 instances were required per model constraint, resulting in 204 total equations (models). When these models were used for binary classification of positive and negative RPO, error rates were 1% false negatives and 9% false positives. Applying this trained model from simulated data for prediction of RPO for 102 actual replacement records from the University of Wisconsin-Madison dairy herd resulted in a 0.994 correlation with 0.10 relative absolute error rate. Overall results showed that model tree has a potential to be used in conjunction with DP to assist farmers in their replacement decisions. Copyright © 2014 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Centers for Disease Control and Prevention guidelines for preventing central venous catheter-related infection: results of a knowledge test among 3405 European intensive care nurses.

PubMed

Labeau, Sonia O; Vandijck, Dominique M; Rello, Jordi; Adam, Sheila; Rosa, Ana; Wenisch, Christoph; Bäckman, Carl; Agbaht, Kemal; Csomos, Akos; Seha, Myriam; Dimopoulos, George; Vandewoude, Koenraad H; Blot, Stijn I

2009-01-01

To determine European intensive care unit (ICU) nurses' knowledge of guidelines for preventing central venous catheter-related infection from the Centers for Disease Control and Prevention. Multicountry survey (October 2006-March 2007). Twenty-two European countries. ICU nurses. Using a validated multiple-choice test, knowledge of ten recommendations for central venous catheter-related infection prevention was evaluated (one point per question) and assessed in relation to participants' gender, ICU experience, number of ICU beds, and acquisition of a specialized ICU qualification. We collected 3405 questionnaires (70.9% response rate); mean test score was 44.4%. Fifty-six percent knew that central venous catheters should be replaced on indication only, and 74% knew this also concerns replacement over a guidewire. Replacing pressure transducers and tubing every 4 days, and using coated devices in patients requiring a central venous catheter >5 days in settings with high infection rates only were recognized as recommended by 53% and 31%, respectively. Central venous catheters dressings in general are known to be changed on indication and at least once weekly by 43%, and 26% recognized that both polyurethane and gauze dressings are recommended. Only 14% checked 2% aqueous chlorhexidine as the recommended disinfection solution; 30% knew antibiotic ointments are not recommended because they trigger resistance. Replacing administration sets within 24 hrs after administering lipid emulsions was recognized as recommended by 90%, but only 26% knew sets should be replaced every 96 hrs when administering neither lipid emulsions nor blood products. Professional seniority and number of ICU beds showed to be independently associated with better test scores. Opportunities exist to optimize knowledge of central venous catheter-related infection prevention among European ICU nurses. We recommend including central venous catheter-related infection prevention guidelines in educational curricula and continuing refresher education programs.

Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients.

PubMed

Reardon, Michael J; Van Mieghem, Nicolas M; Popma, Jeffrey J; Kleiman, Neal S; Søndergaard, Lars; Mumtaz, Mubashir; Adams, David H; Deeb, G Michael; Maini, Brijeshwar; Gada, Hemal; Chetcuti, Stanley; Gleason, Thomas; Heiser, John; Lange, Rüdiger; Merhi, William; Oh, Jae K; Olsen, Peter S; Piazza, Nicolo; Williams, Mathew; Windecker, Stephan; Yakubov, Steven J; Grube, Eberhard; Makkar, Raj; Lee, Joon S; Conte, John; Vang, Eric; Nguyen, Hang; Chang, Yanping; Mugglin, Andrew S; Serruys, Patrick W J C; Kappetein, Arie P

2017-04-06

Although transcatheter aortic-valve replacement (TAVR) is an accepted alternative to surgery in patients with severe aortic stenosis who are at high surgical risk, less is known about comparative outcomes among patients with aortic stenosis who are at intermediate surgical risk. We evaluated the clinical outcomes in intermediate-risk patients with severe, symptomatic aortic stenosis in a randomized trial comparing TAVR (performed with the use of a self-expanding prosthesis) with surgical aortic-valve replacement. The primary end point was a composite of death from any cause or disabling stroke at 24 months in patients undergoing attempted aortic-valve replacement. We used Bayesian analytical methods (with a margin of 0.07) to evaluate the noninferiority of TAVR as compared with surgical valve replacement. A total of 1746 patients underwent randomization at 87 centers. Of these patients, 1660 underwent an attempted TAVR or surgical procedure. The mean (±SD) age of the patients was 79.8±6.2 years, and all were at intermediate risk for surgery (Society of Thoracic Surgeons Predicted Risk of Mortality, 4.5±1.6%). At 24 months, the estimated incidence of the primary end point was 12.6% in the TAVR group and 14.0% in the surgery group (95% credible interval [Bayesian analysis] for difference, -5.2 to 2.3%; posterior probability of noninferiority, >0.999). Surgery was associated with higher rates of acute kidney injury, atrial fibrillation, and transfusion requirements, whereas TAVR had higher rates of residual aortic regurgitation and need for pacemaker implantation. TAVR resulted in lower mean gradients and larger aortic-valve areas than surgery. Structural valve deterioration at 24 months did not occur in either group. TAVR was a noninferior alternative to surgery in patients with severe aortic stenosis at intermediate surgical risk, with a different pattern of adverse events associated with each procedure. (Funded by Medtronic; SURTAVI ClinicalTrials.gov number, NCT01586910 .).

Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association.

PubMed

Sacks, Frank M; Lichtenstein, Alice H; Wu, Jason H Y; Appel, Lawrence J; Creager, Mark A; Kris-Etherton, Penny M; Miller, Michael; Rimm, Eric B; Rudel, Lawrence L; Robinson, Jennifer G; Stone, Neil J; Van Horn, Linda V

2017-07-18

Cardiovascular disease (CVD) is the leading global cause of death, accounting for 17.3 million deaths per year. Preventive treatment that reduces CVD by even a small percentage can substantially reduce, nationally and globally, the number of people who develop CVD and the costs of caring for them. This American Heart Association presidential advisory on dietary fats and CVD reviews and discusses the scientific evidence, including the most recent studies, on the effects of dietary saturated fat intake and its replacement by other types of fats and carbohydrates on CVD. In summary, randomized controlled trials that lowered intake of dietary saturated fat and replaced it with polyunsaturated vegetable oil reduced CVD by ≈30%, similar to the reduction achieved by statin treatment. Prospective observational studies in many populations showed that lower intake of saturated fat coupled with higher intake of polyunsaturated and monounsaturated fat is associated with lower rates of CVD and of other major causes of death and all-cause mortality. In contrast, replacement of saturated fat with mostly refined carbohydrates and sugars is not associated with lower rates of CVD and did not reduce CVD in clinical trials. Replacement of saturated with unsaturated fats lowers low-density lipoprotein cholesterol, a cause of atherosclerosis, linking biological evidence with incidence of CVD in populations and in clinical trials. Taking into consideration the totality of the scientific evidence, satisfying rigorous criteria for causality, we conclude strongly that lowering intake of saturated fat and replacing it with unsaturated fats, especially polyunsaturated fats, will lower the incidence of CVD. This recommended shift from saturated to unsaturated fats should occur simultaneously in an overall healthful dietary pattern such as DASH (Dietary Approaches to Stop Hypertension) or the Mediterranean diet as emphasized by the 2013 American Heart Association/American College of Cardiology lifestyle guidelines and the 2015 to 2020 Dietary Guidelines for Americans. © 2017 American Heart Association, Inc.

Preoperative Aspirin Use and Lung Injury After Aortic Valve Replacement Surgery: A Retrospective Cohort Study.

PubMed

Mazzeffi, Michael; Kassa, Woderyelesh; Gammie, James; Tanaka, Kenichi; Roman, Philip; Zhan, Min; Griffith, Bartley; Rock, Peter

2015-08-01

Acute respiratory distress syndrome (ARDS) occurs uncommonly after cardiac surgery but has a mortality rate as high as 80%. Aspirin may prevent lung injury in at-risk patients by reducing platelet-neutrophil aggregates in the lung. We hypothesized that preoperative aspirin use would be associated with a decreased risk of ARDS after aortic valve replacement surgery. We performed a retrospective single-center cohort study that included all adult patients who had aortic valve replacement surgery during a 5-year period. The primary outcome variable was postoperative ARDS. The secondary outcome variable was nadir PaO2/FIO2 ratio during the first 72 hours after surgery. Both crude and propensity score-adjusted logistic regression analyses were performed to estimate the odds ratio for developing ARDS in aspirin users. Subgroups were analyzed to determine whether preoperative aspirin use might be associated with improved oxygenation in patients with specific risk factors for lung injury. Of the 375 patients who had aortic valve replacement surgery during the study period, 181 patients took aspirin preoperatively (48.3%) with most taking a dose of 81 mg (72.0%). There were 22 cases of ARDS in the cohort (5.5%). There was no significant difference in the rate of ARDS between aspirin users and nonusers (5.0% vs 6.7%, P = 0.52). There was also no significant difference in the nadir PaO2/FIO2 ratio between aspirin users and nonusers (P = 0.12). The crude odds ratio for ARDS in aspirin users was 0.725 (99% confidence interval, 0.229-2.289; P = 0.47), and the propensity score-adjusted odds ratio was 0.457 (99% confidence interval, 0.120-1.730; P = 0.13). Within the constraints of this analysis that included only 22 affected patients, preoperative aspirin use was not associated with a decreased incidence of ARDS after aortic valve replacement surgery or improved oxygenation.

Chia (Salvia hispanica L) gel can be used as egg or oil replacer in cake formulations.

PubMed

Borneo, Rafael; Aguirre, Alicia; León, Alberto E

2010-06-01

This study determined the overall acceptability, sensory characteristics, functional properties, and nutrient content of cakes made using chia (Salvia hispanica L) gel as a replacement for oil or eggs. Chia gel was used to replace 25%, 50%, and 75% of oil or eggs in a control cake formulation. Seventy-five untrained panelists participated in rating cakes on a seven-point hedonic scale. Analysis of variance conducted on the sensory characteristics and overall acceptability indicated a statistically significant effect when replacing oil or eggs for color, taste, texture, and overall acceptability (P<0.05). Post hoc analysis (using Fisher's least significant difference method) indicated that the 25% chia gel cakes were not significantly different from the control for color, taste, texture, and overall acceptability. The 50% oil substituted (with chia gel) cake, compared to control, had 36 fewer kilocalories and 4 g less fat per 100-g portion. Cake weight was not affected by chia gel in the formulation, although cake volume was lower as the percentage of substitution increased. Symmetry was generally not affected. This study demonstrates that chia gel can replace as much as 25% of oil or eggs in cakes while yielding a more nutritious product with acceptable sensory characteristics. 2010 American Dietetic Association. Published by Elsevier Inc. All rights reserved.

Combined Effects of Non-Conforming Fly Ash and Recycled Masonry Aggregates on Mortar Properties

PubMed Central

Torres-Gómez, Ana Isabel; Ledesma, Enrique F.; Otero, Rocio; Fernández, José Maria; Jiménez, José Ramón; de Brito, Jorge

2016-01-01

This work evaluates the effects of using non-conforming fly ash (Nc-FA) generated in a thermoelectric power plant as filler material for mortars made with natural sand (NA) and recycled sand from masonry waste (FRMA). The incorporation of powdered recycled masonry filler (R-MF) is also tested as an alternative to siliceous filler (Si-F). Three families of mortars were designed to study: the effect of replacing Si-F with Nc-FA on mortars made with NA; the effect of replacing Si-F with Nc-FA on mortars made with 50% of NA and 50% of FRMA; and the effect of replacing Si-F with R-MF on mortars made with NA and FRMA. Replacing Si-F with Nc-FA is a viable alternative that increases the mechanical strength, the workability and durability properties and decreases the shrinkage. The use of FRMA and Nc-FA improved the mechanical strength of mortars, and it slightly increased the shrinkage. The replacement of Si-F with R-MF on mortars made with FRMA is not a good alternative, because it has a negative impact on all of the properties tested. This work can help both to reduce cement and natural resources’ consumption and to increase the recycling rate of Nc-FA and FRMA. PMID:28773849

Combined Effects of Non-Conforming Fly Ash and Recycled Masonry Aggregates on Mortar Properties.

PubMed

Torres-Gómez, Ana Isabel; Ledesma, Enrique F; Otero, Rocio; Fernández, José Maria; Jiménez, José Ramón; de Brito, Jorge

2016-08-25

This work evaluates the effects of using non-conforming fly ash (Nc-FA) generated in a thermoelectric power plant as filler material for mortars made with natural sand (NA) and recycled sand from masonry waste (FRMA). The incorporation of powdered recycled masonry filler (R-MF) is also tested as an alternative to siliceous filler (Si-F). Three families of mortars were designed to study: the effect of replacing Si-F with Nc-FA on mortars made with NA; the effect of replacing Si-F with Nc-FA on mortars made with 50% of NA and 50% of FRMA; and the effect of replacing Si-F with R-MF on mortars made with NA and FRMA. Replacing Si-F with Nc-FA is a viable alternative that increases the mechanical strength, the workability and durability properties and decreases the shrinkage. The use of FRMA and Nc-FA improved the mechanical strength of mortars, and it slightly increased the shrinkage. The replacement of Si-F with R-MF on mortars made with FRMA is not a good alternative, because it has a negative impact on all of the properties tested. This work can help both to reduce cement and natural resources' consumption and to increase the recycling rate of Nc-FA and FRMA.

Clinical outcome of using gastric remnant or jejunum or colon conduit in surgery for esophageal carcinoma with previous gastrectomy.

PubMed

Jun, Wang; Wei, Wen; Weibing, Wu; Jing, Xu; Fuxi, Zhen; Xiaoxiang, Xi; Bihong, Lu; Tong, Zhou; Liang, Chen; Jinhua, Luo

2017-05-01

For esophageal carcinoma patients with early gastrectomy, individualized surgical plans-including selection of replacement conduit and operation route based on patient's new lesion and surgical history-can achieve the desired therapeutic effect and improve postoperative life quality. We investigated the outcomes at our institution. The clinical data of 42 esophageal carcinoma patients with early gastrectomy were analyzed retrospectively. Esophagectomy was performed combining replacement with remnant stomach in 16 patients, jejunum in 17, and colon in 9. Esophagectomy combining replacement with gastric remnant got advantages of shorter operation time and less bleeding over that of replacement with jejunum or colon. Gastric remnant group scored higher on the QLQ-C30 questionnaire than jejunum or colon group with respect to overall quality of life, physical function, and social relationships. In QLQ-OES18 questionnaire, the scores of appetite recovery and reflux mitigation were more favorable in remnant stomach group than those in jejunum or colon group. Survival analysis showed no significant difference in survival rate among the patients undergoing replacement with gastric remnant, jejunum, or colon. For esophageal carcinoma patients with early gastrectomy, esophagus-gastric remnant anastomosis possesses advantages of shorter operation time, less surgical trauma, and greater life quality after surgery. © 2017 Wiley Periodicals, Inc.

Usage of Bone Replacement Grafts in Periodontics and Oral Implantology and Their Current Levels of Clinical Evidence - A Systematic Assessment.

PubMed

Salem, Daliah; Natto, Zuhair; Elangovan, Satheesh; Karimbux, Nadeem

2016-08-01

The aim of this review is to evaluate the levels of clinical evidence for bone replacement grafts available in the United States for periodontics and oral implantology purposes. A search was performed using PubMed, the Cochrane Library, and Google Scholar for articles relating to the use of bone replacement grafts in implant and/or periodontics by two independent reviewers. Articles unrelated to the topic, not involving patients, not including abstracts, or in languages other than English were excluded. Selected articles were graded according to "levels of evidence" based on guidelines originally introduced by Wright et al. (2003). There was limited published peer-reviewed clinical literature available regarding US commercially available bone replacement grafts in periodontics and oral implantology. Of 144 bone replacement grafts available in the United States according to Avila-Ortiz et al. (2013), only 52 met the inclusion criteria. The majority of materials used were allografts (26 of 93 available in the United States), followed by alloplasts (15 of 30) and xenografts (11 of 21). Dental providers should be aware of the limited evidence that qualified for a strong rating supporting the clinical efficacy of these materials for periodontics and oral implantology purposes using the inclusion criteria selected in this study.

Polyethylene wear in Oxford unicompartmental knee replacement: a retrieval study of 47 bearings.

PubMed

Kendrick, B J L; Longino, D; Pandit, H; Svard, U; Gill, H S; Dodd, C A F; Murray, D W; Price, A J

2010-03-01

The Oxford Unicompartmental Knee replacement (UKR) was introduced as a design to reduce polyethylene wear. There has been one previous retrieval study involving this implant, which reported very low rates of wear in some specimens but abnormal patterns of wear in others. There has been no further investigation of these abnormal patterns. The bearings were retrieved from 47 patients who had received a medial Oxford UKR for anteromedial osteoarthritis of the knee. None had been studied previously. The mean time to revision was 8.4 years (sd 4.1), with 20 having been implanted for over ten years. The macroscopic pattern of polyethylene wear and the linear penetration were recorded for each bearing. The mean rate of linear penetration was 0.07 mm/year. The patterns of wear fell into three categories, each with a different rate of linear penetration; 1) no abnormal macroscopic wear and a normal articular surface, n = 16 (linear penetration rate = 0.01 mm/year); 2) abnormal macroscopic wear and normal articular surfaces with extra-articular impingement, n = 16 (linear penetration rate = 0.05 mm/year); 3) abnormal macroscopic wear and abnormal articular surfaces with intra-articular impingement +/- signs of non-congruous articulation, n = 15 (linear penetration rate = 0.12 mm/year). The differences in linear penetration rate were statistically significant (p < 0.001). These results show that very low rates of polyethylene wear are possible if the device functions normally. However, if the bearing displays suboptimal function (extra-articular, intra-articular impingement or incongruous articulation) the rates of wear increase significantly.

Kinetic studies of halon replacements.

NASA Astrophysics Data System (ADS)

Orkin, Vladimir L.

2013-04-01

Despite their excellence as fire suppressants, the production of halons (bromofluorocarbons) is being phased out because of the danger they pose to the Earth's stratospheric ozone layer. A number of bromine free substances have been proposed and tested, but the effort to find replacements continues to return to bromine-containing compounds because of the properties of bromine as a chemically active flame suppressant. The primary approach to this problem has been to test candidate replacement compounds that have short atmospheric lifetimes or/and lack bromine, the halogen atoms that catalyze ozone destruction. Various chemical classes (alkanes, ethers, alkenes) have been studied both earlier and recently. The reaction with atmospheric hydroxyl radicals dictates the residence time and accumulation in the atmosphere of all potential halon replacements. Therefore, we improved a flash photolysis - resonance fluorescence apparatus to provide the most accurate OH reaction rate constants measured over the atmospheric temperatures. Supplementary UV absorption spectra were measured to allow the estimation of ODPs. Although a thorough 3-D modeling is required to assess ODPs, the simplified estimations can be made based on the compounds lifetimes.

Fisics-Incor bovine pericardial bioprostheses: 15 year results.

PubMed

Pomerantzeff, P M; Brandao, C M; Cauduro, P; Puig, L B; Grinberg, M; Tarasoutchi, F; Cardoso, L F; Lerner, A; Stolf, N A; Verginelli, G; Jatene, A D

1998-01-01

From March 1982 to December 1995, 2,607 Fisics-Incor bovine pericardial bioprostheses were implanted in 2,259 patients. Mean age was 47.2 +/- 17.5 years, and 55% were male. Rheumatic fever was present in 1,301 (45.7%) patients. One thousand and seventy-three aortic valve replacements, 1,085 mitral replacements, 27 tricuspid replacements, 195 mitral-aortic replacements, and 16 other combined valve replacements were carried out. Combined procedures were performed in 788 (32.9%) patients, the most frequent being tricuspid valve repair (9.2%) and coronary artery bypass grafting (7.7%). Hospital mortality was 8.6% (194 patients), 8.6% for the mitral group, 4.7% for the aortic group, and 12.8% for double-valve replacements. The linear rates for calcification, thromboembolism, rupture, leak and endocarditis were, respectively, 1.1%, 0.2%, 0.9%, 0.1% and 0.5% patient-year. The actuarial survival curve was 56.7 +/- 5.4% in 15 years. Survival free from endocarditis was 91.92%, survival free from thromboembolism was 95 +/- 1.7%, survival free from rupture was 43.7 +/- 9.8%, survival free from leak was 98.9 +/- 4.5%, and survival free from calcification was 48.8 +/- 7.9% in 15 years. In the late postoperative period, 1,614 (80.6%) patients were in New York Heart Association functional Class I. We conclude that the results with the Fisics-Incor bovine pericardial prostheses were satisfactory in our group of patients.

Bacterial colonization of penile prosthesis after its withdrawal due to mechanical failure.

PubMed

Etcheverry-Giadrosich, B; Torremadé-Barreda, J; Pujol-Galarza, L; Vigués-Julià, F

2017-12-01

Prosthetic surgery to treat erectile dysfunction has a risk of infection of up to 3%, but this risk can increase to 18% when the surgery involves replacement. This increased risk of infection is attributed to the bacterial colonization of the prosthesis during the initial surgery. To analyse the presence of germs in the prosthesis that is withdrawn due to mechanical failure (not infection), as well as the surgical results and its progression. A retrospective study was conducted of all replacements performed between 2013 and 2016 at a single centre. We analysed demographic data, prior type of prosthesis, surgical procedure, microbiological study and follow-up. Of the 12 replacement procedures, a microbiological study of the extracted prosthesis was performed in a total of 10 cases. Of the 10 replacements, the cultures were positive in 5 cases (50%). Staphylococcus epidermidis was the most prevalent germ. All patients underwent a flushing procedure, and an antibiotic-coated prosthesis was implanted. We recorded no infections with the new implanted device after a mean follow-up of 27.33 months (SD 4.13; 95% CI 18.22-36.43). In our study population, we observed a high rate of bacterial colonization of the prostheses that were replaced due to mechanical failure. When a flushing procedure was performed during the replacement surgery, there were no more infections than those reported in treatment-naive cases. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Molecular clock or erratic evolution? A tale of two genes.

PubMed Central

Ayala, F J; Barrio, E; Kwiatowski, J

1996-01-01

We have investigated the evolution of glycerol-3-phosphate dehydrogenase (Gpdh). The rate of amino acid replacements is 1 x 10(-10)/site/year when Drosophila species are compared. The rate is 2.7 times greater when Drosophila and Chymomyza species are compared; and about 5 times greater when any of those species are compared with the medfly Ceratitis capitata. This rate of 5 x 10(-10)/site/year is also the rate observed in comparisons between mammals, or between different animal phyla, or between the three multicellular kingdoms. We have also studied the evolution of Cu,Zn superoxide dismutase (Sod). The rate of amino acid replacements is about 17 x 10(-10)/site/year when comparisons are made between dipterans or between mammals, but only 5 x 10(-10) when animal phyla are compared, and only 3 x 10(-10) when the multicellular kingdoms are compared. The apparent decrease by about a factor of 5 in the rate of SOD evolution as the divergence between species increases can be consistent with the molecular clock hypothesis by assuming the covarion hypothesis (namely, that the number of amino acids that can change is constant, but the set of such amino acids changes from time to time and from lineage to lineage). However, we know of no model consistent with the molecular clock hypothesis that would account for the increase in the rate of GPDH evolution as the divergence between species increases. Images Fig. 2 Fig. 5 PMID:8876205

Rock mass classification system : transition from RMR to GSI.

DOT National Transportation Integrated Search

2013-11-01

The AASHTO LRFD Bridge Design Specifications is expected to replace the rock mass rating : (RMR) system with the Geological Strength Index (GSI) system for classifying and estimating : engineering properties of rock masses. This transition is motivat...

7 CFR 784.6 - Rate of payment and limitations on funding.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., DEPARTMENT OF AGRICULTURE SPECIAL PROGRAMS 2004 EWE LAMB REPLACEMENT AND RETENTION PAYMENT PROGRAM § 784.6... proration provisions of § 784.7, payments for qualifying operations shall be $18 for each qualifying ewe...

Salvage Procedures for Management of Prosthetic Joint Infection After Hip and Knee Replacements

PubMed Central

Mahmoud, Samer S.S.; Sukeik, Mohamed; Alazzawi, Sulaiman; Shaath, Mohammed; Sabri, Omar

2016-01-01

Background: The increasing load placed by joint replacement surgery on health care systems makes infection, even with the lowest rates, a serious concern that needs to be thoroughly studied and addressed using all possible measures. Methods: A comprehensive review of the current literature on salvage procedures for recurrent PJIs using PubMed, EMBASE and CINAHL has been conducted. Results: Prolonged suppressive antibiotic therapy (PSAT), resection arthroplasty and arthrodesis were the most common procedures performed. Suppressive antibiotic therapy is based on the use of well tolerated long term antibiotics in controlling sensitive organisms. Resection arthroplasty which should be reserved as a last resort provided more predictable outcomes in the hip whereas arthrodesis was associated with better outcomes in the knee. Various methods for arthrodesis including internal and external fixation have been described. Conclusion: Despite good union and infection control rates, all methods were associated with complications occasionally requiring further surgical interventions. PMID:28144373

Implication of femoral stem on performance of articular surface replacement (ASR) XL total hip arthroplasty.

PubMed

Cip, Johannes; von Strempel, Archibald; Bach, Christian; Luegmair, Matthias; Benesch, Thomas; Martin, Arno

2014-11-01

Taper junctions of large diameter metal-on-metal femoral heads and femoral stems were described as metal ion generator due to accelerated wear and corrosion. However, literature about the Articular Surface Replacement (ASR) total hip arthroplasty (THA) invariably deals with stems manufactured by DePuy Orthopedics (Warsaw, IN, USA). Nothing is known whether different stems with common 12/14 mm tapers affect failure rate or ion release. 99 ASR THA (88 patients) implanted with CoxaFit or ARGE Geradschaft stems (K-Implant, Hannover, Germany) were retrospectively analyzed. After a mean follow-up of 3.5 years revision rate was 24.5%, mostly due to adverse reaction to metal debris (ARMD). CT scan revealed component loosening in 10.3% and pseudotumoral lesions in 12.6%. Elevated ion concentrations (>7 μg/l) were found in 38.6%. Copyright © 2014 Elsevier Inc. All rights reserved.

The High-efficiency LED Driver for Visible Light Communication Applications

PubMed Central

Gong, Cihun-Siyong Alex; Lee, Yu-Chen; Lai, Jyun-Liang; Yu, Chueh-Hao; Huang, Li Ren; Yang, Chia-Yen

2016-01-01

This paper presents a LED driver for VLC. The main purpose is to solve the low data rate problem used to be in switching type LED driver. The GaN power device is proposed to replace the traditional silicon power device of switching LED driver for the purpose of increasing switching frequency of converter, thereby increasing the bandwidth of data transmission. To achieve high efficiency, the diode-connected GaN power transistor is utilized to replace the traditional ultrafast recovery diode used to be in switching type LED driver. This work has been experimentally evaluated on 350-mA output current. The results demonstrate that it supports the data of PWM dimming level encoded in the PPM scheme for VLC application. The experimental results also show that system’s efficiency of 80.8% can be achieved at 1-Mb/s data rate. PMID:27498921

Redo surgery after permanent pacemaker implantation: performance indicator of surgical techniques and pacing technology.

PubMed

Bharat, Vijaya

2004-01-01

The incidence of permanent pacemaker-related complications is reducing due to advancement of technology and increasing operator experience. There are only few series from India reporting the annual complication rates from a single center over the years. This is a series of 782 pacemakers implanted over 20 years in a secondary healthcare set-up. Eighty-two patients underwent redo surgery, either for a procedure-related complication (n=34) or for replacement of a malfunctioning/end-of-life pacemaker (n=48). Through critical analysis and corrective measures, all the procedural complications were reduced to less than 4% of the annual implantations. The introduction of a pacemaker follow-up clinic contributed to reducing the rate of elective replacement for battery depletion from 19.17% of the implanted VVI pacemakers to 0.63%. Despite being a low-volume center, with less than 100 pacemakers implanted annually, the performance of our pacing practice has shown continuous improvement.

Effects of Smoking Abstinence, Smoking Cues and Nicotine Replacement in Smokers with Schizophrenia and Controls

PubMed Central

Tidey, Jennifer W.; Rohsenow, Damaris J.; Kaplan, Gary B.; Swift, Robert M.; Adolfo, Amy B.

2010-01-01

The mechanisms underlying the low smoking cessation rates among smokers with schizophrenia (SS) are unknown. In this laboratory study, we compared the responses of 21 SS and 21 non-psychiatric controls (CS) to manipulations of 5-hour smoking abstinence, transdermal nicotine replacement (0, 21 and 42 mg), and in vivo smoking cues. Results indicate that SS were more sensitive than CS to the effects of acute abstinence on CO boost, but not more sensitive to the effects of abstinence on urge levels or withdrawal symptoms. SS and CS did not differ in urge response to in vivo smoking cues, but SS were less consistent in their reactions. These findings suggest that heightened sensitivity to the effects of abstinence on smoke intake may partially account for the low cessation rates experienced by SS, but other potential mechanisms should be explored using behavioral laboratory models. PMID:18584468

Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative.

PubMed

Ferket, Bart S; Feldman, Zachary; Zhou, Jing; Oei, Edwin H; Bierma-Zeinstra, Sita M A; Mazumdar, Madhu

2017-03-28

Objectives  To evaluate the impact of total knee replacement on quality of life in people with knee osteoarthritis and to estimate associated differences in lifetime costs and quality adjusted life years (QALYs) according to use by level of symptoms. Design  Marginal structural modeling and cost effectiveness analysis based on lifetime predictions for total knee replacement and death from population based cohort data. Setting  Data from two studies-Osteoarthritis Initiative (OAI) and the Multicenter Osteoarthritis Study (MOST)-within the US health system. Participants  4498 participants with or at high risk for knee osteoarthritis aged 45-79 from the OAI with no previous knee replacement (confirmed by baseline radiography) followed up for nine years. Validation cohort comprised 2907 patients from MOST with two year follow-up. Intervention  Scenarios ranging from current practice, defined as total knee replacement practice as performed in the OAI (with procedural rates estimated by a prediction model), to practice limited to patients with severe symptoms to no surgery. Main outcome measures  Generic (SF-12) and osteoarthritis specific quality of life measured over 96 months, model based QALYs, costs, and incremental cost effectiveness ratios over a lifetime horizon. Results  In the OAI, total knee replacement showed improvements in quality of life with small absolute changes when averaged across levels of confounding variables: 1.70 (95% uncertainty interval 0.26 to 3.57) for SF-12 physical component summary (PCS); -10.69 (-13.39 to -8.01) for Western Ontario and McMaster Universities arthritis index (WOMAC); and 9.16 (6.35 to 12.49) for knee injury and osteoarthritis outcome score (KOOS) quality of life subscale. These improvements became larger with decreasing functional status at baseline. Provision of total knee replacement to patients with SF-12 PCS scores <35 was the optimal scenario given a cost effectiveness threshold of $200 000/QALY, with cost savings of $6974 ($5789 to $8269) and a minimal loss of 0.008 (-0.056 to 0.043) QALYs compared with current practice. These findings were reproduced among patients with knee osteoarthritis from the MOST cohort and were robust against various scenarios including increased rates of total knee replacement and mortality and inclusion of non-healthcare costs but were sensitive to increased deterioration in quality of life without surgery. In a threshold analysis, total knee replacement would become cost effective in patients with SF-12 PCS scores ≤40 if the associated hospital admission costs fell below $14 000 given a cost effectiveness threshold of $200 000/QALY. Conclusion  Current practice of total knee replacement as performed in a recent US cohort of patients with knee osteoarthritis had minimal effects on quality of life and QALYs at the group level. If the procedure were restricted to more severely affected patients, its effectiveness would rise, with practice becoming economically more attractive than its current use. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Potential for Worldwide Displacement of Fossil-Fuel Electricity by Nuclear Energy in Three Decades Based on Extrapolation of Regional Deployment Data

PubMed Central

Qvist, Staffan A.; Brook, Barry W.

2015-01-01

There is an ongoing debate about the deployment rates and composition of alternative energy plans that could feasibly displace fossil fuels globally by mid-century, as required to avoid the more extreme impacts of climate change. Here we demonstrate the potential for a large-scale expansion of global nuclear power to replace fossil-fuel electricity production, based on empirical data from the Swedish and French light water reactor programs of the 1960s to 1990s. Analysis of these historical deployments show that if the world built nuclear power at no more than the per capita rate of these exemplar nations during their national expansion, then coal- and gas-fired electricity could be replaced worldwide in less than a decade. Under more conservative projections that take into account probable constraints and uncertainties such as differing relative economic output across regions, current and past unit construction time and costs, future electricity demand growth forecasts and the retiring of existing aging nuclear plants, our modelling estimates that the global share of fossil-fuel-derived electricity could be replaced within 25–34 years. This would allow the world to meet the most stringent greenhouse-gas mitigation targets. PMID:25970621

Higher failure rate and stem migration of an uncemented femoral component in patients with femoral head osteonecrosis than in patients with osteoarthrosis.

PubMed

Radl, Roman; Hungerford, Marc; Materna, Wilfried; Rehak, Peter; Windhager, Reinhard

2005-02-01

Several authors have found poorer outcome after hip replacement for osteonecrosis than after hip replacement for arthrosis. In a retrospective study we evaluated the performance of an uncemented femoral component in patients with osteonecrosis and arthrosis of the hip. 31 patients operated for osteonecrosis, and 49 patients operated for osteoarthrosis were included. The median follow-up time was 6.1 (2-11) years for the patients with osteonecrosis, and 5.9 (4-8) for the arthrosis patients. Migration analysis performed by the Einzel-Bild-Roentgen Analysis (EBRA) technique revealed a median stem migration of 1.5 (-8.8-0) mm in the patients with osteonecrosis, but only 0.6 (-2.8-0.7) mm in the patients with arthrosis (p < 0.001). Survivorship analysis with stem revision as endpoint for failure was 74% (95% CI: 55-94) in the osteonecrosis, and 98% (95% CI: 94-100) in the arthrosis group (p = 0.01). We suggest that the higher failure rate and stem migration of uncemented total hip replacement in the patients with osteonecrosis is a consequence of the disease. On the basis of these findings, we recommend close monitoring of the patients with osteonecrosis, which should include migration measurements.

Toilet Grab-Bar Preference and Center of Pressure Deviation During Toilet Transfers in Healthy Seniors, Seniors With Hip Replacements, and Seniors Having Suffered a Stroke.

PubMed

Kennedy, Matthew Joel; Arcelus, Amaya; Guitard, Paulette; Goubran, R A; Sveistrup, Heidi

2015-01-01

Multiple toilet grab-bar configurations are required by people with a diverse spectrum of disability. The study purpose was to determine toilet grab-bar preference of healthy seniors, seniors with a hip replacement, and seniors post-stroke, and to determine the effect of each configuration on centre of pressure (COP) displacement during toilet transfers. 14 healthy seniors, 7 ambulatory seniors with a hip replacement, and 8 ambulatory seniors post-stroke participated in the study. Toilet transfers were performed with no bars (NB), commode (C), two vertical bars (2VB), one vertical bar (1VB), a horizontal bar (H), two swing-away bars (S) and a diagonal bar (D). COP was measured using pressure sensitive floor mats. Participants rated the safety, ease of use, helpfulness, comfort and preference for instalment. 2VB was most preferred and had the smallest COP deviation. Least preferred was H and NB. C caused largest COP displacement but had favourable ratings. The preference and safety of the 2VB should be considered in the design of accessible toilets and in accessibility construction guidelines. However these results need to be verified in non-ambulatory populations. C is frequently prescribed, but generates large COP deviation, suggesting it may present an increased risk of falls.

Evaluating the suitability of maggot meal as a partial substitute of soya bean on the productive traits, digestibility indices and organoleptic properties of broiler meat.

PubMed

Khan, S; Khan, R U; Sultan, A; Khan, M; Hayat, S U; Shahid, M S

2016-08-01

This study was conducted to replace soya bean meal with maggot meal at difference percentages. A total of 120 one-day-old broiler chicks were divided into four groups. Four diets were formulated with maggot meal to replace soya bean meal at the rate of 0%, 10%, 20% and 30% designated as A, B, C and D respectively. Feed and water were offered ad libitum during the study which lasted for 28 days. Feed intake decreased significantly in treated groups while body weight, Feed conversion ratio and dressing percentage increased significantly in group D. Apparent metabolizable energy increased significantly in the group fed 30% maggot meal; however, no significant difference was found in dry matter, crude protein, crude fibre, ether extract, ash and nitrogen free extract between the control and treated groups. The result of sensory evaluation revealed that tenderness and juiciness increased significantly in group C and B respectively. The colour and flavour were most accepted in group B and C. The results indicate that replacement of soya bean meal at the rate of 30% in broiler feed produced most favourable results. Journal of Animal Physiology and Animal Nutrition © 2016 Blackwell Verlag GmbH.

Estimation of death rates in US states with small subpopulations.

PubMed

Voulgaraki, Anastasia; Wei, Rong; Kedem, Benjamin

2015-05-20

In US states with small subpopulations, the observed mortality rates are often zero, particularly among young ages. Because in life tables, death rates are reported mostly on a log scale, zero mortality rates are problematic. To overcome the observed zero death rates problem, appropriate probability models are used. Using these models, observed zero mortality rates are replaced by the corresponding expected values. This enables logarithmic transformations and, in some cases, the fitting of the eight-parameter Heligman-Pollard model to produce mortality estimates for ages 0-130 years, a procedure illustrated in terms of mortality data from several states. Copyright © 2014 John Wiley & Sons, Ltd.

Modeling of polymer photodegradation for solar cell modules

NASA Technical Reports Server (NTRS)

Somersall, A. C.; Guillet, J. E.

1982-01-01

It was shown that many of the experimental observations in the photooxidation of hydrocarbon polymers can be accounted for with a computer simulation using an elementary mechanistic model with corresponding rate constants for each reaction. For outdoor applications, however, such as in photovoltaics, the variation of temperature must have important effects on the useful lifetimes of such materials. The data bank necessary to replace the isothermal rate constant values with Arrhenius activation parameters: A (the pre-exponential factor) and E (the activation energy) was searched. The best collection of data assembled to data is summarized. Note, however, that the problem is now considerably enlarged since from a theoretical point of view, with 51 of the input variables replaced with 102 parameters. The sensitivity of the overall scheme is such that even after many computer simulations, a successful photooxidation simulation with the expanded variable set was not completed. Many of the species in the complex process undergo a number of competitive pathways, the relative importance of each being often sensitive to small changes in the calculated rate constant values.

SYBR safeTM efficiently replaces ethidium bromide in Aspergillus fumigatus gene disruption.

PubMed

Canela, H M S; Takami, L A; Ferreira, M E S

2017-02-08

Invasive aspergillosis is a disease responsible for high mortality rates, caused mainly by Aspergillus fumigatus. The available drugs are limited and this disease continues to occur at an unacceptable frequency. Gene disruption is essential in the search for new drug targets. An efficient protocol for A. fumigatus gene disruption was described but it requires ethidium bromide, a genotoxic agent, for DNA staining. Therefore, the present study tested SYBR safe TM , a non-genotoxic DNA stain, in A. fumigatus gene disruption protocol. The chosen gene was cipC, which has already been disrupted successfully in our laboratory. A deletion cassette was constructed in Saccharomyces cerevisiae and used in A. fumigatus transformation. There was no statistical difference between the tested DNA stains. The success rate of S. cerevisiae transformation was 63.3% for ethidium bromide and 70% for SYBR safe TM . For A. fumigatus gene disruption, the success rate for ethidium bromide was 100 and 97% for SYBR safe TM . In conclusion, SYBR safe TM efficiently replaced ethidium bromide, making this dye a safe and efficient alternative for DNA staining in A. fumigatus gene disruption.

Evaluation of anesthetic technique on surgical site infections (SSIs) at a single institution.

PubMed

Curry, Craig S; Smith, Kahsi A; Allyn, John W

2014-12-01

To determine whether the previously published relationship between anesthetic technique and rate of surgical site infections (SSIs) was influenced by institution specific effects. Retrospective Review of Quality Assurance and Hospital Epidemiology databases. Metropolitan medical center. The records of 7,751 patients who underwent knee or hip joint replacement from 2004 to 2010 were analyzed. Data regarding anesthetic technique, age, ASA status, gender, postoperative temperature, duration of anesthesia and type of surgery were from the department of anesthesiology quality assurance database and SSI cases were identified from the department of epidemiology database. The impact of anesthetic technique and other variables was assessed using bivariate and multivariate techniques. There was no association of anesthetic technique on the rate of SSI. Duration of anesthesia and ASA status were associated with effects on the rate of SSI. The impact of anesthetic technique on SSI following hip and knee replacement surgery may be site specific and using locally gathered quality data may assist in assessing specific institutional impact. Copyright © 2014 Elsevier Inc. All rights reserved.

Pharmacokinetics and Pharmacodynamics of Piperacillin-Tazobactam in 42 Patients Treated with Concomitant CRRT

PubMed Central

Bauer, Seth R.; Salem, Charbel; Connor, Michael J.; Groszek, Joseph; Taylor, Maria E.; Wei, Peilin; Tolwani, Ashita J.

2012-01-01

Summary Background and objectives Current recommendations for piperacillin-tazobactam dosing in patients receiving continuous renal replacement therapy originate from studies with relatively few patients and lower continuous renal replacement therapy doses than commonly used today. This study measured the pharmacokinetic and pharmacodynamic characteristics of piperacillin-tazobactam in patients treated with continuous renal replacement therapy using contemporary equipment and prescriptions. Design, setting, participants, & measurements A multicenter prospective observational study in the intensive care units of two academic medical centers was performed, enrolling patients with AKI or ESRD receiving piperacillin-tazobactam while being treated with continuous renal replacement therapy. Pregnant women, children, and patients with end stage liver disease were excluded from enrollment. Plasma and continuous renal replacement therapy effluent samples were analyzed for piperacillin and tazobactam levels using HPLC. Pharmacokinetic and pharmacodynamic parameters were calculated using standard equations. Multivariate analyses were used to examine the association of patient and continuous renal replacement therapy characteristics with piperacillin pharmacokinetic parameters. Results Forty-two of fifty-five subjects enrolled had complete sampling. Volume of distribution (median=0.38 L/kg, intraquartile range=0.20 L/kg) and elimination rate constants (median=0.104 h−1, intraquartile range=0.052 h−1) were highly variable, and clinical parameters could explain only a small fraction of the large variability in pharmacokinetic parameters. Probability of target attainment for piperacillin was 83% for total drug but only 77% when the unbound fraction was considered. Conclusions There is significant patient to patient variability in pharmacokinetic/pharmacodynamic parameters in patients receiving continuous renal replacement therapy. Many patients did not achieve pharmacodynamic targets, suggesting that therapeutic drug monitoring might optimize therapy. PMID:22282479

77 FR 25162 - Golden Spread Electric Cooperative, Inc. v. Southwestern Public Service Company; Notice of Complaint

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-27

... April 20, 2012, pursuant to sections 201, 206, and 306 of the Federal Power Act, 16 U.S.C. 824, 824e and... rate of Replacement Power Sales Agreement (RPSA) by and between Golden Spread and SPS and that the formula rate of the Xcel Joint Energy Open Access Tariff applicable to pricing of transmission service...

78 FR 46332 - Golden Spread Electric Cooperative, Inc. v. Southwestern Public Service Company; Notice of Complaint

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-31

... 309 of the Federal Power Act, 16 U.S.C. 824, 824e, and 825e (2013) and Rule 206 of the Federal Energy...), alleging that the formula rate Replacement Power Sales Agreement (RPSA) by and between Golden Spread and SPS and the formula rate of the Xcel Joint Energy Open Access Tariff applicable to pricing of...

Comparison of methionine hydroxy analogue chelated versus sulfate forms of copper, zinc, and manganese on growth performance and pregnancy rates in yearling beef replacement heifers

USDA-ARS?s Scientific Manuscript database

Our objectives were to compare growth performance and pregnancy rates of heifers supplemented with Cu, Zn, and Mn as either methionine hydroxy analog chelate (provided as MINTREX) or in the S04 form. The experiment used 3 ranches, each having 2 replicate pens per treatment. Performance data were ana...

Crystal structure of the fluorescent protein from Dendronephthya sp. in both green and photoconverted red forms

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

Pletneva, Nadya V.; Pletnev, Sergei; Pakhomov, Alexey A.

The fluorescent protein fromDendronephthyasp. (DendFP) is a member of the Kaede-like group of photoconvertible fluorescent proteins with a His62-Tyr63-Gly64 chromophore-forming sequence. Upon irradiation with UV and blue light, the fluorescence of DendFP irreversibly changes from green (506 nm) to red (578 nm). The photoconversion is accompanied by cleavage of the peptide backbone at the C α—N bond of His62 and the formation of a terminal carboxamide group at the preceding Leu61. The resulting double C α=C βbond in His62 extends the conjugation of the chromophore π system to include imidazole, providing the red fluorescence. Here, the three-dimensional structures of nativemore » green and photoconverted red forms of DendFP determined at 1.81 and 2.14 Å resolution, respectively, are reported. This is the first structure of photoconverted red DendFP to be reported to date. The structure-based mutagenesis of DendFP revealed an important role of positions 142 and 193: replacement of the original Ser142 and His193 caused a moderate red shift in the fluorescence and a considerable increase in the photoconversion rate. It was demonstrated that hydrogen bonding of the chromophore to the Gln116 and Ser105 cluster is crucial for variation of the photoconversion rate. The single replacement Gln116Asn disrupts the hydrogen bonding of Gln116 to the chromophore, resulting in a 30-fold decrease in the photoconversion rate, which was partially restored by a further Ser105Asn replacement.« less

Compliance factors associated with contact lens-related dry eye.

PubMed

Ramamoorthy, Padmapriya; Nichols, Jason Jay

2014-01-01

To determine if compliance factors are associated with contact lens-related dry eye (CLDE). The data were derived from subject responses to a compliance survey administered in a cross-sectional study including 100 healthy, daily (nonovernight), experienced soft contact lens wearers (50 normal and 50 with CLDE). Classification into normal or CLDE groups was based on Contact Lens Dry Eye Questionnaire scores, tear breakup time, and 2 hours difference between total and comfortable daily lens wear hours. The compliance survey queried aspects of lens care, rub and rinse practices, lens and lens case replacement frequency, solution replacement, and sleeping with lenses. Statistical analysis of the data was performed using unpaired T tests, χ, and Fisher exact tests as applicable. The average age of all subjects was 24.8±4.4 years, and 60% were women. Overall compliance rates were low for several variables including recommended replacement of contact lenses (53%), rub and rinse practices (69% and 45%, respectively), care solution topping-off (80%), and washing hands before handling lenses (48%). However, almost no compliance factors were associated with CLDE status, with the exception of perceived ease or difficulty with lens care, which was rated as more difficult by the CLDE group (P=0.004). Overall compliance rates with contact lens care practices are very low, highlighting the need for more effective methods of patient education regarding contact lens care and compliance. However, almost no compliance factors were found to be associated with CLDE. Factors other than compliance likely play a bigger role in CLDE.

Analysis of risk factors of type a aortic dissection (TAAD) operation of frozen elephant trunk and total arch replacement.

PubMed

Shang, W; Ma, M; Ge, Y-P; Liu, N; Zhu, J-M; Sun, L-Z

2016-11-01

To investigate the incidence and risk factors of acute renal failure (ARF) after operation of frozen elephant trunk and total arch replacement for acute thoracic aortic aneurysm and dissection (TAAD) with mild hypothermic circulatory arrest (MHCA), and to analyze the long-term survival rate of the patients with ARF. From February 2009 to March 2015, patients with acute TAAD accepted operation of frozen elephant trunk and total arch replacement were enrolled. Those patients who were treated with renal replacement treatment (RRT) before the operation were excluded. The age, gender, cardiovascular disease history, preoperative serum creatinine and extracorporeal circulation duration in operation were recorded. On the basis of requiring RRT after TAAD operation, the patients were divided into ARF group and non-ARF group. The risk factors of ARF after TAAD operation were assessed by univariate and multivariate analysis. After completion of clinical follow-up, Kaplan-Meier curve was drawn to analyze five-year survival. A total of 524 patients were included in the study. 51 cases of them got postoperative ARF. The incidence was 9.7%. The mortality rate of ARF group in the hospital was significantly higher than non-ARF group (25.5% vs. 3.6%; p<0.001). Univariate analysis showed that there was statistically significant difference in the age, gender, hypertension history, preoperative serum creatinine ≥200 µmol/L, extracorporeal circulation duration ≥260 min and combined with coronary artery bypass surgery simultaneously (p<0.05). Multiple logistic regression analysis showed that there were three independent risk factors of ARF after the operation, including hypertension (p=0.031, OR=2.377), preoperative serum creatinine ≥200 µmol/L (p=0.005, OR=4.451) and extracorporeal circulation duration ≥260 min (p=0.002, OR=3.295). The total five-year survival rate of ARF group after the operation was 56%. There was no statistically significant difference in the five-year survival rate between preoperative serum creatinine ≥200 µmol/L group and <200 µmol/L group (p>0.05). The incidence of ARF after the operation was 9.7%. Preoperative serum creatinine ≥200 µmol/L, hypertension history and extracorporeal circulation duration ≥260 min were independent risk factors of ARF after the operation. The five-year survival rate of ARF after the operation was 56%. The preoperative serum creatinine level had no influence on the postoperative long-term survival.

Should English healthcare providers be penalised for failing to collect patient-reported outcome measures? A retrospective analysis

PubMed Central

Street, Andrew; Gomes, Manuel; Bojke, Chris

2015-01-01

Summary Objective The best practice tariff for hip and knee replacement in the English National Health Service (NHS) rewards providers based on improvements in patient-reported outcome measures (PROMs) collected before and after surgery. Providers only receive a bonus if at least 50% of their patients complete the preoperative questionnaire. We determined how many providers failed to meet this threshold prior to the policy introduction and assessed longitudinal stability of participation rates. Design Retrospective observational study using data from Hospital Episode Statistics and the national PROM programme from April 2009 to March 2012. We calculated participation rates based on either (a) all PROM records or (b) only those that could be linked to inpatient records; constructed confidence intervals around rates to account for sampling variation; applied precision weighting to allow for volume; and applied risk adjustment. Setting NHS hospitals and private providers in England. Participants NHS patients undergoing elective unilateral hip and knee replacement surgery. Main outcome measures Number of providers with participation rates statistically significantly below 50%. Results Crude rates identified many providers that failed to achieve the 50% threshold but there were substantially fewer after adjusting for uncertainty and precision. While important, risk adjustment required restricting the analysis to linked data. Year-on-year correlation between provider participation rates was moderate. Conclusions Participation rates have improved over time and only a small number of providers now fall below the threshold, but administering preoperative questionnaires remains problematic in some providers. We recommend that participation rates are based on linked data and take into account sampling variation. PMID:25827906

Should English healthcare providers be penalised for failing to collect patient-reported outcome measures? A retrospective analysis.

PubMed

Gutacker, Nils; Street, Andrew; Gomes, Manuel; Bojke, Chris

2015-08-01

The best practice tariff for hip and knee replacement in the English National Health Service (NHS) rewards providers based on improvements in patient-reported outcome measures (PROMs) collected before and after surgery. Providers only receive a bonus if at least 50% of their patients complete the preoperative questionnaire. We determined how many providers failed to meet this threshold prior to the policy introduction and assessed longitudinal stability of participation rates. Retrospective observational study using data from Hospital Episode Statistics and the national PROM programme from April 2009 to March 2012. We calculated participation rates based on either (a) all PROM records or (b) only those that could be linked to inpatient records; constructed confidence intervals around rates to account for sampling variation; applied precision weighting to allow for volume; and applied risk adjustment. NHS hospitals and private providers in England. NHS patients undergoing elective unilateral hip and knee replacement surgery. Number of providers with participation rates statistically significantly below 50%. Crude rates identified many providers that failed to achieve the 50% threshold but there were substantially fewer after adjusting for uncertainty and precision. While important, risk adjustment required restricting the analysis to linked data. Year-on-year correlation between provider participation rates was moderate. Participation rates have improved over time and only a small number of providers now fall below the threshold, but administering preoperative questionnaires remains problematic in some providers. We recommend that participation rates are based on linked data and take into account sampling variation. © The Royal Society of Medicine.

The changing demographics of total joint arthroplasty recipients in the United States and Ontario from 2001 to 2007.

PubMed

Ravi, Bheeshma; Croxford, Ruth; Reichmann, William M; Losina, Elena; Katz, Jeffrey N; Hawker, Gillian A

2012-10-01

The rates of total joint arthroplasty (TJA) of the hip and knee have increased in North America over the last decade. While initially designed for elderly patients (>70 years of age), several reports suggest that an increasing number of younger patients are undergoing joint replacements. This suggests that more people are meeting the indication for TJA earlier in their lives. Alternatively, it might indicate a broadening of the indications for TJA. We used the administrative databases available at the Healthcare Cost and Utilization Project (HCUP) and the Institute for Clinical Evaluative Sciences (ICES) to determine the rates of TJA of the hip and knee in the United States, and Ontario, Canada, respectively. We determined the crude rates of THA and TKA in both areas for four calendar years (2001, 2003, 2005 and 2007). We also calculated the age- and sex-standardised rates of THA and TKA in both areas for each time period. We compared the age distribution of TJA recipients between the US and Ontario, and within each area over time. The crude and standardised rates of THA and TKA increased over time in both the US and Ontario. The crude rates of THA were higher in the US in 2001 and 2003, but were not significantly different from the rate in Ontario in 2005 and 2007. The crude rates of TKA were consistently higher in the US for all time periods. In addition, the US consistently had more THA and TKA recipients in 'younger' age categories (<60 years of age). While the age- and sex-standardised rates of TKA were greater in the US in all time periods, the relative increase in rates from 2001 to 2007 was greater in Ontario (US - 59%, Ontario - 73%). For both the US and Ontario, there was a significant shift in the demographic of THA and TKA recipients to younger patients (p < 0.0001). The utilisation of primary hip and knee arthroplasty has increased substantially in both the US and Ontario in the period from 2001 to 2007. This increase has been predominantly in knee replacements. The demographics of joint replacement recipients has become younger, with substantial increases in the prevalence of patients <60 years old amongst TJA recipients, and significant increases in the incidence of TJA in these age groups in the general population, in both the US and Ontario. Copyright © 2012 Elsevier Ltd. All rights reserved.

Indication for percutaneous aortic valve implantation

PubMed Central

Akin, Ibrahim; Kische, Stephan; Rehders, Tim C.; Nienaber, Christoph A.; Rauchhaus, Mathias; Schneider, Henrik; Liebold, Andreas

2010-01-01

The incidence of valvular aortic stenosis has increased over the past decades due to improved life expectancy. Surgical aortic valve replacement is currently the only treatment option for severe symptomatic aortic stenosis that has been shown to improve survival. However, up to one third of patients who require lifesaving surgical aortic valve replacement are denied surgery due to high comorbidities resulting in a higher operative mortality rate. In the past such patients could only be treated with medical therapy or percutaneous aortic valvuloplasty, neither of which has been shown to improve mortality. With advances in interventional cardiology, transcatheter methods have been developed for aortic valve replacement with the goal of offering a therapeutic solution for patients who are unfit for surgical therapy. Currently there are two catheter-based treatment systems in clinical application (the Edwards SAPIEN aortic valve and the CoreValve ReValving System), utilizing either a balloon-expandable or a self-expanding stent platform, respectively. PMID:22371763

The Bimetric cementless total hip replacement: 7-18 year follow-up assessing the influence of acetabular design on survivorship.

PubMed

Russell, R C; Ghassemi, A; Dorrell, J H; Powles, D P

2009-08-01

The purpose of this study was to evaluate the mid- to long-term survivorship of Bimetric cementless total hip replacement and assess how it is affected by the acetabular design. This was a retrospective analysis of 127 Bimetric cementless total hip replacements in 110 patients with a follow-up of 7-18 years. A single design stem and three different cementless metal-backed acetabular designs were used. Patients were assessed clinically using the Harris hip score and radiologically by independent review of current hip radiographs. There was only one case of aseptic loosening of the femoral stem. The earliest acetabular design showed a high failure rate whilst the latter two designs showed a 96% survivorship at a mean of 9.5 years. We conclude that a combination of the bimetric stem with either of the latter acetabular cup designs has a good mid- to long-term performance.

Minimizing the dependency ratio in a population with below-replacement fertility through immigration

PubMed Central

Simon, C.; Belyakov, A.O.; Feichtinger, G.

2012-01-01

Many industrialized countries face fertility rates below replacement level, combined with declining mortality especially in older ages. Consequently, the populations of these countries have started to age. One important indicator of age structures is the dependency ratio which is the ratio of the nonworking age population to the working age population. In this work we find the age-specific immigration profile that minimizes the dependency ratio in a stationary population with below-replacement fertility. It is assumed that the number of immigrants per age is limited. We consider two alternative policies. In the first one, we fix the total number of people who annually immigrate to a country. In the second one, we prescribe the size of the receiving country’s population. For both cases we provide numerical results for the optimal immigration profile, for the resulting age structure of the population, as well as for the dependency ratio. PMID:22781918

Experience with the use of a partial ossicular replacement prosthesis with a ball-and-socket joint between the plate and the shaft.

PubMed

Birk, Stephanie; Brase, Christoph; Hornung, Joachim

2014-08-01

In the further development of alloplastic prostheses for use in middle ear surgery, the Dresden and Cologne University Hospitals, working together with a company, introduced a new partial ossicular replacement prosthesis in 2011. The ball-and-socket joint between the prosthesis and the shaft mimics the natural articulations between the malleus and incus and between the incus and stapes, allowing reaction to movements of the tympanic membrane graft, particularly during the healing process. Retrospective evaluation To reconstruct sound conduction as part of a type III tympanoplasty, partial ossicular replacement prosthesis with a ball-and-socket joint between the plate and the shaft was implanted in 60 patients, with other standard partial ossicular replacement prosthesis implanted in 40 patients and 64 patients. Pure-tone audiometry was carried out, on average, 19 and 213 days after surgery. Results of the partial ossicular replacement prosthesis with a ball-and-socket joint between the plate and the shaft were compared with those of the standard prostheses. Early measurements showed a mean improvement of 3.3 dB in the air-bone gap (ABG) with the partial ossicular replacement prosthesis with a ball-and-socket joint between the plate and the shaft, giving similar results than the standard implants (6.6 and 6.0 dB, respectively), but the differences were not statistically significant. Later measurements showed a statistically significant improvement in the mean ABG, 11.5 dB, compared with 4.4 dB for one of the standard partial ossicular replacement prosthesis and a tendency of better results to 6.9 dB of the other standard prosthesis. In our patients, we achieved similarly good audiometric results to those already published for the partial ossicular replacement prosthesis with a ball-and-socket joint between the plate and the shaft. Intraoperative fixation posed no problems, and the postoperative complication rate was low.

Use of fiber reinforced concrete in bridge approach slabs.

DOT National Transportation Integrated Search

2008-12-01

Bridge approach slabs are deteriorating at a much faster rate than expected resulting in a massive need for repairs and premature replacement : costing millions of dollars annually. Both environmental and traffic loading causes the concrete to worsen...

National Fenestration Rating Council (NFRC) | Efficient Windows

Science.gov Websites

Collaborative Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring

Assessment of driver yield rates pre- and post-RRFB installation, Bend, Oregon.

DOT National Transportation Integrated Search

2011-12-01

The Oregon Department of Transportation improved two crosswalks on US 97 (Bend Parkway) near Bend, Oregon by installing Rectangular Rapid Flashing Beacons (RRFB), replacing signs, and enhancing pavement markings. At the location of the intersections ...

Fluid consumption and sweating in National Football League and collegiate football players with different access to fluids during practice.

PubMed

Godek, Sandra Fowkes; Bartolozzi, Arthur R; Peduzzi, Chris; Heinerichs, Scott; Garvin, Eugene; Sugarman, Eric; Burkholder, Richard

2010-01-01

Considerable controversy regarding fluid replacement during exercise currently exists. To compare fluid turnover between National Football League (NFL) players who have constant fluid access and collegiate football players who replace fluids during water breaks in practices. Observational study. Respective preseason training camps of 1 National Collegiate Athletic Association Division II (DII) football team and 1 NFL football team. Both morning and afternoon practices for DII players were 2.25 hours in length, and NFL players practiced for 2.25 hours in the morning and 1 hour in the afternoon. Environmental conditions did not differ. Eight NFL players (4 linemen, 4 backs) and 8 physically matched DII players (4 linemen, 4 backs) participated. All players drank fluids only from their predetermined individual containers. The NFL players could consume both water and sports drinks, and the DII players could only consume water. We measured fluid consumption, sweat rate, total sweat loss, and percentage of sweat loss replaced. Sweat rate was calculated as change in mass adjusted for fluids consumed and urine produced. Mean sweat rate was not different between NFL (2.1 +/- 0.25 L/h) and DII (1.8 +/- 0.15 L/h) players (F(1,12) = 2, P = .18) but was different between linemen (2.3 +/- 0.2 L/h) and backs (1.6 +/- 0.2 L/h) (t(14) = 3.14, P = .007). We found no differences between NFL and DII players in terms of percentage of weight loss (t(7) = -0.03, P = .98) or rate of fluid consumption (t(7) = -0.76, P = .47). Daily sweat loss was greater in DII (8.0 +/- 2.0 L) than in NFL (6.4 +/- 2.1 L) players (t(7) = -3, P = .02), and fluid consumed was also greater in DII (5.0 +/- 1.5 L) than in NFL (4.0 +/- 1.1 L) players (t(7) = -2.8, P = .026). We found a correlation between sweat loss and fluids consumed (r = 0.79, P < .001). During preseason practices, the DII players drinking water at water breaks replaced the same volume of fluid (66% of weight lost) as NFL players with constant access to both water and sports drinks.

Quit Intentions Moderate Subjective and Physiological Responses to Acute Nicotine Replacement Therapy Administration in Dependent Smokers.

PubMed

Schlagintweit, Hera E; Campbell, Niamh K; Barrett, Sean P

2017-08-01

This study assessed the impact of expectancy and administration components of acute nicotine inhaler use on craving, heart rate, and smoking behavior in smokers with varying intentions to quit. 47 dependent smokers that differed in self-reported intention to quit (no intention to quit during the next month N = 26 vs. intention to initiate a quit attempt within 2 weeks N = 21) were randomly administered a 4 mg nicotine or nicotine-free inhaler across two sessions. Instructions regarding the inhaler's nicotine content (expect nicotine vs. expect nicotine-free; nicotine expectancy) and flavor (mint vs. citrus) varied across sessions. Craving and heart rate were assessed before and after inhaler administration (two-second inhalations every 10 seconds over 20 minutes). Next, participants were offered an opportunity to self-administer puffs of their preferred tobacco brand during an hour-long progressive ratio task. Across participants, nicotine expectancy independently reduced withdrawal related craving (p = .018), but no comparable effects of nicotine administration were evident. In quitting motivated smokers, nicotine expectancy and administration interacted to reduce intention to smoke (p = .040), while nicotine expectancy (p = .047) and administration (p = .025) independently reduced intention to smoke in quitting unmotivated smokers. Blunted heart rate reactivity to nicotine administration was observed in quitting motivated relative to unmotivated smokers (p = .042); however, neither expectancy nor administration impacted smoking behavior in either group (p values > .25). Findings indicate that participant quitting intentions moderate acute nicotine replacement therapy responses. In quitting motivated smokers, a combination of pharmacological and psychological factors may be necessary for nicotine replacement therapy to impact craving. Findings from this study demonstrate that motivations to quit smoking moderate subjective and physiological responses to acute nicotine administration and expectancy in dependent cigarette smokers. Quitting motivated smokers showed blunted heart rate reactivity to nicotine administration, suggesting that they may be less sensitive to the rewarding aspects of nicotine consumption. Nicotine administration and expectancy were found to interact to reduce craving in quitting motivated but not in unmotivated smokers, suggesting that pharmacological and psychological factors may be necessary for nicotine replacement therapy to impact craving in smokers who plan to quit. © The Author 2016. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

New Paradigms and Improved Results for the Surgical Treatment of Acute Type A Dissection

PubMed Central

Bavaria, Joseph E.; Pochettino, Alberto; Brinster, Derek R.; Gorman, Robert C.; McGarvey, Michael L.; Gorman, Joseph H.; Escherich, Alison; Gardner, Timothy J.

2001-01-01

Objective To examine the effect of an integrated surgical approach to the treatment of acute type A dissections. Summary Background Data Acute type A dissection requires surgery to prevent death from proximal aortic rupture or malperfusion. Most series of the past decade have reported a death rate in the range of 15% to 30%. Methods From January 1994 to March 2001, 104 consecutive patients underwent repair of acute type A dissection. All had an integrated operative management as follows: intraoperative transesophageal echocardiography; hypothermic circulatory arrest (HCA) with retrograde cerebral perfusion (RCP) to replace the aortic arch; HCA established after 5 minutes of electroencephalographic (EEG) silence in neuromonitored patients (66%) or after 45 minutes of cooling in patients who were not neuromonitored (34%); reinforcement of the residual arch tissue with a Teflon felt “neo-media”; cannulation of the arch graft to reestablish cardiopulmonary bypass at the completion of HCA (antegrade graft perfusion); and remodeling of the sinus of Valsalva segments with Teflon felt “neo-media” and aortic valve resuspension (78%) or replacement with a biologic or mechanical valved conduit (22%). Results Mean age was 59 ± 15 (range 22–86) years, with 71% men and 13% redo sternotomy after a previous cardiac procedure. Mean cardiopulmonary bypass time was 196 ± 50 minutes. Mean HCA with RCP time was 42 ± 12 minutes (range 19–84). Mean cardiac ischemic time was 140 ± 45 minutes. Eleven percent of patients presented with a preoperative neurologic deficit, and 5% developed a new cerebrovascular accident after dissection repair. The in-hospital death rate was 9%. Excluding the patients who presented neurologically unresponsive or with ongoing cardiopulmonary resuscitation (n = 5), the death rate was 4%. In six patients adverse cerebral outcomes were potentially avoided when immediate surgical fenestration was prompted by a sudden change in the EEG during cooling. Forty-five percent of neuromonitored patients required greater than 30 minutes to achieve EEG silence. Conclusion The authors have shown that the surgical integration of sinus segment repair or aortic root replacement, the use of EEG monitoring, partial or total arch replacement using RCP, routine antegrade graft perfusion, and the uniform use of transesophageal echocardiography substantially decrease the death and complication rates of acute type A dissection repair. PMID:11524586

Amino acid supplementation of calf milk replacers containing plasma protein.

PubMed

Morrison, S Y; Campbell, J M; Drackley, J K

2017-06-01

We determined the effects of calf milk replacers containing 0, 5, or 10% bovine plasma protein (PP), either without or with the supplemental amino acids (AA) Ile and Thr, on growth and health of male Holstein calves (n = 104) for 56 d. Milk replacers were formulated to contain 22% crude protein (CP), 20% fat, and 2.0% Lys. Milk replacers (12.5% solids) were fed at a rate of 1.5% of body weight (BW) on a dry matter basis during wk 1 and 1.75% of BW beginning on d 8. Starter was introduced on d 36 so that effects of PP and AA balance in milk replacers could be isolated. Intake, respiratory scores, and fecal scores were measured daily. Body weight and stature were measured weekly and blood serum samples were obtained during wk 4. Treatments had no effects on intakes of dry matter, CP, or metabolizable energy. During wk 6 and 8, BW was less as PP inclusion increased without AA supplementation compared with the other treatments. In wk 7, calves fed the higher level of PP without AA had lower BW than calves fed either the lower level of PP without supplemented AA or the higher inclusion of PP with supplemented AA. Average daily gain and gain:feed were lowest for calves fed the higher inclusion of PP without supplemented AA; heart girth in wk 7 was smallest for those calves. During the first 21 d, occurrence of scours was greater in calves fed the control milk replacer than in calves fed milk replacers containing the higher inclusion of PP either without or with supplemental AA. Occurrence of scours was also greater for the lower inclusion of PP compared with the higher inclusion of PP when AA were supplemented. Throughout the 56-d experiment, the chance of antibiotic treatment was greater for calves fed the control milk replacer than for all other treatments except the higher inclusion of PP without supplemental AA. Additionally, chance of antibiotic treatment was greater for the higher inclusion of PP without supplemental AA than for other milk replacers with PP. Calves fed treatments with the higher inclusion of PP had fewer days of scours than the controls. All milk replacers with PP, except the milk replacer containing higher PP without supplemental AA, had fewer days of treatment with antibiotics compared to the all-milk control. Inclusion of PP provided similar performance and improved health as long as milk replacers were balanced for Ile and Thr. Copyright © 2017 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Glucose uptake and glycolytic flux in adipose tissue from rats adapted to a high-protein, carbohydrate-free diet.

PubMed

Brito, S R; Moura, M A; Kawashita, N H; Brito, M N; Kettelhut, I C; Migliorini, R H

2001-10-01

Rates of glucose uptake by epididymal and retroperitoneal adipose tissue in vivo, as well as rates of hexose uptake and glycolytic flux in isolated adipocytes, were determined in rats adapted to a high-protein, carbohydrate-free (HP) diet and in control rats fed a balanced (N) diet. Adaptation to the HP diet induced a significant reduction in rates of glucose uptake, estimated with 2-deoxy-[1-(3)H]-glucose, both by adipose tissue (epididymal and retroperitoneal) in vivo and by isolated adipocytes. Twelve hours after replacement of the HP diet with the balanced diet, rates of adipose tissue uptake in vivo in HP-adapted rats returned to levels that did not differ significantly from those in N-fed rats. The rate of flux in the glycolytic pathway, estimated with (3)H[5]-glucose, was also significantly reduced in adipocytes from HP-fed rats. In agreement with the above findings, the activities of hexokinase (HK), phosphofructo-1-kinase (PFK-1), and pyruvate kinase (PK) were markedly reduced in adipose tissue from HP-adapted rats. The activity of pyruvate kinase was partially reverted by diet replacement for 12 hours. The low-plasma insulin and high-glucagon levels in HP-fed rats may have played an important role in the reduction of adipose tissue glucose utilization in these animals. Copyright 2001 by W.B. Saunders Company

Ultra Reliable Closed Loop Life Support for Long Space Missions

NASA Technical Reports Server (NTRS)

Jones, Harry W.; Ewert, Michael K.

2010-01-01

Spacecraft human life support systems can achieve ultra reliability by providing sufficient spares to replace all failed components. The additional mass of spares for ultra reliability is approximately equal to the original system mass, provided that the original system reliability is not too low. Acceptable reliability can be achieved for the Space Shuttle and Space Station by preventive maintenance and by replacing failed units. However, on-demand maintenance and repair requires a logistics supply chain in place to provide the needed spares. In contrast, a Mars or other long space mission must take along all the needed spares, since resupply is not possible. Long missions must achieve ultra reliability, a very low failure rate per hour, since they will take years rather than weeks and cannot be cut short if a failure occurs. Also, distant missions have a much higher mass launch cost per kilogram than near-Earth missions. Achieving ultra reliable spacecraft life support systems with acceptable mass will require a well-planned and extensive development effort. Analysis must determine the reliability requirement and allocate it to subsystems and components. Ultra reliability requires reducing the intrinsic failure causes, providing spares to replace failed components and having "graceful" failure modes. Technologies, components, and materials must be selected and designed for high reliability. Long duration testing is needed to confirm very low failure rates. Systems design should segregate the failure causes in the smallest, most easily replaceable parts. The system must be designed, developed, integrated, and tested with system reliability in mind. Maintenance and reparability of failed units must not add to the probability of failure. The overall system must be tested sufficiently to identify any design errors. A program to develop ultra reliable space life support systems with acceptable mass should start soon since it must be a long term effort.

Therapeutic Plasma Exchange in Critically Ill Children Requiring Intensive Care.

PubMed

Cortina, Gerard; McRae, Rosemary; Chiletti, Roberto; Butt, Warwick

2018-02-01

To characterize the clinical indications, procedural safety, and outcome of critically ill children requiring therapeutic plasma exchange. Retrospective observational study based on a prospective registry. Tertiary and quaternary referral 30-bed PICU. Forty-eight critically ill children who received therapeutic plasma exchange during an 8-year period (2007-2014) were included in the study. Therapeutic plasma exchange. A total of 48 patients underwent 244 therapeutic plasma exchange sessions. Of those, therapeutic plasma exchange was performed as sole procedure in 193 (79%), in combination with continuous renal replacement therapy in 40 (16.4%) and additional extracorporeal membrane oxygenation in 11 (4.6%) sessions. The most common admission diagnoses were hematologic disorders (30%), solid organ transplantation (20%), neurologic disorders (20%), and rheumatologic disorders (15%). Complications associated with the procedure occurred in 50 (21.2%) therapeutic plasma exchange sessions. Overall, patient survival from ICU was 82%. Although patients requiring therapeutic plasma exchange alone (n = 31; 64%) had a survival rate of 97%, those with additional continuous renal replacement therapy (n = 13; 27%) and extracorporeal membrane oxygenation (n = 4; 8%) had survival rates of 69% and 50%, respectively. Factors associated with increased mortality were lower Pediatric Index of Mortality 2 score, need for mechanical ventilation, higher number of failed organs, and longer ICU stay. Our results indicate that, in specialized centers, therapeutic plasma exchange can be performed relatively safely in critically ill children, alone or in combination with continuous renal replacement therapy and extracorporeal membrane oxygenation. Outcome in children requiring therapeutic plasma exchange alone is excellent. However, survival decreases with the number of failed organs and the need for continuous renal replacement therapy and extracorporeal membrane oxygenation.

Combined intravenous, topical and oral tranexamic acid administration in total knee replacement: Evaluation of safety in patients with previous thromboembolism and effect on hemoglobin level and transfusion rate.

PubMed

Jansen, Joris A; Lameijer, Joost R C; Snoeker, Barbara A M

2017-10-01

The aims of this study were to investigate the safety of combined intravenous, oral and topical tranexamic acid (TXA) in primary total knee replacement. We assessed dose-related efficacy on hemoglobin level, transfusion, length of stay and thromboembolic complications. In addition, TXA safety in patients with previous history of thromboembolism >12months ago was monitored specifically. From January 2013 until January 2016, 922 patients were included who received TXA after primary total knee replacement. Patients without TXA administration or with thromboembolic events <12months ago were excluded. TXA dosage groups were divided into ≤10mg/kg, >10-25mg/kg and >25-50mg/kg. Between the three TXA groups no significant difference was found in thromboembolic complications (deep venous thrombosis (DVT) and pulmonary embolism (PE)), wound leakage and transfusion rate. For patients with DVT or PE in their history >12months ago specifically, no more complications were noted in higher-TXA-dosage groups compared to the low-dosage group. Length of stay was shorter in the highest-TXA-dosage group compared with lower-dosage groups (median two vs three days). With high TXA dose a smaller difference between pre- and postoperative Hb was found: the >25-50mg/kg TXA group had a 0.419mmol/l smaller decrease in postoperative hemoglobin compared to the lowest-dosage group (P<0.05). Combined intravenous, oral and topical TXA is effective in knee replacement and can safely be given to patients with a thromboembolic history >12months ago. High dosage (>25-50mg/kg) TXA resulted in the smallest decrease in postoperative hemoglobin. Copyright © 2017 Elsevier B.V. All rights reserved.

Outcomes of Transcatheter and Surgical Aortic Valve Replacement in Patients on Maintenance Dialysis.

PubMed

Alqahtani, Fahad; Aljohani, Sami; Boobes, Khaled; Maor, Elad; Sherieh, Assem; Rihal, Charanjit S; Holmes, David R; Alkhouli, Mohamad

2017-12-01

The introduction of transcatheter aortic valve replacement (TAVR) expanded definitive therapy of aortic stenosis to many high-risk patients, but it has not been fully evaluated in the dialysis population. We aimed to evaluate the current trend and in-hospital outcome of surgical aortic valve replacement (SAVR) and TAVR in the dialysis population. Severe aortic stenosis patients on maintenance dialysis who underwent SAVR or TAVR in the Nationwide Inpatient Sample database from January 1, 2005, through December 31, 2014, were included in our comparative analysis. The trends of SAVR and TAVR were assessed. In-hospital mortality, rates of major adverse events, hospital length of stay, cost of care, and intermediate care facility utilization were compared between the 2 groups using both unadjusted and propensity-matched data. Utilization of aortic valve replacement in dialysis patients increased 3-fold; a total of 2531 dialysis patients who underwent either SAVR (n = 2264) or TAVR (n = 267) between 2005 and 2014 were identified. Propensity score matching yielded 197 matched pairs. After matching, a 2-fold increase in in-hospital mortality was found with SAVR compared with TAVR (13.7% vs 6.1%, P = .021). Patients who underwent TAVR had more permanent pacemaker implantation (13.2% vs 5.6%, P = .012) but less blood transfusion (43.7% vs 56.8%, P = .02). Rates of other key morbidities were similar. Hospital length of stay (19 ± 16 vs 11 ± 11 days, P <.001) and non-home discharges (44.7% vs 31.5%, P = .002) were significantly higher with SAVR. Cost of hospitalization was 25% less with TAVR. In patients on maintenance dialysis, TAVR is associated with lower hospital mortality, resource utilization, and cost in comparison with SAVR. Copyright © 2017 Elsevier Inc. All rights reserved.

Assessing the influence of risk factors on rates and dynamics of peripheral vein phlebitis: an observational cohort study.

PubMed

Mestre Roca, Gabriel; Berbel Bertolo, Cristina; Tortajada Lopez, Purificación; Gallemi Samaranch, Gema; Aguilar Ramirez, Mari Carmen; Caylà Buqueras, Joan; Rodríguez-Baño, Jesús; Martinez, José Antonio

2012-07-21

To assess the influence of risk factors on the rates and kinetics of peripheral vein phlebitis (PVP) development and its theoretical influence in absolute PVP reduction after catheter replacement. All peripheral short intravenous catheters inserted during one month were included (1201 catheters and 967 patients). PVP risk factors were assessed by a Cox proportional hazard model. Cumulative probability, conditional failure of PVP and theoretical estimation of the benefit from replacement at different intervals were performed. Female gender, catheter insertion at the emergency or medical-surgical wards, forearm site, amoxicillin-clavulamate or aminoglycosides were independent predictors of PVP with hazard ratios (95 confidence interval) of 1.46 (1.09-2.15), 1.94 (1.01-3.73), 2.51 (1.29-4.88), 1.93 (1.20-3.01), 2.15 (1.45-3.20) and 2.10 (1.01-4.63), respectively. Maximum phlebitis incidence was reached sooner in patients with ≥2 risk factors (days 3-4) than in those with <2 (days 4-5). Conditional failure increased from 0.08 phlebitis/one catheter-day for devices with ≤1 risk factors to 0.26 for those with ≥3. The greatest benefit of routine catheter exchange was obtained by replacement every 60h. However, this benefit differed according to the number of risk factors: 24.8% reduction with ≥3, 13.1% with 2, and 9.2% with ≤1. PVP dynamics is highly influenced by identifiable risk factors which may be used to refine the strategy of catheter management. Routine replacement every 72h seems to be strictly necessary only in high-risk catheters. Copyright © 2011 Elsevier España, S.L. All rights reserved.

Sexual activity after total hip replacement in Korean patients: how they do, what they want, and how to improve.

PubMed

Yoon, Byung-Ho; Lee, Kyung-Hag; Noh, Serae; Ha, Yong-Chan; Lee, Young-Kyun; Koo, Kyung-Hoi

2013-12-01

Concerns of patients on sexual activity after total hip arthroplasty have not been well studied in Asian patients. This study aimed to determine the following: (1) what are the concerns of patients related to sexual activity after total hip arthroplasty? (2) what are the changes in sexual activity after total hip replacement in Korean patients? Details of sexual activity and concerns were obtained using a questionnaire designed specifically for the study. The questionnaire was administered to 64 patients in a face-to-face interview at an outpatient clinic. Preoperatively, 53.1% of patients experienced difficulties, primarily due to hip pathology and limitations of motion. The median time to the resumption of sexual activity was 3 months postoperatively, and most patients had no increase in the frequency of sexual activity after the total hip replacement. In 39.1% of patients were seen having difficulties with leg positioning following total hip replacement, and they were likely to change coital positions. The most common concern regarding sexual activity of patients was the fear of dislocation. Furthermore, patients with a higher stress level had lower satisfaction rates. Most patients were unable to obtain information on sexual activity following the total hip arthroplasty, and they did not consult with a physician due to the private nature of the topic. Dislocation was the most common concern of patients during sexual activity following a total hip arthroplasty, and a higher stress level was found to be associated with a lower satisfaction rate. Because most patients were unprepared to consult a physician, the provision of appropriate information before a consultation might be beneficial.

Sexual Activity after Total Hip Replacement in Korean Patients: How They Do, What They Want, and How to Improve

PubMed Central

Yoon, Byung-Ho; Lee, Kyung-Hag; Noh, Serae; Ha, Yong-Chan; Koo, Kyung-Hoi

2013-01-01

Background Concerns of patients on sexual activity after total hip arthroplasty have not been well studied in Asian patients. This study aimed to determine the following: (1) what are the concerns of patients related to sexual activity after total hip arthroplasty? (2) what are the changes in sexual activity after total hip replacement in Korean patients? Methods Details of sexual activity and concerns were obtained using a questionnaire designed specifically for the study. The questionnaire was administered to 64 patients in a face-to-face interview at an outpatient clinic. Results Preoperatively, 53.1% of patients experienced difficulties, primarily due to hip pathology and limitations of motion. The median time to the resumption of sexual activity was 3 months postoperatively, and most patients had no increase in the frequency of sexual activity after the total hip replacement. In 39.1% of patients were seen having difficulties with leg positioning following total hip replacement, and they were likely to change coital positions. The most common concern regarding sexual activity of patients was the fear of dislocation. Furthermore, patients with a higher stress level had lower satisfaction rates. Most patients were unable to obtain information on sexual activity following the total hip arthroplasty, and they did not consult with a physician due to the private nature of the topic. Conclusions Dislocation was the most common concern of patients during sexual activity following a total hip arthroplasty, and a higher stress level was found to be associated with a lower satisfaction rate. Because most patients were unprepared to consult a physician, the provision of appropriate information before a consultation might be beneficial. PMID:24340146

Review of Kinemax total knee replacements performed at the NHS treatment centre, Weston-Super-Mare: five-year results.

PubMed

Hickey, B A; Kempshall, P J; Metcalfe, A J; Forster, M C

2012-04-01

As part of the national initiative to reduce waiting times for joint replacement surgery in Wales, the Cardiff and Vale NHS Trust referred 224 patients to the NHS Treatment Centre in Weston-Super-Mare for total knee replacement (TKR). A total of 258 Kinemax TKRs were performed between November 2004 and August 2006. Of these, a total of 199 patients (232 TKRs, 90%) have been followed up for five years. This cohort was compared with 258 consecutive TKRs in 250 patients, performed at Cardiff and Vale Orthopaedic Centre (CAVOC) over a similar time period. The five year cumulative survival rate was 80.6% (95% confidence interval (CI) 74.0 to 86.0) in the Weston-Super-Mare cohort and 95.0% (95% CI 90.2 to 98.2) in the CAVOC cohort with revision for any reason as the endpoint. The relative risk for revision at Weston-Super-Mare compared with CAVOC was 3.88 (p < 0.001). For implants surviving five years, the mean Oxford knee scores (OKS) and mean EuroQol (EQ-5D) scores were similar (OKS: Weston-Super-Mare 29 (2 to 47) vs CAVOC 29.8 (3 to 48), p = 0.61; EQ-5D: Weston-Super-Mare 0.53 (-0.38 to 1.00) vs CAVOC 0.55 (-0.32 to 1.00), p = 0.79). Patients with revised TKRs had significantly lower Oxford knee and EQ-5D scores (p < 0.001). The results show a higher revision rate for patients operated at Weston-Super-Mare Treatment Centre, with a reduction in functional outcome and quality of life after revision. This further confirms that patients moved from one area to another for joint replacement surgery fare poorly.

Cross-sectional analysis of association between socioeconomic status and utilization of primary total hip joint replacements 2006-7: Australian Orthopaedic Association National Joint Replacement Registry.

PubMed

Brennan, Sharon L; Stanford, Tyman; Wluka, Anita E; Henry, Margaret J; Page, Richard S; Graves, Stephen E; Kotowicz, Mark A; Nicholson, Geoffrey C; Pasco, Julie A

2012-04-30

The utilization of total hip replacement (THR) surgery is rapidly increasing, however few data examine whether these procedures are associated with socioeconomic status (SES) within Australia. This study examined primary THR across SES for both genders for the Barwon Statistical Division (BSD) of Victoria, Australia. Using the Australian Orthopaedic Association National Joint Replacement Registry data for 2006-7, primary THR with a diagnosis of osteoarthritis (OA) among residents of the BSD was ascertained. The Index of Relative Socioeconomic Disadvantage was used to measure SES; determined by matching residential addresses with Australian Bureau of Statistics census data. The data were categorised into quintiles; quintile 1 indicating the most disadvantaged. Age- and sex-specific rates of primary THR per 1,000 person years were reported for 10-year age bands using the total population at risk. Females accounted for 46.9% of the 642 primary THR performed during 2006-7. THR utilization per 1,000 person years was 1.9 for males and 1.5 for females. The highest utilization of primary THR was observed in those aged 70-79 years (males 6.1, and females 5.4 per 1,000 person years). Overall, the U-shaped pattern of THR across SES gave the appearance of bimodality for both males and females, whereby rates were greater for both the most disadvantaged and least disadvantaged groups. Further work on a larger scale is required to determine whether relationships between SES and THR utilization for the diagnosis of OA is attributable to lifestyle factors related to SES, or alternatively reflects geographic and health system biases. Identifying contributing factors associated with SES may enhance resource planning and enable more effective and focussed preventive strategies for hip OA.

Recent Advances in Hydrocortisone Replacement Treatment.

PubMed

Mallappa, Ashwini; Debono, Miguel

2016-01-01

Since the first use of cortisone in patients around 65 years ago, the use of synthetic glucocorticoids has made a crucial impact on the treatment of several diseases in medicine. Although significant reductions in morbidity and mortality have occurred in patients suffering from cortisol deficiency, conventional hydrocortisone replacement treatment is still inadequate. A major limitation is that it fails to replace cortisol in a physiological manner. Cortisol has a distinct circadian rhythm and acts as a secondary messenger synchronizing the central to peripheral clocks, hence playing a key role in biological processes and the circadian timing system. Circadian misalignment has been associated with ill-health and so nonphysiological glucocorticoid treatment could explain the increased mortality rate, poor quality of life and metabolic complications in patients suffering from adrenal insufficiency. Attempts at replacing cortisol in a physiological manner have shown significant progress in the past decade with the development of modified-release formulations of hydrocortisone (Chronocort® and Plenadren®) and continuous subcutaneous hydrocortisone infusions. Initial studies investigating the use of these replacement regimens are promising, demonstrating both clinical and biochemical improvement. Larger studies are needed to determine whether this novel approach enhances long-term outcomes in both children and adults with cortisol deficiency. This is a work of the U.S. Government and is not subject to copyright protection in the United States. Foreign copyrights may apply. Published by S. Karger AG, Basel.

Optimization of a sponge cake formulation with inulin as fat replacer: structure, physicochemical, and sensory properties.

PubMed

Rodríguez-García, Julia; Puig, Ana; Salvador, Ana; Hernando, Isabel

2012-02-01

The effects of several fat replacement levels (0%, 35%, 50%, 70%, and 100%) by inulin in sponge cake microstructure and physicochemical properties were studied. Oil substitution for inulin decreased significantly (P < 0.05) batter viscosity, giving heterogeneous bubbles size distributions as it was observed by light microscopy. Using confocal laser scanning microscopy the fat was observed to be located at the bubbles' interface, enabling an optimum crumb cake structure development during baking. Cryo-SEM micrographs of cake crumbs showed a continuous matrix with embedded starch granules and coated with oil; when fat replacement levels increased, starch granules appeared as detached structures. Cakes with fat replacement up to 70% had a high crumb air cell values; they were softer and rated as acceptable by an untrained sensory panel (n = 51). So, the reformulation of a standard sponge cake recipe to obtain a new product with additional health benefits and accepted by consumers is achieved. Practical Application:  In this study, fat is replaced by inulin in cakes, which is a fiber mainly obtained from chicory roots. Sponge cake formulations with reductions in fat content up to 70% are achieved. These high-quality products can be labeled as "reduced in fat" according to U.S. FDA (2009) and EU regulations (European-Union 2006). © 2012 Institute of Food Technologists®

Replacement policy of residential lighting optimized for cost, energy, and greenhouse gas emissions

NASA Astrophysics Data System (ADS)

Liu, Lixi; Keoleian, Gregory A.; Saitou, Kazuhiro

2017-11-01

Accounting for 10% of the electricity consumption in the US, artificial lighting represents one of the easiest ways to cut household energy bills and greenhouse gas (GHG) emissions by upgrading to energy-efficient technologies such as compact fluorescent lamps (CFL) and light emitting diodes (LED). However, given the high initial cost and rapidly improving trajectory of solid-state lighting today, estimating the right time to switch over to LEDs from a cost, primary energy, and GHG emissions perspective is not a straightforward problem. This is an optimal replacement problem that depends on many determinants, including how often the lamp is used, the state of the initial lamp, and the trajectories of lighting technology and of electricity generation. In this paper, multiple replacement scenarios of a 60 watt-equivalent A19 lamp are analyzed and for each scenario, a few replacement policies are recommended. For example, at an average use of 3 hr day-1 (US average), it may be optimal both economically and energetically to delay the adoption of LEDs until 2020 with the use of CFLs, whereas purchasing LEDs today may be optimal in terms of GHG emissions. In contrast, incandescent and halogen lamps should be replaced immediately. Based on expected LED improvement, upgrading LED lamps before the end of their rated lifetime may provide cost and environmental savings over time by taking advantage of the higher energy efficiency of newer models.

Assessing of the potential of extruded flour paste as fat replacer in O/W emulsion: A rheological and microstructural study.

PubMed

Román, Laura; Martínez, Mario M; Gómez, Manuel

2015-08-01

Extruded flour represents an economical and environmental friendly alternative as fat replacer. In this research, the potential use of an extruded flour-water paste as fat replacer in an oil-in-water emulsion was studied. The effect of flour-water ratio and level of oil replacement (30, 50 and 70%) on the microstructure, rheological properties and stability of mayonnaise-like emulsion was evaluated. Fat replacement by extruded flour gradually increased the number and reduced the size of oil droplets. All the emulsion samples showed a pseudoplastic behaviour. At low shear rates a Newtonian region characterised by Carreau model appeared (R 2 >0.99). In general, the limiting viscosity of the Newtonian region and the consistency index increased with the decreased water content of the paste and increased the level of oil substitution. A decrease in oil concentration led to a greater thixotropic behaviour. Oscillatory test revealed that predominance of the continuous or dispersed phase influenced viscoelastic behaviour. Reduction in oil content resulted in an increased freeze-thaw stability. Results suggested that if the flour-water ratio of the paste is controlled, extruded flour is appropriate for preparing reduced-fat oil-in-water emulsion with similar rheological properties to the full fat and greater freeze-thaw stability. Copyright © 2015 Elsevier Ltd. All rights reserved.

Effects at early stage of life of elevated milk replacer feeding on growth rate, plasma IGF-I concentration and intestinal nutrient transporter expression in Holstein bull calves.

PubMed

Orihashi, Takenori; Mashiko, Takanori; Sera, Kenji; Roh, Sang-Gun; Katoh, Kazuo; Obara, Yoshiaki

2012-01-01

In order to evaluate the effects of an elevated amount of modified milk replacer on body weight, daily gain, starter intake, plasma endocrine parameters and expression of nutrient transporters in small intestinal epithelia, Holstein bull calves (n=24) were fed for 60days either with the usual amount of 24% crude protein (CP) and 20% fat milk (CF) replacer (C group), or with a double amount of a modified milk replacer of 28% CP and 16% CF (E group). Body weight from D20 to D60 and daily gain before D40 was greater or tended to be greater for the E group than the C group. Plasma concentrations of insulin-like growth factor-1 (IGF-I) and insulin were greater for the E group than the C group on D28 but not on D56, without changing plasma growth hormone levels. Gene expression for sodium-dependent glucose transporter 1 and fatty acid translocase (CD36) was altered in day- and intestine-dependent manners. From these findings, we conclude that an elevated intake of milk replacer given up to 40days old is sufficient to enhance body weight, which may be associated with increased plasma IGF-I concentrations, in Holstein bulls. © 2011 The Authors. Animal Science Journal © 2011 Japanese Society of Animal Science.

Yemen: Preventing the Next Afghanistan

DTIC Science & Technology

2012-03-22

the AQAP “regional franchise .”8 Since its founding, AQAP has taken the lead on offensive terror operations against the US mainland and against US...their ground water supply by replacing food crops with the water intensive narcotic plant Qat.21 Recent estimates place the unemployment rate in Yemen...population.103 Should the Yemeni military disintegrate, the social and economic impact would be crippling given the current 35% unemployment rate.104

Incidence and treatment of ESRD among indigenous peoples of Australasia.

PubMed

McDonald, S

2010-11-01

Indigenous people in Australia and New Zealand experience rates of ESKD several times higher than non-indigenous people. This relative rate is highest among people aged 45 - 54 for Aboriginal Australians, and 65 - 74 years for Maori. The majority of this is driven by diabetic nephropathy. Both groups have lesser utilization of transplantation as a renal replacement therapy than non-indigenous comparators, and lesser utilization of home dialysis modalities.

7 CFR 246.10 - Supplemental foods.

Code of Federal Regulations, 2011 CFR

2011-01-01

... methodology described in accordance with paragraph (h)(2) of this section. 9 Fresh banana may replace up to 16 ounces of infant food fruit at a rate of 1 pound of bananas per 8 ounces of infant food fruit. 10 In lieu...

7 CFR 246.10 - Supplemental foods.

Code of Federal Regulations, 2014 CFR

2014-01-01

... methodology described in accordance with paragraph (h)(2) of this section. 9 Fresh banana may replace up to 16 ounces of infant food fruit at a rate of 1 pound of bananas per 8 ounces of infant food fruit. 10 In lieu...

7 CFR 246.10 - Supplemental foods.

Code of Federal Regulations, 2013 CFR

2013-01-01

... methodology described in accordance with paragraph (h)(2) of this section. 9 Fresh banana may replace up to 16 ounces of infant food fruit at a rate of 1 pound of bananas per 8 ounces of infant food fruit. 10 In lieu...

7 CFR 246.10 - Supplemental foods.

Code of Federal Regulations, 2012 CFR

2012-01-01

... methodology described in accordance with paragraph (h)(2) of this section. 9 Fresh banana may replace up to 16 ounces of infant food fruit at a rate of 1 pound of bananas per 8 ounces of infant food fruit. 10 In lieu...

7 CFR 246.10 - Supplemental foods.

Code of Federal Regulations, 2010 CFR

2010-01-01

... methodology described in accordance with paragraph (h)(2) of this section. 9 Fresh banana may replace up to 16 ounces of infant food fruit at a rate of 1 pound of bananas per 8 ounces of infant food fruit. 10 In lieu...

Impact of bridge ratings on the timber transportation industry.

DOT National Transportation Integrated Search

2009-08-01

The logging industry plays an important role in the State of Wisconsins economy. Additionally, the condition of some of Wisconsins bridges, as : well as the state of our nations bridges, is deteriorated due to lack of funding for replacement...

78 FR 47695 - Sam Rayburn Dam Power Rate

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-06

... replacements in the hydroelectric generating facilities and small increases to annual operations and... K. McDonald, Vice President for Corporate Operations/Chief Operating Officer, Southwestern Power... Code of Federal Regulations (18 CFR 300). Southwestern markets power from 24 multi-purpose reservoir...

[Frequency, etiology, and outcomes of acute renal failure (data of Kaunas University of Medicine Hospital in 1995-2006)].

PubMed

Skarupskiene, Inga; Kuzminskis, Vytautas; Ziginskiene, Edita

2007-01-01

The aim of this study was to determine the frequency, etiology, and outcomes of acute renal failure. We retrospectively collected data on all patients (n=1653) who received renal replacement therapy for acute renal failure at the Kaunas University of Medicine Hospital during 1995-2006. The number of patients with acute renal failure increased nine times during the 11-year period. The mean age of patients was 59.76+/-17.52 years and increased from 44.97+/-17.1 years in 1995 to 62.84+/-16.49 years in 2006. The most common causes of acute renal failure were renal (n=646, 39%), prerenal (n=380, 23%), and obstructive (n=145, 9%). The renal replacement therapy was discontinued because of recovery of renal function in 49.9% of cases. The overall hospital mortality rate was 45.1%. Renal function did not recover in 6.7% of patients. The mortality rate over the 11-year period varied from 37.8 to 57.5%. The highest mortality rate was in the neurosurgical (62.3%) and cardiac surgical (61.8%) intensive care units. High mortality rate (more than 50%) was in the groups of patients with acute renal failure that was caused by hepatorenal syndrome, shock, sepsis, and reduced cardiac output.

Bicarbonate secretion and chloride absorption by rabbit cortical collecting ducts. Role of chloride/bicarbonate exchange.

PubMed Central

Star, R A; Burg, M B; Knepper, M A

1985-01-01

Cortical collecting ducts (CCD) from rabbits treated with deoxycorticosterone (DOC) actively secrete bicarbonate at high rates. To investigate the mechanism of bicarbonate secretion, we measured bicarbonate and chloride transport in CCD from rabbits treated with DOC for 9-24 d. Removal of chloride (replaced with gluconate) from both perfusate and bath inhibited bicarbonate secretion without changing transepithelial voltage. Removal of chloride only from the bath increased bicarbonate secretion, while removal of chloride only from the perfusate inhibited secretion. In contrast to the effect of removing chloride, removal of sodium from both the perfusate and bath (replacement with N-methyl-D-glucamine) did not change the rate of bicarbonate secretion. The rate of bicarbonate secretion equaled the rate of chloride absorption in tubules bathed with 0.1 mM ouabain to inhibit any cation-dependent chloride transport. Under these conditions, chloride absorption occurred against an electrochemical gradient. Removal of bicarbonate from both the perfusate and bath inhibited chloride absorption. Removal of bicarbonate only from the bath inhibited chloride absorption, while removal of bicarbonate from the lumen stimulated chloride absorption. We conclude that CCD from DOC-treated rabbits actively secrete bicarbonate and actively absorb chloride by an electroneutral mechanism involving 1:1 chloride/bicarbonate exchange. The process is independent of sodium. PMID:3930570

Prosthetic replacement of the infrahepatic inferior vena cava for leiomyosarcoma.

PubMed

Illuminati, Giulio; Calio', Francesco G; D'Urso, Antonio; Giacobbi, Daniela; Papaspyropoulos, Vassilios; Ceccanei, Gianluca

2006-09-01

Resection of the infrahepatic inferior vena cava associated with prosthetic graft replacement for caval leiomyosarcoma is an acceptable procedure to obtain prolonged and good-quality survival. A consecutive sample clinical study with a mean follow-up of 40 months. The surgical department of an academic tertiary center and an affiliated secondary care center. Eleven patients, with a mean age of 51 years, who have primary leiomyosarcoma of the infrahepatic inferior vena cava. All of the patients underwent radical resection of the tumor en bloc with the affected segment of the vena cava. Reconstruction consisted of 10 cavocaval polytetrafluoroethylene grafts and 1 cavobiliac graft. An associated right nephrectomy was performed in 2 cases. The left renal vein was reimplanted in the graft in 3 cases. Cumulative disease-specific survival, disease-free survival, and graft patency rates expressed by standard life-table analysis. No patients died in the postoperative period. The cumulative (SE) disease-specific survival rate was 53% (21%) at 5 years. The cumulative (SE) disease-free survival rate was 44% (19%) at 5 years. The cumulative (SE) graft patency rate was 67% (22%) at 5 years. Radical resection followed by prosthetic graft reconstruction is a valuable method for treating primary leiomyosarcoma of the infrahepatic inferior vena cava.

Endovascular repair vs open surgical repair of abdominal aortic aneurysms: comparative utilization trends from 2001 to 2006.

PubMed

Levin, David C; Rao, Vijay M; Parker, Laurence; Frangos, Andrea J; Sunshine, Jonathan H

2009-07-01

Within the past few years, endovascular aneurysm repair (EVAR) has come into use for the treatment of abdominal aortic aneurysms (AAAs). In many cases, EVAR has the potential to replace traditional open surgical repair (OSR), which is more invasive, risky, and expensive. The aim of this study was to determine to what extent EVAR is replacing OSR, whether the frequency of treatment is increasing with the advent of the less invasive approach, and which specialties are performing the procedures. The Medicare Part B data sets for 2001 through 2006 were studied. Procedure volume and utilization rates per 100,000 Medicare beneficiaries were determined for the 7 Current Procedural Terminology, fourth edition, procedure codes that describe EVAR and the 4 codes that describe OSR for AAA. Medicare's physician specialty codes were used to ascertain the specialties of the physician providers. A total of 31,965 OSRs for AAA were performed in Medicare beneficiaries in 2001, dropping to 15,665 by 2006 (-51%). In contrast, EVAR was carried out in 11,028 instances in 2001, increasing to 28,937 by 2006 (+162%). The utilization rate per 100,000 for OSR dropped from 90 to 42 (a rate decrease of 48) during the study period, while the rate for EVAR increased from 31 to 77 (a rate increase of 46). The combined utilization rate per 100,000 of the two types of interventions for AAA (EVAR and OSR) decreased from 121 in 2001 to 119 in 2006. In performing EVAR, procedure volume and market share in 2006 by specialty were 1) 22,003 procedures by surgeons, a 76% share; 2) 3,287 procedures by radiologists, an 11% share; 3) 1,915 procedures by cardiologists, a 7% share; and 4) 1,732 procedures by all other physicians, a 6% share. Treatment for AAA seems to be an example of the responsible use of new technology by physicians. The newer, less invasive, and less risky procedure (EVAR) is replacing the older and more invasive procedure (OSR) to a considerable degree. However, the overall combined utilization rate of both types of AAA treatment has remained stable in the Medicare population. There is thus no evidence to suggest that the introduction of the newer approach has led to the overtreatment of patients. Although radiologists do have a role in EVAR, surgeons strongly predominate.

Early Left and Right Ventricular Response to Aortic Valve Replacement.

PubMed

Duncan, Andra E; Sarwar, Sheryar; Kateby Kashy, Babak; Sonny, Abraham; Sale, Shiva; Alfirevic, Andrej; Yang, Dongsheng; Thomas, James D; Gillinov, Marc; Sessler, Daniel I

2017-02-01

The immediate effect of aortic valve replacement (AVR) for aortic stenosis on perioperative myocardial function is unclear. Left ventricular (LV) function may be impaired by cardioplegia-induced myocardial arrest and ischemia-reperfusion injury, especially in patients with LV hypertrophy. Alternatively, LV function may improve when afterload is reduced after AVR. The right ventricle (RV), however, experiences cardioplegic arrest without benefiting from improved loading conditions. Which of these effects on myocardial function dominate in patients undergoing AVR for aortic stenosis has not been thoroughly explored. Our primary objective is thus to characterize the effect of intraoperative events on LV function during AVR using echocardiographic measures of myocardial deformation. Second, we evaluated RV function. In this supplementary analysis of 100 patients enrolled in a clinical trial (NCT01187329), 97 patients underwent AVR for aortic stenosis. Of these patients, 95 had a standardized intraoperative transesophageal echocardiographic examination of systolic and diastolic function performed before surgical incision and repeated after chest closure. Echocardiographic images were analyzed off-line for global longitudinal myocardial strain and strain rate using 2D speckle-tracking echocardiography. Myocardial deformation assessed at the beginning of surgery was compared with the end of surgery using paired t tests corrected for multiple comparisons. LV volumes and arterial blood pressure decreased, and heart rate increased at the end of surgery. Echocardiographic images were acceptable for analysis in 72 patients for LV strain, 67 for LV strain rate, and 54 for RV strain and strain rate. In 72 patients with LV strain images, 9 patients required epinephrine, 22 required norepinephrine, and 2 required both at the end of surgery. LV strain did not change at the end of surgery compared with the beginning of surgery (difference: 0.7 [97.6% confidence interval, -0.2 to 1.5]%; P = 0.07), whereas LV systolic strain rate improved (became more negative) (-0.3 [-0.4 to -0.2] s; P < 0.001). In contrast, RV systolic strain worsened (became less negative) at the end of surgery (difference: 4.6 [3.1 to 6.0]%; P < 0.001) although RV systolic strain rate was unchanged (0.0 [97.6% confidence interval, -0.1 to 0.1]; P = 0.83). LV function improved after replacement of a stenotic aortic valve demonstrated by improved longitudinal strain rate. In contrast, RV function, assessed by longitudinal strain, was reduced.

Timing of initiation of enzyme replacement therapy after diagnosis of type 1 Gaucher disease: effect on incidence of avascular necrosis

PubMed Central

Mistry, Pramod K; Deegan, Patrick; Vellodi, Ashok; Cole, J Alexander; Yeh, Michael; Weinreb, Neal J

2009-01-01

Data from the International Collaborative Gaucher Group Gaucher Registry were analysed to assess the relationship between enzyme replacement therapy with imiglucerase (ERT) and incidence of avascular necrosis (AVN) in type 1 Gaucher disease (GD1), and to determine whether the time interval between diagnosis and initiation of ERT influences the incidence rate of AVN. All patients with GD1 enrolled in the Gaucher Registry who received ERT and did not report AVN prior to starting therapy (n = 2700) were included. The incidence rate of AVN following initiation of ERT was determined. An incidence rate of AVN of 13·8 per 1000 person-years was observed in patients receiving ERT. Patients who initiated ERT within 2 years of diagnosis had an incidence rate of 8·1 per 1000 person-years; patients who started ERT ≥2 years after diagnosis had an incidence rate of 16·6 per 1000 person-years. The adjusted incidence rate ratio was 0·59 [95% confidence interval (CI) 0·36–0·96, P = 0·0343]. Splenectomy was an independent risk factor for AVN (adjusted incidence rate ratio 2·23, 95% CI 1·61–3·08, P < 0·0001). In conclusion, the risk of AVN was reduced among patients who initiated ERT within 2 years of diagnosis, compared to initiating treatment ≥2 years after diagnosis. A higher risk of AVN was observed among patients who had previously undergone splenectomy. PMID:19732054

A comparative review of nurse turnover rates and costs across countries.

PubMed

Duffield, Christine M; Roche, Michael A; Homer, Caroline; Buchan, James; Dimitrelis, Sofia

2014-12-01

To compare nurse turnover rates and costs from four studies in four countries (US, Canada, Australia, New Zealand) that have used the same costing methodology; the original Nursing Turnover Cost Calculation Methodology. Measuring and comparing the costs and rates of turnover is difficult because of differences in definitions and methodologies. Comparative review. Searches were carried out within CINAHL, Business Source Complete and Medline for studies that used the original Nursing Turnover Cost Calculation Methodology and reported on both costs and rates of nurse turnover, published from 2014 and prior. A comparative review of turnover data was conducted using four studies that employed the original Nursing Turnover Cost Calculation Methodology. Costing data items were converted to percentages, while total turnover costs were converted to US 2014 dollars and adjusted according to inflation rates, to permit cross-country comparisons. Despite using the same methodology, Australia reported significantly higher turnover costs ($48,790) due to higher termination (~50% of indirect costs) and temporary replacement costs (~90% of direct costs). Costs were almost 50% lower in the US ($20,561), Canada ($26,652) and New Zealand ($23,711). Turnover rates also varied significantly across countries with the highest rate reported in New Zealand (44·3%) followed by the US (26·8%), Canada (19·9%) and Australia (15·1%). A significant proportion of turnover costs are attributed to temporary replacement, highlighting the importance of nurse retention. The authors suggest a minimum dataset is also required to eliminate potential variability across countries, states, hospitals and departments. © 2014 John Wiley & Sons Ltd.

Management of End-Stage Ankle Arthritis: Cost-Utility Analysis Using Direct and Indirect Costs.

PubMed

Nwachukwu, Benedict U; McLawhorn, Alexander S; Simon, Matthew S; Hamid, Kamran S; Demetracopoulos, Constantine A; Deland, Jonathan T; Ellis, Scott J

2015-07-15

Total ankle replacement and ankle fusion are costly but clinically effective treatments for ankle arthritis. Prior cost-effectiveness analyses for the management of ankle arthritis have been limited by a lack of consideration of indirect costs and nonoperative management. The purpose of this study was to compare the cost-effectiveness of operative and nonoperative treatments for ankle arthritis with inclusion of direct and indirect costs in the analysis. Markov model analysis was conducted from a health-systems perspective with use of direct costs and from a societal perspective with use of direct and indirect costs. Costs were derived from the 2012 Nationwide Inpatient Sample (NIS) and expressed in 2013 U.S. dollars; effectiveness was expressed in quality-adjusted life years (QALYs). Model transition probabilities were derived from the available literature. The principal outcome measure was the incremental cost-effectiveness ratio (ICER). In the direct-cost analysis for the base case, total ankle replacement was associated with an ICER of $14,500/QALY compared with nonoperative management. When indirect costs were included, total ankle replacement was both more effective and resulted in $5900 and $800 in lifetime cost savings compared with the lifetime costs following nonoperative management and ankle fusion, respectively. At a $100,000/QALY threshold, surgical management of ankle arthritis was preferred for patients younger than ninety-six years and total ankle replacement was increasingly more cost-effective in younger patients. Total ankle replacement, ankle fusion, and nonoperative management were the preferred strategy in 83%, 12%, and 5% of the analyses, respectively; however, our model was sensitive to patient age, the direct costs of total ankle replacement, the failure rate of total ankle replacement, and the probability of arthritis after ankle fusion. Compared with nonoperative treatment for the management of end-stage ankle arthritis, total ankle replacement is preferred over ankle fusion; total ankle replacement is cost-saving when indirect costs are considered and demonstrates increasing cost-effectiveness in younger patients. As indications for and utilization of total ankle replacement increase, continued research is needed to define appropriate subgroups of patients who would likely derive the greatest clinical benefit from that procedure. Economic and decision analysis Level II. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Standard versus accelerated initiation of renal replacement therapy in acute kidney injury (STARRT-AKI): study protocol for a randomized controlled trial.

PubMed

Smith, Orla M; Wald, Ron; Adhikari, Neill K J; Pope, Karen; Weir, Matthew A; Bagshaw, Sean M

2013-10-05

Acute kidney injury is a common and devastating complication of critical illness, for which renal replacement therapy is frequently needed to manage severe cases. While a recent systematic review suggested that "earlier" initiation of renal replacement therapy improves survival, completed trials are limited due to small size, single-centre status, and use of variable definitions to define "early" renal replacement therapy initiation. This is an open-label pilot randomized controlled trial. One hundred critically ill patients with severe acute kidney injury will be randomly allocated 1:1 to receive "accelerated" initiation of renal replacement therapy or "standard" initiation at 12 centers across Canada. In the accelerated arm, participants will have a venous catheter placed and renal replacement therapy will be initiated within 12 hours of fulfilling eligibility. In the standard initiation arm, participants will be monitored over 7 days to identify indications for renal replacement therapy. For participants in the standard arm with persistent acute kidney injury, defined as a serum creatinine not declining >50% from the value at the time of eligibility, the initiation of RRT will be discouraged unless one or more of the following criteria are fulfilled: serum potassium ≥6.0 mmol/L; serum bicarbonate ≤10 mmol/L; severe respiratory failure (PaO₂/FiO₂<200) or persisting acute kidney injury for ≥72 hours after fulfilling eligibility. The inclusion criteria are designed to identify a population of critically ill adults with severe acute kidney injury who are likely to need renal replacement therapy during their hospitalization, but not immediately. The primary outcome is protocol adherence (>90%). Secondary outcomes include measures of feasibility (proportion of eligible patients enrolled in the trial, proportion of enrolled patients followed to 90 days for assessment of vital status and the need for renal replacement therapy) and safety (occurrence of adverse events). The optimal timing of renal replacement therapy initiation in patients with severe acute kidney injury remains uncertain, representing an important knowledge gap and a priority for high-quality research. This pilot trial is necessary to establish protocol feasibility, confirm the safety of participants and obtain estimated events rates for design of a large definitive trial. NCT01557361.

Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years.

PubMed

Guery, Jacques; Favard, Luc; Sirveaux, François; Oudet, Didier; Mole, Daniel; Walch, Gilles

2006-08-01

Reverse total shoulder arthroplasty is currently being used to treat selected patients with disabling shoulder arthropathy. The purposes of this study were to investigate the medium-term results of reverse total shoulder arthroplasty and to analyze the influence of etiology on the result. We carried out a multicenter study with a minimum follow-up of five years and determined the survival rate of the prosthesis according to the initial etiology of the shoulder arthropathy. Eighty prostheses were implanted in seventy-seven patients between 1992 and 1998. Sixty-six shoulders had an arthropathy with a massive rotator cuff tear, and fourteen shoulders had a disorder with another etiology (rheumatoid arthritis, trauma, or revision arthropathy). At the time of review, eighteen patients had died and two were lost to follow-up. The remaining fifty-seven patients (sixty shoulders) were examined or interviewed by telephone at a mean follow-up of 69.6 months. Cumulative survival curves were generated with replacement of the prosthesis, glenoid loosening, and a functional Constant score of <30 as the end points. The survival rate with replacement of the prosthesis and glenoid loosening as the end points were 91% and 84%, respectively, at 120 months, with shoulders that had arthropathy with a massive rotator cuff tear demonstrating a significantly better result than those that had a disorder with another etiology (p < 0.05). On the other hand, the survival rate with an absolute Constant score of <30 as an end point was 58% at 120 months, with no significant difference with respect to etiology. Two breaks were observed in the survival curves. The first concerned survival until replacement of the prosthesis and occurred at around three years, reflecting early loosening of the prosthesis. The curve then became stable. A second break started at around six years and reflected progressive deterioration of the functional result. Our findings indicate that the reverse total prosthesis should be reserved for the treatment of very disabling shoulder arthropathy with a massive rotator cuff rupture, and it should be used exclusively in patients over seventy years old with low functional demands.

WATCHMAN: A Data Warehouse Intelligent Cache Manager

NASA Technical Reports Server (NTRS)

Scheuermann, Peter; Shim, Junho; Vingralek, Radek

1996-01-01

Data warehouses store large volumes of data which are used frequently by decision support applications. Such applications involve complex queries. Query performance in such an environment is critical because decision support applications often require interactive query response time. Because data warehouses are updated infrequently, it becomes possible to improve query performance by caching sets retrieved by queries in addition to query execution plans. In this paper we report on the design of an intelligent cache manager for sets retrieved by queries called WATCHMAN, which is particularly well suited for data warehousing environment. Our cache manager employs two novel, complementary algorithms for cache replacement and for cache admission. WATCHMAN aims at minimizing query response time and its cache replacement policy swaps out entire retrieved sets of queries instead of individual pages. The cache replacement and admission algorithms make use of a profit metric, which considers for each retrieved set its average rate of reference, its size, and execution cost of the associated query. We report on a performance evaluation based on the TPC-D and Set Query benchmarks. These experiments show that WATCHMAN achieves a substantial performance improvement in a decision support environment when compared to a traditional LRU replacement algorithm.

Characterization of solidified radioactive waste due to the incorporation of high- and low-density polyethylene granules and titanium dioxide in mortar matrices

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

Peric, A.

1997-12-31

The rutile form of titanium dioxide and granules of high density polyethylene (PEHD) and low density polyethylene (PELD) were used to prepare mortar matrices for immobilization of radioactive waste materials containing {sup 137}Cs. PELD, PEHD and TiO{sub 2} were added to mortar matrix preparations with the objective of improving physico-chemical characteristics of the radwaste-mortar matrix mixtures, in particular the leach-rate of the immobilized radionuclide. One type of PELD and two types of PEHD were used to replace 50 wt.% of stone granules normally used in the matrix, in order to decrease the porosity and density of the mortar matrix andmore » to avoid segregation of the stone particles at the bottom of the immobilized radioactive waste cylindrical form. TiO{sub 2} was also added to the mortar formulation, replacing 5 and 8 wt.% of the total cement weight. Cured samples were investigated under temperature stress conditions, where the temperature extremes were: T{sub min} = {minus}20 C, T{sub max} = +70 C. Samples were periodically immersed in distilled water at the ambient room temperature, after each freezing and heating treatment. Results of accelerated leaching experiments for these samples and samples prepared exclusively with polyethylenes replacing 100% of the stone granules and TiO{sub 2}, treated in nonaccelerated leaching experiments, were compared. Even using an accelerated ageing leach test that overestimates {sup 137}Cs leach rates, it can be deduced, that radionuclide leach rates from the radioactive waste mortar mixture forms were improved. Leach rates decreased from 5%, for the material prepared with stone aggregate, to 3.1 to 4.0%, for the materials prepared solely with PEHD, PELD or TiO{sub 2}, and to about 3% for all six types of the TiO{sub 2}-PEHD and TiO{sub 2}-PELD mixtures tested.« less

Locomotion in simulated microgravity: gravity replacement loads

NASA Technical Reports Server (NTRS)

McCrory, Jean L.; Baron, Heidi A.; Balkin, Sandy; Cavanagh, Peter R.

2002-01-01

BACKGROUND: When an astronaut walks or runs on a treadmill in microgravity, a subject load device (SLD) is used to return him or her back to the treadmill belt. The gravity replacement load (GRL) in the SLD is transferred, via a harness, to the pelvis and/or the shoulders. This research compared comfort and ground reaction forces during treadmill running in a microgravity locomotion simulator at GRLs of 60%, 80%, and 100% of body weight (BW). Two harness designs (shoulder springs only (SSO) and waist and shoulder springs (WSS)) were used. HYPOTHESES: 1) The 100% BW gravity replacement load conditions would be comfortably tolerated and would result in larger ground reaction forces and loading rates than the lower load conditions, and 2) the WSS harness would be more comfortable than the SSO harness. METHODS: Using the Penn State Zero Gravity Locomotion Simulator (ZLS), 8 subjects ran at 2.0 m x s(-1) (4.5 mph) for 3 min at each GRL setting in each harness. Subjective ratings of harness comfort, ground reaction forces, and GRL data were collected during the final minute of exercise. RESULTS: The 100% BW loading conditions were comfortably tolerated (2.3 on a scale of 0-10), although discomfort increased as the GRL increased. There were no overall differences in perceived comfort between the two harnesses. The loading rates (27.1, 33.8, 39.1 BW x s(-1)) and the magnitudes of the first (1.0, 1.4, 1.6 BW) and second (1.3, 1.7, 1.9 BW) peaks of the ground reaction force increased with increasing levels (60, 80, 100% BW respectively) of GRL. CONCLUSIONS: Subjects were able to tolerate a GRL of 100% BW well. The magnitude of the ground reaction force peaks and the loading rate is directly related to the magnitude of the GRL.

NASA Shuttle Logistics Depot (NSLD) - The application of ATE

NASA Technical Reports Server (NTRS)

Simpkins, Lorenz G.; Jenkins, Henry C.; Mauceri, A. Jack

1990-01-01

The concept of the NASA Shuttle Logistics Depot (NSLD) developed for the Space Shuttle Orbiter Program is described. The function of the NSLD at Cape Canaveral is to perform the acceptance and diagnostic testing of the Shuttle's space-rated line-replaceable units and shop-replaceable units (SRUs). The NSLD includes a comprehensive electronic automatic test station, program development stations, and assorted manufacturing support equipment (including thermal and vibration test equipment, special test equipment, and a card SRU test system). The depot activities also include the establishment of the functions for manufacturing of mechanical parts, soldering, welding, painting, clean room operation, procurement, and subcontract management.

Effects of changing the ionic environment on passive and active membrane properties of pregnant rat uterus

PubMed Central

Abe, Y.

1971-01-01

1. In pregnant rat myometrium electrotonic potentials, produced by externally applied current, were recorded intracellularly. 2. The space constant, λ, was 1·8 mm, the time constant, τm, 120 msec. The values obtained on the 7th day and on the 20th day of pregnancy were the same. 3. The magnitude of the electrotonic potential and the time constant of the membrane were increased in the absence of potassium from the external solution and decreased by excess potassium. 4. The magnitude of the electrotonic potential and the time constant of the membrane were increased by the replacement of chloride with C6H5SO3- or SO42-, and decreased with NO3- or I- replacement. 5. When the sodium chloride was replaced with sucrose (16·7 mM sodium remaining in the buffers) the spontaneous spikes deteriorated and activity stopped within 30 min. However, for periods up to 4 hr, a spike of larger amplitude and faster rate of rise than in normal solution could be evoked when a depolarizing current was applied. 6. When the external calcium concentration was raised (5 and 10 mM) the amplitude and the rate of rise of the evoked spike were increased. They were decreased by reducing calcium. In zero calcium spontaneous activity stopped within 15 min. 7. The effects of calcium deficiency were much less marked and slower in onset when, simultaneously, the sodium concentration was reduced to 16·7 mM. 8. When calcium was replaced with strontium (2·5 mM), the membrane was depolarized and the duration of the spontaneous and evoked action potential was prolonged, mainly due to a slowed rate of repolarization. When the concentration of strontium was raised to 7·5 or 12·5 mM the membrane was hyperpolarized, the duration of the action potential became short and the amplitude of the spike was increased. 9. Addition of barium or the replacement of calcium with barium caused depolarization and oscillatory membrane activity. However, a spike could be evoked by applying conditioning hyperpolarization. 10. Manganese abolished the spontaneous and evoked spike. Tetrodotoxin had no effect. 11. The results show that rat uterus has cable-like properties. The action potential may be due to calcium entry, while sodium, by influencing the membrane potential in competition with calcium, may be involved in the spontaneous spike generation and the spread of excitation. PMID:5103422

Plasma protein and supplemental isoleucine in milk replacers for dairy calves.

PubMed

Vasquez, K M; Morrison, S Y; Campbell, J M; Drackley, J K

2017-01-01

We measured the effects of milk replacers containing 0, 33, 66, or 100% of the total replaceable whey protein as bovine plasma protein (PP), without or with Ile supplementation, on the intake, growth, and health of 124 male Holstein calves for 35d. Milk replacers were formulated to contain 18% crude protein and 20% fat, with contents of Lys and Met equalized. When fed to calves at 1.5% of body weight (dry matter basis) under thermoneutral conditions, diets were predicted to allow average daily gains of 0.55kg/d based on metabolizable energy or 0.40kg/d based on apparent digestible protein. Protein supply was more limiting than energy so that differences in protein use could be detected. Dry matter intakes decreased with increased PP, irrespective of Ile supplementation. Final body weights decreased linearly with increasing PP, regardless of Ile supplementation. Average daily gain tended to be affected in a quadratic manner as PP increased, either with or without Ile supplementation; average daily gain and gain-feed ratio were greatest for calves fed diets containing 33% PP and lowest for calves fed 100% PP. The analyzed Lys content in the milk replacers was variable compared with formulated values, and this may have affected growth results. However, the gain-Lys ratio was affected by an interaction of the linear effect of increasing PP with Ile supplementation: it decreased with increasing PP but was improved by supplementation with Ile for calves fed 100% PP. Body measurements decreased with increasing PP inclusion; only decreased heart girth was reversed with Ile supplementation. The lowest and highest inclusion of PP, regardless of Ile supplementation, decreased the occurrence of scours compared with the control diet (all whey protein). Calves fed the lowest and highest PP without Ile supplementation also had fewer total days of scours in the first 21d. In addition, calves fed 100% PP without supplementation of Ile had fewer days of medication compared with the control diet. Even at the highest PP inclusion, average daily gain was minimally affected if Ile was supplemented. Growth rates, gain-feed ratio, and gain-Lys ratio were decreased at higher PP inclusion, but Ile overcame part of the reduction in gain-Lys ratio for 100% PP. Additional titration studies will have to be conducted to determine optimal PP inclusion rates, with a focus on supplementation of potentially limiting essential AA, as well as effects at higher growth rates. Copyright © 2017 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

40 CFR 270.4 - Effect of a permit.

Code of Federal Regulations, 2010 CFR

2010-07-01

... regarding leak detection systems for new and replacement surface impoundment, waste pile, and landfill units, and lateral expansions of surface impoundment, waste pile, and landfill units. The leak detection system requirements include double liners, CQA programs, monitoring, action leakage rates, and response...

Administrator's Guide to Technology: Planning, Funding & Implementation.

ERIC Educational Resources Information Center

Aspen Education Development Group, Gaithersburg, MD.

This document provides guidelines for administrators related to instructional technology and planning. Chapter 1 discusses planning, including developing a technology plan, facility assessment, e-rate planning, formation of a technology committee, budget planning, and hardware/software replacement plan and costs. Chapter 2 addresses…

Ladies and Gentlemen, Start Your Engines.

ERIC Educational Resources Information Center

Cates, Ward Mitchell

1983-01-01

An approach to problem solving is described that is based on analysis of how fast model race cars can go. The exercises were used to replace standard time/rate/distance exercises, and were found to be greatly enjoyed by both girls and boys. (MP)

Influence of starter protein content on growth of dairy calves in an enhanced early nutrition program.

PubMed

Stamey, J A; Janovick, N A; Kertz, A F; Drackley, J K

2012-06-01

Our objectives were to determine the effect of starter crude protein (CP) content on growth of Holstein calves from birth to 10 wk of age in an enhanced early nutrition program, and to compare the enhanced program to a conventional milk replacer program. Calves (64 female, 25 male) were assigned to 3 treatments in a randomized block design: 1) conventional milk replacer (20% CP, 20% fat) plus conventional starter [19.6% CP, dry matter (DM) basis], 2) enhanced milk replacer (28.5% CP, 15% fat) plus conventional starter, and 3) enhanced milk replacer plus high-CP starter (25.5% CP, DM basis). Calves began treatments (n=29, 31, and 29 for treatments 1 to 3) at 3 d of age. Conventional milk replacer (12.5% solids) was fed at 1.25% of birth body weight (BW) as DM daily in 2 feedings from wk 1 to 5 and at 0.625% of birth BW once daily during wk 6. Enhanced milk replacer (15% solids) was fed at 1.5% of BW as DM during wk 1 and 2% of BW as DM during wk 2 to 5, divided into 2 daily feedings. During wk 6, enhanced milk replacer was fed at 1% of BW as DM once daily. Calves were weaned at d 42. Starter was available for ad libitum intake starting on d 3. Starter intake was greater for calves fed conventional milk replacer. For calves fed enhanced milk replacer, starter intake tended to be greater for calves fed enhanced starter. During the weaning period, enhanced starter promoted greater starter DM intake than the conventional starter. Over the 10-wk study, the average daily gain of BW (0.64, 0.74, and 0.80 kg/d) was greater for calves fed enhanced milk replacer with either starter and, for calves fed enhanced milk replacer, tended to be greater for calves fed high-CP starter. Rates of change in withers height, body length, and heart girth were greater for calves fed enhanced milk replacer but did not differ between starter CP concentrations. The postweaning BW for enhanced milk replacer treatments was greater for calves receiving the enhanced starter at wk 8 (73.7, 81.3, and 85.8 kg) and wk 10 (88.0, 94.9, and 99.9 kg). Starter CP content did not affect height, length, or heart girth within enhanced milk replacer treatments. Regression analysis showed that gain of BW during the first week postweaning (wk 7) increased with greater 3-d mean starter intake in the week before weaning. Starter with 25.5% CP (DM basis) provided modest benefits in starter intake (particularly around weaning) and growth for dairy calves in an enhanced early nutrition program compared with a conventional starter (19.6% CP). Copyright © 2012 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

A preprocessor for the Urbana coherent-scatter radar

NASA Technical Reports Server (NTRS)

Zendt, F. T.; Bowhill, S. A.

1982-01-01

The design, interfacing, testing, and operation of a preprocessor to increase the altitude and temporal resolution of the present coherent-scatter system are described. This system upgrade requires an increase in the data collection rate. Replacing the present, relatively slow, ADC with two high speed ADCs achieves the increased echo sampling rate desired. To stay within the capabilities of the main computer's I/O and processing rate the data must be reduced before transfer to the main computer. Thus the preprocessor also coherently integrates the data before transfer.

Sediment acoustic index method for computing continuous suspended-sediment concentrations

USGS Publications Warehouse

Landers, Mark N.; Straub, Timothy D.; Wood, Molly S.; Domanski, Marian M.

2016-07-11

Once developed, sediment acoustic index ratings must be validated with additional suspended-sediment samples, beyond the period of record used in the rating development, to verify that the regression model continues to adequately represent sediment conditions within the stream. Changes in ADVM configuration or installation, or replacement with another ADVM, may require development of a new rating. The best practices described in this report can be used to develop continuous estimates of suspended-sediment concentration and load using sediment acoustic surrogates to enable more informed and accurate responses to diverse sedimentation issues.

Long-Term Adaptive Servo-Ventilator Treatment Prevents Cardiac Death and Improves Clinical Outcome.

PubMed

Imamura, Teruhiko; Kinugawa, Koichiro; Nitta, Daisuke; Komuro, Issei

2016-01-01

Adaptive servo-ventilation (ASV) is a recently developed, noninvasive therapeutic tool for the treatment of heart failure (HF). However, the efficacy of ASV therapy in patients with advanced HF remains uncertain, especially as regards its contribution to freedom from cardiac replacement therapy. A total of 85 patients with advanced HF (New York Heart Association [NYHA] class IV 71%, inotrope infusion-dependent 34%) refractory to guideline-directed medical therapy, received ASV therapy, irrespective of sleep-disordered breathing, at our institute between 2008 and 2014. Among these 85 patients, 46 continued ASV therapy for > 1 month (continued group), whereas 39 discontinued the therapy after < 1 month because of intolerance (discontinued group). There were no significant differences in baseline variables between the two groups. Heart rate indicating sympathetic activity, left ventricular (LV) reverse remodeling assessed by LV diastolic diameter, LV ejection fraction, and the grades of mitral and tricuspid regurgitations, HF severity assessed by NYHA class and plasma level of B-type natriuretic peptide, and end-organ dysfunction, improved significantly at 6 months following the initiation of ASV therapy (P < 0.05 for all). All-cause mortality and cardiac death rate were significantly lower during 2-year follow up in the continued group (P < 0.05 for both). In conclusion, ASV is a novel therapeutic tool prior to cardiac replacement therapy in patients with advanced HF and may prolong the period until cardiac replacement therapy becomes necessary.

Complications of porous-coated press-fit cementless total hip replacement in dogs.

PubMed

Kidd, Scott W; Preston, Christopher A; Moore, George E

2016-09-20

To report postoperative complications using a commercially available porous-coated press-fit cementless total hip replacement (THR) system in dogs. Medical records were reviewed for client-owned dogs with hip pathologies requiring THR. A minimum of six-week postoperative orthopaedic examination and orthogonal pelvic radiographs were used to assess outcome and complications in the perioperative period. Referring veterinarian medical records, phone interviews with clients, or both were used to assess long-term functional outcome and complications. Bilateral THR was performed in 36 dogs, and unilateral in 147 dogs, making a total of 219 THR procedures in 183 dogs. A total complication rate of 31.1% (68/219) was observed. A catastrophic complication was observed in 8.2% (n = 18), a major complication in 9.6% (n = 21), and a minor complication in 13.2% (n = 29) of procedures. The most common complications were intra-operative femoral fissure (n = 46), diaphyseal femoral fracture (n = 15), and coxofemoral luxation (n = 9). Full return to function was achieved in 88.1% of procedures with a median follow-up period of 42 months. Porous-coated press-fit cementless collarless total hip replacements have a high complication rate. The majority of complications occur intra-operatively or perioperatively, with few complications occurring beyond 12 weeks postoperatively. Both fissure fractures and diaphyseal femoral fractures carry a favourable prognosis with immediate cerclage wiring and plate fixation, respectively.

Proximal femoral bone loss and increased rate of fracture with a proximally hydroxyapatite-coated femoral component.

PubMed

Radl, R; Aigner, C; Hungerford, M; Pascher, A; Windhager, R

2000-11-01

We performed a retrospective analysis of the clinical and radiological outcomes of total hip replacement using an uncemented femoral component proximally coated with hydroxyapatite. Of 136 patients, 118 who had undergone 124 primary total hip replacements were available for study. Their mean age was 66.5 years (19 to 90) and the mean follow-up was 5.6 years (4.25 to 7.25). At the final follow-up the mean Harris hip score was 92 (47.7 to 100). Periprosthetic femoral fractures, which occurred in seven patients (5.6%), were treated by osteosynthesis in six and conservatively in one. We had to revise five femoral components, one because of aseptic loosening, one because of septic loosening and three because of periprosthetic fracture. At the final follow-up there were definite signs of aseptic loosening in two patients. Radiologically, proximal femoral bone loss in Gruen zones I and VI was evident in 96.8% of hips, while bone hypertrophy in zones III and V was seen in 64.7%. In 24 hips (20.2%) the mean subsidence of the stem was 3.7 mm which occurred within the first 12 postoperative weeks. This indicated poor initial stability, which might have been aggravated by early weight-bearing. The high rate of failure in our study suggests that proximal femoral bone loss affects the long-term survival of the replacement.

High incidence of loosening of the femoral component in legacy posterior stabilised-flex total knee replacement.

PubMed

Han, H S; Kang, S-B; Yoon, K S

2007-11-01

We have examined the results obtained with 72 NexGen legacy posterior stabilised-flex fixed total knee replacements in 47 patients implanted by a single surgeon between March 2003 and September 2004. Aseptic loosening of the femoral component was found in 27 (38%) of the replacements at a mean follow-up of 32 months (30 to 48) and 15 knees (21%) required revision at a mean of 23 months (11 to 45). We compared the radiologically-loose and revised knees with those which had remained well-fixed to identify the factors which had contributed to this high rate of aseptic loosening. Post-operatively, the mean maximum flexion was 136 degrees (110 degrees to 140 degrees) in the loosened group and 125 degrees (95 degrees to 140 degrees) in the well-fixed group (independent t-test, p = 0.022). Squatting, kneeling, or sitting cross-legged could be achieved by 23 (85%) of the loosened knees, but only 22 (49%) of the well-fixed knees (chi-squared test, p = 0.001). The loosened femoral components were found to migrate into a more flexed position, but no migration was detected in the well-fixed group. These implants allowed a high degree of flexion, but showed a marked rate of early loosening of the femoral component, which was associated with weight-bearing in maximum flexion.

Younger age increases the risk of early prosthesis failure following primary total knee replacement for osteoarthritis. A follow-up study of 32,019 total knee replacements in the Finnish Arthroplasty Register.

PubMed

Julin, Jaakko; Jämsen, Esa; Puolakka, Timo; Konttinen, Yrjö T; Moilanen, Teemu

2010-08-01

Total knee replacements (TKRs) are being increasingly performed in patients aged < or = 65 years who often have high physical demands. We investigated the relation between age of the patient and prosthesis survival following primary TKR using nationwide data collected from the Finnish Arthroplasty Register. From Jan 1, 1997 through Dec 31, 2003, 32,019 TKRs for primary or secondary osteoarthritis were reported to the Finnish Arthroplasty Register. The TKRs were followed until the end of 2004. During the follow-up, 909 TKRs were revised, 205 (23%) due to infection and 704 for other reasons. Crude overall implant survival improved with increasing age between the ages of 40 and 80. The 5-year survival rates were 92% and 95% in patients aged < or = 55 and 56-65 years, respectively, compared to 97% in patients who were > 65 years of age (p < 0.001). The difference was mainly attributable to reasons other than infections. Sex, diagnosis, type of TKR (condylar, constrained, or hinge), use of patellar component, and fixation method were also associated with higher revision rates. However, the differences in prosthesis survival between the age groups < or = 55, 56-65, and > 65 years remained after adjustment for these factors (p < 0.001). Young age impairs the prognosis of TKR and is associated with increased revision rates for non-infectious reasons. Diagnosis, sex, type of TKR, use of patellar component, and fixation method partly explain the differences, but the effects of physical activity, patient demands, and obesity on implant survival in younger patients warrant further research.

Relative Expression of PBMC MicroRNA-133a Analysis in Patients Receiving Warfarin After Mechanical Heart Valve Replacement

PubMed Central

Kabiri Rad, Hamid; Mazaheri, Mahta; Dehghani Firozabadi, Ali

Background: MicroRNAs (miRNAs) are implicated in various biological processes including anticoagulation. However, the modulation of miRNA by pharmacological intervention such as warfarin treatment in patients receiving warfarin has not been disclosed yet. The aim of this study work was to assess the effect of warfarin drug on expression level of mir-133a-3p in patients with mechanical heart valve replacement. Methods: In this research, the expression level of miRNA-133a-3p was analyzed in Peripheral Blood Mononuclear Cells (PBMCs) from mechanical valve replacement patients who had received warfarin for at least 3 months continuously. Quantitative RT-PCR method was used for this assay. Results: Our findings indicated a significant diffrence between the rate of miR-133a-3p expression in individuals receiving warfarin and the control group (p<0.01). There was also a statistically significant difference in miR-133a-3p expression in patients with different ages (p<0.05) suggesting that the rate of miR-133a-3p expression in persons receiving warfarin is related to age. However, other variables like warfarin dose, International Normalized Ratio (INR), gender, and Body Mass Index (BMI) were not significantly effective on the miR-133a-3p experssion rate in individuals receving warfarin. Conclusion: Based on our results, it can be concluded that miR-133a-3p is involved in the coagulation pathway. The recent result indicates that warfarin affects the expression of miR-133a. This expression may be potentially important for treatment by anticoagulants. Awareness of the time course of miRNA expression profile can improve efficiency of response to warfarin. PMID:29296264

Hemodialysis tunneled central venous catheters: five-year outcome analysis.

PubMed

Mandolfo, Salvatore; Acconcia, Pasqualina; Bucci, Raffaella; Corradi, Bruno; Farina, Marco; Rizzo, Maria Antonietta; Stucchi, Andrea

2014-01-01

Tunneled central venous catheters (tCVCs) are considered inferior to arteriovenous fistulas (AVFs) and grafts in all nephrology guidelines. However, they are being increasingly used as hemodialysis vascular access. The purpose of this study was to document the natural history of tCVCs and determine the rate and type of catheter replacement. This was a prospective study of 141 patients who underwent hemodialysis with tCVCs between January 2008 and December 2012. The patients used 154 tCVCs. Standard protocols about management of tCVCs, according to European Renal Best Practice, were well established. All catheters were inserted in the internal jugular vein. Criteria for catheter removal were persistent bloodstream infection, detection of an outbreak of catheter-related bloodstream (CRBS) infections, or catheter dysfunction. Event rates were calculated per 1,000 catheter days; tCVC cumulative survival was estimated by Kaplan-Meier analysis. Catheter replacement occurred in 15 patients (0.29 per 1,000 days); catheter dysfunction was the main cause of replacement (0.18 per 1,000 days), typically within 12 months of surgical insertion. A total of 53 CRBS events in 36 patients were identified (0.82 per 1,000 days); 17 organisms, most commonly Gram-positive pathogens, were isolated; 87% of CVC infections were treated by systemic antibiotics associated with lock therapy. tCVC cumulative survival was 91% at 1 year, 88% at 2 years and 85% at 4 years. Our data show a high survival rate of tCVCs in hemodialysis patients, with low incidence of catheter dysfunction and CRBS events. These data justify tCVC use for hemodialysis vascular access, also as first choice, especially in patients with exhausted peripheral access and limited life expectancy.

Efficacy of a novel strategy for poststernotomy deep sternal infection after thoracic aorta replacement using a prosthetic graft.

PubMed

Kuriyama, Motone; Yoshida, Yukitaka; Ninomiya, Hitoshi; Yamamoto, Shin; Sasaguri, Shiro; Akita, Shinsuke; Mitsukawa, Nobuyuki

2018-05-01

Poststernotomy deep sternal wound infections are persistent and occasionally fatal, especially in cases involving prosthetic grafts, because of their complicated structure and virtual impossibility of removal. We aimed to verify the influence of cooperation with plastic surgeons and our novel strategy for treating deep sternal wound infection after aortic replacement on cardiovascular surgery outcomes. Nine hundred eighty-three consecutive patients were divided into two groups: an early group (2012-2013) and a late group (2014-2015). The late group had received cooperatively improved perioperative wound management: our novel strategy of deep sternal infection based on radical debridement and immediate reconstruction decided by reference to severities of the patient's general condition and widespread infection by early intervention of plastic surgeons. The groups were analysed retrospectively. Binary variables were analysed statistically with the Fisher exact test and continuous variables with the Mann-Whitney U test. Inter-group differences were assessed with the chi-square test. Twenty of 390 cases in the early group and 13 of 593 cases in the late group were associated with deep sternal infection. Morbidity rates of deep sternal wound infection and associated mortality rates 1 year after reconstruction surgery were significantly less (p <0.05 for both) in the late group. Intervention by plastic surgeons improved perioperative wound management outcomes. Our treatment strategy for deep sternal wound infection also reduced associated mortality rates. Facilities should consider the early inclusion of plastic surgeons in the treatment of patients undergoing aortic replacement to facilitate better outcomes. Copyright © 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Has Metal-On-Metal Resurfacing Been a Cost-Effective Intervention for Health Care Providers?-A Registry Based Study.

PubMed

Pulikottil-Jacob, Ruth; Connock, Martin; Kandala, Ngianga-Bakwin; Mistry, Hema; Grove, Amy; Freeman, Karoline; Costa, Matthew; Sutcliffe, Paul; Clarke, Aileen

2016-01-01

Total hip replacement for end stage arthritis of the hip is currently the most common elective surgical procedure. In 2007 about 7.5% of UK implants were metal-on-metal joint resurfacing (MoM RS) procedures. Due to poor revision performance and concerns about metal debris, the use of RS had declined by 2012 to about a 1% share of UK hip procedures. This study estimated the lifetime cost-effectiveness of metal-on-metal resurfacing (RS) procedures versus commonly employed total hip replacement (THR) methods. We performed a cost-utility analysis using a well-established multi-state semi-Markov model from an NHS and personal and social services perspective. We used individual patient data (IPD) from the National Joint Registry (NJR) for England and Wales on RS and THR surgery for osteoarthritis recorded from April 2003 to December 2012. We used flexible parametric modelling of NJR RS data to guide identification of patient subgroups and RS devices which delivered revision rates within the NICE 5% revision rate benchmark at 10 years. RS procedures overall have an estimated revision rate of 13% at 10 years, compared to <4% for most THR devices. New NICE guidance now recommends a revision rate benchmark of <5% at 10 years. 60% of RS implants in men and 2% in women were predicted to be within the revision benchmark. RS devices satisfying the 5% benchmark were unlikely to be cost-effective compared to THR at a standard UK willingness to pay of £20,000 per quality-adjusted life-year. However, the probability of cost effectiveness was sensitive to small changes in the costs of devices or in quality of life or revision rate estimates. Our results imply that in most cases RS has not been a cost-effective resource and should probably not be adopted by decision makers concerned with the cost effectiveness of hip replacement, or by patients concerned about the likelihood of revision, regardless of patient age or gender.

Are Physics-Based Simulators Ready for Prime Time? Comparisons of RSQSim with UCERF3 and Observations.

NASA Astrophysics Data System (ADS)

Milner, K. R.; Shaw, B. E.; Gilchrist, J. J.; Jordan, T. H.

2017-12-01

Probabilistic seismic hazard analysis (PSHA) is typically performed by combining an earthquake rupture forecast (ERF) with a set of empirical ground motion prediction equations (GMPEs). ERFs have typically relied on observed fault slip rates and scaling relationships to estimate the rate of large earthquakes on pre-defined fault segments, either ignoring or relying on expert opinion to set the rates of multi-fault or multi-segment ruptures. Version 3 of the Uniform California Earthquake Rupture Forecast (UCERF3) is a significant step forward, replacing expert opinion and fault segmentation with an inversion approach that matches observations better than prior models while incorporating multi-fault ruptures. UCERF3 is a statistical model, however, and doesn't incorporate the physics of earthquake nucleation, rupture propagation, and stress transfer. We examine the feasibility of replacing UCERF3, or components therein, with physics-based rupture simulators such as the Rate-State Earthquake Simulator (RSQSim), developed by Dieterich & Richards-Dinger (2010). RSQSim simulations on the UCERF3 fault system produce catalogs of seismicity that match long term rates on major faults, and produce remarkable agreement with UCERF3 when carried through to PSHA calculations. Averaged over a representative set of sites, the RSQSim-UCERF3 hazard-curve differences are comparable to the small differences between UCERF3 and its predecessor, UCERF2. The hazard-curve agreement between the empirical and physics-based models provides substantial support for the PSHA methodology. RSQSim catalogs include many complex multi-fault ruptures, which we compare with the UCERF3 rupture-plausibility metrics as well as recent observations. Complications in generating physically plausible kinematic descriptions of multi-fault ruptures have thus far prevented us from using UCERF3 in the CyberShake physics-based PSHA platform, which replaces GMPEs with deterministic ground motion simulations. RSQSim produces full slip/time histories that can be directly implemented as sources in CyberShake, without relying on the conditional hypocenter and slip distributions needed for the UCERF models. We also compare RSQSim with time-dependent PSHA calculations based on multi-fault renewal models.

MEDIATORS OF THE RELATIONSHIP BETWEEN NICOTINE REPLACEMENT THERAPY AND SMOKING ABSTINENCE AMONG PEOPLE LIVING WITH HIV/AIDS

PubMed Central

Stanton, Cassandra A.; Lloyd-Richardson, Elizabeth E.; Papandonatos, George D.; de Dios, Marcel A.; Niaura, Raymond

2012-01-01

Cigarette smoking is highly prevalent among people living with HIV/AIDS and poses unique health risks. Smoking cessation programs tailored to this population have documented improved smoking outcomes with nicotine replacement therapy (NRT). The current study examined 6-month abstinence rates from a randomized clinical trial targeting 412 HIV-positive adult current smokers (51% European American, 19% African American, and 17% Hispanic American) and tested whether psychosocial variables, such as self-efficacy and decisional balance, mediated the relationship between NRT and long-term abstinence. Meeting criteria for complete mediation, 6-month smoking abstinence rates improved significantly with increases in these mediators, and the association of NRT and smoking abstinence was no longer significant once changes in self-efficacy and decisional balance were taken into account. Failure to translate gains in self-efficacy among African Americans into improved abstinence rates accounted for racial/ ethnic differences among participants. Specific psychosocial factors, such as self-efficacy, may be particularly amenable to change in cessation interventions and should be addressed with greater awareness of how cultural and social contextual factors impact treatment response among people living with HIV/AIDS. PMID:19537955

Replacing precious metals with carbide catalysts for hydrogenation reactions

DOE PAGES

Ruijun, Hou; Chen, Jingguang G.; Chang, Kuan; ...

2015-03-03

Molybdenum carbide (Mo₂C and Ni/Mo₂C) catalysts were compared with Pd/SiO₂ for the hydrogenation of several diene molecules, 1,3- butadiene, 1,3- and 1,4-cyclohexadiene (CHD). Compared to Pd/SiO₂, Mo₂C showed similar hydrogenation rate for 1,3-butadiene and 1,3-CHD and even higher rate for 1,4-CHD, but with significant deactivation rate for 1,3-CHD hydrogenation. However, the hydrogenation activity of Mo₂C could be completely regenerated by H₂ treatment at 723 K for the three molecules. The Ni modified Mo₂C catalysts retained similar activity for 1,3-butadiene hydrogenation with significantly enhanced selectivity for 1-butene production. The 1-butene selectivity increased with increasing Ni loading below 15%. Among the Nimore » modified Mo₂C catalysts, 8.6%Ni/Mo₂C showed the highest selectivity to 1-butene, which was even higher selectivity than that over Pd/SiO₂. Compared to Pd/SiO₂, both Mo₂C and Ni/Mo₂C showed combined advantages in hydrogenation activity and catalyst cost reduction, demonstrating the potential to use less expensive carbide catalysts to replace precious metals for hydrogenation reactions.« less

Aortic valve replacement in elderly patients.

PubMed

Glock, Y; Pecoul, R; Cerene, A; Laguerre, J; Puel, P

1984-01-01

The results for 62 consecutive patients aged 70 or more given aortic valve replacement (A.V.R.) between 1970 and 1982 are reported. All the patients were in the New York Heart Association (N.Y.H.A.) functional class III (29%) or IV (71%); 54.8% had angina and 30.6% had experienced syncope. Forty patients had aortic stenosis (A.S.), 10 had aortic regurgitation and 12 had mixed aortic valve disease. The operative myocardial infarction rate was 6.4%. Tilting disk valves were used. Eighty percent of the patients were anticoagulated with Warfarin whilst twenty percent received only antiplatelet drugs. All the patients were followed up for a mean period of 26 months; late mortality was 22.6% with 4.8% cardiac deaths. The thromboembolic rate was 1.6% and the disinsertion rate was 3.2%. Cerebral stroke was fatal in 3 cases in anticoagulated patients but the mechanism of the accident was not known. At the termination of the study 93% of surviving patients were in N.Y.H.A. class I or II. No patient was in class IV. The probability of five year survival is 71% for the entire group.

Optimization of wireless Bluetooth sensor systems.

PubMed

Lonnblad, J; Castano, J; Ekstrom, M; Linden, M; Backlund, Y

2004-01-01

Within this study, three different Bluetooth sensor systems, replacing cables for transmission of biomedical sensor data, have been designed and evaluated. The three sensor architectures are built on 1-, 2- and 3-chip solutions and depending on the monitoring situation and signal character, different solutions are optimal. Essential parameters for all systems have been low physical weight and small size, resistance to interference and interoperability with other technologies as global- or local networks, PC's and mobile phones. Two different biomedical input signals, ECG and PPG (photoplethysmography), have been used to evaluate the three solutions. The study shows that it is possibly to continuously transmit an analogue signal. At low sampling rates and slowly varying parameters, as monitoring the heart rate with PPG, the 1-chip solution is the most suitable, offering low power consumption and thus a longer battery lifetime or a smaller battery, minimizing the weight of the sensor system. On the other hand, when a higher sampling rate is required, as an ECG, the 3-chip architecture, with a FPGA or micro-controller, offers the best solution and performance. Our conclusion is that Bluetooth might be useful in replacing cables of medical monitoring systems.

24 CFR 266.420 - Closing and endorsement by the Commissioner.

Code of Federal Regulations, 2010 CFR

2010-04-01

.... (a) Closing. Before disbursement of loan advances in periodic advances cases, and in all cases after... market occupancy percentages, value/replacement cost, interest rate, and similar statistical information... certification for periodic advances cases, if submitted for final endorsement, that advances were made...

Weathering effects on fuel moisture sticks: corrections and recommendations.

Treesearch

Donald A. Haines; John S. Frost

1978-01-01

Describes response to weathering of 100-gram (1/2-inch) fuel moisture sticks over 6-month fire season in the Northeast. Presents a chart for correcting weathered-stick values and gives replacement recommendations for those sticks used in the National Fire Danger Rating System.

Growth arrest despite growth hormone replacement, post-craniopharyngioma surgery.

PubMed Central

DeVile, C J; Hayward, R D; Neville, B G; Grant, D B; Stanhope, R

1995-01-01

Children with growth failure, whether secondary to an endocrinopathy such as growth hormone deficiency or secondary to neurological handicap with poor nutrient intake, grow at a subnormal rate but it is most unusual for a child to have complete growth arrest. PMID:7745571

Assessment and evaluation of timber piles used in Nebraska for retrofit and rating.

DOT National Transportation Integrated Search

2014-04-01

The cost of an effective retrofitting and rehabilitation of timber piles is less than cost of replacing the piles. However, some of the retrofit options used in Nebraska failed to result in the expected performance levels. Further, design and detaili...

NON-POLLUTING REPLACEMENT FOR CHROMATE CONVERSION COATING & ZINC PHOSPHATING IN POWDER COATING APPLICATIONS

EPA Science Inventory

Picklex, a proprietary formulation, is an alternative to conventional metal surface pretreatments. Its developers claim that it does not produce waste or lower production rates, and it will maintain performance compared to conventional processes. A laboratory program was designed...

76 FR 10233 - Schedule of Water Charges

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-24

..., operation, maintenance, replacement, reserves and associated administrative costs.'' Id., par. A.2.b. The...'s Beltzville and Blue Marsh reservoirs. The rates established in 1978--$60 per million gallons for... reference, Water resources, Water reservoirs, Water supply, Watersheds. For the reasons set forth in the...

An update on blast furnace granular coal injection

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

Hill, D.G.; Strayer, T.J.; Bouman, R.W.

1997-12-31

A blast furnace coal injection system has been constructed and is being used on the furnace at the Burns Harbor Division of Bethlehem Steel. The injection system was designed to deliver both granular (coarse) and pulverized (fine) coal. Construction was completed on schedule in early 1995. Coal injection rates on the two Burns Harbor furnaces were increased throughout 1995 and was over 200 lbs/ton on C furnace in September. The injection rate on C furnace reached 270 lbs/ton by mid-1996. A comparison of high volatile and low volatile coals as injectants shows that low volatile coal replaces more coke andmore » results in a better blast furnace operation. The replacement ratio with low volatile coal is 0.96 lbs coke per pound of coal. A major conclusion of the work to date is that granular coal injection performs very well in large blast furnaces. Future testing will include a processed sub-bituminous coal, a high ash coal and a direct comparison of granular versus pulverized coal injection.« less

The economic value of rapid deployment aortic valve replacement via full sternotomy.

PubMed

Moore, Matt; Barnhart, Glenn R; Chitwood, W Randolph; Rizzo, John A; Gunnarsson, Candace; Palli, Swetha R; Grossi, Eugene A

2017-06-01

To compare the economic value of EDWARDS INTUITY Elite™ (EIE) valve system for rapid-deployment aortic valve replacement (RDAVR) in a full sternotomy (FS) approach (EIE-FS-RDAVR) versus FS-AVR using conventional stented bioprosthesis. A simulation model to compare each treatment's 30-day inpatient utilization and complication rates utilized: clinical end points obtained from the TRANSFORM trial patient subset (EIE-FS-RDAVR) and a best evidence review of the published literature (FS-AVR); and costs from the Premier database and published literature. EIE-FS-RDAVR costs $800 less than FS-AVR per surgery episode attributable to lowered complication rates and utilization. Combined with the lower mortality, EIE-FS-RDAVR was a superior (dominant) technology versus FS-AVR. This preliminary investigation of EIE-FS-RDAVR versus conventional FS-AVR found the EIE valve offered superior economic value over a 30-day period. Real-world analyses with additional long-term follow-up are needed to evaluate if this result can be replicated over a longer timeframe.

Use of collagen hydrolysate as a complex nitrogen source for the synthesis of penicillin by Penicillium chrysogenum.

PubMed

Leonhartsberger, S; Lafferty, R M; Korneti, L

1993-09-01

Optimal conditions for both biomass formation and penicillin synthesis by a strain of Penicillium chrysogenum were determined when using a collagen-derived nitrogen source. Preliminary investigations were carried out in shaken flask cultures employing a planned experimental program termed the Graeco-Latin square technique (Auden et al., 1967). It was initially determined that up to 30% of a conventional complex nitrogen source such as cottonseed meal could be replaced by the collagen-derived nitrogen source without decreasing the productivity with respect to the penicillin yield. In the pilot scale experiments using a 30 l stirred tank type of bioreactor, higher penicillin yields were obtained when 70% of the conventional complex nitrogen source in the form of cottonseed meal was replaced by the collagen hydrolysate. Furthermore, the maximum rate of penicillin synthesis continued for over a longer period when using collagen hydrolysate as a complex nitrogen source. Penicillin synthesis rates were determined using a linear regression.

Patient-specific positioning guides versus manual instrumentation for total knee arthroplasty: an intraoperative comparison.

PubMed

Kassab, Safa; Pietrzak, William S

2014-01-01

Traditional manual instruments for total knee arthroplasty are associated with a malalignment rate of nearly 30%. Patient-specific positioning guides, developed to help address alignment, may also influence other intraoperative factors. This study compared a consecutive series of 270 Vanguard total knee replacements performed with Signature patient-specific positioning guides (study group) to a consecutive series of 595 similar knee replacements performed with manual instrumentation (control group). The study group averaged 16.7 fewer minutes in the operating room (p < .001), utilized tibial inserts that averaged 0.4 mm thinner with a smaller proportion of "thick" tibial inserts (14-18 mm) (p < .001), and required fewer transfusions (p = .022). The Signature-derived surgical plan accurately predicted correct femoral and tibial component sizes in 86.3% and 70.3% of the cases, respectively. These rates increased to 99.3% and 99.2%, respectively, for accuracy to within one size of the surgical plan, similar to published values for manual instrumentation.

Clinical and Radiographic Assessment of Reasons for Replacement of Metal- Ceramic Fixed Dental Prostheses in Patients Referring to Dental School.

PubMed

Al Refai, Roa'a; Saker, Samah

2018-01-01

The expected length of service and reasons for fixed dental prostheses (FDPs) replacement are a frequent inquiry by patients while the answers were mainly based on studies reports that was conducted outside the middle east region. This clinical and radiographic survey was constructed to assess and survey clinically and radiographically the reasons of replacement of metal-ceramic fixed dental prostheses, amongst patients reporting at dental school in Taibah University. Between January and May 2016, 151 patients were recruited for this study. Interview (include questions pertained to the length of service of the prosthesis, the nature of complaint as told by patient in her own words), clinical examination, intra-oral photographs, and periapical radiographs, were done by the researchers. The parameters assessed were secondary caries, open margins, loss of retention, failure of endodontic treatment of the abutment and periodontal diseases. A total number of 249 failed fixed dental prostheses were evaluated. Of which 180 (39.7%) were single crowns, 159 (35.0%) were retainers and 117 (25.8%) were pontics in 69 fixed partial denture. The most common reason for replacement of fixed restorations was periodontal diseases affecting 92.8% of all types' restorations, followed by defective margin in 90.4% of examined restoration, poor aesthetic in 88% of restorations, while periapical involvement was found in 85.5% of fixed dental prosthesis. The survival rates of fixed prostheses were not predictable, and no association was found between number of years in service and the number of restorations. The most common reasons for replacing single unit fixed dental prostheses are periodontal diseases and periapical involvement, while defective margins and poor aesthetic mainly associated with multi-unit fixed dental prostheses. Key words: Failure, Fixed dental prosthesis, Survival, Replacement.

The time-adjusted gradual replacement injection method enables better visualization of the right heart.

PubMed

Nakahara, Takehiro; Jinzaki, Masahiro; Niwamae, Nogiku; Saito, Yuuichirou; Arai, Masashi; Tsushima, Yoshito; Kuribayashi, Sachio; Kurabayashi, Masahiko

2014-01-01

Despite the improvement of cardiac CT, right heart visualization remains challenging. We herein describe a new method, called the time-adjusted gradual replacement injection protocol. The aim of this study was to compare this protocol with the split-bolus injection protocol. Fifty-two patients who had undergone dual-source cardiac CT were retrospectively recruited. Twenty-six patients were injected by using the split-bolus injection protocol, and 26 patients were injected by using the time-adjusted gradual replacement injection protocol. For this method, we injected contrast medium for 10 seconds at a flow rate of 0.07 × body weight mL/s, then gradually replaced the contrast material with saline until 2 seconds before finishing the scans. The CT attenuation was measured in 4 chambers, the aorta, and the coronary arteries. The visualization of the anatomic structures and the occurrence and severity of streak artifacts were scored for the cardiac structures in the heart. For the analyses, either Welch t-test or Student t-test was performed. In the right heart, the CT values and visualization scores were significantly higher in the time-adjusted replacement injection group than in the split-bolus injection group, whereas the artifact scores were comparable between the 2 groups. The CT values, visualization scores, and artifact scores of the left heart were not significantly different between the 2 groups. In this study, the time-adjusted gradual replacement injection protocol provided excellent attenuation for visualization of the right heart. This method may help to accurately evaluate the right cardiac anatomy and thereby identify any potential diseases. Copyright © 2014 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

Evaluation of the prevalence of periodontal disease as a non-classical risk factor in the group of patients undergoing hip and/or knee arthroplasty.

PubMed

Adamkiewicz, Karolina; Płatek, Anna E; Łęgosz, Paweł; Czerniuk, Maciej R; Małdyk, Paweł; Szymański, Filip M

2018-01-01

Periodontal disease is a chronic disease causing an inflammatory process that affects various organs and is as-sociated with an increased risk of many diseases, including bone and cardiovascular disease. The aim of this study was to establish the prevalence of periodontal disease in continuous patients scheduled for hip or knee replacement surgery. The study was a prospective, epidemiological analysis performed in consecutive patients scheduled for total joint (hip or knee) replacement surgery. Patients enrolled into the study were screened for classical risk factors and had a dental evaluation performed for the diagnosis of periodontal disease. The study population consisted of 228 patients. A total of 137 (60.1%) patients were scheduled for a hip replace-ment surgery, while 91 (39.9%) had a knee replacement. The mean age of the study population was 66.8 ± 12.2 years, and 83 (36.4%) patients were male. A clinically significant disease was present in 65 (28.5%) cases, while all (100%) of the patients had at least minimal signs of periodontal disease. In patients with periodontal disease the percentage of tartar involvement of the teeth was 33.1 ± 26.8%, mean dental plaque coverage was 48.1 ± 29.8%, and bleeding occurred at a rate of 35.4 ± 29%. As for the hygiene level, it was generally poor in the majority of patients with periodontal disease. No differences in terms of baseline risk factors were present between patients with and without periodontal disease. In conclusion, periodontal diseases are highly prevalent in patients undergoing hip and/or knee replacement surgery. The presence of the periodontal disease is possibly associated with a worse prognosis and should be treated.

The pharmacokinetics and extracorporeal removal of N-acetylcysteine during renal replacement therapies.

PubMed

Hernandez, Stephanie H; Howland, Maryann; Schiano, Thomas D; Hoffman, Robert S

2015-01-01

Acetaminophen-induced fulminant hepatic failure is associated with acute kidney injury, metabolic acidosis, and fluid and electrolyte imbalances, requiring treatment with renal replacement therapies. Although antidote, acetylcysteine, is potentially extracted by renal replacement therapies, pharmacokinetic data are lacking to guide potential dosing alterations. We aimed to determine the extracorporeal removal of acetylcysteine by various renal replacement therapies. Simultaneous urine, plasma and effluent specimens were serially collected to measure acetylcysteine concentrations in up to three stages: before, during and upon termination of renal replacement therapy. Alterations in pharmacokinetics were determined by applying standard pharmacokinetic equations. Over 2 years, 10 critically ill patients in fulminant hepatic failure requiring renal replacement therapy coincident with acetylcysteine were consecutively enrolled. All 10 patients required continuous venovenous hemofiltration (n = 10) and 2 of the 10 also required hemodialysis (n = 2). There was a significant alteration in the pharmacokinetics of acetylcysteine during hemodialysis; the area under the curve (AUC) decreased 41%, the mean extraction ratio was 51%, the mean hemodialytic clearance was 114.01 ml/kg/h, and a mean 166.75 mg/h was recovered in the effluent or 41% of the hourly dose. Alteration in the pharmacokinetics of acetylcysteine during continuous venovenous hemofiltration did not appear to be significant: the AUC decreased 13%, the mean clearance was 31.77 ml/kg/h and a mean 62.12 mg/h was recovered in the effluent or 14% of the hourly dose. There was no significant extraction of acetylcysteine from continuous venovenous hemofiltration. In contrast, there was significant extracorporeal removal of acetylcysteine during hemodialysis. A reasonable dose adjustment may be to double the IV infusion rate or possibly supplement with oral acetylcysteine during hemodialysis.

The welfare implications of using exotic tortoises as ecological replacements.

PubMed

Griffiths, Christine J; Zuël, Nicolas; Tatayah, Vikash; Jones, Carl G; Griffiths, Owen; Harris, Stephen

2012-01-01

Ecological replacement involves the introduction of non-native species to habitats beyond their historical range, a factor identified as increasing the risk of failure for translocations. Yet the effectiveness and success of ecological replacement rely in part on the ability of translocatees to adapt, survive and potentially reproduce in a novel environment. We discuss the welfare aspects of translocating captive-reared non-native tortoises, Aldabrachelys gigantea and Astrochelys radiata, to two offshore Mauritian islands, and the costs and success of the projects to date. Because tortoises are long-lived, late-maturing reptiles, we assessed the progress of the translocation by monitoring the survival, health, growth, and breeding by the founders. Between 2000 and 2011, a total of 26 A. gigantea were introduced to Ile aux Aigrettes, and in 2007 twelve sexually immature A. gigantea and twelve male A. radiata were introduced to Round Island, Mauritius. Annual mortality rates were low, with most animals either maintaining or gaining weight. A minimum of 529 hatchlings were produced on Ile aux Aigrettes in 11 years; there was no potential for breeding on Round Island. Project costs were low. We attribute the success of these introductions to the tortoises' generalist diet, habitat requirements, and innate behaviour. Feasibility analyses for ecological replacement and assisted colonisation projects should consider the candidate species' welfare during translocation and in its recipient environment. Our study provides a useful model for how this should be done. In addition to serving as ecological replacements for extinct Mauritian tortoises, we found that releasing small numbers of captive-reared A. gigantea and A. radiata is cost-effective and successful in the short term. The ability to release small numbers of animals is a particularly important attribute for ecological replacement projects since it reduces the potential risk and controversy associated with introducing non-native species.

Dynamic biomechanical examination of the lumbar spine with implanted total spinal segment replacement (TSSR) utilizing a pendulum testing system.

PubMed

Daniels, Alan H; Paller, David J; Koruprolu, Sarath; Palumbo, Mark A; Crisco, Joseph J

2013-01-01

Biomechanical investigations of spinal motion preserving implants help in the understanding of their in vivo behavior. In this study, we hypothesized that the lumbar spine with implanted total spinal segment replacement (TSSR) would exhibit decreased dynamic stiffness and more rapid energy absorption compared to native functional spinal units under simulated physiologic motion when tested with the pendulum system. Five unembalmed, frozen human lumbar functional spinal units were tested on the pendulum system with axial compressive loads of 181 N, 282 N, 385 N, and 488 N before and after Flexuspine total spinal segment replacement implantation. Testing in flexion, extension, and lateral bending began by rotating the pendulum to 5°; resulting in unconstrained oscillatory motion. The number of rotations to equilibrium was recorded and bending stiffness (N-m/°) was calculated and compared for each testing mode. The total spinal segment replacement reached equilibrium with significantly fewer cycles to equilibrium compared to the intact functional spinal unit at all loads in flexion (p<0.011), and at loads of 385 N and 488 N in lateral bending (p<0.020). Mean bending stiffness in flexion, extension, and lateral bending increased with increasing load for both the intact functional spinal unit and total spinal segment replacement constructs (p<0.001), with no significant differences in stiffness between the intact functional spinal unit and total spinal segment replacement in any of the test modes (p>0.18). Lumbar functional spinal units with implanted total spinal segment replacement were found to have similar dynamic bending stiffness, but absorbed energy at a more rapid rate than intact functional spinal units during cyclic loading with an unconstrained pendulum system. Although the effects on clinical performance of motion preserving devices is not fully known, these results provide further insight into the biomechanical behavior of this device under approximated physiologic loading conditions.

Dynamic Biomechanical Examination of the Lumbar Spine with Implanted Total Spinal Segment Replacement (TSSR) Utilizing a Pendulum Testing System

PubMed Central

Daniels, Alan H.; Paller, David J.; Koruprolu, Sarath; Palumbo, Mark A.; Crisco, Joseph J.

2013-01-01

Background Biomechanical investigations of spinal motion preserving implants help in the understanding of their in vivo behavior. In this study, we hypothesized that the lumbar spine with implanted total spinal segment replacement (TSSR) would exhibit decreased dynamic stiffness and more rapid energy absorption compared to native functional spinal units under simulated physiologic motion when tested with the pendulum system. Methods Five unembalmed, frozen human lumbar functional spinal units were tested on the pendulum system with axial compressive loads of 181 N, 282 N, 385 N, and 488 N before and after Flexuspine total spinal segment replacement implantation. Testing in flexion, extension, and lateral bending began by rotating the pendulum to 5°; resulting in unconstrained oscillatory motion. The number of rotations to equilibrium was recorded and bending stiffness (N-m/°) was calculated and compared for each testing mode. Results The total spinal segment replacement reached equilibrium with significantly fewer cycles to equilibrium compared to the intact functional spinal unit at all loads in flexion (p<0.011), and at loads of 385 N and 488 N in lateral bending (p<0.020). Mean bending stiffness in flexion, extension, and lateral bending increased with increasing load for both the intact functional spinal unit and total spinal segment replacement constructs (p<0.001), with no significant differences in stiffness between the intact functional spinal unit and total spinal segment replacement in any of the test modes (p>0.18). Conclusions Lumbar functional spinal units with implanted total spinal segment replacement were found to have similar dynamic bending stiffness, but absorbed energy at a more rapid rate than intact functional spinal units during cyclic loading with an unconstrained pendulum system. Although the effects on clinical performance of motion preserving devices is not fully known, these results provide further insight into the biomechanical behavior of this device under approximated physiologic loading conditions. PMID:23451222

Fast Gas Replacement in Plasma Process Chamber by Improving Gas Flow Pattern

NASA Astrophysics Data System (ADS)

Morishita, Sadaharu; Goto, Tetsuya; Akutsu, Isao; Ohyama, Kenji; Ito, Takashi; Ohmi, Tadahiro

2009-01-01

The precise and high-speed alteration of various gas species is important for realizing precise and well-controlled multiprocesses in a single plasma process chamber with high throughput. The gas replacement times in the replacement of N2 by Ar and that of H2 by Ar are measured in a microwave excited high-density and low electron-temperature plasma process chamber at various working pressures and gas flow rates, incorporating a new gas flow control system, which can avoid overshoot of the gas pressure in the chamber immediately after the valve operation, and a gradational lead screw booster pump, which can maintain excellent pumping capability for various gas species including lightweight gases such as H2 in a wide pressure region from 10-1 to 104 Pa. Furthermore, to control the gas flow pattern in the chamber, upper ceramic shower plates, which have thousands of very fine gas injection holes (numbers of 1200 and 2400) formed with optimized allocation on the plates, are adopted, while the conventional gas supply method in the microwave-excited plasma chamber uses many holes only opened at the sidewall of the chamber (gas ring). It has been confirmed that, in the replacement of N2 by Ar, a short replacement time of approximately 1 s in the cases of 133 and 13.3 Pa and approximately 3 s in the case of 4 Pa can be achieved when the upper shower plate has 2400 holes, while a replacement time longer than approximately 10 s is required for all pressure cases where the gas ring is used. In addition, thanks to the excellent pumping capability of the gradational lead screw booster pump for lightweight gases, it has also been confirmed that the replacement time of H2 by Ar is almost the same as that of N2 by Ar.

Molecular replacement: tricks and treats

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

Abergel, Chantal, E-mail: chantal.abergel@igs.cnrs-mrs.fr

2013-11-01

To be successful, molecular replacement relies on the quality of the model and of the crystallographic data. Some tricks that could be applied to the models or to the crystal to increase the success rate of MR are discussed here. Molecular replacement is the method of choice for X-ray crystallographic structure determination provided that suitable structural homologues are available in the PDB. Presently, there are ∼80 000 structures in the PDB (8074 were deposited in the year 2012 alone), of which ∼70% have been solved by molecular replacement. For successful molecular replacement the model must cover at least 50% ofmore » the total structure and the C{sub α} r.m.s.d. between the core model and the structure to be solved must be less than 2 Å. Here, an approach originally implemented in the CaspR server (http://www.igs.cnrs-mrs.fr/Caspr2/index.cgi) based on homology modelling to search for a molecular-replacement solution is discussed. How the use of as much information as possible from different sources can improve the model(s) is briefly described. The combination of structural information with distantly related sequences is crucial to optimize the multiple alignment that will define the boundaries of the core domains. PDB clusters (sequences with ≥30% identical residues) can also provide information on the eventual changes in conformation and will help to explore the relative orientations assumed by protein subdomains. Normal-mode analysis can also help in generating series of conformational models in the search for a molecular-replacement solution. Of course, finding a correct solution is only the first step and the accuracy of the identified solution is as important as the data quality to proceed through refinement. Here, some possible reasons for failure are discussed and solutions are proposed using a set of successful examples.« less

Meal Replacement Mass Reduction and Integration Acceptability Study

NASA Technical Reports Server (NTRS)

Sirmons, T.; Barrett, A.; Richardson, M.; Arias, D.; Schneiderman, J.; Slack, K.; Williams, T.; Douglas, G.

2017-01-01

NASA, in planning for long-duration missions, has an imperative to provide a food system with the necessary nutrition, acceptability, and safety to ensure sustainment of crew health and performance. The Orion Multi-Purpose Crew Vehicle (MPCV) and future exploration missions are mass constrained; therefore the team is challenged to reduce the mass of the food system by 10% while maintaining product safety, nutrition, and acceptability. Commercially available products do not meet the nutritional requirements for a full meal replacement in the spaceflight food system, and it is currently unknown if daily meal replacements will impact crew food intake and psychosocial health over time. The purpose of this study was to develop a variety of nutritionally balanced breakfast replacement bars that meet spaceflight nutritional, microbiological, sensorial, and shelf-life requirements, while enabling a 10% savings in food mass. To date, six nutrient-dense meal replacement bars (approximately 700 calories per bar) have been developed, using traditional methods of compression as well as novel ultrasonic compression technologies developed by Creative Resonance Inc. (Phoenix, AZ). The four highest rated bars were evaluated in the Human Exploration Research Analog (HERA) to assess the frequency with which actual meal replacement options may be implemented. Specifically, overall impact of bars on mood, satiety, digestive discomfort, and satisfaction with food. These factors are currently being analyzed to inform successful implementation strategies where crew maintain adequate food intake. In addition, these bars are currently undergoing shelf-life testing to determine long-term sensory acceptability, nutritional stability, qualitative stability of analytical measurements (i.e. water activity and texture), and microbiological compliance over two years of storage at room temperature and potential temperature abuse conditions to predict long-term acceptability. It is expected that this work will enable a successful meal replacement strategy to be implemented that will maintain crew food consumption and health, while informing exploration missions with appropriate mass savings expectations.

Chimeric bovine respiratory syncytial virus with attachment and fusion glycoproteins replaced by bovine parainfluenza virus type 3 hemagglutinin-neuraminidase and fusion proteins.

PubMed

Stope, M B; Karger, A; Schmidt, U; Buchholz, U J

2001-10-01

Chimeric bovine respiratory syncytial viruses (BRSV) expressing glycoproteins of bovine parainfluenza virus type 3 (BPIV-3) instead of BRSV glycoproteins were generated from cDNA. In the BRSV antigenome cDNA, the open reading frames of the major BRSV glycoproteins, attachment protein G and fusion protein F, were replaced individually or together by those of the BPIV-3 hemagglutinin-neuraminidase (HN) and/or fusion (F) glycoproteins. Recombinant virus could not be recovered from cDNA when the BRSV F open reading frame was replaced by the BPIV-3 F open reading frame. However, cDNA recovery of the chimeric virus rBRSV-HNF, with both glycoproteins replaced simultaneously, and of the chimeric virus rBRSV-HN, with the BRSV G protein replaced by BPIV-3 HN, was successful. The replication rates of both chimeras were similar to that of standard rBRSV. Moreover, rBRSV-HNF was neutralized by antibodies specific for BPIV-3, but not by antibodies specific to BRSV, demonstrating that the BRSV glycoproteins can be functionally replaced by BPIV-3 glycoproteins. In contrast, rBRSV-HN was neutralized by BRSV-specific antisera, but not by BPIV-3 specific sera, showing that infection of rBRSV-HN is mediated by BRSV F. Hemadsorption of cells infected with rBRSV-HNF and rBRSV-HN proved that BPIV-3 HN protein expressed by rBRSV is functional. Colocalization of the BPIV-3 glycoproteins with BRSV M protein was demonstrated by confocal laser scan microscopy. Moreover, protein analysis revealed that the BPIV-3 glycoproteins were present in chimeric virions. Taken together, these data indicate that the heterologous glycoproteins were not only expressed but were incorporated into the envelope of recombinant BRSV. Thus, the envelope glycoproteins derived from a member of the Respirovirus genus can together functionally replace their homologs in a Pneumovirus background.

Short-term hunger intensity changes following ingestion of a meal replacement bar for weight control.

PubMed

Rothacker, Dana Q; Watemberg, Salo

2004-05-01

Meal replacement products for weight loss are popular and safe for most unsupervised consumers desiring to lose weight. Previously we reported that the thickness of meal replacement diet shakes had a direct and significant effect on hunger intensity during the first 2 h and that hunger intensity scores for liquid meal replacements were significantly below baseline for 3 h following consumption (Mattes & Rothacker, 2001) This study uses the same protocol to investigate meal replacement bars designed for overweight consumers. Subjects were prescreened to include only those that normally ate breakfast and liked chocolate. The bar used in this study contained 250 calories (about 30 more than most liquid diet shakes), 4 g dietary fiber, 14 g protein and 8 g fat. Subjects were instructed to consume the entire bar with a glass of water following an overnight fast when they would normally consume their first meal of the day and to assess their hunger on a 1 (not hungry at all) to 9 (as hungry as I have ever felt) scale before consumption, immediately after and hourly for 6 h (only on typical weekdays). Similar assessments were made for the perception of stomach fullness (1=empty, 9=extremely full), strength of the desire to eat (1=no desire, 9=extremely strong) and thirst (1=not at all thirsty, 9=extremely thirsty). One-hundred and eight subjects (23 male and 85 female) completed the study. No gender satiety differences were found. Hunger ratings and desire to eat remained significantly below baseline for 5 h following consumption. Stomach fullness scores were significantly above baseline for 5 h. Thirst scores were significantly below baseline for 3 h. In conclusion, although the meal replacement diet bars contained only 30 additional calories than liquids, they provided an additional 2 h of hunger suppression from baseline that may have an impact on overall weightloss success. These results support superior short-term hunger control with solid meal replacements.

The autoshaping procedure as a residual block clock

PubMed Central

Dinsmoor, James A.; Dougan, James D.; Pfister, John; Thiels, Edda

1992-01-01

In the first experiment, 4 pigeons were each presented with a recurring sequence of four key colors followed by the delivery of grain (block clock). Once the rate of pecking had stabilized, three of the colors were replaced, during different series of sessions, by a darkening of the key. The rate of pecking was reduced within those segments of the interval between deliveries of food during which the key was dark; when the key was dark during the final portion of the interval, rates were reduced throughout the entire interval. In the second experiment, 3 new pigeons were exposed to a different sequence of colors, and the final stimulus was replaced in successive conditions by a novel color, a darkened key, and a restoration of the original color. The data indicated that darkening the key had a more severe, more extensive, and more persistent effect than did a mere change in color. These results suggest that it may be fruitful to conceptualize the autoshaping procedure as a special version of the block clock in which pecking is suppressed throughout the greater part of the interval by darkening the key. In the final condition, the same stimulus appeared in each of the last three portions of the interval. The rate of pecking was lower during the last two portions than when distinctive colors were presented, with the peak rate now appearing in the fifth of seven equal temporal components. PMID:16812666

Temporal Trends in Fertility Rates: A Nationwide Registry Based Study from 1901 to 2014.

PubMed

Blomberg Jensen, Martin; Priskorn, Lærke; Jensen, Tina Kold; Juul, Anders; Skakkebaek, Niels Erik

2015-01-01

Increasing age at first childbirth has been suggested to increase the risk for infertility. Our objective is to determine whether women above thirty years of age historically have been able to sustain fertility rates above replacement level. A descriptive nationwide Danish study using birth registries from 1901-2014. Information on women's age at childbirth was obtained by using records from primary, secondary and tertiary institutions. Mothers to 8,024,969 live births. Mothers were stratified according to age at childbirth to determine total and age specific fertility rates. Total fertility rate (TFR) decreased from 4.1 to 1.8 children per woman and age specific fertility also decreased from 1901 to 2014. Women aged 30-34, 35-39 or 40-44 years in the first decade of the 20th century had higher fertility rates than the corresponding five year younger age groups (25-29, 30-34 and 35-39, respectively) have had for the last 65 years. On average, women gave birth to two children after the age of 30 and one or more child after 35 years of age in the beginning of the 1900s. Furthermore, women more than 40 years of age accounted for 10% of TFR in 1901 compared with 4% in 2014 despite usage of assisted reproduction. This nationwide study shows that women above 30 years of age historically have been able to sustain fertility rates above replacement level. This implies that other factors besides age are strong determinants of fertility in women above 30 years of age.

A randomised controlled trial comparing three analgesia regimens following total knee joint replacement: continuous femoral nerve block, intrathecal morphine or both.

PubMed

Olive, D J; Barrington, M J; Simone, S A; Kluger, R

2015-07-01

This randomised controlled trial compared three analgesia regimens following primary unilateral total knee joint replacement: continuous femoral nerve block (CFNB), intrathecal morphine (ITM), and both. The primary outcome was pain ratings over the first 24 hours. Secondary outcomes included morphine consumption, nausea, pruritus and sedation ratings, oxygen saturation (SpO2) ratings, and ability to mobilise postoperatively. All patients received a spinal anaesthetic and a postoperative patient-controlled morphine pump. Patients were randomised to receive CFNB, ITM, or both. In patients with no CFNB, the use of ITM was blinded. Eighty-one patients were randomised and there were no withdrawals. At 24 hours, the ITM-only group had higher pain ratings than either of the other groups (P=0.04 versus CFNB, P=0.01 versus combination). In the 18 to 24 hour period, the ITM group used more morphine than either of the other groups. There were no statistically significant differences in pain ratings or morphine consumption at earlier time intervals. The ITM group were less likely to be able to sit out of bed on day one. Patients who received ITM were more likely to have pruritus. There were no statistically significant differences in nausea, SpO₂or sedation ratings. This study showed that a CFNB resulted in reduced pain and was also associated with less morphine consumption and improved mobilisation at 24 hours compared to ITM. This study did not show any statistically significant differences between CFNB alone and CFNB+ITM.

Effect of engine load and biogas flow rate to the performance of a compression ignition engine run in dual-fuel (dieselbiogas) mode

NASA Astrophysics Data System (ADS)

Ambarita, H.

2018-02-01

The Government of Indonesia (GoI) has released a target on reduction Green Houses Gases emissions (GHG) by 26% from level business-as-usual by 2020, and the target can be up to 41% by international supports. In the energy sector, this target can be reached effectively by promoting fossil fuel replacement or blending with biofuel. One of the potential solutions is operating compression ignition (CI) engine in dual-fuel (diesel-biogas) mode. In this study effects of engine load and biogas flow rate on the performance and exhaust gas emissions of a compression ignition engine run in dual-fuel mode are investigated. In the present study, the used biogas is refined with methane content 70% of volume. The objectives are to explore the optimum operating condition of the CI engine run in dual-fuel mode. The experiments are performed on a four-strokes CI engine with rated output power of 4.41 kW. The engine is tested at constant speed 1500 rpm. The engine load varied from 600W to 1500W and biogas flow rate varied from 0 L/min to 6 L/min. The results show brake thermal efficiency of the engine run in dual-fuel mode is better than pure diesel mode if the biogas flow rates are 2 L/min and 4 L/min. It is recommended to operate the present engine in a dual-fuel mode with biogas flow rate of 4 L/min. The consumption of diesel fuel can be replaced up to 50%.

Nine-year outcome after anatomic stemless shoulder prosthesis: clinical and radiologic results.

PubMed

Hawi, Nael; Magosch, Petra; Tauber, Mark; Lichtenberg, Sven; Habermeyer, Peter

2017-09-01

Several stemless shoulder implants are available on the market, but only a few studies have presented results with sufficient mid- to long-term follow-up. The present study evaluated clinical and radiologic outcomes 9 years after anatomic stemless shoulder replacement. This is a prospective cohort study evaluating the stemless shoulder prosthesis since 2005. Anatomic stemless shoulder replacement using a single prosthesis was performed in 49 shoulders; 17 underwent total shoulder replacement, and 32 underwent hemiarthroplasty. Forty-three patients were clinically and radiologically monitored after a mean of 9 years (range, 90-127 months; follow-up rate, 88%). The indications for shoulder replacement were primary osteoarthritis in 7 shoulders, post-traumatic in 24, instability in 7, cuff tear arthropathy in 2, postinfectious arthritis in 1, and revision arthroplasty in 2. The Constant-Murley Score improved significantly from 52% to 79% (P < .0001). The active range of motion also increased significantly for flexion from 101° to 118° (P = .022), for abduction from 79° to 105° (P = .02), and for external rotation from 21° to 43° (P < .0001). Radiologic evaluation revealed incomplete radiolucency in 1 patient without clinical significance or further intervention. No revision caused by loosening or countersinking of the humeral implant was observed. The 9-year outcome after stemless shoulder replacement is comparable to that of third- and fourth-generation standard shoulder arthroplasty. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Esophageal replacement by gastric transposition: A single surgeon's experience from a tertiary pediatric surgical center.

PubMed

Foster, Jake D; Hall, Nigel J; Keys, S Charles; Burge, David M

2018-06-02

Many pediatric surgeons have limited experience of esophageal replacement. This study reports outcomes of esophageal replacement by gastric transposition performed by a single UK-based pediatric surgeon. Consecutive patients were identified who underwent esophageal replacement by gastric transposition over a 28 year period. Clinical and demographic data were collected. Weight-for-age Z-scores were calculated for esophageal atresia patients. Nineteen patients were identified. Indication in the majority was long-gap esophageal atresia (n = 17; 10 with tracheoesophageal fistula). At surgery, median age was 8.5 months (range 2-55); median weight was 7.4 kg (range 4.0-17.4 kg). A right-sided thoracotomy or transhiatal approach was used. Median postoperative length of stay was 17.5 days (range 7-130); median intensive care stay was three days (range 1-63). There were no deaths. Anastomotic leak rate at 30 days was 10.5% (n = 2). One patient required early stricture dilatation. Median weight-for-age Z-score increased from -2.17 at one year of age to -1.86, -1.70 and -1.93 at 5, 10 and 15 years. Esophageal replacement by gastric transposition offers a potentially life-changing treatment; however, it is associated with significant morbidity. The majority of patients eventually achieve full oral feeding and maintenance of weight gain trajectory. A right-sided approach to the esophagus is feasible. Treatment Study. IV. Copyright © 2018 Elsevier Inc. All rights reserved.

[Optimizing primary total hip replacement--a technique to effect saving of manpower].

PubMed

Huber, J F; Rink, M; Broger, I; Zumstein, M; Ruflin, G B

2003-01-01

Development of a standardized surgical technique for total hip replacement thereby saving manpower (one assistant) by using a retractor system. Total hip replacement is performed with the patient in a true lateral position on a tunnel cushion. By means of a direct lateral approach the pelvitrochanteric muscles are partially detached using an omega-shaped cut. The Bookwalter retractor is fixed dorsally on the operating table. The ring is centered keeping the greater trochanter in the middle. The Hohmann retractors are fixed to the ring to sufficiently expose the acetabulum. To insert the femoral stem the ring needs to be opened dorsally and the patient's leg is bent 90 degrees in the hip and the knee over the tunnel cushion. The muscles inserting at the greater trochanter are retracted by a separate Hohmann retractor with weight. In a case control study with matched pairs the patients treated with this technique were compared with those treated in supine position with the transgluteal approach. The number of assistants required and the operating time were assessed. All the hip replacements with the patient in side position were performed with one assistant, in supine position with two assistants. The operating time did not differ significantly (supine position 110 min/side position 112 min). The complication rate in both groups was comparable (one secondary wound healing, one transient ischalgia). The process of total hip replacement can be optimized. The described technique allows to spare one surgical assistant without prolonging the operating time.

Computer-generated scenes depicting the HST capture and EVA repair mission

NASA Image and Video Library

1993-11-12

Computer generated scenes depicting the Hubble Space Telescope capture and a sequence of planned events on the planned extravehicular activity (EVA). Scenes include the Remote Manipulator System (RMS) arm assisting two astronauts changing out the Wide Field/Planetary Camera (WF/PC) (48699); RMS arm assisting in the temporary mating of the orbiting telescope to the flight support system in Endeavour's cargo bay (48700); Endeavour's RMS arm assisting in the "capture" of the orbiting telescope (48701); Two astronauts changing out the telescope's coprocessor (48702); RMS arm assistign two astronauts replacing one of the telescope's electronic control units (48703); RMS assisting two astronauts replacing the fuse plugs on the telescope's Power Distribution Unit (PDU) (48704); The telescope's High Resolution Spectrograph (HRS) kit is depicted in this scene (48705); Two astronauts during the removal of the high speed photometer and the installation of the COSTAR instrument (48706); Two astronauts, standing on the RMS, during installation of one of the Magnetic Sensing System (MSS) (48707); High angle view of the orbiting Space Shuttle Endeavour with its cargo bay doors open, revealing the bay's pre-capture configuration. Seen are, from the left, the Solar Array Carrier, the ORU Carrier and the flight support system (48708); Two astronauts performing the replacement of HST's Rate Sensor Units (RSU) (48709); The RMS arm assisting two astronauts with the replacement of the telescope's solar array panels (48710); Two astronauts replacing the telescope's Solar Array Drive Electronics (SADE) (48711).

Mid- to long-term outcome comparison of the Medtronic Hancock II and bi-leaflet mechanical aortic valve replacement in patients younger than 60 years of age: a propensity-matched analysis.

PubMed

Wang, Yin; Chen, Si; Shi, Jiawei; Li, Geng; Dong, Nianguo

2016-03-01

This study aims to compare mid-long-term clinical outcomes between patients younger than 60 years of age undergoing bioprosthetic and mechanical aortic valve replacement. From January 2002 to December 2009, patients younger than 60 years of age who received Medtronic Hancock II porcine bioprostheses were selected and compared with those who received mechanical bi-leaflet valves in the aortic position. A stepwise logistic regression propensity score identified a subset of 112 evenly matched patient-pairs. Mid-long-term outcomes of survival, valve-related reoperations, thromboembolic events and bleeding events were assessed. The follow-up was only 95.1% complete. Fourteen measurable variables were statistically similar for the matched cohort. Postoperative in-hospital mortality was 3.6% (bioprosthetic valves) and 2.7% (mechanical valves) (P = 0.700). Survival at 5 and 10 years was 96.3 and 88.7% for patients receiving bioprosthetic valve replacement versus 96.3 and 87.9% for patients receiving mechanical valve replacement (P = 0.860), respectively. At 5 and 10 years after operations, freedom from valve-related reoperation was 97.2 and 94.8% for patients receiving mechanical valve replacement, and 96.3 and 90.2% for patients receiving bioprosthetic valve replacement (P = 0.296), respectively. There was no difference between freedom from thromboembolic events (P = 0.528) and bleeding events (P = 0.128) between the matched groups during the postoperative 10 years. In patients younger than 60 years of age undergoing aortic valve replacement, mid-long-term survival rate was similar for patients receiving bioprosthetic versus mechanical valve replacement. Bioprosthetic valves were associated with a trend for a lower risk of anticoagulation treatment and did not have significantly greater likelihood of a reoperation. These findings suggest that a bioprosthetic valve may be a reasonable choice for AVR in patients younger than 60 years of age. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

On Orbit ISS Oxygen Generation System Operation Status

NASA Technical Reports Server (NTRS)

Diderich, Greg S.; Polis, Pete; VanKeuren, Steven P.; Erickson, Robert; Mason, Richard

2011-01-01

The International Space Station (ISS) United States Orbital Segment (USOS) Oxygen Generation System (OGS) has accumulated almost a year of operation at varied oxygen production rates within the US Laboratory Module (LAB) since it was first activated in July 2007. It was operated intermittently through 2009 and 2010, due to filter clogging and acid accumulation in the recirculation loop. Since the installation of a deionizing bed in the recirculation loop in May of 2011 the OGA has been operated continuously. Filters in the recirculation loop have clogged and have been replaced. Hydrogen sensors have drifted apart, and a power failure may have condensed water on a hydrogen sensor. A pump delta pressure sensor failed, and a replacement new spare pump failed to start. Finally, the voltage across the cell stack increased out of tolerance due to cation contamination, and the cell stack was replaced. This paper will discuss the operating experience and characteristics of the OGS, as well as operational issues and their resolution.

Fluid shifts during thermal stress with and without fluid replacement

NASA Technical Reports Server (NTRS)

Myhre, L. G.; Robinson, S.

1977-01-01

Six unacclimatized men rested for 4 hr in a hot, dry environment without fluid replacement (DH). Another group of six men were exposed to the same thermal stress, replacing evaporative fluid loss with warm 0.1% NaCl solution (FRP). Total grams of circulating hemoglobin, determined by CO immediately prior to and again during the last minutes of heat exposure, increased an insignificant 1.6 and 1.3% during DH and FRP, respectively. With DH, body weight loss of 2.6% was accompanied by a 7.8% reduction in calculated plasma volume (PV). Even when body weight was maintained (FRP), PV decreased 2.9% during the heat exposure. Total circulating serum protein did not change as a result of the heat stress with either DH or FRP. In a test-retest series of experiments on four men, DH was not detrimental to sweat rate. It is shown that hemodilution is not a general response to acute heat exposure. The disproportionately large reduction in PV during thermal dehydration is confirmed.

Aortic valve surgery of the 21st century: sutureless AVR versus TAVI.

PubMed

Costache, Victor S; Moldovan, Horatiu; Arsenescu, Catalina; Costache, Andreea

2018-04-01

Surgical aortic valve replacement (sAVR) has been a safe, effective and time-proven technique and is still the standard of care all over the world for aortic valve treatment. The vast majority of centers perform this procedure by doing a median sternotomy with several disadvantages. While many others specialties went minimally invasive decades ago, in cardiovascular field transcatheter valve implantation was the first minimally invasive valvular procedure that gained rapid worldwide acceptance. Transcatheter valve replacement (TAVR) is now marketed as a procedure that should be performed under local anesthesia, by an interventional cardiologist via trans femoral route with no other healthcare professional invited to the patient selection or case planning. An increasing number of surgeons are promoting minimally invasive aortic valve replacement, which is gaining grounds, especially with the help of the new sutureless valve technology. With these two new technologies emerging, legitimate questions arise and need to be answered - which has the longest durability, lower complication rate and lower overall mortality.

Dietary citrus pulp reduces lipid oxidation in lamb meat.

PubMed

Inserra, L; Priolo, A; Biondi, L; Lanza, M; Bognanno, M; Gravador, R; Luciano, G

2014-04-01

This study investigated the effect of replacing cereal concentrates with high levels of dried citrus pulp in the diet on lamb meat oxidative stability. Over 56 days, lambs were fed a barley-based concentrate (Control) or concentrates in which 24% and 35% dried citrus pulp were included to partially replace barley (Citrus 24% and Citrus 35%, respectively). Meat was aged under vacuum for 4 days and subsequently stored aerobically at 4 °C. The Control diet increased the redness, yellowness and saturation of meat after blooming (P<0.01). Regardless of the level of supplementation, dietary dried citrus pulp strongly reduced meat lipid oxidation over 6 days of aerobic storage (P<0.001), while colour parameters did not change noticeably over storage and their variation rate was not affected by the diet. In conclusion, replacing cereals with dried citrus pulp in concentrate-based diets might represent a feasible strategy to naturally improve meat oxidative stability and to promote the exploitation of this by-product. Copyright © 2013 Elsevier Ltd. All rights reserved.

The Bimetric cementless total hip replacement: 7–18 year follow-up assessing the influence of acetabular design on survivorship

PubMed Central

Ghassemi, A.; Dorrell, J. H.; Powles, D. P.

2008-01-01

The purpose of this study was to evaluate the mid- to long-term survivorship of Bimetric cementless total hip replacement and assess how it is affected by the acetabular design. This was a retrospective analysis of 127 Bimetric cementless total hip replacements in 110 patients with a follow-up of 7–18 years. A single design stem and three different cementless metal-backed acetabular designs were used. Patients were assessed clinically using the Harris hip score and radiologically by independent review of current hip radiographs. There was only one case of aseptic loosening of the femoral stem. The earliest acetabular design showed a high failure rate whilst the latter two designs showed a 96% survivorship at a mean of 9.5 years. We conclude that a combination of the bimetric stem with either of the latter acetabular cup designs has a good mid- to long-term performance. PMID:18551293

Amenorative effects of exogenous gonadotropins on reproductive profiles of replacement gilts with delayed puberty in a farm in Thailand.

PubMed

Am-In, Nutthee; Roongsitthichai, Atthaporn

2017-02-01

This study was to investigate the effect of gonadotropins on reproductive profiles of replacement gilts with delayed puberty. Totally, 136 Landrace X Yorkshire crossbred gilts, were categorized into control (n = 58) and treatment (n = 78) groups. Gonadotropins (400 U eCG plus 200 IU hCG) were administered in treatment group only. The results revealed that gilts in treatment group had higher number of gilts with estrus (92.3 vs 25.9%, P < 0.001), shorter onset to estrus (4.7 ± 0.3 vs 9.0 ± 0.8 d, P < 0.001), higher number of dominant follicles (18.0 ± 0.2 vs 13.2 ± 0.3 follicles, P < 0.001), and higher farrowing rate (87.5 vs 53.3%, P = 0.002) than those in control group. In conclusion, gonadotropins containing 400 IU eCG plus 200 IU hCG could improve reproductive profiles in replacement gilts with delayed puberty.

Physico-chemical and sensory characteristics of steviolbioside synthesized from stevioside and its application in fruit drinks and food.

PubMed

Khattab, Sherine N; Massoud, Mona I; Abd El-Razek, Amal M; El-Faham, Ayman

2017-01-01

Steviolbioside (Sb) was synthesized from stevioside and characterized by infrared, nuclear magnetic resonance ( 1 H NMR and 13 C NMR) spectroscopy. The purity melting point, solubility, acute toxicity, heat stability and sensory properties of Sb were evaluated. Physico-chemical and sensory properties of low calorie fruit drinks and shortened cake prepared by replacing sugar with Sb were evaluated. Sb was stable in neutral or acidic aqueous solutions maintained at 100 °C for 2 h. The sweetness intensity rate of Sb was found to be about 44 and 18.51 times sweeter than 0.5% and 10% sucrose solution, respectively. Sb solutions had sweet taste without bitterness compared to stevioside. No significant differences between the organoleptic properties of cakes prepared using sugar and those prepared replacing sugar with 50% Sb were observed. All drinks replacing sugar with Sb at 66% level had the highest overall acceptability scores comparable to those prepared using sugar alone.

APS Storage Ring Monopulse RF BPM Upgrade

NASA Astrophysics Data System (ADS)

Lill, R.; Pietryla, A.; Norum, E.; Lenkszus, F.

2004-11-01

The Advanced Photon Source (APS) is a third-generation synchrotron light source in its ninth year of operation. The storage ring monopulse radio frequency (rf) beam position monitor (BPM) was designed to measure single-turn and multi-turn beam positions for operations and machine physics studies. Many of the components used in the original design are obsolete and costly to replace. In this paper we present a proposal to upgrade the monopulse rf BPMs in which the existing system hardware is repartitioned and the aging data acquisition system is replaced. By replacing only the data acquisition system, we will demonstrate a cost-effective approach to improved beam stability, reliability, and enhanced postmortem capabilities. An eight-channel ADC/digitizer VXI board with sampling rate of up to 105 MHz (per channel) and 14-bit resolution coupled with a field-programmable gate array and embedded central processing will provide the flexibility to revitalize this system for another decade of operation. We will discuss the upgrade system specifications, design, and prototype test results.

Testosterone replacement therapy improves health-related quality of life for patients with late-onset hypogonadism: a meta-analysis of randomized controlled trials.

PubMed

Nian, Y; Ding, M; Hu, S; He, H; Cheng, S; Yi, L; Li, Y; Wang, Y

2017-05-01

Although testosterone replacement therapy can restore serum testosterone concentrations to normal level in late-onset hypogonadism patients, whether it can improve patients' quality of life remains uncertain. Therefore, we perform a meta-analysis of randomized controlled trials on this issue. Five randomized controlled trials total 1,212 patients were included. Fixed-effect model was used to calculate the weighted mean difference of score of Aging Males' Symptom rating scale. Our result reveals that testosterone replacement therapy improves patients' health-related quality of life in terms of the decrease in the AMS total score [WMD = -2.96 (-4.21, -1.71), p < .00001] and the psychological [WMD = -0.89 (-1.41, -0.37), p = .0008], somatic [WMD = -0.89 (-1.41, -0.37), p = .0008] and sexual [WMD = -1.29 (-1.75, -0.83), p < .00001] subscale score. © 2016 Blackwell Verlag GmbH.

Mineral growth in rocks: kinetic-rheological models of replacement, vein formation, and syntectonic crystallization

NASA Astrophysics Data System (ADS)

Fletcher, Raymond C.; Merino, Enrique

2001-11-01

We model three cases of coupling between mineral growth kinetics and mechanical response of the rock: (i) dispersed spherical crystals growing by replacement in a hydrostatically stressed elastic rock; (ii) growth of veins or vein networks accommodated by viscous relaxation of surrounding rock; and (iii) syntectonic crystallization in a rock undergoing bulk pure shear. Such models for the microscopic environment of mineral growth, together with additional assumptions or knowledge about rheological behavior and aggregate geometry, provide refined estimates of the behavior of a macroscopic volume element, which could be combined with geochemical reaction-transport models. Crucial in the models are the various consequences-pressure solution, creep, fracturing-of the local stress that is necessarily generated by mineral growth in rocks (other than in pores). In the first model, the dispersed spherical crystals of mineral A are assumed to grow within a spherical volume of rock consisting of mineral B, the ;mineralized zone; (MZ), itself embedded in elastic rock. The macroscopic stress in the MZ and the far-field stress in the surrounding rock are uniform and hydrostatic. Mineral growth of the A crystals is driven by supersaturation with respect to mineral A, is accommodated by replacement of B grains, and leads to an expansion of the MZ described by an infinitesimal strain. The radial growth rate of a spherical crystal of mineral A, with replacement of mineral B, is da/dt=kARTln(ΩA)[kBV0B/(kBV0B+kAV0A)], where kA and kB are kinetic constants, R is the gas constant, T the temperature in kelvin, and V0A and V0B are specific volumes. Reference saturation states of mineral A, ΩA > 1, and host mineral B, ΩB = 1, are specified at the far-field hydrostatic stress, σ0. The microscopic environment of each crystal of A is modeled by a representative volume element (RVE) consisting of a sphere of mineral A embedded in a spherical shell of mineral B. In each RVE, stress is neither uniform nor hydrostatic. The model links the local microscopic stress with the macroscopic stress in the MZ and surrounding rock. The second model refers to veins that make room for themselves by growing, not to veins that form by cementation of previously opened, or opening, cracks. If the growth of mineral A as propagating veins or as an interconnected vein network takes place by deformation and expansion of the MZ-with the deformation itself driven by the stress arising from the supersaturation-driven growth-the surrounding rock undergoes deformation and is treated as viscous. The rate of growth in vein width, w, is dw/dt=2kA[RTln(ΩA)-SV0A]/(1+M), where M = 16ηkAV0Ac2/(3b3), η is the medium viscosity, c is the vein radius, and each vein is treated as centered in a spherical RVE of radius b. S is an effective tensile stress required for vein propagation. For a vein network, in which veins surround equant polyhedra of rock of radius b, we set c = b and drop the term in S for simplicity. Veins may also widen by replacement. The ratio of vein widening by expansion to that by replacement is (dw/dt)expansion/(dw/dt)replacement={(3b/16η)/[(3b/16η)+kAV0A]}/[kBV0B/(KBV0B+kAV0A)]. Both mechanisms of accommodation contribute equally when η = 3b/(16kBV0B); at higher viscosity, replacement is dominant. The incipient growth of a cylindrical crystal with circular cross section in a medium deforming in pure shear simulates syntectonic crystallization. Both dissolution and deformation of the host accommodate growth. In the model, the crystal tends to grow faster in the direction of maximum rate of extension. In this direction, the host mineral may either dissolve to accommodate growth, or precipitate to form a pressure shadow. Accommodation by host dissolution is greatest in the direction of maximum rate of shortening.

40 CFR 60.144a - Test methods and procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

... replaced with the following instructions for recording observations and reducing data: (i) Section 2.4... follows: (1) For devices that monitor and record the exhaust ventilation rate, compare velocity readings recorded by the monitoring device against the velocity readings obtained by Method 2. Take Method 2...

40 CFR 60.144a - Test methods and procedures.

Code of Federal Regulations, 2011 CFR

2011-07-01

... replaced with the following instructions for recording observations and reducing data: (i) Section 2.4... follows: (1) For devices that monitor and record the exhaust ventilation rate, compare velocity readings recorded by the monitoring device against the velocity readings obtained by Method 2. Take Method 2...

38 CFR 3.381 - Service connection of dental conditions for treatment purposes.

Code of Federal Regulations, 2011 CFR

2011-07-01

... dental conditions for treatment purposes. 3.381 Section 3.381 Pensions, Bonuses, and Veterans' Relief... Rating Considerations Relative to Specific Diseases § 3.381 Service connection of dental conditions for treatment purposes. (a) Treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses...

38 CFR 3.381 - Service connection of dental conditions for treatment purposes.

Code of Federal Regulations, 2010 CFR

2010-07-01

... dental conditions for treatment purposes. 3.381 Section 3.381 Pensions, Bonuses, and Veterans' Relief... Rating Considerations Relative to Specific Diseases § 3.381 Service connection of dental conditions for treatment purposes. (a) Treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses...

Characterizing body temperature and activity changes at the onset of estrus in replacement gilts

USDA-ARS?s Scientific Manuscript database

Accurate estrus detection can improve sow conception rates and increase swine production efficiency. Unfortunately, current estrus detection practices based on individual animal behavior may be inefficient due to large sow populations at commercial farms and the associated labor required. Therefore,...

Effects of Taxi Regulatory Revision in San Diego, California

DOT National Transportation Integrated Search

1983-05-01

Effective January 1979 the City of San Diego removed its previous ceiling on taxi licenses and began issuing 6 new taxi permits every month; in July, this limit was raised to 15. In August, the city replaced the standard rate of fare with a variable ...

Current and Emerging Water Distribution Main Renewal Technologies

EPA Science Inventory

The funding needed to address aging underground infrastructure renewals range as high as $325 billion over the next 20 years and with the current annual replacement rate at 0.5%, pipes are being expected to last for 200 years, which is unreasonable considering most pipes are desi...

Effect of substituting increasing levels of organic Zn for inorganic Zn on performance, hematological and serum biochemical constituents, antioxidant status and immune response in rat.

PubMed

Nagalakshmi, D; Sridhar, K; Swain, P S; Reddy, A G

2016-01-01

The effect of replacing dietary Zn supplemented from inorganic (ZnCO 3 ) source with organic Zn (Zn methionine; Zn-met) was investigated in 72 rats (98.42 ± 1.483 g) by randomly allotting to 4 diets (6 replicates/diet, 3 rats/replicate). Basal diet was prepared with purified ingredients without Zn. The control diet (AIN-76A) contained 12 ppm of Zn from ZnCO 3 (100-I). In the other diets ZnCO 3 was replaced with Zn-met at the rates of 50 (50I:50O), 75 (25I:75O) or 100% (100-O). Weekly body weight and daily feed intake were recorded for 14 weeks. Blood was collected by retro-orbital puncture on the 70th and 80th day to determine haematological and various serum biochemical constituents, and antioxidant enzyme activities in haemolysate, respectively. Rats were antigenically challenged with sheep RBC on day 73 to assess humoral immune response (HIR), and on day 95 for cell mediated immune response (CMIR) and rats were sacrificed at the end of rearing period to collect liver, muscle, pancreas and kidneys for Zn estimation and oxidative stress markers in liver. The data were analysed using completely randomized design. Weight gain and feed intake, hematological and serum biochemical constituents, Zn content in organs (except liver) were not influenced by replacing ZnCO 3 with Zn-met. Zinc concentrations in the serum and liver were higher (P<0.05) with 50% replacement of ZnCO 3 with Zn-met compared to 0 or 100% replacement. Lower (P<0.05) lipid peroxidation and higher (P<0.05) glutathione peroxidase and glutathione reductase activities were observed with 50 and 75% replacement of ZnCO 3 with Zn-met compared to 0 or 100% replacement. Protein carbonyls and reduced glutathione in liver were not affected, while TBARS decreased (P<0.05) with substituting Zn-met (50-100%) for ZnCO 3 . The HIR and CMIR increased with increasing Zn-met supplementation and the highest response was observed with 75-100% replacement of ZnCO 3 with Zn-met. It is concluded that replacement of 50 or 75% of ZnCO 3 with Zn-met increased antioxidant and immune response in rats with no effect on growth.

Dealing with China's future population decline: a proposal for replacing low birth rates with sustainable rates.

PubMed

Cao, Shixiong; Wang, Xiuqing

2009-09-01

Decreasing population levels due to declining birth rates are becoming a potentially serious social problem in developed and rapidly developing countries. China urgently needed to reduce birth rates so that its population would decline to a sustainable level, and the family planning policy designed to achieve this goal has largely succeeded. However, continuing to pursue this policy is leading to serious, unanticipated problems such as a shift in the country's population distribution towards the elderly and increasing difficulty supporting that elderly population. Social and political changes that promoted low birth rates and the lack of effective policies to encourage higher birth rates suggest that mitigating the consequences of the predicted population decline will depend on a revised approach based on achieving sustainable birth rates.

Mesh-Sequenced Realizations for Evaluation of Subgrid-Scale Models for Turbulent Combustion (Short Term Innovative Research Program)

DTIC Science & Technology

2018-02-15

conservation equations. The closure problem hinges on the evaluation of the filtered chemical production rates. In MRA/MSR, simultaneous large-eddy...simulations of a reactive flow are performed at different mesh resolution levels. The solutions at each coarser mesh level are constrained by the filtered ...include the replacement of chemical production rates with those filtered from the underlying fine mesh and the construction of ‘exact’ forms for

Trends in Medicare Reimbursement for Orthopedic Procedures: 2000 to 2016.

PubMed

Eltorai, Adam E M; Durand, Wesley M; Haglin, Jack M; Rubin, Lee E; Weiss, Arnold-Peter C; Daniels, Alan H

2018-03-01

Understanding trends in reimbursement is critical to the financial sustainability of orthopedic practices. Little research has examined physician fee trends over time for orthopedic procedures. This study evaluated trends in Medicare reimbursements for orthopedic surgical procedures. The Medicare Physician Fee Schedule was examined for Current Procedural Terminology code values for the most common orthopedic and nonorthopedic procedures between 2000 and 2016. Prices were adjusted for inflation to 2016-dollar values. To assess mean growth rate for each procedure and subspecialty, compound annual growth rates were calculated. Year-to-year dollar amount changes were calculated for each procedure and subspecialty. Reimbursement trends for individual procedures and across subspecialties were compared. Between 2000 and 2016, annual reimbursements decreased for all orthopedic procedures examined except removal of orthopedic implant. The orthopedic procedures with the greatest mean annual decreases in reimbursement were shoulder arthroscopy/decompression, total knee replacement, and total hip replacement. The orthopedic procedures with the least annual reimbursement decreases were carpal tunnel release and repair of ankle fracture. Rate of Medicare procedure reimbursement change varied between subspecialties. Trauma had the smallest decrease in annual change compared with spine, sports, and hand. Annual reimbursement decreased at a significantly greater rate for adult reconstruction procedures than for any of the other subspecialties. These findings indicate that reimbursement for procedures has steadily decreased, with the most rapid decrease seen in adult reconstruction. [Orthopedics. 2018; 41(2):95-102.]. Copyright 2018, SLACK Incorporated.

Breakeven costs for embryo transfer in a commercial dairy herd.

PubMed

Ferris, T A; Troyer, B W

1987-11-01

Differences in Estimated Breeding Values expressed in dollars were compared by simulation of two, 100-cow, closed herds. One herd practiced normal intensity of female selection. The other herd generated various herd replacements by embryo transfer by varying 1) selection rate of embryo transfer dams and 2) numbers of daughters per dam from which embryos were transferred, while varying the merit of mates of embryo transfer dams. Estimated Breeding Value dollars were compounded each generation and regressed to remove age adjustments and added feed and health costs. Beginning values in both herds included a standard deviation of 55 Cow Index dollars, herd average of -23 Cow Index dollars, and a 120 Predicted Difference dollars for mates of dams not embryo transferred. Average merit of all sires used increased $12 per year. Herd calving rate (.70), proportion females (.5), calf loss (.15), and heifer survival rate (.83) were used. Breakeven cost per embryo transfer cow entering the milking herd was computed by Net Present Value analysis using a 10% discount rate over 10 and 20 yr. Breakeven cost or the maximum expense that would allow a 10% return on the expenditure ranged from $135 to $510 per surviving cow, $24 to $125 per transfer, $47 to $178 per pregnancy, and $81 to $357 per female calf born. As the number of replacements resulting from embryo transfer increased, breakeven cost per embryo transfer cow decreased due to diminishing return.

[Hip resurfacing arthroplasty].

PubMed

Witzleb, W-C; Knecht, A; Beichler, T; Köhler, T; Günther, K-P

2004-11-01

In comparison to stemmed total hip replacements, hip resurfacing offers advantages especially in joint stability and amount of femoral bone resection. After the poor results achieved with this concept that were mainly caused by failure of the materials used, reintroduction of the metal-on-metal bearing initiated a renaissance. This bearing, the cementless cup, and the improved surgical technique led to better short- to medium-term results. Revision and complication rates are now comparable to conventional total hip replacements. The functional capacity of the method is higher. Because long-term results are not available, however, questions remain, for instance, the consequences of the higher metal ion serum concentrations or the impossibility of changing the inlay when femoral revision becomes necessary.

Dose determinants in continuous renal replacement therapy.

PubMed

Clark, William R; Turk, Joseph E; Kraus, Michael A; Gao, Dayong

2003-09-01

Increasing attention is being paid to quantifying the dose of dialysis prescribed and delivered to critically ill patients with acute renal failure (ARF). Recent trials in both the intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT) realms have suggested that a direct relationship between dose and survival exists for both of these therapies. The purpose of this review, first, is to analyze critically the above-mentioned dose/outcome studies in acute dialysis. Subsequently, the factors influencing dose prescription and delivery are discussed, with the focus on continuous venovenous hemofiltration (CVVH). Specifically, differences between postdilution and predilution CVVH will be highlighted, and the importance of blood flow rate in dose delivery for these therapies will be discussed.

A kinetic study of the replacement of calcite marble by fluorite

NASA Astrophysics Data System (ADS)

Trindade Pedrosa, Elisabete; Boeck, Lena; Putnis, Christine V.; Putnis, Andrew

2016-04-01

Replacement reactions are relevant in any situation that involves the reequilibration between a solid and an aqueous fluid phase and are commonly controlled by an interface-coupled dissolution-precipitation mechanism (Putnis and Putnis, 2007). These reactions control many large-scale Earth processes whenever aqueous fluids are available, such as during metamorphism, metasomatism, and weathering. An important consequence of coupled dissolution-precipitation is the generation of porosity in the product phase that then allows the infiltration of the fluid within the mineral being replaced. Understanding the mechanism and kinetics of the replacement of carbonates by fluorite has application in earth sciences and engineering. Fluorite (CaF2) occurs in all kinds of rocks (igneous, sedimentary, and metamorphic) and its origin is commonly associated with hydrothermal fluids. Moreover, calcium carbonate has been suggested as a successful seed material for the sequestration of fluoride from contaminated waters (Waghmare and Arfin, 2015). The aim of the present work is to investigate aspects of the replacement of calcium carbonate by fluorite to better understand the mechanism and kinetics of this reaction. Small cubes (˜ 3 × 3 × 3 mm) of Carrara marble (CaCO3 > 99 %) were cut and reacted with a 4 M ammonium fluoride (NH4F) solution for different times (1 to 48 hours) and temperatures (60, 80, 100, and 140 ° C). The microstructure of the product phases was analysed using SEM. The kinetics of replacement was monitored from the Rietveld analysis of X-ray powder diffraction patterns of the products as a function of temperature and reaction time. After reaction, all samples preserved their size and external morphology (a pseudomorphic replacement) and the product phase (fluorite) was highly porous. The activation energy Ea (kJ/mol) of the replacement reaction was empirically determined by both model-fitting and model-free methods. The isoconversional method yielded an empirical activation energy of 41 kJ/mol, and a statistical approach applied to the model-fitting method revealed that the replacement of Carrara marble by fluorite is better fitted to a diffusion-controlled process. This is consistent with ion diffusion through the fluid phase. These results suggest that the replacement reaction is dependent on the fluid migration rate through the newly formed porosity. Putnis, A., Putnis C.V., 2007. The mechanism of reequilibration of solids in the presence of a fluid phase. Journal of Solid State Chemistry, 180, 1783-1786. Waghmare, S.S., Arfin, T. (2015). Fluoride removal from water by calcium materials: A state-of-the-art review. Int. J. Innov. Res. Sci. Eng. Technol. 4, 8090-8102.

Mechanical properties of recycled concrete with demolished waste concrete aggregate and clay brick aggregate

NASA Astrophysics Data System (ADS)

Zheng, Chaocan; Lou, Cong; Du, Geng; Li, Xiaozhen; Liu, Zhiwu; Li, Liqin

2018-06-01

This paper presents an experimental investigation on the effect of the replacement of natural coarse aggregate (NCA) with either recycled concrete aggregate (RCA) or recycled clay brick aggregate (RBA) on the compressive strengths of the hardened concrete. Two grades (C25 and C50) of concrete were investigated, which were achieved by using different water-to-cement ratios. In each grade concrete five different replacement rates, 0%, 25%, 50%, 75% and 100% were considered. In order to improve the performance of the recycled aggregates in the concrete mixes, the RCA and RBA were carefully sieved by using the optimal degradation. In this way the largest reduction in the 28-day compressive strength was found to be only 7.2% and 9.6% for C25 and C50 recycled concrete when the NCA was replaced 100% by RCA, and 11% and 13% for C25 and C50 recycled concrete when the NCA was replaced 100% by RBA. In general, the concrete with RCA has better performance than the concrete with RBA. The comparison of the present experimental results with those reported in literature for hardened concrete with either RCA or RBA demonstrates the effectiveness in improving the compressive strength by using the optimal gradation of recycled aggregates.

Cardiac Surgery in Patients Infected with Human Immunodeficiency Virus

PubMed Central

Abad, Cipriano; Cárdenes, Miguel Angel; Jiménez, Pedro Conrado; Armas, Mario-Vicente; Betancor, Pedro

2000-01-01

From January 1991 through December 1999, 5 consecutive patients who were infected with human immunodeficiency virus presented in need of cardiac surgery. All were men; the median age was 44 years. Two of them presented with mitral and aortic infectious valve endocarditis, 1 with tricuspid endocarditis, 1 with prosthetic valve endocarditis, and 1 with pericarditis and pericardial tamponade. Under cardiopulmonary bypass, the 4 patients with endocarditis underwent these procedures: mitral and aortic valve replacement (2), tricuspid valve replacement (1), and aortic valve replacement (reoperation) and concomitant repair of a mycotic ascending aortic aneurysm (1). In the patient who had pericardial effusion, subxifoid pericardiostomy and drainage were performed, and a pericardial window was created. There was no intraoperative mortality. The patient with pericardial effusion died 8 days after surgery; he was in septic shock and had multiple organ failure. Two deaths occurred at 2 and 63 months, due to hemoptysis and sudden death, respectively. The 2 patients who underwent double valve replacement are alive and in good condition after a median follow-up of 71 months. Cardiac surgery is indicated in selected patients infected by the human immunodeficiency virus. These patients are frequently drug abusers or homosexual. Valvular endocarditis is the most common finding. Hospital morbidity and mortality rates are higher than usual in this group of patients. PMID:11198308

Reverse total shoulder replacement for nonunion of a fracture of the proximal humerus.

PubMed

Zafra, M; Uceda, P; Flores, M; Carpintero, P

2014-09-01

Patients with pain and loss of shoulder function due to nonunion of a fracture of the proximal third of the humerus may benefit from reverse total shoulder replacement. This paper reports a prospective, multicentre study, involving three hospitals and three surgeons, of 35 patients (28 women, seven men) with a mean age of 69 years (46 to 83) who underwent a reverse total shoulder replacement for the treatment of nonunion of a fracture of the proximal humerus. Using Checchia's classification, nine nonunions were type I, eight as type II, 12 as type III and six as type IV. The mean follow-up was 51 months (24 to 99). Post-operatively, the patients had a significant decrease in pain (p < 0.001), and a significant improvement in flexion, abduction, external rotation and Constant score (p < 0.001), but not in internal rotation. A total of nine complications were recorded in seven patients: six dislocations, one glenoid loosening in a patient who had previously suffered dislocation, one transitory paresis of the axillary nerve and one infection. Reverse total shoulder replacement may lead to a significant reduction in pain, improvement in function and a high degree of satisfaction. However, the rate of complications, particularly dislocation, was high. ©2014 The British Editorial Society of Bone & Joint Surgery.

Quality of Low Fat Chicken Nuggets: Effect of Sodium Chloride Replacement and Added Chickpea (Cicer arietinum L.) Hull Flour

PubMed Central

Verma, Arun K.; Banerjee, Rituparna; Sharma, B. D.

2012-01-01

While attempting to develop low salt, low fat and high fibre chicken nuggets, the effect of partial (40%) common salt substitution and incorporation of chickpea hull flour (CHF) at three different levels viz., 5, 7.5 and 10% (Treatments) in pre-standardized low fat chicken nuggets (Control) were observed. Common salt replacement with salt substitute blend led to a significant decrease in pH, emulsion stability, moisture, ash, hardness, cohesiveness, gumminess and chewiness values while incorporation of CHF in low salt, low fat products resulted in decreased emulsion stability, cooking yield, moisture, protein, ash, color values, however dietary fibre and textural properties were increased (p<0.01). Lipid profile revealed a decrease in total cholesterol and glycolipid contents with the incorporation of CHF (p<0.01). All the sensory attributes except appearance and flavor, remained unaffected with salt replacement, while addition of CHF resulted in lower sensory scores (p<0.01). Among low salt, low fat chicken nuggets with CHF, incorporation CHF at 5% level was found optimum having sensory ratings close to very good. Thus most acceptable low salt, low fat and high fibre chicken nuggets could be developed by a salt replacement blend and addition of 5% CHF. PMID:25049565

Application of the rapid prototyping technique to design a customized temporomandibular joint used to treat temporomandibular ankylosis

PubMed Central

Chaware, Suresh M.; Bagaria, Vaibhav; Kuthe, Abhay

2009-01-01

Anthropometric variations in humans make it difficult to replace a temporomandibular joint (TMJ), successfully using a standard “one-size-fits-all” prosthesis. The case report presents a unique concept of total TMJ replacement with customized and modified TMJ prosthesis, which is cost-effective and provides the best fit for the patient. The process involved in designing and modifications over the existing prosthesis are also described. A 12-year- old female who presented for treatment of left unilateral TMJ ankylosis underwent the surgery for total TMJ replacement. A three-dimensional computed tomography (CT) scan suggested features of bony ankylosis of left TMJ. CT images were converted to a sterolithographic model using CAD software and a rapid prototyping machine. A process of rapid manufacturing was then used to manufacture the customized prosthesis. Postoperative recovery was uneventful, with an improvement in mouth opening of 3.5 cm and painless jaw movements. Three years postsurgery, the patient is pain-free, has a mouth opening of about 4.0 cm and enjoys a normal diet. The postoperative radiographs concur with the excellent clinical results. The use of CAD/CAM technique to design the custom-made prosthesis, using orthopaedically proven structural materials, significantly improves the predictability and success rates of TMJ replacement surgery. PMID:19881026

Beta-Cell Replacement: Pancreas and Islet Cell Transplantation.

PubMed

Niclauss, Nadja; Meier, Raphael; Bédat, Benoît; Berishvili, Ekaterine; Berney, Thierry

2016-01-01

Pancreas and islet transplantation are 2 types of beta-cell replacement therapies for type 1 diabetes mellitus. Since 1966, when pancreas transplantation was first performed, it has evolved to become a highly efficient procedure with high success rates, thanks to advances in surgical technique and immunosuppression. Pancreas transplantation is mostly performed as simultaneous pancreas-kidney transplantation in patients with end-stage nephropathy secondary to diabetes. In spite of its efficiency, pancreas transplantation is still a major surgical procedure burdened by high morbidity, which called for the development of less invasive and hazardous ways of replacing beta-cell function in the past. Islet transplantation was developed in the 1970s as a minimally invasive procedure with initially poor outcomes. However, since the report of the 'Edmonton protocol' in 2000, the functional results of islet transplantation have substantially and constantly improved and are about to match those of whole pancreas transplantation. Islet transplantation is primarily performed alone in nonuremic patients with severe hypoglycemia. Both pancreas transplantation and islet transplantation are able to abolish hypoglycemia and to prevent or slow down the development of secondary complications of diabetes. Pancreas transplantation and islet transplantation should be seen as two complementary, rather than competing, therapeutic approaches for beta-cell replacement that are able to optimize organ donor use and patient care. © 2016 S. Karger AG, Basel.

Pharmacokinetic Evaluation of Two Nicotine Patches in Smokers.

PubMed

Rasmussen, Scott; Horkan, Kathleen Halabuk; Kotler, Mitchell

2018-02-02

Smoking continues to be a major preventable cause of early mortality worldwide, and nicotine replacement therapy has been demonstrated to increase rates of abstinence among smokers attempting to quit. Nicotine transdermal systems (also known as nicotine patches) attach to the skin via an adhesive layer composed of a mixture of different-molecular-weight polyisobutylenes (PIBs) in a specific ratio. This randomized, single-dose, 2-treatment, crossover pharmacokinetic (PK) trial assessed the bioequivalence of nicotine patches including a replacement PIB adhesive (test) compared with the PIB adhesive historically used on marketed patches (reference). The test and reference patches were bioequivalent, as determined by the PK parameters of C max and AUC 0-t . In addition, the parameters T max and t 1/2 did not significantly differ between the 2 patches, supporting the bioequivalence finding from the primary analysis. The tolerability profiles of the patches containing the replacement and previously used PIB adhesives were similar; application-site adverse events did not significantly differ between test and reference patches. Overall, these data establish the bioequivalence of the nicotine patch with the replacement PIB adhesive formulation and the previously utilized PIB adhesive formulation. © 2018 The Authors. Clinical Pharmacology in Drug Development published by Wiley Periodicals, Inc. on behalf of The American College of Clinical Pharmacology.